Professional Documents
Culture Documents
Case Presentation
Presented To:
Mrs. Dolores Maloles
Clinical Instructor
Presented By:
Group 11 BSN III-C
Causapin , Jiggle
Elmundo , Cristina Lu
Pesquisa , Jaymee O .
Reforma , Reynold
Zurbano , Ivy
General Objectives
The purpose of this study
is to gain additional
knowledge, develop related
nursing skills and apply the
right attitudes that student
nurses in rendering quality
nursing care to the patient
with Hypertensive
Arteriosclerotic Cardiovascular
Disease, it’s importance and
Specific Objectives
To understand condition of disease and
associate it with the patient through
the introduction of the case
HASCVD (Hypertensive
arteriosclerotic cardiovascular disease) is a
fancy way of saying "blocked arteries
secondary to cholesterol plaques and in the
setting of hypertension." It describes a
common clinical syndrome, where the walls
of coronary (heart) arteries are lined with
cholesterol plaques.
The plaques have a tendency to
grow slowly over time and narrow the
arteries. Unfortunately, some of
these plaques can suddenly burst
open, blocking the artery completely.
Such blocked artery leads to blood
deprivation to the heart muscle, a
phenomenon we all know as a heart
attack.
It’s the progressive hardening of
the arteries due to long standing
hypertension. In this case
cardiovascular arteries are hardened,
compromising blood flow to the heart
muscle and tissue. complications
include Angina Pectoris, MI (Heart
Attack) and Heart failure.
B. Rationale for choosing the case
- none
c. Allergies
- Vehicular Accident
e. Hospitalizations
f. Medication used or currently taking
- Metoprolol 50mg 1tab twice a day (8am-6pm)
- Amlodipine 10mg 1 tab once a day (8pm)
- Telmisartan (Pritor) 80mg 1tab once a day (8am)
- Betahistine (Serc) 16mg 1 tab thrice a day (8am-1pm-
6pm)
- Atorvastatin (Lipitor) 80mg 1tab once a day at hours
of sleep (8pm)
g. Domestic Travel
- The only and usual route of the patient is from Lucena
to Cavity.
•
D. Family History (genogram)
Grand mother unknown Grand mother unknown
Grand father Grand Father
unknown unknown
Father
unknown Mother unknown
Brother
Brother Sister Sister Brother Patient
80y/0
81y/0 70y/0 49y/0 29y/0 72y/0
cardiac
old aging Heart disease peptic ulcer murder
arrest
E. Social History – Include Theories and
Growth and Development
PSYCHOSOCIAL THEORY ACCORDING TO ERIK
ERIKSON
Nutritional / Met
Activity and
c. ADL everyday
Cognitive / Perceptual
a . orientation Oriented to
b . responsiveness time , place and
person
Responds
appropriately
to verbal and
physical
stimuli
Roles / Relationship
his wife
With good
relationship with
his co-worker and
manager
Self Have a high Have a high
Perception / Sel self self
f Concept worth / importance worth / importanc
Coping Stress He seeks advice to eHe seeks advice
his wife and to his son and
friends when he friends when he
has problems, has problems,
burdens and burdens and
stresses. He wants stresses. He wants
to talk about it to talk about it
right away. He also right away. He
trust God in also trust God in
everything he do. everything he do.
Component ResultNormal Interpretation Implication Nursing
J. Laboratory
RangeDiagnostic Exam Responsibilities
Cholesterol 208 mg/dl 0-200 mg/dl The patient has Instruct the patient
a high level of to choose
cholesterol alternative fats.
Replace saturated
and trans fats in
your diet with
monounsaturated and
polyunsaturated fats.
Triglycerides 285 mg/dl 0-150 mg/dl The patient has Instruct the patient
a high level of to eat food with
triglycerides soluble fiver, as
part of low salt fat
diet, soluble fiber
can help lower total
blood cholesterol
Direct HDL 46 mg/dl 40-60 mg/dl
ALT 36 U/L
VLDL 57 mg/dl 0-35 mg/dl The patient has - increased Instruct the
a high level of risk of patient to limit
cardiovascular intake of
VLDL dietary
events cholesterol to
300 mg or less
than 200 mg.
LDL 105 mg/dl 0-150 mg/dl
CHOL/dHDL 4.53
HEART DIAGNOSTIC TEST
RBS RESULT
150 -100
URINALYSIS
Protein Neg.
Sugar Neg.
PH 7.0
Microscopic
Puscells 1.3/hpf
RBC 0.2/hpf
K. Impression/Diagnosis
HASCVD (Hypertensive
Arteriosclerotic Cardiovascular
Disease), Hypertension, Essential
Stage 2 uncontrolled Dyslipidemia,
BPPV (Benign Paroxysmal Positional
Vertigo)
III. Clinical Discussion of the Disease
•Gender •Lifestyle
•Age •Uncontroll
ed HN
•Diet
Hypertension Hyperlipidemia
dysrrhythmias
Localized acidosis and free radical
Formation
Cell injury
CVA
Prognosis
If Treated If
untreated
Return of Coma
normal Cerebral
perfusion death
Decreased Loss of
Edema neural
feedback
Improved mechanism
function
Cessation of
physiologic
functions
Multi-organ
failure
DEATH
Precipitating Factors:
Predisposing Factors: •Lifestyle
•Gender •Uncontroll
ed HN
•Age
•Diet high
cholesterol
& high fatty
acid
Hypertension Hyperlipidemia
confusion ↑ ICP
Cell injury
CVA
Drug
study
PREPARATION REACTION CONSIDERATION
Metoprolol Hypertension 50 mg 1tab bid Block beta CNS: Always check pts
(Beta- receptors fatigue, apical pulse
blocker) which dizziness. rate bfore
decreases giving drug. If
cardiac CV: it’s slower than
output, hypotension 60bpm withhold
peripheral , drug and call AP
resistance bradycardia immediately
and cardiac
oxygen GI: nausea, Monitor bp
consumption diarrhea frequently.
RESPI: Instruct pt to
dyspnea take drus as
prescribed and
SKIN: rash with meals.
DRUG INDICATION DOSAGE & ACTION ADVERSE NURSING
PREPARATI REACTION CONSIDERATION
ON
Amlodipine Hypertension 10mg 1tab Inhibits CNS: headache, Monitor bp
(Norvasc) OD calcium ion fatigue. frequently during
Calcium influx Dizziness therapy because
channel across drug-induced
blocker cardiac and CV: vasodilation has
smooth palpitations, a gradual onset.
muscle edema
cells, Caution patient
dilates GI: abdominal to continue
coronary pain taking drug even
arteries and when she feels
decreases RESPI: dyspnea better.
blood
pressure SKIN: rash
demand.
DRUG INDICATION DOSAGE & ACTION ADVERSE NURSING
PREPARATI REACTION CONSIDERATION
ON
Telmisartan(Pr Hypertension 80mg 1tab Blocks CNS: Monitor patient for
itor) (Used alone OD vasoconstric- dizziness, hypotension after
AngiotensinII or with other ting and headache, starting drug. Place
receptor antihyper- aldosterone- fatigue pt supine if
antagonist tensives) secreting hypotension occurs
effect of CV: chest pain and give NSS if
angiotensin II needed.
by GI: nausea.
preventing it Diarrhea Tell pt if she feels
from binding dizzy or has low bp
to the GU: UTI on standing she
angiotensin I should lie down
receptor RESPI: cough and rise slowly
from lying to
Other: flu-like standing position.
symptoms
RUG INDICATION DOSAGE AND ACTION ADVERSE NURSING
PREPARATION REACTION CONSIDERATION
Tell patient to
inform if adverse
reaction occur
particularly muscle
aches and pain
PLAIN
NATURAL
SALINE
SOLUTION
IV . Nursing Process
A . Longterm Objectives
The study aims to find ways to enable the
patient to function to his optimum capacity and to
prevent complications through collaborative
management with the health team.
B. Prioritized List Nursing Problem
Problem Ranking Justification
Risk for injury 1 It focuses on actions
related to which are designed to
dizziness solve or minimize the
secondary to existing problem.
increased blood
pressure
Activity Intolerance 2 This should be given
r/t body malaise and priority because it
vertigo secondary to can lead to more
prolonged bed rest. complications if not
managed appropriately
Sleep pattern 3 Sleep pattern
disturbances related disturbance must be
to unfamiliar given priority because
environment secondary it is one of basic
to hospitalization need of patient’s well
being
C. NCP
( based on the sequence of
prioritized problem )
Assessment Nursing Planning Nursing Rationale Evaluation
Diagnosis Intervention
Subject:
“ Hilong-hilo ako.” Risk for injury At the end of the Establish rapport. To gain trust and Goal partially met
as verbalized by related to nursing Safety measures cooperation as evidenced by
the patient. dizziness interventions rendered. To avoid further patient BP
Objective: secondary to patient’s BP and Promote injury. decrease from
BP= elevated blood PR will be conducive To provide 150/100mmHg to
180/100mmHg pressure. decrease to its environment comfort 140/90mmHg and
PR= 112bpm normal range. Promote rest and PR decrease from
Weakness noted sleep To conserve 112bpm to 77bpm
Irritable noted. Administer energy
To help reduce
antihypertensive
as doctors BP and PR.
prescribed
Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
S: “nanghihina ako Activity Intolerance At the end of nursing establish rapport to facilitate NPI. Patient verbalized
kasi lagi na lang r/t body malaise and interventions, the pt. place the client in a to prevent willingness to and
akong nakahiga” vertigo secondary to will verbalize comfortable position backaches or muscle was able to
as verbalized by the prolonged bed rest. willingness to and take and record vital aches. participate in
patient. demonstrate signs to note any activities.
O: participation in Determine patient's significant changes
Conscious and activities. perception of causes that may be brought
coherent of fatigue or activity about by the disease
ambulatory c intolerance. These may be
afebrile (36.8 oC) of mobility. permanent, physical
c body malaise Assess nutritional or psychological.
c good capillary refill status. Assessment guides
Monitor patient's treatment.
in 2-3 secs.
c good skin turgor sleep pattern and This aids in defining
Medications:
•
Environment:
•
• Avoid crowded areas, especially
during cold and flu season.
• Avoid close contact with anyone who
is ill.
• Provide safety measure to promote
safe environment and individual
safety.
• Sanitary handling of food and water.
Treatment:
• Eating a healthy diet, including the
DASH diet (eating more fruits,
vegetables, and low fat dairy
products, less saturated and total
fat).
• Reducing the amount of sodium in
your diet to 2,300 milligrams (about
1 teaspoon of salt) a day or less.
• Getting regular aerobic exercise (such
as brisk walking at least 30 minutes
a day, several days a week).
• Limiting alcohol to two drinks a day
for men, one drink a day for
women.
• In addition to lowering blood
pressure, these measures enhance
the effectiveness of high blood
pressure drugs.
• Angiotensin-converting enzyme
(ACE) inhibitors
• In addition to lowering blood
pressure, these measures enhance
the effectiveness of high blood
pressure drugs.
• In addition to lowering blood
pressure, these measures enhance
the effectiveness of high blood
pressure drugs.
•
• Angiotensin-converting enzyme
(ACE) inhibitors
•
• Angiotensin || receptor blockers (ARBs)
•
• Diuretics
•
• Beta-blockers
•
• A fte r d isch a rg e , a d vise p a tie n t to co m e
b a ck to sp e cifie d d a te sa id b y th e
p h ysicia n .
Diet
Ø reduction of sodium intake
Ø moderation of alcohol
Ø weight loss in the obese
Ø possibly increasing potassium
and calcium intake
Ø ingestion of a vegetarian diet or
fish oil supplements.
Thank
you !