Holy Angel University

Angeles City
College of Nursing

A case study about

Gestational Hypertension

In partial fulfillment of the requirements in NCM 104 RLE

Submitted by:
Emano, Syrah
Enriquez, Lora Mae
Garcia, Christine
Lansang, Camille
Lebrilla, Gina
Lutchiang, Krisha
Manabat, Sarah
Manaloto, Angelie
Manongdo, Jackielyn
Mateo, Hannah Clarise
Pangilinan, Francheska
Puzon, Venhar
Rivera, Maria Aurora
Timbol, Paul John

Submitted to:
Ms. Donabel Pascual, RN, MAN
I. INTRODUCTION

Pregnancy is one of the most profound times in a woman's life. It is marked by a variety of
physical changes, as well as by thoughts and feelings that sometimes overwhelm the mother-
to-be. Though pregnancy is generally a time of joy and well-being, complications can occur
that cloud the experience and put the patient and her unborn child at
risk.
-Marie Norlund-
These complications include bleeding in early or late pregnancy, hyperemesis gravidarum,

gestational diabetes mellitus, and preterm rupture of membranes, preterm labor and pregnancy-

related hypertension. Pregnancy related hypertension happens when blood pressure increases

during pregnancy. Blood pressure is the force of the blood pushing against the walls of the

arteries (blood vessels that carry oxygen-rich blood to all parts of the body). When the pressure

in the arteries becomes too high, it is called high blood pressure or hypertension.

About 8 percent of women have problems with high blood pressure during pregnancy because of

hormonal changes. There are several types of high blood pressure that affect pregnant women.

Some types start before pregnancy, and others develop during pregnancy. All types of high blood

pressure can pose risks to the pregnant woman and her baby. Fortunately, problems usually can

be managed with proper prenatal care.

There are three main types of high blood pressure caused during pregnancy:

· Chronic hypertension is high blood pressure that was present before the pregnancy.

If high blood pressure occurs before week 20, it is usually chronic hypertension (either

essential or secondary).

· Gestational hypertension also known as pregnancy induced hypertension (PIH) is

high blood pressure caused by increased levels of estrogen. This usually returns to normal

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 a few months after the baby is delivered. But it may compromise a women's pregnancy if

not treated early. Gestational hypertension is the most common form of hypertension in

pregnancy. A normal blood pressure reading is 120/80, if your blood pressure is above

this,( e.g 140/90) it means that you have gestational hypertension When diagnosed

before 30 weeks, there is a higher chance that it will progress to preeclampsia

· Preeclampsia (also called toxemia of pregnancy) BP > 140/90),

and proteinuria (>300 mg of protein in a 24-hour urine sample). a serious condition

characterized by high blood pressure and protein in the urine after 20 weeks of

pregnancy. Left untreated, preeclampsia can lead to serious and even fatal complications

for mother and baby.

Risk Factors includes having your first baby before the age of 20 or after

35 having a history of diabetes and hypertension (high blood pressure) before pregnancy,

having multiple births (twins, triplets etc.) and being of African descent.

Symptoms of gestational hypertension include:

• High blood pressure

• Pallor

Complications of gestational hypertension

It is important to bear in mind that this does increase the risk of pre-eclampsia or other

complications such as:

• Stillborn baby

• Intra-uterine growth restriction (low birth weight)

• Premature birth

• Placental abruption (placenta separates before birth)

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The treatment of gestational hypertension follows a different set of guidelines than the treatment

of general high blood pressure outside of pregnancy. The main goal of treatment in pregnant

women is to prevent the development of more serious conditions like fetal growth

restriction or placental abruption. Pregnancy also introduces other concerns into traditional

treatment plans, since the well-being of the baby must be considered along with that of the

mother. The most commonly used treatment options for pregnant women with high blood

pressure are:

· Bed rest

· Short-term (acute) drug therapy

· Long-term (chronic) drug therapy

Statistics

Locally in the Philippines, maternal health has also been labeled as a public health
concern. Every day, there are 11 Filipinas who die every day due to childbirth complications
such as pregnancy induced hypertension, eclampsia and hemorrhage.

The latest statistics from the Philippine Obstetrical and Gynecological Society(2006)
listed hypertension as causing 143/545(26.24%) maternal deaths. Further broken down,
hypertension deaths were preeclampsia (50), eclampsia (66), pre-existing hypertension (8),
chronic hypertension with pre-eclampsia (8) and HELLP syndrome (11). In the Philippines,
according to Department of Health, Maternal Mortality Rate (MMR) is 162 out of 10,000 live
births (Family Planning Survey 2006). Maternal deaths account for 14% of deaths among
women. For the past five years all of the causes of maternal deaths exhibited an upward trend.
Preeclampsia showed an increasing trend of 6.89%; 20%; 40%; and 100%. Ten women die every
day in the Philippines from pregnancy and childbirth related causes but for every mother who
dies, roughly 20 more suffer serious disease and disability. The UNFPA office in the
Philippines declared that family planning can help prevent maternal deaths by 35%.

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According to the Philippine Department of Health, the following have been the 5 leading causes
of maternal mortality since 2004:
1. Complications related to pregnancy

2. Hypertension complicating pregnancy and childbirth

3. Postpartum hemorrhage

4. Pregnancy with abortive outcome

5. Hemorrhage in early pregnancy

GLOBAL STATISCTICS

World Health Organization

Maternal morbidity July 2003

Number of studies (%)

Morbidity
Hypertensive disorders of pregnancy 885 (14.9)
Stillbirth 828 (13.9)
Preterm delivery 489 (8.2)
Induced abortion 400 (6.7)
Haemorrhage (antepartum, intrapartum, postpartum, unspecified) 365 (6.2)
Anaemia 267 (4.5)
Placenta anomalies (pravia, abruptio, etc.) 245 (4.1)
Spontaneous abortion 235 (4.0)
Gestational diabetes 224 (3.8)
Ectopic pregnancy 146 (2.5)
Premature rupture of membranes 140 (2.4)
Perineal laceration 139 (2.3)
Uterine rupture 116 (2.0)
Obstructed labour 102 (1.7)

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 Number of studies (%)
Morbidity
Depression (postpartum, during pregnancy) 96 (1.6)
Puerperal infection 86 (1.5)
Violence during pregnancy 77 (1.3)
Urinary tract infection 66 (1.1)
Malaria 54 (0.9)
Other conditions 973 (16.4)
Overall 593

Objectives

Nurse-Centered Objectives
Upon completion of this case study, the student nurse should be able to:
1. Identify the risk factor contributing to the occurrence of the disease
2. To gain new facts and ideas about the disease.
3. Identify the different medications administered for this disease their
indications, contraindications, side effect, and specific responsibility.
4. Identify the laboratory and diagnostic procedure done with the
patient, their indication and purposes, and specific nursing responsibilities.
5. Formulate related nursing diagnosis from the patients health data and to the
current problems the patient experiences and to come out with different
nursing interventions effective for the patient to improve and progress on the
most possible time

Client-Centered Objectives

Upon completion of this case study, the client should be able to:
1. Understand awareness of her disease.
2. Know the possible causes of the disease.
3. Learn and understand why such laboratory examinations are being done.
4. Cooperate in necessary interventions and managements to be done.

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II. NURSING ASSESSMENT

Personal Data

a. Demographic data

Gabriella is a 19 year old woman cohabitating with her boyfriend. She is the only child of
Sharpay and Ryan. She currently resides at Sulib Florida Blanca Pampanga and her nationality is
Filipino and she is a Roman Catholic by faith. She was born on October 8, 1990 at Guagua
Pampanga. She was admitted at Jose B. Lingad Memorial Regional Hospital last September 15,
2010 at 1:08pm with a diagnosis of uterine pregnancy 41 2/7 AOG seizure disorder and
gestational hypertension.

b. Socio- economic and cultural factors

At present she lives with her grandmother and her boyfriend in Sulib Florida Blanca. She
does not live with her parents since her mother died at the age of 33 while her father currently
lives in Laguna. She does not have any work presently and the main source of income in their
family is her 23 year old boyfriend who works at the Municipality as a market security and earns
150 php daily. At the same time, her mother and father- in-law support them as her mother-in-
law has a small eatery which earns approximately 500php a day and his father-in-law does
school service and earns 1,000 php for each student. According to Gabriella, whenever a member
of the family gets sick, they directly go to a nearby clinic.

c. Environmental factors

Gabriella lives with her grandmother and her boyfriend in Sulib Florida Blanca
Pampanga. Their house is made of blocks and it has two rooms and a bathroom. According to
Gabriella, she and her boyfriend Troy started to live together since College because her
grandmother is already old and they feel secured if there would be a man in the house.

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2. Maternal- Child Health History

a. Maternal- obstetric record

Gabriella is not married with her 23 year old boyfriend, because according to her, getting
married entails lot of expenses and at the moment they are still saving money for their growing
child. Her obstetric history is G1P1 (1001) and her AOG is 41 2/7. Her LMP was on November
30, 2009. She delivered her first baby via NSD at JBLMRH last September 15, 2010. She is
having her pre- natal check- up with her OB- gynecologist who is Dra. Guevarra and her clinic is
at Guagua Pampanga. Her hospital number is 288540.

b. Antepartal/ Prenatal preparation

Gabriella had her first prenatal check up on the month of February wherein according to
her ob gynecologist; her baby was already 3 months old. Subsequently, she had her regular
monthly check up until the month of July. And on the ninth month of her pregnancy, she did not
have her check up because according to her, she felt lazy.

c. Significant Trimestral changes

According to Gabriella, at first she did not knew she was pregnant, even though she did
not have her period for the month of December. And as far as she can recall, she had a fever
which lasted for three days on that month, and because she did not knew she was pregnant she
took Paracetamol to manage her fever. After taking the said drug for three days, her fever
subsided. And at the month of January, she decided to have a pregnancy test and the result was
positive. She stated that upon knowing she was pregnant, she took 6 tablets of Cytotec orally and
4 tablets were inserted vaginally. And at the month of February because her baby was not
aborted, she decided to have a check up, and an ultrasound.

She had morning sickness up to her fifth month of pregnancy, she said that she felt like
vomiting every morning and she is relieved when she vomits. According to her also, at her third
month of pregnancy, thru an ultrasound, her gynecologist told her she has subchronic
hemorrhage and she was then given tocolytic. And at her sixth month of pregnancy, her ob
gynecologist said that the bleeding has lessened and so she stopped taking the medication which
she can no longer remember. Furthermore, during her third month of pregnancy, she suffered

8
hypogastric pain which prompted her to consult her physician, her physician then said she has
Urinary Tract Infection, Gabriella thinks she had UTI because she refused in drinking water, so
her attending physician gave her antibiotic which she took for two weeks. Gabriella was also
fond of eating chocolates (snickers) during her pregnancy, also, Gabriella said that she was
craving for foods from Jollibee specifically spaghetti and chicken. Until her 9th month of
pregnancy she still craves for the same food.

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 3. Family Health Illness History

Grandpa Edward Grandma Grandpa Harry

78 y/o Bella Grandma 78 y/o
79 y/o Jeannie
67y/o

Mercedes Ryan Vin

62 y/o 60 y/o Rachelle 53 y/o Sharpay
Sue
58 y/o
-57 y/o

Gabriella
19 y/o

LEGEND:

MALE HYPERTENSION DECEASED

FEMALE DIABETES GABRIELLA (PATIENT)

ASTHMA OLD AGE ARTHRITIS

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The above diagram shows that Gabriella’s grandfather on his father side has asthma and arthritis,
and her grandmother also has arthritis. While on her mother side, her grandfather died because of
old age, he died at the age of 78, according to Gabriella, her grandmother on the other hand has
no illness. Her father Ryan has asthma, and her mother died at the age of 33 because of
hypertension.

4. History of Past Illness

According to Gabriella, she had her chicken pox at the age of 13, she also experiences
cough and colds during her childhood years. She also had asthma but at the age of six it
subsided. She also had an allergy to “bagoong” when she was elementary. When she reached
high school, particularly third year level, she had her first attack of seizure. It started when she
was having their CAT classes, according to her, it was a very hot day and she had difficulty of
breathing then she had seizure. She was then brought to the school clinic and was given O2
therapy. One month later, she had her second attack, at the same class, she was then brought to
Florida San Jose Hospital and was referred to St. Anthony hospital, where she had an EEG and
ECG, the doctor said that the results revealed her left heart is thicker than the right, she was then
given medication for her heart but she can no longer remember what is it. She was also given
medications for her seizure which was Phenobarbital, which she took for only two weeks. She
stopped taking the said medication because according to her, her seizure did not recur. Gabriella
said that she had approximately three episodes of seizure until fourth year high school. Her last
attack of seizure happened last July 2009 when they were having their duty in the rehabilitation
in Magalang for her practical nursing course. She did not take any medication at the said time.

5. History of Present Illness

Gabriella said that 3am that morning, she had watery vaginal discharge, she thought it
was just urine and so she still slept. And at around 9:00 am, her BOW ruptured, she also had
labor pains which prompted her to go to Romana Pangan but because her blood pressure was
130/90, she was referred to JBLMRH. And upon admission, her blood pressure was 140/90. She
was then given 1 tablet of Nifedipine 10mg. when her BP was 110/70, they proceeded with the
delivery. After the delivery, she was given an O2 therapy due to DOB.

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 6. Physical Examination

Physical Examination (IPPA- Cephalocaudal Approach)

September 15 , 2010 (lifted from the chart, assessed upon admission at 1:08 pm)

General Appearance:

HEENT: anicteric sclerae, pink palpebral conjunctiva

Lungs: symmetric chest expansion, (+) wheezes on both lung fields

Heart: adynamic, NRRR

Vital Signs: T: 37. 3

P: 84

R: 26

BP: 140/90

FHT: 140

GCS: 15

September 15 , 2010 (Wednesday)

Initial Assessment of Student Nurses at 3:20 pm

General Appearance:

Gabriella was lying on bed in a supine position, conscious and coherent with time,
place and person. She’s with an ongoing IVF #1 D5 LRS 1L + 30 units Oxytocin regulated 30
gtts/min. at level of 550cc, infusing well on the right arm. She looks pale and weak upon
assessment. Vital signs taken and recorded as follows:

T: 37.1 C

P: 84 bpm

R: 26

BP: 110/70 mmHg

SKIN
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 • With light brown skin and uniform in color
• Good skin turgor
• pale skin
• diaphoresis noted
• cold clammy skin

NAILS

• capillary refill of 2-3 secs

HEAD

• symmetrical in shape
• proportion with the body size
• no tenderness or lumps

EYES

• pupils are equally rounded and reactive to light accommodation

• eyebrows symmetrically aligned
• eyelashes equally distributed
• with pale palpebral conjunctiva

EARS:

• auricle aligned with outer canthus of eye

• with dry cerumen
• normal voice tones audible

NOSE:

• symmetrical in shape
• with clear discharge
• no lesions noted

MOUTH:

• pale color and dry lips

• smooth and moist gums
• tongue in central position and moves freely, with white furrows
• no tenderness and palpable nodules
• no dentures used
NECK:

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 • head-centered
• with coordinated and smooth movements of head
• lymph nodes are not enlarged
• carotid pulse is palpable

HAIR:

• evenly distributed hair, no infection and infestation

SKULL AND FACE:

• rounded, smooth skull contour, absence of nodules and masses

THORAX AND LUNGS:

• chest symmetric, chest wall intact, no tenderness and masses

• wheezes on both lung field

• uses accessory muscles when breathing

• with non-productive cough

ABDOMEN:

• with tense, glistening skin,

• reported pain on umbilical region (pain scale of 8/10)

CARDIOVASCULAR SYSTEM

• With symmetric peripheral pulses

• regular heart rhythm

MUSCULOSKELETAL SYSTEM:

• No muscles and tendons contractures, presence of flaccidity, no deformities and

tenderness or swelling of bones
• with limited range of motion in one or more joints

NEUROLOGIC SYSTEM:

• Performs with slow, movements and irregular timing

• has difficulty alternating from supination to pronation
• restlessness noted

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7. Diagnostic and Laboratory Procedures

Diagnostic/ Date ordered Indication/ Purpose Result Normal Values Analysis and
Laboratory Date Result (units used in the Interpretation of Result
procedures IN hospital)

Urinary D.O: It is used to diagnose a Color : Yellow Pale yellow to Few epithelial cells may
Analysis 09-15-10 urinary tract or kidney amber suggest inflammation within
infection, to evaluate causes the bladder. Specific gravity
D.R: of kidney failure, to screen Appearance: Clear to light results indicate that urine is
09-15-10 for progression of some Hazy hazy diluted.
chronic conditions such as
diabetes mellitus and high
blood pressure. Specific
Gravity: 1.005 1.015-1.025
Pus Cell : 1-2 Negative
hpf

Epithelial cells: Negative

few

Mourphous
Negative
urease: few

Albumin:
Negative Negative

*Note: Doctor ordered BUN, Creatinine, and CBC with Platelet count but results were not yet available during student
nurse’s assessment.

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Nursing Responsibilities for Urinalysis:

Before

 Explain the procedure to the patient.

 Tell the patient that no fasting is required.

During

 Collect a voided specimen in a urine container.

 Have the client collect midstream specimen by:
 Having the patient begin to urinate in a bedpan, urinal, or toilet and then stop
urinating.
 Correctly position a sterile urine container, into which patient voids 3 to 4 ounces
of urine.
 Capping the container.
 Allowing the patient to finish voiding.
After

 Transport the urine specimen to the laboratory promptly.

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III. ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE ORGANS

Ovaries
The ovaries are the main reproductive organs of a woman. The two ovaries, which are
about the size and shape of almonds, produce female hormones (estrogens and progesterone) and
eggs (ova). All the other female reproductive organs are there to transport, nurture and otherwise
meet the needs of the egg or developing fetus.
The ovaries are held in place by various ligaments which anchor them to the uterus and
the pelvis. The ovary contains ovarian follicles, in which eggs develop. Once a follicle is mature,
it ruptures and the developing egg is ejected from the ovary into the fallopian tubes. This is
called ovulation. Ovulation occurs in the middle of the menstrual cycle and usually takes place
every 28 days or so in a mature female. It takes place from either the right or left ovary at
random.
Fallopian tubes
The fallopian tubes are about 10 cm long and begin as funnel-shaped passages next to the
ovary. They have a number of finger-like projections known as fimbriae on the end near the
ovary. When an egg is released by the ovary it is ‘caught’ by one of the fimbriae and transported

17
along the fallopian tube to the uterus. The egg is moved along the fallopian tube by the wafting
action of cilia — hairy projections on the surfaces of cells at the entrance of the fallopian tube —
and the contractions made by the tube. It takes the egg about 5 days to reach the uterus and it is
on this journey down the fallopian tube that fertilisation may occur if a sperm penetrates and
fuses with the egg. The egg, however, is only usually viable for 24 hours after ovulation, so
fertilisation usually occurs in the top one-third of the fallopian tube.
Uterus
The uterus is a hollow cavity about the size of a pear (in women who have never been
pregnant) that exists to house a developing fertilised egg. The main part of the uterus (which sits
in the pelvic cavity) is called the body of the uterus, while the rounded region above the entrance
of the fallopian tubes is the fundus and its narrow outlet, which protrudes into the vagina, is the
cervix.
The thick wall of the uterus is composed of 3 layers. The inner layer is known as the
endometrium. If an egg has been fertilised it will burrow into the endometrium, where it will stay
for the rest of its growth. The uterus will expand during a pregnancy to make room for the
growing fetus. A part of the wall of the fertilised egg, which has burrowed into the endometrium,
develops into the placenta. If an egg has not been fertilised, the endometrial lining is shed at the
end of each menstrual cycle.
The myometrium is the large middle layer of the uterus, which is made up of interlocking
groups of muscle. It plays an important role during the birth of a baby, contracting rhythmically
to move the baby out of the body via the birth canal (vagina).
Vagina
The vagina is a fibromuscular tube that extends from the cervix to the vestibule of the
vulva. The vagina is a passage connecting the uterus with the external genitals, receives the penis
and the sperm ejaculated from it during sexual intercourse. It also serves as an exit passageway
for menstrual blood and for the baby during birth. The external genitals, or vulva, include the
clitoris, erectile tissue that responds to sexual stimulation, and the labia, which are composed of
elongated folds of skin.

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Breasts (Mammary Glands)
After birth the infant is fed with milk from the breasts, or mammary glands, which are also
sometimes considered part of the reproductive system

The Circulatory System

The circulatory system is responsible for the transport of water and dissolved materials
throughout the body, including oxygen, carbon dioxide, nutrients, and waste. The circulatory
system transports oxygen from the lungs and nutrients from the digestive tract to every cell in the
body, allowing for the continuation of cell metabolism. The circulatory system also transports
the waste products of cell metabolism to the lungs and kidneys where they can be expelled from
the body. Without this important function toxic substances would quickly build up in the body.

Anatomy of the Circulatory System

The human circulatory system is organized into two major circulations. Each has its own
pump with both pumps being incorporated into a single organ -- the heart. The two sides of the
human heart are separated by partitions, the interatrial septum and the interventricular septum.
Both septa are complete so that the two sides are anatomically and functionally separate pumping
units. The right side of the heart pumps blood through the pulmonary circulation (the lungs)
whiles the left side of the heart pumps blood through the systemic circulation (the body).

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 The human heart is a specialized, four-chambered muscle that maintains the blood flow
in the circulatory system. It lies immediately behind the sternum, or breastbone, and between the
lungs. The apex, or bottom of the heart, is tilted to the left side. At rest, the heart pumps about 59
cc (2 oz) of blood per beat and 5 l (5 qt) per minute. During exercise it pumps 120-220 cc (4-7.3
oz) of blood per beat and 20-30 l (21-32 qt) per minute. The adult human heart is about the size
of a fist and weighs about 250-350 gm (9 oz).

The human heart begins beating early in fetal life and continues regular beating
throughout the life span of the individual. If the heart stops beating for more than 3 or 4 minutes
permanent brain damage may occur. Blood flow to the heart muscle itself also depends on the
continued beating of the heart and if this flow is stopped for more than a few minutes, as in a
heart attack, the heart muscle may be damaged to such a great extent that it may be irreversibly
stopped.

The heart is made up of two muscle masses. One of these forms the two atria (the upper
chambers) of the heart, and the other forms the two ventricles (the lower chambers). Both atria
contract or relax at the same time, as do both ventricles.

An electrical impulse called an action potential is generated at regular intervals in a

specialized region of the right atrium called the sinoauricular (or sinoatrial, or SA) node. Since

20
the two atria form a single muscular unit, the action potential will spread over the atria, a fraction
of a second later, having been triggered by the action potential, the atrial muscle contracts.

The ventricles form a single muscle mass separate from the atria. When the atrial action
potential reaches the juncture of the atria and the ventricles, the atrioventricular or AV node
(another specialized region for conduction) conducts the impulse. After a slight delay, the
impulse is passed by way of yet another bundle of muscle fibers (the Bundle of His and the
Purkinje system.) Contraction of the ventricle quickly follows the onset of its action potential.
From this pattern it can be seen that both atria will contract simultaneously and that both
ventricles will contract simultaneously, with a brief delay between the contractions of the two
parts of the heart.

The electrical stimulus that leads to contraction of the heart muscle thus originates in the
heart itself, in the sinoatrial node (SA node), which is also known as the heart's pacemaker.
This node, which lies just in front of the opening of the superior vena cava, measures no more
than a few millimeters. It consists of heart cells that emit regular impulses. Because of this
spontaneous discharge of the sinoatrial node, the heart muscle is automated. A completely
isolated heart can contract on its own as long as its metabolic processes remain intact.

The rate at which the cells of the SA node discharge is externally influenced through the
autonomic nervous system, which sends nerve branches to the heart. Through their stimulatory
and inhibitory influences they determine the resultant heart rate. In adults at rest this is between
60 and 74 beats a minute. In infants and young children it may be between 100 and 120 beats a
minute. Tension, exertion, or fever may cause the rate of the heart to vary between 55 and 200
beats a minute.

The Heart Sounds

The closure of the heart valves and the contraction of the heart muscle produce sounds
that can be heard through the thoracic wall by the unaided ear, although they can be heard better
when amplified by a stethoscope. The sounds of the heart may be represented as lubb-dubb-
pause-lubb-dubb-pause. The lubb sound indicates the closing of the valves between the atria and
ventricles and the contracting ventricles; the dubb sound indicates the closing of the semilunar
valves. In addition, there may also be cardiac murmurs, especially when the valves are abnormal.
Some heart murmurs, however, may also occur in healthy persons, mainly during rapid or
pronounced cardiac action. The study of heart sounds and murmurs furnishes valuable
information to physicians regarding the condition of the heart muscle and valves.

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 Coronary Circulation

The coronary arteries supply blood to the heart muscle. These vessels originate from the
aorta immediately after the aortic valve and branch out through the heart muscle. The coronary
veins transport the deoxygenated blood from the heart muscle to the right atrium. The heart's
energy supply is almost completely dependent on these coronary vessels. When the coronary
vessels become blocked, as in arteriosclerosis or hardening of the arteries, blood flow to the
cardiac muscle is compromised. This is when the common "bypass surgery" is performed where
the coronary arteries are "bypassed" by replacing them with, for example, a vein from the leg. A
"double bypass" is when two coronary arteries are bypassed. A "triple bypass" is when three are
bypassed, etc.

The Heartbeat

The heart muscle pumps the blood through the body by means of rhythmical contractions
(systole) and relaxations or dilations (diastole). The heart's left and right halves work almost
synchronously. When the ventricles contract (systole), the valves between the atria and the
ventricles close as the result of increasing pressure, and the valves to the pulmonary artery and
the aorta open. When the ventricles become flaccid during diastole, and the pressure decreases,
the reverse process takes place.

The Pulmonary Circulation

From the right atrium the blood passes to the right ventricle through the tricuspid valve,
which consists of three flaps (or cusps) of tissue. The tricuspid valve remains open during
diastole, or ventricular filling. When the ventricle contracts, the valve closes, sealing the opening
and preventing backflow into the right atrium. Five cords attached to small muscles, called
papillary muscles, on the ventricles' inner surface prevent the valves' flaps from being forced
backward.

From the right ventricle blood is pumped through the pulmonary or semilunar valve,
which has three half-moon-shaped flaps, into the pulmonary artery. This valve prevents backflow
from the artery into the right ventricle. From the pulmonary artery blood is pumped to the lungs
where it releases carbon dioxide and picks up oxygen.

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 The Systemic Circulation

From the lungs, the blood is returned to the heart through pulmonary veins, two from
each lung. From the pulmonary veins the blood enters the left atrium and then passes through the
mitral valve to the left ventricle. As the ventricles contract, the mitral valve prevents backflow of
blood into the left atrium and blood is driven through the aortic valve into the aorta, the major
artery that supplies blood to the entire body. The aortic valve, like the pulmonary valve, has a
semilunar shape.

The aorta has many branches, which carry the blood to various parts of the body. Each of
these branches in turn has branches, and these branches divide, and so on until there are literally
millions of small blood vessels. The smallest of these on the arterial side of the circulation are
called arterioles. They contain a great deal of smooth muscle, and because of their ability to
constrict or dilate, they play a major role in regulating blood flow through the tissues.

The blood passing through the arterioles passes through a bed of minute vessels called
capillaries, which are a single cell thick. These capillaries are so small that the red blood cells
must line up single file to pass through. The exchange of nutrients and waste products takes
place between the capillary blood and the tissue fluids. The arterialized blood that enters the
capillaries thus becomes venous blood as it passes through them.

The capillaries empty the venous blood into collecting tubes called venules, and these in
turn empty into small veins, which empty into larger veins, and so on until finally all the blood
returns to the heart through two large veins, the superior and inferior vena cavae. These
terminate in the right atrium, and the systemic circulation is complete.

23
 A one-way flow of blood in this system is maintained by valves located, not only in the
heart, but in the veins as well. Some veins also have semilunar valves and the pressure of
contracting muscles against the veins works with the action of these valves to increase the
venous return to the heart. This is the reason that exercise is so important for the circulation.

The Lymphatic System

An often overlooked part of the circulatory system is the lymphatic system. As blood
passes through the capillaries, some of the fluid diffuses into the surrounding tissues. One
function of the lymphatic system is to collect and recycle this fluid (called lymph). Lymph passes
from capillaries to lymph vessels and flows through lymph nodes that are located along the
course of these vessels. Cells of the lymph nodes phagocytize, or ingest, impurities such as
bacteria, old red blood cells, and toxic and cellular waste. Finally, lymph flows into the thoracic
duct, a large vessel that runs parallel to the spinal column, or into the right lymphatic duct, both
of which transport the lymph back into veins of the shoulder areas where is mixes with blood and
is returned to the heart. All lymph vessels contain one-way valves, like the veins, to prevent
backflow.

The tissues of the lymphatic system include the spleen. The spleen serves as a reservoir
for blood, releasing additional blood into the circulatory system as needed. It is also involved
with destruction of old cells and other substances by phagocytosis. The lymphatic system is also
responsible for collecting nutrients that the digestive system has extracted from our foods, and is
a very important part of the immune system. We will cover the lymphatic system in detail in the
lesson on the immune system.

24
25
 The Blood

The blood transports life-supporting food and oxygen to every cell of the body and
removes their waste products. It also helps to maintain body temperature, transports hormones,
and fights infections. The brain cells in particular are very dependent on a constant supply of
oxygen. If the circulation to the brain is stopped, death shortly follows.

Blood has two main constituents. The cells, or corpuscles, comprise about 45 percent,
and the liquid portion, or plasma, in which the cells are suspended comprises 55 percent. The
blood cells comprise three main types: red blood cells, or erythrocytes; white blood cells, or
leukocytes, which in turn are of many different types; and platelets, or thrombocytes. Each type
of cell has its own individual functions in the body. The plasma is a complex colorless solution,
about 90 percent water, that carries different ions and molecules including proteins, enzymes,
hormones, nutrients, waste materials such as urea, and fibrinogen, the protein that aids in
clotting.

Red Blood Cells

The red blood cells are tiny, round, biconcave disks, averaging about 7.5 microns (0.003
in) in diameter. A normal-sized man has about 5 l (5.3 qt) of blood in his body, containing more
than 25 trillion red cells. Because the normal life span of red cells in the circulation is only about
120 days, more than 200 billion cells are normally destroyed each day by the spleen and must be
replaced. Red blood cells, as well as most white cells and platelets, are made by the bone
marrow.

The main function of the red blood cells is to transport oxygen from the lungs to the
tissues and to transport carbon dioxide, one of the chief waste products, it to the lungs for release
from the body.

The substance in the red blood cells that is largely responsible for their ability to carry
oxygen and carbon dioxide is hemoglobin, the material that gives the cells their red color. It is a
protein complex comprising many linked amino acids, and occupies almost the entire volume of
a red blood cell. Essential to its structure and function is the mineral iron.

White Blood Cells

The leukocytes, or white blood cells, are of three types; granulocytes, lymphocytes, and
monocytes. All are involved in defending the body against foreign organisms.

There are three types of granulocytes: neutrophils, eosinophils, and basophils, with
neutrophils the most abundant. Neutrophils seek out bacteria and phagocytize, or engulf, them.

The lymphocytes' chief function is to migrate into the connective tissue and build
antibodies against bacteria and viruses. Leukocytes are almost colorless, considerably larger than
red cells, have a nucleus, and are much less numerous; only one or two exist for every 1,000 red
cells. The number increases in the presence of infection.

26
 Monocytes, representing only 4 to 8 percent of white cells, attack organisms not
destroyed by granulocytes and leukocytes.

The granulocytes, accounting for about 70 percent of all white blood cells, are formed in
the bone marrow. The lymphocytes on the other hand are produced primarily by the lymphoid
tissues of the body -- the spleen and lymph nodes. They are usually smaller than the
granulocytes. Monocytes are believed to originate from lymphocytes. Just as the oxygen-
carrying function of red cells is necessary for our survival, so are normal numbers of leukocytes,
which protect us against infection.

Platelets

Platelets, or thrombocytes, are much smaller than the red blood cells. They are round or
biconcave disks and are normally about 30 to 40 times more numerous than the white blood
cells. The platelets' primary function is to stop bleeding. When tissue is damaged, the platelets
aggregate in clumps to obstruct blood flow.

Plasma

The plasma is more than 90 percent water and contains a large number of substances,
many essential to life. Its major solute is a mixture of proteins. The most abundant plasma
protein is albumin. The globulins are even larger protein molecules than albumin and are of
many chemical structures and functions. The antibodies, produced by lymphocytes, are globulins
and are carried throughout the body, where many of them fight bacteria and viruses.

An important function of plasma is to transport nutrients to the tissues. Glucose, for

example, absorbed from the intestines, constitutes a major source of body energy. Some of the
plasma proteins and fats, or lipids, are also used by the tissues for cell growth and energy.
Minerals essential to body function, although present only in trace amounts, are other important
elements of the plasma. The calcium ion, for example, is essential to the building of bone, as is
phosphorus. Calcium is also essential to the clotting of blood. Copper is another necessary
component of the plasma.

27
IV. PATHOPHYSIOLOGY

Book- based

PRECIPITATING FACTORS:
PREDISPOSING FACTORS:
Medical conditions like Diabetes Mellitus, essential
Family History of Hypertension
hypertension, kidney diseases
African-American race
Malnourished women at start of pregnancy
Hereditary
Overweight
Age (<20 and >40 years old)
Multiple pregnancies
Previous PIH
Inadequate prenatal care
Primigravida
Poor nutrition

IMPAIRED RESPONSIVENESS TO BLOOD

PRESSURE CHANGES

INCREASED PERIPHERAL HYPERTENSIO

VASCULAR RESISTANCE N

28
INCREASED ARTERIAL INADEQUATE PERFUSION
BLOOD PRESSURE TO THE PLACENTA

INADEQUATE
PERFUSION TO THE DEGENERATIVE CHANGES
PERIPHERAL ORGANS CAUSING IMPAIRMENT IN
PLACENTAL FUNCTION
(TISSUE ISCHEMIA)
PALLOR

↓ FETAL PREMATURE
NOURISHMENT AND PLACENTAL
OXYGENATION DETERIORATION

PREMATURE
BIRTH

FETAL INTRAUTERIN
RESPIRATORY E GROWTH PLACENTAL
DISTRESS RESTRICTION ABRUPTION
(placenta separates
STILLBOR before birth)
N BABY

29
Synthesis of the condition

a. Definition of the disease

Gestational hypertension is defined as systolic blood pressure ≥140 mmHg and/or diastolic blood
pressure ≥90 mmHg in a previously normotensive pregnant woman who is ≥20 weeks of
gestation and has no proteinuria. The blood pressure readings should be documented on at least
two occasions at least six hours apart. It is considered severe when sustained elevations in
systolic blood pressure ≥160 mmHg and/or diastolic blood pressure ≥110 mmHg are present for
at least six hours.

Gestational hypertension is a temporary diagnosis for hypertensive pregnant women who do not
meet criteria for preeclampsia (both hypertension and proteinuria) or chronic hypertension
(hypertension first detected before the 20th week of pregnancy). The diagnosis is changed to:

• Preeclampsia, if proteinuria develops

• Chronic hypertension, if blood pressure elevation persists ≥12 weeks postpartum
• Transient hypertension of pregnancy, if blood pressure returns to normal by 12 weeks
postpartum

Thus, reassessment up to 12 weeks postpartum is necessary to establish a final definitive

diagnosis.

b.1 Predisposing Factors:

1. Family History of Hypertension- familial history of hypertension can increase the risk of
developing hypertension during pregnancy

2. African-American race – importance of race is fairly debatable. Several studies proposed an

increased risk of gestational hypertension among African-Americans

3. Hereditary- gestational hypertension is known to be a hereditary condition

-
4. Age (<20 and >40 years old)- this age is known to be at high risk age for pregnancy because
they are more prone to developing complications and one of which is gestational hypertension.

5. Previous PIH- having a history of gestational hypertension or PIH slightly increase the risk of
having the condition again

30
6. Primigravida- primigravid mother are more prone to gestational hypertension compare to
multigravid mothers.

b.2. Precipitating Factors:

1. Medical conditions like Diabetes Mellitus, essential hypertension, kidney diseases- this
conditions highly increase the chance of developing gestational hypertension

2. Malnourished women at start of pregnancy- due to improper nutrition of the body, a

woman may tend to develop hypertension during her pregnancy

3. Overweight- generally, overweight persons are more prone of developing hypertension, and
an overweight or obese pregnant mother is at high risk of developing gestational hypertension.

4. Multiple pregnancies- gestational hypertension is found to be more common on mothers with

multiple pregnancies

5. Inadequate prenatal care- inadequate eating habits and lack of prenatal check up can
increase the risk of having gestational hypertension.

6. Poor nutrition- the eating habit of a pregnant mother may have an effect on her body, eating a
poorly nutritious specifically fatty and salty food may lead to the development of gestational
hypertension

c. Signs and symptoms with rationale

1. Hypertension (140/90mmHg)- Vasospasm of blood vessels causes vasoconstriction and

increased peripheral resistance leading to an increase in blood pressure.

2. Pallor- the peripheral organs tend to receive less blood due to the vasoconstriction of the
vessels.

Other signs that may manifest:

Intrauterine growth restriction, placental abruption, premature birth and stillborn baby—this may
all happen or manifest when there was a decrease in placental perfusion over an extended period
of time.

31
Client centered:

PREDISPOSING FACTORS:
PRECIPITATING FACTORS:
Familiy History of Hypertension
Age (19y/o) Inadequate prenatal care
Primigravida

IMPAIRED RESPONSIVENESS TO BLOOD

PRESSURE CHANGES

INCREASED ARTERIAL INCREASED PERIPHERAL HYPERTENSION

BLOOD PRESSURE VASCULAR RESISTANCE 140/90mmHg
(September 15, 2010)

INADEQUATE
PERFUSION TO THE
PERIPHERAL ORGANS

PALLOR
(September 15,
2010

32
Synthesis of the condition

a. Predisposing/ Precipitating factors

Predisposing Factors:

1. Family History of Hypertension- Gabriella has a hypertension as a disease running in both

sides of her family, her mother died because of hypertension and one brother of her father has
hypertension, thus increasing her risk of developing and aquiring gestational hypertension.

2. Age – because Gabriella belong to the high risk age group during pregnancy, she tends to
develop her condition which is gestational hypertension

3. Primigravida- studies shows that primigravids are more prone of developing gestational
hypertension compare to multigravids, since the client is a primigravid mother, this increases the
risk, thus she developed gestational hypertension

Precipitating Factor:

1. Inadequate prenatal care- Gabriella said that she stopped having her prenatal check up on
the 9th month of her pregnancy, she was also fond of eating chocolate during the course of her
pregnancy.

b.. Signs and symptoms with rationale

1. Hypertension (140/90mmHg, September 15, 2010) – this is associated with the

vasoconstriction of the peripheral vasculature due to the impaired responsiveness to blood
pressure changes

2. Pallor (September 15, 2010) - the peripheral organs tend to receive less blood due to the
vasoconstriction of the vessels.

33
V. PATIENT AND HIS CARE

1. Medical Management

Date Ordered
Client’s Response to
Medical Management General Description Indications/Purpose Date Performed
Treatment
Date Changed or D/C

Dextrose 5% in Lactated It is a sterile, Indicated as a source of Date ordered: The client did not
Ringer’s Solution nonpyrogenic solution water, electrolytes and September 15, 2010 experience dehydration.
(D5LRS 1Lx30gtts/min) for fluid and electrolyte calories or as an
with 30 “u” Oxytocin replenishment and alkalinizing agent. Date performed:
caloric supply in a single September 15, 2010
dose container for
intravenous
administration.

Oxytocin is a hormone Oxytocin is given for

involved in muscle induction of labor at
contraction and nerve term and control of
sensitivity. postpartum bleeding.

Nursing Responsibilities:

Before:

 Check and verify the doctor’s order.

 Explain the procedure to the patient and why it has to be done.
 Check the amount of IV fluid ordered and how long it will be consumed.

34
During:
 Practice aseptic technique.
 Instruct patient to relax especially the hand where the needle is to be inserted to avoid reinsertion and facilitate easy insertion.
 Check again the IV fluid ordered and hours to run in the doctor’s order to avoid medication errors.
 Check IV level and patency of the tubing if it is infusing well.
 Check for backflow by lowering the IV bottle. The bottle should be lower than the IV site.
 Regulate as ordered.
 Label the IV bottle with the name of the IV fluid, route and time of administration and signature.
 Document the procedure given.

After:
 Press the site where the needle is inserted and secure it with micro pore.
 Check the site of hand where the needle is inserted if bulging is not visible.
 Advice patient to avoid scratching the site, less movement of the hand where the needle was inserted to keep it in place.
 Instruct patient and significant others to inform the nurse on duty if bulging of the site is visible, if there is back flow of blood
or if IVF is not infusing well.
 IVF regulation should be checked and monitored upon receiving patient.
 Always check the doctor’s order for new orders regarding the IVF supplement of the patient.
 Always check if the IVF is infusing well and intact.
 Monitor the patient’s skin integrity.

35
 Date Ordered
Client’s Response to
Medical Management General Description Indications/Purpose Date Performed
Treatment
Date Changed or D/C

Oxygen Therapy The body is constantly Oxygen therapy is the D.O.: September 15, The patient was relieved
taking in oxygen and administration of oxygen 2010 from difficulty of
releasing carbon at concentrations greater breathing.
dioxide. If this process is than that in room air to D.P.: September 15,
inadequate, oxygen treat or prevent hypoxia. 2010
levels in the blood
decrease and the patient
may need supplemental
oxygen.

Nursing Responsibilities:

Before the procedure

1. Explain procedure to patient and review safety precautions necessary when oxygen is in us
2. Perform hand hygiene.

During the procedure:

3. Connect nasal cannula to oxygen setup with humidification, if one is in use. Adjust flow rate as ordered by physician. Check
the oxygen is flowing out of prongs.
4. Place the prongs in patient’s nostrils. Adjust according to type of equipment:
a. Over and behind each ear with adjuster comfortably under chin or around patient’s head.
5. Use gauze pads at ear beneath tubing as necessary.
6. Encourage patient to breathe through nose with mouth closed.

After the procedure:

7. Perform hand hygiene.
8. Assess and chart patient’s response to therapy.
9. Remove and clean cannula and assess nares at least every 8 hours or according to agency recommendations. Check nares for
evidence of irrigation or bleeding

1
b. Pharmacotherapy

Name of Drugs Date Ordered, Date Route of General Action, Client’s response to
Generic Name taken/Given, Date Administration, dosage Classification, medication with actual
Brand Name change/discontinued and frequency of Mechanism of action side effects
Administration

Cefuroxime Sodium Date ordered: 750mg IV q8 (-ANST) Antibiotic The client complied with
September 15, 2010 the therapeutic regimen
(zinacef) Date given: Prophylaxis for infection. and shows improvement
September 15, 2010 in her health condition.
Interferes with bacterial
cell wall synthesis by
inhibiting the final step in
the cross-linking of
peptidoglycan strands.
Peptidoglycan makes the
cell membrane rigid and
protective. Without it,
bacterial cells rupture and
dies

Ferrous Sulfate Date ordered: 1tab OD PO Anti-anemic The client complied with
September 15, 2010 the therapeutic regimen
(feosol) Date given: To provide iron and shows improvement
September 15, 2010 supplementation during in her health condition.
pregnancy.

Acts to normalized RBC

production by binding
with hemoglobin or being
oxidized and stored as
 hemosiderin or
aggregated ferritine in
reticuloendothelial cells
of the liver, spleen, and
bone marrow. Iron is
essential component of
hemoglobin, myoglobin,
and several enzymes,
including cytochromes,
catalase, and peroxidase.

Nifedipine Date ordered: 10mg BID PO Anti-hypertensive Client’s blood pressure

September 15, 2010 decreased from 140/90 to
(adalat cc) Date given: May slow movement of 110/70
September 15, 2010 calcium into myocardial
and vascular smooth
muscle cells by
deforming calcium
channel in cell
membranes, inhibiting
ion-controlled gating
mechanism, and
disrupting calcium
release from sarcoplasmic
levels inhibits smooth-
muscles cells contractions
and dilates arteries, which
decreases myocardial
oxygen demands,
peripheral resistance, BP,
and afterload
 Mefenamic Acid Date ordered: 500mg TID PO Nonsteroidal Anti- Decreased discomfort/pain
September 15, 2010 inflammatory Drugs from 8/10 to 4/10.
(ponstan) Date given: (NSAIDs)
September 15, 2010
To treat Mild to moderate
pain

Mefenamic acid inhibits

the enzymes
cyclooxygenase (COX)-1
and COX-2 and reduces
the formation of
prostaglandins and
leukotrienes. It also acts
as an antagonist at
prostaglandin receptor
sites. It has analgesic and
antipyretic properties
with minor anti-
inflammatory activity.
NURSING RESPONSIBILITY FOR MEDICATION ADMINISTRATION:

Prior to:

1. Take a medication history.

2. Assess the clients understanding about illness, including past experience.
3. Conduct physical assessment.
4. Obtain information about social network and resources.
5. Identify desired outcomes of nursing intervention.
 6. Focus on:
• Why the drug is needed
• How the drug will be administered
• Common indication of adverse effects
• Other nursing measures that will enhance the likelihood of achieving outcomes
During:

1. Ensure cleanliness of your hands, work area, and supplies.

2. Ensure the availability of supplies
3. Ensure adequate lighting and decrease environmental destruction
4. Remember the rights of medication administration
5. Do not touch tablet or capsules with your hands
6. Check the label on medication 3x before administering any drugs
7. Identify the client
8. Stay with the client as he/she swallow the medication
9. Provide necessary assistance
After:

1. Following administration, be certain the client is comfortable

2. Provide appropriate instruction to the client regarding to the medication
3. Immediately record the procedure this should include the name of the drug, dosage, route, time of administration, and your
name or initial
4. Record indication of the effectiveness of the medication
c. Diet

TYPE OF DIET DATE ORDERED GENERAL INDICATIONS AND CLIENTS RESPONSE

DATE STARTED DESCRIPTION PURPOSES OR REACTION TO
DATE CHANGED THE DIET

Diet as tolerated. This
DAT Date ordered: particular diet is only
September 15, 2010 given when client can
now tolerate any food
Date started: she desires that is
September 15, 2010 nutritious, if this will not
lead to any
complications and if the
client needs further
monitoring for lab test
For the stomach to be The client had this diet
not overwhelmed or be after she gave birth, she
upset with foods and ate nutritious foods, and
liquids that are taken she complied with the
after the client diet given to her.
undergone her delivery

Nursing Responsibilities for Diet:

Prior:

-Assess patient’s general condition

-Verify the doctors order to the patients chart and ask the patient if they were inform about the diet
-Verify the right client, ask the patient so to be safe
-Be certain that the diet is properly explained, instructed and must be comprehensive
-Obtain initial assessment about the progress of the management.
During:
-Monitor patient’s tolerance to diet
-Observe if the client complies with the given diet
-Note any untoward signs/behavior manifested by the client upon the diet ordered
-Be certain if there are complaints of severe thirst
-Always practice aseptic technique
After:
-Advice client to follow the diet order
d. Activity/ Exercise

DATE ORDERED/ CLIENT’S

DATE STARTED/ RESPONSE &/ OR
TYPE OF EXERCISE DATE CHANGED GENERAL INDICATION(S) OR REACTION TO THE
DESCRIPTION PURPOSE(S) ACTIVITY/
EXERCISE

>Lying flat on bed/ >to decrease pt’s oxygen >The client lies flat on
supine position. This is demand and to provide bed. Patient maintained a
Flat on bed DO: 09-15-10 (after the usual position rest for the pt after flat on bed position
delivery) ordered for post-op. delivery
DS: 09-15-10 patient is positioned flat
on bed, the head is erect
or slightly flexed
Nursing Responsibilities for Activity/ Exercise:

Prior:
>Assess patient’s condition
>Check doctors order
>Explain procedure to the client and its rationale
>Instruct patient to maintain flat on bed

During:

>Monitor patient’s tolerance to activity/exercise

>Provide assistance if necessary
>Note any untoward signs/ behavior manifested by the client upon performance of the
activity/exercise
>Tell the patient to abstain from moving, seating and standing to minimize fatigue

After:
>Advice client to pursue ambulation to aid in better prognosis of the disease condition
>Assist the client when ambulating
>Explain the purpose of early ambulation
>Instruct client to cooperate
>Asses client ability to ambulate
>Never leave patient when ambulating
>Instruct patient to avoid engaging in strenuous activity especially when body weakness is felt
VI. NURSING CARE PLAN

Assessment Nursing Scientific Objective Nursing Rationale Expected

Diagnosis Explanation Intervention Outcome

Subjective: Ineffective Normally, the After 2H of >elevate head of >to aid in lung The pt will
airway clearance airway should be nursing the pt by using 2 expansion demonstrate
“Nahihirapan r/t retained clear and free of intervention the pillows behaviors to
akong huminga.” secretions AEB any secretions or pt will improve her
wheezes on both obstructions but demonstrate >encourage deep airway
Objective: breathing and >to maximize
lung fields because the behaviors to breathing effort
> with non- patient has improve or coughing
exercise and
productive secretions on her maintain clear expectoration of
cough airway, she was airway. secretion
having a
>with clear >demonstrate >to help the pt
difficulty of
secretion deep breathing learn the proper
breathing and
>pallor noted maintaining a and coughing way
clear airway. exercise
> with wheezes
on both lung >encourage to
increase oral >to facilitate
fields dilution and
fluid intake
>respiratory rate passage of
of 26 bpm secretions

>use of >encourage to >to boost

accessory eat foods rich in immune system
muscles when Vit. C
breathing
>restlessness
noted
>provide >to promote
comfort comfort and
measures such as relief
stretching the
linen and
fanning the pt
Assessment Nursing Scientific Objective
Objectives Nursing Rationale Expected
Diagnosis Explanation Intervention Outcome

Subjective: Acute Pain r/t Pain is produce After 1H of >monitor and >to obtain The pt shall
uterine by the nursing record vital signs baseline data and report a reduced
“Masakit etong contraction AEB contraction of intervention the to evaluate the pain scale from
banda dito pain scale of uterus which pt will be able to effect of pain 8/10 to 4/10
(holding her 8/10, guarding stimulates the report a reduced
abdomen) >perform a >to gain a better
behavior and nerve endings pain scales from comprehensive
parang facial grimaces leading to the 8/10 to 4/10 or an objective
manganganak assessment of understanding of
release of pain pain; one is to
ulit” chemical the subjective
instruct pt to rate report of pain
Objective: prostaglandin. level of pain
through a pain
>rated a pain scale of 8/10
scale of 8/10
>provide
>facial grimaces comfort >to promote

>guarding measures such as comfort and

straigtening the relief
behavior
linens
>restlessness
noted >encourage pt to >to divert
have adequate
attention and to
rest period
limit self
focusing
>administer
analgesic as >to relieve pain
ordered.
Subjective: Anxiety r/t threat Anxiety is a After 1H of >monitor V/S >to identify The pt will
to health status vague uneasy nursing physical report a
“Kinakabahan (seizure attack) feeling of intervention the responses reduction of
ako baka AEB cold discomfort or pt will appear associated with anxiety level
magseizure ako, clammy skin and dread relaxed and emotional
para kasing verbal report of accompanied by report anxiety is condition
naninigas anxiety an autonomic reduced to a
katawan ko” >stay with the pt >to make the pt
response; it is a manageable
at bedside feel that she’s
Objective: feeling of level
apprehension not alone
>cold clammy caused by >to avoid and
skin anticipation of > provide
limit self
danger. It is an diversional
>restlessness focusing
altering signal activities like to
noted talking to the
that warns of
>increase impending student nurses
>to promote
perspiration danger and
>provide comfort and
enables the
>pallor noted comfort relief
individual to
measures such as
take measure to
back rubbing
deal with the
and stretching
threat
the linen
>to help the pt
>encourage deep reduced her
breathing tension
exercise
VII. CONCLUSION and RECOMMENDATION

Gestational hypertension is high blood pressure that develops after the twentieth week of
pregnancy. The causes of this condition are unknown, but it is clear that the condition affects
blood flow to organ such as the placenta and sometimes the brain and the liver. There is no way
of preventing this type of hypertension, but regular prenatal care will usually catch it early,
reducing the chances of complications. The treatment of gestational hypertension follows a
different set of guidelines than the treatment of general high blood pressure outside of
pregnancy. The main goal of treatment in pregnant women is to prevent the development of more
serious conditions like fetal growth restriction or placental abruption.

RECOMMENDATION

Because high blood pressure can affect blood flow to the placenta, your attending
physician will order an ultrasound to be sure that your baby has been growing well and to see if
you have a normal amount of amniotic fluid. You may also have a biophysical profile (BPP)
done at the same time to check on your baby's well-being. And in certain cases, you'll have a
Doppler ultrasound to check blood flow to your baby.
Your caregiver may also order a set of blood tests and ask you to collect urine for 24
hours to check for protein (this is a more sensitive test than the urine dip done at each prenatal
visit). These lab tests will help her determine whether you have preeclampsia and allow her to
gauge any later changes in your condition. Beyond these initial measures, how your caregiver
will manage your condition depends on how high your blood pressure is, how your baby's doing,
and how far along you are in your pregnancy.

If your condition is mild

If you develop mild gestational hypertension at 37 weeks or later, you'll probably be
induced right away (or delivered by c-section if your baby can't tolerate labor or there are other
reasons you can't have a vaginal birth.) If you haven't yet reached 37 weeks but your condition is
mild, you may be hospitalized for a few days of monitoring. After that, if you and your baby are
doing well, you may be sent home to take it easy or possibly put on some degree of bed rest.
You'll need to see your caregiver frequently so she can monitor your blood pressure,
check your urine for protein, and watch for changes in your condition. Your baby will be closely
monitored as well with weekly or biweekly BPPs and nonstress tests (NST). You'll also have
ultrasounds every three weeks or so to keep an eye on your baby's growth.
In addition, your caregiver may ask you to monitor your movements by doing daily "fetal
kick counts." This is a good way to for you to monitor your baby's well-being between prenatal
appointments. Whether you're doing actual kick counts or not, call your caregiver immediately if
you notice that your baby is moving less than before.
You'll need to be seen immediately if you develop symptoms of preeclampsia (such as
swelling, sudden weight gain, persistent or severe headaches, changes in your vision, upper
abdominal pain or tenderness, or nausea and vomiting) or signs of placental abruption (such as
vaginal spotting or bleeding, or uterine tenderness or pain). If there are any signs of problems
with you or your baby, you'll probably be hospitalized and you may need to deliver your baby.

If your condition is severe

If you're diagnosed with severe gestational hypertension (a blood pressure reading of
160/110 or higher), you'll be given medication to lower your blood pressure and hospitalized
until you have your baby. If you're at 34 weeks or beyond, you'll be induced or delivered by c-
section. If you're not yet at 34 weeks, you'll be given corticosteroids to speed the development of
your baby's lungs and other organs.
If your condition is getting worse or your baby isn't thriving inside your womb, you'll be
induced or delivered by c-section (depending on the situation), even though your baby is still
premature. If you don't need to deliver right away, you'll remain in the hospital so both you and
your baby can be monitored very closely while your baby has more time to mature.
VIII. BIBLIOGRAPHY/ REFERENCES

Books:

Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family, 5th ed,
Adelle Pilliteri

Medical-Surgical Nursing: clinical Management for Positive Outcome, 8th ed, Joyce M. Black
and Jane Hokanson Hawks

Internet sources:

www.who.int/entity/healthinfo/statistics/body
www.memorialhealth.com/healthinfo/content.aspx?pageid=P02484
www.reshealth.org/yourhealth/healthinfo/default
www. highbloodpressure.about.com/od/treatmentmonitoring
http://www.babycenter.com/0_gestational-hypertension-pregnancy-induced-
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http://emedicine.medscape.com/article/261435-overview