HYPERTENSION IN GERI NURSING Essays

Assessment of an Elderly Patient for Hypertension When assessing an elderly patient for hypertension, both objective and subjective data should be taken into account. Objective data should include both blood pressure readings on three separate occasions and orthostatic blood pressure readings. To get an accurate picture ensure that all equipment is in proper working condition, the cuff size is appropriate, as well as the arm is supported at heart level. Instruct the patient to abstain from caffeine and cigarettes thirty minutes prior to blood pressure measurements. Blood pressure readings with a systolic blood pressure of 120-139 mm Hg or a diastolic of 80-89 mm Hg should be considered as pre-hypertensive and require lifestyle modifications. Blood pressure readings with a systolic of 140-159 mm Hg and a diastolic of 90-99 mm Hg do require initiation of hypertensive medications. In people over the age of 50 a systolic or greater than 140 mm Hg is more important than an increased diastolic when trying to assess a risk for cardiovascular disease. Subjective data that is obtained from the patient is important. Be sure to ask the patient if any symptoms have occurred such as fatigue, headaches, nose bleeds or dizziness. These symptoms can be early indicators of hypertension. More severe hypertension may result in occipital headaches, confusion, vision loss and focal deficits. Include the family members or caretakers in discussion of recent changes or symptoms they have witnessed when caring for the patient. In some cases a blood pressure diary may be helpful. Having the patient record blood pressure readings throughout the day may show important patterns. It is imperative to be able to recognize modifiable risk factors for hypertension. Assess physical activity, weight, diet, co-morbidities and smoking status. If hypertension is caught at an early stage lifestyle modifications may benefit the patient. It is important to remember when changing diet or exercise in the elderly to begin slowly and build up to a point that the patient is able to maintain. The nurse should emphasize the need for a low-sodium, low-fat and reduced calorie

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