Emilio Aguinaldo College

College of Nursing
Dasmariñas, Cavite

Case Study of

Hypertension
In Partial Fulfillment of the Requirement in NCM 102 – RLE

Submitted By: Submitted To:

Paul Stephen E. Pineda
BSN III – 4
Group 3
I. Introduction.
Definition:
High Blood Pressure is a disease of vascular regulation resulting from malfunction of arterial
pressure control mechanisms (central nervous system, rennin-angiotensinaldosterone system, extracellular
fluid volume.) the cause is unknown, and there is no cure. The basic explanation is that blood pressure is
elevated when there is increased cardiac output plus increased peripheral vascular resistance.
The two major types of hypertension are primary (essential) hypertension,  in which diastrolic pressure is 90
mm Hg or higher and systolic pressure is 140 mm Hg or higher in absence of other causes of
hypertension (approximately 95 % of patients); andSecondary hypertension,  which results primarily from
renal disease, endocrine disorders, and coarctation of the aorta. Either of these conditions may give rise
toaccelerated hypertension – a medical emergency –  in which blood pressure elevates very rapidly to
threaten one or more of the target organs: the brain, kidney, or the heart.
Hypertension is one of the most prevalent chronic diseases for which treatment is available;
however, most patients with hypertension are unaware, untreated, or inadequately treated. Risk factors for
hypertension are age between 30 and 70; black; overweight; sleep apnea; family history; cigarette smoking;
sedentary lifestyle; and diabetes mellitus. Because hypertension presents no over symptoms, it is termed
the “silent killer.” The untreated disease may progress to retinopathy, renal failure, coronary artery disease,
heart failure, and stroke.
Hypertension in children is defined as the average systolic or diastolic blood pressure greater than
or equal to the 95th percentile for age and sex with measurement on at lease three occasions. The incidence
of hypertension in children is low, but it is increasingly being recognized in adolescents; and it may occur in
neonates, infants, and young children with secondary causes.

Morbidity Rate:
5th Causes of Morbidity Rate in the Philippines Hypertension
Number and Rate /100,000 Population, Philippines
CAUSE 5 Year Average (2000- 2005*
2004)
No. Rate No. Rate
5. Hypertension 314,175 400.5 382,662 448.8
II. Patient Profile.
Name: Mr. N.R.H.
Age: 70 years old
Gender: Male
Address: Salawag
Date of Birth: March 22, 1939
Place of Birth: Salawag
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Married
Occupation: Resigned/Retired
Date of Admission: November 19, 2009
Time of Admission: 5:00 pm
Physician: Dr. Sembrano
Place of Admission: Metro South Medical Center
Admitting Diagnosis: t/c Transient Ischemic Attack, Hypertension Uncontrolled

Chief Complaint:
• The patient complains of Stiffening of Extremities and Dizziness.

III. Patient History.

Present Illness
• Together with his sister, they walked for meters just to reach the church which caused him over
fatigue. When the patient got home he took a rest and got his dinner. While watching television program
she felt stiffening of extremities, and dizziness so his relatives asked his neighbor to take his blood pressure
and it was 180/90 as the result of the blood pressure they rushed him to the hospital.

Past Medical Illness

(+) Hypertension

Family Health History

• According to his relatives, some of their relatives also have a hypertension.

Personal and Social History

• According to the relatives of the patient, he spent mostly his time with his grandchildren, guiding
them with their studies and performs his responsibility as a good grandfather. After her retirement as a
teacher, he turned as catechist as his hobby. As a volunteer in their community she also does neighboring.
IV. Gordon’s Functional Health Pattern.
Health Perception and Health Management
• Complies with medication regimen
• Smokes at least 3 sticks a day
• No difficulty in securing services d/t family support
Nutritional and Metabolic Pattern
• Eats 3 times a day
• Poor Appetite
• With dietary restriction of Low Fat, Salt, No Sweats and Tea
• Drinks at least 6-8 glasses of water.
Elimination Pattern
• Bowel Movement was normal
• Defecate once a day
• Urinates 5 to 6 times a day.
• With bedside comode
Activity and Exercise Pattern
• Requires help from another person and equipment device
• No occupation
• No musculoskeletal impairment
Sleep and Rest Pattern
• Difficulty in sleeping pattern d/t nurses regular monitoring
and medicine giving
Cognitive and Perceptual Pattern
• Pupils 3, Equal brisk reaction
• Impaired hearing problem
• Disoriented to time, place and person
• Drowsy d/t difficulty in sleeping as manifested by nurses
regular monitoring and meds giving
Self-Perception and Self-Concept Pattern
• Patient Verbalize “Nahihilo ako, masama pakiramdam ko.”
• Has a body disturbance image.
Role-Relationship Pattern
• No works has resigned already
• With speech problem
• No dysfunctional family interactions
• Married with 2 children.
Sexuality-Reproductive Pattern
• Satisfied with his sexual relationship.
• No problems in sexual functioning.
Coping – Stress Tolerance pattern
• Handles stress efficiently
• No signs of stress
Value – Belief Pattern
• Roman Catholic
• Always have the bible at his bed side
 V. Physical Assessment.
Normal Findings Actual Findings
1. General Health Survey
a. Weight 55 kg
b. Height 167 cm
c. Vital Signs
c.1.Temperature 37.3 Celcius
c.2. Pulse 55 – 105 bpm 87 bpm
c.3. Respiration 12 – 20 cpm 24cpm
c.4. Blood Pressure 120/80 mmHg 180/90 mmHg
2. Integumentary
a. Skin Texture Skin intact, no lesion Presence of scars, dry skin
b. Hair Evenly distributed, no pediculosis Evenly distributed hair; no lesions, no
dandruff and absence of pediculosis
c. Nails Concave Concave, pinkish, CRT for 2-3 seconds
3. HEENT
Head/Neck Head size becomes more
proportionate to the body
Eyes V.A. should be 20/20 by age 6 Eyes are symmetrical, sees the ball of
20ft distance
Ears Hearing intact, tympanic membrane No drainage, able to recognize high
intact; no drainage pitch
Nose Nasal mucosa pink and intact. Absence of any fluid secretion, nasal
mucosa pink
Throat/Mouth Tonsils are usually large; oral musosa Presence of dental caries, tonsils are
pink, no lesions. Child loses first teeth large, absence of lesions in oral cavity
during these time.
4. Respiratory Lungs clear R.R: 24 cpm, absence of wheezing and
crackles
5. Cardiovascular Regular rhythm, no extra sounds P.R:87 bpm, no extra sounds detected
such as murmurs
6. Gastrointestinal Abdomen soft, non-tender, no Abdomen is soft, non-tender, no mass
organomegaly found out
7. Urinary External genetalia intact, appropriate Absence of pain during urination,
development for child’s age yellow color of urine, no blood or no
other color seen.
8. Reproductive External genetalia intact, appropriate
development for child’s age
9. Musculoskeletal Normal curves noted, no
abnormalities, no weakness
10. Neurological Balance and coordination greatly
improved; with refinement of fine
motor skills
a. Cranial Nerves
a.1.Olfactory Identified the substance Able to identify the coffee
a.2.Optic Visual acuity intact 20/20 OU
a.3.Oculomotor PERRLA direct and consensual
a.4.Trochlear
a.5.Abducens
a.6.Trigeminal Client perceives light touch and Perceived the cotton bilaterally
superficial pain bilaterally
a.7.Facial Able to make faces Able to perform facial expressions
Taste sensation on anterior tongue Tasted the coffee in the anterior
tongue
a.8.Acoustic Hearing intact Able to respond and didn’t lost his
Negative Romberg’s Test balance
a.9.Glossopharyngeal Taste on posterior tongue intact
a.10.Vagus Swallow and cough reflex intact Able to cough out and swallow
Speech clear
a.11.Accessory Moved against resistance without Moved against resistance without
pain pain
a.12.Hypoglossal Can protrude tongue medially Able to move tongue medially and
bilaterally
IV. Anatomy and Physiology.
Central Nervous System
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.
Cardiovascular System
Baroreceptor, pressure-sensitive 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 xhemical 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+.
Renal System

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.
VII. Pathophysiology.
Family
History

Bilateral Renal Artery Stenosis

cellular retention of sodium

water retention, with increased ECF volume

increased blood volume, cardiac output

and events of early primary hypertension

disruption of sodium-potassium pump

net increase of intracellular sodium & calcium

Prolongs vasoconstriction

Stimulates smooth muscle

hypertrophy & hyperplasia

Decreases arterial lumen size

Inflammation

Release of histamine, leukotrienes, prostaglandins

Increase vascular permeability

Increase sodium,
calcium, water, proteins, humoral substances

Increase vessel thickening

Calcium increases smooth muscle contraction

Increase vasoconstriction

Increase peripheral resistance

Blood pressure elevation

VIII. Nursing Process.
Assessment Diagnosis Planning Intervention Evaluation
SUBJECTIVE: Risk for prone After 8 hours of INDEPENDENT: After 8 hours of
“Bakit kaya behavior related nursing  Define and state the nursing
madalas sumsaskit to lack of interventions, the limits of desired BP. interventions,
ulo ko at knowledge about patient will Explain hypertension the patient was
nahihilo?” as the disease. verbalize and its effect on the able to verbalize
verbalized by the understanding of heart, blood vessels, understanding
patient. the disease kidney, and brain. of the disease
process and  Assist the patient in process and
OBJECTIVE: treatment identifying modifiable treatment
 Request for regimen. risk factors like diet regimen.
information.  high in sodium,
 Agitated saturated fats and • Goal Partially
behavior cholesterol. Met
 Inaccurate  Reinforce the
follow through importance of
of instructions. adhering to treatment
 V/S taken as regimen and keeping
follows: follow up
T: 37.3 appointments.
P: 82  Suggest frequent
R: 21 position changes, leg
BP: 180/90 exercises when lying
down.
 Help patient identify
sources of sodium
intake.
 Encourage patient to
decrease or eliminate
caffeine like in tea,
coffee, cola and
chocolates.
 Stress importance of
accomplishing daily
rest periods.

DEPENDENT:
 Give due medications
 Assessment Diagnosis Planning Intervention Evaluation
SUBJECTIVE: INDEPENDENT:
“Bakit kaya Fatigue related After 8hours of • Teach name, dose, After 8 hours of
madalas ako to effects of nursing action, and side effects of nursing
mahilo?” hypertension intervention her antihypertensive interventions,
as verbalized by the and stresses of blood pressure medication. the patient was
patient. daily life. readings will able to manage
reduce to less • Discuss stress-reducing his stress.
OBJECTIVE: than 150 techniques, helping
¨ Request for systolic and 90 identify possible • Goal Partially
information. diastolic choices. Met
¨ Agitated
behavior DEPENDENT:
¨ Inaccurate •Give due medications
follow through
of instructions.
¨ V/S taken as
follows:
T: 37.2
P: 84
R: 18
BP: 180/110

Assessment Diagnosis Planning Intervention Evaluation

SUBJECTIVE: INDEPENDENT:
“Bakit kaya Dizziness related After the 1hr • Discuss strategies for After 2 hours of
madalas ako to effects of nursing achieving a realistic nursing
mahilo?” hypertension intervention the weight loss goal. interventions,
as verbalized by the secondary to patient will the patient has
patient. improper diet. comply with • Refer for a dietary been reduced
low-sodium and consultation for further his risk for
OBJECTIVE: low-fat foods teaching about fat hypertension.
¨ Request for from a list and sodium restrictions.
information. provided • Goal Partially
¨ Agitated into his diet. Met
behavior  DEPENDENT:
¨ Inaccurate •Give due medications
follow through
of instructions.
¨ V/S taken as
follows:
T: 37.2
 P: 84
R: 18
BP: 180/110

IX. Drug Study.

Drug Name Action Indication Side Effects Nsg.Consideration
Amlodipine long-acting calcium Anti-Hypertensive peripheral edema, • Take with meals if
-anti- channel dizziness; palpitatio upset stomach
hypertensive blocker(dihydropyridi ns; muscle-, stomac occurs.
ne class) used as h-
an anti-hypertensive a or headache; dyspe
nd in the treatment psia; nausea, blood 
of angina. Like other disorders,
calcium channel development
blockers, amlodipine of breasts in men (
acts by relaxing gynecomastia), imp
the smooth muscle in otence, depression, 
the arterial wall, insomnia, tachycar
decreasing total dia, 
peripheral erratic behavior, he
resistance and hence patitis, jaundice, hy
reducing blood perglycemia, tremo
pressure; in angina it r, Stevens-Johnson
increases blood flow syndrome
to the heart muscle.

Clopidrogel inhibit blood clots Prevention of Headache, • Provide small,

-anti-platelet in coronary artery vascular ischaemic e dizziness, frequent meals if GI
disease, peripheral vents in patients weakness, upset.
vascular disease, with syncope, flushing, • Provide comfort
and cerebrovascular symptomatic athero hypertension, measures and
disease. sclerosis edema, Rash, arrange for
pruritus analgesics if
headache occurs.
Ciprobay Inhibits DNA-gyrase Infections of the seizures, dizziness, •Assess patient for
-anti-biotics in susceptible respiratory tract, drowsiness, infection prior to
organism; inhibits middle ear, sinuses, headache, and during therapy.
relaxation of eyes, kidneys and insomnia, acute •Observe patient
supercoiled DNA and urinary tract, genital psychosis, for signs and
promotes breakage of organs, abdomen, agitation, symptoms of
double-stranded DNA. skin and soft confusion, anaphylaxis
tissues, bones and hallucination, •Monitor
joints. increased prothrombin time
intracranial closely in patients
pressure, light- receiving
headedness, fluoroquinolones
 tremors and warafarin

Drug Name Action Indication Side Effects Nsg. Consideration

Catapres Stimulates alpha- Prevents pain signal Drowsiness, Hypersensitivity,
-anti- adrenergic receptors transmission to the depression, Serious cardiac or
hypertensive in the CNS; which CNS by stimulating dizziness, cerebrovascular
results in decreased alpha-adrenergic nervousness, disease
sympathetic outflow receptors in the nightmares,
inhibiting spinal cord bradycardia,
cardioacceleration Nursing Implications hypotension
and vasoconstriction (increased with
centers epidural),
palpitations,
Metoprolol Competitively blocks Hypertension, alone Dizziness, vertigo, Do not discontinue
-anti- beta-adrenergic or with other drugs, tinnitus, fatigue, drug abruptly after
hypertensive receptors in the heart especially diuretics emotional long-term therapy
and juxtaglomerular depression, (hypersensitivity to
apparatus, decreasing paresthesias, sleep catecholamines may
the influence of the disturbances, have developed,
sympathetic nervous hallucinations, causing exacerbation
system on these disorientation, of angina, MI, and
tissues and the memory loss, ventricular
excitability of the slurred speech arrhythmias). Taper
heart, decreasing drug gradually over
cardiac output and 2 wk with
the release of renin, monitoring.
and lowering BP

X. Discharge Planning.
Medication:
• Take home medication as prescribed by the physician.
Exercise:
• Instruct to walk for at least 15mins a day as an exercise.
Treatment:
• Take home medication and follow dietary plans
Health Teaching:
• Discourage patient from stressful and heavy activities
Out Patient Follow-Up:
• Instruct patient to visit physician if signs and symptoms of HTN shows.
Diet:
• Instruct patient with Low Salt, Low Fat, No Sweats and Tea diet.