HYPERTENSION

Hypertension, also known as high or raised blood pressure, is a condition

in which the blood vessels have persistently raised pressure.
PATIENT INFORMATION

 Name: Mrs. Lida

 Address: Magurang Pol. Albay
 Sex: Female
 Religion: Catholic
 Age: 59
 Civil Status: Widowed
Subjective data

 “ Minsan kasi di ko talaga napipigilan, napapakain ako ng marami”

 “ nanghihina ako at nahihilo”
 “di ko na alam ang gagawin ko nahihirapan na ako”
 “Madalas sumakit ang ulo ko”
 “ bakit kaya madalas sumasakit ako ulo ko at madali akong manghina? ”
HISTORY

 History of Present Illness

The patient has hypertension. She usually experiences dizziness, weakness and
fatigue. Her current blood pressure is 160/100
 Diet
Patient doesn’t eat much rice but there was also a time that she can’t help it. The
patient said that she was not picky eater. But sometimes she forgets to eat lunch
or she just doesn’t want to eat.
 Activities of Daily Living
The patient is a teacher so she needs to go to school every day. She walks or rides
her bicycle when going to school. Sometimes when she doesn’t need to be early for
school she goes to public to market with her bike to buy some necessities.
CONTINUATION

 Nature of Work
The patient was a grade 2 teacher and the assigned personnel for feeding program in the
school. Before the pandemic she has to do the preparation for the feeding program and
meet with her class from morning to afternoon. And go home at 5.
 Environment
The patient working area was across the main road. Her classroom was made of cement
and has open window. Her husband died 10 years ago. She has 4 daughters but only lives
with her youngest daughter.
 Predisposing Factor
Sex, Age, Family history, diabetes
 Precipitating Factor
Unhealthy diet, physical inactivity
Anatomy and Physiology

 Superior vena cava Vein that returns blood from the head
and neck, upper limbs, and thorax to the right atrium
 Right atrium receives and holds deoxygenated blood from
the superior vena cava, inferior vena cava, anterior cardiac
veins and smallest cardiac veins and the coronary sinus,
which it then sends down to the right ventricle 
 Right ventricle Receives blood from the right atrium and
pumps it to the lungs, where it is loaded with oxygen
 The inferior vena cava (IVC) is ultimately responsible for the
transport of almost all venous blood (deoxygenated) from the
abdomen and lower extremities back to the right side of the
heart for oxygenation.
 Aorta Large, elastic artery that is the main trunk of the systemic arterial
system; carries blood from the left ventricle of the heart and passes
through the thorax and abdomen.
 Left atrium has four relatively uniform openings from the four pulmonary
veins that receive blood from the lungs
 Left ventricle is the thickest of the heart's chambers and is responsible for
pumping oxygenated blood to tissues all over the body
 Pulmonary trunk Large, elastic artery that carries blood from the right
ventricle of the heart to the right and left pulmonary arteries.
 Pulmonary veins one of the veins that carry blood from the lungs to the left
atrium of the heart.
BLOOD VESSELS

 Arteries carry blood away from the heart.

 Elastic Arteries - contain larger numbers of collagen and elastin
filaments in their tunica media than muscular arteries do, giving
them the ability to stretch in response to each pulse.
 Muscular Arteries -  contain layers of smooth muscle providing
allowing for involuntary control of vessel caliber and thus control
of blood flow
 Arterioles – provide approximately 80% of the total resistance to
blood flow through the body
 Veins – Medium-sized veins collect blood from small veins and
deliver it to large veins; having diameters greater than 2 mm
contain valves, which allow blood to flow toward the heart
but not in the opposite direction
  Venules - a small blood vessel in the microcirculation that allows deoxygenated blood to return from
capillary beds to larger blood vessels called veins.
 Portal vein - a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and
spleen to the liver
 Valve - prevent backflow.
 Vasa Vasorum - deliver nutrients and oxygen to arterial and venous walls and to remove “waste” products

 Capillaries - oxygen, nutrients, and wastes are exchanged between the blood and the tissues.
 Continuous capillaries - approximately 7–9 μm in diameter, and their walls exhibit no gaps between the
endothelial cells
 Fenestrated capillaries - endothelial cells have numerous fenestrae
 Sinusoidal capillaries - are larger in diameter than either continuous or fenestrated capillaries, and their
basement membrane is less prominent (figure 21.2c) or completely absent
 Sinusoids - large-diameter, sinusoidal capillaries.
 Structure

Arteries and Vein

 The intima, the inner layer lined by a smooth tissue called
endothelium
 The media, a layer of muscle that lets arteries handle the high
pressures from the heart
 The adventitia, connective tissue anchoring arteries to nearby
tissues
Capillaries
 Capillaries are very thin, approximately 5 micrometres in
diameter, and are composed of only two layers of cells—an
inner layer of endothelial cells and an outer layer of epithelial
cells. They are so small that red blood cells need to flow
through them single file.
Amlodipine

Nursing Consideration Action Adverse Effects

Monitor patient stable angina, More severe and
carefully (BP, cardiac vasospastic, angina frequent chest pain
rhythm, and output)    
while adjusting drug to To reduce risk of Rapid, ponding
therapeutic dose; use hospitalization because heartbeat
special caution if of angina  
patient has CHF   Fainting
To reduce risk of
coronary
revascularization
procedure in patients
with recently
documented CAD
Losartan

Nursing Consideration Action Adverse Effects

Teach the client that Belongs to a class of Severe headace
this drug is taken by drugs called angiotensin  
mouth, usually once receptor blockers Muscle weakness
daily with or without (ARBs). It works by  
food. The dosage is relaxing blood vessels so Fainting
based on doctors order. that blood can flow  
  more easily. Swelling
Advise the client to take  
this drug regularly to Irregular heartbeat
get the most benefit  
from it. Unusual change in the
  amount of urine
Advise to notify or
consult to physician if
condition does not
improve or if it worsens