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    CHAPTER 1 INTRODUCTION

    1.1 Background

    The cardiovascular system is a closed transport system consisting of the heart, blood

    components, and blood vessels (Muttaqin, 2009). The function of the cardiovascular 

    system is to provide and drain the supply of oygen and nutrients to all tissues and organs

    that are required in the process of metabolism. !ormally every tissue and organ of the body

    "ill receive the bloodstream in sufficient quantities so that the tissues and organs receive

    adequate nutrition. #ardiovascular $ystem that serves as the regulatory system perform a

    variety of mechanisms to respond to all the activities of the body. %n certain circumstances,

    more blood "ill flo" in vital organs such as the heart and brain to maintain the circulatory

    system organs.

    #ardiac function that circulates blood throughout the body. This circulation process "ill

    "or& "ell if the pumping process is going "ell. %f pumping is not perfect, the distribution

    of oygen decreases "ere compensated by the heart by increasing the respiration rate. %f 

    the compensation process occurs continuously, eventually the heart "ill fail to do

     pemompaaan. 'eart pump "or&s through the stages called the cardiac cycle consisting of 

    systole and diatol (onny, et al., 200).

    *lood pressure is the force that is necessary so blood can reach all tissues of the human body. $ystolic blood pressure is the blood pressure "hen the heart menguncuo (systole).

    +dapaun diastolic blood pressure is the blood pressure "hen the heart relaes bac& 

    (diastole). 'uman blood pressure can be classified into three groups lo" blood pressure

    (hypotension), normal (normotensive), and high (hypertension) (-una"an, 200).

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    CHAPTER 2. BASIC CONCEPTS OF DISEASE

    2.1 Definiion of H!"eren#ion

    'ypertension is defined as blood pressure above normal or persistent blood pressure "here

    the systolic pressure above /0 mm'g and diastolic pressure above 90 mm'g. %n an aging

     population, hypertension is defined as systolic pressure of 0 mm'g and a diastolic

     pressure of 90 mm'g. 'ypertension is a ma1or cause of heart failure, stro&e, and &idney

    failure. no"n as the 3silent &iller3 because people "ith hypertension often have no

    symptoms. 'alf the people "ho suffer from hypertension are not a"are of the condition.

    4nce the disease suffered, the patient5s blood pressure should be monitored at regular 

    intervals because hypertension is a lifelong condition.

    2.2 Eio$og! H!"eren#ion

    *ased on the etiology of hypertension are divided into t"o categories, namely

    . 6ssential hypertension or primary hypertension

    'ypertension is hypertension is un&no"n peyebabnya also called idiopathic hypertension.

    There are 978 of cases ($melter : *are, 200). Many factors influence it, such as gender,

    genetics, age, environment, reninangiotensin system and the nervous system

    otonom.;a&tor other factors, namely smo&ing, ecessive salt inta&e, alcohol, obesity, stress

    and lac& of eercise < physical activity. (=auralee, 200> dalamahmadani, 20).

    2. $econdary hypertension

    'ypertension, there are about 78 of all cases of hypertension prevalence. The specific

    cause is &no"n, for eample> &idney disease (acute glomerulonephritis, chronic nephritis,

    diseases polyarthritis, diabetic nephropathy), endocrine diseases (hypothyroidism,

    hypercalcemia, acromegaly), &oar&tasioaorta, hypertension in pregnancy, neurological

    disorders, drugs and other substances (=auralee, 200> dalamahmadani, 20).

    ?rimary hypertension is present in more than 908 of hypertensive patients, "hile the

    remaining 08 are caused by secondary hypertension (-una"an, 200). +lthough primary

    hypertension is not &no"n "ith certainty the cause, research data have found several

    factors that often lead to hypertension. These factors are as follo"s

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    . 'eredity

    ;rom the statistical data proved that someone "ill be more li&ely to get hypertension if 

     parents are hypertensive.

    2. %ndividual #haracteristics

    %ndividual characteristics that influence the onset of hypertension are

    a. +ge (if the T@ increases "ith age)

     b. -ender (males higher than females)

    c. ace (blac&s more than "hites)

    %n general, hypertension does not have a specific cause. 'ypertension occurs in response to

    increased cardiac output or increased peripheral pressure. *ut there are several factors that

    influence the occurrence of hypertension

    . -enetic nerologi response to stress or disorders atautransport !a ecretion.

    2. 4besity, associated "ith high insulin levels resulting in increased blood pressure.

    A. 6nvironmental $tress.

    /. The loss of tissue elasticity and arteris&lerosis parents and dilation of blood vessels.

    The cause of hypertension in the elderly is the change B change to

    . The elasticity of the aortic "all decreases

    2. valvular heart to thic&en and become stiffer 

    A. The ability of the heart to pump blood decreases 8 every year after the age of 20 years

    decreased blood pumping ability of the heart contractions and caused a decline in volume.

    /. =oss of elasticity of blood vessels

    This happens &arena&urangnya effectiveness for peripheral vascular oygenation

    7. %ncreased peripheral vascular resistance

    2.% Pa&o"&!#io$og! of H!"eren#ion

    +ccording $melter : *are (2002 9) says that the mechanisms that control the

    constriction and relaation of blood vessels located in the vasomotor center in the medulla

    oblongata in the brain "hich of vasomotor began the sympathetic nerves that continues

    do"n the spinal cord and out of olomna cord to the sympathetic ganglia in tora and

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    abdomen, vasomotor center stimulation delivered in the form of an impulse that moves

    do"n"ard through the sympathetic nervous system. +t the point of this ganglion

     preganglionic neurons release acetylcholine "hich stimulates postBganglion nerve fibers to

    the blood vessels, "hich by releasing norepinefrine lead to constriction of blood vessels.

    ;actors such as aniety and fear can affect the vascular response to stimuli vasoconstrictive

    "hich causes vasoconstriction of blood flo" to the &idneys is reduced or decreased and

    results produced renin, renin stimulates production of angiostensin %, "hich is then

    converted into angiostensin %% is a potent vasoconstrictor "hich stimulates aldosterone

    secretion by the adrenal corte hormone aldosterone "hich is cause retention of sodium

    and "ater by the &idney tubules and caused an increase in intra vascular fluid volume that

    causes hypertension. The occurrence of hypertension can be caused by several factors as

    follo"s

    . The cardiac output and peripheral resistance

    Maintaining a normal blood pressure depends on the balance bet"een cardiac output and

     peripheral vascular resistance. The vast ma1ority of patients "ith essential hypertension had

    normal cardiac output, but increasing peripheral prisoners. ?eripheral resistance is

    determined not by the large arteries or capillaries, but by small arterioles, "hose "alls

    contain smooth muscle cells. #ontraction of smooth muscle cells suspected to be related to

    an increase in intracellular calcium concentration (=umbantobing, 200). ontri&si smooth

    muscle lasts long been suspected of inducing change structurally "ith the blood vessel "all

    thic&ening of the arterioles, probably mediated by angiotensin, and could lead to increased

     peripheral resistance is irreversible. +t a very early hypertension, peripheral resistance is

    not increased and the increase in blood pressure caused by increased cardiac output, "hich

    is associated "ith sympathetic overactivity. %ncreased prisoners ?eifer happened possibility

    is compensated to prevent an increase in pressure is not distributed to a net"or& of 

    capillary blood vessels, "hich "ill be able to substantially disrupt cell homeostasis

    (=umbantobing, 200).

    2. The reninBangiotensin system

    eninBangiotensin system may be an endocrine system that is most important in controlling

     blood pressure. enin is secreted from renal 1utaglomerular apparatus in response to the

    lac& of perfusion glomerular or less inta&e of salt. 'e also released in response to

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    stimulation and the sympathetic nervous system (=umbantobing, 200). enin is

    responsible converts renin substrate (angiotensinogen) to +ngiotensin %% in the lungs by

    angiotensin converting enyme (+#6). +ngiotensin %% is a po"erful vaso&ontri&tor and

    lead to increased blood pressure (=umbantobing, 200).

    A. The autonomic nervous system

    $timulation of the autonomic nervous system can cause constriction of arterioles and

    dilatation of arterioles. $o the autonomic nervous system has an important role in

    maintaining normal blood pressure. %t also has an important role in mediating the changes

    that too& place briefly on the blood pressure response to stress and physical "or& 

    (=umbantobing, 200).

    /. atrial natriuretic peptides (atrial natriuretic pept ideas < +!?)

    +!? is a hormone produced by the atria of the heart in response to increased blood

    volume. The effect is to increase the ecretion of salt and "ater from the &idneys, so as a

    &ind of a natural diuretic. @isturbances in the system can lead to fluid retention and

    hypertension (=umbantobing, 200).

    2.' Sign# and S!("o(# of H!"eren#ion

    #linical manifestations in clients "ith hypertension are

    . %ncreased blood pressureC /0

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    in $ari, 20). 4ne can assume headache, diiness or nosebleed merupa&antanda the rise

    of blood pressure, but the symptoms are only a small part yangter1adi due to hypertension

    ($heps, 2007> in $ari, 20) .+ study found no association bet"een pain &epaladengan

    increased blood pressure, even some people do not feel any signs or symptoms.

    4ther signs and symptoms are often associated "ith hypertension, such as ecessive

    s"eating, muscle cramps, frequent urination and a fast heart rate and irregular or 

     palpitations ($heps, 2007> in $ari, 20). 4ther symptoms that commonly occur in patients

    "ith hypertension, diiness, flushing, headache, bleeding from the nose of a sudden, nec& 

    ached and others (Eiryo"idagdo, 2002> in $agala, 200). ushartanti (200) mentions

    hypertension symptoms that include headache, stiff nape of the nec&, stiff shoulder,

    numbness, nausea, "ea&ness, bac& pain and shortness nafas.Menurut $melter : *are

    (200) factors affecting the symptoms of hypertension that is the damage < vascular 

    disorders "ith manifestations typical corresponding "ith divas&ularisasi organ systems.

    $ymptoms of hypertension is a clinical manifestation of a disorder perceived convenience

    of patients. ?atients can treat a disorder symptoms of hypertension as a convenience or not

    depends on several factors. +ccording to ?otter : ?erry (2007) some of these factors,

    namely> age, gender, culture, the meaning of pain, concern, aniety, fatigue, previous

    eperiences, coping and social support for families.

    2.) Diagno#ic Procedure#

    . 6amination =aboratory

    a. 'b or 't to eamine the relationship of the cells to the volume of fluid (viscosity) and

    may indicate ris& factors such as hipo&oagulabilitas and anemia

     b. *F! or creatinine provide information about renal perfusion or function

    c. -lucose 'yperglycemia (@M is the originator of hypertension) can be caused by

    spending &eto&olamin levels. 'ypertension is accompanied by diabetes "ith hypertension

    or diabetes that may pose a ris& to the vital organs. %t is therefore necessary for the

    monitoring of glucose levels in the blood

    d. Frinalisa assessing the blood, protein, glucose, sho"ed no &idney dysfunction and the

     presence of @M

    2. #T $can to assess their cerebral tumor and encelopati

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    A. 6#- may sho" patterns of strain, eactly "here and ho" much breadth, ? "ave

    elevation is one of the early signs of heart disease hypertension

    /. %F? identify the causes of hypertension, such as &idney stones and &idney repair 

    7. Thora ?hoto destruction can sho" calcification of the valve area and an enlarged heart

    2.* +anage(en of H!"eren#ion

    Management of hypertension can be done by

    . Therapeutic nonfarma&ologi

    2. ?harmacological Therapy

    1. T&era"euic nonfar(ako$ogi

    +dopt a healthy lifestyle for everyone is essential to prevent high blood pressure and is an

    important part in the treatment of hypertension. +ll patients "ith prehypertension and

    hypertension should ma&e lifestyle changes. #hanges that have been seen to lo"er blood

     pressure can be seen in Table / in accordance "ith the recommendations of the G!# H%%.

    *esides lo"ering blood pressure in patients "ith hypertension, lifestyle modification can

    also reduce blood pressure continued to hypertension in patients "ith blood pressure

     prehipertensi.2 important lifestyle modification is seen to lo"er blood pressure is to

    reduce "eight for obese individuals or fat> adopting the @+$' diet (@ietary +pproaches to

    $top 'ypertension) is rich in potassium and calcium> lo"Bsodium diet> physical activity>

    and consuming a little alcohol. %n some patients "ith blood pressure control is quite good

    "ith an antihypertensive drug therapy> reduce salt and "eight can free patients from using

    the drug. 0 easy diet program received is designed to lose "eight slo"ly in patients "ho

    are obese and obese limiting the influ of sodium and alcohol. This requires education to

     patients, and encouragement. The follo"ing facts can be told to the patient so that the

     patient understands rationality dietary intervention

    a. 'ypertension is 2BA times more common in obese people compared to people "ith ideal

    "eight

     b. More than 08 of patients "ith hypertension are obese (over"eight)

    c. Eeight loss, "ith only 0 pounds (/.7 &g) can lo"er blood pressure significantly in

    obese people

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     patient and < or disease. The practice of evidenceBbased medicine for hypertension include

    selecting particular by data sho"ing a decrease in mortality and cardiovascular morbidity

    or target organ damage caused by hypertension. $cientific evidence sho"s that simply

    lo"ering blood pressure, tolerability, and cost alone can not be used in the selection of 

    hypertension medications. *y considering these factors, drugs that are most useful are

    diuretics, angiotensin converting enyme inhibitors (+#6%), angiotensin receptor bloc&ers

    (+*s), beta bloc&ers, and calcium antagonists (##*).

    Most patients "ith hypertension require t"o or more antihypertensive medications to

    achieve blood pressure targets desired. The addition of a second drug from a different class

    of drug use began "hen single doses of commonly fail to achieve blood pressure targets. %f 

    the blood pressure of 20

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    CHAPTER %. NURSIN,

    %.1 A##e##(en

    %.1.1 Hea$& Hi#or!

    'ealth history is an assessment of health status, both current health status (history of 

     present illness), past health status (past medical history), and the health status of the family

    (family history).

    a. @isease 'istory !o"

    + process or "or&flo" ho" complaints can occur. Ehen inside the main complaint does

    not eplain ho" could a ma1or complaint in the hypertension that arises, then in the history

    of present illness raised. %n this assessment could arise various other complaints. That

    needs to be as&ed on the client is to process complaints regarding hypertension that could

    happen, any measures ta&en to alleviate the patient and family complaints that arise as a

    result of hypertension (including the treatment that has been done), ho" the process until

    the patient "as ta&en to hospital. ;or eample if the hypertension is usually the patient

    feels diy. Things that are as&ed include

    ) @escription of diiness or headaches eperienced by the patient

    2) Ehen the diiness arisesJ

    A) Ehat causes diiness due to the increase in blood pressure eperienced by the patient is

    getting "orseJ

    /) %s the patient has used drugs to relieve the symptoms of hypertensionJ

    7) +re the side effects of the drugs consumed "hether or not to diiness or headache that

    feltJ

    ) +nd so on.

     b. ?ast medical history

    6amines "hether the patient ever suffered illness in the past. This is done to determine

    "hether the disease earlier it had suffered an impact on emerging disease in patients at this

    time. %t is necessary to study "hether patients had a history of hypertension once and never 

    M$ "ith the same complaint. %n addition it should also be as&ed "hether the patient had

    suffered from diseases associated "ith cardiovascular disease.

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    c. ;amily @isease 'istory

    ;amily health history is aimed to find "hether there is heredity or congenital. %t as&ed "ere

    there any family members "ho had suffered from hypertension before. +ssessment on

    family medical history should not forget to include genogram.

    %.1.2 A##e##(en- NANDA Paern ,ordon

     patterns !+!@+

    a. ?atternB'ealth Management 'ealth ?erception

    Ehich need to be studied

    K 'o" do clients and families deal "ith problems that eist eg hypertension drug "hat is

    given "hen the patient5s blood pressure to rise

    K 'o" is the patient and his family control the environment that supports healing patients

    "ith hypertension

    K %s the patient has been chec&ed out regularly to health care facilities

    K 'istory of hospitaliation and surgery

    K @oes the patient5s blood pressure chec&ed often

    K The etent to "hich patients and families &no" the results of tests done by patients

    K ;actor in healthBrelated ris&s eg lifestyle and socioeconomic status

     b. MetabolicB!utritional ?atterns

    Ehich need to be studied

    K 'abit number of meals and snac&s consumed by patients

    K Types of food and drin&s are often consumed

    K 6plain the good food and drin& consumed to patients for 2/ hours

    K %s there an increase or decrease in "eight

    K %s there a change in appetite

    K @iet A the last day or the last 2/ hours

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    c. 6limination pattern

    Ehich need to be studied

    K The habit patterns of *+ for hypertension

    K 'abit #'+?T6 patterns for hypertension

    K The use of drugs to aid ecretion

    d. ?atternB6ercise +ctivity

    Ehich need to be studied

    K @aily activities performed by patient

    K @oes the client li&e to do sports

    K The type of eercise that often do patients

    K The ability to care for themselves due to hypertension today

    K @oes the client using tools such as crutches or a cane due to hypertension eperienced

    K %s the energy level decreased during hypertension

    K The "or&ing environment of patients

    e. estB$leep ?atterns

    Ehich need to be studied

    K The habit of sleeping passion everyday

    K #onfidence culture

    K @o patients using medications that facilitate patient to rest or sleep

    K $chedule rest and relaation that is done by the patient

    K +re there any symptoms of disruption of sleep patterns emerging

    K +ssess the factors that relate eg aging process

    f. ?erceptionB#ognitive ?attern

    Ehich need to be studied

    K 4vervie" of the senses patients

    K %s there any influence of hypertension "ith an overvie" of the five senses

    K The use of tools supporting the five senses eg glasses, hearing aids, etc.

    K ?erception of discomfort

    K =evel of education

    K The ability of patients and their families in ma&ing decisions

    K Ehen "here patients feel diy

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    g. ?atterns of $elfB#oncept $elf ?erception

    Ehich need to be studied

    K social circumstances 1ob, family situation, social groups

    K ?ersonal %dentity a description of yourself, strengths and "ea&nesses

    K The physical state everything to do "ith the body, li&es or disli&es

    K $elfBesteem feeling about yourself 

    K Threats to self suffered from hypertension for eample changing role

    K Ehat do patients feel "hen suffering from hypertension

    h. ?atternBole elationships

    Ehich need to be studied

    K 4vervie" of the role related to family, friends, and co"or&ers

    K $atisfaction or dissatisfaction role

    K The effect of the change in health status

    K The importance of family support to patients suffering from hypertension

    K elationships "ith other people5s patients

    K %s the patient eperienced health problems affecting the changing role and responsibilities

    "ithin the family, friends, "or&, or social activities.

    i. eproductive patternB$euality

    Ehich need to be studied

    K ?roblems or seual attention

    K 4vervie" of seual behavior 

    K @o hiperensi suffered by patients interfere "ith seual activity

    K no"ledge related to seuality and reproduction

    K menstrual and reproductive history

    K %s the problem hypertensive patients "ho "ere naturally intrusive role of the patient as a

    "oman or man

     1. ?attern Tolerance to $tressBoping

    Ehich need to be studied

    K The nature of the stress eperienced originators recently

    K The level of perceived stress

    K 4vervie" of the general and specific response to the stress that comes

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    K The strategies used to cope "ith stress as "ell as its effectiveness

    K #hanges in life and loss

    K coping strategies used

    K +ssessment capabilities "ill control events eperienced by patients

    K no"ledge and use stress management

    K elationship stress management "ith the patient5s family dynamics

    K 'istory related to psychological problems

    K Eho helped patients in the adaptation to hypertension disease that happened today

    K %s the patient eperiencing stress due to hypertensive

    &. #onfidence patternBHalue

      Ehich need to be studied

    K cultural or ethnic bac&ground

    K The economic status, health behaviors related to cultural or ethnic group

    K The purpose of the patient5s life

    K Ehat is used is important for patients and their families

    K The health impacts of the spiritualied

    K 'ope in the future related to the problems facing patients

     patterns -ordon

    . ?atterns of ?erception and health ?emeliharaab

    ?atients say &no" about the importance of health so that if there is one sic& family "as

    immediately ta&en to hospital.

    2. ?atterns !utrition

    a. before the pain

    ) 6at A day (rice, vegetable, side dish) is consumed serving

    2) @rin& BD cups a day ("ater and tea)

     b. during illness

    ) 6at 2 daily, diet *- of $, ehausted L servings

    2) @rin& 7B cups sie of 200 cc, 900 cc infusion types %

    A. The pattern of 6limination

    a. before the pain

    ) #'+?T6 normal 2 times a day, solid, yello".

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    2) normal *+ B times a day, yello"ish color.

     b. during illness

    ) #'+?T6 B2 times daily liquid, solid, yello" color, distinctive odor.

    2) liquid *+ B times a day, a distinctive smell.

    /. est and $leep ?atterns

    ) *efore you sic& 

    ?atients say before hospital bed DB hours < day

    2) @uring the illness

    ?atients sleep only AB7 hours < day because of diiness.

    7. The pattern of perceptual

    ($ight, hearing, taste, sensation)

    ) *efore you sic& 

    a. 'earing the patient is already some"hat impaired

     b. The patient has blurred vision

    c. The tasting of patients still good

    d. The sensation of the patient is still good

    2) @uring the illness

    a. 'earing the patient "as some"hat disturbed because it is old

     b. The patient has blurred vision

    c. The tasting patients less "ell due to the patient5s lips tasted bitter 

    d. The sensation of the patient is still go

    . ?atterns of $elf ?erception

    ) *efore you sic& 

    a) +niety There is no aniety or nervousness

     b) $elfB#oncept B

    2) @uring the illness

    a) The client loo&ed "ea& and pale

     b) The level of client aniety can be seen "hen the patient "ill be performed nursing

    actions, frequently as&ed something about his illness

    D. ?attern ole elationships

    a. #ommunication %n communicating patient communicates "ell "ith his family.

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     b. elationships "ith others ?atients socialie "ell "ith the environment and his family,

     proved many brothers or relatives "ho visit her.

    c. ;inancial #apability ;amilies of patients can be classified in a middleBclass social

    groups.

    . $eual and eproductive ?atterns

    ) *efore you sic& 

    ?atients already menopause

    2) @uring the illness

    ?atients do not have seual desire

    9. $tress Tolerance ?attern

    ) *efore you sic& 

    ?atients said they "ere delighted to get along "ith people around

    2) @uring the illness

    ?atients are seen as space for patient saturated diabatasi.

    0. #onfidence ?atterns

    ) *efore you sic& 

    ?atients say the %slamic religion, and diligent in "orship

    2) @uring the illness

    ?atients do not carry out their daily prayer as usual because of illness, but patients al"ays

     pray for &esembuhanya.

    %.1.% P&!#ica$ E/a(inaion

    . Eeight and height no "eight gain

    2. 'air normal hair distribution, strong hair, hair net, no lesions, no tenderness in the head

    A. 6yes +symmetrical, eyelashes normal distribution, eamination fundoscopy for retinal

    arteriolar narro"ing, bleeding, eudates and edema, no tenderness eye area, con1unctiva

     pin&, "hite eye se&lera there is redness, smaller pupil

    /. $&in $&in is clean, there are changes in s&in color 

    7. !ose symmetrical, nostril no deformity, no tenderness

    . 6ar symmetrical, no tenderness

    D. !ec& no in1ury, no peming&atan the GH?, noisy carotid artery and an enlarged thyroid

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    . Mouth symmetrical, blac& lip color purple

    9. =ungs %nspection (+symmetric, mammary areola loo&s clean and blac&, no in1ury,),

     palpation (asymmetric chest movement, vocal fremitus palpable on both sides, nonBtender),

     percussion (sonor), auscultation (rhythm irregular, tachypnea, breath sounds "eiing)

    0. 'eart inspection (+symmetric, no in1ury in the thoracic), palpation (asymmetric chest

    movement, vocal fremitus palpable on both sides, nonBtender), pe&usi (dullness),

    auscultation (no sound heart in $A and $/, no noisy heart, T@C 20)

    . +bdomen no noise, no renal enlargement

    2. 6tremities "ea&ness or loss of pulse parifer and edema

    A. !eurology a sign of cerebral thrombosis and bleeding

    %.1.' Daa Ana$!#i# and Pro0$e(

    @$ B patients said &epalnya sore and stiff nec&.

    B ?atients say pendangannya blurry and diy "hen standing and "al&ing

    B The patient says his body feels "ea& and difficult to carry out its activities independently

    @4 B patients are seen painfully

    B ?ain scale D

    B ?atients are seen to stagger "hen "al&ing and al"ays holding

    B ?atients are seen bedres

    B ?atients seen helped by other people "hile doing the activity &a

    %.2 Nur#ing Diagno#i#

    a. @ecreased cardiac output *.@. increased afterload

     b. *.d activity intolerance "ea&ness eperienced by the patient due to hypertension

    c. *.d acute pain headache

    d. !eeds more nutrients the body needs *.@. obesity

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    %.% P$anning Nur#ing

    a. !ursing @iagnosis

    +im

    #riteria esults

    K ?articipate in activities that degrade Td < "or&load of the heart.

    K Maintain T@ in the range of individuals "ho can be accepted.

    K ?aying attention to rhythm and frequency of the patient5s heart stabildalam normal range.

     b. !ursing @iagnosis 2

    +im

    #riteria esults

    K ?articipate in activities that desired < required

    K eport an increase in tolerance activity can be measured

    K @emonstrate the decline in signs of intolerance physiology

    c. !ursing @iagnosis A

    +im

    #riteria esults

    K eport lost or the pain or discomfort controlled

    K @isclose the method provides a reduction

    K ;ollo"ing the pharmacological regimen prescribed.

    d. !ursing @iagnosis /

    +im

    #riteria esults

    K %dentify the relationship bet"een hypertension and obesity

    K $ho"s changes in diet (eg, choice of food, quantity, and so on), maintain a desirable

    "eight "ith maintenance of optimal health.

    K #onduct or maintain a proper eercise program individually.

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    %.' Nur#ing Inerenion#

    a. Nur#ing Diagno#i# 1

     !ursing %nterventions

    Mandiri

    K monitor T@. Measure on both arms < thighs for an initial evaluation.

    K !ote the presence, quality and parifer central pulsation.

    K tone auscultation of heart and breath sounds.

    K 4bserve the color, moisture, temperature, and capillary refill time.

    K ecord generalied edema < certain.

    K ?rovide a quiet neighborhood, convenient, reduce the activity < environment commotion.

    =imit the number of visitors and length of stay.

    K Maintain restrictions on activities such as resting in bed < chair> uninterrupted rest period

    schedule> help the patient to perform selfBcare activities as needed.

    K ?erform actions "ere comfortable> such as bac& and nec& massage, elevating the head of 

    the bed.

    K 6ncourage relaation techniques, imagination guide, diversion activities.

    #ollaboration

    K -ive medications in accordance "ith the indications, for eample

    . thiaide diuretics, eg. lorotiaid (@iuril)> hydrochlorothiaide (6sidri < hidro@%F%=)>

     bendroflumentiiaid (naturetin)>

    2. =oop diuretics, ie. ;urosemide (=asi)> eta&rinic acid (6decrin), bumetanide (burme)>

    A. @iuriti& potassiumBsparing, eg, spironolactone (+ldactone)> triamterene (@yrenium)>

    amilioride (midamore)>

    /. %nhibitor sympathetic, eg, propranolol (%nderal)> metroponol (lepressor)> atenolol

    (ternomin)> nadolol (corgard)> methyldopa (+ldomet)> reserpine (serpasil)> clonidine

    (#atapres)>

    7. vasodilators, eg, minoidil (loniten)> hydralaine (apresoline)> calcium channel bloc&ers,

    eg, nifedipine (?rocardia)> verapamil (#alan)>

    . agents antiadrenergi&> alphaB bloc&er praosin (minipres)> tetaosin ('ytrin)>

    D. !uron +drenergic *loc&ers guanadrel ('yloree) quanetidin (%smelin)> reserpine

    ($erpasil)>

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    . adrenergic inhibitors that "or& is central clonidine (#atapres)> guanabens (Eytension)>

    methyldopa (+ldomet)

    9. The coBdirect vasodilator hydralaine (+presoline)> minoidil> (=oniten)

    0. The oral vasodilator that acts directly diao&sid ('yperstat)> nitroprusside> (!ipride,

     !itropess)

    . *loc&er ganglion ie., -uanetidin (%smelin)> trimetapan (+rfonad). +#6 inhibitors, ie.,

    #aptopril (#apoten)

    2. -ive fluid and dietary sodium restriction as indicated

    A. ?repare for the distinction "hen indicated

    0. Nur#ing Diagno#i# 2

     !ursing %nterventions

    . +ssess the patient5s response to the activity, perhatia&n pulse rate more than 20 times per 

    minute above the frequency of brea&s> significant increases in blood pressure during or 

    after activity (systolic pressure increased by /0mm < 'g or diastolic blood pressure

    increased by 20mm < 'g)> dyspnea or pain tones> ecessive fatigue and "ea&ness>

    diaphoresis> diiness or fainting.

    2. %nstruct the patient about energy saving techniques, eg., Fsing a bath seat, sit do"n

    "hile combing the hair or brushing teeth, doing it slo"ly.

    A. 6ncourage daily activity or self care gradually if it can ditolenransi. ?rovide assistance

    as needed

    c. Nur#ing Diagno#i# %

     !ursing %nterventions

    Mandiri

    . Maintain bed rest during the acute phase

    2. -ive nonpharmacological measures to relieve headaches, for eample> cold compress on

    the forehead, bac& and nec& massage, quiet, dim room light, relaation techniques

    (imagination guide, distraction) and leisure activities.

    A. 6liminate or minimie vasoconstriction activity that can increase headaches, for 

    eample> straining during defecation, coughing long, bent.

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    /. +ssist patients in ambulation as needed

    7. -ive liquids, soft foods, regular oral care "hen bleeding nose or nasal pac& has been

    done to stop the bleeding.

    #ollaboration

    -ive as indicated analgesics> antiansietas, for eample> loraepam (+tivan), diaepam

    (Halium).

    d. Nur#ing Diagno#i# '

     !ursing %nterventions

    Mandiri

    . +ssess the patient5s understanding of the direct relationship bet"een hypertension and

    obesity.

    2. @iscuss the importance of lo"ering caloric inta&e and limit fat inta&e, salt, and sugar as

    indicated.

    A. $et the patient5s desire to lose "eight

    /. evie" the daily caloric inta&e and diet selection

    7. $et a "eight loss plan that is realistic "ith patients, such as "eight loss of 0.7 &g per 

    "ee&.

    . 6ncourage the patient to &eep a daily food inta&e, including "hen and "here the meal is

    done and the environment and the feeling around the time food is eaten.

    D. %nstruct and help choose the right foods, avoid foods "ith a high fat saturation (butter,

    cheese, eggs, ice cream, meat) and cholesterol (fatty meats, egg yol&s, canned products,

    offal)

    collaborative

    efer to a dietitian as indicated

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    CHAPTER '. COER 

    '.1 conc$u#ion#

    'ypertension is defined as blood pressure above normal or persistent blood pressure "here

    the systolic pressure above /0 mm'g and diastolic pressure above 90 mm'g. *ased on

    the cause of hypertension is divided into t"o, namely primary hypertension or 

    hypertension "ith a cause that is not &no"n for certain. $econdary hypertension is

    hypertension caused by certain specific cause, such as &idney disease (acute

    glomerulonephritis, chronic nephritis, polyarthritis disease, diabetic nephropathy),

    endocrine diseases (hypothyroidism, hypercalcemia, acromegaly), &oar&tasioaorta.

    '.2 Reco((endaion#

    The advice "e can give is a hypertension treatment starts "ith lifestyle changes to help

    lo"er blood pressure and reduce your ris& of heart disease. %f the changes do not provide

    results, you may need to ta&e medications to patients "ith hypertension, of course in

    consultation "ith a doctor. 6ven if you have to ta&e your medicine, even better if 

    accompanied by lifestyle changes that can help you reduce the amount of medications you

    are ta&ing.

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    BIB3IO,RAPH4

    *runner and $uddarth. 2002. Medical Surgical Nursing . Ga&arta 6-#.

    #arpenito, =.G. Nursing Diagnosis Handbook 2000 Edition 8. Ga&arta. 6-#.

    @almartha, $etia"an and !ova $utarina. 200. Your Self Care Hypertension. Ga&arta

    $preaders ?lus.

    @ongoes, Marlynn.6.d&&.999. Nursing Care Plans ssue !. Ga&arta 6-#.

     !+!@+. 202. Nanda Nursing Diagnosis "uide. Noya&arta ?rima Medi&a.

    ilantono, = et al. 2002. #e$tbook of Cardiology. Ga&arta Fniversity.