ThisisCarePlanscontent

COORDINATED CARE ACROSS THE CONTINUUM

Learn more about our Care Planning solution, which combines the patient story, 600+ evidence-based clinical practice guidelines and standardized assessments into one patient-centered plan of care across all care settings and disciplines.

Mar.04.2021

Hypertension Comorbidity (Adult Inpatient)

Clinical Description

Care of the hospitalized patient with a known diagnosis of hypertension.

Key Information

Patients with hypertension rarely have signs or symptoms, even when pressures are dangerously high. For this reason, they may interpret medication or risk factor modification unnecessary.

Systolic and diastolic values that reflect classifications of hypertension vary depending on international guidelines used.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:

Blood Pressure in Desired Range

B. Patient, family or significant other will teach back or demonstrate education topics and points:

Education: Comorbidity: Self-Management

Correlate Health Status

Correlate health status to:
- history, comorbidity
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care

Hypertension Comorbidity

Signs/Symptoms/Presentation

known history of hypertension
maintenance medication use

Problem Intervention

Maintain Blood Pressure Management

Evaluate adherence to home antihypertensive regimen (e.g., exercise and activity, diet modification, medication).
Provide scheduled antihypertensive medication; consider administration time and effects (e.g., avoid giving diuretic prior to bedtime).
Monitor response to antihypertensive medication therapy (e.g., blood pressure, electrolyte levels, medication effects).
Minimize risk of orthostatic hypotension; encourage caution with position changes, particularly if elderly.

Associated Documentation

Medication Review/Management
Syncope Management

Education

CPG-Specific Education Topics

Comorbidity: Self-Management

adherence to disease management plan
when to seek medical attention

General Education Topics

General Education

admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan

Safety Education

call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support

References

Abegaz, T. M.; Shehab, A.; Gebreyohannes, E. A.; Bhagavathula, A. S.; Elnour, A. A. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine. 2017, January;96(4), e5641. doi:10.1097/MD.0000000000005641 [Metasynthesis,Meta-analysis,Systematic Review]
Abegaz, T. M.; Shehab, A.; Gebreyohannes, E. A.; Bhagavathula, A. S.; Elnour, A. A. Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine. 2017, January;96(4), e5641. doi:10.1097/MD.0000000000005641 [Metasynthesis,Meta-analysis,Systematic Review]
Centers for Disease Control and Prevention (CDC). (2016, October). Blood Pressure Control. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Centers for Disease Control and Prevention (CDC). (2016, October). Blood Pressure Control. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Foroumandi, E.; Kheirouri, S.; Alizadeh, M.. The potency of education programs for management of blood pressure through increasing self-efficacy of hypertensive patients: a systematic review and meta-analysis. Patient Education and Counseling. 2020;(103), 451-461. doi:10.1016/j.pec.2019.09.018 [Meta-analysis,Systematic Review]
Graudal, N.; Jurgens, G.; Baslund, B.; Alderman, M. H. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: A meta-analysis. American Journal of Hypertension. 2014;27(9), 1129-1137. doi:10.1093/ajh/hpu028 [Metasynthesis,Meta-analysis,Systematic Review]
Hawkins, G. C.; Rao, S. G.; Vaccarino, V.; Mohammed, K. A. Effects of different dietary interventions on blood pressure. Hypertension. 2016;67, 733-739. doi:10.1161/HYPERTENSIONAHA.115.06853 [Meta-analysis,Systematic Review]
Ignatavicius, D. D.; Workman, M. L.; Rebar, C. R. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Ignatavicius, D. D.; Workman, M. L.; Rebar, C. R. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Liu, L-S.; Wu, Z.; Wang, J.; Wang, W. 2018 Chinese guidelines for prevention and treatment of hypertension a report of the revision committee of Chinese guidelines for prevention and treatment of hypertension. Journal of Geriatric Cardiology. 2019;16, 182-241. [Quality Measures,Clinical Practice Guidelines]
Musini, V. M.; Tejani, A. M.; Bassett, K.; Puil, L.; Wright, J. M.. Pharmacotherapy for hypertension in adults 60 years or older. Cochrane Database of Sytstematic Reviews. 2019;(6) doi:10.1002/14651858.CD000028.pub3 [Systematic Review]
National Committee for Quality Assurance. (2017). NQF 0018. Controlling high blood pressure. Source[Quality Measures,Clinical Practice Guidelines]
National Heart Foundation of Australia. (2016). Guideline for the diagnosis and management of hypertension in adults. Melbourne: National Heart Foundation of Australia. [Quality Measures,Clinical Practice Guidelines]
National Institute for Health and Care Excellence (NICE). (2019). Hypertension in adults; Diagnosis and management. NICE guideline [NG136]. Source[Quality Measures,Clinical Practice Guidelines]
National Institute for Health and Care Excellence (NICE). (2019). Hypertension in adults; Diagnosis and management. NICE guideline [NG136]. Source[Quality Measures,Clinical Practice Guidelines]
Natsis, M.; Antza, C.; Doundoulakis, I.; Stabouli, S.; Kotsis, V. Hypertension in obesity: novel insights. Current Hypertension Reviews. 2020;16, 30-36. doi:10.2174/1573402115666190415154603 [Review Articles]
Nettina, S. M. (2019). Lippincott manual of nursing practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Rabi, D. M.; McBrien, K. A.; Sapir-Pichhadze, R.; Makhla, M.; Ahmed, S. B.; Dumanski, S. M.; et al.. Hypertension Canada's 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Canadian Journal of Cardiology. 2020;36, 596-624. doi:10.1016/j.cjca.2020.02.086 [Clinical Practice Guidelines]
Reboussin, D. M.; Allen, N. B.; Griswold, M. E.; Guallar, E.; Hong, Y.; Lackland, D. T.; Miller, E. R.; Polonsky, T.; Thompson-Paul, A. M.; Vupputuri, S. Systematic review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71, e116-e135. doi:10.1161/HYP.0000000000000067 [Metasynthesis,Meta-analysis,Systematic Review]
Seravalle, G.; Grassi, G. Obesity and hypertension. Pharmacological Research. 2017;122, 1-7. Source[Review Articles]
Strilchuk, L.; Cincione, R. I.; Fogacci, F.; Cicero A. F. G. Dietary interventions in blood pressure lowering: current evidence in 2020. Kardiologia Polska. 2020;78(7-8), 659-666. doi:10.33963/KP.15468 [Review Articles]
Vondracek, S.; Scoular, S.; Patel, T. Management of severe asymptomatic hypertension in the hospitalized patient. Journal of the American Society of Hypertension. 2016;10(12), 974. doi:10.1016/j.jash.2016.10.008 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
Weiss, J.; Kerfoot, A.; Freeman, M.; Motu'apuaka, M.; Fu, R.; Low, A.; Paynter, R.; Kondo, K.; Kansagara, D. (2015). Benefits and harms of treating blood pressure in older adults: A systematic review and meta-analysis. Washington, D. C.: Department of Veterans Affairs; Health Services Research & Development Service. [Metasynthesis,Meta-analysis,Systematic Review]
Whelton, P. K.; Carey, R. M.; Aronow, W. S.; Casey, D. E.; Collins, K. J.; Dennison Himmelfarb, C.; DePalma, S. M.; Gidding, S.; Jamerson, K. A.; Jones, D. W.; MacLaughlin, E. J.; Muntner, P.; Ovbiagele, B.; Smith, S. C.; Spencer, C. C.; Stafford, R. S.; Taler, S. J.; Thomas, R. J.; Williams Sr., K. A.; Williamson, J. D.; Wright, J. T. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2017; doi:https://doi.org/10.1016/j.jacc.2017.11.006 [Quality Measures,Clinical Practice Guidelines]
Williams, B.; Mancia, G.; Spiering, W.; Rosei, E. A.; Azizi, M.; Burnier, M.; . . . Desormais, I. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension.. Journal of Hypertenison. 2018;36(10), 1953-2041. doi:10.1097/HJH.0000000000001940 [Quality Measures,Clinical Practice Guidelines]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.