Nursing diagnosis and some physiological signs and their changes during the
Arterial Hypertension
Azjargal.B1, Batsereedene.B2, Naranchimeg.S2, Zevgee.T1
School of Nursing, MNUMS1-2
Azjargal.b@mnums.edu.mn
Abstract:
Background:In socialist Mongolia nurses learned to do nursing procedures, like injections,
distribution oral medicines, skin care, wound care, bed care, ets. Prevalence of non
communicable diseases in Mongolia dictate the implementation of new nursing system
with 5 stage of nursing activities.
Objective:To learn the current situation of nursing activities during the hypertension, aids
and services among the nurses who are working at the hospitals and family clinics of
provinces and districts in capital city.
Results:Nurses with Bachelor degree who are working in province, district hospitals have
more knowledge about 5 stages of nursing activities, compared with nurses with nursing
diploma
(P<0.05). Hospital nurses have more knowledge about 5 stages of nursing
activities, compared with nurses who worked in family clinics and outpatient settings. Most
nurses provide assessment of hemodynamic changes, like blood pressure, pulse,
respiratory rate, edema of patients with hypertension, but very rare they assessed the risk
factors, psychosocial, family factors of hypertension. Most nurses not enough made
nursing diagnosis, nursing planning, education, evaluation, because of poor assessment
stage of nursing. Patients with hypertension just received medicine from nurses and not
educated about risk factors, no stimulation to fight with smoking, unhealthy diet.
Conclusion: 1. It is understandable that, nursing diagnosis based on subjective and
objective methods of patients’ assessment. Assessment made by nurses with bachelor
degree is different from assessment made by ordinary nurses (P<0.05).
2. Assessment made by asking questions, physical examination of patients with arterial
hypertension mostly defined symptoms of functional dysfunction of cardiovascular system
like dyspnoea, edema, chest pain, peripheral cyanosis, hypertrophy left ventricular, and
these symptoms can be theoretical and methodological aspects of nursing diagnosis.
3. Symptoms, first and secondary risk factors of arterial hypertension defined by laboratory
investigations, asking questions, physical examination (increased level of blood sugar,
cholesterol, triglycerides, decreased level of LDLP, increased systolic and diastolic blood
pressure). These findings can be theoretical and methodological aspects for nursing
diagnosis.
Key words: Nursing process, assessment, diagnosis, planning, implementation,
evaluation.
Background:
Besides nursing is the medical and independent science, nursing care and service is being
performed according to own specifc principle, rule and technology as well as the nursing
science has developed depending on socioeconomic changes. The nursing science has
just delievered the health care for ill people though, in present it pays attention healthy
people and prevent them from diseases. For last few decades the population sickness rate
has been altering through the way that increasing number of patients who have
noncommunicable disease such as, wrong living habits, inappropriate diet, lack of
movement and related to smoking and alcoholics as well as noncommunicable diseases
are playing imajor role for mortality rate caused by primary (inappropriate diet, lack of
movment, cigarette and alcoholic drinks) and additional factors (overweight, hypertension,
hyperlipidaemie, glusoemia) and all these are taking account of nursing science[1].
The goal of the study:
The goal of study is to define the relation between nursing diagnosis and some
physiological (hemodynamic) changes during arterial hypertension and diabetes.
The objectives of the study:
1. To provide survey within nurses who work in the district hospital and family health
centers by questionnaire about 5 stages of nursing activities during nursing care of
patients with arterial hypertension and diabetes.
2. To provide study of 5 stages of nursing activities, nursing diagnosis and some
hemodynamic changes within patients with arterial hypertension cared in cardiology
department using patients’ chart and nurses’ notes in the chart.
3. To develop nursing diagnosis and methodological purposes by collecting complains,
symptoms, objective data, risk factors, results of investigations from the chart of patients
with arterial hypertension treated in the cardiology department.
Materials and methods of study :
Descriptive cross-section study:We prepared questionnaire about 5 steps of nursing
activities for completing by nurses, who work in the district hospitals and family health
centers and we collected information from this. We used SPSS17 program for analyzing
results of survey. Collection of patients chart information made in April 2011, collection of
nursing notes made in September 2012. 93 nurses were involved in the study aged
between 21-59 and 3 (3,2%) of them male, 90 (96,8%) of them female and 43 were
bachelor of nursing science and 50 had nursing diploma. We used questionnaire for
nursing procedure and formulated by analytical cross-sectional study. The survey was
formulated in SPSS 17, EXCEL program and result was expressed as t test and pvalue.
Statistic evaluation has been done when p<0,05 by x2 is considered more probability.
Study results:
Table.1. Nurses’ position status
Nursing education
Position
(III)
(II)
(I)
n (%)
n(%)
n (%)
Total
Bachelor nurse
30 (32.3)
7 (7.5)
6 (6.4)
43 (46.2)
Diploma nurse
16 (17.2)
16 (17.2)
18 (19.3)
50 (53.7)
Total
46 (49.5)
23 (24.7)
24 (25.7)
93 (100)
As we seen the figure, 46 (48,8%) nurses work in the state hospital, 23 (24,4%)
nurses in the district hospital and 23 (26,8%) nurses work in the family health center.
53,7% of them have diploma education and 46,2% were baccalaureate. 87% of nurses
who works in the state and district hospital and 13% in the family health center are
baccalaureate. As level of education, baccalaureates are dominating in the state or district
hospitals. (X2f=5.45>X2st=3.84 K=1 P < 0.05)
Table.2. Nursing care assessment of Diabetes and Arterial hypertension
Nursing education
Total
Assessment indicator
Bachelor
Diploma
n(%)
n(%)
n(%)
Ask about disease
42 (45.2%)
44 (47.3%)
86 (92.5%)
Observation
14 (15%)
13 (13.9%)
27 (28.9%)
Measure blood presuure
42 (45.2%)
44 (47.3%)
86 (92.5%)
Measure temperature,
36 (38.7%)
44 (47.3%)
80 (86%)
breath and pulse
Measure weight and height
29 (31.2%)
36 (38.7%)
65 (69.9%)
Palpation
13 (13.9%)
15 (16.1%)
28 (30.1%)
Auscultation
11 (11.8%)
11 (11.8%)
22 (23.7%)
Percussion
27 (29%)
17 (18.3%)
44 (47.3%)
According to the 5 stages of nursing activities, 42 (45,2%) of baccalaureate nurses
measured blood pressure and 36 (38,7%) body temperature, 29 (31,2%) of them counted
breath and pulses, 13 (13,9%) measured weight and height, 27 (29%) done percussion
and 11 (11,8%) auscultation. Identification of vital signs (hemodynamic status) was
particularly similar depend on baccalaureate and diploma nurses (P=0,05). However, body
examination was different baccalaureate nurses from diploma nurses (P>0,05).
Table.3. Nursing diagnosis during Diabetes mellitus and Arterial hypretension (II
stage)
Nursing diagnosis of the
Total
NANDA
Bachalavr Diploma
Х²
Р value
Vital signs (Hemodynamic
indicator) :
Changes in blood pressure
33 (35.4%)
36 (38.7%)
69 (74.1%)
Change of blood vessel
26 (27.9%)
27 (29%)
53 (56.9%)
Heart disorder
28 (30.1%)
25 (26.9%)
53 (57%)
Edema
Disorder and symptoms:
Insomnia
12 (12.9%)
18 (19.3%)
30 (32.2%)
12 (12.9%)
21 (22.5%)
33 (35.4%)
Nausea
18 (19.3%)
12 (12.9%)
30 (32.2%)
Fever
9 (9.6%)
9 (9.6%)
18 (19.2%)
Weakness
18 (19.3%)
22 (23.6%)
40 (42.9%)
Anxiety
Risk factors :
19 (20.4%)
22 (23.6%)
41 (44%)
Smoking
6 (6.4%)
14 (15%)
20 (21.5%)
Drink alcohol
27 (29%)
30 (32.2%)
57 (61.2%)
Movement changes
16 (17.2%)
14 (15%)
30 (32.2%)
Lack of knowledge
9 (9.6%)
8 (8.6%)
17 (18.2%)
Change in social
communication
Change of intelligence
4 (4.3%)
11 (11.8%)
15 (16.1%)
3 (3.2%)
12 (12.9%)
15 (16.1%)
Verbal changed
4 (4.3%)
11 (11.8%)
15 (16.1%)
8.9
P<0.05
21.9
P<0.05
14
P<0.05
5.5
P<0.05
Psychosocial needs:
As we seen the figure 2, nurses made 4 diagnoses for hemodynamic signs, 5 for disorders
and symptoms, 4 for risk factors and 3 for psychosocial need respectively. It identifies that
beyond the changes of organ system, individual need and risk factors are influencing on
diagnosis.
Table.4. Planning and impelementation of nursing activity on I-III level of
Diabetes and Hypertension (III-IY Stages)
Nursing care and service
Level of hypertension
II level
III level
n
%
n
%
93
100%
93
100%
27
29.0%
27
29.0%
29
31.1%
29
31.1%
13
13.9%
15
16.1%
n
93
25
27
11
I level
%
100%
61.0%
65.9%
26.8%
22
19
0
0
53.7%
46.3%
0.0%
0.0%
24
21
2
0
25.8%
22.5%
2.1%
0.0%
24
26
51
37
25.8%
27.9%
54.8%
39.7%
Wash the body
Recommend take medicine
permanently
0
12
0.0%
12.9%
0
27
0.0%
29%
0
52
0.0%
55.9%
Recommend healthy diet
Recommend to relax
Suggestion for bad habits
Recommend to do exercise
advice “Stress”
27
26
3
2
25
65.9%
63.4%
3.2%
2.1%
26.8%
28
28
3
3
28
30.1%
30.1%
3.2%
3.2%
30.1%
28
30
24
21
29
30.1%
32.2%
25.8%
22.5%
31.1%
Treating with medicine
Check vital signs every 4h
Control liquid balance
Measure weight before
breakfast
Put warm compress
Check edema
Semi-sitting position and kept
Provide oxygen
As we seen the figure, even though nurses give medicine 100% at any stage of
hypertension, patient care has been done unlikely depend on stages for patients. Only in 1
day, due to many kind of injections are gave frequently, proper nursing care could not be
provided for the patients because of inadequate time as well as it is statistically similar
(P<0,001) comparing to other researchers’ work.
Table.5. Evaluation stages for nursing activity
Evaluation indicators for result
Ask about disorder
Observation
Examination
Identification of additional disorder
n
31
33
22
23
(%)
(33.3%)
(35.5%)
(23.6%)
(24.7%)
Assess the diagnosis
Assess the planning
Assess the implementation
3
5
5
(3.2%)
(5.3%)
(5.3%)
Patient improvement
Normal health status
7
0
0
33
(7.5%)
0%
0%
(35.4%)
Write down on nursing card
2. During the study collected from the nursing chart and nurses notes we defined that
nurses diagnosed in 57.4% of patients with arterial hypertension edema, in 43.3%
dyspnoea, in 14.6% chest pain, in 5.9% palpitation, in 1.4% cough, in 1.5% blooding from
nose, in 1.5% confusion, 1.5% restricted movement. It shows that nurses mostly
diagnosed some hemodynamic changes during the hypertension, but not diagnosed main
criteria of hypertension.
3. During the study collected from the hospitals chart patients’ and nurses notes we
determined that nurses diagnosed by asking questions in 21.7% of patients with arterial
hypertension dyspnoea, in 63% chronic headache and posterior neck pain, in 17.2%
blurring vision , in 17.2% , in 8.7% fatigue, 11.3% anxiety, 17.2% sleep disorder, by
physical examination defined hemodynamic changes like increasing systolic pressure in
male patients up to 172.21±0.07, in female patients up to 168.04±2.14, increasing
diastolic pressure in male patients up to 104.09±0.009, in female patients up to 105±1.32.
It means that increasing both, systolic and diastolic pressure, tachycardia in 15.1%,
palpitation in 17.2%, edema in 6.5%, peripheral cyanosis, in 8.7%, changes papilla by
ophthalmoscope in 6.5%, pale of skin and mucous membrane in 15.2%, cardiac
hypertrophy by the left ventricular in 19.6%. Next primary risk factors determined, like
alcohol consumption in 43.3% of patients, tobacco use in 60.8%, non healthy diet in
56.5%, over weight in 26%, obesity in 36.9% of patients. By laboratory investigation
determined physiological risk factors like increased cholesterol in 96.5%, decreased
LDLP in 57.1%, increased triglycerides in 92%, increased blood sugar in 21.9% were
different within male and female. These findings can be theoretical and methodological
aspects for nursing diagnosis.
Discussion:
46,2% of baccalaureate nurses have been participated in our study and it shows
that there is need to train nurses as baccalaureate to improve quality of nursing care
when comparing to the study by S.Naranchimeg and others (2). Nurses’ average age
was 38.8± 8.2 and it was likely result of study by B.Davaakhuu and others (3). In that
study, nurses’ average age was 41.2±2.1 (P<0.05). When we studied nursing care of
implementation stage of the nursing activity, medicine treatment or give injection were
given dominately and its result was similar to the survey by Sh.Tsermaa and others. It
shows (Р<0.001) that only in a day, due to many kind of injections are given frequently,
proper nursing care could not be provided for the patients because of inadequate time
[4].
Conclusion:
1. It is understandable that, nursing diagnosis based on subjective and objective
methods of patients’ assessment. Assessment made by nurses with bachelor degree is
different from assessment made by ordinary nurses (P<0.05).
2. Assessment made by asking questions, physical examination of patients with arterial
hypertension mostly defined symptoms of functional dysfunction of cardiovascular
system like dyspnoea, edema, chest pain, peripheral cyanosis, hypertrophy left
ventricular, and these symptoms can be theoretical and methodological aspects of
nursing diagnosis.
3. Symptoms, first and secondary risk factors of arterial hypertension defined by
laboratory investigations, asking questions, physical examination (increased level of
blood sugar, cholesterol, triglycerides, decreased level of LDLP, increased systolic and
diastolic blood pressure). These findings can be theoretical and methodological
aspects for nursing diagnosis.
4. The result of this study shows that we have to cooperate and work productively with
team of doctors and nurses for implementing nursing care, nursing activities and
nursing diagnosis.
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