Western Mindanao State University

College of Nursing

REQUIREMENTS IN RELATED LEARNING EXPERIENCE

Rotation number: 1 Clinical Instructor: Prof. Marites Yusop RN, MAN

Name: Orpiano, Blessy Gaile B. Rotation Area: ZCMC Medical Unit
Pineda, Junita Rose Rotation Dates: October 8, 9, 10, 2020
Vasquez, Patricia Anne C. October 15, 16, 17, 2020
Year and Section: BSN 3B
 BIOGRAPHICAL DATA
DEMOGRAPHICS

Name: Client B Marital Status: Married

Age: 50 years old Ordinal Position: 9th

Gender: Male No. of Children: 2

Birthdate: February 19, 1970 Educational Attainment: College

Birthplace: Zamboanga City Occupation: Government Employee

Current Address: Purok 5, Talisayan, Zamboanga City

Country: Philippines

Postal Code: 7000

Client’s physician: Dr. Mae Alfonso
Nationality: Filipino

Dialect: Tagalog, Chavacano, Ilocano

Religion: Roman Catholic

 Gordon’s 11 Functional Health Pattern
Pattern of Health Perception and Health Management

Mr. B is a 50 year old, male resident of barangay Talisayan, Zamboanga City. He had an occurrence of cough and cold the past 6 months, but other than, his health has been
generally stable and rates it at 8 over 10. He reiterated that since he was not getting any younger so he is more conscious in his choice of food intake. Although he admitted that he
forgets this sometimes and enjoys eating way to much than his body needs. When questioned whether he had any existing condition, he mentioned that he was diagnosed with
hypertension way back 20 years ago. He was prescribed with 2 medications, namely; Losartan Potassium (100 mg) and Amlodipine Besylate (100 mg), along with these, he is
taking a supplement called Spirulina, which he believes is a prime factor in lowering down the tendency of manifesting a High Blood Pressure. He mentioned that there are days
wherein he forgets to take it but he does not double dose himself the day after that because he is aware that it might cause an adverse reaction. He mentioned that they have a
history of hypertension and diabetes in the family. He is well aware that his weight plays a tremendous role for aggravating his condition and his overall lifestyle must be altered.

Nutritional Metabolic Pattern

The client mentioned that his daily food intake consists of 2 cups of rice, 2 viands (usually fried) and soda. He reiterated that it consistently includes pork and chicken
(rarely vegetable), rice and pairs this usually with soda (coke) and sometimes water. When questioned if he had any impairment regarding his ability to swallow and masticate, he
mentioned none.

Pattern of Elimination

The client mentioned that his urinary output ranges from 3-5 a day, depending on the amount of water and activity he had on that day. He mentioned rare occurrence of
constipation or diarrhea for the past 6 months. When questioned if he had any difficulty revolving around his pattern of elimination, he mentioned none.

Pattern of Activity and Exercise

The client mentioned that he does not adhere to any exercise program and plans to modify this lifestyle habit. He generally spends his day off to rest and bond with his
family and sometimes spends the night off with his friends, drinking and eating. As aforementioned before, he has hypertension and alongside with this, he is way overweight, so it
generally limits him to execute any strenuous activity that may stimulate serious problems such as having a heart attack so he focuses on altering the amount of his food intake.
Cognitive Perceptual Pattern

The client does not utilize any assistive devices such as eyeglasses, hearing aid or other prostheses. Although he mentioned that he experiences difficulty reading under low
or poor lighting. He rates his sense of hearing at 9 over 10 and does not consider any utilization of hearing devices. He attained a degree in college and does not manifest any
discrepancies in grasping and processing of what is questioned. He mentioned no family history of mental illness or condition of any type.

Pattern of Sleep and Rest

Mr. B’s sleep and wake cycle depends on whether he has to go to work or not. In most days, Mr. B usually wakes up at 6:00 a.m. in the morning to prepare himself and take
his breakfast. Afterwards, he takes off and drives himself to work since he lives far from where his workplace is. He comes home and rest after 9:00 or 10:00 a.m.at night. He
mentioned no difficulty sleeping or tendencies of insomnia or other sleeping disorders.

Upon visual examination, the client presents well rested and relaxed. He has no visible dark marking under his eyes, indicating that he is not manifesting any predicaments
regarding his sleep and rest pattern.

Pattern of Self-Perception and Self-Concept

The client reiterated that the way he looks doesn’t bother him because over the years, he developed this sense of comfortability and contentment about his body. Although
he is aware that he must cut off some pounds in order for him to enjoy an optimum life and see his children grow up, have their family and bond with his grandchildren.

He reiterated that his patience has grown thinner over the years but this does not generally detriment his relationship with other people. He is in control of his emotions and
frustrations towards something.

Role-relationship Pattern

He is married to his wife for 25 years now and has 2 children, all of which are grown-ups now. He reiterated that he had devoted his life to his family and provided them all
of their needs. He got this attitude from his parents and he wanted that his children would also manifests this type of behavior or principle in life. He mentioned no profound life
changes in their family, no grand conflicts from the past years and is just generally happy with life, despite the pandemic.
Sexuality-Reproductive Pattern

The client mentioned that he and his wife didn’t had any problems regarding fertility and reproduction.

Pattern of Coping and Stress Tolerance

Whenever he encounters predicaments revolving around family, work, money and life in general, he sits down with his wife and related this problems to her. He states that
talking to his wife has been his therapeutic way of managing stress and frustration. This has been his customary practice and it generally assist him to address the problem and look
for a solution for whatever predicament he may have.

Pattern of Values and Beliefs

Mr. B is a Zamboangueňo, who adheres to the religious teachings of the Roman Catholic. He was raised by his parents to follow the practices of the church and he passed
this behavior now to his children. He reiterated that they go to church every Sunday, or any day that he and his family is complete and devotes that time to give thanks to the
Almighty for all the blessing they receive as a family.
 STUDY OF ILLNESS CONDITION - HYPERTENSION
Organ/System Involved Normal Pathophysiology Diagnostic Procedure Analysis
Assessment Function/Physiology

Subjective Cues: The heart is a hollow, Although the precise A thorough health BP reading of
 “Si ta subi miyo bp, muscular organ located in cause for most cases of history and physical 150-160/100
ta dwele mio the center if the thorax, hypertension cannot be examination are MmHg
kabesa y ta where it occupies the space identified, it is understood necessary. The retinas The frequent
tormenta resulya. between the lungs that hypertension is a are examined, and clinical
Maluya el kwerpo (mediastinum) and rests on multifactorial condition. laboratory studies are manifestation of
tambien kwando the diaphragm. It weighs Because hypertension is a performed to assess hypertension is
toma medisina”. approximately 300 g (10.6 sign, it is most likely to possible target organ heightened blood
(Whenever I oz.), although heart weight have many causes. For damage. Routine pressure. The
experience an and size are influenced by hypertension to occur laboratory tests include normal
increase in bp, my age, gender, body, weight, there must be a change in urinalysis, blood classification of
head hurts and I extent of physical exercise one or more factors chemistry (i.e. analysis blood pressure for
find it difficult to and conditioning, and heart affecting the peripheral of sodium, potassium, adults age 18 and
breath. My body disease. The heart pumps resistance or cardiac creatinine, fasting above ranges from
generally feels blood to the tissue, supplying output. In addition, there glucose, and total high less than 130 over
weak after drinking them with oxygen and other must be a problem with density lipoprotein 85MmHg. Those
the medication). nutrients. the control systems that [HDL], cholesterol who manifests a
monitor or regulate levels), and a 12-lead systolic pressure
The pumping action of the pressure. Single gene electrocardiogram. Left greater than 140
Objective Cues: heart is accomplished by the mutations have been ventricular hypertrophy mmHg, with a
Vital signs rhythmic contraction and identified for a few rare can be assessed by diastolic pressure
1. Initial BP reading: relaxation of its muscular types of hypertension, but echocardiography. Renal of 90 mmHg and
160/100 MmHg wall. During systole most types of damage may be above, indicates
(Contraction of the muscle), hypertensions are thought suggested by elevations that a person has
Second BP reading: the chambers of the heart to be polygenic (mutations of BUN and creatinine hypertension. It
150/100 MmHg become smaller as the blood in more than one gene) levels or by must be noted that
is ejected. During diastole (Dominiczak, et al., microalbuminuria. two or more
2. Temperature: (relaxation of the muscle), 2000). Additional studies, such consecutive
37.4 oC the heart chambers fill with as creatinine clearance, reading must be
blood for the preparation of Several hypotheses about renin level, urine tests done for
3. Pulse rate: subsequent ejection. A the pathophysiologic and 24-hour urine validation.
82 bpm normal resting adult heart is bases of elevated blood protein, may be
beats approximately 60-80 pressure are associated performed. The client’s blood
4. Respiratory rate: times per minute. Each with the concept of pressure values
18 bpm ventricle ejects hypertension as a A risk factor assessment, were 160/100 for
approximately 70 mL of multifactorial condition. as advocated by the JNC the initial reading
Weight: 96 kg blood per beat and has an Given the overlapping VI, is needed to classify and 150/100 for
Height: 165 cm. output of approximately 5 L among these hypotheses, and guide treatment of the second
BMI: 35.26 (Obese) per minute. it is likely that aspects of hypertensive people at reading, which
all of them will eventually risk for cardiovascular indicates that he is
Heart Chambers prove correct. damage. hypertensive.
The 4 chambers of the heart Hypertension may be
constitute the right and left- caused by one or more of Factor such as the
sided pumping systems. The the following: weight of the
right side of the heat, made  Increased sympathetic client contributes
up of the atrium and right nervous system to the increase in
ventricle, distributes benous activity related to blood pressure
blood (deoxygenated blood) dysfunction of the because the
to the lungs via the autonomic nervous. cardiovascular
pulmonary artery  Increased renal system of obese
(pulmonary circulation) for reabsorption of individuals works
oxygenation. The right sodium, chloride, and differently than
atrium receives blood water related to a those belonging to
returning from the superior genetic variation in the normal weight
vena cava (head, neck, and the pathways by range. Their heart
upper extremities), inferior which kidneys handle has to work harder
vena cava (trunk and lower sodium. to pump blood to
extremities) and coronary  Increased activity of the different parts
sinus (coronary circulation). the renin-angiotensin- of the body. This
The left side of the heart, aldosterone system, strains the arteries
composed of the left atrium resulting in expansion and in turn, resists
and ventricle, distributes of extracellular fluid the flow of blood,
oxygenated blood to the volume and increased causing the rise in
remainder of the body to the systemic vascular blood pressure.
aorta. resistance.
The varying thickness of  Decreased
the arterial and ventricular vasodilation of the
walls relate to the workload arterioles related to
required by each chamber. dysfunction of the
The atria are thin walled vascular endothelium.
because blood returning to  Resistance to insulin
these chambers generates action, which may be
low pressure. In contrast, the a common factor
ventricular walls are thicker linking hypertension,
because they generate greater type 2 diabetes
pressure during systole. mellitus,
hypertriglyceridemia,
Heart Valves obesity, and glucose
The four valves in the heart intolerance.
permit blood to flow in only
one direction. There are two
types of blood: Gerontological
atrioventricular and Considerations
semilunar. Structural and functional
changes in the heart and
Coronary Arteries blood vessels contribute to
The left and right coronary increases in blood
arteries and their branches pressure that occur with
supply arterial blood to the age. The changes include
heart. These arteries accumulation of
originate from the aorta just atherosclerotic plaque,
above the aortic valve fragmentation of arterial
leaflets. The heart has large elastin, increased collagen
metabolic requirements, deposits and impaired
extracting approximately vasodilation. The result of
70% to 80% of the oxygen these changes is a
delivered (other organs decrease in the elasticity
consume, on average, 25%). of the major blood
Unlike other arteries, the vessels. Consequently, the
coronary arteries are aorta and large arteries are
perfused during diastole. An less able to accommodate
increase in heart rate the volume of blood
shortens diastole and can pumped out by the heart
decrease myocardial (stroke volume), and the
perfusion. energy that would have
stretched the vessels
Cardiac Muscle instead elevates the
The myocardium is systolic blood pressure.
composed of specialized Isolated Systolic
muscle tissue. hypertension is more
Microscopically, myocardial common in older adults.
muscle resembles striated
(skeletal) muscle, which is
under conscious control.
Functionally, myocardial
muscle resembles smooth
muscle because its
contraction is involuntary.

Cardiac Conduction System

The cardiac conduction
system is a group of
specialized cardiac muscle
cells in the walls of the heart
that send signals to the heart
muscle causing it to contract.
The main components of the
cardiac conduction system
are the SA node, AV node,
bundle of His, bundle
branches, and Purkinje
fibers. The SA node
(anatomical pacemaker)
starts the sequence by
causing the atrial muscles to
contract. From there, the
signal travels to the AV
node, through the bundle of
His, down the bundle
branches, and through the
Purkinje fibers, causing the
ventricles to contract. This
signal creates an electrical
current that can be seen on a
graph called an
Electrocardiogram (EKG or
ECG). Doctors use an EKG
to monitor the cardiac
conduction system's
electrical activity in the
heart.

Cardiac Output
Cardiac output (CO) is the
amount of blood pumped by
the heart minute and is the
mechanism whereby blood
flows around the body,
especially providing blood
flow to the brain and other
vital organs. The body’s
demand for oxygen changes,
such as during exercise, and
the cardiac output is altered
by modulating both heart
rate (HR) and stroke volume
(SV). As a result, the
regulation of cardiac output
is subject to a complex
mechanism involving the
autonomic nervous system,
endocrine, and paracrine
signaling pathways.

The amount of blood

pumped by the heart is
closely matched to global
metabolic needs. Changes in
cardiac output from baseline
are directly proportionate to
changes in total body oxygen
needs. During times of
physiologic stress, cardiac
output will increase to ensure
adequate tissue perfusion.
Cardiac output can be
increased by a variety of
signaling methods including
enhancement of sympathetic
tone, catecholamine
secretion, and circulation of
thyroid hormone. These
mechanisms increase HR by
exerting positive effects via
chronotropy (timing),
dromotropy (conduction
speed), and lusitropy
(myocardial relaxation rate).
These influences also
increase preload through
increased venous return via
receptor-mediated
vasoconstriction.

Impairment of cardiac
function can arise through a
variety of pathophysiologic
mechanisms. Common
etiologies include
hypertension, coronary
disease, congenital problems,
myocardial ischemia and
infarction, congestive heart
failure, shock, arrhythmias,
genetic diseases, structural
abnormalities, pericardial
effusions, emboli,
tamponade, and many others

Cardiac output must be

responsive to changes in the
metabolic demands of
tissues. Changes in heart rate
are accomplished by reflex
control mediated by the
autonomic nervous system,
including its sympathetic and
parasympathetic division.
The parasympathetic
impulses, which travel to the
heart through the vagus
nerve, can slow the cardiac
rate, whereas the
sympathetic impulses
increase it. These effects of
heart rate result from action
on the SA node, to either
increase or decrease its
inherent rate. The heart rate
is stimulated also by an
increase in levels of
circulating catecholamines
(secreted by the adrenal
gland) and excess thyroid
hormone, which produces a
catecholamine-like effect. It
is also affected by central
 nervous system and
baroceptor activity;
specialized nerve cells
located in the aortic arch in
both right and left internal
carotid arteries and is
sensitive to elevations in BP.
During elevations in blood
pressure, these cells increase
their rate of discharge,
transmitting impulses to the
medulla. This initiates
parasympathetic activity and
inhibits sympathetic
response, lowering heart rate
and BP.

References:

 Brunner & Suddarth. (2004). Medical Surgical Nursing (10th ed., pp. 647–666).

 Cardiac conduction system - Health Video: MedlinePlus Medical Encyclopedia. Retrieved from medlineplus.gov website: https://medlineplus.gov/ency/anatomyvideos/000021.

 Anatomy of the human heart and cardiovascular system | myVMC. (2006, June 25). Retrieved October 11, 2020, from HealthEngine Blog website:

https://healthengine.com.au/info/cardiovascular-system-heart

 King, J., & Lowery, D. R. (2019, May 7). Physiology, Cardiac Output. Retrieved from Nih.gov website: https://www.ncbi.nlm.nih.gov/books/NBK470455/

 Re, R. N. (2009). Obesity-related hypertension. The Ochsner Journal, 9(3), 133–136. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096270/
 NURSING CARE PLAN - HYPERTENSION

Planning
Assessment Implementation Evaluation
Objectives of Care Intervention Rationale

Chief of Complaints At the end of 2 weeks, the patient will be

 Hypertension with able to:
a BP reading of:
Initial: 160/100 1. Demonstrate appropriate changes a) Establish a realistic a) Reducing caloric a) Assisted the client in 1. Demonstrated
MmHg in lifestyle and behaviors, weight reduction intake by 500 determining which type of gradual
Second Reading: including eating patterns, food plan with the patient calories daily diet and exercise program to alteration in
150/100 MmHg quality/quantity and exercise
1 such as 1 lb weight theoretically yields pursue. lifestyle and
program 4
Subjective Cues: loss per week. a weight loss of 1 dietary habits
 “Si ta subi miyo lb per wk. Slow (food intake
bp, ta dwele mio reduction in weight and choices).
kabesa y ta is therefore Exercise
tormenta resulya. indicative of fat program was
Maluya el kwerpo loss with muscle not yet
tambien kwando sparing and started.
toma medisina”. generally reflects a
(Whenever I change in eating
experience an
habits.9
increase in bp, my
head hurts and I
find it difficult to b) Instruct and assist in b) Avoiding foods b) Presented the possible
breath. My body appropriate food high in saturated healthy food options that he
generally feels selections, such as a fat and cholesterol may consume while on a
weak after diet rich in fruits, is important in diet. Utilized the DASH diet
drinking the vegetables, and low- preventing food options.
medication). fat dairy foods progressing
referred to as the atherogenesis.
DASH Dietary Moderation and
Objective Cues: Approaches to Stop use of low-fat
Vital signs
Hypertension) diet products in place
5. Initial BP reading:

1
Doenges, Moorehouse, & Murr. (2011). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions and Rationales (11th ed.).
4
Vera, M., BSN, & R.N. (2018a, August 12). Nursing-Diagnosis-for-Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5/
9
Vera, M., BSN, & R.N. (2018a, August 12). Nursing-Diagnosis-for-Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5/
 160/100 MmHg and avoiding foods of total abstinence
high in saturated fat from certain food
Second BP (butter, cheese, eggs, items may prevent
reading: ice cream, meat) and sense of
150/100 MmHg cholesterol (fatty deprivation and
meat, egg yolks, enhance
6. Temperature:
37.4 oC whole dairy products, cooperation with
shrimp, organ dietary regimen.
5
7. Pulse rate: meats). The DASH diet, in
82 bpm conjunction with
exercise, weight
8. Respiratory rate: loss, and limits on
18 bpm salt intake, may
reduce or even
Weight: 96 kg eliminate the need
Height: 165 cm. for drug therapy.10
BMI: 35.26 (Obese)

Medical Diagnosis:
9. Hypertension 2. Identify the correlation
between hypertension and a) Assess patient a) Reduction in a) Asked multiple questions 2. Enhanced
Nursing Diagnosis: obesity.2 understanding of weight may regarding the correlation of knowledge on
10. Imbalanced direct relationship obviate the need weight and hypertension. the correlation
Nutrition: More between for drug therapy or specifically: of weight to
than Body hypertension and decrease the 1. What is hypertension.
Requirement obesity. amount of hypertension?
related to medication needed 2. How do you think
Excessive Intake for control of BP. your lifestyle habits
in Relationship to
Faulty eating influenced your
Metabolic Need
habits contribute to blood pressure?
atherosclerosis and 3. What do you think is
obesity, which the possible risk
predispose to associated with
hypertension and weight to
subsequent hypertension?
complications

2
Doenges, Moorehouse, & Murr. (2011). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions and Rationales (11th ed.).
5
Vera, M., BSN, & R.N. (2018a, August 12). Nursing-Diagnosis-for-Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5/
10
Vera, M., BSN, & R.N. (2018a, August 12). Nursing-Diagnosis-for- Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5/
 (stroke, kidney
disease, heart
failure).11

b) Discuss necessity for b) Excessive salt b) Discussed the possible risks

decreased caloric intake expands the associated with continuing
intake and limited intravascular fluid unhealthy eating habits.
intake of fats, salt, volume and may
and sugar as damage kidneys,
indicated.6 which can further
aggravate
hypertension.12
3. Initiate/maintain individually
appropriate diet and exercise
program.3 a) Determine current a) Exercise furthers a) Queried about the usual 3. Initiated
activity levels and weight loss by exercise he does and minimal
plan progressive reducing appetite; suggested other possible change in
exercise program increasing energy; program he might dietary habits.
(walking) tailored to toning muscles; follow. Exercise
the individual’s goals and enhancing program not
and choice.7 cardiac fitness, yet
sense of well- established.
being, and
accomplishment.
Commitment on
the part of the
patient enables the
setting of more
realistic goals and
adherence to the
plan.13

b) Consult with dietitian b) Can provide b) Presented options to

to determine caloric additional where he might go seek
and nutrient counseling and consultation about his

3
Doenges, Moorehouse, & Murr. (2011). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions and Rationales (11th ed.).
6
Vera, M., BSN, & R.N. (2018a, August 12). Nursing Diagnosis for Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5
7
Vera, M., BSN, & R.N. (2018a, August 12). Nursing Diagnosis for Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5/1
 requirements for assistance with dietary and exercise
individual’s weight meeting individual program.
loss.8 dietary needs.14

11
Vera, M., BSN, & R.N. (2018a, August 12). Nursing-Diagnosis-for-Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5/
12
Vera, M., BSN, & R.N. (2018a, August 12). Nursing-Diagnosis-for-Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5/
13
Vera, M., BSN, & R.N. (2018a, August 12). Nursing-Diagnosis-for-Hypertension: 6 Nursing Care Plans. Retrieved from Nurseslabs website: https://nurseslabs.com/6-hypertension-htn-nursing-care-plans/5/
8
Rozzette. (2019, August 28). Nursing-Care-Plan-for-Hypertension - NurseBuff. Retrieved from NurseBuff website: https://www.nursebuff.com/nursing-care-plan-for-hypertension/1
14
Rozzette. (2019, August 28). Nursing-Care-Plan-for-Hypertension - NurseBuff. Retrieved from NurseBuff website: https://www.nursebuff.com/nursing-care-plan-for-hypertension/
 DRUG STUDY
Generic Name: Losartan Potassium Mechanism of Action: Side Effects Nursing Responsibility
Inhibits vasoconstrictive and aldosterone  Drug can be used alone or with
secreting action of angiotensin II by  Low Blood Glucose other hypertensive drugs.
blocking angiotensin II receptor on the
 Anemia
Brand Name: Cozaar surface of vascular smooth muscle and  If antihypertensive effects is
other tissue cell.  Urinary Tract Infection inadequate using once daily-doses,
a twice daily regimen using the
 Chest Pain
same or increased total daily dose
Classification: Angiotensin II receptor Indication  Weakness may give a more satisfactory
antagonist 1. Hypertension response
 Diarrhea
a) 50 mg/day orally (25 mg/day in
patients with possible  Cough  Monitor patients BP closely to
intravascular depletion or evaluate effectiveness of therapy.
 Upper Respiratory Tract Infection
Dosage or Frequency: 100 mg, once- receiving diuretics)
daily b) Dosage range: 25-100 mg/day  High Blood Pressure  Monitor patients who are also
orally in 1 or 2 daily doses taking diuretics for asymptomatic
 Dizziness
hypotension.
 Skin Infection
Route: Oral 2. Nephropathy in type II diabetic  Regularly assess the patient’s renal
 Gastritis
patients function (via creatinine and BUN
a) 50-100 mg orally once/day  Nausea levels).
 Rapid Swelling
Illustration:  Patients with severe heart failure
3. To reduce risk of stroke in patients  Swelling whose renal function depends on
with hypertension and left the angiotensin-aldosterone system
 Low Blood Pressure In Patients
ventricular hypertrophy. may develop acute renal failure
a) 50 mg orally once/day initially; With Low Blood Plasma Or during therapy.
may increase to 100 mg orally
Diuretic-Using Patients
once/day; may use in
combination with a thiazide  Abnormal Weakness
diuretic
 Headache
Contraindication  Feeling Unwell (Malaise)
 Contraindicated in patients
 Nausea
hypersensitive to drug.
Breastfeeding isn’t recommended
 during losartan therapy.  Abdominal Pain
 Use cautiously in patients with
 High Potassium Levels
impaired renal or hepatic function
  Back Pain
 Drugs that act directly on the renin-
 Worsening Renal Failure
angiotensin system (such as
losartan) can cause fetal and
neonatal morbidity and death when
Adverse Effects
given to women in second or
Patients with hypertension
trimester of pregnancy. These
 Angioedema
problems have not been detected
when exposure was limited to first
trimester. If pregnancy is
Patients with Nephropathy
suspected, notify prescriber
 Hyperkalemia
because drug should be stopped.
 Hypoglycemia
 Diabetic vascular disease
 Angioedema
 DRUG STUDY
Generic Name: Amlodipine Besylate Mechanism of Action: Side Effects Nursing Responsibility
Inhibits calcium ion influx across cardiac  Headache  Monitor patient carefully. Some
and smooth muscle cells, dilates coronary  Somnolence patients, especially those with
arteries and arterioles and decreases blood severe obstructive coronary
Brand Name: Norvasc  Fatigue
pressure and myocardial oxygen demand. disease, have developed increased
 Dizziness frequency, duration, or severity of
 Light-headedness angina or acute MI after initiation
Classification: Calcium Channel Blocker Indication of calcium channel blocker therapy
 Edema
1. Chronic Stable Angina or at time of dosage increase.
(Printzmetal or variant  Flushing
angina)  Palpitations  Monitor blood pressure frequently
Dosage or Frequency: 100 mg, once-
a) The recommended dose for during initiation of therapy.
daily  Nausea
chronic stable or Because drug induced vasodilation
 Abdominal pain has a gradual onset, acute
vasospastic angina is 5–10
mg  Myalgia hypotension is rare.
Route: Oral b) Elderly Patients: Initially, 5  rash
mg PO daily.  Notify prescriber if signs of heart
failure occur, such as swelling of
2. Hypertension Adverse Effects hands and feet or shortness of
Illustration:
a) Adults: Initially, 2.5 to 5  Peripheral Ischemia breath.
mg. daily. Dosage adjusted  Syncope
according to patient  Abrupt withdrawal of drug may
 Vasculitis
response and tolerance. increase frequency and duration of
 Hypoesthesia chest pain. Taper dose gradually
b) Elderly patients: Initially,
2.5 mg PO daily.  Neuropathy Periphera under medical supervision.
 Asthenia
 Caution patient to continue taking
 Arthralgia drug even when feeling better.
Contraindication
 Contraindicated in patients  Arthrosis
hypersensitive to drug.  Angioedema  Tell patient S.L nitroglycerin may
  Erythema Multiforme be taken as needed when angina
 Use cautiously in patients receiving  Sexual dysfunction symptoms are acute.
other peripheral vasodilators,
especially those with severe aortic
stenosis, and in those with heart
failure. Because the drug is
metabolized by the liver, use
cautiously and in reduced dosage in
patients with severe hepatic
disease.

References

 Lippincott. (2008). Nursing 2008 Drug Handbook (28th ed.; Williams & Wilkins, Eds.).
 Norvasc (Amlodipine Besylate): Uses, Dosage, Side Effects, Interactions, Warning. (n.d.). Retrieved October 11, 2020, from RxList website:
https://www.rxlist.com/norvasc-drug.
 Losartan (Cozaar) Nursing Pharmacology Considerations. (2018, October 9). Retrieved October 11, 2020, from NURSING.com website: https://nursing.com/blog/losartan-
cozaar-nursing-pharmacology-considerations/
 HEALTH TEACHING PLAN

General Objective: After 3 minutes of teaching, the client will be able to attain essential information regarding hypertension and how healthy lifestyle affects its stability.

Topic: Hypertension (Diagnosed)

Learning Needs
The client is a 50 year old male client who is diagnosed with hypertension 20 years ago. The surrounding environment is conducive
P
for learning and has no communication barriers (e.g. loud sounds, other people present in the area). He is focused enough to learn

multiple things at a time and attentive when discussing matters.

The client is aware of his condition and its underlying implications to his health. His fear of it had gone over the years of

E chronically having it. His main support system consists of his family and friends, to which he can relate anything. He consciously

knows that he has to lose on weight to avoid aggravating the disease and considered modification of diet and lifestyle habits.

The client is Zamboangueño, who doesn’t adhere to any health practices by his forefathers. He is enthusiastic and looking forward
E
to the changes the plan may yield. He reiterated that he can cope up swiftly with any predicaments he may encounter.

The client has finished college and has ample insights on the implications of high blood pressure. He is able to grasp knowledge
K
without any difficulty and reads with ease. The client is an Audio-Visual learner.

Learning diagnosis: Readiness for Enhanced Knowledge related to Management of High Blood Pressure
Subject Matter: Hypertension

Time Allotment: 3 minutes

General Objective: After 3 minutes of teaching, the client will be able to attain essential information regarding hypertension and how healthy lifestyle affects its stability.

Specific Objective Contents Time Allotment Teaching Strategy Resources

After 3 minutes of Health
Teaching, the individual
will be able to:
1. Recall the a) Definition of Hypertension 1 minute Leaflet/Brochure Printed Infographic Paper
Blood pressure is the force
definition of
exerted by circulating blood
Hypertension and against the walls of the body’s
arteries, the major blood
the risk factors
vessels in the body.
associated. Hypertension is when blood
pressure is too high.

Hypertension is diagnosed
if, when it is measured on two
different days, the systolic
blood pressure readings on
both days is ≥140 mmHg
and/or the diastolic blood
pressure readings on both days
is ≥90 mmHg.

b) Risk Factors associated with

Hypertension
 Modifiable risk factors
include unhealthy
diets, physical
inactivity, consumption
of tobacco and alcohol,
and being overweight
 or obese.

 Non-modifiable risk
factors include a family
history of
hypertension; age over
65 years and co-
existing diseases such
as diabetes or kidney
disease.

2. Identify 30 seconds Leaflet/Brochure Printed Infographic Paper

a) DASH diet and High blood
appropriate diet pressure
 Eat more fruits,
and healthy eating
vegetables and low-fat
habits
dairy foods.
 Cut back on foods that
are high in saturated
fat.
 Eat more whole grain
foods, fish, poultry and
nuts.
 Limit sodium, sweets,
sugary drinks, and red
meats.
3. Enumerate the a) Prevention and Management 1 minute Leaflet/Brochure Printed Infographic Paper
of Hypertension
different ways on
Reducing hypertension prevents
how to prevent heart attack, stroke, and kidney
damage, as well as other health
and manage
problems
Elevated Blood Prevention
Reducing salt intake (to less
Pressure
than 5g daily)
 Reducing alcohol
consumption
 Limiting the intake of
foods high in saturated fats
 Eliminating/reducing trans
fats in diet

Management
Reducing and managing
mental stress
 Regularly checking blood
pressure
 Treating high blood
pressure
 Managing other medical
conditions

Leaflet/Brochure Printed Infographic Paper

4. Lay out the Importance of Healthy lifestyle to 30 seconds
hypertensive patients
significance of  They point out that
adherence to effective lifestyle
modification can lower
healthy lifestyle. blood pressure by at least
as much as a single
 antihypertensive drug.
Even a 2 mmHg decrease
in diastolic blood pressure
has been found to reduce
hypertension prevalence
by 17%, risk of coronary
heart disease by 6%, and
stroke by 15%.

 Physical activity not only

helps control high blood
pressure (HBP or
hypertension), it also helps
you manage your weight,
strengthen your heart and
lower your stress level. A
healthy weight, a strong
heart and general
emotional health are all
good for your blood
pressure.
References:
 WHO. (2015). Hypertension. Retrieved from www.who.int website: https://www.who.int/news-room/fact-sheets/detail/hypertension

 Akbarpour, S., Khalili, D., Zeraati, H., Mansournia, M. A., Ramezankhani, A., & Fotouhi, A. (2018). Healthy lifestyle behaviors and control of hypertension among adult

hypertensive patients. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-26823-5

 Carolina, J. P. H. C., PharmD, CDE, Retrieved October 11, 2020, from www.uspharmacist.com website: https://www.uspharmacist.com/article/exploring-the-link-between-

blood-pressure-and-lifestyle
LEAFLET