Académique Documents
Professionnel Documents
Culture Documents
INTRODUCTION
DEFINITION
Generally, the terminology describing hypertensive emergencies can be confusing. Terms such
as hypertensive crisis, malignant hypertension, hypertensive urgency, accelerated hypertension
and severe hypertensions are all used to=in the literature and often overlap.
As a specific term hypertensive emergency is primarily used as a crisis with a diastolic pressure
of 120 mm hg and above plus end organ damage (Brain, Cardiovascular, renal) as described
above in contrast to hypertensive urgency where as yet no end organ damage has developed.
The former requires immediate lowering of blood pressure as with Sodium Nitroprusside
infusions.
1
Heart palpitations
DIAGNOSTIC EXAM
Blood pressure monitoring using sphygmomanometer
Electrocardiogram (ECG)
Complete Blood Count(CBC)
Physical Examination
LDL-HDL Ratio
TREATMENT
The usual treatment is to reduce blood pressure using anti –hypertensive drugs, it includes:
ACE inhibitors;
ARBs;
Diuretics;
Beta-blockers;
Calcium- blockers
Diuretics are usually recommended as the first line of therapy for most people who have high blood
pressure. If one drug doesn’t work or is disagreeable, other types of diuretics are available.
NURSING INTERVENTION
The primary responsibility of the nurse is to assess the condition of the patient during the
treatment. It includes the following but are not limited to;
2
A. Client’s profile:
Name: Mr. AM
Address: Abbay Maddela Quirino
Age: 26 years old
Sex : Male
Civil status : Married
Nationality : Filipino
Religion : Born Again
BirthDate : November 5,1983
Occupation : BaKer
Date of admission: May 4, 2010
Time of admission: 2:45PM
Chief Complaint: body weakness and pale looking
Diet : DAT
Diagnosis: Anemia to consider Blood Dyscrasia
Physician: Dr.X
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 that’s why they decided to have his check
up at QPH and his Physician advised him for confinement with a
diagnosis of Anemia. Admitted last May 4, 2010 @ 2:45pm
3
II GORDONS HEALTH FUNCTIONAL PATTERN
2. NUTRITIONAL-METABOLIC PATTERN
3. ELIMINATION PATTERN
4. ACTIVITY-EXERCISE PATTERN
4
BEFORE HOSPITALIZATION: The pt. is fun of playing basketball
and this serve as his exercise.
5. SLEEP-REST PATTERN
5
BEFORE HOSPITALIZATION: He is a responsible father and
husband. He is a baker on a small
bakery at Zamora.
9. SEXUALITY-REPRODUCTIVE PATTERN
He was 7 years old when he was circumcised by what they call “de
pok-pok”before.
6
PHYSICAL ASSESSMENT
7
Teeth Inspection With Due to poor
presen hygiene
ce of
dental
carrie
s
Gums Inspection Pinkish in Normal
color
Tongue Inspection Moist Normal
FACE Inspection Pale in Due to lack of red
Palpation color blood cell
No
masse Normal
s
NECK Inspection Symmetri Normal
cal
and Due to present
pale condition
in
color
UPPER Inspection No lesion Due to present
EXTREMITIES Palpation and condition
pale
in
color
Symmetri Normal
cal,
no
bones
disloc
ated
8
pale condition
in
color.
9
left
leg.
10
be pumped through the aorta to the different organs of the
body.
III. PATHOPHYSIOLOGY
HYPERTENSIVE EMERGENCY
Obesity
Increased BP
Age
Stress
Stressor initiated
Angiotensin is produced
Angiotensin I is converted to
Angiotensin II
11
IV. COURSE IN THE WARD
5/5/10
10:10 am
>TF: PNSS1L at KVO for electrolytes and fluid balance
> For Peripheral blood smear to check abnormalities of blood
> for referral to Hematologist for further evaluation and management
> continue for BT To replace components of blood loss
> refer To evaluate condition
5/6/10
9:30am
Continue BT To replace components of blood loss
5/7/10
Still for BT To replace components of blood loss
Continue IVF PNSS1L x 24hrs
5/7/10
3:00pm
For referral to Hematologist For further evaluation and management
D5NM1L x 25 gtts/min For electrolytes and fluid balance
Multivit. + Iron 1 capsule TID To boost immune system
refer For further evaluation
12
V. LABORATORY RESULTS
Name: Mr AM
Result Normal
values
WBC 3.5
13
URINALYSIS
Chemical Examination
Color: yellow
Clarity: clear
MICROSCOPIC EXAMINATIONS:
Bacteria: +/hpf
Photologist ( 59251)
14
CHEMISTRY
Photologist ( 59251)
15
16
SERUM ELECTROLYTES
Photologist ( 59251)
HEMATOLOGY
17
XII. VITAL SIGNS
18
November 30, 2009
4pm-12am
• 6:00pm bp-150/100 PR-58bpm
• 8:30pm bp-170/100 PR-64bpm
• 9:40pm bp-140/100 PR-60bpm
• 10:40pm bp-140/100 PR-57bpm
• 11:30pm bp-160/100 PR-60bpm
•
December 1, 2009
12am-8am
• 1:30am bp-170/110 PR-62bpm
• 2:30am bp-160/110 PR-64bpm
• 3:30am bp-180/120 PR-57bpm
• 4:30am bp-170/100 PR-58bpm
• 5:30am bp-170/110 PR-62bpm
December 1, 2009
8am-4pm
• 9:00ambp-160/100 PR-80bpm
• 10:00am bp-180/110 PR-86bpm
• 10:15am bp-170/100 PR-83bpm
• 10:30am bp-160/100 PR-86bpm
• 10:45am bp-160/100 PR-85bpm
• 11:00am bp-170/100 PR-80bpm
• 11:15am bp-160/100 PR-66bpm
• 11:30am bp-160/100 PR-64bpm
• 11:45am bp-170/110 PR-63bpm
• 12:30pm bp-160/110 PR-60bpm
• 1:00pm bp-160/110 PR-68bpm
• 1:15pm bp-160/110 PR-67bpm
• 2:00pm bp-160/110 PR-65bpm
• 2:30pm bp-160/110 PR-64bpm
• 3:30pm bp-170/110 PR-66bpm
19
December 1, 2009
4pm-12am
• 5:00pm bp-170/110 PR-66bpm
• 6:45pm bp-180/110 PR-68bpm
• 9:30pm bp-180/110 PR-61bpm
• 10:00pm bp-140/110 PR-64bpm
• 11:00pm bp-170/110 PR-65bpm
December 2, 2009
12am-8am
• 1:00am bp-180/120 PR-72bpm
• 2:30am bp-180/90 PR-70bpm
• 5:30am bp-160/110 PR-80bpm
• 7:30am bp-160/100 PR-79bpm
December 2, 2009
8am-4pm
• 9:00am bp-160/110 PR-62bpm
• 10:00am bp-150/90 PR-64bpm
• 11:00am bp-160/100 PR-66bpm
• 12:00pm bp-150/100 PR-62bpm
• 2:00pm bp-150/100 PR-63bpm
December 2, 2009
4pm-12am
• 6:30pm bp-170/110 PR-80bpm
• 7:00pm bp-160/110 PR-94bpm
• 9:00pm bp-140/90 PR-87bpm
• 10:00 bp-150/110 PR-92bpm
December 3, 2009
12am-8am
20
December 3, 2009
8am-4pm
• 9:30am bp-140/100 PR-89bpm
• 10:30am bp-140/100 PR-87bpm
• 11:30am bp-160/100 PR-90bpm
• 12:30pm bp-140/100 PR-93bpm
• 1:30pm bp-140/90 PR-86bpm
• 2:00pm bp-140/90 PR-78bpm
• 2:30pm bp-140/100 PR-68bpm
December 3, 2009
4pm-12am
• 6:00pm bp-140/90 PR-66bpm
• 10:00pm bp-130/90 PR-68bpm
December 4, 2009
12am-8am
• 12:30am bp-160/120 PR-85bpm
• 1:15am bp-150/120 PR-86bpm
• 1:30am bp-140/100 PR-89bpm
• 1:45am bp-140/100 PR-86bpm
• 2:00am bp-140/100 PR-83bpm
• 2:15am bp-140/100 PR-86bpm
• 6:00am bp-140/100 PR-79bpm
December 3, 2009
8am-4pm
• 10:00am bp-140/100 PR-86bpm
21
VI. NURSING CARE PLAN
22
23
NURSING CARE PLAN
24
inter
est /
parti
cipat
ion
of
self
care.
25
NURSING CARE PLAN
26
VII. DRUG STUDY
27
Hypertension Panceatitis, preparations in t
Brand name: thrombocytope the early afterno
nia. Watch for signs
weakness and cr
Stock:
Doctor’s order:
1 amp IV now then
OD
Generic name: Neutropenia,
Paracetamol leucopenia,
Non opiod pancytopenia Alert: Many OTC
analgesic and Mild pain and/or and contain acetami
Brand name: anti pyretics fever hypoglycemia when calculating
Stock:
Doctor’s order:
1 amp IV stat
Generic name:
Bisacodyl
Give drugs at times t
Diphenyl methane Chronic Dizziness, faintness, scheduled activi
Brand name: derivative constipation muscle Before giving for con
Dulcolax weakness with patient has adeq
28
excessive use diet.
Abdominal cramps
Electrolyte
imbalance
29