Z

HYPERTENSION
Family Case Presentation
Department of Family and Community Medicine
Eastern Visayas Regional Medical Center

PLIMACO-GARCIA, JERVY B.
ROBEL, JO QUEENSTEIN LYDIA L.
Medical Clerks
 General Objective

• To be able to understand and impart

knowledge acquired in dealing with patients
and their families with this condition and
apply the necessary skills to contribute to the
management of these patients.
 Specific Objectives
At the end of the presentation, we will be able to:
• To present a case of an elderly male with a chief
complaint of persistent elevated blood pressure.
• To establish the family diagnosis, intervention and
recommendation using family assessment tools
• To see how the family dynamics deal with the challenges
brought about by the disability
• To assess the family adapt to the situation
Index Case Profile
 General Data

F.G.N.
70 y/o
MALE

MARRIED
ROMAN CATHOLIC FILIPINO

BRGY. DITA, JULITA LEYTE

sought consult at EVRMC Geriatrics OPD

 Chief Complaint

Persistently elevated BP
(170/100mmHg)
 History of Present Illness
• BP taken
• 160/100mmHg
2
• no other associated symptoms
weeks • no consult done
PTC • no medications taken
 History of Present Illness

• Repeat BP
• 170/100mmHg
1 day • No other subjective complaints
PTC • no consult done
• no medications taken
 Past Medical History
Unknown history of childhood illnesses

Non diabetic, Non hypertensive

November 2011: Admitted at Burauen 2008: Admitted at Burauen District Hospital

District Hospital with a diagnosis of CAP-MR for 3 days due to AGE

Non asthmatic, No known allergy to

food/drugs

No previous surgical operations

Family History

• Mother, deceased, 55 y/o, Rabies

• Father deceased, 53 y/o, Vehicular
accident
• Patient has 3 siblings,
• Eldest, deceased, 25 y/o, suicide
• 2 other siblings claimed to be well
• No known heredofamilial diseases
Psychosocial History
• worked as farmer for 55 years
• Nonsmoker
• non alcoholic drinker
• no history of illicit drug use
• Usual diet: fish, vegetables, 1 cup
rice
• Family income is estimated to be
P 200/day
 Psychosocial History

• living with his wife

• house made up of light materials
• Water source: LMWD
• Refuse disposal: burning and compost pit
• Firewood for cooking
 Comprehensive Geriatric Assessment

“CGA is a multidimensional, interdisciplinary patient evaluation that

leads to the identification of patient’s problems”.

-formulates a plan to address issues w/c are of concern to the older

person
 Review of Systems

GENERAL: (-) fever

SKIN: (-) itchiness
HEAD: (-) lightheadedness, (-) dizziness
EYES: (+) blurring of vision, (-) pain, (-) excessive tearing
EARS: (-) tinnitus
NOSE AND SINUSES: (-) colds, (-) itching, (-) epistaxis
MOUTH AND THROAT: (-) bleeding gums, (-) hoarseness
 Review of Systems (cont.)

NECK: (-) dysphagia, (-) rigidity

RESPIRATORY: (-) difficulty breathing, (-) hemoptysis
CARDIOVASCULAR: (-) palpitations, (-) difficulty of breathing
GIT: (-) constipation (-) melena, (-) hematochezia
GUT: (-) anuria
HEMATOLOGIC: (-) easy bruising
ENDOCRINE: (-) heat and cold intolerance, (-) excessive thirst/hunger,
PSYCHIATRIC: (-) nervousness, (-) tension, (-) memory loss
 Physical Examination
Patient was seen & examined :
¾awake, sitting on a chair, not in distress, with
the following vital signs:
VS ACTUAL VALUE
Weight: 74kg BP 170/100 mmHg
Height: 169cm Repeat BP 160/100 mmHg
BMI: 26.42 kg/m2
HR 101 bpm, regularly regular

RR 19 cpm
TEMP 36.9C
 Physical Examination (cont.)

SKIN: brown, no hypo/hyperpigmentation, warm to touch, no lumps,

senile turgor
HEENT:
Head: atraumatic, normocephalic,
Eyes: pale palpebral conjunctivae, no hemorrhage; dirty sclera; pupils
are symmetrical, 3 mm in diameter, equally round and reactive to light
and accommodation
 Physical Examination (cont.)

Ears: symmetrical, no discharges, no active lesions, no tenderness, (+)

hearing difficulty (AU)

Nose: no epistaxis, moist nasal mucosa, no nasal discharges, septum at

midline;

Mouth: dry lips, no gum bleeding. Tonsils not inflamed, nonhyperemic

Neck: (-) neck vein engorgement, no thyroid gland enlargement, no

cervical lymphadenopathies, no bruits upon auscultation
 Physical Examination (cont.)

CHEST AND LUNGS: Truncal in shape, symmetrical lung expansion,

no lagging, no bulging, (-) intercostal, (-) subcostal retractions; no
masses, no tenderness; clear breath sounds

CARDIOVASCULAR: Adynamic precordium, (-) visible pulsations,

no precordial bulging; No heaves, no thrills. PMI palpable at the 5th
ICS MCL; normal rate, regular rhythm, no murmurs
 Physical Examination (cont.)

• ABDOMEN: Full, no visible peristalsis, no engorged veins; no

striae; soft, nontender, no masses, tympanitic in all quadrant,
normoactive bowel sounds
• EXTREMITIES: no edema, no cyanosis, no atrophy, pulses full and
equal
• DRE: not done
 Neurologic Examination
• CRANIAL NERVES:
CN I: Not done
CN II : Pupils 3mm in diameter, symmetrical, briskly reactive to light
and good direct and consensual light stimulation.
CN III, IV, VI: Full extraocular muscle movement.
CN V: Facial sensation is intact to light touch. Corneal responses are
intact.
CN VII: Face is symmetric with normal eye closure and is able to smile.
 Neurologic Examination (cont.)
CN VIII. (+) response to verbal stimuli
CN IX and X: Palate elevates symmetrically. Phonation is normal.
CN XI: Head turning and shoulder shrug are intact.
CN XII: Tongue is midline with normal movements and no atrophy.
• MOTOR: Patient can flex and extend both upper and lower extremities
without limitation. Strength is full bilaterally.
• REFLEXES: Not examined
• CEREBELLUM: There are no abnormal or extraneous movements.
Patient able to walk with normal gait.
Family Assessment
 THE FAMILY
I. The Family Structure and II. Family Psychodynamics
Function APGAR
 Genogram  SCREEM
 Type of Family
 Stage in the Family Cycle
 Family Identification
Family Structure: Nuclear
Social Class: Lower Class
Family Set-up: Democratic
Authority: Patriarchal
 Genogram
GAMBA- NEBASA FAMILY
Jan. 17, 2019
Julita, Leyte LEGEND:
I

x
x
Juanito
?
x
Atanasia MVA -
53 55

Rabies -
II
x
Remegio
Florenci
1970

Anacleta Evelina ?
Diomida Suicide -
o 64 60
25 70 69

III

Leah Ruby Evan

44 40 36
FAMILY CIRCLE
 Family in Unattached
Later Years Young Adult

Launching Newly Married

Family Life Cycle
Family Couple

Family with
Family with
Young
Adolescents
Children
FAMILY APGAR
 Palagi Paminsan- Halos
Iskor: 2 minsan Hindi
Iskor: 1 Iskor: 0

A “”Ako ay nasisiyahan dahil nakakaasa

ako ng tulong sa aking pamilya sa oras
2 Score FLORENCIO:
10
ng problema.”

P ““Ako ay nasisiyahan sa paraang

pakikipagtalakayan sa akin ng aking
2

pamilya tungkol sa aking problema.”

“Ako ay nasisiyahan at ang aking 2

G pamilya ay tinatanggap at
sinusuportahan ang aking mga nais
gawin patungo sa bagong landas para
sa aking ikauunlad.”
A “Ako ay nasisiyahan sa paraang
ipinadarama ng aking pamilya ang
2

kanilang pagmamahal at
nauunawaan nila ang aking
damdamin katulad ng galit, lungkot,
at pag-ibig.”
R “Ako ay nasisiyahan at ang aking
pamilya at ako ay nagkakaroon ng
2

panahon sa isa’t-isa.”
 Palagi Paminsan- Halos
Iskor: 2 minsan Hindi
Iskor: 1 Iskor: 0

A “”Ako ay nasisiyahan dahil nakakaasa

ako ng tulong sa aking pamilya sa oras
2
Score ANACLETA: 10
ng problema.”

P ““Ako ay nasisiyahan sa paraang

pakikipagtalakayan sa akin ng aking
2

pamilya tungkol sa aking problema.”

“Ako ay nasisiyahan at ang aking 2

G pamilya ay tinatanggap at
sinusuportahan ang aking mga nais
gawin patungo sa bagong landas para
sa aking ikauunlad.”
A “Ako ay nasisiyahan sa paraang
ipinadarama ng aking pamilya ang
2

kanilang pagmamahal at
nauunawaan nila ang aking
damdamin katulad ng galit, lungkot,
at pag-ibig.”
R “Ako ay nasisiyahan at ang aking
pamilya at ako ay nagkakaroon ng
2

panahon sa isa’t-isa.”
SCREEM
 SCREEM LUBOS NA
SUMASANGAYON
LUBOS NA HINDI
SUMASANG AYON SUMASANGAYON

• Ang bawat isa ay nagtutulungan sa aming pamilya

SOCIAL • Natutulungan kami ng aming mga kaibigan at kasamahan sa 

komunidad

• Ang aming kultura ay nagpapatatag ng loob ng aming pamilya

CULTURAL 
• Ang kultura ng pagtutulungan at pagmamalasakit sa aming
komunidad ay nakakatulong sa aming pamilya

• Ang aming pananampalataya at relihiyon ay nakakatutulong sa

aming pamilya
RELIGION 
• Natutulongan kami ng aming mga kasamahan sa simbahan o mga
grupong relihiyoso
 SCREEM
LUBOS NA LUBOS NA HINDI
SUMASANGAYON
SUMASANG AYON SUMASANGAYON

ECONOMIC • Sapat ang naipong/kinikitang pera ng pamilya para sa aming 

pangangailangan

• Sapat ang aming edukasyon/kaalaman upang maintindihan ang

mga impormasyong tungkol sa sakit
EDUCATIONAL 
• Sapat ang aming edukasyon/kaalaman upang maalagaan ang may
sakit

• Madaling makakuha ng tulong medical sa aming komunidad

MEDICAL 
• Natutulungan kami ng mga doctor, nars at health workers
 SCREEM
SOCIAL 3
CULTURAL 3
RELIGION 3
ECONOMIC 2
EDUCATIONAL 2
MEDICAL 3

Adwquate Family 16/18

Resources
 SOCIAL
RESOURCE
Florencio and Anacleta
used to participate in
merry-making activities
during barangay festivities
The family has good
rapport to neighbors and
the community.
PATHOLOGY
 Florencio can
sometimes be overly
committed to barangay
activities that he devote
most of his time helping
in the preparation in
merry-making activities.
 CULTURAL

RESOURCE PATHOLOGY
The family believes that Waraynon are  None
resilient and innovative.
The family believes that Waraynon are
diligent.
The family believes that Waraynon
have utmost hospitality.
The family is a proud Waraynon.
 RELIGION
PATHOLOGY
RESOURCE
 None
The family is an active member of
Roman Catholic Church.
The family observes Sunday mass
and special church occasions.
The family celebrates church holiday
seasons .
They don't have rigid religious
customs and rituals.
 ECONOMIC
RESOURCE PATHOLOGY
 Their main source of income is from selling  None
kangkong to neighbors; they have little income
 EDUCATION
RESOURCE PATHOLOGY
 Florencio finished grade 4 .  None

 Anacleta is an elementary grad.

 Their children are college graduates.
 Finding solutions of problems encountered by the
family is based on experience and known
competency.
 MEDICAL
RESOURCE PATHOLOGY
 They are all PhilHealth members.  None
 The Stage in Family Illness Trajectory

Stage III: Major Therapeutic Efforts

Second crisis:

Coping mechanism
-
 SALIENT FEATURES

Identifying Data • 70
• Male
• Filipino

History of Present • Persistently elevated BP

Illness • No associated symptoms

49
 SALIENT FEATURES (cont.)

Personal and Social • Nonsmoker

Hx • Non alcoholic drinker
• Usual diet include fish, 1 cup rice, vegetables

Family History • No heredofamilial diseases

50
 SALIENT FEATURES (cont.)

Review of System • No significant finding

51
 SALIENT FEATURES (cont.)

Physical 170/100 mmHg

Examination 170/100 mmHg (repeat)
101 bpm, regularly regular
19 cpm
(-) neck vein engorgement
(-) intercostal retractions

52
 Initial Impression:
• Hypertension, Stage II
 Family Wellness Plan
Patient
• BP monitoring every week or 2 weeks
• FBS – every month or every 2 weeks
• Lipid profile – every 6 months
• Blood uric acid – 1x/year
• Eye examination – every year
• KUB UTZ to include prostate- yearly (BPH)
• Diet: low salt, low fat diet; increase oral fluid intake
• Regular exercise – 2-3x/week
 Family Wellness Plan
Family
• BP annually ; wife- every 2 months
• Cholesterol annually from age 40
• Annual Physical examination
Lifestyle modification
• High fiber diet, low salt, low fat
• Vegetables and fruits in the diet
• Regular exercise (2-3x/week)