ppt hascvd

Manuel S. Enverga University FoundationCollege of Nursing And Allied Health Sciences

Case PresentationPresented To:

Mrs. Dolores MalolesClinical Instructor

Presented By:Group 11 BSN III-C

Causapin , JiggleElmundo, Cristina Lu Pesquisa, Jaymee O.

Reforma, ReynoldZurbano, Ivy

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 implication.

General Objectives

Specific ObjectivesTo understand condition of disease and associate

it with the patient through the introduction of the case

To know the nursing history, personal data, health history and physical assessment of the patient

To illustrate the anatomy and physiology and

pathophysiology of the affected organ.

To discuss and determine manifestation and complications of the disease.

To develop an effective skill on how to manage care in patient with the disease

To formulate a drug study with regards to the patients condition and correlate lab results to its normal values.

To provide the client a nursing care plan and discharge plan to assure for clients total wellness during her hospitalization up to the time of her hospital discharge .

I. IntroductionA.Background of the Study

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

The group decided to choose the case of HASCVD (Hypertensive arteriosclerotic cardiovascular disease) to make a difference in the usual case presentations where in diseases are presented. To give us learning regarding the disease and to be able to know the nursing care appropriate for such case.

C. Significance of the Study

The significance of this study is to gain and enhance knowledge, to develop skills and to apply the right attitudes of student nurses in rendering and giving care to the patient with, Hypertensive Arteriosclerotic Cardiovascular Disease it’s importance and implication. This study will serve as guidelines in assessing and providing proper nursing care to pt. with the same problem or disease.

These are other significance of the study that would support the above statement:

• Understand condition of HASCVD and associate it with the patient through the introduction of the case.

• To know the Nursing history: Personal data, Health history and physical assessment of the patient.

• Illustrate the anatomy and physiology and pathophysiology of the affected body organ or system.

• Apply effective skill on how to manage proper care in patient with

• Discuss and determine manifestations and complications.

• Formulate a drug study of the drug’s that is being used for the patient’s treatment.

• Correlate the lab result to its normal value.

• To formulate a nursing care plan and discharge plan to serve as guidelines for patient’s continuous care during his hospitalization up to the time of his hospital discharge.

D. Scope of limitation of the study

The study would only focus on Hypertensive Arteriosclerosis Cardiovascular Disease, it’s background, signs and symptoms and effects which is indicative to the client’s health condition and it’s underlying nursing care relevant for the client within the three- week duty at Mt. Carmel Diocesan General Hospital.

E. Conceptual and Nursing Theory

Theoretical Framework: Dorothea OremModel Of Nursing

Since the diagnosis of our patient is Hypertensive Arteriosclerotic Cardiovascular Disease , we relate Dorothea Orem theory of self care Model of Nursing.

It is particularly used in rehabilitation and primary care setting where the patient is encouraged to be as independent as possible. The Orem model is based upon the philosophy that all "patients wish to care for themselves". They can recover more quickly and holistically if they are allowed to perform their own self cares to the best of their ability.

Related Literature

Hypertensive Arteriosclerotic Cardiovascular disease

Atherosclerosis (also known as Arteriosclerotic Vascular Disease or ASVD) is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol.

It is a syndrome affecting arterial blood vessels, a chronic inflammatory response in the walls of arteries, in large part due to the accumulation of macrophage white blood cells and promoted by Low density lipoproteins (plasma proteins that carry cholesterol and triglycerides)

without adequate removal of fats and cholesterol from the macrophages by functional high density lipoproteins (HDL), (see apoA-1 Milano). It is commonly referred to as a hardening or furring of the arteries. It is caused by the formation of multiple plaques within the arteries.

CAUSESAtherosclerosis develops from low-density

lipoprotein molecules (LDL) becoming oxidized (ldl-ox) by free radicals, particularly oxygen free (ROS). When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage to the artery wall caused by oxidized LDL.

The LDL molecule is globular shaped with a hollow care to carry cholesterol throughout the body to generate brain tissues, vitamin D, and soon cholesterol can move in the bloodstream only by being transported by lipoprotein. The body's immune system responds to the damage to the artery wall caused by oxidized LDL by sending specialized white blood cells (macrophages and T-lymphocytes) to absorb the oxidized-LDL forming specialized foam cells.

Atherosclerosis typically begins in early adolescence, and is usually found in most major arteries, yet is asymptomatic and not detected by most diagnostic methods during life. Atheroma in arm, or more often in leg arteries, which produces decreased blood flow is called peripheral artery occlusive disease (PAOD).

Physiologic factors that increase risk

Various anatomic, physiological & behavioral risk factors for atherosclerosis are known. These can be divided into various categories: congenital vs acquired, modifiable or not, classical or non-classical. The points labeled '+' in the following list form the core components of "metabolic syndrome".

Treatment

Some symptoms such as angina pectoris can be treated. Non-pharmaceutical means are usually the first method of treatment, such as cessation of smoking and practicing regular exercise. If these methods do not work, medicines are usually the next step in treating cardiovascular diseases, and, with improvements, have increasingly become the most effective method over the long term. However, medicines are criticized for their expense, patented control and occasional undesired effects

II. Clinical SummaryA. General Data ProfileName: Mrs. X Address: Brgy. Market View 2

Calumpit St. Lucena, City Birthday: December 12, 1937 Birth Place: Lucban, Quezon Spouse Name: Rommel Abuan Nationality: Filipino Religion: Roman Catholic Occupations: House Wife

Date of admission: January 19, 2010 Admitting Diagnosis: Hypertensive

Arteriosclerotic Cardiovascular Disease Admitting Physician: Dr. Ma. Delta A. Canela

B. Chief Complaint Prior to admission the patient

experienced dizziness and vertigo.

C. Nursing History

History of present illness Prior to admission, last October 2008 after

arriving from the school of her granddaughter the patient felt severe headache or vertigo, dizziness, blurred vision and body malaise. She is also pale and weak in appearance as her son notice so they decided to bring her at Mt. Carmel Diocese General Hospital.

By December 2009 the patient is again admitted at MMG Hospital Lucena, City because of the vehicular accident so by means of that the physician gave her treatment and medication for her condition. After a year she had been experience again vertigo, dizziness, nervous and palpitation the reason why she admitted again at Mt. Carmel Diocese General on last January 19, 2010 under the supervision of Dra. Canela.

And she requested to undergo for CBC, Heart Diagnostic Test, RBS, and Urinalysis. After waiting the result the physician instructed her to have minimal exercise to prevent dizziness she also gives maintenance for her condition. Then after 3 days of staying at the hospital her final diagnosis was HASCVD or also known as Hypertensive Arteriosclerotic Cardiovascular Disease.

a. Childhood Illness

- Cough and cold, flu and measles b. Immunizations

- nonec. Allergies

- Sea foods such as: shrimp and crabd. Accidents

- Vehicular Accidente. Hospitalizations

- Last October 2009 she admitted at Mt. Carmel Dioces General hospital. After a year which is last December 2009 she admitted at MMG hospital Lucena, City. And last January 19 2010 she admitted again at Mt. Carmel Dioces General Hospital in the same reason.

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.

Grand fatherunknown

Grand fatherunknown

Grand Fatherunknown

Grand Fatherunknown

FatherunknownFather

unknown

Brother 80y/0

cardiac arrest

Brother 80y/0

cardiac arrest

Brother 81y/0

old aging

Brother 81y/0

old aging

Brother29y/0

murder

Brother29y/0

murder

Grand mother

unknown

Grand mother

unknown

Mother unknownMother

unknown

Grand mother

unknown

Grand mother

unknown

Patient72y/0

Patient72y/0

Sister49y/0peptic ulcer

Sister49y/0peptic ulcer

Sister70y/0Heart

disease

Sister70y/0Heart

disease

D. Family History (genogram)

E. Social History – Include Theories and Growth and Development

PSYCHOSOCIAL THEORY ACCORDING TO ERIK ERIKSON

STAGE AGE CENTRAL TASK INDICATORS OF POSITIVE

RESOLUTION

INDICATORS OF NEGATIVE

RESOLUTION

Maturity 65 to death Ego Integrity Vs

Despair

Older adults need to look back on life and feel a sense of fulfilment. Success at this stage leads to feeling of wisdom

Failure at this stage results in regret, bitterness, and despair.

ACCORDING TO SIGMUND FREUD’S THEORY ON PSYCHOSEXUAL DEVELOPMENT

STAGE AGE CHARACTERISTICS IMPLICATION

Maturity 65 to death Energy is directed toward full sexual maturity and function and development of skills needed to cope with the environment.

Encourage separation from parents, achievement of independence, and decision makings.

F. Environment/Living Condition

The client lives in a village where the environment is said to be clean. They have a little garden in their backyard where they grow different kinds of flowers. Their way of disposing garbage is collected by the city garbage collector. The water that they use for bathing, dishwashing and laundry came from metropolitan water district while they buy the water that they drink from a refilling station. There location is accessible to a hospital, school, church and mall.

G. Physical Assessment

PARAMETERS NORMAL FINDINGS ACTUAL FINDINGS

INTERPRETATION

General Appearance

- Clean in appearance and well groomed- Cooperative

-weak in appearance- Cooperative-well groomed

-The patient’s appears weak because of dizziness and vertigo she felt

Skin -With good skin turgor

- with good skin turgor- Slightly warm to touch

Hair

-Evenly distributed hair -Thick hair

-Evenly distributed-black curly hair

Nails -With good capillary refill of 1-2 seconds-with pinkish nail beds-with clean and short nails

- With good capillary refill of 1-2 seconds-with pale nail beds-with nail polish

Skull & Face -Mount uniform consistency absence of nodules and masses -Rounded smooth skull contour-Symmetrical facial movement

-Mount uniform consistency absence of nodules and masses-Rounded smooth skull contour-Symmetrical facial movement

Eyes -No eye discharge-With anicteric sclera-Eyebrows hair evenlydistributed/skin intact -(+) blink reflex -With pinkish conjunctive

-No eye discharge-with anicteric sclera-Eyebrows hair evenly distributed/skin intact-with sunkenand dark circle around the eye-(+) blink reflex-with slightly pale conjunctive

Because of sleep pattern disturbances

Ears -Auricle color same as facial skin-Auricle are mobile firm and not tender-Able to hear on both ears

-Auricle color same as facial skin-Auricle are mobile firm and not tender-Able to hear on both ears

Mouth -Pinkish lips-Without missing teeth-With pink gums-No foul odour-With symmetrical contour

-dry lips-with missing teeth-with pale gums-with slightly foul odour-with symmetrical contour

Musculosketal (Upper & Lower extremities

-symmetrical-No atrophy-With full range of motion

-symmetrical-no atrophy-with full range of motion

Abdomen -No abdominal distention-Flat rounded abdomen-Symmetrical contour-No surgical incision

-no abdominal distension-with soft and non tender abdomen-symmetrical contour-no surgical incision

H. Patterns of FunctioningFunctional Health

PatternBefore

HospitalizationDuring

HospitalizationInterpretation

Health Management

Self medication • Treatment Patient responsible to take medication as maintenance for her condition

Nutritional/Metabolica. number of meals per dayb. appetitec. glass of water per dayd. body builte. height and weight

3 times a day w/ good appetite 8 glasses of

water w/ normal body

built 5’7”

3 times a day w/ good appetite 3-4 glasses of

water Weak but in

normal body built

5’0’’ and 49

The patient still eats 3x each day with good appetite but decreased fluid intake resulting sometimes dehydration and weakness

Eliminationa. frequency of urinationb. amount of urine per dayc. frequency of bowel movementd. consistency of the fecese. amount defecated per day

3-5 times per day

Moderate Once a day Formed Moderate

2-3 times per day

Moderate Once a day Formed scanty

The frequency of his urination and bowel decreased but still with the same amount. This maybe caused by his decreased fluid intake and compression of bladder

Activity and Exercisea. exerciseb. fatigabilityc. ADL

Walking Easy to get tired Going to market

everyday

This is due to his condition

Cognitive/Perceptuala. orientationb. responsiveness

Oriented to time, place and personResponds appropriately to verbal and physical stimuli

Roles/Relationship

a. as a sonb. as a brotherc. as a husbandd. as an employee and co-

worker

With good relationship to his parents and he provided financial aid to the familyWith good relationship to his sisters and brothersWith good relationship to his wifeWith good relationship with his co-worker and manager

With good relationship to his parents and he provided financial aid to the familyWith good relationship to his sisters and brothersWith good relationship to his husband

Self Perception/Self Concept

Have a high self worth/importance

Have a high self worth/importance

Coping Stress He seeks advice to his wife and

friends when he has problems, burdens and stresses. He wants to talk about it right away. He also trust God in everything he do.

He seeks advice to his son and friends when he has problems, burdens and stresses. He wants to talk about it right away. He also trust God in everything he do.

Values/Belief He has awareness that God really exist

Believe more in medical sciences than such folk beliefs when it comes to health

His awareness to God became stronger than before

I. Course in the Ward

Jan. 19, 2010,

At 4:15pm admitted a 72 y/o female per wheelchair in due to dizziness BP 180/100mmhg, with doctor’s order please admit to room of choice under the service of Dr. Canela, secure consent, with low salt low fat diet, v/s every 4hrs., request for the following: CBC, RBS, Na, K, Crea and 12 lead ECG, IVF PNSS 1L @ 20gtts/min, medications of Captopril 25mg tab ½ tab sublingual now, Metoprolol 50mg tab/ 1 tab bid, input and output every shift, 2D echo study, in the morning FBS, Uric Acid, Lipid profile, AST, ALT, Urinalysis with Micral test, start medications: Amlodipine 10mg tab (Norvasc) 1tab OD every pm, Telmisartan 80mg tab/ 1tab OD am. At 4:20pm given Captopril @ ½ tab sublingual. At 4:30pm IVF of PNSS 1L inserted at L metacarpal vein IV cannula g#22 done aseptically, CBC, RBS, Na K, Crea forwarded, ECG done, attending physician notified through text and brought to room of choice.

January 20, 2010Received 72 year old female per stretcher with chief

complaint of dizziness with ongoing IVF of PNSS 1L x 20gtts/min. With decrease dizziness, positive headache, negative nausea, negative angina, BP 140/90mmhg and advised on low salt low fat diet. For ECG, 2D echo, FBS, ALT and AST. With verbal order from Dr. Mendoza to nurse on duty E. Capistrano. And instructed on vestibular exercises. Seen and examined by Dra. Canela at 9:00pm with new orders made. With same IVF to follow: PNSS 1L x 20gtts/min, may ambulate with assistance, start Atorvastatin (Lipitor) 80mg tab ½ tab OD HS and if stable allow billing in the morning.

January 21, 2010

Received lying on bed without contraption noted. With negative headache, negative nausea, negative angina. With orders made by AP home meds include: Metoprolol 50mg tab 1 tab bid #100, Telmisartan (pritor) 80mg tab 1tab OD am #60, Amlodipine (Norvasc) 19mg tab 1tab OD am #60, Betahistine (Lipitor) 80mg tab ½ tab OD HS #60 and follow-up check up on February 23, 2010 and instructed on vestibular exercises.

J. Laboratory Diagnostic Exam

Component Result Normal Range

Interpretation Implication Nursing Responsibilities

Glucose 89 mg/dl 74-106 mg/dl

Cholesterol 208 mg/dl 0-200 mg/dl The patient has a high level of cholesterol

Instruct the patient to choose 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 a high level of triglycerides

Instruct the patient to eat food with 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

Uric Acid 4.5 mg/dl 2.5-6.2 mg/dl

Component Result Normal Range

Interpretation Implication Nursing Responsibilities

AST 34 U/L

ALT 36 U/L

VLDL 57 mg/dl 0-35 mg/dl The patient has a high level of VLDL

- increased risk of cardiovascular events

Instruct the patient to limit intake of dietary cholesterol to 300 mg or less than 200 mg.

LDL 105 mg/dl 0-150 mg/dl

CHOL/dHDL

4.53

DIMENSION PATIENT FUNCTION PATIENT

(ed) 4.2 (4.5-5.0) LVEPV

(es) 3.0 LVESV

RV (ed) 3.1 (2.2-3.5) Stoke Volume 44 ml

LA (es) 3.1 (3.0-3.5) C. O. 2.0 l/min

RA (es) 3.1 3.5 EF % 55.0 % (55-77.0)

Aorta 2.9 3.5 FS % 28.0 % (28-92.0)

PA 2.5 3 VCF (0.8-1.5)

IVS (ed) 1.1 (0.8-1.1) EPSS (< 195)

IIS (es) 1.3 Wall stress (S) ( < OOD )

LVP W (ed) 1.1 (0.8-1.1) Wall stress (D)

LVPW (es) 1.3 LVWMSI 1

MV ANNU LVTD 1.7

HEART DIAGNOSTIC TEST

TEST RESULT NORMAL RESULT

Creatinine .8 mg/dl .5-1.0

Sodium 141. mnol/l 137.- 145

Potassium 4.2 mnol/l 3.5- 5.1

RESULT NORMAL VALUE

150 -100

RBS RESULT

Color Light Yellow

Trans. SL. Turbid

Protein Neg.

Sugar Neg.

PH 7.0

Sp. Grav. 1.005

Microscopic

Puscells 1.3/hpf

RBC 0.2/hpf

URINALYSIS

K. Impression/Diagnosis

HASCVD (Hypertensive Arteriosclerotic Cardiovascular Disease), Hypertension, Essential Stage 2 uncontrolled Dyslipidemia, BPPV (Benign Paroxysmal Positional Vertigo)

III. Clinical Discussion of the Disease1.Anatomy and Physiology

The heart is a hollow muscular organ of a somewhat conical form; it lies between the lungs in the middle mediastinum and is enclosed in the pericardium. It is placed obliquely in the chest behind the body of the sternum and adjoining parts of the rib cartilages, and projects farther into the left than into the right half of the thoracic cavity, so that about one-third of it is situated on the right and two-thirds on the left of the median plane.

Size. The heart, in the adult, measures about

12 cm. in length, 8 to 9 cm. in breadth at the broadest part, and 6 cm. in thickness. Its weight, in the male, varies from 280 to 340 grams; in the female, from 230 to 280 grams. The heart continues to increase in weight and size up to an advanced period of life; this increase is more marked in men than in women.

Component Parts.

The heart is subdivided by septa into right and left halves, and a constriction subdivides each half of the organ into two cavities, the upper cavity being called the atrium, the lower the ventricle. The heart therefore consists of four chambers, right and left atria, and right and left ventricles.

The division of the heart into four cavities is indicated on its surface by grooves. The atria are separated from the ventricles by the coronary sulcus (auriculoventricular groove); this contains the trunks of the nutrient vessels of the heart, and is deficient in front, where it is crossed by the root of the pulmonary artery. The interatrial groove, separating the two atria, is scarcely marked on the posterior surface, while anteriorly it is hidden by the pulmonary artery and aorta.

The ventricles are separated by two grooves, one of which, the anterior longitudinal sulcus, is situated on the sternocostal surface of the heart, close to its left margin, the other posterior longitudinal sulcus, on the diaphragmatic surface near the right margin; these grooves extend from the base of the ventricular portion to a notch, the incisura apicis cordis, on the acute margin of the heart just to the right of the apex.

BLOOD FLOW THROUGH THE HEART1. Deoxygenated blood returning from the body enters the heart

through the superior vena cava and inferior vena cava.2. Blood passes into the right atrium and right ventricle3. Right ventricle pushes the blood through the pulmonary

arteries4. Blood passes through the lungs where it loses carbon dioxide

and picks up oxygen5. This oxygenated blood returns to the heart via the pulmonary

veins6. Blood enters the left atrium and left ventricle7. The left ventricle pushes the blood out through the main

artery, the aorta8. Blood travels to all parts of the body where it delivers oxygen

and picks up carbon dioxide

The CORONARY ARTERIES branch from the aorta as soon as it emerges from the heart (please see diagram of the heart at left). They deliver oxygenated blood the heart muscle. Coronary artery disease (or coronary heart disease) involves the buildup of deposits in these crucial vessels. This reduces and sometimes completely blocks the flow of blood resulting in a heart attack .

ARTERIES: are vessels that take blood away from the heartVEINS: are vessels that bring blood towards the heartATRIUM: smaller chamber of the heart through which

blood enters the heartVENTRICLE: larger chamber of the heart which pushes

blood away from the heartAORTA: major artery carrying blood away from the left

ventricleVENA CAVA: main vein returning blood to the right atriumCORONARY ARTERIES: the first vessels to branch from the

aorta; they supply blood to the heart muscle

Predisposing Factors:

· Gender

· Age

Precipitating Factors:

· Lifestyle

· Uncontrolled HN

· Diet

Hypertension Hyperlipidemia

↑Shearing force

Damage of arterial endothelial layer

Fatty disposition into arterial wall

Inflammatory response & intramuscular clotting

Thrombus FormationAtheromatous aorta

S: Sx

↑BP, dyspnea,

Angina, edema,

Dizziness, swollen

Neck vein,

Palpitations, mental

confusion

LVH Narrowing of the lumenEmbolic occlusion in myocardial artery

Disrupted brain cell metabolism

Accumulation of H2O, Ca, NA

↑ ICP

Localized acidosis and free radical Formation

Cell injury

CVA

CADS: Sx

Chest pain,

Dyspnea, dizziness, unusual fatigue,

ECG changes,

dysrrhythmias

Prognosis

Coma

Cerebral death

Loss of neural feedback

mechanism

Cessation of physiologic functions

Multi-organ failure

DEATH

Return of normal

perfusion

Decreased Edema

Improved function

If Treated If untreated

Predisposing Factors:

· Gender

· Age

Precipitating Factors:

· Lifestyle

· Uncontrolled HN

· Diet high cholesterol & high fatty acid

Hypertension Hyperlipidemia

↑Shearing force

Damage of arterial endothelial layer

Fatty disposition into arterial wall

Inflammatory response & intramuscular clotting

Thrombus FormationAtheromatous aorta

S: Sx

↑BP, dyspnea,

Angina, edema,

Dizziness, swollen

Neck vein,

Palpitations, mental

confusion

LVH Narrowing of the lumenEmbolic occlusion in myocardial artery

Disrupted brain cell metabolism

Accumulation of H2O, Ca, NA

↑ ICP

Localized acidosis and free radical Formation

Cell injury

CVA

Drug study

DRUG INDICATION DOSAGE & PREPARATION

ACTION ADVERSE REACTION

NURSING CONSIDERATION

Metoprolol (Beta-blocker)

Hypertension 50 mg 1tab bid Block beta receptors which decreases cardiac output, peripheral resistance and cardiac oxygen consumption

CNS: fatigue, dizziness.

CV: hypotension , bradycardia

GI: nausea, diarrhea

RESPI: dyspnea

SKIN: rash

Always check pts apical pulse rate bfore giving drug. If it’s slower than 60bpm withhold drug and call AP immediately

Monitor bp frequently.

Instruct pt to take drus as prescribed and with meals.




Amlodipine (Norvasc) Calcium channel blocker

Hypertension 10mg 1tab OD

Inhibits calcium ion influx across cardiac and smooth muscle cells, dilates coronary arteries and decreases blood pressure demand.

CNS: headache, fatigue. Dizziness

CV: palpitations, edema

GI: abdominal pain

RESPI: dyspnea

SKIN: rash

Monitor bp frequently during therapy because drug-induced vasodilation has a gradual onset.

Caution patient to continue taking drug even when she feels better.




Telmisartan(Pritor) AngiotensinII receptor antagonist

Hypertension (Used alone or with other antihyper-tensives)

80mg 1tab OD

Blocks vasoconstric-ting and aldosterone-secreting effect of angiotensin II by preventing it from binding to the angiotensin I receptor

CNS: dizziness, headache, fatigue

CV: chest pain

GI: nausea. Diarrhea

GU: UTI

RESPI: cough

Other: flu-like symptoms

Monitor patient for hypotension after starting drug. Place pt supine if hypotension occurs and give NSS if needed.

Tell pt if she feels dizzy or has low bp on standing she should lie down and rise slowly from lying to standing position.

DRUG INDICATION DOSAGE AND PREPARATION



Betahistine (Serc)

Peripheral vertigo

16mg 1tab OD May affect neural pathways originating in the labyrinth to inhibit nausea and vomiting.

CNS: drowsiness, restlessnessCV: hypotension, palpitationsEENT: dry nose and throatGI: anorexia, constipationGU: urine retentionSKIN: rash

Advise patient to avoid hazardous activities that requires alertness’

Urge patient to report persistent or serious adverse reactions promptly.




Atorvastatin (Lipitor)

Reduce risk of death from CV disease and CV events in pts at high risk for coronary disease

80mg/tab 1tab OD HS

Used to lower cholesterol and triglyceride (fat-like substances) levels in the blood.

CNS: headache

GI: abdominal pain and constipationRESPIRATORY: upper respiratory tract infection

Patient should follow a diet restricted in saturated fats and cholesterol during therapy.

Instruct patient to take drug in the evening.

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.

Risk for injury related to dizziness secondary to increased blood pressure

1 It focuses on actions which are designed to solve or minimize the existing problem.

Activity Intolerance r/t body malaise and vertigo secondary to prolonged bed rest.

2 This should be given priority because it can lead to more complications if not managed appropriately

Sleep pattern disturbances related to unfamiliar environment secondary to hospitalization

3 Sleep pattern disturbance must be given priority because it is one of basic need of patient’s well being

B. Prioritized List Nursing ProblemProblem Ranking Justification

C. NCP (based on the sequence of prioritized problem)

Assessment Nursing Diagnosis

Planning Nursing Intervention

Rationale Evaluation

Subject:“ Hilong-hilo ako.” as verbalized by the patient.Objective:o BP=

180/100mmHg

o PR= 112bpmo Weakness

notedo Irritable

noted.

Risk for injury related to dizziness secondary to elevated blood pressure.

At the end of the nursing interventions patient’s BP and PR will be decrease to its normal range.

o Establish rapport.

o Safety measures rendered.

o Promote conducive environment

o Promote rest and sleep

o Administer antihypertensive as doctors prescribed

o To gain trust and cooperation

o To avoid further injury.

o To provide comfort

o To conserve

energyo To help

reduce BP and PR.

Goal partially met as evidenced by patient BP decrease from 150/100mmHg to 140/90mmHg and PR decrease from 112bpm to 77bpm


Planning Interventions Rationale Evaluation

S: “nanghihina ako kasi lagi na lang akong nakahiga”as verbalized by the patient.O:o Conscious

and coherento ambulatory c

assistanceo afebrile (36.8

oC)o c body

malaiseo c good

capillary refill in 2-3 secs.

o c good skin turgor

o on low cholesterol, low salt/fat diet

o c good appetite, consumed all foods served.

Activity Intolerance r/t body malaise and vertigo secondary to

prolonged bed rest.

At the end of nursing

interventions, the pt. will verbalize

willingness to and demonstrate participation in

activities.

o establish rapport

o place the client in a comfortable position

o take and record vital signs

o Determine patient's perception of causes of fatigue or activity intolerance.

o Assess patient's level of mobility.

o Assess nutritional status.

o Monitor patient's sleep pattern and amount of sleep achieved over past few days.

o to facilitate NPI.

o to prevent backaches or muscle aches.

o to note any significant changes that may be brought about by the disease

o These may be temporary or permanent, physical or psychological. Assessment guides treatment.

o This aids in defining what patient is capable of, which is necessary before setting realistic goals.

Patient verbalized

willingness to and was able to

participate in activities.

Assess emotional response to change in physical status.

Encourage adequate rest periods, especially before meals, other ADLs, and ambulation.

Refrain from performing nonessential procedures. Assist with ADLs as indicated; however, avoid doing for patient what he or she can do for self.

Teach energy conservation techniques.

Depression over inability to perform required activities can further aggravate the activity intolerance.

Rest between activities provides time for energy conservation and recovery. Patients with limited activity tolerance need to prioritize tasks.

Assisting the patient with ADLs allows for conservation of energy. Caregivers need to balance providing assistance with facilitating progressive endurance that will ultimately enhance the patient's activity tolerance and self-esteem.These reduce oxygen consumption, allowing more prolonged activity.


Planning Interventions Rationale Evaluation

S-“Hirap na hirap akong makatulog.” As verbalized by the patient.O-dark circles under eyesincreasing irritabilityRestlessnessFrequent yawning

Sleep pattern disturbances related to unfamiliar environment secondary to hospitalization

At the end of the nursing interventions the patient will report improvement in sleep/rest pattern

Discuss the reasons for differing individual sleep requirements, including age, activity level and other possible factors.Institute measures to promote relaxation:a. Maintain dark, quiet environmentb. Ensure good room ventilationc. Closed the door, if desired.Teach the client sleep-promoting measures likeattempting to sleep only when feeling sleepyAssist with usual routines as necessary, such as personal hygieneExplain the importance of regular exercise in promoting good sleep

Although many believe that a person needs 8hrs of sleep each night, no scientific evidence support this. Individual sleep requirements vary greatly. Generally, a person who can relax and rest easily requires less sleep to feel refreshed.Sleep is difficult without relaxation. The unfamiliar environment can hinder relaxationThese practices may help to promote sleep.A familiar ritual may promote relaxation and sleep.Regular exercise not only increases endurance and enhances the ability to tolerate psychological stress but also promotes relaxation.

Goal partially met as evidence by patient verbalized “nakatulog narin ako kahit papaano di gaya kahapon wala talagang halos naitulog

D. Discharge Plan (M.E.T.H.O.D.)

Medications:• 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)

• Advise patient to take the prescribed medications continuously at home

• Always check the expiration date of the medicine before taking

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



• Angiotensin-converting enzyme (ACE) inhibitors

• Angiotensin || receptor blockers (ARBs)

• Diuretics

• Beta-blockers

• Calcium channel blockers

Health Teachings

• Teach the patient to use a self-monitoring blood pressure cuff and to record the reading at least twice a week.

• Tell the patient to take his blood pressure at the same hour each time, with out more than usually activity preceding the measurement.

• Tell the patient and family to keep a record of drugs used in the past.

• To encourage compliance with antihypertensive therapy, suggest establishing a daily routine for taking medication. Warn the patient that uncontrolled hypertension may cause stroke and heart attack. Tell him to report any adverse reactions to prescribed drugs. Advise him to avoid high-sodium antacids and over-the-counter cold and sinus medications containing harmful vasoconstrictors.

• Help the patient examine and modify his lifestyle behavior.

• Suggest stress-reduction groups, dietary changes, and an exercise program.

• Encourage a change in dietary habits. Help the obese patient plan a reducing diet.

• Tell to the patients to avoid high-sodium foods, table salt, and foods high in cholesterol and saturated fat.

• Encourage a change in dietary habits. Help the obese patient plan a reducing diet.

• Tell to the patients to avoid high-sodium foods, table salt, and foods high in cholesterol and saturated fat.

Out Patient Referral Check-Up

• After discharge, advise patient to come back to specified date said by the physician.

Diet

reduction of sodium intake moderation of alcohol weight loss in the obese possibly increasing potassium and

calcium intake ingestion of a vegetarian diet or fish oil

supplements.

Thank you!