I.

OBJECTIVES GENERAL OBJECTIVES
To be able to render nursing to the client particularly to her conditional status prior to her situation and will be able to enhance participation in conducting such intervention thus, influencing the overall health status.

SPECIFIC OBJECTIVES

y To be able to define about Hypertension. y To be able to know what causes Hypertension. y To be able to discuss the pathophysiology of Hypertension. y To be able to know the medical management appropriate to Hypertension. y To be able to construct Nursing Care Plan appropriate for client reliable to the case. y To be able to attain and maintain health of the client by giving health teaching to the parent and sharing of nursing consideration. y To be able to give appropriate nursing teachings for patient, prior to discharge to maintain self-awareness of the parents in giving care for their child.

and even Heart Failure. and they lived together with her 3 sons. February 04 2010 at 11:30am the patient was admitted to Luzon Medical Center together with her son Mr. Aquino Age: 71 y/o Address: Nilombot. Diabetes. it occurs during the blood pressure was elevated. IV. upon admission of the patient she complaint nausea and vomiting and loss of consciousness associated with severe headache. His mother known to have hypertension. sometimes his mother goes to the barangays clinic near to their house. Go Chief Complaint: Loss of consciousness associated with severe headache Diagnosis: Hypertension III. The patient enjoys eating vegetables and fruits but she eats a lot of salty and fatty foods and she drinks too much coffee. Armando Aquino. PATIENTS PROFILE Name: Catalina M. go her attending physician and he was ordered medicines. and weakness. Dr. and she was diagnosed with Hypertension with severe headache. The staff nurses of the institution give further intervention and checked Vital Signs and they noted that her Blood Pressure is elevated. 2010/ 11:30am Attending Physician: Dr. blurring of vision. and laboratory test and other appropriate intervention for the patient. 1928 Gender: Female Religion: Roman Catholic Date/Time Admitted: February 02. Mapandan Pangasinan Birthdate: November 09. FAMILY AND PATIENTS HISTORY The patient·s son is being interviewed and he verbalized that in his family members has a history of Hypertension. fatigue. The patient·s husband died last 5 years ago. PAST AND PRESENT ILLNESS The patient has a past illness of headache.II. .

V. such as kidney disease or tumours (adrenal adenoma or pheochromocytoma). Beginning at a systolic pressure (which is peak pressure in the arteries. cardiovascular disease (CVD) risk doubles for each increment of 20/10 mmHg. It is considered high if it is consistently over 140. 120 over 80 (written as 120/80 mmHg). Essential or primary hypertension means that no medical cause can be found to explain the raised blood pressure. the pressure created when your heart beats. At severely high pressures. and is a leading cause of chronic renal failure. It is also referred to as high blood pressure or shortened to HT. Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers. Secondary hypertension indicates that the high blood pressure is a result of (i. by itself. the pressure inside blood vessels when the heart is at rest. Either or both of these numbers may be too high. For example. If you have pre-hypertension. The word "hypertension". y y The top number is your systolic pressure. Hypertension can be classified as either essential (primary) or secondary. arterial hypertension. which occurs near the beginning of the cardiac cycle when the ventricles are filled with blood) of 75 mmHg (commonly written as 115/75 mmHg). The bottom number is your diastolic pressure. you are more likely to develop high blood pressure. heart failure and arterial aneurysm. Hypertension is a chronic medical condition in which the blood pressure is elevated. It is considered high if it is consistently over 90.. secondary to) another condition. Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89 on multiple readings. INTRODUCTION/ MEDICAL DIAGNOSIS HYPERTENSION Hypertension is the term used to describe high blood pressure. heart attacks. HTN or HPN.e. . which occurs near the end of the cardiac cycle when the ventricles are contracting) of 115 mmHg and diastolic pressure (which is minimum pressure in the arteries. Causes Blood pressure measurements are the result of the force of the blood produced by the heart and the size and condition of the arteries. Persistent hypertension is one of the risk factors for strokes. Even moderate elevation of arterial blood pressure leads to shortened life expectancy. About 90-95% of hypertension is essential hypertension. It is common. defined as mean arterial pressures 50% or more above average. normally refers to systemic. a person can expect to live no more than a few years unless appropriately treated.

including: o Glomerulonephritis (inflammation of kidneys) o Kidney failure o Renal artery stenosis o Renal vascular obstruction or narrowing Medications o Appetite suppressants o Certain cold medications o Corticosteroids o Migraine medications Hemolytic-uremic syndrome Henoch-Schonlein purpura Obesity Pain Periarteritis nodosa Pheochromocytoma Pregnancy (called gestational hypertension) Primary hyperaldosteronism Renal artery stenosis Retroperitoneal fibrosis Wilms' tumor Symptoms Most of the time. Smoking. or blood vessels The levels of different body hormones High blood pressure can affect all types of people. there are no symptoms. You have a higher risk of high blood pressure if you have a family history of the disease. Too much salt in your diet can lead to high blood pressure. High blood pressure that results from a specific condition. habit. Secondary hypertension may also be due to: y y y y y y y y y y y y y y y y y y y y y y Adrenal gland tumor Alcohol abuse Anxiety and stress Arteriosclerosis Birth control pills Coarctation of the aorta Cocaine use Cushing syndrome Diabetes Kidney disease. Most of the time. nervous system. This is called essential hypertension. no cause is identified. including: y y y How much water and salt you have in your body The condition of your kidneys.Many factors can affect blood pressure. or medication is called secondary hypertension. Symptoms that may occur include: y y y y y y y Chest pain Confusion Ear noise or buzzing Irregular heartbeat Nosebleed Tiredness Vision changes . and diabetes are all risk factors for hypertension. obesity. High blood pressure is more common in African Americans than Caucasians.

The measurements need to be repeated over time. lose weight. see your doctor right away. you may be asked the following questions: y y y y What was your most recent blood pressure reading? What was the previous blood pressure reading? What is the average systolic (top number) and diastolic (bottom number) reading? Has your blood pressure increased recently? Other tests may be done to look for blood in the urine or heart failure. Often. your doctor may think you have high blood pressure. Your doctor will look for signs of complications to your heart. a single blood pressure drug may not be enough to control your blood pressure. If you have pre-hypertension. your doctor will recommend the same lifestyle changes to bring your blood pressure down to a normal range. It is very important that you take the medications prescribed to you. and follow a healthier diet. . If you have side effects. eyes. so that the diagnosis can be confirmed. and other organs in your body. These tests may include: y y y y Chem-20 Echocardiogram Urinalysis Ultrasound of the kidneys Treatment The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. including aliskiren (Tekturna) Vasodilators Your doctor may also tell you to exercise. and you may need to take two or more drugs. If you monitor your blood pressure at home. If the measurement is high. Exams and Tests Health care provider will perform a physical exam and check your blood pressure. including: y y y y y y y y y Alpha blockers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARBs) Beta-blockers Calcium channel blockers Central alpha agonists Diuretics Renin inhibitors. your health care provider can substitute a different medication. kidneys.If you have a severe headache or any of the symptoms above. These may be signs of a complication or dangerously high blood pressure called malignant hypertension. There are many different medicines that can be used to treat high blood pressure.

especially if someone in your family has or had high blood pressure. Try to manage your stress. it is important to have your blood pressure checked during your yearly check-up. Eat a diet rich in fruits. Even if you have not been diagnosed with high blood pressure. Lifestyle changes may help control your blood pressure: y y y y y y y Lose weight if you are overweight. keep your blood sugar under control. Do not consume more than 1 or 2 alcoholic drinks per day. treat. In some cases. (See: Heart disease and diet) Avoid smoking. (See: Nicotine withdrawal) If you have diabetes. Call your health care provider right away if home monitoring shows that your blood pressure remains high or you have any of the following symptoms: y y y y y y y y Chest pain Confusion Excessive tiredness Nausea and vomiting Severe headache Shortness of breath Significant sweating Vision changes Prevention Adults over 18 should have their blood pressure checked routinely. you will have regularly scheduled appointments with your doctor. exercise for 30 minutes on most days. Exercise regularly. Excess weight adds to strain on the heart. or control possible causes of secondary hypertension. . weight loss may be the only treatment needed. and low-fat dairy products while reducing total and saturated fat intake (the DASH diet is one way of achieving this kind of dietary plan). Follow your health care provider's recommendations to modify.Possible Complications y y y y y y y y y y Aortic dissection Blood vessel damage (arteriosclerosis) Brain damage Congestive heart failure Kidney damage Kidney failure Heart attack Hypertensive heart disease Stroke Vision loss When to Contact a Medical Professional If you have high blood pressure. If possible. vegetables.

and veins carry oxygen-poor blood back to your heart. which is far enough to circle the earth more than twice! The one-way circulatory system carries blood to all parts of your body. Arterioles further branch into capillaries. the true deliverers of oxygen and nutrients to your cells. Blood is carried from your heart to the rest of your body through a complex network of arteries.500 kilometers). In the diagram. It is the pulmonary artery that brings oxygen-poor blood into your lungs and the pulmonary vein that brings oxygen-rich blood back to your heart. Your heart works as a pump that pushes blood to the organs. the vessels that carry oxygen-rich blood are colored red. Blood is returned to your heart through venules and veins.000 miles (more than 96. and cells of your body. arterioles. If all the vessels of this network in your body were laid end-to-end. In pulmonary circulation. Blood delivers oxygen and nutrients to every cell and removes the carbon dioxide and waste products made by those cells. they would extend for about 60. tissues. and capillaries. ANATOMY AND PHYSIOLOGY Cardiovascular System Your heart and circulatory system make up your cardiovascular system.VI. This process of blood flow within your body is called circulation. and the vessels that carry oxygen-poor blood are colored blue. where they branch into smaller vessels called arterioles. Most capillaries are . though. Arteries carry oxygen-rich blood away from your heart. Twenty major arteries make a path through your tissues. the roles are switched.

Venules eventually join to form veins. They are an essential part of the urinary system. will beat approximately 2. exceptions are the pulmonary and umbilical veins. The vertebrate heart is composed of cardiac muscle. rhythmic contractions.thinner than a hair. . Kidneys are seen in many types of animals. both of which carry oxygenated blood. and blood pressure.Their principal function is to transport oxygen from the atmosphere into the bloodstream. but have several secondary functions concerned with homeostatic functions. Heart. they move the blood back through wider vessels called venules. which have the production of urine as their primary function. many are so tiny. It weighs on average 250 g to 300 g in females and 300 g to 350 g in males. including vertebrates and some invertebrates. which deliver the blood back to your heart to pick up oxygen. Veins-n the circulatory system. veins (from the Latin vena) are blood vessels that carry blood towards the heart. Veins differ from arteries in structure and function. Most veins carry deoxygenated blood from the tissues back to the lungs. beating at 72 beats per minute.5 billion times during an average 66 year lifespan. This exchange of gases is accomplished in the mosaic of specialized cells that form millions of tiny. The average human heart. only one blood cell can move through them at a time. Kidney-The kidneys are paired organs. arteries are more muscular than veins and they carry blood away from the heart. Lungs. for example. Once the capillaries deliver oxygen and nutrients and pick up carbon dioxide and other waste. and to release carbon dioxide from the bloodstream into the atmosphere. Arteries-is a specialized bodily fluid that delivers necessary substances to the body's cells ² such as nutrients and oxygen ² and transports waste products away from those same cells.is a muscular organ found in all vertebrates that is responsible for pumping blood throughout the blood vessels by repeated. exceptionally thin-walled air sacs called alveoli. which is an involuntary striated muscle tissue found only within this organ. In fact. acid-base balance. Blood-is a specialized bodily fluid that delivers necessary substances to the body's cells ² such as nutrients and oxygen ² and transports waste products away from those same cells. These include the regulation of electrolytes.

PATHOPHYSIOLOGY OF HYPERTENSION .VII.

Mean Corpuscular Volume (MCV) 80 100mm3 86mm3 Measures the average size of your RBCs. COPD & dehydration. malaria. and / or hemolysis. Decrease indicates anemia. Increase indicates myeloproliferative syndrome. Decrease indicates hemorrhage. Increase indicates dengue fever. Increases and decreases can point to abnormal conditions. Increase indicates Macrocytic anemia. Red Blood Cell (RBC count) 4.30-6.11x106/L Indicates actual number of red blood cells per volume of blood . Hematocrit (Hct) 37-55% 32% Measures the amount of space red blood cells take up in the blood. . LABORATORY RESULTS: COMPLETE BLOOD COUNT (CBC) Normal Values Hemoglobin (Hgb) 12-18g/dl Result 12.20 x 106/ L 4. Decrease indicates Microcytic anemia.VIII. Decrease indicates symptoms of anemia and other hemoglobinopathies.4g/dl Significance Measures the amount of oxygen-carrying protein in the blood.

2g/dl Indicates concentration of hemoglobin inside the RBCs. Hemoglobin inside your RBCs. they would also tend to have higher MCH values. .7pg Indicates the amount of oxygen-carrying. Increased MCHC values are seen in conditions where the hemoglobin is abnormally concentrated inside the red cells. since macrocytic RBCs are larger than either normal or microcytic RBCs. Dimished MCH indicates decreased amount of Hgb per cell in pictograms (pg) Mean Corpuscular Hemoglobin Concentration (MCHC) 31 -36g/ dl 34. Decreased MCHC values (hypochromia) are seen in conditions where the hemoglobin is abnormally diluted inside the red cells.Mean Corpscular Hemoglobin (MCH) 27 34pg 34. such as in iron deficiency anemia and in thalassemia. such as in hereditary spherocytosis. a relatively rare congenital disorder.

Lymphocytes 1-5 x 103/L (25-50%) 3. Both increases & decreases can point to abnormal conditions of excess bleeding or clotting. viral . and parasitic infection. Increase indicates presence of microorganism infection.White Blood Cell (WBC) count 5-10 x 103/L 11x 103/L Indicates the actual number of white blood cells per volume of blood. Granulocytes (Neutrophils. Increase indicates spreading of infection. Platelet Count 150 400 x 103/L 344 x 103/L Indicates number of platelets In a given volume of blood. Monocytes (2 . bacterial.1 x 103/L (59.8%) Indicates the actual number of granule containing WBCs per volume of blood.2 10%) (5%) Indicates the actual number of macrophages per volume of blood. and Basophils) 2 -8 x 103/L (65 80%) 2. Increase indicates chronic infection. Increase Indicates allergies.8 x103/ L (65%) Indicates the actual number of T-Cells and B-Cells per volume of blood. . Eosinophils.

Decrease indicates metabolic acidosis.015 Determines the ratio of density of substances in the urine.02mmol/L Significance Increased glucose level indicates hyperglycemia if chronic.URINE CHEMISTRY (URINALYSIS) Normal Values Glucose random Negative Result Negative Significance Presence of glucose may mean glycosuria w/c generally indicates Diabetes mellitus.1mmol/L 1. possible for Diabetes mellitus.11 ± 2.6 8.5 Increase in pH indicates metabolic alkalosis.9 ± 7.6mmol/L . pH 4.035 1. Protein Negative 1+ sence of protein in urine may mean stress. 3. PIH. FBS ± LIPID PROFILE Normal Values Glucose Levels.9 ± 6.003 1. Specific Gravity 1.0 6.63mmol/L Triglycerides 0. Diabetic Nephropathy & HPN.5mmol/L 5. Increase indicates the presence of atheromatous disease. Increase indicates the development of atheroerosis & pancreatiti Cholesterol 2.1mmol/L Result 11.

3mEq/L 4. Increase would aggravate Renal problems. and shift of brain structure.ELECTROLYTES AND CREATININE Normal Values Sodium ( Na) 135 ± 152mEq/L Result 155. hematoma. Go his attending physician and they ordered medical management: the ff.5mol/L IX. Atherosclerotic vertebrobasilar and supraclinoid internal carotid arteries Mild left ventricular cardiomegaly and tortous atherosclerotic aorta.11mEq/L Chloride (Cl ) 98 ± 107mEq/L 99. Increase may indicate excess fluid loss. medical management : Procedures Done Reasons Why Used Impression Result Laboratory Tests: This is to assess fro abnormalities internally happening to the cardiovascular system and other bad conditions present. It reveals infarction. Dr. thirst. Refer to the Laboratory test Result Head CT Scan Acute Subarachnoid hemorrhage and mild communicating hydrocephalus infarcts.4 ± 123. and Cardiac arrhythmias. Potassium ( K ) 3.4mEq/L Creatinine 35. lates creatinine clearance (CICr). 2010.5Meq/L Significance Increase would elevate blood pressure & could lead to stroke or death. This determines if there is presence of infarction that can cause stoke. Mediatinum diaphragm and v isualized bone are unremarkable Chest X-Ray This determines if there is presence of abnormal condition of the chest.4 ± 5. MEDICAL MANAGEMENT: DIAGNOSTIC TESTS: February 06. Clear lungs parenchyma without vascular congestion. . can indicate renal disease. vomiting and diarrhea.76mol/L 57. which reflects the glomerular filtration rate (GFR).

02/05/10  pls Transfer to ICU  Start Mannitol 100ml now  IVF PNSS 1 liter x 16 hours +30mg Kcl  Monitor Hgt every 12 hours  For neurosurgical evaluation and management to Dr. Low Fat Diet  Monitor Vital Signs every 4 hours  Monitor I and O every 1 hour  IVF=PNSS x 24 hours  For CBC.  Pls refer accordingly  Maintain Bedsores Precaution  Pls Catheter the patient  Monitor Vital Signs every 1 hour  Monitor I and O every 1 hour  On low salt low fat diet .02/04/10  Please Admit under my Service (Dr. K.Ray  For Electrocardiogram  Add 30ml of KCl same IVF rate to run for 24 hours  Mefenamic Acid (Ponstan) 500mg 1 Tab now. RBS  For Na. Florendo  CT Scan @ Bedside  Give vit k 1 amp IV every 8 hours x 3 doses 02/06/10  Same IVF  Cont.Go)  Low Salt. Meds. Creatinine  For Chest X.

Meds 02/12/10  Possible Discharged or may if ok  IVF PLR I liter x 16 hours 02/13/10  Telephone order Ok to discharge  Cont. Meds  May remover foley Catheter today after bladder training  IVF to consume .02/07/10  Pls insert NGT if the patient cannot eat or drink.  Monitor BP every 1 hour  Maintain Bedsores Precaution  Strict Aspiration Precaution  I and O ever shift 02/10/10  Administer Kcl 1 amp 30mg in D5w 120ml x 12 hours  PLRS 1 liter x 16 hours  For repeat Hgt @ 9pm 02/11/10  IVF PLRS I liter x 16 hours  HGT monitoring every 12 hours (pre-breakfast & pre-dinner)  PNSS I liter x 16 hours  To consume mannitol  Cont.  Pls Give Catopril 25mg 1 tab Now  Refer accordingly 02/08/10  May transfer to room  IVF PLRS 1 liter x 24 hours  Cefotaxime 500mg twice a day 02/09/10  Continue Meds.

Provide the patient and the patient s family info s on how to maintain healthy lifestyle. IX. Reinforce the right diet for the patient 2. VIII. VI. VII. DISCHARGE PLANNING: Before patient has to discharge from the hospital. IV. . 4. Maintain Proper Personal hygiene 3. the nurse should: 1. (Refer to the Drug Study) XII. Arcoxia 60mg 1 tab Nimodipine (nimatop) 20mg 1 tab Once a Day Omeprazole (prosel ) 20mg 1 tab Once a Day Lactulose 20ml @ bedtime Citicoline 500mg 1 tab three time a day Topiramate 50mg ½ Tab @ bedtime Metformine 500mg 1 tab Once a day Micardis 80mg 0D in Morining Carvedolol 25mg ½ Tab Once a day in Morining  For follow up check up on 02/25/10 and 03/0310 TREATMENT: The Physician had ordered medications appropriate for the patient. Gliclazide 1 tab OD with breakfast 02/14/10  May Go Home 02/15/10  Home Medication are the ff. V. III. I. Remind patients of the restrictions and home medications. II.

Introduction/ Medical Dx. Nursing Care Plan XII. III. Past and Present Illnesses V. II. Drug Study XI. Anatomy and Physiology VII. Discharged Planning . VI. Objectives Patients Profile Family and Patient History IV. Medical Management X.TABLE OF CONTENT I. Pathophysiology VIII. Laboratory Result IX.

Raelyn Joanne Lim. Clinical Instructor . RN. Dagupan City A Case Study of In partial fulfillment and requirements in RLE Submitted By: James Joel S.University of Luzon College Of Nursing and Midwifery Perez Blvd. Reyes Luzon Medical Center MTW/3-11shift Submitted To: Ms.

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