Introduction

Objectives

Health History

Discharge Plan

Drug Study

Anatomy and Physiology

NCP 1

NCP 2

Health Teaching Plan

Pathophysiology

HTP Content

The heart is a muscular organ that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions. The vertebrate heart is composed of cardiac muscle, which is an involuntary striated muscle tissue found only within this organ. The average human heart, beating at 80 beats per minute, will beat approximately 2.5 billion times during an average 66 year lifespan, and weighs approximately 250 to 300 grams (9 to 11 oz) in females and 300 to 350 grams (11 to 12 oz) in males. Blood pressure is the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries, which carry the blood throughout the body. Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. With every heart beat, the heart pumps blood through the arteries to the rest of the body. If the pressure is too high, the heart has to work harder to pump, and this could lead to organ damage and several illnesses. Hypertension may be classified as essential or secondary. Essential hypertension or primary hypertension is the term for high blood pressure with unknown cause. It accounts for about 95% of cases. Secondary hypertension is the term for high blood pressure with a known direct cause, such as kidney disease, tumors and blood vessel abnormalities that can usually be corrected. There are a lot of factors that may cause hypertension. Although doctors don't know what causes hypertension most of the time, they do know a few factors that can worsen hypertension and these factors are: Smoking, Obesity and being overweight, Stress, too much Alcohol, lack of physical activity, too much salt in the diet, older age, genetics, family history of high blood pressure and chronic kidney disease.

High Blood Pressure can be treated by Lifestyle Changes and these includes: losing weight if you are overweight or obese, quitting smoking, eating a healthy diet, including the DASH diet (Eating more fruits, vegetables, and low-fat dairy foods, cutting back on foods that are high in saturated fat, cholesterol, and total fat, Eating more whole grain products, fish, poultry, and nuts, eating less red meat and sweets, eating foods that are rich in magnesium, potassium, and calcium.) and limiting alcohol to two drinks a day for men, one drink a day for women. We can also use drugs in treating hypertension, and these may drugs include: diuretics, beta-blockers, calcium channel blockers, etc. One of the most dangerous aspects of hypertension is that you may not know that you have it. There are generally no symptoms of high blood pressure, so you usually don't feel it. The only way to find out if you have high blood pressure is to get your blood pressure checked on a regular basis. If your blood pressure is extremely high, there may be certain symptoms to look out for, including: severe headache, fatigue or confusion, vision problems, chest pain, difficulty breathing, irregular heartbeat, blood in the urine, pounding in your chest, neck, or ears. Untreated hypertension can lead to serious diseases, including stroke, heart disease, kidney failure and eye problems. According to the Department of Health, hypertension is the fifth leading cause of morbidity in the Philippines on the year 2005 with a number of 382,662 and a rate of 448.8

After 1 hour of having case study presentation, BSN-3 Group 40 students will be able to: 1. Formulate discharge plan for the patient. 2. Discuss about Pathophysiology of increased blood pressure (hypertension). 3. Come up with the appropriate intervention for the client 4. Study the drugs being taken by the patient. 5. Review the patient s health status.

Blood has three main functions: Transport Blood transports the following substances: Gases, namely oxygen (O2) and carbon dioxide (CO2), between the lungs and rest of the body Nutrients from the digestive tract and storage sites to the rest of the body Waste products to be detoxified or removed by the liver and kidneys Hormones from the glands in which they are produced to their target cells Heat to the skin so as to help regulate body temperature Protection Blood has several roles in inflammation: Leukocytes, or white blood cells, destroy invading microorganisms and cancer cells Antibodies and other proteins destroy pathogenic substances Platelet factors initiate blood clotting and help minimize blood loss Regulation Blood helps regulate: pH by interacting with acids and bases Water balance by transferring water to and from tissues

Arteries are muscular blood vessels that carry oxygenated blood away from the heart (except the pulmonary and umbilical arteries). Arteries carry oxygen-rich blood at high pressure, so they are tough on the outside and smooth on the inside. The arteries have three layers and the smoothness of the inner layer enables blood to flow easily with no obstacles. Veins are blood vessel channels that carry waste-rich blood back to the lungs and heart. Veins carry blood at a lower pressure than the arteries, so they are not as tough as the arteries. They have three layers, which are thinner and contain less tissue than those in the arteries. The veins have valves inside them, which help ensure the blood flows in one direction through the veins and that the blood flows against the force of gravity. Capillaries are very thin, fragile blood vessels that receive oxygen-rich blood from arteries, exchange oxygen and carbon dioxide and then deliver the waste-rich blood to the veins. Capillaries are only one epithelial cell thick and blood can only flow through them in a single file. The red blood cells inside the capillary release their oxygen, which passes through the wall and into the surrounding tissue. The tissue releases its waste products, e.g. carbon dioxide, which pass through the wall and into the red blood cells. The exchange occurs and the waste blood is carried back to the heart and lungs through the veins.

The Circulation of Blood The human circulatory system is really a two-part system whose purpose is to bring oxygen-bearing blood to all the tissues of the body. When the heart contracts it pushes the blood out into two major loops or cycles. In the systemic loop, the blood circulates into the body s systems, bringing oxygen to all its organs, structures and tissues and collecting carbon dioxide waste. In the pulmonary loop, the blood circulates to and from the lungs, to release the carbon dioxide and pick up new oxygen. The systemic cycle is controlled by the left side of the heart, the pulmonary cycle by the right side of the heart. Let s look at what happens during each cycle:

Your heart is located under the ribcage in the center of your chest between your right and left lungs. Its muscular walls beat, or contract, pumping blood continuously to all parts of your body. The size of your heart can vary depending on your age, size, and the condition of your heart. A normal, healthy, adult heart most often is the size of an average clenched adult fist. Some diseases of the heart can cause it to become larger. The Septum The right and left sides of your heart are divided by an internal wall of tissue called the septum. The area of the septum that divides the atria (the two upper chambers of your heart) is called the atrial or interatrial septum. The area of the septum that divides the ventricles (the two lower chambers of your heart) is called the ventricular or interventricular septum. Heart Chambers The picture shows the inside of your heart and how it's divided into four chambers. The two upper chambers of your heart are called atria. The atria receive and collect blood. The two lower chambers of your heart are called ventricles. The ventricles pump blood out of your heart into the circulatory system to other parts of your body. Heart Valves The picture shows your heart's four valves. Shown counterclockwise in the picture, the valves include the aortic (ay-OR-tik) valve, the tricuspid (tri-CUSS-pid) valve, the pulmonary valve, and the mitral (MI-trul) valve.

The systemic loop begins when the oxygen-rich blood coming from the lungs enters the upper left chamber of the heart, the left atrium. As the chamber fills, it presses open the mitral valve and the blood flows down into the left ventricle. When the ventricles contract during a heartbeat, the blood on the left side is forced into the aorta. This largest artery of the body is an inch wide. The blood leaving the aorta brings oxygen to all the body s cells through the network of ever smaller arteries and capillaries. The used blood from the body returns to the heart through the network of veins. All of the blood from the body is eventually collected into the two largest veins: the superior vena cava, which receives blood from the upper body, and the inferior vena cava, which receives blood from the lower body region. Both venae cavae empty the blood into the right atrium of the heart. From here the blood begins its journey through the pulmonary cycle. From the right atrium the blood descends into the right ventricle through the tricuspid valve. When the ventricle contracts, the blood is pushed into the pulmonary artery that branches into two main parts: one going to the left lung, one to the right lung. The fresh, oxygen-rich blood returns to the left atrium of the heart through the pulmonary veins. Although the circulatory system is made up of two cycles, both happen at the same time. The contraction of the heart muscle starts in the two atria, which push the blood into the ventricles. Then the walls of the ventricles squeeze together and force the blood out into the arteries: the aorta to the body and the pulmonary artery to the lungs. Afterwards, the heart muscle relaxes, allowing blood to flow in from the veins and fill the atria again. In healthy people the normal (resting) heart rate is about 72 beats per minute, but it can go much higher during strenuous exercise. Scientists have estimated that it takes about 30 seconds for a given portion of the blood to complete the entire cycle: from lungs to heart to body, back to the heart and out to the lungs.

Generic Name: Furosemide Brand Name: (Lasix) Classification: Antihypertensive Diuretic Mechanism of Action: Inhibits sodium and water reabsorption in the loop of Henle and increases urine formation. As the body s plasma volume decreases, aldosterone production increase, which promotes sodium reabsorption and the loss of potassium and hydrogen ions. Furosemide also increases the excretion of calcium, magnesium, bicarbonate, ammonium, and phosphate. Reducing intracellular and extracellular fluid volume, the drug reduces blood pressure and decreases cardiac output. Over time, cardiac output returns to normal. Contraindication: Anuria unresponsive to furosemide; hypersensitivity to furosemide, sulfonamides, or their components. Indications, Route And Dosage: Oral Lasix may be used in adults for the treatment of hypertension alone or in combination with other antihypertensive agents. Actual dose: 40 mg, ampule IVTT b.i.d Side Effects: CNS: dizziness, fever, headache, paresthesia, restlessness, vertigo, weakness CV: orthostatic hypotension, shock, thromboembolism. EENT: blurred vision, ototoxicity, stomatitis, tinnitus, transient hearing loss (rapid I.V injection) yellow vision ENDO: hyperglycemia GI: abdominal cramps, anorexia, constipation, diarrhea, nausea, vomiting GU: bladder spasms, glycosuria HEME: agranulocytosis (rare), aneia, aplastic anemia (rare), azotemia, hemolytic anemia, leucopenia. MS: muscle spasms SKIN: exfoliative dermatitiss, jaundice, photosensitivity, pruritus, rash, urticaria OTHER: allergic reaction (interstitial, nephritis, necrotizing vasculitis, systemic vasculitis), dehydration. Nursing Responsibilities: 1.) Monitor blood pressure and hepatic and renal function as well as BUN, blood glucose, and serum creatinine, electrolyte, and uric acid levels, appropriate. 2.) Be aware that elderly patients are more susceptible to hypotensive and electrolyte-altering effects and thus are greater risk. 3.) Prepare drug for infusion with NS, LR, or D5W. 4.) Monitor patient s heart rate and v/s closely.

Generic Name: Hydralazine Hydrochloride Brand Name: Apresoline Classification: Antihypertensive Vasodilator (peripheral) Mechanism of Action: Acts directly on vascular smooth muscle to cause vasodilation, primarily arteriolar, decreasing peripheral resistance, maintains or increases renal and cerebral blood flow. Contraindication: Contraindicated with hypersensitivity to hydralazine tartrazine, CAD, mitral valvular rheumatic heart disease. Use cautiously with CVAs, increased intracranial pressure (drug-induced BP decrease increases risk of cerebral ischemia), severe hypertension with uremia advanced renal damage, slow acetylators (higher plasma levels maybe achieved, lower dosage maybe adequate), lactation, pregnancy, pulmonary hypertension. Indications,Route And Dosage: To manage essential hypertension alone or with other antihypertensives Actual dose: 10mg/day P.O b.i.d. Side Effects: CNS: Headache, peripheral neuritis, dizziness, tremors, disorientation or anxiety CV: Palpitations, tachycardia, angina pectoris, hypotension, paradoxical pressor response, orthostatic hypertension GI: Anorexia, nausea, vomiting, diarrhea, constipation, paralyticileus Gu: Difficult micturition, impotence Hematologic: Blood dyscrasions Hypersensitivity: Rash, urticaria, puritus, fever, chills, arthralgia, eosinophilia, rarely: hepatitis, obstructive jaundice Nursing Responsibilities: 1.) Monitor CBC, lupus erythematosus cell preparation and ANA titer before therapy and periodically as appropriate during long term treatment. 2.) Give tablets with food to increase bioavailability. 3.)Monitor blood pressure and PR regularly and weigh patient daily during therapy. 4.) Warning: Expect to discontinue drugs immediately if patient expertences lupus like symptoms, such as arthralgia, fever, myalgia, pharyngitis. 5.) Expect prescribes to withdraw drug gradually to avoid a rapid increase in blood pressure. 6.) Expect to treat peripheral neuritis pyridoxine. 7.)Patient Teaching Instruct patient to notify immediately prescribes about the fever, muscle and joint ashes and sore throat.

Generic Name: Nifedipine Brand Name: -Procrdia Classification: Antihypertensive Mechanism of Action: May slow movement of calcium into myocardial and vascular smooth-muscle cells by deforming calcium channels in cell membranes, inhibiting ion-controlled gating mechanisms & disrupting calcium release from sacroplasmic reticulum. Decreasing intracellular calcium level inhibits smoothmuscle cell contraction & dilates arteries which decreases myocardial oxygen demand, peripheral resistance, blood pressure, and afterload. Contraindication: Hypersensitivity to a calcium channel blocker, 2nd or 3rd-degree AV block without artificial pacemaker sick sinus syndrome Indications, Route And Dosage: To manage hypertension Actual Dose: 1 tab per PO q.i.d Side Effects: CNS: anxiety, ataxia, confusion, tremor, weakness, headache CV: Arrhythmias ,chest pain, heart failure,hypotension, palpitations, peripheral edema EENT: Altered taste, blurred vision, tinnitus, nasal congestion ENDO: Gynecomastia, hyperglycemia GI: Anorexia, nausea, vomiting, constipation, hepatitis GU: Dysnria, nocturia, polruria, sexual dysfunction HEME: Anemia, leucopenia, thrombocytopenia MS: Joint stiffness, muscle cramps RESP: Chest congestion, cough, dyspnea, respiratory tract infection, wheezing SKIN: Dermatitis, diaproresis, flushing, rash, urticaria Nursing Responsibilities: 1.)Monitor closely the patient; v/s and esp. the BP and PR. 2.) Monitor fluid intake and output and daily weight; fluid retention leads to heart failure. 3.) Patient teaching: urge patient to take nifedipine exactly as prescribed, even she s feeling well.advise to notify prescriber if she misses two or more doses. 4.) WARNING: caution patient against stopping nifedine abruptly because angina or dangerously high lood pressure could result. 5.) Urge patient to avoid alcoholic beverages becausethey may worsen dizziness, drowsiness and hypotension. 6.) Stress the need for good oral hygiene and regular dental visits 7.) Advise patient to avoid prolonged sun exposure and to wear protective wear outdoors.