Priority problem in arterial hypertension. What is the nursing process for hypertension

In order to properly implement caring for patients with hypertension and timely and competently plan nursing process Let's look at the definition of the disease itself. Thus, hypertension is a disease accompanied by such pathological condition like hypertension or hypertension.

Arterial hypertension or hypertension is an increase in blood pressure, which is caused by non-natural reactions of the body to certain physiological situations (stress, heat, somatic disease). At arterial hypertension there is an imbalance in the systems responsible for maintaining blood pressure within normal limits.

According to the recommendation of the WHO (World Health Organization), high blood pressure is considered to be blood pressure from 140/90 mm Hg. Art. Hypertension is a disease, the leading symptom of which is a tendency to arterial hypertension. Risk factors for developing hypertension are considered to be:

• genetic predisposition;
• chronic stressful situations;
• frequent heavy physical activity;
• absence or minimum physical activity;
• psychological trauma;
• unbalanced diet (including increased consumption of table salt);
• alcohol abuse;
• smoking;
• overweight and obesity.

Hypertension until recently was considered a disease of the age of 40 years. However, in last years hypertension, like other cardiovascular pathologies, has become much younger and is quite common in young people (up to 30 years old).

Stages of hypertension

I stage - unstable increase in blood pressure to 140/90 - 160/100 mm Hg. Art., maybe for several days in a row. Blood pressure levels return to normal after rest. However, recurrence of the rise in blood pressure is inevitable. changes internal organs at stage I GB is not available.

II stage - blood pressure level from 180/100 - 200/115, there are fixed changes in internal organs (often - left ventricular hypertrophy, retinal angiopathy). The level of blood pressure cannot normalize on its own, it happens. At this stage it is required drug therapy.

III stage - persistent increase in blood pressure, reaching the level of 200/115 - 230/130. There are lesions of the heart, kidneys, fundus. At this stage, there is a high risk of acute damage. cerebral circulation- stroke or acute myocardial infarction.

Proper care of a patient with hypertension consists in following several rules:

• creation of optimal working and rest conditions;
• organization of a balanced diet (diet with reduced content salts and liquids)
• control over general condition and well-being of the patient;
• control over timely compliance drug treatment.

Even before the implementation of full-fledged care and assistance to a patient with hypertension, a nurse needs to determine his real and potential problems. This is especially important for early stage the development of the disease.

Problems of a patient with stage I hypertension

Real (existing):

• headache;
• dizziness;
• anxiety;
• irritability;
• sleep disorders;
• unbalanced diet;
• tense rhythm of life, lack of proper rest;
• the need for continuous medicines, lack of serious attitude to this issue;
• lack of knowledge about the disease and its complications.

Potential (probable):

• visual impairment;
• development of a hypertensive crisis;
• development of renal failure;
• development of a heart attack or stroke.

After identifying problems during the initial examination nurse collects patient information.

Questioning a patient with hypertension

The nurse needs to find out:

• conditions of professional activity;
• relationships within the team with colleagues;
• family relationships;
• the presence of hypertension in close relatives;
• nutritional features;
• Availability bad habits(smoking, drinking alcohol);
• taking medications: which ones he takes, how regularly, how he tolerates them;
• complaints at the time of the study.

Physical examination of the patient

The nurse records:

• position of the patient in bed;
• color skin, including the presence of cyanosis in some areas $
• blood pressure level;
• pulse rate.

Nursing interventions in the care of a patient with hypertension

Modern care for patients with hypertension includes the following nursing interventions:

Interviews with the patient and his relatives:

• on the need to comply with the regime of work and rest, improve working conditions and improve the quality of rest;
• on the importance of following a low-salt, low-cholesterol diet;
• about the importance of timely systematic intake of drugs;
• on the effects of smoking and alcohol on blood pressure.

Patient and family education

• measurement of blood pressure and pulse rate;
• recognition of the first signs of a hypertensive crisis;
• providing first aid with a hypertensive crisis;
• relaxation methods and their application in a stressful situation and prophylactically.

Ensuring that the patient stays in the hospital for maximum benefit

• control of the day regimen, ventilation of premises, proper nutrition, including transfers, taking prescribed drugs, conducting research and medical procedures;
• control of body weight, motor mode;
• in the event of a threatening complication of the disease, urgently call a doctor, fulfill all prescriptions, and care for the patient as if he were seriously ill.

Arterial hypertension is a condition in which a repeated or constant increase in pressure above 140/90 is recorded, at least during 2 visits to the doctor. High blood pressure is a painless but potentially fatal disease, and the incidence is increasing in the general population. According to experts, in our country up to 35% of adults aged 25-64 suffer from hypertension. The frequency of the disease increases with age, increasing the risk of cardiovascular and brain problems. An important role in the treatment of the disease is played by the nursing process in hypertension. What should be the actions of a nurse with hypertension? What is high blood pressure nursing?

Fundamentals of the nursing process in hypertension

The algorithm of actions of a nurse for hypertension is a specially organized method of individual care for each patient.

Nursing assistance while working with a patient:

• creation of conditions for treatment;
• implementation of all hygiene procedures;
• disease prevention work;
• assistance in the implementation of some wishes of the patient;
• conducting training for the patient and his relatives (acquiring the necessary skills aimed at supporting the patient's health);
• expansion of scientific knowledge and research activities with subsequent application in practice.

Stages of the nursing process in hypertension:

• patient care;
• diagnostics;
• determination of the purpose of medical intervention;
• care plan preparation and implementation;
• analysis of results.

Important! It should be borne in mind that the nursing process in arterial hypertension is especially important in atherosclerosis caused by hypertension.

Stages nursing care in hypertension, include certain actions aimed at supporting and improving the patient's condition.

Stage 1

The purpose of the 1st stage is to conduct a nursing survey, including the collection of subjective information, an objective analysis of the results and the psychosocial state of the patient.

Step 1 of the process is as follows:

• establishing trust in the patient;
• getting an answer to the question: “What does a person expect from treatment?”;
• analysis of all the necessary information to create the right plan for patient care.

Stage 2

The purpose of the 2nd stage of the nursing process is to identify all existing potential problems of a patient with hypertension. Nursing interventions also include the diagnosis of all complaints. The patient's problems can be physiological and psychological, so the diagnosis of each complaint is necessary.

Table physiological problems and their diagnosis

Stage 3

The tactics that determine the activities of a nurse in the work of a school of arterial hypertension help to develop an individual treatment plan. Tasks - short-term, designed for a week or a little more, and long-term, applied throughout the therapeutic course.

For more exact definition goals and the role of the nurse in the management of hypertension, it is important that the objectives meet the following criteria:

• the reality of achievement;
• the urgency of implementation;
• participation of patients in the discussion.

Before setting a specific goal for an intervention, the nurse should determine:

• what actions the patient is able to do independently;
• whether the patient can master the features of self-care.

Stage 4

The purpose of this stage of the nursing process is to develop a plan and standard for nursing intervention, and their implementation.

The plan contains the following items:

• primary date;
• patient's problem
• target result;
• description of medical care;
• patient response to nursing intervention;
• target date.

This plan may contain several potential solutions to the problem. This ensures a high percentage of treatment success.

When implementing the plan, the nurse must observe the following rules:

• the developed plan should be carried out systematically;
• in the implementation process, it is necessary to involve the patient and his relatives;
• in case of any changes in the patient's condition or the appearance / elimination of complaints (symptoms), the plan should be changed;
• all planned procedures must be performed exactly in accordance with the algorithm of the nursing process for hypertension.

Stage 5

Competent analysis and evaluation of the results of nursing intervention is an important stage in the development of the patient's future lifestyle, c.

During the assessment, the following questions should be answered:

• whether some progress has been made during treatment;
• whether the expected result is achieved;
• how effective the nurse's intervention is for each patient;
• whether a revision of the plan is required.

To obtain more accurate results, the final assessment is carried out by the same nurse who performed the initial examination of the patient. Evaluation of the effectiveness of therapy will be incomplete if the following rules are not observed during nursing care:

• all medical interventions (major and minor) were not recorded;
• not all activities were immediately documented;
• no change in the patient's condition was recorded;
• conditions for treatment were not created;
• graphs in the plan remained empty.

Important! As a result of care, the patient should feel an improvement in his condition, he and his family should study the main stages of the developed plan, receive recommendations for preventing the disease.

Patient problems

Features of nursing in hypertension include the study of the patient's problems and the prevention of their development.

Signs depend on the degree of hypertension:

• - hypertension without changes in the organs in the circulatory system, fundus, kidneys. Sometimes there are headaches, neurotic problems, fatigue, confusion, dizziness, nosebleeds.
• - a steady increase in blood pressure, changes in organs - hypertrophy of the left ventricle, kidneys, changes in the fundus, minor changes in the arteries. The patient has subjective difficulties similar to the manifestations of the disease of the 1st degree.
• - functional disorders in individual organs. Heart - manifestations coronary disease, myocardial infarction, heart failure. CNS - cerebral hemorrhage. Kidneys - nephropathy = decreased kidney function. Fundus of the eye - hypertensive retinopathy = retinal hemorrhage.

A plan is drawn up according to the problems of the patient. The nursing process is based on the risks of the disease - if a hypertensive crisis is suspected, an algorithm is drawn up aimed at first aid for a hypertensive crisis. With parenchymal renal () arterial hypertension, emphasis is placed on monitoring the condition of the kidneys.

Collection of information during the initial survey

As with any other illness, the primary responsibility of the nurse is to obtain personal, family, pharmacological, social, professional history(compiling an anamnesis). Information is collected on genetic predisposition, medications taken, personal data, health problems, working conditions, lifestyle (smoking, eating habits, degree of physical activity), susceptibility to stress. A family history is very important for diagnosis, since genetic predisposition is one of the most dangerous factors risk.

A medical examination is also carried out in cooperation with the local (attending) doctor (visually, palpation, listening, tapping). The most important role of the nurse and a necessary part of the diagnosis is the measurement of blood pressure in several positions of the patient (lying, standing). It is necessary to follow the principles and algorithm for measuring blood pressure!

Nursing interventions, including work with the patient's family

Care of patients with hypertension is usually carried out on an outpatient basis. Hospitalization is required for only a small percentage of patients. Inpatient care is recommended for disease resistant to outpatient treatment, hypertensive crisis, coronary complications, differential diagnosis secondary hypertension.

The nurse informs the patient about the treatment regimen, draws up medical card. During hospitalization, the nurse, in cooperation with the patient, draws up nursing documentation, provides the necessary nursing care in accordance with the needs of the patient.

Interventions for complications (with hypertensive crisis)

After rendering emergency care with a hypertensive crisis conducted by a doctor, nursing care is needed.

Patient care, independent nursing intervention in hypertensive crisis:

• informing the patient (in an acceptable form) about his state of health, possible complications and necessary changes in the diet;
• motivating the patient to actively engage in treatment, adhere to the established therapeutic regimen;
• assessment of the patient's condition depending on the degree of his self-sufficiency;
• administration of medications to the patient in accordance with the doctor's prescription;
• regular control physiological functions patient (determining the pulse, pressure indicators, etc.), recording them;
• power control;
• ensuring patient safety;
• maintaining nursing records.

The psychological approach of the nurse to the patient is important, bringing him to a positive attitude towards life. If necessary, the patient's family is involved in the treatment process.

When transferring to home treatment for the patient himself and his family members, the need for regular use is emphasized. medicines, regular visits to the doctor, adherence to proper nutrition, the required amount of exercise and active rest, regular measurements of blood pressure (any tonometer suitable for the patient is used).

Possible problems involving dependent nursing intervention in hypertensive crisis, introduction to the doctor's course, treatment under his direct control:

• shortness of breath due to heart failure;
• decreased heart activity due to a heart disorder;
• pain in the organs due to increased pressure;
• violation of adaptation to lifestyle changes due to the inability to accept the disease;
• lack of awareness of the disease and subsequent complications;
• fear associated with measuring values ​​during regular checks;
• sexual dysfunction caused by side effects medicines;
• elimination, if any.

When organs are damaged, the nursing process for a hypertensive crisis, diagnosis, treatment are based on the actual state of the disease, the specific affected organ.

Purpose of the nursing process in hypertension

The task of the nurse is to conduct an error-free collection of biological material. It is important to know the principles of urine and blood collection. Another part of the diagnosis is visual examination methods. These include radiography chest, ultrasound examination of the heart, electrography, eye research. The nurse prepares the patient for examinations.

Goals of patient care:

• providing the patient with sufficient information about ongoing research;
• motivation to cooperate in treatment, adherence to prescribed therapeutic steps;
• providing information on the importance of self-monitoring in the home environment.

Patient Education

Education of patients with a diagnosed disease is an integral part of any patient interview with a doctor or nurse after diagnosis. Providing education is a complex process included in the types of nursing interventions. It requires adherence to set goals to ensure that the patient is properly informed.

The educational process is a systematic, gradual, logical, science-based, planned process of activity, where the nurse is the teacher and the patient is the student. They participate in learning activities that bring about the desired change.

When communicating between a nurse and a patient, the medical professional must be aware of his influence on the sick person. Therefore, it is necessary to think about what should be told to him. The communication process consists of five components, each of which must be included in the communication, otherwise the communication process will not be completed.

• 1 component - a nurse informing the patient of his diagnosis. The style in which a message is conveyed may depend on several factors. For example, from communication abilities or needs.
• 2 component - the patient receiving the message. A person's culture, experience, goals affect the receipt of a message.
• 3 component - a message that depends on the person, his own understanding of what is happening.
• 4 component - feedback, in which the nurse receives responses from the patient to determine if he understood the message. This component is very important.
• 5 component - a specific situation and environment. In this section, it is important to think about communication barriers that can affect the outcome of the entire communication process.

The process of education is somewhat similar to the process of nursing care, with the difference that care is focused on diagnosing physical and diagnostic needs. The main task of the education process is to determine the priority needs for patient education, learning styles, and the patient's willingness to learn. The educational process is divided into several stages that cannot be replaced or skipped.

• Stage 1 - the initial diagnosis, when the nurse finds out whom and why she should teach. After the first step, the nurse plans what style and tools to use.
• Stage 2 - determining the goal of the current process, planning the gradual steps that will be taken to educate the patient.
• Stage 3 - implementation, where the process of education itself is carried out using the selected methods and tools.
• Stage 4 - the last part of the educational process, is to evaluate the results, the goals achieved.

Conclusion

Every year the number of people suffering from the diseases of civilization is growing. Society needs to develop a concept of health education that maximizes public health awareness. It is important to be aware of the risks of hypertension, which is often asymptomatic from the patient's point of view. Nurses should be more active in educating the public. Special attention should be given to prevention, which, first of all, involves maintaining a healthy lifestyle. People should be aware that they can influence the incidence and course of the disease on their own. This is evident in the words of Florence Nightingale, which she said more than 100 years ago: "Nurses today treat the sick, but the day will come when they will care for the healthy."

Hypertension is common disease, characterized by an increase in blood pressure that is not associated with any known disease of the internal organs. The World Health Organization (WHO) at the UN considers high blood pressure (regardless of age) over 140/90 mm Hg. Art.

Real problems:

Headache;

dizziness;

Sleep disturbance;

Irritability;

Lack of mandatory alternation of work and rest;

Lack of adherence to a low-salt diet;

Lack of regular medication;

Lack of knowledge about the factors contributing to the increase in blood pressure.

Potential issues:

The risk of developing a hypertensive crisis;

The risk of developing acute myocardial infarction or acute cerebrovascular accident;

Early deterioration of vision;

risk of developing chronic renal failure.

The main way to treat hypertension is to switch to healthy lifestyle life. Patients whose blood pressure is 160/100 mm Hg. Art. and above, you must also take medication for hypertension. But if the patient does not want to give up bad habits, then the pills will be of little use.

9. Present and potential problems in myocardial infarction. Principles of treatment. Care.

Myocardial infarction is one of the clinical forms of coronary heart disease that occurs with the development of ischemic necrosis of a portion of the myocardium, due to the absolute or relative insufficiency of its blood supply. Real Problems: sensations of "pressure", "heaviness" and "burning" in the central part of the chest with irradiation to the shoulder girdle, arm, jaw, epigastric region are more often described. The patient is restless, puts his hand to the sternum. For an elderly patient with multiple comorbidities, myocardial infarction often manifests itself in signs of heart failure (increased dyspnea, edema, palpitations, atypical angina pectoris ). Potential issues: cardiogenic shock, acute cardiovascular failure, arrhythmia, cardiac muscle rupture . Treatment: If, with a suspected myocardial infarction, the patient has pain in the region of the heart, the nurse should call the doctor for help. Before his arrival, she must calm the patient, measure blood pressure and assess the state of the pulse. In the region of the heart and on the sternum, the patient must put mustard plasters. It is also necessary to give the patient safely nitroglycerin. If the drug is in the form of tablets, then the patient must be given 5 milligrams of the drug, in the presence of a one percent alcohol solution of nitroglycerin, it must be given to the patient one drop on a tablet of validol or a piece of sugar. Next, the nurse should give the patient Corvalol or Valocordin in the amount of 25-30 drops. Before the arrival of the doctor, it is necessary to carefully monitor the patient's state of health. After the doctor arrives, the nurse tells him about the readings of blood pressure and pulse, as well as the general condition of the patient. Based on these data, the doctor prescribes treatment. It is necessary for the nurse to feed the patient, taking into account a strict diet. It should limit the amount of fluid consumed by the patient to 0.6-1 liters and salt to 4-5 grams per day. During this time, the patient can eat no more than 800 calories. If the products contain a large amount of fiber, fats, then their use must be limited several times. Care: Patients with such an ailment will need to observe bed rest, not to burden themselves not only physically, but also mentally. Since movements are limited during this period, the patient should be helped to roll over in bed. Nursing care for myocardial infarction involves monitoring the pulse, timely supply of food and drink, regular measurement of blood pressure, and hygiene procedures. Strict bed rest during a heart attack often causes bedsores. It is necessary to carefully examine the skin of the patient every day and take care of it - massages, antiseptic solution.

10. Present and potential problems in peptic ulcer stomach and duodenum 12. Principles of treatment. Care. Peptic ulcer is a disease in which defects (ulcers) form in the stomach and (or) duodenum of a person. Most often suffer from peptic ulcer men from 20 to 50 years. Most often, the ulcer makes itself felt in spring and autumn. peptic ulcer duodenum much more common than peptic ulcer disease. Helicobacter pylori plays a leading role in the development of the disease. . Real problems: Abdominal pain. Heartburn. Nausea. Vomiting. Constipation. Weakness. Loss of body weight. The need for a long-term diet. Fear of Opportunity surgical treatment. Potential issues: Bleeding. Perforation of the ulcer. Development of pyloric stenosis. Change of professional activity, place of work. Treatment: 1 Quit smoking - this reduces the scarring of ulcers and reduces the frequency of exacerbation of the disease, increases the effectiveness of anti-Helicobacter therapy.2 Alcohol consumption should be reduced if it is excessive (no more than 14 drinks per week for women and no more than 20 drinks for men), but complete abstinence (abstinence) is not necessary, but desirable.3. Stop taking non-steroidal anti-inflammatory drugs (aspirin, butadione, indomethacin, etc.) and steroids, if possible. But if their intake is vital to continue the course of treatment, then it is advisable to reduce the dose (for example, aspirin to 75-100 mg / day) and take them simultaneously with antisecretory drugs.4. Diet does not significantly affect the course of peptic ulcer disease, however, patients should be given advice on a rational litany with the exclusion from the diet of food that exacerbates the symptomatic manifestations of the disease. The use of mechanically and chemically sparing anti-ulcer diets is justified only in case of symptomatic manifestations of an exacerbation of peptic ulcer (sparing diet type No. 1b). Mandatory 5 meals a day are provided, food is steamed. As the subjective signs of the disease disappear, a diet without mechanical sparing is indicated. Food is given in a boiled, not pureed form (meat and fish - in pieces, crumbly cereals, vegetables - not pureed), parsley, dill, etc. are added. However, the patient constantly, even in the remission phase, must comply with the regimen. fractional nutrition, excluding spicy, pickled and smoked products.5. Patients with peptic ulcer can be treated on an outpatient basis, but it has been found that with the same method of anti-relapse treatment, the rate and frequency of remission are higher in patients treated in a hospital. Drug treatment.Basic The following are recognized as the direction of drug therapy for peptic ulcer disease: reduction of intragastric acidity and sanitation of the mucous membrane from helicobacter pylori. As antisecretory agents, the use of H + K + ATPase inhibitors (omeprazole (losek), rabeprazole, pantoprazole, lansoprazole) and histamine H2 receptor blockers (ranitidine or famotidine) according to the schemes presented in the table . Care: During the period of exacerbation, the patient must observe bed rest (you can go to the toilet, wash your face, sit down at the table for food) for 2-3 weeks. With a successful course of the disease, the regime is gradually expanding, however, the mandatory restriction of physical and emotional stress remains. It is necessary to monitor the general condition of the patient: skin color, pulse, blood pressure, stool. Control over the full and timely intake of medicines prescribed by the doctor. In case of gastric bleeding, first of all, it is necessary to call a doctor. It is necessary to provide complete rest to the patient, to calm him down. Put an ice pack on the stomach area. Hemostatic agents are administered to stop bleeding. If all these measures do not give a result, then the patient is subject to surgical treatment.

11. Current and potential problems with changes in blood pressure (hypotension). Principles of treatment. Care. Hypotension (hypotension) is a violation of blood pressure in the vessels. Arterial hypotension is, accordingly, a violation of pressure in the arteries. The pressure depends on the heart rate. The prefix "hypo-" indicates insufficient pressure, that is, the blood in the arteries is not pumped as intensively as it should. You can talk about hypotension if the pressure is 20% lower than normal. The norm is considered to be 120/80, and with indicators lower than 90/60, it is worth considering the presence of hypotension. Real Problems: General weakness, lethargy, drowsiness; Increased sweating and violations of thermoregulation (cold extremities); Rapid pulse; sleep disorders; Irritability, emotional instability; weather sensitivity; Headache (mainly dull in the frontal and temporal areas), dizziness; Dyspnea. Potential issues: Fainting, which most often occurs with the so-called orthostatic hypotension. Clinically, this is manifested by a sharp decrease in pressure when patients try to take the “standing” position from the initial “lying” or “sitting” position. Especially dangerous at this moment is the possibility of injury (bruises, concussions, fractures) when falling. It has been proven that patients with a fracture of the femoral neck, being forced to lie down for several months, die from symptoms of heart failure. Blood that chronically does not reach vital regulatory centers in the brain can cause an ischemic stroke. The danger arises precisely when, with orthostatic hypotension, there is a sharp jump in pressure down. Senile dementia or dementia can occur due to constant jumps in blood pressure. With the diagnosis of hypotension, the consequences can develop in the heart muscle. An ischemic form of myocardial infarction or cardiogenic shock can occur if blood stops flowing to the heart muscle. Violation of the peripheral arterial and venous blood supply, which can eventually lead to a violation of the sensitivity of the legs and arms. As a result of long-term hypotension, the vessels are somewhat rebuilt, and with age they become narrower, causing such a complication as arterial hypertension. . Treatment: In most cases, medical treatment of hypotension is not required. The most common reasons low pressure- Unhealthy lifestyle and stress. Physiological hypotension should not be treated, but it must be remembered in order to prevent pressure surges. If you are concerned about any one symptom of hypotension, for example, drowsiness, then, first of all, it is worth adjusting the daily routine. This alone is enough to cope with an unpleasant condition. Can be called to combat hypotension traditional medicine. Medicines for low blood pressure:"Askofen", "Kofetamine", "Ortho-taurine", "Piramein", "Regulton", "Saparal", "Citramon". Care: You can increase your blood pressure by eating foods containing caffeine and salt. It is these components that stimulate the blood vessels, and they narrow, stabilizing the level of blood pressure at an acceptable level. Rest and good sleep are also important for a typical patient.

12. Present and potential problems in chronic pyelonephritis. Principles of treatment. Care. Pyelonephritis is understood as a non-specific inflammatory process, which involves not only the pelvis and calyces of the kidney, but also, mainly, the renal parenchyma with a predominant lesion of its interstitial tissue. Patient problems: a) Physiological: a triad of symptoms is characteristic: fever with chills, dysuria, pain in the lumbar region. b) Priority: fever with chills, dysuria. c) Potential: paranephritis, subdiaphragmatic abscess, peritonitis, hepatorenal syndrome, bacteriological shock, necrosis of the papillae of the kidneys with the development of acute renal failure. Treatment: 1. Increase fluid intake for the purpose of detoxification and mechanical sanitation of the urinary tract. Water load is contraindicated if there is: urinary tract obstruction, postrenal acute renal failure; nephrotic syndrome; uncontrolled arterial hypertension; chronic heart failure, starting from the second stage IIA; preeclampsia in the second half of pregnancy. 2. Antimicrobial therapy is the basic treatment for pyelonephritis. The outcome of chronic pyelonephritis depends precisely on the competent prescription of antibiotics. 3. Treatment of pyelonephritis is supplemented according to indications with antispasmodics, anticoagulants (heparin) and antiplatelet agents (pentoxifylline, ticlopidine). 4. Phytotherapy is an additional, but not an independent method of treatment. It is used during the period of remission 2 times a year as a prophylactic course (spring, autumn). Use for at least 1 month, combine with antiplatelet agents. Don't get carried away with taking medicinal herbs due to their possible damaging effect on the renal tubules. 5. Physiotherapy and spa treatment of pyelonephritis. This treatment pyelonephritis is used in the remission phase, using the antispasmodic effect of thermal procedures (inductothermy, UHF- or SMW-therapy, paraffin-ozocerite applications ). Care: sanitation of chronic foci of infection, avoid cooling, personal hygiene, timely emptying Bladder daily change underwear, 10 days of each month to carry out a general cleaning of the bladder - use diuretic herbs; life dispensary observation, Spa treatment.

13. Present and potential problems in chronic heart failure. Principles of treatment. Care. CHF is circulatory failure associated with a decrease in myocardial contractility, as a result of which the provision of organs and tissues with substances necessary for their normal functioning is disrupted. The reasons chronic insufficiency blood circulation are diverse: hypertension, heart defects, atherosclerosis coronary arteries, anemia, intoxication, infections, endocrine diseases. real: Shortness of breath (on exertion and at rest). Palpitation. Edema. Cough. Hemoptysis. Sleep disturbance. Constipation. Decreased physical activity. Difficulties in the implementation of physiological functions in the usual position. The need for frequent visits to the toilet with frequent urination (when taking diuretics). Lack of knowledge about your health. Fall risk. Potential: Risk of pressure sores. risk of developing congestive pneumonia. Risk of drug overdose (cardiac glycosides). Loss of social status and role in society, family. Opportunity to change profession, disability. Treatment: Heart failure is much easier to prevent than to cure. Its prevention includes the treatment of arterial hypertension, the prevention of atherosclerosis, a healthy lifestyle, physical exercises, smoking cessation and diet. If heart failure still develops, the cardiologist prescribes treatment. This usually includes diuretics (to reduce the volume of blood pumped), ultraselective beta-blockers (to reduce the heart's oxygen demand), metabolic therapy, and, of course, treatment of the underlying disease. Care: Together with the patient, choose a position in bed in which shortness of breath and palpitations will significantly decrease or disappear. Convince the patient to reduce physical activity and follow the regimen prescribed by the doctor. Provide frequent ventilation of the room where the patient is located. Discuss with the patient/family and loved ones about the need for a strict diet with salt and fluid restriction. Support the patient's efforts to change diet and exercise habits. control the frequency respiratory movements, pulse and blood pressure. If the pulse slows down below normal (an overdose of cardiac glycosides), immediately notify the enemy. Carry out oxygen therapy as prescribed by the doctor. Monitor the dynamics of edema, the condition of the skin in the area of ​​edema. To carry out the prevention of bedsores, congestive pneumonia, constipation (as prescribed by a doctor - setting a cleansing enema).

14. Current and potential problems with heart defects. Principles of treatment. Care. Real problems: palpitations; dyspnea; swelling; cyanosis; pain and interruptions in the region of the heart; cough; hemoptysis; ascites; weakness. Potential problems: Development of heart failure (a condition in which the heart is unable to adequately supply blood to all organs and tissues). Irregular heart rhythm (any heart rhythm that is not normal). Thromboembolic complications (complications in which blood clots (blood clots in a vessel) with blood flow can enter any vessel of the body, clog its lumen and cause dysfunction of the organ). Disability of patients. Lethal outcome (death ). Treatment: Conservative (drug) treatment of acquired heart disease is prescribed only to stabilize the heart rhythm, prevent heart failure (a condition in which the heart is unable to provide normal blood flow in all organs), complications and relapses (repetitions) of the underlying disease that caused heart disease. The main method of treatment of acquired heart defects is surgical. Correction of a valve defect: valvotomy (dissection of fused folds of heart valves); valvuloplasty (restoration of the valve by dissecting the walls of the valve and subsequent stitching of new leaflets). Prosthetics (replacement with an artificial) valve. Care: The nurse provides: accurate and timely fulfillment of doctor's prescriptions; timely intake of medications; control of blood pressure, respiratory rate, pulse, body weight and daily diuresis; conducting exercise therapy; if necessary, oxygen therapy. She also conducts: conversations with patients and their relatives about the possibility of surgical treatment of heart disease and the good result of such treatment; on the importance of systematic intake of cardiac drugs; on the importance of a diet with fluid and salt restriction for the prevention of chronic heart failure; teaching patients to control (self-control) respiratory rate and pulse.

15. Current and potential problems in acute cholecystitis. Principles of treatment. Care. Acute cholecystitis - acute inflammation gallbladder. Real problems: persistent pain in the right hypochondrium (right upper abdomen), which can radiate to the right side of the chest, neck, right hand. Often, before the onset of pain, an attack of biliary colic occurs; nausea and vomiting, after which there is no relief; feeling of bitterness in the mouth; increase in body temperature. Potential: purulent inflammation (gangrene, empyema) and perforation of the gallbladder, after which peritonitis can occur - inflammation of the peritoneum; the appearance of biliary fistulas that connect the gallbladder with the stomach, intestines or kidney; the formation of a limited purulent focus (the so-called subhepatic abscess); mechanical jaundice; acute pancreatitis . Treatment: Treatment of acute cholecystitis is carried out in a surgical hospital. The first few hours the patient lies under the "dropper". He is prescribed antispasmodic drugs (baralgin), antibiotics, detoxification is carried out. If the manifestations of the disease subside, the patient is prepared for a planned abdominal or laparoscopic operation to remove the gallbladder (cholecystectomy).

). If the attack of cholecystitis does not stop, the operation will have to be done urgently. With the development of complications, surgical intervention is performed on an emergency basis. Cholecystectomy for cholecystitis

In most cases, cholecystectomy is performed, and if this is not possible due to comorbidities or old age the patient - cholecystotomy (a hollow tube is inserted through the skin into the gallbladder, through which bile is brought out). This procedure allows you to remove the inflammatory process in gallbladder. Care: a) In the morning and in the evening the temperature is taken and the data is entered in the temperature sheet b) Blood pressure is measured and the data is also entered in the temperature sheet 2. Personal hygiene. a) Change of bed linen 1 time in 7-10 days or as it becomes dirty b) Straighten the patient’s bed in the morning, at night and before daytime rest diaper rash and bedsores e) Prevent bedsores and diaper rash 3. Food

16. Present and potential problems in bronchial asthma. Principles of treatment. Care. Bronchial asthma- this is allergic disease, which is characterized by repeated attacks of suffocation (bronchospasm). Existing problems caused by bronchospasm. swelling of the mucous membrane, hypersecretion of mucus into the lumen of the bronchi: expiratory dyspnea, participation in the act of breathing of auxiliary muscles. tachycardia, cough with viscous sputum. Potential problems: risk of atelectasis, emphysema, pneumothorax. heart failure. Treatment: There is no cure for chronic asthma yet. There is a concept of a stepwise approach to treatment bronchial asthma. Its meaning is to change the dose of drugs depending on the severity of asthma. "Step up" is an increase in dose, "step down" is a decrease in dose. Most clinical guidelines There are 4 such “steps”, which correspond to 4 degrees of severity of the disease. Treatment should take place under the constant supervision of a physician. For the treatment of bronchial asthma, basic therapy drugs are used that affect the mechanism of the disease, through which patients control asthma, and symptomatic drugs that affect only the smooth muscles of the bronchial tree and relieve an attack. Symptomatic drugs include bronchodilators

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Regional State Budgetary Vocational Educational Institution

"Karsun Medical College"

Course work

Nursing care for hypertension

R.p. Karsun. 2015

CONTENTS

INTRODUCTION

1. HYPERTENSION

1.1 Etiology and pathogenesis

1.2 Clinic

1.3 The course of hypertension

1.4 Diagnostic methods and preparation for them

1.5 Features of treatment

1.6 Emergency care

1.7 Prevention, rehabilitation, prognosis

2. NURSING PROCESS IN HYPERTENSION

2.1 Manipulations performed by a nurse

2.2 Features of the nursing process

3. PRACTICAL PART

3.1 Observation from practice 1

3.2 Observation from practice 2

CONCLUSION

LITERATURE

APPS

INTRODUCTION

Among diseases of the cardiovascular system, hypertension occupies a special place, due to the fact that it often leads to the development of coronary artery disease, cerebral stroke, and they, in turn, lead to disability and death.

Hypertension is one of the most common diseases of the cardiovascular system. It has been established that 20-30% of the adult population suffers from it. With age, the prevalence of the disease increases and reaches 50-65% in people over 65 years of age.

According to statistics, in Russia, the primary referral for diseases of the circulatory system is steadily growing. Over the past 13 years, it has doubled - from 1044 to 2113 cases per 100 thousand people. At the same time, against the background of hypertension in patients, there is an increase in such severe complications as myocardial infarction and stroke (an increase of 2.5 times). The disease also affects younger people.

In our country, the situation is aggravated by the fact that only 37% of men and 58% of women are informed that they have a disease, and only 21% and 46% of them are treated, including effectively 6% and 18%, respectively. Numerous studies of VNOK have convincingly shown that a decrease in elevated systolic and diastolic blood pressure even by 5-10 mm Hg. Art. leads to a decrease in the frequency of cerebral strokes in men by 34% and in women by 56%, and coronary artery disease by 21% and 37%, respectively. Favorable success in the treatment and prevention of hypertension can be achieved if the patient has a clear understanding of his disease, is able to independently control the course of the disease and meaningfully follow the recommendations of the attending physician on lifestyle changes.

Subject of study: Nursing process in hypertension.

Object of study: Nursing process.

The purpose of the study serves as a study of the nursing process in hypertension.

Should explore:

Etiology and contributing factors for the occurrence of hypertension;

Clinical picture and diagnostic features this disease;

Methods of examination and preparation for them;

Principles of treatment and prevention of hypertension;

Complications;

Manipulations performed by a nurse;

Features of the nursing process in this pathology.

To achieve this goal of the study, it is necessary analyze:

Two cases describing the tactics of a nurse in the implementation of the nursing process in a patient with this disease;

The main results of the examination and treatment of patients with HD, required to complete the list of nursing interventions.

The following methods were used to conduct the study:

Scientific and theoretical analysis of medical literature on this topic;

Empirical - observation, additional methods research:

Organizational (comparative, complex) method;

Subjective method of clinical examination of the patient (history taking);

Objective methods of examination of the patient (physical, instrumental, laboratory);

Biographical (analysis of anamnestic information, study of medical records);

Psychodiagnostic (conversation).

Practical significance: Detailed disclosure of material on the topic term paper"Nursing process in hypertension" will improve the quality nursing care, get acquainted with the causes of this disease, its course, the principles of examination and treatment, the features of care.

1. HYPERTENSION

Hypertension(arterial or true hypertension) is chronic illness, affecting various body systems, characterized by an increase in blood pressure above normal, the most common disease of the cardiovascular system.

Distinguish between primary and secondary arterial hypertension.

Essential (primary) arterial hypertension or hypertension is a chronic disease, the main symptom of which is an increase in blood pressure caused by a violation of the regulation of vascular tone and heart function and is not associated with primary organic damage to organs and systems.

Symptomatic (secondary) arterial hypertension is a form of increased blood pressure, causally associated with certain diseases of the internal organs (kidney disease, endocrine system etc.). Secondary arterial hypertension requires a different treatment than primary.

The World Health Organization (WHO) considers high blood pressure (regardless of age) to be more than 139/89 mm Hg. Art.

1.1 Etiology and pathogenesis

The etiology of this disease is not yet fully understood.

There are provoking and contributing factors of hypertension:

? stress;

? features of the profession (requiring great responsibility and increased attention);

? systematic use of alcohol;

? smoking;

? excess salt;

? alimentary obesity;

? heredity;

? skull trauma;

? excessive consumption of strong coffee.

Pathogenesis. Stress leads to an increase in the level of adrenaline and norepinephrine in the blood, which leads to high cardiac output, vasospasm, and an increase in peripheral resistance in the vessels. In the kidneys, high activity of the sympathetic NS stimulates the release of renin. Renin converts angiotensionogen to angiotensin I, which is converted to angiotensin under the influence of ACE (angiotensin converting enzyme). Angiotensin II stimulates the secretion of aldesterone (adrenal hormone) and vasopressin (antidiuretic hormone in the hypothalamus). Under their influence, the reabsorption of sodium and water in the renal tubules increases and the reabsorption of potassium decreases, which leads to edema of the vessel wall, an increase in the volume of circulating blood (BCC). These are factors that increase blood pressure. Angiotensin II causes hypertrophy of the myocardium, the muscular membrane of the arteries and further increases blood pressure. The activity of the depressor system of the kidneys decreases due to a decrease in the synthesis of vasodilating prostaglandins, which leads to the stabilization of high blood pressure.

1.2 Clinic

According to WHO, there are 3 stages of hypertension.

StageI- high blood pressure is unstable, often under the influence of rest, in the absence of adverse factors, it normalizes on its own. Changes in internal organs are not detected.

Stage II- blood pressure increased more stably, to reduce it requires the use of drugs. An increase in the left ventricle, signs of damage to the kidneys, heart vessels, and fundus are revealed.

Stage III- Blood pressure is persistently elevated. Possible complications: cerebrovascular accident, heart failure, myocardial infarction, less often - renal failure. Blood pressure after the development of complications can normalize, so arterial hypertension is not a sign of stage 3 of the disease.

Patient complaints:

? Headache accompanied by dizziness, staggering, tinnitus.

? Neurotic disorders: emotional lability, irritability, tearfulness, fatigue.

? Pain in the region of the heart type of angina pectoris.

? heartbeat, interruptions in the heart (extrasystole).

? visual impairment- fog before the eyes, the appearance of circles, spots, flickering flies, loss of vision.

? Related complaints- Weakness, decreased mental and physical performance.

Symptoms. The main complaint is a headache due to an increase in blood pressure. Most often, a headache appears in the morning, is localized in the occipital region and is combined with a feeling of a "heavy, stale head." Patients may complain of poor sleep, increased irritability, decreased memory and mental performance. Over time, there are complaints of pain in the heart, interruptions, shortness of breath during physical exertion. In some patients, against the background of constantly elevated blood pressure, visual impairment occurs. However, in some patients, before the development of complications, there may be no complaints, despite the fact that they had high blood pressure for a long time.

When examining a patient, first of all, high blood pressure is detected. In stage I diseases note only high blood pressure, there are no changes in the internal organs. In stage II, in addition to high blood pressure, an increase in the left ventricle is detected (with a direct examination of the patient, with an X-ray examination or ECG). At this time, signs of involvement in the pathological process of the kidneys may also be noted - traces of protein, single erythrocytes appear in the urine (arteriosclerosis of the kidneys develops). Changes in the vessels of the kidneys, against the background of regularly administered drug treatment, develop much less frequently.

In stage II also develops atherosclerosis of the coronary arteries. It is manifested by attacks of angina pectoris: attacks of compressive pain behind the sternum that occur during exercise and disappear after the cessation of exercise (for example, walking) or taking nitroglycerin.

In stage III hypertensive disease, the development of myocardial infarction, as well as cerebrovascular accidents (transient or with organic signs in the form of paresis and paralysis), are possible. Perhaps a sharp decrease in vision, up to its complete loss.

1.3 The course of hypertension

Benign variant

A benign variant of the course of hypertension is characterized by: slow progression; wavy alternation of periods of deterioration and improvement; slow damage to the heart; vessels of the brain, kidneys, retina; effectiveness of treatment, late development of complications.

Malignant variant

A malignant variant of the course of hypertension is characterized by: an increase in blood pressure of 230/130 mm Hg. Art., resistance to antihypertensive therapy, the rapid development of complications from the kidneys, brain, fundus vessels.

1.4 Diagnostic methods and preparation for them

In a patient with hypertension, it is necessary to conduct the following complex of examinations:

General blood analysis

2. Urinalysis

3. Blood pressure measurement

Blood sugar test

Blood chemistry

Phonocardiography

Examination of the fundus of the eye (on admission and further according to indications)

Ultrasound of the heart and kidneys

Chest X-ray

Technique for measuring blood pressure

Equipment: tonometer, phonendoscope, pen, paper, temperature sheet, napkin with alcohol.

I. Preparation for the procedure

1. Warn the patient about the upcoming study 15 minutes before it starts.

Clarify the patient's understanding of the purpose and course of the study and obtain his consent to conduct.

Select the correct cuff size.

Ask the patient to lie down or sit at the table

II. Performing a procedure

5. Invite the patient to put his hand correctly: in an unbent position, palm up. Help move or remove clothes from your hand.

Apply the cuff to the patient's bare shoulder 2-3 cm above the elbow; fasten the cuff so that only one finger passes through. The center of the cuff is over the brachial artery.

Connect the pressure gauge to the cuff and check the position of the pressure gauge pointer relative to the zero mark of the scale.

Find the place of pulsation of the brachial artery in the region of the cubital fossa and firmly place the membrane of the phonendoscope on this place.

With the other hand, close the valve on the “pear” by turning it to the right, with the same hand quickly inflate air into the cuff until the pressure in it exceeds 30 mm Hg. - the level at which the Korotkoff tones disappear.

Release air from the cuff at a speed of 2-3 mm Hg. in 1s by turning the valve to the left. At the same time, with a phonendoscope, listen to the tones on the brachial artery and monitor the indication of the pressure gauge scale: when the first sounds appear, “mark” on the scale and remember the number corresponding to the systolic pressure.

Continuing to release air from the cuff, note the amount of diastolic pressure corresponding to the weakening and complete disappearance of the Korotkoff sounds.

Inform the patient of the measurement result.

Repeat the procedure after 2-3 minutes.

III. Completion of the procedure

14. Round off the measurement data to 0 or 5, write it down as a fraction (the numerator is systolic pressure, and the denominator is diastolic).

Wipe the membrane of the phonendoscope with a cloth moistened with alcohol.

Record the study data in the required documentation.

Wash the hands.

Urine collection technique

On the eve of the patient, it is necessary to refrain from eating large amounts of carrots and beets, from taking diuretics;

you can not change the drinking regime the day before the study;

wash the urethral area immediately before collecting urine;

start urinating into the toilet, continue into the prepared container (100-150 ml of urine is needed for the study);

close the container with a lid;

Wash the hands.

1.5 Features of treatment

Treatment of GB is outpatient, if the condition worsens, hospitalization is necessary.

1. Motor activity

In the early days, the patient should observe bed rest to reduce the load on the heart. When transferring to half-bed mode, classes are held physical therapy individually or in groups sitting and standing at a slow and then medium pace. The patient performs elementary physical exercises mainly for the joints of the upper and lower extremities with full amplitude, combined with breathing. Massage of the collar zone is prescribed.

2. Diet therapy.

With hypertension, diet No. 10 is prescribed. The severity of compliance depends on the stage of the disease. The diet is characterized by a slight decrease in energy value due to fats and partly carbohydrates; a significant restriction of the amount of salt, a decrease in fluid intake. Culinary processing with moderate mechanical sparing. Meat and fish are boiled. Indigestible foods are excluded. Food is prepared without salt. The temperature is normal. Diet: 5 times a day in relatively uniform portions.

3. Drug therapy.

The basic principle of the treatment of patients with hypertension is the sequential (stepwise) use of drugs of the main groups: diuretics, beta-blockers, calcium antagonists, vasodilators and ACE inhibitors.

1. Beta-blockers: atenolol, metoprolol, bisoprolol, carvedilol, betaxolol, propranolol, etc.

Decrease heart rate,

Reduce energy consumption for the work of the heart.

! It should be remembered that with a sudden cessation of taking these drugs, a “withdrawal syndrome” can develop, manifested by a sharp increase in blood pressure. Therefore, the dose of beta-blockers should be reduced gradually.

2. Diuretics: veroshpyon (spironolactone), indapamide, triampur, furosemide, hypothiazide, etc.

Causes a decrease in circulating blood volume

Promote the release of salts and water, which leads to a decrease in blood pressure.

Patients receiving diuretics (furosemide, hypothiazide, indapamide) are advised to increase the content of potassium with food.

3. Angiotensin-converting enzyme inhibitors (ACE inhibitors): diroton, enalapril, ramipril, captopria, capon, etc.

Block the formation biologically active substances, which have a pronounced vasoconstrictive effect,

Favorably affect lipid and carbohydrate metabolism.

4. Calcium antagonists: cordovlex, felodipine, diltiazem, nifedipine, corinfar, etc.

Act as vasodilators by increasing the diameter of arteries

For treatment, it is preferable to use long-acting drugs: felodipine, amplodipine,

Short-acting drugs (cordavlex, corinfar, cordipin) should only be used to relieve a hypertensive crisis.

5. Peripheral vasodilators: nitroglycerin, apressin, sodium nitroprusside, etc.

Definitely under BP control.

1.6 Emergency care

At any stage of hypertension, a sharp increase in blood pressure can occur - a hypertensive crisis, accompanied by an exacerbation of the symptoms of the disease. As a result of various external influences, a sharp headache, dizziness occur; nausea, visual disturbances may occur. Due to the violation of cerebral circulation that occurs simultaneously with an increase in blood pressure, speech disorders and movement disorders appear. Complications of a hypertensive crisis - myocardial infarction or acute left ventricular failure - an attack of cardiac asthma. In severe cases, there is a hemorrhage in the brain - a stroke.

The reasons:

Physical or mental overexertion;

Insufficient sleep;

Excessive alcohol consumption;

Excess consumption of salty foods;

Medication abuse.

Symptoms:

1. Cerebral symptoms: a sharp headache, especially in the occipital region, dizziness, noise in the head, flashing "flies", spots before the eyes, double vision, visual disturbances, transient blindness.

Cardiac symptoms: pain and interruptions in the heart, palpitations, shortness of breath.

Neurovegetative: chills, trembling, sweating, fear of death, feeling hot, etc.

Distinguish between hypertensive crises two types.

Hypertensive crisis type 1 - (neurovegetative form): characterized by a sudden onset; excitation, hyperemia and moisture of the skin, tachycardia, trembling in the body, hand tremor, frequent profuse urination, mainly an increase in systolic pressure. Such crises are short-term, proceed relatively favorably, and occur in the early stages of arterial hypertension.

Hypertensive crisis type 2 (water-salt form): occurs gradually. Deterioration of vision, flickering flies, fog before the eyes, feeling of a veil, drowsiness, weakness, lethargy, pallor, puffiness, swelling, headache to vomiting, pain in the heart, interruptions, state of stupor, transient paresis, parasthesia throughout the body, increased clotting time blood. Systolic and diastolic pressure rises evenly or with a predominance of the latter. It proceeds severely and can be complicated by myocardial infarction, stroke, acute left ventricular failure.

Treatment of hypertensive crisis.

First aid:

Call a doctor through a third party

2. Lay the patient down with the head of the head raised high, calm

When vomiting, turn your head to one side, give a tray

Provide access to fresh air

Put cold on the head, put mustard plasters on the neck and calf muscles (distraction therapy)

As prescribed by a doctor, parenteral administration of short-acting antihypertensive drugs intravenously, intramuscularly, if parenteral administration is not possible, drugs can be administered orally under the tongue - 1 tablet of clonidine (nifedipine, captopril) to accelerate absorption, the tablet should be chewed or crushed.

After stopping an uncomplicated hypertensive crisis, the patient should be under the supervision of a nurse. It is important to measure blood pressure while lying down to avoid the development of orthostatic hypotension.

1.7 Prevention, rehabilitation, prognosis

Primary: elimination of psycho-emotional overload, rational nutrition, reduction of salt intake, healthy lifestyle, physical activity.

Secondary: non-drug methods for correcting risk factors, resting in a horizontal position daily for at least 30 minutes, systematic antihypertensive therapy.

Patient education.

Successful treatment of patients with hypertension is impossible without their active participation. It is necessary to teach patients the technique and rules for measuring blood pressure, early diagnosis of complications of the disease, and tactics of behavior when they occur. The patient should be given recommendations on the regimen, diet, physical activity, methods and ways of taking antihypertensive drugs, blood pressure control during drug therapy.

Patients keep diaries to evaluate the effectiveness of ongoing drug therapy (based on the results of self-monitoring of blood pressure), control the effectiveness of physical activity, assess the quality of life, etc.

To educate patients in medical institutions, schools for patients with hypertension are being created.

2. NURSING PROCESS IN HYPERTENSION

2. 1 Manipulations performed by a nurse

Technique for taking blood for research.

Purpose: diagnostic.

Equipment: a vacuum test tube, a vacuum system, a rubber band, an oilcloth pad, a test tube rack, a container for transporting blood, sterile wipes, sterile cotton balls, tweezers, ethyl alcohol 70%, gloves, glasses or a plastic screen; a sterile mask, a sterile tray, an Anti-AIDS first aid kit, a container with a disinfectant solution. hypertension nurse

Injection sites: veins of the elbow, veins of the hands, veins of the forearm.

Preparation for the procedure:

1. Wash your hands, dry them, put on a mask, glasses or a plastic screen, gloves, after treating them with alcohol.

Collect the vacuum tube, vacuum system and put on a sterile tray.

Ask the patient if he has taken any food.

Performing a procedure

4. Above the elbow bend, over clothes or a napkin, apply a rubber tourniquet.

Feel the pulse on the radial artery (it must be saved).

Invite the patient to clench-unclench his fist, then clamp it.

Palpate the vein and treat with the left hand with a sterile alcohol ball from the bottom up widely, then narrowly with the other.

Hold the third ball with alcohol in your left hand.

With the thumb of the left hand, pull the skin down, below the puncture site, fix the vein

Take the needle and remove the protective cap from the side closed by the rubber membrane

Insert the needle into the holder and screw until it stops. Prepare all necessary test tubes.

Remove the protective cap from the second side of the needle, insert the selected test tube with the cap into the holder

Without piercing the rubber stopper in the cap of the tube, insert the holder-needle system into the patient's vein, as is done in the usual procedure for taking blood with a syringe.

At this moment, the blood does not pass through the needle, since its second end is closed with a rubber membrane.

Insert the tube into the holder until it stops.

In this case, the needle pierces the rubber membrane and the rubber stopper in the lid of the tube - a channel is formed between the tube with vacuum and the vein cavity. The blood passes into the test tube until the vacuum created in the test tube is compensated (if the blood does not flow, this means that the needle has passed through the vein - in this case, you need to pull the needle out a little (but do not remove it!), Until the blood goes into the test tube ).

After stopping the blood flow, remove the tube from the holder.

The rubber membrane returns to its original position, blocking the blood flow through the needle. If necessary, a number of other tubes are inserted into the holder to obtain the desired volume of blood for various studies.

It is not necessary to re-insert the needle for this.

When using tubes with additives, it is necessary to carefully invert the tube 8-10 times to completely mix the blood with reagents or clot activator.

After the last tube is full, remove the holder with the needle from the vein.

Lightly press the third cotton ball moistened with alcohol to the puncture site and quickly remove the needle from the vein.

Invite the patient to bend the arm at the elbow for 3-5 minutes. End of procedure

25. Write on the tube the patient number corresponding to the direction.

26. Disinfect used cotton balls, syringe, needle.

Place tubes with blood in a rack and then in a container. Separately put in a plastic bag directions.

Remove gloves, soak in disinfectant solution

Wash the hands.

Deliver the test material to the laboratory.

2. 2 Features of the nursing process

During the initial assessment of the patient, it is necessary to conduct an objective study - this will allow the nurse to assess his physical and mental state, as well as identify problems and suspect diseases of the cardiovascular system, including hypertension, and form a care plan.

Analysis of the data obtained helps to identify the patient's problems - nursing diagnosis. Such as:

? lack of awareness of the presence of an increase in blood pressure;

? ignorance of the factors contributing to the increase in blood pressure;

? ignorance of the complications that lead to an increase in blood pressure;

? headache;

? irritability, anxiety;

? sleep disturbance;

? decreased vision;

? the need to comply with the regime of life, work and nutrition;

? the need for continuous medication.

Survey data can be subjective or objective.

Sources of subjective information are: the patient himself, who states his own assumptions about his state of health; family and friends of the patient.

Sources of objective information: physical examination of the patient by organs and systems; acquaintance with the medical history of the disease.

The nurse informs the patient and his family members about the essence of the disease, the principles of treatment and prevention, explains the course of certain instrumental and laboratory research and preparation for them.

Nursing care for patients with GB includes:

Teaching the patient relaxation techniques to relieve tension and anxiety;

2. Conducting conversations:

* about the importance of the regime of work and rest, food regimen; * the effect of smoking and alcohol on the increase in blood pressure; * the importance of medication and periodic visits to the doctor.

Teaching the patient and his family members: * determining the pulse rate and measuring blood pressure;

* recognition of the first signs of a hypertensive crisis;

* Providing first aid for hypertensive crisis.

Control over food and transfers of relatives;

5. Control of the patient's body weight and diuresis;

Carrying out the procedure for setting leeches;

Distribution of medicines to patients, control over the rules and regularity of their intake;

Preparation of patients for examinations (blood, urine, ECG, FCG, ultrasound, etc.);

Monitoring the patient's compliance with the motor regimen;

In case of violation of cerebral circulation, an attack of cardiac asthma, care is carried out as for a seriously ill patient with strict bed rest.

3. PRACTICAL PART

3 .1 Observation from practice 1

A 40-year-old patient was admitted for inpatient treatment in the cardiology department with a diagnosis of stage II hypertension, exacerbation.

The patient complains of recurrent severe headaches in the occipital region, weakness, poor sleep. He has been ill for about 5 years, worsening for the last 2 months, after a stressful situation. He takes medications prescribed by a doctor irregularly, mainly when he feels unwell. Does not follow a diet, abuses spicy, salty foods, drinks a lot of liquids, especially loves instant coffee. She does not know how to independently measure her own blood pressure, but would like to learn. He notes that in the last year it has become worse, but he tries not to pay attention to the disease and live as before.

Overnutrition patient (height 162 cm, weight 87 kg). NPV - 20 per minute, pulse 80 per minute, rhythmic, tense, blood pressure - 180/100 mm Hg. Art.

Objectively: state moderate, consciousness is clear, the skin is clean, of normal color.

Patient problems:

Real: does not understand that it is necessary to change the way of life with hypertension; does not know how to eat properly with arterial hypertension; does not understand the need to limit salt and fluids, drinks a lot of coffee; not able to measure his own blood pressure; Doesn't understand the importance of taking your doctor's prescribed medicines regularly sleeping badly

Potential: the risk of developing a hypertensive crisis, myocardial infarction, stroke.

The priority problem of the patient: does not understand that it is necessary to change the way of life in case of hypertension.

Objective: The patient will demonstrate knowledge of the correct lifestyle for hypertension by the end of the week.

Evaluation: The patient demonstrates knowledge about diet, management of risk factors, the need for continuous medication. The goal has been reached.

3.2 Observation from practice 2

In the cardiology department, a patient suffering from hypertension complained to a nurse that he had shortness of breath, a feeling of “lack of air”, a cough with pink, foamy sputum.

On examination: a serious condition. The skin is pale, cyanotic. Breathing is noisy, bubbling, pink foamy sputum is released from the mouth, NPV 35 per minute. Heart sounds are deaf, pulse is 120 per minute, blood pressure is 210/110 mm Hg. Art.

A patient on the background of a hypertensive crisis (BP 210/110) developed acute left ventricular failure - pulmonary edema.

Information that allows the nurse to suspect an emergency:

Noisy bubbling breath;

Cough with pink frothy sputum.

2. Algorithm of nurse actions:

Call a doctor to provide qualified medical care;

Provide a sitting position, with lowered legs to reduce the flow of venous blood to the heart, create absolute peace, release from tight clothing to improve breathing conditions;

Clear oral cavity from foam and mucus, in order to remove mechanical obstacles to the passage of air;

Give one dose of nitroglycerin under the tongue;

Provide inhalation of oxygen moistened with a defoamer (ethyl alcohol) in order to improve oxygenation conditions and prevent foaming;

The imposition of venous tourniquets on the limbs in order to deposit blood;

Provide monitoring of the patient's condition (BP, pulse, respiratory rate);

Prepare for the arrival of the doctor: antihypertensive drugs, diuretics;

Follow doctor's orders.

After analyzing the literature and clinical cases of hypertension, we can conclude that the nurse does not treat the patient on her own, but fulfills the prescription of the attending physician. She can only notice the changes occurring in the patient's condition, since she is most of the time near the patient.

The nurse must know all the rules for caring for patients, skillfully and correctly perform healing procedures, clearly and clearly present the effect of drugs on the patient's body. The treatment of hypertension depends on careful and proper care, adherence to the regimen and diet. In this regard, the role of the nurse in timely and effective treatment is increasing.

CONCLUSION

Having studied in depth the nursing process in hypertension, after analyzing two cases from practice, it was concluded that the goal of the work was achieved. In the course of the work it is shown that the use of all stages of the nursing process, namely:

stage: assessment of the condition (examination) of the patient;

stage: interpretation of the obtained data (definition of the patient's problems);

stage: planning of forthcoming work;

stage: implementation of the drawn up plan (nursing interventions);

stage: evaluation of the results of the listed stages, allows you to improve the quality of nursing care

So, the goal of the nursing process is to maintain and restore the independence of the patient, the satisfaction of the basic needs of the body. As part of nursing interventions for hypertension, the nurse should talk with the patient and / or his relatives about the causes of the disease, risk factors for complications or exacerbations. It should teach the patient the principles of rational nutrition, taking medications as prescribed by the doctor, and outline with him the correct mode of physical activity.

In conclusion, it can be concluded that modern view about the development of nursing in society is to help individuals, families and groups develop their physical, mental and social potential and maintain it at an appropriate level, regardless of changing living and working conditions. This requires the nurse to work to promote and maintain health, as well as disease prevention.

LITERATURE

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3. Lychev V. G., Karmanov V. K. - Guidelines for conducting practical classes on the subject "Nursing in therapy with a course of primary care": - educational Toolkit M.: - Forum infra, 2010. - 384 p.

4. Makolkin V.I., Ovcharenko S.I., Semenkov N.N. - Nursing in therapy - M .: - LLC Medical Information Agency, 2008. - 544 p.

5. Mukhina S.A., Tarnovskaya I.I. - Theoretical foundations of nursing - 2nd ed., Rev. and add. - M .: - GEOTAR - Media, 2010. - 368 p.

6. Mukhina S.A., Tarnovskaya I.I. - A practical guide to the subject "Fundamentals of nursing"; 2nd edition Spanish. add. M.: - GEOTAR - Media 2009. - 512 p.

7. Nurse - Scientific and practical journal - "Medizdat" -.

8. Nurse - Scientific and practical and journalistic journal - Publishing House "Russian Doctor" -.

9. Obukhovets T.P., Sklyarov T.A., Chernova O.V. - Fundamentals of nursing - ed. 13th add. revised Rostov n / a Phoenix - 2009 - 552s

10. Ostrovskaya I.V., Shirokova N.V. Fundamentals of Nursing: Textbook. - M.: GEOTAR - Media, 2008

11. Shapkin V.E., Zazdravnov A.A., Bobro L.N. Pasieshvili - Handbook of therapy with the basics of rehabilitation - M .: - Phoenix - 2007.- 275 p.

APPSI

Papplication 1

Rice. 1. Ultrasound method for examining the heart.

Papplication 2

Table 1. Primary Nursing Assessment Sheet

Name of the patient Melikhova Nina Petrovna Address of residence st. Bolshaya Embankment, 9, apt. 22 ____________________________________ Phone 89060349425______________________ Attending physician Matveeva Yu.M.

Entered

by ambulance on your own

polyclinic referral translation

Method of transportation to the department

on a wheelchair on a chair on foot

Consciousness

clear contact oriented

disoriented

confused stupor stupor

The need for breathing

free impeded

Respiratory rate 20 per minute

Pulse rate 80 per minute

rhythmic arrhythmic

BP 180/100 mmHg

Is a smoker

Number of cigarettes smoked __________

yes dry with phlegm no

The need for adequate food and drink

Body weight 87 kg height 162 cm

Takes food and drink

self needs help

normal low

elevated absent

Does he have diabetes

If yes, how is the disease regulated?

insulin hypoglycemic tablets

observes

allergy _____________________________

Dyspeptic disorders

nausea, vomiting

heaviness, discomfort in the abdomen

Teeth saved missing

partially preserved

Are there removable dentures?

yes top bottom

Takes liquid

limited enough

Ability to dress, undress, choose clothes, personal hygiene

independent dependent fully partially

Dressing, undressing

on one's own

with outside help

Does it have a choice of clothes yes no

Does he care about his appearance

messy

shows no interest

Can it on its own

alone partially cannot

To wash hands

wash your face

Brush your teeth

look after

prostheses

To shave

Perform perineal hygiene

comb your hair

Take a bath, shower

wash your hair

Cut nails

The state of the oral cavity sanitized not sanitized

Skin condition

dry normal oily

puffiness

rashes

Ability to maintain normal body temperature

Body temperature at the time of examination 36.6°C

decreased normal increased

sweating chills feeling hot

Physiological departures

Urination

normal in frequency

rare painful

night (how many times) _________________

incontinence catheter

Bowel function

Chair character

regular consistency

liquid solid

incontinence

Need for movement

independent

fully

partially

walking

on one's own

with outside help

use of accessories

Can you on your own? Can you partially walk up the stairs?

Sit on the chair

Get to the toilet

Move to

contracture beds

paresis __________________________________

paralysis ________________________________

Fall risk yes no

Pressure ulcer risk yes no

Number of points on the Waterlow scale _____

no risk - 1 - 9 points

there is a risk - 10 points

high risk - 15 points

very high risk - 20 points

Need for sleep

uses sleeping pills

sleep well

Sleep habits _______________________

Sleep disturbing factors: severe headaches

The need to work and rest

works

Accountant at a construction company

does not work

pensioner

student

disability

hobbies _____________________________________

Is it possible to realize your hobbies

Possibility of communication

Spoken language Russian

Difficulties in communication

normal

hearing loss right left

hearing aid

normal

contact lenses right left

blindness right left complete

ocular prosthesis right left

Ability to maintain a safe environment

Maintaining Security

on one's own

with outside help

Motor and sensory abnormalities

dizziness

unsteadiness of gait

Papplication 3

Table 2. Degrees of arterial hypertension based on the level of blood pressure.

Table 3. Factors affecting risk assessment.

Table 4. Target organ damage.

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Clinical signs hypertension, its classification according to a number of features. risk factors for the disease. Causes of hypertensive crises. Treatment of hypertension, prevention of complications. Nursing activity in hypertension.

In order to properly implement caring for patients with hypertension and timely and competently plan the nursing process, we will analyze the definition of the disease itself. So, hypertension is a disease accompanied by such a pathological condition as hypertension or hypertension.

Arterial hypertension or hypertension is an increase in blood pressure, which is caused by non-natural reactions of the body to certain physiological situations (stress, heat, somatic disease). With arterial hypertension, there is an imbalance in the systems responsible for maintaining blood pressure within the normal range.

On the recommendation of the WHO (World Health Organization), high blood pressure is considered to be blood pressure from 140/90 mm Hg. Art. Hypertension is a disease, the leading symptom of which is a tendency to arterial hypertension. Risk factors for developing hypertension are considered to be:

• genetic predisposition;
• chronic stressful situations;
• frequent heavy physical activity;
• the absence or the very minimum of physical activity;
• psychological trauma;
• unbalanced diet (including increased consumption of table salt);
• alcohol abuse;
• smoking;
• overweight and obesity.

Hypertension until recently was considered a disease of the age of 40 years. However, in recent years, hypertension, like other cardiovascular pathologies, has become much younger and is quite common in young people (up to 30 years old).

Stages of hypertension

I stage - unstable increase in blood pressure up to 140/90 - 160/100 mm Hg. Art., maybe for several days in a row. Blood pressure levels return to normal after rest. However, recurrence of the rise in blood pressure is inevitable. There are no changes in the internal organs in stage I GB.

II stage - blood pressure level from 180/100 - 200/115, there are fixed changes in internal organs (often - left ventricular hypertrophy, retinal angiopathy). The level of blood pressure cannot normalize on its own, it happens hypertensive crises . At this stage, drug therapy is required.

stage III - persistent increase in blood pressure, reaching the level of 200/115 - 230/130. There are lesions of the heart, kidneys, fundus. At this stage, there is a high risk of acute cerebrovascular accident - stroke or acute myocardial infarction.

Proper care of a patient with hypertension consists in following several rules:

• creation of optimal working and rest conditions;
• organization of a balanced diet (diet with a low content of salt and liquid);
• monitoring the general condition and well-being of the patient;
• monitoring the timely adherence to medical treatment.

Even before providing full-fledged care and assistance to a patient with hypertension, a nurse needs to determine his current and potential problems. This is especially important to do at an early stage in the development of the disease.

Problems of a patient with stage I hypertension

Real (existing):

• headache;
• dizziness;
• anxiety;
• irritability;
• sleep disorders;
• unbalanced diet;
• tense rhythm of life, lack of proper rest;
• the need for constant medication, the lack of a serious attitude to this issue;
• lack of knowledge about the disease and its complications.

Potential (probable):

• visual impairment;
• development of a hypertensive crisis;
• development of renal failure;
• development of a heart attack or stroke.

After identifying problems during the initial examination, the nurse collects information about the patient.

Questioning a patient with hypertension

The nurse needs to find out:

• conditions of professional activity;
• relationships within the team with colleagues;
• family relationships;
• the presence of hypertension in close relatives;
• nutritional features;
• the presence of bad habits (smoking, drinking alcohol);
• taking medications: which ones he takes, how regularly, how he tolerates them;
• complaints at the time of the study.

Physical examination of the patient

The nurse records:

• position of the patient in bed;
• skin color, including the presence of cyanosis in some areas $
• blood pressure level;
• pulse rate.

Nursing interventions in the care of a patient with hypertension

Modern care for patients with hypertension includes the following nursing interventions:

Interviews with the patient and his relatives:

• on the need to comply with the regime of work and rest, improve working conditions and improve the quality of rest;
• on the importance of following a low-salt, low-cholesterol diet;
• about the importance of timely systematic intake of drugs;
• on the effects of smoking and alcohol on blood pressure.

Patient and family education

• measurement of blood pressure and pulse rate;
• recognition of the first signs of a hypertensive crisis;
• providing first aid for hypertensive crisis;
• relaxation methods and their application in a stressful situation and prophylactically.

Ensuring that the patient stays in the hospital for maximum benefit

• control of the daily routine, ventilation of premises, proper nutrition, including transfers, taking prescribed drugs, conducting research and medical procedures;
• control of body weight, motor mode;
• in the event of a threatening complication of the disease, urgently call a doctor, fulfill all prescriptions, and care for the patient as if he were seriously ill.