UNIVERSITY OF ZAMBIA

SCHOOL OF NURSING SCIENCES

CLASSROOM TEACHING: LESSON PLAN
PRESENTER:
COMPUTER NO./PROGRAMME.:
TOPIC: HYPERTENSION
COURSE/COURSE CODE:
VENUE:
CLASS:
DATE/TIME:
DURATION:
TEACHING METHOD: LECTURE/DISCUSSION
SUPERVISOR:
INTRODUCTION
Good morning everyone my name is a 2nd year student of Master of science in Clinical Nursing, I am your tutor for
today and we discuss Hypertension. Hypertension also known as high blood pressure, is a condition in which the blood vessels have
persistently raised pressure. Blood is carried from the heart to all body parts of the body in vessels. Each time the heart beats it pumps
blood into the vessels, blood pressure is created by the force of blood pushing against the walls of blood vessels as it is pumped by the
heart. The higher the pressure, the harder the heart is pumping.

GENERAL OBJECTIVE
At the end of the lecture/discussion students should gain understanding on Hypertension and its management

SPECIFIC OBJECTIVES
At the end of the lecture/discussion students should be able to;
1. Define hypertension
2. Explain the epidemiology
3. State the stages of hypertension
4. State the classification of Hypertension
5. List the risk factors
6. Describe the pathophysiology of hypertension
7. State the clinical features
8. Describe the management of Hypertension
TIME SPECIFIC CONTENT TEACHING VISUAL TEACHER’S STUDENTS EVALUATION
OBJECTIVE METHOD AID ACTIVITY ACTIVITY
Define Hypertension, often referred to as high Lecture/ Presentation Explaining Listening What is
hypertension blood pressure, is defined as a chronic hypertension?
Discussion Slides Asking Writing notes
medical condition characterized by elevated
blood pressure in the arteries. Blood questions Asking
pressure is measured in millimeters of
Answering questions
mercury (mmHg) and consists of two
components: systolic pressure (the pressure questions Answering
exerted when the heart contracts) and
questions
diastolic pressure (the pressure in the
arteries when the heart is at rest between
beats). This is a condition in which there is
persistent blood pressure of 120-140/80-
100 mmHg or higher. Normal blood is 100-
120/60-80 mmHg or lower. (Hinkle, J. L.,
& Cheever, K. H. 2017).

TIME SPECIFIC CONTENT TEACHING VISUAL TEACHER’S STUDENTS EVALUATION

 OBJECTIVE METHOD AID ACTIVITY ACTIVITY
Explain the An estimated 1.28 billion adults aged Lecture/ Presentation Explaining Listening What is the
epidemiology between 30-79 years worldwide have most affected
Discussion Slides Asking Writing notes
hypertension, most (two thirds) living in age group of
low and middle income countries. An questions Asking hypertension?
estimated 46% of adults with hypertension
Answering questions
are unaware that they have the condition.
Approximately 1 in 5 adults with questions Answering
hypertension have it under control.
questions
Hypertension is a major cause of premature
death worldwide. About 3.3% of deaths in
Zambia are due to hypertension in Zambia.
34.8% of adults in Zambia are living with
hypertension. 38.0% of males and 33.3% of
females. 46.9% of the adult population in
rural Zambia is living with hypertension.

TIME SPECIFIC CONTENT TEACHING VISUAL TEACHER’S STUDENTS EVALUATION

OBJECTIVE METHOD AID ACTIVITY ACTIVITY
 State the stages • Elevated or pre-hypertensive blood Lecture/ Presentation Explaining Listening What is
of hypertension pressure is from top pressure of 120 emergency
Discussion Slides Asking Writing notes
to 129 mmHg and the bottom hypertensive
number is between 80-89 mmHg questions Asking crisis?
this is also called stage 1
Answering questions
hypertension
• Stage 2 hypertension: the top questions Answering
number is 140 mmHg or higher and
questions
the bottom number is 90 mmHg or
higher
• Blood pressure higher than 180/120
mmHg is considered an emergency
or hypertension crisis.( Smeltzer, S.
C., 2017)

TIME SPECIFIC CONTENT TEACHING VISUAL TEACHER’S STUDENTS EVALUATION

OBJECTIVE METHOD AID ACTIVITY ACTIVITY
State the  It is classified into two i.e. Lecture/ Presentation Explaining Listening What are the
classification of  Primary or essential hypertension: types of
Slides Asking
 Hypertension This type affects 90-95% of cases Discussion questions Writing notes hypertension?
therefore the commonest. The cause
Answering Asking
is idiopathic or unknown. The cause
is idiopathic or unknown. questions questions
 Primary hypertension is
Answering
further subdivided into:
• Benign HTN which can be questions
present for a long time
without causing serious
problems
• Malignant HTN which is of
sudden onset and produces
severe symptoms making
survival to a few months or
up to 2 years if not properly
managed
 Secondary hypertension: It accounts
for 5-10% of people with
hypertension. This means that the
hypertension in these individuals is
secondary to (caused by) a specific
disorder of a particular organ or
blood vessel, such as the kidney,
adrenal gland, or aortic artery
 Essential hypertension is a far more
common condition and accounts for
(90-95% of hypertension.
(Smeltzer, S. C.,2017)
TIME SPECIFIC CONTENT TEACHING VISUAL TEACHER’S STUDENTS EVALUATION
OBJECTIVE METHOD AID ACTIVITY ACTIVITY
List the risk  Age over 60 years Lecture/ Presentation Explaining Listening
factors  Male gender
Slides Asking
  Black africans Discussion questions Writing notes
 History of diabetes
Answering Asking
 Family of HTN
 Obesity questions questions
 Life stile
Answering
 Excessive intake of salt
 Emotional stress questions
(Silvestri, L. A. (2020)
TIME SPECIFIC CONTENT TEACHING VISUAL TEACHER’S STUDENTS EVALUATION
OBJECTIVE METHOD AID ACTIVITY ACTIVITY
Describe the  Regulation of Blood Pressure Lecture/ Presentation Explaining Listening What are the
pathophysiolog (B.P) systems that
Discussion Slides Asking Writing notes
y of B.P is proportional to product of Cardiac regulate blood
hypertension output (C.O) and Peripheral vascular questions Asking pressure?
resistance (PVR). Physiologically, B.P is
Answering questions
maintained by moment-to-moment
regulation of C.O and PVR exerted at 4 questions Answering
anatomic sites: - Arterioles, Post-capillary
questions
venules, heart and kidney. Regulation of
B.P occurs through:
A- Baroreceptors and Sympathetic nervous
system:
- Carotid baroreceptors (stimulated by
stretch of blood vessel wall by internal B.P)
normally send inhibitory impulses to
vasomotor centre (VMC) in the medulla.
A fall in B.P causes carotid baroreceptors
to send fewer inhibitory impulses to VMC
increasing sympathetic activity to the heart
(increased C.O) as well as arteriolar
vasoconstriction (increased PVR) and
vasoconstriction of the venules (increased
venous return), thus leading to restoration
of normal B.P.

 This baroreflex acts in response to:

- Changes in posture.
- Decrease in PVR secondary to
vasoconstrictors.
- Decreased intravascular volume due to
low sodium diet, diuretics, blood loss and
C.H.F.
 B- Renin-Angiotensin-Aldosterone
System (RAAS):
By controlling blood volume, kidney is
responsible for long term B.P control.
This occurs through:
Decreased Renal perfusion pressure
resulting in increased Renal salt and water
reabsorption.
Decreased pressure in renal arterioles
leading to increased Renin. This results in
formation of Angiotensin II leading to
vasoconstriction, increased NE and
secretion of Aldosterone which results in
increased B.P.
Hypertension is a multifactorial condition.
When there excess sodium intake, renal
sodium retention occurs, which increases
fluid volume resulting in increased preload
and increase in contractility which in turn
increases blood pressure. Obedity is also a
factor in hypertention because
hyperinsulinemia develops and structural
hypertrophy results leading to increased
 peripheral vascular resistance
TIME SPECIFIC CONTENT TEACHING VISUAL TEACHER’S STUDENTS EVALUATION
OBJECTIVE METHOD AID ACTIVITY ACTIVITY
State the  Uncomplicated high blood pressure Lecture/ Presentation Explaining Listening What are the
clinical features usually occurs without any signs and
Discussion Slides Asking Writing notes
symptoms (silently) and so symptoms of
hypertension has been labeled "the questions Asking hypertension?
silent killer. “
Answering questions
 It is called this because the disease
can progress to finally develop questions Answering
potentially fatal complications of
questions
hypertension such as heart attacks
or strokes.
 Uncomplicated hypertension may
be present and remain unnoticed for
many years, or even decades.
 This happens when there are no
symptoms, and those affected fail to
undergo periodic blood pressure
screening.
 Some people with uncomplicated
hypertension, however, may
experience symptoms such as
 headache due to cerebral hypoxia.
 dizziness due to cerebral hypoxia.
 shortness of breath due to impaired
gaseous exchange.
 blurred vision due to rupture of
blood vessel supplying the retina.
 Confusion due to damage to the
brain
 Chest pain due to angina pain as a
 result myocardial ischemia
 Ear noise or buzzing due to ear
involvement
 Palpitation due to over work of the
heart
 Nose bleed due to rapture of blood
vessel in the nose
 Tiredness due to impaired tissue
perfusion
TIME SPECIFIC CONTENT TEACHING VISUAL TEACHER’S STUDENTS EVALUATION
OBJECTIVE METHOD AID ACTIVITY ACTIVITY
Describe the INVESTIGATIONS Lecture/ Presentation Explaining Listening What
management of  History will reveal HTN in the investigations
Discussion Slides Asking Writing notes
Hypertension family are carried out
 Blood pressure will be high e.g. questions Asking to make
150/100 i.e. on three different days. hypertension
Answering questions
 Renal function test to rule out renal diagnosis?
disease questions Answering
 Aortography to rule out Coarctation What is the
questions
 Renal angiography to r/o stenosis correct drug
 Urinalysis can be done to r/o renal combination of
disorder hypertension?
 Urinalysis
 Fundoscopy What are some
 Electrocardiogram of the steps
 Chest x-ray you can take to
 Echocardiogram manage a
 Urea, creatinine and electrolytes • patient with
 Random blood sugar hypertension?
 Lipid profile
 Abdominal ultrasound
(Ignatavicius, D. D., Workman, M. L. 2018)
TREATMENT
 Aim of Antihypertensive therapy
The aim of therapy is to prevent target
organ damage by keeping B.P below
140/90mmHg
 Diuretics Lasix 20-40mg tds 5/7
 Calcium channel blockers
(Nifedipine retard 20mg two times
daily orally or Amlodipine 5 -10 mg
once daily orally
 Angiotensin-converting enzyme
inhibitors (Captopril 25-50mg two
or three times daily orally, Enalapril
5-20mg once daily orally). Those
who cannot tolerate ACEI may be
given Losartan potassium 50-100mg
once daily orally
 Hypertensive Emergency – very
severe to malignant hypertension: •
Start with Labetalol 50 mg IV over
at least a minute, repeated after five
minutes if necessary, maximum
dose is 200mg OR • Hydralazine 10
mg IV stat followed by 5 mg IV
every 30 minutes until diastolic BP
is 110 mm Hg or less • Frusemide
40-80mg IV may be used as
adjunctive therapy as a stat dose.
(standard treatment guidelines.
2020)
NURSING CARE
The nursing management of patients with
hypertension involves a holistic approach
aimed at controlling blood pressure,
preventing complications, and promoting
overall cardiovascular healt:
1. Assessment: Conduct a thorough
assessment including medical
history, family history, lifestyle
factors, and current medications.
Monitor blood pressure regularly
and assess for signs of end-organ
damage.
2. Education: Provide patient
education on hypertension,
including its causes, risk factors,
and complications. Teach lifestyle
modifications such as dietary
changes, regular exercise, smoking
cessation, and stress management.
3. Medication Management:
Administer prescribed medications
as ordered, educate patients on the
importance of adherence, and
monitor for medication side effects.
Common medications include
diuretics, ACE inhibitors,
angiotensin II receptor blockers,
calcium channel blockers, and beta-
blockers.
4. Dietary Management: Encourage a
heart-healthy diet rich in fruits,
vegetables, whole grains, and lean
proteins. Emphasize reducing
sodium intake and limiting alcohol
consumption.
5. Exercise: Promote regular physical
activity as part of hypertension
management. Encourage patients to
engage in aerobic exercise such as
walking, swimming, or cycling for
at least 30 minutes most days of the
week.
6. Stress Reduction: Teach stress
reduction techniques such as deep
breathing exercises, meditation,
yoga, or mindfulness techniques to
help patients manage stress and
lower blood pressure.
7. Monitoring and Follow-Up:
Monitor blood pressure regularly
and adjust treatment as needed
based on patient response. Schedule
regular follow-up appointments to
assess progress and reinforce
education.
8. Complications Prevention: Monitor
for signs of complications such as
cardiovascular disease, stroke,
kidney disease, and vision
problems. Educate patients on the
importance of regular screenings
and preventive measures.
9. Collaboration: Collaborate with
other healthcare team members,
including physicians, pharmacists,
dietitians, and physical therapists, to
provide comprehensive care and
support for patients with
 hypertension.
10. Patient Empowerment: Empower
patients to take an active role in
their hypertension management by
providing information, support, and
resources to help them make
informed decisions about their
health. (Jarvis, C. (2019)

Conclusion
We have come to the end of the lecture/discussion, we have been looking at Hypertension which we defined as a sustained blood
pressure of systolic above 120mmHg and diastolic above 100mmHg. We discussed that hypertension is one of the most widespread
conditions among adults, we said that drinking, smoking and sedentary lifestyle are some of the risk factors. We went on to discuss
that the body has its own blood pressure regulation mechanism and that under some conditions the pressure goes up without the
regulation being able to bring down and that is what makes it a condition. We discussed the choice of drugs and what investigations
can be carried out to make a diagnosis, then we discussed the nursing care that can be implemented to manage a patient with
hypertension. Have a good day we meet in the next class where we discuss Heart failure.
Assignment: conduct a literature review on the effectiveness of different pharmacological treatments used in managing hypertension
and state the nursing interventions for each drug?
The assignment should be typed using times new roman 12 not less than 6 pages but not more than 7 pages

References
1. Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2017). Brunner & Suddarth's Textbook of Medical-Surgical
Nursing (14th ed.). Wolters Kluwer.
2. Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care (9th ed.). Elsevier Health Sciences.
3. Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2017). Medical-Surgical Nursing: Assessment
and Management of Clinical Problems (10th ed.). Elsevier Health Sciences.
4. Silvestri, L. A. (2020). Saunders Comprehensive Review for the NCLEX-RN Examination (8th ed.). Elsevier.
5. Jarvis, C. (2019). Physical Examination and Health Assessment (8th ed.). Elsevier Health Sciences.
6. McKinney, E. S., James, S. R., Murray, S. S., Nelson, K. L., & Ashwill, J. W. (2017). Maternal-Child Nursing (5th ed.).
Elsevier.