THE ENGLISH-LANGUAGE PAPER NURSING

"hypertension"

Supervising Professors: rottumadasih,sst

By :

GROUP 9

1. DAIYAN ILA AQWAMI THORIQ (201601011)

2. DHENEL GUSFIRNANDOU (201601014)

3. DIKI IRVANDA NUR ARIFIN (201601017)

4. DISA WALIYATUL FIRDAUS (201601020)

5. NOFI PERMATASARI (201601046)

IIA

THE NURSING ACADEMY OF PONOROGO

JL. CIPTOMANGUNKUSUMO No. 82A, PONOROGO
2016/2017

1
 THE FOREWORD

our Praise IS over the presence of the Almighty God WHO has given wisdom and his
guidance over the completion this paper writing entitled "hypertension”This paper is
structured to fulfill courses" English nursing ".
In writing this paper we experienced a lot of obstacles and difficulties. However, thanks
to the help of all support, SO we can complete this paper. We also thank the various support
who have helped and gave a briefing as well as support to us, especially to:
1. Lecturer OF English nursing I courses in nursing i.e.rottumadasih,ss the person in
charge of courses.
2. Our parents ' loyal support to complete this paper.
3. Friends who always give support in order to finish this paper.
We realize that in the writing of this paper there are many flaws and far from perfection.
Therefore, we accept all the criticisms and suggestions of improvement for the sake of
building handouts.
Finally, with all the limitations, we hope that this paper may be useful for readers in General

compiler

Ponorogo, July 2017

2
 TABLE OF CONTENTS

COVER ...................................................................................................................... 1

THE FOREWORD .................................................................................................... 2

TABLE OF CONTENTS ........................................................................................... 3

CHAPTER 1 INTRODUCTION
A. Background ........................................................................................ 4
B. Formulation of the problem................................................................ 4
C. Objectives and Benefits ..................................................................... 4

CHAPTER II DISCUSSION
A. Definition of hypertensi ..................................................................... 5
B. Epidemiology ..................................................................................... 6
C. Signs and symptoms ........................................................................... 7
D. Etiology .............................................................................................. 7
E. Pathogenesis ....................................................................................... 7
F. Clinical Symptoms ............................................................................. 9
G. Diagnosis ............................................................................................ 10
H. Treatment ........................................................................................... 13
CHAPTER III CLOSING
A. Conclusion .......................................................................................... 16
B. advice ................................................................................................. 16
BIBLIOGRAPHY

3
 CHAPTER I

INTRODUCTION

A. Background
in industrialized countries hypertension is one of the major health problems. in
indonesia hypertension is also a health prolem that needs to be noticed by doctors who
work at primary health care because of its high prevalence rate and the long-ther
consequences it brings. until now hipertension still remains a problem for several
reasons,among other increased prevalence of hypertension, there are still many
patients with hypertension who have not received treatment nor who has been treated
but blood pressure has not reached the target, and the presence of comorbidities and
compication that can improve mortility and morbidity.

B. Formulation of the problem

On our discussion in this paper we will slightly limit problemof will be
discussed. Of which:
1. What Definition of hypertensi?
2. How Epidemiology of hypertensi?
3. How Signs and symptomsof hypertensi?
4. How Etiology of hypertensi?
5. How Pathogenesis of hypertensi?
6. How Clinical Symptoms of hypertensi?
7. What Diagnosis of hypertensi?
8. How Treatment of hypertensi?
C. Objectives and Benefits
1. Describe Definition of hypertensi
2. Describe Epidemiology of hypertensi
3. Describe Signs and symptoms of hypertensi
4. Describe Etiology of hypertensi
5. Describe Pathogenesis of hypertensi
6. Describe Clinical Symptoms of hypertensi
7. Describe Diagnosis of hypertensi
8. Describe Treatment of hypertensi

4
 CHAPTER II

DISCUSSION

A. definition of hypertensi

High blood pressure or hypertension is a medical condition in which the an

increase in blood pressure in chronic (long term). Sufferers who have at least three
blood pressure readings exceeding 140/90 mmHg at rest is estimated to have a State
high blood. Blood pressure is always high is one of the factors of risk for stroke, heart
attack, heart failure and arterial aneurysm, and is a major cause of chronic heart
failure.

Restrictions regarding hypertension undergoing developments such as seen

from a different classification of the lot. Kaplan (1985) compiled a classification with
differentiated age and gender.

The classification is a man aged 45 years < expressed hypertension If the

blood pressure at the time of lay 130/90 mm Hg or more, while aged > 45 years
expressed hypertension if pressure blood 145/95 mm Hg or more. While the woman
who had blood teken 160/95 mm Hg or more is revealed of hypertension. diastolic
pressure less than 90 mmHg or diastolic pressure is still in the normal range.

Hypertension is often found in old age. In line with increasing age, almost
everyone is experiencing a rise in blood pressure; systolic pressure continued to rise
until the age of 80 years and the diastolic pressure continued to rise until the age of
55-60 years, then decreased slowly or even declined. In patients with diabetes mellitus
or kidney disease, research has indicates that the above blood pressure 130/80 mmHg
should be considered a risk factor and should be given treatment.

According to The Seventh Report of The Joint National Committtee On

Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
classification of blood pressure in adults are divided into groups of normal,
hypertension degrees 1 and 2 degrees.

5
 Blood pressure Classification chart according to INC 7

Classification Of Blood TDS (mmHg) TDD (mmHg)

Pressure

Normal < 120 < 80

Prahipertensi 120 – 139 80 – 89

Hypertension degrees 1 140 – 159 90 – 99

Hypertension degrees 2 ≥ 160 ≥ 100

TDS = Systolic Blood Pressure, Diastolic Blood Pressure = TDD

B. Epidemiology

Hypertension is a health problem that requires a global response. There are

several factors that affect some of the prevalence of hypertension such as race, age,
obesity, high salt intake, and the presence of hypertension in family history.

In Indonesia, to date there has not been an investigation of the nonprofit

national, multisenter, which can describe the prevalence of hypertension. Many
investigations conducted separately with a raw yet we.

Boedidarmojo in his writings is collected from a variety of research reports

that 1.8 – 28.6% of residents aged above 200 years is hypertensive patients. In
General, the prevalence of hypertension ranges between 8.6 – 10%. The lowest
prevalence expressed that data comes from the village of Kalirejo, Central Java, i.e. of
1.8%, while in the regions of Aceh, Northern Sumatra Arun of 5.3%. Other data
presented Gunawan S, which investigates the society that is isolated in the Baliem
valley, Irian Jaya get hypertension prevalence 0.65%.

6
C. Signs and symptoms
 Headache
 Bleeding from the nose
 Dizziness
 Facial redness and fatigue
D. Etiology

Primary hypertension of unknown cause or idiopathic. But arise due to the

interaction between specific risk factors. Risk factors that encourage the onset of a
rise in blood pressure are:

 Risk Factors such as diet and salt intake, stress, obesity, race, smoking,
genetic.
 Sympathetic dystrophy: nervous system
a. Tonus sympathetic dystrophy
b. Diurnal Variation
 The balance between the modulator vasodilatory and Vascular Endothelial
vasokontriksi: the main role, but the remodeling of smooth muscle,
endothelial, and interstisium also contributes to the end.
 The influence of local endocrine system plays a role in the system of
renin, angiotensin, aldosteron.
E. Pathogenesis

To present knowledge of the pathogenesis of primary hypertension continues

to grow because not obtained satisfactory answers that can explain the occurrence of
increased blood pressure. Blood pressure is influenced by precipitation of the heart
and peripheral custody. Some of the factors that affect the heart and peripheral
custody precipitation will affect blood pressure.

In addition to the bulk of the heart and peripheral custody, actual blood
pressure is influenced also by right atrial pressure. Right atrial pressure therefore
approaches zero, the values do not have a lot of influence.

In the body there is a system function to prevent acute blood pressure changes
caused by impaired circulation, which seeks to maintain the stability of the blood
pressure in the long run. Based on the speed of the reaction, the control system is

7
distinguished in the system which reacts immediately, which reacts less quickly, and
react in the long run. Cardiovascular reflex via the nervous system including control
system that reacts immediately. An example is baroreseptor which is located in the
carotid sinus and aortic arkus function detects changes in blood pressure. Another
example of neural control system against blood pressure acting immediately is
reseptor, the response of the central nervous iskemis order, and reflex that originates
from the atrium, artery pulmonalis, and smooth muscle.

Displacement of fluid between capillaries and interstitial cavities circulation

are in control by angiotensin and vasopressin including control system that reacts less
quickly. Blood in the long term stability is maintained by the system that regulates the
amount of fluid the body involving various organs especially kidney.

So it is seen that the blood pressure control system started by the system reacts
fast followed by a system which reacts less quickly and by the system of its potential
in the long term. Various factors such as genetic factors cause changes in the nyang
kidney and cell membranes, nervous system and the sympathetic dystrophy activity of
renin-angiotensin which affect the State of the hemodynamic, sodium intake and
sodium metabolism in the kidney, as well as factors of obesity and endothelial factors
have a role in the increase of blood pressure in primary hypertension.

The role of genetic factors in primary hypertension is evidenced by the facts

that you found. The existence of evidence that the incidence of hypertension is more
plentiful in patients monozigot than heterozygous twins, if one of them suffers from
hypertension supports the notion that genetic factors influence the onset of haven
hypertension. Animal experiments provide much additional evidence about the role of
genetic factors. Spontaneously hypertensive rats the Japanese rat (SHR), Dahl salt
sensitive (S), New Zealand genetically hypertensive rat (GH), salt resistant (R), and
the Milan hypertensive rat strains (MHS) showed evidence of such. Two rat first
mentioned derivatives have a neurogenik factor genetically derived as an important
factor in hypertension, while two other derivative showed factor sensitivity to salts are
also genetically derived as a major factor in the onset of hypertension.

At an early stage of primary hypertension bulk heart rises while the peripheral
normal prisoner. This situation caused an increase in sympathetic activity. On the next
stage of the bulk of the heart back to normal while in custody on peripheral reflex is

8
 caused by increased due to autoregulasi is the body's mechanism for maintaining the
State of hemodynamic normal. Because the bulk of the heart increases occur
constricting sphincter pre-capillaries resulting in a decrease in precipitation and
elevation of the peripheral custody.

Improvement of the peripheral custody on primary hypertension occurs

gradually in a long time while the autoregulasi process happens in a short time.
Therefore, there were factors other than the presumed factors at play on the
hemodynamic hypertension primer. Definitely not yet known hormonal factors or
anatomical changes that occur in blood vessels that are influential in the process. The
hemodynamic disorder followed structural abnormalities in the blood vessels and
heart. On the blood vessel wall hypertrophy occurs while heart wall thickening occurs
in the ventricles.

F. Clinical Symptoms

The elevation of the blood pressure is not uncommon is the only mark on
primary hypertension. Rely on high blood pressure symptoms that arise can vary.
Sometimes hypertension primer walking without symptoms, and new symptoms after
complications arose on the target organs such as the kidneys, eyes, brain and heart.
Symptoms like headache, epitaksis, dizziness and migraine can be found as the
primary hypertension clinical symptoms though not rarely found without symptoms.
On the investigation of hypertension in Paris, from 1771 poasien untreated
hypertension, symptoms sakiit head first debuted (40.5%), followed by palpitations
(28.5%), nokturia (20.4%), dizziness (20.8%), and at the tinitus (13.8%). On the
investigation has not obtained a correlation between high blood pressure and
symptoms that arise. Survey on hypertension in Indonesia, noted a range of
complaints associated with hypertension.

On the research of a. (Gani and his friends in South Sumatra), dizziness, quick
temper, and ringing ears a symptom frequently encountered, in addition to other
symptoms such as nosebleeds, hard beds and shortness of breath. The invention is not
much different from the Harmaji report and coauthors, who also get complaints of
dizziness, a sense of the weight , and hard and difficult to sleep as the most frequently
encountered symptoms in patients of hypertension. A sense of fatigue and also
encountered angry sooner while the nosebleeds are rarely found. Sugiri and coauthors

9
 report that heavy taste, headache, eye sparkel like fireflies, and difficult to sleep is a
symptom that many found.

Other symptoms caused by complications such as hypertension, impaired

eyesight disorders Neurology, heart failure, and kidney function disorders are not rare.

Heart failure and impaired encountered severe hypertension or hypertension in

maligna generally also accompanied disturbance of kidney function and even kidney
failure. Cerebral disorders caused by hypertension may be due to bleeding symptoms
or spasms of the blood vessels of the brain in the form of paralysis, impaired
consciousness and even coma. The incidence of these symptoms is a sign that the
blood pressure needs to be immediately unloaded.

G. Diagnosis

Evaluation of hypertensive patients had three goals:

1. Identify causes of hypertension

2. Assessing the existence of a target organ damage and cardiovascular
disease, the severity of disease, as well as the response to treatment.
3. identified the presence of cardiovascular risk factors or penyakiit
companion, which determine the prognosis and determine treatment
guide.

Data on the need for the evaluation obtained by means of the anamnesis,
physical examination, laboratory examination, and examination of supporting. In 70-
80% of cases of primary hypertension hypertension history obtained in the family
although it is not yet able to ascertain the diagnosis. Jiak obtained a history of
hypertension on to two parents alleged against burgeoning primary hypertension. The
majority of primary hypertension occurs at the age of 25-45 years and only 20% occur
under the age of 20 years and above 50 years old.

If it is known to have hypertension previously required information about the

treatment that has been obtained, namely about the effectiveness and effects of
smaping drugs. It is necessary to determine the type and dose of medication used.
Information on the drug that is being drunk patients who might be able to cause
hypertension such as the corticosteroids, the monoamin oxidase inhibitor (monoamine

10
oxidase PIs), and the simpatomimetik is indispensable. The habit of eating food that
contains a lot of salt needs to be asked to get apicture of a amount of salt intake in
patients. In women needed information on pregnancy hypertension history, labor
history, eklamsia history and the use of contraceptive pills. Other information
required is about other diseases such as diabetes mellitus suffered, kidney disease, as
well as their risk factors for the occurrence of hypertension such as cigarettes, alcohol,
stress factors, dean weight data. Family history about polycystic kidney disease,
thyroid cancer, feokromositoma, kidney stones, and hyperparathyroidism have to
asked for complete anamnesis.

Examination of hypertensive patients support consists of:

o A routine blood test

o Blood glucose
o Total serum cholesterol
o Serum HDL and LDL cholesterol
o Serum triglycerides
o Serum uric acid
o Serum creatinin
o Serum potassium
o Hemoglobin and hematokrit
o Urinalysis
o Electrocardiogram
Electrocardiogram Some guidelines handling of hypertension recommends other tests
such as:
o An Echocardiogram
o Carotid ULTRASOUND
o C-reactive protein
o Microalbuminuria or comparison of albumin/creatinin
o Quantitative Proteinuria
o Funduskopi

In patients of hypertension, some examination to determine the presence of target

organ damage can be done on a regular basis, while other pemerikasaan are only done

11
when there is a suspicion, supported by patient symptoms and complaints.
Examination to evaluate the presence of target organ damage include:

1. The heart of the

a. Physical examination
b. Photos plain chest (to see the enlargement of the heart, the
condition of the arterial intrathoraks and pulmonary circulation)
c. Electrocardiography (for detection of ischemia, arrhythmias,
conduction disturbances, as well as left ventricular hypertrophy)
d. Echocardiography

2. Blood Vessels

a. Physical examination including a calculation of the pulse pressure

b. Carotid Ultrasonography (ultrasound)
c. Endothelial Function

3. Brain

a. Neurological examination
b. Diagnosis of stroke is enforced by usingcranial computed
tomography (CT) scan or magnetic resonance imaging (MRI) for
patients with neural disturbances, memory loss or cognitive
disorders.

4. Eye Funduskopi

5. Kidney function

a. Examination of kidney function and determination of the presence

of proteinuria, micro-makroalbuminuria and creatinin albumin
ratio.
b. The glomerulus filtration rate Estimates, that for patients in stable
condition had estimated by using a modification of the formula of
the cockroft-Gault according denganthe suggestion of the National
Kidney Foundation (NKF).

12
H. Treatment

The goal of treatment of hypertensive patients are:

1. 140/90 < Target blood pressure mmHg, for individuals at high risk
(diabetes, kidney failure proteinuria) < 130/80 mmHg.
2. The decline in cardiovascular mortality and morbidity.
3. Inhibits the rate of renal disease proteinuria

In addition, the treatment of hypertension treatment against the risk factors or

conditions such as diabetes miletus companion or other should also be implemented to
achieve the target of therapy each condition. Treatment of hypertensive therapy consists
of nonfarmakologis and farmakologis. Nonfarmakologis therapy should be
implemented by all patients of hypertension with the aim of lowering blood pressure
and controlling the factors as well as other diseases of companion.

Nonfarmakologis therapy consists of:

1. Stop smoking
2. Lose excess weight
3. Lose excess alcohol consumption
4. Physical exercise
5. Lowering salt intake
6. Increasing fruit and vegetable consumption and lowering fat intake.

Types of drug antihipertensi to te neat pharmacological hypertension is recommended

by JNC 7:

1. Diuretika, especially Thiazide type (Thiaz) or

2. Aldosterone Antagonist(Aldo Ant)
3. Beta blockers(BB)
4. Calcium Chanel Blocker or Calcium Antagonist (CCB)
5. Angiotensin Converting Enzyme Inhibitors (ACEI)
6. Angiotensin II Receptor Blockers receptor antagonist, or AT/blocker
(ARB).

13
 Hypertension Medications each have an effectiveness and safety in the
treatment of hypertension, but the selection of drug antihipertensi also influenced
several factors, namely:

1. Socio economic Factors.

2. Cardiovascular risk factor Profile
3. There is not damage to the target.
4. There is an absence of disease Companion.
5. Individual Variation of the response of patients against drug
antihipertensi.
6. The possibility of interactions with drugs used for patients of other
diseases.
7. Scientific proof of the ability of the drug antihipertensi to be used in the
cardiovascular risk lower.

Based on clinical trials, nearly all of the manual handling of hypertension

treatment benefits stating that nonhypertensi is a decrease in blood pressure itself,
regardless of the type or class of a certain non hypertensi drugs have groups for
certain patients.

For the purposes of treatment, there is a grouping of patients on the basis of

which requires special consideration (Special Consideration) that the Group indication
that forces (Compelling Indication) and other special circumstances (Special
Situasion).

Indications that forces include:

1. Heart Failure
2. Post infarction myocardium
3. Coronary Vascular Disease Risk high
4. Diabetes
5. Chronic kidney Peyakit
6. Recurrent stroke prevention

14
Other special circumstances include:

1. Minority Populations
2. Obesity and the metabolic syndrome
3. Right ventricular Hypertrophy
4. Peripheral artery disease
5. Hypertension in the elderly
6. Hypertension postural
7. Dementia
8. Hypertension in women
9. Hypertension in children and young adults
10. Hypertensive urgency on civil defence emergency

For most patients, the therapy of hypertension begins secar gradually, and the
target blood pressure are achieved progressively in a few weeks. It is recommended to
start with the antihipertensi drug with long working period or which gives efficacy 24
hours by administering once a day. Options are starting therapy with one type of
medication antihipertensi or with a combination depending on the initial blood
pressure and whether or not there are complications. If therapy begins with one type
of medication and in low doses, and then blood pressure has not yet reached the
target, then the next step is to increase the dosage of the drug, or switch to other
antihipertensi drugs with low doses. Side effects generally can be avoided by using
low doses, either single or combination. Most patients require a combination drug
antihipertensi to reach the target blood pressure, but the combination therapies can
medical expenses and decrease compliance of patients because the amount of
medication that must be taken.From the investigation that there visible presence, a
tendency that more urban communities suffered hypertension compared with rural
communities.

15
 CHAPTER III
CLOSING

A. Conclusion
High blood pressure or hypertension is a medical condition in which the an
increase in blood pressure in chronic (long term). Sufferers who have at least three
blood pressure readings exceeding 140/90 mmHg at rest is estimated to have a State
high blood. Blood pressure is always high is one of the factors of risk for stroke, heart
attack, heart failure and arterial aneurysm, and is a major cause of chronic heart
failure.
B. advice
after reading this paper I told the readers to always maintain health.health is a
give that is priceless.because in a strong soul there is a healtybody.always pay
attention to the intake of food tht enters our body.eatnutritios food that cen meet the
next of our bodies and diligent exercise.

16
 BIBLIOGRAPHY

http://www.leonard.files.wordpress.com
https://www.makalahhipertensi.pdf.scribecom
www.akademia.edu
jafar,nurhaedar.(2010).hipertensi,1.

17