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Liceo de Cagayan University

RN. Pelaez Blvd. Kauswagan, Cagayan de Oro City

College of Nursing
NCM501202

A Case Study
of a 44 year old male diagnosed with

Hypertensive
Urgency
Submitted to:

Ms. Michelle Jacalan RN

Clinical Instructor

Submitted By:

Kier John Aboy

Student

January 25, 2010


I. Introduction

a. Overview of the Study

Hypertensive urgency is elevated blood pressure (usually over 180/110) without


evidence of end organ damage.

Hypertensive Urgency is a severe elevation in blood pressure without progressive


target organ dysfunction. It is a crucial step in distinguishing between hypertensive
emergency and urgency for an appropriate management.

Patients with hypertension or hypertensive urgency do not need to go to the emergency


department for treatment if they have reliable follow up with their primary care doctor.

Several classes of antihypertensive agents are recommended and the choice for the
antihypertensive agent depends on the cause for the hypertensive crisis, the severity of
elevated blood pressure and the patient's usual blood pressure before the hypertensive
crisis. In most cases, the administration of an intravenous sodium nitroprusside
injection which has an almost immediate antihypertensive effect is suitable but in many
cases not readily available. In less urgent cases, oral agents like captopril, clonidine,
labetalol, prazosin, which all have a delayed onset of action by several minutes
compared to sodium nitroprusside, can also be used.

It is also important that the blood pressure is lowered not too abruptly, but smoothly.
The initial goal in hypertensive emergencies is to reduce the pressure by no more than
25% (within minutes to 1 or 2 hours) and then toward a level of 160/100 mm Hg within
2–6 hours. Excessive reductions in pressure may precipitate coronary, cerebral, or renal
ischemia. The diagnosis of a hypertensive emergency is not only based on the absolute
level of blood pressure, but also on the individual regular level of blood pressure before
the hypertensive crisis. Individuals with a history of chronic hypertension may not
tolerate a "normal" blood pressure.
b. Objective of the Study

This study aims to:

• Conduct and evaluate an assessment for the client

• Determine the causes, predisposing and precipitating factors that constitute the onset
of the disease process.

• Render series of nursing interventions for the client’s care

• Provide and disseminate important information as teachings to the client and the
significant others to boost the knowing and understanding of the nature of the said
health condition.

• Improve skills and knowledge as health care providers in the clinical area.

c. Scope and Limitation of the Study

This study includes the collection of information specifically to the patient’s


health condition. The study also includes the assessment of the physiological and
psychological status, adequacy of support systems and care given by the family as well as
other health care providers. The scope of this study would include:

a. Data collected via assessment, interviews with the patient and family members.

b. Actual problems for 1 day including appropriate nursing intervention that would be
applied within her stay in the hospital at Polymedic General Hospital.

c. Developing a plan of care that will reduce identified predicaments and complications.

d. Coordinating and delegating interventions within the plan of care to assist the client
to reach maximum functional health.

An array of factors influencing the limitations of this study includes:

a. Data collected is limited only to assessment and interview to the patient’s significant
others.

b. The interaction, assessment and care were only limited to a total of 12 hours with
actual nursing intervention done.
II. Heath History

a. Patients Profile

Name: Abraham Olegario Jr. Weight: 11 lbs

Age: 44 Years old Temperature: 36.5 oc

Date of Birth: June 15, 1965 PR: 82 bpm

Sex: Male RR: 22 cpm

Civil Status: Married Height: 163 cm

Religion: Roman Catholic Nationality: Filipino

Address: 14th – 21 st. Macasandig, Cagayan de Oro City

Informants: Roselyn Olegario

Allergy: No Known Foods and Drugs Allergy

Date of Admission: December 14, 2009

Time of Admission: 3:00 am

Chief complaints: Nosebleeding

Diagnosis: Hypertensive Urgency


b. Family and Personal health History

According to his wife, both of the family side has a history of Hypertension.

1. History of Present Illness

Abraham Olegario Jr. a 44 yrs old. live in 14th – 21 st. Macasandig, Cagayan de Oro
City. PTA patient suffers nosebleeding, hypertension was noted that it started December
14, 2009 at 1am in the morning. The night before admission patient had experience
sleep difficulties. Consequently, around 3:00 am patient was rushed to the hospital with
the Diagnosis of Hypertensive Urgency.

Chief Complaints

The patient was admitted because of nosebleeding, BP – 150/100.

III. Developmental Data

Sigmund Freud’s Psychosexual Theory:

Freud advanced a theory of personality development that centered on the effects of


the sexual pleasure drive on the individual psyche. At particular points in the
developmental process, he claimed, a single body part is particularly sensitive to sexual,
erotic stimulation. These erogenous zones are the mouth, the anus, and the genital
region. The child's libido centers on behavior affecting the primary erogenous zone of
his age; he cannot focus on the primary erogenous zone of the next stage without
resolving the developmental conflict of the immediate one.

A child at a given stage of development has certain needs and demands, such as the
need of the infant to nurse. Frustration occurs when these needs are not met;
Overindulgence stems from such an ample meeting of these needs that the child is
reluctant to progress beyond the stage. Both frustration and overindulgence lock some
amount of the child's libido permanently into the stage in which they occur; both result
in a fixation. If a child progresses normally through the stages, resolving each conflict
and moving on, then little libido remains invested in each stage of development. But if
he fixates at a particular stage, the method of obtaining satisfaction which characterized
the stage will dominate and affect his adult personality.

FREUD’S PSYCHOSEXUAL THEORY

Age Name Pleasure Source Conflict

puberty onwards Genital Physical sexual Social Rules


changes reawaken
repressed needs.
Direct sexual feelings
towards others lead
to sexual
gratification.
Eric Erickson’s Psychosocial Theory:

Erik Erikson (1902-1994) said we develop in psychosocial stages. Erikson


emphasized developmental change throughout the human life span. In Erikson’s theory,
eight stages of development unfold as we go through the life span. Each stage consists of
a crisis that must be faced. According to Erikson, this crisis is not a catastrophe but a
turning point of increased vulnerability and enhanced potential.

Generativity is the concern of establishing and guiding the next generation. Socially-
valued work and disciplines are expressions of generativity. Simply having or wanting
children does not in and of itself achieve generativity.

During middle age the primary developmental task is one of contributing to society
and helping to guide future generations. When a person makes a contribution during
this period, perhaps by raising a family or working toward the betterment of society, a
sense of generativity- a sense of productivity and accomplishment- results. In contrast, a
person who is self-centered and unable or unwilling to help society move forward
develops a feeling of stagnation- a dissatisfaction with the relative lack of productivity.

Stages Developmental Task or Conflict to be


Resolved
Adulthood (35-50 years) Generativity vs. stagnation. Middle
aged adults are productive, performing
meaningful work, and raising a family, or
become stagnant and inactive.
Jean Piaget’s Cognitive Theory:

Swiss biologist and psychologist Jean Piaget (1896-1980) observed his children (and
their process of making sense of the world around them) and eventually developed a
four-stage model of how the mind processes new information encountered. He posited
that children progress through 4 stages and that they all do so in the same order. These
four stages are:

• Sensorimotor stage (Birth to 2 years old). The infant builds an understanding


of himself or herself and reality (and how things work) through interactions with
the environment. It is able to differentiate between itself and other objects.
Learning takes place via assimilation (the organization of information and
absorbing it into existing schema) and accommodation (when an object cannot be
assimilated and the schemata have to be modified to include the object.
• Preoperational stage (ages 2 to 4). The child is not yet able to conceptualize
abstractly and needs concrete physical situations. Objects are classified in simple
ways, especially by important features.
• Concrete operations (ages 7 to 11). As physical experience accumulates,
accomodation is increased. The child begins to think abstractly and
conceptualize, creating logical structures that explain his or her physical
experiences.
• Formal operations (beginning at ages 11 to 15). Cognition reaches its final
form. By this stage, the person no longer requires concrete objects to make
rational judgements. He or she is capable of deductive and hypothetical
reasoning. His or her ability for abstract thinking is very similar to an adult.
Robert Havighurst Developmental Task Theory

Another Psychologist that further elaborated on Erickson's view on personality


development was Robert. J Havighurst. He asserted that "Erickson's analysis of stages
of development could be applied in a different way to shed light on other facets of
development. He suggested some development tasks for different age, levels, starting
from the pre-school and kindergarten age.

According to Havighurst, this age ushers in an era of formation of simple concepts of


societal and physical reality. It is a familiarity seeking stage with the social surroundings
including every day objects. Children are curious at this stage asking questions. The
questions if answered expose them to experiences they hitherto do not have. The child
would want to relate emotionally with his parents, siblings and other people around
mostly through imitation. He would like to distinguish right from wrong and develop a
conscience.

Secondary grades: At the secondary grade, nine (9) developmental tasks have been
similarly identified by Havighurst, which are related mostly to adolescents and adult
behaviors. The list comprises of :

Achieving new and mature relations with age mates of both sexes;

Achieving masculine or feminine social role;

Accepting one's physique and using the body effectively;

Achieving emotional independence from parents and other adults;

Achieving assurance of economic independence and selecting and preparing for


occupation;

Preparing for marriage and family life;

Developing intellectual skills and concepts necessary for civic competence;

Desiring and achieving socially responsible behavior; and

Acquiring a set of values and an ethical system as a guide to behavior.

Havighurst emphasized the importance of timing and teachable moments in addressing


issues related to the achievement of the developmental tasks, failing which there would
be an adverse repercussion in later aspects of development. These issues have also been
discussed under psychology of adolescence.
IV Medical Management

a. Medical Orders and Rationale


Doctors Order Rationale

December 14, 2009

• Admitted to Semi private • For management and


room at Station 6 under the treatment of condition
supervise and sevice of Dr.
Bedayo
• At Low salt , Low fat diet
• To supply nutrients and
• FF IVF D5W 500cc 1 amp prevent wait loss
with nicardipine @40 cc/hr

• To provide access for


• Labs intravenous medications

• CBC • To screen patients blood


components and to detect
for any abnormalities like
infection. These results will
serve as a guide for
evaluation and to counteract
with the existing problem.

• To screen patients urine


components and to detect
• Urinalysis for any abnormalities

• To screen patients feces and


to detect for abnormalities.
• Fecalysis

o For baseline date


purposes and to
monitor patients
• v/s q 1 hour condition
Drug Study

Generic Name of Ordered Drug: Nifedipine

Brand Name:Adalat

Date Ordered: December 14, 2009

Classification: Antianginal, Antihypertensive

Dose/Frequency/Route: 30mg 1 tab OD PO

Mechanism of Action: inhibits calcium transport into myocardial smooth cells

Contraindication: Hypersensitivity to Adalat

Side Effects/Toxic Effects: headache, abnormal dreams, dizziness, drowsiness

Nursing Precaution: severe hepatic imapairement


Drug Study

Generic Name of Ordered Drug: Nasathera

Date Ordered: December 14, 2009

Classification: cough and cold remedies

Dose/Frequency/Route: 1 capsule OD PO

Mechanism of Action: to help to minimize the cough and colds

Specific Indication: Nasal congestion, headache & fever associated w/ sinusitis,


rhinitis, common cold & flu.

Contraindication: Hyperthyroidism; HTN, coronary disease; MAOIs;


nephropathy; benign prostatic hypertrophy & closed-angle glaucoma.

Side Effects/Toxic Effects: Giddiness, headache; GI upsets; sweating, thirst;


tachycardia, precordial pain, palpitations; difficulty in micturition; muscle weakness;
tremors, anxiety, insomnia; skin eruptions.

Nursing Precaution: Cardiac disease or decompensation, angina, diabetes;


hepatic or renal impairment
Drug Study

Generic Name of Ordered Drug: Sodium Bicarbonate

Brand Name:

Date Ordered: December 14, 2009

Classification: Antiulcer agents

Dose/Frequency/Route: 250mg 1 tab bid PO

Mechanism of Action: Take this medication by mouth as directed. Chewable


tablets are to be chewed thoroughly before swallowing followed by a glass of water.
Take this medication exactly as directed. Do not increase the dose, take it more often
or continue taking this for longer than prescribed.

Contraindication: Hypersensitivity to this drug

Side Effects/Toxic Effects: This medication is generally well tolerated. However,


high doses may cause headache, nausea or irritability. If any of these effects continue
or become bothersome, inform your doctor. Notify your doctor if you develop:
muscle weakness, slow reflexes, confusion, swelling of the feet or ankles, black tar-
like stools, coffee-ground vomit. If you notice other effects not listed above, contact
your doctor or pharmacist.

Nursing Precaution: Tell your doctor if you have: pre-existing heart disease,
kidney disease, liver disease, high blood pressure, any allergies. Because this
medication contains a large amount of sodium, remind your doctor if you are on a
low sodium diet. This medication should be used only if clearly needed during
pregnancy. Discuss the risks and benefits with your doctor. Since small amounts of
this medication appear in breast milk, consult your doctor before breast-feeding.
V. Pathophysiology

Name Of Patient: Abraham Olegario Jr.

Diagnosis: Hypertensive urgency

Definition: Hypertensive Urgency is a severe elevation in blood pressure without


progressive target organ dysfunction. It is a crucial step in distinguishing between
hypertensive emergency and urgency for an appropriate management.

Predisposing Factors: environment, hygiene and stress

Precipitation Factors: all ages, male and female


BIBLIOGRAPHY
Doenges, Marilynn E., et. al. Nursing Care Plans: Guidelines for Individualizing
Patient Care, 6th Edition. Thailand: F.A. Davis Company, 2002.

Kozier, Barbara, et. al. Fundamentals of Nursing, 7th Edition. Philippines:


Pearson Education, 2004.

Smeltzer, Suzanne and Bare, Brenda, ed. Medical-Surgical Nursing, 10th


Edition. New York: Lippincott Williams & Wilkins, 2004.

“Acute Gastritis” [Online] Available


http://www.3m.com/us/healthcare/pdfs/acute_gastritis.pdf, July 28,
2006.

Adelle Pilliteri, Maternal and Child Nursing y Volume 1, 5th Edition

Doenges et al. Nurses pocket guide; nursing diagnoses with intervention: Fourth
Edition

Nursing 2006 Drug Handbook (26th ed.), Philadelphia, J.B. Company, 2006

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