ASSESSMENT

Subjective:
Hindi ako
Katurog hay
sa ubo ko as
verbalized by
The patient.
Objective:
Fatigue.
Dyspnea.
V/S taken as
follows:
T: 37.7 C
P: 90 cpm
R: 22 bpm
BP:110/80
mmHg

DIAGNOSIS

PLANNING

Activity
intolerance
related to
exhaustion
associated with
interruption in
usual sleep
pattern because
of discomfort,
excessive
coughing and
dyspnea.

After 4 hours of
nursing
interventions,
the patient will
demonstrate
measurable
increase
intolerance
inactivity with
absence of
dyspnea and
excessive
fatigue.

INTERVENTIO
NS
Independent:
Evaluate
patients
response to
activity.
Provide a
quiet
environment
and limit
visitors during
acute phase.
Elevate head
and
encourage
frequent
position
changes, deep
breathing and
effective
coughing.
Encourage
adequate rest
balanced with
moderate
activity.
Promote
adequate
nutritional
intake.
Force fluids
to at least
3000 ml per
day and offer
warm, rather
than cold
fluids
Collaborative:
Administer
medications
as prescribe:
mucolytic
Or
expectorants.

RATIONALE

EVALUATION

Establishes
patients
capabilities or
needs and
facilitates
choice of
interventions
Reduces
stress and
excess
stimulation,
promoting
rest.

After 4 hours
of nursing
interventions,
the patient
was able to
demonstrate
measurable
increase
intolerance
inactivity with
absence of
dyspnea and
excessive
fatigue.

These
measures
promotes
maximal
inspiration,
enhance
expectoration
of secretions
to improve
ventilation.
Facilitates
healing
process and
enhances
natural
resistance.
Fluids
especially
warm liquids
aid in
mobilization
and
expectoration
of secretions.
Aids in
reduction of
bronchospasm
and
mobilization
of secretions.

Mandeoya, Angie G. BSN-2

A.

Nursing Care Plan

ASSESSMENT
Subjective:
nabudlayan
ako
maginhawa,
as verbalized
by the
patient.
Objective:
Use of
accessory
muscle.
Abnormal
breath
sounds.
Restlessness
Cough
Rapid
breathing
V/S taken as
follows:
T: 37.3 C
P: 82 bpm
R: 25 cpm
BP: 130/80

DIAGNOSIS
Ineffective
airway
clearance
related to
asthma

PLANNING

INTERVENTIO
NS

RATIONALE

EVALUATION

After 3 days of
nursing
interventions,
the patient will
demonstrate
behaviours to
improve airway
clearance.

Independent:
Auscultate
breath
sounds. Note
adventitious
breath sounds
like wheezes,
and crackles

Some degree
of
bronchospasm
is present
with
obstructions
in airway and
mayor may
not be
manifested in
adventitious
breath
sounds.
Elevation of
the bed
facilitates
respiratory
function by
use of gravity.

After 3 days of
nursing
interventions,
the patient was
able to
demonstrate
behaviours to
improve airway
clearance.

Elevate head
of the bed,
have patient
lean on over
bed table or
sit on edge of
the bed.
Keep
environmental
pollution to a
minimum like
dust, smoke
and feather
pillows,
according to
individual
situation.
Encourage or
assist with
abdominal or
pursed lip
breathing
exercises.
Assist with
measures to
improve
effectiveness
of cough
effort.
Increased
fluid intake to
3000 ml/ day.
Provide warm
or tepid
liquids.

Collaborative:
Administer
bronchodilator

Precipitators
of allergic
type of
Respiratory
reactions that
can trigger or
exacerbate
onset of acute
episode.
Provides
patient with
some means
to cope with
or control
dyspnea and
reduce air
tapping.
Coughing is
most effective
in an upright
position after
chest
percussion.
Hydration
helps
decrease the
viscosity of
secretions,
facilitating
expectoration.
Using warm

s as
prescribed.

liquids may
decrease
bronchospasm
.
To reduce
the viscosity
of secretion.

ASSESSMEN
T

DIAGNOSIS

PLANNING

INTERVENTION
S

RATIONALE

EVALUATION

Subjective:
nagasakit
ang busong
ko, kapin pa
kun tapus ko
kaun, as
verbalized by
the patient.
Objective:
Restless
Pacing
Rigid
abdomen
Self-focused
Wrinkled
nose
Raised
upper lips
Rapid
breathing
Rated pain
as 7/10 in a
pain scale of
0-10
Vital Signs:
BP:120/80
mmHg
PR: 87 bpm
RR: 32 cpm
Temp: 37.4C

Acute pain
related to
chemical burn
of gastric
mucosa

After 2 hours
of nursing
interventions,
the patient
will verbalize
relief from
pain and rate
it as 2/10
from 7/10.

Independent:
Assess pain
characteristics
(quality,
severity,
location, onset,
duration,
precipitating and
relieving
factors).
Observe or
monitor signs
and symptoms
associated with
pain, such as BP,
heart rate,
temperature,
color and
moisture of skin,
restlessness,
and ability to
focus.
Assess for
probable cause
of pain.

Identify and
limit foods that
cause
discomfort such
as spicy foods
and carbonated
drinks.
Dependent:
Administer
analgesic for
relief of pain
(e.g. morphine
sulphate).

These data
can be used to
identify the
extent of the
pain as well as
serve as
baseline
information.
Some people
deny the
experience of
pain when it is
present.
Attention to
associated sign
s may help the
nurse in
evaluating pain
.
Different
etiological
factors respond
better to
different
therapies.
Food has
acid neutralizin
g effect
and dilutes
gastric
content.

Administer
antacids(e.g.
Magnesium
Hydroxide
Aluminium
Hydroxide

Relieves
abdominal pain
by reducing
the peristaltic
activity.
Helps relieve
pain
by neutralizing
stomach acid
and increasing
bicarbonate
and mucus
secretion.

Collaborative:
Provide and
implement
prescribed
dietary
modifications.

Patient may
receive nothing
by mouth
initially. When
oral intake is

Goal met.
After2 hours
of nursing
interventions
, the patient
verbalized
relief from
pain and
rated it as
2/10from
7/10.

allowed,
food choices
will depend on
the diagnosis.

B.

Journal Article

High blood pressure: The silent killer

By Dr. Philip S. Chua
Published: February 5, 2015
What is High Blood Pressure?
High Blood Pressure, or Hypertension, is a condition where the persons blood pressure is persistently elevated
beyond what is medically considered normal level. Normal blood pressure has a wide range from person to
person. When taking blood pressure, there are two sets of figures noted by the physician, the systolic and the
diastolic pressure, expressed in Millimetres of Mercury as systolic pressure over the diastolic pressure, like
120/80.
What is systolic and diastolic blood pressure?
The systolic pressure is the force of the flow of blood as it travels inside and through the arterial pipe, while the
diastolic pressure is the force exerted by the blood against (perpendicular to) the inner wall of the artery.
What is the normal blood pressure?
A systolic pressure of 100 to 140, over a diastolic pressure of 60 to 90 are the normal sets of figures. For
instance, blood pressure of 100/60 to 140/90 is the range of normal. The diastolic pressure (the second figure) is
most important in determining if a person has hypertension or not. If the systolic is higher than 140 and the
diastolic pressure is higher than 90 on at least three separate office visits, then the diagnosis of hypertension
applies. So, a blood pressure of 130/92, taken as described above, is considered hypertension (though mild). The
older the patient is, the higher the diastolic pressure, and the higher the diastolic is, the more severe the
hypertension is.
How does one know if he/she has high blood pressure?
Obviously by having the blood pressure taken, preferably by an experienced nurse or a physician. Other factors
and conditions in the patient will be considered by the physician before making a diagnosis of Hypertension.
Once a hypertensive always a hypertensive?
Basically, yes, once you are diagnosed to have high blood pressure, you are always a hypertensive, even if your
pressure is lowered to normal level and well-controlled by medication. Once a hypertensive always a
hypertensive, the reason why high blood pressure requires medication for life to maintain a normal blood
pressure.
What is White-Coat Hypertension?
White-Coat Hypertension is a condition where the patients blood pressure goes up when he/she goes to visit
the doctor. Somehow the White Lab Coat of the physician taking the blood pressure seems to jack up anxiety
and the adrenalin level in the waiting patient, leading to a rise in the blood pressure of this patient, but only
temporarily if the patient is really not a hypertensive. And when a nurse takes the blood pressure, it is back
down to normal.
What are the signs or symptoms of hypertension?
Not all persons with high blood pressure have symptoms. As a matter of fact, many of them do not have
symptoms, especially the mild to moderate hypertensive. This is why it is called the silent killer. Some simply
develop a stroke or a heart attack, before learning they have hypertension. Classically, though, some of the
symptoms might include headaches, feeling of wanting to explode, being short-tempered, of being flushed;
and nervousness, irritability, impatience, etc.

How common is high blood pressure?

About 20% or 50 million of the population of the United States have high blood pressure (systolic higher than
140 and diastolic higher than 90 mm. Hg). Hypertension occurs more in black than in white Americans. This
writer does not have statistics on the prevalence of hypertension in the Philippines. In a northern province of
Japan, inhabitants consume the highest amount of salt per capita, and the incident of hypertension in that area is
the highest in the country. Since we Filipinos love to eat salty food, I would not be surprised if the incidence of
high blood pressure in the Philippines is at least like that of the United States, about 20% of the population.
Does ingesting salty food really aggravate high blood pressure?
Yes, because when one eats salty food, water is retrained in the body, increasing the volume of total body fluids,
which leads to elevation of blood pressure, especially among hypertensive persons. There is another
mechanism, a chemical one, that goes into effect when the person with high blood pressure ingests salt or salty
food, aggravating the high blood pressure. This is why physicians strongly recommend a low-salt diet as an
essential part of the treatment strategy for patients with high blood pressure.
Do we really need to eat salt?
No, unless the person has lost an abnormal amount of Sodium from severe diarrhea, dehydration, or other
illnesses that lower the serum sodium level in the person. In these cases, sodium chloride ingestion, or even
intravenous infusion of sodium chloride might be needed. There is really no need to start shaking the salt
shaker, because the fruits, vegetables, fish, meat, etc. that Mother Nature has given us all contain the perfect
amount of sodium already. Adding salt to our food, even before we even taste it, is just a bad habit that many of
us have developed over the years. Indeed, it is best to be on a low-salt diet, especially as we grow older than 30.
What else is bad for a person with high blood pressure?
Smoking, lack of exercise, eating eggs and red meats (pork, beef, etc.), stress, lack of rest and relaxation, are
some of the aggravating factors in a patient with hypertension.
Is hypertension curable?
No, there is no cure for high blood pressure. The only exception to this are conditions or tumors in the adrenal
glands (located on top of the kidneys), where the high blood pressure ceases after surgery. The commonest high
blood pressure conditioncalled Essential Hypertension or Primary Hypertensionis not curable. It is
controllable with medications.
Can a person with high blood pressure live normally?
Yes, with current day treatment, a person with high blood pressure who is under effective management with
pills, low-salt and low-fat diet, exercise and no smoking, can live a normal life. As long as the treatment is taken
daily, and as long as the blood pressure is controlled well, the person could even have a normal life span. With
several medications available today in the physicians armamentarium against hypertension, persons with high
blood pressure nowadays, who are compliant with the treatment, can be as healthy as the next person who
does not have high blood pressure. However, there are some persons with the so-called malignant hypertension,
who are resistant to the conventional treatment. These are the ones whose blood pressure is not well-controlled
and these individuals are prone to develop complications of hypertension.
How often should the blood pressure be checked?
It depends. If the blood pressure is erratic or hard to control, like when the patient is starting on a new
medication for hypertension, the blood pressure should be taken once a day until the medication is adjusted and
the blood pressure is basically controlled. If the blood pressure is within normal limits (as described above), as a
response to treatment, the medications should be continued for life, and the blood pressure could be taken once
a week. If it is really stable at the normal range, then it could be done once every two weeks or once a month. It

is important to continue taking medications daily or regularly (as prescribed by the physician) for life, even if
the blood pressure is well-controlled and now normal. What is keeping it normal is the medication! So, do not
stop, unless ordered by your physician.
***
Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac
surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus
in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine
College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the
Filipino United Network USA, a 501(c)(3) humanitarian foundation in the United States. Email:
scalpelpen@gmail.com
Reference:
Chua, P.S. (2015, February 5).High blood pressure: the silent killer. Retrieved from
http://asianjournal.com/lifestyle/high-blood-pressure-the-silent-killer/

Summary
Elevated arterial pressure is the most important public health problem in developed countries being common,
asymptomatic, readily detectable, usually easily treatable, and oft en leading to lethal complications if left
untreated. Effective hypertension treatment can reduce the risk of stroke, heart attack and congestive heart
failure, hypertensive retinopathy and nephropathy. The goal of hypertension treatment is to reduce blood
pressure levels. Treatment of hypertension and proper lifestyle changes reduce the risk of serious hypertension
complications. High BP is a major risk factor for strokes, heart attacks, heart failure, kidney failure and
cardiovascular morbidity and mortality. Treatment not only reduces the incidence of strokes and coronary
events but also prevents left ventricular hypertrophy, heart failure, renal failure and dementia. Appropriate
management of individuals with high BP should include correction of other cardiovascular risk factors. The fact
remains that many individuals in the UK with high BP are inadequately controlled. Finally, it is imperative for
healthcare professionals to assess treatment non-adherence by toxicological urine testing to prevent wrong
measures being taken. Specifically referring to hypertension as an illness, highlighting the chronic damage
caused by exposure to high values of blood pressure and providing patients with information about the
importance of the various treatment modalities in a way that would address their individual reservations may
improve control of both diabetes and hypertension. High blood pressure (BP) or hypertension is one of the
major modifiable risk factors for cardiovascular morbidity and mortality. Treatment of hypertension not only
reduces the incidence of death and morbidity from strokes and heart attacks but also prevents heart failure, renal
failure, aortic disease, peripheral vascular disease and dementia. This article is very helpful for a hypertensive
person because they can gain ideas about the disease. It can give ideas on how to prevent and minimize the
disease. For me this also gives me knowledge about hypertension and I can use the ideas I learned here to health
educate my patient.