INTRODUCTION

A. Background Hypertension

Hypertension has no specific cause but multi-factor as a response to increased cardiac

output or the peripheral pressure. Factor - factors that affect the two forces are: Genetic, Obesity,
Stress environment. Loss of elastic tissue and arteriosclerosis of the aorta and other large arteries.
Secondary hypertension may be as a result of a wide - range of primary causes.

Triggering factors of hypertension can be divided into two:

1. Over that can not be controlled (such as obesity, lack of exercise, smoking, and alcohol
consumption and salt).

2. And that can be controlled (such as heredity, gender, and age) and salt).

B. Objectives

1. To improve knowledge about hypertension, causes, signs and symptoms, investigation,

treatment and prevention.

2. Reviewing, Creating Planning, Implementing, and Evaluating cases of hypertension in the

form of nursing care.

C. Problem Formulation

1. Knowledge of hypertension, fundamentally.

2. The definition, etiology, pathophysiology, clinical manifestations, investigations, pathway,

hypertension disease management, diagnosis and intervention.

3. Nursing care on hypertension

A. DEFINITION OF HYPERTENSION

Hypertension is defined as blood pressure that persistent systolic pressure above 140 mmHg
and diastolic above 90 mmHg. The aging population, hypertension is defined as systolic pressure of
160 mmHg and a diastolic pressure of 90 mmHg. (Smeltzer, 2001) According to WHO (1978), the
blood pressure at or above 160/95 mmHg expressed as hypertension. Hypertension is the increase of
the diastolic pressure above the standard associated with age. (KDP dep. Kes 1993) Hypertension is
blood pressure levels where complications may arise is real. (Soeparman and we Sarwono 1990)
Hypertension is a person who has a systolic blood pressure above 160 and diastolic pressure above
95mmhg. (dr. Boedi Warsono 1979) Type - Type of Hypertension Hypertension is often called the
silent disease. Generally, people do not know he suffered from hypertension before his blood
pressure checked. This disease is also known as heterogeneous group of disease because they can
menyeang anyone from different age groups and socio-economic groups. Hypertension can be
grouped into two broad categories, namely:

a. Primary hypertension means hypertension, unexplained clearly. A variety of factors

thought to play a role as a cause of primary hypertension, such as: v Increasing age, psychological
stress v, v and heredity (ancestry). Approximately 90 percent of patients with hypertension is
estimated to fall into this category.

b. The second class is the cause of secondary hypertension may be said to have been bound,
for example: v The kidneys are not functioning, use of oral contraceptives v, v and the disruption of
hormone balance is a factor regulating blood pressure.

The division of hypertension according to (media aeuscolopis FKUI 1982)

a. Mid Hypertension: diastolic pressure 90-110 mmHg

b. Modessatif Hypertension: diastolic blood pressure 110-130 mmHg

c. Severe Hypertension: diastolic blood pressure> 130 mmHg Classification Hypertension v

Hypertension Systolic is the exaltation tekana systolic tampa followed by elevation of the
diastolic pressure, and the criteria if the elevation of pressure> 2x reduced diastolic blood pressure
15mmhg, tampa followed by elevation of pressure diastolic or systolic blood pressure of more than
2x diastolic pressure if the diastolic pressure does not exceed 90mmHg. (Soeparman & Sarwono,
1990) or are Systolic blood pressure when the heart pumps blood into the arteries (when the heart
contract). v diastolic hypertension is very rare and only seen with mild elevation of the diastolic
pressure, for example 120 / 100mmHg and is commonly found in children - children and young
adults. (H. Tagor G.M 1997). Or Diastolic blood pressure is when the heart expands and blood
sucking back (arteries deflate empty). v Malignant hypertension is severe hypertension, which if not
treated, akan menimbulkan death within 3-6 months. Clinically degree of hypertension can be
classified in accordance with the recommendations of "The Sixth Report of the Join National
Committee, Prevention, Detection and Treatment of High Blood Pressure" (JNC - VI, 1997) as follows:
No. Category Systolic (mmHg) Diastolic (mmHg)
1. Optimal <120 <80 span = "span">

2. Normal 120-129 80-84

3. High Normal 130-139 85-89

4. Hypertension Grade

1 (mild) 140-159 90-99 Grade

2 (moderate ) 160 - 179100-109 Grade

3 (severe) 180-209100 - 119 Grade

4 (very severe)> 210> 120

The classification of blood pressure according to the Joint National Committee, On Detection,
Evaluation, And Treatment Of High Blood preassure Th 1993. Category Systolic (mmHg) Diastolic
(mmHg)

B. Etiology

Primary hypertension has no specific cause but multi-factor as a response to increased

cardiac output or the peripheral pressure. Factor - factors that influence these two forces are: v
Genetic Obesity v v v Loss of environmental stress elastic tissue and arteriosclerosis of the aorta and
other lar) And ge arteries. Secondary hypertension may be as a result of a wide - range of primary
causes. Causes in general: The triggering factors of hypertension can be divided into two: 1) On
which can not be controlled (such as obesity, lack of exercise, smoking, and alcohol consumption and
salt). 2 that can be controlled (such as heredity, gender, and age) and salt).

C. Pathophysiology

mechanism of hypertension is through the formation of angiotensin II from angiotensin I by

angiotensin I-converting enzyme (ACE). ACE holds an important physiological role in regulating blood
pressure. Blood contains angiotensinogen produced in the liver. Furthermore, by hormones, renin
(produced by the kidney) will be converted into angiotensin I. By ACE contained in the lungs,
angiotensin I is converted into angiotensin II. Angiotensin II is this which has a key role in raising
blood pressure through two main actions. The first action is to increase the secretion of antidiuretic
hormone (ADH) and thirst. ADH is produced in the hypothalamus (the pituitary gland) and acts on
the kidneys to regulate the osmolality and urine volume. With the increased ADH, very little urine
excreted out of the body (antidiuresis), so that it becomes thick and high osmolality. For dilution,
extracellular fluid volume will be increased by withdrawing fluid from the intracellular part. As a
result, increased blood volume, which in turn increases blood pressure. The second action is to
stimulate the secretion of aldosterone from the adrenal cortex. Aldosterone is a steroid hormone
that has an important role in the kidney. To adjust the volume of extracellular fluid, reduces
aldosterone excretion of sodium chloride (salt) by way mereabsorpsinya of the renal tubules. Rising
concentrations of NaCl will be diluted by increasing the extracellular fluid volume which in turn will
increase the volume and blood pressure. Blood pressure is determined by two factors: the flow of
blood and blood resistant. Arterial blood pressure equal to the pressure cardiac output. tkanan
increased blood will lead to increased detention vaskulerperifer, increases cardiac output when
vasoconstriction decreases blood flow to the kidneys. This is because the secretion of angiotensin
renindan form will lead to increased secretion of aldosterone causes retention of water and sodium
in the kidneys. As a result, an increase in extra cellular fluid volume. Increasing the volume of
extracellular fluid causes increased cardiac output and increased arterial pressure. The sympathetic
nervous system also controls blood pressure by non pineptin in situations setress primary causes
vasoconstriction usually begin with increased blood pressure in intermeffen and other things that
sustain increased blood pressure are usually asymptomatic.

D. CLINICAL

Increased blood pressure sometimes - sometimes the one - the only symptom of
hypertension and depending on high or low blood pressure, symptoms are different - different
sometimes without symptoms hypertension runs and stone symptoms after complications in target
organs such as the kidneys, eyes , brain, and heart. Clinical symptoms of people with hypertension as
follows:

1) symptoms due to raised blood pressure.

a. Occipital headache, especially in the morning

b. Pounding - pounding

c. Easily tired

d. Epitaksis

e. Migraine

f. Difficulty sleeping

2) symptoms - symptoms of target organ complications.

a. Kidney: the possibility arises of chronic kidney failure.

b. Eye known as Hypertension retineae which bradenya by keith w, as follows:

Brade 1: narrowing / spasma of blood vessels. Brade 11: crossing phenomena Brade
111: Brade bleeding exudation at 1V: pupil edema.

c. V Hypertrofi heart and left ventricular dilatation. v systolic ejection nuts - nuts due
Crummy v v cardiac ischemic heart disease.

3) Symptoms - symptoms in general.

a. dizziness

b. flushing,

c. headache

d. bleeding from the nose suddenly

 E. Investigations

Various checks are routinely done as the work-up of patients with hypertension are as
follows:

1. Examination of urine, which includes: a. Albumin b. Reduction c. Sediment d. Urine culture

(when da signs of infection gental uru). e. BD urine

2. Blood tests, which include: a. Hb to see the presence of anemia. b. BUN, serum creatinine
to see the damage to the kidneys c. Colesterol and trigiseda in case of hypertension as a predisposing
factor. d. Glucose to see hyperglikemia because DM is the originator of hypertension

3. ECG examination, which includes: a. Is there a heart hypertrofi b. Are there any signs -
signs of cardiac ischemia. c. Is there a sign - a sign eritmia.

4. Examination of the thorax, which includes: a. Is there any enlargement of the heart b. Is
there a sign - a sign of lung

5. Examination funduscopy To see signs of hypertensive retinopathy.

6. Examination of IVP on indications as follows: a. Age <25 years, diastolic blood pressure>
110 mm Hg b. Age> 25 years, diastolic blood pressure> 130 mmHg. c. There is no response to the
drug. d. Hypertension is marked with a sign - a sign of kidney disease.

F. MANAGEMENT

1. Prevention

a. Life style Hypertension can be prevented by setting a good diet and enough physical
activity. Changes in diet leads to a dish prepared meal that contains fat, protein, and high salt but low
in dietary fiber (dietary fiber), a consequence of the development of degenerative diseases (heart
disease, diabetes, various cancers, osteoporosis and hypertension. Settings menu for patients
hypertension can be done in four ways.

1) The first is a low-salt diet, which consists of a light diet (consumption of salt from 3.75 to
7.5 grams per day), medium (1.25 to 3.75 grams per day) and weight (less than 1.25 grams per day).
2) The second method, a diet low in cholesterol and fat is limited.

3) The third way high-fiber diet.

4) And fourth, a diet low in energy (for those who are overweight

b. Threshold Sense As mentioned previously, sodium plays an important role against the
onset of hypertension. Sodium and chloride are the major ion extracellular fluid. Consumption of
sodium excess causes sodium concentration in the fluid extracellular increase. For menormalkannya,
the intracellular fluid is pulled out so that the volume of extracellular fluid increases. The increase in
the volume of extracellular fluid causes increased blood volume, which leads to the onset of
hypertension. Therefore, it is advisable to reduce the consumption of sodium / sodium. The source
of sodium / sodium primary is sodium chloride (salt), food seasoning (monosodium glutamate =
MSG) and sodium carbonate. The consumption of salt (containing iodine) recommended no more
than 6 grams per day, equivalent to one teaspoon. In fact, excessive consumption due cooking
culture of our society are generally wasteful use salt. Our taste buds since childhood has been taught
to have a high threshold for salty taste, so it is difficult to accept the food was rather tasteless. Salt
intake is difficult to control, especially if we are accustomed to eating meals outside the home (cafes,
restaurants, hotels, etc.). A source of sodium which also needs to be watched is derived from food
seasoning (MSG). Cultural use of MSG has reached an alarming level. Almost all the housewives, food
vendors, and providers of catering services always use it. Use of MSG in Indonesia has been so freely,
so sellers meatballs, chicken porridge, soup, and others, arbitrarily add it to the bowl without a clear
dose.