CASE PRESENTATION OF A

PATIENT WITH A
DIAGNOSIS OF

HYPERTENSION

SUBMITTED BY: ARQUIZA, EDELINA I.

BSN 3-C GROUP 1
SUBMITTED TO: MR. JAVIER
HYPERTENSION
Hypertension (HTN) or high blood pressure is a
chronic medical condition in which the blood
pressure in the arteries is elevated. It is classified as
either primary (essential) or secondary. Primary
hypertension which refers to high blood pressure
for which no medical cause can be found. The
Secondary hypertension are caused by another
conditions that affect the kidneys, arteries, heart, or
endocrine system.
SIGN AND SYMPTOM:

Tiredness
Irregular Heartbeat
Blurred Vision
Confusion
Headache
High blood pressure
RISK FACTORS:
• Diabetes Mellitus
• Family History
• Advance age
• Obesity
• Sedentary Lifestyle
• Stress
• Smoking
• High intake of Na, saturated fats
• Alcohol
 LABORATORY RESULTS
NORMAL RESULTS
VALUE

WBC 5-10∗10 g/L 15.8

RBC 4.2-5.4 x 106µL 5.51

Hgb 12.0-16.0 g/dl 15.8

Hct 37%-47% 48.6%

Lymphocyte 20-40% 14%

Monocyte 2%-8% 5%
 ANATOMY
AND
PHYSIOLOGY
The heart's job is to pump blood around
the body. The heart is located in
between the two lungs. It lies left of the
middle of the chest.
The main function of the
cardiovascular system is therefore
to maintain blood flow to all parts
of the body, to allow it to survive.
Veins deliver used blood from the
body back to the heart. Blood in
the veins is low in oxygen (as it has
been taken out by the body) and
high in carbon dioxide (as the body
has unloaded it back into the
blood).
All the veins drain into the superior and
inferior vena cava which then drain into the
right atrium. The right atrium pumps blood
into the right ventricle. Then the right
ventricle pumps blood to the pulmonary
trunk, through the pulmonary arteries and
into the lungs. In the lungs the blood picks
up oxygen that we breathe in and gets rid of
carbon dioxide, which we breathe out.
The blood is becomes rich in
oxygen which the body can use.
From the lungs, blood drains
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 then
distributes it to the rest of the
body through other arteries.
PATHOPHYSIOLOGY
 Diabetes Mellitus
Family History
Advance age
Obesity
Sedentary Lifestyle
Stress
Smoking
High intake of Na, saturated
fats
and alcohol

Kidney release
RENIN into the
bloodstream

RENIN helps
convert
angiotensin I
in liver
Angiotensin I is
converted to Aldosterone: Retained Na
angiotensin II (a Angiotensin Causes Na and and Water
potent II water Increased
vasoconstrictor) in retention Blood Volume
lungs

Increased Blood Arteriolar

pressure and vascular constriction
resistance to Increased
hypertension Peripheral
vascular
resistance
NURSING
CARE
PLAN
NCP 1
SUJECTIVE:
“Bakit kaya madalas ako mahilo?” as
verbalized by the patient.
OBJECTIVE:
Request for information
Confuse
Inaccurate follow through of instructions
V/S:
T: 37.2
P: 84
R: 18
BP: 180/110

NURSING
DIAGNOSIS
( A ): Deficit knowledge related to lack of understanding
and information about the disease.
PLANNING:
After rendering nursing care interventions,
the patient will verbalize understanding of
the disease process and treatment
regimen.
INTERVENTION:
• Monitored vital sign especially blood pressure.
• Explained hypertension and its effect on the heart, blood
vessels, kidney, and brain.
• Reinforced the importance of adhering to treatment regimen
and keeping follow up appointments.
• Encouraged patient to decrease or eliminate caffeine like in
tea, coffee, cola and chocolates.
• Provided basis for understanding elevations of BP, and
clarifies misconceptions and also understanding that high BP
can exist without symptom or even when feeling well.
• Suggested frequent position changes, leg exercises when
lying down.
RATIONALE:
• Provides basis for understanding elevations of
BP, and clarifies misconceptions and also
understanding that high BP can exist without
symptom or even when feeling well.
• Lack of cooperation is common reason for
failure of antihypertensive therapy.
• Decreases peripheral venous pooling that may
be potentiated by vasodilators and prolonged
sitting or standing.
• Caffeine is a cardiac stimulant and may
adversely affect cardiac function.
• Community resources like health centers
programs and check ups are helpful in
controlling hypertension.
EVALUATION:

After rendering nursing care

interventions, the patient was able to
verbalize understanding of the disease
process and treatment regimen.
NCP 2
SUBJECTIVE:
“Nanghihina ako at madaling mapagod kya
maghapon lang akong nakahiga” as verbalized by
the patient.
OBJECTIVE:
• Body weakness
• Fatigue
• V/S:
BP=160/100
PR=55 bpm

NURSING
DIAGNOSIS
( A ): Activity Intolerance
related to body weakness.
PLANNING:
After rendering nursing care interventions, the patient will
be able to report measurable increase in energy and will
participate in necessary desired activities.

INTERVENTION:

• Assessed response to activity including pre/post

v/s.
• Provided patient with positive atmosphere.
• Encouraged patient’s participation in planning of
activities.
• Assisted patient in carrying out self-care activities.
• Encouraged patient to carry out ADLs.
• Placed patient on a position of comfort.
RATIONALE:
• To identify causative factors.
• To assist pt. to deal with manage factors that
contribute to fatigue.
• To provide pt. with a sense of control.
• To improve mobility.
• To enhance motivation.
• To maintain body alignment.

EVALUATION:
After rendering nursing care interventions, the
patient was able to report measurable increase
in energy and was able to participate in
necessary desired activities.
NCP 3

SUBJECTIVE:
“Nahihilo at nanghihina ako” as verbalized by
the patient.
OBJECTIVE:
• Restlessness.
• Body malaise.
• Body weakness.
• V/S:
PR=55 bpm

NURSING
DIAGNOSIS
( A ):
Decreased cardiac output r/t altered stroke
volume.
PLANNING:
After rendering nursing care interventions, the patient’s cardiac
output will become adequate.

INTERVENTION:
• Monitored and recorded v/s.
• Assessed radial pulse
every hour and reported any deviations from the baseline.
• Reduced stressful elements, such as excessive noise in the
patient’s environment.
• Encouraged the patient to increase fluid intake and dietary fiber .
• Provided dietary
• Changed patient’s position frequently.
restrictions.
• Due medication such as metoprolol given.
RATIONALE:
• To establish baseline data.
• To monitor for arrhythmias; impending cardiac arrest.
• To help decrease arrhythmias.
• To avoid valsalvas maneuver during defecation, which can
increase heart rate and blood pressure, and decrease cardiac
output.
• To promote comfort and avoid tachycardia.
• To reduce risk of cardiac disease.
• It is a drug indicated for hypertension.

EVALUATION:
After rendering nursing care interventions, the
patient’s cardiac
output was become adequate.
MEDICAL
AND
SURGICAL
MANAGEMENT
Life style

Lose weight.
Exercise regularly.
Eat a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and
saturated fat intake.
Avoid smoking.
Do not consume more than 1 or 2 alcoholic drinks per day.

Keep your blood sugar under control.

Try to manage your stress.

Follow your health care provider's recommendations.
DRUG
STUDY
GENERIC CLASSIFICATION: CONTRAINDICATI ADVERSE REACTION: NSG. CONSIDERATION:
NAME: CV agent; ACE inhibitor; ON : •Give an hour before meal.
Captopril antiHPN History of •Advise client to report to the
angioedema physician without delay the
related to onset of unexplained fever,
previous ACE unusual fatigue, sore throat &
inhibitor use, mouth, easy bruising & bleeding.
pregnancy (Cat. •Advise physician promptly if
D), lactation vomiting & diarrhea occur.
•Monitor VS , potassium,
hematologic, renal.
BRAND MECHANISM OF SPECIAL SIDE EFFECT: •Lost of taste may be experience.
NAME: ACTION : Inhibits PRECAUTION: Rash, dysgeusia, gastric
Capoten angiotensin-converting Use with caution irritation, aphthous
enzyme resulting in in case of ulcer/peptic ulcer,
decreased plasma impaired renal headache, dizziness,
angiotensin II, which function and fatigue, drowsiness,
leads to decreased during lactation. malaise, N&V, diarrhea,
vasopressor activity and May cause a dry mouth,
decreased aldosterone profound drop in
secretion. BP following the
first dose or if DRUG INTERACTION:
used with Indomethacin/↓24-hr
CHEMICAL INDICATION: diuretics.
CONTENT: HPN; in conjunction with antihypertensive effects
Tablet- digitalis & diuretics in of captopril
stock 25 CHF, diabetic Iron salt/↓Captopril
mg/tab nephropathy, blood levels; separate
rheumatoid arthritis, administration by atleast
Raynaud’s syndrome, 2 hr
idiopathic edema, Probenecid/↑Captopril
Bartter’s syndrome. blood levels
R/T↓renal excretion.
GENERIC CLASSIFICATION: CONTRAINDICATI ADVERSE NSG. CONSIDERATION:
NAME: CV agent; Ca channel ON: REACTION: •Monitor BP & sugar level. Nifedipine
Nifedipine antagonist; Hypersensitivity has diabetogenic properties.
antiarrhythmic (Class and lactation. •Avoid smoking.
IV); nonnitrate A.cute MI •Inspect gums everyday & seek
vasodilator. prompt treatment for symptoms of
gingival hyperplasia (easy bleeding of
BRAND NAME: MECHANISM OF SPECIAL SIDE EFFECTS: the gingiva, & gradual enlarging of the
Calcibloc ACTION: PRECAUTION: Flushing, gingival mass).
Inhibits the influx of Use with caution headache,
calcium through the in impaired fatigue/lethargy, •Protect capsules from light and
moisture.
cell membrane, hepatic or renal edema, peripheral
resulting in a function and in edema, weakness, •Can be taken without regard to
meals.
depression of elderly clients. muscle cramps,
automaticity and Initial increase in dizziness, •Maintain fluid intake of 2-3L/day to
avoid constipation.
conduction velocity frequency, lightheaded,
leading to a duration, or disturbed •Brush teeth and floss regularly to
reduce swelling and tenderness of the
depression of severity of angina. equilibrium. gums.
contraction.
DRUG •Do not crushed or chewed or divided
CHEMICAL INDICATION: INTERACTION: the sustained release tablets.
CONTENT: treatment of Digoxin/↑effect of Grapefruit may cause increased serum
Stock- essential HPN; Digoxin by drug level.
5mg/cap; 10 coronary ↓excretion by
mg/cap insufficiency with or kidney.
without angina; Possible/ ↑effect
vasospastic angina, of theophylline.
to increase heart rate Barbiturates/↓Nife
in sinus bradycardia dipine effect.
& sick sinus Mg
syndrome. sulfate/↑Neuromu
scular blockade
and hypotension.
GENERIC NAME: CLASSIFICATION: CONTRAINDIC ADVERSE EFFECT: NSG. CONSIDERATION:
Nicardipine CV agent; Ca channel ATION: •Give on EMPTY stomach.
hydrochloride blocker; antiHPN hypersensitivity; •Monitor BP. defer if
advanced aortic <90/60mmHg.
stenosis; •Assess for CHF, if beta
lactation. blockers prescribed,
monitor closely.
BRAND NAME: MECHANISM OF SPECIAL SIDE EFFECT:
Cardene ACTION: PRECAUTION: Flushing, increased •Report any
persistent/bothersome side
Moderately increases Safety and angina, hypotension, effects such as dizziness,
CO and HR and efficacy in palpitation, chest pain, SOB, weight
significantly decreases children less than tachycardia, gain, and swelling of
peripheral vascular 18 years of age vasodilation, anxiety, extremities.
resistance. Slight have not been dizziness,
increase in QT interval established. Use lightheadedness, •Maintain proper intake of
fluids to prevent
and slight to no with caution in headache, N&V, constipation.
decrease in patients with blurred vision, malaise,
myocardial CHF, impaired polyuria •Avoid alcohol and limit
caffeine.
contractility. No effect liver function,
on QRS complex or PR reduced hepatic DRUG INTERACTION: •Avoid prolonged sun
Cimetidine/Ranitidine/ exposure.
interval. blood flow or  
impaired renal ↑Bioavailability of
CHEMICAL CONTENT: INDICATION: function. nicardipine↑plasma
Stock- Capsules, chronic, stable(effort- levels.
Extended-release: 30 associated) angina; Rifampin/↓nicardipine
mg, 45 mg,60 mg,; HPN; effect.
Capsules, Immediate- Cyclosporine
release: 20mg, 30 /↑increases plasma
mg; Injection: 2.5 levels of cyclosporine
mg/ml. possibly leading to
renal toxicity.
GENERIC CLASSIFICATION: CONTRAINDICATION: ADVERSE EFFECT: NSG. CONSIDERATION:
NAME: CV agent; central Pregnancy, lactation; •Monitor BP closely.
Clonidine acting hypertensive scleroderma, presence •Monitor I & O.
hydrochloride analgesic of an injection site •Determine wt. daily.
infection, patients on •Instruct to not
anticoagulant therapy, abruptly discontinue
in bleeding diathesis. taking this meds.
BRAND NAME: MECHANISM OF SPECIAL PRECAUTION: SIDE EFFECTS: •Instruct to not rake
OTC drugs, alcohol, or
Catapres ACTION: Use with caution Dry mouth, drowsiness, other CNS depressants
Stimulates alpha- during lactation and in dizziness, sedation, without prior
adrenergic receptors the presence of severe constipation, headache, discussion with
on the CNS, resulting coronary insufficiency, fatigue, malaise, anxiety, physician.
in inhibition of the recent MI, chronic insomnia, respiratory
sympathetic renal failure, depression, loss of libido, •Examine site when
transderm patch is
vasomotor centers cerebrovascular nocturia, N&V. removed.
and decreased nerve disease.
impulses. DRUG INTERACTION: •Report if erythema,
Alcohol/↑depressant rash, irritation or
CHEMICAL INDICATION: effects. hyper-pigmentation
CONTENT: Hypertension, Mirtazapine/ Loss of BP occurs.
Stock- 75 psychosis in control→antagonism of
mg/tab; 150 schizophrenia, alpha-2 adrenergic
mg/tab. ulcerative colitis, receptors.
epidurally adjunct Tolazoline/ Blocks
therapy for severe antihypertensive effect.
pain, attention deficit Verapamil/ ↑Risk of AV
hyper-activity block and severe
disorder, Gilles de la hypotension.
Tourette’s syndrome. Narcotic analgesics/
Potentiation of clonidine
hypotensive effect.
GENERIC CLASSIFICATION: CONTRAINDICATION: ADVERSE EFFECT: NSG. CONSIDERATION:
NAME: CV agent ; nonnitrate Coronary artery •Determine antinuclear
Hydralazine vasodilator; antiHPN. disease, mitral antibody titer before
hydrochloride valvular rheu-matic initiation of therapy &
heart disease, MI, periodically during
tachycardia, SLE. Safe prolonged therapy.
use during pregnancy •Monitor BP and HR
(category C) or closely.
lactation is •Monitor I & O when given
established, parenterally & in those
hypersensitivity. with renal dysfunction.
BRAND NAME: MECHANISM OF SPECIAL SIDE EFFECT: •Monitor weight, check for
edema.
Apresoline ACTION: PRECAUTION: Headache, tachycardia,
Decreases peripheral Use with caution in flushing, dyspnea, •Make position changes
slowly and to avoid
resistance but impaired hepatic or peripheral edema, standing still, hot
concurrently elevates renal function and in erythematosus-like baths/showers, strenuous
cardiac output. Acts elderly clients. Initial synsrome. exercise and excessive
directly on smooth increase in alcohol intake.
muscle of blood frequency, duration, DRUG INTERACTION:
vessels. or severity of angina. Digoxin/↑effect of Digoxin •Do not drive.Do not
by ↓excretion by kidney. breastfeed while taking
CHEMICAL INDICATION: Possible/ ↑effect of this drug.
CONTENT: Moderate to severe theophylline.  
Stock- HPN. Also in early Barbiturates/↓Nifedipine
20mg/ml malignant HPN & effect.
resistant HPN that Mg
persists after sympa- sulfate/↑Neuromuscular
thectomy and PIH. blockade and hypotension.
RESOURCES OF
DRUG STUDY:
• 2008 Edition PDR Nurse’s Drug Handbook
George R. Spratto, Adrienne L. Woods.

• Brunner & Suddarth’s Textbook of Medical-Surgical Nursing

11th Edition. Volume 1

• Emergency drugs. ( own ).

 LEARNING FEEDBACK DIARY
It was my first time in GEAMH ER area with Mr. Javier. At first this day was an
manic day for me, because we all though that our time of duty was 6-2, we are all
in school at exact 4:30 am, afraid of being late. But when we arrived at GEAHM to
meet Mam Lim, we thought that she was our CI for that day and she said that she
is not our CI, her time is 10-6. We are all disappointed for that circumstances,
because none of them inform us that our duty was 2-10. Well anyway, I don’t
blame anyone. When we met sir Javier he rushed us for preparing our para-
phernalia that should be use inside the ER. I have a feeling that we were so busy
inside the ER, and I’m right. When I entered I already my patient, we were
accidentally assigned at Pedia area. Meeting with my patient helps me a lot when
providing care to them. I learned from the first day of my duty that patient is a
must and important, although all of us know it. I also experienced giving TSB on
my patient. I learned that you should not be affected of the condition they have.
And you should put yourself on the shoes of your patient. You should act like what
who they are, be humble and never ignore them when they need your help.
I also got the chance to observe a procedure to a one of the patient in Pedia
who is newborn. The newborn should have an orogastric tube (OGT). It was a
good experience for me.

MOTTO:
We all have dreams. But in order to make dreams into reality, it takes an
awful lot of determination, dedication, self-discipline, and effort.

May 13, 2010 ARQUIZA, EDELINA I.

GEAMH BSN 3C GROUP 1
ER
2-10 PM
MR. JAVIER
 LEARNING FEEDBACK DIARY
This was the last day of our duty and we are busy again. I have so many
experienced and learning inside the ER. I have a patient who fallen from a
tree and I experience giving him a wound care. I also experienced giving skin
test and an intramuscular injection to him for anti tetanus. I learned not in
giving care but also participating in the other member of the staff in the ER
station. I also got the chance to observe inserting a catheter in a male patient
with the guide and supervision of our C.I..And be alert at all the times. Even in
a single question you should provide an answer to them and there’s no
problem if you don’t know the answer just tell them that you don’t know.
Never act like you’re the best in the world.
MOTTO:
Few things in the world are more powerful than a positive
push. A smile. A world of optimism and hope. A you can do it
when things are tough.

May 14, 2010 ARQUIZA, EDELINA I.

GEAMH BSN 3C GROUP 1
ER
2-10 PM
MR. JAVIER
THANK YOU SIR JAVIER!!! LOVE YOU!!!
God bless!!  thanks for guiding us during our duty at ER.
For sharing the knowledge that you have. For trusting us
and for giving us a chance to experience a feeling of being
registered nurse. Sana maging C.I. po namin kayo ulit.
Always take care sir. mua *