Group task

Supervisor : Dra.Sitti Hamsina S,M.Pd.,Ph.D

PAPERS ABOUT

EMERGENCY HYPERTENSION

BY :
GROUP 7

1. ITA TIRTAYANA (142046)

2. NURHASNAH (
3. ENDERINA (
4. YOMANTUS (

SEKOLAH TINGGI ILMU KEPERAWATAN (STIKPER)

GUNUNG SARI MAKASSAR
YEAR 2017/2018
 FOREWORD

The praise and gratitude of the writer prayed to the presence of God Almighty,
because for His blessings and grace this paper can be resolved.
Through this paper, we can find out about " HYPERTENSION". The making of this
paper uses the method of literature, as well as writer data obtained from several sources and
thoughts that the authors combine to become a paper that may be useful for the reader.
The author is aware of the weaknesses and shortcomings of this paper. Therefore, the
author needs criticism and suggestions that are constructive, so this paper will be better
served. Hopefully this paper can be useful for all readers.

Makassar, 15 November 2017

Author
 TABLE OF CONTENTS

Foreword

Table Of Contents..

CHAPTER I: INTRODUCTION

A. Background
B. Problem Formulation.
C. Purpose of Writing.

CHAPTER II: OVERVIEW OF THE THEORY

A. Definition of Hipertension.....
B. Etiology of Hypertension ... .................................................................
C. Pathophysiology Hypertension.........................................................................
D. Signs and Symptoms of Hypertension..............................................................
E. Hypertension diagnostic procedures .................................................................
F. management of Hypertension............................................................................
G. prevention of Hypertension...............................................................................
H. first aid Hypertension.........................................................................................

CHAPTER III: CLOSING

A. Conclusion..
B. Suggestions.

BIBLIOGRAPHY
 CHAPTER I

PRELIMINARY

A. 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 supply and supply oxygen and nutrients to all the tissues
and organs needed in metabolic processes. Normally every tissue and organs of the
body will receive enough blood flow so that the tissues and organs of the body receive
adequate nutrition. The cardiovascular system that functions as a regulatory system
performs various mechanisms in response to all body activities. In certain
circumstances, the blood will flow more in the vital organs such as the heart and brain
to maintain the circulatory system of these organs.
The heart functions to circulate blood throughout the body. This circulation
process will work well if the pumping process is going well. If the pumping is not
perfect, the oxygen distribution will decrease compensated by the heart by increasing
the rate of respiration. If the compensation process occurs continuously, the heart will
eventually fail to pump. The heart pump works through a stage called the heart cycle
consisting of systole and diatol (Ronny, et al., 2008).
Blood pressure is the force needed to allow blood to flow through all the tissues
of the human body. Systolic blood pressure is the blood pressure at the time of the
heart menguncuo (sistol). Adapaun diastolic blood pressure is the blood pressure at
the time the heart relaxes back (diastole). Human blood pressure can be classified into
three groups, namely low blood pressure (hypotension), normal (normotensi), and
high (hypertension) (Gunawan, 2001).
B. Problem Formulation
1. What Is Hypertension Definition?
2. What is Hypertension etiology?
3. How is the pathophysiology of Hypertension?
4. What are the signs and symptoms of Hypertension?
 5. How is the diagnostic procedure for hypertensive disease?
6. How is hypertension management managed?
7. How to prevent hypertension?
8. How is first aid hypertension?

C. Writing purpose
1. To know the definition of hypertension;
2. To know the etiology of hypertension;
3. To know the pathophysiology of hypertension;
4. To know the signs and symptoms of hypertensive disease;
5. To know hypertension diagnostic procedure;
6. To know the management of hypertension disease;
7. To know the prevention of hypertension disease;
8. To know first aid hypertension;
 CHAPTER II

LITERATURE REVIEW

A. Defenition of Hypertension
Hypertension can be defined as an increase in blood pressure above normal or
persistent blood pressure where the systolic pressure is above 140 mmHg and diastolic
pressure above 90 mmHg. In the elderly population, hypertension is defined as 160 mmHg
systolic pressure and diastolic pressure of 90 mmHg.
Hypertension is a major cause of heart failure, stroke, and kidney failure. Called a
"silent killer" because people with hypertension often do not show symptoms. Half of
people with hypertension are unaware of their condition. Once the disease is suffered, the
patient's blood pressure should be monitored at regular intervals because hypertension is a
lifelong condition.

B. Etiology of Hypertension
Based on the etiology of hypertension is divided into two groups, namely:
1. Essential hypertension or primary hypertension
This hypertension is an unknown hypertension or also called idiopathic
hypertension. There are 95% of cases (Smeltzer & Bare, 2001). Many factors affect it,
such as gender, genetics, age, environment, reninangiotensin system and autonomic
nervous system.Other factors include smoking, excessive salt intake, alcohol, obesity,
stress and lack of exercise / physical activity. (Lauralee, 2001; in Rahman, 2011).
2. Secondary Hypertension
This hypertension is present in about 5% of all hypertensive prevalence. Specific
causes are known, for example; kidney disease (acute glomerulonephritis, chronic
nephritis, poliartritis disease, diabetes nephropathy), endocrine diseases
(hypothyroidism, hypercalcemia, acromegaly), coarctationaorta, hypertension in
pregnancy, neurological disorders, drugs and other substances (Lauralee, 2001; 2011).

Primary hypertension is present in more than 90% of hypertensive patients, while

the remaining 10% is due to secondary hypertension (Gunawan, 2001). Although
primary hypertension is not known for certain causes, research data have found several
factors that often lead to hypertension. These factors are as follows:
1. Hereditary factors

From statistical data proved that a person will have greater possibility to get
hypertension if her parents are hypertension sufferers.

2. Individual characteristics

Individual characteristics that affect the onset of hypertension are:

a. Age (if age increases TD increases)

b. Gender (male is higher than female)

c. Race (more black race than whites)

In general, hypertension has no specific cause. Hypertension occurs as a

response to increased cardiac output or increased peripheral pressure. But there are
several factors that affect the occurrence of hypertension:
1. Genetic: Nerological response to stress or abnormalities of Na oral excretion.

2. Obesity, associated with high insulin levels that result in increased blood
pressure.

3. Environmental Stress.

4. Elasticity of tissue loss and arterisklerosis in the elderly and dilation of blood
vessels.

The cause of hypertension in people with elderly is the occurrence of changes

to:
1. Elasticity of the aortic wall decreases

2. Heart valve thickens and becomes stiff

3. The ability of the heart to pump blood decreases by 1% every year after
the age of 20 years the ability of the heart to pump blood decreases
causing decreased contraction and volume.
 4. Loss of elasticity of blood vessels This happens because of the
effectiveness of peripheral blood vessels for oxygenation

5. Increased resistance of peripheral blood vessels

C. Pathophysiology Hypertension
According to Smeltzer & Bare (2002: 898) says that the mechanisms that control
the constriction and relaxation of blood vessels lie at the vasomotor center of the medulla
oblongata in the brain from which the vasomotor begins the sympathetic nerve that
continues down the spinal cord and exits from the medulla column to the sympathetic
ganglia torax and abdomen, vasomotor center stimulation is delivered in the form of an
impulse that moves downward through the sympathetic nervous system. At this ganglion
point the preganglion neuron releases acetylcholine which stimulates the post-ganglion
nerve fibers to the blood vessels, which by releasing norepinephrine results in
constriction of the blood vessels.
Factors such as anxiety and fear may affect the vascular response to
vasoconstrictive stimuli causing vasoconstriction of blood vessels due to blood flow to
the kidneys to decrease or decrease and result in the production of renin, renin will
stimulate the formation of angiostensin I which is then converted to angiostensin II
which is a powerful vasoconstrictor which stimulates aldosterone secretion by the
adrenal cortex wherein this aldosterone hormone causes sodium and water retention by
the renal tubules and causes an increase in intra vascular fluid volume that causes
hypertension.
The occurrence of hypertension can be caused by several factors as follows:
1. Cardiac output and peripheral resistance

Maintaining a normal blood pressure depends on the balance between

cardiac output and peripheral vascular resistance. Most patients with essential
hypertension have normal cardiac output, but their peripheral resistance increases.
Peripheral resistance is determined not by large arteries or capillaries, but by small
arterioles, whose walls contain smooth muscle cells. Contraction of smooth muscle
cells is thought to be associated with an increase in intracellular calcium
concentration (Lumbantobing, 2008). Long-lasting smooth muscle contractions are
thought to induce a structural change by thickening arterial blood vessels, possibly
mediated by angiotensin, and may result in increased irreversible peripheral
 resistance. In very early hypertension, peripheral resistance does not increase and
increased blood pressure is caused by increased cardiac output, which is associated
with sympathetic overactivity. Increased peifer resistance may be compensated to
prevent increased pressure from being disseminated to capillary blood vessel
tissue, which would interfere with substantial cellular homeostasis (Lumbantobing,
2008).
2. The renin-angiotensin system
The renin-angiotensin system may be the most important endocrine system in
controlling blood pressure. Renin is secreted from the renal juxtaglomerular
apparatus in response to less glomerular perfusion or less salt intake. It is also
released in response to stimulation and the sympathetic nervous system
(Lumbantobing, 2008). Renin is responsible for converting the substrate renin
(angiotensinogen) to angotensin II in the lung by angiotensin converting enzyme
(ACE). Angiotensin II is a powerful vasoconstrictor and results in an increase in
blood pressure (Lumbantobing, 2008).
3. Autonomic nervous system
Stimulation of the autonomic nervous system may result in arteriole
constriction and arteriole dilatation. Thus the autonomic nervous system has an
important role in maintaining normal blood pressure. It also has an important role
in mediating short-lived changes in blood pressure in response to stress and
physical work (Lumbantobing, 2008).
4. Atrial natriuretic peptide (atrial natriuretic pept idea / ANP)
ANP is a hormone produced by the atrium of the heart in response to an
increase in blood volume. The effect is to increase the excretion of salt and water
from the kidneys, so as a kind of natural diuretic. Disturbances in this system can
lead to fluid retention and hypertension (Lumbantobing, 2008).

D. Signs and Symptoms of Hypertension

Clinical manifestations of clients with hypertension are:

1. Increased blood pressure> 140/90 mmHg
2. Headache
3. Dizziness / migraine
4. Heaviness is bent
 5. Difficulty sleeping
6. Sparkling eyes
7. Weak and tired
8. Pale face
9. Body temperature is low
Most patients with hypertension usually have no specific symptoms that show an
increase in their blood pressure and are only identified by blood pressure alone (Kurt,
2000, in Sari 2011). One may consider headaches, dizziness or a bloody nose as a sign of
increased blood pressure, whereas the symptoms are only a small part of the result of
hypertension (Sheps, 2005, in Sari, 2011). A study found no association between headache
with increased blood pressure, even some people do not feel any signs or symptoms
Other signs and symptoms often associated with hypertension such as excessive
sweating, muscle spasms, frequent urination and rapid and irregular heartbeat or
palpitations (Sheps, 2005; in Sari, 2011). Other symptoms that generally occur in people
with hypertension is dizziness, red face, headache, blood out of the nose suddenly, neck
stiff and others (Wiryowidagdo, 2002; in Sagala, 2010). Kushartanti (2008) mentions
symptoms of hypertension that includes dizziness, neck stiffness, stiff shoulders, tingling,
nausea, weakness, lumbago and shortness of breath.According to Smeltzer & Bare (2001)
factors that affect the symptoms of hypertension that is the damage / vascular disorders
with typical manifestations appropriate with a vascularized organ system.
Symptoms of hypertension are a clinical manifestation of the patient's perceived
comfort disorder. Patients can consider a symptom of hypertension as a comfort disorder
or not dependent on several factors. According to Potter & Perry (2005) several factors
are; age, gender, culture, meaning of pain, attention, anxiety, fatigue, prior experience,
coping and family social support.

E. Diagnostic Procedure
1. Laboratory Examination:
a. Hb or Ht: to examine the relationship of cells to fluid volume (viscosity) and may
indicate risk factors such as: hypokoagulability and anemia
b. BUN or creatinine: provides information about perfusion or kidney function
c. Glucose: Hyperglycemia (DM is the originator of hypertension) can be caused by
expulsion of ketokolamin levels. Hypertension accompanied by diabetes or diabetes
 with hypertension can pose a risk to important organs. Therefore monitoring is
required for blood glucose levels
d. Urinalysis: examined in blood, protein, glucose, indicating dysfunction in the
kidneys and presence of DM

2. CT Scan: to assess the presence of cerebral tumors and encelopati

3. EKG: can show strain patterns, where the location and how wide, P wave elevation is
one of the early signs of hypertensive heart disease
4. IUP: identifies causes of hypertension, such as: kidney stones and kidney repair
5. Thorax photo: can show the destruction of calcification in the valve area and heart
enlargement

F. The Management of Hypertension

Management of hypertension can be done by:
1. Nonpharmacology therapy
2. Pharmacological therapy

1. Nonpharmacology therapy
Applying a healthy lifestyle for everyone is very important to prevent high
blood pressure and is an important part in the treatment of hypertension. All patients
with prehypertension and hypertension should make lifestyle changes. Visible changes
to lower blood pressure can be seen in Table 4 in accordance with the recommendations
of JNC VII. In addition to lowering blood pressure in patients with hypertension,
lifestyle modification can also reduce the onset of blood pressure to hypertension in
patients with prehypertensive blood pressure.12 Important lifestyle modifications seen
to lower blood pressure are weight loss for obese individuals or fat; adopting a Dietary
Approach to Stop Hypertension diet rich in potassium and calcium; low-sodium diet;
physical activity; and consume only a small amount of alcohol. In some patients with
good blood pressure control with antihypertensive drug therapy; reducing salt and
weight can relieve patients from using drugs. 10 Acceptable diet programs are those
designed to slowly lose weight in obese and obese patients with sodium and alcohol
intake restrictions. This requires education to the patient, and moral encouragement.
 The following facts can be told to patients to understand the rationality of dietary
interventions:
a. Hypertension 2 - 3 times more often in obese people than people with ideal body
weight
b. More than 60% of patients with hypertension are obese (overweight)
c. Weight loss, with just 10 pounds (4.5 kg) can lower blood pressure significantly in
obese people
d. Abdominal obesity is associated with metabolic syndrome, which is also a
precursor of hypertension and insulin resistant syndrome that can progress to type
2 diabetes, dyslipidemia, and subsequently to cardiovascular disease.
e. Diet rich in fruits and vegetables and low in saturated fat can lower blood pressure
in individuals with hypertension.
f. Although there are hypertensive patients who are insensitive to salt, most patients
experience systolic blood pressure reduction with sodium restriction.

JNC VII recommends diet DASH is a diet rich in fruit, vegetables, and dairy
products redah fat with total fat and saturated fat is reduced. Recommended sodium <2.4 g
(100 mEq) / day. Physical activity can lower blood pressure. Regular aerobic exercise for
at least 30 minutes / day several days per week is ideal for most patients. Studies show that
aerobic exercise, such as jogging, swimming, walking, and using a bicycle, can lower
blood pressure.
This advantage can occur even without weight loss. Patients should consult with a
doctor to find out which type of exercise is best especially for patients with target organ
damage. Smoking is a major independent risk factor for cardiovascular disease.
Hypertensive patients who smoke should be counseled in relation to other risks that
smoking may cause.
2. Pharmacological Therapy
There are 9 classes of antihypertensive drugs. Diuretics, beta blockers, angiotensin
converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and calcium
antagonists are considered the main antihypertensive drugs. These drugs either alone or in
combination, should be used to treat the majority of patients with hypertension because
evidence shows benefits with this class of drugs. Some of these classes of drugs (eg
diuretics and calcium antagonists) have subclasses where significant differences from the
study are seen in work mechanism, clinical use or side effects. Alpha blockers, 2-central
 alpha agonists, adrenergic inhibitors, and vasodilators are used as an alternative medicine
in certain patients in addition to the main drug.
Evidence-based medicine is a treatment based on the best evidence available in
making decisions when choosing a drug consciously, clearly, and wisely on each patient
and / or illness. Evidence-based practices for hypertension include choosing specific drugs
based on data showing decreased mortality and cardiovascular morbidity or target organ
damage due to hypertension. Scientific evidence suggests that simply lowering blood
pressure, tolerability, and cost alone can not be used in hypertensive drug selection.
Taking these factors into consideration, the most useful medications are diuretics,
angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs),
beta-blockers, and calcium antagonists (CCB). Most patients with hypertension require
two or more antihypertensive medications to achieve the desired blood pressure target.
The addition of a second drug from a different class begins when the use of a single drug
with the usual dose fails to reach the target of blood pressure. If blood pressure exceeds
20/10 mm Hg above target, it may be considered to initiate therapy with two drugs. What
should be noted is the risk for orthostatic hypotension, especially in patients with diabetes,
autonomic dysfunction, and the elderly.
G. Prevention of Hypertension
1. Reduce consumption of salt in your diet. If you already suffer from high blood pressure
you should avoid foods containing salt.
2. Consumption of foods containing potassium, magnesium and calcium. Potassium,
magnesium and calcium can reduce high blood pressure.
3. Reduce drinking or alcoholic beverages. If you suffer from high blood pressure, you
should avoid excessive alcohol consumption. For men suffering from hypertension, the
maximum amount of alcohol allowed is 30 ml of alcohol per day while women are 15
ml per day.
4. Exercise regularly can lower high blood pressure. If you suffer from high blood
pressure, choose a mild exercise such as walking, cycling, running, and swimming. Do
it for 30 to 45 minutes a day 3 times a week.
5. Eat high-fiber vegetables and fruits such as green vegetables, bananas, tomatoes,
carrots, melons, and oranges.
6. Run anti-stress therapy to reduce stress and you are able to control your emotions.
7. Quitting smoking also plays a major role to reduce high blood pressure or hypertension.
8. Take control of your cholesterol levels.
 9. Take control of your diabetes.
10. Avoid drugs that can increase blood pressure. Consult a doctor if you are receiving
treatment for a specific disease, to request a drug that does not increase blood pressure

H. First class of hypertension

1. Take a deep breath and exhale so Mom does not lack oxygen feel more calm.
2. If you are in a stressful environment, go from there. Go into a more relaxed
environment such as noisy gardens or gardens.
3. If your mother's nose is bleeding, place cold water (or ice cubes) on the forehead to
stop the nosebleed. 4. Consume beverages that contain high potassium levels to
compensate for high levels of sodium in the body, so that blood pressure decreases. For
example, fruit juice without salt.

In addition to the first treatment for hypertension, which is also important to

remember is the way of prevention. Eat a healthy, balanced diet, and reduce your salt
intake. Reduce weight if you are overweight / obese. Drink plenty of water every day,
and do not forget to exercise at least 2.5 hours per week. The most important thing, do
not smoke and limit alcohol consumption.
 CHAPTER III
COVER
A. Conclusion
Hypertension can be defined as an increase in blood pressure above normal or
persistent blood pressure where the systolic pressure is above 140 mmHg and diastolic
pressure above 90 mmHg. Hypertension based on the cause is divided into 2, that is
primary hypertension or is hypertension with unknown cause for sure. Secondary
hypertension is hypertension caused by certain specific causes, such as renal disease (acute
glomerulonephritis, chronic nephritis, polyarthritis disease, diabetes nephropathy),
endocrine disease (hypothyroidism, hypercalcemia, acromegaly), coarctationaorta.
B. Suggestions
The advice we can give is Treatment of hypertension begins with lifestyle changes
to help lower blood pressure and reduce the risk of heart disease. If those changes do not
work, you may need to take medication for hypertension, of course, in consultation with a
doctor. Even if you have to take medication, it's better to be accompanied by lifestyle
changes that can help you reduce the amount or dose of medicines you are taking
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