CASE PRESENTATION

‘PULMONARY
HYPERTENSION ’

MATRIX NO. : 0154

GROUP : 3 (2/2009)
 LEARNING OBJECTIVES

1. State the Meaning or Definition of Pulmonary Hypertension.

2. State the Etiology of Pulmonary Hypertension.
3. Explain the Pathophysiology of Pulmonary Hypertension.
4. State the Clinical Manifestation of Pulmonary Hypertension.
5. List down the Complication of Pulmonary Hypertension.
6. Explain the Management for patient with Pulmonary Hypertension.
7. Carry out the care for patient with Pulmonary Hypertension using
nursing process.
8. Appreciate the Health Education given for the patient in home care
planning.
NURSING ASSESSMENT
 NURSING ASSESSMENT

 Name : Mr S
 Sex : Male
 MRN Number : 287828
 Age : 41 years old
 IC No. :681028-01-5703
 Address :Tiang 6, belakang taman suraya,
jalan kukup, 8200 Pontian Johor
 Tel. No. : 013-7557575
 Marital Status : Married with 4 children
 Occupation : Factory worker(lorry driver)
 Race : Malay
 Religion : Islam
 Language spoken : Malay, English
 Ward : 6th floor(premier)
 Room No. : 621B
 Consultant : Dr. Y
 Date and Time of admission : 10th May 2010 @ 1915 hours
 NURSING ASSESSMENT

 Reason of admission : c/o cough with blood x2/52

 Medical history : Nil
 Surgical history : Nil
 Family history : Nil
 Current Medication : Nil
 Allergics : Nil
 Diagnosis : Pulmonary Hypertension
 Date of discharge : 12 May 2010 @ 1030 hours
 Date of follow up :
26 May 2010 @ 1130 hours at Dr. Y clinic
 NURSING ASSESSMENT

During the admission time in the ward, his vital sign has been taken
and the result is as follow :

Temperature : 35.70 C
Pulse : 82 beats/min
Respiration : 18 breaths/min
Blood Pressure : 146 / 101 mmHg
Weight : 79 kg
Height : 166 cm
PHYSICAL EXAMINATION
 PHYSICAL EXAMINATION
Inspection Of The Head :
 Hair : Mr S hair is curly; black in color. Its structure is fine and soft.
 Eyes : Mr S eyes is quite normal. His eyes is free from pale or jaundice
(yellow)
 Ears : Mr S hearing is normal. He can hear without any complication and
he can hear clearly.
 Mouth : Mr S mouth is moisture, there is no oral mucosa presence, no
lesions at tongue. Gums and teeth are normal.
 Neck : Mr S neck is normal, there is no swelling or surgical scars.
 Face : Mr S face is round in shape, there is no presence of edema or
scars at his face.
Inspection Of The Body :
 Chest : Mr S chest is normal, he can breath well without any
complication. There is no edema or swelling.
 Axilla: Mr S axilla is normal. There is no presence of lymph nodes, no
infection of fungal.
 Abdomen : Mr S abdomen is normal, there is no surgical scars,
tenderness or mass.
 PHYSICAL EXAMINATION
Inspection Of The Upper Limbs :
 Nails : Mr S nails are clean, no clubbing spoon shape. I pintch at his
nails to check his blood circulation and its normal.
 Fingers : Mr S fingers is normal and adequate. Movement of the
fingers also normal.
 Skin : Mr S has a good condition of skin, no rashes or sign of
dehydration. No presence of lesion or scars.
Inspection Of Groin And Genitalia :
 Actually for this part of examination, Mr S is refused, he don’t want to
expose it. But he told me that he always take good care of his groin and
genitalia. He saids that there is no infection of fungal, no discharge or
swelling.
Inspection Of The Lower Limbs :
 All is normal, in correct allignment, good movement and blood
circulation and there is no varicose vein.
Inspection Of Spine :
 Mr S spine is normal, no tenderness, mass, backache or pressure sore.
 There is no hordosis ( an abnormal forward curve of the lumbar spine ).
ACTIVITY OF DAILY LIVING
 ACTIVITY OF DAILY LIVING

 Breathing :
Mr S can breath normally without any complication. His depth
respiration is normal. His rhythm of respiration is regular and
normal and the character of his breathing is normal and no more
sound is out from her breathing.

 Cough :
When Mr S is admitted he is having a coughing with blood.

 Smoke :
Mr S is a smoker.

 Eating / Drinking :
When Mr S is admitted at the hospital, I see that he is not having
any problems to eat but he verbalized that he cannot eat the diet at
the hospital, he loss appetite. At home, he eat all foods witout any
good diet, he likes to eat curry, all the kind of foods. About
drinking, he drink a lot of water daily.
 ACTIVITY OF DAILY LIVING
 Bowel elimination :
Mr S past motion daily everyday.

 Bladder elimination :
Mr S past urine every 3 – 4 hours per day. And he don’t have any
problems to passing his urine and he don’t get up at night to past
urine.

 Sleeping :
Mr S said to me, he hasn’t any problem in sleeping.

 Mobility :
Mr S is independent. He able to move without any assisstant.

 Personal Hygiene :
Mr S personel hygiene is maintain. He said to me that he always
have his shower twice a day.
 ACTIVITY OF DAILY LIVING

 Safe Environment :
Mr S safe environment is safety, he just need a siderails to prevent his
from accident and drop to the floor .

 Communication :
Mr S can speak in English and Malay language clearly and he can
understand properly.

 Spiritual :
Hospital is allowed his to bring any prayers for his safety from
mosque or surau.

 Hobby :
Mr S likes to reading when he in free time. He likes to read newspaper
and books.
ANATOMY AND PHYSIOLOGY
 ANATOMY AND PHYSIOLOGY
Heart
The heart is roughly cone-shape hollow muscular porgan. It is about
10cm long and is about the size of owners fist. It weight about 225g in
women is heavier in men about 310g.
Position Of The Heart
The heart lies in the thoracic cavity in the media sternum between the
lungs. It lies obliquely, a little more to the left than the right, and
presents a base above, and an apex below. The apex is about 9 cm to the
left of the midline at the level of the 5th intercoastals spaces, a little
below the nipple and slightly nearer the midline. The base extends to the
level of the 2nd rib.
Structure Of The Heart
A double-layered membrane called the pericardium surrounds like a sac.
The outer layer of the pericardium surrounds the roots of the hearts
major blood vessels and is attached by ligaments to spinal column,
diaphragm and other part of body. The inner layer of the percardium is
attached to the heart muscle.
 ANATOMY AND PHYSIOLOGY

The heart has 4 chambers. The upper chambers are called the left and
right atria, and the lowers chambers are called the left and right
ventricles. A wall of muscle called the septum separates the left and the
right atria and the left and the right ventricles. The left ventricles is the
largest and the strongest chamber in the heart. The left ventricles
chambers walls are only about a half-inch thick, but they have enough
force to push blood through the aortic valve and into the body.
Function Of The Heart
The role of the heart is to deliver the oxygen in order to live and
function. The role of heart is to deliver the oxygen-rich blood to every
cell in the blood. The arteries are the passageways through which the
blood is delivered. The largest artery is the aorta, which branches of the
heart and then divides into many smaller arteries. The veins carry
deoxygenated blood back to the lung to pick up more oxygen, and then
back to the heart once again. Blood flows continuously through the
circulatory system, and the heart muscle is the pump which it all
possible.
ANATOMY AND PHYSIOLOGY
 ANATOMY AND PHYSIOLOGY
FLOW OF BLOOD THROUGH THE HEART

UNOXYGENATED BLOOD

Superior and Inferior vena cava

Right atrium

Right atrioventricular valve

Right ventricle

Pulmonary valve

Pulmonary artery

Lungs

OXYGENATED BLOOD

Pulmonary veins

Left atrium

Left atrioventricular valve

Left ventricle

Aortic valve

Aorta

* Refer diagram – Direction of blood flow through the body.

ANATOMY AND PHYSIOLOGY
 ANATOMY AND PHYSIOLOGY

Blood Vessels

Arteries And Arterioles

Transport blood away from the heart. Consist more elastic tissue and
less smooth muscle. It also has thicker walls and enables them to
withstand the blood pressure.
Veins And Venules :
Return blood at lower pressure to the heart. The walls are thinner
because less muscle and elastic tissue.
Structure Of Blood Vessels Walls
The blood vessels walls consist of three layers :
Tunica Intema
 Inner most layer.
 Endothelium
I – Simple squamous
Some larger vessels have subendothelium
I – Loose connective tissue.
II – Basement membrane.
 ANATOMY AND PHYSIOLOGY
Tunica Media
 Middle layer.
 Circulatory arranged smooth muscle.
 Chemical and nervous control of degree of contraction.
I – Sympathetic nervous system.
Change in diameter
I – Vasoconstiction
II – Vasodilation
Tunica Adventitia
 Made of collagen fibers
 Function : protection, reinforcement, anchor to surrounding tissue.
 Accessory tissue : nerve fibers, lymphatic vessels, elastic network, tiny
blood vessels within layer – vasa vasorum.
Arterial Systems
 Classification based on size and function.
Elastic ( conducting ) arteries
Characteristics :
I – Thick – walled
II – Near heart
III – Largest diameter
IV – More elastic
 ANATOMY AND PHYSIOLOGY

V – Large lumen
Properties :
I – Dampen BP changes associated with heart contraction.
II – Passive accomodation results in smooth flow of blood.
Size : 2.5 cm
Muscular arteries – distributing arteries
 Distal to elastic arteries.
 Deliver blood to specific organs.
 Thick media layer.
I – More smooth muscle.
Size : 0.3 – 1.0 cm
Arterioles
 Determine flow into capillary beds.
 Mostly smooth muscle.
 Size : 10 um – 0.3 cm.
 ANATOMY AND PHYSIOLOGY
Capillaries

 Smooth blood vessels.

 I – 8 – 10 um
 Tunica intema only.
 Exchange of materials.

Control Of Blood Vessels Diameter.

 Vasometer centre in the medulla oblongata supplies nerves to the smooth

muscle fibres, of all blood vessels except capillaries.
 These nerves can change the diameter of the lumen of the blood vessels and
control the volume of blood they contain.
 Small arteries and arterioles respond to nerve stimulation whereas the
diameter of large arteries varies according to the amount of blood they
contain due to the quantity of muscle tissues.
 ANATOMY AND PHYSIOLOGY
Vasodilation and vasoconstriction.

 Decreased muscle stimulation – smooth muscle relax, vessel wall

thinned, lumen enlarged – VASODILATION – increased blood flow.
 Increased nerve stimulation – increased thickness and contraction –
VASOCONSTRICTION – decreased blood flow.
 Peripheral resistance :
 Provided by arterioles to maintain homeostasis of blood pressure.
 Determined by 3 factors : diameter, length and viscosity of fluid
involved.

Auto regulation.

 Accumulation of metabolities in local tissues can influence the degree of

dilation of arterioles to ensure adequate blood supply to meet tissue
need.
 Example : lactic acid accumulates in muscles after exercise causes
vasodilation.
 DEFINITION OF PULMONARY HYPERTENSION
 The right ventricle pumps blood returning from the body into the
pulmonary arteries to the lungs to receive oxygen. The pressures in the
lung arteries (pulmonary arteries) are normally significantly lower than
the pressures in the systemic circulation. When pressure in the pulmonary
circulation becomes abnormally elevated, it is referred to as pulmonary
hypertension.
(http://www.medicinenet.com/pulmonary_hypertension/article.htm#tocc)
 Pulmonary hypertension is defined as the mean pulmonary artery blood
pressure greater than 25 millimeter of mercury (mmHg) measured by
right heart catheterization. The pressures can be much higher than 25
mmHg in some people. Therefore, the pulmonary hypertension can be
labeled as mild, moderate, or severe based on the pressures.
 Mean arterial pressure is two-thirds of the difference
between systolic and diastolic blood pressure (systolic is the upper
number and diastolic is the lower number in measuring blood pressure).
 Pulmonary hypertension generally results from constriction, or stiffening,
of the pulmonary arteries that supply blood to the lungs. Consequently, it
becomes more difficult for the heart to pump blood forward through the
lungs. This stress on the heart leads to enlargement of the right heart and
eventually fluid can build up in the liver and other tissues, such as the in
the legs.
 In the conventional classification, pulmonary hypertension, is divided
into two main categories:
1) primary pulmonary hypertension (not caused by any other disease or
condition)
2) secondary pulmonary hypertension (caused by another underlying
condition)
 Primary pulmonary hypertension has no identifiable underlying cause.
Primary pulmonary hypertension is also referred to as idiopathic
pulmonary hypertension.
 Primary pulmonary hypertension is an unusually aggressive and often
fatal form of pulmonary hypertension that commonly affects young
people. Whereas it is known that the arterial obstruction is caused by a
building up of the smooth muscle cells that line the arteries, the
underlying cause of the disease has long been a mystery.
 ETIOLOGY – FOR ESSENTIAL PULMONARY
HYPERTENSION
1. HEREDITY

2. SMOKING

3. OBESITY

4. DIABETES

5. DIET

6. STRESS

7. RACE

8. MINERAL INTAKE

9. INSULIN RESISTANCE

10. *UNKNOWN
ETIOLOGY – FOR SECONDARY HYPERTENSION

1.RENAL DISEASE(renal vascular and parenchymal disease).

Example : glomerulonephritis, pyelonephritis, renal tumors.

2. ENDOCRINE DISORDER
Example : primary aldosteronism, crushing’s syndrome.

3. COARCTATION OF THE AORTA

4. NEUROGENIC
Example : Brain tumors, Encephalitis.

5. PREGNANCY

6. INCREASE INTRAVASCULAR VOLUME

7. BURNS
PATHOPHYSIOLOGY
 CLINICAL MANIFESTATION

1. Morning occipital headache

2. Weak/fatigue

3. Dizziness

4. Nausea and vomiting

5. Palpitation

6. Flushing

7. Hemoptysis(coughing up blood)

8. Shortness of breath
 COMPLICATION

1. Hypertensive heart disease

2. Heart attacks
3. Congestive heart failure
4. Blood vessels damage (arterosclerosis)
5. Aortic dissection
6. Kidney failure
7. Stroke
8. Brain damage
9. Loss of vision

* There is no complications that occurs to Mr S.

MANAGEMENT OF PATIENT WITH
HYPERTENSION
 INVESTIGATION

The investigation that done to

Mr S are :

1. Urine FEME
2. Blood Test
3. Chest X-ray
4. CT Scan Angiogram
5. Electrocardiogram(ECG)
6. Echocardiography
 INVESTIGATION
PATHOLOGY REPORT
Date :10 May 2010 @1932 hours

examination result unit Reference range

Urine FEME (urinalysis)
Appearance,urine Yellow clear Yellow /pale yellow
Specific gravity,urine 1.005 1.005-1.025
pH,urine 7.0 4.8-7.5
Protein,urine Negative Negative
Glucose,urine Negative Negative
Ketone,urine Negative Negative
Bilirubin screen,urine Negative Negative
Urobilinogen,urine Normal Normal
Nitrite,urine Negative Negative
Leukocytes esterase,urine Negative Negative
Blood,urine Negative Negative
 INVESTIGATION
PATHOLOGY REPORT

examination Result unit Reference range

Microscopic examination,urine
WBC,urine 3/hpf 0-5
RBC,urine 0/hpf 0-3
Epithelial cell,urine Nil
Cast,urine Nil
Crystal,urine Nil
Bacteria,urine Nil
yeast, cell,urine Nil
Others,urine Nil
 INVESTIGATION
PATHOLOGY REPORT
Date :10 May 2010 @ 1802 hours

Full executive screening male (GP61J)

examination Result unit Reference range
Haematology
Haemaglobin 16.3 g/dL 13.0-18.0
Red cell count 5.6 10 12/L 4.5-5.9
Haematocrit (PCV) 48% 41-53
MCV 86 fl 80-96
MCH 29 pg 26-34
MCHC 34 g/dL 31-36
Platelet count 260 10 3/UL 150-450
ESR 5 mm/hr 0-15
White blood cell count 9.9 10 3/UL 4.3-10.5
 INVESTIGATION
PATHOLOGY REPORT

examination Result unit Reference range

White blood cell differential count
Neutrophil 51.2% 40-75
Lymphocyte 41.0% 20-45
Eosinophil 2.0% 0-6
Monocyte 5.5% 1-11
Basophil 0.3% 0-2
 INVESTIGATION
PATHOLOGY REPORT

Peripheral blood film comment:

 Red cells show normochomic and normocytic picture.
 White cell appear normal.
 Platelet are adequate.

~coagulation test~
INR 1.18 0.85-1.35
The INR (International normalised ratio) is a good indicator of the affectiveness and risk of
bleeding during warfarin therapy and is kept about 2.5,with a target range of 2.0-3.0 for most
clinical conditions.

~biochemistery~
Diabetes mellitus screen
**glucose 6.7 mmol/L 3.9-6.1
 INVESTIGATION

Renal function & bone metabolism screen

examination Result unit Reference range

**uric acid 499 u mol/L 202-434
Creatinine 70 u mol/L 51-133
Urea 4.4 mmol/L 2.0-6.8
Sodium 139 mmol/L 135-155
Potassium 4.5 mmol/L 3.5-5.5
Chloride 102 mmol/L 95-111
Calcium 2.31 mmol/L 2.20-2.55
Phosphate 1.23 mmol/L 0.78-1.50
 INVESTIGATION

examination Result unit Reference range

Lipid profile
**total cholesterol 5.7 mmo/L <5.2
**tryglycerides 2.30 mmo/L <2.28
**HDL cholesterol 1.15 mmo/L >1.42
**LDL cholesterol 3.5 mmo/L <2.6
**chol/HDL cholesterol 4.8 mmo/L Up to 4.0

Risk classification of lipid profile of Laboratory Standardization Panel of National Cholesterol Education
Program (adult treatment panel III) in United states:
-----------------------------------------------------------------------------------------------------------------------------------------
Risk classification cholesterol Tryglycerides HDL-chol LDL-chol
Desirable <5.2 <1.71 >1.42 <2.6
Borderline 5.2-6.2 1.71-2.28 1.03-1.42 2.6-4.1
Risk indicator >6.2 >2.28 <1.03 >4.1
-----------------------------------------------------------------------------------------------------------------------------------------
 INVESTIGATION

Examination Result unit Reference range

Liver function screen
Total protein 73 g/L 63-83
Albumin 43 g/L 35-50
Globulin 30 g/L 25-40
A/G ratio 1.4 1.0-2.0
Total bilirubin 5.3 u mol/L 2.0-28.0
Direct bilirubin 1.6 u mol/L <6.8
Indirect bilirubin 3.7 u mol/L <20.5
SGOT/AST 18 U/L 7-44
SGPT/ALT 18 U/L 7-48
CKMB 19 U/L <25
Lactate dehydrogenase, LDH 403 U/L 211-423
Alkaline phosphate 65 U/L 45-122
**Gamma –GT 52 U/L 11-50
 INVESTIGATION
PATHOLOGY REPORT

Examination result unit reference range

-serology-
--blood group--
ABO group O
Rheusus group (D) positive
--Thyroid function screen--
Free T4 17.9 p mol/L 9.1-24.4
TSH 1.38 m IU/L 0.30-4.50
--rheumatoid factor screen--
Rheumatoid factor 4.7 10 /mL <15
 INVESTIGATION

PATHOLOGY REPORT

Examination result unit reference range

--veneral disease screen--
VDRL(RPR) non reactive non reactive
--AIDS screen--
HIV I/II antigen/antibodies non reactive non reactive
H .pylory antibody (qualitiative) negative negative
--hepatitis screen--
*Hep A virus (HAV)IgG non reactive
Interpretation : positive to Hep A virus antibody.
May indicate absence of immunity against Hep A virus. Advice vaccination.
 PATHOLOGY REPORT

Examination result unit reference range

--Hep B screen--
HBs antigen non reactive non reactive
HBs antibody <2.0 mIU/ML
HbsAb interpretation: non reactive ,no protective level of anti Hbs
Recommendation :vaccination/booster if HbsAg is non reactive
--cancer marker screen--
Alpha-fetoprotein 1.9 ng/mL <15.0
Prostate specific antigen(PSA) 0.19 ng/mL <4.0
As an acid in the detection of prostate cancer when used in conjection with digital rectum exam(DRE)
in men 50 years old or older.
Prostatic biopsy in required for diagnosis of cancer.
CEA 1.6 ng/ML <5.0
 INVESTIGATION
RADIOLOGIST REPORT

Service:
Doppler USG lower limbs:

 Both femoral, popliteleal and posterior tibial veins and arteries have
normal wavepattern.
 These veins are compressible.
 Augmentation test was positive for both veins.
 No trombus within.

IMP: The deep veins of both lower limbs are patent.

 INVESTIGATION
RADIOLOGIST REPORT
Service:
CT Thorax:
Post contrast contigous 10mm axial images from the apixes of the thorax to the adrenal.
 There are scattered ground glass changes in both lungs, predominantly in lateral segment of
the middle lobe,superobasal and medialbasal segments of both lower lobes and
apicoposterior segment of the left upper lobe.
 There are no areas of decrease vascularity or eligmia in both lungs fields.
 The bronchial walls are not thickened.
 No fluid within bonchi.
 There are no mediastinal or hilar masses.
 There are no pleural abnormalities.
 The thoracic aorta and pulmonary vasculature are intact.
 There are no intra luminal filling defects to suggest foci of emboli in the main pulmonary
artery and branches.
 No aortic dissection or aneurysmal dilatation seen.
 The heart size is normal.
 The adrenals are not enlarged.
 INVESTIGATION
RADIOLOGIST REPORT

IMP:
 Features would be suggestive of bilateral pneumonitis/alveolitis.
 No features of pilmonary embolism.
 No mediastinal lymphadenophathy.
 MEDICATION

NAME DOSAGE FREQUENCY ROUTE PACKING DATE ON

VERAPAMIL 40 mg BD Oral Tablet 11/5/2010

INDEX 30 mg DAILY Oral Tablet 11/5/2010
PARACETAMOL 50 mg DAILY Oral Tablet 12/5/2010
 NURSING CARE PLAN

1. Knowledge deficit related to home care management of

hypertension.
 Name : Mr S
NURSING CARE PLAN 1 MRN No. : 287828
PSH Age : 41 years
DIAGNOSIS : PULMONARY HYPERTENSION Sex : Male
Dr. Y

S/N Nursing Diagnosis Goal Nursing Action Initiated Evaluation Sign

By Sign

1. Date / Data Date/ Time /

Time Data

10 Knowledge deficit Patient will 1. Assess patient 10 May 2010

May related to home care verbalize that he understanding @ 2110
2010 management of will better about his disease. hours.
@ pulmonary understanding ® As a baseline 1. Patient
1910 hypertension. about data to plan verbalized
hours This is evidenced in management of nursing that he
: disease after intervention. understands
Patient verbalized explanation given (I) During how to
that he does not within 2 hours assessment, I manage his
understand well during identify my disease.
regarding to hospitalization. patient knowledge 2. Patient
STN
pilmonary about verbalized SULAIMI
hypertension. management of that he will
diet, exercise, etc STN follow the
is not clear. SULAIMI advice.
2. Re-explain to
the patient by
using layman
what the doctor
said.
® To ensure that
he understand
about his
condition.
(I)I used ‘Bahasa
Malaysia’ when
communicate with STN
SULAIMI
my patient.
3. Encourage
patient to ask
question about
management of
disease.
® To ensure
patient understand
and clear
explanation given.
(I) My patient
asks about diet STN
and hour to SULAIMI
control tension.
4. Advice patient
to take low salt
diet, diabetic diet,
soft diet, take
more vegetables
and fruits.
® Salty food may
increase patient
Blood Pressure
and fat food
increase body
weight.
(I)I advice my
patient to not
STN
taking high SULAIMI
cholesterol.
5. Teach patient to
do an exercise
once a week.
® For better
healthy living.
(I)I ask patient to STN
go for jogging SULAIMI
once a week.
6. Ensure patient
to complete his
medications at
home.
® Because at
home there was
no nurse to
remind him to
take his
medications
everyday.
(I)I advice patient
to take his
medications at
home & do not STN
stop without SULAIMI
doctor advice.
7. Advice patient
to come for follow
up as ordered by
doctor.
® To monitor his
progress and
condition.
(I)I encourage
patient top come
for his next follow
up because it is STN
SULAIMI
important to see
his progress.
8. Ask patient to
change his
lifestyle to reduce
his stress.
® Tension
increase the blood
pressure which
can cause
hypertension. STN
(I)I advice patient SULAIMI
to take for relax.
9. Explain to the
patient about the
early clinical
manifestation and
the complication.
® To detect any
abnormalities
earlier.
(I)I encourage
patient to see
doctor if he
complain having
numbers of the
extremities / STN
severe headache SULAIMI
and giddiness.
 HEALTH EDUCATION

 LIFESTYLE-Encourage patient to do tolerated exercise

such as jogging.I also advice my patient to stop smoking.
 MEDICATION-I advice to my patient to take the
medications following right time and dosage.
 FOLLOW UP-I advice my patient to come foe follow up
after discharge with doc Y.
 DIET-Encourage patient to take well balanced diet and
avoid taking oily foods.
 DISCHARGE

During discharge time, his condition of vital sign is stable with :

Temperature :36.80C
Pulse :70 bpm
Respiration :20 bpm
Blood Pressure :140 / 90 mmHg
 FOLLOW UP

During the first follow up, his condition of vital sign is more stable
with :

Temperature :36.50C
Pulse :80 bpm
Respiration : 21 bpm
Blood Pressure : 130 / 90 mmHg
 SUMMARY

During the admission time in the ward, his vital sign has been taken
and the result is as follow :

Temperature : 35.70 C
Pulse : 82 beats/min
Respiration : 18 breaths/min
Blood Pressure : 146/ 101 mmHg
Weight : 79 kg
Height : 166 cm

Mr S next appoinment on 23 June 2010 at clinic doctor Y.

REFERENCES
 REFERENCES

 Walsh M.,(2004) Watson’s Clinical Nursing and Related Sciences (6th

Edition), Baillire Tindall, New York.(p.p 247 – 331).
 Waugh A., and Grant A., (2002) Rose and Wilson, Anatomy and
Physiology (9th Edition), Churchill Livingstone, New York (p.p 78 –
127).
 MIIMS Annual Malaysia, Dims,P.J, Malaysian Index of Medical
Specialisties 101st Edition (2005) Sdn. Bhd. CMP (Clinical Business
Media).
 MIMS Annual Malaysia, Dims, P.J,(Full prescribing information) 16th
Edition (2004) Sdn. Bhd.
 REFERENCES

 www.yahoo.com/hypertension
 http://www.americanheart.org/-- American College of Cardiology
(800-253-4636)
 http://www.ash-us.org/ -- American Society of Hypertension
 www.nhlbi.nih.gov/hbp -- National Heart, Lung, and Blood Institute
 http://www.heartinfo.org/ -- Information on the heart
 http://www.heartriskevaluations.com/ -- A useful heart risk evaluation
test
 http://www.ishib.org/ -- International Society on Hypertension in
Blacks
 THE END,
THANK YOU!!!!!

PREPARED BY
STN SULAIMI SADIRAN