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Hypertension Case Presentation

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Jhay Cosino

on 17 October 2012

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Transcript of Hypertension Case Presentation

Initial data base Del Carpio, Divine Conde, Danielle Kalehna H.
Azada, Rizalino Cosino, Jeremy John C.
Colina, Wilstone Saldua, Jovell
Malche, Caroline Gladys Hypertension Introduction Classification of Blood Pressure for Adults Age 18 and Older:

BP Classification: Systolic BP (mmHg) Diastolic BP (mmhg)

-Normal < 120 and < 80

-Prehypertension 120-139 or 80-89

-Stage 1 hypertension 140-159 or 90-99

-Stage 2 hypertension > 160 or >100 Primary (essential) hypertension
In 90 to 95 percent of high blood pressure cases in adults, there's no identifiable cause.( Oparil, Zaman and Calhoun,2003) This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

Secondary hypertension
The other 5 to 10 percent of high blood pressure cases are caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, ( Kaplan, Lieberman, and Neal, 2002) Causes:

There are two types of high blood pressure. Blood pressure is the product of cardiac output multiplied by peripheral resistance. Cardiac output is the product of the heart rate multiplied by the stroke volume. In normal circulation, pressure is exerted by the flow of blood through the heart and blood vessel. High blood pressure, known as hypertension, can result from a change in cardiac output, a change in peripheral resistance, or both. The medications used for treating hypertension decrease peripheral resistance, blood volume, or the strength and rate of myocardial contraction (Medical and surgical by brunner and suddart)



The group choose this study of hypertension because this will help to gain knowledge and improve nursing care to a patient diagnosed with hypertension and also to know more about its sign and symptoms, anatomy and physiology, pathophysiology, nursing intervention and drugs that are suitable for the patient. Including:
- Kidney abnormalities
- Tumors of the adrenal gland
- Certain congenital heart defects
- Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
- Illegal drugs, such as cocaine and amphetamines 1 out of 4 filipino adult suffers from hypertension (according to DOH)
Male are more prone to hypertension than female because of vises such as alcoholism and smoking Hypertension Prevalence in the philippines: High blood pressure has many risk factors. Some you can't control. High blood pressure risk factors include: Risk Factors The risk of high blood pressure increases as you age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause. Age High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks. Race High blood pressure tends to run in families. Other risk factors for high blood pressure are within your control. Family history The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls. Being overweight or obese People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight. not being physically active Not only does smoking tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Smoking Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure too much salt (sodium) in diet Potassium helps balance the amount of sodium in your cells. If you don't consume or retain enough potassium, you may accumulate too much sodium in your blood. too little potassium in your diet High levels of stress can lead to a temporary, but dramatic, increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure. stress It's uncertain if having too little vitamin D in your diet can lead to high blood pressure. Researchers think vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure. More studies are necessary to determine vitamin D's role in blood pressure. too little vitamin D in your diet Over time, heavy drinking can damage your heart. Having more than two or three drinks in a sitting can also temporarily raise your blood pressure, as it may cause your body to release hormones that increase your blood flow and heart rate. drinking too much alcohol Certain chronic conditions also may increase your risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea. Sometimes pregnancy contributes to high blood pressure, as well. Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits such as an unhealthy diet and lack of exercise contribute to high blood pressure. certain chronic conditions The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage. Uncontrolled high blood pressure can lead to: complications This can result in hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications. damage to your arteries Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening. aneurysm To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure. heart failure High blood pressure in the arteries leading to your brain can either slow the blood flow to your brain or cause a blood vessel in your brain to burst, causing a stroke. a blocked or ruptured blood vessel in your brain This syndrome is a cluster of disorders of your body's metabolism including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), or "good," cholesterol, high blood pressure, and high insulin levels. If you have high blood pressure, you're morelikely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke. metabolic syndrome High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks. weakened or narrowed blood vessel in your kidneys This can result in vision loss. Thickened, narrowed or torn blood vessels in the eyes. Uncontrolled high blood pressure also may affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people who have high blood pressure. trouble with memory or understanding -This study aims to provide effective nursing care to a patient diagnosed with Hypertension by understanding the patient history, disease process and management. It also aims to educate the patient about hypertension to prevent complications from the disease. General
objectives Specific Objective:
At the end of the session the student will: -Enhance the knowledge and awareness of the patient by providing health teaching about hypertension. -Formulate family nursing care plan gather through nurse-patient interaction to help the patient towards wellness. -Enhance the knowledge of the patient about proper nutritional diet such as low in salt and low in cholesterol diet that will help to maintain healthy lifestyle. -Promote exercises such as aerobics to improve the cardiac contractility and blood circulation of the patient. family structure and characteristics Client belongs to an extended family since her son who has his own family lives with them. She is living with her husband who works as a welder, her son and daughter-in-law who is pregnant and their two children, and her youngest daughter who is in elementary socio-economic and structural factors The husband and the son of the client work and provide for the family. Since her husband don’t have a regular income for a welder, sometimes they come to a point that they don’t have enough resource for their basic needs. Because of that, her budget for her medicine are used instead for their basics such as food and other daily necessities, which is why she resorts her herbal medications (garlic) instead of the prescribed medication. She also often drinks pineapple juice for her hypertension because it is said to contain higher level of potassium which help brings down high blood pressure and lower bad cholesterol. Also contains powerful antioxidants and phytochemicals that stir our body free from toxin and waste substance. Garlic lowers blood pressure by thinning the blood, by blocking angiotensin II and by acting on the adrenal system. It is a natural blood thinner and anticoagulant. environmental factors The family resides in a congested area and in a very steep and narrow pathway place. Since the houses are very close to each other, there is inadequate ventilation which adds to the uncomfortable ambiance to the family. But since they are living in the area for quite some time now, they are used to the environment. value placed on prevention of disease Most of the time the client stays at home and takes her rest. She sleeps more often at daytime. When she is bored and wants to have a new look for the place she just go outside and chat with her relatives and friends in the neighborhood. health assessment of the family members Except of the client herself having a hypertension, her husband also suffers from arthritis sometimes. Her son appears to be healthy and had not suffered from any illness for the past few weeks, but her wife is pregnant with their third child and she appears to be pale and thin for a pregnant. Her youngest daughter only suffers from fever, cough and colds but only depends on the season or weather. Chief Complaint:
Headache, Nape Pain
History of Present Illness
Prior to consult patient complained of light-headedness and headache with pain behind her neck. She states that whenever her blood pressure is taken, it’s always high. The client verbalized that her last blood pressure was 150/110 and that she was informed for having a hypertension. When we took her BP again the result was 150/100. The last time she went to the health center, the physician prescribed her a medicine for hypertension. Unfortunately she is not taking her maintenance due to financial constraint. Client only take alternative way/ medication such as garlic and pineapple juice for her high blood pressure. Health history Patient

(-) Hypertension
(-) Diabetes Mellitus
(-) Asthma
(-) Cancer Husband

(+) Arthritis
(-) Diabetes Mellitus
(-) Cancer Patient’s mother

(+) Hypertension
(-) Asthma
(-) Diabetes Mellitus
(-) Cancer Husband’s Mother

(+) Arthritis
(-) Diabetes Mellitus
(-) Hypertension
(-) Cancer Patient’s father

(+) Hypertension
(-) Asthma
(-) Diabetes Mellitus
(-) Cancer Husband’s Father

(+) Arthritis
(-) Diabetes Mellitus
(-) Hypertension
(-) Cancer Patient’s Data

Name: Mrs. A.R
Age: 52 years old
Sex: female
Address: San Miguel St. Mandaluyong City
Religion: Roman Catholic
Civil Status: Married
Occupation: Housewife
Educational Attainment: High School Graduate
Place of Origin: Bicol
Length of Residency: 28 years
Name of Husband: Mr. A.R
Number of Children: 5 Children Nursing history Date and Time: September 2012

General Survey:

Our client is 52 years old and she weighs 200lbs. When in standing she is erect, relaxed and coordinated when walking. She is neat, has no signs of any distress or illness. Our client is cooperative when given instructions and is understandable and clear when speaking. She is able to answer the questions correctly during the interview. Physical Assessment Temperature 36.8 degree Celsius

Pulse 61 bpm

Respiration- 19 bpm

Blood pressure 150/100 mmHg vital signs Brain
Skin Inspection
Palpation Skin color: intact skin with fair skin tone

Uniformity: generally uniform in color

Asses for Edema: No edema was noted. But the client appears to be fat since she is overweight

Skin lesions: Client has no lesions, only the presence of moles in the face and arms.

Skin turgor: client’s skin is able to return in its previous skin in less than 2 sec No deviation from normal Hair inspection Client has:

Evenly distributed
hair

Thick hair

Silky and resilient

There’s no presence of
infection or any
infestation

And variable body hair no deviations from normal Nail inspection Finger snail plate shape: she has a convex curvature nail

Nail texture: smooth

Nail color: pink in color and vascular in appearance

Surrounding tissue: Has an intact skin around the nails

Blanch Test: prompt return of color in less than 4secs no deviations from normal skull and face inspection Skull size, shape Symmetry:

client’s head is normocephalic, round and symmetric with no presence of nodules and masses upon palpation

Facial Features: client’s has a symmetric features, no edema on the eyes were noted and able to move her facial features, thus is symmetric no deviations from normal
lower extremities Inspection
palpation Intact skin, presence of moles on the calf and feet
Toenails are long and appears to be dirty No deviations from normal
Dirt under nails only indicates poor hygienic practice mouth inspection Lips: pink in color, with slightly dry appearance

Teeth and Gums:

With incomplete teeth and presence of dental carries, moist and smooth but no lesions were noted Client has incomplete teeth. Presence of dental carries neck inspection
palpation Neck Muscles:

Equal in size and strength, with coordinated movement

Assess for LN:

Not palpable upon palpation, trachea is in central placement

Assess Thyroid
Gland:

Not visible, palpable when patient is swallowing no deviations from normal upper extremities Inspection
Palpation Intact skin, no presence of lesions
Fingernails appears to be dirty No deviations from normal

Dirt under fingernails only indicate poor hygienic practice posterior thorax and lungs Inspection
Palpation
Percussion
Auscultation Client has a fair complexion but with dark color on the skin folds

No tenderness noted upon palpation

Resonance was heard when percussed

And no adventitious breath sounds were noted when auscultate Dark color on skin folds with presence of fats indicate Acanthosis Nigricans, anteror thorax and lungs inspection
palpation
percussion
auscultate Skin is intact and uniform in color except on the skinfolds

No tenderness were noted, equal fremitus felt when palpated and breast is large due to her body size

No adventitious sounds were noted no deviations from normal abdomen inspection
palpation
percussion
auscultation Intact skin, presence of moles on the calf and feet
Toenails are long and appears to be dirty no deviations from normal upper extremities Inspection
Palpation Intact skin, no presence of lesions
Fingernails appears to be dirty No deviations from normal

Dirt under fingernails only indicate poor hygienic practice posterior thorax and lungs Inspection
Palpation
Percussion
Auscultation Client has a fair complexion but with dark color on the skin folds

No tenderness noted upon palpation

Resonance was heard when percussed

And no adventitious breath sounds were noted when auscultate Dark color on skin folds with presence of fats indicate Acanthosis Nigricans, anteror thorax and lungs inspection
palpation
percussion
auscultate Skin is intact and uniform in color except on the skinfolds

No tenderness were noted, equal fremitus felt when palpated and breast is large due to her body size

No adventitious sounds were noted no deviations from normal abdomen inspection
palpation
percussion
auscultation Intact skin, presence of moles on the calf and feet
Toenails are long and appears to be dirty no deviations from normal Forebrainis responsible for a variety of functions including receiving and processing sensory information, thinking, perceiving, producing and understanding language, and controlling motor function. Most of the actual information processing in the brain takes place in thecerebral cortex.Midbrainis involved in auditory and visual responses as well as motor function.Hindbrain These regions assist in maintaining balance and equilibrium, movement coordination, and the conduction of sensory information. Also controls autonomic functions such as breathing, heart rate, and digestion.
Functions:
Thought and Voluntary movement
Posture and Balance
Basic Life Functions Forebrain  is responsible for a variety of functions including receiving and processing sensory information, thinking, perceiving, producing and understanding language, and controlling motor function. Most of the actual information processing in the brain takes place in the cerebral cortex.  Mid brain  is involved in auditory and visual responses as well as motor function.Hindbrain These regions assist in maintaining balance and equilibrium, movement coordination, and the conduction of sensory information. Also controls autonomic functions such as breathing, heart rate, and digestion. 

Functions:
Thought and Voluntary movement
Posture and Balance
Basic Life Functions

Basal Ganglia
Involved in cognition and voluntary movement.
Diseases related to damages of this area are Parkinson's and Huntington's

Brainstem
Relays information between t-he peripheral nerves and spinal cord to the upper parts of the brain.

Broca's Area
Speech production
Understanding language

Cerebellum
Controls movement coordination and maintains balance and equilibrium.
Cerebral Cortex
Outer portion (1.5mm to 5mm) of the cerebrum Receives and processes sensory information.

Cerebrum
Largest portion of the brain.

Cranial Nerves
Twelve pairs of nerves that originate in the brain, exit the skull, and lead to the head, neck and torso. Hypothalamus
Directs a multitude of important functions such as body temperature, hunger, and homeostasis

Olfactory Cortex
Receives sensory information from the olfactory bulb and is involved in the identification of odors


Thalamus
mass of grey matter cells that relay sensory signals to and from the spinal cord and the cerebrum
Medulla Oblongata
Lower part of the brainstem that helps to control autonomic functions

Meninges
Membranes that cover and protect the brain and spinal cord

Pituitary Gland
Endocrine gland involved in homeostasis
Regulates other endocrine glands

Pons
Relays sensory information between the cerebrum and cerebellum
The heart is the organ that helps supply blood and oxygen to all parts of the body. It is divided by a partition or septum into two halves, and the halves are in turn divided into four chambers. The heart is situated within the chest cavity and surrounded by a fluid filled sac called the pericardium. This amazing muscle produces electrical impulses that cause the heart to contract, pumping blood throughout the body.

Functions:
Transporting Oxygen and removing Carbon Dioxide
Transporting Nutrients and removing Wastes
Fighting Disease
Transporting Hormones
Regulating Body Temperature
Chambers
Atria- upper two chambers of the heart.

Ventricles- lower two chambers of the heart.

Heart Wall
Epicardium- the outer layer of the wall of the heart.

Myocardium- the muscular middle layer of the wall of the heart.

Endocardium- the inner layer of the heart.
Cerebral Cortex
Outer portion (1.5mm to 5mm) of the cerebrum Receives and processes sensory information.

Cerebrum
Largest portion of the brain.

Cranial Nerves
Twelve pairs of nerves that originate in the brain, exit the skull, and lead to the head, neck and torso. Hypothalamus
Directs a multitude of important functions such as body temperature, hunger, and homeostasis

Olfactory Cortex
Receives sensory information from the olfactory bulb and is involved in the identification of odors


Thalamus
mass of grey matter cells that relay sensory signals to and from the spinal cord and the cerebrum Cardiac Conduction
Cardiac Conduction is the rate at which the heart conducts electrical impulses. The following structures play an important role in causing the heart to contract:
Atrioventricular Bundle- bundle of fibers that carry cardiac impulses.
Atrioventricular Node- a section of nodal tissue that delays and relays cardiac impulses.
Purkinje Fibers- fiber branches that extend from the atrioventricular bundle.
Sinoatrial Node- a section of nodal tissue that sets the rate of contraction for the heart.

Cardiac Cycle
The Cardiac Cycles the sequence of events that occurs when the heart beats. Below are the two phases of the cardiac cycle:
Diastole Phase- the heart ventricles are relaxed and the heart fills with blood.
Systole Phase- the ventricles contract and pump blood to the arteries.
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