Hypertension 2° ASHD

7/28/2019 Hypertension 2 ASHD

1/22


2/22

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.


3/22

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


4/22

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


5/22

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


6/22

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


7/22

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.


8/22

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


9/22

Extremities Bounding pulse


10/22

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)


11/22

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


12/22

CBC

Hgb- 149 (normal)

Rbc4.69 (normal)

Hct0.44 (normal)

Mcv92.8 (high)

Mch- 31.8 (high) Platelet224 (normal)

Wbc6.2 (normal)


13/22

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


14/22


15/22

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.


16/22

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.


17/22

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.


18/22

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+.


19/22

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.


20/22

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.


21/22

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


22/22

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.

Documents

Hypertension 2° ASHD