STUDENT’S NAME: Jilkiah Mae A.

Campomanes

Name of the Patient: Allan Morales Bernados Age: 77

Diagnosis: HCVD

I. Brief Description of the Disease

A. Definition
Hypertensive heart disease refers to heart conditions caused by high blood
pressure. The heart working under increased pressure causes some different
heart disorders. Hypertensive heart disease includes heart failure,
thickening of the heart muscle, coronary artery disease, and other
conditions. Hypertensive heart disease can cause serious health problems.
It’s the leading cause of death from high blood pressure.

B. Risk factors
 Smoking High LDL, or "bad" cholesterol, and low HDL, or "good"
cholesterol
 Uncontrolled high blood pressure
 Physical inactivity
 Obesity (having a BMI greater than 25)
 Uncontrolled diabetes
 High C-reactive protein
 Uncontrolled stress, depression, and anger
 Poor diet
 Alcohol use
C. Signs and Symptoms or Clinical Manifestation
 Chest pain, chest tightness, chest pressure and chest discomfort
(angina)
 Shortness of breath.
 Pain, numbness, weakness or coldness in your legs or arms if the
blood vessels in those parts of your body are narrowed.
 Pain in the neck, jaw, throat, upper abdomen or back.
D. Management/Nursing Interventions
1. Assess the patient’s health history
2. Perform physical examination as appropriate.
3. The retinas are examined to assess possible organ damage.
4. Laboratory tests are also taken to check target organ damage.
5. Encourage the patient to consult a dietitian to help develop a plan for
improving nutrient intake or for weight loss.
6. Encourage restriction of sodium and fat
7. Emphasize increase intake of fruits and vegetables.
8. Implement regular physical activity.
9. Advise patient to limit alcohol consumption and avoidance of tobacco.
10. Assist the patient to develop and adhere to an appropriate exercise
regimen.
II. Patient’s Signs and Symptoms or Clinical manifestations
 BP = 160/100
 RR = 38
 Slurring of speech
 L sided weakness
 ANATOMY AND PHYSIOLOGY

HEART

Function/s:

The heart is a pump, usually beating about 60 to 100 times per minute. With each heartbeat,
the heart sends blood throughout our bodies, carrying oxygen to every cell. After delivering
the oxygen, the blood returns to the heart. The heart then sends the blood to the lungs to pick
up more oxygen.
The heart has four chambers — two on top and two on bottom:
 The two bottom chambers are the right ventricle and the left ventricle. These pump
blood out of the heart. A wall called the interventricular septum is between the two
ventricles.
 The two top chambers are the right atrium and the left atrium. They receive the
blood entering the heart. A wall called the interatrial septum is between the atria.
The atria are separated from the ventricles by the atrioventricular valves:
 The tricuspid valve separates the right atrium from the right ventricle.
 The mitral valve separates the left atrium from the left ventricle.
Two valves also separate the ventricles from the large blood vessels that carry blood leaving
the heart:
 The pulmonic valve is between the right ventricle and the pulmonary artery, which
carries blood to the lungs.
 The aortic valve is between the left ventricle and the aorta, which carries blood to the
body.
Reference/Source: https://kidshealth.org/en/parents/heart.html
 HYPERTENSION CARDIOVASCULAR
DISEASE

HEART

Risk Factors:
Etiology/Causative agent: Modifiable:
1. Smoking
Increase intake of fats 2. Alcohol
Decreased blood flow ________________________________ 3. Unhealthy Diet
to the arteries of the 4. Obesity
heart 5. Physical Inactivity
Nonmodifiable:
Fat clogs on arteries 1. Age
2. Genetic/Inheritance
Ischemia ________________________ 3. Diabetes

Angina Narrowing of blood vessels

______________________________

Increased vascular resistance

_________________________________________

Decreased blood flow to organs

_________________________________________

Activation of RAAS

Increased contraction/pumping of
the heart

Palpitation

Increased blood pressure Hypertension

S/Sx: Symptoms include:
 Chest pain, chest tightness, chest pressure and chest discomfort
(angina)
 Shortness of breath.
 Pain, numbness, weakness or coldness in your legs or arms if the
blood vessels in those parts of your body are narrowed.
 Pain in the neck, jaw, throat, upper abdomen or back.
Reference/Source: https://www.springer.com/gp/book/9789024725342

LABORATORY/DIAGNOSTIC STUDIES
Date/Exam Patient’s Normal Significance/Interpretation
Results Values
Hematology/Complete CBC is a blood test. It helps healthcare providers
Blood Count detect a range of disorders and conditions. It
         RBC 3.64 4.50 – 5.90 also checks your blood for signs of medication
         WBC side effects. Providers use this test to screen for
              Eosinophil 2.3 0-7 diseases and adjust treatments. A CBC
measures and counts your blood cells.
              Basophil 0.2 0-2.5
               INTERPRETATIONS:
Hematocrit: A low hematocrit level means
Neutrophil 76 37-80 there are too few red blood cells in the body.

         Platelet 166 150-450

         

Hemoglobin 10.8 14-17.5

         Hematocrit 32.8 41.5-50.4

Urinalysis A urinalysis is a simple test that looks at a small
Microscopic Examination sample of your urine. It can help find problems
Color Light Yellow Yellow that need treatment, including infections or
Transparency Hazy Clear kidney problems. It can also help find serious
Specific Gravity 1.015 1.005 – 1.025 diseases in the early stages, like kidney disease,
diabetes, or liver disease. A urinalysis is also
Chemical Examination called a “urine test.”
Albumin 1+ NEGATIVE
6.0 4.6 – 8
pH INTERPRETATIONS:
NEGATIVE NEGATIVE
Ketone NEGATIVE
Albumin: Albuminuria is a sign of kidney disease
Blood 2+ and means that you have too much albumin in
NEGATIVE
Glucose 2+ your urine. Albumin is a protein found in the
NEGATIVE
Nitrite NEGATIVE NEGATIVE blood. A healthy kidney doesn't let albumin
Bilirubin NEGATIVE NEGATIVE pass from the blood into the urine. A damaged
Urobilinogen NORMAL NORMAL kidney lets some albumin pass into the urine.
The less albumin in your urine, the better.
WBC
RBC 2-5 /HPF NORMAL Blood: Most causes of blood in your urine are
20-25 /HPF not serious, But sometimes red or white blood
 cells in your urine can mean that you have a
medical condition that needs treatment, such as
a kidney disease, urinary tract infection, or liver
disease.

Glucose: Glycosuria is a condition in which a

person's urine contains more sugar, or glucose,
than it should. It typically occurs due to high
blood sugar levels or kidney damage.

RBC: RBC in the urine can indicate that there is

a problem with the urinary tract. If a person
discovers blood in their urine, they should
contact their healthcare provider. If a test
confirms the presence of RBC in the urine, a
doctor will likely want to run further tests to
figure out what is causing it.
Clinical Chemistry: Clinical chemistry is a quantitative science that
Creatinine 3.66 0.51-0.95 is concerned with measurement of amounts of
BUN 41.5 6.0-20.0 biologically important substances (called
BUA 9.20 2.4-5.7 analytes) in body fluids. The methods to
HBA1C 7.50 4.0-6.0 measure these substances are carefully
designed to provide accurate assessments of
their concentration.

INTERPRETATIONS:
Creatinine: high levels of creatinine can indicate
that your kidneys aren't working well.

BUN: a high BUN level means your kidneys

aren't working well. But elevated BUN can also
be due to: Dehydration, resulting from not
drinking enough fluids or for other reasons.
Urinary tract obstruction.

BUA: a high uric acid level occurs when your

kidneys don't eliminate uric acid efficiently.

HBA1C: A high HbA1c means you have too

much sugar in your blood.

Reference/Source: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-
diabetes/hba1c#:~:text=A%20high%20HbA1c%20means%20you,your%20risk%20of
%20devastating%20complications.

https://www.mayoclinic.org/symptoms/high-uric-acid-level/basics/causes/sym-
20050607#:~:text=Most%20of%20the%20time%2C%20a,and%20drinking%20too%20much
%20alcohol.
https://www.mayoclinic.org/tests-procedures/blood-urea-nitrogen/about/pac-
20384821#:~:text=Generally%2C%20a%20high%20BUN%20level,Urinary%20tract
%20obstruction
 DRUG STUDY

Name of the Mechanism of Action Indications Side Effects Nursing

Drug Responsibilities
Generic Mannitol is an osmotic Used for the
name: diuretic that is promotion of CNS: Before:
Mannitol metabolically inert in diuresis before Headache, Obtain baseline vital
humans and occurs irreversible renal tremor, signs
Brand name: naturally, as a sugar or failure becomes convulsions,
Osmitrol sugar alcohol, in fruits established, the dizziness, During:
and vegetables. reduction of transient muscle Note IV injection
Classification: Mannitol elevates intracranial rigidity. sites for signs of
Diuretics, blood plasma pressure, the phlebitis (redness,
Osmotic osmolality, resulting in treatment of CV: swelling, pain)
Agents enhanced flow of cerebral edema, and Edema, CHF,
water from tissues, the promotion of angina-like pain, After:
including the brain and urinary excretion of hypotension, Monitor for
Dosage: cerebrospinal fluid, toxic substances. hypertension, manifestations of
200cc into interstitial fluid thrombophlebitis. hypersensitivity
and plasma. As a Contraindications
Frequency: result, cerebral edema, Anuria; marked Eye: Monitor closely
every 4H elevated intracranial pulmonary Blurred vision serum and urine
pressure, and congestion or electrolytes and
Route: cerebrospinal fluid edema; severe CHF; GI: kidney function
Intravenous volume and pressure metabolic edema; Dry mouth, during therapy.
may be reduced. As a organic CNS disease, nausea, vomiting
Timing: diurectic mannitol intracranial Measure I&O
induces diuresis bleeding; shock, Urogenital: accurately and
because it is not severe dehydration, Marked diuresis, record to achieve
reabsorbed in the history of allergy; urinary retention, proper fluid
renal tubule, thereby pregnancy (category nephrosis, balance.
increasing the C), lactation; uricosuria.
osmolality of the concomitantly with Monitor vital signs
glomerular filtrate, blood. closely.
facilitating excretion of
water, and inhibiting
the renal tubular
reabsorption of
sodium, chloride, and
other solutes.
Mannitol promotes the
urinary excretion of
toxic materials and
protects against
nephrotoxicity by
preventing the
concentration of toxic
substances in the
tubular fluid. As an
Antiglaucoma agent
mannitol levates blood
 plasma osmolarity,
resulting in enhanced
flow of water from the
eye into plasma and a
consequent reduction in
intraocular pressure. As a
renal function diagnostic
aid mannitol is freely

Reference/Source: https://www.rxlist.com/consumer_mannitol_osmitrol/drugs-condition.htm

http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/M008.html

Name of the Drug Mechanism of Indications Side Effects Nursing

Action Responsibilities
Generic name: Citicoline Cerebrovascular CNS:
Citicoline consumption diseases, Head Increased Before:
promotes brain Trauma of parasympatheti Assess for
Brand name: metabolism by varying c effects, hypersensitivity
restoring
Cognizin severity, Headache
phospholipid
content in the brain
Cognitive During:
Classification: disorders of CV: Note IV injection
and regulation of
Central stimulant, neuronal diverse Fleeting and sites for signs of
Nootropic agent membrane etiology, discrete phlebitis (redness,
excitability. It also Parkinson’s hypotension swelling, pain)
Dosage: influences the disease effect,
1 gm mitochondria or hypotension, After:
energy factories of Contraindication chest tightness Monitor for
Frequency: the brain cells and s adverse effects
Every 8hrs found to improve Hypertonia of GI:
memory function. the Tingling in
Route: After several parasympathetic mouth and
IVTT clinical trials, throat, Nausea,
nervous system.
Citicoline has been Diarrhea
shown to raise the Hypersensitivit
Timing: y.
amount of SKIN:
acetylcholine in the Itching or hives,
brain.
swelling in face
or hands,

EYES:
Blurred vision
 Reference/Source: https://rnspeak.com/citicoline-drug-study/

https://www.mims.com/philippines/drug/info/citicoline?mtype=generic

Name of the Mechanism of Indications Side Effects Nursing

Drug Action Responsibilities
Generic name: Atorvastatin Therapy with lipid-altering
Atorvastatin competitively agents should be only one CNS: Before:
inhibits 3- component of multiple risk Insomnia Assess for
Brand name: hydroxy-3- factor intervention in hypersensitivity.
Lipitor methylglutaryl- individuals at significantly
coenzyme A increased risk for CV: Monitor liver
Classification: (HMG-CoA) atherosclerotic vascular disease Chest pain, function tests
Lipid- reductase. By due to hypercholesterolemia.
Lowering preventing the Drug therapy is recommended RESPI: During:
Agents, conversion of as an adjunct to diet when the Runny or Note IV injection
Statins; HMG- HMG-CoA to response to a diet restricted in stuffy nose, sites for signs of
CoA mevalonate, saturated fat and cholesterol Shortness phlebitis (redness,
Reductase statin and other nonpharmacologic of breath swelling, pain)
Inhibitors medications measures alone has been
decrease inadequate. In patients with GI:
cholesterol CHD or multiple risk factors for Diarrhea, After:
Dosage:
80mg/tab, 1 tab production in the CHD, LIPITOR can be started Nausea, Monitor for S&S of
liver. simultaneously with diet. Loss of a hypersensitivity
Frequency: appetite, reaction
Once Daily Contraindications Indigestion,
Atorvastatin is contraindicated mouth and Monitor for
in patients with atorvastatin throat pain therapeutic
Route:
hypersensitivity or effectiveness which
NGT
hypersensitive to any Others: is indicated by
Timing: components of the product Muscle reduction in the
selected. spasms, level of LDL
muscle
pain,

Reference/Source: https://www.rxlist.com/consumer_atorvastatin_lipitor/drugs-condition.htm
https://www.pdr.net/drug-summary/lipitor?druglabelid=2338
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/A080.html
Name of the Mechanism of Action Indications Side Effects Nursing
 Drug Responsibilities
Generic The mechanism of Short-term treatment
name: action of of erosive CNS: Before:
Pantoprazole pantoprazole is to esophagitis Headache, Assess for
inhibit the final step associated with insomnia hypersensitivity
Brand name: in gastric acid gastroesophageal
Protonix, production. In the reflux disease GI: During:
Somac gastric parietal cell of (GERD). Diarrhea, Note IV injection
Control the stomach, flatulence, sites for signs of
pantoprazole Contraindications abdominal phlebitis (redness,
Classification: covalently binds to Hypersensitivity to pain swelling, pain)
proton-pump the H+/K+ ATP pantoprazole or
inhibitors pump to inhibit other proton pump After:
gastric acid and basal inhibitors (PPIs); Monitor for dose-
Dosage:
acid secretion. The severe hepatic related adverse
40mg
covalent binding insufficiency, effects
prevents acid cirrhosis.
Frequency: Monitor for and
secretion for up to 24
Every 24hrs immediately
hours and longer.
report S&S of
Route: angioedema or a
IVTT severe skin
reaction.
Timing:

Reference/Source:
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/C108.html

https://glowm.com/resources/glowm/cd/pages/drugs/c081.html

Name of the Mechanism of Action Indications Side Effects Nursing

Drug Responsibilities
Generic name: By deforming the Used for the CNS: Before:
nicardipine channel, inhibiting management of patients Dizziness or Establish baseline
hydrochloride ion-control gating with chronic stable headache, data including
mechanisms, and/or angina and for the fatigue, BP, pulse, and lab
Brand name: interfering with the treatment of anxiety, values of liver
Cardene I.V. release of calcium hypertension. depression, and kidney
from the parerethesias, function.
Contraindications
Classification: sarcoplasmic Cardene I.V. Premixed insomnia,
During:
Calcium reticulum, Injection is somnolence,
Channel Monitor BP
nicardipine inhibits contraindicated in nervousness.
Blockers; the influx of during initiation
patients with advanced
Calcium extracellular calcium and titration of
aortic stenosis because CV:
 part of the effect of
Cardene I.V. Premixed
Injection is secondary
to reduced afterload.
Reduction of diastolic
pressure in these
patients may worsen
rather than improve
myocardial oxygen
balance.

Channel Blockers, across the myocardial Pedal edema, dosage carefully

Dihydropyridine. and vascular smooth hypotension,
muscle cell membranes flushing, After:
Dosage: The decrease in palpitations, Observe for large
10mg + 90cc intracellular calcium tachycardia, peak and trough
PNSS inhibits the contractile increased angina differences in BP
processes of the
Frequency: myocardial smooth RESPI:
muscle cells, causing Shortness of
Route: dilation of the coronary breath,
Iintravenous and systemic arteries,
increased oxygen GI:
Timing: delivery to the Anorexia,
myocardial tissue, nausea,
Reference/Source: https://www.rxlist.com/cardene-iv-drug.htm#warnings
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/N029.html

NURSING CARE PLAN

Defining Nursing Scientific Analysis Goal of Care Nursing Rationale

Characteristics Diagnosis Interventions
“Vaso” actually Independent:
Subjective Risk for means blood At the end 1. Check
Cues: decreased vessel. of eight laboratory data 1. To identify
“Sumasakit cardiac Vasoconstriction is hours, the (cardiac contributing factors.
yung puso ko output narrowing or patient will markers,
pati sa balikat related to constriction of the be able to complete blood
at likod ko” vasoconstric blood vessels. It achieve cell count,
tion happens when adequate electrolytes,
smooth muscles in cardiac ABGs, blood
blood vessel walls output as urea nitrogen
Objective tighten. This makes evidenced and creatinine,
Cues: the blood vessel by: cardiac
 BP: 160/100 opening smaller. enzymes, and
 RR: 38 Vasoconstriction -BP not cultures, such
 L sided may also be called more than as blood,
weakness vasospasm. 120/ 80 wound, or
 Slurred Vasoconstriction -pulse rate secretions).
speech reduces the within 60 2. Assess 2.Weak, thready
volume or space -100bpm; peripheral peripheral pulses may
inside affected full pulses reflect hypotension,
blood vessels. pulsations, vasoconstriction,
When blood vessel bilateral shunting and venous
volume is lowered, -Adequate congestion
blood flow is also urinary 3. Encourage bed 3.Comparison of
reduced. At the output of 30 rest. pressures provides a
same time, the ml/hour complete picture of
resistance or force vascular involvement
of blood flow is or the scope of the
raised. This causes problem.
higher blood 4. Monitor and 4. Helpful in
pressure. record BP. reducing myocardial
Measure in oxygen consumption
both arms and
thighs three
times, 3–5 min
apart while the
patient is at
rest, then
sitting, then
standing for
initial
evaluation. 5. To promote
5. Provide calm, comfort and decrease
restful tissue demand.
surroundings,
minimize
environmental
activity and
noise. Limit the
number of
 visitors and
length of stay.

6. Instruct in 6. Can reduce stressful

relaxation stimuli, produce a
techniques, calming effect,
guided imagery, thereby reducing BP.
distractions.

Dependent:
1. Administer 1. Pharmacologic
medications, as treatment helps in
ordered. acquiring adequate
cardiac output.
2. Implement
dietary sodium, 2.These restrictions can
fat, and help manage fluid
cholesterol retention and, with
restrictions as the associated
indicated. hypertensive
response, decrease
myocardial workload.

Reference/Source: https://nurseslabs.com/hypertension-nursing-care-plans/