Case presented by: Quipit, Olive Quennie M.

Introduction Hypertension is sometimes called the silent killer because people who have it are often symptom free. In a national survey conducted from 2003-2004,24% of people who had pressures exceeding 140l90mmhg were unaware of their elevated blood pressure ,should be monitored at regular intervals because hypertension is a lifelong condition. Hypertension often accompanies other risk factors for artherosclerotic heart disease, such as dyslipidimia (abnormal blood fat levels), obesity, diabetes mellitus, metabolic syndrome, and a sedentary lifestyle.

Pathophysiology Blood pressure is the product of cardiac output multiplied by resistance. Cardiac output is the product of the heart rate multiplied by the stroke volume. In the normal circulation, pressure is transferred from the heart muscle to the blood each time the heart contracts and then pressure is exerted by the blood as it flows through the blood vessels. Hypertension can result from an increase in cardiac output, an increase in peripheral resistance, or both. Although no precise cause can be identified for most cases of hypertension, it is understood that hypertension is a multifactorial condition. Because hypertension is a sign, it is most likely to have many causes; just a fever has many causes.

Patient s profile Mrs. A, 76 years old was admitted at FUMC 5-8-11 w/a chief complain of body weakness. The patient is a non-smoker and non-alcoholic. Few hours DTA, the patient experience body weakness accompanied by(+) loss of appetite, not associated w/ (-) fever (-) H/A, (-)N/M, prompting consult hence @. Patient s History & Family History Mrs. A has, (+) CVA on May 2010 and (+) HPN w/ meds of Nicabed Norvsac. (-) DM, (-) asthma, and (-) allergy. Her family history (-) HTN, (-) DM, for physical History (-) smoker,(-) non- alcoholic, No kidney and liver disease.

Physical Assessment y General Survey  Conscious & coherent, ambulatory, not in cardio pulmonary distress. Body weakness on the right side extremity. y Integumentary  Brown, moist, w/ good skin turgor, no active lesions

y HEENT  Pink palpebral conjunctiva, unicteric sclera, w/ normal size of skull, hair are evenly distributed, strands are thin and brittle. y Chest and lungs  Normal lungs expansion, no retraction and vesicular breath sound, or both lungs filled.

y Heart  Apical beat at 6th ICS ,(-)murmur y Abdomen  Flat, soft normoactive bowel sound, no tenderness. y Extremities  No cyanosis, no edema y Cranial nerves  CN 1-12 are intact y Motor
R 4/5 L 5/5

4/5

5/5

y Vital signs  BP-140/70  T -36.7  R -15  P-82 y Assessment  HTN- uncontrolled S/P. SVD infarction

Laboratory Test y X-ray result y Examination: chest AP

 Interpretation  There are ill defined diversifies noted on the paracardiac area y Aorta sclerotic y Heart is enlarged  Impression:  Pneumonic infiltrate cardiomegaly, atheromatous aorta

CT scan Examination Head CT plain INTERPRETATION: there are multiple hypodensites noted on the right corona radiate and at the left internal capsule w/c may relate to a cerebral ischemic. INTERPRETATION: cerebral infarct Clinical Chemistry Result 4.13 mmol/L 0.67 mmol/L 1.02 mmol/L 2.81 mmol/L Normal 5.16-6.17 <1.70 <1.03 2.58-3.38 interpretation Borderline Normal Low Low optional

Cholesterol Triglycerides HDL LDL

Creatinine Sodium Potassium Calcium Chloride

Result 100.7 umol/L 128.1 meq/L 3.0 meq/L 1.10 meq/L 82 meq/L

Normal 61.88-123.76 umo/L 138.146 meq/L 3.6-5.0 meq/L 1.5-1.29 meq/L 96-110 meq/L

Differential Count WBC-6.1 Neutrophil Lymphocyte Monocyte Eosinophil Basophil Hgb Hct Hgt RBC MCV MCH MCHC Plt Drug Study Drug Lexotan Classification
Antiolytics

.60 .25 .08 .06 .01 119 .35 99 3.88 90 30.6 3.40 215

Action
>inhibits reuptake of serotonin and norepinephrine >inhibits HMGCOA reductase >preventing angiotensinI to convert to angiotensin II

Indication
>Anxiety, tension, depressed mood,and insomia >patients w/ elevated chol. > essential HPN, CHF prevention or stroke recurrence w/ hx of cardiovascular dse.

C.T
>pregnancy and lactated women. >Allergy to avastin >pts. Who are pregnant, children and hypotensive

Adverse effect
>dizziness, Lightheadness, Sleep d/o, taste d/o >headache, flatulence, heartburn > dizziness, Lightheadness, Sleep d/o, taste d/o

Nrsng. consideration
>monitor BP

Lipitor

Anti-hyper lipidemic

>arrange periodic drug test while taking drug >monitor BP

Peridopril Ace inhibitor

Nursing Care Plan Assessment S- inaantok lang ako, gusto kong matulog. O: Temp:36 Pulse:72 Resp.r:14 BP:140/70 Diagnosis >sleep deprivation to non sleep inducing practices as manifested by drowsiness/sleepy Planning >w/in 1hr. of nursing. Intervention the pt. can identify on what are the Appropriate interventions to promote sleep and report improvement in sleep/rest pattern. Intervention >evaluate for the use of meds. And other drugs affecting sleep such as antihypertensive. >note environmental factors affecting sleep. >determine interventions client has tried to date. Helps identify appropriate options. >encourage client to develop plan to restrict caffeine and other stimulating substances from late afternoon/evening intake, and avoid eating large at late night. These factors are known to disrupt sleep pattern. Evaluation >After 1hr of nursing intervention the pt. was able to identify on what are the appropriate interventions to promote sleep and report improvement in rest pattern.

Progress Notes
May 9, 2011
    

Received pt. lying on bed conscious and coherent Regulating IV fluid PNSS 1L plus 20meq KCL regulated @ 25gtts/min Vital signs are taken and recorded. Above IVF consumed, PNSS 1L plus 20meq KCL Document all the procedures.

May 10, 2011

 Received client in bed fully awake w/ ongoing IVF of 500ml PNSS regulated @25gtts/min.  On DAT  Carotid duplex scan to follow  v/s taken and recorded  advice to comply to medication regimen  settled bills  Rx; discharge planning is given  Discharged per wheelchair

Discharge planning
 Instruct the relatives to follow medication regimen.  Encourage the relative to follow regular checkup for the continuity of treatment.  Encourage the relative to take blood pressure and pulse rate before giving medications.  Advice the relative to monitor if there are any sudden changes in patient and report immediately.  Instruct the relative to feed client on time w/ nutritious food that is low in sodium, low in cholesterol, low in fat and give citrus fruits.  Follow the diet prescribed by the physician.