Final

Socioeconomic
Status
TABLE OF CONTENTS
I. INTRODUCTION
A. General Objective
B. Specific Objective
II. PATIENT’S DATA
A. Vital Information
B. Family Background
C. History of Past Illness
D. History of Present Illness
E. Effects and Expectations of Illness to Self and Family
F. Genogram
G. Developmental Data
III. REVIEW OF SYSTEM
IV. PHYSICAL ASSESSMENT
V. TEXTBOOK DISCUSSION
A. Complete Diagnosis
B. Anatomy and Physiology
C. Definition of Terms
D. Symptomatology and Etiology
E. Pathophysiology
VI. LABORATORY RESULTS
VII. DOCTOR’S ORDER
VIII. LIST OF DRUGS
IX. DRUG STUDY
X. LIST OF PRIORITIZED NURSING PROBLEM
XI. NURSING CARE PLAN
XII. PROGNOSIS
XIII. BIBLIOGRAPHY
INTRODUCTION
This is the case of a female patient, 44 years old living at Brgy. Lutayan Proper, Lutayan, Sultan
Kudarat. She was admitted September 23, 2018 at 9:00 AM at South Cotabato Provincial
Hospital Under the service of Dr. Brown. She was diagnosed with Cholecystolithiasis and was
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sent to the operating room for a Cholecystectomy to be done.
According to Brunner and Suddarth’s Textbook of Medical Surgical Nursing (12th Edition),
Cholecystectomy is the removal of the gallbladder. The operation is done to remove the
gallbladder due to gallstones causing pain or infection. Gallstones that causes biliary colic (acute
pain in the abdomen caused by spasm or blockage of the cystic or bile duct) are the most
common reason for cholecystectomy. The most common symptoms are sharp pain in the upper
right part of the abdomen, low fever, nausea and feeling bloated and jaundice. Before 1991, an
open technique was the standard procedure for cholecystectomy. Today, 92% of all
cholecystectomies are done laparoscopically.
Every year, approximately 500,000 cholecystectomies are performed in the US. Cholelithiasis
affects approximately 10% of the adult population in the United States. In 2011, cholecystectomy
was the 8th most common operating room procedure performed in hospitals in the United States,
with over 750,000 operations being performed annually. In 2013, Australia had one of the
highest rates of laparoscopic cholecystectomy among countries. The rate of laparoscopic
cholecystectomy per 100,000 people was 216 in Australia compared with 202 in Canada, 197 in
Germany, 133 in Denmark, 125 in the United Kingdom and 116 in New Zealand.
According to the Philippine Council for Health Research and Development, thousands of new
cases are diagnosed each year and cholecystectomy (the surgical removal of the gallbladder), is
one of the most common abdominal operations done locally in the Philippines. As of 2014, it
th
ranked 5 as the leading cause of major surgical operation. A study of the natural history of
cholelithiasis demonstrates that approximately 35% of patients initially diagnosed with having,
but not treated for, gallstones later developed complications or recurrent symptoms leading to
cholecystectomy.
Asking the question of how this condition occurs, this case study will provide information about
acute gastroenteritis that may help the listeners understands the cause of this condition. Our case
study will help you enhance your knowledge and skills in dealing with patients who suffer from
this condition.
OBJECTIVES OF THE STUDY
General Objective:
After though research and analysis, we will able to present all important information
about Hypertension, broad in our knowledge and skills, enhance our attitudes in the application
of nursing process and management of the disease.
Specific Objective:
After 1-2 hours of presenting the case study, the listeners will be able to:
1) Present correctly the important information regarding patient’s data by presenting the ff:
a. Vital Information
b. Background of the family
c. History of past illness
d. History of present illness
e. Effects and Expectations of the family and the patient to the illness.
f. Developmental Data
2) Discuss briefly the result of the Physical Assessment of the patient.
3) Discuss comprehensively the complete diagnosis of the patient.
4) Discuss briefly the involved Anatomy and Physiology of the System affected by
Hypertension stage 2.
5) Present the etiology and symptomatology of Hypertension stage 2.
6) Traces schematically the pathophysiology of Hypertension stage 2.
7) Enumerate the predisposing and precipitating factors thoroughly.
8) Interpret the laboratory and other diagnosis results to the patient.
9) Identify and prioritize the possible diagnosis to the patient and formulate applicable

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interventions.
10) Present the drugs that the physician ordered for the wellness of the patient and discuss
the mechanism and its effects.
11) Present the prognosis.
PATIENT’S DATA
Vital Information
Patient’s Name: Mrs. Sugar
Age: 51 years old
Gender: Female
Address: Prk. Mabuhay, Reyes (Poblacion), Banga, South Cotabato
Date of Birth: February 28, 1967
Place of birth: Banga, South Cotabato
Religion: Roman Catholic
Tribe: Ilonggo
Civil Satus: Married
Occupation: Housewife
Educational Attainment: High School Graduate
Date Admitted: February 27,2019
Time Admitted: 6:50 PM
Chief Complaint: Difficulty of Breathing, Left-sided numbness
Attending Physician: Dr. Coffee
Name of Institution: South Cotabato Provincial Hospital
Spouse’s Name: Mr. Sugar
Age: 54 yrs old
Address: Banga, South Cotabato
Religion: Roman Catholic
Tribe: Ilokano
Occupation: Bus Driver
Educational Attainment: High School Graduate
Children
Name Age Gender
Educational Attainment
1. Ginger 31 Female High School
Level
2. Onion 25 Male Elementary
Level

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Source of Information: Patient and Patient’s Chart
Source of Income: Husband’s Occupation
FAMILY BACKGROUND
Mrs. Sugar is the third born child of Mr. And Mrs. Vinegar. They reside in Prk. Mabuhay,
Reyes (Poblacion), Banga, South Cotabato and are of the Catholic faith. Mr. Sugar along with his
wife live in a simple house made of wood. It has a large space where they plant vegetables and
other fruit trees. Mr. Sugar currently works as a bus driver. He had been working as a driver for
10 years as estimated by Mrs. Sugar. He experienced working as a construction worker, laborer,
truck driver and many more. They have one son and one daughter. Both of them are no longer
living with them but their daughter does visit them frequently. Mr. Sugar’s income is enough to
supply for the basic needs. On Saturdays and Sundays, they also sell barbecue chicken and pork
outside their house for extra income. Their diet mainly consists of meats to include beef, chicken
and fish and vegetables. Mrs. Sugar confessed that she is fond of drinking softdrinks and eats a
lot of rice every meal. They usually eat fruits within their yard such as guava, mango and chico.
When asked about medical needs the family noted that they do not use herbal medicines for
minor illnesses such as mild fever, coughs and the flu, instead using over the counter
pharmaceuticals. Also, they rarely visit the hospitals for consultations or regular checkups.
She mentioned that her brother and uncle is diagnosed with diabetes. Her uncle had his
left leg amputated due to complication. Both also has hypertension.
HISTORY OF PAST ILLNESS

Upon interview of Mrs. Sugar’s past diseases, she informed us that she already had
chicken pox, measles and mumps. She also had common diseases such as flu, coughing and
fevers. She also said that she is a fully immunized child. Mrs. Sugar stated that she has no history
of asthma, kidney or liver conditions; She has no history of hospitalization.
However, on December she mentioned that she felt numbness and tingling sensation in
her left side of the body and was never relieved. She also experienced edema which went away
when she elevated her feet. She consulted a doctor and was asked to have her blood sugar tested
but due to financial constraints, she wasn’t able to comply. She didn’t return for her follow-up
check-up which was supposedly scheduled on January.

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HISTORY OF PRESENT ILLNESS
An hour prior to admission, Mrs. Sugar experienced difficulty of breathing which is why
her sister-in-law brought her to the hospital. She was then confined to the hospital and had an
admitting diagnosis of Hypertension stage 2 to consider Diabetic Neuropathy secondary to
Diabetes Mellitus 2. Her chief complaint also included left sided numbness. She was transferred
from the Emergency Room to the Female Medical Ward on the same day for further observation
and treatment.
EFFECTS AND EXPECTATIONS OF ILLNESS TO SELF AND FAMILY
Effects of illness to self

According to Mrs. Sugar, she was aware that Hypertension and Diabetes is in their family
history and still didn’t watch her diet. She regretted disregarding her health and didn’t come back
for her follow-up check-up. She had questions regarding the disease and was concerned if the
numbness and tingling sensation can still be cured.
Effects of illness to Family
Mrs. Sugar’s family is worried about her condition and prays for her fast recovery.
They're trying to give their best efforts in helping Mrs. Sugar and to assist her and provide all of
her necessities. Although some relatives have offered to help, they can't avoid thinking about the
expenses and hospital bills. They agree to be more responsible in their diet and to educate their
relatives about the disease.
Expectation of illness to self
Mrs. Sugar expects to feel better soon. She hopes she can go home to continue her
recovery in a more comfortable environment. She also expects that her illness will not
complicate.
Expectation of illness to Family
Mr. Sugar’s husband is slightly bothered with the money being spent on her wife.
Although, their son and daughter does reach out their help financially, they are also concerned of
the possible complications. They promised to eat a well-balanced diet, minimize sodas and
exercise.
DEVELOPMENTAL DATA

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Psychosocial Theory
(Erik Erikson)
Erik Erikson. (1950,1963) a german psychoanalyst heavily influenced by Sigmund Freud,
explored three aspects of identity. The Ego Identity (self), the Personal Identity, (personal
idiosyncrasies that distinguish a person from another) the Social/Culture Identity (collection of
social roles a person might play).
Erikson’s Psychosocial Theory of Development considers the impact of external factors, parents
and society on personality development from childhood to adulthood. According to Erkison’s
theory, every person must pass through a series of eight (8) interrelated stages over the entire life
cycle.
Task Justification Remarks

Infancy: Birth-18 months old Mrs. Sugar said her parents >Achieved
Trust vs. Mistrust took care of her when she Successfully
During the first or second year of life, the major was an infant. She didn’t
emphasis is on the mother and father’s have a nanny since but her
nurturing ability and care for a child, especially mother and grandmother
in terms of visual contact and touch. The child were always available to
will develop optimism, trust, confidence, and take care of her needs.
security if properly cared for and handled. If the
child does not experience trust, he/she may
develop insecurity, worthlessness and general
mistrust to the world.
Toddler/Early Childhood years:18 mo.s-3 yrs Mrs. Sugar said that they >Achieved
old were given the freedom to Successfully
Autonomy vs. Shame and doubt choose which toy they want
At this point, the child has an opportunity to to play with, but their
build self-esteem and autonomy and he/she parents seldom buy them
learns new skills and right from wrong. The toys. Since she has 10
well-cared for child is sure of himself, carrying siblings, she was used to
him/herself with pride rather than shame. learning things on her own
During this time of the “terrible twos”, like taking a bath or
defiance, and stubbornness can also appear. cleaning up after she played
with her toys.
Preschooler: 3-5 yrs. Old Mrs. Sugar said that she >Achieved
Initiative vs. Guilt looks up to her mother who Successfully
During this period we experience a desire to is a strong and loving
copy the adults around us and take initiative in woman and her sister who is
creating play situations. We make up stories multi-talented. She
with Barbies and Kens, toy phones and sometimes fantasize or role
miniature cars, playing out roles in a trial play that she is her sister.
universe.
The most significant relationship is with basic
family.
School Age: 6-12 years old Mrs. Sugar was very active >Achieved
Industry vs. Inferiority in school activities. She Successfully
During this stage, we are capable of learning, stated that she is competitive
creating and accomplishing numerous new in games. She had her group
skills and knowledge. Thus developing a sense of friends which she always
of industry, This is also a very social stage of plays with. She said she has
development and if we experience unresolved no problems in socializing
feelings of inadequacy and inferiority among but does get nervous when
our peers, we can have serious problems in she becomes the center of
terms of competence and self-esteem. attraction.
Parents are no longer complete authorities they
once were, although they are still important.
Adolescence: 12-18 years old Mrs. Sugar said she had no >Achieved

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Identity vs. Role Confusion difficulties when she began Successfully
During this stage adolescents search for a sense to be independent. She was
of self and personal identity, through an intense already thinking of finding a
exploration of personal values, beliefs and job when she was in 3rd year
goals. During adolescence the transition from high school. She was
childhood to adulthood is most important. already determined to work
Children are becoming more independent, and and save money to buy a
begin to look at the future in terms of career, house of her own.
relationships, families, housing, etc. The
individual wants to belong to a society and fit
in. This is a major stage in development where
the child has to learn the roles he will occupy as
an adult.
Young adulthood: 18-40 years old Mrs. Sugar said that her >Achieved
Intimacy vs. Isolation husband was her longtime Successfully
During this stage, we explore relationships boyfriend. She became more
leading toward longer term commitments with comfortable with him after
someone other than a family member. they got married and said
Successful completion of this stage can lead to that they communicate well
comfortable relationships and a sense of and felt safe in their
commitment, safety, and care within a relationship. She believes
relationship. Avoiding intimacy, fearing that marrying him wasn’t a
commitment and relationships can lead to mistake. Although, they
isolation, loneliness, and sometimes depression. were forced to get married
Success in this stage will lead to the virtue of due to her pregnancy.
love.
Middle adulthood: 40 to 65 years old Mrs. Sugar is a housewife >Partially
Generativity vs. Stagnation and is proud that her Achieved
During this stage, we establish our careers, children are well-mannered
settle down within a relationship, begin our own and respectful. She said that
families and develop a sense of being a part of she and her husband guided
the bigger picture. her children well spiritually.
We give back to society through raising our
children, being productive at work, and
becoming involved in community activities and
organizations. By failing to achieve these
objectives, we become stagnant and feel
unproductive. Success in this stage will lead to
the virtue of care.
-
Psychosexual Theory
- (Sigmund Freud)
According to Freud’s theory of Psychosexual Development, the personality develops in five
overlapping stages from birth to adulthood. The libido changes its location of emphasis within
the body from one stage to another. Therefore, a particular body area has special significance to a
client at a particular stage.
If the individual does not achieve satisfactory progression at each stage, the personality
becomes fixated at that stage. Ideally, an individual progress through the tasks of each stage and

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balance is achieved between the id, ego and superego.
-
Oral Stage Mrs. Sugar was exclusively >Achieved
Birth-1 year old breastfed until 1 year old and Successfully
>pleasure centers around the mouth and the shifted to instant formulated
ingestion of food. milk products thereafter. She
>a child derives pleasure through mouth by also used a pacifier but forgot
sucking, biting and swallowing. Conflict when it stopped. She started
arises when the oral needs of the child are eating solid food during her 6th
not met. month.
Anal Stage Mrs. Sugar was toilet trained >Achieved
1-3 years old at the age of 2 years old and Successfully
>withholding elimination until its ultimate but still uses a diaper at night
release is a source of pleasure. because she wets the bed
>anus becomes the center of gratification sometimes.
as toilet training starts and the pleasure is
derived by defecating or retaining feces.
Phallic Stage Mrs. Sugar is very close to her >Achieved

4-6 years old father and older brother. She Successfully
>pleasure centers around the genitals. said she remembered having
>self-manipulation is the chief source of her first crush when she was
pleasure. in grade 3.
Genitals become the center of gratification
and children develop attraction towards the
parent of the opposite sex.
Genital Stage Mrs. Sugar is married with 2 >Achieved
Puberty-death children. Successfully
>the genital stage is a time of sexual
reawakening.
>the source of pleasure now becomes
someone outside of the family.
>it is the puberty period when sexual urges
reawaken that may lead to children
exploring their sexuality.
Developmental Task Theory

(Robert Havighurst)
Robert Havighurst believed that learning is the basic to life and that people continue to learn
throughout life. He described growth and development as occurring during six stages. Each
associated with 6-10 tasks to be learned.
Havighurst promoted the concept of Developmental Tasks in the 1950’s. A

developmental task is “a task which arises about a certain period in the life of an individual,
successful achievement of which leads to his happiness and to success with later task, while
failure leads t unhappiness in the individual disapproved by the society and difficulty with
later tasks.”
Middle Adulthood
> Achieving adult civic and Mrs. Sugar does participate in >Achieved Successfully
social responsibility barangay activities so long as it won’t

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affect her time in doing her
responsibilities as a housewife.
> Establishing and maintaining Mrs. Sugar said that her husband’s >Achieved Successfully
an economic standard of living income is enough to supply their
basic needs.
> Assisting teenage children to Mrs. Sugar said that her children no >Achieved Successfully
become responsible and happy longer depend on them and is already
adults employed. She is proud to say that
they are responsible.
> Developing adult leisure-time Mrs. Sugar does watch TV and >Achieved Successfully
activities sometimes spend time with her
neighbors socializing.
>Relating oneself to one’s Mrs. Sugar said that her husband does >Achieved Successfully
spouse as a person his best to understand her and vice
versa.
>Accepting and adjusting to the Mrs. Sugar isn’t bothered of the >Achieved Successfully
physiologic changes of middle physiological changes of middle age.
age She said that she already knows what
to expect as she grows old.
>Adjusting to aging parents. Mrs. Sugar’s parents already passed >Achieved Successfully
away but she was able to take care of
them when they were aging. Her
siblings were supporting each other
emotionally which made them better
adjust.
Physical Assessment
General Appearance:
The patient is female, lying on the bed with a #1 PNSS hooked at right cephalic vein at KVO rate
with 970cc remaining, patent and infusing well. The patient is conscious, oriented to date, time
and place.
Vital Signs: T-36.4C RR-20cpm PR-100bpm BP- 130/90mmHg

Skin, hair, nails:
Inspection: skin is tan in color, generally uniform. No abrasion and lesions noted. No scars noted.
Dark spots on face noted. Hair is evenly distributed, thin and black in color. Nails are short with
minimal dirt.
Palpation: Good skin turgor noted, warm to touch, capillary refill returns within 3 seconds.
Head:
Inspection: Skull is round and symmetrical. Head is proportion to the body. Skull is intact, no
dandruff noted. Lips are slightly pale. No acnes noted on scalp and face.
Palpation: Hair is thin, skull is firm with no nodules and mass noted. No tenderness and
inflammation noted.

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Eyes and vision:
Inspection: Eyebrows and eyelashes are evenly distributed. Sclera is white. Eyelids close
symmetrical. Conjunctiva is pink in color. Pupils are equally round, reactive to light and
accommodation.
Ear:
Inspection: Pinna is normal in size, located to the left and right of the head. Auricles are in same
color, no lesions and abnormalities noted. No abnormal discharges noted.
Palpation: no mass noted. Pina recoils when folded.
Nose:
Inspection: External nose are symmetric and straight, uniform in color and no discharges noted.
Palpation: No tenderness and lesions noted upon palpation of maxillary and frontal sinuses.
Mouth and Pharynx:

Inspection: Slightly pale lips noted. No ulceration noted. Uvula is on the center. Tonsils were not
inflamed. No oral thrush noted.
Neck:
Inspection: Neck muscles are equal in size with head positioned at the center. Range of motion is
not limited and in normal range. No inflammation noted.
Palpation: No tenderness noted, thyroid gland and lymph nodes are not palpable. Trachea is in
central placement in midline. No presence of papules noted.
Thorax and Lungs:

Inspection: Symmetrical chest expansion and depression. Chest configuration is normal. Able to
breathe properly.
Auscultation: No abnormal or crackling sounds noted. Equal and clear breath sounds.
Abdomen:
Inspection: moles noted. Abdomen is smooth and umbilicus is in the center and not protruding.
No redness or swelling noted.
Extremities: Upper: No deformities noted and swelling are observed. Lesions are not seen during
inspection. Low muscle tone noted.
Lower: No lesions or deformities noted. The nails in the feet are dirty.
Genitals: Patient refused to be assessed due to her personal reasons.

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Review of Systems
General: Patient complaint of having difficulty doing tasks due to numbness of her left side.
Skin and nails: Patient denied feeling of itchiness.

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Head: Patient complaints feeling of dizziness
Eyes: Patient denies visual correction but verbalized that she can’t see from afar. Upon interview,
she can clearly see until approximately 6ft. She also has difficulty reading text messages with
normal fonts and needs a larger font.
Ears: Patient denies of hearing loss or having pain.
Nose: Patient denies obstruction or runny nose.
Mouth/Throat: Patient denies having difficulty eating or pain in swallowing.
Neck: Patient denies having stiffness of neck
Lymph nodes: Patient denies having pain or tenderness when palpated
Respiratory: Patient verbalized difficulty of breathing during noon time.
Cardiovascular: Patient denies having chest pain or feelings of palpitations.
Gastrointestinal: Patient denies having abdominal pain or feeling bloated
Endocrine: Patient denies pain or tenderness when thyroid glands were palpated. She also denies
heat or cold intolerance.
Reproductive: Patient denies having pain during urination. She verbalized polyuria.
Musculoskeletal: Patient has difficulty moving her left side of the body due to numbness. She
also mentioned that she feels a tingling sensation on her left side of the body since December.
Hematologic: Patient denies of having anemia
Neurologic: Patient denies of having loss of consciousness. She only complaint of dizziness and
difficulty sleeping.
Psychiatric: Patient is worried about her condition.
COMPLETE DIAGNOSIS
Hypertension, also known as high or raised blood pressure, is a condition in which the
blood vessels have persistently raised pressure. Blood is carried from the heart to all parts of the
body in the 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 (arteries) as it is pumped
by the heart. The higher the pressure the harder the heart has to pump.
Blood pressure measurement
To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm
cuff around your arm and measure your blood pressure using a pressure-measuring gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first,
or upper, number measures the pressure in your arteries when your heart beats (systolic
pressure). The second, or lower, number measures the pressure in your arteries between beats
(diastolic pressure).

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Blood pressure measurements fall into four general categories:
• Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg.
• Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to
129 mm Hg and a diastolic pressure below 80 mm Hg. Elevated blood pressure tends to get
worse over time unless steps are taken to control blood pressure.
• Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139
mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
• Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure
of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is
even more significant. Isolated systolic hypertension is a condition in which the diastolic
pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to
130 mm Hg). This is a common type of high blood pressure among people older than 65.
Taking your blood pressure at home

An important way to check if your blood pressure treatment is working, to confirm if you have
high blood pressure, or to diagnose worsening high blood pressure, is to monitor your blood
pressure at home.
Home blood pressure monitors are widely available and inexpensive, and you don't need a
prescription to buy one. Home blood pressure monitoring isn't a substitute for visits to your
doctor, and home blood pressure monitors may have some limitations.
Make sure to use a validated device, and check that the cuff fits. Bring the monitor with you to
your doctor's office to check its accuracy once a year. Talk to your doctor about how to get
started with checking your blood pressure at home.
Devices that measure your blood pressure at your wrist or finger aren't recommended by the
American Heart Association.
Causes
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there's no identifiable cause of high blood pressure. This type of high blood
pressure, called primary (essential) hypertension, tends to develop gradually over many years.
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high
blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood
pressure than does primary hypertension. Various conditions and medications can lead to
secondary hypertension, including:
• Obstructive sleep apnea
• Kidney problems

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• Adrenal gland tumors
• Thyroid problems
• Certain defects you're born with (congenital) in blood vessels

• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-
counter pain relievers and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines
Risk Factors
High blood pressure has many risk factors, including:
• Age. The risk of high blood pressure increases as you age. Until about age 64, high blood
pressure is more common in men. Women are more likely to develop high blood pressure
after age 65.
• Race. High blood pressure is particularly common among people of African heritage, often
developing at an earlier age than it does in whites. Serious complications, such as stroke,
heart attack and kidney failure, also are more common in people of African heritage.
• Family history. High blood pressure tends to run in families.
• Being overweight or obese. The more you weigh the more blood you need to supply oxygen
and nutrients to your tissues. As the volume of blood circulated through your blood vessels
increases, so does the pressure on your artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The
higher your heart rate, the harder your heart must work with each contraction and the
stronger the force on your arteries. Lack of physical activity also increases the risk of being
overweight.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood
pressure temporarily, but the chemicals in tobacco can damage the lining of your artery
walls. This can cause your arteries to narrow and increase your risk of heart disease.
Secondhand smoke also can increase your heart disease risk.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to
retain fluid, which increases blood pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium in your
cells. If you don't get enough potassium in your diet or retain enough potassium, you may
accumulate too much sodium in your blood.
• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more
than one drink a day for women and more than two drinks a day for men may affect your
blood pressure.
If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a
day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces
of wine or 1.5 ounces of 80-proof liquor.
• Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to
relax by eating more, using tobacco or drinking alcohol, you may only increase problems
with high blood pressure.
• Certain chronic conditions. Certain chronic conditions also may increase your risk of high
blood pressure, such as kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.

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Although high blood pressure is most common in adults, children may be at risk, too. For some
children, high blood pressure is caused by problems with the kidneys or heart. But for a growing
number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise,
contribute to high blood pressure.
Complications
The excessive pressure on your artery walls caused by high blood pressure can damage your
blood vessels, as well as organs in your body. The higher your blood pressure and the longer it
goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:
• Heart attack or stroke. High blood pressure can cause hardening and thickening of the
arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge,
forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
• Heart failure. To pump blood against the higher pressure in your vessels, the heart has to
work harder. This causes the walls of the heart's pumping chamber to thicken (left
ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping
enough blood to meet your body's needs, which can lead to heart failure.
• Weakened and narrowed blood vessels in your kidneys. This can prevent these organs
from functioning normally.
• Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
• Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism,

including increased waist circumference; high triglycerides; low high-density lipoprotein
(HDL) cholesterol, the "good" cholesterol; high blood pressure and high insulin levels.
These conditions make you more likely to develop diabetes, heart disease and stroke.
• Trouble with memory or understanding. Uncontrolled high blood pressure may also affect
your ability to think, remember and learn. Trouble with memory or understanding concepts
is more common in people with high blood pressure.
• Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain
type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also
can cause vascular dementia.
Treatment
Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor
may recommend you make lifestyle changes including:
• Eating a heart-healthy diet with less salt
• Getting regular physical activity

• Maintaining a healthy weight or losing weight if you're overweight or obese
• Limiting the amount of alcohol you drink
Your blood pressure treatment goal depends on how healthy you are. Your blood pressure
treatment goal should be less than 130/80 mm Hg if:
• You're a healthy adult age 65 or older

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• You're a healthy adult younger than age 65 with a 10 percent or higher risk of developing
cardiovascular disease in the next 10 years
• You have chronic kidney disease, diabetes or coronary artery disease
Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need
treatment (medications) to reach that level.
If you're age 65 or older, and use of medications produces lower systolic blood pressure (such as
less than 130 mm Hg), your medications won't need to be changed unless they cause negative
effects to your health or quality of life.
The category of medication your doctor prescribes depends on your blood pressure
measurements and your other medical problems. It's helpful if you work together with a team of
medical professionals experienced in providing treatment for high blood pressure to develop an
individualized treatment plan.
Medications to treat high blood pressure
• Thiazide diuretics
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)

• Calcium channel blockers
Additional medications sometimes used to treat high blood pressure

If you're having trouble reaching your blood pressure goal with combinations of the above
medications, your doctor may prescribe:
• Alpha blockers
• Alpha-beta blockers
• Beta blockers
• Aldosterone antagonists
• Renin inhibitors
• Vasodilators
• Central-acting agents
Resistant hypertension: When your blood pressure is difficult to control

If your blood pressure remains stubbornly high despite taking at least three different types of
high blood pressure drugs, one of which usually should be a diuretic, you may have resistant
hypertension.
People who have controlled high blood pressure but are taking four different types of
medications at the same time to achieve that control also are considered to have resistant
hypertension. The possibility of a secondary cause of the high blood pressure generally should be
reconsidered.
Having resistant hypertension doesn't mean your blood pressure will never get lower. In fact, if
you and your doctor can identify what's behind your persistently high blood pressure, there's a
good chance you can meet your goal with the help of treatment that's more effective.

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Your doctor or hypertension specialist may:
• Evaluate potential causes of your condition and determine if those can be treated
• Review medications you're taking for other conditions and recommend you not take any that
worsen your blood pressure
• Recommend that you monitor your blood pressure at home to see if you may have higher
blood pressure in the doctor's office (white coat hypertension)
• Suggest healthy lifestyle changes, such as eating a healthy diet with less salt, maintaining a
healthy weight and limiting how much alcohol you drink
• Make changes to your high blood pressure medications to come up with the most effective
combination and doses
• Consider adding an aldosterone antagonist such as spironolactone (Aldactone), which may
lead to control of resistant hypertension
Some experimental therapies such as catheter-based radiofrequency ablation of renal sympathetic
nerves (renal denervation) and electrical stimulation of carotid sinus baroreceptors are being
studied.
Lifestyle and Home Remedies
Lifestyle changes can help you control and prevent high blood pressure, even if you're taking
blood pressure medication. Here's what you can do:
• Eat healthy foods..
• Decrease the salt in your diet

• Maintain a healthy weight
• Increase physical activity
• Limit alcohol
• Don't smoke.
• Manage stress
• Monitor your blood pressure at home
• Practice relaxation or slow, deep breathing

• Control blood pressure during pregnancy
• Fiber, such as blond psyllium and wheat bran
• Minerals, such as magnesium, calcium and potassium

• Folic acid
• Supplements or products that increase nitric oxide or widen blood vessels (vasodilators),
such as cocoa, coenzyme Q10, L-arginine or garlic
• Omega-3 fatty acids, found in fatty fish, high-dose fish oil supplements or flaxseed
Some research is studying whether vitamin D can reduce blood pressure, but more research is
needed.
While it's best to include these supplements in your diet as foods, you can also take supplement

Page 17 of 29
pills or capsules. Talk to your doctor before adding any of these supplements to your blood
pressure treatment. Some supplements can interact with medications, causing harmful side
effects, such as an increased bleeding risk that could be fatal.
You can also practice relaxation techniques, such as deep breathing or meditation, to help you
relax and reduce your stress level. These practices may temporarily reduce your blood pressure.
Coping and Support
High blood pressure isn't a problem that you can treat and then ignore. It's a condition you need
to manage for the rest of your life. To keep your blood pressure under control:
• Take your medications properly. If side effects or costs pose problems, don't stop taking
your medications. Ask your doctor about other options.
• Schedule regular doctor visits. It takes a team effort to treat high blood pressure
successfully. Your doctor can't do it alone, and neither can you. Work with your doctor to
bring your blood pressure to a safe level, and keep it there.
• Adopt healthy habits. Eat healthy foods, lose excess weight and get regular physical activity.
Limit alcohol. If you smoke, quit.
• Manage stress. Say no to extra tasks, release negative thoughts, maintain good relationships,
and remain patient and optimistic.
Definition of Terms
hyper- a prefix appearing in loanwords from Greek, where it meant “over,”.
Tension- "condition of being stretched or strained, or in which pressure is exerted"

Hypertension - also known as high blood pressure (HBP), is a long-term medical condition in
which the blood pressure in the arteries is persistently elevated.
Hypertension stage 2- is a hypertension with systolic pressure of 140 mm Hg or higher or a
diastolic pressure of 90 mm Hg or higher.
Diabetic neuropathy- is a type of nerve damage that can occur if you have diabetes. High blood
sugar (glucose) can injure nerves throughout your body. Diabetic neuropathy most often
damages nerves in your legs and feet.

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Diabetes Mellitus- commonly referred to as diabetes, is a group of metabolic disorders in which
there are high blood sugar levels over a prolonged period.
Symptomatology
Symptom Rationale Justification Remarks

Dizziness While dizziness can be a Patient is taking Losartan Present
side effect of some blood to manage hypertension
pressure medications, it is every 8am as prescribed
not caused by high blood by doctor during
pressure. admissions
Headache When the body Patient denies of Not present
experiences a experiencing headaches.
hypertensive crisis, the
blood pressure spikes to
very high levels and
pressure builds up in the
cranium. This causes
excruciating headaches
Nausea and vomiting A common symptom of The patient denies Not Present
hypertension is nausea experiencing nausea or
and vomiting vomited.
Blurred Vision Hypertension can damage The patient denied having Not present
the vessels of the blurry visions
supplying blood to the
retina causing retinopathy
which can lead to blurry

Page 19 of 29
division
Etiology
Predisposing/Precipitating factors Rationale Remarks
Obesity As body weight increases, the Not present

blood pressure rises. Obese people
are two to six times more likely to
develop high blood pressure than
people whose weight is within a
healthy range.
Alcohol use Drinking more than one to two Not Present
drinks of alcohol per day tends to
raise blood pressure in those who
are sensitive to alcohol.
Birth control pills Some women who take birth Not Present
control pills develop high blood
pressure.
Family History The tendency to have high blood Present
pressure appears to run in families.
Age The older a person is, the greater Not present

the likelihood that he or she will
develop high blood pressure,
especially elevated systolic
readings. Women are more likely to
develop high blood pressure after

Page 20 of 29
age 65.
Socioeconomic status High blood pressure is found more Present
commonly among the less educated
and lower socioeconomic groups.
Diet Salt in one's diet is a well- Present
recognized contributor to high
blood pressure.
Pathophysiology
Predisposing Precipitating
Factors Factors
Family Diet
History
Changes in
arteriolar bed
Increase Systemic
Vascular
Resistance
Increase
Afterload
Decrease Blood flow

to kidney

Page 21 of 29
Kidney releases
renin
Angiotensino
gen
Angiotensin 1 convert to
angiotensin2
Arteriolar
Vasoconstriction
Increase peripheral
resistance
Increase Blood
Pressure
If treated: If not treated:

BP is within may
BP= 150/100
normal range complicate to
mmHg
aneurysm,
heart failure
and other
complications
which may
Laboratory Results lead to death.
Hematology
Complete Blood Count - The complete blood count (CBC) is one of the most commonly ordered
blood tests. The complete blood count is the calculation of the cellular (formed elements) of
blood. These calculations are generally determined by special machines that analyze the different
components of blood in less than a minute. A major portion of the complete blood count is the
measure of the concentration of white blood cells, red blood cells, and platelets in the blood.
Components Result Normal value Interpretation Nursing

Responsibility
Monocytes Increase fluid intake.

0.09 0.02-0.011 Normal
Hemoglobin 135-180 Decrease Encourage patient to take

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121 May indicate food rich in iron like liver.
anemia
Lymphocytes 0.37 0.25-0.36 Slight increase Encourage rest and sleep.
May indicate
infection
Basophils 0.01 0-0.05 Normal Encourage patient to take
food rich in iron like liver.
Eosinophil 0.07 0.02-0.04 Normal Increase fluid intake
Segmenters 0.50 0.55-0.65 Decrease Encourage patient to have

May indicate rest and sleep.
infection
WBC count 6.23x10 9/L 5-10 Normal Encourage patient to have
rest and sleep.
Platelet count 268x10 9/L 150-350 Normal Encourage rest and sleep.
Educate on any concerns
with regards to treating
underlying cause
Hematocrit 0.38 35-47 Decrease Encourage patient to take
May indicate food rich in iron.
anemia
Urinalysis
A urinalysis is used to detect and manage a wide range of disorders, such as urinary tract
infections, kidney disease and diabetes. A urinalysis involves checking the appearance,
concentration and content of urine.
Component Result Normal value Interpretation Nursing
Responsibility
Color Dark Straw-dark Normal Increase fluid intake
Yellow amber
Reaction (PH) 6.0 4-5.8 Increase Continue proper
May indicate urinary hygiene and well-
tract infection balanced diet
Specific Gravity 1.030 1.05-1.025 Increase Increase fluid intake
May indicate
dehydration,UTI or
decreased blood flow to
kidney
Pus cells 8.12/HPF 0-4 Increase Increase fluid intake
May indicate infection and get rest and sleep
RBC 0.2/HPF <2HPF Normal Encourage to report
signs of pain when
urinating
Amorphous Many None-few Increase Increase fluid intake
urates May indicate acidic urine
Bacteria Many None Increase Increase fluid intake
May indicate UTI and eat well balanced
diet

Page 23 of 29
Serum Electrolytes
Serum is the component of blood which does not contain cells. It is the portion of blood that is
not the erythrocytes (blood cells) or any of the clotting factors.
Electrolytes per strict definition are ions in liquid or gel form. In the context of serum,
electrolytes are the components of our blood that carry out the "helper" tasks. They're the
components of our bodies that use their charge (negative/positive) to lend a helping hand to our
proteins/enzymes/etc. so they may carry out their functions properly.
Component Result Normal value Interpretation Nursing

Responsibility
Sodium 138.80 mmol/L 136-145 mmol/L Normal Encourage a well-

balanced diet
Potassium 3.58 mmol/L 3.5-5.1 mmol/L Normal Encouraged to eat
food rich in
potassium such as
banana.
Calcium 1.16 mmol/L 1.15-1.33 Normal Instructed to eat

mmol/L food rich in
calcium and
vitamin D

Page 24 of 29
Hba1c
is a form of hemoglobin that is covalently bound to glucose. It is formed in a non-enzymatic

glycation pathway by hemoglobin's exposure to plasma glucose. It is measured primarily to
identify the three-month average plasma glucose concentration and thus can be used as a
diagnostic test for diabetes and as assessment test for glycemic control in people with diabetes.
Result Normal Interpretation Nursing

value Responsibility
7.10% 4.0-6.5% Increase Encourage and
May indicate educate on low
Diabetes diabetic diet.

Page 25 of 29
DOCTOR’S ORDER
Date and Time Doctor’s Order Rationale Remarks
02/27/2019 The patient was admitted for The patient was
Please Admit. further observation and admitted.
6:50pm management.
BP Secure consent to care Consent is needed to care for Consent was secured
150/100mmHg patient
Monitor vital sign q4 This is done to monitor the Vital signs were taken
patient’s vital signs especially by NOD.
the blood pressure
Low salt, low fat, This is done to prevent The patient was placed
diabetic diet possible complications on specified diet
PNSS 1L x KVO To serve as route for patient’s PNSS was hooked

medication and to maintain
fluid and electrolyte balance.
Dx: Laboratory test were needed The patient submitted

Page 26 of 29
CBC to confirm patient’s diagnosis specimens and
Urinalysis and check for other possible participated in taking
12 lead ECG complications that needs to diagnostic exams
Serum electrolytes be addressed.
FBS: lipid profile
S. Creatinine
S. Albumin
S. Uric acid
Chest Xray PA view
Hba1c
Meds: Meds were prescribed to Meds were given by
Captopril 25mg tab,1 manage blood pressure NOD
tab PO q6 for BP
>150/90
Amlodipine 10mg tab
OD
Losartan 50mg tab, OD
(AM) to start tomorrow
Monitor intake and To monitor for possible fluid Intake output were
output 1 shift excess or deficit. monitored
02 @2-4L per minute To manage dyspnea O2 was available at
via nasal cannula PRN bedside
for dyspnea
2/28/19 Cefuroxime 750mg Cefuroxime is an anti Meds were given.
IVTT q8 ANST infective while gliclazide is
Gliclazide 60mg 1 tab used to lower blood sugar
OD pre breakfast levels.
List of Drugs
1) Captopril 25mg tab
2) Amlodipine 10mg
3) Losartan 50mg tab
4) Cefuroxime 750mg
5) Gliclazide 60mg

Page 27 of 29
Prognosis
Prognosis Good Fair Poor Justification
Onset of illness 1 Patient had DOB and left sided
numbness.
Duration of illness 1 Patient had been experiencing left
sided numbness since December.
Hygiene 1 Patient is well-groomed but with
minimal dirt in nails.
Diet 1 Patient no longer drinks softdrinks
and complied to low salt, low fat,
diabetic diet
Age 1 Patient is 51 years old
Performance level 1 Patient can still perform ADL but
with a slower pace.

Page 28 of 29
Willingness to 1 Patient showed willingness and
undergo treatment preparedness to undergo treatment.
Family support 1 Her family gave their full support
especially financially and socially to
our patient from onset of the illness.
6/8 1/8 1/8

Good - 4/8 x 100 = 50
Fair -3/8 x 100 = 37.5
Poor – 1/8 x100 = 12.5
Remark: Prognosis shows the patient’s condition in getting well is good, because most of the
points are marked here. Patient is willing to undergo treatment for fast recovery.
BIBLIOGRAPHY
1) BRUNNER AND SUDDARTH’S TEXTBOOK OF MEDICAL-SURGICAL NURSING
2) NURSE’S POCKET GUIDE 11 EDITIONTH
3) NURSING SPECTRUM DRUG HANDBOOK 2008

4) WWW.EMEDICINEHEALTH.COM
5) WWW.NURSINGCRIB.COM
6) WWW.MAYOCLINIC.COM

Page 29 of 29

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Socioeconomic

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HISTORY OF PAST ILLNESS

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EFFECTS AND EXPECTATIONS OF ILLNESS TO SELF AND FAMILY

Effects of illness to self

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Task Justification Remarks

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Phallic Stage Mrs. Sugar is very close to her >Achieved

Developmental Task Theory

​Havighurst promoted the concept of Developmental Tasks in the 1950’s. A

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Vital Signs: ​T-36.4C ​RR-20cpm ​PR-100bpm ​BP- 130/90mmHg

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Mouth and Pharynx:

Thorax and Lungs:

Genitals: Patient refused to be assessed due to her personal reasons.

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Taking your blood pressure at home ​

There are two types of high blood pressure.

Primary (essential) hypertension

• Obstructive sleep apnea

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• Certain defects you're born with (congenital) in blood vessels

High blood pressure has many risk factors, including:

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Uncontrolled high blood pressure can lead to complications including:

• Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism,

• Eating a heart-healthy diet with less salt

• Getting regular physical activity

• Limiting the amount of alcohol you drink

• You're a healthy adult age 65 or older

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Medications to treat high blood pressure

• Angiotensin-converting enzyme (ACE) inhibitors

• Angiotensin II receptor blockers (ARBs)

Additional medications sometimes used to treat high blood pressure

Resistant hypertension: When your blood pressure is difficult to control

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Lifestyle and Home Remedies

• Eat healthy foods..

• Decrease the salt in your diet

• Increase physical activity

• Monitor your blood pressure at home

• Practice relaxation or slow, deep breathing

• Fiber, such as blond psyllium and wheat bran

• Minerals, such as magnesium, calcium and potassium

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Coping and Support

hyper- a prefix appearing in loanwords from Greek, where it meant “over,”.

Tension- "condition of being stretched or strained, or in which pressure is exerted"

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Symptom Rationale Justification Remarks

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Predisposing/Precipitating factors Rationale Remarks

Obesity As body weight increases, the Not present

Age The older a person is, the greater Not present

Havighurst promoted the concept of Developmental Tasks in the 1950’s. A

Vital Signs: T-36.4C RR-20cpm PR-100bpm BP- 130/90mmHg

Taking your blood pressure at home