CASE PRESENTATION

VENICE ANN M. SALALILA

HYPERTENSION
INTRODUCTION
HYPERTENSION
It is a chronic elevation of blood pressure, abnormally high blood pressure, it is a disease
more common with men than women and it is more on the side of elderly, but there are some
cases with teenagers. Persistent elevation of SBP >140 mmHg & DBP > 90 mmHg (in at least 2
to 3 consecutive reading).
High Blood Pressure may be lead to myocardial infarction (heart attacks). An elevation of BP
of unknown cause is called “Primary Hypertension”, and elevation of BP of known cause is
called “Secondary Hypertension”, and intermittent elevation of BP or pre essential
hypertension is known as “Labile a.k.a Borderline”.
High blood pressure usually causes no symptoms and high blood pressure
often is labelled "the silent killer." People who have high blood pressure
typically don't know it until their blood pressure is measure. It can be
prevented by having a healthy lifestyle, proper exercise
This are the factors associated by hypertension heart problems ,cigarette
smoking, heavy alcohol consumption, obesity, lack of proper exercise,
fatigue, pregnancy and it is also cause by gene factors or known as
“hereditary”. The mayor cause of hypertension is heart failure, stroke,
and kidney failure.
Sign and Symptoms
Chest pain
Epistaxis (nose bleeding)
Dizziness
Blurred vision
Fatigue
Nocturia (frequent urinating at night)
Headache
Depression
 
Population of people with Hypertension
 
The latest population of the people suffering from
hypertension according to Department of Health in the
Philippines is 6 people out of 10 are at risk of having high
blood pressure or more than 60% of the population of the
Filipinos are suffering from hypertension. The main reason of
the Filipinos of having or suffering from hypertension because
of having a bad lifestyle such as heavy consumption of
alcohol, cigarette smoking, lack of exercise and even poverty
is one of the factors.
This disease are more common with men than women and it
is more on the side of elderly, there’s a lot of elderly suffer
from this disease and this is one of the disease that causes
death among Filipinos.
 
NEW TRENDS
Hypertension Latest News, High-Sodium Diets can lead to Hypertension in children. These days not only elderly are suffering from hypertension but also
children’s and teenagers, because of High-Sodium Diets. More children’s loves to eat junk foods and some commercial snacks that is high in sodium it gives high
factor from having high blood pressure or hypertension, they eat more junk food that is high in sodium than eating vegetable, because junk foods are more
cheaper than other, they are choosing this kind of food that is bad to our health. Children under 10 years old are more at risk of having hypertension.
 
Objectives:
Nurse – Centered
Short – Term Objectives:
After 1-3 days of nursing interventions, the nurse will be able to:
 
Established trust with the significant others.
Introduced oneself to the qualified client/significant others and state one’s
purpose.
Identify patient and learn more about the patient in the case study.
Maintain good communication with the significant other by making use of self as
a therapeutic agent.
Asses the following such as:
 
Personal history such as demography data
Personal Family – Health and history by making of diagram
History of Past and Present illness
Conduct physical assessment (IPPA, Cephalocaudal Approach)
Review and monitor diagnostic and laboratory result
Explain to the significant other each purpose of specific medical management
performed and activety participate with the different medical management
undergone patient.
Apply the nursing responsibilities to each medical management.
 
Long Term Objectives:
After 2-3 days of interventions, the nurse will be able to:
Define and identify the modifiable and non-modifiable that contributed
to the occurrence of pneumonia.
Review literature and background of the pathogenesis of the disease
condition and formulated client centered path physiology.
Review literature and background of the signs and symptoms of the
disease condition with rationale and identify specific sign and symptoms
manifested by the client.
Identify nursing diagnosis from the collected data, formulate nursing care
plan, perform nursing intervention and complete evaluation, and if
necessary carry out reassessment if objectives are not met.
Provided health teachings to each medical management received by the
patient do actual soapier.
 
Complete nursing proc.
Objective:
(Patient Centered)
Short term objective
After 1-2 days of interventions, the significant other will be able to:
Acknowledgement the presence and purpose of the nurse in conducting
case study
Develop a trusting relationship during the interview
Understand the purpose of the nurse
Cooperate during assessment and interview
Ask and interest during the course of nursing process

Objectives:
(Patient Centered)
Long term objective
After 2-3 days of nursing interventions, the significant other will be able to:
Follow with the health teachings given by the nurse for each nursing
management
Identify effective and efficient ways on how to deal with condition
Maintain trust during the study to gain its cooperation and achieve strong
compliance to attain optimum level of functioning.
NURSING PROCESS
 
Assessment
Demographic data, Socio economical and environmental factors.
 
Her name is Daniel Quinto 60 years old Male. Married Filifino citicen he
was born on Dec, 24, 1950. He lives in San Francisco Lubao Sitio Quinto
Pampanga with his wife Miranda.She was a Roman Catholic, and they are
prepared of eating pork than vegetable, and he loves to eat vegetable.
Mang Daniel has Two (2) children, one son and one daughter. They
traditionally go to church when Sunday.
The house where Mang Daniel lives is made of concrete and wood. It has 3
bedrooms and 1 toilet. Their water is produce from water pump their
electricity was provided by Pelco.
Their environment is clean, they lived in a town wherein the air is pure,
but there is no medical facility is their place. They had kind neighbors in
their community.
Mang Daniel’s wife is a vendor in bargain and her daughter who support
them she was earing 800 – 1100php. A weekly.
 
Personal History
 
Mang Daniel was born and raised in San Francisco lubao Pampanga.
According to her he was a healthy man before. In their time immunization
is not yet organized, that’s why he was not given a immunization and ever
proper medications..
 
Growth and Development
SIGMUND FREUD PSYCHOSEXUAL DEVELOPMENT: Genital stage
(adolescence and onwards)
 
During the final stage of psychosexual development, the
individual develops a strong sexual interest in the opposite
sex. Where in earlier stages the focus was solely on individual
needs, interest in the welfare of other grows during this
stage. If the other stage have been completed successfully,
the individual should now be well –balanced, warm, caring,
the goal of this stage is to establish a balance between the
various life areas.
ERIK ERIKSON STAGE OF PSYCHOSOCIAL DEVELOPMENT:
(Middle Adulthood 35 -36)
‘‘Generativety” is the concern of establishing and guiding the next
generation. Socially – valued work and disciplines are expression of
generatively. Simply having or wanting children a children is a human
between the stage of birth and puberty. The legal defication of ‘‘child”
generally refers to a minor, otherwise known as a person younger than
the age of majority. Child may also describe a relationship with a parent or
authority figure, or signify group membership in a clean, tribe, or religion.
It can does not in and of itself achieve generatively.
 
During middle age the primary development task is one of
contributing to society and helping to guide future
generations. When a person makes a contribution during this
period, perhaps by raising a family or working toward the
betterment of society a sense of generatively a sense of
productivity and accomplishment result. In contrast, a person
who is self-centered and unable or unwilling to help society
move forward develops a feeling of Stagnation-
dissatisfaction with the relative lack of productivity.
Family Health Illness History
This chart is reflect to family health illness history of Mang Daniel Quinto ,
on both of his paternal and maternal side, on the “ Paternal side” his
grandfather was suffered from liver disease which ended his life, while
her grandmother was suffered from DM she died because of her disease.
On the “Maternal side” his grandfather was suffered from HPN and died
because of some complication, and his grandmother has no illness’ she’s
died because of old age.
His grandfather died because of liver disease. His father also died
because of liver disease a few years ago, while his mother is still alive yet
she’s old and strong, with simple illnesses like cough and colds.
History of Past illness
 
According to Mang Daniel does not admitted to hospital before because
he has good and health condition.
 
 
History of Present illness
 
Mang Daniel two days before her admission to the hospital was
complaining of chest pain and severe headache. According to him the
medicines he takes everyday his not effective. His wife brought him in the
hospital last November 25, 2010 in Florida Romana Pangan District
Hospital.
Physical Examination (November 27, 2010)
 
HAIR: round and symmetrical size is proportional to the size of the body, no felt upon
palpation.
HAIR AND SCALP: Short, black, no sign of parasitic infection.
EYE BROWS: thin and symmetrical, able to move eye brows up and down.
EYE AND EYE LASHES: with anistric sclera, has pale palpebral conjunctiva, able to move
eyes up and down, and side to
side, no discharges. Eye lashes are short, curved in forward direction, positive of blinking
reflex.
EARS: symmetrical with the same sizes and slightly with normal hearing ability, no
discharges.
NOSE: both nostrils are patent, no nasal discharge.
MOUTH AND PHARYNS: has pole, dry lips, and gums, with denture.
NECK: (+) tenderness
CHEST AND LUNGS: with symmetrical chest expansion, slightly have
pain during palpation, no DOB, no abnormal curvature of the sign.
HEART: abnormal rate, rhythm.
ABDOMEN: globular, umbilicus is located in the midline.
SKINS: dry skin, no synopsis noted.
NAILS: clean, short, white in color.
GENITOURINARY: with FC.
MUSCULOSKELETAL: with symmetrical upper and lower extremities.
 
November 27, 2010 Romana Medical Hospital, Patient lying on bed,
conscious with IVF d5 lrs 1L @ 30gtt/min infusing hand with FC 500cc level
connected to UB with yellow in color urine.
 
Anatomy and Physiology
 
Cardiovascular system
 
The cardiovascular system can be thought of as the transport system of the body. This system has three main components: the heart, the blood vessel and the blood itself. The heart
is the system's pump and the blood vessels are like the delivery routes. Blood can be thought of as a fluid which contains the oxygen and nutrients the body needs and carries the
wastes which need to be removed. The following information describes the structure and function of the heart and the cardiovascular system as a whole.
Structure and Function of the Heart
 
Function and Location of the Heart
The heart's job is to pump blood around the body. The heart is located in
between the two lungs. It lies left of the middle of the chest.

Structure of the Heart

The heart is a muscle about the size of a fist, and is roughly cone-shaped.
It is about 12cm long, 9cm across the broadest point and about 6cm thick.
The pericardium is a fibrous covering which wraps around the whole
heart. It holds the heart in place but allows it to move as it beats. The wall
of the heart itself is made up of a special type of muscle called 
cardiac muscle.
 
Chambers of the Heart
The heart has two sides, the right side and the left side. The heart has four
chambers. The left and right side each have two chambers, a top chamber
and a bottom chamber. The two top chambers are known as the 
left and right atria (singular: atrium). The atria receive blood from
different sources. The left atrium receives blood from the lungs and the
right atrium receives blood from the rest of the body. The bottom two
chambers are known as the left and right ventricles. The ventricles pump
blood out to different parts of the body. The right ventricle pumps blood
to the lungs while the left ventricle pumps out blood to the rest of the
body. The ventricles have much thicker walls than the atria which allows
them to perform more work by pumping out blood to the whole body.
 
Blood Vessels
Blood Vessel are tubes which carry blood. Veins are blood vessels which carry
blood from the body back to the heart. Arteries are blood vessels which carry
blood from the heart to the body. There are also microscopic blood vessels
which connect arteries and veins together called capillaries. There are a few
main blood vessels which connect to different chambers of the heart. The aorta
 is the largest artery in our body. The left ventricle pumps blood into the aorta
which then carries it to the rest of the body through smaller arteries. The 
pulmonary trunk is the large artery which the right ventricle pumps into. It
splits into pulmonary arteries which take the blood to the lungs. The 
pulmonary veins take blood from the lungs to the left atrium. All the other veins
in our body drain into the inferior vena cava (IVC) or the
superior vena cava (SVC). These two large veins then take the blood from the
rest of the body into the right atrium.
 

 
Valves
Valves are fibrous flaps of tissue found between the heart chambers and
in the blood vessels. They are rather like gates which prevent blood from
flowing in the wrong direction. They are found in a number of places.
Valves between the atria and ventricles are known as the right and left
atrioventricular valves, otherwise known as the tricuspid and mitral valves
respectively. Valves between the ventricles and the great arteries are
known as the semi lunar valves. The aortic valve is found at the base of
the aorta, while the pulmonary valve is found the base of the pulmonary
trunk. There are also many valves found in veins throughout the body.
However, there are no valves found in any of the other arteries besides
the aorta and pulmonary trunk.
 
(B1) definition of the disease
Hypertension is chronic medical condition in the blood pressure is elevated. It is
also referred to High Blood Pressure or shortened to HT, HTN or HPN. The word
Hypertension’’ by itself, normally refers to systemic, arterial hypertension.
Hypertension can be classified as either essential (primary) or secondary.
Essential or primary hypertension means that no medical cause can found to
explain the raised blood pressure, it is common. About 90-95% of hypertension
is essential hypertension.
Elderly patient who particular when treated may show orthostatic
hypotension, measuring lying sitting and standing BP may be useful. The BP
should at some time have been measured in each arm, and the higher pressure
arm preferred for subsequent measurements.
 
 
Synthesis of the disease.
>HPN is commonly cause of same factors (modifiable and non-modifiable)
it is asymptomatic, but it is also symptomatic some sign of HPN are head
ache, chest pain and other. HPN affect the body’s blood flow because
some of our blood vessels charges in size, it affected the flow to the
organ, the kidney is the main organ affected the enzyme of the kidney
also affected it is called “renin”, it cause some vasoconstriction.
>Some drugs can also cause vascular vasoconstriction, the adrenal cortex
bit secreting hormone called aldosteron, it NA and H2O reabsorption so it
will lead to increase plasma volume, so our BP is increasing
ACTUAL SOAPIE
 
1. November 27, 2010
 
S-
O- Received pt. lying on the bed awake with an ongoing IVF of PNSS 1000 ml
level @ 30ggts/min infusing well the right hand. With O2 @ 3-4 1pm via nasal
canula. VS taken as follow T: 36.5 C PR: 90 bpm. RR: 22cpm BP: 170/100 mmhg
A- Ineffective breathing pattern related to respiratory muscle weakness
P- After 4 hours nursing intervention the pt. Will establish normal/effective
respiratory pattern.
I-
>Established rapport with pt.
>Monitored respiratory status, rate and depth of breath sounds.
>Administered oxygen as prescribe
>Provided a quiet environment.
>Maintained HOB elevated.
>Provided adequate bed rest.
E- Goal met. After 4 hours NI the pt. establish normal/effective respiratory
pattern.
ACTUAL SOAPIE
 
1. November 27, 2010
 
S-
O- Received pt. lying on the bed awake with an ongoing IVF of PNSS 1000 ml
level @ 30ggts/min infusing well the right hand. With O2 @ 3-4 1pm via nasal
canula. VS taken as follow T: 36.5 C PR: 90 bpm. RR: 22cpm BP: 170/100 mmhg
A- Ineffective breathing pattern related to respiratory muscle weakness
P- After 4 hours nursing intervention the pt. Will establish normal/effective
respiratory pattern.
I-
>Established rapport with pt.
>Monitored respiratory status, rate and depth of breath sounds.
>Administered oxygen as prescribe
>Provided a quiet environment.
>Maintained HOB elevated.
>Provided adequate bed rest.
E- Goal met. After 4 hours NI the pt. establish normal/effective respiratory
pattern.
2. November 27, 2010
 
S-
O- Received pt lying on bed awake, with an ongoing IVF of PNSS 1000ml level
@30 ggts/min infusing well @the right hand. With O2 @ 3-4 lmp via nasal
canula. VS taken as follows: T: 36.5 C PR: 90 bpm RR: 22cpm. BP: 170/100 mmhg
A- Ineffective breathing pattern related to respiratory muscle weakness
P- After 4 hours nursing intervention the pt. Will establish normal/effective
respiratory pattern.
I-
>Established rapport with pt.
>Monitored respiratory status, rate and depth of breath sounds.
>Administered oxygen as prescribe
>Provided a quiet environment.
>Maintained HOB elevated.
>Provided bed rest.
E- Goal met. After 4 hours NI the pt. establish normal/effective respiratory
pattern
 
VII. Discharge Planning
General Condition: During my last visit December 12, 2010 the patient is stable. No
oxygen apparatus was hooked. Vital signs were taken and recorded as follow:
Temperature-36.4 degrees Celsius, PulseRate-94bpm, RespiratoryRate-18cpm
BloodPressure-120/80mmHg. The patient doctor prescribed his medicines & the
nurses provided teachings
 
Method:
Metroprolol 100mg oral/bid
Paracetamol 250mg oral/bid
Ampicillin 500mg IV/anst.
 
 
Exercise:
Encourage to have regular exercise, if possible 30 minutes and above a day.
 
 
 
Treatment:
Explained the purpose of treatment and schedule of medicine that she needs to take.
Explained the importance of his treatment.
Health Teaching
Encourage to manage her stress
Encourage to regular visit is his doctor at least to 3 months to monitor his
condition
Instructed the pt. Have deep breathing exercise to reduced his tension.
Promoted to lifestyle change.
Encourage to have adequate rest period.
 
 
OPD
Is follow up schedule
Encourage to salt diet
Encourage to have healthy diet
Encourage to eat fruits and vegetables instead of high fat food
VIII – Finding of the Study
 
This case of Mang Daniel a 60 yr/old male, Suffering from Hypertension he was
admitted in Romana Medical Hospital, Nov 25,2010
The intervention was done to the pt. Mostly health teaching, and reminders are
important on his condition.
Those health teaching that were given to Mang Daniel, are simple to understand
so he can understand his disease condition as well he can, he also known how to
prevent his illness, doing proper management to prevent complication.
 
 
 
IX. Recommendation
Therefore conclude the Hypertension can be asymptomatic something the
person suffering from this can felt some s/sx. Hypertension can be prevented by
having proper diet avoid alcohol intake, and regular exercise.
If you are suspecting that you have Hypertension, it is extremely important that
you qualified medical attention as son possible. The sooner you are diagnosed,
the fastest recovery begins.
It is very important that patient is thoroughly examined by a physician, in order
for the diagnosis to be made correctly before the pt can begin treatment.
 
Conclusion
Hypertension (high blood) is a condition of chronic elevation of BP w/ the persistent
systolic BP of more than 140mmHg and diastolic more than 90mmHg. Hypertension
(high blood pressure) is a disease of vascular regulation resulting from malfunction of
arterial pressure control mechanisms (central nervous system, rennin, angiotensin,
aldosterone `system, extracellular fluid volume.) The basis explanation
is that blood pressure is elevated when there is increase cardiac output plus increase
peripheral vascular resistance.

 
 
 
 
Bibliography
>Google chrome
>www.medline.com
>www.DOH.Phil.com
>www.Hypertension new.com
>8th education Nanda (Pages, 433,499,543,847)