Case Presentation

Submitted By: Ignatius Elpedes Claricia Enriquez Jecel Eran Claire Esic Risalyn Estrellas

Submitted to: Emmie L. Estiller, RN, MN

Patients Profile

Name: Qivtiya Asjali Alfa Address: San Roque, Zamboanga City Age: 39 y/o Sex: Female Status: Married Occupation: Housewife Educational Attainment: College Graduate Ethnic group: Tausug Dialect Spoken: Tausug, Tagalog Religion: Islam Chief Complaints: Dizziness Medical impression:

Case Study on Hypertension

System involve: Normal Function: Pathophysiology: How does high blood pressure hurt the arteries?

HBP damages the walls of the arteries. o If you have high blood pressure, the force on your arteries is too high. It's so high that it creates microscopic tears in the artery walls that then turn into scar tissue. Damaged arteries trap more plaque. o Acting like latticework inside your arteries, this scar tissue provides a lodging place for particles of fat, cholesterol and other substances, which are collectively called plaque. As the plaque builds up, the arteries slowly narrow and harden, causing conditions such as peripheral artery disease (PAD) and Coronary Artery Disease (CAD). HBP speeds up hardening of the arteries.

As you age, your arteries will naturally harden and become less elastic over time. This happens even in people without HBP. However, uncontrolled high blood pressure speeds up the hardening process.

Damaged and hardened arteries can lead to:

Damaged organs o Damaged arteries cannot deliver adequate blood flow to the body's organs. The organs suffer because they do not receive a full supply of blood, which they depend on for oxygen and nutrients. So over time, not only are the arteries unable to function properly, but the organs can't perform as they should either. Blood clots o When arteries are narrowed by fatty deposits, you have a greater risk for developing blood clots. Your blood can carry these clots until they become lodged in narrow spaces. When this happens, the clot can significantly or completely block the blood supply to parts of the body.

Definition Hypertension is a chronic elevation of blood pressure that, in the long-term, causes endorgan damage and results in increased morbidity and mortality. Blood pressure is the product of cardiac output and systemic vascular resistance. It follows that patients with arterial hypertension may have an increase in cardiac output, an increase in systemic vascular resistance, or both. Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase. Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time. Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg. Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Hypertension may be classified as essential or secondary. Essential hypertension is the term for high blood pressure with unknown cause. It accounts for about 95% of cases. Secondary hypertension is the term for high blood pressure with a known direct cause, such as kidney disease, tumors, or birth control pills.
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Cause Most of the time, no cause of high blood pressure is found. This is called essential hypertension. High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary hypertension may be due to:

Chronic kidney disease Disorders of the adrenal gland (pheochromocytoma or Cushing syndrome) Pregnancy (see: preeclampsia) Medications such as birth control pills, diet pills, some cold medications, and migraine medications Narrowed artery that supplies blood to the kidney (renal artery stenosis) Hyperparathyroidism

Risk Factors

African American obese often stressed or anxious Drink too much alcohol (more than one drink per day for women and more than two drinks per day for men) Eat too much salt in your diet Have a family history of high blood pressure Have diabetes Smoke

Signs and Symptoms High blood pressure typically has no symptoms at all, that is why we can call it as Silent killer. Although there are many symptoms that occur simultaneously with this disorder and are widely believed to be associated with high blood pressure. These include headaches, nosebleeds, dizziness, a flushed face and fatigue. Although people with high blood pressure may have many of these symptoms, they occur just as frequently in those with normal blood pressure. When these symptoms occur, if a person has high blood pressure that is severe or longstanding and left untreated, symptoms such as headache, fatigue, nausea, vomiting, shortness of breath, restlessness, and blurred vision can occur as a result of damage to the brain, eyes, heart and kidneys. In rare cases, high blood pressure may cause brain swelling, which can lead to drowsiness and coma. Common symptoms of high blood pressure. Breathlessness
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Headache Bleeding from the nose (Epistaxis) Fatigue and Sleepiness Confusion Tinnitus or ringing in the ears Vomiting Profuse sweating and Blurred vision

Complications The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage. Uncontrolled high blood pressure can lead to:

Heart attack or stroke.

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High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure. This can prevent these organs from functioning normally. This can result in vision loss. This syndrome is a cluster of disorders of your body's metabolism including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), or "good," cholesterol, high blood pressure, and high insulin levels. If you have high blood pressure, you're more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.

Aneurysm.
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Heart failure.
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Weakened and narrowed blood vessels in your kidneys.

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Thickened, narrowed or torn blood vessels in the eyes.

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Metabolic syndrome.
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Trouble with memory or understanding.

Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people who have high blood pressure.

Lab Studies Besides taking your blood pressure, your doctor will do a physical exam and medical history. Your doctor may also have you get other tests to find out whether high blood pressure has damaged any organs or caused other problems. These tests may include:

Urine tests- to check for kidney or liver disease. Blood tests- to check your levels of potassium, sodium, and cholesterol. A blood glucose test- to check for diabetes. Tests to measure kidney function. An electrocardiogram (EKG, ECG)- to find out whether there is any damage to the heart.

Routine lab tests are recommended before beginning treatment of high blood pressure to determine organ or tissue damage or other risk factors. These lab tests include urinalysis, blood cell count, blood chemistry (potassium, sodium, creatinine, fasting glucose, total cholesterol and HDL cholesterol), and an ECG (electrocardiogram). Treatment The goal of treatment is to reduce your blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you. Lifestyle and home remedies Lifestyle changes can help you control and prevent high blood pressure even if you're taking blood pressure medication. Here's what you can do: 1. Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. 2. Decrease the salt in your diet. A lower sodium level 1,500 milligrams (mg) a day is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have hypertension, diabetes or chronic kidney disease. Otherwise healthy people can aim for 2,300 mg a day or less. 3. Maintain a healthy weight. If you're overweight, losing even 5 pounds (2.3 kilograms) can lower your blood pressure.

4. Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day. 5. Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation up to one drink a day for women and everyone older than age 65, and two drinks a day for men. 6. Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit 7. Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too. 8. Monitor your blood pressure at home. 9. Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. Drug Study 1. Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first but not the only choice in high blood pressure medications. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. 2. Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks or in older adults but they're effective when combined with a thiazide diuretic. 3. Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. 4. Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action not the formation of a natural chemical that narrows blood vessels. 5. Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks and older adults than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions. 6. Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. Due to a

risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs. If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe: 1. Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels. 2. Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. 3. Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels. 4. Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing. Once your blood pressure is under control, your doctor may have you take a daily aspirin to reduce your risk of cardiovascular disorders. Nursing Management Assessent Monitor BP Obtain complete history to assess for symptoms that indicate target organ damage (whether other body systems have been affected by the elevated blood pressure). Ex: anginal pain; shortness of breath; alterations in speech, vision, or balance; nosebleeds; headaches; dizziness; or nocturia. Pulse rate, rhythm, and character of apical and peripheral pulses Nursing Diagnosis 1. Deficient knowledge regarding the relation between the treatment regimen and control of the disease process 2. Noncompliance with therapeutic regimen related to side effects of prescribed therapy Interventions Objective : lowering and controlling the bloodpressure without adverse effects and without undue cost Support and teach the patient to adhere to treatment regimen o Implement necessary lifestyle changes o Take medications as prescribed
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o Schedule regular follow-up appointments Teach disease process and how lifestyle changes and meds can control hypertension. Emphasize concept of controlling hypertension rather than curing it.

Teachings about Medications Most common side effects of diuretics are potassium depletion and orthostatic hypotension. The most common s/e of different antihypertensive drugs is orthostatic hypotension. Take meds at regular basis. Assume sitting or lying position for few minutes. Change position gradually. Avoid very warm bath, prolonged sitting or standing. Measuring Blood Pressure: Instructions for Patients Avoid smoking cigarettes or drinking caffeine for 30 minutes before blood pressure is measured. Sit quietly for 5 minutes before the reading. Sit comfortably with the forearm supported at heart level on a firm surface, with both feet on the ground. Provide written information : expected effects and side effects of medications; report s/e Sexual dysfunction o some medications, such as beta-blockers, may cause sexual dysfunction and that, if a problem with sexual function or satisfaction occurs, other medications are available Monitor BP at home. Trends and Research Studies High blood pressure in women 'more dangerous' than in men (January 2, 2014) The study, published in the journal Therapeutic Advances in Cardiovascular Disease, was conducted by scientists at Wake Forest Baptist Medical Center in North Carolina.

But in this latest study, researchers found "significant differences" in the mechanisms that cause high blood pressure in women, compared with men. "This is the first study to consider sex as an element in the selection of antihypertensive agents or base the choice of a specific drug on the various factors accounting for the elevation in blood pressure," says Dr. Carlos Ferrario, lead author and professor of surgery at Wake Forest Baptist. Commenting on their results, Dr. Ferrario says: "Our study findings suggest a need to better understand the female sex-specific underpinnings of the hypertensive processes to tailor optimal treatments for this vulnerable population." He suggests that new protocols are needed to treat high blood pressure in women, and the team says the condition may need to be treated earlier and more aggressively than in men. According to the study, during the past 20 to 30 years, there has been a significant decline in cardiovascular disease-related mortality in men. However, the same statistic does not apply to women. Heart disease is now the leading cause of death in women. The CDC recommends certain lifestyle patterns for decreasing the risk for elevated blood pressure and heart disease. These include: eating a healthy diet, maintaining a healthy weight, staying physically active, not smoking, and limiting alcohol use.

References:
http://www.mayoclinic.org

www.heart.org http://www.medicalnewstoday.com

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