CHAPTER TWO
2.0 Introduction
2.1 Literature Review of hypertension is commonly described as a condition of persistent high levels of
blood pressure with a systolic pressure of 140mmHg or more and diastolic pressure of 90mmHg or
more. The heart pumps blood through the vessels throughout the body (circulation). This ensures that,
essential nutrients and oxygen are supplied to the tissues. When the lumen of the small arteries
becomes narrow, it becomes difficult for the heart to pump blood through them and as a result cause
blood pressure to rise above normal which results in hypertension. In describing hypertension, the
persistence of the high levels is considered because; certain factors and activities can increase an
individual’s blood pressure for a brief period which might not be hypertension. This means that,
hypertension is diagnosed on series of high values than a single measurement of the blood pressure.
Hypertension is a major cause of heart failure, stroke and kidney failure. It is also called the silent killer’’
because about 50% of those with the condition do not know they have it and so are taken unaware. The
condition may therefore kill before it is recognized. (Offei, V. 2012)Incidence Hypertension is a
worldwide epidemic with an estimated number of 690 million people living with high blood pressure
(Lewis et al 2003). In 2008 researchers (WHO 2007) and (National AIDS Control Program 2008 – 2015
estimates) reveals that more than 3.5 million Ghanaian adults are living with hypertension and do not
even know it and incidence of the condition increases with age. About 50% of all people sixty years and
above have hypertension. It is common in obese and people with coronary heart diseases. It is also
common in blacks as compared to whites in terms of race and also, they develop it at early age than
whites, reasons not known. Pathophysiology of hypertension. The excess amounts of an enzyme called
rennin is secreted by the kidneys (particularly when the kidneys are deficient of blood supply) either in
response to stimulation of the sympathetic nervous system or without any stimulation. Renin converts
angiotensinogen into angiotensin 1, which is also converted to angiotensin [Link] 11 causes
constriction of the arteries. It also stimulates the adrenal cortex to increase the secretion of
Aldosterone. Aldosterone promotes retention of sodium and water which increases extra cellular fluid
volume. The combination of excess peripheral vasoconstriction (narrowing of the blood vessels) and
increase in the blood volume results in increased blood pressure. Types of hypertension There are two
main types of hypertension according to Offei, V. (2012)
Primary or essential hypertension
Secondary hypertension.
Primary hypertension is also known as essential hypertension.
It has no known cause and forms about 90% of hypertension cases. It runs in families usually beginning
between the ages of 25 and 55 years. It is further categorized into:
Benign which has a slow onset and is initially without symptoms.
Malignant which has a sudden onset but develop symptoms rapidly as the disease progresses and
usually leads to death within 2 years.
Secondary hypertension
Secondary hypertension occurs as a result of identifiable causes such as kidney disease, eclampsia,
congestive cardiac failure (CCF), raised intracranial pressure and also cerebral damage.
Contributing factors of Hypertension
Contributing factors of hypertension include; ageing, stress, obesity, human habit, excessive fat intake
and excessive intake of cholesterol foods.
Age – As an individual advances in age, there is loss of arterial elasticity which causes peripheral
resistance to blood flow.
Stress – Under constant stress there is pathologic response which causes excessive stimulation of the
sympathetic nervous system. This causes vasoconstriction (contracting of the walls of the blood vessels
and reduction of the lumen) therefore decreases blood flow which results in increased blood pressure.
Obesity (excessive weight gain) – Extra body weight increases workload for the heart and strain on the
blood vessels.
Nicotine (smoking and caffeine) – There cause constriction of the blood vessels resulting in resisted
blood flow through them.
Excessive salt intake –salt makes your body hold onto water if you eat too much the extra pressure on
your blood vessel walls, raising your blood pressure. High cholesterol levels – Too much cholesterol in
the body gets deposited in the lumen of the blood vessels to narrow it and causing resistance to blood
flow through it.
Atherosclerosis and Arteriosclerosis –When fat is deposited in the lumen of the blood vessels
(atherosclerosis) it results in the narrowing and hardening of the vessels (arteriosclerosis), and this
increases the force against the arterial walls as blood flows through them.
Pregnancy – Pregnancy may cause high blood pressure (pregnancy induced hypertension) which
resolves after delivery in most cases, but in few cases it becomes chronic What predisposed my patient
Obesity: Because my patient was fat, a lot of strain was put on the heart making it to pump harder,
which result in raising her blood pressure.
Stress: Mrs G.A from her speech she was always worried about one of her son who was at the university
in need of school fees and giving a verbal warning. Due to that, she is always stressed up. This stressed
causes constriction of the blood vessels as a result of stimulation of the sympathetic nervous system
resulting in increased heart rate leading to increase blood pressure. Excessive salt intake: Mrs G.A from
her speech, she like taking salted fish. This result in water retention in the body system causing
increased blood volume to be pumped through the vessels. This gives extra workload to the circulatory
system which eventually weakens the blood vessels.
Signs and symptoms of hypertension
Mild Sever
Headache Fatigue
Nosebleeds Nausea
Vomiting
Irregular heart rhythm
Confusion
Vision changes Anxiety
Buzzing in the ear Chest pains
SIGNS AND SYMPTOMS EXPERIENCED BY MY CLIENT
Insomnia
Dizziness
Fatigue
Palpitations
Elevation of blood pressure
Edema
DATE Specimen INVESTIGATION RESULTS NORMAL INTERPRETATION REMARK
VALUE
28/07/24 Blood Hemoglobin 10.4g/10⁹/DI Male:12.5- Normal. No treatment
level estimate 18.5g/dL. prescribed and
client was
Female:11.5- encouraged to
16.5gDI. eat well
balanced diet
28/07/24 Blood Full blood 28.8×10/L For Adult Increase white Antibiotic,
count 150- blood count injection
400×10⁹/L. indicating cefuroxime 1g
infection. start was
1-12 years. prescribed and
administered
4.0-12.0
3.5-10.0.
28/07/24 Chest Chest X-ray Hyper inflated Lungs Inflammation due Antibiotic
chest ,Air Should be to infection. Ceftriazone
bronchogram clear with no injection 1 was
s and for dense prescribed and
consolidation shadow. administered
How my client was diagnoses
Mrs. .G A was rushed to the hospital due to the signs and symptoms. She was physically examined; vital
signs were taken and other laboratory investigation done and she was diagnosed as hypertensive
Complications of hypertension
Coronary thrombosis: occlusion on the coronary vessels by which the heart muscles is deprived of blood,
causing myocardial ischemia and often leading to myocardial infarction.
Heart failure: this can be acute as in coronary thrombosis or chronic.
Peripheral arterial disease.
Cardiac ischemia: deficiency in blood supply to the heart muscles.
Arterial aneurysm: local dilatation of a blood vessel, usually an artery.
Cardiovascular accident/stroke: a disorder assisting from an embolus, thrombus or hemorrhage
cerebrum. This may vary in severity from a transient weakness/tingling in a limb to profound paralysis,
coma and death.
Diabetes : is often referred to as group of metabolic diseases in which the person has high blood glucose
(blood sugar) either because insulin production in inadequate or because the body cells do not respond
properly to insulin or both.
Management of Hypertension
Hypertension can be managed in two ways, which are;
Drug or pharmacological therapy.
Non –pharmacological or nursing management.
2.2b. Causes of Client’s Condition
With reference to the laboratory investigation, the cause of Mrs. G.A. condition was caused by bacteria
pneumococci.
Table 2.2c Signs and symptoms of hypertension
Mild Sever
Headache Fatigue
Nosebleeds Nausea
Irregular heart rhythm Vomiting
Vision changes Confusion
Buzzing in the ear Anxiety
Chest pains
2.2d MEDICAL TREATMENT GIVEN TO CLIENT
The following treatment was prescribed for Mrs. G.A. Due to her condition, which is
Bronchopneumonia.
IVF Dextrose in sodium chloride 5%IN 0.9 %( 500ml) 500ml start.
Ringer Lactate solution, 500ml start.
Paracetamol IV 1000mg, 1g start.
Ceftriaxone injection 1g start.
Cefuroxime injection 1gstart then, 750mg daily ×2days.
Gentamycin injection 40mg/ml IN 2ml, 90mg daily ×2.
Paracetamol syrup, 120mg/5ml, 10ml bd×7days.
Cefuroxime suspension 125mg/5ml, 10ml bd×7days.
