🩺 Nursing Care Plan on Hypertension

Medical-Surgical Nursing | NANDA Nursing Care Plan Format

Cardiovascular Nursing | Practical File Ready

⚠️ Educational Purpose Only: This nursing care plan is prepared for academic nursing practical file work. Not for actual clinical decision-making.

📋 Student Information

Student Name	[Your Name]
Course	BSc Nursing / GNM / ANM
Subject	Medical-Surgical Nursing
Topic	Nursing Care Plan on Hypertension
Format	NANDA-I Nursing Care Plan Format
Date of Submission	[Enter Date]
Clinical Instructor	[Instructor Name]

📄 Page 1 — Patient Identification Data

Name	Mr. Rajendra Prasad Sharma
Age	58 Years
Sex	Male
Address	Jodhpur, Rajasthan
Occupation	Shopkeeper
Marital Status	Married
Religion	Hindu
Annual Income	₹3,60,000/- approximately
Diagnosis	Stage 2 Hypertension with Headache and Dizziness
Type of Family	Nuclear Family
Family Size	5 Members
Ward Name	Medical Ward
Bed Number	12
Doctor Incharge	Dr. A. K. Mehta, MD Medicine
Date of Admission	10/05/2026
Hospital Name	Government Hospital, Jodhpur

📄 Page 2 — Chief Complaints & Clinical History

CHIEF COMPLAINTS

The patient was admitted to the medical ward with the following complaints:

Severe headache since 2 days.
Dizziness and heaviness in head since 1 day.
Occasional blurring of vision.
Palpitations on exertion.
Fatigue and disturbed sleep.
Blood pressure recorded at home: 180/110 mmHg.

HISTORY OF PRESENT ILLNESS

Mr. Rajendra Prasad Sharma, a 58-year-old male shopkeeper, was apparently well until 2 days before admission when he developed severe headache mainly in the occipital region. The headache was dull aching in nature, persistent, and associated with heaviness of head.

He also complained of dizziness while standing and walking, occasional blurring of vision, and palpitations during mild exertion. The symptoms gradually increased, and the patient visited a nearby clinic where his blood pressure was recorded as 180/110 mmHg.

He was advised hospital admission for further evaluation and management of uncontrolled hypertension. On admission, his blood pressure was 176/108 mmHg, pulse 96/min, respiratory rate 20/min, temperature 98.6°F, and SpO₂ 98% on room air.

The patient gave a history of hypertension for the last 6 years but admitted irregular intake of antihypertensive medicines. He often stopped medicines when symptoms improved. He also reported high salt intake, frequent consumption of fried and oily foods, lack of regular exercise, and increased work-related stress.

PAST MEDICAL HISTORY

Known case of hypertension for 6 years.
Irregular medication intake for hypertension.
No known history of diabetes mellitus.
No history of myocardial infarction, stroke, chronic kidney disease, thyroid disorder, or epilepsy.
No history of asthma or tuberculosis.
No known drug or food allergy.

PAST SURGICAL HISTORY

No history of any major surgical intervention.
No history of previous hospitalization for surgery.
No history of blood transfusion.

MEDICATION HISTORY

Tablet Amlodipine 5 mg once daily — irregular intake.
Occasional use of painkiller for headache without medical advice.
No regular follow-up with physician.

📄 Page 3 — Family History, Family Composition & Family Tree

FAMILY HISTORY

The patient belongs to a nuclear family.
There are 5 current members in the family — patient, wife, son, daughter-in-law, and grandson.
Patient reports that hypertension is present in the family history.
Patient’s father had hypertension and died due to stroke at old age.
Patient’s mother had hypertension with diabetes mellitus.
Younger brother is also diagnosed with hypertension.
There is a positive family history of hypertension and cardiovascular disease.

FAMILY COMPOSITION

Name	Age/Sex	Education	Occupation	Marital Status	Relationship	Health Status
Mr. Rajendra P. Sharma	58/M	Graduate	Shopkeeper	Married	Self / Patient	Stage 2 Hypertension
Mrs. Sunita Sharma	54/F	Secondary	Housewife	Married	Wife	Healthy
Mr. Amit Sharma	30/M	MBA	Private Job	Married	Son	Healthy
Mrs. Pooja Sharma	27/F	B.Com	Housewife	Married	Daughter-in-law	Healthy
Master Aarav Sharma	4/M	Nursery	Student	Unmarried	Grandson	Healthy

FAMILY TREE

👨‍🦳

Mr. Rajendra Sharma

Patient

Stage 2 Hypertension

♡

👩‍🦳

Mrs. Sunita Sharma

Wife

Healthy

👨

Mr. Amit Sharma

Son

Healthy

♡

👩

Mrs. Pooja Sharma

Daughter-in-law

Healthy

👦

Master Aarav Sharma

Grandson

Healthy

Male Female Patient Highlighted

📄 Page 4 — Dietary, Personal, Socio-Economic & Environmental History

DIETARY HISTORY

The patient takes a mixed diet, mostly vegetarian with occasional non-vegetarian food.
Diet is high in salt due to regular intake of pickles, papad, namkeen, salted snacks, and added table salt.
Patient consumes fried and oily foods such as kachori, samosa, pakora, and puri 3–4 times per week.
Uses full-cream milk and ghee frequently in daily diet.
Low intake of fresh fruits, green leafy vegetables, and dietary fiber.
Consumes 4–5 cups of tea daily with sugar.
Fluid intake is approximately 2 liters per day.
No known food allergy reported.

PERSONAL HISTORY

Sleep: Disturbed sleep for the last few days due to headache and anxiety.
Appetite: Normal.
Bowel: Regular, once daily.
Bladder: Normal frequency, no burning micturition.
Habits: Occasional tobacco chewing for the last 15 years.
Alcohol: Occasional social alcohol intake.
Activity: Sedentary lifestyle due to shop work; no regular exercise or morning walk.
Stress: Increased work-related stress and financial responsibilities.
Allergy: No known drug or food allergy.
BMI: 29 kg/m², suggestive of overweight.

SOCIO-ECONOMIC HISTORY

The patient belongs to a middle-class family.
He is the main earning member of the family and runs a small shop.
Monthly family income is approximately ₹30,000.
The family lives in their own house.
Patient has access to nearby health facilities but does not attend regular follow-up visits.
Family members are supportive and involved in patient care.

ENVIRONMENTAL HISTORY

The patient lives in a pucca house with adequate ventilation and lighting.
Safe drinking water is available at home.
Sanitation facilities are adequate.
No exposure to industrial chemicals or heavy pollution.
Uses LPG for cooking.
Home environment is clean, but patient has stressful work environment due to long shop hours.

📄 Page 5 — Physical Examination

GENERAL CONDITION

Patient is conscious, oriented to time, place, and person. He appears anxious and uncomfortable due to headache and dizziness. He is cooperative during examination and able to answer questions properly.

VITAL SIGNS ON ADMISSION

Temperature: 98.6°F
Pulse: 96 beats/minute
Respiration: 20 breaths/minute
Blood Pressure: 176/108 mmHg
SpO₂: 98% on room air
Pain Score: Headache 7/10

GENERAL APPEARANCE

Built: Moderately built and overweight.
Posture: Sitting comfortably but complains of heaviness in head.
Facial expression: Anxious and tired.
Speech: Clear and coherent.
Skin: Warm, dry, no cyanosis.
Hydration: Adequate.
Edema: No pedal edema present.

SYSTEMIC EXAMINATION

Cardiovascular System	Heart sounds S1 and S2 audible. No murmur heard. Pulse rate 96/min, regular rhythm. Peripheral pulses palpable. Blood pressure elevated at 176/108 mmHg.
Respiratory System	Chest symmetrical. Respiratory rate 20/min. Air entry equal bilaterally. No wheeze, crackles, or respiratory distress present.
Central Nervous System	Patient conscious and oriented. GCS 15/15. Pupils equal and reacting to light. Complains of headache and dizziness. No weakness, no slurring of speech, no focal neurological deficit.
Gastrointestinal System	Abdomen soft and non-tender. No distension. Bowel sounds present. Appetite normal. No nausea or vomiting.
Genitourinary System	Urine output adequate. No burning micturition. No history of hematuria. No bladder distension.
Musculoskeletal System	Normal range of motion in all limbs. No joint swelling. Muscle strength normal. Patient feels fatigue on exertion.
Skin	Skin warm and dry. No cyanosis, pallor, clubbing, or edema. Skin turgor normal.

📄 Page 6 — Head-to-Toe Examination

Head	Complains of occipital headache. No injury, swelling, or scalp lesion noted.
Eyes	Occasional blurring of vision reported. Pupils equal and reactive to light. No redness or discharge.
Ear	Hearing normal. No discharge or pain.
Nose	Nasal passage clear. No bleeding or discharge.
Mouth	Oral mucosa moist. Teeth slightly stained due to tobacco chewing. No oral ulcer.
Neck	No lymph node enlargement. No thyroid swelling. Neck movement normal.
Chest	Chest expansion equal bilaterally. No respiratory distress.
Heart	S1 and S2 heard clearly. No murmur. Pulse regular.
Abdomen	Soft, non-tender. No organomegaly. Bowel sounds present.
Extremities	No edema. Peripheral pulses palpable. No weakness or deformity.

📄 Page 7 — Vital Signs Monitoring Record

DATE/TIME	TEMP	PULSE	RESP	BP	SpO₂	REMARKS
Day 1 — 8:00 AM	98.6°F	96/min	20/min	176/108 mmHg	98%	Headache and dizziness present
Day 1 — 2:00 PM	98.4°F	90/min	20/min	164/100 mmHg	98%	BP reduced after medication
Day 2 — 8:00 AM	98.2°F	84/min	18/min	150/94 mmHg	99%	Headache reduced
Day 3 — 8:00 AM	98.6°F	80/min	18/min	140/90 mmHg	99%	Condition improving
Day 4 — 8:00 AM	98.4°F	78/min	16/min	132/84 mmHg	99%	Stable for discharge planning

📈 Nursing Trend: Blood pressure gradually reduced from 176/108 mmHg to 132/84 mmHg with medication, rest, diet control, and regular monitoring.

📄 Page 8 — Diagnostic Investigations

SR. NO.	INVESTIGATION	NORMAL VALUE	PATIENT VALUE	INTERPRETATION
1	Hemoglobin	13–17 g/dL	13.8 g/dL	Normal
2	Total WBC Count	4,000–11,000/mm³	8,600/mm³	Normal
3	Platelet Count	1.5–4 lakh/mm³	2.5 lakh/mm³	Normal
4	Fasting Blood Sugar	70–110 mg/dL	118 mg/dL	Slightly elevated
5	Serum Creatinine	0.7–1.3 mg/dL	1.0 mg/dL	Normal renal function
6	Blood Urea	15–40 mg/dL	32 mg/dL	Normal
7	Serum Sodium	135–145 mEq/L	140 mEq/L	Normal
8	Serum Potassium	3.5–5.0 mEq/L	4.1 mEq/L	Normal
9	Total Cholesterol	<200 mg/dL	238 mg/dL	Elevated
10	LDL Cholesterol	<100 mg/dL	152 mg/dL	High
11	HDL Cholesterol	>40 mg/dL	36 mg/dL	Low
12	Triglycerides	<150 mg/dL	210 mg/dL	Elevated
13	ECG	Normal sinus rhythm	Left ventricular strain pattern	Suggestive of long-standing hypertension
14	Urine Routine	No protein/sugar	Trace protein	Needs monitoring

📄 Page 9 — Medical Management / Drug Chart

SR. NO.	MEDICATION	DOSE	FREQUENCY	ROUTE	ACTION / PURPOSE
1	Tab. Amlodipine	5 mg	OD	Oral	Calcium channel blocker; relaxes blood vessels and reduces blood pressure.
2	Tab. Telmisartan	40 mg	OD	Oral	Angiotensin receptor blocker; controls BP and protects heart and kidneys.
3	Tab. Hydrochlorothiazide	12.5 mg	OD	Oral	Diuretic; removes excess sodium and water, helping to lower BP.
4	Tab. Atorvastatin	20 mg	HS	Oral	Lipid-lowering drug; reduces LDL cholesterol and cardiovascular risk.
5	Tab. Paracetamol	500 mg	SOS	Oral	Analgesic and antipyretic; given for headache relief.
6	Tab. Pantoprazole	40 mg	OD before breakfast	Oral	Proton pump inhibitor; prevents gastric irritation due to medicines.

Nursing Note: Monitor blood pressure before and after antihypertensive medication. Observe for dizziness, postural hypotension, weakness, excessive urination, electrolyte imbalance, and medication compliance.

📄 Page 10 — NANDA Nursing Diagnoses

Deficient knowledge regarding hypertension, medication regimen, diet control, lifestyle modification, and follow-up care as evidenced by irregular medication intake and lack of awareness about complications.
Ineffective health management related to inadequate control of modifiable risk factors as evidenced by elevated blood pressure, high salt intake, sedentary lifestyle, and dyslipidemia.
Risk for decreased cardiac output related to increased afterload secondary to persistent hypertension.
Acute pain related to increased vascular pressure as evidenced by headache, dizziness, and elevated blood pressure.
Risk for impaired renal perfusion related to long-standing uncontrolled hypertension.
Activity intolerance related to fatigue and increased cardiac workload secondary to hypertension.

📄 Page 11-13 — Nursing Care Plans

Nursing Care Plan — 1: Deficient Knowledge

ASSESSMENT	NURSING DIAGNOSIS	GOAL	PLANNING	IMPLEMENTATION	EVALUATION
Patient reports irregular intake of antihypertensive medicines and lack of knowledge about low-salt diet and complications of hypertension.	Deficient knowledge regarding hypertension and its management as evidenced by irregular medication intake and poor awareness of lifestyle modification.	Patient will verbalize understanding of hypertension, medication schedule, diet control, warning signs, and follow-up care before discharge.	Assess patient’s existing knowledge. Provide simple explanation about disease, medicines, diet, exercise, and follow-up.	Explained hypertension as persistently increased blood pressure. Educated about taking medicines daily at the same time. Advised low-salt diet and avoidance of pickle, papad, namkeen, fried foods. Explained warning signs such as severe headache, chest pain, breathlessness, weakness, and blurred vision. Encouraged regular BP monitoring and follow-up visits.	Patient verbalized correct understanding of medicine timing, low-salt diet, and importance of regular follow-up.

Nursing Care Plan — 2: Ineffective Health Management

ASSESSMENT	NURSING DIAGNOSIS	GOAL	PLANNING	IMPLEMENTATION	EVALUATION
BP 176/108 mmHg on admission, high salt intake, sedentary lifestyle, increased cholesterol level, irregular medication use.	Ineffective health management related to inadequate control of modifiable risk factors as evidenced by uncontrolled BP and unhealthy lifestyle habits.	Patient will demonstrate improved health management by following medication, diet, exercise, and BP monitoring plan.	Prepare individualized health management plan including diet, exercise, medication adherence, and follow-up schedule.	Prepared daily medication schedule. Advised 30 minutes walking daily as tolerated. Encouraged weight control and avoidance of smoking/alcohol if present. Advised DASH-style diet rich in fruits, vegetables, whole grains, and low-fat foods. Instructed patient to maintain BP record at home.	Patient agreed to follow diet, exercise, medication, and BP monitoring plan after discharge.

Nursing Care Plan — 3: Acute Pain

ASSESSMENT	NURSING DIAGNOSIS	GOAL	PLANNING	IMPLEMENTATION	EVALUATION
Patient complains of headache and dizziness. BP 176/108 mmHg. Patient appears uncomfortable.	Acute pain related to increased vascular pressure as evidenced by headache, dizziness, and elevated blood pressure.	Patient will report reduction in headache and show improved comfort within 24 hours.	Assess pain score, monitor BP, provide rest, reduce stimuli, and administer prescribed medication.	Assessed headache intensity using pain scale. Monitored BP regularly. Provided quiet environment and advised bed rest. Administered prescribed antihypertensive and analgesic medication. Observed for warning signs like severe headache, vomiting, blurred vision, or neurological deficit.	Headache reduced and patient appeared comfortable. BP decreased gradually to 132/84 mmHg.

📄 Page 14 — Remaining Nursing Care Plans

Nursing Care Plan — 4: Risk for Decreased Cardiac Output

ASSESSMENT	NURSING DIAGNOSIS	GOAL	PLANNING	IMPLEMENTATION	EVALUATION
Patient has long-standing hypertension. BP 176/108 mmHg on admission. Pulse 96/min. Complaints of dizziness and fatigue.	Risk for decreased cardiac output related to increased afterload secondary to persistent hypertension.	Patient will maintain stable cardiac status as evidenced by controlled BP, normal pulse, absence of chest pain, and adequate peripheral perfusion.	Monitor cardiovascular status, BP trends, pulse, chest pain, peripheral perfusion, and response to medication.	Monitored BP, pulse, respiration, and SpO₂ regularly. Assessed for chest pain, palpitations, dyspnea, edema, and fatigue. Administered antihypertensive medicines as prescribed. Maintained calm environment and advised adequate rest. Encouraged low-salt diet to reduce fluid retention and cardiac workload. Observed for signs of hypertensive emergency.	Patient maintained stable pulse and oxygen saturation. No chest pain or dyspnea occurred. BP improved gradually.

Nursing Care Plan — 5: Risk for Impaired Renal Perfusion

ASSESSMENT	NURSING DIAGNOSIS	GOAL	PLANNING	IMPLEMENTATION	EVALUATION
Long-standing hypertension. Urine routine shows trace protein. Serum creatinine 1.0 mg/dL and blood urea 32 mg/dL.	Risk for impaired renal perfusion related to long-standing uncontrolled hypertension.	Patient will maintain adequate renal perfusion as evidenced by normal urine output, stable renal function tests, and absence of edema.	Monitor intake-output, urine changes, renal function tests, edema, and BP control.	Maintained intake-output record. Observed urine color, frequency, and amount. Monitored serum creatinine, blood urea, and urine routine reports. Assessed for facial puffiness and pedal edema. Educated patient to control BP to prevent kidney damage. Advised adequate water intake unless restricted by physician.	Urine output remained adequate. No edema observed. Renal function remained within normal limits.

Nursing Care Plan — 6: Activity Intolerance

ASSESSMENT	NURSING DIAGNOSIS	GOAL	PLANNING	IMPLEMENTATION	EVALUATION
Patient complains of fatigue and dizziness during activity. Sedentary lifestyle reported. BP elevated on admission.	Activity intolerance related to fatigue and increased cardiac workload secondary to hypertension.	Patient will gradually tolerate activity without dizziness, excessive fatigue, chest pain, or abnormal BP rise.	Assess tolerance to activity, provide rest periods, and encourage gradual activity as tolerated.	Assessed fatigue level and dizziness before activity. Advised rest during acute phase of high BP. Encouraged gradual mobilization after BP control. Instructed patient to avoid sudden position changes. Advised daily walking as tolerated after discharge. Educated patient to stop activity if chest pain, breathlessness, dizziness, or palpitations occur.	Patient tolerated mild activity without dizziness. Patient agreed to continue gradual walking routine after discharge.

📄 Page 15 — Discharge Summary

Mr. Rajendra Prasad Sharma, a 58-year-old male, was admitted with complaints of severe headache, dizziness, fatigue, and elevated blood pressure. On admission, his blood pressure was 176/108 mmHg, indicating uncontrolled hypertension. He had a history of irregular medication intake, high salt consumption, sedentary lifestyle, and dyslipidemia.

During hospitalization, the patient was managed with prescribed antihypertensive medicines, low-salt diet, rest, regular blood pressure monitoring, and health education. Diagnostic investigations revealed elevated total cholesterol, LDL cholesterol, triglycerides, and trace protein in urine, indicating the need for regular monitoring and lifestyle modification.

The patient’s blood pressure gradually improved from 176/108 mmHg to 132/84 mmHg. Headache and dizziness reduced, and the patient became clinically stable. He was educated regarding medication compliance, low-salt diet, regular exercise, BP monitoring, avoidance of smoking and alcohol, stress management, and regular follow-up.

Condition at Discharge: Stable, conscious, oriented, headache relieved, BP controlled, no chest pain, no breathlessness, and no edema.

Discharge Advice

Take antihypertensive medicines regularly as prescribed.
Do not stop medicine without doctor’s advice even if BP becomes normal.
Monitor blood pressure at home and maintain a BP record.
Follow low-salt diet and avoid pickle, papad, namkeen, chips, and packaged foods.
Avoid fried, oily, and high-fat foods.
Walk for 30 minutes daily as tolerated.
Maintain healthy body weight.
Avoid smoking, tobacco, and alcohol.
Practice relaxation techniques such as deep breathing and meditation.
Attend regular follow-up visits.
Immediately report to hospital if severe headache, chest pain, breathlessness, weakness of one side of body, blurred vision, or confusion occurs.

📄 Page 16 — Health Education

Medication Compliance

The patient was educated to take all prescribed antihypertensive medicines regularly at the same time every day. He was instructed not to skip doses and not to stop medicines suddenly without consulting the physician, because uncontrolled blood pressure can lead to stroke, heart attack, kidney disease, and eye problems.

Dietary Advice

Follow a low-salt diet.
Limit total salt intake to about one teaspoon per day or as advised by the doctor.
Avoid pickle, papad, namkeen, chips, packaged snacks, processed foods, and extra salt on salad.
Take more fruits, vegetables, whole grains, pulses, and low-fat milk products.
Avoid fried foods, ghee, butter, vanaspati, fast food, and bakery items.
Drink adequate water unless restricted.

Lifestyle Modification

Do regular walking or light exercise for 30 minutes daily as tolerated.
Maintain healthy body weight.
Avoid smoking and tobacco completely.
Avoid alcohol.
Take adequate sleep for 7–8 hours daily.
Reduce stress by meditation, yoga, deep breathing, and family support.

Home Blood Pressure Monitoring

The patient was advised to check blood pressure regularly at home, preferably at the same time each day. He should sit quietly for 5 minutes before checking BP, keep the arm at heart level, and record readings in a notebook to show during follow-up visits.

Warning Signs

The patient and family were educated to seek immediate medical help if any of the following symptoms occur:

Severe headache not relieved by rest or medicine
Chest pain or tightness
Shortness of breath
Sudden weakness or numbness of face, arm, or leg
Difficulty speaking
Blurred vision
Confusion or fainting
Swelling of feet or reduced urine output

Follow-up Care

The patient was advised to attend regular follow-up visits for blood pressure monitoring, medication adjustment, lipid profile, kidney function tests, urine examination, and assessment of complications. Family members were encouraged to support the patient in diet control, exercise, and regular medication intake.

📄 Page 17 — Conclusion

This case study presents Mr. Rajendra Prasad Sharma, a 58-year-old male diagnosed with uncontrolled hypertension. The patient was admitted with complaints of headache, dizziness, fatigue, and elevated blood pressure. His condition was associated with irregular medication intake, high salt consumption, sedentary lifestyle, and dyslipidemia.

During hospitalization, the patient received antihypertensive medication, regular blood pressure monitoring, dietary modification, rest, and nursing care. His blood pressure gradually improved from 176/108 mmHg to 132/84 mmHg, and symptoms such as headache and dizziness were relieved.

The nursing care focused on assessment of vital signs, prevention of complications, medication compliance, lifestyle modification, dietary counseling, patient education, and follow-up care. The patient and family were educated about the importance of regular medication, low-salt diet, exercise, stress management, and early recognition of warning signs.

Hypertension is a chronic condition that requires lifelong management. With proper medication adherence, lifestyle modification, regular follow-up, and family support, complications such as stroke, myocardial infarction, renal failure, and heart failure can be prevented. This case study highlights the important role of nurses in health education, monitoring, prevention of complications, and promotion of self-care among hypertensive patients.

📄 Page 18 — Bibliography

Brunner, L.S. & Suddarth, D.S. (2022). Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer.
NANDA International. (2024). Nursing Diagnoses: Definitions and Classification 2024–2026 (13th ed.). Thieme Medical Publishers.
Lewis, S.L., Bucher, L., Heitkemper, M.M., Harding, M.M., Kwong, J., & Roberts, D. (2023). Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier.
Park, K. (2023). Park’s Textbook of Preventive and Social Medicine (27th ed.). Banarsidas Bhanot Publishers.
World Health Organization. (2025). Hypertension — Fact Sheet. WHO, Geneva.
Indian Council of Medical Research. (2024). Standard Treatment Guidelines for Hypertension. ICMR, New Delhi.
Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2024). Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. F.A. Davis Company.

⚕️ Medical Disclaimer: This nursing care plan is prepared for educational and academic purposes only as part of nursing practical file work. It is not intended for actual patient care, clinical decision-making, or medical diagnosis. Always follow your institution’s guidelines and standard nursing textbooks.