Case study on hypertension
Abstract
My patient, Javed, is a 68-year-old retired government employee. He
lives with his wife and two adult children. Javed visited the hospital with
complaints of persistent dizziness, blurred vision, and shortness of
breath. His blood pressure was measured at 170/100 mmHg, indicating
uncontrolled hypertension
Definition:
Hypertension, or high blood pressure, occurs when the force of the
blood pushing against the artery walls is consistently too high. Over
time, this excess pressure can cause damage to the heart, blood vessels,
and kidneys, leading to serious health complications.
Types of Hypertension:
1. Primary Hypertension:
The most common type with no identifiable cause. It develops
gradually over time.
2. Secondary Hypertension:
Caused by an underlying condition, such as kidney disease,
adrenal gland tumors, or certain medications.
3. Isolated Systolic Hypertension:
Common in the elderly, where only the systolic pressure is
elevated.
4. Resistant Hypertension:
High blood pressure that remains uncontrolled despite treatment
with multiple medications.
5. Malignant Hypertension:
A severe form that requires immediate medical intervention to
prevent organ damage.
Etiology:
Primary Hypertension:
Multifactorial, involving genetics, aging, and environmental
factors.
Secondary Hypertension:
Often due to conditions such as kidney disease, thyroid disorders,
obstructive sleep apnea, or the use of certain drugs.
Risk Factors:
Advanced age (especially over 65)
Sedentary lifestyle
Excessive sodium intake
Smoking and alcohol use
Obesity
Family history of hypertension
Poor dietary habits
Clinical Manifestations:
Persistent dizziness
Blurred vision
Shortness of breath
Headache
Epistaxis (nosebleeds)
Chest pain
Irregular heartbeat
Pathophysiology :
Patient History:
Demographic Data:
o Name: Javed
o Age: 68 years
o Gender: Male
o Ethnicity: Urdu-speaking
o Admission Date: 10-12-2024
o D.O.D : 12-12-2024
o Department: Medical Ward
o Diagnosis: Uncontrolled Hypertension
o Chief Complaint: Dizziness, blurred vision, shortness of
breath
o Informant: Patient self
Present Medical History:
Complains of dizziness, blurred vision, and occasional shortness of
breath.
Past Surgical History:
Appendectomy 20 years ago.
Socio-economic History:
Javed lives in a joint family, middle-class.
Personal History:
Smokes occasionally, moderate alcohol intake, takes 4-5 hours of
sleep nightly, non-vegetarian diet
Vital Signs:
Temperature: 98.2°F
Pulse: 82 beats per minute
Respiratory Rate: 22 breaths per minute
Blood Pressure: 170/100 mmHg
General Examination:
Nourishment: Average
Body Build: Medium
Health Status: Unwell
Activity: Reduced
Systemic examination :
Respiratory System:
Inspection:
o Chest shape: Symmetrical, normal expansion
o Use of accessory muscles: Mild, seen with shortness of
breath
o Respiratory effort: Slightly increased, no visible retractions
Palpation:
o Chest wall: No tenderness
o Symmetrical expansion during deep breathing
Percussion:
o Resonant over lung fields
o No dullness indicating fluid accumulation
Auscultation:
o Breath sounds: Clear bilaterally
o No crackles, wheezes, or abnormal sounds
o Deep breathing effort observed
Cardiovascular System:
Inspection:
o No visible pulsations or heaves
o No jugular venous distension (JVD)
Palpation:
o Peripheral pulses: Strong and regular in both arms
o No edema in extremities
Auscultation:
o Heart Sounds: Normal S1 and S2
o No murmurs, gallops, or rubs
o Pulse regular and strong
Blood Pressure:
o 170/100 mmHg on both arms, indicating hypertension
Abdominal Examination:
Inspection:
o Abdomen shape: Flat and symmetrical
o No visible scars, masses, or abnormal movements
o Skin: Normal color, no visible distension
Auscultation:
o Bowel sounds: Present in all four quadrants
o No bruits over the aorta or renal arteries
Percussion:
o Tympany over the stomach and intestines
o No shifting dullness, indicating no fluid accumulation
Palpation:
o Soft and non-tender
o No organomegaly (liver or spleen not enlarged)
o No masses or abnormal findings
o No rebound tenderness
Neurological Examination:
Mental Status:
o Fully conscious, alert, and oriented to time, place, and person
Cranial Nerves:
o All cranial nerves intact
o Pupils equally reactive to light
o No facial asymmetry
Motor System:
o Muscle strength 5/5 in all extremities
o No tremors or involuntary movements
Sensory System:
o No sensory loss or paresthesias
Reflexes:
o Normal deep tendon reflexes
Skin and Extremities:
Inspection:
o Skin: Warm, dry, no rashes or cyanosis
o Nails: Normal, no clubbing or discoloration
o Extremities: No edema, no signs of peripheral vascular
disease
Palpation:
o Peripheral pulses strong in all extremities
Diagnostic Evaluation:
History collection
Physical examination
Blood tests: Serum electrolytes, renal function test
Lab Investigations:
Test Value Remarks
Hemoglobin 12.9 g/dL Normal
RBC 4.7 mm³ Normal
WBC 9,500 mm³ Normal
Platelets 250,000/mm³ Normal
Urea 25 µg/day Elevated
Creatinine 1.4 mg/dL Abnormal
Sodium 142 mEq/L Normal
Potassium 3.8 mEq/L Normal
Nursing Diagnosis:
1. Risk for ineffective tissue perfusion related to elevated blood
pressure as evidenced by dizziness and blurred vision.
2. Impaired gas exchange related to shortness of breath as
evidenced by respiratory rate of 22 breaths per minute.
3. Imbalanced nutrition: More than body requirements related to
lack of physical activity and high sodium intake as evidenced by
hypertension.
4. Ineffective coping related to stress and lifestyle factors as
evidenced by occasional smoking and alcohol use.
NURSING CARE PLAN :
Risk for ineffective tissue perfusion related to elevated blood
pressure as evidenced by dizziness and blurred vision
Assessmen plannin diagnosis implementation evaluatio
t g n
Subjective: Short- Risk for -Assess BP BP
Complaints term: ineffectiv every hour. reduced to
of Maintain e tissue 140/85
dizziness, BP perfusion - Administer mmHg,
blurred within related to antihypertensive dizziness
vision, normal elevated s as prescribed. subsided
fatigue range. BP as
evidenced - Educate
Objective: Long- by patient on
BP 170/100 term: dizzines lifestyle
mmHg, Prevent modifications
pulse 82 organ
damage Monitor
respiratory status
regularly
. - Provide
oxygen therapy
if needed.
- Position
patient to
promote easy
breathing
Medical Management:
1. Tablet Amlodipine 5 mg orally once daily
2. Tablet Losartan 50 mg orally once daily
3. Tablet Hydrochlorothiazide 25 mg orally once daily
4. Injection Enalapril 1.25 mg IV if BP remains uncontrolled
5. Monitor for signs of hypertensive emergency
Nursing Interventions:
Monitor vital signs every hour, particularly BP.
Administer prescribed antihypertensive medications.
Encourage deep breathing exercises to relieve shortness of breath.
Educate patient on the importance of a low-sodium diet and
reducing alcohol intake.
Encourage physical activity, such as walking, to promote better
cardiovascular health.
Discharge Plan:
Antihypertensive medication prescribed for home use.
Instructions on home blood pressure monitoring.
Follow-up appointment scheduled in one week.
Educate patient to seek medical care if symptoms like chest pain or
severe headache occur.
Home Teaching:
Stay active with at least 30 minutes of moderate exercise daily.
Get adequate sleep (7-8 hours).
Avoid high-sodium foods.
Reduce alcohol consumption and quit smoking.
Regularly monitor blood pressure at home.
Attend follow-up visits regularly.
Objectives:
1. Define hypertension and explain its impact on health.
2. Identify and modify risk factors associated with
hypertension.
3. Understand the importance of lifestyle changes in
managing hypertension.
4. Educate the patient on antihypertensive medications and
their proper use.
