Objectives

In presenting the case of Mrs. Candelario, several

objectives have been taken into consideration. These

objectives include:

a. Gather related literature significant to the condition of

the patient for a more complete understanding of

HYPERTENSION and how to properly care for such a case.

b. Evaluate the condition of the client by getting pertinent

data through history, physical assessment, and

laboratory tests in order to come up with appropriate

nursing diagnoses that will help aid in his recovery.

c. Discuss the pathophysiology or the actions that the

hypertension takes on a patient’s body.

d. Prepare nursing care plans suitable for the subjective and

objective symptoms and/or complaints manifested and/or

verbalized by the patient.

e. Evaluate the result of nursing care provided, and to make

necessary changes as needed.

f. Educate the patient regarding hypertension and how she

can help care for herself outside the hospital.

IntroductionAlthough certain hormonal abnormalities cause hypertension, the

vast majority of cases are secondary to genetic factors, obesity, age and inactivity. Smoking, diabetes and excess alcohol consumption make hypertension worse.  Salt intake does not play as great a role in

the control or cause of high blood pressure as was once commonly believed.

High blood pressure (BP >140/90 mm Hg, as defined by the World Health Organization) occurs in acute stroke in up to 75% of cases. Subsequently, BP settles over a period of about a week, although 40% of patients remain hypertensive. High blood pressure (HBP) or hypertension means high pressure (tension) in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called "pre-hypertension", and a blood pressure of 140/90 or above is considered high.

The top number, the systolic blood pressure, corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number, the diastolic pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed.

-History

Based on the dissection of ancient Egyptian mummies, high blood pressure (hypertension) has been a health problem since the early Egyptian empires. The blood pressure cuff was invented in 1896, but it wasn't until the 1950s that we became aware of the importance of high blood pressure as a herald of the complications commonly attributed to "old age". Recent research has shown a critical relationship between high blood pressure and strokes, heart attacks, congestive heart failure, and vascular disease, which together comprise the leading cause of death in the United States for men and women.

-Epidemiology IHypertension is the most common primary diagnosis and most

common cause of death in the United States (Whelton, 2002; Brashers, 2006). It is estimated that 50 million Americans are affected by hypertension. Of these 50 million, only 70% (35 million) are aware of their condition. In addition, only 50% (17.5 million) of those aware of their condition are receiving treatment. Remarkably, only 25 % of all hypertensive patients have their blood pressure under control

(Brashers). More men have hypertension than women in early life, but this disparity practically disappears by the 6th decade (Whelton). The life-long risk of developing hypertension in normotensives after the sixth decade of life is approximately 90%. The incidence and prevalence of hypertension is about 50% higher in African-American adults compared with their counterparts who are white or Mexican-American (Whelton).-Epidemiology II

Hypertension is a risk factor for coronary artery disease, congestive heart failure, stroke and renal failure (Brashers, 2006). Risk factors in all populations include age, obesity, sedentary lifestyle, family history, smoking, alcohol, high sodium intake, low potassium or magnesium intake, and the use of NSAIDS (Brashers). Each 20mm Hg increase in systolic pressure or 10mmHg increase in diastolic pressure above normal increases cardiovascular risk twofold (Brashers).

Nursing Health HistoryBiographical InformationName: Pura S. CandelarioSex: FemaleAddress: Lot 8 Block 17 Ciudad Real Subd. San Jose Del Monte, BulacanDate of Birth: January 12, 1943Place of Birth: Malinao, AklanAge: 65Religion: Roman CatholicCitizenship: FilipinoOccupation: Catechist

Civil Status: MarriedEmployment Status: Resigned/ RetiredDisabilities: Visual Impairment

Chief complaint“Nahihilo ako. High blood na naman yata ako.” As verbalized by

the patient. Mrs. Candelario was complaining of:- Dizziness- Fatigue- Nape pain- Hypertension

History of Present IllnessAccording to the patient, she attended seminar in Sta. Maria,

Bulacan which started at 6:00 in the morning up to 6:00 of the evening with regards of being a catechist. Together with her older sister, they walked for meters just to reach the church which caused her over fatigue. When the patient got home she took a rest and got her dinner. While watching television program she felt dizziness so she slept early. On the next day, she went to her neighbor and asked to take her blood pressure and it was 160/100. She went to her house and she took a rest for an hour. She thought it was just because of her fatigue but after several hours, she went again to her neighbor to take her blood pressure and it was 140/90. Mrs. Candelario was aware in her hypertension that’s why she went to the hospital together with her sister.Past Medical Illness

The patient has asthma. It was started when she was in her early 20’s. Her asthma attacks when it is dusty or in polluted area or there’s sudden weather changes. There was a time that her asthma attacked that led to confinement in De Los Santos Hospital. According to her because of her asthma, her upper extremities got anesthetized.

Social HistoryAccording to the patient, she spent mostly her time with her

children, guiding them with their studies and performs her responsibility as a good mother. After her retirement as a teacher, she turned as catechist as her hobby. As a volunteer in their community she also does neighboring.

Health ManagementThe patient stated that she maintains her personal hygiene by

taking a bath everyday, brushing her teeth twice a day. The patient also said that she was taking some food supplements like vitamins.

She also takes some medication for her blood pressure maintenance and also for her arthritis.

In the hospital she is not prohibited to do her routine hygiene.She is ordered to take and bathroom privileges.

Nutritional MetabolicThe patient stated that she eats 3 times a day, but on the first

confinement on San Lorenzo hospital, she was put on a nothing per orem (NPO), for her blood screening.

EliminationAccording to the patient, her bowel movement was normal, she

defecate once a day and urinates 5 to 6 times a day.

Rest and SleepThe patient gets her complete bed rest in the hospital as what

needed. She wakes up every time someone takes her vital signs.

Cognitive PerceptualThe patient was retired as an elementary teacher so she now

spent mostly her time with her family. She served as a catechist in Sta. Maria, Bulacan.

According to Piaget’s cognitive developmental process, the patient ends with the formal operations phase. According to Kohlberg, the patient’s moral development is completed. He hypothesized that an older person at the preconventional level obeys rules to avoid pain and the displeasures of others.

According to Erickson, the developmental task of the patient is ego integrity versus despair. People who attain ego integrity view life with sense of wholeness and derive satisfaction from past accomplishments. They view death as an acceptable completion of life. By contrast, people who despair often believe they may have poor choices during life and wish they could live life over.

Course in the wardPre-operative phaseThe patient was admitted on August 14, 2008 at around 9:30 of

the evening due to hypertension, headache, and dizziness because the case occurred after an hours before the admission. According to the

patient it was started when they went to a seminar in Sta. Maria, Bulacan that caused her fatigue and the following effects:

Vital sign are taken and complete physical health assessment is done with the physician are:

General Survey: conscious and coherentHEENT:Heart:Lungs:Abdomen:Extremities:After the initial assessment, the patient was accompanied by her

sister with the help of some ER NOD with on going intravenous fluid of D5W 500 cc regulated at keep vein open (KVO). The patient was assessing to her room (Female Medical Ward 01). When the patient reached her bed to relax, IV fluid interrupted by Mannitol 200 cc given as stat ordered, retaking of vital signs was been done and the medicine was administered to the patient and she took a rest.

At around 11:25 pm vital signs had been monitored by a healthcare provider. The patient was accompanied by her sister and she was put on a nothing per orem diet (NPO) for the blood test on the next day.

August 15, 2008, at around 7 am the patient was lying on her bed with ongoing IVF D5 water 300 cc level regulated at 200 mgtts/min and infusing well. Vital sign was monitored and her medication was also administered.

Intra-operative PhaseThe patient was on her bed, accompanied by a healthcare

provider. She was put on diet as tolerated. She was still on her intravenous fluid. Her vital signs were continuously monitored by the nurse. Around 12 pm. The patient refused to undergo CT scan.

Post-operative PhaseOn the same day, around 4:25 of the afternoon the patient has

been discharged from the hospital.

Discharged orderAugust 15, 2008 at around 4:15 of the afternoon, Mrs. Candelario

requested for HAMA. The attending physician, Dr. Calderon requested her for CT scan but the patient refused. The patient received the original copies of her laboratory results and ECG result.

The NOD provided information for her health improvement. The NOD educated the patient about health teaching:

-good hygiene

- Proper diet (DASH diet, healthy low-fat diet rich in natural sources of vitamins and minerals, reduce salt intake)- taking her food supplements and her medication as ordered- Exercise and maintaining healthy weight

Diagnostic Procedure

Date Name of Procedure

Normal Values Result Interpretation and Analysis

8/15/08 Hematology WBC- 10 x 10

SEGMENTER- 0.50-0.70LYMPHOCYTE-0.20-0.40RBC- 4.2- 5.4 x 10HEMOGLOBIN- 120-160HEMATOCRIT-0.37-0.47

8.200.860.144.411320.40

-slightly decrease-increase-decrease-normal-normal-normal> Base from the result of hematology the patient was having a decrease lymphocyte that indicates that there is no infection.> Leukocytes or white blood cell count determine the number of circulating WBC’s count per cubic millimeter of whole blood. High WBC counts are often seen in the presence of bacterial infection. Possible cause of increase neutrophil may be stress and acute infection; lymphocytes may be chronic infection, viral infection, mononucleosis(abnormal increase in number of mononuclear leukocytes in the blood)