I.

INTRODUCTION:
Hypertension Definition

Hypertension is defined as sustained abnormal elevation of the arterial blood

pressure (Brashers, 2006). The purpose of the control of blood pressure is to ensure
constant blood flow to vital organs. Without this constant blood flow, life is immediately
threatened. Additionally, continually elevated blood pressure of hypertension produces
detrimental effects on the heart, kidneys, and blood vessels. Hypertension is a
contributing factor to disability and premature death as a result (Mattson Porth, 2004).

Components of Blood Pressure

Before discussing the pathophysiology of hypertension, a short review of the
mechanisms of blood pressure is needed. The systolic and diastolic components of
blood pressure are cardiac output (CO) and peripheral vascular resistance (PVR).
Cardiac output is the result of stroke volume of the heart and the heart rate. Peripheral
vascular resistance changes as the size of the arterioles and thickness of the blood
changes (Mattson Porth, 2004). Cardiac output and peripheral vascular resistance both
fluctuate in order to compensate for changes in the other.
Systolic blood pressure is reflective of the blood entering into the aorta. As blood
enters, the aorta stretches and the pressure rises. The degree of increased pressure is
determined by the amount of blood in the stroke volume, rate of ejection, and elasticity
of the aorta.
Diastole occurs as the ventricles relax and blood flows to the periphery. The diastolic
pressure is maintained by the energy that has been stored in the elastic walls of the
aorta during systole. Components that affect the maintenance of diastolic pressure
include the elasticity of the aorta and large vessels, ability of these vessels to stretch
and store energy, and amount of resistance of the arterioles (Mattson Porth, 2004).

Another component of blood pressure is the pulse pressure. Pulse pressure is

the difference between the systolic and diastolic blood pressures. The pulse pressure
reflects the pulsatile nature of arterial blood flow (Mattson Porth, 2004). Pulse pressure
rises when extra amounts of blood enter the arterial circulation. Pulse pressure declines
when resistance to outflow declines. Mattson Porth (2004) cites the example of
hypovolemia. The pulse pressure decreases as a result of decreased stroke volume
and systolic pressure despite increases in peripheral vascular resistance.
The last component of blood pressure to mention is the mean arterial pressure
(MAP). This reading is indicative of the average blood pressure in the systemic
circulation. The mean arterial pressure is a good indicator of tissue perfusion and is
monitored in critically ill individuals (Mattson Porth, 2004).
Reasons for choosing the Case:
Initially the researchers have difficulty of an appropriate case for presentation
since most of the cases presentations on the institution are common.
With that problem in hand, the group decided to came up into a medical case of a
63 years old female with a diagnosis of Hypertensive Urgency. The researchers decided
to choose this case because they wanted to acquire more knowledge about
Hypertension. They wanted to use the knowledge that they have acquired in promoting
awareness in order to prevent the development and progression of Hypertension. The
researchers also wanted to focus on preventive measures.
Significance of the Study
This study will help the nursing profession by providing information about the
proper management and care for Hypertensive patient. It will also educate the people,
especially those with Hypertension and vulnerable individuals to seek medical care in
order to prevent Hypertension. It will increase awareness about the importance of
having a healthy lifestyle.

Objectives:
After the completion of the study, the researchers shall be able to:
 Identify and differentiate risks for Hypertension
 Perform a comprehensive assessment of Hypertension
 Enumerate the different signs and symptoms of Hypertension
 Formulate nursing care plans utilizing the nursing process
 Formulate conclusions based on the findings and enumerated a
recommendations concerning Hypertension

Nurse Centered Objectives:

At the end of the study, the researchers:

• Shall have critical thinking skills necessary for providing safe and effective
nursing care.

• Shall have a comprehensive assessment and implement care base on our

knowledge and skills of the condition

• Shall have familiarized us with effective inter-personal skills to emphasized

health promotion and illness prevention.

• Shall have imparted the learning experience from direct patient care.
I. BIOGRAPHIC DATA

Name: Mrs. D.B.M.

Address: San Jose Rodriguez Montalban Rizal

Age: 63 years old Gender: Female Religion: Roman Catholic

Marital Status: Married Birthday: October 27, 1947 Occupation: Retired

government employee

Room and bed no.Hallway 3

Chief complaint: Left Sided Weakness

Provisional Dx: Hypertensive Urgency

Attending Physician: Dr. Keith R. Vitan

II. NURSING HISTORY

A. Past Health History

During the interview, Mrs. D.B.M. revealed that his childhood illness were cough,
colds, fever and Chicken Pox. She was also given complete immunization as stated by
her daughter who was accompanying her during the time of interview. According to the
patient‘s daughter the client doesn’t have any allergies to any food, drug or any
substance. Mrs. D.B.M. first hospitalization was due to Difficulty of Breathing and in
urinating last August 2008. The client is taking medication for hypertension. He is taking
Norvasc, Simvastine and Amlodipine.
Mrs. DBM was diagnosed to be positive for PTB (pulmonary tuberculosis) last
year (2008) but completed the 1 year treatment. And patient was also brought to
Orthopedic due to the Right Shoulder Fracture last Month. The client is Diabetic for
about ten years and Hypertensive for 24 years.

B. History of Present illness

Three days prior to admission the patient experienced Left Sided Weakness,
Vomiting and loss of balance. And 1 day PTA, she started experiencing headache and
dizziness. And upon admission patient is experiencing slurring of speech to ER, BP
noted to be elevated advised admission at ER.
C. Family History

According Mrs. D.B.M.’s daughter, Mrs. D.B.M. has familial history of

Hypertension on her father side.

III. PATTERNS OF FUNCTIONING

A. Psychological Health

Coping Pattern

According to the client’s daughter, when she is having a stress, she usually
experiencing headache. There are also times when she has stress; she will just invite
the family to eat outside. And according to her it is not effective to relieve her stress
because after that she is still having a headache. Her family is the one who helps with
her when she has stressed especially his husband. The client usually share her problem
with her family because as verbalized by the client’s daughter “ mas maganda kapag
ishashare niya kasi makakatulong ito para malaman din namin”. And another reason is
that they have a close relationship to each other like having an open communication to
each other. According also to the client’s daughter, she is not taking medicines when
she has stress.

Analysis:
Coping mechanisms are behaviors used to decrease stress and anxiety. Many
coping behaviors are learned based on one’s family, past experiences, and
sociocultural influences and expectations. Typical behaviors include crying, laughing,
sleeping, cursing, physical activity, exercise, smoking, drinking, lack of eye contact,
withdrawal, and limiting relationships to those with similar values and interests.
(Fundamentals of Nursing: The Art and Science of Nursing Care/Carol Taylor, Carol
Lillis, Priscilla LeMone—5th ed. page 855).

Interpretation:
Not Normal, because sometimes she cannot cope and manage her stress. But
her family is the one who helps with her when she is having a stress.

Cognitive Perceptual Pattern

The client has a blurred vision. According to Mrs.D.B.M’s daughter, she wears
eyeglasses whenever she reads something. She also had difficulty in hearing when we
assessed and talked to the client. But she doesn’t have any problem in smell or taste.
The client is experiencing difficulty in speaking. She doesn’t have difficulty in learning or
understanding.

Analysis:
Cognitive development refers to the manner in which people learn to think, reason,
and use language. It involves a person’s intelligence, perceptual ability to process
information. Cognitive development represents a progression of mental abilities from
illogical to logical thinking, from simple to complex problem solving and from
understanding concrete ideas to understanding abstract concept. (Fundamentals of
Nursing by Kozier, et al..page 359).
Cognitive-Perceptual: No sensory deficits, pupil 3 mm, equal, brisk reaction, must be
oriented to time, place, and person, responsive, responds appropriately to verbal and
physical stimuli, and recent and remote memory intact. (Fundamentals of Nursing by
Kozier, et al..page 273)

Interpretation:
Based on the interview with client’s daughter, the client has a problem in vision,
hearing and also in speaking.

Self-Concept
The client has a positive outlook in life. As of now she is not contented in her
physical appearance because as of now she is ill. The nature of the client’s clothes is
loose fitted and clean. She said that she usually interacts with her friends and family
most of the time. The client appears clean and neat.

Analysis:
Self concept is developed through a very complex process that involves many
variables. The four components of self-concept frequently considered by nurses are
identify, body image, self esteem and role performance. Self concept is a Psychic
representation of an individual, the central core of “I” around which all perceptions and
experiences are organized.
Source: Fundamentals of Nursing, 5th Edition by: Patricia A. Potter & Anne Griffin
Perry, page 541

Interpretation:
The client has a positive outlook in life, even as of now she is not contented
about his physical condition because of illness.

Emotional Patterns
The client is happy with her life together with her family. She said that she is not
experiencing any conflict with her family and the people around her. According to the
client’s daughter, the client is also friendly and cheerful. She is also active,
accommodating and very vocal to other people.

Analysis:
Individuals and groups, though interpersonal relationships can provide comfort
and assistance, encouragement and information. Social support fosters successful
coping and promotes satisfying and effective living. (Pender, 2002)
Social support systems contribute to health by creating an environment that
encourages healthy behaviours, promotes self-esteem and wellness and provides
feedback that person’s actions will lead to desirable outcomes. (Fundamentals of
Nursing by Kozier et. al.)
Interpretation:
The client does not have any difficulty in expressing her emotions.

Sexuality
When the client was asked if she is contented and happy about being a woman,
she answered “yes”. She said that she usually expressive about her feelings to her
husband and children. She is also happy having a partner. As they aged she admits that
they are becoming less active in sex.

Analysis:
As a person grows and develops, so does his or her sexuality. Each stage of
development brings changes in sexual functioning and the role of sexuality in
relationships. Source:(FUNDAMENTALS OF NURSING BY POTTER AND PERRY pg.
567)

Sexuality is the degree to which a person exhibits and experiences maleness or

femaleness physically, emotionally and mentally. Sexuality is a learned behaviour in
how one behaves in relationships with others. Because our sexuality is so basic to our
sense of self, nurses need to value sexuality as a critical element of health and well-
being in general and must be skilled in identifying and meeting problems related to
several self-concept, body image, and sexual identity. Sexual identity encompasses a
person's self-identity, biologic sex, gender identity, gender role behaviour or orientation,
and sexual orientation or preference.(Fundamentals of Nursing by Kozier)

Interpretation:
The client is happy being a woman, because she has partner in life and this
makes her feel complete.

B. SOCIO-CULTURAL PATTERN

Cultural Patterns
The client’s daughter stated that she believes that giving respect to elders is one
of the most important values that she practices until now; she also passes this on to her
children. “Nakagisnan nya ng gumamit ng po at opo at sa ibang mga nakatatanda
bilang paggalang. Itinuro ko din ito sa mga anak namin.” Every year, they are having
family gatherings and reunions, she said that she usually participates and attend on it,
“Sa lahat ng reunion ng pamilya namin lagi siya kasama”. Her family also celebrates
birthdays and New Year. She and his husband is the decision maker of their family..
And as their health belief and practice, the client verbalized, “Naniniwala ako sa mha
herbal plants”
Analysis:
Culture may be defined as a shared system of beliefs, values, and behavioral
expectations that provides social structure for daily living. Culture defines roles and
interactions with others as well as with families and communities. And is a parent in the
attitudes and institutions unique to particular group. Culture includes the beliefs, habits,
likes and dislikes and customs and rituals learned from ones family. (FUNDAMENTALS
OF NURSING BY TAYLOR pg. 40)

Interpretation:
The client has respect with the elders as a sign of respect. They celebrate
different family affairs wherein she is always present. They also believed in herbal
plants.

Significant Relationships
The client considers her husband, children and relatives as the significant people
in her life. As verbalized by the client’s daughter, “Importante sila at kami kasi nandiyan
kami lagi sa tabi niya lalo na kapag may problema siya o kaya kapag ganitong
nagkakasakit siya. Binibigyan naming siya ng payo at pinapakinggan sa mga problema
para maging ok na siya”. She said that their family didn’t have any major conflict. When
asked about the reaction of her family related to health-concerns she mentioned,
“Tinatanggap lang nila at sinusuportahan. Pinaapagamot pa nga nila ako”.

Analysis:
Family members, friends and caregivers are especially helpful sources of data
when the patient is a child or has limited capacity to share information with the nurse.
Friends of an acompany a patient or an agency and can supply useful information. Also,
there should be a clear understanding by the patient, family and friends of the
confidentiality of the data collected.
Source:(FUNDAMENTALS OF NURSING BY KOZIER pg.240)

Interpretation:
The client gives importance to the significant people in his life and doesn’t have
any conflict with his family. Whenever he needs help, he is consulting it to his family.

Recreation Patterns
The client enjoys watching T.V. as her leisure activities. According to Mrs. D.B.M.
she feels happy during leisure time for the reason that this is the time that he could
relax. She is not active in Exercise. She said that “Paglalakad lang yung Exercise ko eh
minsan tinatamad kasi ako.”
Analysis:
Consider recreational facilities in the community and outside the community.
Theaters and movie houses, numbers and types of church and religious services.
Number and utilization of Playgrounds, pools, parks and sport facilities. Level of
participation in various church programs number and types of social communities,
organizations and clubs available.
Source: Fundamentals of Nursing, 7th Edition by: Barbara Kozier, Glenora Erb, Audrey
Berman & Shirlee Snyder, page 201

Interpretation:
The client is not active in sports and exercise. Walking is the only form of
exercise of the client.

Environment
According to the client’s daughter she lives in a clean baranggay and a
comfortable house. The client’s daughter verbalized, “Komportable naman siya sa
tinitirahan namin kaso medyo magulo pa din kasi binaha kami.” The client said that their
house is spacious and adequate for them. Vectors and rodents are present in their
house. The client’s daughter also stated that the house is safe and in order. They are
nine people living in their house.

Analysis:
For effective communication, the environment should meet participant needs for
physical and emotional, comfort and safety. Noise, temperature extremes, destructions,
and lack of privacy or space may create confusion tension and discomfort.
Environmental Destructions are common in Health Care settings and can interfere with
messages sent between people, so nurses must try to control the environment as much
as possible to create favorable conditions for effective communication.
Source: Fundamentals of Nursing, 5th Edition by: Patricia A. Potter & Anne Griffin
Perry, page 449

Interpretation:
The client’s environment is a comfortable place for her but as of now it is still not
stable due to the recent typhoon and flood. It is also clean and adequate for them.
There is no presence of accident prone area such as the stairs.

Economic
According to the client, there is an adequate income for them that can support
their basic needs, although she also said that sometimes their budget is short. He
verbalized “Sakto lang naman ang panggastos namin pero minsan nagigipit din kami
lalo na kapag may mga hindi inaasahang gastos na dumadating tulad ngayon.” They
usually prioritize their monthly necessities like foods, water & electric bills.

Analysis:
 Greater financial support provided through public and private health insurance
program has increased the demand for nursing care. As a result, people who could not
afford healthcare in the past are increasingly using such health service as emergency
room care, mental health counseling, and preventive physical examination.
Source: Fundamentals of Nursing, 7th Edition by: Barbara Kozier, Glenora Erb, Audrey
Berman & Shirlee Snyder, page 13

Interpretation:
The client and her family had an adequate income, enough to support their basic
needs. They are also able to budget their income and prioritize things according to their
needs. The source of their income is from the client’s husband and from children. The
husband of the client is working as an operator.

C. SPIRITUAL PATTERNS

Religious Beliefs and Practices

According to the client, she is a Roman Catholic. Before hospitalization she is
attending mass once a month. She also has strong faith in the power of God. But as of
now, because of his illness she said that he cannot attend the mass. She has no
Religious Organization.

Analysis:
Spirituality is a concept that is unique to each individual. Individual’s definitions of
their own spirituality or influenced by their culture devellopment, life experiences,
beliefs, and ideas about life.

Source: Fundamentals of Nursing, 5th Edition by: Patricia A. Potter & Anne Griffin
Perry, page 591

Interpretation:
The client has strong faith in God. She also attends mass before hospitalization.

Values and Valuing

According to the client, the important things for her are the lives and health of her
family and the people around her. She considers her family as the most important
people in her life. The client sees herself in the society as an observer of rules and
regulations. Another thing that is important to her is God. She also believes in Herbal
Medicines and some superstitious beliefs.

Analysis:
 Values is a personal belief about the worth of a given idea, attitude, custom or
object that sets standards that influence behavior. The values that an Individual holds
reflect cultural and social influences, relationships and personal needs.
Source: Fundamentals of Nursing, 5th Edition by: Patricia A. Potter & Anne Griffin
Perry, page 406

Interpretation:
The client considers her family as the most important thing in her life, because
nothing can replace them. She has a good and harmonious relationship with her family.
There is no conflict between her and family.

IV. ACTIVITIES OF DAILY LIVING

ACTIVITIES BEFORE DURING INTERPRETATION AND

OF DAILY HOSPITALIZATION HOSPITALIZAYION ANALYSIS
LIVING
1. Nutrition Mrs. DBM’s food Mrs. DBM’s eats Mrs. DBM can’t eat her
preference was low fat, low salt and preferred food due to her
fried foods, soft diet illness. She is restricted for
vegetables and salty and fatty foods.
soups as stated by
her daughter. And Proper nutrition involves
Sometimes she adequate food intake
eats Pork Adobo. which consists of balanced
essential nutrients: H2O,
carbohydrates, proteins,
fats, vitamins, and
minerals (Fundamentals of
Nursing y Kozier, et. Al. p.
1171)

2. Elimination Mrs. DBM’s stated Mrs. DBM’s was Mrs. DBM can urinate and
that she has a good able to urinate and defecate normally even
fecal elimination defecate without though she is ill
and no difficulty or any discomfort and
discomfort in difficulties. FECES: variable, pungent,
urinating. She has a may be affected by foods
regular elimination ingested, soft semisolid
pattern before and formed.
hospitalization. (Fundamentals of Nursing
by Taylor 5th edition:
Characteristics of Stool, p.
1346)
Normal feces are made up
 of about 75% of water and
25% solid materials,
usually soft but formed
normally brown
(Fundamentals of Nursing
by Kozier, et. al. p. 1260)

3. Exercise According to Mrs. Mrs. DBM’s cannot Mrs. DBM’s cannot

DBM’s her usual perform exercise in exercise due to her illness
exercise is walking her current state.
only. The amount of exercise
has been found to be a
greater factor in exerting a
positive effect on the
cardiovascular system
than the type of exercise
performed. According to
Healthy people 2010,
regular physical activity
helps to prevent certain
chronic diseases such as
HPN, type 2 diabetes,
cardiovascular Dse. ,
obesity and osteoporosis.
(p.1116-1117 FON, Taylor
5th ed.)
4. Hygiene Mrs. DBM’s stated Mrs. DBM’s stated Mrs. DBM’s is not yet
the she takes a that she doesn’t taking a bath and brushing
bath every take a bath and her teeth because of her
afternoon and brush her teeth for condition.
brush her teeth 2 2 days.
times a day Bathing/Skin Care: Uses
deodorants and
antiperspirants as needed
since secretions from
newly active glands react
with bacteria on the skin
causing a pungent odor
(Fundamentals of Nursing
by Kozier et. al.)
Oral Care: Brush teeth
thoroughly after meals and
at bedtime, Floss the teeth
daily, Ensure an adequate
intake of nutrients,Avoid
 sweet foods and drinks
between meals, Eat
coarse, fibrous foods
(cleansing foods), Have a
checkup by a dentist every
6 months (Fundamentals
of Nursing by Kozier et.
al.)

6. Sleep and Mrs. DBM’s stated Mrs. DBM’s was not Mrs. DBM’s sleep has
Rest that the usual time able to sleep decreased due to her vital
of her sleep was continuously signs monitoring
9pm and wakes up because of vital
at 1am in the monitoring every 2 There are many causes of
morning and sleeps hrs. sleep deprivation and the
again at 2am and manifestations progress
wake up again at from irritability and
7am. Her sleeps impaired mental abilities to
are not continuous. a total disintegration of
She usually naps in personality. Partial sleep
the afternoon for deprivation may result in
about 2 hours. loss of concentration;
inattention and impaired
information processing
and pose serious safety
risks. The strange
environment of the
hospital, physical
discomfort and pain, the
effects of medication, and
the need for 24-hour
nursing care may also
contribute to sleep
deprivation in hospitalized
patients. It is unclear
whether irreversible
damage to body tissues
results from prolonged or
chronic sleep deprivation.
(p.1178 FON, Taylor 5th
ed.)
7. Sexual Mrs. DBM’s stated Not Possible. The client usually
activity that as they aged expresses her feelings to
they become less her husband and children.
active. She is also happy having a
partner. As they aged she
 admits that they are
becoming less active in
sex.
As a person grows
and develops, so does his
or her sexuality. Each
stage of development
brings changes in sexual
functioning and the role of
sexuality in relationships.
Source:(FUNDAMENTALS
OF NURSING BY
POTTER AND PERRY pg.
567)

Laboratory Results:

Microscopic exam

Amorphous urates: rare Epithelial cells:

Pus cells: 0-2/hpf Mucus threads: rare

Red cells: 0-1/hpf Bacteria:

Analysis:

Part of the urinalysis is the examination of some urine with a microscope. Cells,
crystals, and other substances are counted and reported either as the number observed
“per low power field” (LPF) or “per high power field” (HPF). In addition, some entities are
estimated as “few,” “moderate,” or “many,” such as epitheial cells, bacteria, and
crystals. (www.labtestsonline.org/understanding/analytes/urinalysis/ui_exams-3.html)

Normal

Hemoglobin 187 120-160 g/L

 HCT 0.55 M 0.36-0.48 CV

WBC ct. ADEQ adult 5.0-10.0x109/L

Analysis:

CBC identifies the total number of WBC and RBC, platelet count, HGB and HCT.
The CBC is carefully monitored in points with CVD. The HCT is a measure of the
relative proportion of RBC and plasma. Decreased HGB and HCT levels have serious
consequences for points with CAD such as more frequent angina episodes. ( MS by
Brunner and Suddarth’s, p.644)

Problem Prioritization

Nursing Cues Rank Justification

Diagnosis

Ineffective health I: 3 - This nursing

maintenance related to diagnosis is not life
The client’s daughter threatening and
lack of exercise pattern Verbalized: doesn’t need
immediate attention
-“Paglalakad lang yung
compared to the two
Exercise niya eh minsan
other diagnosis.
tinatamad din kasi siya.”
However, it can
affect the body’s
-“Mabilis din kasi siya normal functioning.
mapagod kung
mageexercise”
-“Minsan hindi niya
maiwasan kumain dati
ng maalat”
O:
- weak in appearance
- Lack of knowledge
regarding basic health
 practices.
Acute pain related to I: 1 This is a priority
increased
-“nahihilo daw siya at
cerebrovascular sumasakit ang ulo niya
pressure as evidenced
kapag bumabangon.”
verbal reports and
-“nang tumaas din yung
facial grimace.
bp nya sumakit ang ulo
nya.”
-“7/10”
O:
-guarded/protective
behavior.
-facial mask of pain.
- Facial grimacing
-distraction behavior
-irritability
-reduced interaction to
people
-frequent change in the
position of sleep
Sleep Deprivation I: 2 This problem ranks
related to interruption
for therapeutics, -“napuputol yung tulog
monitoring, and other dahil kinukuhaan siya
generated awakening ng BP.”
-Hindi siya madalas
makatulog dahil
sumasakit din ulo niya”
O:
-Weak in appearance
problem because it
needs an immediate
intervention on the
patient’s condition.
This is also under the
physiologic needs of
Maslow’s Hierarchy of
needs. And if this
problem is solved
other complication can
be avoided and it will
gain client’s
cooperation for other
nursing interventions.
the second because
this affects the
current health status
of the patient, but
acute pain needs
more attention. This
problem, if treated,
will contribute to the
progress of health
status of the patient.
It is partially
-irritability modifiable which
includes the hospital
-lack of energy environment and
-Inability to concentrate lighting facility; but
the monitoring of the
-Frequent yawning vital signs is a factor
that makes his
sleeping disturbed.

- This condition
doesn’t need
immediate attention
but needs to be
addressed for sleep
is a basic human
need.
-This is a physiologic
need but needs
lesser attention
compared to acute
pain.
DISCHARGE PLAN

M – Medications

• Advice the client and client’s Significant Other (SO) to continue with the
medications as prescribed by her physician in order to help ensure an optimal
recovery as possible.
• Reinforce to the client and the client’s SO the details and instruction regarding
the medications which may include the right dosage, frequency and route. Notify
them also about the possible side effects and contraindications to the
medications.
• Advise the client and the SO to report immediately to their health care provider
when untoward effects arise due to the use of medications.

E – Exercise

• Reinforce to the client and SO the importance of performing specific ROM

exercises in aiding in improving the client’s muscle strength and prevent
contractures.
• Teach the client and SO proper exercises and transfer techniques.
• Explain the importance of assisting the client during such exercises or activities.
• Reinforce safety precautions with the client and the SO especially during the
exercises.
• Remind the client about the importance of having adequate rest after having
exercise or after certain activities.
• Advise the client to avoid strenuous activities to avoid overexertion and fatigue.

T – Treatments

• Advise the client to stick on to the treatment regimen to attain optimal health
• Reinforce to then client the importance of complying with the home-treatment
regimen

H – Health Teachings

• Educate the client, as well as his SO about his condition to know the background
and how they can provide care
• Include in the teachings the definition of the condition, the diagnosis done, the
manifestations, the treatment and the possible complications
• Explain the importance of the SO’s assistance to a more foreseeable recovery of
the client
 • Clarify any concerns and questions the client or the SO’s may have

O – Outpatient Follow-up

• Advise the client and the SO to come back for a follow-up appointment
depending on what the client’s physician may advise
• Reinforce any previous health teachings when needed

D – Diet

• Encourage the client to adhere to a well-balanced meal

• Advise the SO to prepare foods that are low-fat and low-sodium