UNIVERSITY OF LUZON

COLLEGE OF NURSING
DAGUPAN CITY

CASE STUDY

SUBMITTED BY:
ROCHELLE M. SERIOSA
TW 7-3 SHIFT

SUBMITTED TO:
MS. KRISTINE GRACE BUSTILLO
CLINICAL INSTRUCTOR

I.OBJECTIVES

1. To be able to gain knowledge on the disease entity.

 2. To be able to know the anatomy and physiology as well as the
pathophysiology of chronic hypertensive vascular disease.
3. To be able for us to know its etiology as the sign and symptoms manifested
by the patient.
4. To be familiarized with the disease, chronic hypertensive vascular disease
(CHVD).
5. To anticipate the appropriate nursing nursing interventions for the patient
with CHVD.

II.PATIENT PROFILE

Name: Rousenna Aquino

Address: Poblacion, Mangaldan, Pangasinan
Age: 32
Sex: Female
Birthday: Dec. 17, 1776
Religion: Roman Catholic
Nationality: Filipino
Date and time of admission: July 25, 2009 at 3:45 pm
Attending physician: Dr. Posadas
Diagnosis: Chronic Hypertensive Vascular Disease (CHVD)

III.PAST AND PRESENT HISTORY

➢ They are the one who experienced the situation of being hypertensive. They
have simple activities of daily living. Both in their father and mother side has
no disease of chronic hypertensive vascular disease.

IV.MEDICAL DIAGNOSIS

Chronic Hypertensive Vascular Disease (CHVD) - is a form of cardiovascular

disease primarily affecting the blood vessels. Some conditions, such as myocardial
ischemia, can be considered both vascular diseases and heart diseases.
Blood pressure is a measure of how hard the blood pushes against the walls of
your arteries blood pressure is high, it starts to damage the blood vessels, heart,
and kidneys blood pressure consists of two numbers: systolic and diastolic.
Someone with a systolic pressure of 120 and a diastolic pressure of 80 has a blood
pressure of 120/80, or "120 over 80."
 The systolic number shows how hard the blood pushes when the heart is pumping.
 The diastolic number shows how hard the blood pushes between heartbeats,
when the heart is relaxed and filling with blood.
V.ANATOMY AND PHYSILOGY
 The complex nature of the human body demands an efficient
circulatory system in order to sustain life. The trillions of cells
which comprise the human body demand this efficiency in order to
maintain the functions of the multitudes of systems within the
human body, which represents an ingenious division of labor. The
majority of the body’s cells are immobile, and therefore can not
retrieve the basics of their existence independently. This means a
well organized and efficient circulatory system is responsible for
deliver life sustaining oxygen and nutrients to the cells which are
incapable of fending for themselves.
The blood within the circulatory system is responsible for
delivering this life sustaining oxygen and nutrients. The adult
human body hosts nearly 60,000 miles of passageway for the blood,
also known as the blood vessels, in order to effectively deliver life
to the immobile cells.
The red blood cells, which are responsible for the delivery of
oxygen and nutrients, can also deliver within its frame work,
bacteria, fungus, infection, disease, and other life denying (to the
cells) toxins that can compromise the integrity of the immobile
cells. The human body has a built in defense system to counteract
this situation and come to the aid of the compromised cells known
as white blood cells. The white blood cells in conjunction with the
lymphatic system are often able to target cells which are being
attacked by a toxic element and come to their rescue like little
warrior cells.
The circulatory system is not a stand alone system, and it
requires the assistance of systems such as the respiratory,
urinary, endocrine, digestive, and integumentary systems in order
to maintain its proper function and give the body the life
sustenance it requires to live. While the circulatory system has
numerous functions, the various capabilities and functions of this
intense system can be segregated into two basic responsibilities.

Transportation of the substances necessary to maintain cellular

metabolism is one of two main functions of the circulatory system.
In conjunction with the respiratory system, red blood cells by the
name of erythrocytes are responsible for the transportation of
oxygen which are systematically delivered to the cells waiting
throughout the body. The human body takes a breath, which enters
the lungs. In the lungs, the oxygen molecules attach themselves to
VI.PATHOPHYSIOLOGY

Risk factor:
Family history
Age
High salt intake
Low potassium intake
Obesity
Excessive alcohol consumption
Smoking
Stress

Change in arterial bed

systemic vascular resistance

afterload

Increase blood flow to organs

Blood pressure
Increase perfusion Beta receptor

Hyponatremia Juxtaglomerular cells Hypovolemia

Renin

Anglotensinogen

Anglotensinogen arteriolar Anglotensin I

vasoconstriction
Anglotensin II

Adrenal cortex stimulation II

Aldosterone
Peripheral resistance
Na reabsorption

H2O reabsorption
 Blood pressure Plasma volcano (ECF)

VII.LABORATORY TEST

Hematology Result
Parameter Result Normal Limits
WBC 16.17 5.0-10.0
Neu % 72.5 50.0-70.0
Lym % 17.1 20.0-44.0
Mon % 7.8 2.0-9.0
Eos % 2.0 0.0-4.0
Bas % 0.6 0.0-2.0
RBC 3.54 4.20-5.40
HGB 98 125-160
HCT 30.8 37.0-47.0
MCV 86.9 78.0-100.0
MCH 27.7 27.0-31.0
MCHC 318 320-360
RDW-CN 14.3 11.5-14.5
RDW-SD 44.4 35.0-56.0
PLT 232 150-450

Oral Glucose Tolerance Test

Result Normal Range
Fasting: 5.50 mmol/L 6.40 mmol/L
1st hour: 8.20 mmol/L 11.2 mmol/L
2nd hour: 7.30 mmol/L X.80 mol/L

X-ray Result
➢ Chest (AP) Supine:
Expiratory film shows no active lung parenchymal infiltrates is noted.
Heart is magnified probably slightly enlarged. Aorta is not unusual. Prominent right
superior mediastinum partly due to dilated arch vessels. The diaphragm and
visualized bones of the thorax are intact.

VIII.MEDICAL MANAGEMENT AND TREATMENT

Medications:
➢ Nifedipine 30 mg OD
➢ Cefuroxime 500 mg BID
➢ Fe fumarate 1cap TID
➢ Nalbuphine 10 mg IV q 4 hrs. x 2 doses then prn for severe pain
 ➢ Hydralazine 10 mg IV q 2 hrs. prn for BP 170/100 mmHg
➢ Ranitidine 50 mg IV q 8 hrs.
➢ Furosemide 40 mg IV x 2 doses

IX.DISCHARGE PLANNING

1. Instruct the patient to avoid heavy activities that may cause her blood
pressure increase.
2. Instruct the family of the patient to administer only the prescribed
medication.
3. Encourage patient to eat more vegetables and fruits rather than foods that
rich in cholesterol.
4. If her blood pressure increase, advise the patient to take prescribed
medication for hypertension.
5. Provide the patient and the patients family information on how to maintain
healthy life style.