VISION

Republic of the Philippines MISSION

A premier university in
historic Cavite recognized for
excellence in the
development of morally
upright and globally
competitive individuals.
College of Nursing
CAVITE STATE UNIVERSITY
Don Severino Delas Alas
Campus Indang, Cavite
Cavite State University shall provide
excellent, equitable and relevant
educational opportunities in the arts,
science and technology
through quality instruction and
relevant research and development
activities. It shall
produce professional, skilled and
morally upright individuals for
global competitiveness.

HYPERTENSION
Presented by

LEVEL II / MW 2A – 1 / GROUP 3

ALO. LAICA M.

DY, QUEEN JUSTINE M.

HUBILLA, JENALYN L.

MENDOZA, ANGELICA EDLYN MAE. E

VICEDO, DANIELLA PRIA S.

Presented to:
Ms. Ariane Joy Cantilero, RM, RMT
Ms. Varhielyn M. Escalante, RM
Ms. Maria Khristina C. Huerto, RM
Ms. Joymie F. Matreo, RM, LPT
Ms. Kcllyn Joy O. Separa, RM
Ms. Maria Judith T. Tugado, RM

Clinical Instructors, Level II

February 1, 2023

In Partial Fulfillment of the Requirement in

MDWY 90 for the Diploma in Midwifery
 TABLE OF CONTENTS

ACKNOWLEDGEMENT

INTRODUCTION

I. DEMOGRAPHIC DATA……………………………………………………………….1

II. REASON FOR SEEKING HEALTH CARE…………………………………………2

III. HISTORY OF PRESENT ILLNESS............................................................................2

IV. PAST MEDICAL HISTORY.........................................................................................3

V. OBSTETRIC-GYNECOLOGICAL HISTORY.............................................................4

VI. HEREDO-FAMILIAL HISTORY……………………………………………………...5

VII. DEVELOPMENTAL HISTORY.................................................................................7

VIII. GORDON’S FUNCTIONAL HEALTH PATTERNS...............................................8

IX. PHYSICAL EXAMINATION.......................................................................................15

X. DIAGNONSTIC TEST.................................................................................................31

XI. ANATOMY OF APPENDIX.......................................................................................32

XII. CONCEPT MAPS.....................................................................................................33

XIII. CASE MANAGEMENT….......................................................................................35

A. MEDICAL........................................................................................................35

B. NURSING.......................................................................................................46

XIV. ONGOING APPRAISAL........................................................................................60

APPENDICES.................................................................................................................61

A. REFERENCES..............................................................................................62
 ACKNOWLEDGEMENT

In carrying out our duties as student midwives, particularly in finishing our case

study, we have had many opportunities to learn from and comprehend our case presentation

that we had faced. Without everyone's aid and collaboration, it would not have been feasible

to complete this project. Salutations to each and every member of this group for a job well

done!

To our panelists, we are immensely grateful for your presence, it was an honor to

have you. We know your time is precious but you were able to spare out some time with us.

We would like to express our special thanks of gratitude to Dr. Evelyn M. Del

Mundo, Dean of College of Nursing and Mrs. Hydra Jane O. Pantilgan, Principal of

Department of Midwifery for their unceasing support.

A deeper gratitude is also owed to Ms. Merry Olegario, our adviser. Her guidance

and advice carried us through all the stages of doing our case study.

We are also grateful for all our clinical Instructors for the professional knowledge

and expertise they shared which encouraged us to do better.

We would also like to extend our sincere thanks and gratitude to our family as a

whole for their continuous support and understanding during undertaking our case study.

Their prayer for us was what sustained us this far.

Finally, we would like to thank God for enlightening us through all the difficulties.

We have experienced your guidance day by day. You are the reason why we are here

standing in front of our panelists, confidently speaking. We will keep on trusting you for our

future.

From the bottom of our hearts, thank you.

 INTRODUCTION

Hypertension or elevated blood pressure is a serious medical condition that

significantly increases the risks of heart, brain, kidney, and other diseases. Hypertension

is called a "silent killer". The majority of persons with this kind of condition may not

have any symptoms or warning indications. Nevertheless, some individuals may encounter

symptoms including early morning headaches, nosebleeds, irregular heart rhythms, vision

changes, and buzzing in the ears. Severe hypertension can cause fatigue, nausea, vomiting,

confusion, anxiety, chest pain, and muscle tremors. It is important to monitor your blood

pressure regularly with the help of health professionals. Having blood pressure measured

is quick and painless. Although some people can measure their own blood pressure

using automated devices, an evaluation by a health care provider is essential for assessment

of risk and associated conditions.

Modifiable risk factors of hypertension include unhealthy diets which are excessive

salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and

vegetables, physical inactivity, consumption of tobacco and alcohol, and being overweight or

obese.

This chosen case would purposefully give knowledge to our client which was

diagnosed with hypertension. Lattermost of this study, the client will able to comprehend the

condition in a sensible and empirical situation. This would also enlighten the client to know

the censorious details about her illness which may have a beneficial influence to improve her

lifestyle modification. Furthermore, the students’ capabilities in providing holistic care to the

clients with particular illnesses, mainly those with hypertension, are expected to improve due

to this case study.

I. DEMOGRAPHIC DATA

A. Initials of Clients’ Name: ERBM Date of Admission: January 9,

2023

B. Address: Dexterville Royal, Dasmarinas City, Cavite

C. Age: 23 years old Time of Admission: 9:00 AM

D. Birth Date: April 12, 1999 Date of Interview: January 9, 2023

E. Birth Place: Dasmarinas City, Cavite Primary Informant: ERBM

F. Sex: Female Secondary Informant: None

G. Civil Status: Single Other Data Sources: Laboratory

Results

H. Religion: Roman Catholic

I. Highest Educational Attainment: College

J. Occupation: Service crew

K. Monthly Income: Php 13,000

Daily Monthly Per Day
Consumption Expenses Expenses
Electricity 550/month 550/30 Php 18

Water 130/month 130/30 Php 4

Internet/Load 1099/month 1099/30 Php 37

Grocery 4000/month 4000/30 Php 133

Transportation 3500/month 3500/30 Php 117

Personal Wants 2000/month 2000/30 Php 67

Total Php 11,279 Php 376

Table 1: Monthly and Daily Expenses - Client ERBM has a gross income of estimated

13,000 per month. The total expenses of Client ERBM’s family is 11, 279 pesos. Therefore,

there is exact 1,721 pesos left for their savings.

1
II. REASON FOR SEEKING HEALTH CARE

Client ERBM arrived at Rentosa Maternity Lying-In Clinic on January 9, 2023 at 9 in

the morning who was currently in active labor. Upon evaluating the client, she complained that

her legs were getting bigger and heavier. She also stated that she easily gets tired whenever she

does light activities and she sometimes feels chest pain and nervousness. Our client admitted

that she usually consumes fatty and greasy foods. In addition to this, according to her, she has

no history of high blood pressure as well as her family.

III. HISTORY OF PRESENT ILLNESS

On January 9, 2023, same date which client ERBM was admitted, we underwent

assessment through taking her vital signs and performing physical examination. We, student

midwives, found out that her blood pressure was not normal which is consistently around

130/80mmhg to 130/90mmhg and as we examined her body with her permission, we noticed

that her legs were swelling and increased in size as well as her abdomen.

Upon interviewing our client, “Noong nag follow up check-up po ako dito sa

Rentosa, 37 weeks akong buntis, ang bp ko din po ay 130/80 kaya niresetahan po ako

ng gamot ng OB ko na Methyldopa. Hanggang January 8 ko lamang po siya ininom.

Pero, sa lahat po ng check-up ko before, normal po ang bp ko.” she stated. The client

revealed that she was aware regarding her abnormal blood pressure since she was diagnosed

with hypertension by her obstetrician when she reached 37 th week of her gestation. She also

added that her previous blood pressure throughout her prenatal

2
check-up was normal. She regularly took her medicine, Methyldopa with 250mg dosage through

oral route every morning and evening up until the day before admission.

IV. PAST MEDICAL HISTORY

Client ERBM loved to eat seafoods when she was a child and every time she eats it,

she noticed that the other parts of her skin was irritated and she thought it was normal or a

coincidence. Her skin was full of rashes and wounds and she had no idea why did it come

out from her skin. With that, she continued eating it regardless of her irritated skin.

As stated by client ERBM, on September 2009, she decided to go to the hospital to

consult because she could not resist to scratch her skin due to increasing rashes and wounds.

The physician asked her if she had consulted before. “First time ko lang po mag konsulta

kasi tolerable po ang pangangati dati, pero ngayon po hindi ko na po kaya tiisin at

lalo pong lumalala” she said. In addition to this, the doctor asked her if she put ointment or

drink medicine to manage her irritated skin. According to her, she always puts BL cream

whenever she feels uncomfortable as her skin was itchy. Based upon the assessment of the

client, the physician diagnosed that she was allergic to seafoods and other fishy foods and

prescribed her an ointment named Lidex Ointment and told her to stop using BL cream and

avoiding seafoods and other fishy foods were strictly enforced because it could be possibly

the reason why her skin was getting worse. Client ERBM regularly applied Lidex ointment

three times a day after bath or shower.

At the age of 19, our client was experiencing frequent headaches and dizziness

which were tolerable for her. As time went by, she suddenly felt severe headache which she

could not resist. Thus, client ERBM and her mother decided to go to the hospital for

consultation and she was referred to an ophthalmologist for her eyes to be checked.

Subsequently, after checking her eyes, the result came out and

3
the ophthalmologist told her that her eye grade was not normal, 250/100 vision to be exact.

This perhaps the reason of her frequent headaches and dizziness.

V. OBSTETRIC-GYNECOLOGICAL HISTORY

Client ERBM stated that she had her first menstrual period when she was 14 years

old. April 12, 2022 is the date of her last menstrual period. Our client normally experiences

her period monthly, before she got pregnant. Whenever her period comes, it lasts within

three to five days and she uses three to four pads daily. Therefore, her menstrual cycle is

regular and normal. Client ERBM’s OB score is G1P0(0000) which means that it is her first

pregnancy.

4
 The figure above shows the genogram of our client who had hypertension. Based on the client's interview, who has no hereditary hypertension

both maternal and paternal side also no history of hypertension in the 2nd and 3rd generations of her family.
B. amily APGAR

Constructs Questions Almost Some of Hardy

Always the Time Ever

(2) (1) (0)

Adaptation I am satisfied with the help that I receive 2

from my family when something is

troubling me.

Partnership I am satisfied with the way my family 2

discusses items of common interest and
shares problem solving with me

Growth I find that my family accepts my wishes to 2

take on new activities or make

changes in my lifestyle.

Affection I am satisfied with the way my family 2

expresses affection and responds to my
feelings such as anger, sorrow, and love.

Resolve I am satisfied with the way my family and I 2

spend time together.

TOTAL 10 pts. 0 pt. 0 pt.

Table 2: Family APGAR - The table shows that the client seems have a good relationship

with her family, she receives comfort when she experiences personal problems. The client

shares her problem with her family and solve every problem together with her family. Her

family supports her in anything she tries and any lifestyle changes. Her family handles her

anger and sorrow well. The client spends time with her family.

7
 VII. DEVELOPMENTAL HISTORY
Stage Specific Task(s) Evidences of Milestone

Trust Vs Mistrust Feeding Client ERBM was breastfed. Her mother told her that she cries
whenever stranger touches her.

(Birth-18 months)

Autonomy Vs Toilet training The client used to wear washable diapers to save money, she
only wears disposable diapers when they leave their house
Shame and Doubt and at the same time, her mother also teaches her how to
urinate properly on the toilet bowl.
(1-3 years old)

Initiative vs Exploration ERBM claims that when she was younger, they visited their
godmother. Her godmother asked about her name, but
because she is so introverted, she felt embarrassed to respond.
Guilt (3-5 years old)

Industry vs inferiority School Her parents reward her at any moment she receives a school
achievement that feeling of industry fosters.

(5-12 years old)

Identify vs role Social Relationships During adolescence, the client knows in where she excels.

Confusion (12-18 years She participates in activities that are related to her interests.

old) She tries new things to discover what she likes and to know

herself better.

Intimacy vs isolation Relationships The client cares for others and have a strong sense of self. She

(18-40 years old) has no fear of commitment. She can able to open up to others

about some things.

Table 3: Developmental History of Client ERBM - The Figure above shows the

developmental history of our client ERBM through Erik Erikson’s Developmental Theory

which conveys that personality develops from infancy to childhood in a preset order through

stages of development.

8
 VIII. GORDON’S 11 FUNCTIONAL HEALTH PATTERNS

A. Health Perception – Health Management

The client acknowledged at the initial interview that she was informed about both her first pregnancy

and her present state of health. She stated that she wanted to be ready in the upcoming delivery of her

baby. The client also attends her follow-up appointments, as she feels that in order for her to obtain

appropriate and sufficient health care and to be informed of her health state, it is crucial that she adhere

to them.

B. Nutritional – Metabolic

Customer ERBM claimed that she eats whatever is on the table and doesn't follow any particular dietary

behaviors. She added that she eats compulsively.

To better comprehend the eating behavior of the client. The 3-day diet recall is shown in the table below

under.

*3-day Diet Recall

Table 4: 3-day Diet Recall of Client ERBM

MEALS FRIDAY SATURDAY SUNDAY

Breakfast 2 pcs chocolate donut 1 serving porridge 1 serving champorado

5:00AM
(720 kcal) (340 kcal) (220 kcal)
250 mL water 1 glass sterilized milk 3 bottles yakult
(129 kcal) (150 kcal)
Lunch 2 cups white rice 2 cups white rice 1 cup white rice
2:00PM (532 kcal) (532 kcal) (266 kcal)
1 serving sinigang sa 1 serving sweet and 1 serving adobong
miso sour tilapia baboy
(191.6 kcal) (243 kcal) (454 kcal)
1 pc big orange 1 bottle orange juice 2 pcs small dalandan
(86 kcal) (70 kcal kcal) (80 kcal)
250 mL water 250 mL water
Snacks 1 serving palabok 5 pcs of fish balls 1 cup of ice cream
5:00PM
(295 kcal) (73 kcal) (270 kcal)
1 can soda 250 mL water 250 mL water
(139 kcal)

9
 Dinner 2 cups of white rice 1 cup of rice 2 cups of white rice
10:00PM (532 kcal) (266 kcal) (532 kcal)
4 pcs sliced spam 1 serving tinolang 1 serving porkchop
(359 kcal) manok (326 kcal)
1 can mango juice (143 kcal) 250 mL water
(130 kcal) 1 small cucumber
(14 kcal)
250 mL water
Total Fluid Intake 1070 mL 990 mL 990 mL

Total kcal Intake 2,984 kcal 1,810 kcal 2, 298 kcal

Table 4: 3-Day Diet Recall Interpretation:

According to Table 3, the patient consumed 1070 mL of fluid and 2,984 kcal of calories on

the first day. She consumes 1,810 calories overall and 990 ml of liquids on day two. She

consumed 2,298 total calories and 990 mL of fluid on the preceding day. Hence, our client

ERBM's 3-day total kcal is 7,092kcal.

Based on the information provided above, it can be concluded that the client consumed a

balanced diet and an adequate number of fluids on the first and second days, but that the

food she consumed contained an excessive amount of carbohydrates, indicating that she is a

large consumer.

C. Elimination

The client claims that she does not encounter difficulties with elimination.
She believes it is because of her eating habits, but the client's only issue is
that she needs to urinate frequently due to a UTI and she voids once a day

She further noted that she typically urinates seven to eight times per day,
and that her urine is yellow in color. She typically has daily bowel
movements and it is usually brown with a firm texture

10
 D. Activity – Exercise

The 7-Day Activity Table shows that client ERBM exercises in the form of

walking, doing Household chores, she stated that she often uses her time by

watching Television or YouTube. Her form is not that great because she always in

slouch position. She stated that her hygiene is good.

Table 5: 7-Day Activity Table

LEGEND:

DARK BLUE- Sleeping GREEN- Actively Moving

ORANGE - Waking Time YELLOW - Eating

VIOLET- Resting

11
 *Katz Index of Independence in Activities of Daily Living
Activities Independence = 1 point Dependence = 0 point
No supervision, With supervision,
Points (1 or 0) direction or personal direction or personal
assistance needed assistance or total care

Bathing 1

Dressing 1

Toileting 1

Transferring 1

Continence 1

Feeding 1

TOTAL 6 pts.

POINTS:

Table 6: Katz Index of Independence in Activities of Daily

Living of Client ERBM

Interpretation:

The client received a perfect score of six, meaning that they are fully capable of

performing the listed activities of bathing, dressing, using the restroom, transferring,

maintaining continence, and feeding without supervision, guidance, or assistance from

others.

12
 *7-Day Sleep Diary
Constructs Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Hours of 9 hrs. 7 hrs. 8 hrs. 7 hrs. 7 hrs. 10hrs. 10hrs.

Sleep

Sleeping Time 10 PM 10 10 10 10 10 10 PM

PM PM PM PM PM

Waking Time 5 AM 5 AM 6 AM 5 AM 5 AM 5 AM 5 AM

Bedtime 9 PM 9 PM 9 PM 9 PM 9 PM 9 PM 9 PM

Routine

Feeling upon None None None None None None None

waking up

Problem None None None None None None None

Encountered

Table 7: 7-Day Sleep Diary of Client ERBM

E. Sleep-Rest

Client has an average of 8-9hrs of sleep, she stated that she doesn’t have

difficulty in sleeping and can sleep peacefully through the night. She thinks that her hours of

sleep are enough to start her day right.

F. Cognitive – Perceptual

According to the client interview, she has a sharp memory and is really

receptive. She was prompt and thorough in her responses. Client ERBM responded

directly to the question and did not stutter over her words.

13
G. Self-Perception – Self-Concept

Client believes she needs to alter her eating habits and engage in regular exercise to

reduce her risk of illness as a result of how she feels in the impending birth of her child.

She believed that in order to improve herself and her family, she needed to change.

H. Role-Relationship

The client gets along well with her husband and all of the family members that live with

her. She believes that the open and considerate relationship they share at home is the ideal for

many families. When it comes to domestic decision-making, she supports her husband. She

also wanted to take part in their community event, but she was hesitant because she felt like

she should take it more slowly.

14
 The client has strong connection to her Family, Extended Family and to the Church

because she is a devoted Roman Catholic. She also receives stress from Bills,

Needs and Chores,

I. Sexuality – Reproductive

Based on the client responds, when she was 14 years old, she experienced her first

menstruation and notices some physical changes during that time. Client ERBM

stated that she and her husband does have contact at least twice a week. The

client is in her first pregnancy.

J. Coping-Stress

She is used to being composed in the face of issues, pressure, and challenges. She
would simply pause, relax, and consider uplifting thoughts.

K. Value-Belief

The client’s values and beliefs came from her surrounding and from both of her

parents. That why she respects others people values and belief. When she feels that

they are disrespecting her belief she doesn’t mind them and still respects their

perspective and opinions.

IX. COMPREHENSIVE PHYSICAL EXAMINATION

A. Vital Signs

Name: ERMB Date/Time of Exam: January 9 2023, 8am

15
 Temperature 36.8 OC

Pulse rate 86 bpm

Respiratory rate 19 cpm

Blood pressure 140/80 mmHg

Table 8: Vital Signs of Client ERBM

Interpretation:

The data indicated above presents the client’s vital signs. ERBM took an exam on the

9TH of January at 8 AM. The client shows the normal body temperature at 36.8°C, normal

frequency of pulse rate at 86 beats per minute, normal respiratory rate at 19 counts per

minute. and elevated blood pressure at 130/80. Upon checking the client, there is no pain

observed.

B. Anthropometric Data

Name: ERBM Date/Time of Exam:1/9/2023,

8:30AM

Height 171 cm (1.71 m)

Weight 87 kg

BMI 29.8 kg/m2

IBW 54.1 - 73.1 kgs

Table 9: Anthropometric Data of Client ERBM

Interpretation:

16
 The data above shows the client’s anthropometric status. ERBM took an exam on

the 9th of January at 8:30 Upon observation, the client weighs 87 kg while its height is

1.71 m. Therefore, the client’s body mass index is 29.8, which means client ERBM is

overweight

C. General Appearance

The total physical, behavioral, and emotional health of ERBM was evaluated.

According to the client's BMI range of 29.8 kg/m, proportionality between the client's height, weight,

and body build is expected. There is less obvious posture and gait as a result of lower back pain. The

client is well-groomed and practices decent hygiene. She has a body of the endomorph type. The

patient is in a state of stable mind. She can respond correctly and has a positive mindset. She converses

in her native tongue with moderate fluency and discourse quality.

Body part Actual findings Normal Findings Clinical

significance

SKIN
Color Skin has a Skin color varies
consistent/fair from light to deep.
Lesions uniform color. There
are some moles
Moisture present in the body
areas. Generally, uniform
Turgor except in areas of
: Birthmark is present lighter pigmentation
at left lower back. :

Edema is present at
stomach and leg area. :

Patient’s skin is dry

and warm to touch.
Moisture in skin folds
When client’s skin is
being pinched, the and axillae. When
pinched, skin springs

17
 indent remains in the back to previous
edematous area. state.

NAILS
Texture Smooth Smooth texture

Plate Shape Short nail surface Convex curvature;

with clean edges angle between nail
and nail bed.

Bed Color Highly vascular and

Pink Bed Color pink in light skinned
clients. Dark skinned
clients may have
brown or black
pigmentation.
Client’s Blanched nail
Blanched nail regains
Blanch Test regains pink
pink appearance
appearance within 2
within 2 seconds
seconds

Head

Hair Patient’s hair is evenly Evenly distributed

distributed. She has a
Evenness long thick hair : No No infection or
existence of infection infestation.
Texture and Oiliness and infestation. : Body
hair is present
Thickness/ Thinness
Smooth to touch.

Eyes

Cornea (Clarity) 250/100 Disorders of vision

shift with age.
Eyebrows for hair Evenly distributed Healthy young adults
distribution generally have
refractive errors. Up to
Eyelids (Ability of 25% of adults older
Blinking Blinks involuntarily
than 65 years have
refractive errors;
Pupils Both eyes are black
cataracts, macular
in color, equal in size,
degeneration, and
round, regular.

18
 glaucoma also
become more
prevalent. (BATES,
Pocket Guide to
Physical
Examination, page
102)

Breast and Axillae

Breast (Size, Small, asymmetric, No discoloration,

Symmetry, round, undefined retraction, and
Discoloration, contour, without hypervascularity. No
Swelling, Edema) discoloration, without presence of swelling
retraction, without and edema. * No
hypervascularity, present discharge,
swelling and edema masses, and lesions.

Areola are about 1

Areola inch, round,
symmetric, pinkish, No lymph nodes,
soft, without masses masses, nodules and
and lesion discharge. No
tenderness and
Nipples are small, swelling
Nipples
round, in the middle
of areola, pinkish to
light brown, without
discharge and le

Abdomen

Skin integrity The client’s abdomen Uniform color Physiologic edema

is uniform in color, no results from
Contour and pain when palpated, The abdomen has a hormone-induced
Symmetry and bowel sounds are symmetric contour sodium retention.
able to hear clearly Edema may also
Bowel Sounds Audible bowel occur when the
The client’s abdomen sounds. enlarged uterus
Edema has an edema intermittently
No edema
compresses the
inferior vena cava
during recumbency,
obstructing outflow
from both femoral
veins. (BATES,
Pocket Guide to
Physical
Examination, page
362)

19
Neurologic

Mental Status Our client was able

to:

express oneself
Orientation using speech Alert, memory is
sharp, and no
Language Uses Filipino speech difficulty.
language

Awake, alert, oriented

Attention Span to person, place, date
and time

Able to reminisce past

Memory
events and past
experiences

Consciousness Level
Able to concentrate

Musculoskeletal

Structure and Our client's legs, No deformity, Dependent edema

Deformity ankles, foot has fractures, and appears in the feet and
edema abnormalities lower legs when
Edema and sitting or in the
Tenderness No edema and no sacrum when
tenderness bedridden BATES,
Pocket Guide to
Physical Examination,
page 147)

GENITALS
RECTUM & ANUS
(NOT ABLE TO
PERFORM AS
CLIENT DOES NOT
AGREE TO BE
ASSESS IN THIS
AREAS)

20
 X. DIAGNOSTIC TEST
Specific Test Actual Finding Normal Finding Clinical Significance

CBC (December 16, 2022)

Hematocrit 0.37 0.37-0.48

NORMAL

Red Blood Cells 4.09 4.0-5.4 NORMAL

White Blood Cells 8.20 5.0-10.0

NORMAL

Lymphocytes 15.0 20-45 NORMAL

Monocytes 4.0 1.0-7.0 NORMAL

Eosinophils 3.0 1.0-5.0 NORMAL

Neutrophils 78.0 40-75.0 NORMAL

URINALYSIS (January 6,

2023

Color YELLOW Yellow (light/pale to NORMAL

dark/deep amber)

Transparency TURBID CLEAR

Albumin TRACE ALBUMIN SHOULD ABNORMAL

NOT BE IN THE

URINE

Sugar NEGATIVE

Pus Cells TNC INFECTION

Epithelial Cells Abundant

Table 10: Diagnostic Test of Client ERBM

21
XI. ANATOMY OF THE HEART

The main function of the

cardiovascular system is

transportation. Blood vessel is a

tube where the blood with

nutrients, oxygen-rich blood and

other substances passes through.

And the

deoxygenated blood goes

through the right side of the heart

and pass through the

lungs to be oxygenated. The oxygenated blood pass through the left side of the body and

deliver to the rest of the body. A healthy blood circulation effectively eliminates waste from

the cells, reinforce the body’s temperature and it maintains pH balances. It enables the body

to carry out more physical and mental activities task due to the increase of energy levels.

22
XII.Concept Maps

Figure 2. Theory-based Physiology

- The patient with the said condition may experience veins constriction due to high blood

pressure, this might happen in different body parts commonly affected part is kidney, thus if

renal blood vessel is constricted the organ will not function well leading to minor or major

effects one of which is Edema, the patient may also experience tremor. In addition, the patient

has tachycardia due to existing hypertension, this may happen as a result of excessive

pumping of the heart that leads to irregular pulse rate or heartbeat, the patient can suffer from

chest pain, feelings of tiredness, shortness of breath and possible fainting.

23
 CASE MANAGEMENT A. Medical 1.
XIII.
Pharmacologic Intervention

Drug Features Therapeutic Effects Nursing Responsibilities

Co-amoxiclav / Indication Contraindication Desired Actively involved in antibiotic

Untoward
Augmentin educating the client
It is used to treat both Patients with a history of Co-amoxiclav is an
Diarrhea, thrush, and delivery while
Classification of Drug: adults and children penicillin hypersensitivity or antibiotic used to
and feeling or being keeping a
with middle ear who are prone to treat bacterial
Antibiotics. unwell are the most monitor on their effectiveness to
infections and sinus cholestatic jaundice or infections. It is used to ensure proper antibiotic
common co- administration and so reduce
Form: infections. Infections hepatic dysfunction caused by treat skin, joint, urinary antibiotic resistance.
amoxiclav side
of the respiratory amoxicillin and tract, sinus, and
Tablet effects. Co- amoxiclav
tract, such as the throat potassium injection should occasionally
avoid co-amoxiclav. fluids
or lungs. tooth infections. It is
Route:
have the potential to
also given before
stain teeth. Because
Oral several surgical
this is not a
procedures to
Frequency: permanent stain,
prevent the spread of
infection. brushing your teeth
1 tab twice a day
will remove any stains.

24
 Dosage: If the medication

makes you feel

625mg Time:
nauseous, it is best to
avoid alcohol.
8am and 8pm for 7 days

Table No. 11 Co-amoxiclav Pharmacologic Intervention

The patient has been prescribed Co-amoxiclav. Co-amoxiclav is an antibiotic used for bacterial infections. Co-amoxiclav belongs to a class of

drugs Antibiotics. It is used to treat both adults and children with middle ear infections and sinus infections. Infections of the respiratory tract, such as the

throat or lungs.

25
 Drug Features Therapeutic Effects Nursing Responsibilities

Generic name: Indication Contraindication Untoward The patient should be

Desired
warned that this medication
Lactulose Lactulose is Galactose is present in lactulose; Diarrhea is a common
Constipation can be may cause flatulence,
indicated as a hence it should not be consumed by side effect of
Brand name: treated with lactulose. It burping, or abdominal pain. If
laxative to treat patients who need to eat a diet free lactulose, especially at
aids patients with a this begins to worry you or
Generlac chronic of it. Lactulose is generally not high doses. This
history of chronic if diarrhea occurs, you
constipation indicated before surgery, especially occurs in more than one
(long-lasting) should consult a doctor.
Classification of Drug:
through adults and if proctoscopy or out of every ten
constipation in Encourage the patient to
elderly. colonoscopy will involve people. To avoid
Lactulose belongs to a increasing the number of inform the doctor if she is
electrocautery. dehydration, drink
class of drugs called bowel movements per planning a pregnancy,
plenty of fluids, such
Laxatives, Osmotic; day and the suspecting a pregnancy, or
as water or squash. nursing a child.
Ammonium Detoxicants. number of days on which
Peeing less than
bowel
Form: usual or having dark,
movements take place. strong-smelling pee

Syrup Only a

prescription from your

26
 Route: doctor is required to are both signs of

purchase this dehydration.

Oral
medication.

Frequency:

30cc once a day

Dosage:

3.3g

Time:

9pm

Table No. 12 Lactulose Pharmacologic Intervention

The patient has been prescribed Lactulose. Lactulose is used to treat constipation. Lactulose belongs to a class of drugs called Laxatives, Osmotic;

Ammonium Detoxicants. It is used to soften poop and make it easier to move, feces are broken down in your bowel into compounds that draw water from

your body into your colon.

27
 Drug Features Therapeutic Effects

Nursing
Responsibilities

Indication Contraindication Desired Untoward The patient can have

Generic name:
symptoms such as
To treat hypertension, Contraindications to methyldopa High blood pressure is Nausea,
Methyldopa weakness, tiredness,
methyldopa may be include: treated with Diarrhea,
headaches, stuffy noses,
Brand name: taken either alone or methyldopa. Headache, Dizziness,
• with liver disease that is dizziness, and
in combination with Methyldopa belongs to Sedation, Dry mouth,
Dopamet currently active, such as acute lightheadedness as the
hydrochlorothiazide. the class of drugs known Rash may occur
hepatitis and active cirrhosis. patient’s body becomes
Classification of Drug: Hypertension crises as
used to the medicine. In
are managed with • who had previously been antihypertensives. It
Methyldopa belongs to the event that any of these
methyldopa. treated with methyldopa treatment works by relaxing the
the general class of symptoms linger or get
for liver problems. blood vessels,
medicines called worse, contact the doctor
allowing blood to flow
antihypertensives • who have an extreme or pharmacist right away.
through the body
sensitivity to any product ingredient.
Form: more easily.

Tablet

28
 Route:

Oral

Frequency:

Two times a day

Dosage:

250mg.

Time:

7 am and 7 pm

Table No. 13 Methyldopa Pharmacologic Intervention

The patient has been prescribed Methyldopa. Methyldopa is used to treat high blood pressure. Methyldopa is in a class of medications called

antihypertensives. It works by relaxing the blood vessels so that blood can flow more easily through the body.

29
2. Dietary Prescription / Restriction

Client E.R.B.M asserts that her doctor advised her to limit her intake of

iodine. Her doctor also advises her to eat fewer fatty foods. Chocolate, iodized salt,

dairy products, and nuts are all foods to avoid.

3. Procedures

Client E.R.B.M.'s blood pressure was 130/80mmHg at the time of her

checkup, which was higher than normal despite her previous reading being normal.

The doctor prescribed methyldopa (dopamet), a medication, and she was instructed

on how and when to take it.

Following that, she regularly monitors her blood pressure with the help of a

friend, and according to her, her blood pressure was consistently around

130/80mmhg to 130/90mmhg, which is manageable for her with no signs and

symptoms. She took her medication every morning and night. She also kept a

healthy diet by eating vegetables, fruits, pineapple juice, and garlic on occasion.

The client also avoided high-calorie, fatty, salty, and high-sodium foods.
 A. Nursing Management

1. List of Problems

a. OVERWEIGHT

b. ELEVATED BLOOD PRESSURE

c. EDEMA

2. Prioritization of Nursing Problems Problem

Problem a: Overweight

Criteria Weight Multiplier Computation Justification

Nature and Extent 3 Actual Problem 1 1/3x1 = 0.67 Being overweight isn’t life-threatening to the patient, but it can cause

2 Risk / Potential serious problems to the patient if not managed properly.

1 Wellness State

Modifiability 2 Easily Modifiable 2 2/2x2 = 0.5 This can be modified by doing light exercises like walking frequently
or trying to keep the patient active in their daily routine.
1 Partially Modifiable

0 Not Modifiable

32
Preventive Potential 3 High 1 3/3x1 = 1 A healthy diet with fruits and vegetables per day can help prevent it.
It can also be prevented by drinking more water. To prevent on being
2 Moderate overweight, the patient can also start engaging in daily light
exercises.
1 Low

Salience 2 Needs immediate attention 1 1/2x1 = 0.5 It doesn’t need immediate attention since it can be resolve by doing
some light exercises and eating a balanced diet.
action

1 Not needing immediate

attention

0 Not perceived as a
problem/condition needing
change

TOTAL 2.33 Priority # 3

Table 14: Overweight - According to the table above shows that being overweight isn’t life-threatening to the patient, but it can cause serious problems

to the patient if not managed properly. It can be prevented by eating a balanced diet such as eating at least 5 types of fruit and vegetables every day. It can

also be prevented by drinking more water. The patient can also do light exercises every day to prevent on being overweight. This can be modified by doing

light exercises like walking frequently or trying to keep the patient active in their daily routine. Because it can be resolved through light exercise and a well-

balanced diet, it does not need immediate attention.

33
Problem b: Edema
Criteria Weight Multiplier Computation Justification

Nature and Extent 3 Actual Problem 1 3/3x1 = 1 Edema is an actual problem present on the
client it is also due to her Hypertension.

2 Risk / Potential

1 Wellness State

Modifiability 2 Easily Modifiable 2 1/2x2 = 0.25 The affected area can be massaged toward

the heart with firm, but not painful, pressure to

1 Partially help move fluid out of that area. This can be used
to manage it.
Modifiable

0 Not Modifiable

Preventive Potential 3 High 1 2/3x1 = 0.67 By avoiding foods that are packaged and
processed and have a lot of salt, it can be avoided.
and, if necessary, by keeping a healthy weight.
2 Moderate

1 Low

34
Salience 2 Needs immediate attention action 1 1 2/2x1 = 1 It needs immediate attention because it may lead

to Swelling that gets more and more painful.

Not needing immediate attention 0 Not
Problem’s walking.
perceived as

a problem/condition needing change Stiffness.

TOTAL 2.92 Priority # 2

Table 15: Edema - According to the table edema is a problem that is occurring onto the patient due to her hypertension, it can be prevented by avoiding

packaged and processed foods with a high salt content. And by also maintaining a healthy weight, if appropriate. It can be modified by massaging the

affected area toward the heart using firm, but not painful, pressure might help move fluid out of that area. Overall, it needs immediate attention because it

may lead to Swelling that gets more and more painful.

35
Problem c: Elevated blood Pressure
Criteria Weight Multiplier Computation Justification

Nature and Extent 3 Actual Problem 1 3/3x1 = 1 Elevated blood pressure is an actual problem occurring to the patient due to
her hypertension.
2 Risk / Potential

1 Wellness State

Modifiability 2 Easily Modifiable 2 1/2x2 = 0.25 Eating whole grains, low-fat dairy, fruits and vegetables, and other
healthy foods can help to modify elevated blood pressure. Regular
1 Partially Modifiable exercise can also help to modify it.

0 Not Modifiable

Preventive Potential 3 High 1 2/3x1 = 0.67 Physical activity, a healthy diet, enough sleep, and avoiding fatty foods
can all help to prevent elevated blood pressure.
2 Moderate

1 Low

36
Salience 2 Needs immediate attention 1 2/2x1 = 1 It does need immediate attention because it has the potential to harm
the patient's organs. And it can lead to more problems.
action

1 Not needing immediate

attention

0 Not perceived as a
problem/condition needing change

TOTAL 2.92 Priority # 1

Table 16: Elevated Blood Pressure - As you can see elevated blood pressure is an actual problem occurring to the patient due to her hypertension as

stated in the table above. Eating whole grains, low-fat dairy, fruits and vegetables, and other healthy foods can help to modify elevated blood pressure.

Regular exercise can also help to modify it. Physical activity, a healthy diet, enough sleep, and avoiding fatty foods can all help to prevent elevated blood

pressure. It does need immediate attention because it has the potential to harm the patient's organs. And it can lead to more problems.

37
 Plans of Nursing Action

Nursing Care plan

• Edema

• Elevated Blood Pressure

Edema
Assessment Diagnosis Planning Implementation Evaluation

Subjective: Health threat from The clients to start avoiding [1] Elevate the legs when [1] Improved circulation can The plan was

The client verbalized “ang bigat eating too much packaged and processed foods sitting or lying down. be achieved by repeatedly raising successfully implemented,

bigat ng legs ko kapag processed food with with a high salt content. And by the enlarged body part above the and the

naglalakad”. high salt content, dairy also maintaining a healthy [2] Exercising and level of the objective was

products, and nuts weight, if appropriate. constant moving. heart. In some achieved. Her feet and legs

The client identified that she has also an abnormal circumstances, elevating the injured returned to normal because

edema when her collection of fluids in Within a week of nursing body part while she sleeps may be the client was cooperative
[3] Eating healthy foods.

legs start swelling. the patient's tissue can interventions, the client will be helpful. and aware
able to achieve evident results
induce such as: that all nursing

edema if not [2] The return of extra fluid interventions required

to the heart may be facilitated by
moving and using the of her had been
Objective:
completed.

38
• Swelling/Puffy feet and addressed right • No more swelling is muscles of the affected body
away.
legs. seen. area, particularly the legs.

• Stretch/shiny skin • No more pain when Spend as little time as possible

walking. standing or sitting still.

[3] Avoiding processed food

and eat healthy foods such as
fruits and vegetables that can
help the client’s health.

Table 17: Nursing Care Plan for Edema - According to the table shown above, if the client will be able to do all the nursing intervention given toward her by

the student midwives, the swelling of her feet and legs will be eliminated. It will result to a good outcome.

39
 Elevated Blood Pressure
Assessment
Subjective:
The client verbalized that “simula
nung nag stop ako mag work,
ang bilis ko mapagod at minsan
nakakaramdam ako ng
kaba at paninikip ng dibidb".
The client was able to identify that
she has an Elevated Blood Pressure
by checking her vital signs.
Objective:
• Temperature is 36.8 C
• Pulse Rate is 86 beats per
minute
Diagnosis
The client has a blood
pressure of 130/80. High
blood pressure reduces the
oxygen and blood flow to
your heart, it makes your
arteries less elastic, which
can raise
your chance of developing
heart
disease. Chest pain, often
known as angina,
can result from
insufficient cardiac blood
flow if it is not addressed
right away.
Planning Implementation Evaluation
The client needs to drink plenty [1] Eating nutritious foods. [1] Eating fruits and All the planning and
implementation have worked
of water and to avoid eating vegetables and and the clients’ blood
pressure gets back to normal.
greasy foods and [2] Exercising regularly. avoiding processed foods
start to be physically active can help the
by doing some light exercises. client's health.
[3] Keep the patient on
healthy weight.
The client also needs to monitor
her blood pressure to prevent
other possible health risks [2] Regular exercise
associated with hypertension.
can help the
patient's blood
pressure and
heart strength, allowing her
to pump more blood with
less effort.
[3] A healthy weight is
important for the
patient's overall health and
can help prevent other
diseases.
40
• Respiratory Rate is 19
breaths per minute

• Blood Pressure is

130/80mm/Hg

Table 18; Nursing Care Plan for Elevated Blood Pressure - As shown on the table above, the nursing care plan for Elevated Blood Pressure

the expected outcome of all the planning and implementation made by the student midwife was to normalize the blood pressure of the patient.

41
4.Teaching Plan
Intended outcomes Content Strategies Resources Evaluation

After 30 minutes of health teaching, the Definition and importance Lectures and informal Student midwife/nurse Use of The client payed
discussion with
client will be able to: of recognizing explanation to will define what is medical brochure attention and
the client.
hypertension. hypertension and the was able to

importance toknow Time and effort of both understand the

• Have
the client, significant
Hypertension also known your blood pressure. others, and the student definition and
adequate knowledge
midwife.
as high or raised blood Student midwife/nurse importance
regarding hypertension.

pressure, is a condition will of recognizing

in which the blood discuss the risk hypertension

• Identify the risk
factors vessels have persistently raised factorsof n.

contributing to hypertension. pressure. hypertension. Student

midwife/nurse will speak The client was able to share

up regarding factors she
• Recognize the symptoms of Blood pressure is a
the symptoms of acquired.
hypertension. measurement of the force
hypertension
against the walls of the
n. Student
arteries as the heart pumps The client was able to
• Acknowledge the importance of understand the
midwife/nurse
having the blood pressure blood through the body. symptoms
checked.

will teach the client on

how

42
• It is important to monitor your to basically prevent the of hypertension
hypertension.
blood pressure regularly so and shared her
Know the different ways to
that you have a clearer picture experience through it.
prevent or control
of your risk for diseases and
hypertension.
other conditions. It also helps The client listened

to diagnose and evaluate attentively on how to

Prevent hypertension
treatment for hypertension.
and shared her
realizations regarding
hypertension.
The top number is

called the systolic blood

pressure, and the bottom

number is called the diastolic

blood pressure.

• Normal blood pressure is

120/80mmhg or lower most

of the time.

43
• High
blood pressure or hypertension

is

130/90mmhg or above

most of the time.

Risk Factors

Several factors can affect

blood pressure, including:

• Excessive salt
consumption

• A diet high

in saturated fats

and trans fats

• Low

44
intake of fruits

45
46
and vegetables.

Particularly, no cause of

high blood pressure is

found. This is called

essential hypertension

High blood pressure that is

caused by another medical

Condition is called

secondary hypertension.

This may be due to:

• Chronic
kidney disease

• Disorders
of

the

adrenal gland

47
• Pregnancy

48
49
• Medications such

as birth control pills, some

cold medications, and

migraine medications •

Narrowed artery

that supplies

blood to the kidney

Symptoms

• Headaches

• Dizziness

• Nosebleed •

Irregular
heart

rhythms

• Vision
changes

50
Buzzing in the ears

51
Some people do not

experience such symptoms of

hypertension.

For most patients, high blood

pressure is found

when they
visit

health care workers or have it

checked elsewhere.

Prevention

Hypertension can be prevented

through:

• Eating fruits,

vegetables, whole grains,

poultry, fish, and low-fat
dairy foods

52
 • Plenty of
potassium from

natural sources

• Avoid salty foods

• Reduce the intake

of saturated fat and trans

fats

• Exercise
regularly

• Avoid
consumption of tobacco and

alcohol.

Table 19: Teaching Plan - Every relevant health teaching is shown above and has been carefully designed by offering all necessary materials in order to

ensure that the client fully comprehends the benefits and drawbacks of adhering to all of the health teachings.

53
DISCHARGE PLAN
MEDICATION EXERCISE TREATMENT HEALTH OPD FOLLOW- DIET SIGNS AND
EDUCATION UP SYMPTOMS

1. Co-amoxiclav / 1. Stretching Lifestyle - Follow- DASH Diet Seek advice

up
Augmentin 2. Cardiovascular Modifications Provide patient and immediately to the
check up
or aerobic relative written and healthcare
- Rentosa - Increase
Dose exercise Lifestyle changes verbal information provider if you
consumption of fruits,
Mternity and
625mg/tab 3. Strengthening such as: regarding the have any of the
vegetables, low-fat
Lying-In Clinic -
Frequency exercises following: following:
dairy foods, whole
After 1 week
1 tab two times a -DASH diet which grain products, fish,
of giving birth
day Do active range of motion stands for Dietary 1. Monitor blood poultry, and nuts. - Chest pain

Route with slow progression in Approaches to Stop pressure regularly. - Weakness

- Oral frequency and provide Hypertension. 2. Seek medical - Dizziness

Vegetarian Diet
Time assistance if needed. advice from -Unexplained weight

- 8am and 8pm for 7 healthcare provider in gain or

- Weight loss
days Moderate physical case of - Eating more swelling or any

Side effects activity on most days of complication. potassium, complex other symptoms that
- Decrease the
the week for at least 30
- Diarrhea 3. Encourage carbohydrate, cause
minutes such as: brisk amount of sodium in
strict
your diet polyunsaturated fat, concern.
medication
fiber, calcium

54
2. Mefenamic Acid walking, dancing, compliance and to take magnesium, vitamin C

/ Ponstel cycling, racket sports, or - Regular medications as and A, all of which may
aerobic
gardening. directed. have a beneficial
exercise
Dose 4. Compliance influence on blood
to
- 500mg/cap pressure.
follow-up
- Reducing stress
Frequency
examinations or
- 1 cap every 6
checkups.
hours - Avoid
consumption 5. Providing
Route
of alcohol and support.
- Oral
tobacco 6. Indicate
Time
enough bed
- 6am, 12nn, 6pm
rest.
and 12mn

Side effects

- Stomach pain,

cramping, or

burning

55
3. Ferrous Sulfate /

Sangobion

Dose

- 300mg/cap

Frequency

- 1 cap two times a

day

Route

- Oral

Time

- 8AM and 8PM

Side effects

-nausea, vomiting,

or constipation

4. Malunggay

Capsule / Lacta

Flow

56
 Dose

- 500mg/cap

Frequency

- 1 cap three times a

day

Route

- Oral

Time

- 6AM, 2PM, and

10PM

Side effects

- Stomach upsets

5. Losartan /

Cozaar

Dose

- 50mg/tab

57
Frequency

- 1 tab once a day

Route

- Oral

Time

- After breakfast for

30 days

Side effects

- Dizziness,

headaches, or muscle

pain

6. Calcium Tablet /

Caltrate Plus

Dose

- 600mg/tab

Frequency

- 1 tab once a day

58
 Route

- Oral

Time

- At bedtime

Side effects

- Constipation

Table 20: Discharge Plan - This table focuses on engaging our client in the discharge process from the clinic to home. Collaboration, communication,

and compliance were strictly implemented to ensure our client’s full recovery.

59
XIV. ONGOING APPRAISAL

DAY 1

After the client gave birth to her baby, she feels anxious, tired, and overwhelmed.

DAY 2

The client feels better now than yesterday. After checking her blood pressure, it was still

elevated.

DAY 3

The client feels more better, no more numbness or pain in her body except for the vaginal

seams.

60
APPENDICES

Picture 1: Hematology Result

Picture 2: Glucose test

Picture 3: Urinalysis

Picture 4: Clinical Chemistry

References

61
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%20effects%20include%3A

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WebMD. (n.d.). Www.webmd.com. Retrieved February 5, 2023, from

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xm_Ltsg_u0SCfJ8N1epf9tWUHtSpG-nnTVqJowFIL1nSmngKcU.

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https://www.medicalnewstoday.com/articles/cardiovascular-system

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