First Session

1. Okay, is everyone here? Can we proceed now?

2. Assalamualaikum wbt. My name is …………… and my ID Number is five
nine two one five one one nine zero one zero .. and I will be your
chairperson for today’s session.
3. Now, since today is the first session of our PBL, we will be discussing
the trigger in detail and try to come out with the learning outcomes.
4. Can we please have a volunteer to read the trigger? – Thank you.
5. I’ll now read the trigger line by line. So, if there’s any difficult word
that needs to be defined or clarified, please do stop me.
6. Is there anyone who still have any doubt or question about the
trigger?
7. before we proceed with the LOs.. can we write the pt history first? so,
it will easy to us to discuss about the lo
8. If there’s no more question, can we now proceed with the learning
outcomes?
9. Now, for the first learning outcome, who can give us a suggestion? –
What do you guys think? Can we add that to our list, or anyone wants to add
on anything?
LOs SUGGESTION
1) Define and classify/differentiate the dx
2) Discuss a pathophysiology of dx
3) Explain generally the clinical presentation of dx
4) Describe causes and risk factors dx
5) Explain lab test use to diagnose the disease
- Discuss the pharmacological treatment (MOA, side effect,
dosage, indication, drug interaction, special precaution) for
dx
- discuss non-pharmacological treatment for dx
...end…
10. I think that’s all of our discussion for today session. Thank you all for
your contribution. Have a nice day everyone.Then, i will pass this session to
our beloved lecturer ………

2nd Session
1. Good morning and Assalamualaikum wbt to Dr seow and my pbl-mate.
My name is Nik Nur Alya with ID Number is five nine two one five one
one nine zero one zero and I will be your chairperson for today’s session.
2. since today is the 2nd session of our PBL, we will be discussing the Los
that we have come out in last PBL session.
3. Before that, lets we recap the trigger first which an elderly man was
presented to a&E with hypertension. And he had complained some sign
&symptoms. This patient also has several past medical histories and have
a chronic disease like diabetes type 2 and also hypercholestol. Then, his
vital sign was found to be abnormal and was admitted into icu. Further
renal investigation also turns out to be abnormal. So, from the trigger,
we have discussed about this patient and have come out with 7 learning
outcomes.
4. Before we begin our first LO, please do mention your name together with
id numbers and If you have any doubt or any question or want to add the
information, please click the raise hand button in the bar.
5. For the first Lo, Dr seow have pick the person to present the LO number
1. DR, which is Nor azalia.
6. Ok, ……….. You may proceed now – Thank you
7. Is there anyone who still have any doubt or question want to add
anything? – thank you for the question.
8. Next, we will proceed with 2nd Lo, and will be present by Naurah.
9. If there’s no more question, now we proceed with the next learning
outcomes. So, Luqman nisa, you may proceed with LO no 3.
10. Then, we proceed for the LO no 4 Nasrul. You can proceed
11.Without further ado, Dr, please pick the person to present lo no 5.
12.Next, we proceed with LO6, which we will discuss more about the
pharmacological therapy. In this LO, we will have 3 person to present.So,
Dr, who is the first person? – 2nd person ? and lastly for the last person to
present about the pharmacological treatment is?
13.And lastly,, for the last LO. Auni will present
For the conclusion based on our today’s discussion, we notice that this
patient is having hypertensive emergencies because his blood pressure is
245/115 mmHg, above the normal range for elderly and having some other
factors. First, we know that hypertension is a condition in which the blood
vessels have persistently raised pressure that created by the force of blood
that push against the walls of (arteries). For the hypertensive emergencies,
severe elevation of blood pressure associated with new or progressive end
organ damage/complication like hypertensive encephalopathy, acute renal
failure, acute coronary syndromes and others. So this patients, he is high
risk to get hypertensive emergencies because he is an elderly man and
having chronic condition like diabetes and hypercholesterolemia. and the
important thing is, we confirmed that he is getting hypertensive
emergencies because his kidney has already been affected as his creatinine
serum is high. Furthermore, this patient also having blurred vision. Which,
occurred due to vasoconstriction that can cause the pressure to the optic
vessel. We also, disccuss about the complication for hypertensive person,
which chronic kidney disease is the most common complication. Other than
that, it can lead to stroke, heart failure, heart attack and also sexual
dysfunction. So then, to diagnose hypertensive emergency, As presented by
our friend, dr will do the diagnostic test which including blood test, urine
test, through ultrasound, also using echocardiogram. Which by blood test,
we can test the serum creatinine level which it can determine how well the
function of the kidney. As for monitoring parameter, as we know , it
depending on the age, which if the person is 18 and above, their blood
pressure is need to maintained the blood pressure at 140/90 mmHg or
lower. Meanwhile for the person above 60, the goal is 150/90 mmHG or
lower. Therefore, for the person who have hypertensive emergencies, the
main goal of the therapy is to reduce the blood pressure as quickly as
possible to prevent further organ damage by given intravenously.
So, for the pharmacology treatment that are suitable for this patient is by
giving Sodium nitroprusside as it can give vasodilation effect. Thus,
decreasing peripheral resistance in just 2 to 5 minutes with a lower dose. Or
other choices of drug can be given like IV nicardipine, nitroglycerin and IV
esmolol. On the other hand, IV hydralazine also can be given for the
treatment of hypertensive crisis especially in emergency. For the IV
Nicardipine I think it is not suitable for this patients, because this drug can
cause some side effect like tachycardia and abnormality in ECG reading. As
we know, this patient has medical problem like IHD and MI. So, it might in a
high risk to these condition to reoccur.
Then, as for non- pharmacological treatment we can advice this patient to
reduce the sodium intake. Because high sodium in diet can increase the
blood pressure. as we discuss in pathophysiology, its stated that
hypertension is occur due to abnormality in renal sodium haemostasis that
lead to inadequate excretion of sodium in the urine. Furthermore, regular
physical activity at least 150 min per weeks is also important for this patient
as it can lower their blood pressure which then resulting reducing in
diastolic and systolic reading. not to this patient, even we also can take note
that by exercising, we can maintain a healthy body and can prevent from
hypertension. Other than that, hypertensive people can do relaxation
therapy, eat a healthy food and also limit in alcohol intake.
That is all for the conclusion. IS there anyone who want to add anything? - IF
there is no person want to add anything. I think that’s all of our discussion
for today session. Thank you all for your contribution. Then, i will pass this
session to Dr Seow to give some comment. Dr, the floor is yours. Thank you!