Hypertension

A. Congeniality
Hypertension is an situation where happened the make-up of blood pressure of sistolik more than 160 mmHg and or blood pressure of diastolik more than 90 mmHg most serikit when is different (Brunner and of Suddarth, 2002).
In general hypertension classified pursuant to value of diastolik.
Light hypertension : 90-100 mmHg
Middle hypertension : 100-114 mmHg
Heavy hypertension : 110-118 mmHg
Hypertension of Maligna > 120 mmHg
Hypertension crisis is natural blood pressure increase which quickly so that cause damage of organ quickly repair only can be got with blood pressure.
According to new classification :
Stage I : 90-98 mmHg
Stage II : 100-108 mmHg
Stage III : 110-118 mmHg
Stage IV > 120 mmHg
Blood pressure determined by 2 primary factor
1. Level of dilution volume filling vein determined by pouring heart
2. Prisoner (venous resistensi) of edge (perifer) to blood stream emiting a stream of.

B. Anatomy Physiology
Heart represent especial organ in functioning blood cyrculation as pump. When bud hence blood pumped to aorta with strong forceps pressure later then blood poured into and artery of arteriole with lighter pressure, this pressure very needed to tired blood entire/all tissue and organ and also can return to heart. Blood pressure vena to artery wall can be measured with expressed tensimeter with set of mmHg.
Difference of blood pressure of sistolik is artery blood pressure when bud heart/ konstriksi. Diastolik is blood pressure when dilatation heart return. Blood pressure influenced by pouring heart, prisoner of perifer from and blood volume.
Control system which play a part in to maintain blood pressure:
1. System of Baroreseptor
2. System arrangement of body dilution volume
3. System of Renin angiotensin
4. System of Autoregulasi vascular
( Barbara Engram, 1999)

C. Patofisiologi
Hypertension represent an disparity/symptom of mechanism trouble of regulasi blood pressure. Body have an system to arrange height of blood pressure that is system of renin aldosteron angiostenin (RAAS). Certain Cells of kidney can form hormone of renin discharged if blood pressure downhill glumerolus. Only happened when amount of blood arranging to through kidney decrease. For example because degradation of blood volume or stricture of kidney artery. In plasma, renin joint forces with to become angiostensin I which by enzyme of ACE (Angiostensi Convertury enzyme) can become angiostensin II.
From other side hormone regulasi still there are some physiology factor able to influence blood pressure, for example
1. Volume Stroke
That is amount of blood pumped out of heart every konstriksi, ever greater of this blood pressure volume excelsior. Salt retention improve dilution volume so that volume mount. Hence pressure of wall small channel of blood is increase.

2. Wall artery Elasticity
Artery which its wall have ossified because cholesterol sediment/fat (artherosclerosis) cause higher blood pressure than wall which still is elastic.
3. Release of neurohormon
For example adrenalain of functioning nerodrenalin narrow vein of perifer so that blood pressure mount. At the time of emotion mount or energetic athletic, nerve system of adrenergik reacted and discharge neurohormon. Situation of Stres and smoke also increase product adrenolin neurohormon (Sandra M Hettina, 2002).

D. Factor Cause of Hypertension
1. Primary Hypertension : unknown cause
2. Sekunder Hypertension because of
a. Disease of kidney perenkim or is kidney vascular
b. Endocrine trouble of diabetes
c. Stricture of congenital aorta
d. Tumor Neurogenik, enoufalitas, singe, increase of volume of intravaskuler and psychiatry trouble.
3. Other Risk factor
a. Obesitas
b. Low intake and high salt
c. Smoker
d. Stres
e. Usage of pill anti pregnancy

E. Sign and Symptom
Sign and symptom of hypertensi, that is
1. Headache
2. Epitaksis
3. Confused of migraine
4. Nokturia
5. Finitus
6. Weakness/ worn-out
7. Queasy of puking
8. Out of breath
9. Difficult to sleep
10. Eye have Firefly
11. Feeling buckling weight
12. Increase of BP from is normal
13. Degradation of hand strength
14. Heart frequency mount
15. Takipnea
16. Change of heart rhythm
(Sandra M Hettina, 2002)

F. Pathway

G. Complication
There are some complication able to happened at hypertension that is
a. Damage of vein, manifestasi emerge according to hit organ system
b. Heart sickness of coroner with angiria
c. Left Ventrikel Hipertrofi
d. Change of kidney fatologis
e. Brain blood/ stroke
f. Serebri Infark
(Brunner and of Suddart, 2002)

H. Diagnostic Inspection
a. Hb/HCL to assess relation between cells of blood viskositas as risk factor of hiperkoagulasi, enemia, etc
b. BUN/ creatinin to know kidney function
c. Glucose, hiperglikemia effect of height of katekolamin will add hypertension
d. System of Potasium. If found the existence of this hipokalamia represent sign of existence of primary aldostenon as side effects of diuretika
e. Calcium serum, if high usually signifikan at hypertension
f. Serum of Trigliserida and cholesterol if high represent factor of predisposisi hypertension
g. Tiroid. Hipertirordisme cause vascular vasokontriksi
h. WP to identify cause of hypertension, do representing disease of kidney parenkim or is kalikulo renal.
(Brunner and of Suddart, 2002)

I. Therapy
a. Program degradation of BB to fat
b. Low salt and lower fat diet
c. Altering ugly habit pursuant to health
d. Regular Athletic
e. Check blood pressure regularly
f. Therapy of Farmakologis
1. Diuretik : HCT, lasix
2. Beta of Blocker : propanaol
3. Alpha of Blocker : phentolamin, vrozqazine (minipres)
4. Simpatolik
5. Vasodilator
6. Calcium of Antagonis
(Barbara Engram, 1999)

J. Assessment
1. Assessment
This study cover patient identity, old age, work, disease history now is, former, and family
In study of Doengoes (1999) covering practice and activity, eliminasi, habit of defecate and urinate, eat and dilution cover habit of consumed food and beverage of fatty food type, high cholesterol have, alcohol, high salt, etcetera. Sensori Neuron : headache symptom, weaken, rest, and sleep, existence of sleepless, habit of sleep, cognate perception, perception of pandemic client while for all important physical examination is vital marking that is blood tension, existence of increase
2. Diagnosa and Intervention Treatment
According to Doengoes (1993) at hypertension client can be found by the following treatment intervention and diagnosa
a. Trouble perfuasi of tissue referring to decrease of O2supply to perifer tissue
1) Target of : supply of O2 to tissue fufilled
2) Criterion result of :
a) Visible Husk squeezing do not cyanosis
b) Temperature body in normal boundary 36°C s.d 37°C
c) Nadi in normal boundary (60-80 x/mnt)

3) Intervention
a) Monitor blood pressure, to evaluate early using accurate technics and correct manset.
Rationalization : comparison of pressure give more complete picture about involvement of vascular problem
b) Note existence, quality of perifer central pulsation
Rationalization : pulsation of karotis, juguralis, and radialis of femoralis possible perceived/throb terpolasi at downhill to tungkai possible express and effect of vasokontriksi and of kongesti vena
c) Perceive husk colour, dampness, temperature, and a period of/to capillary admission filling.
Rationalization : existence of turning pale, to be chilled, damp husk and a period of/to tardy capillary refil, possible its bearing with vasokontriksi or express dekompensasi/bulk heart degradation
d) Note the existence of oedem / certain
Rationalization : earn identification fail heart, damage of kidney or is vascular.
e) Create balmy environment
Rationalization : assisting to degrade stimulus of simpatis, improving relaksasi
f) Limit activity
Rationalization : degrading stress and stress which blood pressure effect and journey of disease
g) Conduct action balmy like heightening head in place sleep
Rationalization : lessening uncomfortable and can degrade stimulus of simpatis.
h) Watch respon to drug to control blood pressure
Rationalization : respon to drug therapy, depended effect individual of sinergis medicinize because effect of sampinh, hence important to use drug in number a few/little and low dose.
Kolaborasi : giving drug according to indication.
b. Acute pain (headache) relate to the make-up of serebral vascular pressure
1) Target of : pain in bone decrease / lose
2) Criterion result of :
a) Blood pressure go down / maximal normal 140 / 90mmHg
b) Client do not feel dizzy / neck lost to stiff again
c) Visible peace client
3) Intervention
a) Maintain lie down during a period of/to is acute
Rationalization : minimization of stimulasi / increase of relaxation.
b) Give non farmakologik action to eliminate headache, for example : compress cool water at forehead, squeeze back.
Rationalization : action of massage aim to to degrade vascular pressure of serebral and slow down sympathetic respon, effective in eliminating pain in bone.
c) Eliminate / activity minimization of vasokontriksi able to improve headache, for example : cough length and moving many
Rationalization : activity which mounting vasokontriksi cause headache make-up of vascular pressure.
d) Assist client in ambulasi according to requirement.
Rationalization : confused and blurry eyesight often relate to client headache also earn hypertension episode mengalamio of postural.
e) Give dilution , soft food which is easy to be swallowed.
Rationalization : improving public freshment and lessen requirement of energi/ tired.
f) Give analgetik according to therapy indication.
Rationalization : degrading pain in bone and stimulate nerve system of simpatis.
c. Activity Intoleran relate to fatigue
1) Target of : activity client can be unassisted
2) Criterion result of :
a) Client able to have activity
b) Client can do simple activity
1) Intervention :
a) Study family respon to activity
Rationalization : studying physiological respon to activity stress and if any representing indicator of activity work related to activity storey;level.
b) Intruct client about thrift of energi technical
Rationalization : thrift of energi lessen technics degradation of energi, also balance help supply and requirement of O2.
c) Give motivation to conduct activity / treatment of x'self in phases, giving aid according to requirement.
Rationalize : progress of activity in phases prevent the make-up of heart activity sudden. Giving aid only limited to requirement will push independence in conducting activity.
d. Trouble take a rest and sleep relate to sekunder confusedly with make-up of Intra Cranial Pressure (ICP)
1) Target of : patient can take a rest and sleep quietly
2) Criterion result of :
a) Patient can sleep ± 8 hours a day.
b) Eye do not see to squeeze
3) Intervention
a) Study habit of sleep / rest
Rationalization : study and identify correct intervention.
b) Study habit usage of sedative drug
Rationalize : habit of sedative drug usage very is influencing sleep pattern.
c) Create calm atmosphere
Rationalization : giving situation of kondusif for sleep.
d) Suggest technicsly of relaxation
Rationalization : assisting to induce sleep.
e) Balmy Berry sleep position
Rationalization : change of position alter the way of pressure and improve rest.
e. Less knowledge relate to cognate limitation
1) Target : patient understand pandemicly
2) Criterion result of : patient can lay open about hypertension, symptom, sign, cause, complication, and prevention
3) Intervention
a) Study the readiness of and resistance in learning the including people closest
Rationalize : Assess mount ability of client, which can influence client enthusiasm/ people closest to study disease, progress of and therapy of prognisis and also resistance that happened in course of medication.
b) Specify and determine normal blood pressure, explaining about hypertension and effect at heart, venous, brain and kidney.
Rationalization : giving real correct knowledge base about blood pressure and also explain risk factors which show in supporting hypertension and disease of kardiovaskuler.
c) Assist client in risk factors identify of kardiovaskuler able to be altered, for example obesitas, diet high of saturated fat and cholesterol, smoke, alcoholic, and pattern live full of stress
d) Explain about therapy, drugs and also side effects that happened.
Rationalize : explaining risk factor and altered possibility and also benefit able to be taken.
e) Suggest client for consultancy with giver of commemoration before using drug which recipe and or which do not recipe
Rationalize : important care in prevention of drug interaction which is dangerous possibility.


SOURCE

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