INTRODUCTION REPORT

HYPERTENSION

A. Understanding
Hypertension is the increased pressure in the systole, the height of which depends on the
age of the affected individual. Blood pressure fluctuates within certain limits, depending on
body position, age and stress level. Hypertension can also be classified as mild, moderate or
severe, based on diastole. Mild hypertension if the diastolic pressure is 95 - 104 mmHg,
moderate hypertension if the diastolic pressure is 105 - 114 mmHg, severe hypertension
when the diastolic pressure is> 115 mmHg.
B. Pathophysiology
The increase in blood pressure in the arteries can occur in several ways, namely: the heart
pumps stronger so that it flows more fluid every second, the large arteries lose their
flexibility and become stiff, so they cannot expand when the heart pumps blood through
these arteries, this is because the blood at each heart beat is forced through the narrower
blood vessels than usual and causes the pressure to rise. This is what happens in old age,
where the artery walls have become thickened and stiff due to arteriosclerosis.
C. Tiology
1. Age
Hypertension will increase with increasing age of hypertension in those aged from
35 years, clearly increasing the incidence of arterial disease and premature death.
2. Gender

based on male gender, there is generally a higher incidence than women. However, in middle age,
the incidence in women begins to increase, so that at the age of 65 years, the incidence in women is
higher.

c. Race

Hypertension in blacks is at least twice that of whites.

d. Lifestyle

Factors such as education, income and lifestyle factors of patients have been investigated, without
clear results. Low incomes, low levels of education and a stressful life or work are likely to be
associated with a higher incidence of hypertension. Obesity is also seen as a major risk factor.

4. Based on the causes, hypertension is divided into 2 groups:

A. Primary / essential hypertension

Examination of hypertension, the cause of which is unknown, is usually related to heredity and
environment

b. Secondary hypertension

Consists of hypertension whose causes can be identified with certainty, such as blood disorders and
kidney disease.

5. Trigger factor
A. Obesity

b. Smoking habit

c. Alcoholic beverages

d. Diabetes and heart disease

e. Women who don't menstruate

f. Stress and lack of exercise

g. Diet that is not balanced, fatty foods and high cholesterol

6. Signs and Symptoms

A. Headache and dizziness

b. Spinning headache

c. The feeling of heaviness in the nape of the neck

d. Anger / emotionally unstable

e. Lightheaded eyes

f. Ears buzzing

g. Difficulty sleeping h. Tingling sensation

h. Difficulty speaking

me. Nausea / vomiting

j. Epistaxis

k. Migraine

l. Tiring easily

m. Tinistus which is thought to be associated with increased blood pressure

7. Classification of Hypertension

The classification of hypertension is based on The Joint National Committee on Detection Evaluation
and Treatments of High Blood Pressure, as follows:

Diastolic Systolic Category

A. Normal height (border) 130 - 139 85 - 89

b. Stage 1, mild 140 - 159 90 - 99

c. Stage 2, moderate 160 - 179 100 - 109

d. Stage 3 ,, very heavy 210> 120>

8. Complications

A. Stroke

b. Myocardial infarction

c. Kidney failure

d. Encephalopathy

e. Visual disturbances

NURSING CARE IN Mrs.U WITH HYPERTENSION

DIRUANG IN BANDUNG CITY RSUD

1. Review the case

A. Assessment

1). Data collection

A. Client identity

Name: Mrs.U

Age: 51 years

Female gender

Islam

Tribe / Nation: Sundanese

Occupation: Housewife

Date of Entry: 19 July 2011

Date of Assessment: 20 July 2011

Medical Diagnosis: Hypertension

Address: Babakan teak RT 04/07, gumuruh village district. Batununggal

b. The identity of the person in charge

Name: Muhydin

Age: 23 Years

Relationship with clients: Children

2). Medical history

A. main complaint

nausea and vomiting.

b. Medical History Now

The general condition of weakness, nausea and vomiting relapsed, the client awakened from sleep,
nausea and vomiting in the clinical state in a normal resting state (not sleeping), scale 4.

c. Past Medical History

Before the client was treated at the Bandung City Hospital the client said he had hypertension and
had treated doctors and the use of food stalls, a week before being treated at the Bandung City
Hospital the patient was dizzy.

d. Family Health History

clients discuss in the family there are the same diseases as clients.

3). Physical examination

General Conditions:

Level of consciousness: moderate pain (composmetis) GCS 15

Tall body:

Weight:

Vital sign:

Blood pressure: 140/100 mmHg

Temperature: 35.6 C

Pulse: 84x / minute

Respiration Rate: 20x / minute

From head to toe

A. Head

When the inspection on the client is symmetrical, smooth evenly, clean enough, when palpation
there is no tenderness.

b. Eye

When the palpation of the two eyes looks symmetrical, the sclera and conjugtiva are normal, light
reflex (+), pupil constriction, when on palpation do not complain of pain, eye movement in all
directions, the vision is a bit blurry.

c. Nose
When palpated, the nose is symmetrical, the nostrils are clean, when on palpation there is no
tenderness in the sinuses, the smell is normal.

d. Mouth

When palpated, the mouth was symmetrical, slightly dry, slightly dirty, no lesions, good taste.

e. Ear

Looks symmetrical, the ears are quite clean, there is a hearing loss in the left ear, there are no lumps.

f. Skin

Olive color, normal texture and tugor, good skin sensation.

g. Neck

When on palpation it looks symmetrical, and on palpation there is no swelling of the lymph nodes
and thyroid hands, there is no tenderness.

h. Chest

The chest looks symmetrical, there are no lesions, the frequency of breath is 20x / minute, when on
auscultation there is no wizing sound.

me. Heart

The heart sound s1 (lub) is more pronounced in the tricuspid and mitral. S2 (dup) is more
pronounced in the aortic valve area, the frequency is 84x / minute.

j. Abdomen

When in auslkutation there is sound of bowel sounds, flat stomach, skin condition

slightly dry, when on palpation there is no feeling of tenderness.

k. Extrmity

• Top

Symmetrical shape, normal muscle strength (return <2 seconds) reflex bisef and trisef + / +, no
edema, good skin sensation.

• Down

Symmetrical shape, normal muscle strength (return <2 seconds), reflex patella and cichilles + / +, no
edema, good skin sensation.

l. Genetalia

Normal ability to urinate, not using catheter aids.

4). Psychosocial Aspects

Weakness, anxiety and reduced interactions.

5). Spiritual Aspects

The client said that the illness he was suffering from was a test from one almighty God, a client who
always prayed and hoped that the disease he suffered was quickly cured by one God, and Lien
believed that Allah would provide healing for himself.

6). Supporting data

Laboratory examination

No Normal Value Check Results

1. Crechne 0.82 1.00

2. Vric acid 3.92 6.00

3. Cholesterol 168.1 200.00

4. 56pt 18.1 35.0

7). Therapy

 Feeding little but often.

 Say warm water.

 Administration of fluid infusion RL 20 tts / minute.

 Administration of ceptopril 3 x 25 mg.

 Administration of ranitidine 2 x 1 mg.

 Administration of odenceton 2 x 1 mg.

Analisa data

DS: the patient complains of nausea.

DO: the patient looks weak.

The patient appears nauseous and vomits.

TD 120/110 mmHg.
There is no nursing diagnosis Objective of Intervention Rational Day / date of Implementation of
Evaluation

1. Nutrition less than requirement based on inadequate intake is followed

DS: the patient complains of nausea.

DO: the patient looks weak.

The patient appears nauseous and vomits.

TD 120/110 mmHg. Nutritional needs are met within 4 days with the following criteria:

The patient looks reluctant.

Complained of nausea and vomiting until it disappears.

TTV is within normal limits. Assess patient complaints.

Observe vital signs.

Encourage drinking warm water.

Encourage small, frequent meals.

Give medicine according to the advice. Assessing patient complaints.

Observe vital signs.

Greetings warmly.

Break up eating a little but often.

Provide medicine as needed. Wednesday, July 20, 2011

Thursday, July 21, 2011

Friday, July 22, 2011

a. Observing for signs of Vita.

TD: 190/100 mmHg.

N: 86x / minute

R: 26x / minute

S: 35.8 C.

b. Warm drinking warm water.

c. Disappointing bedres

d. Giving medicine

ranitidine 2x1 amp.

On and 2x1 amp. Through IV.

Metocrapiomide.

e. using the infusion fluid RL 17 drops / minute.

a. Make the patient's bed.

b. observe vital signs.

TD: 130/90 mmHg

N: 80x / minute

R: 20x / minute

S: 35.5 C

c. replace the infusion fluid RL 17 drops / minute

d. Giving medicine

Ranitidine 2x1 amp

Ondanceton 2x1 amp, through IV

a. take a break

b. observe vital signs

TD: 130/80 mmHg

N: 80x / minute

R: 20x / minute

S: 35.8 C S: the patient complained of nausea.

O: the patient looks weak, vomiting.

A: the problem is being resolved.

P: intervention.

E: Nausea increases and vomiting.

S: the patient complains of nausea.

O: the patient is sick with nausea, the IV is attached.

A: The problem is partially resolved.

P: intervention.

E: nausea (-).

S: -

O: the patient is weak

TD: 130/80 mmHg

A: problem is resolved

P: -

E: the patient goes home