c
c



 
c


To be able to render nursing to the client particularly to her
conditional status prior to her situation and will be able to enhance
participation in conducting such intervention thus, influencing the
overall health status.


cc
c



 To be able to define about Hypertension.
 To be able to know what causes Hypertension.
 To be able to discuss the pathophysiology of
Hypertension.
 To be able to know the medical management appropriate
to Hypertension.
 To be able to construct Nursing Care Plan appropriate for
client reliable to the case.
 To be able to attain and maintain health of the client by
giving health teaching to the parent and sharing of
nursing consideration.
 To be able to give appropriate nursing teachings for
patient, prior to discharge to maintain self-awareness of
the parents in giving care for their child.










cc
 c
c

à
Catalina M. Aquino

Ñ y/o

à

     


 à

¦




  


 



¦   




 !"




#$   %   



ë
 

ccc
 c

 c
c 

 The patient·s son is being interviewed and he verbalized that in his family
members has a history of Hypertension, Diabetes, and even Heart Failure. His
mother known to have hypertension, sometimes his mother goes to the
barangays clinic near to their house. The patient enjoys eating vegetables and
fruits but she eats a lot of salty and fatty foods and she drinks too much coffee.
The patient·s husband died last 5 years ago, and they lived together with her 3
sons.

c
 

 
c

The patient has a past illness of headache, fatigue, blurring of vision,
and weakness, it occurs during the blood pressure was elevated. February 04
20 0 at
30am the patient was admitted to Luzon Medical Center together
with her son Mr. Armando Aquino, upon admission of the patient she
complaint nausea and vomiting and loss of consciousness associated with
severe headache. The staff nurses of the institution give further intervention
and checked Vital Signs and they noted that her Blood Pressure is elevated. Dr.
go her attending physician and he was ordered medicines, and laboratory test
and other appropriate intervention for the patient, and she was diagnosed with
Hypertension with severe headache.


cc
c 
c
 c

ë


Hypertension is the term used to describe high

blood pressure.

ë
  is a chronic medical
condition in which the blood pressure is elevated.
It is also referred to as 
 or
shortened to ë, ë or ë
. The word
"hypertension", by itself, normally refers to
systemic, arterial hypertension.

Hypertension can be classified as either

  (primary) or  . Essential or primary hypertension means
that no medical cause can be found to explain the raised blood pressure. It is
common. About 90-95% of hypertension is essential hypertension. Secondary
hypertension indicates that the high blood pressure is a result of (©
,
secondary to) another condition, such as kidney disease or tumours (adrenal
adenoma or pheochromocytoma).

Persistent hypertension is one of the risk factors for strokes, heart

attacks, heart failure and arterial aneurysm, and is a leading cause of chronic
renal failure. Even moderate elevation of arterial blood pressure leads to
shortened life expectancy. At severely high pressures, defined as mean arterial
pressures 50% or more above average, a person can expect to live no more than
a few years unless appropriately treated. Beginning at a systolic pressure
(which is peak pressure in the arteries, which occurs near the end of the
cardiac cycle when the ventricles are contracting) of 5 mmHg and diastolic
pressure (which is minimum pressure in the arteries, which occurs near the
beginning of the cardiac cycle when the ventricles are filled with blood) of
Ñ5 mmHg (commonly written as 5/Ñ5 mmHg), cardiovascular disease (CVD)
risk doubles for each increment of 20/ 0 mmHg.

Blood pressure readings are measured in millimeters of mercury (mmHg)

and usually given as two numbers. For example, 20 over 80 (written as
20/80 mmHg).

 The top number is your systolic pressure, the pressure created when your heart
beats. It is considered high if it is consistently over 40.
 The bottom number is your diastolic pressure, the pressure inside blood vessels
when the heart is at rest. It is considered high if it is consistently over 90.

Either or both of these numbers may be too high.

Pre-hypertension is when your systolic blood pressure is between 20

and 39 or your diastolic blood pressure is between 80 and 89 on multiple
readings. If you have pre-hypertension, you are more likely to develop high
blood pressure.

p

Blood pressure measurements are the result of the force of the blood
produced by the heart and the size and condition of the arteries.
Many factors can affect blood pressure, including

 How much water and salt you have in your body

 The condition of your kidneys, nervous system, or blood vessels
 The levels of different body hormones

High blood pressure can affect all types of people. You have a higher risk of
high blood pressure if you have a family history of the disease. High blood
pressure is more common in African Americans than Caucasians. Smoking,
obesity, and diabetes are all risk factors for hypertension.

Most of the time, no cause is identified. This is called essential hypertension.

High blood pressure that results from a specific condition, habit, or

medication is called secondary hypertension. Too much salt in your diet can
lead to high blood pressure. Secondary hypertension may also be due to

 Adrenal gland tumor

 Alcohol abuse
 Anxiety and stress
 Arteriosclerosis
 Birth control pills
 Coarctation of the aorta
 Cocaine use
 Cushing syndrome
 Diabetes
 ]idney disease, including

¬ ›lomerulonephritis (inflammation of kidneys)
¬ ]idney failure
¬ ÷enal artery stenosis
¬ ÷enal vascular obstruction or narrowing
 Medications
¬ Appetite suppressants
¬ Certain cold medications
¬ Corticosteroids
¬ Migraine medications
 Hemolytic-uremic syndrome
 Henoch-Schonlein purpura
 Êbesity
 Pain
 Periarteritis nodosa
 Pheochromocytoma
 Pregnancy (called gestational hypertension)
 Primary hyperaldosteronism
 ÷enal artery stenosis
 ÷etroperitoneal fibrosis
 milms' tumor

 


Most of the time, there are no symptoms. Symptoms that may occur include

 Chest pain
 Confusion
 Ear noise or buzzing
 Irregular heartbeat
 Nosebleed
 Tiredness
 Vision changes
If you have a severe headache or any of the symptoms above, see your doctor
right away. These may be signs of a complication or dangerously high blood
pressure called malignant hypertension.

 

Health care provider will perform a physical exam and check your blood
pressure. If the measurement is high, your doctor may think you have high
blood pressure. The measurements need to be repeated over time, so that the
diagnosis can be confirmed.

If you monitor your blood pressure at home, you may be asked the following
questions

 mhat was your most recent blood pressure reading?

 mhat was the previous blood pressure reading?
 mhat is the average systolic (top number) and diastolic (bottom number)
reading?
 Has your blood pressure increased recently?

Êther tests may be done to look for blood in the urine or heart failure. Your
doctor will look for signs of complications to your heart, kidneys, eyes, and
other organs in your body.

These tests may include

 Chem-20
 Echocardiogram
 Xrinalysis
 Xltrasound of the kidneys

  

The goal of treatment is to reduce blood pressure so that you have a lower risk
of complications.

There are many different medicines that can be used to treat high blood
pressure, including

 Alpha blockers
 Angiotensin-converting enzyme (ACE) inhibitors
 Angiotensin receptor blockers (A÷Bs)
 Beta-blockers
 Calcium channel blockers
 Central alpha agonists
 Diuretics
 ÷enin inhibitors, including aliskiren (Tekturna)
 Vasodilators

Your doctor may also tell you to exercise, lose weight, and follow a healthier
diet. If you have pre-hypertension, your doctor will recommend the same
lifestyle changes to bring your blood pressure down to a normal range.

Êften, a single blood pressure drug may not be enough to control your blood
pressure, and you may need to take two or more drugs. It is very important
that you take the medications prescribed to you. If you have side effects, your
health care provider can substitute a different medication.

p
 

 Aortic dissection
 Blood vessel damage (arteriosclerosis)
 Brain damage
 Congestive heart failure
 ]idney damage
 ]idney failure
 Heart attack
 Hypertensive heart disease
 Stroke
 Vision loss

m p  


If you have high blood pressure, you will have regularly scheduled
appointments with your doctor.

Even if you have not been diagnosed with high blood pressure, it is important
to have your blood pressure checked during your yearly check-up, especially if
someone in your family has or had high blood pressure.

Call your health care provider right away if home monitoring shows that your
blood pressure remains high or you have any of the following symptoms

 Chest pain
 Confusion
 Excessive tiredness
 Nausea and vomiting
 Severe headache
 Shortness of breath
 Significant sweating
 Vision changes

 

Adults over 8 should have their blood pressure checked routinely.

Lifestyle changes may help control your blood pressure

 Lose weight if you are overweight. Excess weight adds to strain on the heart. In
some cases, weight loss may be the only treatment needed.
 Exercise regularly. If possible, exercise for 30 minutes on most days.
 Eat a diet rich in fruits, vegetables, and low-fat dairy products while reducing
total and saturated fat intake (the DASH diet is one way of achieving this kind
of dietary plan). (See
Heart disease and diet)
 Avoid smoking. (See
Nicotine withdrawal)
 If you have diabetes, keep your blood sugar under control.
 Do not consume more than or 2 alcoholic drinks per day.
 Try to manage your stress.

Follow your health care provider's recommendations to modify, treat, or control

possible causes of secondary hypertension.



c
 

 c


p  
Your heart and circulatory system make up your cardiovascular system. Your
heart works as a pump that pushes blood to the organs, tissues, and cells of
your body. Blood delivers oxygen and nutrients to every cell and removes the
carbon dioxide and waste products made by those cells. Blood is carried from
your heart to the rest of your body through a complex network of arteries,
arterioles, and capillaries. Blood is returned to your heart through venules and
veins. If all the vessels of this network in your body were laid end-to-end, they
would extend for about 60,000 miles (more than 96,500 kilometers), which is
far enough to circle the earth more than twice! The one-way circulatory system
carries blood to all parts of your body. This process of blood flow within your
body is called circulation.   carry oxygen-rich blood away from your
heart, and  carry oxygen-poor blood back to your heart.

In pulmonary circulation, though, the roles are switched. It is the pulmonary

artery that brings oxygen-poor blood into your lungs and the pulmonary vein
that brings oxygen-rich blood back to your heart.

In the diagram, the vessels that carry oxygen-rich blood are colored red, and
the vessels that carry oxygen-poor blood are colored blue.

Twenty major arteries make a path through your tissues, where they branch
into smaller vessels called arterioles. Arterioles further branch into capillaries,
the true deliverers of oxygen and nutrients to your cells. Most capillaries are
thinner than a hair. In fact, many are so tiny, only one blood cell can move
through them at a time. Ênce the capillaries deliver oxygen and nutrients and
pick up carbon dioxide and other waste, they move the blood back through
wider vessels called venules. Venules eventually join to form veins, which
deliver the blood back to your heart to pick up oxygen.

ë - is a muscular organ found in all vertebrates that is responsible for

pumping blood throughout the blood vessels by repeated, rhythmic
contractions. The vertebrate heart is composed of cardiac muscle, which is an
involuntary striated muscle tissue found only within this organ. The average
human heart, beating at Ñ2 beats per minute, will beat approximately 2.5
billion times during an average 66 year lifespan. It weighs on average 250 g to
300 g in females and 300 g to 350 g in males.

!-is a specialized bodily fluid that delivers necessary substances to the

body's cells ² such as nutrients and oxygen ² and transports waste products
away from those same cells.

 -is a specialized bodily fluid that delivers necessary substances to the

body's cells ² such as nutrients and oxygen ² and transports waste products
away from those same cells.

"-n the circulatory system, veins (from the Latin J
) are blood vessels
that carry blood towards the heart. Most veins carry deoxygenated blood from
the tissues back to the lungs; exceptions are the pulmonary and umbilical
veins, both of which carry oxygenated blood. Veins differ from arteries in
structure and function; for example, arteries are more muscular than veins
and they carry blood away from the heart.

] -The kidneys are paired organs, which have the production of urine as
their primary function. ]idneys are seen in many types of animals, including
vertebrates and some invertebrates. They are an essential part of the urinary
system, but have several secondary functions concerned with homeostatic
functions. These include the regulation of electrolytes, acid-base balance, and
blood pressure.

#- Their principal function is to transport oxygen from the atmosphere

into the bloodstream, and to release carbon dioxide from the bloodstream into
the atmosphere. This exchange of gases is accomplished in the mosaic of
specialized cells that form millions of tiny, exceptionally thin-walled air sacs
called alveoli.

cc
  c


 c


ccc
  
  





  

 Normal Values Result Significance

ë
 &ë' (
  !)
   $

     *(  
 

     
!  

       
$

       (

    
 
 !

ë  &ë'  +(,,-  32%    $

     



 .

     
 
!/ 

       $

     0  1  !

          (

      !

2


 )! (3!*3#  4.11x106/L /   
$

&2'     







     $
!/  

       
  (

     
  !/ 

       


$  

     !     

      
  

     
 !

 

 4   3       5$

6
&6'     2!/ 

           !

           (

        !


 

  +4 )
  )!+
  /   $

ë
 &ë'     *(  !ë(

     
   2!

        2 

    
  


       2

     %

 

      ë
!

        ë    

       $ë

    


 
 &
'

 

  ( 3
  )!
 /    $

ë
      
   2!

  &ë'       ë


     &
 '  

       %

     
   



     
  



        $  

        
 !

     / ë


        

     %
  

     

 

      

 

       
 

     
 
  


      !


m 2


 ,(* #  11x 103/L /   


&m2'     $% 






     
$
!/ 

       
$ (

        $ !

" 
(* #  !* # /   


&à

  &3,4-'  &,!-' $ 
  m2

7 

     

$
!/ 

2 

'     /  

  


      
 
    $ !

#
 (,* #  !* # /   
$

  &,(,-'  &3,-' 8(

 2(






     $
!/    

     
  $ $ !

 &!4-'  &,-'  /   
$

      

 

$

     
!/    

       $ !


 ,4)* # ))* # /  $




     /  
$
!

     2  1 

      
  


       $*
 

     
 ! 
XRINE CHEMISTRY (XRINALYSIS)

 Normal Values Result Significance

"
  à     à   $
  

         
 %



             

!

   à     9  $

   

            /ë

            à

1ë à!

ë   )!34!   3!,  /  

ë   

          

.
 !  

            
   !

:
 $ "   ! 4! ,   !,      $

          $  

          !

¦  ¦!


 à
" # #   


 

›
 

  èè


  
  
      
      
      



   !
"
#  #
"    
     

     


$  %
!
  
"   
      &
         '

 !! $!à!àà!

 
 à
" # #   


 

(
)*+  ##!,- è %  .
 
      
'

     /


0
)1+
2#
,- 2
,-  .

     3  
     


 ) +  4% ,- 
2,-  
         5
 
         


  #
2!
"  #
#   
          )  +.
           

          )›63+7
          



c
c 
 


c
 c
  

February 06, 20 0. Dr. ›o his attending physician and they ordered medical
management
the ff. medical management

$  m %  

 

#   This is to assess fro ÷efer to the Laboratory test

 & abnormalities internally ÷esult
happening to the
cardiovascular system and
other bad conditions present.

This determines if there is presence Acute Subarachnoid hemorrhage

ëp of
 infarction
 that can cause stoke. and mild communicating
It reveals infarction, hematoma, hydrocephalus infarcts.
 and shift of brain structure! Atherosclerotic vertebrobasilar and
supraclinoid internal carotid
 arteries
 Mild left ventricular cardiomegaly
This determines if there is
p '(  and tortous atherosclerotic aorta.
presence of abnormal
Clear lungs parenchyma without
 condition of the chest. vascular congestion. Mediatinum
diaphragm and v isualized bone are
unremarkable
02/04/ 0

± Please Admit under my Service (Dr.›o)

± Low Salt, Low Fat Diet

± Monitor Vital Signs every 4 hours

± Monitor I and Ê every hour

± IVF=PNSS x 24 hours

± For CBC, ÷BS

± For Na, ], Creatinine

± For Chest X- ÷ay

± For Electrocardiogram

± Add 30ml of ]Cl same IVF rate to run for 24 hours

± Mefenamic Acid (Ponstan) 500mg Tab now.

02/05/ 0

± pls Transfer to ICX

± Start Mannitol 00ml now

± IVF PNSS liter x 6 hours +30mg ]cl

± Monitor Hgt every 2 hours

± For neurosurgical evaluation and management to Dr. Florendo

± CT Scan @ Bedside

± ›ive vit k amp IV every 8 hours x 3 doses

02/06/ 0

± Same IVF

± Cont. Meds.

± Pls refer accordingly

± Maintain Bedsores Precaution

± Pls Catheter the patient

± Monitor Vital Signs every hour

± Monitor I and Ê every hour

± Ên low salt low fat diet

02/0Ñ/ 0

± Pls insert N›T if the patient cannot eat or drink.

± Pls ›ive Catopril 25mg tab Now

± ÷efer accordingly

02/08/ 0

± May transfer to room

± IVF PL÷S liter x 24 hours

± Cefotaxime 500mg twice a day

02/09/ 0

± Continue Meds.

± Monitor BP every hour

± Maintain Bedsores Precaution

± Strict Aspiration Precaution

± I and Ê ever shift

02/ 0/ 0

± Administer ]cl amp 30mg in D5w 20ml x 2 hours

± PL÷S liter x 6 hours

± For repeat Hgt @ 9pm

02/ / 0

± IVF PL÷S I liter x 6 hours

± H›T monitoring every 2 hours (pre-breakfast & pre-dinner)

± PNSS I liter x 6 hours

± To consume mannitol

± Cont. Meds

02/ 2/ 0

± Possible Discharged or may if ok

± IVF PL÷ I liter x 6 hours

02/ 3/ 0

± Telephone order Êk to discharge

± Cont. Meds

± May remover foley Catheter today after bladder training

± IVF to consume
 ± ›liclazide tab ÊD with breakfast

02/ 4/ 0

± May ›o Home

02/ 5/ 0

± Home Medication are the ff.

I. Arcoxia 60mg tab

II. Nimodipine (nimatop) 20mg tab Ênce a Day

III. Êmeprazole (prosel ) 20mg tab Ênce a Day

IV. Lactulose 20ml @ bedtime

V. Citicoline 500mg tab three time a day

VI. Topiramate 50mg ½ Tab @ bedtime

VII. Metformine 500mg tab Ênce a day

VIII. Micardis 80mg 0D in Morining

IX. Carvedolol 25mg ½ Tab Ênce a day in Morining

± For follow up check up on 02/25/ 0 and 03/03 0

TREATMENT:

8       


 $
 !&$ :'

cc
c  

 c



efore patient has to discharge from the hospital, the nurse should:
         
!  $  $
 
!    
 
 
!  
  
 ;$ 
 $;%  


$
!
)!  
 $      !

  



        
/! 0< 
//!   $

///! ¦ 
   ë 
/6!   /


6! /  
 *!
6/! =    

6//! 
 

6///! #  

/>!  
  
>!  :
>/! à  

>//!    
 








X
&
#'
 8*
9.
0:; 

 


< (


 
#

 %#


!

#(

 
== (
3

:9  
9$> &

#(


9
3 =3*