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A case study about
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 motherto-be. Though pregnancy is generally a time of joy and well-being, complications can occur that risk. -Marie NorlundThese complications include bleeding in early or late pregnancy, hyperemesis gravidarum, gestational diabetes mellitus, and preterm rupture of membranes, preterm labor and pregnancyrelated 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. cloud the experience and put the patient and her unborn child at
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
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)
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%.
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 Morbidity Hypertensive disorders of pregnancy Stillbirth Preterm delivery Induced abortion Anaemia Placenta anomalies (pravia, abruptio, etc.) Spontaneous abortion Gestational diabetes Ectopic pregnancy Premature rupture of membranes Perineal laceration Uterine rupture Obstructed labour Number of studies (%) 885 (14.9) 828 (13.9) 489 (8.2) 400 (6.7) 267 (4.5) 245 (4.1) 235 (4.0) 224 (3.8) 146 (2.5) 140 (2.4) 139 (2.3) 116 (2.0) 102 (1.7)
Haemorrhage (antepartum, intrapartum, postpartum, unspecified) 365 (6.2)
3. Understand awareness of her disease. 4. during pregnancy) Puerperal infection Violence during pregnancy Urinary tract infection Malaria Other conditions Overall Objectives Nurse-Centered Objectives Number of studies (%) 96 (1. To gain new facts and ideas about the disease.1) 54 (0.5) 77 (1. Identify the risk factor contributing to the occurrence of the disease 2. side effect.3) 66 (1. the client should be able to: 1.9) 973 (16. Know the possible causes of the disease. and specific responsibility.6) 86 (1. and specific nursing responsibilities. 5. 3. 4.4) 593 Upon completion of this case study. 2. contraindications. 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. Cooperate in necessary interventions and managements to be done. Learn and understand why such laboratory examinations are being done.Morbidity Depression (postpartum. their indication and purposes. Identify the laboratory and diagnostic procedure done with the patient. 6 . Identify the different medications administered for this disease their indications. the student nurse should be able to: 1.
She currently resides at Sulib Florida Blanca Pampanga and her nationality is Filipino and she is a Roman Catholic by faith. Socio. her mother and father. 2010 at 1:08pm with a diagnosis of uterine pregnancy 41 2/7 AOG seizure disorder and gestational hypertension.II. At the same time. She is the only child of Sharpay and Ryan. Their house is made of blocks and it has two rooms and a bathroom. Environmental factors Gabriella lives with her grandmother and her boyfriend in Sulib Florida Blanca Pampanga. According to Gabriella. they directly go to a nearby clinic.000 php for each student. She was born on October 8. b. Demographic data Gabriella is a 19 year old woman cohabitating with her boyfriend. 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.economic and cultural factors At present she lives with her grandmother and her boyfriend in Sulib Florida Blanca. According to Gabriella. c. 7 . 1990 at Guagua Pampanga. NURSING ASSESSMENT Personal Data a. She does not live with her parents since her mother died at the age of 33 while her father currently lives in Laguna. Lingad Memorial Regional Hospital last September 15. whenever a member of the family gets sick. She was admitted at Jose B.in-law support them as her mother-inlaw has a small eatery which earns approximately 500php a day and his father-in-law does school service and earns 1. 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.
during her third month of pregnancy. she took 6 tablets of Cytotec orally and 4 tablets were inserted vaginally. Her obstetric history is G1P1 (1001) and her AOG is 41 2/7. Her hospital number is 288540.obstetric record Gabriella is not married with her 23 year old boyfriend.gynecologist who is Dra. her ob gynecologist said that the bleeding has lessened and so she stopped taking the medication which she can no longer remember. thru an ultrasound. b.2. Furthermore. at her third month of pregnancy. she had her regular monthly check up until the month of July. she did not have her check up because according to her. she decided to have a check up. She is having her pre. Maternal. According to her also. And at the month of January.up with her OB. And on the ninth month of her pregnancy. Significant Trimestral changes According to Gabriella. because according to her. her gynecologist told her she has subchronic hemorrhage and she was then given tocolytic. Maternal.Child Health History a. and an ultrasound. she had a fever which lasted for three days on that month.natal check. After taking the said drug for three days. c. and because she did not knew she was pregnant she took Paracetamol to manage her fever. Her LMP was on November 30. She delivered her first baby via NSD at JBLMRH last September 15. her baby was already 3 months old. getting married entails lot of expenses and at the moment they are still saving money for their growing child. And at the month of February because her baby was not aborted. 2010. And at her sixth month of pregnancy. Guevarra and her clinic is at Guagua Pampanga. at first she did not knew she was pregnant. Antepartal/ Prenatal preparation Gabriella had her first prenatal check up on the month of February wherein according to her ob gynecologist. 2009. And as far as she can recall. even though she did not have her period for the month of December. she decided to have a pregnancy test and the result was positive. she felt lazy. She had morning sickness up to her fifth month of pregnancy. She stated that upon knowing she was pregnant. Subsequently. her fever subsided. she suffered 8 . she said that she felt like vomiting every morning and she is relieved when she vomits.
Gabriella was also fond of eating chocolates (snickers) during her pregnancy. 9 .hypogastric pain which prompted her to consult her physician. Until her 9th month of pregnancy she still craves for the same food. so her attending physician gave her antibiotic which she took for two weeks. also. Gabriella said that she was craving for foods from Jollibee specifically spaghetti and chicken. Gabriella thinks she had UTI because she refused in drinking water. her physician then said she has Urinary Tract Infection.
3. Family Health Illness History Grandpa Edward 78 y/o Grandma Bella 79 y/o Grandpa Harry 78 y/o Grandma Jeannie 67y/o Mercedes 62 y/o Ryan 60 y/o Rachelle 58 y/o Vin 53 y/o Sue -57 y/o Sharpay Gabriella 19 y/o LEGEND: MALE FEMALE HYPERTENSION DIABETES DECEASED GABRIELLA (PATIENT) ASTHMA OLD AGE ARTHRITIS 10 .
where she had an EEG and ECG. her blood pressure was 140/90. she had watery vaginal discharge. When she reached high school. And upon admission. she had her second attack. It started when she was having their CAT classes. he died at the age of 78.The above diagram shows that Gabriella’s grandfather on his father side has asthma and arthritis. she had her first attack of seizure. when her BP was 110/70. she was then brought to Florida San Jose Hospital and was referred to St. it was a very hot day and she had difficulty of breathing then she had seizure. she was then given medication for her heart but she can no longer remember what is it. She was then brought to the school clinic and was given O2 therapy. 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. History of Past Illness According to Gabriella. Gabriella said that she had approximately three episodes of seizure until fourth year high school. she was referred to JBLMRH. which she took for only two weeks. One month later. she also experiences cough and colds during her childhood years. She also had asthma but at the age of six it subsided. according to her. she had her chicken pox at the age of 13. Anthony hospital. particularly third year level. her grandfather died because of old age. her BOW ruptured. the doctor said that the results revealed her left heart is thicker than the right. History of Present Illness Gabriella said that 3am that morning. at the same class. her grandmother on the other hand has no illness. She stopped taking the said medication because according to her. according to Gabriella. 5. After the delivery. 11 . 4. they proceeded with the delivery. And at around 9:00 am. She was then given 1 tablet of Nifedipine 10mg. Her father Ryan has asthma. She was also given medications for her seizure which was Phenobarbital. and her grandmother also has arthritis. She did not take any medication at the said time. and her mother died at the age of 33 because of hypertension. She also had an allergy to “bagoong” when she was elementary. her seizure did not recur. she thought it was just urine and so she still slept. she also had labor pains which prompted her to go to Romana Pangan but because her blood pressure was 130/90. she was given an O2 therapy due to DOB. While on her mother side.
(+) wheezes on both lung fields Heart: adynamic.6. conscious and coherent with time. Physical Examination Physical Examination (IPPA. at level of 550cc. assessed upon admission at 1:08 pm) General Appearance: HEENT: anicteric sclerae. She looks pale and weak upon assessment. pink palpebral conjunctiva Lungs: symmetric chest expansion. 2010 (Wednesday) Initial Assessment of Student Nurses at 3:20 pm General Appearance: Gabriella was lying on bed in a supine position. She’s with an ongoing IVF #1 D5 LRS 1L + 30 units Oxytocin regulated 30 gtts/min. 2010 (lifted from the chart.1 C P: 84 bpm R: 26 BP: 110/70 mmHg SKIN 12 . 3 P: 84 R: 26 BP: 140/90 FHT: 140 GCS: 15 September 15 . place and person. NRRR Vital Signs: T: 37. Vital signs taken and recorded as follows: T: 37.Cephalocaudal Approach) September 15 . infusing well on the right arm.
• • • • • NAILS • HEAD • • • EYES • With light brown skin and uniform in color Good skin turgor pale skin diaphoresis noted cold clammy skin capillary refill of 2-3 secs symmetrical in shape proportion with the body size no tenderness or lumps • • • EARS: pupils are equally rounded and reactive to light accommodation eyebrows symmetrically aligned eyelashes equally distributed with pale palpebral conjunctiva • • • NOSE: • • auricle aligned with outer canthus of eye with dry cerumen normal voice tones audible • MOUTH: symmetrical in shape with clear discharge no lesions noted • 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: 13 .
smooth skull contour. no infection and infestation SKULL AND FACE: • rounded. chest wall intact. 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. no tenderness and masses wheezes on both lung field uses accessory muscles when breathing with non-productive cough ABDOMEN: • • with tense. glistening skin. absence of nodules and masses THORAX AND LUNGS: • • • • chest symmetric. no deformities and tenderness or swelling of bones with limited range of motion in one or more joints NEUROLOGIC SYSTEM: • • • Performs with slow. presence of flaccidity.• • • • HAIR: head-centered with coordinated and smooth movements of head lymph nodes are not enlarged carotid pulse is palpable • evenly distributed hair. movements and irregular timing has difficulty alternating from supination to pronation restlessness noted 14 .
1.R: 09-15-10 Indication/ Purpose Result Normal Values (units used in the hospital) Pale yellow amber Clear hazy to Analysis and Interpretation of Result It is used to diagnose a urinary tract or kidney infection. and CBC with Platelet count but results were not yet available during student nurse’s assessment. Color : Yellow Appearance: Hazy Specific Gravity: 1.7.015-1.005 Pus Cell : 1-2 hpf Epithelial cells: few Mourphous urease: few Albumin: Negative to Few epithelial cells may suggest inflammation within the bladder. to screen for progression of some chronic conditions such as diabetes mellitus and high blood pressure. Creatinine. Diagnostic and Laboratory Procedures Diagnostic/ Laboratory procedures Urinary Analysis Date ordered Date Result IN D. to evaluate causes of kidney failure.025 Negative Negative Negative Negative *Note: Doctor ordered BUN. 15 .O: 09-15-10 D. Specific gravity light results indicate that urine is diluted.
During Collect a voided specimen in a urine container. into which patient voids 3 to 4 ounces of urine. After Transport the urine specimen to the laboratory promptly. 16 . Have the client collect midstream specimen by: Having the patient begin to urinate in a bedpan. Allowing the patient to finish voiding. or toilet and then stop urinating.Nursing Responsibilities for Urinalysis: Before Explain the procedure to the patient. Correctly position a sterile urine container. Tell the patient that no fasting is required. Capping the container. urinal.
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 . This is called ovulation. produce female hormones (estrogens and progesterone) and eggs (ova). The ovaries are held in place by various ligaments which anchor them to the uterus and the pelvis. It takes place from either the right or left ovary at random. which are about the size and shape of almonds. All the other female reproductive organs are there to transport. ANATOMY AND PHYSIOLOGY FEMALE REPRODUCTIVE ORGANS Ovaries The ovaries are the main reproductive organs of a woman.III. in which eggs develop. it ruptures and the developing egg is ejected from the ovary into the fallopian tubes. The ovary contains ovarian follicles. Once a follicle is mature. Ovulation occurs in the middle of the menstrual cycle and usually takes place every 28 days or so in a mature female. The two ovaries. nurture and otherwise meet the needs of the egg or developing fetus.
If an egg has not been fertilised. The thick wall of the uterus is composed of 3 layers. 18 . while the rounded region above the entrance of the fallopian tubes is the fundus and its narrow outlet. receives the penis and the sperm ejaculated from it during sexual intercourse. It plays an important role during the birth of a baby. The vagina is a passage connecting the uterus with the external genitals. is only usually viable for 24 hours after ovulation. If an egg has been fertilised it will burrow into the endometrium. 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. so fertilisation usually occurs in the top one-third of the fallopian tube. or vulva. however. the endometrial lining is shed at the end of each menstrual cycle. The egg. which has burrowed into the endometrium. erectile tissue that responds to sexual stimulation. A part of the wall of the fertilised egg. which are composed of elongated folds of skin. where it will stay for the rest of its growth. include the clitoris. develops into the placenta. which protrudes into the vagina. The inner layer is known as the endometrium. and the labia. contracting rhythmically to move the baby out of the body via the birth canal (vagina). The uterus will expand during a pregnancy to make room for the growing fetus. 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 main part of the uterus (which sits in the pelvic cavity) is called the body of the uterus.along the fallopian tube to the uterus. 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. is the cervix. The external genitals. It also serves as an exit passageway for menstrual blood and for the baby during birth. The myometrium is the large middle layer of the uterus. Vagina The vagina is a fibromuscular tube that extends from the cervix to the vestibule of the vulva. which is made up of interlocking groups of muscle.
Both septa are complete so that the two sides are anatomically and functionally separate pumping units. including oxygen. carbon dioxide. The two sides of the human heart are separated by partitions. Without this important function toxic substances would quickly build up in the body. 19 .Breasts (Mammary Glands) After birth the infant is fed with milk from the breasts. allowing for the continuation of cell metabolism. and waste. nutrients. The circulatory system also transports the waste products of cell metabolism to the lungs and kidneys where they can be expelled from the body. 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. the interatrial septum and the interventricular septum. Each has its own pump with both pumps being incorporated into a single organ -. or mammary glands. 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). The circulatory system transports oxygen from the lungs and nutrients from the digestive tract to every cell in the body. Anatomy of the Circulatory System The human circulatory system is organized into two major circulations.the heart.
is tilted to the left side.The human heart is a specialized.3 oz) of blood per beat and 20-30 l (21-32 qt) per minute. four-chambered muscle that maintains the blood flow in the circulatory system. The adult human heart is about the size of a fist and weighs about 250-350 gm (9 oz). 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. and the other forms the two ventricles (the lower chambers). One of these forms the two atria (the upper chambers) of the heart. the heart pumps about 59 cc (2 oz) of blood per beat and 5 l (5 qt) per minute. or SA) node. 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. The heart is made up of two muscle masses. The apex. and between the lungs. or breastbone. Since 20 . or bottom of the heart. The human heart begins beating early in fetal life and continues regular beating throughout the life span of the individual. It lies immediately behind the sternum. Both atria contract or relax at the same time. as in a heart attack. At rest. as do both ventricles. If the heart stops beating for more than 3 or 4 minutes permanent brain damage may occur. During exercise it pumps 120-220 cc (4-7. the heart muscle may be damaged to such a great extent that it may be irreversibly stopped.
Some heart murmurs. 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. The study of heart sounds and murmurs furnishes valuable information to physicians regarding the condition of the heart muscle and valves. having been triggered by the action potential. The rate at which the cells of the SA node discharge is externally influenced through the autonomic nervous system. in the sinoatrial node (SA node). exertion. The sounds of the heart may be represented as lubb-dubbpause-lubb-dubb-pause. Because of this spontaneous discharge of the sinoatrial node. After a slight delay. 21 . The lubb sound indicates the closing of the valves between the atria and ventricles and the contracting ventricles. the heart muscle is automated. may also occur in healthy persons. the action potential will spread over the atria. the impulse is passed by way of yet another bundle of muscle fibers (the Bundle of His and the Purkinje system. however. which is also known as the heart's pacemaker. measures no more than a few millimeters. which lies just in front of the opening of the superior vena cava. the atrial muscle contracts. Tension. with a brief delay between the contractions of the two parts of the heart. It consists of heart cells that emit regular impulses. mainly during rapid or pronounced cardiac action. From this pattern it can be seen that both atria will contract simultaneously and that both ventricles will contract simultaneously.the two atria form a single muscular unit. In infants and young children it may be between 100 and 120 beats a minute. although they can be heard better when amplified by a stethoscope. In adults at rest this is between 60 and 74 beats a minute. A completely isolated heart can contract on its own as long as its metabolic processes remain intact. When the atrial action potential reaches the juncture of the atria and the ventricles. or fever may cause the rate of the heart to vary between 55 and 200 beats a minute. there may also be cardiac murmurs. especially when the valves are abnormal. the dubb sound indicates the closing of the semilunar valves. the atrioventricular or AV node (another specialized region for conduction) conducts the impulse. The ventricles form a single muscle mass separate from the atria. which sends nerve branches to the heart. The electrical stimulus that leads to contraction of the heart muscle thus originates in the heart itself. a fraction of a second later.) Contraction of the ventricle quickly follows the onset of its action potential. This node. In addition. Through their stimulatory and inhibitory influences they determine the resultant heart rate.
sealing the opening and preventing backflow into the right atrium. The coronary veins transport the deoxygenated blood from the heart muscle to the right atrium. the reverse process takes place. The tricuspid valve remains open during diastole. These vessels originate from the aorta immediately after the aortic valve and branch out through the heart muscle. etc. which consists of three flaps (or cusps) of tissue. a vein from the leg. and the pressure decreases. and the valves to the pulmonary artery and the aorta open. The Pulmonary Circulation From the right atrium the blood passes to the right ventricle through the tricuspid valve. From the right ventricle blood is pumped through the pulmonary or semilunar valve. blood flow to the cardiac muscle is compromised. When the ventricles become flaccid during diastole. called papillary muscles. A "double bypass" is when two coronary arteries are bypassed. the valve closes. When the coronary vessels become blocked.Coronary Circulation The coronary arteries supply blood to the heart muscle. This valve prevents backflow from the artery into the right ventricle. as in arteriosclerosis or hardening of the arteries. This is when the common "bypass surgery" is performed where the coronary arteries are "bypassed" by replacing them with. When the ventricles contract (systole). The heart's energy supply is almost completely dependent on these coronary vessels. into the pulmonary artery. 22 . or ventricular filling. The heart's left and right halves work almost synchronously. which has three half-moon-shaped flaps. Five cords attached to small muscles. the valves between the atria and the ventricles close as the result of increasing pressure. on the ventricles' inner surface prevent the valves' flaps from being forced backward. When the ventricle contracts. A "triple bypass" is when three are bypassed. The Heartbeat The heart muscle pumps the blood through the body by means of rhythmical contractions (systole) and relaxations or dilations (diastole). From the pulmonary artery blood is pumped to the lungs where it releases carbon dioxide and picks up oxygen. for example.
and these in turn empty into small veins. the mitral valve prevents backflow of blood into the left atrium and blood is driven through the aortic valve into the aorta. two from each lung. These capillaries are so small that the red blood cells must line up single file to pass through. and so on until finally all the blood returns to the heart through two large veins. which carry the blood to various parts of the body. The aorta has many branches. which are a single cell thick.The Systemic Circulation From the lungs. These terminate in the right atrium. From the pulmonary veins the blood enters the left atrium and then passes through the mitral valve to the left ventricle. Each of these branches in turn has branches. The blood passing through the arterioles passes through a bed of minute vessels called capillaries. As the ventricles contract. The smallest of these on the arterial side of the circulation are called arterioles. the superior and inferior vena cavae. 23 . like the pulmonary valve. has a semilunar shape. the blood is returned to the heart through pulmonary veins. which empty into larger veins. and because of their ability to constrict or dilate. and the systemic circulation is complete. the major artery that supplies blood to the entire body. The aortic valve. They contain a great deal of smooth muscle. The capillaries empty the venous blood into collecting tubes called venules. they play a major role in regulating blood flow through the tissues. The exchange of nutrients and waste products takes place between the capillary blood and the tissue fluids. and so on until there are literally millions of small blood vessels. The arterialized blood that enters the capillaries thus becomes venous blood as it passes through them. and these branches divide.
or into the right lymphatic duct. Lymph passes from capillaries to lymph vessels and flows through lymph nodes that are located along the course of these vessels. Finally. 24 . It is also involved with destruction of old cells and other substances by phagocytosis. and is a very important part of the immune system. some of the fluid diffuses into the surrounding tissues. both of which transport the lymph back into veins of the shoulder areas where is mixes with blood and is returned to the heart. old red blood cells. This is the reason that exercise is so important for the circulation.A one-way flow of blood in this system is maintained by valves located. but in the veins as well. One function of the lymphatic system is to collect and recycle this fluid (called lymph). releasing additional blood into the circulatory system as needed. 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. like the veins. The Lymphatic System An often overlooked part of the circulatory system is the lymphatic system. lymph flows into the thoracic duct. The tissues of the lymphatic system include the spleen. not only in the heart. impurities such as bacteria. All lymph vessels contain one-way valves. a large vessel that runs parallel to the spinal column. and toxic and cellular waste. The lymphatic system is also responsible for collecting nutrients that the digestive system has extracted from our foods. As blood passes through the capillaries. We will cover the lymphatic system in detail in the lesson on the immune system. to prevent backflow. or ingest. Cells of the lymph nodes phagocytize. The spleen serves as a reservoir for blood.
considerably larger than red cells. or thrombocytes. The cells. that carries different ions and molecules including proteins. lymphocytes. nutrients. granulocytes. round. It also helps to maintain body temperature. and occupies almost the entire volume of a red blood cell. or leukocytes. them. containing more than 25 trillion red cells. The brain cells in particular are very dependent on a constant supply of oxygen. averaging about 7. one of the chief waste products. or plasma. White Blood Cells The leukocytes. If the circulation to the brain is stopped. Red Blood Cells The red blood cells are tiny. biconcave disks. with neutrophils the most abundant. the protein that aids in clotting. have a nucleus. and monocytes. Because the normal life span of red cells in the circulation is only about 120 days. hormones. The main function of the red blood cells is to transport oxygen from the lungs to the tissues and to transport carbon dioxide. All are involved in defending the body against foreign organisms. and are much less numerous. or engulf. only one or two exist for every 1. Leukocytes are almost colorless. Blood has two main constituents. The plasma is a complex colorless solution. There are three types of granulocytes: neutrophils. comprise about 45 percent. eosinophils.000 red cells. The substance in the red blood cells that is largely responsible for their ability to carry oxygen and carbon dioxide is hemoglobin. and fibrinogen. A normal-sized man has about 5 l (5. and platelets. The lymphocytes' chief function is to migrate into the connective tissue and build antibodies against bacteria and viruses. enzymes. as well as most white cells and platelets. the material that gives the cells their red color. or erythrocytes. waste materials such as urea. white blood cells. The blood cells comprise three main types: red blood cells. and fights infections.5 microns (0. or corpuscles. Red blood cells. which in turn are of many different types. The number increases in the presence of infection. or white blood cells. and basophils. about 90 percent water. transports hormones. Each type of cell has its own individual functions in the body. It is a protein complex comprising many linked amino acids. Neutrophils seek out bacteria and phagocytize. and the liquid portion. it to the lungs for release from the body.003 in) in diameter. 26 . Essential to its structure and function is the mineral iron. are of three types. in which the cells are suspended comprises 55 percent.The Blood The blood transports life-supporting food and oxygen to every cell of the body and removes their waste products.3 qt) of blood in his body. more than 200 billion cells are normally destroyed each day by the spleen and must be replaced. death shortly follows. are made by the bone marrow.
the spleen and lymph nodes. for example. The most abundant plasma protein is albumin. The globulins are even larger protein molecules than albumin and are of many chemical structures and functions. many essential to life. absorbed from the intestines. Minerals essential to body function. When tissue is damaged. which protect us against infection. They are round or biconcave disks and are normally about 30 to 40 times more numerous than the white blood cells. attack organisms not destroyed by granulocytes and leukocytes. are other important elements of the plasma. as is phosphorus. the platelets aggregate in clumps to obstruct blood flow. An important function of plasma is to transport nutrients to the tissues. Copper is another necessary component of the plasma. Its major solute is a mixture of proteins. Plasma The plasma is more than 90 percent water and contains a large number of substances. The granulocytes. The platelets' primary function is to stop bleeding. are formed in the bone marrow. although present only in trace amounts. so are normal numbers of leukocytes. The lymphocytes on the other hand are produced primarily by the lymphoid tissues of the body -. is essential to the building of bone. representing only 4 to 8 percent of white cells. accounting for about 70 percent of all white blood cells. Monocytes are believed to originate from lymphocytes. Platelets Platelets. Some of the plasma proteins and fats. 27 . produced by lymphocytes. Just as the oxygencarrying function of red cells is necessary for our survival. where many of them fight bacteria and viruses. or lipids. for example. are also used by the tissues for cell growth and energy. are globulins and are carried throughout the body. The calcium ion. are much smaller than the red blood cells. The antibodies.Monocytes. Glucose. Calcium is also essential to the clotting of blood. constitutes a major source of body energy. or thrombocytes. They are usually smaller than the granulocytes.
IV. PATHOPHYSIOLOGY Book.based PRECIPITATING FACTORS: Medical conditions like Diabetes Mellitus. kidney diseases Malnourished women at start of pregnancy Overweight Multiple pregnancies Inadequate prenatal care Poor nutrition PREDISPOSING FACTORS: Family History of Hypertension African-American race Hereditary Age (<20 and >40 years old) Previous PIH Primigravida IMPAIRED RESPONSIVENESS TO BLOOD PRESSURE CHANGES INCREASED PERIPHERAL VASCULAR RESISTANCE HYPERTENSIO N 28 . essential hypertension.
INCREASED ARTERIAL BLOOD PRESSURE INADEQUATE PERFUSION TO THE PERIPHERAL ORGANS INADEQUATE PERFUSION TO THE PLACENTA DEGENERATIVE CHANGES CAUSING IMPAIRMENT IN PLACENTAL FUNCTION (TISSUE ISCHEMIA) PALLOR ↓ FETAL NOURISHMENT AND OXYGENATION PREMATURE PLACENTAL DETERIORATION PREMATURE BIRTH FETAL RESPIRATORY DISTRESS STILLBOR N BABY INTRAUTERIN E GROWTH RESTRICTION PLACENTAL ABRUPTION (placenta separates before birth) 29 .
familial history of hypertension can increase the risk of developing hypertension during pregnancy 2.having a history of gestational hypertension or PIH slightly increase the risk of having the condition again 30 . The blood pressure readings should be documented on at least two occasions at least six hours apart. African-American race – importance of race is fairly debatable.gestational hypertension is known to be a hereditary condition 4.1 Predisposing Factors: 1. Several studies proposed an increased risk of gestational hypertension among African-Americans 3.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. if blood pressure returns to normal by 12 weeks postpartum Thus. Previous PIH. The diagnosis is changed to: • • • Preeclampsia. 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. reassessment up to 12 weeks postpartum is necessary to establish a final definitive diagnosis.Synthesis of the condition a. 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. Hereditary. 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). 5. if proteinuria develops Chronic hypertension. if blood pressure elevation persists ≥12 weeks postpartum Transient hypertension of pregnancy. Family History of Hypertension. b. Age (<20 and >40 years old).
Poor nutrition.2. Medical conditions like Diabetes Mellitus.the peripheral organs tend to receive less blood due to the vasoconstriction of the vessels. Primigravida. and an overweight or obese pregnant mother is at high risk of developing gestational hypertension. b. Signs and symptoms with rationale 1. 31 .Vasospasm of blood vessels causes vasoconstriction and increased peripheral resistance leading to an increase in blood pressure. Hypertension (140/90mmHg). Overweight. Malnourished women at start of pregnancy.gestational hypertension is found to be more common on mothers with multiple pregnancies 5. Precipitating Factors: 1. 2. essential hypertension.6. placental abruption. a woman may tend to develop hypertension during her pregnancy 3. 6. Inadequate prenatal care. Pallor.inadequate eating habits and lack of prenatal check up can increase the risk of having gestational hypertension.generally. Multiple pregnancies. 4. kidney diseases.the eating habit of a pregnant mother may have an effect on her body.due to improper nutrition of the body. eating a poorly nutritious specifically fatty and salty food may lead to the development of gestational hypertension c. 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.this conditions highly increase the chance of developing gestational hypertension 2. Other signs that may manifest: Intrauterine growth restriction. overweight persons are more prone of developing hypertension.primigravid mother are more prone to gestational hypertension compare to multigravid mothers.
2010 32 . 2010) PALLOR (September 15.Client centered: PREDISPOSING FACTORS: Familiy History of Hypertension Age (19y/o) Primigravida PRECIPITATING FACTORS: Inadequate prenatal care IMPAIRED RESPONSIVENESS TO BLOOD PRESSURE CHANGES INCREASED ARTERIAL BLOOD PRESSURE INADEQUATE PERFUSION TO THE PERIPHERAL ORGANS INCREASED PERIPHERAL VASCULAR RESISTANCE HYPERTENSION 140/90mmHg (September 15.
she tends to develop her condition which is gestational hypertension 3..studies shows that primigravids are more prone of developing gestational hypertension compare to multigravids. Pallor (September 15. Age – because Gabriella belong to the high risk age group during pregnancy. thus she developed gestational hypertension Precipitating Factor: 1. Hypertension (140/90mmHg. Primigravida. 2010) – this is associated with the vasoconstriction of the peripheral vasculature due to the impaired responsiveness to blood pressure changes 2. Signs and symptoms with rationale 1.Gabriella has a hypertension as a disease running in both sides of her family. she was also fond of eating chocolate during the course of her pregnancy. 33 . this increases the risk. September 15. Family History of Hypertension.Synthesis of the condition a. b. Predisposing/ Precipitating factors Predisposing Factors: 1. her mother died because of hypertension and one brother of her father has hypertension. since the client is a primigravid mother. thus increasing her risk of developing and aquiring gestational hypertension. 2010) . Inadequate prenatal care. 2.the peripheral organs tend to receive less blood due to the vasoconstriction of the vessels.Gabriella said that she stopped having her prenatal check up on the 9th month of her pregnancy.
Oxytocin is a hormone involved in muscle contraction and nerve sensitivity. 34 . Nursing Responsibilities: Before: Check and verify the doctor’s order. Indications/Purpose Indicated as a source of water. PATIENT AND HIS CARE 1. Oxytocin is given for induction of labor at term and control of postpartum bleeding. 2010 Client’s Response to Treatment The client did not experience dehydration. Check the amount of IV fluid ordered and how long it will be consumed. Date Ordered Date Performed Date Changed or D/C Date ordered: September 15. Medical Management Medical Management Dextrose 5% in Lactated Ringer’s Solution (D5LRS 1Lx30gtts/min) with 30 “u” Oxytocin General Description It is a sterile. Explain the procedure to the patient and why it has to be done. 2010 Date performed: September 15.V. nonpyrogenic solution for fluid and electrolyte replenishment and caloric supply in a single dose container for intravenous administration. electrolytes and calories or as an alkalinizing agent.
35 . Check for backflow by lowering the IV bottle. less movement of the hand where the needle was inserted to keep it in place.During: Practice aseptic technique. Monitor the patient’s skin integrity. Check IV level and patency of the tubing if it is infusing well. Document the procedure given. Regulate as ordered. Always check if the IVF is infusing well and intact. Always check the doctor’s order for new orders regarding the IVF supplement of the patient. Advice patient to avoid scratching the site. Instruct patient to relax especially the hand where the needle is to be inserted to avoid reinsertion and facilitate easy insertion. After: Press the site where the needle is inserted and secure it with micro pore. Check again the IV fluid ordered and hours to run in the doctor’s order to avoid medication errors. Label the IV bottle with the name of the IV fluid. IVF regulation should be checked and monitored upon receiving patient. Check the site of hand where the needle is inserted if bulging is not visible. route and time of administration and signature. The bottle should be lower than the IV site. 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.
if one is in use. Assess and chart patient’s response to therapy.Medical Management Oxygen Therapy General Description The body is constantly taking in oxygen and releasing carbon dioxide. Adjust according to type of equipment: a. 8. Use gauze pads at ear beneath tubing as necessary. Indications/Purpose Oxygen therapy is the administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxia. oxygen levels in the blood decrease and the patient may need supplemental oxygen. Perform hand hygiene. Over and behind each ear with adjuster comfortably under chin or around patient’s head.O. Encourage patient to breathe through nose with mouth closed.P. 2. Connect nasal cannula to oxygen setup with humidification. 6.: September 15. During the procedure: 3. Place the prongs in patient’s nostrils.: September 15. If this process is inadequate. 2010 D. 9. 5. Explain procedure to patient and review safety precautions necessary when oxygen is in us Perform hand hygiene. 4. Date Ordered Date Performed Date Changed or D/C D. Check the oxygen is flowing out of prongs. Remove and clean cannula and assess nares at least every 8 hours or according to agency recommendations. 2010 Client’s Response to Treatment The patient was relieved from difficulty of breathing. After the procedure: 7. Adjust flow rate as ordered by physician. Nursing Responsibilities: Before the procedure 1. Check nares for evidence of irrigation or bleeding 1 .
Peptidoglycan makes the cell membrane rigid and protective. Mechanism of action Client’s response to medication with actual side effects Cefuroxime Sodium (zinacef) Date ordered: September 15. dosage and frequency of Administration 750mg IV q8 (-ANST) General Action. Pharmacotherapy Name of Drugs Generic Name Brand Name Date Ordered. 2010 Date given: September 15. Acts to normalized RBC production by binding with hemoglobin or being oxidized and stored as . Classification.b. The client complied with the therapeutic regimen iron and shows improvement during in her health condition. 2010 1tab OD PO Anti-anemic To provide supplementation pregnancy. Date change/discontinued Route of Administration. 2010 Antibiotic Prophylaxis for infection. bacterial cells rupture and dies The client complied with the therapeutic regimen and shows improvement in her health condition. Ferrous Sulfate (feosol) Date ordered: September 15. Date taken/Given. Interferes with bacterial cell wall synthesis by inhibiting the final step in the cross-linking of peptidoglycan strands. 2010 Date given: September 15. Without it.
and disrupting calcium release from sarcoplasmic levels inhibits smoothmuscles cells contractions and dilates arteries. and afterload Client’s blood pressure decreased from 140/90 to 110/70 . Nifedipine (adalat cc) Date ordered: September 15. spleen. catalase. which decreases myocardial oxygen demands.hemosiderin or aggregated ferritine in reticuloendothelial cells of the liver. 2010 Date given: September 15. peripheral resistance. inhibiting ion-controlled gating mechanism. and several enzymes. myoglobin. and bone marrow. and peroxidase. BP. 2010 10mg BID PO Anti-hypertensive May slow movement of calcium into myocardial and vascular smooth muscle cells by deforming calcium channel in cell membranes. Iron is essential component of hemoglobin. including cytochromes.
Take a medication history. 2010 500mg TID PO Nonsteroidal inflammatory (NSAIDs) Anti. 4. Assess the clients understanding about illness. Identify desired outcomes of nursing intervention. 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 has analgesic and antipyretic properties with minor antiinflammatory activity. 2010 Date given: September 15. Conduct physical assessment. It also acts as an antagonist at prostaglandin receptor sites. NURSING RESPONSIBILITY FOR MEDICATION ADMINISTRATION: Prior to: 1. Obtain information about social network and resources. including past experience. 5.Mefenamic Acid (ponstan) Date ordered: September 15. 2. 3.Decreased discomfort/pain Drugs from 8/10 to 4/10. .
Do not touch tablet or capsules with your hands 6.6. Stay with the client as he/she swallow the medication 9. Identify the client 8. Record indication of the effectiveness of the medication 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 . 2. Check the label on medication 3x before administering any drugs 7. Following administration. Remember the rights of medication administration 5. Ensure the availability of supplies 3. work area. be certain the client is comfortable 2. Focus on: • • • • During: 1. Ensure cleanliness of your hands. and your name or initial 4. Provide necessary assistance After: 1. Provide appropriate instruction to the client regarding to the medication 3. and supplies. Immediately record the procedure this should include the name of the drug. route. dosage. Ensure adequate lighting and decrease environmental destruction 4. time of administration.
instructed and must be comprehensive -Obtain initial assessment about the progress of the management. During: -Monitor patient’s tolerance to diet . DAT 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. Diet TYPE OF DIET DATE ORDERED DATE STARTED DATE CHANGED Date ordered: September 15. ask the patient so to be safe -Be certain that the diet is properly explained. she ate nutritious foods. if this will not lead to any complications and if the client needs further monitoring for lab test INDICATIONS AND PURPOSES For the stomach to be not overwhelmed or be upset with foods and liquids that are taken after the client undergone her delivery CLIENTS RESPONSE OR REACTION TO THE DIET The client had this diet after she gave birth. and she complied with the diet given to her. 2010 Date started: September 15. This particular diet is only given when client can now tolerate any food she desires that is nutritious. 2010 GENERAL DESCRIPTION Diet as tolerated.c.
-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 .
Activity/ Exercise TYPE OF EXERCISE DATE ORDERED/ DATE STARTED/ DATE CHANGED GENERAL DESCRIPTION INDICATION(S) OR PURPOSE(S) CLIENT’S RESPONSE &/ OR REACTION TO THE ACTIVITY/ EXERCISE Flat on bed DO: 09-15-10 (after delivery) DS: 09-15-10 >Lying flat on bed/ supine position. Patient maintained a flat on bed position . the head is erect or slightly flexed >to decrease pt’s oxygen demand and to provide rest for the pt after delivery >The client lies flat on bed. This is the usual position ordered for post-op. patient is positioned flat on bed.d.
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 .
Nursing Intervention >elevate head of the pt by using 2 pillows >encourage deep breathing and coughing exercise Rationale >to aid in lung expansion Expected Outcome The pt will demonstrate behaviors to improve her airway Ineffective airway clearance “Nahihirapan r/t retained akong huminga. C .VI. the airway should be clear and free of any secretions or obstructions but because the patient has secretions on her airway.” secretions AEB wheezes on both Objective: lung fields > with nonproductive cough >with clear secretion >pallor noted > with wheezes on both lung fields >respiratory rate of 26 bpm >use of accessory muscles when breathing >to maximize breathing effort and expectoration of secretion >to help the pt learn the proper way >demonstrate deep breathing and coughing exercise >encourage to increase oral fluid intake >to facilitate dilution and passage of secretions >to boost immune system >encourage to eat foods rich in Vit. she was having a difficulty of breathing and maintaining a clear airway. Objective After 2H of nursing intervention the pt will demonstrate behaviors to improve or maintain clear airway. NURSING CARE PLAN Assessment Subjective: Nursing Diagnosis Scientific Explanation Normally.
>restlessness noted >provide >to promote comfort comfort and measures such as relief stretching the linen and fanning the pt .
Objective Objectives After 1H of nursing intervention the pt will be able to report a reduced pain scales from 8/10 to 4/10 Nursing Intervention Rationale Expected Outcome The pt shall report a reduced pain scale from 8/10 to 4/10 >monitor and >to obtain record vital signs baseline data and to evaluate the effect of pain >perform a comprehensive assessment of pain. >to divert attention and to limit self focusing >to relieve pain . one is to instruct pt to rate level of pain through a pain scale of 8/10 >to gain a better or an objective understanding of the subjective report of pain >provide >to promote comfort measures such as comfort and relief straigtening the linens >encourage pt to have adequate rest period >administer analgesic as ordered. guarding behavior and facial grimaces Scientific Explanation Pain is produce by the contraction of uterus which stimulates the nerve endings leading to the release of pain chemical prostaglandin.Assessment Subjective: “Masakit etong banda dito (holding her abdomen) parang manganganak ulit” Objective: >rated a pain scale of 8/10 >facial grimaces >guarding behavior >restlessness noted Nursing Diagnosis Acute Pain r/t uterine contraction AEB pain scale of 8/10.
it is a feeling of apprehension caused by anticipation of danger. It is an altering signal that warns of impending danger and enables the individual to take measure to deal with the threat After 1H of nursing intervention the pt will appear relaxed and report anxiety is reduced to a manageable level >monitor V/S >to identify physical responses associated with emotional condition >to make the pt feel that she’s not alone >to avoid and limit self focusing The pt will report a reduction of anxiety level >stay with the pt at bedside > provide diversional activities like to talking to the student nurses >to promote >provide comfort and comfort relief measures such as back rubbing and stretching the linen >to help the pt >encourage deep reduced her breathing tension exercise .Subjective: “Kinakabahan ako baka magseizure ako. para kasing naninigas katawan ko” Objective: >cold clammy skin >restlessness noted >increase perspiration >pallor noted Anxiety r/t threat to health status (seizure attack) AEB cold clammy skin and verbal report of anxiety Anxiety is a vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
and how far along you are in your pregnancy. The causes of this condition are unknown. After that. but regular prenatal care will usually catch it early. you may be hospitalized for a few days of monitoring. Your baby will be closely . how your caregiver will manage your condition depends on how high your blood pressure is. The main goal of treatment in pregnant women is to prevent the development of more serious conditions like fetal growth restriction or placental abruption. CONCLUSION and RECOMMENDATION Gestational hypertension is high blood pressure that develops after the twentieth week of pregnancy. 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. you may be sent home to take it easy or possibly put on some degree of bed rest. you'll have a Doppler ultrasound to check blood flow to your baby.) If you haven't yet reached 37 weeks but your condition is mild. reducing the chances of complications. and watch for changes in your condition. 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'll need to see your caregiver frequently so she can monitor your blood pressure. RECOMMENDATION Because high blood pressure can affect blood flow to the placenta. if you and your baby are doing well. Beyond these initial measures. 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.VII. If your condition is mild If you develop mild gestational hypertension at 37 weeks or later. You may also have a biophysical profile (BPP) done at the same time to check on your baby's well-being. but it is clear that the condition affects blood flow to organ such as the placenta and sometimes the brain and the liver. And in certain cases. The treatment of gestational hypertension follows a different set of guidelines than the treatment of general high blood pressure outside of pregnancy. There is no way of preventing this type of hypertension. how your baby's doing. check your urine for protein.
you'll probably be hospitalized and you may need to deliver your baby. 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. call your caregiver immediately if you notice that your baby is moving less than before. 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. . changes in your vision. you'll be induced or delivered by c-section (depending on the situation). you'll be induced or delivered by csection. If you don't need to deliver right away. you'll be given medication to lower your blood pressure and hospitalized until you have your baby. sudden weight gain. even though your baby is still premature." This is a good way to for you to monitor your baby's well-being between prenatal appointments. or nausea and vomiting) or signs of placental abruption (such as vaginal spotting or bleeding. upper abdominal pain or tenderness. If your condition is severe If you're diagnosed with severe gestational hypertension (a blood pressure reading of 160/110 or higher). Whether you're doing actual kick counts or not.monitored as well with weekly or biweekly BPPs and nonstress tests (NST). If you're at 34 weeks or beyond. persistent or severe headaches. You'll need to be seen immediately if you develop symptoms of preeclampsia (such as swelling. If there are any signs of problems with you or your baby. If you're not yet at 34 weeks. You'll also have ultrasounds every three weeks or so to keep an eye on your baby's growth. your caregiver may ask you to monitor your movements by doing daily "fetal kick counts. In addition. or uterine tenderness or pain).
about.com/healthinfo/content.bc http://emedicine. Adelle Pilliteri Medical-Surgical Nursing: clinical Management for Positive Outcome.aspx?pageid=P02484 www.who.com/od/treatmentmonitoring http://www.com/0_gestational-hypertension-pregnancy-inducedhypertension_1427402. Joyce M.org/yourhealth/healthinfo/default www. 8th ed.memorialhealth.com/article/261435-overview . Black and Jane Hokanson Hawks Internet sources: www. highbloodpressure.int/entity/healthinfo/statistics/body www.reshealth. 5th ed. BIBLIOGRAPHY/ REFERENCES Books: Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family.medscape.VIII.babycenter.
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