Colegio de San Juan de Letran
Brgy. Bucal, Calamba City
Hypertension
Submitted by:
Abuan, Jenna Marie O.
Submitted to: Ms. Eufemia L. Cortado, RN, MN
Clinical Instructor
Hypertension, an intermittent or sustained elevation in diastolic or systolic blood pressure, occurs as two major
types: essential (idiopathic) hypertension, the most common, and secondary hypertension which results from renal
disease or another identifiable cause. Malignant hypertension is a severe, fulminant form of hypertension common to both
types. Hypertension is a major cause of stroke, cardiac disease, and renal failure. The prognosis is good if this disorder is
detected early and treatment begins before complications develop. Severely elevated blood pressure (hypertensive crisis)
may be fatal. Risk Factors and Causes
Hypertension affects 25% of the adults in the United States. If untreated, it carries a high mortality.
Risk factors for hypertension include:
family history,
race (most common in blacks),
stress,
obesity,
a high diet in saturated fats or sodium,
tobacco use,
sedentary lifestyle, and
aging.
Secondary hypertension may result from:
renal vascular disease;
pheochromocytoma;
primary hyperaldestoronism;
Cushings syndrome;
thyroid, pituitary, or parathyroid dysfunction;
coarctation of the aorta;
pregnancy;
neurologic disorders;
and use of hormonal contraceptives or other drugs such as cocaine, epoetin alfa, and cyclosporine.
Complications
Stroke
Coronary artery disease
Angina
Myocardial Infarction
Heart failure
Arrhythmias
Sudden death
Cerebral infarction
Hypertensive encephalopathy
Hypertensive retinopathy
Renal failure
Signs and Symptoms
Hypertension usually doesnt show any clinical symptoms until vascular changers in the major organs occur.
Severely elevated BP damages the intima of small vessels, resulting in fibrin accumulation in the vessels, development of
local edema and, possibly intravascular clotting. Symptoms produced by this process depend on the location of the
damaged vessels:
brain stroke
retina blindness
heart myocardial infarction
kidneys proteinuria, edema and, eventually, renal failure.
HPN increases the hearts workload, causing left ventricular hypertrophy and, later, left- and right-sided
heart failure and pulmonary edema.
Diagnosis
Serial blood pressure measurements are obtained and compared to previous readings and trends to reveal an
increase in diastolic and systolic pressures.
Normal < 120/80 mm Hg
Pre-hypertension 120/80 to 139/89 mm Hg
Hypertension Stage I 140/90 to 159/99 mm Hg
Hypertension Stage II Equal or more than 160/100 mm Hg
Laboratory tests might also be ordered to identify:
Elevated cholesterol in the blood
Echocardiogram or electrocardiogram to identify heart disease
Basic metabolic panel and urinalysis or kidney ultrasound to identify kidney disease
Treatment
Lifestyle Modifications:
Weight loss
Moderation of alcohol intake
Regular exercise
Low fat and low salt diet
Smoking cessation
Stress reduction
Drug therapy:
Thiazide diuretics
Angiotensin-converting Enzyme (ACE) inhibitors
Beta-adrenergic blocker
Calcium channel blocker
Angiotensin receptor blocker
Emergency drug therapy:
Typically, hypertensive emergencies require parenteral administration of a vasodilator or an adrenergic
inhibitor or oral administration of a selected drug, such as nifedipine, captopril, clonidinem or labetalol, to rapidly
reduce blood pressure.
Hypertension without accompanying symptoms or target-organ disease seldom requires emergency drug
therapy.
Nursing Considerations
Suggest to the patient to establish a daily routine of taking his/her medications.
Encourage a change in dietary habits.
Help patient examine and modify his lifestyle (reducing stress and exercising regularly)
Ask the hospitalized client if he was taking any prescribed medications.
When routine blood pressure screening reveals elevated BP, first make sure the cuff size is appropriate for
the patients upper arm circumference. Take the pressure in both arms in lying, sitting, and standing positions.
Ask the patient if he smoked, drank a beverage containing caffeine, or was emotionally upset before the test.
Advise him to return for blood pressure testing at a frequent and regular intervals.
A. Clients profile:
Name:
Patient XX
Address:
Pansol, Calamba Laguna
Age:
49 years old
Sex
:
Male
Civil status
:
Married
Nationality
:
Filipino
Religion :
Roman Catholic
BirthDate :
November 5,1966
Occupation
:
Construction worker
Chief Complaint:
body weakness and dizziness
MEDICAL HISTORY:
Present health history of illness:
- Two weeks prior to admission the patient suffered body weakness associated with pale
looking. According to the patient he also felt dizziness and severe headache; he take
paracetamol to relieve the pain but then he was not relieve thats why they decided to
have his check up at Dr. Jose Rizal Memorial Hospital and his Physician advised him for
confinement with a diagnosis of hypertension.
Family health history:
Father
+
-
Possible hereditary
HPN
Asthma
Cancer
DM
II GORDONS HEALTH FUNCTIONAL PATTERN
Mother
+
-
1. HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN
BEFORE HOSPITALIZATION: the Pt. verbalized that he is healthy. He can actually maintain his body
healthy without any problems.
DURING HOSPITALIZATION: when he was admitted at Dr. Jose Rizal Hospital he still thinks that he is
okay because he feel good still but easily feel tiredness.
2. NUTRITIONAL-METABOLIC PATTERN
BEFORE HOSPITALIZATION: Patient XX prefers vegetables than meat. He rarely eats meat because he
thinks those are the reason thats why he is suffering anemia.
DURING HOSPITALIZATION: the doctor ordered DAT diet. And the hospital usually serves meat as their
viand.
3. ELIMINATION PATTERN
BEFORE HOSPITALIIZATION: PTA, the pt. urinates 7-8x a day with colorless - light yellow urine with no foul
odor.
DURING HOSPITALIZATION: when he was admitted, he urinates 6-7x a day. And perspires at all times
because of warm environment in the hospital.
4. ACTIVITY-EXERCISE PATTERN
BEFORE HOSPITALIZATION: The patient is a construction worker and this serve as his exercise.
DURING HOSPITALIZATION: He cant work because of his condition .
5. SLEEP-REST PATTERN
BEFORE HOSPITALIZATION: Sometimes his number of sleep ranges from 6-7 hours a day. But mostly
he has hard time on getting his sleep with unknown cause.
DURING OSPITALIZATION:
he mentioned that, since his confinement in Dr. Jose Rizal Memorial
Hospital, he cant sleep because of many interruption and he had no more worries
about his routine activities.
6. COGNITIVE PERCEPTUAL PATTERN
Patient XX is only a high school undergraduate but he can read and write. He can
easily understood and respond to our questions directly.
7. SELF PERCEPTION/ SELF CONCEPT PATTERN
BEFORE HOSPITALIZATION: He sees himself as a very busy person and responsible father on his two
child.
DURING HOSPITALIZATION:
Because of her stay at Dr. Jose Rizal Memorial Hospital, his anxiety about
his daily routines/activities at home is temporarily relieved.
8. ROLE RELATIONSHIP PATTERN
BEFORE HOSPITALIZATION: He is a responsible father and husband. He is a contractual construction
worker.
DURING HOSPITALIZATION:
he cant work anymore because of his condition.
9. SEXUALITY-REPRODUCTIVE PATTERN
He was 7 years old when he was circumcised by what they call de pok-pokbefore.
10. COPING STRESS MANAGEMENT
BEFORE HOSPITALIZATION: Due to his routine Activities, he was not aware that he was under stress.
He had been encountering it every day which may trigger the disease.
DURING HOSPITALIZATION:
he now understand that having enough rest when he is tired and stressed is
very indispensable to overcome his condition. He also recognizes though
our health teachings are the essence of taking of multivitamins rich in iron
to strengthen his immune system.
11. VALUE BELIFE PATTERN
BEFORE HOSPITALIZATION: He is Roman Catholic. He sometimes attends mass together with his wife
and children at their nearby church.
DURING HOSPITALIZATION:
Now that he is confined, he cant attend mass anymore but still prays all
the time.
DRUG NAME
CLASSIFICA
TION
INDICATION/
ACTION
SIDE EFFECTS
NSG. RESPONSIBILITIES
Generic
name:
Non- steroidal
antiinflammator
y
Short term
manageme
nt of
moderately
severe,
acute pain
for single
Ketorolac
Brand name:
Stock:
Headache
Dyspepsia
GI pain
Constipation
Flatulence
Correct Hypovolemia
before giving.
Alert: Maximum
Combined duration of
parenteral and oral
therapy is 5 days.
When appropriate, give
Doctors order:
Generic
name:
Ranitidine
Anti ulcer
drugs
Brand Name:
dose
treatment
by deep IM injection. Pt
may feel pain at the
injection site which can
be relieve by applying
cold bags.
Anaphylaxis
Headache
Blurred
vision
Gastric
irritation
Stock:
Doctors order:
Generic
Name:
metocloprami
de
Brand name:
plasil
Stock:10mg/2
ml
Anti-emetics
Nausea and
vomiting
Doctors order:
1 amp IV now
then q8
PRN
Bradycardia,
supravetricul
ar
tachycardia
Neuroleptic
malignant
syndrome,se
izures,
suicide
ideation.
Vertigo,
Assess pt for abdominal
pain. Note presence of
blood in emesis, stool
or gastric aspirate.
Drug may be added to
total parenteral
solutions.
Monitor bowel sounds.
Safety and effectiveness
of drug havent been
established for therapy
lasting longer than 12
weeks.
Generic
name:
Furosemide
Diuretics
Hypertension
headache,
dizziness.
Panceatitis,
thrombocyto
penia.
Brand name:
Stock:
Doctors order:
1 amp IV now
then OD
Generic
name:
Paracetamol
Non opiod
analgesic
and anti
pyretics
Mild pain
and/or
fever
Neutropenia,
leucopenia,
pancytopeni
a and
hypoglycemi
a
To prevent nocturia, give
P.O. and IM preparations
in the morning. Give 2nd
dose in the early
afternoon.
Watch for signs of
hypokalemia such as
muscle weakness and
cramps.
Brand name:
Stock:
Generic
name:
Doctors order:
1 amp IV stat
Anti
For
Headache,
dizziness, fatigue,
abdominal pain,
nausea, back pain
or leg pain, cough
Alert: Many OTC and
prescription products
contain acetaminophen;
be aware of this when
calculating total daily
dose.
Losartan
potassium
hypertensiv
es
hypertensi
on
and respiratory
infection
Brand name:
getzar
Drugs can be used alone or with
other antihypertensives.
Generic
name:
Bisacodyl
Diphenyl
methane
derivative
Chronic
constipatio
n
Dizziness,
faintness, muscle
weakness with
excessive use
Abdominal cramps
Electrolyte
imbalance
Monitor patients BP to evaluate
effectiveness of therapy and
monitor patients who are also
taking diuretics for symptomatic
HpN.
Brand name:
Dulcolax
Give drugs at times that dont
interfere with scheduled
activities or sleep.
Before giving for constipation,
determine whether patient has
adequate fluid intake, exercise
and diet.
DRUG STUDY
