Hypertensive nursing graduation thesis 1: "Talking about the nursing of patients with essential hypertension" Key words hypertension; Nursing; health education
The number of hypertensive patients in China is increasing by 3 million every year, which makes many people suffer greatly. However, if patient care and health education are well done, the harm can be minimized. Nursing and health education for patients with essential hypertension are as follows.
1 estimation of patients' basic situation
1. 1 Nursing history Ask patients if they have family history, lifestyle before illness, diet, hobbies, nature of work, headache and dizziness, etc. Pathogenic factors, elevated blood pressure are mainly related to the following factors. (1) Family history: Hypertension is related to heredity. (2) Living habits and diet: Excessive intake of sodium salt, heavy drinking, drinking coffee, excessive intake of saturated fatty acids, obesity, overweight, strenuous exercise, constipation and smoking can all increase blood pressure. (3) Psycho-psychological factors and occupations: The high incidence of mental work and stress work may be related to social and psychological factors such as mental stress, bad mental stimulation, cultural accomplishment, family background and economic conditions. (4) Other medical history: Hypertension is higher in men than in women with age, which may also be related to climatic conditions and environmental noise.
Main performance of 1.2
1.2. 1 Progressive hypertension Essential hypertension is more common. (1) Stage I: Usually asymptomatic or manifested as headache, head swelling, palpitation, fatigue, tinnitus, insomnia, numbness of limbs, etc. Blood pressure increased during physical examination, and clinical manifestations of unintentional brain and kidney damage were observed, which was the first stage of essential hypertension. (2) The second stage: the blood pressure continues to rise. With the arteriosclerosis of arterioles, the target organs such as heart, brain, kidney and fundus are gradually damaged, such as: ① left ventricular hypertrophy; ② fundus artery stenosis; ③ Proteinuria and/or serum creatinine slightly increased, which is the second stage of essential hypertension. (3) Stage III: The damage of heart, brain, kidney and other important organs develops into one of the following: ① Left heart failure; ② Cerebrovascular accident or hypertensive encephalopathy; ③ Renal failure; ④ Fundus hemorrhage or oozing blood and optic papilla edema are the third stage of essential hypertension.
1.2.2 rapid hypertension accounts for about 1% ~ 5%, which is more common in young people. Acute onset, sudden headache, dizziness, blurred vision and palpitation, shortness of breath, blood pressure and diastolic pressure increased significantly. 16.9kPa, heart, brain, kidney and fundus changes occurred in a short time, which developed rapidly and the condition was serious. If not treated actively, you may die of renal failure or heart failure.
1.2.3 hypertensive emergency (1) hypertensive encephalopathy: refers to the continuous severe spasm of cerebral arterioles during the course of hypertension, leading to acute cerebral blood circulation disorder, brain edema and increased intracranial pressure, severe headache, vomiting, irritability, bradycardia, blurred vision, black convulsion, disturbance of consciousness and even coma. (2) Hypertensive crisis: refers to the temporary intense spasm of peripheral arterioles during the course of hypertension, which leads to a sharp increase in blood pressure, and symptoms such as headache, irritability, nausea, vomiting, sweating, pale or flushing, blurred vision, etc. Systolic blood pressure can reach 33.8kPa What about diastolic blood pressure? 15.6 kpa.
1.3 patients with hypertension in mental and emotional state often have personality defects such as emotional instability, fragile personality and lack of decisiveness. In the initial stage, they are very nervous, and they often use drugs blindly. When their symptoms get worse, they can't work normally and their daily life is affected. Later, he was depressed and lost confidence because of the pathological changes of heart, brain, kidney and other organs.
2 nursing physical examination
Nurses mainly check the changes of patients' blood pressure to see if there are any corresponding signs caused by changes of heart, brain and kidney. 3 auxiliary inspection results
(1) Laboratory examination showed that routine urine examination included red blood cells, proteinuria and tubular urine. When renal function decreases, the proportion of urine decreases and creatinine and urea nitrogen in blood increase. (2) Chest X-ray showed tortuous dilatation of aorta, and left ventricular enlargement and pulmonary congestion were seen in hypertensive heart disease. (3) When the heart is involved, the electrocardiogram shows left ventricular hypertrophy, strain and various arrhythmias.
4 principles of treatment
The purpose of treating essential hypertension is to lower blood pressure, approach or reach the normal range, and prevent or delay the occurrence of complications.
4. 1 antihypertensive treatment and nursing
4. 1.65438+ Avoid foods high in cholesterol, saturated fatty acids and sodium, restrict smoking and alcohol, avoid irritating foods, increase the intake of foods high in vegetables, fruits and cellulose, reduce the heart load, prevent water and sodium retention, reduce peripheral vascular resistance, prevent constipation and lower blood pressure; (2) lose weight and control weight. Increased blood volume and endocrine disorders in obese people are risk factors for hypertension. We should reduce daily calorie intake and increase exercise to control blood pressure. (3) sports. Taking part in proper physical exercise and labor can relieve mental tension and adjust life. Different patients should do what they can and gradually increase the amount of exercise. (4) others. Supplemented by psychological training, music therapy, relaxation therapy and other measures.
4. 1.2 Application and nursing of antihypertensive drugs
4. 1.2. 1 See table 1 (quoted from internal medicine nursing) [1] for commonly used antihypertensive drugs.
Table 1 Commonly used antihypertensive drugs, classification, dosage, route of administration, side effects and indications
Indications of side effects of commonly used routes of administration of classified drugs
Diuretic agent hydrochlorothiazide 12.5 ~ 25mg/d is suitable for hyponatremia, hypokalemia, hypochloremia and hyperuricemia.
Furosemide 20 ~ 40mg 1 ~ 2 times /d orally, intramuscularly and intravenously, as above.
? Oral atenolol 50 ~ 200mg 1 ~ 2 times /d inhibits myocardial contractility and bradycardia, making bronchial contraction suitable for early stage.
The calcium antagonist nimodipine 40 ~ 60 mg 2 ~ 3 times /d is suitable for mild to moderate headache, dizziness, flushing, gastrointestinal discomfort and skin itching.
Verapamil 40 ~ 80mg 1 ~ 3 times /d oral bradycardia.
Angiotensin converting enzyme inhibitor captopril 12.5 ~ 25mg 3 times/day, increased to 100 ~ 150mg/ day. Oral dizziness, fatigue, epigastric discomfort, anorexia, etc. It is suitable for all stages of renal function damage with caution.
Sodium nitroprusside 10 ~ 30? G/min intravenous drip of headache, head swelling and flushing is suitable for hypertensive emergencies.
Sodium nitroprusside 20 ~ 100? G/min intravenous infusion of long-term high-dose thiocyanate poisoning reaction is suitable for hypertension emergency.
Reserpine is taken orally at 0. 1.25 ~ 0.25 mg 1 ~ 3 times /d, and intramuscular injection is rarely used for nasal congestion, hyperacidity, drowsiness, fatigue and depression.
4. 1.2.2 Observation and prevention of adverse drug reactions Under normal circumstances, the use of drugs starts with a small dose, and the dose is adjusted according to the doctor's advice. It is not allowed to increase or decrease drugs or change them suddenly, and most patients need to take maintenance doses for a long time; Pay attention to lowering blood pressure, especially for elderly patients; Some antihypertensive drugs have postural hypotension, so patients should be instructed to move slowly when changing their postures to prevent constipation. The water temperature should not be too high when taking a bath. When dizziness, dizziness, nausea and dizziness occur, you should lie flat immediately, raise your lower limbs and increase your blood volume.
4.2 Prevention and nursing of complications
4.2. 1 The main complications of hypertension are hypertensive heart disease, coronary heart disease, acute cerebrovascular disease and chronic renal failure [2]. Instruct patients to take therapeutic diet, avoid emotional tension, take medicine according to doctor's advice, exercise properly, effectively control blood pressure and prevent complications. And pay attention to the observation of complications for early detection and treatment. For example, observe whether there are symptoms of heart damage such as dyspnea, cough, phlegm and foam, and sudden pain attack behind the sternum. Observe the symptoms of acute cerebrovascular disease such as headache, mental state, vision and language ability, and observe the change of urine volume, the proportion of urine volume between day and night, whether there is edema and the results of renal function examination, so as to find renal failure early.
4.2.2 Emergency Nursing of Hypertension (1) Put the patient in a semi-recumbent position: avoid all bad stimulation and unnecessary activities, calm down the mood, and use sedatives according to the doctor's advice when necessary. (2) Oxygen inhalation: keep the respiratory tract unobstructed. If there are more respiratory secretions and the patient's vomiting ability is reduced, an aspirator should be used to suck them out. (3) Establish venous access immediately and quickly choose antihypertensive drugs according to the doctor's advice. Sodium nitroprusside is generally preferred. Intravenous drip should avoid light and closely observe the changes of blood pressure. Pay attention to the blood pressure should not be too low, so as to avoid insufficient blood supply to the brain, reduced renal blood flow, sweating, anxiety, headache, palpitations and other symptoms. If the blood vessels are excessively dilated, such as retrosternal pain, the drip should be stopped immediately; Nitroglycerin and nifedipine can also be taken sublingually, and diazepam is injected intramuscularly or intravenously to relieve spasm; Use furosemide or mannitol to reduce intracranial pressure and relieve brain edema. (4) Closely monitor the change of illness, and closely observe blood pressure, pulse, respiration, heart rate, consciousness, pupil and urine volume. Blood pressure 1 time was measured every 5 ~ 10 min during intravenous infusion of antihypertensive drugs. If you find abnormal changes, please contact your doctor at any time. (5) provide protective care. When the patient is in a coma, add a bed rail to prevent him from falling off the bed; When convulsions occur, put a tooth pad between the upper and lower molars to prevent lip and tongue bites.
5 Health education
(1) Combination of work and rest: maintain a good physical and mental state, reasonably arrange rest and activities according to blood pressure, stay in bed when blood pressure rises, reduce activities, and avoid the increase of heart rate and blood pressure caused by exercise. At ordinary times, you can do planned moderate exercise, such as taking a walk every morning, playing Tai Ji Chuan, gardening or reading newspapers, writing and painting, engaging in interesting entertainment activities, etc., so as to relax your body and mind, relieve stress and get a good rest. (2) Adapting to the therapeutic diet, adhering to the low-salt and low-cholesterol diet, eating less and eating more meals, avoiding over-saturated irritating foods, and eating reasonably are important for the prevention and treatment of hypertension. (3) Guide patients to adhere to medication, help patients to establish mental preparation for long-term treatment, and be sure to take medication on time according to the doctor's advice, and don't arbitrarily increase or decrease or stop using antihypertensive drugs according to your own feelings. Only by insisting on treatment can they control their blood pressure and reduce complications. Remind patients to pay attention to adverse drug reactions, learn self-observation and nursing. (4) Avoid all kinds of inducing factors, such as emotional excitement, tension, physical and mental fatigue, mental trauma, etc. , can increase intracranial pressure, pathological blood vessels are easy to rupture, causing cerebral hemorrhage. Let patients understand the importance of emotional self-control; Cold stimulation can make blood vessels contract and blood pressure rise. Pay attention to keep warm when going out in winter, and the room temperature should not be too low. Keep the stool unobstructed, avoid strenuous exercise and severe cough, the environment should be quiet and comfortable, and avoid noise stimulation and activities that cause high mental excitement. (5) Follow up blood pressure regularly, and seek medical advice immediately when the condition changes.
refer to
1 sheet. Internal medicine nursing, 3rd edition. Shijiazhuang: Hebei Education Press, 200 1.2.
2 Dong. China Journal of Integrated Traditional Chinese and Western Medicine, 20 10,11(1):11.
The second part of hypertension nursing paper: nursing experience of hypertension patients Objective To explore the nursing of hypertension patients. Methods 400 patients were given nursing care in diet, exercise, psychology, medication and health education. Results The patient's blood pressure was well controlled. Conclusion Careful nursing and effective treatment are the key to reduce or delay the complications of hypertension.
Hypertension; nurse
Hypertension is a disease with high incidence, many complications and high disability rate, which seriously threatens people's health and quality of life. It is of great significance to effectively control hypertension, help patients correctly understand the treatment knowledge of hypertension, and reduce and avoid the damage of important organs of patients. From June 2009 to June 20165438+June 2009, our department treated 400 patients with hypertension, and achieved good results through effective nursing.
Clinical data of 1
There are 400 cases in this group, including male 28 1 and female 1 19. The oldest is 86 years old and the youngest is 4 1 year; There were 64 cases of cerebral infarction, 8 cases of cerebral hemorrhage, 93 cases of coronary heart disease and 0 cases of renal failure/kloc-0. After active treatment and careful nursing, the patient's blood pressure is well controlled.
2 Ask about the medical history in detail.
It is extremely important for patients with hypertension to collect medical history comprehensively, which should include: family history: asking patients whether they have family history of hypertension, diabetes, dyslipidemia, coronary heart disease, stroke or kidney disease; Course of disease: the time of suffering from hypertension, blood pressure level, whether you have received antihypertensive treatment and its curative effect and side effects; Symptoms and past history: whether there are symptoms or medical history of coronary heart disease, heart failure, cerebrovascular disease, peripheral vascular disease, diabetes, gout, dyslipidemia, bronchospasm, sleep apnea syndrome, sexual dysfunction and kidney disease and their current and past treatment, and whether there are indications of secondary hypertension; Lifestyle: carefully understand the intake of fat, salt, alcohol, smoking times and physical activity in the diet; Ask about the weight gain in adulthood; Drug-induced hypertension: ask in detail whether you have taken drugs that may increase blood pressure, such as oral contraceptives, non-steroidal anti-inflammatory drugs, licorice, etc. Psychosocial factors: Understand in detail the personal psychological, social and environmental factors that may affect the course and curative effect of hypertension, including family situation, working environment and education level.
3 nursing experience
3. 1 General nursing ensures reasonable rest and sleep, avoids fatigue and advocates appropriate physical activity. Especially for patients with mild hypertension with high heart rate, aerobic exercise is effective, such as cycling, running, doing gymnastics and playing Tai Ji Chuan. However, we should pay attention to the combination of work and rest, avoid long-term strenuous activities, and use sedatives appropriately for patients with autonomic nervous dysfunction. Patients with severe hypertension should stay in bed, and patients with hypertensive crisis should absolutely stay in bed and need to be hospitalized for observation.
3.2 Diet Care Diet should be low in salt, fat, cholesterol and cellulose, limit animal fat, viscera, roe and other foods, and supplement appropriate amount of protein. Quit smoking, control drinking, and ensure adequate intake of essential trace elements such as potassium, calcium and magnesium. Foods rich in potassium can resist sodium-induced hypertension and vascular injury. Adequate calcium and magnesium are beneficial to the treatment of hypertension. Eat more fresh vegetables and fruits to prevent constipation, because defecation force will raise blood pressure and even lead to blood vessel rupture. Obese people should control their weight and reduce the total daily calories. 3.3 Precautions for medication and nursing: The use of antihypertensive drugs should start with a small dose, and the dose should be adjusted according to the doctor's advice. It is not allowed to increase or decrease the dosage or change the medicine suddenly. Most patients need to take maintenance dose for a long time. Pay attention to reducing blood pressure too fast or too low. If you have syncope, nausea, fatigue and other symptoms after taking the medicine, you should immediately lie flat, head down and feet up to increase cerebral blood flow. Elderly patients should not stand for too long after taking medicine, because standing for a long time will dilate the blood vessels in the legs, accumulate blood in the lower limbs and reduce the blood flow in the brain, leading to syncope. During medication, patients should not be instructed to get up too fast and move too hard to prevent dizziness from getting worse; Be accompanied when going out to prevent fainting from causing accidents.
3.4 Psychological nursing
(1) psychological counseling. Most patients have psychological characteristics such as excitability, anxiety and depression, and mental tension, emotional excitement and bad stimulation are closely related to this disease. Therefore, patients should be patient, kind, kind and considerate. According to the characteristics of patients, targeted psychological counseling. At the same time, let patients know the importance of controlling blood pressure, help patients train their self-control ability and cultivate tolerance for people and things.
(2) Reduce stress and maintain psychological balance. Long-term depression or emotional excitement, severe mental trauma can increase sympathetic adrenaline activity and raise blood pressure. Therefore, patients should be instructed to learn self-regulation, reduce mental stress, avoid emotional excitement, tension and other adverse stimuli, and maintain a healthy psychological state. Nurses should understand the personality characteristics of elderly patients and related social and psychological factors for psychological counseling, teach patients to train self-control ability, do a good job of family members for excitable elderly patients, reduce bad stimulation, and ensure patients have a quiet and comfortable training environment.
(3) Instruct patients to use relaxation techniques, such as slow breathing and music therapy. To sum up, hypertension is the most common cardiovascular disease. Nurses must understand the new diagnostic criteria and antihypertensive goals of hypertension, guide patients to use drugs rationally, give health guidance to patients, and strengthen psychological care, so as to improve the quality of life of patients with hypertension.
3.5 Non-drug therapy and medicated bath diet are very important for patients with hypertension. They often eat foods with antihypertensive effects, such as celery, garlic, radish, raw peanuts, apocynum venetum leaves, chrysanthemum tea and coarse grains. We have used Chinese medicine bath to soak our feet for many years, and it also has a good antihypertensive effect. The method is to wrap Chinese herbal pieces such as Radix Paeoniae Rubra, Radix Angelicae Sinensis, Dried Meat, Herba Menthae, Rhizoma Zingiberis Recens, Semen Persicae, Flos Carthami and Prunellae Spica with emery cloth, and soak feet with warm water once every night for half a month.
Chapter 3: Talking about the clinical application of nursing intervention in elderly hypertension nursing: 72 elderly patients with essential hypertension from 2065 438 to 2065 438+04 in our hospital were randomly selected, and all patients were randomly divided into observation group and control group, in which patients in the control group were given routine nursing measures, while patients in the observation group were given nursing intervention on the basis of the control group, and the therapeutic effects of the two groups were observed.
Results: After a period of nursing, the patients in the observation group were significantly higher in medication compliance and satisfaction with hospital care than those in the control group. The patients in the observation group were 100% satisfied with high-quality nursing interventions, and their rehabilitation was also significantly better than that in the control group, P
Conclusion: Nursing intervention can improve the compliance of elderly hypertensive patients with drugs, reduce the occurrence of side effects and stabilize patients' emotions, which is worthy of clinical promotion.
The elderly are prone to all kinds of chronic diseases, including hypertension, and the incidence of the elderly has its particularity. Understanding the incidence and clinical characteristics of hypertension in the elderly is very important for correct medication to improve curative effect and timely prevention and treatment of complications. From April 20 13 to April 20 14, 72 elderly patients with hypertension were randomly selected for nursing. The report is as follows.
Clinical data and methods of 1
1. 1 general information. From April 20 13 to April 20 14, 72 elderly patients with hypertension admitted to our hospital were randomly divided into two groups, including 36 male patients and 6 female patients 16, with an average age of 65.82? 3.78 years old. In the control group, there were 36 male patients (19) and 7 female patients (60-76 years old with an average age of 64.86? 3.65 years old, there is no obvious difference in age, sex and disease between the two groups, P & gt0.05, comparable.
1.2 method. All patients were randomly divided into observation group and control group. Patients in the control group were given routine nursing measures, while patients in the observation group were given nursing intervention on the basis of the control group. The therapeutic effects of the two groups were compared.
1.3 statistical processing. Statistical software SPSS 18.0 was used to sort out and statistically analyze the collected data, and chi-square test was conducted, P
2 nursing
2. 1 ordinary care.
2. 1. 1 rest. Elderly hypertensive patients without complications should pay attention to the combination of work and rest, avoid excessive tension and fatigue, and ensure adequate sleep. Patients should be encouraged to take part in various activities within their power, such as walking, playing Tai Ji Chuan and practicing Qigong. Patients with complications should rest properly according to their condition.
2. 1.2 diet. It is advisable to enter a low-salt and low-fat digestible diet; Try to eat less foods rich in cholesterol, such as animal offal, animal fat, cream, fish eggs, etc. Avoid alcohol and tobacco; Obese people should control calories properly to lose weight.
2. 1.3 Observe the condition. Measure your blood pressure regularly every day. For elderly patients with continuously rising blood pressure, blood pressure should be measured 3-4 times a day. When necessary, blood pressure should be measured in standing, sitting and lying position respectively, and recorded carefully to grasp the changing law of blood pressure in time. Elderly patients with hypertension are prone to serious complications such as cerebrovascular accident and heart failure. Therefore, patients with unstable and rapidly rising blood pressure should be closely observed, and symptoms such as mental change, numbness of limbs, severe headache, blurred vision, nausea and vomiting should be dealt with in time. When elderly hypertensive patients get up in the morning or get up at night to urinate, they should prevent cerebral ischemia, especially those taking vasodilators and angiotensin converting enzyme inhibitors. Therefore, elderly hypertensive patients should move slowly before getting up every time to prevent cerebral ischemia.
2.2 medication care. Older people are sensitive to drugs and are prone to adverse reactions after taking them. Therefore, it is necessary to closely observe the reaction of various antihypertensive drugs, and the blood pressure should not be too fast or too low to avoid insufficient blood supply to various organs or postural hypotension.
2.3 Psychological care. Hypertension is a chronic disease that needs long-term treatment. Only by mobilizing patients' subjective initiative and cooperating with treatment measures can we get good results. Especially in elderly patients with hypertension, there are often emotional reactions such as anxiety, depression and excitement, which in turn will promote the increase of blood pressure and form a vicious circle. Therefore, we should care about patients, make their lives stable and full of emotions, and try our best to keep their blood pressure at a normal or near-normal level.
2.4 Nursing care of hypertensive crisis. Any type of hypertension disease, due to some reason, makes the blood pressure suddenly rise, the condition changes sharply, and endangers the patient's life, which is called hypertension crisis. Hypertensive crisis is a medical emergency and should be rescued in time.
Three results
After a period of nursing, the medication compliance and satisfaction with hospital care in the observation group were significantly higher than those in the control group. The satisfaction of patients in the observation group with high-quality nursing intervention measures was 100%, and the rehabilitation situation was obviously better than that in the control group, P
Table 1 Comparison of medication compliance between two groups
Note: Compared with the control group, P
4 discussion
The treatment of hypertension in the elderly should follow the principle of individualization, and consider many factors such as risk factors, target organ damage, drug tolerance, adverse reactions and so on. It should be considered and treated reasonably and effectively to minimize the total risk of cardiovascular disease and death. The purpose of treatment for elderly patients with hypertension is to reduce peripheral vascular resistance, improve cardiac output, protect renal function, avoid the harm of postural hypotension and drug-controlled hypotension, pay attention to the quality of life, and emphasize non-drug treatment. Elderly patients with hypertension advocate combined medication, and give full play to the synergistic effect of different drugs to improve the curative effect and reduce the adverse reactions caused by a single dose increase, so as to better cope with various treatment contradictions caused by complications of elderly patients [4]. Elderly patients with hypertension often suffer from multiple chronic diseases at the same time. When choosing antihypertensive drugs, we should pay attention to the interaction between antihypertensive drugs and other drugs. The data of this group show that nursing intervention can improve the compliance of elderly patients with hypertension with drugs, reduce the occurrence of side effects and stabilize patients' emotions, which is worth popularizing in clinic.
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