The case we have chosen is Hypertension 2 ASHD. Hypertension is one of the most common worldwide diseases afflicting humans.

Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. We chose this case because most of our family members experience Hypertension. This case will help us further understand the said condition.

Hypertension (HTN) or high blood pressure, sometimes arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed (diastole) between beats. Normal blood pressure is at or below 120/80 mmHg. High blood pressure is said to be present if it is persistently at or above 140/90 mmHg

I.

BIOGRAPHIC DATA Name: L.G. Gender: Male Provincial address: Camarines Sur City address: Balintawak, Q.C. Birthdate: November 24, 1940

Religion: Roman

Catholic Civil status: Married Nationality: Filipino Occupation: Retired accountant Informant: Patient Reliability: 100% Educational attainment: College graduate

I.

II.

CHIEF COMPLAINT Elevated blood pressure of 230/130 for 3 hours HISTORY OF PRESENT ILLNESS 3 days PTA, the patient experienced increased blood pressure noted to be 230/130. he self medicated with Losartan and BP was decreased. Few hours PTA patients BP rose to 230/100 which prompted him for consultation at USTH OPD hence admission.

III.

HISTORY OF PAST ILLNESS Past illness: 10 years chronic hypertension Allergies: None Immunization: Complete Previous hospitalization: Elevated BP at USTH (March 20ll) Previous surgeries: Removal of cyst at Makati Medical Center(2001) Chronic diseases: Chronic hypertension

 FAMILY HISTORY

(+) Hypertension - paternal and maternal side (+) DM - paternal side (-) Asthma (-) Thyroid disorders IV. PERSONAL /SOCIAL Alcohol intake: 4-5 bottles per day for 50 years Smoking: 50 packyears Diet: Eats wide variety of foods especially fruits and vegetables OFI: More than 8 glasses of water per day Exercise: Swimming, Basketball, Tennis Sexual history: Sexually active

The patient is conscious, coherent and is not in distress. He looks according to age and is calm and engaging. One can see that he is well nourished and practices good hygiene.

Body part assessed

Actual finding

Interpretation

Skin

Skin color is dark and even. Skin is smooth with fair skin turgor
Evenly distributed hair Symmetrical eyelids. Pinkish conjunctiva White sclera Lips dark and dry Tongue at midline Gums and mucosa dark No palpitations

Normal

Head Eyes

Normal Normal

Mouth

Smoking

Cardiovascular

Normal

Extremities

Bounding pulse <2 seconds capillary refill

Compensatory mechanism for decreased cardiac output Normal

Abdomen

Symmetrical and no tenderness

Normal

Blood chemistry test

Sodium- 135 (low) Potassium- 3.96 (normal) Urea nitrogen- 8.83 (low) Creatinine- 1.25 (high) Troponin- 0.02 (normal) Cholesterol- 190.79 (normal) Triglycerides- 114.64 (normal) HDL- direct 34.52 (normal) LDL- direct 129.30 (normal)

Urinalysis
Physical characteristics Color: light yellow Transparency: slightly turbid Chemical test Ph: 5 Specific gravity: 1.01 Albumin: (+) Sugar: (-) Leukocytes: (-) Erythrocytes: (+) Bilirubin: (-) Nitrite: (-) Ketones: (-) Urobilinogen: normal

CBC
Hgb- 149 (normal) Rbc 4.69 (normal)

Hct 0.44 (normal)

Mcv 92.8 (high) Mch- 31.8 (high)

Platelet 224 (normal)

Wbc 6.2 (normal)

Urinalysis- ordered to help assess kidney function Hematocrit- may be ordered as part of CBC to evaluate the ratio of fluid to solids in the blood Urea nitrogen and creatinine- to detect or monitor kidney dysfunction or to monitor the effect of medications on the kidney Potassium- may be ordered as part of electrolyte panel ; used to monitor and balance the bodys electrolytes; some high BP can upset the balance by causing excessive sodium and potassium loss Lipid profile- may be ordered to evaluate levels of total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides

Medulla Oblongata; relays motor and sensory impulses between other parts of the brain and the spinal cord. Reticular formation (also in pons, midbrain, and diencephalon) functions in consciousness and arousal. Vital centers regulate heartbeat, breathing (together with pons) and blood vessel diameter.

Hypothalamus; controls and intergrates activities of the autonomic nervous system and pituitary gland. Regulates emotional and behavioral patterns and circadian rhythms. Controls body temperature and regulates eating and drinking behavior. Helps maintain the waking state and establishes patterns of sleep. Produces the hormones oxytocin and antidiuretic hormone.

Baroreceptor, pressuresensitive sensory receptors, are located in the aorta, internal carotid arteries, and other large arteries in the neck and chest. They send impulses to the cardiovascular center in the medulla oblongata to help regulate blood pressure. The two most important baroreceptor reflexes are the carotid sinus reflex and the aortic reflex.

Chemoreceptors, sensory receptors that monitor the chemical composition of blood, are located close to the baroreceptors of the carotid sinus and the arch of the aorta in small structures called carotid bodies and aortic bodies, respectively. These chemoreceptors detect changes in blood level of O2, CO2, and H+.

Renin-Angiotensin-Aldosterone system. When blood volume falls or blood flow to the kidneys decreases, juxtaglomerular cells in the kidneys secrete renin into the bloodstream. In sequence, renin and angiotensin converting enzyme (ACE) act on their substrates to produce the active hormone angiotensin II, which raises blood pressure in two ways. First, angiotensin II is a potent vasoconstrictor; it raises blood pressure by increasing systemic vascular resistance. Second, it stimulates secretion of aldosterone, which increases reabsorption of sodium ions and water by the kidneys. The water reabsorption increases total blood volume, which increases blood pressure.

Antidiuretic hormone. ADH is produced by the hypothalamus and released from the posterior pituitary in response to dehydration or decreased blood volume. Among other actions, ADH causes vasoconstriction, which increases blood pressure.

Atrial Natriuretic Peptide. Released by cells in the atria of the heart, ANP lowers blood pressure by causing vasodilation and by promoting the loss of salt and water in the urine, which reduces blood volume.

Medications

Exercise

Take antihypertensive medications OD. Advise patient to do daily walking and other exercise

Treatment

that can be tolerated by the patient. antihypertensive drugs.

Encourage patient to comply with the prescribed

Health teaching

Encourage patient to control his diet Avoid eating fatty and salty foods Limit alcohol intake Increase fluid intake Avoid sedentary lifestyle

OPD follow-up
Tell patient to seek consultation if symptoms

will recur.

Diet
Low sodium and high protein diet.

Sexuality
Men are more prone to develop

hypertension because of their lifestyle.