CHAPTER ONE

INTRODUCTION

Background Of The Study

Hypertension is a long-term condition where blood pressure is increased. It is the leading

cause of death worldwide, affecting more than 1.4 billion people and accounting for more

than 28,000 deaths each day. Initially it does not cause any symptoms but if left untreated it

can lead to stroke, heart attack, kidney disease, vision loss, and dementia. Control of high

blood pressure can help protect against these conditions and there are many steps that can be

taken to help lower blood pressure (WHO 2020).

The 2023 European Society of Hypertension guidelines for hypertension define it as a blood

pressure reading of 140/80 or higher. The 2017 American College of Cardiology/American

Heart Association guidelinesTrusted Source define hypertension as a blood pressure reading

of 130/80 or higher.

Clinical medical guideline, 2023 define hypertension has a blood pressure higher than 140

over 90 mm of mercury (mmHg). The systolic reading of 140mmHg refers to the pressure at

the heart contracts and pumps blood to the body while diastolic reading of 80 mmHg refers to

the pressure as the heart as the heart relaxes and refills blood.

Hypertension is also known as "silent killer" because of absence of typical signs and

symptoms and many people are even on aware of having hypertension. Some patients may

experience symptoms such as dull headache, dizzy spell vomiting, drowsiness, and more

frequent nose bleeding. The only way to diagnose hypertension is measurement of blood

pressure by some physicians or other healthcare professionals. Various factors that increase

the person's risk for developing hypertension include health condition, lifestyle, and family

history. Some risk factors cannot be controlled such as age, race, family history, while others

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such as physical activity, diet, and stress can be controlled to decrease the risk of developing

hypertension in patients.

Hypertension is a complex condition with many causes including lifestyle factors, such as

physical activity, a rich diet with high processed and fatty food, alcohol and tobacco use.

Unfortunately, the incidence of hypertension is increasing at an alarming rate from developed

countries to emerging economies such as India, China and Africa countries.

According to David (2019), the clinical manifestation of hypertension in blue light

headedness, vertigo, tinnitus, altered vision, dyspnea, orthopnea, anorexia, and Edema.

Treating high blood pressure can take a multi-pronged approach including the diet changes,

medication, and exercise someone the lifestyle changes include dietary changes physical

exercise and weight-loss why some.

Some medication used in treating hypertension include but not limited to the following

calcium channel blockers angiotensin-converting enzyme inhibitors angiotensin 2 receptor

blockers, diuretics, beta blockers etc .All these drugs work in a variety of ways to lower

blood pressure for (Bauman,2020).

According to Adam selman 2019 hypertension is another name for high blood pressure. it can

lead to severe health complication and increase the risk of heart disease, stroke, and

sometimes death.

The first line of treatment for hypertension is lifestyle changes including dietary changes,

physical exercise and weight loss, though these have all been recommended scientific

advisories (Bauman 2020)

Description of the disease condition

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 Hypertension is a chronic medical condition that leads to increase susceptibility of life

threatening coronary heart disease and stroke, the number one and two leading cause of death

in the united state are directly attributed to hypertension (marshall, et al, 2020).

Hypertension is defined as the average systolic or diastolic blood pressure on three or more

occasion, equal or higher than the 95th percentile appropriate for the sex, age and height of

the individual. High blood pressure must be confirmed on repeated visit however, before

characterizing an individual as having hypertension (chiolero, cachet, Burnier, paccaud &

Bovet 2020).

Blood pressure is determined both by the amount of blood your heart pumps and the amount

of resistance to blood flow in your arteries. The more blood your heart pumps and the

narrower your arteries, the higher your blood pressure. A blood pressure reading is given in

millimeters of mercury (mmHg). It has two numbers.

Top number (systolic pressure): The first, or upper, number measures the pressure in your

arteries when your heart beats.

Bottom number (Diastolic pressure): The second, or lower, number measures the pressure

in your arteries between beats.

Normal blood pressure ranges from 115 to 120mmHg systolic and 75 - 80mmHg diastolic.

The normal pulse pressure, which is the difference between the systolic and diastolic levels,

is approximately 40mmHg.

World Health organization classified pressures of 140/90mmHg or less as normal and

160/90mmHg or more as hypertensive.

Based on the above premise, hypertension can be defined as persistent elevation of blood

pressure above 140/90 mmHg.

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You can have high blood pressure for years without any symptoms; uncontrolled high blood

pressure increases your risk of serious health problems, including heart attack and stroke.

Fortunately, high blood pressure can be easily detected, and once you know you have high

blood pressure, you can work with your doctor to control it.

High blood pressure contribute to the risk of coronary heart disease, stroke (thromboembolic

and haemorrhagic) and damage to the heart, brain, kidney and retina.

The levels of systolic and diastolic blood pressure used to define hypertension are arbitrary.

There are no thresholds of risk for the sequelae of hypertension, the higher the blood

pressure, the higher the risk. However, thresholds can be defined based on evidence of the

effectiveness of pharmacological interventions at different blood pressure levels. For

essential hypertension, we have adopted such thresholds.

Pulse pressure is the difference between the systolic and diastolic blood pressure readings. It

reflects the force exerted by the heart each time it contracts.For example, if a person's blood

pressure is 120/80 mmHg, their pulse pressure would be 40 mmHg (120 - 80 = 40).Pulse pressure is

an important indicator of cardiovascular health and can provide insights into conditions such as

arterial stiffness or heart failure.

Types of Hypertension

Blood pressure can be checked at any age. However, routine blood pressure screenings are

typically recommended starting around age 3 during regular pediatric check-ups. For adults,

it's generally advised to have blood pressure checked at least once every two years, starting at

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age 18. However, if there are risk factors for hypertension or other health concerns, more

frequent

There Are Two Types Of Hypertension

1. primary hypertension

2. secondary hypertension

1. Primary hypertension

Primary hypertension is also known as essential hypertension. Most adults with hypertension

have this type.

This is the most common type of hypertension, accounting for about 90-95% of cases.

Primary hypertension develops gradually over time with no identifiable cause. It's often

related to lifestyle factors such as diet, physical inactivity, obesity, stress, and genetics.

Despite years of research on hypertension, the specific cause isn’t known. It’s thought to be a

combination of:

1. genetics

2. diet

3. lifestyle

4. age

5. Lifestyle factors that may contribute to hypertension include:

6. smoking

7. too much alcohol consumption

8. stres

9. overweight or obesity

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 10. too much salt in your diet

11. lack of exercise

12. Changes in your diet and lifestyle can lower your blood pressure and your risk of

complications from hypertension.

secondary hypertension

This type of hypertension is caused by an underlying medical condition or certain

medications. Secondary hypertension accounts for about 5-10% of cases. Underlying

conditions that can cause secondary hypertension include kidney disease, adrenal gland

tumors, thyroid problems, obstructive sleep apnea, and certain congenital heart defects.

If you have secondary hypertension, it means your high blood pressure has an identifiable —

and potentially reversible — cause.

Only 5% to 10% of cases of hypertension are the secondary type.

Secondary hypertension is more prevalent in younger people. An estimated 30% of people

ages 18 to 40 years old who have hypertension have the secondary type.

Classification of Blood pressure for Adults Age18 and older

Hypertension may be mild, moderate and severe

 Normal blood pressure: 120/80 mmHg

 Low blood pressure: Below 90/60 mmHg( hypertension)

 Pre- hypertension: 120/80 - 139- 89 mmHg(mild hypertension)

 Stage 1 hypertension:140/90 - 149/99 mmHg(moderate hypertension)

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  Stage 2 hypertension:150/100- 160/100 above (severe hypertension)

Optimal blood pressure with respect to cardiovascular risk is below 120/80 mmHg. However,

unusually low readings should be evaluated for clinical significance. Based on the average of

two or more readings taken at each of two or more visits after an initial screening.

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 Objectives of the study

1. To gain more knowledge on hypertension, it's causes, predisposing factors, clinical

manifestations, incidence, management, prevention and prognosis.

2. To assist the clients and family adopt to treatment pattern of hypertension while in the

hospital or at home.

3. To impact the whole knowledge to client, his family and the entire society.

DEFINITION OF TERMS

1. Hypertension: This is defined as persistent elevation of blood pressure above

140/90mmHg.

2. Heart: The heart is a hollow muscular organ which pumps blood through the blood

vessels of the circulatory system to organs of the body.

3. Angina: Chest pain due to inadequate supply of oxygen to the heart.

4. Blood pressure: The pressure of blood within the artery.

5. Systolic pressure: The maximum pressuring during ventricular contraction.

6. Diastolic pressure: The lowest pressure that remains in the arteries before the next

ventricular contraction.

7. Stroke volume: The volume of blood pumped by each ventricle in every heartbeat.

8. Dyspnea: Difficulty in breathing

9. Congestive heart failure: This is the ability of the heart to inadequately pump blood

which can be as a result of untreated high blood pressure, heart attack or infections.

10. Contraction: The tightening and softening of a muscle.

11. Artery: A vessel that carries blood high in oxygen content from the body away from

the heart to the body.

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12. Vein: A blood vessel that carries blood that is low in oxygen content from the body

back to the heart.

13. Angiotensin converting Enzyme (ACE) inhibitors: Medications use in treatment of

high blood pressure. It prevents the body from making the chemical angiotensin11.

These drugs relax blood vessels.

14. Prognosis: The forecast of the probable outcome or course as a disease.

15. Pulse: The rhythmic dilation of artery that results from beating of the heart.

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10
ANATOMY AND PHYSIOLOGY OF THE AFFECTED ORGAN( Research gate 2020)

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The heart:

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According to Anne and Allison (2020), The heart is a roughly cone shaped hollow muscular

organ. It is about 10cm long and is about the size of owner fist. It weighs about 225g in

woman and is heavier in men (about 310g)

Position:

The heart lies in the thoracic cavity in the mediastanum (the space 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 9cm to the left of the midline at the level of the 5th intercostal space

i.e a little below the nipple and slightly nearer the midline. The base extends to the level of

the 2nd rib.

Waugh and Grant (2019) said that the heart is surrounded by structure which includes:

 Inferiorly: the apex rest on the central tendon of the diagram

 Superiorly: the great blood vessels, I. e the aorta, superior vena cava, pulmonary

artery and pulmonary veins

 Posteriorly: the oesophagus, trachea, left and right branchus, descending aorta,

inferior vena cava and thoracic vertebrae.

 Laterally: the lungs- the lungs overlaps the left side of the heart

 Anteriorly: the sternum, the ribs and intercoastal muscles.

Layers of the heart

According to Waugh and Grant(2020) the wall of the heart is made up of 3 layers of tissue,

namely,

 Pericardium

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  Myocardium

 Endocardium

Pericardium: is the outmost layer and is made up of 2 closed sacs, the outer sac is called

fibros pericardium and consist of fibrous tissue. The inner is called serous pericardium and it

consists of a double layer of serous membrane. The outer layer of serous pericardium lines

the fibrous pericardium. The inner layer called visceral pericardium is adherent to the heart

muscle. Between the layers of the serous pericardium, there is a thin film of serous fluid

(pericardial fluid) secreted by the epithelial cells of the membrane, the fluid allows smooth

movement when the heart beats.

Myocardium: This is the middle layer of the heart. It is composed of cardiac muscle found

only in the heart. Cardiac muscles have the ability of contracting as a unit, so fibres are not

stimulated individually. Within the myocardium is a network of specialized conducting fibers

that helps transmit the heart's electrical signals. The myocardium is thickest at the apex

(ventricle) especially the left ventricles due to its greater workload. Specialised muscle cells

in the Atrial secrete atrial Natriuretic peptide( ANP).

Endocardium: This is the innermost layer of the heart. It lines the chamber of the heart and

also forms the valve of the heart. This layers consist of simple squamous epithelium that is

continuous with the endothelium of the blood vessels.

Blood supply

The heart receives arterial blood supply through the right and left coronary arteries. The

coronary arteries branch out from the aorta immediately after the aortic valve and enter into

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the wall of the heart forming a vast network of capillaries that provides nutrients and oxygen

to the tissues of the heart. The coronary arteries receive about 5% of the cardiac output.

These arteries branch off from the aorta, the main artery that carries oxygen-rich blood from

the heart to the rest of the body.The two main coronary arteries are the left coronary artery

(LCA) and the right coronary artery (RCA). The left coronary artery further divides into the

left anterior descending artery (LAD) and the left circumflex artery (LCx). These arteries

supply oxygenated blood to different regions of the heart muscle.The coronary arteries supply

the heart with the oxygen and nutrients it needs to function properly. Any blockages or

narrowing in these arteries can lead to reduced

Venous drainage: The heart drained by many tiny veins which joins up to form a bigger vein

called the coronary sinus that helps to empty the venous blood into the right atrium.

The function of the heart

The heart is a vital organ responsible for pumping blood throughout the body, delivering

oxygen and nutrients to tissues and organs while removing waste products. Its main functions

include:

1. Pumping Blood: The heart pumps oxygen-rich blood to the body's tissues and organs

through arteries and returns oxygen-poor blood to the lungs for oxygenation through

veins.

2. Maintaining Blood Pressure: By contracting and relaxing rhythmically, the heart

helps maintain blood pressure, ensuring adequate circulation of blood to meet the

body's needs.

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 3. Circulating Oxygen and Nutrients: Blood carries oxygen and nutrients from the

lungs and digestive system to cells throughout the body, supporting cellular function

and metabolism

4. .Removing Waste Products: Blood also transports waste products, such as carbon

dioxide and metabolic waste, away from cells to be eliminated by the lungs, kidneys,

and other organs.

5. Regulating Body Temperature: The heart helps regulate body temperature by

distributing heat generated by metabolic processes throughout the body.

Overall, the heart's function is crucial for maintaining the body's overall health and

homeostasis. Any disruption in its function can lead to serious health consequences.

CHAPTER TWO

LITERATURE REVIEW

Introduction

Hypertension is defined as persistent elevation of blood pressure above 140/90mmHg

taken after three times at different interval at rest (Abasa, 2019).

According to Markus macgili(2020).blood pressure is the force exerted by the blood against

the walls of the blood vessels.

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 Hypertension is a chronic medical condition in which the blood pressure in the arteries is

elevated(WHO, 2020)

Medical guidance (2020) hypertension is blood pressure higher than 140mmHg over

90mmHg. The systolic reading of 140mmHg refers to the pressure as the heart pumps blood

round the body. The diastolic reading of 90mmHg refers to pressure as the heart relaxes and

refills with blood. It is the level of blood pressure at which the institution of therapy reduces

blood pressure related to morbidity and mortality.

Incidence of the disease condition (hypertension)

Hypertension is a worldwide problem that affects 26% of the world population.

Hypertension is known as a silent killer as it showed no symptoms. Even though it is simple

to diagnose and usually can be controlled by healthy diet, regular exercise, medication

prescribed by doctors or a combination of these, untreated hypertension will cause serious

condition (compbell, lack land, lisheng, Niebylski, Nilsson, Zhang 2020). According to

WHO(2020) hypertension is a major cause of premature death worldwide.

Optead & Banasila(2019)argued that the overall mortality rate of hypertension is high with

about 50% of patient dying within 5years of diagnosis. The proportion of the global burden of

disease attributed to hypertension has significantly increased from about 4.5 percent in 2010

to 7 percent in 2020(Lozano & Naghavi 2020). This makes hypertension the single most

important cause of morbidity and mortality globally and high lights the urgent need of action

to address the problem. By 2025, almost 3 out of every 4 people with hypertension will be

living in low and middle income countries.

Timothy (2022) further stated that hypertension is more prevalent among the business

executives and both sexes are affected.

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AETIOLOGY / CAUSES OF HYPERTENSION

Timothy (2022) opined that the causes of hypertension are related to structural defeat of the

renal pathology and endocrine pathology are listed thus

 Acute and chronic glomerulonephritis,

 Phaecromacytoma

 Cushing syndrome,

 Tozaemia of pregnancy

 Oral contraceptive

 Increased intracranial pressure.

Scleroedema: an increment in collagenous connective tissue in the skin, either focal or

diffuse. Coarctation of the aorta, thyrotoxicosis, Renal artery stenesis. He further stated that

the exact cause is idiopathic but some theories concerning the cause aband. These are

hereditary- family tendency, emotional stress, obesity, fluid electrolyte metabolism,

personality variable and autonomic nervous system, activity vasoactivity.

Other factors include sleeping apnea and obesity, smoking, high sodium diet, excessive

alcohol consumption, drugs use such as cocaine and amphetamine, lack of physical activities,

aging, chronic kidney disease e.t.c.

PREDISPOSING FACTORS OF HYPERTENSION

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Based on clinical study, it was determined that one in every five people will develop

hypertension in their life time. Some of the most common risk factors for hypertension

include

 Age

 Race of ethnicity

 Being over weight

 Gender

 Life style

 Habits

 Family history of hypertension

 Too much salt in diet

 Stress and certain chronic condition

American Hospital Association,2022), also added that irregular heartbeat, viruses and certain

medications like non- steroidal anti -inflammatory drugs, sleep apnea and congressional heart

defects as predisposing factor of hypertension.

PATHOPHYSIOLOGY OF HYPERTENSION

Hypertension is defined as persistent elevation of blood pressure above 140/90mmHg taken

after three times at different interval at rest (Abasa 2019)

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 In hypertension, the various causes stimulate the vasomotor center in the medullar of the

brain. This will lead to the release of acetylcholine epinephrine and norepinephrine resulting

in the constriction of blood vessels and vasoconstrictions of peripheral vessels. This will

result in increased peripheral resistance leading to elavated blood pressure continuous

peripheral resistance results in compensatory mechanism of the heart thereby increasing heart

rate and cardiac output. If the condition persists, there will be hypertrophy of the myocardial

tissue and arteriosclerotic changes in the tiny blood vessels because the tiny blood vessels are

susceptible to rupture, there will epistaxis and retina bleeding. This further occludes the

vessels thereby depriving vital organs of blood supply. Reduced blood supply to the brain

will cause headache, dyspnea and confusion. Reduced blood flow to the kidneys due to

vasoconstriction will lead to the release of renin. Renin leads to the formation of angiotensin

1 which converts to angiotensin 11 that will further increase vasoconstriction. Secretion of

aldosterone by the adrenal cortex will lead to reabsorption of sodium and water which will

further elevate the blood pressure and cause oliguria. Rupturing of the tiny blood vessels of

the brain will lead to cerebro vascular accident (stroke).

CLINICAL MANIFESTATION OF HYPERTENSION

According to webmed. Com, the sign and symptoms of severe hypertension include

 Dizziness

 Nervousness

 Sweating

 Trouble sleeping

 Facial flushing

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  Nose bleeding

 Severe headache

 Vision problem

 Fatigue

 Chest pain

 Irregular heartbeat

DIAGNOSIS/ INVESTIGATION OF HYPERTENSION( oloriegbe ofumami 2020)

The following investigation can be used to confirm the diagnosis of hypertension

1. History taking and documentation: This will reveal a disorder or conditions that

can precipate hypertension.

2. Physical examination: Including inspection, palpation, percussion and auscultation

that will help to detect thickening, narrowing or hemorrhage in the blood vessels.

3. Serial blood pressure reading: Above 140/90 mmHg in person younger than age 60

and 160/100 mmHg in person older than age 60 in a minimum of three readings on

separate occasions is diagnostic.

4. Chest radiograph: Shows left ventricular hypertrophy

5. Laboratory investigation: Urine analysis for blood, protein, glucose and

microscopic examination of urine.

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 6. Electrocardiogram: An electrocardiogram should be performed when ever clinical

assessment reveals the presence of target organ damage or suggest the possibility of

left ventricular hypertrophy or of other cardiovascular disease.

7. Renal ultrasonography: Renal ultrasonography should be performed if renal disease

is suspected.

All patients with hypertension and protein in the urine should have a urine microscopy,

culture and sensitivity done to exclude infection. (If infection is excluded and protein persists

in the urine, the patient should be referred to the physicians).

NURSING MANAGEMENT/ RATIONAL (oloriegbe ofumami 2020)

1. Admission: Patient should be admitted in a comfortable and noiseless environment.

Adequate rest with relaxation techniques should be provided to reduce stimulation of

sympathetic nervous system workload and to conserve energy.

2. Observation: Vital signs especially blood pressure should be monitored regularly to

know the effects of medications and to confirm if there is improvement.

3. Nutrition: Prevent over weight by reducing calories intake and restrict sodium intake

to reduce heart overload. Avoid constipation by taking high fiber diet.

4. Physical care: Assist in activities of daily living, self care , passive and active

exercise. Apply ice pack if there is epistaxis, but if bleeding is much the nose is

packed.

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 5. Monitor side effects and adverse effect of drugs so that changes can be made on

report, explain orthostatic hypotension and how to manage it eg by rising from bed

slowly.

6. Client and family education or teaching.

7. Advice client to reduce weight by restricting caloric intake.

8. Instruct client to restrict sodium, alcohol and caffeine.

9. Encourage client to conduct a regular physical activity and exercise Programme since

exercise enhance the sense of well-being.

10. Teach client and family about disease process, factors contributing to symptoms and

risk and the important of effective management.

11. Intervene in a hypertensive crises, blood pressure need to be lowered immediately, iv

antihypertensive agent are used and blood pressure monitors every 5 - 15 minutes

because in hypertensive crises the BP is usually very high (250/150mmHg and

above).

MEDICAL MANAGEMENT( oloriegbe ofumami 2020)

The goal of hypertension treatment is to prevent death and complication by achieving and

maintaining the arterial blood pressure at 140 over 90 mmHg or lower. This is achieved by

either of the following means:

1. Chemotherapy

For patients with uncomplicated hypertension and no specific indications for another

medication, the recommended initial medications include diuretics, beta blockers or

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 both. Patients are first given low dose of medications. If blood pressure does not fall

to or less than 140 / 90 mmHg, the does is increased gradually, and additional

medications are included as necessary to achieve control.

2. Oral diuretics: These are drugs that reduce the amount of fluid within the blood

thereby reducing the blood pressure. These drugs help in decreasing blood volume by

promoting micturition thereby decreasing heart workload, Examples are

chlorothiazide (Esidex), furosemide (lasix), spironolactone(Aldactone)

3. Vasodilator: These drugs dilate the wall of the blood vessels thereby reducing the

peripheral resistance (Abasa, 2019). These drugs act on the smooth muscle of blood to

cause vasoconstriction and decreasing peripheral resistance. Examples hydralazine,

hydrochloride (Apresonline), nitroglycerine, minoxidil and diazoxide.

4. Adrenergic inhibitor: These drugs impair the synthesis and re- uptake of nor

epinephrine thereby causing vasodilation. Eg are reserpine (peripheral agent),

guanethidine, methyldopa (aldomet), propranolometropolo and nadolol(beta blocker).

5. Angiotensin 11 Receptor blockers: These drugs block the affects of angiotensin 11

at the receptor there by reducing peripheral resistance and reducing blood pressure.

Eg are losartan, vasantsn, candisartan , Tososartern and irbesartan.

6. Calcium channel blockers: These drugs inhibits calcium ion infux thereby reducing

cardium impulse and reducing cardiac workload causing vasodilation of coronary and

peripheral arteriole. Eg are Amlodipine, verapamil, felodipine, Nifedipine, istadipine

and verapamil.(oloriegbe, 2020).

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PROGNOSIS OF HYPERTENSION

Untreated hypertension is notorious for increasing the risk of mortality and is often described

as a silent killer, mild to moderate hypertension. If left untreated may be associated with a

risk of artherosclerotic disease in 30% of people and organ damage in 50% of people within

8-10 years after onset (chobanian, Bakris & Black et, 2019). Death from ishemic heart

disease or stroke progressively as BP increases for every 20mmHg systolic or10mmHg

diastolic increases in BP above 115/75mmHg, the mortality rate for both ischemic heart

attack disease and stroke doubles.

The prognosis of hypertension is generally very good if it is caught early and properly

monitored and treated. It typically take many years for high blood pressure to become sever

enough to cause serious complication although uncontrolled hypertension overtime is related

to an increased risk of heart attack, stroke and death.

The majority of patients with hypertension, however, can keep it under control and can

expect to live a full life when proper lifestyle changes are implemented ( chobanian, Bakris,

Black et al 2019).

PREVENTION OF HYPERTENSION

The following steps can be taken in order to prevent hypertension

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 1. In order to reduce the risk of hypertension, patient should avoid using illegal drugs,

adopt heart healthy lifestyle habit such as heart healthy eating, aiming for healthy

weight, managing stress, physical activity and quitting smoking.

2. For people who are at high risk for hypertension, can take some steps to reduce the

risk. People at high risk like those with coronary artery disease, diabetes, and

congestive cardiac failure. These individuals should follow all the steps listed above

and also talk with their doctor about the type and amount of physical activity are safe

for them. It is important to treat and control any condition that can cause

hypertension, take medications as prescribed by the doctor and avoid drinking alcohol

and then see the doctor for ongoing care.

(iii) For people who have hypertension but no sign of hypertension, should reduce the risk of

developing the condition by taking the steps and also taking medications as prescribed in

order to reduce the heart workload (National Heart, Lung and Blood institute, NHLBI 2020)

COMPLICATION OF HYPERTENSION

Hypertension increases the risk of the following:

 Myocardial infarction

 Retinal hemorrhage

 Renal insufficiency

 Cerebrovascular accident

 Heart failure

 Left ventricular hypertrophy

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 Transient ishemic attack

 Blindness

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 CHAPTER THREE

CLIENT DEMOGRAPHICS DATA

Name of client: Mrs. I.B

Sex: Female

Age: 42yrs

Ward: Female Ward

Diagnosis: Hypertension

Address: Eziakani Ukpa, Afikpo

Religion: Christian

Next of kin: I.E (daughter)

Date of admission: 18/9/2023

Informant/ Relationship: Mr. I. M (husband)

Father: Mr. U .F

Mother: Mrs. U.A

Interviewer: O.K (SN)

Date of discharge: 28/9/2023

Date of study Ended: 12/10/2023

FAMILY AND SOCIAL HISTORY

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Mrs. I.B , a 42 years old woman from Eziakani Ukpa, Afikpo North is the fourth child of her

family he is also married with seven children all are alive. Mrs. I.B is a lovely and

responsible mother living happily with her husband and children.

PAST MEDICAL/SURGICAL HISTORY

She is a cerebrovascular accident patient and also a well known hypertensive patient. And she

gave birth through ceaserian section.

HISTORY OF PRESENT ILLNESS

Mrs. I. B walk into the Female Ward on 28 September 2023 by 04:56pm in the accompany of

an OPD nurse and her daughter. On observation, there was nil oedema, no skin rashes, he was

conscious and alert, not pale, but there was dizziness.

ADMISSION

On admission, Mrs. I. B came into the ward in the company of OPD nurse and her daughter

at 04: 56pm on 18th September 2023. He complained of dizziness which started on 16th of

September 2023.

His vital signs read thus:

Temperature: 35.6Oc

Pulse: 69 b/m

Respiration:18c/m

Blood pressure:200/150mmHg

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Mrs. I. B was admitted in the general section female medical ward on a well made cardiac

bed in a supine position. The prescription made by doctor were collected and commenced

immediately, Mrs. Inya Beatrice and family were reassured.

NURSING RESPONSIBILITY TOWARDS INVESTIGATION

The client and her family were informed of the various investigations which Mrs. I.B was to

go for. He was made to understand the need for the investigation so that effective treatment

will be rendered, and his consent gotten. The specimen of blood was collected and other test

was also carried out. The results of these tests were collected for proper management.

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INVESTIGATION AND THEIR RESULTS

The investigation that were carried out on Mrs. I.B and their results include

INVESTIGATION RESULTS NORMAL RANGE

Sodium 144.2mmol/L 136-155 mmol/L

Potassium 4.6 mmol/ L 3.4 - 5.4 mmol/L

Chloride 109.2mmol/L 96- 106 mmol/L

Urea 3.5 mmol/L 1.7- 9.1mmol/L

Creatine 87mmol/L 44 - 80mmol/L

BLOOD PRESSURE OBSERVATION CHART FOR MRS. I. B

Date Time BP SIGN REMARK

16/9/2023 15hrs 240/160mmHg OJN Hypertension

16/9/2023 16: 45 hrs 170/110mmHg OIP Hypertension

16/9/2023 22:51hrs 170/100 mmHg OJN Hypertension

17/9/2023 06:00hrs 170/110 mmHg IMN Hypertension

17/9/2023 09:10 hrs 190/110 mmHg OIC Hypertension

17/9/2023 21: 30hrs 170/120 mmHg ODN Hypertension

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18/9/2023 08:44hrs 140/100 mmHg APF Fair

18/9/2023 13:50hrs 130/80 mmHg COC Good

19/9/2023 08: 07 hrs 170/110 mmHg IMC Hypertension

19/9/2023 10:05 hrs 170/120mmHg OCA Hypertension

20/9/2023 09:15hrs 140/100mmHg CFC Fair

20/9/2023 18:00hrs 130/80mmHg ACA Good

21/9/2023 05:09hrs 170/110mmHg IMC Hypertension

21/9/2023 09:08 hrs 150/80mmHg ABU Hypertension

22/9/2023 13:40hrs 140/80mmHg ABU Fair

23/9/2023 14:10hrs 120/80mmHg UAE Good

24/9/2023 08:20 hrs 130/80mmHg VOC Good

25/9/2023 14:00hrs 110/70mmHg OCC Good

26/9/2023 18:18hrs 110/70mmHg ODO Good

27/9/2023 06:08hrs 120/80mmHg ACA Good

27/9/2023 08:40hrs 110/80mmHg OGE Good

32
DRUG THERAPY

DRUGS MODE OF INDICATION SIDE EFFECT ROUTE OF CONTRAINDICA DOSAGE NURSING

ACTION ADMINISTRATI TIONS RESPONSIBILI

ON TY

LOSARTAN It blocks the Hypertension ,le Diarrhea,taste Orally Breastfeeding, 50mg once 1. Watch for any

vesoconstrictor ft ventricular disturbance , cough, cirhosis, biliary daily. It can hypersensitivity

(angiotensin11) hypertrophy ,dia arthralgia, fatigue , obstruction and also be reaction and

and aldosterone betic migraine ,vertigo, pregnancy administered quickly

secreting effects nephroproaphy ulticaria, hypersensitivity to once or twice discontinue the

of in type 2 pruritus,rash, losartan potassium. daily with total administration of

angiotensin11,th diabetes headache ,dizziness doses ranging these drugs.

ereby preventing mellitus. ,abdominal from 25-

2. Monitor the
the retention of pain ,hypercalcemia 100mg.
intake and output
reabsorption of .
charts since
sodium and
changes in renal
water , which
function have been
invariably lead
reported in
to decreased
susceptible

33
 cardiac output individuals treated

and lowering of with this drugs

blood pressure. based on the

consequences of

inhibiting action of

losartan on the

renin-angiotensin-

aldosterone

system.

3. Monitor the

vital signs

especially blood

pressure and pulse

to assess the

cardio-pulmonary

function.

LABETALOL Labetalol has P for treatment Postural Intravenously Asthma, 2mg/ minute 1. Monitor patient

HYDROCHLO both alpha and of arterial hypertension, uncontrolled heart until to avoid upright

34
RIDE beta hypertension, tiredness, failure, marked satisfactory position during

(Trandate). adrenoceptor which ranges headache, rashes, bradycardia, response is and for three

blocking from acute difficulty in a hypertension,cardio attained then hours after

properties. The hypertensive micturition, genic shock, discontinue). intravenous

peripheral artes crisis ( epigastric pain, metabolic acidosis, administration to

are dilated by urgent/emergen nausea, vomiting, bronchospasm, prevent postural

the blockade of cy) to stable liver damage. 2nd and 3rd degree hypotension.

the alpha chronic AV block, frequent

2. Liver function
receptors and hypertension episode of
test is to be
reflex cardiac and hypoglycemia,
carried out at first
stimulation is hypertension phaeochromocytom
symptoms of liver
prevented by during a.
dysfunction and
the beta pregnancy,
where laboratory
blockade ,thus myocardial
results shows
lowering the infarction.
evidence of liver
blood pressure.
damage (example

jaundice) then

discontinue

35
 labetalol

administration.

AMLODIPINE It relaxes and My to moderate Nausea, dizziness, Orally Cardiogenic shock, 5- 10mg daily Precautions must

(Norvasc) dilates the hypertension, palpitations,headac unstable angina during or after be taken before

coronary and coronary he,fatigue,ankle aortic stenosis, meal. giving it to

systemic blood thrombosis, swelling, flushing, breastfeeding,hyper pregnant and

vessels, angina pectoris. abdominal pain, sensitivity to lactating mother

allowing blood sleep disturbance. dihydropyridiness. and those with

to flow freely impaired hepatic

from the heart function.

reducing the
2. Where a daily
peripheral
dose is missed,
resistance and
don't take a
consequently
double dose the
reducing the
next day.
blood pressure.
3. Monitor the

vital signs closely

36
 especially the

blood pressure.

37
NURSING DIAGNOSIS

 Activity intolerance related to increase blood pressure evidence by dizziness, blurred

vision and persistent headache.

 Risk for decreased cardiac output related to increased vascular resistance evidence by

consecutive high blood pressure reading.

 Deficient knowledge related to ineffective health management/lack of knowledge as

evidence by request for information/inadequate follow through of instructions.

38
39
 NURSING CARE PLAN OF MRS I.B WITH HYPERTENSION

S/N NURSING NURSING NURSING SCIENTIFIC EVALUATION

DIAGNOSIS OBJECTIVE INTERVENTION PRINCIPAL/ RATIONAL

Activity intolerance Patients ability to -Note presence of factors -fatique affect both the Patient was able to

related to increased perform some contributing to fatigue clients actual and perceived perform some activities

blood pressure activities will example heart failure. ability to participate in after 22 hours of nursing

evidence by dizziness normalise gradually -Instruct patients in energy- activity. intervention

blurred vision and within 24 hours of conserving techniques. -Energy saving techniques

persistent headache. nursing intervention -Encourage progressive reduce the energy

activities and self-care. expenditure thereby

-Assess emotional and assisting in equalization of

psychological factors affecting oxygen supply and demand.

the current situations - Gradual activity

progressive prevent a

sudden increase in cardiac

workload .

40
 -Stress or depression maybe

increasing the effects of the

illness.

2 Risk for decreased Patient blood pressure 1. Check laboratory data 1. To serve as a baseline Patient maintained normal

cardiac output related will normalise within (cardiac markers, complete data. cardiac output within the

to increased vascular 24 hours of nursing blood cell count, electrolytes, 2. Presence of Pallor, Cool period of hospitalization.

resistance evidence by intervention ABG's blood urea nitrogen moist skin, and delayed

consecutive high blood and creatinine, cardiac capillary refill time maybe

pressure reading enzymes, and cultures such as due to peripheral

blood , wound or secretions) vasoconstriction or reflect

2. Observe skin colour, cardiac decompensation and

moisture, temperature and decreased output.

capillary refill time and 3. May indicate heart failure

record. renal or vascular

3. Note dependent and general impairment.

edema. 4. Decrease discomfort and

4. Provide comfort measures may reduce sympathetic

(back and neck massage

41
 elevation of head). stimulation.

3 Deficient knowledge related to health 1. Define and state the limits Provides basis for Patients verbalize

management/lack of knowledge as evidence by of desired blood pressure understanding elevation of understanding of disease

request for information/inadequate follow-up explain blood pressure and its blood pressure common and process and treatment

through of instructions. effect on the heart blood clarifies frequently used regimen and maintain

Patient will verbalizes understanding of disease vessel, kidney and brain. medical terminology. blood pressure within

process and treatment regimen and maintain 2. Asses patient in identifying 2. These risk Factors have individually acceptable

blood pressure within individually acceptable modifiable risk Factor been shown to contribute to parameters within the

parameters within the period of hospitalization. (obesity) diet high in sodium hypertension and period of hospitalization.

saturated salt and cholesterol cardiovascular and renal

sedentary lifestyle such as diseases.

alcohol intake smoking. 3. Scheduling minimizes

3. Diuretics: advise patient to nighttime urination.

take daily dose (or larger 4. Primary indicator of

doses) in the early morning. effectiveness of diuretic

4. Weigh patient on a regular therapy.

schedule and record

42
43
NURSING MANAGEMENT FROM ADMISSION TO DISCHARGE

ADMISSION

Mrs. I. B was admitted on 18th September 2023 in female medical Ward history of illness

was taken and vital sign and weight on admission were check and recorded appropriately.

Consent form was signed by her daughter who brought her to the hospital after letting her

know the need for compliance.

She was nursed on a cardiac bed because of the presenting symptoms, her daughter was

reassured after the mother has been made comfortable and rapport created. The need for

investigation written by the doctor was explain to her daughter The laboratory technician was

informed of the requested investigations and patients name was registered into the admission

booklet.

DAY 1: History of the patient's past and present medical, surgical, family occupational and

social history was taken. Patient was introduced into the ward

Client vital signs were check and recorded this: Temperature: 35.6C Pulse: 69b/m

Respiration: 18c/m Blood pressure: 200/150mmHg Spo2:95%

 Prescribed medication was collected and comments

 Patience and her daughter were educated about the rules regulations guiding the

hospital.

DAY 2: Client was reviewed by a medical doctor at 19 a.m. the need for more investigation

was written by the doctor which includes chest X-ray, ECG, urinalysis. It was clearly

explained to the clients and relatives and they paid for the test which was later carried

out .New prescription was made and the drugs collected and commenced.

44
DAY 3: Client was also reviewed by the doctor at 12 p.m. vital signs was checked and

documented laboratory results was collected and shown to the doctor. Other nursing care

such as conservation of the patients continued.

DAY 4: Normal routine care rendered to the patient when necessary. She was encouraged to

move around.

DAY 5: Clients wakeup very strong and happy. Her vital signs were checked and recorded,

medication administered and chatted.

DAY 6: Client was reviewed by 3:40 p.m. by the medical doctor. New prescription was made

and the drugs was collected, commenced, and charted appropriately

DAY 7: Clients condition improved today. She had visitors and chatted with them freely and

happily. Her due medication was given and all other nursing care rendered when necessary.

DAY 8: Client was strong today and was telling the doctor to discharge her when he came on

around. The doctor promise to discharge him the next day as he still needs to be observed

again

DAY 9 : Client woke up very fresh and happy. She appeared much better. The dizziness that

was complained by the clients earlier has subsided. She was reviewed by the Doctor who

came on rounds and was also discharged home. The client settled his bill through the help of

her husband and daughter and went home on a satisfactory condition.

1. ADVICE ON DISCHARGE

Mrs. I. B was advised to take her drugs properly he was also advised to do the following

 Avoid high cholesterol foods such as egg yolk fatty meal

45
  Avoid or reduce your intake of food that are high in saturated fat including animal and

dairy products such as meat cream cheese and butter.

 Have foods in your diet that contain unsaturated fats including, vegetables ,products

such as corn or soya bean oil , and other vegetable oil but not coconut oil or palm oil

because they are high in saturated fat

 Reduce your daily salt/ sodium intake exercise to prevent obesity diet free from fat

 client was advised to keep following updates and reporting any change to the health

caregiver

 Explain the need to know causes risk Factor and reduce her weight

 Need to take prescribed drugs and for adequate sleep and rest.

 Advise the patient on need For frequent medical checkup

 Need for adequate nutrition.

FOLLOW UP CARE

Mrs. I.B was called few days after discharge and he reported to be doing very well and kept

to advice given to him he was reminded of his appointment with the doctor on 12th of

October and was encouraged on exercise and reduction of food to lose weight.

TERMINATION OF NURSE/ PATIENT RELATIONSHIP

46
Client was made to understand that when she is fully recovered our relationship will come to

an end he came on his appointment day and was seen by the doctor .she left the hospital

happily and the nurse /patient relationship ended.

47
 CHAPTER FOUR

SUMMARY

Mrs. I B was admitted on 18th September 2023 into the female Ward . History of the illness

was taken and her vital signs were checked and recorded appropriately. Mrs. I B was

reassured and made comfortable. The need for investigation written by the doctor was explain

to the patient, the laboratory technician was informed of the request investigation. Prescribed

drug were collected and administered and a holistic nursing and medical care was also

rendered throughout the period of hospitalization. Her prognosis was very good and she was

discharged after 9 Days of hospitalization with her home drugs, adequate instructions was

given to her and husband, they left in a good health and was brought back to the hospital after

three weeks for his medical check-up. The physician reviewed her and they left in sound

health and his care terminated.

CONCLUSION

Hypertensive heart disease is the cardiomyopathy that results from the response of the

myocardium to the biomechanical stress imposed on the left ventricle by the progressively

increased blood pressure.

It may be caused as a result of long-standing hypertension characterized by myocardial

structure and function in the absence of other primary cardiovascular abnormalities.

The condition is not curable but can be managed with prescribe drugs such as tab losartan,

tab Esidex, tab Amlodipine, frusemide, aldomet etc and other life changes. The preventive

measures are: physical activities, which improve cardiac function and reduced blood

pressure. If can also have prevented by limited alcohol consumption, weight reductions and

48
other lifestyle changes, if not well managed, it can lead to celebrovascular accident, heart

failure, myocardial infarction, renal complications, and arteriosclerosis and others.

49
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