Hypertension 2° ASHD

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    The case we have chosen is Hypertension 2 ASHD.

    Hypertension is one of the most commonworldwide diseases afflicting humans.

    Because of the associated morbidity and mortalityand the cost to society, hypertension is animportant public health challenge.

    We chose this case because most of our family

    members experience Hypertension.

    This case will help us further understand the saidcondition.

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    Hypertension (HTN) orhigh bloodpressure, sometimes arterialhypertension, is a chronic medicalcondition in which the blood pressure inthe arteries is elevated.

    This requires the heart to work harderthan normal to circulate blood throughthe blood vessels.

    Blood pressure involves twomeasurements, systolic and diastolic,which depend on whether the heartmuscle is contracting (systole) or

    relaxed (diastole) between beats. Normal blood pressure is at or below

    120/80 mmHg.

    High blood pressure is said to bepresent if it is persistently at or above140/90 mmHg

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    I. BIOGRAPHIC DATA

    Name: L.G.

    Gender: Male

    Provincial address:Camarines Sur

    City address:Balintawak, Q.C.

    Birthdate: November24, 1940

    Religion: RomanCatholic

    Civil status: Married

    Nationality: Filipino

    Occupation: Retiredaccountant

    Informant: Patient

    Reliability: 100%

    Educational attainment:College graduate

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    I. CHIEF COMPLAINT

    Elevated bloodpressure of 230/130 for 3hours

    II. HISTORY OF PRESENTILLNESS

    3 days PTA, the patientexperienced increasedblood pressure noted tobe 230/130. he selfmedicated withLosartan and BP wasdecreased.

    Few hours PTA patients

    BP rose to 230/100which prompted him forconsultation at USTHOPD hence admission.

    III. HISTORY OF PAST ILLNESS

    Past illness: 10 yearschronic hypertension

    Allergies: None Immunization: Complete

    Previous hospitalization:

    Elevated BP at USTH(March 20ll)

    Previous surgeries:Removal of cyst atMakati MedicalCenter(2001)

    Chronic diseases:

    Chronic hypertension

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    FAMILY HISTORY

    (+) Hypertension - paternal and maternal side

    (+) DM - paternal side

    (-) Asthma

    (-) Thyroid disorders

    IV. PERSONAL /SOCIAL

    Alcohol intake: 4-5 bottles per day for 50 years

    Smoking: 50 packyears Diet: Eats wide variety of foods especially fruits and

    vegetables

    OFI: More than 8 glasses of water per day

    Exercise: Swimming, Basketball, Tennis

    Sexual history: Sexually active

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    The patient is conscious, coherent and isnot in distress.

    He looks according to age and is calmand engaging. One can see that he iswell nourished and practices goodhygiene.

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    Body part assessed Actual finding Interpretation

    Skin Skin color is dark and

    even.Skin is smooth with fairskin turgor

    Normal

    Head Evenly distributed hair Normal

    Eyes Symmetrical eyelids.Pinkish conjunctivaWhite sclera

    Normal

    Mouth Lips dark and dryTongue at midline

    Gums and mucosadark

    Smoking

    Cardiovascular No palpitations Normal

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    Extremities Bounding pulse

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    Blood chemistry test Sodium- 135 (low)

    Potassium- 3.96 (normal)

    Urea nitrogen- 8.83 (low)

    Creatinine- 1.25 (high)

    Troponin- 0.02 (normal)

    Cholesterol- 190.79 (normal) Triglycerides- 114.64 (normal)

    HDL- direct 34.52 (normal)

    LDL- direct129.30 (normal)

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    Urinalysis Physical characteristics

    Color: light yellow

    Transparency: slightly turbid

    Chemical test

    Ph: 5

    Specific gravity: 1.01

    Albumin: (+) Sugar: (-)

    Leukocytes: (-)

    Erythrocytes: (+)

    Bilirubin: (-) Nitrite: (-)

    Ketones: (-)

    Urobilinogen: normal

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    CBC

    Hgb- 149 (normal)

    Rbc4.69 (normal)

    Hct0.44 (normal)

    Mcv92.8 (high)

    Mch- 31.8 (high) Platelet224 (normal)

    Wbc6.2 (normal)

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    Urinalysis- ordered to help assess kidney function Hematocrit- may be ordered as part of CBC to

    evaluate the ratio of fluid to solids in the blood Urea nitrogen and creatinine- to detect or monitor

    kidney dysfunction or to monitor the effect ofmedications on the kidney

    Potassium- may be ordered as part of electrolytepanel ; used to monitor and balance the bodyselectrolytes; some high BP can upset the balance by

    causing excessive sodium and potassium loss Lipid profile- may be ordered to evaluate levels of

    total cholesterol, HDL cholesterol, LDL cholesterol,and triglycerides

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    Medulla Oblongata; relaysmotor and sensory impulsesbetween other parts of thebrain and the spinal cord.

    Reticular formation (also inpons, midbrain, anddiencephalon) functions inconsciousness and arousal.Vital centers regulateheartbeat, breathing(together with pons) andblood vessel diameter.

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    Hypothalamus; controlsand intergrates activities ofthe autonomic nervoussystem and pituitary gland.

    Regulates emotional andbehavioral patterns andcircadian rhythms. Controlsbody temperature andregulates eating and

    drinking behavior. Helpsmaintain the waking stateand establishes patterns ofsleep. Produces thehormones oxytocin andantidiuretic hormone.

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    Baroreceptor, pressure-sensitive sensory receptors, arelocated in the aorta, internalcarotid arteries, and otherlarge arteries in the neck and

    chest. They send impulses tothe cardiovascular center inthe medulla oblongata tohelp regulate blood pressure.The two most importantbaroreceptor reflexes are the

    carotid sinus reflex and theaortic reflex.

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    Chemoreceptors, sensory receptors that monitor thechemical composition of blood, are located close to thebaroreceptors of the carotid sinus and the arch of the aortain small structures called carotid bodies and aortic bodies,

    respectively. These chemoreceptors detect changes in bloodlevel of O2, CO2, and H+.

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    Renin-Angiotensin-Aldosterone system.When blood volume falls or blood flowto the kidneys decreases,juxtaglomerular cells in the kidneyssecrete renin into the bloodstream. Insequence, renin and angiotensin

    converting enzyme (ACE) act on theirsubstrates to produce the activehormone angiotensin II, which raisesblood pressure in two ways. First,angiotensin II is a potentvasoconstrictor; it raises blood pressureby increasing systemic vascularresistance. Second, it stimulates

    secretion of aldosterone, whichincreases reabsorption of sodium ionsand water by the kidneys. The waterreabsorption increases total bloodvolume, which increases bloodpressure.

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    Antidiuretic hormone. ADHis produced by thehypothalamus and

    released from the posteriorpituitary in response todehydration or decreasedblood volume. Amongother actions, ADH causesvasoconstriction, which

    increases blood pressure.

    Atrial Natriuretic Peptide.Released by cells in theatria of the heart, ANP

    lowers blood pressure bycausing vasodilation andby promoting the loss ofsalt and water in the urine,which reduces bloodvolume.

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    Medications Take antihypertensive medications OD. Exercise

    Advise patient to do daily walking and other exercisethat can be tolerated by the patient.

    Treatment Encourage patient to comply with the prescribed

    antihypertensive drugs.

    Health teaching Encourage patient to control his diet

    Avoid eating fatty and salty foods Limit alcohol intake

    Increase fluid intake

    Avoid sedentary lifestyle

    OPD f ll

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    OPD follow-up

    Tell patient to seek consultation if symptomswill recur.

    DietLow sodium and high protein diet.

    SexualityMen are more prone to develop

    hypertension because of their lifestyle.