NCP on

HYPERTENSION

SUBMITTED TO SUBMITTED BY
PROFESSOR M.SC NURSING 1ST YEAR
OBG

IDENTIFICATION DATA

Name : MR. Munsiram

Age/ Sex : 49 Yrs./ male

C.R. No. : 122

Address : H.No.-113, Gali No.-3,

Hisar

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Father’s Name : Mr. Ravisha

D.O.A. : 12.05-2021

T.O.A. : 1:30 p.m.

D.O.D. : 17-05-2021

Education of Father : Illiterate

Occupation of Father : Farmer

Religion : Hindu

Diagnosis : HYPERTENSION

Dr. In-charge : Dr.ParveenKatthuria

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PRESENT HEALTH HISTORY:

Patient Munsiram48 years old, male was admitted in the hospital on 12th May 2021
with complaints of:-

C/ excessive thirst x 2 months

Fever x 2 months
Excessive urination x 20 days
Fever - high grade & intermittent which same time respond to drug.
No. H/o - Vomit / Cough
No. H/o - Bleeding
H/o - Burning maturation- 20 days back
H/o – Black Colour stool
- Not significant before 2 months
- No black colour stool
- Not significant before 2 months.
- Patient’s not able to walk for 1 month due to pain in pelvis.
- Body weight = 50 kg.

PAST HEALTH HISTORY:

Before illness the patient was healthy and active and performed activities of daily life
independently but sometimes with a little help. There is no H/o any significant diseases
like – No H/o T.B., Jaundice, Hepatitis etc.

- MEDICAL ILLNESS:
Patient has no. H/o of T.B., and any other childhood diseases like measles mumps,
Diphtheria, Tetanus, Rubella, Pertussis etc.

- No. H/o any other medical conditions like allergic reactions, poisoning, burns etc.

- SURGICAL ILLNESS:
There is no history of any surgical interventions done in my patient

FAMILY HISTORY

Genogram

Grand Father Grand Mother

Father (PATIENT) Mother

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Head of the family: Grandfather

S.No. Name Relationship to Age/ Sex Education Occupation

1. Ramesh Grand-father 70 Yrs./M 5th Class pass Retired
watchman
2. Meena Grand Mother 62 Yrs./F Illiterate House wife
3. Munsiram Father 49Yrs./M 10+2 pass Farmer
4. Laxmi Mother 35 Yrs./F Illiterate House-wife
5. Divya Sister 10 Yrs./F 5th class Student
6. Krishan Grandson 19 yr / f 12 ass Student

Health Status of all family members is good.

No. H/o TB, HTN, Asthma, Heart-attack, Cancer in any of the family members.

 TYPE OF FAMILY:
Patient Krishan lives in a joint family with her father, mother, sister and grand-parents.

 SOCIO - ECONOMIC STATUS:

Patient krishan lives in a family of good socio - economic status. Her father is in a private
business of socks, ties & gloves & handkerchiefs & earns about Rs.8,500/- per month. Her
mother is a house wife.

Therefore, total income of the family is Rs.8,500/- per month.

 RELIGIOUS CUSTOMS :
My patient follows Hindu religious customs.

 PHYSICAL ENVIRONMENT & LIVING CONDITION:

Area- Padam Nagar area in crowded
Type of House - Own Pakka House
No. of rooms- 3 rooms
Kitchen - Separate kitchen
Bathroom / Toilet- Separate toilet & bathroom
Refuse disposal - Proper refuse disposal
Ventilation - No proper ventilation in rooms.
Electricity & water supply - There is a proper supply of electricity & water in their house.

 DIETARY & NUTRITIONAL HISTORY:

- DIET OF THE FAMILY:

Type of diet consumed: Vegetarian diet

Breakfast: Tea, Bread
Lunch: Roti, Dal, Rice, Sabji

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 Dinner: Roti, Sabji

- Diet of the patient

Breakfast - Tea, Bread
Lunch - Roti, Dal, Rice
Dinner - Roti, Sabji

 HEALTH HISTORY OF CHILD :

- NATAL HISTORY
The child was born full term normal vaginal delivery & episiotomy given- conducted in
a govt. hospital near by. The child immediately cried after birth (according. to mother)

- HISTORY OF SCHOOLING

Before illness the patient was active & was studying in 1st standard in a govt.
school in Padam Nagar, Old Faridabad.

 HISTORY OF IMMUNIZATION

Patient krishan has received all the vaccinations are - BCG, OPV, DPT, Hepatitis B,
Measles, D.T.

B﴿ OBJECTIVE DATA

1. VITAL SIGNS

S.No. VITAL VALUE OF EXPECTED VALUE REMARKS

SIGNS CHILD
1. Temperature 38.50C 37-37.50C Increased
2. Pulse 120/ min. 85+ to beat/min. Increased
3. Respiration 20/min. 21/min. Increased
4. B.P. 170/114 min. Hg. 105/min. Hg. Severe hypertension

2. HEAD TO FOOT EXAMINATION

GENERAL APPEARANCE:-

» SKIN:

Colour : Whitish (pale)

Texture : Dry
Temperature : warm, 38.50c

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 Lesions : Absent, no rashes

» POSTURE:

Normal body curves &

Proper body alignment

» HEAD:

Scalp : Hair loss due to chemotherapy

Face – Puffiness present

» EYES:

Eye brows : Normal

Eye lashes : No infection
Eye lids : No edema, lesions etc.
Conjunctiva : Pale
Eye ball : Neither sunken nor protruded
Cornea : Normal
Pupil : Normal
Vision : Normal

» NOSE:

External nares : Normal

Nasal septum : Normal, no deviation
Nostrils : Clean

» MOUTH AND THROAT:

Lips : Dry
Gums : Pink in colors, no bleeding
Mucous membrane : Ulcers present
Tongue : Normal, no difficulty in speech
Teeth : No dental caries
Throat : Normal, no enlarged tonsils,

» NECK:
No enlarged lymph nodes

» CHEST:

Chest circumference : B/L Chest clear

» LUNGS: Expanded fully

Air entry is equal

» HEART:

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 - CVS normal
- S1S2 heard

» ABDOMEN:

Abdominal girth: 22 cm
Soft in touch
No swelling present over the abdomen

Observation: No rashes, scar or ascites, skin is normal

Auscultation: Bowel sounds are normal
Palpation: No hernia, no tenderness at the area of appendix.
Percussion: No presence of gas, fluid or masses.

» EXTERMITIES: Normal

- No clubbing of fingers or edema presence.

- Full range of motion.

» BACK: Normal

- No abnormal curves

» GENITALIA & RECTUM:

- Testes & scrotum are normal in size.

- No abnormality detected.

CONDITION OF THE PATIENTAT THE TIME OF ADMISSION:

At the time of admission, patient Krishi was suffering from:

C/o Bone pain Science 2 months
Fever science 2 months
Pallor science 20 days

Fever high grade & intermittent, respond to drug.

No H/o vomit / cough
No H/o Bleeding

 H/o Burningmicturation. – 20 days

 H/o Black color stool
 Child was not able to walk for one month due to pain in pelvis
 She was fully oriented to time, place & person at that time.

» TREATMENT AT THE TIME OF ADMISSION:

 Inj. Clofron, 500 mg IV ,B.D.

 Inj. Amikacin ,75 mg ,IV ,B.D.

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  PBSCT (Peripheral blood stem cell transplantation)

»
FINAL DIAGNOSIS:
 Acute Lymphoid Leukemia
Or
 Acute Lymphocytic Leukemia

DESCRIPTION OF THE DISEASE

INTRODUCTION ::::-

Hypertension is another name for high blood pressure. It can lead to

severe health complications and increase the risk of heart disease,
stroke, and sometimes death.

DEFININION :-

Blood pressure is the force that a person’s blood exerts against the walls of their blood
vessels. This pressure depends on the resistance of the blood vessels and how hard the
heart has to work.

Almost half of all adults in the United States have high blood pressure, but many are
not aware of this fact.

Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart

attack, heart failure, and aneurysm. Keeping blood pressure under control is vital for
preserving health and reducing the risk of these dangerous conditions.

In this article, we explain why blood pressure can increase, how to monitor it, and ways
to keep it within a normal range.

Management and treatment

Lifestyle adjustments are the standard, first-line treatment for hypertension. We outline
some recommendations here:

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Regular physical exercise
Share on PinterestPeople can measure blood pressure using a sphygmomanometer.

Current guidelines recommend that all people, including those with hypertension,
engage in at least 150 minutes of moderate intensity, aerobic exercise every week, or 75
minutes a week of high intensity exercise.

People should exercise on at least 5 days of the week.

Examples of suitable activities are walking, jogging, cycling, or swimming.

Stress reduction

Avoiding or learning to manage stress can help a person control blood pressure.

Meditation, warm baths, yoga, and simply going on long walks are relaxation
techniques that can help relieve stress.

People should avoid consuming alcohol, recreational drugs, tobacco, and junk food to
cope with stress, as these can contribute to elevated blood pressure and the
complications of hypertension.

Smoking can increase blood pressure. Avoiding or quitting smoking reduces the risk of
hypertension, serious heart conditions, and other health issues.

Medication

People can use specific medications to treat hypertension. Doctors will often
recommend a low dose at first. Antihypertensive medications will usually only have
minor side effects.

Eventually, people with hypertension will need to combine two or more drugs to
manage their blood pressure.

Medications for hypertension include:

- diuretics, including thiazides, chlorthalidone, and indapamide

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 - beta-blockers and alpha-blockers
- calcium-channel blockers
- central agonists
- peripheral adrenergic inhibitor
- vasodilators
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin receptor blockers

The choice of medication depends on the individual and any underlying medical
conditions they may experience.

Anyone on antihypertensive medications should carefully read the labels of any over-
the-counter (OTC) drugs they may also take, such as decongestants. These OTC drugs
may interact with the medications they are taking to lower their blood pressure.

Diet

People can prevent high blood pressure by following a heart-healthy diet.

Reducing salt intake

People’s average salt intake is between 9 grams (g) and 12 g per day in most countries
around the world.

The World Health Organization (WHO) recommend reducing intake to under 5

gTrusted Source a day to help decrease the risk of hypertension and related health
problems.

Lowering salt intake can benefit people both with and without hypertension.

Moderating alcohol consumption

Moderate to excessive alcohol consumption can increase blood pressure.

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The American Heart Association (AHA) recommend a maximum of two alcoholic
drinks a day for men, and one for women.

The following would count as one drink:

 a 12-ounce (oz) bottle of beer

 4 oz of wine
 1.5 oz of 80-proof spirits
 1 oz of 100-proof spirits

A healthcare provider can help people reduce consumption if they find it difficult to
moderate their alcohol intake.

Eating more fruit and vegetables and less fat

People who have high blood pressure or people at high risk of developing high blood
pressure should eat as little saturated and total fat as possible.

Instead, experts recommend:

 whole grain, high fiber foods

 a variety of fruit and vegetables
 beans, pulses, and nuts
 fish rich in omega-3 twice a week
 nontropical vegetable oils, for example, olive oil
 skinless poultry and fish
 low fat dairy products

It is important to avoid trans fats, hydrogenated vegetable oils, and animal fats, as well
as large portion sizes.

Some fats, such as those in oily fish and olive oil, have protective effects on the heart.
However, these are still fats. While they are typically healthful, people with a risk of
hypertension should still include them in their total fat intake.

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Managing body weight

Excess body weight can contribute to hypertension. A fall in blood pressure usually

follows weight loss, as the heart does not have to work so hard to pump blood around
the body.

A balanced diet with a calorie intake that matches the individual’s size, sex, and activity
level .
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Causes
Share on Pinterest Stress can increase the risk of high blood pressure.

The cause of hypertension is often not known. In many cases, it is the result of an
underlying condition.

Doctors call high blood pressure that is not due to another condition or disease primary
or essential hypertension.

If an underlying condition is the cause of increasing blood pressure, doctors call this
secondary hypertension.

Primary hypertension can result from multiple factors, including:

 blood plasma volume

 hormone activity in people who manage blood volume and pressure using
medication
 environmental factors, such as stress and lack of exercise

Secondary hypertension has specific causes and is a complication of another health

problem.

Chronic kidney disease (CKD) is a common cause of high blood pressure, as the

kidneys no longer filter out fluid. This excess fluid leads to hypertension.

Conditions that can lead to hypertension include:

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  diabetes, due to kidney problems and nerve damage
 kidney disease
 pheochromocytoma, a rare cancer of an adrenal gland
 Cushing syndrome that corticosteroid drugs can cause
 congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
 hyperthyroidism, or an overactive thyroid gland
 hyperparathyroidism, which affects calcium and phosphorous levels
 pregnancy
 sleep apnea
 obesity

Risk factors

A number of factors increase the risk of hypertension.

 Age: Hypertension is more common in people who are more than 60 years of
age. Blood pressure can increase steadily with age as the arteries stiffen and
narrow due to plaque buildup.
 Ethnicity: Some ethnic groups are more prone to hypertension than others.
African Americans have a higher riskTrusted Source than other ethnic groups,
for example. · Size and weight: Being overweight or obese is a primary risk
factor.
 Alcohol and tobacco use: Regularly consuming large quantities of alcohol or
tobacco can increase blood pressure.
 Sex: According to a 2018 reviewTrusted Source, males have a higher risk of
developing hypertension than females. However, this is only until after women
reach menopause.
 Existing health conditions: Cardiovascular disease, diabetes, chronic kidney
disease, and high cholesterol levels can lead to hypertension, especially as
people age.

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Other risk factors include:

1) sedentary lifestyle
2) salt rich, high fat diet
3) low potassium intake

Poorly managed stress and a family history of high blood pressure .

Symptoms
Share on Pinterest Most people experience no symptoms from hypertension and may not be aware they have it.

A person with hypertension may not notice any symptoms, and so people often call
it the “silent killer.” Without detection, hypertension can damage the heart, blood
vessels, and other organs, such as the kidneys.

It is vital to check blood pressure regularly.

In rare and severe cases, high blood pressure causes sweating, anxiety, sleeping
problems, and blushing. However, most people with hypertension will experience no
symptoms at all.

If high blood pressure becomes a hypertensive crisis, a person may

experience headaches and nosebleeds.

Complications

Long term hypertension can cause complications through atherosclerosis where plaque

develops on the walls of blood vessels, causing them to narrow.

This narrowing makes hypertension worse, as the heart must pump harder to circulate
the blood.

Hypertension-related atherosclerosis can lead to:

 heart failure and heart attacks

 aneurysm, or abnormal bulge in the wall of an artery that can burst

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  kidney failure
 stroke
 amputation
 hypertensive retinopathies in the eye, which can lead to blindness

Regular blood pressure monitoring can help people avoid these more severe
complications.

Learn more about atherosclerosis here.

Signs

A sphygmomanometer, or blood pressure monitor, can help people keep track of their
blood pressure.

A doctor’s visit is not always necessary for blood pressure monitoring. Home blood
pressure monitors are available for purchase online.

Having high blood pressure for a short time can be a normal response to many
situations. Acute stress and intense exercise, for example, can briefly elevate blood
pressure in an otherwise healthy person.

For this reason, a diagnosis of hypertension requires several readings that show
sustained high blood pressure over time.

The AHA issued guidelines in November 2017 that define hypertension as blood

pressure that is consistently higher than 130 over 80 millimeters of mercury (mmHg).

The systolic reading of 130 mmHg refers to the pressure as the heart pumps blood
around the body. The diastolic reading of 80 mmHg refers to the pressure as the heart
relaxes and refills with blood.

The AHA 2017 guidelines define the following ranges of blood pressure:

Systolic (mmHg) Diastolic (mmHg)

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 Normal blood pressure Less than 120 Less than 80

Elevated Between 120 and 129 Less than 80

Stage 1 hypertension Between 130 and 139 Between 80 and 89

Stage 2 hypertension At least 140 At least 90

Hypertensive crisis Over 180 Over 120

If the reading indicates a hypertensive crisis, wait 2 or 3 minutes and then repeat the
test.

If the reading is the same or higher, this indicates a medical emergency.

The person should seek immediate assistance

Hypertension: medication management :-

 Angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor

blockers (ARBs) are approved medications used in the treatment
of hypertension.
 ACE inhibitors are more commonly prescribed than ARBs.
 A recent study compares the effectiveness, safety profiles, and side effects
associated with each group of medicines.
ACE INHIBITORS medications in the treatment of high blood pressure.

Currently, doctors prescribe ACE inhibitors more often than they do ARBs. However,
few studies have compared the two classes of drugs directly.

A recent study published in hypertension, an American Heart Association journal, set

out to do just that. Study authors investigated whether there were any differences
between the two sets of medication in terms of effectiveness and side effects.

ACE inhibitors and ARBs act on the renin-angiotensin-aldosterone system, which is a

system of hormones that help regulate blood pressure. While both ACE inhibitors and
ARBs are effective, the way they reduce hypertension is different.

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Angiotensin a hormone that narrows blood vessels, thereby restricting blood flow and
increasing blood pressure. ACE inhibitors block an enzyme that triggers the production
of angiotensin, which therefore reduces blood pressure.

ARBs block angiotensin receptors in the blood vessels. This dimi

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