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Manuel S. Enverga University FoundationCollege of Nursing And Allied Health Sciences
Case PresentationPresented To:
Mrs. Dolores MalolesClinical Instructor
Presented By:Group 11 BSN III-C
Causapin , JiggleElmundo, Cristina Lu Pesquisa, Jaymee O.
Reforma, ReynoldZurbano, Ivy
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 implication.
General Objectives
Specific ObjectivesTo 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 and complications of the disease.
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. IntroductionA.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 OremModel 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
Atherosclerosis (also known as Arteriosclerotic Vascular Disease or ASVD) is the condition in which an artery wall thickens as the result of a build-up of fatty materials such as cholesterol.
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.
CAUSESAtherosclerosis develops from low-density
lipoprotein molecules (LDL) becoming oxidized (ldl-ox) by free radicals, particularly oxygen free (ROS). When oxidized LDL comes in contact with an artery wall, a series of reactions occur to repair the damage to the artery wall caused by oxidized LDL.
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 SummaryA. General Data ProfileName: 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. Canela.
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. Childhood Illness
- Cough and cold, flu and measles b. Immunizations
- nonec. Allergies
- Sea foods such as: shrimp and crabd. Accidents
- Vehicular Accidente. 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.
Grand fatherunknown
Grand fatherunknown
Grand Fatherunknown
Grand Fatherunknown
FatherunknownFather
unknown
Brother 80y/0
cardiac arrest
Brother 80y/0
cardiac arrest
Brother 81y/0
old aging
Brother 81y/0
old aging
Brother29y/0
murder
Brother29y/0
murder
Grand mother
unknown
Grand mother
unknown
Mother unknownMother
unknown
Grand mother
unknown
Grand mother
unknown
Patient72y/0
Patient72y/0
Sister49y/0peptic ulcer
Sister49y/0peptic ulcer
Sister70y/0Heart
disease
Sister70y/0Heart
disease
D. Family History (genogram)
E. Social History – Include Theories and Growth and Development
PSYCHOSOCIAL THEORY ACCORDING TO ERIK ERIKSON
STAGE AGE CENTRAL TASK INDICATORS OF POSITIVE
RESOLUTION
INDICATORS OF NEGATIVE
RESOLUTION
Maturity 65 to death Ego Integrity Vs
Despair
Older adults need to look back on life and feel a sense of fulfilment. Success at this stage leads to feeling of wisdom
Failure at this stage results in regret, bitterness, and despair.
ACCORDING TO SIGMUND FREUD’S THEORY ON PSYCHOSEXUAL DEVELOPMENT
STAGE AGE CHARACTERISTICS IMPLICATION
Maturity 65 to death Energy is directed toward full sexual maturity and function and development of skills needed to cope with the environment.
Encourage separation from parents, achievement of independence, and decision makings.
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 accessible to a hospital, school, church and mall.
G. Physical Assessment
PARAMETERS NORMAL FINDINGS ACTUAL FINDINGS
INTERPRETATION
General Appearance
- Clean in appearance and well groomed- Cooperative
-weak in appearance- Cooperative-well groomed
-The patient’s appears weak because of dizziness and vertigo she felt
Skin -With good skin turgor
- with good skin turgor- Slightly warm to touch
Hair
-Evenly distributed hair -Thick hair
-Evenly distributed-black curly hair
Nails -With good capillary refill of 1-2 seconds-with pinkish nail beds-with clean and short nails
- With good capillary refill of 1-2 seconds-with pale nail beds-with nail polish
Skull & Face -Mount uniform consistency absence of nodules and masses -Rounded smooth skull contour-Symmetrical facial movement
-Mount uniform consistency absence of nodules and masses-Rounded smooth skull contour-Symmetrical facial movement
Eyes -No eye discharge-With anicteric sclera-Eyebrows hair evenlydistributed/skin intact -(+) blink reflex -With pinkish conjunctive
-No eye discharge-with anicteric sclera-Eyebrows hair evenly distributed/skin intact-with sunkenand dark circle around the eye-(+) blink reflex-with slightly pale conjunctive
Because of sleep pattern disturbances
Ears -Auricle color same as facial skin-Auricle are mobile firm and not tender-Able to hear on both ears
-Auricle color same as facial skin-Auricle are mobile firm and not tender-Able to hear on both ears
Mouth -Pinkish lips-Without missing teeth-With pink gums-No foul odour-With symmetrical contour
-dry lips-with missing teeth-with pale gums-with slightly foul odour-with symmetrical contour
Musculosketal (Upper & Lower extremities
-symmetrical-No atrophy-With full range of motion
-symmetrical-no atrophy-with full range of motion
Abdomen -No abdominal distention-Flat rounded abdomen-Symmetrical contour-No surgical incision
-no abdominal distension-with soft and non tender abdomen-symmetrical contour-no surgical incision
H. Patterns of FunctioningFunctional Health
PatternBefore
HospitalizationDuring
HospitalizationInterpretation
Health Management
Self medication • Treatment Patient responsible to take medication as maintenance for her condition
Nutritional/Metabolica. number of meals per dayb. appetitec. glass of water per dayd. body builte. height and weight
3 times a day w/ good appetite 8 glasses of
water w/ normal body
built 5’7”
3 times a day w/ good appetite 3-4 glasses of
water Weak but in
normal body built
5’0’’ and 49
The patient still eats 3x each day with good appetite but decreased fluid intake resulting sometimes dehydration and weakness
Eliminationa. frequency of urinationb. amount of urine per dayc. frequency of bowel movementd. consistency of the fecese. amount defecated per day
3-5 times per day
Moderate Once a day Formed Moderate
2-3 times per day
Moderate Once a day Formed scanty
The frequency of his urination and bowel decreased but still with the same amount. This maybe caused by his decreased fluid intake and compression of bladder
Activity and Exercisea. exerciseb. fatigabilityc. ADL
Walking Easy to get tired Going to market
everyday
This is due to his condition
Cognitive/Perceptuala. orientationb. responsiveness
Oriented to time, place and personResponds appropriately to verbal and physical stimuli
Roles/Relationship
a. as a sonb. as a brotherc. as a husbandd. as an employee and co-
worker
With good relationship to his parents and he provided financial aid to the familyWith good relationship to his sisters and brothersWith good relationship to his wifeWith good relationship with his co-worker and manager
With good relationship to his parents and he provided financial aid to the familyWith good relationship to his sisters and brothersWith good relationship to his husband
Self Perception/Self Concept
Have a high self worth/importance
Have a high self worth/importance
Coping Stress He seeks advice to his wife and
friends when he has problems, burdens and stresses. He wants to talk about it right away. He also trust God in everything he do.
He seeks advice to his son and friends when he has problems, burdens and stresses. He wants to talk about it right away. He also trust God in everything he do.
Values/Belief He has awareness that God really exist
Believe more in medical sciences than such folk beliefs when it comes to health
His awareness to God became stronger than before
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, 2010Received 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.
J. Laboratory Diagnostic Exam
Component Result Normal Range
Interpretation Implication Nursing Responsibilities
Glucose 89 mg/dl 74-106 mg/dl
Cholesterol 208 mg/dl 0-200 mg/dl The patient has a high level of cholesterol
Instruct the patient to choose 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 a high level of triglycerides
Instruct the patient to eat food with 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 Range
Interpretation Implication Nursing Responsibilities
AST 34 U/L
ALT 36 U/L
VLDL 57 mg/dl 0-35 mg/dl The patient has a high level of VLDL
- increased risk of cardiovascular events
Instruct the patient to limit intake of dietary cholesterol to 300 mg or less than 200 mg.
LDL 105 mg/dl 0-150 mg/dl
CHOL/dHDL
4.53
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
HEART DIAGNOSTIC TEST
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
RESULT NORMAL VALUE
150 -100
RBS RESULT
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
URINALYSIS
K. Impression/Diagnosis
HASCVD (Hypertensive Arteriosclerotic Cardiovascular Disease), Hypertension, Essential Stage 2 uncontrolled Dyslipidemia, BPPV (Benign Paroxysmal Positional Vertigo)
III. Clinical Discussion of the Disease1.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.
Size. The heart, in the adult, measures about
12 cm. in length, 8 to 9 cm. in breadth at the broadest part, and 6 cm. in thickness. Its weight, in the male, varies from 280 to 340 grams; in the female, from 230 to 280 grams. The heart continues to increase in weight and size up to an advanced period of life; this increase is more marked in men than in women.
Component Parts.
The heart is subdivided by septa into right and left halves, and a constriction subdivides each half of the organ into two cavities, the upper cavity being called the atrium, the lower the ventricle. The heart therefore consists of four chambers, right and left atria, and right and left ventricles.
The division of the heart into four cavities is indicated on its surface by grooves. The atria are separated from the ventricles by the coronary sulcus (auriculoventricular groove); this contains the trunks of the nutrient vessels of the heart, and is deficient in front, where it is crossed by the root of the pulmonary artery. The interatrial groove, separating the two atria, is scarcely marked on the posterior surface, while anteriorly it is hidden by the pulmonary artery and aorta.
The ventricles are separated by two grooves, one of which, the anterior longitudinal sulcus, is situated on the sternocostal surface of the heart, close to its left margin, the other posterior longitudinal sulcus, on the diaphragmatic surface near the right margin; these grooves extend from the base of the ventricular portion to a notch, the incisura apicis cordis, on the acute margin of the heart just to the right of the apex.
BLOOD FLOW THROUGH THE HEART1. 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 ventricle3. Right ventricle pushes the blood through the pulmonary
arteries4. Blood passes through the lungs where it loses carbon dioxide
and picks up oxygen5. This oxygenated blood returns to the heart via the pulmonary
veins6. Blood enters the left atrium and left ventricle7. The left ventricle pushes the blood out through the main
artery, the aorta8. Blood travels to all parts of the body where it delivers oxygen
and picks up carbon dioxide
The CORONARY ARTERIES branch from the aorta as soon as it emerges from the heart (please see diagram of the heart at left). They deliver oxygenated blood the heart muscle. Coronary artery disease (or coronary heart disease) involves the buildup of deposits in these crucial vessels. This reduces and sometimes completely blocks the flow of blood resulting in a heart attack .
ARTERIES: are vessels that take blood away from the heartVEINS: are vessels that bring blood towards the heartATRIUM: smaller chamber of the heart through which
blood enters the heartVENTRICLE: larger chamber of the heart which pushes
blood away from the heartAORTA: major artery carrying blood away from the left
ventricleVENA CAVA: main vein returning blood to the right atriumCORONARY ARTERIES: the first vessels to branch from the
aorta; they supply blood to the heart muscle
Predisposing Factors:
· Gender
· Age
Precipitating Factors:
· Lifestyle
· Uncontrolled HN
· Diet
Hypertension Hyperlipidemia
↑Shearing force
Damage of arterial endothelial layer
Fatty disposition into arterial wall
Inflammatory response & intramuscular clotting
Thrombus FormationAtheromatous aorta
S: Sx
↑BP, dyspnea,
Angina, edema,
Dizziness, swollen
Neck vein,
Palpitations, mental
confusion
LVH Narrowing of the lumenEmbolic occlusion in myocardial artery
Disrupted brain cell metabolism
Accumulation of H2O, Ca, NA
↑ ICP
Localized acidosis and free radical Formation
Cell injury
CVA
CADS: Sx
Chest pain,
Dyspnea, dizziness, unusual fatigue,
ECG changes,
dysrrhythmias
Prognosis
Coma
Cerebral death
Loss of neural feedback
mechanism
Cessation of physiologic functions
Multi-organ failure
DEATH
Return of normal
perfusion
Decreased Edema
Improved function
If Treated If untreated
Predisposing Factors:
· Gender
· Age
Precipitating Factors:
· Lifestyle
· Uncontrolled HN
· Diet high cholesterol & high fatty acid
Hypertension Hyperlipidemia
↑Shearing force
Damage of arterial endothelial layer
Fatty disposition into arterial wall
Inflammatory response & intramuscular clotting
Thrombus FormationAtheromatous aorta
S: Sx
↑BP, dyspnea,
Angina, edema,
Dizziness, swollen
Neck vein,
Palpitations, mental
confusion
LVH Narrowing of the lumenEmbolic occlusion in myocardial artery
Disrupted brain cell metabolism
Accumulation of H2O, Ca, NA
↑ ICP
Localized acidosis and free radical Formation
Cell injury
CVA
Drug study
DRUG INDICATION DOSAGE & PREPARATION
ACTION ADVERSE REACTION
NURSING CONSIDERATION
Metoprolol (Beta-blocker)
Hypertension 50 mg 1tab bid Block beta receptors which decreases cardiac output, peripheral resistance and cardiac oxygen consumption
CNS: fatigue, dizziness.
CV: hypotension , bradycardia
GI: nausea, diarrhea
RESPI: dyspnea
SKIN: rash
Always check pts apical pulse rate bfore giving drug. If it’s slower than 60bpm withhold drug and call AP immediately
Monitor bp frequently.
Instruct pt to take drus as prescribed and with meals.
DRUG INDICATION DOSAGE & PREPARATION
ACTION ADVERSE REACTION
NURSING CONSIDERATION
Amlodipine (Norvasc) Calcium channel blocker
Hypertension 10mg 1tab OD
Inhibits calcium ion influx across cardiac and smooth muscle cells, dilates coronary arteries and decreases blood pressure demand.
CNS: headache, fatigue. Dizziness
CV: palpitations, edema
GI: abdominal pain
RESPI: dyspnea
SKIN: rash
Monitor bp frequently during therapy because drug-induced vasodilation has a gradual onset.
Caution patient to continue taking drug even when she feels better.
DRUG INDICATION DOSAGE & PREPARATION
ACTION ADVERSE REACTION
NURSING CONSIDERATION
Telmisartan(Pritor) AngiotensinII receptor antagonist
Hypertension (Used alone or with other antihyper-tensives)
80mg 1tab OD
Blocks vasoconstric-ting and aldosterone-secreting effect of angiotensin II by preventing it from binding to the angiotensin I receptor
CNS: dizziness, headache, fatigue
CV: chest pain
GI: nausea. Diarrhea
GU: UTI
RESPI: cough
Other: flu-like symptoms
Monitor patient for hypotension after starting drug. Place pt supine if hypotension occurs and give NSS if needed.
Tell pt if she feels dizzy or has low bp on standing she should lie down and rise slowly from lying to standing position.
DRUG INDICATION DOSAGE AND PREPARATION
ACTION ADVERSE REACTION
NURSING CONSIDERATION
Betahistine (Serc)
Peripheral vertigo
16mg 1tab OD May affect neural pathways originating in the labyrinth to inhibit nausea and vomiting.
CNS: drowsiness, restlessnessCV: hypotension, palpitationsEENT: dry nose and throatGI: anorexia, constipationGU: urine retentionSKIN: rash
Advise patient to avoid hazardous activities that requires alertness’
Urge patient to report persistent or serious adverse reactions promptly.
DRUG INDICATION DOSAGE & PREPARATION
ACTION ADVERSE REACTION
NURSING CONSIDERATION
Atorvastatin (Lipitor)
Reduce risk of death from CV disease and CV events in pts at high risk for coronary disease
80mg/tab 1tab OD HS
Used to lower cholesterol and triglyceride (fat-like substances) levels in the blood.
CNS: headache
GI: abdominal pain and constipationRESPIRATORY: upper respiratory tract infection
Patient should follow a diet restricted in saturated fats and cholesterol during therapy.
Instruct patient to take drug in the 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.
Risk for injury related to dizziness secondary to increased blood pressure
1 It focuses on actions which are designed to solve or minimize the existing problem.
Activity Intolerance r/t body malaise and vertigo secondary to prolonged bed rest.
2 This should be given priority because it can lead to more complications if not managed appropriately
Sleep pattern disturbances related to unfamiliar environment secondary to hospitalization
3 Sleep pattern disturbance must be given priority because it is one of basic need of patient’s well being
B. Prioritized List Nursing ProblemProblem Ranking Justification
C. NCP (based on the sequence of prioritized problem)
Assessment Nursing Diagnosis
Planning Nursing Intervention
Rationale Evaluation
Subject:“ Hilong-hilo ako.” as verbalized by the patient.Objective:o BP=
180/100mmHg
o PR= 112bpmo Weakness
notedo Irritable
noted.
Risk for injury related to dizziness secondary to elevated blood pressure.
At the end of the nursing interventions patient’s BP and PR will be decrease to its normal range.
o Establish rapport.
o Safety measures rendered.
o Promote conducive environment
o Promote rest and sleep
o Administer antihypertensive as doctors prescribed
o To gain trust and cooperation
o To avoid further injury.
o To provide comfort
o To conserve
energyo To help
reduce BP and PR.
Goal partially met as evidenced by patient BP decrease from 150/100mmHg to 140/90mmHg and PR decrease from 112bpm to 77bpm
Assessment Nursing Diagnosis
Planning Interventions Rationale Evaluation
S: “nanghihina ako kasi lagi na lang akong nakahiga”as verbalized by the patient.O:o Conscious
and coherento ambulatory c
assistanceo afebrile (36.8
oC)o c body
malaiseo c good
capillary refill in 2-3 secs.
o c good skin turgor
o on low cholesterol, low salt/fat diet
o c good appetite, consumed all foods served.
Activity Intolerance r/t body malaise and vertigo secondary to
prolonged bed rest.
At the end of nursing
interventions, the pt. will verbalize
willingness to and demonstrate participation in
activities.
o establish rapport
o place the client in a comfortable position
o take and record vital signs
o Determine patient's perception of causes of fatigue or activity intolerance.
o Assess patient's level of mobility.
o Assess nutritional status.
o Monitor patient's sleep pattern and amount of sleep achieved over past few days.
o to facilitate NPI.
o to prevent backaches or muscle aches.
o to note any significant changes that may be brought about by the disease
o These may be temporary or permanent, physical or psychological. Assessment guides treatment.
o This aids in defining what patient is capable of, which is necessary before setting realistic goals.
Patient verbalized
willingness to and was able to
participate in activities.
Assess emotional response to change in physical status.
Encourage adequate rest periods, especially before meals, other ADLs, and ambulation.
Refrain from performing nonessential procedures. Assist with ADLs as indicated; however, avoid doing for patient what he or she can do for self.
Teach energy conservation techniques.
Depression over inability to perform required activities can further aggravate the activity intolerance.
Rest between activities provides time for energy conservation and recovery. Patients with limited activity tolerance need to prioritize tasks.
Assisting the patient with ADLs allows for conservation of energy. Caregivers need to balance providing assistance with facilitating progressive endurance that will ultimately 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 akong makatulog.” As verbalized by the patient.O-dark circles under eyesincreasing irritabilityRestlessnessFrequent yawning
Sleep pattern disturbances related to unfamiliar environment secondary to hospitalization
At the end of the nursing interventions the patient will report improvement in sleep/rest pattern
Discuss the reasons for differing individual sleep requirements, including age, activity level and other possible factors.Institute measures to promote relaxation:a. Maintain dark, quiet environmentb. Ensure good room ventilationc. Closed the door, if desired.Teach the client sleep-promoting measures likeattempting to sleep only when feeling sleepyAssist with usual routines as necessary, such as personal hygieneExplain the importance of regular exercise in promoting good sleep
Although many believe that a person needs 8hrs of sleep each night, no scientific evidence support this. Individual sleep requirements vary greatly. Generally, a person who can relax and rest easily requires less sleep to feel refreshed.Sleep is difficult without relaxation. The unfamiliar environment can hinder relaxationThese practices may help to promote sleep.A familiar ritual may promote relaxation and sleep.Regular exercise not only increases endurance and enhances the ability to tolerate psychological stress but also promotes relaxation.
Goal partially met as evidence by patient verbalized “nakatulog narin ako kahit papaano di gaya kahapon wala talagang halos naitulog
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
• After discharge, advise patient to come back to specified date said by the physician.
Diet
reduction of sodium intake moderation of alcohol weight loss in the obese possibly increasing potassium and
calcium intake ingestion of a vegetarian diet or fish oil
supplements.
Thank you!