I. Acknowledgement: Metropolitan Hospital College of Nursing # 1357 G. Masangkay Cor. Mayhaligue, Sta. Cruz, Manila

METROPOLITAN HOSPITAL COLLEGE OF NURSING
# 1357 G. Masangkay cor. Mayhaligue, Sta. Cruz, Manila
I. ACKNOWLEDGEMENT
“Nursing is a profession where lives begin, lives flourish and lives end. To
have that power and responsibility in our hands is amazing. From our perspective,
every aspect of nursing is life. Not all were given that much opportunity to have this
course, definite and distinct individuals was chosen to be mold as a future health
care provider” …………………….. M4
We would like to express our deepest gratitude to the following that helped
us throughout this conduct study, for without them this endeavor would not be
possible.
To almighty God for giving wisdom, strength and guidance that enlightened
us to make it through this study and for continuously showering us with his bountiful
blessings and graces, for without him, everything would not be reality.
Special thanks to our dear Clinical Instructor – Mrs. Ascano, who guided us
all throughout and shared her knowledge and ideas to make it easier for us to
understand this case study and for her unconditional support, unwavering patience
and encouragement that further enhanced our drive to finish this work ahead of
time.
We would also like to express our deepest gratitude to our beloved Clinical
Instructors who have set as our encouragement and guide on all of our exposures in
different clinical areas for our learning experience. To all of our Lectures who in one
way or the other enlightened and taught us everything we know which served as our
tool throughout the preparation for this case presentation. We are truly blessed and
thankful for their sincere support, not only academically but also emotionally and
morally as well. Without the sense of discipline and competence that they instilled in
us, this case presentation could not have been made possible.
Heartfelt thanks to our respective families and friends, without their utmost
understanding and full support, we would not be able to deliver our best during the
preparation of this case presentation.
We would also like to express our heartfelt appreciation to the client and her
family who unselfishly shared their time, attention and trust. For providing us the
necessary information to make this case study possible.
This piece of work became reality with all your presence and spirit by our
side!
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II. INTRODUCTION
Hypertension, or commonly known as high blood pressure, is a medical

condition wherein the blood pressure of an individual is recurrently elevated.
Hypertension is an important contributor to morbidity and mortality from
cardiovascular disease. It is a an independent risk factor for stroke, myocardial
infarction, renal failure, congestive heart failure, progressive atherosclerosis,
dementia, coronary artery disease and peripheral vascular disease. As the
population ages, the prevalence of hypertension will increase even further broad and
effective preventive measures are implemented. In the Philippines, 9.6M are
hypertensive and 15.4M are predisposed to be hypertensive among adults, 20 years
and over. Unfortunately, half of those who has hypertension are not aware that they
have the condition, only 13.1% of them has been treated and 19.3 % has been
controlled. Since hypertension may be present in an individual in years without
noticeable symptoms, it is otherwise known as “The Silent Assasin”
In the Philippines, for over 5 years, hypertension ranks as the fifth leading
cause of morbidity. This implies that hypertension is a chronic problem or condition
of the country and perhaps not much has been done on its control and prevention.
Prolonged and uncontrolled hypertension is very dangerous. Unhealthy lifestyle
which include cigarette smoking, unmanaged stress, salty food consumption,
physical inactivity, or being overweight are the common modifiable risk factors to
having hypertension. Non modifiable factors include genetic predisposition to
hypertension and other disease condition like diabetes, heart and kidney disease,
high cholesterol level, or stroke and an increasing age. Hypertension in its earlier
stage is manageable. The simplest way of controlling high blood pressure is through
lifestyle modification by having healthy diet and regular exercise. Discontinuation of
smoking and alcohol consumption are also advised to individuals with hypertension.
However, medication is prescribed to hypertensive individuals to control persistent
rise in blood pressure. This includes Calcium Channel Blockers, Beta Adrenergic
Blockers, ACE Inhibitors and Angiotensin II Blockers.
Hypertension and its advantage(ARTICLE)
2
If hypertension persists, there are different problems that could arise out of
this problem. People with hypertension can contract a stroke or heart attack at
anytime. Hypertension can also cause faulty or imperfect vision. When the fine blood
vessels of the eyes get damaged because of high blood pressure, people can have
blurry vision which can even lead to blindness. Hypertension can also damage the
kidneys as the blood vessels of the kidney can thicken with high blood pressure.
(John Palsson)
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III. SCOPE AND LIMITATIONS
This document covers solely the time of our home visits to the client, Mrs.
HPN. The encounter started from July 20, 2009 and ended on July 21, 2009.
The case presentation focuses mainly on the disease process of

Hypertension in relation to the present physical manifestation of the client. The
available data that will support this case are quite limited due to the unrecalled data
of the client.
This will deal with the disease process based only on client’s condition, which
is Hypertension.
We requested permission from the client last July 20, 2009 and got her
approval. Thereafter, the assessment and data gathering was obtained on the same
date. The information collected came primarily from the client itself. The formulation
of all nursing care plan was result of assessment performed during the entire course
of our exposure.
We continued to monitor the condition of our client from the date we got her
approval until the end of our exposure July 21, 2009.
Some of the data we have obtained from the client have some
inconsistencies such as she couldn’t recall the medications she have taken and the
view of the client regarding her disease.
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IV. ASSESSMENT
1. Personal Data
Name: “Mrs. HPN”
Age: 70 years old
Address: Antipolo City
Date of Birth: May 15, 1939
Birthplace: Romblon
Gender: Female
Status: Widow
Religion: Catholic
Nationality: Filipino
Informant source: “Mrs. HPN”
Reliability of source: 80%
2. Family Background
A. Demography
Mrs. HPN was born at Romblon to a nuclear family with 9

siblings. She studied in Romblon reaching only up to Grade 6.
Because of financial setbacks, the client was forced to work after
graduation to help her family. She moved in with her sister in
Antipolo and worked as a shoemaker in a shoe factory in
Marikina. She got married in 1957 and was blessed with 5
children.
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3. Health History
A. Family Health History
The hypertension can be traced back to her grandparents

where both grandmothers from paternal and maternal side had
hypertension. Her father also had Hypertension. Three of her
siblings as well as herself, also has hypertension while only one
of her children had the disease accompanied by Diabetes
Mellitus type 2.
B. Past Health History
During the childhood days of Mrs. HPN, she already had

chickenpox and measles. She experienced her first menstruation
at the age of 12. She had appendicitis when she was 14 years
old which resulted to an immediate appendectomy at a hospital in
Odiongam, Romblon, where she was residing at the time. Mrs.
HPN has 4 daughters and 1 son; all were delivered normally. She
was hospitalized 18 years ago at UERM for the reason that she
had an ectopic pregnancy. 3 days after the diagnosis, her
fallopian tube ruptured and was then removed.
The diagnosis of hypertension was made a year ago, on

2008. She complained of dizziness and dyspnea. After a week of
suffering from the said signs an symptoms, one of her children
decided to take her to a private physician in Marikina, hence, the
diagnosis. Laboratory test – urinalysis, blood exam and chest x-
ray was done. She was then given a prescription for Neobloc
15mg to be taken once a day. A month after that, the client
stopped taking the medication due to financial constraints and
personal belief that her disease is non life threatening and can be
relieved by merely resting herself.
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C. Present Health History
On Monday, July 20, 2009, during the student nurses’

first contact with the client, she narrated that she currently
experiences dizziness and blurring of vision in her left eye. Her
BP was taken which revealed a reading of 160/100 mmHg. The
client elaborated that she has been prescribed with Neobloc
15mg once a day but is unable to take the medication due to
financial difficulties. She revealed that she only rests after bouts
of signs and symptoms are noted.
On Tuesday, July 21, 2009, during the second nurse-

client interaction, vital signs were again taken which revealed
normal results except for the BP which was at 160/110 mmHg.
Rest was again the initial action of the client to relieve her
condition. Because of this information and other assessment
findings, the student nurses realized the need for nursing action,
thus, this case study was initiated.
4. Values, Beliefs, Lifestyle Practices
The patient is a non smoker and a non alcoholic

beverage drinker. She regularly drinks coffee in the morning.
She is fond of eating vegetables and fish, but indulges llavishly
on seafoods such as shrimp and crabs when financially able.
She claims that she always has to have a “sawsawan” of Patis
for her viands because this was a habit she has grown up with.
She claims that in her childhood, they usually use the
sawsawan as a viand extender. The client does most of the
food shopping and preparation. At night, she sleeps at about 4-
6 hours at most. She cannot sleep during the day because of
her 7 grandchildren. Nothing was remarkable with the patient’s
elimination pattern. She claims to defecate daily and has no
problems with urination as well. The client maintains personal
hygiene by taking a bath regularly. Sometimes doing household
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chores like washing clothes, she’s also the one taking care of
her 7 grandchildren. Her daughter (mother of her grandchildren)
is working for their living, so in return, she’s spending most of
her time watching over her grandchildren.
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V. PHYSICAL ASSESSMENT
The Physical assessment was done at Mambugan Antipolo City

last July 21, 2009 1000H simultaneously with the Review of Systems.
General Survey:
Upon seeing the client, Mrs. HPN, she was wearing a floral
blouse with matching printed shorts and rubber slippers. She was neat,
clean and odor-free. Mrs. HPN was very accommodating, warm and
friendly during the initial contact and throughout the course of Physical
Assessment.
Latest Vital signs were:
Temperature: 36.5 oC
Pulse Rate : 82 bpm
Respiratory Rate : 17 cpm
Cardiac rate : 85 bpm
Blood pressure : 160/ 110 mmHg
Standing Height and Weight:
Height : 5’3
Weight : 45.4kgs
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Cephalo – Caudal Assessment:
Area Assessed Normal Actual

Technique Evaluation
Findings Findings
INTEGUMENTARY
Skin Inspection Lentigo senilus Brown age Normal
Palpation on exposed spots on face, » Clustering
body parts arms and of
(hands, face & hands. melanocytes
arms). (pigment-
Progressing producing
wrinkling and cells).
sagging of the
skin.
Skin may be Wrinkled »Loss of skin

dry , flaky and dryness and elasticity
rough and sagging in the increased
often itchy skin. Has a dryness and
(ASTEATOSIS) good fair decreased
complexion. subcutaneous
Warm, fats.
smooth and
soft to touch.
No presence
of
dermatoses.
Poor skin »Decreased

turgor in sebaceous
(sluggish) gland activity
and tissue
fluid.
Visible Bright red, »Due to
Talengiectasis fine dilated thinning of the
blood vessels dermis and
loss of
support for
the blood
vessel walls
Decreased Decreased »Due to
perspiration perspiration reduced
Moisture in Number and
skin functions of
folds and when Good skin sweat glands
pinched, skin turgor
brings back to
previous state. Normal
Good skin
Turgor
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Hair Inspection Loss of scalp Thin and Normal

Palpation and axillary graying of the Progressive
hair scalp, and loss of
axillary pigment cells
hair.Fine from the hair
smooth w/o bulbs.
infestation.
a. Distribution Inspection Evenly His hair is Normal

distributed evenly
distributed
b. Texture Palpation Smooth and His hair is Normal

shiny smooth
Nails Inspection Increased Thick Normal

thickness with nailbeds with Due to
ridges ridges decreased
calcium
deposition
because of
aging
Head Inspection Normocephalic Rounded, Normal

and smooth
symmetrical absence of
nodules or
Smooth skull masses
contour
Symmetric
Rounded, facial
smooth,
absence of Head
nodules or circumference
masses is 55 cm.
symmetric
facial movements
movements.
Head is norm
cephalic
round and
contour
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Eyes Inspection Symmetrically Symmetrical Normal

aligned in all planes
a. Eyebrows Inspection Present It is evenly Normal

bilaterally and distributed in
equally both eyes hair
distributed of eyebrows
Hairs of is coarse
eyebrows is
coarse
b. Eyelids Inspection Skin folds are Prominent Normal

prominent and skin folds and
lower lids sags sagging of
No edema and lower lids
with equally No edema
distributed present and
equally
distributed
c. Eyelashes Inspection It is distributed Distributed Normal

equally and equally and
curling toward curling toward
d. Eyeballs Inspection Aligned Alignment is Normal

normally in normal and Due to
their sockets shows decreased
with no positive orbital fats
protrusion and corneal reflex.
sunken Pupillary size:
appearance 3-4mm,
e. Iris and Pupil Inspection Normally it is Slightly Pale Normal

black, equal in conjunctiva, Due to aging
size, round but round and
may be pale equal in size.
Ability of the Pupil is
iris to reactive to
accommodate light.
to darkness Adaptation to
and dim light light and
diminishes darkness
decreases
f. Eye movement Inspection Able to move Can move his Normal.

eyes in full eyes in any Changes in
range of direction and the ciliary
motion or able in full range of muscles, rigid
to move in all motion pupil
direction sphincter
decreases in
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pupil size due

to sclerotic
changes in
iris
g. Vision Inspection Visual acuity The patient Normal

may decreased has a Visual acuity
decreased decreases as
visual acuity the lens of the
The patient is eye ages and
wearing eye becomes
glasses with a more opaque
grade vision and also
of 200/200 loses
elasticity
Nose Inspection Symmetric and Symmetrically Normal

straight aligned with
Moist moist
discharge. No discharges
lesions. Nasal
septum intact
and not tender
Ears Inspection Skin of ears Resilient and Normal

may appear dry skin of Due to loss of
dry and be less ears are connective
resilient present tissue
Mouth, lips and Inspection Oral mucosa Decreased Normal due to

tongue may be drier salivation, aging
than normal appears to be
and presence slightly dry
of caviar pots
I
Gums nspection Pink, smooth, Her gums Normal
without appears
swelling or smooth and is
discharged pink in color
without
discharge
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Teeth Inspection 32 adult teeth She has no Normal

Pink gums teeth and Tooth loss
wearing a occurs as a
false teeth result of
dental
disease due
to poor dental
hygiene and
aging
Neck Inspection Muscles equal Position in Normal

Palpation in size; head midline &
Centred. muscles are
Not palpable. equal in
sides, no
swelling and
no palpable
lumps and
nodes.
It is centered.
a. Trachea Inspection Normally Midline Normal

midline at the placement
suprasternal
notch
b. Thyroid Palpation For many No Normal

individuals it is enlargement
not palpable and
but if present it tenderness
should without noted
tenderness,
enlargement,
masses or
nodules
c. Lymph nodes Palpation The nodes are Non palpable Normal

generally not nodes
palpable: if
palpable, they
should be
small, mobile
and not tender
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Chest Inspection Chest Chest is Normal

symmetric and symmetric in
spine vertically terms of size,
aligned. Chest shape and
wall intact and position.
no tenderness;
a. Color Inspection Uniform in The skin color Normal

color with the in the chest
face and area is the
abdomen. same as his
abdomen and
chest
Back Inspection Symmetric and Presence of Normal

proportion Kyphosis Curvature of
and stoop the upper
posture thoracic spine
result of aging
alone
Heart Auscultation Increase in Systolic and Abnormal

diastolic and diastolic blood »Due to
systolic blood pressure inelasticity of
pressure increases but systemic
increase arteries and
systolic increased
pressure is peripheral
greater resistance.
BP – 160/110
Abdomen Inspection Uniform color. Round, Normal

Palpation Rounded flabby, soft to »It is rounded
Auscultation Symmetric touch non- due to an
contour tender; color increase in
is same as adipose
the skin; tissue and
symmetric decreased
movements muscle tone
are seen
when
breathing.
a. Umbilicus Inspection Centrally Her umbilicus Normal

located and is centrally
normally may located and
be flat, concave in
rounded or shape.
concave
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Located at the
center and
normally
rounded.
Genitalia Inspection Pubic skin Not assessed The client

intact, no refused
lesions. Skin of
vulva is slightly
darker than the
rest of the body
Anus/buttocks Inspection Intact perianal Not assessed The client

skin and refused
normally more
pigmented and
is usally
hairless, rectal
wall is smooth
and not tender
UPPER EXTREMITIES
Arms Inspection Symmetrical & Proportion and Normal

proportion to symmetrical to
the body. No the body
signs of lesions
Fingers and Inspection Have 10 Have 10 Normal

palms Palpation fingers and fingers and
proportion to proportion to
the arms. the arms.
Palms are Palms are
clean and clean and
smooth to smooth to
touch. touch.
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Fingernails Inspection Increased Thick nailbeds Normal

thickness with with ridges »Due to
ridges decreased
calcium
deposition
because of
aging
LOWER EXTREMITIES
Leg Inspection Equal in length. Equal in length. Normal

Proportion in Proportion in
size size
Knee Inspection NO signs of Freely movable Normal

Palpation any lesions
Ankle & foot Inspection Proportion in Proportion in Normal

Palpation shape and size shape and size
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VI. Review of Systems
GENERAL SURVEY
“May isang taon na din ako ganito, paminsan- minsan nahihilo ako.”
System Verbalization
Neurological “Pag nanlalabo na yung kaliwang mata

ko pakiramdam ko hinahigh blood na
ako,” as verbalized by Mrs. HPN
Integumentary ”Hindi pa naman akong mga allergy

saka mga kati kati sa balat.”
Respiratory “ Wala naman akong problema sa

paghinga ko… Wala kaming hika.”
Gastrointestinal “ Wala naman akong napapansing

dugo sa dumi ko saka hindi rin naman
ako nahihirapang dumumi.”
Genitourinary “ Hindi naman masakit kapag umiihi

ako.”
Endocrine “ Wala akong Diabetes. Yung isang
anak ko lang ang nagkaroon.”
Cardiovascular “High blood ako. Yun yung sinabi ng

duktor ko noong isang taon. Kaya daw
ako madalas mahilo ay kasi nga sa
high blood.” as verbalized by Mrs. HPN
Musculoskeletal “Hindi naman ako nanghihina. Malakas

pa nga ako. Nakita mo ba yang mga
sinampay nay an, nilabhan ko iyan
kaninang umaga.” as verbalized by
Mrs. HPN
VII. Anatomy and Physiology
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I. Circulatory system
The circulatory system works closely with other systems in our bodies. It
supplies oxygen and nutrients to our bodies by working with the respiratory system.
At the same time, the circulatory system helps carry waste and carbon dioxide out of
the body. Hormones — produced by the endocrine system — are also transported
through the blood in our circulatory system. As the body's chemical messengers,
hormones transfer information and instructions from one set of cells to another.The
heart and circulatory system make up the network that delivers blood to the body's
tissues. With each heartbeat, blood is sent throughout our bodies, carrying oxygen
and nutrients to all of our cells.Each day, 2,000 gallons (more than 7,570 liters) of
blood travel many times through about 60,000 miles (96,560 kilometers) of blood
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vessels that branch and cross, linking the cells of our organs and body parts. From
the hard-working heart, to our thickest arteries, to capillaries so thin that they can
only be seen through a microscope, the cardiovascular system is our body's lifeline
The circulatory system is composed of the heart and blood vessels, including
arteries, veins, and capillaries. Our bodies actually have two circulatory systems:
The pulmonary circulation is a short loop from the heart to the lungs and back again,
and the systemic circulation (the system we usually think of as our circulatory
system) sends blood from the heart to all the other parts of our bodies and back
again. The circulatory system is an organ system that moves nutrients, gases, and
wastes to and from cells to help fight diseases and help stabilize body temperature
and pH to maintain homeostasis. This system may be seen strictly as a blood
distribution network.
The Heart
The heart is the key organ in the circulatory system. As a hollow, muscular
pump, its main function is to propel blood throughout the body. It usually beats from
60 to 100 times per minute, but can go much faster when it needs to. It beats about
100,000 times a day, more than 30 million times per year, and about 2.5 billion times
in a 70-year lifetime. The heart gets messages from the body that tell it when to
pump more or less blood depending on a person's needs. When we're sleeping, it
pumps just enough to provide for the lower amounts of oxygen needed by our
bodies at rest. When we're exercising or frightened, the heart pumps faster to get
more oxygen to our bodies. The heart has four chambers that are enclosed by thick,
muscular walls. It lies between the lungs and just to the left of the middle of the chest
cavity. The bottom part of the heart is divided into two chambers called the right and
left ventricles, which pump blood out of the heart. A wall called the interventricular
septum divides the ventricles.
The upper part of the heart is made up of the other two chambers of the
heart, called the right and left atria (pronounced: ay-tree-uh). The right and left atria
receive the blood entering the heart. A wall called the interatrial (pronounced: in-tur-
ay-tree-ul) septum divides the atria, and they're separated from the ventricles by the
atrioventricular (pronounced: ay-tree-oh-ven-trik-yoo-lur) valve. The tricuspid valve
separates the right atrium from the right ventricle, and the mitral (pronounced: my-
trul) valve separates the left atrium and the left ventricle.
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Two other heart valves separate the ventricles and the large blood vessels
that carry blood leaving the heart. These valves are called the pulmonic valve, which
separates the right ventricle from the pulmonary artery leading to the lungs, and the
aortic valve, which separates the left ventricle from the aorta, the body's largest
blood vessel.
The Role of Blood Vessels
Blood vessels carrying blood away from the heart are called arteries. They
are the thickest blood vessels, with muscular walls that contract to keep the blood
moving away from the heart and through the body. In the systemic circulation,
oxygen-rich blood is pumped from the heart into the aorta. This huge artery curves
up and back from the left ventricle, then heads down in front of the spinal column
into the abdomen. Two coronary arteries branch off at the beginning of the aorta and
divide into a network of smaller arteries that provide oxygen and nourishment to the
muscles of the heart.
Unlike the aorta, the body's other main artery, the pulmonary artery, carries
oxygen-poor blood. From the right ventricle, the pulmonary artery divides into right
and left branches, on the way to the lungs where blood picks up oxygen.
Blood vessels that carry blood back to the heart are called veins. They are not
as muscular as arteries, but they contain valves that prevent blood from flowing
backward. Veins have the same three layers that arteries do, but they are thinner
and less flexible. The two largest veins are the superior and inferior vena cavae .The
terms superior and inferior do not mean that one vein is better than the other, but
that they are located above (superior) and below (inferior) the heart.
A network of tiny capillaries connects the arteries and veins. Even though
they're tiny, the capillaries are one of the most important parts of the circulatory
system because it is through them that nutrients and oxygen are delivered to the
cells. In addition, waste products such as carbon dioxide are also removed by the
capillaries.
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II.Renin-angiotensin-aldosteron system
Renin-angiotensin-aldosteron system responds to renal persfusion. A drop in

renal perfusion stimulates rennin release. Renin converts angiotensin I, which is
subsequently convertedangiotensin II in the lungs by angiotensin converting enzyme

(ACE). Angiotensin II is a potent vasoconstrictor. It also promotes sodium and water
retention both directly and by stimulating the adrenal medulla to release aldosterone.
III.Other Hormones
Vasopressin or antidiuretic hormone( from posterior pituitary gland) promotes

water retention and vasoconstriction, raising BP. Circulating epinephrine and
norepinephrine from the adrenal cortex (the-fight-or-flight response) stimulates
increase or decrease in heart rate, cardiac output, and constricting arterioles
resulting to BP rise or fall.
23
VIII. Pathophysiology
24
IX. Medical Management
1. Anti hypertensive medications

• Beta Adrenergic Blockers
• ACE inhibitors
• Calcium Channel Blockers
2. Diet: Low salt, low fat, 1 banana

Decrease cholesterol (fat)
• To reduce serum lipid levels

• To reduce blood cholesterol levels, it is important to limit the
saturated fats which are found mainly in meats and dairy
products made with whole milk
• Reducing dietary cholesterol and fats helps to keep blood
cholesterol levels within a healthy range
Low Sodium (salt)
• Too much sodium makes your body retain water which makes
your heart work harder thus, increasing the blood circulating in
your body thus, increase blood pressure
One Banana
• The good source of vitamin C, potassium and dietary fiber

• The good source of potassium from bananas is helpful for your
body to maintain fluid balance in blood and tissue cells.
Potassium is also an essential mineral for protein synthesis and
building of muscles because it stimulates nerve impulses for
muscle contraction
3. Exercise
• A regular program of aerobic exercise adequate to achieve at least a
moderate level of physical fitness that would facilitate cardiovascular
conditioning
• Instruct the patient to avoid strenuous activities to lower the heart
workload
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X. Drug Study
Brand Name Neobloc

Generic Name Metropolol
Classification Beta-blockers
Indication Hypertension, chronic angina pectoris
Action
• Exerts mainly beta 1 adrenergic blocking activity but
also blocks beta 2 receptors at high dose
• Block the sympathetic nervous system (beta

adrenergic receptors), especially the sympathetic to
the heart (myocardium), producing a slower rate and
lowered blood pressure.
Side Effects / Occasionally fatigue, dizziness, headache, G.I.
Adverse disturbance, skin rashes, nausea
Reaction
Route of Per Orem
Administration
Nursing
 Tablet may be crashed or swallowed whole.
Responsibilities
 Instruct client to take with meals.
 Instruct client to avoid strenuous activities.
 Advice client to take enough rest.
 Instruct client to avoid sudden change in position.

 Monitor the apical pulse before administration
because it may cause bradycardia.
XI. Priority Health Problems
26
1. Knowledge Deficit related to lack of motivation
2. Non compliance related to socio-economic factors
3. Health seeking behavior related to hypertension as a risk factor for coronary

artery disease
XII. Nursing Care Plan
27
28
XIII. Home Management
29
• Bawang
This can be use to lower cholesterol levels in blood and to prevent
hypertension. It may be fried, roasted, soaked in vinegar for 30 minutes or
blanched in boiled water for 5 minutes. It should be taken two pieces three
times a day after meal on a full stomach to prevent stomach and intestinal
ulcers.
• Sambong
It uses as Anti- edema and diuretics. It helps the client to eliminate
excess sodium and maintaining the fluid balance thus preventing
Hypertension. The client may boil the chopped leaves in glass of water for 15
minutes until one glassful remains cool and strain. Four table spoon of dried
leaves and six table spoon of fresh leaves and divide decoction into three
parts. Drink one part three times a day.
a. Diet
The client should avoid foods that are high in cholesterol and high in
sodium such as dairy products and animal fats. Restriction sodium and fats
can be used to lower blood pressure in some cases of Stage I hypertension.
The client should also avoid caffeine because ingestion of caffeine may raise
BP, therefore caffeine restriction is not necessary unless cardiac response or
other excessive sensitivity to caffeine is present. Either way, the client should
take foods rich in vitamins and minerals and rich in potassium such as fruits
and vegetables, low fat dairy foods with reduced saturated and total fats.
• Exercises
The client should engage in aerobic exercise adequate to achieve at
least moderate level of physical fitness facilitates cardiovascular conditioning.
Blood pressure can be reduced with moderate intensity physical activity, like
walking for 30-45 minutes most days of the week.
• Regular Monitoring of Blood Pressure
30
The client should have a regular visit at the nearest health center for
the regular monitoring of blood pressure. Blood pressure measurement
should be a routine procedure of people with hypertension.
XIV. Daily Appraisal
31
* July 20 2009, Monday between 9 to 11:30 am
This is the first day of our exposure at Ruhat 5, Antipolo City accompanied by
our CI doing occular survey. We met different people in the community. This is also
the day we met our chosen family for our case study.
* July 21, 2009, Tuesday between 9 to 11:30
Our second day in we initially went to our chosen client Mrs. HPN for our
second interview and assessment. On this day, we conduct our community activities
such as bp taking, and offered free wound cleaning. We also help community center
workers in accomodating pregnant women having their prenatal chech-up and also
did the observation on what and how to do immunization for infants. Then after, we
went to Ruhat 5 day care center to meet our target client the pre-schooler.
XV. References
Brunner & Suddarts Textbook of Medical-Surgical Nursing 8th Edition
Medical-Surgical Nursing; Clinical management for positive outcomes 7th Edition by

Joyce M. Black
Medical –Surgical by Priscilla Lemone
DOH book
32

I. Acknowledgement: Metropolitan Hospital College of Nursing # 1357 G. Masangkay Cor. Mayhaligue, Sta. Cruz, Manila

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I. Acknowledgement: Metropolitan Hospital College of Nursing # 1357 G. Masangkay Cor. Mayhaligue, Sta. Cruz, Manila

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METROPOLITAN HOSPITAL COLLEGE OF NURSING

# 1357 G. Masangkay cor. Mayhaligue, Sta. Cruz, Manila

Hypertension, or commonly known as high blood pressure, is a medical

Hypertension and its advantage(ARTICLE)

III. SCOPE AND LIMITATIONS

The case presentation focuses mainly on the disease process of

Name: “Mrs. HPN”

Age: 70 years old

Address: Antipolo City

Date of Birth: May 15, 1939

Informant source: “Mrs. HPN”

Reliability of source: 80%

Mrs. HPN was born at Romblon to a nuclear family with 9

A. Family Health History

The hypertension can be traced back to her grandparents

B. Past Health History

During the childhood days of Mrs. HPN, she already had

The diagnosis of hypertension was made a year ago, on

C. Present Health History

On Monday, July 20, 2009, during the student nurses’

On Tuesday, July 21, 2009, during the second nurse-

4. Values, Beliefs, Lifestyle Practices

The patient is a non smoker and a non alcoholic

The Physical assessment was done at Mambugan Antipolo City

Latest Vital signs were:

Pulse Rate : 82 bpm

Respiratory Rate : 17 cpm

Cardiac rate : 85 bpm

Blood pressure : 160/ 110 mmHg

Standing Height and Weight:

Cephalo – Caudal Assessment:

Area Assessed Normal Actual

Skin may be Wrinkled »Loss of skin

Poor skin »Decreased

Hair Inspection Loss of scalp Thin and Normal

a. Distribution Inspection Evenly His hair is Normal

b. Texture Palpation Smooth and His hair is Normal

Nails Inspection Increased Thick Normal

Head Inspection Normocephalic Rounded, Normal

Eyes Inspection Symmetrically Symmetrical Normal

a. Eyebrows Inspection Present It is evenly Normal

b. Eyelids Inspection Skin folds are Prominent Normal

c. Eyelashes Inspection It is distributed Distributed Normal

d. Eyeballs Inspection Aligned Alignment is Normal

e. Iris and Pupil Inspection Normally it is Slightly Pale Normal

f. Eye movement Inspection Able to move Can move his Normal.

pupil size due

g. Vision Inspection Visual acuity The patient Normal

Nose Inspection Symmetric and Symmetrically Normal

Ears Inspection Skin of ears Resilient and Normal

Mouth, lips and Inspection Oral mucosa Decreased Normal due to

Teeth Inspection 32 adult teeth She has no Normal

Neck Inspection Muscles equal Position in Normal

a. Trachea Inspection Normally Midline Normal

b. Thyroid Palpation For many No Normal

c. Lymph nodes Palpation The nodes are Non palpable Normal

Chest Inspection Chest Chest is Normal

a. Color Inspection Uniform in The skin color Normal

Back Inspection Symmetric and Presence of Normal

Heart Auscultation Increase in Systolic and Abnormal

Abdomen Inspection Uniform color. Round, Normal

a. Umbilicus Inspection Centrally Her umbilicus Normal