I.

I. A CASE OF HYPERTENSION

Presented by:

Abrera, Rachel Ann B.

Aguilar, Kyle Andrei N.
Amboy, Sean Jian Andre L.
Bernardino, Jhomhel B.
Cacabelos, Karl Vincent B.
Cagurangan, Gladys Mae V.
Capa-an, Princess Chelsea R.
Carbonel, Jonalyn V.
Carig, Alfred
Dela Cruz, Juvelyn A.
Dela Cruz, Mark Johan C.

BSN 2 Section 4 Group - KENTUCKY

Submitted to: Carl E. Balita Institute of Health Science

School of Nursing

1
 TABLE OF CONTENTS

I. A Case Of Hypertension.........................................................................................................................................
I. Introduction.............................................................................................................................................................
II. Objectives Of The Case.........................................................................................................................................
III. Patients Profile......................................................................................................................................................
V. Nursing Health History..........................................................................................................................................
VI. Physical Assessment (Cephalocaudal).................................................................................................................
VII. Activities Of Daily Living..................................................................................................................................
VIII. Developmental Milestone..................................................................................................................................
IX. Course In The Clinic............................................................................................................................................
X. Anatomy And Physiology......................................................................................................................................
XI. Psycho-Pathophysiology......................................................................................................................................
XII. Laboratory Findings............................................................................................................................................
XIII. Drug Study (Medication And Intravenous Fluid Given)..................................................................................
XIV. Treatment...........................................................................................................................................................
XV. Nursing Care Plan...............................................................................................................................................
XVI. Discharge Planning............................................................................................................................................
XVII. Implication Of The Case To The Following Areas..........................................................................................
XVIII. Health Teaching Plan (Based On The Discharge Planning)...........................................................................
XIX. Bibliography......................................................................................................................................................

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 CASE SCENARIO

Ms. R.C., 79 years old, female, visited the community clinic, with a chief complaint of a two-
week history of a persistent cough, knee pain, and chest discomfort during coughing. Vital signs
were recorded: Blood Pressure (BP) at 200/100, Pulse Rate (PR) at 60 bpm, Respiratory Rate
(RR) at 14 bpm, Temperature at 36.4°C, height at 152 cm, and weight at 57.5 kg. It is noted that
she did not take her morning dose of the medication, losartan, for high blood pressure.

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 I. INTRODUCTION

Hypertension is a medical condition that happens when your blood pressure forces the
blood pushing against the artery walls and becomes too high. When the pressure in your blood
vessels is too high (140/90 mmHg or higher). Hypertension is the force of blood pushing against
the artery walls that is consistently too high. It is most common but can be life-threatening if not
treated, other people may not feel symptoms.
There are Many factors that affect your blood pressure including hormone levels, the
condition of the blood vessels and kidney, and how much water and salt are in the diet plan.
Long periods of continued Hypertension can cause cardiovascular disease, kidney disease and
Sleep apnoea. Men are more likely to develop hypertension before age 55, while women tend to
experience it after menopause.
According to the Food Nutrition Research Institute (FNRI), the national prevalence of
hypertension among Filipino adults (20 years old and above), has significantly increased. The
Department of Health (DOH) revealed that hypertension remains to be the leading cause of
illness and is to be one of the identified precipitating factors of premature death in the
philippines.
https://caro.doh.gov.ph/national-hypertension-awareness-month-may-2021/
An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension.
One of the global targets for noncommunicable diseases is to reduce the prevalence of
hypertension by 33% between 2010 and 2030.
https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Hypertension%20(high
%20blood%20pressure)%20is,pressure%20may%20not%20feel%20symptoms.

The purpose of this study is to assess the effectiveness of a theory-based self care
intervention with the application of health literacy. Self care theory focuses on the performance
or practice of activities that individuals initiate and perform on their own behalf to maintain life,
health and well-being. The maintenance of a balance between activity and rest. Strategies to
enhance perceived susceptibility and perceived severity of patients toward the disease. The
patient will face the problem (risk of complications of hypertension problems). The patient will
learn and consume a healthy diet (such as low salt, low fat, fruit and vegetables), going on the
patient will learn about physical activity and weight management. After that the patient will
focus on medication adherence. By discussing the benefits and useful outcome of adherence to
the self care behavior the patient will believe the benefits and possibility of their behavior and
enhance self-efficacy and self care.

II. OBJECTIVES OF THE CASE

GENERAL

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 This case study aims to educate and share information to the public about the
manifestation of increase in blood and risk factors associated with hypertension to raise
awareness of those who are at risk.

SPECIFIC
● To attain and maintain blood pressure levels within the recommended target range.
● To minimize the risk of cardiovascular events, such as heart attacks and strokes,
associated with uncontrolled hypertension.
● To encourage a balanced and low-sodium diet, rich in fruits, vegetables, whole grains,
and lean proteins.
● To discuss potential side effects and the importance of reporting any concerns to
healthcare providers.
● To educate the patient about hypertension, its implications, and the importance of active
participation in their care.

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 III. PATIENTS PROFILE

Name: Ms. R.C

Address: Bantog, Asingan
Age: 79 years old
Gender: Female
Religion: Roman Catholic
Occupation: formerly BHW.
Marital Status: Widowed
Number of Children (if applicable): None
Chief complaint: Cough and cold.
Admission data:
A. Date of admission: December 18, 2023
B. Ethnicity: Filipino
C. Educational Attainment: High school undergraduate.
D. Admitting diagnosis/ Final Diagnosis: Ineffective airway clearance related to foreign
body in airway/ Decreased cardiac output related to increased exertion in workload.

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 V. NURSING HEALTH HISTORY

A. History of present illness

Present Complaint of the patient experiencing a two-week history of persistent
cough, knee pain, chest discomfort during cough. Patient claims that she did not take her
morning dose of losartan, her prescribed medication for high blood pressure, on the day
of the visit. She reports being on this medication for an unspecified duration.The patient's
vital signs were recorded at the time of the visit: Blood Pressure (BP) was elevated at
200/100 mm Hg, Pulse Rate (PR) was 60 bpm, Respiratory Rate (RR) was 14 bpm, and
Temperature was within normal limits at 36.4°C.

The cough has been progressively worsening over the two-week period, and the
knee pain appears to be a new symptom. The chest discomfort is localized and occurs
specifically when she coughs. There is no associated shortness of breath, fever, or recent
upper respiratory tract infection reported.

B. History of past illness

Genogram:

(+) GOUT
(+) (+)HYPERT
LEGEN
F

MOT FAT M

(+) GOUT
(+)HYPERT
DECEASE

PATIE
NT
(+) GOUT
(+)

Immunization history:
● Are your immunizations up to date? Yes

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 ● Did you experience any unusual reactions to the immunizations? No
Observations:
● Observe documents of immunizations

Travel history:
● N/A

Surgical Procedures done:

● What major illnesses and surgeries have you had? N/A
● What treatment did you have for them? N/A
● Was the recovery uneventful? N/A
● Did these have an impact on your lifestyle? N/A
● Are you currently being treated for or affected by these incidents? N/A
● Are you currently taking any medications? N/A
● How have these affected your physical functioning? N/A
Observations:
● Any apparent physical dysfunction or limitations? N/A
Measurements:
● Date of major illnesses, injuries, and surgeries N/A
● Duration of each hospitalization N/A

Hospitalizations:
● N/A
Accident/ Injuries:
● N/A
Childhood illnesses:
● N/A
Socio-economic history:
● Mrs. R.C is a 79 y/o resident of Brgy. Bantog, Asingan Pangasinan that lives in middle
socio-economic status. She is High school undergraduate. She is married and has 1
daughter who has a good income level that supports her in life. She is a retired Barangay
Health Worker for over 15 years. No History of cigarette smoking and alcohol drinking.

Allergies:
Interactions:
● Are you allergic to any foods, medications, or other substances (dust or animals)? NO
DRUG ALLERGIES BUT HAS ALLERGIES TO SHRIMPS AND CLAMS

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 ● What is your usual reaction? EXPERIENCES NAUSEA AND EXPERIENCES
ITCHINESS, REDNESS AND RASHES IN THE SKIN
● Have you ever been treated for allergies? YES
Observations:
● Note appearance of eyes and surrounding tissue, presence of sniffing, need to blow nose.
● Note the condition of skin (redness, scaling) and scratching.

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 VI. PHYSICAL ASSESSMENT (CEPHALOCAUDAL)

A. GENERAL SURVEY

1. Appearance and behavior

On December 18, 2023, at 11:10 am, Mrs. R.C. visited RHU Bantog, Asingan, seeking medical assistance for a two-week
duration of consistent coughing and chest discomfort when coughing. Additionally, she expressed concerns about knee pain.
Throughout the interview, Mrs. R.C. was courteous and provided responses to all inquiries.

2. Speech and Language

Mrs. R.C. delivered a clear speech, and the patient is aware of her surroundings, able to comprehend what is happening, and
responsive to the questions posed.

3. Mood
The patient is fine and confident while answering the given questions, but there is discomfort observed, perhaps due to the
knee pain being experienced.

B. Measurements (Vital signs, Height, Weight)

Blood pressure: 200/100
Pulse rate: 60 bpm
Respiratory rate: 14bpm
Temperature: 36.4
Height: 152 cm
Weight: 57.5 kg

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BODY PARTS TECHNIQUE NORMS/ ACTUAL ANALYSIS INTERPRETATI
STANDARD FINDINGS ON

HEAD Inspection Proportional to >Her skull is Normal A normal head

size of the body, proportional to the size
round with size of the body; it is referred to as
prominences in is normocephalic
frontal, parietal, round with
and occipital Area prominence in
(Normocephalic), frontal, parietal
symmetrical in all and occipital area
planes. (Normocephalic);
it is symmetrical
in all planes.

It is gently curved,
Gently curved, no no lumps, smooth
Palpation lumps, smooth skull contour. Normal
skull contour.

SKULL Inspection rounded smooth Her skull is normal A skull is rounded

skull contour rounded and (normocephalic
symmetrical with frontal,
parietal and
occipital
prominences.)

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SCALP/HAIR Inspection Evenly distributed Her hair is evenly normal Normal hair is
hair distributed, has resilient and
also slick and evenly
thick hair distributed.

FACE

EYES/VISION Assess When looking she can see object normal Can see objects
straight ahead, periphery periphery.
client can see
objects periphery

EYEBALL Assess six ocular Both eyes Both eyes normal Both eyes
movements to coordinate, coordinate, coordinate and
determine eye move in unison, move in unison, move in unison
Alignment and with parallel with and
coordination. alignment. parallel alignment. parallel alignment

EYEBROWS Inspection Hair evenly Her eyebrows is normal Eyebrows is

distributed; evenly distributed evenly
eyebrows and equal distributed and
symmetrically movement equal movement.
aligned

EYELASHES inspection Equally Her eyelash is normal Eyelashes are

distributed; evenly distributed evenly distributed
curled slightly and curled and curled
outward outward outward

EYELIDS inspection Skin intact, no No inflammation, normal Eyelids have no

discharge edema and masses discharge and

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 and discoloration discoloration.

SCLERA inspection appears white Her sclera is white normal Sclera is white
(darker or
yellowish
and with small
brown
macules in dark
skinned
clients)

CORNEA inspection Transparent, shiny Her cornea is normal Cornea is

and transparent, shiny transparent, shiny
smooth and smooth and smooth.

PUPIL inspection Equal in size, Her pupils is equal normal Pupils is equal in
round in size, round and size, round and
smooth border smooth smooth

IRIS inspection Normally flat and Her iris is round normal Iris is round and
round and flat
Ability to flat
accommodate
to darkness and
dim light
diminishes

CONJUNCTIVA inspection >Transparent; Her conjunctiva is normal Conjunctiva is

capillaries transparent and transparent and
sometimes sclera appears sclera appears
evident; sclera white white.
appears white
(darker or
yellowish and with

13
 small
brown macules in
dark
skinned clients

VISUAL Assess each >Pupils constrict Her pupils normal Pupils constrict
ACCOMMODATI pupil’s when constrict when looking at
ON reaction to looking at near when looking at near and dilate
accommodation object; near and dilate when looking at
pupils dilate when when looking at far
looking at far far objects.
object object
Barbara Kozier,
Fundamentals of
Nursing,
7th Ed., p 536

VISUAL FIELD Assess >When looking When she's normal When looking
peripheral straight looking straight ahead, she
visual fields ahead, client can at straight ahead, can see objects in
to determine see she can see objects the periphery.
function of objects in the in periphery
the retina periphery
and neuronal Barbara Kozier,
visual Fundamentals of
pathways to Nursing,
the brain and 7th Ed., p 536
second
(optic)
cranial
nerves.

EARS Inspection >Color same as Her ears color is as normal Auricles are

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 and palpation facial skin; same as facial symmetrical and
of the Symmetrical, and skin, has the same
external ear, auricle aligned and auricle aligned color with facial
inspection of with the outer with the outer skin, it is also
the internal canthus of the eye. canthus of the eye aligned with the
parts of the Pearson, Health outer canthus of
ear by an and Physical the eye, and
otoscope Assessment, p 541 there is so
discharged and
swelling present

EAR CANAL Inspection >Distal third Hear ear canal normal Ear canal
contains hair contains hair contains hair
follicles follicles follicles and
and glands Dry and glands glands.
cerumen,
grayish-tan color;
or sticky, wet
cerumen in various
shades of
brown

HEARING Auscultation >Normal voice Her hearing is normal The patient’s

ACTIVITY tones audible normal hearing is
and tones audible normal and
tones audible.

NOSE inspection >Symmetric and Nose appeared normal A nose is

straight No symmetrical, and symmetric and
discharge or no straight, no
flaring Uniform presence of discharge and
color. discharge,swelling uniform in color
,

15
 or lesions

INTERNAL Inspection > External nose is Her external nose normal The A.P’s
NARES symmetrical is external nose is
with no symmetrical with symmetrical
discolouration, no with no
swelling or discolouration or discolouration,
malformations malformations swelling or
malformations.

SEPTUM inspection Nasal septum Her nasal septum normal Patient’s nasal
intact and in intact and in septum is intact
midline midline and in midline.

MOUTH inspection >moist, smooth, Her mouth is normal Mouth is smooth,

soft, glistening, smooth, soft and has an
and elastic texture soft and has elastic elastic texture.
(drier oral texture
mucosa in older
clients due to
decreased
salivation)
Pearson, Health
and Physical
Assessment, p 574

LIPS inspection Soft, moist, Moist with no normal lips is soft, moist
smooth texture and lesion and pink in color
pink color

GUMS inspection Pink gums, moist, Her gums is pink, The A.P’s gums
firm texture and moist and firm is pink, moist
no retraction texture and firm texture.

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 TEETH inspection 32 adult teeth, Her teeth is white, normal teeth is
smooth, white, shiny tooth enamel white, shiny
shiny and complete tooth enamel
tooth enamel and complete.

TONGUE inspection Central position, Her tongue is in normal tongue

pink color, no central position, is in a central
lesions and pink position, pink
slightly rough color and no color and no
lesions lesions.

HARD PALATE

SOFT PALATE Inspection Light pink, Her soft normal Patient’s soft
smooth palate is palate is pink
light pink

UVULA Inspection Positioned in Her uvula is normal uvula is

midline of soft in midline in midline and
palate, rises and rises rises during
during during vocalization.
vocalization vocalization

TONSILS Inspection Pink and Pink and normal tonsils

smooth no smooth no are pink smooth
discharge of discharge with no discharge
normal size or of normal of normal size not
not visible size or not visible.
visible

FRENULUM Inspection Smooth Smooth tongue normal frenulum is

tongue base base with smooth tongue
with prominent prominent veins base with
veins prominent veins

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BUCCAL Inspection Uniform pink Uniform pink normal buccal
MUCOSA color color mucosa is a
uniform pink
color.

NECK Inspection Muscle equal in Muscle equal in normal neck is

size, head centered size, head centered muscle equal in
size, head
Centered.

ANTERIOR Palpation Full symmetric Full symmetric normal anterior

THORAX excursion; excursion; thorax is fully
symmetric.

POSTERIOR Inspection Anteroposterio r to Anteropost erior to normal posterior

THORAX transverse transverse thorax Increased
diameter in ratio diameter in ratio anteroposterior
of 1:2 of 1:2. to transverse
diameter.

HEART Auscultation Auscultate the Increased or Deviated from may suggest

heart in all four decreased intensity normal increased
anatomic sites: varying intensity workload or
aortic, pulmonic with different pressure on the
tricuspid and beats increased heart. Causes
apical (mitral). intensity at aortic could include
Auscultation need area increased conditions like
not to be limited to intensity at hypertension,
these areas; pulmonic area aortic stenosis, or
however, the nurse sharp-sounding hyperthyroidism.
may need to move ejection clicks s3
the stethoscope to in older adults s4
find the most may be a sign of

18
 audible sound for hypertension
each client.

BREAST Inspection Female: rounded Her breast is normal breast

shape, slightly slightly unequal is slightly
unequal in size size unequal size.
Male: breasts eve
in the chest wall: if
obese, may be
similar in shape to
female breasts

ABDOMEN Inspection Placing the client Contour is flat or Normal Patient’s abdomen
in suppine position rounded and is round and
with knees flexed bilaterally scaphoid
over the pillow, symmetrical.
hands at side or Umbilicus is
over the chest, depressed and
undrape the patient beneath the
from xiphoid abdominal surface.
process to Visible peristalsis
symphysis pubis to is slowly
expose abdomen. transverses the
abdomen in
1. Inspect slanting downward
abdomen from rib movements as
margin to pubic observed in thin
bone and note for client. Pulsation of
contour and the abdominal
symmetry. aorta are visible in
the epigastric area
2. Inspect in thin clients.
umbilicus for

19
 copper location,
signs of
inflammation, or
hernia.

3. Observe for
smooth even
respiratory
movements.

4. Observe for
surface motions
(visible peristalsis)

Auscultate bowel High pitched

sound on sounds heard
abdominal every 5-15 Has an audible
Auscultation quadrants using seconds as Normal bowel sound
diaphragm of the intermittent
stethoscope. gurgling sounds in
all 4 quadrants. As
1. Begin by a result of fluid
placing the and air movement
diaphragm on the in GIT. Bowel
RLQ. Listen for a sounds should
full minute to the always be heard at
frequency or the ileocecal valve
character of bowel
movements

2. Repeat the
same steps

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 preceding in
sequence to RUQ,
LUQ, LLQ.

3. Listen for at
least 5 minutes
before concluding
the absence of
bowel sounds.

Tympany is heard
Begin percussion because of air in
in RLQ, move the stomach and
upward to RUQ, intestines.
cross over LUQ Dullness is heard
and down to LLQ. over organs.
Percussion Note when Normal
tympany changes
to dullness

UPPER EXTREMITIES

SHOULDERS Inspection Equal strength in Her shoulders are normal shoulder has an
each body side. equal strength on equal strength on
each body side. each body side.

ELBOW Inspection/ Equal strength in Her shoulders are normal elbow

palpation each body side. equal strength on has an equal
each body side. strength in each

21
 body side.

WRIST AND The finger resists Equal strength in Her wrist and hand normal wrist
HAND efforts to push the each body side. are both equal in and hands have
fingers together. strength . an equal strength
Grip strength: on each body
grapes index side.
finger and middle
fingers while
attempting to pull
the fingers are out.

LOWER EXTREMITIES

HIP Client is supine, Equal strength in Her hip is equal normal hips
both legs each body side. strength on each have an equal
extended; client body side. strength on each
raises one leg at a body side.
time while you
attempt to hold it
down.

KNEE Assess joint range Varies to some She can limit the normal Limited range of
of motion. degree in range of motion in motion in one or
accordance with a one or more joints. more joints.
person's genetic
makeup and
degree of physical

ANKLE AND > Client resists Equal strength on Her ankle & foot normal ankle
FOOT while you attempt each body side have an equal and foot have an
to dorsiflex the strength on each equal strength on
foot and again side. each body side.
resists while you

22
 attempt to flex the
foot.

SENSORY FUNCTION

PAIN Assess “sharp Able to She can normal can

“dull “ discriminate sharp discriminate sharp discriminate
and dull sensations and dull sensations between sharp
and dull
sensations.

LIGHT TOUCH Ask the client to Light tickling or Light tickling or normal has a
close the eyes and touch sensation touch sensation light tickling or
to respond by touch sensation.
saying “yes” or
“now” whenever
the client feels the
cotton wisp
touching the skin

ONE AND TWO Alternately Perception varies She can normal can
DISCRIMINATIO stimulate the skin widely in adults distinguish distinguish
N with two pins over different parts between a one- between a
simultaneously of the body. and-two stimulus one-and-two
and then with one Normally, a point. stimulus point.
pin. Ask whether patient can
the client feels one distinguish
or two pinpricks. between a one-
and-two point
stimulus within the
following
minimum
distances:Fingertip

23
 s, 2.8 mm Palms
of hands, 8-12 mm
Chest, forearm, 40
mm Back, 50-70
mm Upper arm,
thigh, 75mm Toes,
3-8 mm

MOTOR FUNCTION

FINGER TO > Ask the client to Repeatedly and She repeatedly and normal can
NOSE TEST abduct and extend rhythmically rhythmically repeat and
the arms at touches the nose touches the nose Rhythmically
shoulder height touch the nose
and then rapidly
touch the nose
alternately with
one index finger
and then the other.
The client repeats
the test with the
eyes closed if the
test is performed
easily.

Alternating Ask the client to > Can alternately She can alternately normal can
supination pat both knees supinate and supine and alternate supine
and with the palms of pronate hands at pronation hands at and pronation
pronation both hands and rapid pace rapid pace hands at rapid
of hands then with the pace.
and knees backs of the hands
alternately at an
ever-increasing

24
 rate.

Fingers to Ask the client to Rapidly touches She rapidly normal can
Thumb touch each finger each finger to touches each rapidly touch
of one hand to the thumb with each finger and thumb each finger and
thumb of the same hand with each hand thumbs with each
hand as rapidly as hand.
possible.

BALANCE

WALKING GAIT Ask the client to Has upright She has upright normal has
walk across the posture and steady posture and steady upright posture
room and back, gait with opposing gait with opposing and steady gait
and access the arm swing arm swing with opposing
client’s gait arm swing.

ROMBERG TEST Ask the client to Negative Negative normal is able to

stand with feet Romberg: may Romberg: may maintain upright
together and arms sway slightly but sway slightly but posture and foot
resting at the is able to maintain is able to maintain Stance.
sides, first with upright posture upright posture
eyes open, then and foot stance and foot stance
closed. Stand close
during this test

HEEL-TOE Ask the client to Maintains heel-toe She can maintains normal Can maintain the
WALKING walk a straight walking along a heel-toe walking heel-toe walking
line, placing the straight line along a straight along a straight
heel of one foot line line.
directly in front of
the toes of the
other foot.

25
 REFLEXES

BICEPS REFLEX Client fully Equal strength on Has equal strength normal has an
extends each arm each body side on each body side equal strength on
and tries to flex it each body side.
while you attempt
to hold the arm in
extension.

TRICEPS Client flexes each Equal strength on Has equal strength normal has an
REFLEX arm and then tries each body side on each body side equal strength on
to extend it against each body side.
your attempt to
keep the arm in
flexion.

PATELLAR/ Reflex Hammer Observe the She extends or normal Can extend or kick
KNEE REFLEX normal extension kicks out of the out the legs as the
or kicking out of legs as the quadriceps muscle
the legs as the quadriceps muscle contract
quadriceps muscle contracts.
contracts.

Plantar reflex Babinski's test Observe the She spreads Normal can
response. outward spread outward
Normally, all five and the big toe and the big toe
toes bend moves upward. moves upwards.
downward; this
reaction is
negative Babinski.
In an
abnormal
(positive) Babinski

26
 response the toes
spread
outward and the
big toe moves
upward.

CRANIAL NERVE FUNCTIONS

OLFACTORY Ask client to smell Patient is able to She can identify normal can
different kinds of describe odors mild and strong identify mild and
scents aromas such as strong aromas
orange, coffee, such as orange,
lemon etc. coffee, lemon etc.

OPTIC Assess the visual Patient has 20/20 She can an read normal can read
acuity by near and far vision snellen-type chart snellen-type
determining the very well charts very well.
distance and near
vision

OCULOMOTOR Assess ocular Pupils are Patient has equal- normal has an
movements and equal, round sized and equal-sized and
pupil reaction and reactive to non-reactive non-reactive
light pupils bilaterally pupils bilaterally.
accommodation

TROCLEAR Ask client to move Both eyes move in Patient has the normal Has the ability to
eyeballs obliquely the direction ability to fully fully
indicated as they control and move control and move
follow the the eyes in all the eyes in all
examiner’s directions without directions without
penlight any restrictions or any restrictions or
impairment , and impairment, and

27
 the absence of the absence of
ptosis (drooping of ptosis.
the eyelid).

TRIGEMINAL Elicit blink reflex Patient feels touch Patient has normal normal has
by lightly touching on forehead, muscle strength in normal muscle
lateral sclera maxillary, and the jaw, a present strength in the
mandibular areas corneal reflex, and jaw, a present
of face and chews full sensation in corneal reflex,
without difficulty. the forehead, and full sensation
maxillary, and in the forehead,
mandibular areas. maxillary, and
mandibular
areas.

ABDUCENS Ask client to move Both eyes move in Patient can normal can
eyeball laterally coordination. smoothly and fully smoothly and
move their eyes fully move their
laterally without eyes laterally
any difficulty; without any
patient denies difficulty.
experiencing
diplopia (double
vision)

FACIAL Ask client to do Patient smiles, Patient has a normal Has a normal
different facial raises eyebrows, normal ability to ability to taste.
expressions such puffs out cheeks, taste. Patient has Patient has no
as smiling and closes eyes no facial paralysis facial paralysis or
frowning and without difficulty; or asymmetry of asymmetry of the
raising of patients can the face Face.
eyebrows distinguish
different tastes.

28
 AUDITORY Perform the voice Patient hears Patient has normal normal has
whisper test, whispered words or enhanced normal or
weber test and or finger snaps in hearing in both enhanced
rinne test both ears; the ears and has no hearing in both
patient can walk difficulty walking ears and has no
upright and upright or difficulty walking
maintain balance. maintaining upright or
balance maintaining
balance.

GLOSSOPHARY Elicit the gag Gag reflex is Patient’s gag normal gag
NGEAL reflex by pressing present reflex is present reflex is present
the posterior and patient denies and the patient
tongue with a having dysphagia denies having
tongue depressor dysphagia.

VAGUS Ask client to the patient Patient has clear normal has clear
swallow; assess swallows and speech and no speech and no
clients speech of speaks without difficulty difficulty
hoarseness difficulty. swallowing swallowing.

ACCESSORY Ask client to shrug Patient shrugs Patient has the normal has the
shoulders and turn shoulders and ability to shrug ability to shrug
head from side to turns head side to shoulders and turn shoulders and
side against side against head against turn head against
resistance from resistance. resistance resistance.
nurses hands

HYPOGLOSSAL Ask client to Tongue is midline Patient’s tongue is normal tongue

protrude the and can be moved in midline and is in midline and
tongue and inspect without difficulty. strong strong.
tongue movement

29
30
 VII. ACTIVITIES OF DAILY LIVING

FUNCTIONAL BEFORE DURING ANALYSIS AND

FORMAT HOSPITALIZATIO HOSPITALIZATIO INTERPRETATIO
N N N

A. Health Subjective Data: - The patient The patient forgot to

Perception- - Sumasakit complain take her medication
Health tuhod ko about nausea for hypertension that
Management - 2 weeks and has high day that’s why her
inuubo blood pressure blood pressure is very
- Sumasakit ang due to high
dibdib ko pag hypertension
inuubo ako as - The patient
verbalized by also
the patient complained
about her
Objective Data: cough for
BP: 200/100 more than 2
PR: 60bpm weeks and
RR: 14bpm chest pain
TEMP: 36.6 when
WEIGHT: 57.5 coughing.
HEIGHT: 152cm - The patient
also stated
Taken meds such as that she was
Lozartan for unable to take
hypertension and her
Lagundi for cough maintenance
that’s why she
feels
nauseous.

31
B. Cognitive Before the patient - The medical Cough can have
Perceptual was admitted she condition had various causes,
Pattern stated that she’s been an impact on including respiratory
suffering from severe the patient’s infections, allergies,
cough for 2 weeks cognitive or even medication
and she has past perceptual side effects.
history of pattern. Hypertension, or high
hypertension. - During the blood pressure, can
patient when be influenced by
admitted she factors such as diet,
realized that stress, and genetics.
she should
have taken her
medication to
prevent her
severe
coughing and
to stabilized
her blood
pressure.

C. Self- The patient - The patient’s The medical

Perception verbalized self pity medical condition of the
Self Concepts about her condition condition had patient need more
Pattern and regretting her an impact on attention because she
decision not to take her self- is elderly and elders
her medications. perception and needs to take care of
self-concept their health as they go
older to prolong their
life.

D. Role The patient is happily The conditions of the Understanding the

Relationship married and still patient being in a role relationship

32
 Pattern living with her medical setting pattern between a
husband despite their caused alterations and patient and her
old age, they are still adaptations in the husband, especially
happy with each patient’s role- considering her health
other. relationship pattern. condition, requires a
comprehensive
The focus turned to assessment. Factors
her health and how to like communication,
manage her health support, and shared
condition. responsibilities play
crucial roles. The
impact of the
patient’s health on the
dynamics of the
relationship may
vary.

E. Sexuality The patient is not No known sexual No sexual intercourse

Reproductive sexually active activity with her
Pattern because she is already husband
Senior.

G. Value-Belief Through the The patient stated that The patient’s

Pattern interview the patient her condition had put diagnosis and hospital
stated that she is a her faith to the test. stay resulted in a
Roman Catholic and a She stated that the profound change in
devotor only person in whom her pattern of values
she could put her and beliefs, especially
faith was God. concerning her faith.
These modifications
to the patient’s value-
belief pattern might
be seen as a typical

33
 coping mechanism
for hardship. People
who are going
through a difficult
period sometimes
doubt their
convictions and look
for validation or
purpose.

H. Nutritional She stated that she Due to her age, the Taking your medicine
Metabolic consumed three meals patient’s daughter as prescribed or
Pattern per day and took her was advised to help medication is
medicines routinely. her mother to take her important for
maintenance at the controlling chronic,
right time. The treating temporary
patient is also advised conditions and over-
to limit sodium and all long term health
fat intake and and well-being.
increase fruit and
vegetables intake.

I.Elimination The patient usually The patient doesn’t The typical adult
Pattern voids 3-4 times a day, have any problem bowel movement
she defecates once a regarding voiding and consists of a moderate
day daily, she doesn’t defecating. amount of formed,
experience any brown stool that is
problems in voiding passed without
and defecating. She difficulty. The normal
never used any frequency of bowel
chemical laxatives elimination varies
and stool softener. from several stools
per day to only two or

34
 three per week. Most
adults experience
bowel elimination
every 1 to 2 days.

J.Activity- The patient states that The patients stated As an older adult,
Exercise she does some that she became weak regular physical
Pattern household chores at in prolonged activity is one of the
home such as activities. She can most important things
cleaning their house only do activities due you can do for your
and she considers it to her condition. Her health. It can prevent
as her exercise. exercise is walking or delay many of the
around the hospital. health problems that
seem to come with
age. Regular exercise
can help lower blood
pressure to less
harmful levels.

K. Sleep-Rest The patient usually The patient doesn’t Sleep patterns tend to
Pattern sleeps 7-8 hours, her have any problem change as you age.
earliest time in going regarding sleeping Most people find that
to sleep is at 8:00 pm aging causes them to
and she wakes up at have a harder time
4:00 am, sometimes falling asleep. They
she takes a nap at wake up more often
noon for about 30 during the night and
minutes. She doesn’t earlier in the
use any modification morning. Insufficient
to promote sleep. sleep can result in
poor focus, reduced
cognition, delayed
reactions, mood

35
swings, and higher
risk of illness.

36
 VIII. DEVELOPMENTAL MILESTONE

Theorist age/sex Stage norms/standard Patients description

Dorothea Orem 79/ Female Self-Care Deficit The act of maintaining The patient said that she
life, health, and well- experiences chest pain
being by self-initiated when coughing, it’s
and self-performed been 2 weeks since her
actions. cough started. Vital
signs were checked and
recorded to establish
baseline data.
(BP=200/100mmHg,
PR=60 bpm, RR=14
bpm,
Temperature=36.4°C(te
mporal)). Height and
weight were also
measured.

37
 IX. COURSE IN THE CLINIC

Mrs. R.C, a patient from Brgy. Bantog was at the clinic by morning. The patient had a
complaint of pain on her knees and cough. The patient said that she experiences chest pain when
coughing, it’s been 2 weeks since her cough started. Vital signs were checked and recorded to
establish baseline data. (BP=200/100mmHg, PR=60 bpm, RR=14 bpm,
Temperature=36.4°C(temporal)). Height and weight were also measured. (Height= 152cm,
Weight=57.5 kg) Upon interaction, the patient claims that she forgot to take her medicine of
Losartan by morning. Upon further interaction, the patient presented lab findings and showed
abnormal results of her Hemoglobin values(102g/L) and Uric Acid level (7.89 mg/dL). Physical
examinations were also conducted and found that the patient has redness and rashes on her skin,
as she is allergic to seafood and It’s been 2 days since allergic reactions last manifested.
Independent nursing interventions were conducted by advising the patient to eat a low fat, low
sodium and low sugar diet or Dietary Approaches to Stop Hypertension (DASH) Diet. The
patient was also encouraged to sleep at the right time, complete bed rest and increase her fluid
intake. The patient was then prescribed by the doctor to take medications of the following such
as: 1 tab Folic Acid + FeSO4(Ferrous Sulfate) 100mg O.D, 1 cap Ascorbic Acid 500mg O.D, 1
tab Cetirizine 10 mg O.D, 1 tab Lagundi 600 mg TID.

38
 X. ANATOMY AND PHYSIOLOGY

The Circulatory System is a network of blood vessels through which the heart pumps the
blood and keeps the blood in circulation. The circulation system provides blood to each cell of
the body.

The Circulatory System comprises of two subsystems :

Cardiovascular System and Lymphatic System. The Cardiovascular System consists of the heart,
blood and blood vessels in the form of arteries and veins. The Lymphatic System consists of the
lymph vessels, lymphatic nodes and lymph.

There are two categories of blood vessels:

Arteries and Veins. The Arteries carry oxygenated blood from the heart to the rest of the body
where it distributes the oxygen and nutrients . The Veins carry deoxygenated blood from the
body organs back to the heart. The heart pushes the deoxygenated blood to the lungs, where the
blood exchanges the carbon dioxide with fresh oxygen and is returned to the heart for
recirculation to the body organs. When the blood reaches the intestines, it collects nutrients for
distribution and discards the waste collected from the body cells to the intestines.

Blood cells pick up oxygen in the lungs. Pulmonary veins carry the oxygenated blood from the
lungs to the heart's left atrium (upper heart chamber). The left atrium sends the oxygenated blood
into the left ventricle (lower chamber). This muscular part of the heart pumps blood out to the
body through the arteries.

39
XI. PSYCHO-PATHOPHYSIOLOGY

40
Precipitating factors:
Excessive Predisposing factors:
Sodium intake
Age

Stress Gender
Genetics
Irregular HYPERTENSIO
N

Renal Uric acid Blood volume

dysfunction

Total peripheral
Vasoconstriction
resistance

Blood pressure

41
 XII. LABORATORY FINDINGS

DATE LABORATO NORMAL RESULT CLINICAL NURSING

RY VALUES INTERPRET RESPONSIB
FINDINGS ATION ILITIES
(WITH
REFERENC
E)

Hemoglobin Female: 102.0 Abnormal addressing

120-155g/L inadequate
oxygenation,
managing
fatigue and
activity
intolerance,
identifying
nutritional
deficiencies,
administering
prescribed
medications,
monitoring
blood
transfusions,
providing
education and
support, and
collaborating
with the
healthcare
team for
comprehensiv
e care.

Hematocrit Female: 0.30 Abnormal Provide

0.35-0.49 ongoing
support and
encourageme
nt for healthy
habits that
contribute to
maintain
normal
hematocrit

42
 levels
including
guidance on
nutrition,
exercise, and
overall
wellness.

WBC Count 5.0- 6.1 Normal Educate

10.0x10/L patients about
the
importance of
maintaining a
normal WBC
count and
how it
contributes to
overall
health. Can
also
communicate
with patients
about
lifestyle
factors that
can impact
WBC counts,
such as
nutrition and
hygiene.

43
 XIII. DRUG STUDY (MEDICATION AND INTRAVENOUS FLUID GIVEN)

DATE NAME OF MECHANISM INDICATION CONTRAINDICATION SIDE EFFECT NURSING

THE DRUG OF ACTION RESPONSIBILITY

12-15-2023 Allopurinol. Reduces ● To ● Hypersensitivity to CNS: ● Asses for any

endogenous uric control Allopurinol ● Drowsine onset of rash and
Urisol, acid by hyperuric ● Idiopathic ss fever.
Zyloprim, selectively emia hemochromatosis ● Headache ● Advise the
Lopurin inhibiting action ● Prevent ● Impaired hepatic or ● Vertigo patient to drink
of xanthine recurrent renal function GI: enough fluid at
100 mg/day oxidase, the calcium ● History of peptic ● Nausea least 2000 ml/d.
PO. enzyme oxalate ulcer ● Vomiting ● Report
responsible for stones ● Diarrhea diminishing
converting ● Abdomina urinary output,
hypoxanthine to l cloudy urine,
xanthine and discomfor unusual color or
xanthine to uric t odor to urine,
acid (end ● Indigestio pain or
product of n discomfort on
purine Other: urination.
catabolism). ● Renal ● Advise the
insufficie patient to
ncy minimize
● Hepatotox exposure of eyes
icity to ultraviolet or
sunlight which
may stimulate the
development of
cataracts.

12-18-2023 Ascorbic Acid. water -soluble ● To treat ● Thalassemia GI: ● Monitor for s/sx
vitamin essential scurvy ● G6PD deficiency ● Nausea of acute

44
 Vitamin C, for synthesis and ● Dietary ● Sickle cell disease ● Vomiting hemolytic anemia
Apo-C, maintenance of suppleme ● Hemochromatosis. ● Heartburn and sickle cell
Redoxon collagen and nt ● Abdomina crisis.
intercellular ● To acidify l cramp ● Do not breastfeed
150 - 500 ground urine ● Diarrhea while taking
mg/d, 1 tab, substance of ● Reduce Hematologic: Ascorbic acid.
PO. body tissue cells, severity ● Acute
blood vessels, and hemolytic
cartilage, bone, duration anemia
teeth, skin and of ● Sickle cell
tendons. common crisis
colds. CNS:
● Use as an ● Headache
antioxida ● Insomnia
nt.

12-18-2023 Cetirizine. Cetirizine is a ● Treats ● Hypersensitivity to GI ● Monitor for

potent H1- allergic H1-receptor ● Constipati sedation,
Reactine, receptor rhinitis antihistamines on especially the
Zyrtec. antagonist and ● Chronicle ● Lactation ● Diarrhea older adults.
thus an urticaria. ● Children <2 y/o. ● Dry ● Advise the
5-10 mg/day, antihistamine mouth patient not to use
PO. without CNS: in combination
significant ● Drowsine with OTC
anticholinergic ss antihistamine.
or CNS activity. ● Sedation ● Monitor for drug
● Headache interactions.
● depressio
n

12-18-2023 Clonidine. Centrally acting ● Treat ● Pregnancy CV: ● Monitor BP.

antiadrenergic hypertensi ● Lactation ● Hypotensi ● Monitor I&O
Catapres, derivative. on ● Cautious use: Severe on during the period

45
Duraclone. ● Orthostati coronary (epidural) of dosage.
Stimulates c effects insufficiency; recent ● Tachycard ● Make the position
75 mcg prn, SL Alpha2- ● Prophylax MI; chronic renal ia and change slowly,
adrenergic is for failure. bradycard particularly from
receptor in CNS migraine ia. recumbent to
to inhibit ● Rapid upright position
sympathetic increase and dangle and
vasomotor in BP move legs a few
central. with minutes before
abrupt standing.
Central actions withdrawa
reduce plasma l.
concentration of GI:
norepinephrine. ● Dry
mouth
● Constipati
on
● Abdomina
l pain
● Nausea
and
vomiting
CNS:
● Drowsine
ss
● Sedation
● Dizziness
● Fatigue
● Weakness
● Insomnia
● Nervousn
ess
● Restlessne

46
 ss

12-18-2023 Folic acid + Iron is required ● used for ● Hypersensitive to ● Constipati ● Monitor the
FeSo4 to maintain the folic acid & ferrous on patient for signs
1 tab qd optimal health, treatment sulfate ● Diarrhea of adverse
particularly for of folate- ● stomach reactions or side
helping to form deficiency cramps effects, including
red blood cells ● Megalobl ● upset nausea, vomiting,
● Undiagnosed
(RBC) that carry astic stomach constipation, or
megaloblastic
oxygen around anemia may occur allergic reactions.
anemia; pernicious,
the body ● Iron-
aplastic or
deficiency
normocytic anemia.
allows for more anemia.
rapid increases
in iron levels
when dietary
supply and
stores are not
sufficient

12-18-2023 Lagundi The only Expectorant no known contraindications ● For ● Be aware of

extensively tablets: potential
studied cough Only mild interactions
remedy herbal side between
preparation in effects on lagundi and
the Philippines a few conventional
today. patients medications the
such as patient may be
itchiness, taking. Consult
nausea, with the
vomiting healthcare team
and to ensure there

47
 diarrhea are no
without a contraindication
predomin s or adverse
ating effects when
complaint combining
. lagundi with
prescribed
● For syrup: medications.
None
reported
in clinical
trials

12-18-2023 Losartan Inhibits ● To reduce ● Contraindicated in May increase ● Monitor patient’s

vasoconstriction risk of patients liver enzyme or BP closely to
and aldosterone stroke in hypersensitive to bilirubin levels evaluate
secreting action patients drug. effectiveness of
of angiotensin II with HTN ● Use cautiously in therapy.
by blocking and left patients with ● Monitor patients
angiotensin II ventricula impaired renal or who are also
receptors on the r hepatic function. taking diuretics
surface of hypertrop for symptomatic
vascular smooth hy hypotension
muscle and other
tissue cells.

48
 XIV. TREATMENT

DATE NAME OF INDICATION/PURPOSE NURSING

TREATMENT RESPONSIBILITIES

DECEM Allopurinol Drug used to treat or prevent > Monitor vital signs
BER 15, 100 mg, the following complications regularly, especially if the
2023 P.O, such as: patient has a fever, to assess
OD the response to treatment.
- Joint Inflammation or
Swelling (Gout) > Note for any
hypersensitivity reactions
Reference: - Tumor Lysis Syndrome from the drugs.

Nursing2023 - High values on uric acid > Monitor Fluid intake and
DRUG level (hyperuricemia) output; daily urine output of
HANDBOOK, at least 2L and maintenance
43rd Edition of neutral or slightly alkaline
P. 97 urine are desirable

> Encourage patient to drink

plenty of fluids while taking
drugs unless otherwise
contraindicated

DECEM LAGUNDI Drug used to treat or prevent > Not given to patients with
BER 18, 600 mg the following complications Asthma and Emphysema as it
2023 P.O such as: leads to accumulation of
TID secretions and a loss of
- Cough respiratory reserve.

- Sore Throat > Asses for possible

contraindications and
- Clogged Sinuses cautions.

- Fever > Monitor the temperature to

evaluate for possible
- Rheumatism underlying infection.

49
DECEM Clonidine Drug used to treat or prevent > Monitor BP and Pulse rate
BER 18, 75 mcg prn the following complications frequently. Dosage is usually
2023 P.O such as: adjusted to patient’s BP and
Tolerance
- High Blood Pressure
(Hypertension) > Older adults may be more
sensitive to the drug's
Reference: - Hyperalgesia associated hyposensitive effects than
with sympathetically patients who are younger.
Nursing2023 maintained pain
DRUG > Observe patient for
HANDBOOK, tolerance to drug’s
43rd Edition therapeutic effect, Which may
P. 350 require increased dosage.

> Instruct patient to take

drugs exactly as prescribed to
avoid drug overdosing and
report adverse reactions.

50
 XV. NURSING CARE PLAN
DATE ASSESSMENT DIAGNOSI ANALYSIS PLANNING INTERVENTIO RATIONAL EVALUATION
S N E
12-18-2023 Subjective data: Ineffective Inability to Short term: > educate the > educating Short term:
“dalawang airway clear client about risk the client
linggo na akong clearance secretions or After 1 day factors and about these After 1 day of
inuubo”. related to obstructions of nursing prevention about specific risk nursing
as verbalized by foreign body from the intervention her condition, such factors and intervention the
the patient. in airway as respiratory the patient as: preventive patient have
manifested tract to will - Wearing measures expectorate/
by airway maintain a expectorate/ face mask empowers clear secretions
Objective data: spasms; clear airway. clear - Avoid them to take readily
cough secretions crowded proactive
BP: 200/100 Nurse’s readily places steps to Long term:
mmHg Pocket - Avoid protect their
PR: 60 bpm Guide, 15th Long term: second health. After 1 week of
RR: 14 bpm Ed. Pg. 27 hand nursing
Temp.: 36.4 After 1 week smoke intervention, the
Height: 152 cm of nursing patient have
Weight: 57.5 kg intervention, Advise the patient demonstrated
the patient to take the > Ascorbic behaviors to
will be able following Acid is in a improve or
to medications; class of maintain clear
demonstrate medications airway such as:
behaviors to > Ascorbic Acid called hydration
improve or 1 cap OD antioxidants. positioning
maintain It is needed deep coughing
clear airway by the body and breathing.
such as: to help
hydration wounds heal,
positioning to enhance
deep the
coughing and absorption of

51
breathing. iron from
plant foods,
and to
support the
immune
system

> Cetirizine > Prevents

1 tab OD and treats
allergy
symptoms,
such as red,
itchy eyes,
sneezing, a
runny of
stuffy nose,
or hives

> Lagundi > Lagundi

1 tab OD formulation
was proven to
be effective
in preventing
the spread of
disease-
causing
microorganis
ms, reducing

52
 fever,
decreasing
the viscosity
of mucus,
improving the
color of
phlegm,
alleviating
shortness of
breath and
wheezing,
and lessening
the frequency
of cough.

DATE ASSESSMENT DIAGNOSI ANALYSIS PLANNING INTERVENTI RATIONALE EVALUATIO

S ON N
12-18-2023 Subjective data: Decreased Inadequate Short term: > Educate the > Providing Short term:
“masakit ang cardiac blood pump patient about clear,
dibdib ko pag output related by the heart After 1 hour of her condition accessible After 1 hour of
umuubo” to increased to meet the nursing such as: information nursing
exertion in

53
 workload as metabolic intervention - Preventi and intervention
manifested demands of the patient’s on encouraging the patient’s
by chest pain the body. blood pressure - Risk open blood pressure
Objective data: (angina) will be factors communication lowered.
Nurse’s lowered. - Treatme between the
BP: 200/100 Pocket nt patient and
mmHg Guide, 15th healthcare Long term:
PR: 60 bpm Ed. pg. 113 Long term: provider can After 1 week
RR: 14 bpm After 1 week of enhance the of nursing
Temp.: 36.4 nursing patient's abilityintervention,
Height: 152 cm intervention, to manage their the patient
Weight: 57.5 kg the patient will hypertension have achieved
achieve a effectively. healthy
healthy lifestyle lifestyle the
and the blood > Clonidine is a blood pressure
pressure will medication that returned at the
return at the > Give patient treats high normal range.
normal range. Clonidine blood pressure.
1 tab 75 mg, It relaxes your
sublingual with blood vessels.
doctor’s This decreases
prescription blood pressure
and the amount
of work your
heart has to do.

> It helps your

risk for serious
health problem
be lower, like
diabetes and
heart disease.

54
> encourage the >Lowering
patient to sleep your sodium
regularly, intake helps
should be 8-10 you maintain
hours . normal blood
pressure levels
and keep blood
sugar under
control.
> advice to
lessen the > losartan
sodium intake relaxes the
blood vessels.
A lower blood
pressure will
increase the
supply of the
blood and
oxygen to the
heart. Losartan
> advice the is also used to
patient to decrease the
always take, risk of stroke in
Lozartan patients with
high blood
pressure and
enlargement of
the heart.

55
 DATE ASSESSMENT DIAGNOSI ANALYSIS PLANNING INTERVENTI RATIONALE EVALUATIO
S ON N
12-18-2023 Subjective data: Acute pain Unpleasant Short term: Advise patient To Avoid the Short term:
“masakit ang related to sensory and After 2 hours of to have pain from After 2 hours
tuhod ko” as joint emotional nursing complete bed becoming of nursing
verbalized by inflammation experience intervention, rest and elevate worse and to intervention,
or gout as
the patient manifested associated The patient’s feet upon lying. provide The patient’s
by with actual or condition will comfortability condition has
Objective data:: verbalization potential be lessened as to the patient been lessened
(+) facial of the pain tissue evidenced by as evidenced
grimace from the damage, or an absence of Encourage To ease the by an absence
client described in facial grimace. patient to take pain and of facial
Decreased terms of such pain reliever or discomfort of grimace.
muscle strength damage(Inter Long Term: ibuprofen 200 the patient
national After 1 day of mg, P.O Long Term:
BP: 200/100 (Association nursing After 1 day of
mmHg for the study intervention, nursing
PR: 60 bpm of pain); The patient’s Encourage To treat the intervention,
RR: 14 bpm sudden or pain condition patient to take 1 patient's joint The patient’s
Temp.: 36.4 slow onset of will be relief tablet of inflammation pain condition
Height: 152 cm any intensity and will feel no Allopurinol 100 or gout and has been
Weight: 57.5 kg from mild to pain anymore g, P.O with the lower high uric relieved and
severe and doctor’s acid level felt no pain
with a prescription anymore
duration less
than 3

56
months.

57
 XVI. DISCHARGE PLANNING

Medication

Name of drug Dosage and Route Time Curative Side effects.

frequency effect

Allopurinol 100 mg 1 tab Oral After meal -To control -Drowsiness

a day hyperuricemi -Headache
a -Vertigo
-Nausea and
vomiting
-Diarrhea

Ascorbic acid 150 - 500 mg, Oral Morning, 30 - -To acidify -Nausea and
1 tab a day 40 minutes urine vomiting
before meal -Abdominal
-Use as an cramp
antioxidant -Diarrhea

-Reduce
severity and
duration of
common
colds.

Cetirizine 5 - 10 mg 1 Oral Evening, with -treats -Constipation

tab a day or without allergies. -Diarrhea
meal -Dry mouth

Clonidine 75 mcg prn. Sublingual As needed - -Hypotension

antiadrenergi -Dry mouth
c derivative -Constipation
-decreases -Nausea and
blood vomiting
pressure

Folic acid + 300 mg 1 tab Oral 30 minutes -Used to treat -Diarrhea

FeSo4 a day before meal/ folate -Stomach
2 hours after deficiency cramps.
mean -Treats
megaloblastic
anemia
-Treatment
for iron-

58
 deficiency
anemia

Lagundi 1 tab 3x a day Oral After meal For the relief No known
of mild to side effect
moderate
cough due to
common
colds and flu.

Losartan 1 tab a day Oral Before or used alone or - Dizziness

after meal in -
combination lightheadedne
with other ss
medications
to treat high
blood
pressure

also used to
decrease the
risk of stroke
in people
who have
high blood
pressure and
a heart
condition
called left
ventricular
hypertrophy

Environment

Type of Procedure/ Use of Restrictions Rationale

activity/ Steps equipments
allowed/ to be
continued at
home

Aerobic -Walking N/A Avoid intense Aerobic exercise

59
 exercise exercise to avoid strengthens the
strain heart, enhancing
its ability to
pump blood
efficiently.
Improved Blood
Circulation,
promotes better
blood flow,
which helps
deliver oxygen
and nutrients to
tissues and
organs.

Treatment

Name of Treatment Indication/ Purpose Nursing Responsibilities

Regular blood pressure Track blood pressure levels -Instruct the family on proper
monitoring and assess the effectiveness of home blood pressure
treatment monitoring techniques

-schedule regular follow-up

appointments to monitor
blood pressure.

Stress management Reduce stress levels which -Teach relaxation techniques,

can contribute to hypertension such as deep breathing and
meditation.

-Encourage stress-reducing
activities, such as hobbies or
exercise.

Health Teaching

Explaining the signs and symptoms of hypertension, explain what hypertension is and its
impact on cardiovascular health. Encourage the patient to have heart-healthy diets rich in fruits,
vegetables, whole grains and lean proteins. Recommend engaging in regular aerobic exercise

60
such as walking. Teach stress-reducing techniques like deep breathing, meditation or yoga.
Encourage the patient to take their medication as per physician’s instruction. Emphasize the
importance of attending regular follow-up appointments with healthcare providers and discuss
significance of tracking progress, including improvements in blood pressure readings and
overall health. Educate the patient about the signs and symptoms of a hypertensive crisis and
explain when to seek immediate attention and actions.

Outpatient.

Date Of Return Time/Place Room Number And Name

Of The
Institution/Physician

January 3, 2024 10am at RHU Bantog, Room 26 under Baby Jean C.

Asingan Nidoy., RMT

Diet

Meal Serving Rationale

Breakfast Bananas One to two medium Bananas are rich in

bananas at most each potassium, which can
day help regulate blood
pressure. Potassium
helps counteract the
effects of sodium,
which can raise blood
pressure.

Leafy greens like

Leafy greens 1 cup of leafy greens spinach, kale, swiss
per day chard are rich in
nutrients like
potassium,
magnesium, and
calcium, which can

61
 help regulate blood
pressure. They’re low
in sodium, high in
fiber, and contain
compounds that
support blood vessel
health, all of which
can contribute to
managing
hypertension.

Lunch Grains 3 ounces of whole Eating whole grains,

grains a day such as brown rice or
whole wheat, as part
of a balanced diet can
be beneficial for those
with hypertension

Certain types of fish,

like salmon,
Fish 2 servings of 3 mackerel, and tuna,
ounces of oily fish are rich in omega-3s,
per week which may help lower
blood pressure and
decrease the risk of
complications.associa
ted with hypertension

Fruits and vegetables

are beneficial for
hypertensive
individuals due to
their high content of
Fruits and vegetables 2+2 servings of fruits potassium,
and vegetables per magnesium, and fiber
day which can help lower
blood pressure

Dinner Fish 2 servings of 3 Certain types of fish,

ounces of oily fish like salmon,
per week mackerel, and tuna,
are rich in omega-3s,
which may help lower
blood pressure and
decrease the risk of
complications.associa

62
 ted with hypertension

Fruits and vegetables

are beneficial for
hypertensive
Fruits and vegetables 2+2 servings of fruits individuals due to
and vegetables per their high content of
day potassium,
magnesium, and fiber
which can help lower
blood pressure

63
 XVII. IMPLICATION OF THE CASE TO THE FOLLOWING AREAS

A. NURSING RESEARCH

This study has the potential to enrich current knowledge and research on hypertension by
offering thorough insights into particular instances, symptoms, treatment options, and results.
Furthermore, it may aid in identifying demographic or behavioral factors that may influence the
frequency or severity of hypertension in specific groups. Exploring such characteristics is critical
for personalizing intervention techniques and improving overall hypertension care in a variety of
patient categories.

B. NURSING EDUCATION
This study has the possibility to enhance or improve nursing skills by integrating
contemporary knowledge on hypertension, covering details about its symptoms, diagnostic
methods, and treatments grounded in evidence. It enables student nurses to put into practice the
theoretical understanding acquired in classrooms in practical situations. This involves grasping
the pathophysiology of hypertension, interventions using medications, and strategies for nursing
care. The specific example underscores the vital importance of educating patients in the
management of hypertension. Nursing students develop the ability to communicate effectively
with patients, offering guidance on making lifestyle changes, adhering to medications, and self-
monitoring.

C. NURSING PRACTICE (CLINICAL)

This research has the potential to improve nursing practice by providing a greater
understanding of hypertension as well as practical insights. This study prepares nurses with the
knowledge and skills needed to notice subtle signs and symptoms, resulting in earlier and more
accurate diagnosis by giving information on the pathophysiology, epidemiology, and nursing
care plan for hypertension. Nurses who have a thorough understanding of hypertension are better
prepared to present difficult medical information to patients in an accessible and intelligible
manner.
Furthermore, the study equips nurses to educate patients on hypertension prevention, and
the numerous treatment choices available, as well as the significance of follow-up care. With this
expanded knowledge base, nurses are more equipped to give counseling and emotional support

64
to hypertensive patients. Addressing fears, decreasing stigma, and encouraging open
communication are all part of making patients feel comfortable discussing their cardiovascular
health.

65
 XVIII. HEALTH TEACHING PLAN (BASED ON THE DISCHARGE PLANNING)

Objectives Content (with Method Time Resource Method of evaluation

reference) of allocat s
instructi ed
on

After nursing A. Define One-on- 10 Infograph Question and answer

intervention, hypertension one mins ics
the client will B. Classifications discussi ● What is
be able to: of hypertension on hypertension?
(blood pressure ● How do you
Discuss levels) classify if a
hypertension. C. Signs and person has
(C). symptoms of high blood
hypertension pressure?
Specific ● What are the
objectives: signs and
symptoms of
A. Identify hypertension?
def. Of ● What are the
hyperte factors that
nsion promote
B. Identify hypertension?
signs
and
sympto
ms of
hyperte
nsion
C. Identify
factors
of
hyperte
nsion
D. Improve
lifestyle
manage
ment
i)
Exercis
e
ii)
Healthy

66
 diet
iii)
Avoid
smokin
g

Demonstrate A. Blood pressure Demons 20 Use of Observation of the

the proper way monitoring tration mins instructio demonstration
of using ● Using of nal video procedure
sphygmomano the procedu and
meter and sphygmo re actual
monitoring.(P) manome performi
ter ng to
B Needed materials demonstr
for blood pressure ate blood
monitoring pressure
● Aneroid monitorin
sphygmomanom g
eter

Express any A. Collect One-on- 10 Paper and Q and A

concern concerns and one mins pen
regarding question on the discussi
hypertension. health teaching on
(A) B. Look into any
apprehensions
on the health
teaching

XIX. BIBLIOGRAPHY

Hypertens, J.C (2012). The Role of Uric Acid in the Pathogenesis of Hypertension in the Youn.
Journal Of Clinical Hypertension. 14(6), 346–352. The Role of Uric Acid in the Pathogenesis of
Hypertension in the Young - PMC (nih.gov).

https://images.app.goo.gl/f1fiw1TAxa4i1Ahp8

67
MIMS Group (2020) Lagundex/Lagundex Forte
https://www.mims.com/philippines/drug/info/lagundex-lagundex%20forte?type=full

WebMD LLC (2005-2023) Losartan potassium uses, side effects, etc.

https://www.webmd.com/drugs/2/drug-6616/losartan-oral/details

Circulatory System Reference

https://images.app.goo.gl/f1fiw1TAxa4i1Ahp8

https://my.clevelandclinic.org/health/body/21775-circulatory-system

DOH Hypertension (2021)

https://caro.doh.gov.ph/national-hypertension-awareness-month-may-2021/

WHO Hypertension (high blood pressure)

https://www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Hypertension%20(high
%20blood%20pressure)%20is,pressure%20may%20not%20feel%20symptoms.

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