Case Pres in HTN

8/8/2019 Case Pres in HTN

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INTRODUCTION


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y Hypertension (HTN) or high blood pressure isa chronic medical condition in which the systemicarterial blood pressureis elevated. It is the oppositeof hypotension. It is classified as either primary (essential) orsecondary. About 9095% of cases are termed "primaryhypertension", which refers to high blood pressure for whichno medical cause can be found. The remaining 510% ofcases (Secondary hypertension) are caused by otherconditions that affect the kidneys, arteries, heart, or

endocrine system.y Persistent hypertension is one of the risk factors

for stroke, myocardial infarction, heart failure andarterial aneurysm, and is a leading cause of chronic kidneyfailure. Moderate elevation of arterial blood pressure leads toshortened life expectancy. Dietary and lifestyle changes can

improve blood pressure control and decrease the risk ofassociated health complications, although drug treatmentmay prove necessary in patients for whom lifestyle changesprove ineffective or insufficient.


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Awareness

y The World Health Organization attributes hypertension, orhigh blood pressure, as the leading cause of cardiovascularmortality. The World Hypertension League (WHL), anumbrella organization of 85 national hypertension societies

and leagues, recognized that more than 50% of thehypertensive population worldwide are unaware of theircondition.To address this problem, the WHL initiated aglobal awareness campaign on hypertension in 2005 anddedicated May 17 of each year as World Hypertension Day

(WHD). Over the past three years, more national societieshave been engaging in WHD and have been innovative intheir activities to get the message to the public. In 2007,there was record participation from 47 member countries ofthe WHL. During the week of WHD, all these countries in


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partnership with their local governments, professional societies,nongovernmental organizations and private industries promoted hypertension awareness among the public throughseveral media and public rallies. Using mass media suchasInternet and television, the message reached more than 250

million people. As the momentum picks up year after year, theWHL is confident that almost all the estimated 1.5 billion peopleaffected by elevated blood pressure can be reached.


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Mr. Fidelity was brought in Laguna ProvincialHospital Sta. Cruz, Laguna last September 07, 2010because he got stoke. And his chief complaint wasnumbness of the left side body. This informationcame from his daughter, who were recently there.Other than that she didnt say anything withregards to her fathers condition.


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Rationale for Choosing the Case

This case has been chosen by the group under followingreasons:

y To better understand the study, Hypertension Stage 2 andappropriate interventions that may contribute to patientsrecovery.

y To benefit the student nurses in enhancing their skills ingiving care for such patient diagnose with Stage 2Hypertension

y To formulate proper nursing care plany To defy our capabilities in presenting such challenging

case.y Be able to construct a pathophysiology.y Challenge our skills in connecting relevant details of the

disease to actual care of client.


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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 clientrecovery

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 uponhandling the client and sustaining for her recovery. Hence, we hopeto be of help to our fellow students by sharing first handexperiences about the condition.


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Eclectic ModelA. Bio- Demoghraphic Data

Name: Mr. Fidelity Age: 72 y/oGender: MaleAddress: Santisima, Sta. Cruz, LagunaDate of Birth: October 10, 1937

Marital Status: MarriedReligion: Iglesia Ni CristoOccupation: NoneAllergies: No known allergiesPast Medical History: Hypertention Stage IFamily History: Asthma

Diagnosis: Hypertention Stage IIDate of Admission: September 7, 2010Time of Admission: 7:20PMAttending Physician: Dra. Girang


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Source of Information

y

PrimarySourcey Daughter of Mr. Fidelity

y SecondarySourcey Patients 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 hospitalwith a chief complaint of numbness of the left side of the body. He wasadmitted last Sept.7, 2010 and we were just handled him 1 day last Sept.14, 2010.


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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 friedchicken skin and proven that are usually bought in the

streets. He also likes to eat meat such as pork and beef.


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y General Observation

y General Appearance & Behavior

y Weak in appearancey With NGT intacty With indwelling folly catheter

y With presence of dandruff in heady With continuous scratching of head

y Vital signs

y BP 160/100 mmHgy T 35.6oCy P 51 bpmy R 22 cpm


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Complete Physical Examination

y Heady Round and symmetricaly Hair distributed equallyy No infection or infestation of lice and nitsy There are presence of dandruffy No presence of massy Black hair, oily and thick

yFacey No lesionsy Symmetric facial features

y Eyesy Symmetryy Eyebrows are evenly distributed and symmetrically alignedy

Eyelashes are slightly curled outwardy Eyelids close symmetricaly Sclera whitey Iris: round, symmetrical, flat and gray in colory Pupils equally round & react to light and accommodation


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y Earsy Symmetrical equal size and color same as facial skiny

Auricle aligned with outer canthus of eyesy Mobile, firm and not tender, pinna recoils after it is fold

y osey Symmetrically in size and shape.y Nasal septum located at midline.y No dischargey With NGT inserted

y Mouthy Dry & pale lipsy Dry oral mucosay Tonsils not swollen

y ecky Free from lumps, masses and tendernessy No presences of scars

y Chesty Sternum located at the midliney Heart:With cardiac rate of 51bpmy Respiratory rate: 22cpm


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y Abdomeny No lesions and swellingy Firm

y

y Upper extremitiesy Symmetrical in size and shapey With 5 fingers in both left and right handy Capillary refill 2-3 secondsy No tenderness or swellingy Numbness at the left arm

y

y Lower extremitiesy Symmetrical in size and shapey With 5 fingers in both left and right footy No tenderness or swellingy Numbness at the left Leg

y

y D. Initial Impressiony Hypertension Stage II


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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 mmHgTemp: 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 doctors 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


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Chemistry 09-07-10

Test Result Normal Values Analysis

Interpretation

Sodium

138.4

mmol/L 135 - 155 mmol/L

Within normal

range

Potassium

11.26

mmol/L 3.6 - 5.3 mmol/L Increased

Indicates

hypokalemia


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Circulatory system

The systems involved in giving part to the

development of hypertention is the circulatorysystem.

The circulatory system is a networkthat carries blood throughout the body.

The human circulatory systemsupplies the cells of the body with the food and

oxygen they need to survive. At the same time, itcarries carbon dioxide and other wastes awayfrom the cells. The circulatory system also helpsregulate the temperature of the body and carriessubstances that protect the body from disease. Inaddition, the system transports chemicalsubstances called hormones, which help regulate

the activities of various parts of the body. One ofthe parts of the circulatory system is the heart. Itis a hollow, muscular organ that pumps blood. Itconsists of two pumps that lie side by side. Thesepumps relax when taking in blood and contractas they send out blood. The left side of the heartis a stronger pump than the right side.


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y . The stronger pump receives blood from the lungs and sends it to cellsthroughout 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 tubesthroughout 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 theveins. The blood consists chiefly of liquid called plasma, and threekinds of solid particles known as formed elements. Plasma is made upmostly of water, but it also contains proteins, minerals, and othersubstances. The three types of formed elements are called red bloodcells, white blood cells, and platelets.


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y Medication

y Teach to the patient and SO on how to administer patients home medication.y Explain to the patient and SO importance of proper compliance with the

medication.

y Environmenty Practice proper hygiene.y

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

y Health Teachingsy Teach patient and SO about the clients diet.y Educate patient and SO some range of motion for the client. ( flexion,

extension, rotation)y Encourage patient to have enough rest and sleep.y Instruct to avoid heavy or hard activities.y Advise for regular follow-up care or check-up.


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y Out Patient Scheduley Inform patient and SO about the patients follow-up check up for the

health status of the patient for further assessment of improvementsand proper medications.

y Diety Adopt DASH (dietary approaches to stop hypertension) eating plan.

y This eating plan is rich in:y Fruitsy Vegetablesy Whole grains, andy Low-fat dairy foods;

y meaty fishy poultryy nuts and beans

y Limited in sugar-sweetened foods and beverages, red meat, and added fatsy Discourages the consumption of processed foodsy Dietary sodium reduction


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y Summary

y Hypertension (HTN) or high blood pressure isa chronic medical condition in which the systemicarterial blood pressure is elevated. It is the oppositeof hypotension. It is classified as either primary (essential)or secondary. About 9095% of cases are termed "primaryhypertension", which refers to high blood pressure for

which no medical cause can be found. The remaining 510% of cases (Secondary hypertension) are caused by otherconditions that affect the kidneys, arteries, heart, orendocrine system. It may also lead to different diseases, it isa risk factor for heart diseases and stroke.

y In our patient the underlying cause of his disease isbecause of his lifestyle. He smoke 1 pack of cigarette perday and loves eating high cholesterol foods. This factorscontributed for his present condition.


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Case Pres in HTN