GROUP FIDELITY

CASE PRESENTATION

HYPERTENSION (HTN)
OR
HIGH BLOOD PRESSURE
INTRODUCTION
  Hypertension (HTN) or high blood pressure is a chronic medical
condition in which the systemic arterial blood pressureis elevated.
It is the opposite of hypotension. It is classified as either primary
(essential) or secondary. About 90–95% of cases are termed
"primary hypertension", which refers to high blood pressure for
which no medical cause can be found. The remaining 5–10% of
cases (Secondary hypertension) are caused by other conditions
that affect the kidneys, arteries, heart, or endocrine system.
Persistent hypertension is one of the risk factors
for stroke, myocardial infarction,  heart failure and
arterial aneurysm, and is a leading cause of chronic kidney
failure. Moderate elevation of arterial blood pressure leads to
shortened life expectancy. Dietary and lifestyle changes can
improve blood pressure control and decrease the risk of
associated health complications, although drug treatment may
prove necessary in patients for whom lifestyle changes prove
ineffective or insufficient.
Awareness

 The World Health Organization attributes hypertension, or

high blood pressure, as the leading cause of cardiovascular
mortality. The World Hypertension League (WHL), an
umbrella organization of 85 national hypertension societies
and leagues, recognized that more than 50% of the
hypertensive population worldwide are unaware of their
condition.To address this problem, the WHL initiated a
global awareness campaign on hypertension in 2005 and
dedicated May 17 of each year as World Hypertension Day
(WHD). Over the past three years, more national societies
have been engaging in WHD and have been innovative in
their activities to get the message to the public. In 2007,
there was record participation from 47 member countries of
the WHL. During the week of WHD, all these countries – in
 
partnership with their local governments, professional societies,
nongovernmental organizations and private industries –
promoted hypertension awareness among the public through
several media and public rallies. Using mass media such
asInternet and television, the message reached more than 250
million people. As the momentum picks up year after year, the
WHL is confident that almost all the estimated 1.5 billion people
affected by elevated blood pressure can be reached.
BACKGROUND OF THE STUDY
 Mr. Fidelity was brought in Laguna Provincial
Hospital Sta. Cruz, Laguna last September 07, 2010
because he got stoke. And his chief complaint was
numbness of the left side body. This information
came from his daughter, who were recently there.
Other than that she didn’t say anything with
regards to her father’s condition.
Rationale for Choosing the Case
This case has been chosen by the group under following
reasons:
 
To better understand the study, Hypertension Stage 2 and
appropriate interventions that may contribute to patient’s
recovery.
To benefit the student nurses in enhancing their skills in giving
care for such patient diagnose with Stage 2 Hypertension
To formulate proper nursing care plan
To defy our capabilities in presenting such challenging case.
Be able to construct a pathophysiology.
Challenge our skills in connecting relevant details of the
disease to actual care of client.
Significance of the Study
To the patient :
This study hopes to be most beneficial to the patient as the core
purpose of this is to aid in prompt and successful client recovery
 
To the relatives:
This study will help and give information to the relatives. They
will know how to give proper care and to manage this similar case. 

To the students & to the Clinical Instructor :

  This study presents various observations and encounters upon
handling the client and sustaining for her recovery. Hence, we hope
to be of help to our fellow students by sharing first hand
experiences about the condition.
CLINICAL SUMMARY
 
Eclectic Model
A. Bio- Demoghraphic Data

Name:Mr. Fidelity
Age: 72 y/o
Gender: Male
Address: Santisima, Sta. Cruz, Laguna
Date of Birth: October 10, 1937
Marital Status: Married
Religion: Iglesia Ni Cristo
Occupation: None
Allergies: No known allergies
Past Medical History: Hypertention Stage I
Family History: Asthma
Diagnosis: Hypertention Stage II
Date of Admission: September 7, 2010
Time of Admission: 7:20PM
Attending Physician: Dra. Girang
Source of Information


Primary Source

Daughter of Mr. Fidelity


Secondary Source

 Patient’s record and chart
 
Chief Complaint

Numbness of the left side of the body

 
 
History of Present Illness

According to the daughter of Mr. Fidelity, he was brought to the hospital with a chief
complaint of numbness of the left side of the body. He was admitted last Sept.7, 2010 and
we were just handled him 1 day last Sept.14, 2010.
 
B. Activities of Daily Living

Mr. Fidelity was a smoker and he smokes 1 pack a day.

He was fund of eating high in cholesterol such as fried
chicken skin and “proven” that are usually bought in the
streets. He also likes to eat meat such as pork and beef.
 PHYSICAL
ASSESSMENT
 General Observation

General Appearance & Behavior

Weak in appearance
With NGT intact
With indwelling folly catheter
With presence of dandruff in head
With continuous scratching of head

Vital signs

BP 160/100 mmHg

T 35.6oC
P 51 bpm
R 22 cpm 
Complete Physical Examination
Head
Round and symmetrical
 Hair distributed equally
No infection or infestation of lice and nits
There are presence of dandruff
No presence of mass
Black hair, oily and thick
Face
No lesions
Symmetric facial features
Eyes
Symmetry
Eyebrows are evenly distributed and symmetrically aligned
Eyelashes are slightly curled outward
Eyelids close symmetrical
Sclera white
Iris: round, symmetrical, flat and gray in color
Pupils equally round & react to light and accommodation
Ears
Symmetrical equal size and color same as facial skin
Auricle aligned with outer canthus of eyes
Mobile, firm and not tender, pinna recoils after it is fold
Nose
Symmetrically in size and shape.
Nasal septum located at midline.
No discharge
With NGT inserted
Mouth
Dry & pale lips
Dry oral mucosa
Tonsils not swollen
Neck
Free from lumps, masses and tenderness
No presences of scars
Chest
Sternum located at the midline
Heart: With cardiac rate of 51bpm
Respiratory rate: 22cpm
Abdomen
No lesions and swelling
Firm
 
Upper extremities
Symmetrical in size and shape
With 5 fingers in both left and right hand
Capillary refill 2-3 seconds
No tenderness or swelling
Numbness at the left arm
 
 Lower extremities
Symmetrical in size and shape
With 5 fingers in both left and right foot
No tenderness or swelling
Numbness at the left Leg
 
D. Initial Impression
 Hypertension Stage II
COURSE IN THE
WARD
6:00 – 7:00AM Our duty was started after checking of attendance
7:00 – 9:00AM >received patient with IVF of PNSS 1L @ level of 1000cc inserted @ left metacarpal vein regulated
@ 20gtts/min. and was not regulating and infusing so we informed it immediately to our CI and the
NOD.
> we took vital signs:
BP: 140/70 mmHg
Temp: 35.5 C
PR: 68bpm
RR:27cpm
> he has NGT inserted and patent and an indwelling FC connected to urine bag draining to yellow
colored urine
>we also apply sponge bath to Mr. Fidelity due to unpleasant odor.

10:00AM Checking of sample charting

11:00AM He started his bladder training according to the doctor’s order

12:00NN > giving of medication:

Citicholine 1g IV q8 and Mannitol 50cc @ 20gtts/min in soluset
>vital signs taken :
BP: 160/100 mmHg
Temp: 35.6 C
PR: 57bpm
RR: 22cpm
We immediately informed the NOD and gave him Catapres SL
> administered 400 Kcal osteorized feeding through NGT
> he also tried gelatine Per orem with Aspiration Precaution

1:00PM Endorsement of patient

2:00PM End of the shift

LABORATORY
RESULT
Hematology 09-07-10

Test Result Normal Values Analysis Interpretation

May indicate

presence of

bleeding or

Hemoglobin 13.1 g/dl 14-17 g/dl  Decreased anemia

May indicate

presence of

bleeding or

Hematocrit 0.40 % 0.44 % - 0.47% Decreased anemia

May indicate

presence of

Neutrophils 72 % 45-65 % Increased infection

Chemistry 09-07-10

Interpretation

Test Result Normal Values Analysis

138.4  Within  normal

Sodium mmol/L 135 - 155 mmol/L range

Indicates

hypokalemia
11.26

Potassium mmol/L 3.6 - 5.3 mmol/L Increased 

ANATOMY AND
PHYSIOLOGY
 Circulatory system
The systems involved in giving part to the
development of hypertention is the circulatory
system.
The circulatory system is a network that
carries blood throughout the body.
The human circulatory system supplies the
cells of the body with the food and oxygen they
need to survive. At the same time, it carries
carbon dioxide and other wastes away from the
cells. The circulatory system also helps regulate
the temperature of the body and carries
substances that protect the body from disease. In
addition, the system transports chemical
substances called hormones, which help regulate
the activities of various parts of the body. One of
the parts of the circulatory system is the heart. It
is a hollow, muscular organ that pumps blood. It
consists of two pumps that lie side by side. These
pumps relax when taking in blood and contract
as they send out blood. The left side of the heart
is a stronger pump than the right side.
 . The stronger pump receives blood from the lungs and sends it to cells
throughout the body. The weaker pump receives blood from the cells
throughout the body and sends the blood to the lungs.
Another of the parts of the circulatory system are the blood vessels.
They form a complicated system of connecting tubes throughout the
body. There are three major types of these vessels. Arteries carry blood
from the heart. Veins return blood to the heart. Capillaries are
extremely tiny vessels that connect the arteries and the veins. The
blood consists chiefly of liquid called plasma, and three kinds of solid
particles known as formed elements. Plasma is made up mostly of
water, but it also contains proteins, minerals, and other substances.
The three types of formed elements are called red blood cells, white
blood cells, and platelets.
PATHOPHYSIOLOGY
DRUG STUDY
Medication
Teach to the patient and SO on how to administer patient’s home medication.
Explain to the patient and SO importance of proper compliance with the medication.

Environment
Practice proper hygiene.
Keep Patient room clean and well ventilated.
Keep surrounding clean and far from organism that may lead to sickness.
Always provide safety and prevent or avoid risk for injury/ accident.
Avoid crowded areas.

Health Teachings
Teach patient and SO about the client’s diet.
Educate patient and SO some range of motion for the client. ( flexion, extension,
rotation)
Encourage patient to have enough rest and sleep.
Instruct to avoid heavy or hard activities.
Advise for regular follow-up care or check-up.
Out Patient Schedule
Inform patient and SO about the patient’s follow-up check up for the
health status of the patient for further assessment of improvements and
proper medications.

Diet
Adopt DASH (dietary approaches to stop hypertension) eating plan.
This eating plan is rich in:
 Fruits

 Vegetables

 Whole grains, and

 Low-fat dairy foods;
 meat

 fish

 poultry

 nuts and beans

 Limited in sugar-sweetened foods and beverages, red meat, and added fats
 Discourages the consumption of processed foods

 Dietary sodium reduction

Summary

Hypertension (HTN) or high blood pressure is a chronic medical

condition in which the systemic arterial blood pressure is elevated.
It is the opposite of hypotension. It is classified as either primary
(essential) or secondary. About 90–95% of cases are termed
"primary hypertension", which refers to high blood pressure for
which no medical cause can be found. The remaining 5–10% of
cases (Secondary hypertension) are caused by other conditions that
affect the kidneys, arteries, heart, or endocrine system. It may also
lead to different diseases, it is a risk factor for heart diseases and
stroke.

In our patient the underlying cause of his disease is because of his
lifestyle. He smoke 1 pack of cigarette per day and loves eating high
cholesterol foods. This factors contributed for his present
condition.
Conclusion

We therefore conclude that lifestyle plays a big factor on acquiring or having a disease. Unhealthy
lifestyle may lead to different disease or condition, such as hypertension. Hypertension needs
immediate attention for the well being of the person and prevent further complications.
 
Recommendation

To the patient:

Instructed to eat healthy foods such as vegetables (e.g. kangkong, kalabasa, talbos ng kamote,
upo, pipino, ampalaya), fruits (e.g. ponkan, apple, saging, pinya), and also foods that are low in
fat. 
Instructed to prioritize activities and take some rest on intervals of activities and avoid to much
extraneous activities.
Instructed to lessen his smoking and told him if the time comes that he can stop smoking, stop it.
 
To the student:
 
Study the lessons before going to the area.
Always bring complete paraphernalia
Wear proper and clean uniform.
Always smile