FIRST ASIA INSTITUTE OF TECHNOLOGY AND HUMANITIES COLLEGE OF NURSING LIPA MEDIX MEDICAL CENTER CASE STUDY

HYPERTENSIVE CARDIOVASCULAR DISEASE

SUBMITTED BY: Joseph King D. Macaranas BSN 2A SUBMITTED TO: Ms. Estrella P. Espiritu, R.N., M.A.N. Hospital, Clinical Instructor

PATIENTS PROFILE Name: Fe Mercado Beroga Gender: Female Age: 54 Years Old Date of Birth: Novemmber 21, 1955 Place of Birth: Lipa City, Batangas Citizenship: Filipino Religion: Roman Catholic Date of Admission: January 15, 2010 Time of Admission: 06:02 AM Admitting Diagnosis: Hyperensive Cardiovascular Disease Chief of Complaint: Hypertension PHYSICAL ASSESSMENT HISTORY OF PRESENT ILLNESS Patient known hypertension more than 5 years, in losartan and aspirin. Persistence of elevated blood pressure prompted consult for further evaluation and management. ANATOMY AND PHYSIOLOGY Hypertensive Cardiovascular Disease Hypertensive heart disease refers to coronary artery disease, heart failure, and enlargement of the heart that occur because of high blood pressure. Causes High blood pressure increases the pressure in blood vessels. As the heart pumps against this pressure, it must work harder. Over time, this causes the heart muscle to thicken and the left ventricle to become enlarged. The amount of blood pumped by the heart each minute (cardiac output) goes down. Without treatment, symptoms of congestive heart failure may develop. High blood pressure is the most common risk factor for heart disease and stroke. It can cause ischemic heart disease from the increased supply of oxygen needed by the thicker heart muscle. High blood pressure also contributes to thickening of the blood vessel walls. This may worsen atherosclerosis (increased cholesterol deposits in the blood vessels). This also increases the risk of heart attacks and stroke. Hypertensive heart disease is the leading cause of illness and death from high blood pressure. The heart complications that develop determine the symptoms, diagnosis, treatment, and outlook of hypertensive heart disease. Angina Dilated cardiomyopathy Heart failure Hypertrophic cardiomyopathy Possible Complications Angina Arrhythmias

Heart attack Heart failure Stroke Sudden death

Prevention Have your blood pressure checked at regular intervals (as recommended by your health care provider) to monitor the condition. Frequent blood pressure measurements taken at home are often recommended for people with difficult-to-control high blood pressure. Treat your high blood pressure. Do not stop or change treatment, except on the advice of your health care provider. Carefully control diabetes, hyperlipidemia, and other conditions that increase the risk of heart disease. In addition to medications, recommended lifestyle changes include: Diet changes: Avoid trans fats and saturated fats Increase fruits, vegetables, and low-fat dairy products Reduce salt intake (may be beneficial) Eat whole grains, poultry, and fish Exercise regularly Reduce excessive alcohol consumption Stop smoking -- cigarettes are a major cause of hypertension-related heart disease Lose weight if you are overweight or obese Cardiovascular disease or cardiovascular diseases is the class of diseases that involve the heart or blood vessels (arteries and veins). While the term technically refers to any disease that affects the cardiovascular system (as used in MeSH), it is usually used to refer to those related to atherosclerosis (arterial disease). These conditions have similar causes, mechanisms, and treatments. In practice, cardiovascular disease is treated by cardiologists, thoracic surgeons, vascular surgeons, neurologists, and interventional radiologists, depending on the organ system that is being treated. There is considerable overlap in the specialties, and it is common for certain procedures to be performed by different types of specialists in different hospitals. Most countries face high and increasing rates of cardiovascular disease. Each year, heart disease kills more Americans than cancer. It is the number one cause of death and disability in the United States and most European countries (data available through 2005). A large histological study (PDAY) showed vascular injury accumulates from adolescence, making primary prevention efforts necessary from childhood. By the time that heart problems are detected, the underlying cause (atherosclerosis) is usually quite advanced, having progressed for decades. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise and avoidance of smoking. Causes In his book "The Heart Healthy Program", the cardiologist Dr Richard M. Fleming has identified several key dietary factors that can lower the risk of heart disease, including:

Lowering of LDL cholesterol by reducing saturated fat intake. Lowering of Triglyceride levels by reducing consumption of sugary and processed foods. Reduction of Homocysteine levels by supplementation with Vitamins B6 and B12, and folic acid. Increased antioxidant activity by higher consumption of fruits and vegetables. Lowering of fibrinogen and growth factors by cutting back on foods such as red meat, dairy products, poultry and eggs. Diagnosis Platelet and Fibrin complexes can be seen with the technique of dark field microscopy. They are much bigger than red blood cells and easily block capillaries. These complexes are clearly visible in dark field but not in stained bright field samples because the different staining methods disburse them. However, they are not visible in unstained blood smears. This method of early detection allows to identify people at risk and take appropriate measures. The circulatory system is an organ system that passes nutrients (such as amino acids and electrolytes), gases, hormones, blood cells, etc. to and from cells in the body 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, but some consider the circulatory system as composed of the cardiovascular system, which distributes blood, and the lymphatic system, which distributes lymph. While humans, as well as other vertebrates, have a closed cardiovascular system (meaning that the blood never leaves the network of arteries, veins and capillaries), some invertebrate groups have an open cardiovascular system. The most primitive animal phyla lack circulatory system. The lymphatic system, on the other hand, is an open system. The main components of the human circulatory system are the heart, the blood, and the blood vessels. The circulatory system includes: the pulmonary circulation, a "loop" through the lungs where blood is oxygenated; and the systemic circulation, a "loop" through the rest of the body to provide oxygenated blood. An average adult contains five to six quarts (roughly 4.7 to 5.7 liters) of blood, which consists of plasma, red blood cells, white blood cells, and platelets. Also, the digestive system works with the circulatory system to provide the nutrients the system needs to keep the heart pumping. Two types of fluids move through the circulatory system: blood and lymph. The blood, heart, and blood vessels form the cardiovascular system. The lymph, lymph nodes, and lymph vessels form the lymphatic system. The cardiovascular system and the lymphatic system collectively make up the circulatory system. Pulmonary circulation Main article: Pulmonary circulation The Pulmonary circulation is the portion of the cardiovascular system which transports oxygendepleted blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. Oxygen deprived blood from the vena cava enters the right atrium of the heart and flows through the tricuspid valve into the right ventricle, from which it is pumped through the pulmonary semilunar valve into the pulmonary arteries which go to the lungs. Pulmonary veins return the now oxygen-rich blood to the heart, where it enters the left atrium before flowing through the mitral valve into the left ventricle. Then, oxygen-rich blood from the left ventricle is pumped out via the aorta, and on to the rest of the body.

Systemic circulation Main article: Systemic circulation Systemic circulation is the portion of the cardiovascular system which transports oxygenated blood away from the heart, to the rest of the body, and returns oxygen-depleted blood back to the heart. Systemic circulation is, distance-wise, much longer than pulmonary circulation, transporting blood to every part of the body. Heart

View from the front, which means the right side of the heart is on the left of the diagram (and vice-versa) Main article: heart The heart pumps oxygenated blood to the body and deoxygenated blood to the lungs. In the human heart there is one atrium and one ventricle for each circulation, and with both a systemic and a pulmonary circulation there are four chambers in total: left atrium, left ventricle, right atrium and right ventricle. The right atrium is the upper chamber of the right side of the heart. The blood that is returned to the right atrium is deoxygenated (poor in oxygen) and passed into the right ventricle to be pumped through the pulmonary artery to the lungs for re-oxygenation and removal of carbon dioxide. The left atrium receives newly oxygenated blood from the lungs as well as the pulmonary vein which is passed into the strong left ventricle to be pumped through the aorta to the different organs of the body. Arteries are blood vessels that carry blood away from the heart. All arteries, with the exception of the pulmonary and umbilical arteries, carry oxygenated blood. The circulatory system is extremely important for sustaining life. Its proper functioning is responsible for the delivery of oxygen and nutrients to all cells, as well as the removal of carbon dioxide and waste products, maintenance of optimum pH, and the mobility of the elements, proteins and cells of the immune system. In developed countries, the two leading causes of death, myocardial infarction and stroke each may directly result from an arterial system that has been

slowly and progressively compromised by years of deterioration. (See atherosclerosis). Description The arterial system is the higher-pressure portion of the circulatory system. Arterial pressure varies between the peak pressure during heart contraction, called the systolic pressure, and the minimum, or diastolic pressure between contractions, when the heart expands and refills. This pressure variation within the artery produces the pulse which is observable in any artery, and reflects heart activity. Arteries also aid the heart in pumping blood. Arteries carry oxygenated blood away from the heart except for pulmonary arteries. Anatomy The anatomy of arteries can be separated into gross anatomy, at the macroscopic level, and microscopic anatomy, which must be studied with the aid of a microscope. Gross anatomy The arterial system or the human body is divided into systemic arteries, carrying blood from the heart to the whole body, and pulmonary arteries, carrying blood from the heart to the lungs. Systemic arteries Systemic arteries are the arteries of the systemic circulation, which is the part of the cardiovascular system which carries oxygenated blood away from the heart, to the body, and returns deoxygenated blood back to the heart. Pulmonary arteries See also: Pulmonary circulation Pulmonary arteries are the arteries of the pulmonary circulation, which is the portion of the cardiovascular system which carries deoxygenated blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. Anatomy of the arterial wall The outermost layer is known as the tunica externa formerly known as "tunica adventitia" and is composed of connective tissue. Inside this layer is the tunica media, or media, which is made up of smooth muscle cells and elastic tissue. The innermost layer, which is in direct contact with the flow of blood is the tunica intima, commonly called the intima. This layer is made up of mainly endothelial cells. The hollow internal cavity in which the blood flows is called the lumen.

Types of arteries Pulmonary arteries The pulmonary arteries carry deoxygenated blood that has just returned from the body to the heart towards the lungs, where carbon dioxide is exchanged for oxygen. Systemic arteries Systemic arteries can be subdivided into two types - muscular and elastic - according to the relative compositions of elastic and muscle tissue in their tunica media as well as their size and the makeup of the internal and external elastic lamina. The larger arteries (>10mm diameter) are

generally elastic and the smaller ones (0.1-10mm) tend to be muscular. Systemic arteries deliver blood to the arterioles, and then to the capillaries, where nutrients and gasses are exchanged. The Aorta The aorta is the root systemic artery. It receives blood directly from the left ventricle of the heart via the aortic valve. As the aorta branches, and these arteries branch in turn, they become successively smaller in diameter, down to the arteriole. The arterioles supply capillaries which in turn empty into venules. The very first branches off of the aorta are the coronary arteries, which supply blood to the heart muscle itself. These are followed by the branches off the aortic arch, namely the brachiocephalic artery, the left common carotid and the left subclavian arteries. Arterioles Arterioles, the smallest of the true arteries, help regulate blood pressure by the variable contraction of the smooth muscle of their walls, and deliver blood to the capillaries. Arterioles and blood pressure Arterioles have the greatest collective influence on both local blood flow and on overall blood pressure. They are the primary "adjustable nozzles" in the blood system, across which the greatest pressure drop occurs. The combination of heart output (cardiac output) and systemic vascular resistance, which refers to the collective resistance of all of the body's arterioles, are the principal determinants of arterial blood pressure at any given moment. Capillaries The capillaries are where all of the important exchanges happen in the circulatory system. The capillaries are a single cell in diameter to aid fast and easy diffusion of gases, sugars and other nutrients to surrounding tissues. [edit] Functions of capillaries Capillaries have no smooth muscle surrounding them and have a diameter less than that of red blood cells; a red blood cell is typically 7 micrometers outside diameter, capillaries typically 5 micrometers inside diameter. The red blood cells must distort in order to pass through the capillaries. These small diameters of the capillaries provide a relatively large surface area for the exchange of gases and nutrients. [edit] What capillaries do: In the lungs, carbon dioxide is exchanged for oxygen In the tissues, oxygen and carbon dioxide and nutrients and wastes are exchanged In the kidneys, wastes are released to be eliminated from the body In the intestine, nutrients are picked up, and wastes released In the circulatory system, veins (from the Latin vena) are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the lungs; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood. They differ from arteries in structure and function; for example, arteries are more muscular than veins and they carry blood away from the heart. Anatomy Cross section of a vein showing a valve which prevents backflow

Veins generally function to return deoxygenated blood to the heart, and are essentially tubes that collapse when their lumens are not filled with blood. The thick outermost layer of a vein is made of connective tissue, called tunica adventitia or tunica externa. Deeper are bands of smooth muscle called tunica media, which are generally thin as veins do not function primarily in a contractile manner. The interior is lined with endothelial cells called tunica intima. Most veins have one-way flaps called venous valves that prevent blood from flowing back and pooling in the lower extremities due to the effects of gravity. These are infoldings of the tunica intima. The precise location of veins is much more variable from person to person than that of arteries.[1] Notable veins and vein systems The greater saphenous vein is the most important superficial vein of the lower limb. First described by the Persian physician Avicenna, Saphenous derives its name from Safina, meaning hidden. This vein is "hidden" in its own fascial compartment in the thigh and only exits the fascia near the knee. Incompetence of this vein is an important cause of varicose veins of lower limbs. The pulmonary veins carry relatively oxygenated blood from the lungs to the heart. The superior and inferior venae cavae carry relatively deoxygenated blood from the upper and lower systemic circulations, respectively. A portal venous system is a series of veins or venules that directly connect two capillary beds. Examples of such systems include the hepatic portal vein and hypophyseal portal system. Color Vein color is determined in large part by the color of venous blood, which is usually dark red as a result of its low oxygen content. Veins appear blue because the subcutaneous fat absorbs low frequency light, permitting only the highly energetic blue wavelengths to penetrate through to the dark vein and reflect off. This phenomenon is the opposite of Rayleigh scattering, the reason the sky is blue. Function Veins serve to return blood from organs to the heart. In systemic circulation oxygenated blood is pumped by the left ventricle through the arteries to the muscles and organs of the body, where its nutrients and gases are exchanged at capillaries, entering the veins filled with cellular waste and carbon dioxide. The de-oxygenated blood is taken by veins to the right atrium of the heart, which transfers the blood to the right ventricle, where it is then pumped through the pulmonary arteries to the lungs. In pulmonary circulation the pulmonary veins return oxygenated blood from the lungs to the left atrium, which empties into the left ventricle, completing the cycle of blood circulation. The return of blood to the heart is assisted by the action of the skeletal-muscle pump which helps maintain the extremely low blood pressure of the venous system. Fainting can be caused by failure of the skeletal-muscular pump. Long periods of standing can result in blood pooling in the legs, with blood pressure too low to return blood to the heart. Neurogenic and hypovolaemic shock can also cause fainting. In these cases the smooth muscles surrounding the veins become slack and the veins fill with the majority of the blood in the body, keeping blood away from the brain and causing unconsciousness. The arteries are perceived as carrying oxygenated blood to the tissues, while veins carry deoxygenated blood back to the heart. This is true of the systemic circulation, by far the larger of the two circuits of blood in the body, which transports oxygen from the heart to the tissues of the

body. However, in pulmonary circulation the arteries carry deoxygenated blood from the heart to the lungs and veins return blood from the lungs to the heart. The difference between veins and arteries is their direction of flow (out of the heart by arteries, returning to the heart for veins), not their oxygen content. In addition, deoxygenated blood that is carried from the tissues back to the heart for reoxygenation in systemic circulation still carries some oxygen, though it is considerably less than that carried by the systemic arteries or pulmonary veins. Although most veins take blood back to the heart, there is an exception. Portal veins carry blood between capillary beds. For example, the hepatic portal vein takes blood from the capillary beds in the digestive tract and transports it to the capillary beds in the liver. The blood is then drained in the gastrointestinal tract and spleen where it is taken up by the hepatic veins and blood is taken back into the heart. Since this is an important function in mammals, damage to the hepatic portal vein can be dangerous. Blood clotting in the hepatic portal vein can cause portal hypertension which results in a decrease of blood fluid to the liver. Classification Veins are classified in a number of ways, including superficial vs. deep, pulmonary vs. systemic, and large vs. small. Superficial veins Superficial veins are those whose course is close to the surface of the body, and have no corresponding arteries. Deep veins Deep veins are deeper in the body and have corresponding arteries. Pulmonary veins The pulmonary veins are a set of veins that deliver oxygenated blood from the lungs to the heart. Systemic veins Systemic veins drain the tissues of the body and deliver deoxygenated blood to the heart. The lymphatic system in vertebrates is a network of conduits that carry a clear fluid called lymph. It also includes the lymphoid tissue through which the lymph travels. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated with the digestive system such as the tonsils. The system also includes all the structures dedicated to the circulation and production of lymphocytes, which includes the spleen, thymus, bone marrow and the lymphoid tissue associated with the digestive system.[1] The lymphatic system as we know it today was first described independently by Olaus Rudbeck and Thomas Bartholin. The blood does not directly come in contact with the parenchymal cells and tissues in the body, but constituents of the blood first exit the microvascular exchange blood vessels to become interstitial fluid, which comes into contact with the parenchymal cells of the body. Lymph is the fluid that is formed when interstitial fluid enters the initial lymphatic vessels of the lymphatic system. The lymph is then moved along the lymphatic vessel network by either intrinsic contractions of the lymphatic vessels or by extrinsic compression of the lymphatic vessels via external tissue forces (e.g. the contractions of skeletal muscles). The lymphatic system has three interrelated functions: it is responsible for the removal of interstitial fluid from tissues; it absorbs and transports fatty acids and fats as chyle to the circulatory system; and it transports immune cells to and from the lymph nodes. The lymph transports antigen-presenting cells (APCs), such as dendritic cells, to the lymph nodes where an immune response is stimulated. The lymph also carries lymphocytes from the efferent

lymphatics exiting the lymph nodes. The study of lymphatic drainage of various organs is important in diagnosis, prognosis, and treatment of cancer. The lymphatic system, because of its physical proximity to many tissues of the body, is responsible for carrying cancerous cells between the various parts of the body in a process called metastasis. The intervening lymph nodes can trap the cancer cells. If they are not successful in destroying the cancer cells the nodes may become sites of secondary tumors. Diseases and other problems of the lymphatic system can cause swelling and other symptoms. Problems with the system can impair the body's ability to fight infections.

PATHOPHYSIOLOGY Population based studies in the youth show that the precursors of heart disease start in adolescence. The process of atherosclerosis evolves over decades, and begins as early as childhood. The Pathobiological Determinants of Atherosclerosis in Youth Study demonstrated that intimal lesions appear in all the aortas and more than half of the right coronary arteries of youths aged 79 years. However, most adolescents are more concerned about other risks such as HIV, accidents, and cancer than cardiovascular disease.[5] This is extremely important considering that 1 in 3 people will die from complications attributable to atherosclerosis. In order to stem the tide of cardiovascular disease, primary prevention is needed. Primary prevention starts with education and awareness that cardiovascular disease poses the greatest threat and measures to prevent or reverse this disease must be taken LABORATORY RESULTS NURSING CARE PLAN DRUG STUDY