HYPERTENSION

A. Definition

Hypertension is high blood pressure that is abnormal and measured at least

on three different occasions. In general, a person is considered to have

hypertension if his blood pressure is higher than 140/90 mmHg. Hypertension

is also often interpreted as a condition where systolic blood pressure is more

than 120 mmHg and diastolic pressure is more than 80 mmHg.

Hypertension is a symptom of an increase in blood pressure which then

affects other organs, such as stroke for the brain or coronary heart disease for

the heart and heart muscle. This disease has become one of the main problems

in the public health field in Indonesia and the world. It is estimated, around

80% of the increase in hypertension casuus occurs mainly in developing

countries in 2025; out of a total of 639 million cases in 2000. This number is

estimated to increase to 1.15 billion cases in 2025. This prediction is based on

the number of people with hypertension and current population growth.

Hypertension prevalence rates in Indonesia show that there are still many

hypertensive sufferers in rural areas who have not been reached by health

services. Both in terms of case finding and treatment management, the range is

still very limited. This is coupled with the absence of complaints from most

hypertensive patients. The highest prevalence ranges from 60% to 15%, but

there are also regions with extreme low numbers, such as in Ungaran, Central
Java (1.8%), Balien Valley Jaya Wijaya Mountains, Irian Jaya (0.6%), and

Talang West Sumatra (17.8%).

Can be seen here, the two figures reported by the same group in two rural

areas in West Sumatra show high numbers. Therefore, this phenomenon must

be further investigated, as well as relatively very low numbers. Cardiovascular

disease survey at an advanced age carried out by Boedhi Darmojo, found the

prevalence of hypertension without or with hypertensive heart disease was

33.3% (81 people from 243 parents aged 50 years and over).

Women have a higher prevalence of high blood pressure than men. Of

these cases, it turned out that 68.4% of them included low hypertension

(diastolic 95.104 mmHg), 28.1% moderate hypertension (diastolic 105.129

mmHg), and only 3.5% who entered severe hypertension (diastolic equal or

greater with 130 mmHg). Hypertension in patients with ischemic heart disease

is 16.1%. This percentage is low when compared to the prevalence of the entire

population (33.3%), so it is a less important risk factor.

There was no link between the increase in the prevalence of high blood

pressure patients with increasing age. Therefore, the developing State of

Indonesia in all fields needs to pay attention to educative actions to prevent the

onset of diseases, such as hypertension, cardiovascular disease, degenerative

diseases and others. Groups of people aged 45 years and over require targeted

prevention actions or programs. The aim of the cardiovascular disease

prevention program is to prevent an increase in the number of people at risk of

 cardiovascular disease in society by avoiding diovascular in the community by

avoiding the causes, such as hypertension, diabetes, hyperlipidemia, smoking,

stress, and others.

B. Etiology

1. Primary Hypertension

Primary hypertension is essential hypertension or hypertension which is

90% unknown. Some of the factors thought to be related to the development

of essential hypertension include:

a) Genetic; individuals who have a family history of hypertension, are at a

higher risk of getting this disease than those who don't.

b) Gender and age; men aged 35-50 and postmenopausal women are at high

risk for hypertension.

c) Diet; consumption of a diet high in salt or fat content, is directly related

to the development of hypertension.

d) Weight / obesity (25% heavier than ideal body weight) is also often

associated with developing hypertension.

e) The lifestyle of smoking and alcohol consumption can increase blood

pressure (if the unhealthy lifestyle is still applied).

2. Secondary Hypertension (5-10%)

Secondary hypertension is a type of hypertension whose cause is

known. Some of the symptoms or diseases that cause this type of

hypertension include:

a) Coarctationaorta, which is aortacongenital narrowing that (may) occur at

several levels of the thoracic aorta or abdominal aorta. This narrowing

inhibits blood flow through the aortic arch and results in an increase in

blood pressure above the constricting area.

b) Renal parenchymal and vascular disease. This disease is a major cause of

secondary hypertension. Renovascular hypertension is related to the

narrowing of one or more large arteries, which directly brings blood to

the heart. About 90% of renal artery lesions in patients with hypertension

are caused by atherosclerosis or fibrous dysplasia (abnormal growth of

fibrous tissue). Renal parenchymal disease is associated with infection,

inflammation, and changes in kidney structure and function.

c) Use of hormonal contraception (estrogen). Oral contraceptives that

contain estrogen can cause hypertension through the mechanism of renin-

mediate volume expansion. With cessation of oral contraception, blood

pressure returns to normal after a few months.

d) Endocrine disorders. Andrenal medulla dysfunction or the adrenal cortex

can cause secondary hypertension. Adrenal-mediate hypertension is

caused by the primary excess of aldosterone, cortisol, and

 catecholamines. In primary aldosterone, excess aldosterone causes

hypertension and hypokalemia. Primary aldosteonism usually results

from benign (benign) adrenal cortex adenomas. Pheochromocytomas in

the adrenal medulla are most common and increase excessive

catecholamine secretion. In Cushing's syndrome, there is an excess of

glucocorticoids secreted from the adrenal cortex. Cusbing syndrome may

be caused by adrenocortical hyperplasia or adrenocortical adenoma.

e) Obesity and an inactive lifestyle (lazy to exercise)

f) Stress, which tends to cause a rise in blood pressure for a while. If stress

has passed, then blood pressure will usually return to normal.

g) Pregnancy

h) Burns

i) Increased intravascular volume

j) Smoking. Nicotine in cigarettes can stimulate catecholamine release. This

increase in catecholamines results in increased myocardial irritability of

the heart rate, and causes vasoconstriction which then increases blood

pressure.
 3. Hypertension Classification

Classification of hypertension in patients aged 18 years by the Joint

Committee on Detection, Evaluation, and Treatment of High Blood Pressure

(1998) is as follows.

TTD category (mmHg) TDS (mmHg)

Normal <85 <130

Normal height 85-89 130-139

Hypertension

Height 1 (light) 90-99 140-159

Height 2 (moderate) 100-109 160-179

Height 3 (weight) 110-119 180-120

Height 4 (very heavy) ≥ 120 ≥ 210

C. Anatomy Physiology

The heart is a muscular organ with four chambers located in the thoracic

cavity, under the protection of the ribs, slightly to the side of the sternum kuru.

The heart is in a loose bag containing a liquid called the pericardium. The four

cardiac chambers are left and right at left and right atria of the left ventricle.

The left side of the heart pumps blood to all body cells, except cells that play a

role in gas exchange in the lungs (this is called systemic circulation). The right
side is pumping blood to the lungs to get oxygen (this is called the pulmonary

or pulmonary circulation).

1. Systemic Circulation

Blood enters the left atrium from the pulmonary vein. Blood in the left

atrium then flows into the left ventricle through the ventricular (AV) aortic

valve, which is located in the atrial and ventricular joints (this valve is

called the mitral valve). All heart valves open when the pressure in the heart

chamber or the vessels above it exceeds the pressure in the ruanng or vessels

below.

Blood flow from the left ventricle to a large muscular artery, called the

aorta. Blood flows from the left ventricle to the aorta through the aortic

valve. Blood from the aorta is then distributed throughout the systemic

circulation, namely through the arteries, arterior, and capillaries which are

then reunited to form veins. Veins from the lower part of the body return

blood to the largest vein, the inferior vena cava. Veins from the upper part of

the body return blood to the superior vena cava, which is the two vena cava

which empties into the right atrium.

2. Lung Circulation

Blood in the right atrium flows into the right venticle through another

AV valve, called the semilunar valve (trikuspidalis). Blood comes out of the

right ventricle and flows through the 4th valve, pulmonary valve, and in the

pulmonary artery. This pulmonary artery branches again into the right and
 left pulmonary arteries, each of which flows through the right and left. In

the lungs, these pulmonary arteries branch again into many branches of the

arterioles and then capillaries.

Each capillary perfuses the respiratory unit, through an alveoli. All

capillaries reunite for venules and venules become veins. These veins then

blend to form a large pulmonary vein. Blood flows in the pulmonary veins,

returning to the left atrium to complete the cycle of cardiac blood flow.

D. Pathophysiology

Systemic arterial pressure is the result of multiplying cardiac output with

peripheral total resistance. Cardiac output is obtained from the multiplication

of stroke volume (the volume of blood pumped from the heart's ventricle) with

a heart rate. Peripheral prisoner regulation is maintained by the autonomic

nervous system and circulating hormones. Four control systems play a role in

maintaining blood pressure, including arterial receptor systems, regulation of

body fluid volume, the renin angiotensin system, and vascular autoregulation.

Arterial receptors are mainly found in the carotid sinus, but are often found

also in the aorta and also the left ventricular wall. This preceptor receptor

monitors arterial pressure. The receptor system eliminates an increase in

arterial pressure through the mechanism of slowing the heart by vagal response

(parasympathetic stimulation) and pasodilatation with a decrease in

sympathetic bud.
 Therefore, the circulation control reflex increases systemic arterial

pressure if the receptor pressure drops and decreases systematic arterial

pressure when the co-receptor pressure increases. Until now, it is not known

exactly why this control failed in hypertension. This is shown to increase re-

setting of the sensitive sensitivity, so that the pressure increases inadequately,

even if there is no pressure drop.

Changes in fluid volume affect systemic arterial pressure. When the body

has excess salt and water, blood pressure can be increased through complex

physiological mechanisms that alter venous return and cause increased cardiac

output. If the kidneys function adequately, an increase in arterial pressure can

result in dieresis and a decrease in blood pressure. Pathological conditions that

change the pressure threshold in the kidneys in excreting salt and water will

increase systemic arterial pressure.

Renin and angiotensin play a role in regulating blood pressure. The

kidneys produce renin, which is an enzyme that acts on the plasma protein

substrate to separate angiotensin I, which is then converted by the enzyme

modifying (coverting enzyme) in the lung into angiotensin II, and then into

angiotensin III. Angiotensin II and III have a strong vasoconstrictor action in

blood vessels and are a control mechanism for aldosterone release.

Aldosterone alone has a vital role in hypertension, especially in primary

aldosterone. Besides helping to increase the activity of the sympathetic nervous

system, angiotensin II and III also have an inhibiting or inhibiting effect on the

excretion of salt (sodium) which results in an increase in blood pressure.

Inappropriate renin secretion is thought to be the cause of increased

peripheral vascular resistance in essential hypertension. At high blood pressure,

renin levels must be lowered because increased renal arteriolar pressure may

inhibit renin secretion. However, most people with essential hypertension have

normal renin levels.

Continuous increase in blood pressure in patients with essential

hypertension will cause damage to blood vessels in vital organs. Essential

hypertension also results in medial byperplastia (thickening of arterioles-

arterioles). Because blood vessels thicken, decrease tissue perfusion and cause

damage to the body's organs. This causes myocardial infarction, stroke, heart

failure, and kidney failure.

Vascular autoregulation is another mechanism involved in hypertension.

This vascular autoregulation is a process to maintain relatively constant tissue

perfusion in the body. If the flow changes, autoregulation processes will reduce

vascular resistance and result in confinement of the flow. If the opposite

occurs, vascular resistance will increase as a result of increased flow. Vascular

autoregulation has become an important mechanism in causing symptoms of

hypertension associated with excess salt and water intake.

E. Signs of Symptoms

Some clinical manifestations arise after patients have hypertension for

years. Symptoms include:

1. Headache when awake, sometimes accompanied by nausea and vomiting

due to increased blood pressure

2. Blurred vision due to damage to the retina as a result of hypertension

3. Swing steps that are not permanent because of damage to the central nervous

system.

4. Nocturia (often urinating at night) due to an increase in renal blood flow and

filtration of glomelurus and

5. Dependent edema and swelling due to increased capillary pressure.

In cases of severe hypertension, symptoms experienced by the patient

include headaches (feeling of heaviness in buckling), palpitations, fatigue,

nausea, vomiting, nervousness, excessive sweating, muscle tremor, chest pain,

epistaxis, blurred or double vision, innitus ( ears ringing, and sleep difficulties.

F. Complications

1. Stoke

Stoke can result from bleeding due to high pressure in the brain or due to

an embolus that is released from a non-bald vessel. Stroke can occur in

chronic hypertension when the arteries that bleed the brain experience
 hypertrophy and balancing, so that blood flow to areas that are bleeding

becomes less. Brain arteries that experience atherosclerosis can be

weakened, thus increasing the likelihood of aneurysm formation.

2. Myocardial infarction

It can also be called myocardial infarction if atherosclerotic coronary

arteries cannot supply enough oxygen to the myocardium or when thrombus
is formed which can inhibit blood flow through the vessels that. Because
chronic hypertension and ventricular hypertrophy occur, myocardial oxygen
demand cannot be fulfilled and cardiac ischemia can occur which causes
infarction. Likewise, ventricular hypertrophy can cause changes in the time
of electrical conduct when crossing the venticles, resulting in dysrhythmias,
cardiac hypoxia, and an increased risk of blood clot formation.

3. Gijal Failure

Kidney failure can occur due to progressive damage due to high

pressure on glomelurus capillaries. With glomelurus damage, blood will
flow to the kidney functional units, neurons will be disrupted, and can
continue to be hypoxic and death. With the destruction of the glomelurus
membrane, protein will pass through urine.

4. Encephalopathy

Encephalopathy (brain damage) can occur mainly in malignant

hypertension (rapidly increasing hypertension). Very high pressure due to
this disorder causes an increase in capillary pressure and pushes fluid into
the intertisium space throughout the central nervous system. As a result, the
surrounding neurons collapse and coma and death occur. Women with PIH
can experience seizures. Babies born may have low birth weight due to
inadequate placental perfusion. Babies can also experience hypoxia and
acidosis if the mother experiences seizures during or before labor.

G. Diagnostic Check

1. Hemoglobin / hematocrit; not a diagnostic examination but examines

the relationship of cells to fluid volume (viscosity) and indicates risk
factors, such as hyperkoagubility and anemia.
2. BUN / Kreainin; provide information about perfusion / ginjl function.

3. Glucose; hyperglycemia (diabetes mellitus is the originator of

hypertension) can be caused by an increase in catecholamine levels
(increasing hypertension).

4. serum potassium; Hypokalemia can indicate the presence of major

aldosterone (cause) or a side effect of hypertension therapy.

5. serum calcium; elevated serum calcium levels can increase

hypertension.

6. serum cholesterol and triglycerides; elevated levels can indicate

atheromatous plaque formation (cardiovascular effects).

7. examination of the thyroid; hyperthyroidism can cause

vasoconstriction and hypertension.

8. serum aldosterone levels; This test is used to assess primary

aldosteronism (cause).

9. Urinalisa, blood, protein, glucose implies kidney dysfunction and or

the presence of diabetes.

10. urine VMA (catecholamine metabolites); increase can indicate the

presence of pheochromocytoma (cause). 24-hour urine VMA can be done
to assess pheochromocytoma if hypertension is lost.

11. Uric acid, hyperuricemia has been implicated as a risk factor for
hypertension.

12. Urinary steroids; steroid rise in the urine can indicate

hyperadrenalism, pheochromocytoma or piutitari dysfunction, cusbing
syndrome. Levels in rennin can also increase.

13. IVP; can identify the causes of hypertension, such as renal

parenchymal disease and kidney stones / ureteral stones.

14. Photo of chest; may show calcified obstruction in the valve area,
deposit in and or aortic notch, and enlargement of the heart.

15. CT-scan; study cerebral tumors, CSV, encephalopathy, or

pheochromocytoma.
 16. ECG; can show heart enlargement, strain patterns, and conduction
disturbances. Note: the extent and elevation of P waves is one of the early signs of
hypertensive heart disease. F. Management

H. Pharmacology

Drug therapy in people with hypertension begins with one of the following
drugs:

a. Hydrochlorptiazide (HCT) 12.5-25 mg per day in a single dose in the morning

(in hypertension in pregnancy, only used when accompanied by
hemoconcentration / pulmonary edema).

b. Reserpine 0.1-0.25 mg daily as a single dose.

c. Propanolol starts from 10 mg twice a day which can be increased 20 mg twice a

day (contraindicated for people with asthma).

d. Kaptopril 12.5-25 mg is two to three times a day (contraindicated in pregnancy

as long as a live fetus and asthma sufferer).

e. Nifedipine starts from 5 mg twice a day, can be raised 10 mg twice a day.

2. Nonfarmacology

The initial step is usually to change the patient's lifestyle, namely by:

a. Lose weight to the ideal limit

b. Change diet in diabetics, obesity, or high blood cholesterol levels,

c. Reduces the use of salt to less than 2.3 grams of sodium or g gram of sodium
chloride every day (accompanied by adequate intake of calcium, magnesium and
potassium),

d. Reducing alcohol consumption

e. Stop smoking, and

f. Aerobic exercise that is not too heavy (people with essential hypertension do not
need to limit their activity as long as their blood pressure is controlled).
I. Nursing Care

I. ASSESSMENT
1. Data Collection
a. Patient identity
Name: Mrs. N
Age: 80 years old
Female gender
Marriage Status: Married
Islam
Last Education: Elementary School
Job: Housewife
Tribe / Nation: Sunda / Indonesia
Entry Date: September 6, 2018
Assessment Date: 10 September 2018
Room: 10A / Adult Disease
Medical Record Number: 05010109
Medical Diagnosis: Stage 3 Hypertension
Address: Citepus RT 01 RW 06Pajajaran Bandung

b. Identity of the person in charge

Name: Mrs.R
Age: 38 years old
Female gender
Last Education: Elementary School
Link with Client: Niece
Address: Citepus RT 01 RW 06Pajajaran Bandung

2. Health History
a Health History Now
(1) The main complaint when entering a hospital
Since 5 hours before entering the hospital, the patient feels the
blood coming out of the left nostril suddenly and red is runny,
more than half a glass of starfruit. Blood comes out continuously
until it is hospitalized. Previously, 15 hours before entering the
hospital the client also felt the same complaint, but the blood
that came out was only a little and stopped alone.
(2) The main complaint during the assessment
When examined the client said his body was weak and the spleen
looked bedrest.
b. Past Health History
Since 3 months the client feels frequent urination and many, often
feel hungry, often thirsty and drink a lot. There is no history of
body heat and previous nosebleeds. History of high blood pressure
has been felt since 10 years before entering the hospital and the
spleen is not treated regularly. Highest blood pressure 200 / -
for 2-3 years before entering the hospital. Patients have felt
swelling in both legs, quickly tired when on the move.
c. Family Health History
No family has infectious diseases, hypertension, diabetes
mellitus, and other diseases.
5) Daily Activity Patterns
September 12, 2018
No Type Before Pain After Pain
1 Nutrition
a. Eat

Frequency

Type

Difficulty swallowing
Abstinence / allergies

b. Drink
Frequency
Type
Abstinence

3x / day, consumes 1 portion

Nasi, Sayur, Lauk-Pauk
There is no
There is no

6-7 glasses
Water
There is no

3x / day, consumes 1 portion

Nasi, Sayur, Lauk-Pauk
There is no
Salty, high in sodium

6-7 glasses
Water
There is no
2 Elimination
a. CHAPTER
Frequency
Consistency
Color
b. BAK
Frequency
Color
Difficulty

1x / day
Mushy
Typical yellow feces

3x / day
Clear yellow
There is no

1x / day
Mushy
Typical yellow feces

3x / day
Clear yellow
There is no

3 Sleep Rest
a. Sleep at night

b. Siesta
6 hours / day from 9:00 a.m. to 3:00 p.m.
2 hours / day
6 hours / day from 9:00 a.m. to 3:00 p.m.
2 hours / day
4 Personal Hygiene
a. Bath

b. Tooth brush

c. Hair washing
2x / day, independent

2x / day

Every two days

2x / day, wiped out by family and nurses
2x / day assisted by family and nurses
Every 2 days aided by family and nurses
5 Activities
Clients active as housewives who are always in bedrest Client's
house in bed, ADL needs such as BAB and BAK can still be fulfilled
with the help of nurses and families.
1) Pemeriksaan Fisik
a. Kesehatan Umum
Kesadaran : Composmentis GCS : 15
Vital Sign : Suhu : 36,50 C
Nadi : 67x/menit
Tensi : 130/80 mmHg
Respirasi : 20x/menit
b. Sistem Pernafasan
Bentuk hidung simetris nasal ditengah, tidak terdapat pernafasan

cuping hidung, fungsi penciuman dan kepatenan baik. Leher

ditengah, bentuk dada simetris, pengembangan paru-paru simetris

anterior-posterior, tidak terlihat penggunaaan otot-otot nafas

tambahan, vibrasi kiri dan kanan anterior posterior seimbang

pada kedua paru. Pada perfusi terdengan rensonan pada seluruh

daerah paru, suara nafas murni vesikuler dengan frekuensi nafas

20x/menit.
c. Sistem Kardiovaskuler
Tidak ada peningkatan JVP, CRT kurang dari 3 detik, iktus kordis

teraba pada ICS 6 kanan mid klavikula peranjakan 2 cm, bunyi

jantung murni regular pada S1 dan S2, tidak ada bunyi jantung

hambatan. Nadi radialis 67x/menit. Pada perkusi jantung dullness.

d. Sistem Pencernaan
Mukosa bibir lembab, lidah dan gusi tidak ada stomatis,

pergerakan lidah baik, jumlah gigi 322 lengkap, tidak ada caries,

uvula simetris, reflek menelan baik. Pada auskultasi bisisng usus

21x/menit, pada perkusi tympani pada lambung, dullness pada

hepar, tidak terdapat nyeri tekan dan nyeri lepas pada seluruh

area abdomen dan tidak terdapat pembesaran hati dan lien.

e. Sistem Persarafan
1) Tes serebral fungsi
 Klien dapat berorientasi dengan tempat, orang dan waktu,

klien dapat berespon dengan baik, klien dapat berkomunikasi

dengan normal, GCS (E=4, M=6, V=5).

2) Saraf Cranial

3) Nervus I (Olfactorius)
4) Clients can distinguish the smell of eucalyptus and
coffee with their eyes closed
5) Nervus II (Optics)
6) Clients can read the nurse's nameplate within ± 30
cm. there is no narrowing of the field of view
7) Nervus III (Okulomotorius)
8) There is a 3 mm pupillary contraction of isocorous
round pupils in both eyes
9) IV nerve (Troclearis)
10) There are no nystagmus, diplopia and eye deviation
in both eyes
11) Nervus V (Trigeminus)
12) The client's eyes wink when the lashes are touched
with cotton, the client can feel the swabs on the
eyes, forehead and chin
13) Nervus VI (Abducend)
14) The client is able to move his eyes to the right
and left
15) VII nerve (Facialis)
16) Clients can differentiate salty and sweet taste
with eye contact, symmetrical face shape
17) Nervus VIII (Acoustics)
18) Good roaming function
19) Nervus IX (glossopharyngeal)
20) Reflex swallows the client well and can
distinguish bitter taste
21) Nervus X
22) The symmetrical client's uvula is seen as the
client opens his mouth and says "ah"
23) Nervus XI
24) Clients can shrug their shoulders against
prisoners
25) Nervus XII
26) Symmetrical tongue shape, the client is able to
stick out his tongue and move in all directions
27) f. Urination System
28) There was no complaint of pain in genito urinaria
not palpable kidney enlargement, no sound of bruits
in the renal artery, no tenderness at symisis, no
cursing pain in renal percussion.
29) g. Musculoskeletal system
30) The client appears to lie weak on the bed. The
client said that if you want to go down from tenpat
to sleep or to the amndi room you should be helped
by the family. Both the client's arms and legs are
symmetrical. No edema was found in the upper and
lower extremities. There is a decrease in motoric
 function. The client feels weak in the extremities
as far as left. The level of client mobilization
ability is that it requires simple assistance /
guidance / supervision.
31) h. Integumen system
32) Hair color is mostly white and black, spread of
evenly distributed hair, clean scalp condition,
lesions (-), no dandruff, clean and neat hair.
There is no tenderness in the head area, and the
hair does not fall out easily. Brown skin color,
nails look clean and short, the client looks clean
and not sticky. Skin turgor returns in 3 seconds
36.50C client temperature.
33) i. Endocrine System
34) There was no moonface, no enlargement of the
thyroid and parathyroid glands, no history of
polyuri, no history of polyphagia, no history of
polydipsi.
35) 7) Psychological Data
36) a Status of Emotion
37) The client's emotions are stable, the client's
facial expression is calm and looks anxious.
38) b. Worry
39) The client looks worried from the client always
smiling when reprimanded by the nurse and talking
with his family
40) c. Coping Pattern
41) According to the client if he gets into trouble he
often talks about it with his family
42) d. Communication Style
43) Clients can communicate verbally and nonverbally,
clients can communicate with nurses, families, and
other doctors, languages used in Indonesian and
Sundanese languages
44) e. Self concept
45) (1) Self-description
46) The client likes all parts of his body because all
of this is a gift from the Almighty God that he
must thank
47) (2) Ideal Self
48) The client says he wants to get well soon and act
as usual
49) (3) Self Identity
50) Clients feel proud to be born as women
51) (4) Self-esteem
52) Clients feel happy because many love him even
though they are far from home
53) (5) Role
54) The client is as an aunt from his niece
55) 8) Social Data
56) Client relationships with family, nurses, doctors,
and other clients are good, seen with clients
always communicating with family, nurses, doctors,
and other clients.
57) 9) Spiritual Data
58) Clients adhered to Islam, as long as they were
treated by clients, they would go to bed and always
pray for their recovery. The client takes the pain
as a trial.
59) 10) Supporting Data
60) Laboratory results on September 6, 2018
61) No Result Type Unit Reference Value
62) 1 Hematology
63) Hemoglobin (L)
64) Leukocytes (L)
65) Hematocrit (L)
66) Platelets
67) 10.6
68) 6,806
69) 34
70) 174,000
71) 13-18
72) 3.8-10.6 rb
73) 40-52
74) 150-440 rb
75) gr / dL
76) mm3
77) %
78) mm3
79) 2 Clinical Chemistry
80) Ureum
81) Creatinine (LK)
82) Glucose When
83) Sodium
84) Potassium
85) 43
86) 0.69
87) 166
88) 137
89) 3,3
90) 15-50
91) 0.6
92) <140
93) 135-145
94) 3.6-5.5
95) mg / dL
96) mg / dL
97) mg / dL
98) mEq / L
99) mEq / L
100)
101) 11) Medical therapy
102) • Aspar K 3x1 tab PO
103) • Furomesid 1x40 mg PO
104) • Caltopril 3x12.5 mg PO
105) • Low salt diit
106)
107) II. DATA ANALYSIS
108) No Data Interpretation Data and Possible
Cause of Problems
109) 1 DS:
110) The client said limp
111) DO:
112) Bedrest client Condition of client disease
113)
114) Clients must lie down
115)
116) Causes muscle tone stiffness
117)
118) Risk of stiffness of the extremity muscles
at risk of stiffness of the limb muscles
119) 2 DS:
120) • Clients say they often do not continue
treatment
121) • The client says rarely control
122) DO:
123) • Clients do not know what hypertension is
124) • Clients do not know why routine treatment
is needed
125) Lack of knowledge about understanding,
causes, and prevention of hypertension
126)
127) Do not continue treatment
128)
129) Uncontrolled blood pressure
130)
131) Risk of recurrence Risk of recurrent
hypertension
132) 3 DS:
133) • The client says he is not aware of the
disease
134) • The client says he wants to go home soon
135) DO:
136) • The client asks about the condition of
hypertension
137)
138) Need treatment with old treatment
139)
140) Lack of information about the condition of
the disease and the treatment procedure
141)
142) Stressor for clients
143)
144) Anxiety Discomfort: Anxiety
145) III. NURSING PLANNING
146) No Diagnose Nursing Planning
147) Rational Intervention Objectives
148) 1 2 3 4 5
149) 1 Risk of stiffness of the extremity
muscles in connection with long bed rest. Signed
with
150) DS:
151) The client said limp
152) DO:
153) Bedrest Tupan client:
154) No stiffness of the extremity muscles
155) Tupen:
156) Within 3 days the client is able to move
the upper and lower extremities with the following
criteria:
157) • The client is not weak anymore
158) • Clients are not bedrested again 1.
Gradually mobilize
159) 2. Perform passive ROM
160) 3. Involve the family in every action 1.
Increase gradually the level of client activity to
normal
161) 2. Prevents stiffness and improves blood
circulation
162) 3. The client feels more comfortable when
assisted by the family
163) 2 Risk of recurrence of hypertension due to
lack of knowledge of clients about hypertension.
Marked by
164) DS:
165) • Clients say they often do not continue
treatment
166) • The client says rarely control
167) DO:
168) • Clients do not know what hypertension is
169) • The client does not know why routine
treatment is needed:
170) Repeated hypertension does not occur after
the client returns home.
171) Tupen:
172) Within 1 x 24 hours after receiving health
counseling about hypertendi clients understand the
criteria:
173) • Mengeri about the disease and its
handling
174) • Comply with the self-care program 1. TTV
observation
175) 2. Give health education about
hupertension, including:
176) • Definition of hypertension in brief and
simple
177) • Causes of hypertension
178) • Hypertension diit
179) • Self-care program
180) • Complications of hypertension in brief
and simple
181) 3. Encourage the family to monitor the
client in eating the drug and the client's diit
182) 4. Give low-salt diit with little but often
1. Monitor the development of hypertension
183) 2. With health education expected to
increase client knowledge and the risk of repeated
hypertension can be prevented
184) 3. Clients are more motivated to eat drugs
and run the droplets
185) 4. Reduces nausea