Case Analysis of

Hypertension

In partial fulfillment of the course requirement in NCM 112:

Care of Clients with Problems in Oxygen, Fluid and Electrolytes, Infectious,
Inflammatory and Immunologic Response, Cellular Aberrations, Acute and Chronic

Prepared by:
Maria Samantha Nicole D. Bolante
 Table of Contents
I. Introduction

II. Anatomy and Physiology

III. Pathophysiology

IV. Medical Management

V. Nursing Management

VI. Drug Study

VII. Nursing Care Plan

VIII. Prognosis
I. Introduction
Blood pressure is the weight of blood pushing against the walls of arteries.
Arteries convey blood from your heart to different pieces of your body. Blood
pressure typically rises and falls for the duration of the day, however it can harm your
heart and cause complications on the off chance that it remains high for quite a while.
Hypertension, high blood pressure, is higher than typical or normal. Hypertension
expands the danger for heart disease and stroke, two driving reasons for death in the
US. Hypertension is likewise common and huge number of grown-ups have
hypertension, and many of them are not able to have it under control.

The reason for hypertension is frequently not known. In most instances, it is the
consequence of other condition. Specialists call hypertension that isn't because of
another condition as essential or primary hypertension. In the event that another
condition is the reason for hypertension, specialists call this secondary hypertension.
Primary hypertension can result from numerous components, including: blood plasma
volume, hormone activity in individuals who oversee blood volume, and pressure
using drugs; environmental variables, for example, stress and absence of activity.
Secondary hypertension has explicit causes and is a complexity of another medical
issue. Chronic kidney disease or CKD is a typical reason for hypertension, as the
kidneys at this point don't sift through blood properly. This causes excess fluid which
prompts hypertension. Different conditions that can prompt hypertension include:
diabetes, which causes kidney issues and nerve harm; kidney disease;
pheochromocytoma, cancer of an adrenal organ; Cushing syndrome that corticosteroid
medications can cause; congenital adrenal hyperplasia, a problem of the cortisol-
emitting adrenal organs; hyperthyroidism, or an overactive thyroid organ;
hyperparathyroidism, which affects calcium and phosphorous levels; pregnancy; sleep
apnea; and obesity which is very common in people nowadays.

There are a lot of factors that increases that risk of having hypertension. Age is
the first thing in the list. Hypertension is more normal in individuals who are over 60
years old. Blood pressure can increase consistently with age as the arteries become
stiff and tight because of plaque development. Ethnicity may also pose a risk. Some
ethnic groups are more inclined to hypertension than others. African Americans
have a higher risk than other ethnic groups, for instance. Size and weight also affects
blood pressure. Being overweight is an essential danger factor. Liquor and tobacco
use and misuse is a significant reason. Consistently devouring huge amounts of liquor
or tobacco can increase blood pressure. Sex may likewise influence it. According to a
research conducted in 2018, male have a higher danger of having hypertension than
females. Nonetheless, this is just until after ladies reach menopausal age. Existing
medical issue is another factor. Cardiovascular disease, diabetes, chronic kidney
disease, and high cholesterol levels can prompt hypertension, particularly as
individuals age. Other danger factors incorporate, having an inactive way of life,
having an eating regimen rich in salt rich, high fat substance, low potassium intake,
and inadequately managed hypertension and a family background of hypertension can
likewise add to the danger of contracting hypertension.
II. Anatomy and Physiology

The Cardiovascular System

The cardiovascular system, also called the circulatory system, is the organ system that
transports materials to and from all the cells of the body. The materials carried by the
cardiovascular system include oxygen from the lungs, nutrients from the digestive
system, hormones from glands of the endocrine system, and waste materials from
cells throughout the body. Transport of these and many other materials is necessary to
maintain homeostasis of the body. The main components of the cardiovascular system
are the heart, blood vessels, and blood.

Heart
The heart is a muscular organ in the chest. It consists mainly of cardiac muscle tissue
and pumps blood through blood vessels by repeated, rhythmic contractions. As shown
in the figure below, the heart has four inner chambers: a right atrium and ventricle and
a left atrium and ventricle. On each side of the heart, blood is pumped from the atrium
to the ventricle below it and from the ventricle out of the heart. The heart also
contains several valves that allow blood to flow only in the proper direction through
the heart.Unlike skeletal muscle, cardiac muscle routinely contracts without
stimulation by the nervous system. Specialized cardiac muscle cells send out electrical
impulses that stimulate the contractions. As a result, the atria and ventricles normally
contract with just the right timing to keep blood
pumping efficiently through the heart.

Blood Vessels
The blood vessels of the cardiovascular system are like a network of interconnected,
one-way roads that range from superhighways to back alleys. Like a network of roads,
the blood vessels have the job that allows the transport of materials from one place to
another to happen. There are three major types of blood vessels: arteries, veins, and
capillaries.
● Arteries are blood vessels that carry blood away from the heart (except for the
arteries that supply blood to the heart muscle). Most arteries carry oxygen-rich blood,
and one of their main functions is distributing oxygen to tissues throughout the body.
The smallest arteries are called arterioles.
● Veins are blood vessels that carry blood toward the heart. Most veins carry
deoxygenated blood. The smallest veins are called venules.
● Capillaries are the smallest blood vessels. They connect arterioles and venules. As
they pass
through tissues, they exchange substances including oxygen with cells.

Two Circulations
Cells throughout the body need a constant supply of oxygen. They get oxygen from
capillaries in the systemic circulation. The systemic circulation is just one of two
interconnected circulations that make up the human cardiovascular system. The other
circulation is the pulmonary system. This is where the blood picks up oxygen to carry
to cells. It takes blood about 20 seconds to make one complete transit through both
circulations. The pulmonary circulation involves only the heart and lungs and the
major blood vessels that
connect them. Blood moves through the pulmonary circulation from the heart to the
lungs, and back to the heart again, becoming oxygenated in the process. Specifically,
the right ventricle of the heart pumps deoxygenated blood into the right and left
pulmonary arteries. These arteries carry blood to the right and left lungs, respectively.
Oxygenated blood then returns from the right and left lungs through the two right and
two left pulmonary veins. All four pulmonary veins enter the left atrium of the heart.
In the lungs, it passes through increasingly smaller arteries and finally through
capillary networks surrounding the alveoli. This is where gas exchange takes place.
The deoxygenated blood in the capillaries picks up oxygen from the alveoli and gives
up carbon dioxide to the alveoli. As a result, the blood returning to the heart in the
pulmonary veins is almost completely saturated with oxygen. In the systemic
Circulation, the oxygenated blood that enters the left atrium of the heart in the
pulmonary circulation then passes into the systemic circulation. This is the part of the
cardiovascular system that transports blood toand from all of the tissues of the body to
provide oxygen and nutrients and pick up wastes. It consists of the heart and blood
vessels that supply the metabolic needs of all the cells in the body, including those of
the heart and lungs. In the systemic circulation, the left atrium pumps oxygenated
blood to the left ventricle, which pumps the blood directly into the aorta, the body’s
largest artery. Major arteries branching off the aorta carry the blood to the head and
upper extremities. The aorta continues down through the abdomen and carries blood
to the abdomen and lower extremities. The blood then returns to the heart through the
network of increasingly larger veins of the systemic circulation. All of the returning
blood eventually collects in the superior vena cava (upper body) and inferior vena
cava (lower body), which empty directly into the right atrium of the heart.

Blood
Blood is a body fluid that circulates throughout the body in blood vessels by the
pumping action of the heart. Blood carries oxygen and nutrients to all the body’s cells,
and it carries carbon dioxide and other wastes away from the cells to be excreted.
Blood also transports many other substances, it carries WBCs that defends the body
against infection and aids in repairing body tissues, and controls the body’s pH,
among other functions. One component of blood is called plasma. It is a yellowish,
watery liquid that contains many dissolved substances and blood cells. Types of blood
cells mixed into the plasma include red blood cells, white blood cells, and platelets.
● Red blood cells have the main function of carrying oxygen in the blood. Red blood
cells consist mostly of hemoglobin, a protein containing iron that binds with oxygen.
● White blood cells are far fewer in number than red blood cells. They defend the
body in various ways. For example, white blood cells called phagocytes swallow and
destroy pathogens, dead cells, and other debris in the blood.
● Platelets are cell fragments involved in blood clotting. They stick to tears in blood
vessels and to each other, forming a plug at the site of injury. They also release
chemicals that are needed for clotting to occur.
III. Pathophysiology

Genetic Influences Environmental Factors

Defects in renal sodium Defects in vascular smooth

haemostasis muscle growth and
structure
Functional
vasoconstriction
Inadequate sodium
excretion

Sodium and water

retention
↑ Natriuretic
Hormoe
↑ Plasma and ECF ↑ Vascular wall
volume ↑ Vascular Reactivity
thickness

↑ Cardiac output ↑ Total Peripheral

Resistance

Hypertension
IV. Medical Management

Laboratory Tests Rationale

Urinalysis
Blood Cell Count
Blood Chemistry (potassium, sodium,
creatinine, fasting glucose, total
cholesterol and HDL cholesterol)
Electrocardiogram (ECG)
screen for causes of secondary
hypertension, and to look for damage to
the kidneys as a result of untreated
hypertension
elevated white blood cell count is
associated with incident hypertension
among women and men independent of
smoking and most traditional
cardiovascular risk
baseline values for judging biochemical
effects of therapy
information about your heart rate and
rhythm, and shows if there is enlargement
of the heart due to hypertension or
evidence of a previous heart attack

V. Nursing Management
Primary Goals:
 The patient will
participate in activities that reduce blood pressure
maintain blood pressure within individually acceptable range.
demonstrate stable cardiac rhythm and rate within patient’s normal range.
participate in activities that will prevent stress

Nursing Interventions:
Review clients at risk as noted in related factors as well as individuals with
conditions that stress the heart.
 Check laboratory data (cardiac markers, complete blood cell count, electrolytes,
ABGs, blood urea nitrogen and creatinine, cardiac enzymes, and cultures, such as
blood, wound or secretions).
Monitor and record blood pressure. Measure in both arms and thighs three times, 3–
5 min apart while patient is at rest, then sitting, then standing for initial evaluation.
Use correct cuff size and accurate technique.
Note presence, quality of central and peripheral pulses.
Auscultate heart tones and breath sounds.
Observe skin color, moisture, temperature, and capillary refill time.
Note dependent and general edema.
 Evaluate client reports or evidence of extreme fatigue, intolerance for activity,
sudden or progressive weight gain, swelling of extremities, and progressive
shortness of breath.
VI. Drug Study
DRUG NAME MECHANISM OF INDICATION CONTRAINDICATIO ADVERSE NURSING
ACTION N REACTION RESPONSIBILITIES
Generic Name: Losartan Angiotensin's >hypertension >hypotension >diarrhea >Check BP prior to
+ Amlodipine attachment to the >stroke risk >hypersensitivity >nasal drug administration
receptors causes the >left ventricular congestion >WOF adverse
Brand Name: Cozaar muscle cells to hypertrophy >muscle cramps reactions
XQ contract and the >DM II >insomnia >monitor efficacy of
blood vessels to >diabetic neuropathy >lightheadedness the medication
Dosage: 50mg/5mg narrow >dizziness >provide safe and
(vasoconstrict) >Impotence comfortable
Classification: which leads to an >hyperkalemia environment
Angiotensin II increase in blood >Angioedema >keep side rails
Antagonist pressure secured
Anti-Hypertensive >attend to patients
needs
> monitor intake and
output
>monitor potassium
 level of the patient

Generic Name: These medications >hypertension >hypotension >edema >Check BP prior to

Nicardipine block the >coronary artery disease >hypersensitivity >dizziness drug administration
movement of >angina >breastfeeding mother >fainting >WOF adverse
Brand Name: calcium into the >headache reactions especially
Cardene smooth muscle cells >flashing hypotension
surrounding the >palpitation >monitor efficacy of
Dosage: arteries of the body. >fainting the medication
10mg in 90cc D5W Since calcium >rashes >provide safe and
promotes >hypotension comfortable
Classification: Calcium contraction of environment
Channel Blocker muscle, blocking >keep side rails
 calcium entry into secured
the muscle cells >attend to patients
relaxes the arterial needs
muscles and causes > monitor intake and
the arteries to output
become larger. >monitor potassium
level of the patient

Generic Name: It reduces the >hypertension >insulin therapy >edema >Check BP prior to
Carvedilol heart's rate and >heart failure >pregnancy >dizziness drug administration
force of contraction >bradycardia >WOF adverse
Brand Name: and thereby reduces >headache reactions especially
Coreg the work of the >fainting hypotension
 heart. Carvedilol >lightheadedness >monitor efficacy of
Dosage: also blocks >postural the medication
25mg adrenergic receptors hypotension >provide safe and
on arteries and comfortable
Classification: causes the arteries environment
Beta- Adrenergic to relax and the >keep side rails
Blocker blood pressure to secured
fall. >attend to patients
needs
> monitor intake and
output
>monitor potassium
level of the patient

Generic Name: It blocks the >hypertension >liver impairment >fatigue >Check BP prior to
Olmesartan receptors that >renal impairment >dizziness drug administration
angiotensin II acts >severe heart failure >fainting >WOF adverse
Brand Name: on, and so prevents >headache reactions especially
Alzor Hct its actions. The >cough hypotension
main result of this >hematuria >monitor efficacy of
Dosage: is that the >hyperkalemia the medication
40/12.5mg peripheral blood >rashes >provide safe and
vessels are allowed >hypotension comfortable
Classification: to widen, which >chest pain environment
Angiotensin II receptor means that there is >keep side rails
Antagonist more space and less secured
resistance in these >attend to patients
blood vessels. This needs
is the main > monitor intake and
mechanism by output
which the pressure >monitor potassium
in the blood vessels level of the patient
is lowered.

VII. Nursing Care Plan

ASSESMENT ANALYSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

OBJECTIVE Ineffective tissue After 2 hours of >established rapport >to promote trust After 2 hours of
perfusion related to nursing >IVF monitored and between patient nursing interventions,
>Altered blood vasoconstriction as interventions, the regulated at prescribed and the student the patient’s blood
pressure outside of
evidenced by patient’s blood rate nurse pressure decreased to
acceptable
parameters Increased blood pressure will > VS monitored and >to prevent fluid 120/80 .
pressure decrease to 120/80 documented complications
>Oliguria or anuria;
hematuria >to monitor
occurrence of
>Arterial pulsations,
bruits alterations in
>due meds given vital signs
>Elevation in
BUN/Cr ratio >kept patient safe and
comfortable >to help lower
>I&O monitored and the BP of the
recorded patient
>reinforced prescribed
diet >to promote
>maintained at semi- optimum quality
fowlers to high fowlers of health care
position >to monitor fluid
intake and output
for possible
complication of
fluids
>to promote
wellness, prevent
fluid retention
and high level of
cholesterol
>to prevent
hypertension due
to increased
blood flow
secondary to pull
of gravity
VIII. Prognosis
The prognosis for hypertension depends on how long the patient had it, how
severe it is, and if the patient have other conditions that increase the risk of further
complications. Hypertension can lead to a poor prognosis even if no other symptom is
present. When high blood pressure is treated adequately, the prognosis is much better.
Both lifestyle changes and medications can manage hypertension. Mild to moderate
hypertension, if left untreated, may be associated with a risk of atherosclerotic disease
in 30% of people and organ damage in 50% of people within 8-10 years after onset. 
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