Nursing Diagnosis for Hypertension: imbalanced Nutrition: More than Body Requirements related to excessive intake in relation to metabolic need, sedentary activity level and lifestyle, cultural preferences
Possibly evidenced by
Weight that is 10% to 20% more than ideal for height and frame
Triceps skinfold that is more than 15 mm in men and 25 mm in women, the maximum for age and sex
Reported or observed dysfunctional eating patterns
Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Treatment Regimen
Identify correlation between hypertension and obesity.
Demonstrate change in eating patterns, such as food choices and quantity, to attain desirable body weight with optimal maintenance of health.
Initiate and maintain individually appropriate exercise program.
Nursing Care Plan Intervention and Rationale:
1. Assess client’s understanding of direct relationship between hypertension and obesity.
Rationale: Obesity is an added risk with hypertension because of the disproportion between fixed aortic capacity and increased cardiac output associated with increased body mass. Reduction in weight may reduce or eliminate the need for drug therapy needed to control BP. Note: Recent research suggests that bringing weight within 15% of ideal weight can result in a drop of 10 mm Hg in both systolic and diastolic BP (Khan et al, 2004).
2. Discuss necessity for decreased caloric intake and limited intake of fats, salt, and sugar, as indicated.
Rationale: Faulty eating habits contribute to atherosclerosis and obesity that can predispose to hypertension and subsequent complications, such as stroke, kidney disease, and heart failure. Excessive salt intake expands the intravascular fluid volume and may damage kidneys, which can further aggravate hypertension.
3. Determine client’s desire to lose weight.
Rationale: Motivation for weight reduction is internal. The individual must want to lose weight or the program most likely will not succeed.
4. Review usual daily caloric intake and dietary choices.
Rationale: Identifies current strengths and weaknesses in dietary program. Aids in determining individual need for adjustment and teaching.
5. Establish a realistic weight reduction plan with the client, such as weight loss of 1 pound per week.
Rationale: Slow reduction in weight is associated with fat loss with muscle sparing and generally reflects a change in eating habits.
6. Rationale: Encourage client to maintain a diary of food intake, including when and where eating takes place and the circumstances and feelings around which the food was eaten.
Rationale: Provides a database for both the adequacy of nutrients eaten and the relationship of emotion to eating. Helps focus attention on factors that client can control or change.
7. Instruct and assist client in appropriate food selections, such as implementing a diet rich in fruits, vegetables, and lowfat dairy foods referred to as the Dietary Approaches to Stop Hypertension (DASH) diet. Help the client identify—and thus avoid—foods high in saturated fat, such as butter, cheese, eggs, ice cream, and meat, and those that are high in cholesterol, such as whole dairy products, shrimp, and organ meats.
Rationale: Moderation and use of low-fat products in place of total abstinence from certain food items may prevent client’s sense of deprivation and enhance commitment to achieving health goals. Avoiding foods high in saturated fat and cholesterol is important in preventing progressing
atherogenesis. The DASH diet, in conjunction with exercise, weight loss, and limits on salt intake, may reduce or even eliminate the need for drug therapy in early stages of
hypertension (Elmer et al, 2006).
8. Refer to dietitian or weight management programs, as indicated.
Rationale: Can provide additional counseling and assistance with meeting individual dietary needs.