Primary Nursing Diagnosis

Knowledge deficit related to chronic disease management

OUTCOMES. Knowledge: Diet, Disease process, Health behaviors, Medication, Prescribed activity, Treatment regime

INTERVENTIONS. Health education; Teaching: Diet, Disease process, Health behaviors, Medication, Prescribed activity, Treatment regimen


The long-term goal of care is to limit organ damage. The primary goal is to reduce the blood pressure to less than 140/90. In prehypertension, if the patient has no more than one cardiac risk factor and no organ damage, a trial of nonpharmacologic management is usually initiated with regular follow-up for 6 months. Conservative medical management stresses diet, exercise, and changes in lifestyles. Since weight loss can result in a drop of 10 mm Hg in both

468 Hypertension systolic and diastolic blood pressure, patients are encouraged to reach a weight within 15% of their ideal body weight. Patients are placed on a low-sodium, low-cholesterol diet; reducing sodium intake by 2 g a day can lower systolic readings by 2.2 mm Hg. Advise patients to cease smoking and to reduce alcohol intake to one glass of wine or beer per day. Recommend an aerobic exercise regimen that builds up to 20 to 30 minutes three times a week. When these changes are not effective, drug therapy, along with these recommendations, becomes necessary.

If the blood pressure fails to respond to conservative management, the physician initiates pharmacologic management. In stages 1 and 2, pharmacologic therapy should be started as well as lifestyle modifications and frequent follow-up. If hypertensive crisis occurs (accelerated malignant hypertension, intracranial hemorrhage, aortic dissection, progressive renal failure, or eclampsia), the physician prescribes IV antihypertensives to be given with an infusion device. Maintain continuous noninvasive blood pressure monitoring if the patient does not have an intra-arterial catheter for invasive blood pressure monitoring.

Pharmacologic Highlights

Medication or Drug Class





Varies with drug

Commonly used: atenolol,

Inhibit effects of cate


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