Manuel S.

Enverga University Foundation

College of Nursing And Allied Health Sciences

Case Presentation
Presented To:
Mrs. Dolores Maloles
Clinical Instructor

Presented By:
Group 11 BSN III-C
Causapin , Jiggle
Elmundo , Cristina Lu
Pesquisa , Jaymee O .
Reforma , Reynold
Zurbano , Ivy
 General Objectives
 The purpose of this study
is to gain additional
knowledge, develop related
nursing skills and apply the
right attitudes that student
nurses in rendering quality
nursing care to the patient
with Hypertensive
Arteriosclerotic Cardiovascular
Disease, it’s importance and
 Specific Objectives
 To understand condition of disease and
associate it with the patient through
the introduction of the case


 To know the nursing history, personal

data, health history and physical
assessment of the patient


 To illustrate the anatomy and

physiology and pathophysiology of the
affected organ.

 To discuss and determine manifestation


 To develop an effective skill on how to

manage care in patient with the
disease

 To formulate a drug study with regards
to the patients condition and correlate
lab results to its normal values.


 To provide the client a nursing care plan

and discharge plan to assure for
clients total wellness during her
hospitalization up to the time of her
hospital discharge .
  I. Introduction
A.Background of the Study


 HASCVD (Hypertensive
arteriosclerotic cardiovascular disease) is a
fancy way of saying "blocked arteries
secondary to cholesterol plaques and in the
setting of hypertension." It describes a
common clinical syndrome, where the walls
of coronary (heart) arteries are lined with
cholesterol plaques.

 The plaques have a tendency to
grow slowly over time and narrow the
arteries. Unfortunately, some of
these plaques can suddenly burst
open, blocking the artery completely.
Such blocked artery leads to blood
deprivation to the heart muscle, a
phenomenon we all know as a heart
attack.
 It’s the progressive hardening of
the arteries due to long standing
hypertension. In this case
cardiovascular arteries are hardened,
compromising blood flow to the heart
muscle and tissue. complications
include Angina Pectoris, MI (Heart
Attack) and Heart failure.
B. Rationale for choosing the case

The group decided to choose the case of

HASCVD (Hypertensive arteriosclerotic
cardiovascular disease) to make a
difference in the usual case presentations
where in diseases are presented. To give us
learning regarding the disease and to be
able to know the nursing care appropriate
for such case.
C. Significance of the Study

The significance of this study is

to gain and enhance knowledge, to
develop skills and to apply the right
attitudes of student nurses in
rendering and giving care to the
patient with, Hypertensive
Arteriosclerotic Cardiovascular Disease
it’s importance and implication. This
study will serve as guidelines in
assessing and providing proper nursing
care to pt. with the same problem or
disease.
 These are other significance of the study
•
that would support the above statement:


• Understand condition of HASCVD and

associate it with the patient
through the introduction of the
case.
•
• To know the Nursing history: Personal
data, Health history and physical
assessment of the patient.

• Illustrate the anatomy and
physiology and pathophysiology of
the affected body organ or
system.
•
• Apply effective skill on how to
manage proper care in patient
with
•
• Discuss and determine
manifestations and complications.
•
• Formulate a drug study of the drug’s
that is being used for the patient’s
treatment.
•
• Correlate the lab result to its normal
value.
•
• To formulate a nursing care plan and
discharge plan to serve as
guidelines for patient’s continuous
care during his hospitalization up
to the time of his hospital
discharge.
D. Scope of limitation of the study
The study would only focus on
Hypertensive Arteriosclerosis
Cardiovascular Disease, it’s background,
signs and symptoms and effects which is
indicative to the client’s health
condition and it’s underlying nursing
care relevant for the client within the
three- week duty at Mt. Carmel Diocesan
General Hospital.
 E. Conceptual and Nursing
Theory
 Theoretical Framework:
Dorothea Orem
Model Of Nursing


 Since the diagnosis of our

patient is Hypertensive
Arteriosclerotic Cardiovascular
Disease , we relate Dorothea Orem
theory of self care Model of Nursing.  

 It is particularly used in
rehabilitation and primary care
setting where the patient is
encouraged to be as independent as
possible. The Orem model is based
upon the philosophy that all
"patients wish to care for
themselves". They can recover more
quickly and holistically if they are
allowed to perform their own self
cares to the best of their ability.
  
Related Literature
Hypertensive Arteriosclerotic Cardiovascular
disease

A th e ro scle ro sis ( a lso kn o w n a s

A rte rio scle ro tic V a scu la r D ise a se o r
A S V D ) is th e co n d itio n in w h ich a n
a rte ry w a ll th icke n s a s th e re su lt o f a
b u ild -u p o f fa tty m a te ria ls su ch a s
ch o le ste ro l.
 It is a syndrome affecting
arterial blood vessels, a chronic
inflammatory response in the walls of
arteries, in large part due to the
accumulation of macrophage white blood
cells and promoted by Low density
lipoproteins (plasma proteins that
carry cholesterol and triglycerides)
without adequate removal of fats and
cholesterol from the macrophages by
functional high density lipoproteins (HDL),
(see apoA-1 Milano). It is commonly
referred to as a hardening or furring of the
arteries. It is caused by the formation of
multiple plaques within the arteries.
CAUSES
A th e ro scle ro sis d e ve lo p s fro m lo w -
d e n sity lip o p ro te in m o le cu le s ( LD L )
b e co m in g oxid ize d ( ld l- ox ) b y fre e
ra d ica ls, p a rticu la rly oxyg e n fre e
( ROS ). When oxidized LDL comes in
co n ta ct w ith a n a rte ry w a ll, a se rie s o f
re a ctio n s o ccu r to re p a ir th e d a m a g e
to th e a rte ry w a ll ca u se d b y oxid ize d
LD L .
 The LDL molecule is globular
shaped with a hollow care to carry
cholesterol throughout the body to
generate brain tissues, vitamin D,
and soon cholesterol can move in the
bloodstream only by being
transported by lipoprotein. The
body's immune system responds to
the damage to the artery wall caused
by oxidized LDL by sending
specialized white blood cells
(macrophages and T-lymphocytes) to
absorb the oxidized-LDL forming
specialized foam cells.
 Atherosclerosis typically begins
in early adolescence, and is usually
found in most major arteries, yet is
asymptomatic and not detected by
most diagnostic methods during life.
Atheroma in arm, or more often in
leg arteries, which produces
decreased blood flow is called
peripheral artery occlusive disease
(PAOD).
Physiologic factors that increase risk

Various anatomic, physiological &

behavioral risk factors for
atherosclerosis are known. These can be
divided into various categories:
congenital vs acquired, modifiable or
not, classical or non-classical. The
points labeled '+' in the following
list form the core components of
"metabolic syndrome".
Treatment

Some symptoms such as angina pectoris

can be treated. Non-pharmaceutical means
are usually the first method of treatment,
such as cessation of smoking and
practicing regular exercise. If these
methods do not work, medicines are usually
the next step in treating cardiovascular
diseases, and, with improvements, have
increasingly become the most effective
method over the long term. However, medicines
are criticized for their expense, patented
control and occasional undesired effects
 II. Clinical Summary
 A. General Data Profile
Name: Mrs. X
Address: Brgy. Market View 2
Calumpit St. Lucena, City
Birthday: December 12, 1937
Birth Place: Lucban, Quezon
Spouse Name: Rommel Abuan
Nationality: Filipino
Religion: Roman Catholic
Occupations: House Wife

Date of admission: January 19, 2010
Admitting Diagnosis: Hypertensive
 Arteriosclerotic
 Cardiovascular Disease
Admitting Physician: Dr. Ma. Delta A. Canela
 
B. Chief Complaint

 Prior to admission the patient

experienced dizziness and vertigo.
C. Nursing History
 

 History of present illness

  Prior to admission, last October
2008 after arriving from the school of
her granddaughter the patient felt
severe headache or vertigo, dizziness,
blurred vision and body malaise. She
is also pale and weak in appearance
as her son notice so they decided to
bring her at Mt. Carmel Diocese
General Hospital.

 By December 2009 the patient is
again admitted at MMG Hospital
Lucena, City because of the vehicular
accident so by means of that the
physician gave her treatment and
medication for her condition. After a
year she had been experience again
vertigo, dizziness, nervous and
palpitation the reason why she
admitted again at Mt. Carmel
Diocese General on last January 19,
2010 under the supervision of Dra.
 And she requested to undergo
for CBC, Heart Diagnostic Test, RBS,
and Urinalysis. After waiting the
result the physician instructed her to
have minimal exercise to prevent
dizziness she also gives maintenance
for her condition. Then after 3 days
of staying at the hospital her final
diagnosis was HASCVD or also known
as Hypertensive Arteriosclerotic
Cardiovascular Disease.
a.
b. Childhood Illness
 - Cough and cold, flu and measles
b. Immunizations

 - none
c. Allergies

 - Sea foods such as: shrimp and crab

d. Accidents

 - Vehicular Accident
e. Hospitalizations

 - Last October 2009 she admitted at Mt. Carmel Dioces

General hospital. After a year which is last December 2009 she
admitted at MMG hospital Lucena, City. And last January 19
2010 she admitted again at Mt. Carmel Dioces General Hospital
in the same reason.


  
 f. Medication used or currently taking
 - Metoprolol 50mg 1tab twice a day (8am-6pm) 
 - Amlodipine 10mg 1 tab once a day (8pm)
 - Telmisartan (Pritor) 80mg 1tab once a day (8am)
 - Betahistine (Serc) 16mg 1 tab thrice a day (8am-1pm-
6pm)
 - Atorvastatin (Lipitor) 80mg 1tab once a day at hours
of sleep (8pm) 
 g. Domestic Travel
 - The only and usual route of the patient is from Lucena
to Cavity.

•
D. Family History (genogram)
Grand mother unknown Grand mother unknown
Grand father Grand Father
unknown unknown

Father
unknown Mother unknown

Brother
Brother Sister Sister Brother Patient
80y/0
81y/0 70y/0 49y/0 29y/0 72y/0
cardiac
old aging Heart disease peptic ulcer murder
arrest
 E. Social History – Include Theories and
Growth and Development
PSYCHOSOCIAL THEORY ACCORDING TO ERIK

ERIKSON

STA G E AGE CEN TR A L IN D IC A T O R S IN D IC A T O R S

TA SK O F P O S IT IV E O F
R E S O L U T IO N N E G A T IV E
M a tu rity 6 5 to d e a th E g o In te g rity Older adults need RFailure
E S O Lat
U this
T IO N
Vs to look back on stage results in
D e sp a ir life and feel a regret,
sense of bitterness, and
fulfilment. despair.
Success at this
stage leads to
feeling of wisdom
 ACCORDING TO SIGMUND FREUD’S
THEORY ON PSYCHOSEXUAL
DEVELOPMENT

STA G E AGE CHARACTERISTIC IMPLICATION

S
Maturity 65 to death Energy is Encourage separation
directed toward from parents,
full sexual achievement of
maturity and independence, and
function and
development of decision makings.
skills needed to
cope with the
environment.
 F. Environment/Living Condition

The client lives in a village
where the environment is said to be
clean. They have a little garden in
their backyard where they grow
different kinds of flowers. Their way
of disposing garbage is collected by
the city garbage collector. The water
that they use for bathing,
dishwashing and laundry came from
metropolitan water district while they
buy the water that they drink from a
refilling station. There location is
G. Physical Assessment

P A R A M ETER NORM AL A CTU A L IN T E R P R E T A T I

S F IN D IN G S F IN D IN G S ON
General - Clean in -weak in -The patient’s
Appearance appearance and appearance appears weak
well groomed - Cooperative becauseof
- Cooperative -well groomed dizziness and
vertigo she felt

Skin -With good skin - with good skin

turgor turgor
- Slightly warm
to touch

Hair -Evenly -Evenly

distributed hair distributed
-Thick hair -black curly
hair
Nails -With good - With good
capillary refill of capillary refill of
1-2 seconds 1-2 seconds
-with pinkish nail -with pale nail
beds beds
-with clean and -with nail polish
short nails

Skull & Face -Mount uniform -Mount uniform

consistency absence consistency absence
of nodules and of nodules and
masses masses
-Rounded smooth -Rounded smooth
skull contour skull contour
-Symmetrical facial -Symmetrical facial
movement movement

Eyes -No eye discharge -No eye discharge Because of sleep

-With anicteric -with anicteric pattern disturbances
sclera sclera
-Eyebrows hair -Eyebrows hair
evenly evenly
distributed/skin distributed/skin
intact intact
-(+) blink reflex -with sunkenand
-With pinkish dark circle around
conjunctive the eye
Ears -Auricle color same -Auricle color same
as facial skin as facial skin
-Auricle are mobile -Auricle are mobile
firm and not tender firm and not tender
-Able to hear on -Able to hear on
both ears both ears

Mouth -Pinkish lips -dry lips

-Without missing -with missing teeth
teeth -with pale gums
-With pink gums -with slightly foul
-No foul odour odour
-With symmetrical -with symmetrical
contour contour

Musculosketal -symmetrical -symmetrical

( Upper & Lower -No atrophy -no atrophy
extremities -With full range of -with full range of
motion motion

Abdomen -No abdominal -no abdominal

distention distension
-Flat rounded -with soft and non
abdomen tender abdomen
-Symmetrical -symmetrical
contour contour
-No surgical -no surgical
incision incision
 H. Patterns of Functioning
Functional Before During Interpretation
Health Pattern Hospitalization Hospitalization
Health
  Self medication  Treatment Patient
Management responsible to
take medication
as maintenance
for her condition

Nutritional / Met


abolic 3 times a day 3 times a day The patient still

a. number of meals w/ good appetite w/ good appetite eats 3x each day
per day 8 glasses of 3-4 glasses of with good
b. appetite water water appetite but
c. glass of water w/ normal body Weak but in decreased fluid
per day built normal body built intake resulting
d. body built 5 ’ 7 ” 5’0’’ and 49 sometimes
e. height and dehydration and
weight weakness
Elimination


a. frequency of 3-5 times per day 2-3 times per day

  The frequency
urination Moderate Moderate
of his
b. amount of urine Once a day Once a day
urination and
per day Formed Formed
bowel decreased
c. frequency of Moderate scanty
but still with
bowel movement the same
d. consistency of amount . This
the feces maybe caused by
e. amount his decreased
defecated per day fluid intake
and compression
of bladder

Activity and


Exercise Walking This is due to

a. exercise Easy to get tired
his condition
b. fatigability Going to market

c. ADL everyday
Cognitive / Perceptual
a . orientation Oriented to
b . responsiveness time , place and
person
Responds

appropriately
to verbal and
physical
stimuli
Roles / Relationship

 

a. as a son With good With good

b. as a brother relationship to relationship to his
c. as a husband his parents and parents and he
d. as an employee and he provided provided financial
co-worker financial aid to aid to the family
the family With good

With good relationship to his

relationship to sisters and brothers
his sisters and With good

brothers relationship to his

With good husband
relationship to 

his wife
With good

relationship with
his co-worker and
manager
Self Have a high Have a high
Perception / Sel self self
f Concept worth / importance worth / importanc
Coping Stress He seeks advice to eHe seeks advice
his wife and to his son and
friends when he friends when he
has problems, has problems,
burdens and burdens and
stresses. He wants stresses. He wants
to talk about it to talk about it
right away. He also right away. He
trust God in also trust God in
everything he do. everything he do.

 Values / Belief He has awareness His awareness to



that God really God became

exist stronger than
Believe more in before
medical sciences
than such folk
beliefs when it
comes to health


 I. Course in the Ward



 Jan. 19, 2010,



 At 4:15pm admitted a 72 y/o female per wheelchair in

due to dizziness BP 180/100mmhg, with doctor’s order please
admit to room of choice under the service of Dr. Canela, secure
consent, with low salt low fat diet, v/s every 4hrs., request for
the following: CBC, RBS, Na, K, Crea and 12 lead ECG, IVF PNSS
1L @ 20gtts/min, medications of Captopril 25mg tab ½ tab
sublingual now, Metoprolol 50mg tab/ 1 tab bid, input and
output every shift, 2D echo study, in the morning FBS, Uric
Acid, Lipid profile, AST, ALT, Urinalysis with Micral test, start
medications: Amlodipine 10mg tab (Norvasc) 1tab OD every
pm, Telmisartan 80mg tab/ 1tab OD am. At 4:20pm given
Captopril @ ½ tab sublingual. At 4:30pm IVF of PNSS 1L
inserted at L metacarpal vein IV cannula g#22 done
aseptically, CBC, RBS, Na K, Crea forwarded, ECG done,
attending physician notified through text and brought to room
of choice. 
 January 20, 2010
 Received 72 year old female per stretcher
with chief complaint of dizziness with ongoing
IVF of PNSS 1L x 20gtts/min. With decrease
dizziness, positive headache, negative nausea,
negative angina, BP 140/90mmhg and advised
on low salt low fat diet. For ECG, 2D echo, FBS,
ALT and AST. With verbal order from Dr. Mendoza
to nurse on duty E. Capistrano. And instructed on
vestibular exercises. Seen and examined by Dra.
Canela at 9:00pm with new orders made. With
same IVF to follow: PNSS 1L x 20gtts/min, may
ambulate with assistance, start Atorvastatin
(Lipitor) 80mg tab ½ tab OD HS and if stable
allow billing in the morning.

January 21, 2010


 Received lying on bed without

contraption noted. With negative
headache, negative nausea, negative
angina. With orders made by AP home
meds include: Metoprolol 50mg tab 1 tab
bid #100, Telmisartan (pritor) 80mg tab
1tab OD am #60, Amlodipine (Norvasc)
19mg tab 1tab OD am #60, Betahistine
(Lipitor) 80mg tab ½ tab OD HS #60 and
follow-up check up on February 23, 2010
and instructed on vestibular exercises.
 



Component ResultNormal Interpretation Implication Nursing
J. Laboratory
RangeDiagnostic Exam Responsibilities

Glucose 89 mg/dl 74-106 mg/dl

Cholesterol 208 mg/dl 0-200 mg/dl The patient has Instruct the patient
a high level of to choose
cholesterol alternative fats.
Replace saturated
and trans fats in
your diet with
monounsaturated and
polyunsaturated fats.
Triglycerides 285 mg/dl 0-150 mg/dl The patient has Instruct the patient
a high level of to eat food with
triglycerides soluble fiver, as
part of low salt fat
diet, soluble fiber
can help lower total
blood cholesterol
Direct HDL 46 mg/dl 40-60 mg/dl

Uric Acid 4.5 mg/dl 2.5-6.2 mg/dl

Component Result Normal Interpretatio Implication Nursing
Range n Responsibiliti
es
AST 34 U/L

ALT 36 U/L

VLDL 57 mg/dl 0-35 mg/dl The patient has - increased Instruct the
a high level of risk of patient to limit
cardiovascular intake of
VLDL dietary
events cholesterol to
300 mg or less
than 200 mg.
LDL 105 mg/dl 0-150 mg/dl

CHOL/dHDL 4.53
 HEART DIAGNOSTIC TEST

DIMENSION PATIENT FUNCTION PATIENT

(ed) 4.2 (4.5-5.0) LVEPV

(es) 3.0 LVESV

RV (ed) 3.1 (2.2-3.5) Stoke Volume 44 ml

LA (es) 3.1 (3.0-3.5) C. O. 2.0 l/min

RA (es) 3.1 3.5 EF % 55.0 % (55-77.0)

Aorta 2.9 3.5 FS % 28.0 % (28-92.0)

PA 2.5 3 VCF (0.8-1.5)

IVS (ed) 1.1 (0.8-1.1) EPSS (< 195)

IIS (es) 1.3 Wall stress (S) ( < OOD )

LVP W (ed) 1.1 (0.8-1.1) Wall stress (D)

LVPW (es) 1.3 LVWMSI 1

MV ANNU LVTD 1.7

TEST RESULT NORMAL RESULT

Creatinine .8 mg/dl .5-1.0

Sodium 141. mnol/l 137.- 145

Potassium 4.2 mnol/l 3.5- 5.1

RBS RESULT

RESULT NORMAL VALUE

150 -100
 URINALYSIS

Color Light Yellow

Trans. SL. Turbid

Protein Neg.

Sugar Neg.

PH 7.0

Sp. Grav. 1.005

Microscopic

Puscells 1.3/hpf

RBC 0.2/hpf


 K. Impression/Diagnosis


 HASCVD (Hypertensive
Arteriosclerotic Cardiovascular
Disease), Hypertension, Essential
Stage 2 uncontrolled Dyslipidemia,
BPPV (Benign Paroxysmal Positional
Vertigo)
  

III. Clinical Discussion of the Disease


1. Anatomy and Physiology

 The heart is a hollow muscular organ
of a somewhat conical form; it lies between
the lungs in the middle mediastinum and is
enclosed in the pericardium. It is placed
obliquely in the chest behind the body of the
sternum and adjoining parts of the rib
cartilages, and projects farther into the left
than into the right half of the thoracic
cavity, so that about one-third of it is
situated on the right and two-thirds on the
left of the median plane.   
•
BLOOD FLOW THROUGH THE HEART
1. Deoxygenated blood returning from the body
enters the heart through the superior vena cava
and inferior vena cava.
2. Blood passes into the right atrium and right
ventricle
3. Right ventricle pushes the blood through the
pulmonary arteries
4. Blood passes through the lungs where it loses
carbon dioxide and picks up oxygen
5. This oxygenated blood returns to the heart via
the pulmonary veins
6. Blood enters the left atrium and left ventricle
7. The left ventricle pushes the blood out through
the main artery, the aorta
8. Blood travels to all parts of the body where it
ARTERIES: are vessels that take blood away
from the heart
VEINS: are vessels that bring blood towards the
heart
ATRIUM: smaller chamber of the heart through
which blood enters the heart
VENTRICLE: larger chamber of the heart which
pushes blood away from the heart
AORTA: major artery carrying blood away from
the left ventricle
VENA CAVA: main vein returning blood to the
right atrium
CORONARY ARTERIES: the first vessels to
branch from the aorta; they supply blood to
the heart muscle
 Predisposing Factors: Precipitating Factors:

•Gender •Lifestyle

•Age •Uncontroll
ed HN
•Diet

Hypertension Hyperlipidemia

↑Shearing force Fatty disposition into arterial wall

Damage of arterial endothelial layer

Inflammatory response & intramuscular

clotting
Atheromatous aorta Thrombus Formation
S: Sx
LVH Narrowing of the lumen
↑BP, dyspnea,
Embolic occlusion in myocardial artery
Angina, edema,

Dizziness, Disrupted brain cell metabolism S: Sx

swollen CAD
Chest pain,
Neck vein, Accumulation of H2O, Ca, NA Dyspnea,
Palpitations, dizziness,
mental unusual fatigue,
confusion ↑ ICP ECG changes,

dysrrhythmias
Localized acidosis and free radical
Formation

Cell injury

CVA
 Prognosis

If Treated If
untreated

Return of Coma
normal Cerebral
perfusion death
Decreased Loss of
Edema neural
feedback
Improved mechanism
function
Cessation of
physiologic
functions

Multi-organ
failure

DEATH
 Precipitating Factors:
Predisposing Factors: •Lifestyle
•Gender •Uncontroll
ed HN
•Age
•Diet high
cholesterol
& high fatty
acid

Hypertension Hyperlipidemia

↑Shearing force Fatty disposition into arterial wall

Damage of arterial endothelial layer

Inflammatory response & intramuscular

clotting
Atheromatous aorta Thrombus Formation
S: Sx
LVH Narrowing of the lumen
↑BP, dyspnea,
Embolic occlusion in myocardial artery
Angina, edema,

Dizziness, Disrupted brain cell metabolism

swollen

Neck vein, Accumulation of H2O, Ca, NA

Palpitations,
mental

confusion ↑ ICP

Localized acidosis and free radical

Formation

Cell injury

CVA
Drug
study
 PREPARATION REACTION CONSIDERATION

Metoprolol Hypertension 50 mg 1tab bid Block beta CNS: Always check pts
(Beta- receptors fatigue, apical pulse
blocker) which dizziness. rate bfore
decreases giving drug. If
cardiac CV: it’s slower than
output, hypotension 60bpm withhold
peripheral , drug and call AP
resistance bradycardia immediately
and cardiac
oxygen GI: nausea, Monitor bp
consumption diarrhea frequently.

RESPI: Instruct pt to
dyspnea take drus as
prescribed and
SKIN: rash with meals.
DRUG INDICATION DOSAGE & ACTION ADVERSE NURSING
PREPARATI REACTION CONSIDERATION
ON
Amlodipine Hypertension 10mg 1tab Inhibits CNS: headache, Monitor bp
(Norvasc) OD calcium ion fatigue. frequently during
Calcium influx Dizziness therapy because
channel across drug-induced
blocker cardiac and CV: vasodilation has
smooth palpitations, a gradual onset.
muscle edema
cells, Caution patient
dilates GI: abdominal to continue
coronary pain taking drug even
arteries and when she feels
decreases RESPI: dyspnea better.
blood
pressure SKIN: rash
demand.
DRUG INDICATION DOSAGE & ACTION ADVERSE NURSING
PREPARATI REACTION CONSIDERATION
ON
Telmisartan(Pr Hypertension 80mg 1tab Blocks CNS: Monitor patient for
itor) (Used alone OD vasoconstric- dizziness, hypotension after
AngiotensinII or with other ting and headache, starting drug. Place
receptor antihyper- aldosterone- fatigue pt supine if
antagonist tensives) secreting hypotension occurs
effect of CV: chest pain and give NSS if
angiotensin II needed.
by GI: nausea.
preventing it Diarrhea Tell pt if she feels
from binding dizzy or has low bp
to the GU: UTI on standing she
angiotensin I should lie down
receptor RESPI: cough and rise slowly
from lying to
Other: flu-like standing position.
symptoms
RUG INDICATION DOSAGE AND ACTION ADVERSE NURSING
PREPARATION REACTION CONSIDERATION

etahistine Peripheral 16mg 1tab OD May affect CNS: Advise patient

Serc) vertigo neural drowsiness, to avoid
pathways restlessnes hazardous
originatin s activities that
g in the CV: requires
labyrinth hypotension, alertness’
to inhibit palpitation
nausea and s Urge patient to
vomiting. EENT: dry report
nose and persistent or
throat serious adverse
GI: reactions
anorexia, promptly.
constipatio
n
GU: urine
retention
SKIN: rash
DRUG INDICATION DOSAGE & ACTION ADVERSE NURSING
PREPARATION REACTION CONSIDERATION

Atorvastati Reduce risk 80mg/tab 1tab Used to CNS: Patient should

n (Lipitor) of death from OD HS lower headache follow a diet
CV disease cholesterol restricted in
and CV and GI: abdominal saturated fats and
events in pts triglyceride pain and cholesterol during
at high risk (fat-like constipation therapy.
for coronary substances) RESPIRATOR
disease levels in the Y: upper Instruct patient to
blood. respiratory tract take drug in the
infection evening.

Tell patient to
inform if adverse
reaction occur
particularly muscle
aches and pain
PLAIN
NATURAL
SALINE
SOLUTION
IV . Nursing Process

A . Longterm Objectives
The study aims to find ways to enable the
patient to function to his optimum capacity and to
prevent complications through collaborative
management with the health team.
B. Prioritized List Nursing Problem
Problem Ranking Justification
Risk for injury 1 It focuses on actions
related to which are designed to
dizziness solve or minimize the
secondary to existing problem.
increased blood
pressure
Activity Intolerance 2 This should be given
r/t body malaise and priority because it
vertigo secondary to can lead to more
prolonged bed rest. complications if not
managed appropriately
Sleep pattern 3 Sleep pattern
disturbances related disturbance must be
to unfamiliar given priority because
environment secondary it is one of basic
to hospitalization need of patient’s well
being
 C. NCP
( based on the sequence of
prioritized problem )
Assessment Nursing Planning Nursing Rationale Evaluation
Diagnosis Intervention

Subject:
“ Hilong-hilo ako.” Risk for injury At the end of the Establish rapport. To gain trust and Goal partially met
as verbalized by related to nursing Safety measures cooperation as evidenced by
the patient. dizziness interventions rendered. To avoid further patient BP
Objective: secondary to patient’s BP and Promote injury. decrease from
BP= elevated blood PR will be conducive To provide 150/100mmHg to
180/100mmHg pressure. decrease to its environment comfort 140/90mmHg and
PR= 112bpm normal range. Promote rest and PR decrease from
Weakness noted sleep To conserve 112bpm to 77bpm
Irritable noted. Administer energy
To help reduce
antihypertensive
as doctors BP and PR.
prescribed
Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
S: “nanghihina ako Activity Intolerance At the end of nursing establish rapport to facilitate NPI. Patient verbalized
kasi lagi na lang r/t body malaise and interventions, the pt. place the client in a to prevent willingness to and
akong nakahiga” vertigo secondary to will verbalize comfortable position backaches or muscle was able to
as verbalized by the prolonged bed rest. willingness to and take and record vital aches. participate in
patient. demonstrate signs to note any activities.
O: participation in Determine patient's significant changes
Conscious and activities. perception of causes that may be brought
coherent of fatigue or activity about by the disease
ambulatory c intolerance. These may be

assistance Assess patient's level temporary or


afebrile (36.8 oC) of mobility. permanent, physical
c body malaise Assess nutritional or psychological.
c good capillary refill status. Assessment guides
Monitor patient's treatment.
in 2-3 secs.
c good skin turgor sleep pattern and This aids in defining

on low cholesterol, amount of sleep what patient is

low salt/fat diet achieved over past capable of, which is
c good appetite, few days. necessary before
consumed all foods setting realistic goals.
served. 
Assess emotional Depression over
response to change inability to
in physical perform required
status . activities can
  further aggravate
the activity
intolerance .
Encourage adequate
rest periods , Rest between
especially before activities
meals , other ADLs , provides time for
and ambulation . energy
  conservation and
recovery .
Refrain from  
performing Patients with
nonessential limited activity
procedures . tolerance need to
  prioritize tasks .
Assist with ADLs
as indicated ;
however , avoid Assisting the
doing for patient patient with ADLs
what he or she can allows for
do for self . conservation of
  energy . Caregivers
  need to balance
providing
assistance with
facilitating
progressive
Teach energy endurance that
conservation will ultimately
techniques . enhance the
patient's activity
tolerance and
self - esteem .
These reduce
oxygen
consumption ,
allowing more
prolonged
activity .
Assessment Nursing Diagnosis Planning Interventions Rationale Evaluation
S-“Hirap na hirap Sleep pattern At the end of the Discuss the reasons Although many Goal partially met as
akong makatulog.” As disturbances related to nursing interventions for differing believe that a person evidence by patient
verbalized by the unfamiliar the patient will report individual sleep needs 8hrs of sleep verbalized “nakatulog
patient. environment improvement in requirements, each night, no narin ako kahit
O-dark circles under secondary to sleep/rest pattern including age, activity scientific evidence papaano di gaya
eyes hospitalization level and other support this. kahapon wala talagang
increasing irritability possible factors. Individual sleep halos naitulog
Restlessness Institute measures to requirements vary
Frequent yawning promote relaxation: greatly. Generally, a
a. Maintain dark, quiet person who can relax
environment and rest easily
b. Ensure good room requires less sleep to
ventilation feel refreshed.
c. Closed the door, if Sleep is difficult
desired. without relaxation.
Teach the client sleep- The unfamiliar
promoting measures environment can
like hinder relaxation
attempting to sleep These practices may
only when feeling help to promote sleep.
sleepy A familiar ritual may
Assist with usual promote relaxation
routines as necessary, and sleep.
such as personal Regular exercise not
hygiene only increases
Explain the endurance and
importance of regular enhances the ability to
exercise in promoting tolerate psychological
good sleep stress but also
promotes relaxation.
 D. Discharge Plan (M.E.T.H.O.D.)


Medications:


• Metoprolol 50mg 1tab twice a day

(8am-6pm) 
•
• Amlodipine 10mg 1 tab once a day
(8pm)
•
• Telmisartan (Pritor) 80mg 1tab once a
day (8am)
• Betahistine (Serc) 16mg 1 tab thrice a
day (8am-1pm-6pm)
•
• Atorvastatin (Lipitor) 80mg 1tab once a
day at hours of sleep (8pm) 
•
• Advise patient to take the prescribed
medications continuously at home 
•
• Always check the expiration date of the
medicine before taking


•
Environment:
•
• Avoid crowded areas, especially
during cold and flu season.
• Avoid close contact with anyone who
is ill.
• Provide safety measure to promote
safe environment and individual
safety.
• Sanitary handling of food and water.
 
 Treatment:
• Eating a healthy diet, including the
DASH diet (eating more fruits,
vegetables, and low fat dairy
products, less saturated and total
fat).
• Reducing the amount of sodium in
your diet to 2,300 milligrams (about
1 teaspoon of salt) a day or less.
• Getting regular aerobic exercise (such
as brisk walking at least 30 minutes
a day, several days a week).
• Limiting alcohol to two drinks a day
for men, one drink a day for
women.
• In addition to lowering blood
pressure, these measures enhance
the effectiveness of high blood
pressure drugs.
• Angiotensin-converting enzyme
(ACE) inhibitors
• In addition to lowering blood
pressure, these measures enhance
the effectiveness of high blood
pressure drugs.
• In addition to lowering blood
pressure, these measures enhance
the effectiveness of high blood
pressure drugs.
•
• Angiotensin-converting enzyme
(ACE) inhibitors
•
• Angiotensin || receptor blockers (ARBs)
•
• Diuretics
•
• Beta-blockers


• Calcium channel blockers

•
Health Teachings
• Teach the patient to use a self-
monitoring blood pressure cuff and
to record the reading at least twice
a week.
• Tell the patient to take his blood
pressure at the same hour each
time, with out more than usually
activity preceding the
measurement.
• Tell the patient and family to keep a
record of drugs used in the past.
• To encourage compliance with
antihypertensive therapy, suggest
establishing a daily routine for taking
medication. Warn the patient that
uncontrolled hypertension may cause
stroke and heart attack. Tell him to
report any adverse reactions to
prescribed drugs. Advise him to avoid
high-sodium antacids and over-the-
counter cold and sinus medications
containing harmful vasoconstrictors.
• Help the patient examine and modify
his lifestyle behavior.
• Suggest stress-reduction groups,
dietary changes, and an exercise
program.
• Encourage a change in dietary
habits. Help the obese patient plan
a reducing diet.
• Tell to the patients to avoid high-
sodium foods, table salt, and foods
high in cholesterol and saturated
fat.
• Encourage a change in dietary
habits. Help the obese patient plan
a reducing diet.
• Tell to the patients to avoid high-
sodium foods, table salt, and foods
high in cholesterol and saturated
fat.
•
Out Patient Referral Check-Up


•
• A fte r d isch a rg e , a d vise p a tie n t to co m e
b a ck to sp e cifie d d a te sa id b y th e
p h ysicia n .

Diet
Ø reduction of sodium intake
Ø moderation of alcohol
Ø weight loss in the obese
Ø possibly increasing potassium
and calcium intake
Ø ingestion of a vegetarian diet or
fish oil supplements.
 Thank
you !