ASSESSMENT Subjective: kanayun nak maulaw, as verbalized by the patient.

Objective: >lethargic >decreased cardiac output >decreased stroke volume >increased peripheral vascular resistance >VS taken as follows: T: 37.2 PR: 83 RR: 18 BP: 180/100 NURSING DIAGNOSIS: Decreased Cardiac Output r/t hypertension as manifested by decreased stroke volume

EXPLANATION OF THE PROBLEM Cardiac output is the amount of blood per minute pumped out by each of the two ventricles of the heart. A typical value in an adult at rest is 5 litres per minute. The output of each ventricle is the product of the stroke volume (about 70 ml) and the heart rate (about 70 per minute). The output increases with muscular activity, in work or exercise perhaps to a maximum of 4-5 times the resting rate in an average healthy person, or

OBJECTIVES STO: After 6 hrs of nursing interventions, the client will have no elevation in blood pressure above normal limits and will maintain blood pressure within acceptable limits.

INTERVENTION DX>1. Monitor BP every1-2 hours, or every5 minutes during active titration of vasoactive drugs.

RATIONALE 1. Changes in BP may indicate changes in patient status requiring prompt attention.

EVALUATION STG: Goal met. If after 6 hrs of nursing interventions, the client had no elevation in blood pressure above normal limits and will maintain blood pressure within acceptable limits.

2. Monitor ECG for dysrhythmias, conduction defects and for heart rate.

2. Decrease in cardiac output may result in changes in cardiac perfusion causing dysrhythmias.

LTO:After 72 hours of nursing interventions, the client will maintain adequate cardiac output and cardiac index.

TX>3. Encourage patient to decrease intake of caffeine, cola and chocolates.

3. Caffeine is a cardiac stimulant and may adversely affect cardiac function.

4. Observe skin color, temperature, capillary refill time and diaphoresis.

4.peripheral vasoconstriction may result in pale, cool, clammy skin, with prolonged capillary refill time due to cardiac dysfunction an decreased cardiac output 5 hypertensive patients often haveS4 gallops caused by atrial hypertrophy

LTG: Goal met. If after 72 hours of nursing interventions, the client maintained an adequate cardiac output and cardiac index.

5. Auscultate heart tones.

up to 6-7 times in athletes; heart rate increases by a greater factor than stroke volume. The more blood pumped from the heart per minute (that is, the larger the cardiac output), the higher the blood pressureas long as resistance to blood flow in the arteries remains constant. The body can change the amount of blood pumped during each heartbeat by making each contraction weaker or stronger. The higher the volume of blood in the blood vessels,

6.administer medicines as prescribed by the physician

6.to promote wellness

EDX>7. instruct client &family on fluid and diet requirements and restrictions of sodium

7. Restrictions can assist with decrease in fluid retention and hypertension, thereby improving cardiac output.

8. Instruct client and family on medications, side effects, contraindications and signs to report.

8. Promotes knowledge and compliance with drug regimen.

9. Instruct for frequent position changes.

9. It may decreases peripheral venous pooling that may be potentiated by vasodilators and prolonged sitting or standing.

the higher the blood pressureas long as resistance to blood flow in the arteries remains constant. To increase or decrease blood volume, the kidneys can vary the amount of fluid excreted in urine.

SOURCE: www.wikipidea.com

CLIENT EDUCATION FOR PATIENT WITH HYPERTENSION