CHAPTER 1: ASSESSMENT

A. Nursing Health History (Detailed OB health history)

1. Personal Data
Client V.J. is a 26 year old female, currently living at Makati city. She is married
and gave birth to a term baby girl. She delivered her baby last February 6, 2020. AOG
is 39 weeks. She works as an office staff while her husband works as a housekeeper.
Their religion is Roman Catholic and they are both Filipino Citizens. The patient herself
gave the information on the 10th day of February 2020.

2. Chief Complaint
Client V.J. stated, “Sumasakit na yung tiyan ko pakiramdam ko manganganak na
ako, kaya naisip kong magpa admit na kasi baka mamaya manganak na ako.” As
verbalized by the client. She was admitted last February 5, 2020.

3. History of Present Illness

Two hours prior to admission, Client V.J. complains of labor pains. After giving
birth, she complains of pain on her perineum area because of the episiorrhaphy due to
the delivery of a term baby girl. She’s been experiencing colds for 2 days.

4. Past Medical History

Client V.J. stated that the last time that she got admitted in the hospital was due
to her first pregnancy year 2014.

5. Family Health History

Client V.J. stated that her father has hypertension. Both parents are still alive and
well. Her sisters don’t have any serious diseases or chronic illnesses.

GENOGRAM

The genogram states two generations, where it only shows two existing
conditions. The patient is currently diagnosed with gestational hypertension and her
father has hypertension. Other members of the family don’t have any serious diseases.
The patient was not able to affirm their grandparents’ current conditions, as well as for
the husband’s side.

6. Personal and Social History

Client V.J. is an office staff but currently on leave she will be back after 2 months
of relaxation. Her husband is the one who supports her especially. She does not smoke
but she drinks alcohol occasionally.
7. Review of Systems

I. Self perception self concept pattern

Client V.J. describes herself as a shy woman it takes time for her to be open to
certain people since it’s not always easy to be trusting. When it comes to herself, she’s
contented with her looks because her husband always tells her that she’s always
beautiful inside and out. The only thing that she wants to change from herself is her
height but overall she’s fine with her body and face. If pain has occurred to her body
she’s not dependent to medications instead she just drinks water and take a rest. Also
when there is an approaching problem, she’s always looking forward to be a positive
woman every now and then and she doesn’t want to be stressed since they already
have a new baby.

II. Role Relationship Pattern

Client V.J. is currently living with her husband’s house together with her mother.
both  are working and she said she’s satisfied with their life. she’s the one who budgets
their financial billings and other expenses in their family. She’s married with him and
they have 2 children. When it comes to their neighbors, they have a good foundation
with them but they don’t usually talk. For health purposes she often visits health center
for free check ups and medications.

III. SEXUALITY AND REPRODUCTIVE PATTERN

Client V.J. stated that she has no fetishes with her husband. She stated that they
tried using condom and she herself tried drinking pills. They also did the withdrawal
method whenever they have sex. Client V.J. stated that she first have her menstruation
when she was 14 years old and have a normal menstruation flow that lasts within 3 to 4
days long. She feels slight pain when she is on her period every first day of it but she
said that it is normal and tolerable. Her LMP was May 3, 2019. This was her second
pregnancy that she delivered spontaneously and she has no history of miscarriage.

IV. COGNITIVE PERCEPTUAL PATTERN

Client V.J. does not have any problems with her senses, all of them are working
normally. She does not use any aids or devices for her visual. The patient stated that
she usually completes an 8-hour of sleep. Patient does not experience any memory
loss.

V. COPING STRESS TOLERANCE PATTERN

The patient stated that she get stressed due to family problems and she cope up
with it by talking it out with her husband and resolving it right away. She feels relaxed
when she is out and when she talking with her husband about random topics. Most of
the time she shares her problems to her husband and friends and according to her she
feels better after that.

VI. VALUE BELIEF PATTERN

Client V.J. is satisfied with what her life now especially with the realisation that
she now has a healthy baby girl. Client V.J. values her family so dearly, she stated that
she is family-oriented especially, obviously because they choose to still live with his
husband’s parents. Client V.J. is a Roman Catholic, they go to church but not so
frequent. The client also stated that there are no religious practices that affects their
hospitalisation and in terms of food.

VII. ELIMINATION
Client V.J stated that her normal bowel pattern is once a day. As for her urinary
elimination pattern, she has been frequently urinating in small amounts but she said that
it is because she drinks a lot of fluids. Client stated that she perspires frequently.

VIII. REST AND SLEEP

- ACTIVITY EXERCISE PATTERN

Client V.J ’s usual type of activity is only walking. She sometimes jog when she
feels like it. During her pregnancy stage, she said her activities became limited as
compared to when she was not. She has sufficient energy to do her activities. She do
not use any assistive devices to help her do her activity of daily livings. Her leisure
activities are hanging out with his husband 

- SLEEP REST PATTERN

Client V.J. usually sleeps for 6 to 8 hours, but when she gave birth her sleeping
pattern changed due to the hospital setting. The patient stated that she does not have
any problem sleeping so she does not use any assistive devices. She said that she
sometimes have nightmares. She generally feels rested after a good sleep.

IX. SAFETY AND SECURITY

Client V.J. stated that she has no allergies in food or even in medications. There
are also no surgical incisions present. Since the client just had her delivery but there
were no changes in her body temperature.

X. OXYGENATION
Client V.J stated there had been no difficulties with her daily activities however,
after she gave birth the pain she is experiencing in her vagina makes it hard for her to
move. She does not feel any difficulty in breathing.

XI. NUTRITION
Client V.J’s last meal was chicken from Chowking. She also stated that she eats
mostly all kinds of food. She is not a picky eater. She eats a good amount of food each
meal. There had been no change with her appetite from between before she gave birth
and after. She is fond of drinking softdrinks. Her usual meal is prepared at home and
budgeted by her. She verbalized that she had an increased appetite during her
pregnancy. She does not drink any supplements except for the vitamins that the health
centre provided her during her pregnancy such as; vitabone, ferrous sulfate, and folic
acid.

B. Comprehensive Physical Assessment

A) General Appearance
Client V.J. has a large frame. Posture upright and has a staggering gait.
She is appropriately dressed and well groomed. She has no odor and no
obvious physical deformities.
B) Mental Status
Client V.J is conscious and is oriented to time and place. Her emotional
status is pleasant and she uses simple words.
C) Skin
Client V.J.’s skin is normal and dry. Temperature is warm. Skin turgor is
elastic. Hair distribution is evenly distributed.
D) Nails
Nail plate shape is convex 160 and condition is smooth. Nail bed color is
pink and capillary refills in 3 seconds.
E) Head and Face
Skull is proportionate to the body size scalp has no tenderness. Hair is
evenly distributed and face is symmetrical. Facial movements are
symmetrical.

F) Eyes
Eye condition is straight normal. Eyebrows are thick. Blink response is
bilateral. Eyeballs are symmetric. Bulbar conjunctiva is clear, palpebral
conjunctiva is pink. Sclera is white. Pupils are equal and reactive to light and
accommodation. Lacrimal apparatus is moist.
G) Ears
Ears are in normal racial tone. Ears are symmetrical and elastic. Pinna
recoils when folded. There is no presence of cerumen in the external canal
and the hearing acquity responds to normal voice and whispering voice.
H) Nose
Nose is in normal racial tone. Septum is in the midline. Mucosa is pink.
Both nares are obstructed with clear watery discharge. Sinuses are non-
tender.

I) Mouth
Lips are pink and symmetric. Mucosa is pink. Tongue is in the midline and
is rough and colored pink. Teeth are complete. Gums are pink.
J) Pharynx
The uvula of the pharynx is in the midline. Mucosa is pink. Gag reflex is
present.
K) Neck
Neck muscles are equal in size. Lymph nodes are not palpable. Trachea
is in the midline. Thyroid gland is palpable upon swallowing.
 L) Chest and Lungs
AP to lateral ratio is 2:1. Lung expansion is symmetrical both anteriorly
and posteriorly. Breathing pattern is regular. Breath sounds are
bronchiovesicular. Rhythm is normal. Percussion is resonant.

M) Abdomen
Abdomen is in normal racial tone and is blemished with pink striae
gravidarum. Contour is rounded Bowel sounds are normal. No masses.
Bladder is not distended and liver is not palpable.

N) Upper Extremities
Peripheral pulses are normal. Lymph nodes are not palpable.
O) Lower Extremities
Peripheral pulses are normal. Lymph nodes are not palpable.
P) Genitalia
Genitals were not assessed but an episiotomy was performed after
delivery.

C. Diagnostic Procedure
Client V.J. underwent a series of laboratory test since her day of
admission. The client had a complete blood count (CBC). A CBC test is a
blood test used to evaluate one’s overall health and detect a wide range of
disorders, including anemia, infection, and leukemia. A CBC test measures
several components and features of one’s blood including red blood cells, white
blood cells, hemoglobin, hematocrit, and platelets.
Blood typing (ABO). ABO is a test that determines a person’s blood type,
this is especially important to pregnant women because in the cases the mother
is Rh + and the baby is Rh -, the mother’s body will form antibodies that will
attack the baby’s blood cells.
Another test that was conducted is the Hepatitis B surface Antigen Test
(HBsAg). HBsAg is a blood test ordered to determine if someone is infected with
the hepatitis B virus. If it is found, along with specific antibodies, it means the
person has a hepatitis B infection.
Another one is the Urinalysis (UA). UA is used to assess bladder or
kidney infections, diabetes, dehydration, and Preeclampsia by screening for high
levels of sugars, proteins, ketones, and bacteria.
The client also underwent a Hematology test, Hematology
tests include tests on the blood, blood proteins and blood-producing organs. She
has taken 2 tests under the hematology test; the Prothrombin Time (PT), which
 measures how long it takes the blood to clot, and the Partial Thromboplastin
Time (PTT).

She also underwent a Blood chemistry test, which are blood tests that

measure amounts of certain chemicals in a sample of blood. She has taken 2
tests under the blood chemistry test; the Serum Glutamic-Oxaloacetic
Transaminase (SGTO), which, also known as Aspartate Aminotransferase
(AST), evaluates how much liver enzyme is in the blood, and the Serum
Glutamic Pyruvic Transaminase (SGPT), which, also known as the Alanine
Transaminase (ALT), is measured to see there is any liver damage or disease.
Another procedure done is the Sedimentation Rate (TSR). A
sedimentation rate is common blood test that is used to detect and monitor
inflammation in the body. The sedimentation rate is also called the erythrocyte
sedimentation rate because it is a measure of the red blood cells (erythrocytes)
sedimenting in a tube over a given period of time.
Fundoscopy is an exam that uses a magnifying lens and a light to check
the fundus of the eye (back of the inside of the eye, including the retina and optic
nerve). The pupils may be dilated with medicated eye drops so the doctor can
see through the pupil to the back of the eye. This procedure was done to detect
early signs of preeclampsia or eclampsia.

Nursing responsibilities are as follows:

1. Explain test procedures. Explain that slight discomfort will be felt
when the skin is punctured.
2. Encourage to avoid stress if possible because physiologic status
influences and changes normal hematologic values.
3. Apply manual pressure and dressings over puncture site.
4. Monitor the puncture site for oozing or hematoma formation.
5. Also instruct patient for midstream clean catch urine method.
6. Instruct to resume normal activities and diet.
7. Obtain laboratory results and compare values obtained to the
normal values

Name of Date ordered Normal values Values Clinical

procedure (based on obtained Interpretation
standards of (results of the
the hospital): test):
CBC - - -

ABO - - -
February 05,
HBsAg 2020 - - -

UA - - -
Fundoscopy February 7, - - -
2020
HEMOTOLOGY
SGOT/AST 5 - 34 U/L 217 U/L -
February 06,
2020
SGPT/ALT 0 - 55U/L 434 U/L -

TSR February 11, - - -

2020

BLOOD CHEMISTRY
Prothrombin 10.4 seconds 11.1 seconds -
time (PT)
February 08,
Partial 30.4 seconds 30.8 seconds -
2020
Thromboplastin
time (PTT)
D. Anatomy and Physiology

1. Heart

– The heart is responsible for receiving deoxygenated blood, recycling it

through the lungs, and supplying oxygenated blood to the body. The heart
contains four inner chambers: two atria and two ventricles.

– As the heart beats, it pumps blood around the body so that the muscles can
get all the energy and oxygen they need. To do this, the heart pushes blood
through a network of blood vessels, called arteries. As the blood travels
through the arteries, it pushes against the sides of these blood vessels and
the strength of this pushing is called the blood pressure.

– As the heart squeezes and pushes blood through the arteries, blood pressure
goes up. As the heart relaxes, blood pressure goes down. So with each
heartbeat, your blood pressure will rise to a maximum level and then fall to a
minimum level.

2. Kidney

– The kidneys are a pair of regulatory organs located on either side of the back.
Their main function is to act as a filter system that removes waste products
and excess fluid from the body.

– The kidneys and circulatory system depend on eah other for good health. The
kidneys help filter wastes and extra fluids from blood, and they use a lot of
blood vessels to do so. When the blood vessels become damaged, the
nephrons that filter the blood won’t receive the oxygen and the nutrients they
need to function well.

3. Brain
 – The brain is an organ that serves as the center of the nervous system in a
human body. It is located in the head, usually close to the sensory organs for
senses such as vision. It is the most complex organ in a vertebrate’s body.

– Located in the medulla oblongata of the brain stem, it consists of three distinct
regions:

· The cardiac center stimulates cardiac output by increasing heart rate

and contractility. These nerve impulses are transmitted over
sympathetic cardiac nerves.

· The cardiac center inhibits cardiac output by decreasing heart rate.

These nerve impulses are transmitted over sympathetic cardiac
nerves.

· The vasomotor center regulates blood vessel diameter. Nerve

impulses transmitted over sympathetic motor neurons called
vasomotor nerves innervate smooth muscles in arterioles throughout
the body to maintain vasomotor tone, a steady state of
vasoconstriction appropriate to the region.

4. Arteries

– The arteries carry oxygen-rich blood away from the heart to all of the body’s
tissues. They branch into smaller and smaller arteries as they carry blood
farther from the heart and into organs. The arteries manage the flow of blood
by controlling the speed and direction it flows in.

E. Pathophysiology / Disease Process

Gestational Hypertension
Gestational hypertension is defined as consistently elevation of systemic blood pressure
above or equal to 140/90mmHg in a previously normotensive woman after 20 weeks of
pregnancy, without proteinuria.

Modifiable Risk Factors Non-Modifiable Risk Factors

· Poor nutrition · Hypertension with previous
· Lifestyle pregnancy
· Multiple pregnancy
· Kidney Disease
· Hyperglycemia

Vasoey causes increased blood flow resistance

Vasospasm in kidney causes increased blood flow resistance

Heart is forced to pump against rising of peripheral resistance

 Reduce blood supply to organs (kidney, pancreas, liver, brain and placenta)

Degenerative changes in the glomeruli because of back pressure

Arterial spasm causes bulk of the blood volume in the maternal circulation to be pooled
in venous circulation

Signs and Symptoms:

Elevated blood pressure, sudden weight gain, vision changes such as blurred or double
vision, nausea and vomiting, making small amounts of urine

CHAPTER 2: PLANNING
A. List of Prioritized Nursing Diagnoses

No. Nursing Diagnosis Justification

1 Decreased cardiac output related to altered
afterload as evidenced by blood pressure
readings of 140/90
2 Ineffective airway clearance related to
obstructed patency as evidenced by watery
discharge on nasal cavity, and nasal flaring
3 Impaired tissue integrity related to vaginal
delivery as evidenced by cut in the perineal
area
According to the ABC approach, the
patient’s circulation is affected, thus, it
is the top priority because it will also
affect the patient’s airway and
breathing, and lack of proper
circulation will also affect all other
body systems. The patient had a high
blood pressure reading of 140/90
during pregnancy, and hypertension
during pregnancy puts the client at
risk from pre-eclampsia.
According to the ABC approach, the
patient’s airway is affected. The
patient’s circulation and breathing are
not greatly affected. However, it left
untreated, this might start to affect the
circulation and breathing of the
patient due to low exchange of
oxygen and carbon dioxide in the
lungs.
According to Maslow’s Hierarchy of
Needs, health is included in the safety
and security needs. This includes the

4 Impaired comfort related to cut in the
perineal area secondary to giving birth as
evidenced by verbalization of patient
5 Risk for infection related to cut in the
perineal area
overall health status, such as the
physical, physiologic, and mental
health status of the patient. The
patient has a cut in the perineal area
due to vaginal delivery, so she is at
risk for infection and bleeding, which
poses a risk to her health.
According to Maslow’s Hierarchy of
Needs, comfort is included in the
safety and security needs. The patient
verbalized discomfort due to the cut in
her perineal area, which is the only
thing causing her discomfort at the
moment.
According to Maslow’s Hierarchy of
Needs, this is included in safety and
security needs. Infection might occur
if improper wound care is given and
pose a risk to the patient’s health.
This is easily avoidable with proper
care and health teaching of proper
wound care.
2. Treatment
On February 6, 2020, the patient was prescribed to undergo oxygen via nasal
cannula at 3-4 Lpm. The nasal cannula (NC) is a device used to deliver supplemental
oxygen or increased airflow to a patient or person in need of respiratory help. This
device consists of a lightweight tube which on one end splits into two prongs which are
placed in the nostrils and from which a mixture of air and oxygen flows. The other end of
the tube is connected to an oxygen supply such as a portable oxygen generator, or a
wall connection in a hospital via a flowmeter.
Nasal cannulas are used to deliver oxygen when a low flow, low or medium
concentration is required, and the patient is in a stable state. The purpose of nasal
cannula is to standardize use of low flow oxygen therapy as ordered by physicians.
Nursing responsibilities are as follows:

· Check patient's medical record for details of physician’s order.

· Explain safety rules to the patient and visitors in the room. Suggest removal
of all smoking materials.
· Explain to the patient why he/she is receiving oxygen. Relate it to his/her
disease or injury state.
· Reassure the patient that this is a safe procedure.
· Inform the patient that he/she may remove the oxygen device only with
physician order.
· Instruct patient in safe use of oxygen.

Intravenous fluid administration is given to women with hypertension and may be

a form of treatment. IV fluid therapy is used to maintain homeostasis when enteral
intake is insufficient and to replace any additional losses. These losses is caused by
blood loss from trauma or surgery.

The client was given D5LR upon admission until day 2 and was given PNSS on the next
day.D5LR is a fluid replacement used as a source of water , electrolytes and calories.
Plain Normal Saline Solution (PNSS) is a cornerstone of intravenous solutions
commonly used in the clinical setting. It is a crystalloid fluid and it’s a source of
hydration and electrolyte disturbances.

Nursing responsibilities are as follows:

Discuss the purpose of the IV with the patient. 
Explain ways to keep the IV operating safely and effectively.
Monitor the infusion rate.
Maintain the IV site.
Assess the IV site for signs of infiltration.

3. Diet
The client was prescribed with low salt low fat diet for the next few weeks.
Sodium controlled diets are usually prescribed for patients with hypertension and for
those with excess fluid accumulations. Intake of commercially prepared foods such as
cured or smoked meats, canned vegetables and regular soups as well as buttermilk,
salt and salty foods are limited or avoided. White milk, fresh or frozen meats, unsalted
vegetables and fruits and low sodium foods are included.
 Advice patient to maintain a strict diet by doing the following:

· Choose fresh instead of processed foods when you can.

· Use the Nutrition Facts label to check the amount of sodium. Compare
labels to find products with less sodium.
· Look for foods labeled “low sodium” or “no salt added.”
· Avoiding foods with high cholesterol such as “taba” and oily foods like
fried/fast food
One day meal plan:
Breakfast - apple/banana, water, oatmeal
Lunch - brown rice, baked chicken breast with no skin (marinated)
Dinner - beans and carrots, fresh fish (Bangus)
[Use vegetable oils when frying and try as much as possible to use little amount of
condiments.]
4. Activity
Encourage to do early ambulation with resumption of normal activity as tolerated.
Circulation of blood is promoted through regular movement thus help in healing
process. The mother can be able to begin light exercise within a few days of giving birth.
Regular exercise after giving birth can help the patient feel more energized and less
stressed. Also, advised the client to take adequate rest and sleep to gain back the lost
strength and be able to return to its normal state thus allow ample time for healing.
B. Surgical Management
Surgical management done is the episiotomy upon anesthesia assisted normal
spontaneous delivery.

C. CLIENT’S DAILY PROGRESS CHART

Diagnostic Diet Activity Medications Treatment Surgery

Procedure

Admissio CBC DAT - - Magnesium - D5LR 1L + -

n Sulfate 4g SIVP 10 u
(Feb. 5, ABO Oxytocin x
2020) - Hydralazine 30 gtts/min
HbsAg 5mg q 30m (1)

UA - Hyosine - D5LR 1L +
10 u
Oxytocin x
30 gtts/min
(2)
Day 1 SGOT/AST Low Early ambulation - Cefuroxime - O2 via - Anesthesia
(Feb. 6, salt, 500mg PO q 8h Nasal Assisted
2020) SGPT/ALT low fat x 7d Cannula Vaginal
(3-4pm) Delivery
- Ferrous
Sulfate 325mg - D5LR 1L +
PO BID x 30d 10 u
Oxytocin x
- Paracetamol 20 gtts/min
500mg PO q 8h (3)
for pain

- Nifedipine
30mg 1 tab PO
OD

Day 2
(Feb. 7, Fundoscopy Ambulation - Cefuroxime Continuous -
2020) 500mg PO q 8h IVF
x 7d

- Ferrous
Sulfate 325mg
PO BID x 30d

- Paracetamol
500mg PO q 8h
for pain

- Nifedipine
30mg 1 tab PO
OD

Day 3 PT/PTT Low Ambulation - Cefuroxime - PNSS -

(Feb 8, salt, 500mg PO q 8h 100mL/hr @
2020) low fat x 7d 450mL level
(4)
- Ferrous
Sulfate 325mg
PO BID x 30d

- Nifedipine
30mg 1 tab PO
OD
 - Essential
Phospholipid
tablet 3x/d

-
Ursodeoxycholic
acid
300g 3x/d for 4d
q 8h

- Cefuroxime
Day 4 - Low Ambulation 500mg PO q 8h - PNSS 1L + -
(Feb 9, salt, x 7d MgSO4 20g
2020) low fat (5)
- Ferrous
Sulfate 325mg - PNSS 1L
PO BID x 30d + MgSO4
20mg
- Nifedipine (6)
30mg 1 tab PO
OD - PNSS 1L
100cc/hr
- Essential (7)
Phospholipid
tablet 3x/d - D5LR 1L +
KVO
- (8)
Ursodeoxycholic
acid
300g 3x/d for 4d
q 8h

- Cefuroxime
Day 5 - Low Ambulation 500mg PO q 8h - PNSS -
(Feb 10, salt, x 7d 100mL/hr @
2020) low fat 450mL level
- Ferrous
Sulfate 325mg
PO BID x 30d

- Nifedipine
30mg 1 tab PO
OD

- Essential
Phospholipid
tablet 3x/d
 -
Ursodeoxycholic
acid
300g 3x/d for 4d
q 8h

- Cefuroxime
Day 6 TSR Low Ambulation 500mg PO q 8h - PNSS -
(Feb 11, salt, x 7d 100mL/hr @
2020) low fat 450mL level
- Ferrous
Sulfate 325mg
PO BID x 30d

- Nifedipine
30mg 1 tab PO
OD

- Essential
Phospholipid
tablet 3x/d

-
Ursodeoxycholic
acid
300g 3x/d for 4d
q 8h

Discharge - - - - - -
 CHAPTER 4 – EVALUATION

A. Narrative Evaluation of Actual Nursing Problems

1. Decreased cardiac output related to altered afterload as evidenced by blood pressure

readings of 140/90

 Outcome achieved:

- The client is able to display improved cardiac output with lower blood pressure
reading of at least 120/80 mmHg when at rest.
- The client is able to display good cardiac output with consistent blood pressure
readings of 120/80mmhg when at rest, every 4 hours.

2. Ineffective airway clearance related to obstructed patency as evidenced by watery

discharge on nasal cavity, and nasal flaring

 Outcome achieved:

- The client is able to demonstrate effective airway clearance by expelling nasal

discharge by blowing the nose.
- The client is able to maintain airway patency by absence of signs of nasal
discharge and nasal flaring.

3. Impaired tissue integrity related to vaginal delivery as evidenced by cut in the perineal
area

 Outcome achieved:

- The client is able to demonstrate proper skin hygiene and wound care with
assistance from the nurse or S/O.
- The patient is able to display timely wound healing without complications and
consistent skin hygiene and wound care with little assistance from nurse or S/O.

B. Discharge Planning Instructions

Medication - The following prescribed medications are:

- Paracetamol 500 milligrams 1 tablet every 8 hours for pain
- Cefuroxime 500 milligrams 1 tablet every 8 hours for 7 days
- Ferrous Sulfate 325 milligrams 1 tablet twice a day for 30 days
- Nifedipine 30 milligrams 1 tablet once a day
- Essential phospholipid diet three times a day
- Ursodeocycholic acid 300 grams three times a day

Exercise - The exercise ordered was ambulation; slowly start small or light
exercises like walking and doing household choirs for at least 20-30 minutes a day.
 Treatment - Monitor blood pressure as prescribed by the Physician and drinking of
paracetamol for pain, and ferrous sulfate for anti-anemics.

Health Teaching -The patient was given health teachings about family planning,
perineal care, importance of breastfeeding, breast care, proper positioning of baby
in breastfeeding, proper hygiene, and appropriate nutrition/diet specifically for hy
pertensive patients and patients who are in wound recovery such as low salt low fat
diet and food rich in protein.

Out-Patient Department - As per discussed by the patient's OB-Gyne, the client is

to go back in the hospital if there are any pain and unusual symptoms felt like a sud
den increase of blood pressure.

Diet - The client was prescribed with low salt low fat diet for the next few weeks. Ad
vice patient to maintain a strict diet by doing the following:
 Choose fresh instead of processed foods when you can.
 Use the Nutrition Facts label to check the amount of sodium. Compare
labels to find products with less sodium.
 Look for foods labeled “low sodium” or “no salt added.”
 Avoiding foods with high cholesterol such as “taba” and oily foods like
fried/fast food

One day meal plan:

 Breakfast - apple/banana, water, oatmeal
 Lunch - brown rice, baked chicken breast with no skin (marinated)
 Dinner - beans and carrots, fresh fish (bangus)

[Use only vegetable oils when frying, and try as much as possible to use little amount of
condiments]