Case Study in The Community:

Essential Stage 1 Hypertension: Felomino Guadayo

In partial fulfillment of the requirements of N -107, Nursing Interventions 2

Passed by: John Basil R. Ugalino Passed to: Merle Mejico UPCN Professor

Introduction

This paper aims to look into the case of Mr. Felomino Guadayo, a Stage 1 hypertension patient. This seeks to see the picture of the patient as seen through the nursing process from assessment, diagnosis, planning, implementation and evaluation. It also seeks to show the case of a Stage 1 hypertensive patient and the proper management applicable. Hypertension, most commonly referred to as "high blood pressure",HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. It was previously referred to as arterial hypertension, but in current usage, the word "hypertension" without a qualifier normally refers to arterial hypertension. Hypertension is rarely severe enough to cause symptoms. These typically only surface with a systolic blood pressure over 240 mmHg and/or a diastolic blood pressure over 120 mmHg. Hypertension can be classified as either essential (primary) or secondary. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. Secondary Hypertension indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as kidney disease or tumors (pheochromocytoma and paraganglioma). Over 91% of adult hypertension has no clear cause and is therefore called essential/primary hypertension. In the Philippines, 13 million Filipinos have hypertension. Half of them dont know they are hypertensive until they suffer complications and receive treatment.

A. Database Mr. Felomino Guadayo is a 58 year old male individual. His residence is at De Borja Compound, Masikap, Pateros. He was born during October, 1959 at his province at Pangasinan. He is a married Filipino although he currently has a domestic relationship with Lilia Guadayo. He is a Roman Catholicand his health care financing and usual source of medical care is himself and his family. Mr. Guadayo's main complaint is that of pain at his temple at at the back of his neck during periods when the sun is high or when he is under extreme stress. He also complaions of blurring in his vision. According to mr. Guadayo, his symptoms were observed only last year. Here after a very strong episode of a hypertensive attack when it was at midmorning, the back of his neck became painful about a 7 out of 10. Since there was a medical mission at that time he opted to visit the said mission. Here he was diagnosed with hypertension and was given a drug that he does not remember the name, after 1 month, he stopped taking the drug. Only now, during the 2 weeek community duty at pateros was his hypertension brought up. He had not had any attacks with the severity as that time.He is currently taking Lovastatin 60 mg, 1 tablet, OD everyday for his liver.it s brand names are Mevacor, Altocor Lovastatin is a cholesterol- lowering medicine. It inhibits the production of cholesterol by the liver. It lowers overall blood cholesterol as well as blood LDL cholesterol levels. LDL cholesterol is believed to be the "bad" cholesterol that is primarily responsible for the development of coronary artery disease. Lowering LDL cholesterol levels retards progression and may even reverse coronary artery disease. Minor side effects include comstipation, diarrhea, gas, heartburn, headache, insomnia.

Major side effects include abdominal pain or cramps, blurred vision, dizzainess, itching, muscle pain or cramps, rash, yellowing of the skin or eyes. Mr. Rolando Catindig has already had mumps, measles and chicken pox. He has had no immunizations. He has no allergies. Hewa never hospitalized. He had an accident once where he hit his leg, while working although this did not cause him to go to the hospital. His family is composed of his wife, Lilia and sons Felomino Jr. and Vick and daughter, Mary jane and Mary Chou. He also has had previous wifes and kins to these although he prefers to keeep these data in confidant for private purposes. There are no falmilial incidence of diabetes, hypertension, cancer, asthma and mental illness in the family. Mr. Felomino Guadayos is still generally healthy. He has not been sickly before. He rarely has fever and colds. He has not been practicing anything in particular to help maintain his health. He has smoked since 18 with a pack a day habit; he also is an occassional drinker of alcohol. He usually follows medical advice. He thinks that the cause of his illness is his state of being poor. Curing the illness is the best help that can be given according to him. He has no traditional concepts or beliefs For breakfast, he drinks a cup of cofee and eats 2 pieces of pan de sal. For lubnch and dinner, he usually eats a piece of fish and a cup of cofee. During his driving, he also sometimes eats chicken. He has no particular favorite snack. He takes in about 8 glassess of water a day, about 1 L. He does not have any food or eating discomforts. He claims he was not restricted from eating any particular food. He has not had any weight gain or loss. He heals well and usually recovers from sickness or injuries quickly. He does not have any serious skin problems.

According to mr. Guadayo, he defecates once a day. The case of stage 1 hypertension of Mr. Guadayo was chosen as the case study to be reported on, due to the great deal of change and progress that could be done to the patient, once proper management of the illness is done. It is also notable that Mr. Guadayo comes from a marginalized family, further making his case more challenging. It can also be deduced that by helping the head of the family,we are indirectly relating to the whole of the family, an das such a snowballing effect may be observed. As a nurse, it is important that we focus on the cases that we can help on the most. This case was also chosen for the additional nature of the case, which is that aside from the hypertension, Mr. Guadayo has liver problems. Advancing age may have also affected the condition, as has the nature of his work all of these contribute to a very interesting and thorough case. Noteworthy additional to his hypertension, his risk factor is very high and may lead to further complications. The entry phase of the nursing interaction is also interesting as it is in the re-diagnosis phase. The patients common view of medical help also proves as an additional remark and piques interest to the case.

B. Patient assessment and problem identification

In line with Mr. Felomino Guadayo's hypertension, a thorough physical exam along with a focused physical exam to see whether potential complications have surfaced. The physical exam started with the general survey of Mr. Guadayo. He was Conscious, coherent and oriented to time, person and place. He was well developed

No laboratory examinations were done to the patient, aside from a blood glucose testing during the groupwork implementation of the programs, in which his glucose level was normal. Bp reading daily for 4 days was done, tallied and recorded though.

The main goal of the nursing management is at the end of the 1-week nursing intervention; Mrs. Guadayos BP will not exceed 140/90 mm Hg. This is so as the primary measurement tool used in the measurement of the progression of hypertension is blood pressure. Also as his type of hypertension is Stage 1, many As the main goal was to maintain blood pressure to a minimum or at least not let it aggravate, there were many interventions specific to each objective. Each objective corresponded to a specific intervention. As the community was the setting for this nursing interventions, there were many limitations and also many obstacles in the proper implementation. Health teaching through the discussion of what hypertension is was the intervention taken, in order that the family.may be able to discuss in simple terms what hypertension. It was discussed that hypertension is having a systolic BP of 140 and above or a diastolic BP of 90 above. The factors which can increase blood pressure were also discussed , this included environmental stress, fatty food intake, inadequate exrecixe and psychological stress. More importantly specifing the signs and symptoms which are indicative of hypertension. Emphasize afterwards that absence of these symptoms do not mean absence of hypertension; it could just be the bodys attempt to normalize the BP.The symptoms of which are abrupt headache, chest pain and dyspnea, increase of 1 kg in

weight in a days time. presence of edema, vision problems (sudden loss of clarity of vision), muscle weakness and numbness, sudden and severe nausea, dizziness and vomiting, pain in the back of the neck that The patient needed health instructions as to what to do regarding his condition, due to the fact that in the past, his therapeutic regimen seemed inadequate as his taking odf drugs was off and not taken many times. Also, important to note is that the preliminary visit to the health center was postponed.

Satisfaction that was gained from the nursing care was great.