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I.INTRODUCTION

Hypertension (high blood pressure) is a sustained elevation of

systemic blood pressure to a level that places the patient at increased risk

for target organ damage. These target organ includes the eyes, brain, heart,

kidneys, and the great vessels. Hypertension has been called the silent

disease, because there may be no initial symptoms. Patient may not be

aware of their hypertension until it is identified on a routine assessment.

However, many patients do not regularly see a health care provider and

remain unaware of the dangers of untreated hypertension.

Thirty percent of the U.S. population has hypertension, This is a 23

percent increase from the year 2000. Worldwide, it is estimated that asmany as 1 billion individuals are living with hypertension, and 7.1 million

deaths per year may be attributable to hypertension. In the united states 60

percent of the patients with a diagnosis of hypertension are being treated

but only approximately 35 percent are controlled at recommended levels.

Much of the increased number of patients with hypertension can be

attributed to the increasing problems of obesity and an aging population.

a. Current Trends

b. Reasons for choosing such case for presentationI choose this case to be acquainted with the pathogenesis of

hypertension and to extend my knowledge about the disease. Myaim is to become knowledgeable about the nursing responsibilitiesand to familiarize the clinical management of the disease.

c. Objectives

Student centered To define hypertension and its cause. To identify the signs and symptoms manifested by the patient

with hypertension To distinguish the precipitating and predisposing factors that

triggers hypertension. To formulate appropriate nursing interventions by the

management of the disease.

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To widen and enhance the students nurses knowledge andskills through additional research about the nature of thedisease, its signs and symptoms, its pathophysiology, itsdiagnosis and treatment.

Client centered

The client will further understand her condition. The client will be able to care for herself independently. Client will be able to understand the importance of health

teachings in her present condition.

I.NURSING ASSESSMENT

PATIENTS DATA

Name: Mrs. YAge:52 years oldGender: FemaleBirth date: March 28 1958Adress:1st street fairlane subd. Tarlac cityStatus: MarriedCitizenship: FilipinoLanguage spoken: Tagalog, kapampangan

i. Demographic Data

b. Pertinent Family History

Mrs Y is 51 years old a mother of 6 children. The eldestis 35 years old and the youngest is 24 years old. Mrs Y gotmarried at the age of 14, her husband is a farmer, There family ispresently residing in Gua-Gua Pampanga. Mrs Y is working as ahouse keeper here in tarlac. The familys primary source ofincome is their own farm and Mrs Ys work. According to her, shehas no vices. The family prefers to go to doctors rather than faith

healers in case of emergency.The patient is admatted last February 10, 2010 with adiagnosis of Hypertension.

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c. History of Past Illness

According to Mrs. Y she was admitted in the hospital 3years ago due to mild stroke on the left side of the body.

d. History of Present Illness

Based on Mrs. Y statement, she was brought to the hospitalthe day before she was admitted, she experienced dizziness andbody weakness, the doctor advised her to be confine but sherefuse. So the doctor gave her take home medication. But thefollowing day her blood pressure increases again that is why shedecided to go to the hospital and be admitted.

e. Physical Examination

Examination of Skin dry skin noted

Examination of Nails

Dirty nails with yellow discoloration in both fingernails and toenails With a flat nail beds

Examination of Hair and Scalp

Black and resilient Presence of dandruffs

Examination of Skull

Rounded and symmetrical Without any lesions Absence of masses upon palpation

Examination of Face

symmetrical facial movements

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Examination of Eyes

Has straight normal eye condition, pupil is black in color and even insize.

Examination of Ears

Normal voice tones not audible

Examination of Nose

-symmetric nares

Examination of Mouth

-outer lips are symmetric

a. Diagnostic and Laboratory ProceduresDiagnostic &

Laboratory

Procedures

Date

Ordered

Results in

Indications

or purposes

Results Normal

Values

Remarks Nursing

Responsibilit

ies

Hematology:

1. White

Blood Cells

2.Lymphoc

Feb. 102010

It

measures

the

number

of WBC in

a cubic

millimeter blood. It

is used to

detect

infection

or

inflamma

tion

4.17G/L

0.576G/L

4.1 10.9

G/L

0.6 4.1

G/L

Normal

Abnormal

1. nospecial

preparatio

n needed.

2.explain

the

procedure

to be

done to

the client.

3.Verify

doctors

order.

4.Instruct

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ytes

3. MID

5. Red

blood Cells

(RBC)

6.Hematocrit

(HCT)

These are

produced

by the

lymphoidtissue

and it

participat

es in the

humoral

response.

If the

neutrophi

l were

outnumb

ered by

the

infection

present,

the

lymphocy

tes are

released

to help

the

neutrophils.

To

determin

e the

lymphocy

te blood

count.

To

determin

e the

patients

red blood

0.096

4.17T/L

0.370L/L

0 1.8

4.20-6.30

T/L

.370-.510

L/L

Abnormal

Abnormal

Normal

the

patient

about the

schedule

of test

5.Tell the

patient

that

fasting

not

required.

6.Instruct

patientthere are

no special

measures

needed.

7.Adhereto

standard

precautio

ns.

10.Apply

pressure

or a

pressure

dressing

to the

venipunct

ure site.

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7.

Hemoglobi

n (HGB)

cell in

the

blood.

It is the

measure

of the

RBCs in

the whole

blood

expresse

d as

percenta

ge. It is

used to

measure

and

assess

decrease

d volume

related to

bleeding.

Itevaluates

the

patients

hemoglob

in

content

and thus

the iron

status

andoxygen

carrying

capacity

of

erythrocy

tes by

measurin

127g/L

120-180

g/L

Normal

11.Observ

e the

venipunct

ure site

for

bleeding.

12.Monito

r for signs

and

symptoms

of

infection

13.Arrang

e for

transportof the

specimen.

13.Record

all

procedure

s done.

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g the

number

of

hemoglob

in per

deciliter(100 ml)

of blood.

II.ANATOMY AND PHYSIOLOGY

THE CARDIOVASCULAR SYSTEM

The cardiovascular system can be thought of as the transport

system of the body. This system has three main components: theheart, the blood vessel and the blood itself. The heart is the system'spump and the blood vessels are like the delivery routes. Blood can bethought of as a fluid which contains the oxygen and nutrients the bodyneeds and carries the wastes which need to be removed. The followinginformation describes the structure and function of the heart and thecardiovascular system as a whole.

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Function and Location of the Heart

The heart's job is to pump blood around the body. The heart is located inbetween the two lungs. It lies left of the middle of the chest.

Structure of the Heart

The heart is a muscle about the size of a fist, and is roughly cone-shaped. Itis about 12cm long, 9cm across the broadest point and about 6cm thick. Thepericardium is a fibrous covering which wraps around the whole heart. Itholds the heart in place but allows it to move as it beats. The wall of theheart itself is made up of a special type of muscle called cardiac muscle.

Chambers of the Heart

The heart has two sides, the right side and the left side. The heart has four

chambers. The left and right side each have two chambers, a top chamberand a bottom chamber. The two top chambers are known as the left andright atria (singular: atrium). The atria receive blood from different sources.The left atrium receives blood from the lungs and the right atrium receivesblood from the rest of the body. The bottom two chambers are known as theleft and right ventricles. The ventricles pump blood out to different parts ofthe body. The right ventricle pumps blood to the lungs while the left ventriclepumps out blood to the rest of the body. The ventricles have much thickerwalls than the atria which allows them to perform more work by pumping outblood to the whole body.

Blood Vessels

Blood Vessel are tubes which carry blood. Veins are blood vessels whichcarry blood from the body back to the heart. Arteries are blood vessels whichcarry blood from the heart to the body. There are also microscopic bloodvessels which connect arteries and veins together called capillaries. Thereare a few main blood vessels which connect to different chambers of theheart. The aorta is the largest artery in our body. The left ventricle pumpsblood into the aorta which then carries it to the rest of the body throughsmaller arteries. The pulmonary trunk is the large artery which the rightventricle pumps into. It splits into pulmonary arteries which take the blood tothe lungs. The pulmonary veins take blood from the lungs to the left atrium.All the other veins in our body drain into the inferior vena cava (IVC) or thesuperior vena cava (SVC). These two large veins then take the blood fromthe rest of the body into the right atrium.

Valves

Valves are fibrous flaps of tissue found between the heart chambers and inthe blood vessels. They are rather like gates which prevent blood from

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flowing in the wrong direction. They are found in a number of places. Valvesbetween the atria and ventricles are known as the right and leftatrioventricular valves, otherwise known as the tricuspid and mitral valvesrespectively. Valves between the ventricles and the great arteries are knownas the semilunar valves. The aortic valve is found at the base of the aorta,

while the pulmonary valve is found the base of the pulmonary trunk. Thereare also many valves found in veins throughout the body. However, there areno valves found in any of the other arteries besides the aorta and pulmonarytrunk.

What is the Cardiovascular System

The cardiovascular system refers to the heart, blood vessels and the blood.Blood contains oxygen and other nutrients which your body needs to survive.The body takes these essential nutrients from the blood. At the same time,the body dumps waste products like carbon dioxide, back into the blood, sothey can be removed. The main function of the cardiovascular system is

therefore to maintain blood flow to all parts of the body, to allow it tosurvive. Veins deliver used blood from the body back to the heart. Blood inthe veins is low in oxygen (as it has been taken out by the body) and high incarbon dioxide (as the body has unloaded it back into the blood). All theveins drain into the superior and inferior vena cava which then drain into theright atrium. The right atrium pumps blood into the right ventricle. Then theright ventricle pumps blood to the pulmonary trunk, through the pulmonaryarteries and into the lungs. In the lungs the blood picks up oxygen that webreathe in and gets rid of carbon dioxide, which we breathe out. The blood isbecomes rich in oxygen which the body can use. From the lungs, blooddrains into the left atrium and is then pumped into the left ventricle. The left

ventricle then pumps this oxygen-rich blood out into the aorta which thendistributes it to the rest of the body through other arteries. The main arterieswhich branch off the aorta and take blood to specific parts of the body are:

Carotid arteries, which take blood to the neck and head Coronary arteries, which provide blood supply to the heart itself Hepatic artery, which takes blood to the liver with branches going to

the stomach Mesenteric artery, which takes blood to the intestines Renal arteries, which takes blood to the kidneys Femoral arteries, which take blood to the legs

The body is then able to use the oxygen in the blood to carry out its normal

functions. This blood will again return back to the heart through the veinsand the cycle continues.

I. THE PATIENT AND HER ILLNESS

a. Schematic Diagram of Pathophysiologyb. Synthesis of the Disease

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i. Definition of the Disease

Hypertension (high blood pressure) is a sustainedelevation of systemic blood pressure to a level that placesthe patient at increased risk for target organ damage.

Hypertension tends to run in familiea, if one parent hashypertension, there is a 25 percent of the patientdeveloping it during his or her lifetime. When both parentshave hypertension, the risk ncreases to 60 percent.Multiple studies have shown a genetic component in somefamilies.

High blood pressure tends to rise with age, Primaryhypertension typically appears between the age of 30 and50. Among young and middle aged adults, men are morelikely to have hypertension than women. After the age of55, when most women are beyond menopause, high blood

pressure is more common in women than in men.

ii. Predisposing and Precipitating Fact0rs

Genetic Lifestyle

i. Signs and Symptoms

Fatigue

Dizziness Angina Palpitation Dyspnea

i. Health Promotion and Preventive Aspects of thedisease

II.THE PATIENT AND HER CARE

a. Medical Management

i. IVF

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IV FLUIDS Date

Ordered

General

Descriptio

n

Indication(

s) or

Purposes

Clients

Initial

Reaction

to the

Treatment

Clients

Response

to the

Treatment

Nursing

Responsibil

ities

D5W 1L

D5W 1L

Feb. 10

2010

Feb. 11

2010

The patient

did not

manifest

any

untoward

side effects.

No allergic

signs.

No allergic

signs

reported

Verify the

doctors

order

Prepare the

needed

materials

Inform thepatient of

the

importance

of

administerin

g IVF.

Iorm the

patient that

pain may be

felt

especially

during theinsertion of

the needle.

Check the IV

label for

details like

expiration

date.

Choose the

best pain for

IV insertion.

Clean the

insertion

site.

Check if the

IVF is

infusing well

and regulate

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as ordered.

.

ii. Medications/DrugsGeneric

Name

Brand Name

Metoclopram

ide

Date

Ordered

Feb.10

2010

Route of

Administrati

on, Dosage

and

Frequency

1 amp IVP

PRN

Indications or

Purposes

Specific

Foods

Taken

Clients

Response

to the

Treatment

No adverse

effect noted

Nursing

Responsibilit

ies

1 Check the

doctors

order

2 always

observe

aseptic

technique in

preparing

and

administerin

g.

3 not to be

given inpatients

hypersensiti

ve to drugs

4inform the

patient

about the

possible

side effect

of the drug

1 Check the

doctors

order

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Furosemide

Simvastatin

Feb.10

2010

Feb 10

2010

40 mg IVP

stat

20 mg one

half tab. OD@ HS

Loop

diureticts

In hibits re

absorption of

sodium and

chloride from

the proximal

and distal

tubules and

ascending

limb of the

loop of henle,

leading to a

sodium rich

dieresis

Anti-

hyperlipidemi

c HMG-CoA

reductase,

the enzyme

that catalyzes

the first step

in the

cholesterol,

serum LDLs,

and either an

increase in

serum HDLs.

Antihypertens

ive;

Treatment of

hypertension

alone or in

combination

with other

No adverse

effect noted

No adverse

effect noted

2 always

observe

aseptic

technique in

preparing

and

administerin

g

3 administer

with food or

milk to

prevent GI

upset

1 Check

doctors

order

2 Take the

drugs in the

evening.

1 Check

doctors

order

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iii. DietDiet Date

Ordered

General

Description

Indications

or Purposes

Specific

Foods

Taken

Clients

Response

to

treatment

Nursing

Responsibilit

ies

Low fat,

Low salt

diett

Feb 10

2010

Restriction

to foods

with high

salt and fat

To prevent

further

edema,

fluid

retention,

decrease

metabolic

demand

Soup,

vegetables,

fruits

the Patient

was able to

eat foods

which is low

in fat and

salt.

Provide

health

teachings

about the

foods that

the client

can take

during the

diet.

Position the

client in

sitting

position to

prevent

from

aspiration.

Discontinue

giving foods

if there is

nausea and

vomiting to

prevent

aspiration.

iv. ActivitiesActivity Date

Ordered

Date

Performed

Date

Changed

General

Description

Indications

or Purposes

Specific

Foods

Taken

Clients

Response

to the

Treatment

Nursing

Responsibilit

ies

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Muscle

stretching

Feb.11

2010

b. Nursing Management

Feb. 11 2010Received patient lying in supine position, awake, with ongoing

IVF of D5W at 50cc level regulated at KVO. Weak in appearance andirritable at times. Vital signs taken and recorded, with limited

movements noted. Instructed client to have rest. And advised SO toassist the client when moving or standing. Provided healthteachings, kept the client rested.at 10:30 the client was seen andexamined by doctor Agapito with new orders made and carried out.Feb. 12 2010

Received patient in supine position, awake and coherent, withongoing IVF of D5W at 100cc level regulated at KVO, weak nappearance and limited movement noted. Poor eye contact. Vitalsigns taken and recorded, listen to patients complaints andcomments. Emphasized the importance of medication compliance,provided health teachings, at 10:30am the client was seen and

examined by doctor Agapito with new orders made and carried out,needs of the client were attended. Client was kept rested.

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CUES NURSING

DIAGNOSIS

SCIENTIFIC

EXPLANATIO

NS

PLANNING NURSING

INTERVENTIO

NS

RATIONALE EXPECTED

OUTCOME

S> Nahihilo

ako, hindi ako

makaupo (as

verbalized by

the client)

O> Weak in

appearance

>irritable at

times

>easy

fatigability

>Risk for

injury related

to pre-existing

medical

condition,

dizziness

secondary to

hypertension

>At risk of

injury as a

result of

environmental

conditions

interacting

with the

individuals

adaptive and

defensive

resources.

>After 3 hrs of

nursing

intervention

the patient will

be able to

have

knowledge

about her

condition

>Verbalize

understanding

of individual

factors that

contribute to

possibility of

injury and take

steps to

correct

situation.

>Instructed

client to have

rest

>advised

client to avoid

standing and

walking

without

assistance

>To have the

client

decrease

dizziness, and

to promote

comfort.

>To promote

safe physical

environment

and clients

safety.

>after 3 hrs of

nursing

intervention

the client

possess

knowledge on

how to

prevent injury.

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CUES NURSING

DIAGNOSIS

SCIENTIFIC

EXPLANATIO

NS

PLANNING NURSING

INTERVENTIO

NS

RATIONALE EXPECTED

OUTCOME

S>Hindi pa

naming

nabibili yung

mga gamot,

kaya nahihilo

pa rin ako

O>weak in

appearance

>limited

movements

noted

>Failure to

progress

>Noncomplian

ce due to

financial

constraint

>Behavior of a

person that

fails to

coincide with a

health-

promoting or

therapeutic

plan agreed on

by the person

and health

care

professional;

>After 2 hrs.

of nursing

intervention,

the patient will

be able to

verbalize

accurate

knowledge of

condition and

understanding

of treatment

regimen.

>Discuss with

the patient/SO

their

perception/

understanding

of the

situation

>Listen to

patients

complaints

and comments

>Emphasized

the

importance of

medication

compliance

>Provided

health

teachings

>For clients

further

understanding

of her

situation.

>To assess

what the

clients feel

about the

situation.

>to be able to

understand

the

importance of

medication

compliance.

>After 2 hrs.

of nursing

intervention

the client

response to

interventions,

and was able

to understand

the

importance of

medication

compliance.

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I.LEARNING DERIVED

Hypertension is considered as the second leading causes of

death and disability worldwide. Strokes occur mainly among those

older than 65 years, but 28% occur in individuals younger than 65

years.

In our lifestyle today many people dont know to discipline

ourselves. In this case presented, i learned how to value ones life also

having vices can cause any diseases and sometimes lead to death. I

also learned the causes and factors in acquiring Hypertension. Knowing

these factors helped us to give appropriate nursing care. We can use

this knowledge for our future career as a nurse.

Lastly, we realized how important the nursing process in ourprofession. As a future health care provider, we learned to value our

client as a holistic individual.