Objectives

In presenting the case of Mrs. Candelario, several objectives have

been taken into consideration. These objectives include:

a. Gather related literature significant to the condition of the

patient for a more complete understanding of HYPERTENSION

and how to properly care for such a case.

b. Evaluate the condition of the client by getting pertinent data

through history, physical assessment, and laboratory tests in

order to come up with appropriate nursing diagnoses that will help

aid in his recovery.

c. Discuss the pathophysiology or the actions that the hypertension

takes on a patient’s body.

d. Prepare nursing care plans suitable for the subjective and

objective symptoms and/or complaints manifested and/or

verbalized by the patient.

e. Evaluate the result of nursing care provided, and to make

necessary changes as needed.

f. Educate the patient regarding hypertension and how she can help

care for herself outside the hospital.

Introduction
Although certain hormonal abnormalities cause hypertension, the vast
majority of cases are secondary to genetic factors, obesity, age and
inactivity. Smoking, diabetes and excess alcohol consumption make
hypertension worse. Salt intake does not play as great a role in the control
or cause of high blood pressure as was once commonly believed.

High blood pressure (BP >140/90 mm Hg, as defined by the World

Health Organization) occurs in acute stroke in up to 75% of cases.
Subsequently, BP settles over a period of about a week, although 40% of
patients remain hypertensive. High blood pressure (HBP) or hypertension
means high pressure (tension) in the arteries. Arteries are vessels that
carry blood from the pumping heart to all the tissues and organs of the
body. High blood pressure does not mean excessive emotional tension,
although emotional tension and stress can temporarily increase blood
pressure. Normal blood pressure is below 120/80; blood pressure between
120/80 and 139/89 is called "pre-hypertension", and a blood pressure of
140/90 or above is considered high.

The top number, the systolic blood pressure, corresponds to the pressure in
the arteries as the heart contracts and pumps blood forward into the
arteries. The bottom number, the diastolic pressure, represents the
pressure in the arteries as the heart relaxes after the contraction. The
diastolic pressure reflects the lowest pressure to which the arteries are
exposed.

-History

Based on the dissection of ancient Egyptian mummies, high blood

pressure (hypertension) has been a health problem since the early Egyptian
empires. The blood pressure cuff was invented in 1896, but it wasn't until
the 1950s that we became aware of the importance of high blood pressure
as a herald of the complications commonly attributed to "old age". Recent
research has shown a critical relationship between high blood pressure and
strokes, heart attacks, congestive heart failure, and vascular disease, which
together comprise the leading cause of death in the United States for men
and women.
-Epidemiology I
Hypertension is the most common primary diagnosis and most common
cause of death in the United States (Whelton, 2002; Brashers, 2006). It is
estimated that 50 million Americans are affected by hypertension. Of these
50 million, only 70% (35 million) are aware of their condition. In addition,
only 50% (17.5 million) of those aware of their condition are receiving
treatment. Remarkably, only 25 % of all hypertensive patients have their
blood pressure under control (Brashers). More men have hypertension than
women in early life, but this disparity practically disappears by the 6th
decade (Whelton). The life-long risk of developing hypertension in
normotensives after the sixth decade of life is approximately 90%. The
incidence and prevalence of hypertension is about 50% higher in African-
American adults compared with their counterparts who are white or
Mexican-American (Whelton).
-Epidemiology II
Hypertension is a risk factor for coronary artery disease, congestive
heart failure, stroke and renal failure (Brashers, 2006). Risk factors in all
populations include age, obesity, sedentary lifestyle, family history, smoking,
alcohol, high sodium intake, low potassium or magnesium intake, and the use
of NSAIDS (Brashers). Each 20mm Hg increase in systolic pressure or
10mmHg increase in diastolic pressure above normal increases cardiovascular
risk twofold (Brashers).
Nursing Health History
Biographical Information
Name: Pura S. Candelario
Sex: Female
Address: Lot 8 Block 17 Ciudad Real Subd. San Jose Del Monte, Bulacan
Date of Birth: January 12, 1943
Place of Birth: Malinao, Aklan
Age: 65
Religion: Roman Catholic
Citizenship: Filipino
Occupation: Catechist
Civil Status: Married
Employment Status: Resigned/ Retired
Disabilities: Visual Impairment

Chief complaint
“Nahihilo ako. High blood na naman yata ako.” As verbalized by the
patient. Mrs. Candelario was complaining of:
- Dizziness
- Fatigue
- Nape pain
- Hypertension

History of Present Illness

According to the patient, she attended seminar in Sta. Maria, Bulacan
which started at 6:00 in the morning up to 6:00 of the evening with regards
of being a catechist. Together with her older sister, they walked for meters
just to reach the church which caused her over fatigue. When the patient
got home she took a rest and got her dinner. While watching television
program she felt dizziness so she slept early. On the next day, she went to
her neighbor and asked to take her blood pressure and it was 160/100. She
went to her house and she took a rest for an hour. She thought it was just
because of her fatigue but after several hours, she went again to her
neighbor to take her blood pressure and it was 140/90. Mrs. Candelario was
aware in her hypertension that’s why she went to the hospital together with
her sister.
Past Medical Illness
The patient has asthma. It was started when she was in her early 20’s.
Her asthma attacks when it is dusty or in polluted area or there’s sudden
weather changes. There was a time that her asthma attacked that led to
confinement in De Los Santos Hospital. According to her because of her
asthma, her upper extremities got anesthetized.

Social History
According to the patient, she spent mostly her time with her children,
guiding them with their studies and performs her responsibility as a good
mother. After her retirement as a teacher, she turned as catechist as her
hobby. As a volunteer in their community she also does neighboring.

Health Management
The patient stated that she maintains her personal hygiene by taking
a bath everyday, brushing her teeth twice a day. The patient also said that
she was taking some food supplements like vitamins. She also takes some
medication for her blood pressure maintenance and also for her arthritis.
In the hospital she is not prohibited to do her routine hygiene.
She is ordered to take and bathroom privileges.

Nutritional Metabolic
The patient stated that she eats 3 times a day, but on the first
confinement on San Lorenzo hospital, she was put on a nothing per orem
(NPO), for her blood screening.

Elimination
According to the patient, her bowel movement was normal, she
defecate once a day and urinates 5 to 6 times a day.

Rest and Sleep

The patient gets her complete bed rest in the hospital as what
needed. She wakes up every time someone takes her vital signs.
Cognitive Perceptual
The patient was retired as an elementary teacher so she now spent
mostly her time with her family. She served as a catechist in Sta. Maria,
Bulacan.
According to Piaget’s cognitive developmental process, the patient
ends with the formal operations phase. According to Kohlberg, the patient’s
moral development is completed. He hypothesized that an older person at
the preconventional level obeys rules to avoid pain and the displeasures of
others.
According to Erickson, the developmental task of the patient is ego
integrity versus despair. People who attain ego integrity view life with sense
of wholeness and derive satisfaction from past accomplishments. They view
death as an acceptable completion of life. By contrast, people who despair
often believe they may have poor choices during life and wish they could live
life over.

Course in the ward

Pre-operative phase
The patient was admitted on August 14, 2008 at around 9:30 of the
evening due to hypertension, headache, and dizziness because the case
occurred after an hours before the admission. According to the patient it
was started when they went to a seminar in Sta. Maria, Bulacan that caused
her fatigue and the following effects:
Vital sign are taken and complete physical health assessment is done
with the physician are:
General Survey: conscious and coherent
HEENT:
Heart:
Lungs:
Abdomen:
Extremities:
After the initial assessment, the patient was accompanied by her
sister with the help of some ER NOD with on going intravenous fluid of D5W
500 cc regulated at keep vein open (KVO). The patient was assessing to her
room (Female Medical Ward 01). When the patient reached her bed to relax,
IV fluid interrupted by Mannitol 200 cc given as stat ordered, retaking of
vital signs was been done and the medicine was administered to the patient
and she took a rest.
At around 11:25 pm vital signs had been monitored by a healthcare
provider. The patient was accompanied by her sister and she was put on a
nothing per orem diet (NPO) for the blood test on the next day.
August 15, 2008, at around 7 am the patient was lying on her bed with
ongoing IVF D5 water 300 cc level regulated at 200 mgtts/min and infusing
well. Vital sign was monitored and her medication was also administered.

Intra-operative Phase
The patient was on her bed, accompanied by a healthcare provider.
She was put on diet as tolerated. She was still on her intravenous fluid. Her
vital signs were continuously monitored by the nurse. Around 12 pm. The
patient refused to undergo CT scan.
Post-operative Phase
On the same day, around 4:25 of the afternoon the patient has been
discharged from the hospital.

Discharged order
August 15, 2008 at around 4:15 of the afternoon, Mrs. Candelario
requested for HAMA. The attending physician, Dr. Calderon requested her
for CT scan but the patient refused. The patient received the original copies
of her laboratory results and ECG result.
The NOD provided information for her health improvement. The NOD
educated the patient about health teaching:
-good hygiene
- Proper diet (DASH diet, healthy low-fat diet rich in natural sources
of vitamins and minerals, reduce salt intake)
- taking her food supplements and her medication as ordered
- Exercise and maintaining healthy weight
 Diagnostic Procedure

Date Name of Normal Values Result Interpretation and Analysis

Procedure
8/15/08 Hematology
WBC- 10 x 10 8.20 -slightly decrease
SEGMENTER- 0.50-0.70 0.86 -increase
LYMPHOCYTE-0.20-0.40 0.14 -decrease
RBC- 4.2- 5.4 x 10 4.41 -normal
HEMOGLOBIN- 120-160 132 -normal
HEMATOCRIT-0.37-0.47 0.40 -normal
> Base from the result of
hematology the patient was
having a decrease lymphocyte
that indicates that there is
no infection.
> Leukocytes or white blood
cell count determine the
number of circulating WBC’s
count per cubic millimeter of
whole blood. High WBC
counts are often seen in the
presence of bacterial
infection. Possible cause of
increase neutrophil may be
stress and acute infection;
lymphocytes may be chronic
infection, viral infection,
mononucleosis
(abnormal increase in number
of mononuclear leukocytes in
the blood)