I.

BACKGROUND OF THE STUDY

HYPERTENSION

High blood pressure (HBP) or hypertension means high pressure (tension) in the arteries.

Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the

body. High blood pressure does not mean excessive emotional tension, although emotional

tension and stress can temporarily increase blood pressure. Normal blood pressure is below

120/80; blood pressure between 120/80 and 139/89 is called "pre-hypertension", and a blood

pressure of 140/90 or above is considered high.

The top number, the systolic blood pressure, corresponds to the pressure in the arteries as

the heart contracts and pumps blood forward into the arteries. The bottom number, the diastolic

pressure, represents the pressure in the arteries as the heart relaxes after the contraction. The

diastolic pressure reflects the lowest pressure to which the arteries are exposed.

An elevation of the systolic and/or diastolic blood pressure increases the risk of developing

heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (atherosclerosis or

arteriosclerosis), eye damage, and stroke (brain damage). These complications of hypertension

are often referred to as end-organ damage because damage to these organs is the end result of

chronic (long duration) high blood pressure. For that reason, the diagnosis of high blood pressure

is important so efforts can be made to normalize blood pressure and prevent complications.

It was previously thought that rises in diastolic blood pressure were a more important risk

factor than systolic elevations, but it is now known that in people 50 years or older, systolic

hypertension represents a greater risk.

1|Page
Symptoms of high blood pressure

Uncomplicated high blood pressure usually occurs without any symptoms (silently) and so

hypertension has been labeled "the silent killer." It is called this because the disease can progress

to finally develop any one or more of the several potentially fatal complications of hypertension

such as heart attacks or strokes. Uncomplicated hypertension may be present and remain

unnoticed for many years, or even decades.

Some people with uncomplicated hypertension, however, may experience symptoms such

as headache, dizziness, shortness of breath, and blurred vision. The presence of symptoms can be

a good thing in that they can prompt people to consult a doctor for treatment and make them

more compliant in taking their medications.

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VI. PATIENT’S PROFILE

Hospital case no.: 5774

Name: Mrs. G.P.

Age: 53 yrs. old

Gender: Female

Date of Birth: April 28, 1956

Status: Married

Religion: Aglipay

Ethnic Group: Cebuano

Residence: Mambog Boundary Binangonan, Rizal

Room: Female Ward

Chief Complaint: Dizziness and body weakness

Date and time of admission: Jan. 31, 2010 / 8:35 am

Admitting Diagnosis: Hypertension t/c CVA

Attending Physician: Dr. Zenaida M. Carlos

Date and time of Assessment: Feb.2, 2010 / 10:00 am

3|Page
VII. NURSING HISTORY

Chief Complaint:

“Nahihilo at nanghihina ako” as verbalized by the client.

History of Present Illness:

One day prior to admission, January 30, 2010, Friday afternoon our client experienced

dizziness and weakness a couple of hours after doing house chores brought by her daughter in

law. According to her, she took her maintenance medicine Neoblock and had a rest to relieve the

pain. Sunday morning when she woke up she still felt the dizzy. Again, she took Ziac 5mg/tablet

three times with interval of 6 hours (7am-1pm-7 pm) but it did not relieve the symptoms. Due to

the persistent symptoms, at around 8:35 in the morning of the same day, together with her

daughter in law and her daughter they decided to seek medical assistance.

At the hospital, January 31, 2010, 8:35am in the emergency room, her vital signs were

taken; BP- 170/110 mmHg, RR-24 cpm, PR-75 bpm, temperature 37.2ºC. She was seen and

examined by Dra. Zenaida M. Carlos and was advised to be confined. Then she was given

medications such as Citicoline 500mg 1 tablet, Amlodipine 5mg, Simvastatin 500mg 1tablet and

Hyzar 1 tab. She was admitted and infused with an IVF of PNSS 1Lx 12o at 20gtts/min at her

right metacarpal vein and transferred at Female Ward. She was advised to have a low salt and

low fat diet. Her attending physician was Dr. Zenaida M. Carlos. On the following day, she had

undergone laboratory examinations such as Hematology, Blood Chemistry, Urinalysis and CT

scan.

History of Past Illness:

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 She was not hospitalized last 5years. Aside from common cough and colds were her

illnesses which she only treats by over the counter medicines such as Biogesic and Neozep.

Heredo-Familial History of Disease

They have a history of hypertension at her mother’s side. No history of disease on her

father’s side.

Socio-Economic History

Presently, Mrs. G.P is unemployed. Her husband was the one who shouldered the

hospital bills. He is an OFW Saudi Arabia.

5|Page
VIII. 13 AREAS OF ASSESSMENT

I. Social Status

Our patient Ms. G.P. is a 53 y/o mother of 4 (2boys and 2girls) and were married to Mr.

J.P for 34 years. She was born on April 28, 1956 and resides at Mambog Boundary, Binangonan

Rizal. She is Cebuano in origin both her parents were natives of Cagayan de Oro City,

Mindanao. Were she was born. She is Aglipay by faith.

Mrs. G.P. used to work as a secretary in Notary Public law office. At present, she is a

home maker and depends on the income of her husband who works as an OFW in Saudi Arabia.

Before her confinement, Mrs. G.P.’s favorite past time is watching television, she said it

serves as a relief or rest after doing her household chores.

According to Erik Erickson’s stages of Growth and Development, Mrs. G.P. falls under

the adulthood stage (25-65 y/o). Generativity versus Stagnation is the central task of this stage.

Upon our assessment and interview, Mrs. G.P. is indicative of positive resolutions towards this

stage of her life, as evidenced by the following facts: She managed to raise her 4 child and send

them to school all by herself. At present, though she has no work and depends on her husband,

she handles her obligations responsibly.

II. Mental Status

During our assessment, Mrs. G.P. is conscious and responsive. We were able to talk to her

with ease. We asked her to recite the series of 7 but she was able to recite it. For her recent

memory, we asked her who accompanied her to the hospital and she point out it is her daughter

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in law and her daughter. And for her remote memory, we asked her if she still remember when

was her husband left for Saudi Arabia. She answered that she can’t remember it anymore. She

was oriented to person, place and time. She was able to answer our questions when we asked her

who she’s with; she told us that she was with her daughter in law, to place; she told us that she

was in Carlos Medical and Maternity Clinic and to time; she told us that it is 10 am which was

right. Our client spoke Tagalog words upon our interview. She graduated at Mindanao in 1975

with a course of Computer Science.

III. Emotional Status

During our assessment, we noticed that Mrs. G.P. was cooperative and jolly. She was

very much open with almost everything that we asked like what she feels about her confinement.

She told us that staying longer in the hospital worried her for she was thinking of her daughter

who is a nursing student who looks after her in the hospital. She said that because of her

confinement her daughter wasn’t able to sleep well because she was the one who is taking care

of her.

IV. Sensory and Perception

Vision

Her eyebrows are thin and unevenly distributed, with intact skin, which are

symmetrically aligned. Her eyes are oval shaped and symmetrical with long, thin

eyelashes. Her scleras appear white and have brown-colored irises. Her eyelids’ skin is

7|Page
 also intact with no discoloration and close symmetrically. Her bulbar conjunctivas are

transparent while her palpebral conjunctivas are shiny, smooth and pink in color and are

highly vascular. To test the corneal sensitivity, we asked the client to keep both eyes open

and look straight ahead and tested it with a wisp of cotton. Upon doing so, our client’s

eyes blinked. To assess pupil’s reaction to light, we approached the penlight from the side

and shone a light on her pupil. Her pupils constricted when they are illuminated. To

assess pupil’s reaction to accommodation, we held the penlight at about 10 cm from the

bridge of her nose and asked her to look at the tip of the penlight. We held the penlight

farther from the bridge of her nose then moved the penlight toward the client’s nose. Her

pupils constricted when the penlight was near, dilated when it is held farther and

converged when moved toward the bridge of the nose. Her pupils are equally round and

react to light and accommodation (PERRLA). Her eye muscles are developed and well-

coordinated since we were able to assess the six ocular movements using a penlight. We

asked her to hold her head in a fixed position facing us and follow the movements of the

penlight with her eyes only. We held the penlight 10 inches away from the bridge of her

nose and moved it slowly to the following directions, from the center of her eyes to the

upper right, right, lower right, lower left, left, upper left, and back to the center of her

eyes. Both her eyes can focus on the penlight at the same time. To assess her visual

acuity, we cover the eye not being tested and let her read what is written on our magazine

and what is written in our flash cards and asked her the color of the letters. First to assess

her near vision we provided her with adequate light and we let her read from a magazine

that was held at a distance of 14 inches. She was able to read it. Then we assessed her

distance vision by letting her identify what is written on our flash cards. The size of the

8|Page
 letters was 1 inch which was held at the distance of 30 and 62 inches respectively in

which she was able to identify. Using the same flash cards, we asked her to identify its

color and she identified it correctly.

B. Auditory

Mrs. G.P.’s auricles are bean shaped and of the same color with the facial skin. They are

symmetrical and aligned with the outer canthus of her eyes. We palpated her auricles;

they were firm and not tender. Her pinna recoiled when we folded it. She exhibited no

pain when her auricles were gently pulled upward, downward and backward. Using a

penlight we inspected the external auditory canal and we have observed that both have

cerumen and no discharges.

To test her gross hearing acuity we performed the tuning fork tests. We performed first

the Weber’s test using a tuning fork with her eyes blindfolded; we held the tuning fork at

its base and activated it by tapping the fork gently against the back of our hand near the

knuckles. We placed the base of the tuning fork on top of her head and asked her if she

heard the sound and where she heard it. She said that she heard the sound but cannot

determine the exact location of it.

With her eyes still blindfolded, we also conducted the Rinne test by asking the client to

cover one of her ears. We started on her right ear as we held the handle of the activated

tuning fork on the mastoid process of her ear until she stated that the vibration can no

longer be heard. Then immediately we held the still vibrating fork in front of her right ear

canal. We did the same test on her left ear and she said that the sound was more

prominently heard on the right than the left ear. Mrs. G.P. is Weber negative and positive

9|Page
 Rinne. We have concluded that Mrs. G.P. heard the sound by air conduction louder than

bone conduction.

Olfactory

We observed that Mrs. G.P.’s nose is symmetric and round shaped. Its color is the same

as the facial skin. No discharge was observed from the nares. We lightly palpated her

nose. No tender areas and no lesions palpated. To determine the patency of her nasal

cavities, we asked her to close her mouth and exert pressure on one naris and breathe

through the opposite naris. After doing the procedure on both nares, we noted that the air

moves freely as she breathes. We tested her sense of smell by letting her identify four

sample scents while her eyes were blind folded. We let her smell scented baby oil

(aromatic), fish sauce (foul), vicks vapor rub (menthol) and vinegar (sour). We poured

small amounts of the said scents on a cotton ball. We performed these by occluding one

naris at a time. In between samples, we let her smell coffee bean to get rid of the previous

scent. She was able to identify all the odors correctly.

Gustatory

Mrs. G.P.’s tongue is pinkish and is in central position. It moves freely and its frenulum

is highly vascular. We assessed her sense of taste by letting her taste sugar (sweet), salt

(salty), vinegar (sour), and coffee (bitter) respectively while her eyes were blind folded.

We let her taste first the sugar by placing a pinch of it on the tip of the tongue depressor.

Next, we let her taste the salt by doing the same procedure. Then we let her taste the

vinegar by dipping the tip of the tongue depressor into the vinegar. After which, a pinch

10 | P a g e
 of coffee was also placed on the tip of the tongue depressor allowing her to taste it. We

have done the test by letting her sip water in between tasting each sample. She was able

to identify and differentiate each sample correctly.

E. Tactile

We assessed Mrs. G.P.’s sense of touch with her eyes still blindfolded, by letting her

identify parts of the percussion hammer that are rough, smooth, soft, hard, sharp and

dull. A bowl of hot water and a bottle of cold water were used for our warm Vs cold. We

applied those on her right upper extremity, right lower extremity, left upper extremity,

and left lower extremity. She was able to identify all of it correctly.

V. Motor Ability

Mrs. G.P. was able to ambulate with assistance and has her bathroom privileges. We

asked her to follow us as we do the Range of Motion (ROM). After such she wasn’t able to

rotate, circumduct, abduct, adduct, flex and extend her right upper and right lower extremities.

We also did the same procedure with the left upper and left lower extremities and she was able to

rotate, circumduct, abduct, adduct, flex and extend. All her other body parts can move freely

against gravity and with resistance except for the right upper and lower extremities. To assess her

gait, with the help of her S/O we asked her to walk 3 steps forward and backward. There, we

observed that she has an imbalanced gait. All her muscle strength was graded 3/5.

VI. Body Temperature

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 During our assessment our client was afebrile with a temperature of 36.0 ºC, using a

digital thermometer taken via axilla for 1 minute.

VII. Respiratory Status

Upon our assessment, we observed the rise and fall of her chest and we obtained a

respiratory rate of 18 cycles per minute. We observed the respirations for depth by the rise and

fall movements of her chest. We noticed that she has regular normal respirations. We auscultated

her anterior chest using the flat disc diaphragm of the stethoscope beginning from the bronchi

between the sternum and the clavicles. We asked her to take slow, deep breaths through the

mouth and no adventitious breath sounds were heard. She has quiet, rhythmic and effortless

respirations.

VIII. Circulatory Status

During our assessment, our client’s blood pressure was 130 / 90 mmHg taken at her right

arm. We calculated her pulse pressure and obtained a result of 40 mmHg. Her pulse was easily

palpable, and has equal intervals as we palpated her pulse at the right radial artery and obtained a

pulse rate of 61 bpm. At the same time we also auscultated her apical pulse on the left side of her

chest to the left sternum, 5th intercostal space and procured a pulse rate of 62 bpm. Since her

apical-radial pulse was the same, her pulse deficit was one. We did a capillary refill test (blanch

test) on her right thumb and it returned to its normal color after 1 second.

IX. Nutritional Status

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 We inspected Mrs. G.P’s buccal mucosa using a tongue depressor and a penlight. We

observed that her buccal mucosa is pink in color; her lips are moist and also pink in color. Our

client is not wearing any denture. There are ten permanent maxillary and nine mandibular teeth.

As she stated she has no difficulty in eating. At home our client eats four times a day starting at

4:00a.m. For breakfast she eats sinangag and egg and a glass of water, lunch at 11:00a.m. She

eats rice, meat or fish, merienda at 2:00 p.m. eats crackers and a glass juice and finally for dinner

at 6:00p.m.she eats rice and whatever is available in their table. She also stated that she is fond of

eating meat and salty food. On our assessment she stated that she was able to drink 4 glasses of

water a day with approximately 240 ml per glass. During her entire stay in the hospital she was

on a strict low salt-low fat diet.

Computation of BMI:

WEIGHT = 64 kg.

HEIGHT = 5’4 ft (1.6m)2 = 2.56 m2

BMI = weight in kilograms

Height in meter 2

BMI = _64 kg_

(2.56m)2

BMI = 25 kg/m2 (above the normal range of 18.5 to 24.9).

X. Elimination Status

We asked Ms. G.P. how often she voids per day. She said that before her confinement,

she defecates every two days and she also said that it was formed and hard. She urinates three to

four times daily approximately 120-250ml of urine per day. On the day of our assessment Mrs.
13 | P a g e
G.P. defecated once, according to her it is brown, well formed and is foul in odor. She stated that

there is no pain felt when defecating. She urinated thrice, the color is yellow and the odor is

faint aromatic. We auscultated her bowel sound and it resulted to 2-3 bowel sound in each

quadrant which is below the normal range of 5-20 bowel sound and has a hypoactive sound.

XI. Reproductive Status

Ms. G.P. stated that she had her telarche when she was 12 years old. According to our

client her breasts are symmetrical and have no discharges, no lesions and lumps. She does not

perform BSE because of she did not know how to do it. For her menarche, she had her first

menstruation when she was 16 years old. Her menstrual period lasts for 3 days. More often

than not, she consumes two pads per day and suffers from dysmenorrhea usually on the first

day of her menstruation. Mrs. G.P. has four children (2 boys and 2 girls). She also said that she

uses family planning, the charting method and withdrawal. She has a Score of

G4:T4:P0:A0:L4:M0. There is no any presence of discharge and lesions on her genitals

according to her.

XII. State of Physical Rest and Comfort

At home, she usually sleeps at 8:00 pm, and wakes up at 4:00 am in the morning to start

her daily household chores. She sleeps comfortably in a side-lying position with 3 pillows and a

blanket. She usually sleeps with the light turn off. During her free time, she is fond of watching

television. Whenever her blood pressure shoots up, she takes medicine which is Neoblock to

stabilize her blood pressure and she refrains from doing anything that might aggravate her

condition. In the hospital, since our client stayed in the female ward, she was at ease during her

14 | P a g e
entire stay there. She was able to sleep for a total of 9 hours notwithstanding the fact that there

were slight disturbances such as taking of vital signs as ordered.

XIII. State of Skin and Appendages

Upon observation in a cephalocaudal manner, our client’s hair was black with brown,

well-groomed. The scalp is intact and has no presence of dandruff. She has her IV insertion on

her right metacarpal. The skin of her palm was smooth. Her finger nails were trimmed and

cleaned. Her toenails were trimmed and cleaned as well.

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IX. Anatomy and Physiology

The Cardiovascular System

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17 | P a g e
CARDIOVASCULARSYSTEM
The cardiovascular/circulatory system transports food, hormones, metabolic
wastes, and gases (oxygen, carbon dioxide) to and from cells

• HEART- The heart is a hollow, cone-shaped muscle located between the lungs
and behind the sternum (breastbone). Two-thirds of the heart is located to the left
of the midline of the body and 1/3 is to the right
• JUGULAR VEIN- The jugular veins are veins that bring deoxygenated blood
from the head back to the heart via the superior vena cava.
• CAROTID ARTERY- carotid artery is an artery that supplies the head and neck
with oxygenated blood; it divides in the neck to form the external and internal
carotid arteries.
• PULMONARY ARTERY- The pulmonary arteries carry blood from heart to the
lungs. They are the only arteries (other than umbilical arteries in the fetus) that
carry deoxygenated blood.

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 • PULMONARY VEIN- The four pulmonary veins carry oxygen-rich blood from
the lungs to the left atrium of the heart. They are the only veins in the post-fetal
human body that carry oxygenated (red) blood.
• AORTA- The aorta is the largest artery in the body, originating from the left
ventricle of the heart and bringing oxygenated blood to all parts of the body in the
systemic circulation
• INFERIORVENA CAVA- The inferior vena cava (or IVC) is the large vein that
carries de-oxygenated blood from the lower half of the body into the right atrium
of the heart.
• SUPERIOR VENA CAVA- The superior vena cava is a large, yet short vein that
carries deoxygenated blood from the upper half of the body to the heart's right
atrium.
• HEPATIC VEIN- The hepatic veins are the blood vessels that drain de-
oxygenated blood from the liver and blood cleaned by the liver (from the
stomach, pancreas, small intestine and colon) into the inferior vena cava.
• RENAL ARTERY- The renal arteries normally arise off the side of the
abdominal aorta, immediately below the superior mesenteric artery, and supply
the kidneys with blood
• ILIAC ARTERY- Either of the two large arteries arising by bifurcation of the
abdominal aorta and supplying blood to the lower trunk and legs

19 | P a g e
PATHOPHYSIOLOGY

PREDISPOSING PRECIPITATING FACTOR

FACTOR (Diet)
(Age, Gender, Family History)

Fatty foods ingested

High Low Density

Lipoprotein
(Bad Cholesterol)

Calcium, fatty acids and

cholesterol build up inside
arteries
(Plaque)

Increased heart work load

Elevation of blood pressure

Systolic blood pressure > 170mm Hg;
Diastolic blood pressure > 100 mmHg

Body weakness HYPERTENSION Dizziness

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PATHOPHYSIOLOGY

Blood pressure is the product of cardiac output. Hypertension is the result of the change

in the cardiac output above the normal range. It is sometimes called the “silent killer”

because people who have it are often symptom free. Because hypertension is a sign, it is

likely to have many causes, just as fever has many causes.

Predisposing factor such as age (55 for men and 65 for women), gender (male and female

enters menopause) and family history of hypertension are factors that exert their effects

prior to a behavior occurring. These factors are unchangeable and cannot be altered.

Precipitating factor such as diet (high fat diet) and lifestyle (smoking and alcohol

drinking) are other modifiable factors of hypertension.

The primary cause of hypertension specifically to our client was the ingestion of fatty

foods (“crispy pata”). This type of food is rich in cholesterol that results to fat imbalance

in her system. The liver manufactures enough cholesterol for cells to function normally.

In fact, the liver uses cholesterol in synthesizing bile acids. Then those synthesized bile

acids are secreted into the intestine where they are generally used to mix fat with water

soluble enzymes that actually digest them. And also, it forms a protective coating to the

body and arteries so that we remain protected from infectious diseases. Consuming a

large amount on top of the normal level tends to reach unacceptably high level of

cholesterol.

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High level of Low Density Lipoprotein (LDL; bad cholesterol) and low level of High

Density Lipoprotein (HDL; good cholesterol) will cause calcium, fatty acids and

cholesterol to build up inside arteries. These deposits are commonly called plaque. As the

arteries get smaller, the heart has to work harder to keep up proper blood supply to the

rest of the body. If not corrected, your heart wears out in any of several ways; either

stroke, heart attack or something similar.

In view of the fact that the arteries are getting smaller and smaller and the heart pumps

more blood to properly supply the entire body, there will be an elevation of the blood

pressure. This elevation of blood pressure that results from the partial obstruction of the

arteries is termed as hypertension.

Hypertension is a sign itself that may result to a specific disease such as cardiovascular

disease. It is associated with the signs such as dizziness and fatigue as manifested in our

client.

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 LABORATORIES AND DIAGNOSIS

Referring physician Procedure CT No.:

Dr. Estacio Head technique plan 10-1955 study no.: 03175
Date performed:
January 31, 2010
Referring hospital
Carlos Medical and
Maternity Clinic

COPUTED TOMOGRAPHY RESULT

PERTINENT FINDINGS
ILL DEFINED HYPODENSE FOCI ARE SEEN IN THE RIGHT FRONTO-
TEMPORAL LOBE, INSULAR CORTEX AND CAPSULOGONGLIONIC REGION.
NO ACUTE HEMORRHAGE IS SEEN
THERE IS NO MIDLINE SHIFT
VENTRICULAR SYSTEM IS NOT DILATED

IMPRESSION:
CNSIDER AN ACUTE ISCHEMIC EVENT IN THE RIGTH FRONTO-TEMPORAL
LOBE, INSULAR CORTEX AND CAPSULOGAGLIONIC REGION (RIGHT
MIDDLE CEREBRAL ARTERY TERRRITORY)

Geraldine Gan MD,FPCR

Radiologist

January 31, 2010

URINALYSIS

Test Result Test Result Result Result

Color Yellow Epith. Cells Few Am urate Few

Transparency Slight turbid Puss cells 8-10 hpf

Reaction Acidic RBC 1-3

Sp.gr. 1.010

Albumin +

Sugar -

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 Acela S. Tantiongco MD
Pathologist

BLOOD CHEMISTRY

TEST RESULT

SODIUM 137.4

POTASSIUM 4.06

HEMATOLOGY

TEST RESULT NORMAL TEST RESULT NORMAL

VALUE VALUE
WBC 8.35 5-10 X10 RBC 3.9 4-6 X 10
9/L 12/L
NEUTROPHILS 0.85 0.40-0.70 HEMOGLOBIN 113 F: 120-150
9/L
LYMPHOCYTES 0.15 0.20-0.40 HEMATOCRIT 0.34 F: .33-.48
PLATELET ADEQUATE 150-350 X
10 9/L

February 02,2010
BLOOD CHEMISTRY

TEST RESULT NORMAL VALUE

HDL .60 0.78-1.95mmol/L

Acela S. Tantiongco MD
Pathologist

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 XII. DRUG STUDY

Drug Name Classification/Indicatio Mechanism of Action Adverse Reaction Nursing Responsibility

n

Citicoline 500mg Central nervous system Citicoline is a derivative No manifestation • Monitor blood
q 12 drug of choline and cytidine pressure, pulse
• CVA in acute and involve in the Possible adverse and heart rate
recovery phase biosynthesis of lecithin. reaction: • Assess allergic
• Sign and It is claimed to increase • Shock, reaction like
symptoms of blood flow and oxygen hypersensitivity, gastro intestinal
cerebral consumption in the hypotension, disturbances
insufficiency brain. insomnia, • Must not be
(dizziness, excitement administered to
headache, for • Stimulate patient with
concentration, parasympathetic hypertonia of the
memory loss, action and parasympathetic
disorientation, fleeting and nervous system
recent cranial discreet • Direct IV
trauma) hypotension administration
effect should be made
very slowly to
prevent episodes
of hypotension

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 Drug Name Classification/Indication Mechanism of Action Adverse Reaction Nursing Responsibility

Amlopidine 5mg Antiaginal, Therapeutic effect: CNS: headache, fatigue, • Assess patient’s
1 tab OD (am) antihypertensive Reduces blood pressure somnolence blood pressure
indicated for and prevents agina. CV: edema, dizziness, before therapy and
hypetension flushing, palpitation regular thereafter.
GI: nausea, abdominal • Monitor patient
pain, dyspnea carefully for pain.
• Adjust dosage based
on patient response
and tolerance.
• Advise patient to
continue taking
during even when
felling better.
• Be alert for adverse
reaction and drug
interactions.

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 Drug Name Classification/Indication Mechanism of Action Adverse Reaction Nursing Responsibility

Simvastatin 500mg Antihyperlipemic Therapeutic effects: CNS: headache, • Obtain history of

1 tab OD (pm)
• To reduce risk of CVD
mortality and CV event in
patients at high risk
• To reduce total cholesterol
and LDL levels in patient
with homozygous familial
hypercholesterolemia
• Heterozygous familial
hypercholesterolemia
Asthenia
Lowers LDL and total GI: abdominal pain,
cholesterol levels. constipation, diarrhea,
dyspepsia, flatulence,
nausea
Hepatic: cirrhosis,
hepatitis, hepatic
necrosis
Musculoskeletal:
myalgia • Obtain liver
Respiratory: upper
respiratory tract
infection.
• Monitor patient for
patient’s LDL and
total cholesterol
count levels before
starting therapy,
and reassess
regular thereafter
to monitor the
drug’s
effectiveness
function test result
before starting
therapy and
periodically
thereafter. If
enzyme elevation
persist, a liver
biopsy may be
performed
myalgia-musculat
weakness-and for
elevated CK level,
during treatment.
Rhabdomyolysis
with and without

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 acute renal
insufficiency has
been reported
• Be alert for adverse
reactions and drug
interaction
• Assess patient’s
dietary fat intake
• Assess patient’s
and family’s
knowledge of drug
therapy

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 Drug Name Classification/Indicatio Mechanism of Action Adverse Reaction Nursing Responsibility
n

Citicoline 500mg Central nervous system Citicoline is a derivative No manifestation • Monitor blood
q 12 drug of choline and cytidine pressure, pulse
• CVA in acute and involve in the Possible adverse and heart rate
recovery phase biosynthesis of lecithin. reaction: • Assess allergic
• Sign and It is claimed to increase • Shock, reaction like
symptoms of blood flow and oxygen hypersensitivity, gastro intestinal
cerebral consumption in the hypotension, disturbances
insufficiency brain. insomnia, • Must not be
(dizziness, excitement administered to
headache, for • Stimulate patient with
concentration, parasympathetic hypertonia of the
memory loss, action and parasympathetic
disorientation, fleeting and nervous system
recent cranial discreet • Direct IV
trauma) hypotension administration
effect should be made
very slowly to
prevent episodes
of hypotension

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 Drug Name Classification/Indication Mechanism of Action Adverse Reaction Nursing Responsibility

Amlopidine 5mg Antiaginal, Therapeutic effect: CNS: headache, fatigue, • Assess patient’s
1 tab OD (am) antihypertensive Reduces blood pressure somnolence blood pressure
indicated for hypetension and prevents agina. CV: edema, dizziness, before therapy and
flushing, palpitation regular thereafter.
GI: nausea, abdominal • Monitor patient
pain, dyspnea carefully for pain.
• Adjust dosage based
on patient response
and tolerance.
• Advise patient to
continue taking
during even when
felling better.
• Be alert for adverse
reaction and drug
interactions.

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 Drug Name Classification/Indication
Simvastatin 500mg Antihyperlipemic
1 tab OD (pm)
• To reduce risk of CVD
mortality and CV event in
patients at high risk
• To reduce total cholesterol
and LDL levels in patient
with homozygous familial
hypercholesterolemia
• Heterozygous familial
hypercholesterolemia
31 | P a g e
Mechanism of Action Adverse Reaction Nursing Responsibility
Therapeutic effects: CNS: headache, • Obtain history of
Asthenia patient’s LDL and
Lowers LDL and total GI: abdominal total cholesterol
cholesterol levels. pain, count levels before
constipation, starting therapy,
diarrhea, and reassess
dyspepsia, regular thereafter
flatulence, to monitor the
nausea drug’s
Hepatic: effectiveness
cirrhosis, • Obtain liver
hepatitis, hepatic function test result
necrosis before starting
Musculoskeletal: therapy and
myalgia periodically
Respiratory: thereafter. If
upper respiratory enzyme elevation
tract infection. persist, a liver
biopsy may be
performed
• Monitor patient for
myalgia-musculat
weakness-and for
elevated CK level,
during treatment.
Rhabdomyolysis
with and without
acute renal
insufficiency has
been reported
• Be alert for adverse
reactions and drug
interaction
• Assess patient’s
dietary fat intake
• Assess patient’s
and family’s
knowledge of drug
therapy
 Drug Name Classification/Indication Mechanism of Action Adverse Reaction Nursing Responsibility

Hyzar Hypertension A thiazide diuretic that CNS: dizziness, • To prevent

(hydrochlorothiazide) increases sodium and vertigo, headache, nocturia, give
1 Tab OD (pm) water excretion by paresthetia, drug in the
inhibiting sodium and weakness, morning
chloride reabsorption in restlessness. • Monitor fluid
distal segment of the CV: orthostatic intake and
nephron. hypotension, allergic output, weight,
myocarditis, blood pressure,
vasculitis. and electrolyte
GI: anorexia, nausea, levels.
pancreatitis, • Watch for signs
epigastric distress, and symptoms
vomiting, abdominal of hypokalemia
pain, diarrhea, such as muscle
constipation. weakness and
GU: polyuria, cramps
frequent urination, • Drug may use
renal failure, with potassium-
interstitial nephritis. sparing diuretics
to prevent
potassium loss
• Monitor

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 creatinine and
BUN levels
regularly.
Cumulative
effects of drug
may occur with
impaired renal
function.
• Monitor uric
acid level,
especially in
patient with
history of gout.
• In patient with
hypertension,
therapeutic
response may be
delayed several
weeks.

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 I. NURSING CARE PLANS
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

Subjective: Impaired physical Within 1 hour of • Determine diagnosis that contributes to immobility. Within 1 hour of
" Nahihilo at mobility related to nursing interventions nursing
nanghihina ako, decrease muscle and health teachings R: That may restrict movement. interventions
kailangan ko pa ng strength as evidenced the client will and health
• Encourage participation in self-care,
alalay para pumunta by: increase strength and teachings the
occupational/diver-sional/recreational activities.
ng banyo” as • Muscle grade of functioning of client increases
verbalized by the 3/5 affected or R: Enhances self-concept and sense of independent. strength and
client. compensatory parts. functioning of
Objective: • Slow movement • Encourage adequate intake of fluid/nutritious food. affected or
• Muscle grade compensatory
of 3/5 • Postural R: Promotes well-being and maximizes energy part.
instability production.
• Slow
• Involve client and S/O (s) in care, assisting them to
movement
learn ways of managing problems of immobility.
• Postural
R: To prevent immobilization.
instability
• Demonstrate use of standing aids and mobility
devices (e.g. walker, strollers, scooter, braces, and
prosthetics) and have client/care provider
demonstrate knowledge about/safe use of devices.

R: To promote independence and enhance safety.

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Assessment Diagnosis Planning Implementation Evaluation

Subjective: Imbalanced nutrition Within 30 minutes of Independent: After 30 minutes of

“Madalas akong more than body health teachings the • Identified lifestyle that may health teachings the
kumain ng mga requirements related client will be able to predispose to weight gain such client was able to acquire
matataba at maalat to excessive intake in acquire additional as eating patterns, and factors additional knowledge
na pagkain ” relation to metabolic knowledge about that may impact food intake. about proper ways of

need as evidenced by proper ways of losing R: To serve as baseline data losing and maintaining
Objective: BMI of 25 kg/m2 and maintaining ideal ideal body weight as
• Advised to develop new eating
BMI = 25 kg/m2 (above the normal body weight. evidenced by
patterns/habits.
(above the normal range of 18.5 to 24.9) verbalization of
R: To reduce the possibility of
range of 18.5 to “sisikapin kong bawasan
gaining weight.
24.9) ang pagkain ng matataba
• Advised to limit intake of high

caloric foods such as chocolates, at maalat at gagawin ko

carbonated drinks, and fried nang regular ang pag-

foods. eexercise”.

R: These may increase the chances

of gaining weight and increase

blood pressure

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and vegetables instead of salty

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 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION

 Risk for constipation Within 30 minutes of • Instruct in/ encourage balanced fiber After 30 minutes of
and bulk in diet (e.g. fruits,
related to insufficient nursing interventions vegetables, and whole grains). nursing interventions and

fiber/fluid intake. and health teachings R: to improve consistency of stool and health teachings the

the client will be able facilitate passage through colon. client verbalized

to understand the • Promote adequate fluid intake, understanding of

including water and high-fiber fruit
importance of importance of
juices, also suggest drinking warm
maintaining usual fluids (coffee, hot water, tea). maintaining pattern of

pattern of bowel R: to promote soft stool and stimulate bowel functioning.

functioning bowel activity.

• Encourage activity/exercise within

limits of individual ability.

R: to stimulate contractions of the

intestines.

• Provide privacy and routinely

scheduled time for defecation
(bathroom or commode preferable to
bedpan)

R: so that client can respond to urge.

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