A Case Study On HYPERTENTION

I. ACKNOWLEDGEMENT

We would like to thank Almighty God for giving us guidance and our parents for their support morally and financially.
We would like to acknowledge Mrs. Irene Carreon. RN, MAN our Clinical Instructor for helping and guiding us during our duty and the staffs and members comprising the Deparo Health Center and Lying in for giving us the opportunity to have RLE duty in their area.
We would like to extend our gratitude to Mr. Clarito Bukas and his family to be involved openly to this project.

II. MORBID CASE SUMMARY
We had our Home Visit in the house of Bukas Family. We walked to their house. Mr. Clarito Bukas, 61 years of age, currently unemployed. His wife works as a cook. Her salary is Php 4000-4600 every month, not enough for their monthly expenses and they don’t have source of income in case of emergency.
Their house is composed of mixed materials but they’ve owned it. They have adequate space for everyone. They have enough furniture for daily living. The sanitary condition of their house is fair and they have open drainage outside their house.
The neighborhood is congested. And their garbage disposals are being picked up by the garbage collector. Bukas family sleeps together at their living room. They also have their kitchen, they eat and cook food there. When they have leisure time, Mr. Clarito and his wife will visit of their sons and daughters.
They can also go to Health Center whenever they need it. And they can avail the health center program.

III. INTRODUCTION
Hypertension (high blood pressure) is a disease of vascular regulation resulting from malfunction of arterial pressure control mechanisms (central nervous system, rennin-angiotensinaldosterone system, extracellular fluid volume.) the cause is unknown, and there is no cure. The basic explanation is that blood pressure is elevated when there is increased cardiac output plus increased peripheral vascular resistance.

The two major types of hypertension are
1. Primary (essential) hypertension – in which diastolic pressure is 90 mm Hg or higher and systolic pressure is 140 mm Hg or higher in absence of other causes of hypertension (approximately 95 % of patients).

2. Secondary hypertension – which results primarily from renal disease, endocrine disorders, and coarctation of the aorta. Either of these conditions may give rise to accelerated hypertension – a medical emergency – in which blood pressure elevates very rapidly to threaten one or more of the target organs: the brain, kidney, or the heart.

Hypertension is one of the most prevalent chronic diseases for which treatment is available; however, most patients with hypertension are unaware, untreated, or inadequately treated. Risk factors for hypertension are age between 30 and 70; black; overweight; sleep apnea; family history; cigarette smoking; sedentary lifestyle; and diabetes mellitus. Because hypertension presents no over symptoms, it is termed the “silent killer.” The untreated disease may progress to retinopathy, renal failure, coronary artery disease, heart failure, and stroke.

Hypertension in children is defined as the average systolic or diastolic blood pressure greater than or equal to the 95th percentile for age and sex with measurement on at lease three occasions. The incidence of hypertension in children is low, but it is increasingly being recognized in adolescents; and it may occur in neonates, infants, and young children with secondary causes.

IV. INITIAL DATA BASE
I. FAMILY STRUCTURES, CHARACTERISTICS and DYNAMICS:
Family Information
Head of the Family: Clarito bukas
Address: 115 Villa Maria Subdivision
Members of the Household:
NAME
RELATIONSHIP
AGE, SEX/CIVIL STATUS
POSITION IN THE FAMILY
EDUCATIONAL ATTAINMENT
Teresita Bukas
Wife
51 F/Married

Elementary Graduate
Claritoo Bukas
Husband
61 M/Married
Head
Highschool Undergraduate

1. What is the type of the Family Structures?
____x_____Nuclear __________Patriarchal
__________Extended __________Matriarchal
2. Who makes decisions regarding health care? Teresita Bukas
3. What is the general family relationship?
__________with conflicts between members
_____x_____without conflicts between family members

II. SOCIO ECONOMIC AND CULTURAL CHARACTERISTICS:
A. Income and Expenses
NAME
OCCUPATION
PLACE
SALARY
Teresita Bukas
Cook
Caloocan
4000-4600

1. Does the working family member meet the basic necessities?
___x___ Yes _______ No
2. Any financial assets available in case of an emergency?
_______ Yes ___x___ No
3. Who makes decisions regarding money matters? Teresita Bukas

B. Ethnic Background and Religious Affiliations
1. Religious affiliation? Roman Catholic
2. What roles does the family play in the community?
III. Home and Environmental Factors:
A. Housing
1. Ownership
___x___ Owned _______ Rented _______ Rent free
2. Construction materials used:
_______ Light ___x___ Mixed _______ Strong
3. Living space
___x___ Adequate _________ Inadequate
4. Sleeping arrangements: One bedroom
5. Adequacy in furniture:
___x___ Adequate _________ Inadequate
6. Water source:
___x___ Private _________ Public
7. Food Storage:
_______ Refrigerator _________ Jars
_______ Boxes _________ Cabinet
8. Cooking facility:
_______ Electric Stove ________ Firewood
_______ Gas Stove ____x___ Kerosene Stove
9. Drainage facility:
___x___ Open drainage ________ Blind drainage
_______ None
10. Toilet facility/Type:
_______ Flush type ________Overhung latrine
_______Bored-holed latrine ________Water-sealed latrine
___x___Pail System ________None
11. Sanitary Condition:
____x___ Fair _______ Good _______ Poor
12. Neighborhood:
____x____ Congested ________ Slum ________Other
13. Availability of health care facility:
Describe Briefly: Brgy. Health Center
14. Garbage disposal:
________ Dumped at street corner ________ Buried
____x___ Picked up by garbage collector ________Burned and then buried
15. Eating patter:
How many meals each day? 3x a day
Who appears overweight? None
Who appears underweight? None
16. Leisure time activities?
How does each member spend leisure hours? Watching T.V, and reading
Is it appropriate for the sex and age group? Yes
What is the effect to the family?
Any joint activities for leisure? Walking
IV. Health and Medical History:
A. Presence of illness:
____x___ Diagnosed _________Undiagnosed _______None
NAME
PAST ILLNESS
ILLNESS STATE
HEALTH ACTION TAKEN
Clarito Bukas
None
Hypertension
Taking Catapres

B. Sources of health care:
___x___ Health Center ________Government hospital
_______Private hospital ________Others

V. PATHOPHYSIOLOGY
VI. MORBID CASE SCALING

Health Problems
* Hypertension
CRITERIA
COMPUTATION
ACTUAL SCORE
JUSTIFICATION

1. Nature of problem as health deficit

2. Modifiability of the problem

3. Preventive potential

4. Salience of the problem