minicase hypertension

7/31/2019 Minicase Hypertension

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I. INTRODUCTION

Hypertension, simply put, is a high blood pressure. It is defined as a persistent elevation

of the systolic blood pressure at a level of 140 mm Hg or higher and a diastolic pressure at a

level of 90 mm Hg or higher (Medical-Surgical Nursing 2001). Hypertension is one of the mostcommon complex disorders. The etiology of hypertension differs widely amongst individuals

within a large population; it can be classified as either essential (primary) or secondary.

Essential hypertension is the form of hypertension that by definition has no identifiable cause. It

is the more common type and affects 90-95% of hypertensive patients, and even though there

are no direct causes, there are many risk factors such as sedentary lifestyle , obesity (more than

85% of cases occur in those with a body mass index greater than 25), salt (sodium) sensitivity ,

and alcohol intake. It is also related to aging and to some inherited genetic mutations. Also male

older than 35 years old are more likely to suffer from hypertension than females(http://www.doh.gov.ph/node/1602 ). On the other hand, secondary hypertension by definition

results from an identifiable cause. This type is important to recognize since its treated differently

than essential type by treating the underlying cause (http://en.wikipedia.org/wiki/Hypertension).

The World Health Report 2002 identified hypertension, or high blood pressure, as the

third ranked factor for disability-adjusted life years. Hypertension is one of the primary risk

factors for heart disease and stroke, the leading causes of death worldwide. Recent analyses

have shown that as of the year 2000, there were 972 million people living with hypertension

worldwide, and it is estimated that this number will escalate to more than 1.56 billion by the year 2025 ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560860/ ). Likewise, according to the

Department of Health in the Philippines; hypertension ranks as fifth of their top ten leading

causes of morbidity affecting 382,662 per 100000 population in the year 2005

(http://www.doh.gov.ph/kp/statistics/morbidity ). Moreover, South Cotabato Health Officer

Edgardo Sandig said a report released by the Integrated Provincial Health Office (IPHO) last

2006 that hypertension was one of the killer diseases in the region with 117 cases reported

(http://www.sunstar.com.ph/static/gen/2007/01/29/news/heart.disease.no..1.killer.in.s..cotabato.

html).This case has gained the groups interest due to its characteristics and clinical condition.

It is one of the most common clinical conditions, though most clients remain unmanaged; with

that the group is directed in focusing the kind of nursing interventions that will help in managing

this type of illness. Furthermore, the very core intention of the group is to reveal the

pathophysiologic condition and to investigate the root cause of the illness and find means to
http://en.wikipedia.org/wiki/Sedentary_lifestylehttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Salt#Health_effectshttp://en.wikipedia.org/wiki/Alcoholhttp://en.wikipedia.org/wiki/Aginghttp://en.wikipedia.org/wiki/Genetic_mutationshttp://www.doh.gov.ph/node/1602http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560860/http://www.doh.gov.ph/kp/statistics/morbidityhttp://en.wikipedia.org/wiki/Sedentary_lifestylehttp://en.wikipedia.org/wiki/Obesityhttp://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Salt#Health_effectshttp://en.wikipedia.org/wiki/Alcoholhttp://en.wikipedia.org/wiki/Aginghttp://en.wikipedia.org/wiki/Genetic_mutationshttp://www.doh.gov.ph/node/1602http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2560860/http://www.doh.gov.ph/kp/statistics/morbidity


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help the client cope with this kind of condition. This case challenges the group in an attempt to

test the cognitive aspect which is the primary requisite to become competitive and competent

nurses in terms of providing holistic nursing care to those who are helpless and unable. Thus,

this provides the group the grounds for improvement and change and with the knowledge of this

case; the group will be able to gauge the clients level of coping abilities that is suited to itscondition and to provide efforts to optimize the clients capacity within normal limits.

In this study the group illustrates relevant documents that will help the reader to

understand the clear picture of the clients condition. The data are in detailed presentation,

which includes essential databases, nursing history and physical assessments. This study also

contains the pathophysiology to investigate the cause of the disease. Furthermore, a nursing

care plan is formulated to help the client and significant others in considering other possibilities

that may help prevent the occurrence of the disease.


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II. OBJECTIVES

General:

To investigate the overall disease process of clinically diagnosed type 1

hypertension.

Specific:

To present detailed information on clients biographical profile.

To state the general physical health assessment of the client.

To identify the symptoms of clients having type 1 hypertension.

To determine the risk factors for type 1 hypertension.

To establish the medical and nursing management regarding the disease.

To categorize the drugs used to treat the clients illness.

To formulate appropriate nursing care plan for the management of the clients illness


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III. DATABASE

Patients Name: Mr. Hyper

Age: 77 years old

Sex: Male

Religion: Baptist

Admission Date: November 11, 2009

Admission time: 6:30am

Hospital: Saint Elizabeth Hospital

Admitting Diagnosis: Hypertension 1

Physician: Dr. Tension

Chief Complaint: Tremors, weakness in right upper extremities


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IV. NURSING HEALTH HISTORY

A. Past Illness

During the interview, the patients significant other told us that years ago before

admission to the hospital he undergone urinalysis, and it revealed that he has a urinary

tract infection. But other than the latter, he has no illness but has a usual blood pressure

of 130/90 mmHg to 140/100mmHg.

B. Present illness

The patient suffered from his first attack of stroke thus he was brought to the

hospital around 6:00 AM. During that day, upon having their mealtime, they noticed that

the patient can no longer carry the pitcher full of water and he appears pale then later

the left part of his body fell in which the patient lose control and that alarmed his

companions to bring him to the hospital. She also told us that his admission in the

hospital last November 11, 2009 was the first time that the patient was being

hospitalized. While in the hospital, the patient stayed in the Intensive Care unit for 6

days, then he was transferred at the private room but he is still in a hypertensive state

with a blood pressure 160/100 mmHg.

C. Activities of Daily Living

Personal Hygiene

Upon assessment to the patient, he was weak so he could not attend to his proper

personal hygiene but according to his significant other, before his admission to the hospital,

the patient usually does not take a bath everyday. According to them, the patient takes a

bath only once in a week but he usually cleans himself by sponge bathing with the use of

vinegar and alcohol. However, the patient appears clean, his clothes are well kept and his

hair is properly combed except for his feet because we noticed that it has presence of dirt.

Nutrition

The patient looks thin. Prior to his admission, the patient prefers to eat vegetables rather

than meat. He also wants to consume salty foods just like his family. He eats 3 times a day


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and does not skip meals, but he is fond of drinking soft drinks every meal and during

merienda time, he seldom drinks water, and according the his watcher, he just consumes

approximately 1 liter a day. The physician ordered the insertion of nasogastric tube to aid in

meeting his nutritional needs.

Elimination

With regards to the elimination pattern, before his hospital admission he felt a little

burning sensation when he urinates but he disregarded it, not until he was admitted that

they found out that he has a mild benign prostatic hyperplasia and the urinary output

measurement is approximately 27ml of urine per hour. With regards to his defecation, no

problem occurred with his bowel elimination habits because he defecates every morning.

Rest and SleepThe patient has no problem with his rest and sleep. According to his significant other, he

sleeps at least 8 hours per day. He usually sleeps at around 9:00 PM and wakes up at 5:00

AM. During his working days, he takes his nap at least two hours per day after he had his

lunch.

Exercise

His form of exercise was based on his job wherein at his present age, he still manages

his machine shop and executes heavy tasks. Due to his weak physical condition, was not

able to comply with specific range of motion exercises during hospital confinement. He isbedridden the whole day.

Sexual Life

The patients present condition affected his sexual life. His partner said that their sexual

activity was poor due to his husbands illness and was also affected by their old age.

Social Life

According to his significant other, they had close family ties. They usually eat together

during mealtime. The patient also had lots of friends. His illness greatly affected his family.

During his confinement, his granddaughters took care of him by attending to his personalneeds.

Economic Status

During our interview, the patient has a fair economic standing in which they earn up to

P20000.00 per month taken from their machine shop. Presently, his health care financing

was taken from their business and also with his childrens salary.


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D. Physical Assessment

General Survey: Appearance

- Upon assessing, the patient was bedridden and his movements were

not generally coordinated due to his present condition. No body and breath odor noted

but shows signs of illness of being weak with NGT attached to his left nares, and urinary

catheter attached and patent with no IVF hooked.

Mental Status

- Glasgow coma scale shows 13 out 15, as he opens his eyesspontaneously (4), his words spoken but cannot sustain conversation (3), and able to

obey command (6).

Vital Signs

T 36.5 C

PR 86 bpm

RR 24 cpm

BP 130/100 mmHg

Skin: Light brown in color, no redness and masses noted but wrinkled, paleness on the

palm and affected extremities noted.

Head: Normocephalic, hair color is grey, well distributed, no infection, infestations,

dandruff noted

Eyes: symmetrical, pale conjunctiva, eyeballs were not sunken, white sclera without any

pigments, Pupils Equally Round Reactive to Light and Accommodation

(PERRLA) observed, eyelashes are evenly distributedNose: size is proportional to face, nasogastic tube attached to left external nostril

Ears: symmetrical in size, shape, and placement, external pinnae are firm and recoils

after being folded, no discharges, masses and swelling noted on the external

canal.


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Mouth: Lips are pale and dry; tongue is normally located at midline and appears to be

pale and coated

Thorax / Chest: breathing pattern is regular; chest is free from masses, lesions and

deformities

Abdomen: umbilicus in midline, no redness, masses, and lesions noted, no tendernessupon palpation, light brown in color

Nails: well-trimmed, good capillary refill of less than 3 seconds

Extremities: peripheral muscles are symmetrical, lesion and ulceration was not found,

has limited ROM


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V. ANATOMY AND PHYSIOLOGY

Anatomy of the Brain

The cerebrum is the largest part of the brain and is composed of right and left

hemispheres. It performs higher functions like interpreting touch, vision and hearing, as well as

speech, reasoning, emotions, learning, and fine control of movement.

The cerebellum is located under the cerebrum. Its function is to coordinate muscle

movements, maintain posture, and balance.The brainstem includes the midbrain, pons, and medulla. It acts as a relay center

connecting the cerebrum and cerebellum to the spinal cord. It performs many automatic

functions such as breathing, heart rate, body temperature, wake and sleep cycles, digestion,

sneezing, coughing, vomiting, and swallowing. Ten of the twelve cranial nerves originate in the

brainstem.

The surface of the cerebrum has a folded appearance called the cortex. The cortex

contains about 70% of the 100 billion nerve cells (neurons). The nerve cell bodies color the


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cortex grey-brown giving it its name gray matter (Fig. 4). Beneath the cortex is long

connecting fibers between neurons, called axons, which make up the white matter.

The folding of the cortex increases the brains surface area allowing more neurons to fit

inside the skull and enabling higher functions. Each fold is called a gyrus, and each groove

between folds is called a sulcus. There are names for the folds and grooves that help definespecific brain regions.

Right brain left brain

The right and left hemispheres of the brain are joined by a bundle of fibers called the

corpus callosum that delivers messages from one side to the other. Each hemisphere controls

the opposite side of the body. If a brain tumor is located on the right side of the brain, your left

arm or leg may be weak or paralyzed.

Not all functions of the hemispheres are shared. In general, the left hemisphere controlsspeech, comprehension, arithmetic, and writing. The right hemisphere controls creativity, spatial

ability, artistic, and musical skills. The left hemisphere is dominant in hand use and language in

about 92% of people.

Lobes of the brain

The cerebral hemispheres have distinct fissures, which divide the brain into lobes. Each

hemisphere has 4 lobes: frontal, temporal, parietal, and occipital (Fig 3). Each lobe may be

divided, once again, into areas that serve very specific functions. Its important to understandthat each lobe of the brain does not function alone. There are very complex relationships

between the lobes of the brain and between the right and left hemispheres.

Frontal lobe Personality, behavior, emotions Judgment, planning, problem solving Speech: speaking and writing (Brocas area)

Body movement (motor strip) Intelligence, concentration, self awareness

Parietal lobe Interprets language, words Sense of touch, pain, temperature (sensory strip)


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Interprets signals from vision, hearing, motor, sensory and memory Spatial and visual perception

Occipital lobe Interprets vision (color, light, movement)

Temporal lobe Understanding language (Wernickes area) Memory Hearing Sequencing and organization

Messages within the brain are carried along pathways. Messages can travel from onegyrus to another, from one lobe to another, from one side of the brain to the other, and to

structures found deep in the brain (e.g. thalamus, hypothalamus).

Hypothalamus - The hypothalamus is located in the floor of the third ventricle and is the

master control of the autonomic system. It plays a role in controlling behaviors such as hunger,

thirst, sleep, and sexual response. It also regulates body temperature, blood pressure,

emotions, and secretion of hormones.

Pituitary gland - The pituitary gland lies below the hypothalamus, suspended from a

stalk, in a bony depression at the skull base called the sella turcica. The pituitary controls boneand muscle growth and secretes a number of hormones for growth and sexual maturation.

Sometimes called the master gland, it controls other glands in the body such as the thyroid

and adrenal glands.

Pineal gland - The pineal gland is located behind the third ventricle. It helps regulate the

bodys internal clock and circadian rhythms by secreting melatonin. It has some role in sexual

development.

Thalamus - The thalamus serves as a relay station for almost all information that comes

and goes to the cortex (Fig. 5). It plays a role in pain sensation, attention, alertness andmemory.

Basal ganglia - The basal ganglia include the caudate, putamen and globus pallidus.

These nuclei work with the cerebellum to coordinate fine motions, such as fingertip movements.


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Limbic system - The limbic system is the center of our emotions, learning, and memory.

Included in this system are the cingulate gyri, hypothalamus, amygdala (emotional reactions)

and hippocampus (memory).

LanguageIn general, the left hemisphere of the brain is responsible for language and speech and

is called the "dominant" hemisphere. The right hemisphere plays a large part in interpreting

visual information and spatial processing. In about one third of individuals who are left-handed,

speech function may be located on the right side of the brain. Left-handed individuals may need

special testing to determine if their speech center is on the left or right side prior to any surgery

in that area.

Aphasia is a disturbance of language affecting production, comprehension, reading or

writing, due to brain injury most commonly from stroke or trauma. The type of aphasiadepends on the brain area affected.

Brocas area lies in the left frontal lobe (Fig 3). If this area is damaged, one may have

difficulty moving the tongue or facial muscles to produce the sounds of speech. The individual

can still read and understand spoken language but has difficulty in speaking and writing (i.e.

forming letters and words, doesn't write within lines) called Broca's aphasia.

Wernicke's area lies in the left temporal lobe (Fig 3). Damage to this area causes

Wernicke's aphasia. The individual may speak in long sentences that have no meaning, add

unnecessary words, and even create new words. They can make speech sounds, however theyhave difficulty understanding speech and are therefore unaware of their mistakes.

Memory

Memory is a complex process that includes three phases: encoding (deciding what

information is important), storing, and recalling. Different areas of the brain are involved in

memory depending on the type of memory.

Short-term memory , also called working memory, occurs in the prefrontal cortex. It

stores information for about one minute and its capacity is limited to about 7 items. For example,it enables you to dial a phone number someone just told you. It also intervenes during reading,

to memorize the sentence you have just read, so that the next one makes sense.

Long-term memory is processed in the hippocampus of the temporal lobe and is

activated when you want to memorize something for a longer time. This memory has unlimited

content and duration capacity. It contains personal memories as well as facts and figures.


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Skill memory is processed in the cerebellum, which relays information to the basal

ganglia. It stores automatic learned memories like tying a shoe, playing an instrument, or riding

a bike.

Cardiovascular System

The cardiovascular/circulatory system transports food, hormones, metabolic wastes, and

gases (oxygen, carbon dioxide) to and from cells. Components of the circulatory system include: blood : consisting of liquid plasma and cells blood vessels (vascular system): the "channels" (arteries, veins, capillaries) which carry

blood to/from all tissues. ( Arteries carry blood away from the heart. Veins return blood

to the heart. Capillaries are thin-walled blood vessels in which gas/ nutrient/ waste

exchange occurs.) heart : a muscular pump to move the blood

There are two circulatory "circuits": Pulmonary circulation , involving the "right heart," delivers

blood to and from the lungs . The pulmonary artery carries oxygen- poor blood from the "right

heart" to the lungs, where oxygenation and carbon-dioxide removal occur. Pulmonary veins

carry oxygen- rich blood from the lungs back to the "left heart." Systemic circulation , driven by

the "left heart," carries blood to the rest of the body. Food products enter the system from the
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digestive organs into the portal vein . Waste products are removed by the liver and kidneys. All

systems ultimately return to the "right heart" via the inferior and superior vena cava.

A specialized component of the circulatory system is the lymphatic system , consisting of a

moving fluid (lymph/interstitial fluid); vessels (lymphatic); lymph nodes , and organs ( bone

marrow , liver, spleen , thymus ). Through the flow of blood in and out of arteries, and into theveins, and through the lymph nodes and into the lymph, the body is able to eliminate the

products of cellular breakdown and bacterial invasion.

Blood Components

Adults have up to ten pints of blood.

Forty-five percent (45%) consists of cells - platelets, red blood cells , and white blood cells (neutrophils , basophils , eosinophils , lymphocytes , monocytes ). Of the white blood cells,

neutrophils and lymphocytes are the most important.Fifty-five percent (55%) consists of plasma, the liquid component of blood.
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VI. PATHOPHYSIOLOGY


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VII.MEDICAL MANAGEMENT

A. Laboratory Examination

FECALYSIS

11-22-09

Color: Brown

Consistency: Loose

CLINICAL CHEMISTRY III

11-13-09

Exam SI Normal Range InterpretationSodium(Na) 137.1 mmoL/L 135-148 NormalPotassium(K) 3.59 mmoL/L 3.5-5.0 Normal

Request for: Troponin T

Hemogluco Test (HGT) 8:55AM 105mg/dL

Sample Fluid: Serum

Test Name Result Normal Value InterpretationGLU Glucose 92.48 70.00-110.00 mg/dL NormalChol Cholesterol 247.43 HI 0.00-200.00 Increased. Indicates

hypertension.LDL LDL-Chol 186.1 HI 0.00-150.00 IncreasedTGL Total Triglyceride 83 30-150 Normal

AHDL HDL-Chol 44.77 35.00-60.00 Normal

URINALYSIS

Color Pale yellow Appearance Clear Rxn pH6.0Sugar (-)Protein (-)


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Bile (-)Specific gravity 1.010Pus cells 0.1 hpf RBC 0.2 hpf Crystals:

Amophorous Urates FewTumor markers

PROSTATE SPECIFIC ANTIGEN (PSA)

Normal Range Result Interpretation0.21-6.77 mg/mL 2.0 mg/mL Normal

Test Name Result Normal Range InterpretationVRCA Uric Acid 5.91 2.60-7.20 mg/dL Normal

ALT AlanineAminotranstrace 40.85 30.00-65.00 U/L NormalCreatinine 1.0 0.6-1.3 mg/dL Normal

CLINCAL LABORATORY

HEMATOLOGY

Result Normal Value InterpretationHgb 121 g/L 120-170 NormalHct 37% 40-54 Normal

RBC 4.2x10^11 4.6-6.0 NormalWBC 12.0x1011 5.1-10.0 Increased. Indicates

infection.Neutrophil 0.75 0.50-0.65 IncreasedLymphocytes 0.19 0.25-0.40 DecreasedMonocytes 0.04 0.03-0.09 NormalEosinophile 0.01 0.01-0.03 NormalBasophile 0.01 0.00-0.01 Normal

Platelet count 249x10 150-400 Normal

ROENTGENOLOGICAL REPORT

11-13-09

CXR PA Sitting:


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Follow-up study done when compared with the CXR AP supine taken 11-11-09 shows

progression of the densities at the lower lobes. The rest of the noted findings are

unchanged. No other remarkable findings

REMARK : Pneumonia, progressing

Athermanous aorta

Mild Dextroscoliosis, Thoracic spine

CT SCAN OF THE HEAD

11-13-09

Multiple axial homographic section of the head without contrast were obtained

Follow-up CT image when compared with the previous study done 11-11-09 shows no

significant interval changes. No blood noted. Previous impression is maintained.

KUB/ Prostate Glands

11-12-09

There is no significant disparity between the sizes of both kidneys. The right kidney

measure 9.49x4.10 cm (I x ap) with a cortical thickness of 1.63 cm. the renal

parenchyma shows a normal echo pattern. The pelvocalicer are not dilated. The ureters

are not dilated. No stone are seen. The distended UB shows no intravesicular

masses/calculi. The UB wall is not thickened. Bilateral ureteral jets are seen. The

prostate gland is enlarged with an estimated dimension of 3.90x2.64x4.28cm (l x w x

ap). Approximate at of 23gms. The inner gland and peripheral zone shows normal echo

patterns. No focal masses seen. The capsule is intact.

REMARK : Enlarged prostate gland

Unmarkable kidney, ureters, and urinary bladder sonographically

echocardiography and color flow.

CLINICAL CHEMISTRY III

11-11-09

Exam Result Normal Range InterpretationSodium(Na) 141.3 mmol/L 135.148 mmoL/L Normal


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Potassium(K) 3.78 3.5-5.3 Normal

DOPPLER

11-11-09

QUANTITATIVE

Dimension Pt Normal Function Pt Normal InterpretationLV (ed) 4.67 cm 4.5-5.0 Stroke

volume

68ml Increased

LV (es) 2.93 cm CO 49L/min3.62cm 2.2-4.0 EF 67% 55.0-77.0 Normal

LA (ps) 3.20cm 3.0-3.5 FS 37 28-42 NormalRA (os) 4.50cm 3.5-4.5 EPSS 0.53 (


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Thickened right aortic cusp and non coronary cusp

without restriction of motion.

Structurally normal tricuspid valves and pulmonic

valve of good opening and closing motion.

Normal main pulmonary artery and pulmonary

artery pressure (estimated pulmonary artery systolic pressure of 20mmHg by

acceleration time).

Normal aortic root with calcified anterior and

posterior aortic walls.

No pericardial effusion.

No thrombus noted

DOPPLER

Reverse mitral in flow pattern indicative or mild diastolic dysfunction.

Aortic regurgitation, mild

Mitral regurgitation, mild

Tricuspid regurgitation, mild

CT SCAN OF THE HEAD

11-11-09

Multiple axial tomographic sections of the head without contrast were obtained. The CT

image reveal a well-defined hypodense focus at the cortex of the left temporal lobe.

Minute hypodense form are seen at the right basal ganglia.

The sulci and cisterns are normal in pattern.

The ventricles are normal in size, axis, and position.

The midline structure is no displaced.


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The pineal gland, sellia, including the cerebellum, CP angles and basal cisterns are

intact.

No extra axial fluid collection CT seen.

The orbits, paranasal sinuses, petromastoid and bony caldarium are intact. No fractures

are seen.

REMARK : Acute cortical infarct, left temporal lobe

Lacunar infarct, right basal ganglia.

CXR PA

11-11-09

Reticulonodulonary densities are seen at the lower lobes. Heart is not enlarged. The

aortic knob is calcified. Trachea is midline. The diaphragm CP sulci are intact there is

mild dextroscoliosis thoracic spine. No other remarkable findings.

REMARK : Pneumonia

Atheromatous aorta

Mild dextroscoliosis, thoracic spine

B. Drug Study


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VIII. NURSING MANAGEMENT

A. Discharge Planning

With the given situation, the researchers plan on the possible date of discharge

is to continue supportive treatment. It involves the independent and collaborativeinterventions as follows:

INDEPENDENT

INTERVENTION RATIONALEEncourage patient to have proper diet Proper diet can minimize hypertension.


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DASH (Dietary approaches to stop

hypertension) diet, healthy low fat diet rich

in natural sources of vitamins and

minerals. Reduce salt intake.

Advise patient to take his foodsupplements daily.

To promote good condition and for protection from stress.

Encourage patient to take medications

seriously.

Taking medications seriously helps to

maintain a good blood pressure and

promotes good physical condition.Encourage patient to discontinue tobacco

use and alcohol consumption .

Alcohol consumption and cigarette

smoking can cause hypertension.Weight reduction and regular aerobic

exercise (e.g., walking ) are recommendedas the first steps in treating mild to

moderate hypertension.

Regular exercise improves blood flow and

helps to reduce resting heart rate andblood pressure.

Advise patient to take adequate rest and

sleep daily.

To improve physical condition of the body

and to minimize high blood pressure.

Keep regular appointments with the doctor

and let him/her know of any possible side

effects of the medication.

To observe for any unusualities that might

occur.

COLLABORATIVE

INTERVENTION RATIONALEEncourage emotional and spiritual support

from family and friends.

Emotional and spiritual support relieves

anxiety and enhances patients coping

skills to maintain a good blood pressure Advise family or significant others to

always provide patient a stress free

environment. Reducing stress , with

relaxation therapy, such as meditation and

other mind body relaxation techniques, by

reducing environmental stress such as

high sound levels and over-illumination .

Promotes adequate rest and avoids stress.
http://en.wikipedia.org/wiki/Tobacco_usehttp://en.wikipedia.org/wiki/Tobacco_usehttp://en.wikipedia.org/wiki/Alcohol_consumptionhttp://en.wikipedia.org/wiki/Alcohol_consumptionhttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Aerobic_exercisehttp://en.wikipedia.org/wiki/Aerobic_exercisehttp://en.wikipedia.org/wiki/Walkinghttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Stress_(biological)http://en.wikipedia.org/wiki/Meditationhttp://en.wikipedia.org/wiki/Meditationhttp://en.wikipedia.org/wiki/Meditationhttp://en.wikipedia.org/wiki/Mindbody_relaxationhttp://en.wikipedia.org/wiki/Noise_health_effectshttp://en.wikipedia.org/wiki/Over-illuminationhttp://en.wikipedia.org/wiki/Over-illuminationhttp://en.wikipedia.org/wiki/Tobacco_usehttp://en.wikipedia.org/wiki/Tobacco_usehttp://en.wikipedia.org/wiki/Alcohol_consumptionhttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Aerobic_exercisehttp://en.wikipedia.org/wiki/Aerobic_exercisehttp://en.wikipedia.org/wiki/Walkinghttp://en.wikipedia.org/wiki/Blood_flowhttp://en.wikipedia.org/wiki/Stress_(biological)http://en.wikipedia.org/wiki/Meditationhttp://en.wikipedia.org/wiki/Mindbody_relaxationhttp://en.wikipedia.org/wiki/Noise_health_effectshttp://en.wikipedia.org/wiki/Over-illumination


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Advise family to provide non

pharmacological comfort measures.

To promote relaxation and helps in

refocusing patients attention.

Advise relatives or significant others to

monitor the patients vital signs especiallythe blood pressure.

To observe for changes in the patients

blood pressure.

B. Health Teachings

INTERVENTIONS RATIONALEDiscuss the parts of Central Nervous

System and its functions.

To promote awareness as well as to let the

patient realize its importance. Through this,

the patient as well as the family members

will have an idea on how they should take

care if it.Discuss the predisposing and precipitating

factor that has caused his illness and

thoroughly explain how he developed

such.

To improve awareness and to let the

patient understand how he developed

hypertension.

Discuss the importance of good hygiene To avoid risk for infection.


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especially the regular cleaning of his body.Discuss the importance of adequate rest

and sleep.

To promote good condition of the body.

Instruct patient to avoid strenuous

activities.

To avoid stress that can cause

hypertension.Encourage the patient to have adequate

fluid intake.

To prevent dehydration or overload that

can cause the patients blood pressure to

rise. Avoid fatty foods and which are rich in

cholesterol.

To minimize hypertension.

Encourage the patient to comply with the

medications.

To maintain good blood pressure.

Keep regular appointments with the doctor

and let him/her know of any possible side

effects of the medication.

To maintain good blood pressure.

C. Nursing Care Plan


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D. Prognosis

Generally, there is no cure for hypertension. However, it can be well controlledwith the proper treatment. Therapy with a combination of lifestyle changes and

antihypertensive medicines usually can keep blood pressure at levels that will not cause

damage to the heart or other organs. The key to avoiding serious complications of

hypertension is to detect and treat it before damage occurs. Because antihypertensive

medicines control blood pressure, but do not cure it, patients must continue taking the

medications to maintain reduced blood pressure levels and avoid complications.

Prognosis is poor . Presently, the patients condition has not improved. Hispresent medical condition went worst since more and more complications are arising.

One problem we saw was the impending monetary deficiency. The resources

were exhausted and a foreseeable crisis of not sustaining the therapeutical management

of his conditions might occur.
http://science.jrank.org/pages/3488/Hypertension-Prognosis.htmlhttp://science.jrank.org/pages/3488/Hypertension-Prognosis.htmlhttp://science.jrank.org/pages/3488/Hypertension-Prognosis.htmlhttp://science.jrank.org/pages/3488/Hypertension-Prognosis.html


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minicase hypertension

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