3rd year Medical 5 Hypertension PDF

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Hypertension A Case StudyPresented to the Faculty of School of NursingUniversity of BaguioSchool of Nursing General Luna Road, Baguio CityIn Partial Fulfillment To the Requirements For the subject NCENLOBy: NCA- Boado , Marvin Sison, Lei Sho Mojica, Thea CeasarAugust 2017ACKNOWLEDGMENTWe would like ...

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Hypertension A Case Study Presented to the Faculty of School of Nursing University of Baguio

School of Nursing General Luna Road, Baguio City

In Partial Fulfillment To the Requirements For the subject NCENLO3

By: NCA-1 Boado , Marvin Sison, Lei Sho Mojica, Thea Ceasar

August 2017

ACKNOWLEDGMENT We would like to express our sincerest gratitude to those people who helped in the accomplishment of this study, without them this case study would not be made possible. To the Father Almighty, for the gift of life, for the daily providence, for giving them the strength, divine guidance, wisdom & inspiration in their quest in the field of their chosen course. To

the

Baguio

General

Hospital

&

Medical

Center,

for

granting & giving them the opportunity to render their services & enhance their skills & knowledge by letting them have their duty at the Gynecology Ward Department. To the Medical 5 ward Staff, for their warm accommodation & hospitality during the duty. To

the

Clinical

Instructor

&

Mentor

of

the

group,

Mrs.

Maureen Sabalburo, RN MAN and to Mr. Elton Delos Santos RN MaEd for the guidance & knowledge they shared throughout the duty. To the Family that we belong to, for their continuous and unending

support,

for

their

unwavering

motivation.

TABLE OF CONTENTS

love

and

care

&

TITLE PAGE TABLE OF CONTENTS --------------------------ACKNOWLEDGEMENT ----------------------------I.INTRODUCTION -----------------------------II. PATIENT`S PROFILE ----------------------A. NURSING HEALTH HISTORY ---------------------III. 13 AREAS OF ASSESSMENT ----------------IV. ANATOMY AND PHYSIOLOGY -----------------V.PATHOPHYSIOLOGY A. SCHEMATIC B. NARRATIVE VI. NURSING CARE MANAGEMENT -------------------A. LABORATORY RESULTS B. NURSING CARE PLAN B. DRUG STUDY/MEDICATION VII. SUMMARY OF CARE ------------------------- 29-30 VIII. CONCLUSION -------------IX. RECOMMENDATION -------------X. REFERENCES ------------------------ 31

CHAPTER 1

INTRODUCTION We, the group of NCA – I had our duty at Baguio General Hospital and Medical Center last August 24,25,26,31 and September 1 and 2 ,7-3 shift at the Medical 5 ward under the supervision of Mrs. Maureen Sabalburo, RN MAN and Mr. Elton Delos Santos RN MaEd. We were assigned to different cases of medical ward patients. One of the cases that we was able to handle was Hypertension. It showed a sign and symptoms of Severe headache, fatigue or confusion, vision problems, chest pain, difficulty in breathing, irregular heartbeat, blood in the urine, pounding in your chest, neck, or ears. High blood pressure is the main risk factor for suffering and dying as a consequence of premature cardiovascular events and is the second leading cause of disability in the world. It is also the main cause of ischemic heart disease and stroke. Other complications no less significant due to poor blood pressure control are dilated heart disease, heart failure and arrhythmias. The incidence of hypertension has doubled in the last 5 years in all social strata. It is estimated that between 20% and 40% of the adult population in the Region of the Americas suffer from hypertension. At the global level, it is estimated that of the people with hypertension, only 57% know their condition, 40.6% receive antihypertensive drug treatment but only 13.2% achieve controlled blood pressure figures. This gap between the number of hypertensive patients, the access to treatment and the achievement of control is accentuated in the middle and low income countries where 80% of the burden attributed to cardiovascular diseases occurs.

While high blood pressure is not curable, it can be prevented and treated to keep blood pressure figures below 140/90 mmHg. Adequate control is a cost-effective measure to avoid premature deaths. If we manage to treat half of the population with uncontrolled hypertension, including those treated with suboptimal and untreated blood pressure values, 10 million deaths globally could be prevented in 10 years due to cardiovascular events.

Data from the health department show that hypertension remains to be the leading cause of illness and a primary contributor to premature death in the Philippines. Currently, more than 12 million adult Filipinos are deemed as suffering from hypertension. "Based on national surveys, the total number of hypertensive Filipinos is now more than 12 million, with more than half of them are unaware of their condition," said Ubial. The health official also pointed that around 200,000 deaths yearly in the country can be attributed either directly or indirectly to high blood pressure

Worldwide, it is estimated that high blood pressure causes 51% of deaths due to stroke and 45% due to heart disease  Hypertension is a major risk factor for cardiovascular disease. Metabolic risk factors such as diabetes, high blood cholesterol and obesity, increase the risk of complications from high blood pressure, including heart disease, stroke, kidney failure and blindness  Treating hypertension results in a 40% decrease in the risk of stroke and 15% decrease in risk of MI.

We, chose the case of Hypertension because as we have noted it is one of the most common case nowadays not only to elders but also to the youth. Hence, this gave way for us to be excited and

to apply the skills and concepts that we have gathered during our skills laboratory and lectures. This case helps the group to design

a

condition.

nursing I

care

gained

plan

new

appropriate

learning

from

for

the

patient’s

the

experience

in

conducting the case study. This case study would also equip the group with knowledge, skills and attitude on how to manage future patients with the same condition. Throughout, our duty includes us to show a warm, friendly and kind bed side manner.

II. PATIENT’S PROFILE

Hospital no: 000000000312815 Patient’s Name: Patient X Address: Taloy, Norte Tuba, Benguet Gender: Female Birthday: June 30, 1978 Age: 39 years old Birthplace: Benguet General Hospital Nationality: Filipino Civil Status: Married Religion: Born Again Christian Occupation: none ADMISSION Admitting Time: 5:50 PM Admitting Date: August 22,2017 Admitting Physician: Dr. Jaypee R. Pascua Admitting Diagnosis: Hypertensive Urgency

NURSING HEALTH HISTORY A. Past Medical History: One day prior to admission, the patient felt chest pain. 5/10 crushing in character non- radiating. She took her hypertensive medications which is Metoprolol 50mg. 7 hours prior to admission, when the patient suddenly felt a severe crushing chest pain, 10/10 and associated with shortening of breath. Hence she promptly came to BGH – ER for consultation and was admitted. B. Obstetric & Menstrual History: She has 6 children, 2 Males and 4 female with GTPAL of G6P6 and had her frist menstruation at 13 years old. C. Family Health History According to the patient her parents doesn’t have hypertension but her grandmother and grandfather has a history of hypertension .

III. 13 AREAS OF ASSESSMENT

I.

Psycho-Social Status

Under the Psychosocial Development theory of Erik Erikson, She’s under the stage of middle adulthood which is the generativity versus stagnation. With virtue of production & care and a task of being creative & productive.

II.

Mental and Emotional Status

Prior to admission patient’s son said that she is a good mother to her children, she is very cheerful and active, she loves plants especially orchids. According to patient’s son before she was hospitalized she had a fever on the second week of December and experienced pain in her lower abdomen but for her it is just a simple fever and pain that’s why she just ignored it. On the third week of December she still felt the pain on her lower abdomen that’s why they brought his mother in the hospital near them and the diagnosis was just a urinary tract infection. On the fourth week of December the pain on her lower abdomen is still there that is why they decided again to brought his mother in the hospital and she was ultrasound and the physician found out that there is a lump on her left ovary, the family of the patient decided to brought their mother in Baguio General Hospital and Medical Center, the patient already started to be weak and lethargic. On December 29 she was operated, the suspected lump was an abscess and it already spread in her descending colon that’s why she has a protective ileostomy because they repaired the organs that were affected by the abscesses. On January 6 the patient was discharged and they rushed again their mother on January 8 because of the enlargement

of the stomach of the patient that causes the wounds to open, and that time there were already no discharges on her ileostomy and the physician said it is just normal that’s why they were sent home but also that night the patient started to be unresponsive, and cannot move they rushed again her mother in the hospital and the diagnosis was sepsis. III.

Environmental Status The room is well lighted & ventilated, has accessible

bedside table, chairs & trash can. IV. Sensory Status The patient has equally round pupils. Eyebrows are evenly and equally distributed. She can distinguish objects at specified distance, able to move eyeballs from side to side, look up & down without difficulty or pain. Patient can claim that she can hear and distinguish voices clearly and she can repeat words correctly. No discharges and ear lesions noted. She can distinguish smell of alcohol from cologne. The nostrils are patent and there were no occlusions noted. V.

Motor Status

5/5

5/5

5/5

5/5

The patient is able to perform daily activities. She can walk and sit on her own. She is able to move on her own since she was admitted in Baguio General Hospital-Medical Center.

VI.

Nutritional Status

She can eat on her own, with an IFV of PNSS. Her food within 7-3 shift was measured, she can consume 4/4 of her food given. She drinks about 200cc – 300cc with in the shift. VII. Elimination Status The patient’s elimination status was measured. The characteristic of her stool is lightly yellowish in color, while her urine was 220 – 260cc with in the shift. VIII.

Fluid and Electrolytes Status

Patient’s intake of water was estimated to 200cc – 300cc per day. Her medicine was given orally. In the morning during our shift she is given Valsartan. IX.

Circulatory Status

During the shift, patient’s pulse rate ranges from 80-100 beats per minute taken at radial pulse. Capillary refill ranges from 2-3 seconds. Patient’s blood pressure is within its high range which is 140/100 to 160/100. Patient’s O2 sat ranges from 95% to 98%. X.

Respiratory Status The patient’s respiratory rates ranges from 21 to 24 breaths

per minute during the shift. XI.

Temperature Status

The patient’s body temperature taken via axilla ranges from 36◦C to 36.7◦C during the shift.

XII. Integumentary Status

Patient’s X skin color is brown, has a good skin turgor, and has moist oral & mucous membranes. Her hair color is black and well groomed. Her nails are well trimmed. XIII.Comfort and Rest Status She was doing different relaxtion techniques such as proper positioning to lessen her chest pain and to promote good blood circulation, different breathing exercise and listening to soothing music.

IV.

Anatamoy and Physiology

Physiology

The Cardiovascular System The 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 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 planet Earth more than twice! The one-way system carries blood to all parts of your body. This process of blood flow within your body is called circulation. Arteries carry oxygen-rich blood away from your heart, and veins 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. 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. Once the capillaries deliver oxygen and nutrients and pick up carbon dioxide and other waste, they move the blood back through wider vessels called...