CASE STUDY

I. Client's Profile:
Name: Englatera, J.
Age: 38 years old
Address: Poblacion, Maribojoc, Bohol
Sex: Female
Religion: Catholic
November 28, 2019
Date of Consultation:
Admitting Physician: Dr. Maria Trinidad A. Cabaron
Ward/Clinic: OPD-FP
Consulting Diagnosis: GDM and chronic HPN

II. Client's History

Client had fluctuating BP as claimed since a year after PTC or

Percutaneous transhepatic cholangiography. Client has known
history of familial disease: diabetes mellitus and hypertension.
Client has no history of food and drug allergy.

III. History of Present Illness

On her 31 6/7 weeks of gestation, the result of client's prenatal

follow-up check-up, recorded the following: her vital signs
showed she was afebrile, pulse rate of 106bpm, and blood
pressure was noted to be 150/70mmHg and no other
abnormalities was found.

IV. Laboratory Results

No lab results.
 HEALTH TEACHING
Topic: Dietary recommendation and approaches on clients with chronic hypertension.
Rationale: To avoid and/or decrease the incidence and/or severity of pre-eclampsia.
Objectives:
General:
By the end of the health teaching being presented, the client and
significant others will gain knowledge and demonstrate understanding on
the topic being dicussed.
Specific:
Client and significant other will be able to:
Demonstrate positive attitude towards health teaching.

Enumerate the diet being prescribed for chronic hypertension.

Health Teaching Method: Discussion and interaction of client and client's significant other.
Target Audience:
1) Client
2) Client's significant other
Date & Time: Novemrber 28, 2019
Contents:
Dietary recommendations for client's with chronic hypertension.
1) Reducing sodium (salt) intake.
Reducing the amount of sodium you consume can lower blood pressure if
you have high or borderline-high blood pressure.
2) Avoidance of alcohol beverages.
Drinking an excessive amount of alcohol increases your risk of developing
high blood pressure. This protective effect also applies to people with
preexisting high blood pressure.
3) Eat more fruits and vegetables.
Adding more fruits and vegetables to your diet may reduce high blood
pressure or protect against developing high blood pressure. A strict
vegetarian diet may not be necessary.
4) Eat more fiber-rich foods.

Eating an increased amount of fiber may decrease blood pressure. The

recommended amount of dietary fiber is 20 to 35 grams of fiber per day.

5) Eat more fish meat.

Eating more fish may help to lower blood pressure, especially when
combined with weight loss
6) Avoidance of caffeine.
Caffeine may cause a small rise in blood pressure, although this effect is
usually temporary.
 Dietary Approaches to Stop Hypertension (DASH) eating plan.

Combination of the interventions noted above. It is high in fruits and vegetables, low-
fat dairy, and fiber. Clients who strictly follow the DASH eating plan can also have
fairly significant reductions in blood pressure, particularly when combined with a low-
sodium diet.

Evaluation: Client and significant other were able to gain knowledge and understanding on the health
teaching being presented. And verbalized the importance of proper dietary
recommendations and approaches on chronic hypertension clients.
 BACKGROUND
ASSESSMENT DIAGNOSIS PLANNING
KNOWLEDGE
SUBJECTIVE CUES: Decreased cardiac Chronic hypertension After prenatal follow-
"Grabe daan akong output: increased in pregnancy is up check-up, client
altapresyon sa wala blood pressure defined by the will be aware of the
pako nabuntis, related to chronic American College of complications and
maong ga sige ko ug hypertension Obstetrics and will be given
pa-prenatal aron Gynecology (ACOG) information on how to
mabantayan ang as blood pressure control of pre-existing
pagtaas ni ini." as ≥140 mm Hg systolic hypertension.
verbalized by the and/or 90 mm Hg
client. diastolic before
pregnancy or, in
OBJECTIVE CUES: recognition that many
Vital signs: women seek medical
BP = 120/60 mmHg care only once
RR = 19Bpm pregnant, before 20
PR = 90bpm weeks of gestation,
Family history of use of
hypertension antihypertensive
medications before
pregnancy, or
persistence of
hypertension for >12
weeks after delivery.

Reference:
https://www.ahajourn
als.org/doi/full/10.116
1/CIRCULATIONAHA
.113.003904
 INTERVENTION RATIONALE EVALUATION
Assessed and Provides baseline After prenatal follow-
recorded blood data. up check-up, client is
pressure. aware of the
complications and
Advised to monitor To monitor client's has been given
vital signs and to hypertensive status. information on how to
notify physician for control of pre-existing
any changes. hypertension.
To conserve energy,
Advised to have reduces cardiac
adequate rest workload.
periods.

To control and reduce

Maintained dietary risk of cardiac
restrictions. disease.
 DOSAGE/
CLASSIFI-
DRUG FREQUENCY/RO MECHANISM OF ACTION INDICATION
CATION
UTE
Provides iron, an essential component
For thein hemoglobin, myoglobin, an
prevention and
treatment of iron
deficiency anemia

Ferrous Iron Preparation

1 tab OD po
Sulfate Enzymatic mineral

Calcium is essential for For use as a

function, integrity of nervous, dietary
muscular, skeletal system. supplement when
Important role in normal calcium intake
cardiac, renal function, may be
Antacids
respiration, blood coagulation, inadequate (eg,
Calcium Electrolyte
100g 1 tab OD po and cell membrane and osteoporosis,
Carbonate replenisher
capillary permeability. Assists in osteomalacia,
Antihypocalcemic
regulation release/storage of hypocalcemic
neurotransmitter/hormones. rickets)

DOSAGE/
CLASSIFI-
DRUG FREQUENCY/RO MECHANISM OF ACTION INDICATION
CATION
UTE
 Mechanism of action not Hypertension
conclusively demonstrated:
probably due to drugs IV methyldopate:
metabolism, which lower Acute
arterial BP by stimulating CNS hypertensive
alpha2-adrenergic receptors, crisis
which in turn decreases
sympathetic outflow from the Unlabeled uses:
CNS. Hypertension of
pregnancy
Antihypertensive
Methyldopa 250g 1 tab BID po
Sympatholytic

Antipyretic effect is due to an For pain on

action on the hypothalamus, integumentary
resulting in heat loss by structures,
vasodilation of peropheral myalgia,
blood vessels. Anti- neuralgia,
Antipyretic inflammatory effects are headache,
Aspirin Anti-inflammatory 80mg 1 tab OD po mediated by decrease in dysmenorrhea,
Analgesic prostaglandin synthesis. It also gout, arthritis,
decreases platelet aggregation. SLE, rheumatic
fever.
 CONTRA- NURSING
ADVERSE EFFECTS
INDICATION RESPONSIBILITIES

Hypersensitivity Constipation Advised client that

Hemochromatosis, Contact irritation admnistration of the drug
hemolytic anemia Diarrhea should be with meals.
Dark stools
Gastrointestinal (GI) Warned client that stool
hemorrhage (rare) maybe dark due to this
Gastrointestinal (GI) medication.
irritation
Gastrointestinal (GI)
obstruction (wax matrix
products; rare)
Gastrointestinal (GI)
perforation (rare)
Nausea
Stomach pain
Superficial tooth
discoloration (oral
solutions)
Urine discoloration
Vomiting

Hypersensitivity to Abdominal pain, Advised client to take this

any component of anorexia, constipation, medication 1 hr after meals.
the formulation flatulence, hyperacidity
(acid rebound), Encouraged client to report
nausea, vomiting, any adverse effects.
xerostomia

CONTRA- NURSING
ADVERSE EFFECTS
INDICATION RESPONSIBILITIES
Hypersensitivity to Headache, asthma, Advised client to monitor
methyldopa, active weakness, dizziness, BP.
hepatic disease, light-headed,
previous bradycardia, Advised client to administer
methyldopa therapy pericarditis, drug without regard to
associated with liver myocarditis, orthostatic meals
disorders. hypotension, edema
Encouraged client to report
Use cautiously with any adverse effects.
previous liver
disease, renal
failure, dialysis,
bilateral
cerebrovascular
disease, pregnancy,
RR lactaion.

Hypersensitivity to Dyspepsia, heartburn, Advised client to administer

salicylates, severe anorexia, nausea, drug without regard to
anemia, history of epigastric discomfort, meals
blood coagulation potentiatoin of peptic
defects, vitamin K ulcer, bronchospasm, Encouraged client to report
defeciency, 1 week anaphylaxis, skin any adverse effects.
before and after rashes, urticaria, thirst,
surgery, pregnancy fever, dimness of
in the last trimester. vision.