Professional Documents
Culture Documents
A Case Study
Of
HYPERTENSION EMERGENCY,
HYPERTENSIVE
CARDIOVASCULAR DISEASE
(In partial fulfillment in NCM-101 Related Learning Experience)
Submitted by:
GROUP 2 of BSN 3A
Submitted to:
Clinical Instructor
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
INTRODUCTION
Several classes of antihypertensive agents are recommended and the choice for the
antihypertensive agent depends on the cause for the hypertensive crisis, the severity of elevated
blood pressure and the patient's usual blood pressure before the hypertensive crisis. In most
cases, the administration of an intravenoussodium nitroprussideinjection which has an almost
immediate antihypertensive effect is suitable but in many cases not readily available. In less
urgent cases, oral agents like captopril, clonidine, labetalol, prazosin, which all have a delayed
onset of action by several minutes compared to sodium nitroprusside, can also be used.
It is also important that the blood pressure is lowered not too abruptly, but smoothly. The
initial goal in hypertensive emergencies is to reduce the pressure by no more than 25% (within
minutes to 1 or 2 hours) and then toward a level of 160/100 mm Hg within 2–6 hours. Excessive
reductions in pressure may precipitate coronary, cerebral, or renal ischemia.The diagnosis of a
hypertensive emergency is not only based on the absolute level of blood pressure, but also on the
individual regular level of blood pressure before the hypertensive crisis. Individuals with a
history of chronic hypertension may not tolerate a "normal" blood pressure.
DEMOGRAPHIC PROFILE
AGE: 49
SEX: Male
DATE AND TIME OF ADMISSION: March 07, 2010 at 10:00 in the morning
NURSING HISTORY
On March 07, 2010, Patient D was admitted at Tuguegarao City People’s General
Hospital with chief complaint of epistaxis, dizziness, (+) HPN and body weakness. He was
diagnosed with Hypertension Emergency, Hypertensive Cardiovascular Disease (HCVD) with
the initial vital signs of BP-180/110mmHg, CR-86bpm, RR-18cpm, T-37°C.
He undergone with different laboratories like Complete Blood Count with Actual Platelet
Count (CBC with APC), Blood Chemistry such as Sodium (Na), Potassium (K), Fasting Blood
Sugar (FBS), Total Cholesterol, Triglycerides, HDL and LDL.
On January 4, 2008, he was diagnosed with gallstone at Divine Mercy Wellness Inc., the
physician told him that it is curable by medicines. He was admitted because of the upper right
quadrant pain that radiates at the back.
On March 2009, Patient D was diagnosed with hypertension, gallstone and at the same
time Cardiomegaly in Cagayan Valley Medical Center. He was rushed from Emergency Room
and directly admitted at Intensive Care Unit (ICU) for three days.
He also experienced only mild health problems like cough and colds, headache and fever.
When he experienced those, he buys medication like Paracetamol, Neozep and other over-the-
counter (OTC) products in the Pharmacy but sometimes, he prefers to take a rest.
Family History
According to Patient D, He inherited both of the disease he’s parent died. His mother
died with a gallstone and his father died with hypertension. They also had genetic disease of
Cardiomegaly (the enlargement of the heart). Aside from these diseases, no one in their family
had Cancer, Diabetes, and Respiratory disease.
Medical History
He was not yet undergone with any operation. According to him, he’s gallstone can cure
with medications so he may not be able to undergone any surgery.
He lives in Barangay taguinod St. Linao Norte, Tuguegarao City, where in he is a tricycle
driver and Barangay chief tanod. In the morning, he is a tricycle driver and when he had duty in
the evening he is a Barangay chief tanod. But most of the time, he is a tricycle driver.
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
According to him, he has four beautiful daughter and one adopted son. His elder daughter
is now a professional teacher, his second daughter is now on the Singapore because he is a HRM
Student who happened had their On the-Job-Training (OJT) in one of the prestigious Hotel and
Restaurant in Singapore. His third daughter is a second year College and also his adopted son,
his last daughter is in third year high school.
He is very friendly with good relationship with his neighbor. He went to Church every
Sunday and when he likes to go to Church even though it is not Sunday. He also had vices such
as drinking alcohol and smoking but he stopped it for one year. Then after a year, he began again
to drinks and smokes.
He was circumcised at the age of 14. He, then, get married at the age of 19 years old.
Before Hospitalization:
According to him, being healthy is can partake all necessities including
worked. It is a good source of being healthy because he can do everything
he can without any obstruction.
During Hospitalization:
According to him, it is very difficult for him to be confined because he
cannot do his daily activities like feeding its pig, doing household every
noon and being a tricycle driver.
2. Nutrition-Metabolic Pattern
Before hospitalization:
He usually eats three times a day with snacks in between. He usually eats
vegetables, meats and poultry products. He usually consumes 2 cups of rice and 1
cup of vegetables and other meat. He consumes 8-10 glasses of water a day and
drinks 1-2 carbonated drinks occasionally.
During Hospitalization:
He was advised to eat low fat, low salt diet. He eats the food given by the
hospital. He eats three times a day. He usually eats sausage and drink
carbonated drinks as source of intake. But mostly, the intake of his oral
fluid decreases.
3. Sleep-Rest Pattern
Before Hospitalization:
His usual sleeping pattern is 5-6 hours from 9:00-3:00 AM. If there is a
chance to take naps, he usually takes naps after eating. Sometimes, he
sleeps from 12:00 midnight to 3:00 because of his duty as a chief tanod.
During Hospitalization:
He was not able to sleep well in the ward because of interruption when
taking his blood pressure. It is also being interrupted brought by difficulty
of breathing due to his nasal pack that blocks the way of breathing.
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
4. Elimination Pattern
Before Hospitalization:
The patient was able to void from 4-5 times a day with a yellowish color
and able to defecate 2-3 times with a yellow stool.
During Hospitalization:
He urinates ranging from 2-3 times a day with color yellow. He defecates
1-2 times with a dark stool.
5. Activity-Exercise Pattern
Before Hospitalization:
The patient day to day activity is to take good care and feeding his pigs.
He does also other household chores during afternoon and he cooked for
his family. As a form of exercise, he uses dumbbells and push-ups.
After Hospitalization:
The patient’s daily activities as well as his exercise become altered
because of his condition. He just standing, lying on bed, sitting on the
chair and make some chitchat to other patients.
6. Cognitive-Perceptual Pattern
As General:
He can read and write. He uses tagalong and Itawis as his primary dialect.
He is the most dominant who make decision-making but sometimes, he
also asks his wife regarding with his decision.
7. Self-Perception-Self-Concept Pattern
Before Hospitalization:
He believed that he will recover in just matter of weeks. He believed that
he will regain again his strength. He is type of person who is very
determined and he always thinks of his family. He cares for others and
very helpful to its Barangay.
During Hospitalization:
The patient wants to recover fast to back in his normal life. According to
him, he missed already his daughters and neighborhood. He misses the
things he used to do before he was admitted.
8. Role-Relationship Pattern
Before Hospitalization:
The patient can able to comprehend and speaks Tagalog and Itawis to
other people. He is also a good father even though he was only reached
second year highschool. He is good father because, he never let her
daughters suffer but instead he does his best to send them in school.
During Hospitalization:
Even though his in the hospital, he didn’t forget his role as a father. He
always checks the conditions through texting and calling them in their cell
phones and makes some updates with his wife. He also show courage and
determination to cooperate with the interventions implemented for
promoting wellness.
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
9. Sexuality-Reproductive Pattern
As general:
According to him, he shows his love and affection to his wife by showing
that he loves her, by helping his wife with household chores. He also show
his love to his daughters by giving what they need, also with his adopted
son.
Before Hospitalization:
According to him,for him tocope up with those problems they encountered
in their marriage life, he pray for guidance and get his strength to his
family.
During Hospitalization:
He got strength from his family in recovering. He also makes chitchat
from his student nurse and fellow patients in the ward to divert his
attention from his problems and anxiety.
11.Value-Belief System
Before Hospitalization:
He believed with witch doctors and other creatures that create illness.
They believed in “atang” and other form of rituals. According to him,
“Wala naming mawawalakungmaniniwalaako”. He went to church every
Sunday and when he wants to.
During Hospitalization:
He prays for his fast recovery. He also believed that he must quit in
pursuing his vices and start to follow his diet which is low fat, low salt diet
to prevent any further complications.
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
PHYSICAL ASSESSMENT
General Appearance: the patient is sitting on chair conscious, coherent. He is not too tall or
too short. He is chubby with good posture. He is slightly weak looking, with IV line inserted at
his right arm and with dry nasal pack.
ACTUAL NORMAL
BODY PARTS TECHNIQUE ANALYSIS
FINDINGS FINDINGS
Black, symmetrical,
thick, can raise lower
Black evenly eyebrows
distributed, can symmetrically and
Eyebrows Inspection Normal
raise lower without difficulty,
eyebrows. evenly distributed and
parallel with each
other.
White and
Sclera Inspection White and clear Normal
clear
Absence of
halitosis
No palpable lumps,
masses, tenderness
Palpation No palpable Normal
masses, lumps Adam’s apple are
and tenderness palpable
Freely
Range of motion movable Freely movable without
Inspection Normal
of neck without difficulty
difficulty
No areas of tenderness
No areas of Normal
Palpation
tenderness
1-2 second
Palpation Normal
capillary refill
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
No pulsations
Heart Inspection and No pulsations, No pulsations Normal
Palpation in apical area
pulsations No pulsations
visible and
Pulsations visible and
Aortic valve palpable.
palpable
Pulmonic area Abdominal aortic
Tricuspid area pulsations visible and
palpable.
Apical area
Epigastric area
LABORATORY
9. Right Atrium
10. Right Ventricle
1. Right Coronary
11. Left Atrium
2. Left Anterior Descending
12. Left Ventricle
3. Left Circumflex
13. Papillary Muscles
4. Superior Vena Cava
14. Chordae Tendineae
5. Inferior Vena Cava
15. Tricuspid Valve
6. Aorta
16. Mitral Valve
7. Pulmonary Artery
17. Pulmonary Valve
8. Pulmonary Vein
Aortic Valve (Not
pictured)
The heart is the muscular organ of the circulatory system that constantly pumps blood throughout
the body. Approximately the size of a clenched fist, the heart is composed of cardiac muscle
tissue that is very strong and able to contract and relax rhythmically throughout a person's
lifetime.
Systole
The contraction of the cardiac muscle tissue in the ventricles is called systole. When the
ventricles contract, they force the blood from their chambers into the arteries leaving the heart.
The left ventricle empties into the aorta and the right ventricle into the pulmonary artery. The
increased pressure due to the contraction of the ventricles is called systolic pressure.
Diastole
The relaxation of the cardiac muscle tissue in the ventricles is called diastole. When the ventricles
relax, they make room to accept the blood from the atria. The decreased pressure due to the
relaxation of the ventricles is called diastolic pressure.
The heart is composed primarily of muscle tissue. A network of nerve fibers coordinates the
contraction and relaxation of the cardiac muscle tissue to obtain an efficient, wave-like pumping
action of the heart.
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
PATHOPHYSIOLOGY
Idiopathy
Increase contractility
Fragmentation of arterial
Functional /BV
elastins
Constriction
Increase Cardiac output
Collagen deposits
Peripheral resistance
Elasticity of BV
Increase BP
Nose bleed
Nape pain dizziness
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
Clonidine drip: 90cc of -To lower blood -Assure the ten rights
D5W + 1amp of pressure of administering
clonidine in solucet to medicine
run at 15ugtts/min,
increment 5ugtts/min
every 1 hour if
BP≥140/90.
Amlodipine 10mg/tab, -Management of -meds given once a
1 tab OD (Hold if BP ≤ hypertension, angina day
120/80) pectoris.
High back Rest -to prevent aspiration -Maintained on high
of blood. bask rest
I&O every 4 hour
Refer -For immediate -Report any un
report. towards signs and
symptoms.
Refer to ENT for nasal -To identify the -Facilitated referral to
problem problem within the ENT.
nasal part
1:40 pm For nasal packing -To prevent from -Facilitated nasal
bleeding. packing;dry
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
ENT Notes ----- ----
Thank you for referring acknowledging ----
Partial seen and -To identify the -Facilitated partial
examined problem at the nose examination of the
nose
Anterior nasal packing -For prevention of -Facilitated nasal
dry bleeding packing
Secure consent please For legal purposes Assessed the patient
level of consciousness
before letting him sign
the consent
Start on sultamicillin For upper and lower Sultamicillin started.
750mg tablet TID PO respiratory tract
infections, UTI and
pyelonephritis; skin
and soft tissue and
gonococcal
infections.
Will follow up patient For follow up check Facilitated follow up
up check up
Refer accordingly For immediate report Report it immediately
March 08, 2010 Continue Management For continuous care Continue therapeutic
and management management
TF: D5W ½ L x KVO -To help maintain -Regulated IVF to 8-10
fluid and electrolytes gtts/min
in the body and
replace what was lost
March 09, 2010 IVFTF: D5W ½ L x -To help maintain -Regulated IVF to 8-10
KVO fluid and electrolytes gtts/min
in the body and
replace what was lost
Clonidine drip to -To lower blood -Clonidine drip
consume pressure consumed.
Give captopril 25mg -To lower blood -Meds given as needed
SL prn for SBP ≥140 pressure as needed
March 10, 2010 IVFTF: D5W 1L x -To help maintain -Regulated IVF to 8-10
8:00am KVO fluid and electrolytes gtts/min
in the body and
replace what was lost
Tranexamic Acid -For hemorrhage or -Meds given 2x a day
500mg 1 cap BID risk of hemorrhage in
increase fibrinolysis
or fibrogenolysis.
Possible discharge -Readiness for -Promoted wellness.
tomorrow if OK with enhance therapeutic
Dr. Reyes regimen
management.
March 11, 2010 IVFTF: D5W 1L x -To help maintain -Regulated IVF to 8-10
KVO fluid and electrolytes gtts/min
8:00 Am in the body and
replace what was lost
Cont. meds For continuous care Continue therapeutic
and management management
For nasal cautery For removal of nasal Facilitated the nasal
tomorrow @ 1PM packing under local cautery
under L.A. bedside anesthesia
UNIVERSITY OF PERPETUAL HELP SYTEM-ISABELA CAMPUS
MINANTE UNO, CAUAYAN CITY, ISABELA
Refer accordingly -For immediate -Report any un
report. towards signs and
symptoms.
March 12, 2010 S/P: chemical cautery -for removal of nasal -Facilitated chemical
packing. cautery of nasal septi
vessels.
MGH if ok with other -Readiness for -Promoted wellness.
AP enhance therapeutic
regimen
management.
Home meds: -For upper and lower -Instructed patient to
respiratory tract continue all home
Sultamicillin 750mg infections, UTI and meds.
for TID PO pyelonephritis; skin
and soft tissue and
gonococcal
infections.
Follow up @ -For follow up check -Instructed patient to
CITIMEDIC on up come back on Monday
Monday, March 15, follow up check up at
2010 @ 11am citimedic
Refer accordingly -For immediate -Report any un
report. towards signs and
symptoms.
3:30pm Home meds: -Management of -Instructed patient to
hypertension, angina continue all home
Amlodipine 10mg OD pectoris. meds.
HOME MEDS:
-Amlodipine 10 mg OD