Nursing Care of Pregnancy Conditions

ANGELES UNIVERSITY FOUNDATION
Angeles City
College of Nursing
Nursing Care Management 0109
RELATED LEARNING EXPERIENCE (RLE)
NURSING CARE MANAGEMENT OF CLIENTS WITH

HIGH-RISK PREGNANCY CONDITIONS
MODULE 2
Pregnancy-Induced Hypertension (PIH) and Gestational Diabetes
Mellitus (GDM)
Second Semester, Academic Year 2021 – 2022
Instructions to the Learner:

1. A module is a self-paced learning material. You may proceed with it at
your own pace or speed.
2. If you think you meet the required objectives of this module, you can
proceed to the next module. If not, you have to go through the same
module again.
3. Each module contains a pretest, learning cell, post-test, and feedback.
You have to go through the activities in the following sequences:
3.1.Take the pretest. This is a brief self-administered check-up on the
concept covered in the text.
3.2.Check the answers against the feedback found on the last page.
Never attempt to look at the answers before you start answering the
pretest.
3.3.Read the learning cell.
3.4.Take the post-test.
3.5.If you answer the post-test satisfactorily according to the criterion set,
you may proceed to the next module. However, if you fail to meet the
criterion set, you read the text again and take the test that you failed.
Then you can move on to the next module
Overview
The instructional module on high-risk pregnancy conditions namely pregnancy-
induced hypertension (PIH) and gestational diabetes mellitus (GDM) is designed
and is intended for Level II learners in the full comprehension and appreciation of
learned concepts related to the application of the nursing process in the
management of clients with these conditions. Understanding the very core concept
of care that is derived from learning the disease’s causation, pathogenicity,
symptomatology, diagnosis, and treatment strategies aim to contribute to the
RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

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learner’s capacity to determine areas of required assessment, prioritize health
problems, formulate systematized plans of care, devise health education
measures, to identify individualized and appropriate nursing care, and to appraise
treatment measures.
The high-risk pregnancy conditions, PIH and GDM, while they remain as
significant health alterations greatly affecting the client’s functioning, must require
systematic and efficient management that is directed not only to achieve positive
maternal outcomes but fetal outcomes as well. Notwithstanding adequate
knowledge of disease conditions, the healthcare practitioner must be able to deal
with these clients holistically and this module is made for learners to begin this
journey of learning the concepts related to client care and eventually, actual
handling clients with such conditions.
Learning Outcomes:
In conformance with the directives of Commission on Higher Education (CHED)
Memorandum Order No. 15’s policies, standards, and guidelines, the following are
the module’s learning outcomes aimed at learners to accomplish successfully:
1. Integrate relevant principles of social and health sciences in the care of women
at risk or with problems (PO1a)
2. Assess with the patient and family her health status (PO2a)
3. Formulate with the client and family a plan of care to address health conditions,
needs, problems, and issues based on priorities (PO2b)
4. Implement safe and quality interventions with the client to address the health
needs, problems, and issues (PO2c)
5. Provide appropriate evidence-based nursing care based on: theories and
standards relevant to health and healing, research, and clinical practice (PO3a)
6. Implement strategies/approaches to enhance/support the capability of the client
and care providers to participate in decision-making by the inter-professional
team (PO7b)
7. Provide health education using selected planning models to high-risk women
and their families (PO2d)
8. Collaborate with other members of the health team in the implementation of
services (PO7e)
9. Document nursing services rendered and processes/ outcomes of the nurse-
client working relationship (PO6a)
Learning Objectives:
Upon completion of this module, the learner should be able to:
1. Define high-risk pregnancy conditions in the context of PIH and GDM;
2. Articulate the factors, as causation for PIH and GDM;
3. Acquire understanding in the identification of common assessment findings
observed in PIH and GDM;

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4. Analyze priority nursing problems in the care of clients with PIH and GDM;
5. Associate plan of care accordingly to prioritize health problems on clients with
PIH and GDM;
6. Araw relevant nursing measures in the care of clients with PIH and GDM; and
7. Appraise a variety of nursing interventions through clinical case scenarios on
clients with PIH and GDM.
8. Demonstrate nursing skills ( Capillary Blood Glucose Monitoring CBG, drawing
insulin from a vial and injecting insulin)
Time Allotment for Discussion and Activities

There will be an allotted 26 hours for this module’s discussion of incorporated
concepts, learning activities, modular assessment, and recommended readings/
viewings. The following timetable attempts to capture the activities respective to
their estimated time allotment.
PART OF THE MODULE ESTIMATED TIME FOR

COMPLETION
PREDISCUSSION: Module Pretest 10 minutes
(Formative Assessment, not Graded)
Uploaded in myClass’ as Practice Quiz
DISCUSSION
1. Video Conference No. 1 on introducing PIH as a high- 30 minutes
risk pregnancy condition
2. Video Viewing Activity No. 1 on PIH’s pathophysiology 15 minutes
3. Video Conference No. 2 in the management of clients 30 minutes
with a PIH through the application of the nursing process
4. NURSING SKILL: Insertion of Foley catheter 30 minutes
5. NURSING SKILL: Removal of Foley Catheter 10 minutes
4. Video Conference No. 3 on introducing GDM as a high- 30 minutes

risk pregnancy condition
5. NURSING SKILL DEMONSTRATION Video 10 minutes
Viewing Activity No. 2 on Blood Glucose monitoring
6. Nursing Skill Demonstration on how to draw insulin 30 minutes
from the vial and inject insulin
7. Video Viewing: Insulin pump 10 minutes
8. Video Conference No. 4 in the management of clients 30 minutes
with a GDM through the application of the nursing process
Module Posttest 10 minutes
(Formative Assessment; Not Graded)
Uploaded in myClass as Practice Quiz
ASSESSMENT ACTIVITIES ESTIMATED TIME FOR

Asynchronous COMPLETION
Problem Based Learning (PBL) 4 hours
Simulated Focus-Data-Action-Response (FDAR) 2 hours
Documentation
Case Scenario No. 1 (PIH)
Nursing Care Map 4 hours

Simulated Focus-Data-Action-Response (FDAR) 2 hours

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Case Scenario No. 2 (GDM)
FEEDBACK ON ACTIVITIES
Synchronous
Discussion on Topics covered in Activities:
Nursing Care Management of a Client Undergoing 3 hours
Treatment for a PIH as presented in Case Scenario
No. 1
Nursing Care Management of a Client with a GDM 3 hours
as seen in Case Scenario No. 2
SUMMATIVE EVALUATION
Uploaded in myClass’ as Graded Quiz
Quiz: 30 Items, Multiple Choice 40 minutes

LEARNING HOURS 26 HOURS
PREDISCUSSION: Module Pretest (not graded)

For the purpose of evaluating prior knowledge of the topics incorporated in this
module, a pretest, uploaded in myClass as a practice quiz is prepared for you. Go
over the content of the module after taking the pretest, taking into account the
questions that you may have missed in the pretest assessment.
Assessment
Pretest
Multiple Choice. Choose the best answer.
1. Which of the following is not a classic manifestation of pregnancy-induced

hypertension (PIH)?
A. 3+ edema
B. Blood pressure of 160/110 mmHg
C. Epigastric pain
D. Protein 2+ random urine sample
2. Which of the following is not a commonly associated risk factor for PIH?
A. First pregnancy at the age of 17 years old

B. Multiple gestations
C. Multiple pregnancies
D. Ovarian cancer
3. When administering hydralazine on a client with PIH, the nurse

carefully monitors which of the following as indicators of effectiveness?
A. Blood pressure
B. Edema grading

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C. Heart rate
D. Platelet count
4. Which of the following, if noted on a client taking aspirin 81 mg PO OD for

PIH should be further evaluated and reported to the physician immediately?
A. Black tarry stool

B. Hyperactive bowel sounds
C. Respiration at 10 bpm
D. Variable deceleration on the fetal monitor
5. To which assessment finding, if noted should the nurse be most concern

about a client with severe preeclampsia?
A. Blood pressure of 170/110 mmHg

B. Epigastric pain
C. Halo vision
D. Hypoactive bowel sounds
6. When are pregnant patients tested for gestational diabetes?
A. 6 to 12 weeks AOG
B. 12 to 20 weeks AOG
C. 24 to 28 weeks AOG
D. 30 to 32 weeks AOG
7. The nurse educates the pregnant patient with gestational diabetes that
she should try to have a blood glucose level of ________ 1 hour after a
meal:
A. < 70 mg/dl
B. < 140 mg/dl
C. < 160 mg/dl
D. 250 mg/dl
8. A patient who is 35 weeks pregnant has gestational diabetes. Which

laboratory result for blood glucose is euglycemic?
A. 55 mg/dl
B. 82 mg/dl

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C. 148 mg/dl
D. 200 mg/dl
9. A 32-year-old pregnant female is diagnosed with gestational diabetes at

28 weeks gestation. As the nurse, you know that the test below is used
to diagnose a patient with this condition:
A. 1- hour glucose tolerance test

B. 24-hour urine test
C. Hemoglobin A1C
D. 3-hour glucose tolerance test
10. When do most patients tend to develop GDM during pregnancy?
A. 1st to 3rd month

B. 2nd to 3rd month
C. 1st to 2nd trimester
D. 2nd to 3rd trimester
Note: You may refer to the last page of this module where you can see the
answers of the Pretest on the Feedback page.
DISCUSSION:
Threaded in this module are carefully prepared learning activities ranging from
synchronous interaction, video viewing, and modular assessment activities with
the aim of achieving identified learning outcomes and objectives. You will be
guided with these activities that are lined up for this module by your professor.
I. Video Conference No. 1

Introduction on PIH as a High-Risk Pregnancy Condition
PREGNANCY-INDUCED HYPERTENSION (PIH)

A high-risk pregnancy condition, PIH (also known as gestational
hypertension) is described as hypertension that occurs in the course of
pregnancy resulting from vasospasm of small and large arteries. It must be
remembered that vasospasm causes increased vascular resistance which
causes the heart to increase its pressure to perfuse systemic organs, including
the uterus. It was previously termed as “toxemia” of pregnancy as it was believed
to be caused by a toxin in response to a foreign protein that forms a growing
fetus.
II. Video Viewing Activity No. 1
PIH’s Pathophysiology

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To supplement previous learning on the introduced disease process, a video
viewing activity, seen on this link:
https://www.youtube.com/watch?app=desktop&v=pnGyENcL2j0&fbclid=IwAR2u
6vZ3Qhfp-gVVdoqaAjotmaBp_TEGT5mXXZk_1JfOPqLuvK-M6daIgGw, is
prepared for you as reference. In this video, you will be able to appreciate that
although the main cause of PIH is unknown, it can be thought to be related to
various factors that play a significant role in the progression of the disease.
Moreover, this video viewing activity challenges the learners to identify risk
factors that can be modified to a certain extent in line with the primary preventive
level of care for clients with such conditions.
III. Video Conference No. 2

Nursing Care Management of Clients with a PIH through the Application of
the Nursing Process
APPLICATION OF THE NURSING PROCESS

ASSESSMENT
When receiving a pregnant client with a PIH, assessment should be focused
on maternal history (inclusive of associated risk factors to establish causation)
and presenting clinical manifestations. Be mindful that while PIH’s cause is
unknown, it is commonly related to the following risk factors:
1. Antiphospholipid Syndrome (APS). Clients with APS often exhibit the

strongest association to cases of PIH. While the causal relationship of APS
to PIH is not fully established, the presence of autoantibodies directed
against the phospholipid layer of the blood vessels can cause thrombosis
and diminished circulation, similar to that of what happens in PIH.
2. Women of color. Although not fully understood, Black women tend to show
more cases of PIH than women coming from other races.
3. Multiple pregnancies. The required increase in the cardiac output in
pregnancy reduces the action of prostacyclin (vasodilator) and increases
the effect of thromboxane (vasoconstrictor). Decreasing vasodilation (low
prostacyclin) and increasing vasoconstriction (high thromboxane) generally
lead to artery vasoconstriction and vasospasm. Other than that,
prostaglandin release in pregnancy causes increasing effects of angiotensin
and norepinephrine in PIH. During a normal pregnancy, increased cardiac
output still places the blood pressure within normal ranges because the
blood vessels are not affected by angiotensin and norepinephrine, in
contrast with the presence of a PIH. These justifications are also applicable
in explaining why multiparity is an associated risk factor for PIH.
4. Multiparity. Women who have had five (5) or more pregnancies tend to
show an increasing incidence of PIH.

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5. Primiparas younger than 20 years old or older than 40 years old. In the
teenage population, PIH has a prevalence twice as high as that in the adult
population. Advancing age may be associated with the possible presence
of co-morbidities that include diabetes and hypertension.
6. Low socioeconomic status. Underlying poor nourishment of both the
mother and the fetus can contribute to the development of PIH.
7. Polyhydramnios. Polyhydramnios, characterized by excessive amniotic
fluid accumulation during pregnancy, is believed to be associated with the
development of PIH but the causation remains unclear.
8. Underlying co-morbidities (heart disease, diabetes, hypertension,
renal disease).` These conditions are thought to increase susceptibility to
the development of hypertension during pregnancy.
Symptomatology in PIH emerges beginning about the 20th week of

pregnancy. The classic manifestations of PIH are proteinuria, edema, and
hypertension. When a client with a PIH is presented in the maternity unit, the
nurse must specifically look in his or her assessment the following clinical
manifestations of the disease that commonly include:
1. Hypertension. The associated uterine artery vasospasm causes increased
peripheral vascular resistance (due to low prostacyclin and high
thromboxane; increased effects of angiotensin and norepinephrine). Blood
pressure readings are somewhat important in the classification of a PIH (see
later discussion of PIH classifications). The associated vasospasm can also
increase platelet aggregation inside blood vessel walls.
There are two (2) criteria to remember when the nurse measures and
documents blood pressure reading in a PIH:
a. blood pressure of at least 140/90 mmHg. The blood pressure must be
taken on two (2) separate occasions at least six (6) hours apart. The
diastolic pressure is extremely important as this is the indicator of the
degree of peripheral arterial spasm/ resistance.
b. Comparison of pregnancy and pre-pregnancy blood pressure
readings. Systolic blood pressure greater than 30 mmHg and diastolic
blood pressure greater than 15 mmHg from pre-pregnancy values
establish a PIH. A woman with a pre-pregnancy blood pressure of 90/50
mmHg and a pregnancy blood pressure of 120/65 mmHg can suggest
significant elevation. While a 120/65 mmHg may be well below 140/90
mmHg as the cut-off, this represents hypertension for her. Similarly, a
hypertensive mother (prior to pregnancy) with 150/90 mmHg and
180/110 mmHg as pre-pregnancy and pregnancy values, respectively
requires PIH evaluation by the physician. It must be remembered that
a cut-off of 140/90 mmHg is a more useful tool especially if no
baseline pre-pregnancy is determined during clinical assessment

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(late prenatal checkup).
2. Proteinuria. The renal changes caused by increasing vasospasm in a PIH
favor loss of proteins, particularly albumin, in the urine leading to proteinuria/
albuminuria. The degree of proteinuria helps in the classification of a PIH.
The nurse must be able to review laboratory results and must remember
that the loss of protein in the urine can be either be determined through:
a. Random urine sample. A reading of 1+ represents 1g/L loss of protein
in the urine on a reagent test strip on a random sample. Meanwhile, a 3+
or 4+ reading indicates marked proteinuria. Actual proteinuria is said to
have existed by a reading of at least 1+.
b. 24-hour urine collection. A urine collection over a 24-hour period can
reveal proteinuria and may register 5 g or protein loss which actually
indicates marked proteinuria.
3. Edema (weight gain, skin indenting). This develops primarily due to the
loss of protein. Decreased protein can lead to decreased colloid oncotic
pressure that allows the movement of water from the intravascular into the
interstitial spaces. Other than proteinuria as the cause, edema also emerges
due to the effects of sodium retention and poor glomerular filtration rate
(caused by renal changes) during pregnancy.
The nurse, in his or her assessment of the client with edema, should
particularly look for signs of fluid accumulation that lead often to:
a. weight gain. A weight gain of more than 2 pounds/ week in the
second trimester or 1 pound/week in the third trimester indicates
significant edema or abnormal fluid accumulation. The nurse should
measure the extent of weight gain by checking on the client’s weight at
the same time each day, with the same clothes and a similar weighing
scale.
b. Skin indenting. Extreme edema is mostly noticeable over bony
surfaces (tibia on the anterior leg, ulnar surface of the forearm,
cheekbones). Fluid accumulation can be palpated and the presence of
indenting describes edema as pitting. Meanwhile, non-pitting edema,
a more severe form of fluid accumulation (all interstitial spaces have
been filled by fluid), is described as the absence of indenting with finger
pressure.
Other than describing it as pitting or non-pitting, the nurse can also
evaluate and document edema in terms of grade such as:
1+: at least 2 mm depression; barely detectable; immediate rebound;
mild
2+: at least 4 mm depression; a few seconds to rebound; moderate
3+: at least 6 mm depression; 10 to 12 seconds to rebound; severe
4+: at least 8 mm depression; takes more than 20 seconds to rebound;
very severe

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4. Decreased urine output. The aggravating edema indicates that fluid in the
intravascular spaces is diminishing which also means that there is
inadequate renal tissue perfusion. Along with existing hypertension, the
client’s urine output will decrease owing to renal tissue damage.
For instance, the nurse may encounter a client with preeclampsia with
severe features to reveal urine output of 400 to 600 ml per 24 hours.
Accurate urine output monitoring suggests the degree of renal tissue
perfusion. The nurse may also review laboratory results for increasing
serum creatinine and blood urea nitrogen (BUN) as indicators of renal
tissue damage.
5. Neurologic Disturbances (hyperactive patellar reflex and ankle clonus;
visual changes; headache; convulsion/ seizure). While the cause of
neurologic disturbances, specifically convulsion is unknown, the main
explanation is thought to be related to cerebral artery spasm (due to low
prostacyclin, high thromboxane, high angiotensin, and norepinephrine); and
cerebral edema (due to low colloid oncotic pressure and proteinuria). Visual
changes (e.g. flashing lights, blurred vision, floaters) is believed to be
caused by spasm of the brain’s arteries (cerebellum). Hyperactivity of
reflexes (e.g. patellar reflex) and the presence of ankle clonus are
indicative of neuronal excitability and irritability.
The nurse, in his or her assessment of a client with neurologic
disturbance, must bear in mind that the client’s condition is getting severe
(can lead to eclampsia, a more severe classification of a PIH). To determine
the presence of ankle clonus, the nurse should perform the following in
succession:
a. Dorsiflex the client’s foot three (3) times in rapid succession.
b. While taking the hand away (nurse’s), observe the foot.
c. Absence of movement of the foot means the absence of ankle clonus.
The presence of involuntary movement indicates clonus and the nurse
can grade his or her assessment as:
Mild: 2 movements
Moderate: 3 to 5 movements
Severe: over 6 movements
To assess for patellar reflex, the nurse may perform the following steps:
a. Tell the client to assume a supine position
b. Ask the client to bend her knee slightly
c. Place the hand (nurse’s) under the client’s knee to support the leg.
d. Locate the patellar tendon in the midline of the anterior leg just below the
kneecap.
e. Strike the client’s patellar tendon firmly and quickly with a reflex hammer.
f. Note for the presence of movement of the foot. The presence of

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movement indicates the presence of a patellar reflex. The nurse grades
his or her assessment of the client as:
0: no response; hypoactive; abnormal
1+: somewhat diminished response but not abnormal
2+: average (normal) response
3+: brisker than average but not abnormal
4+: hyperactive; very brisk; abnormal
To aid the physician in the classification of the client’s PIH, the nurse plays a
crucial role in the assessment of the client. This likewise facilitates the nurse’s
choice of interventions in the implementation phase. A sound knowledge of the
classification of PIH is of paramount importance as it not only helps in priority of
care of the client but also her prognosis. Classification, dependent on
symptomatology can be illustrated in Table 1.
Table 1: Classification of Pregnancy-Induced Hypertension (PIH)
Hypertension Type Symptoms

1 Gestational Blood pressure of at least 140/90 mmHg (greater than 30 mmHg and
hypertension 15 mmHg for systolic and diastolic blood pressure respectively from
pre-pregnancy values)
No proteinuria; no edema
Blood pressure within normal range after birth
2 Preeclampsia Blood pressure readings similar with gestational hypertension
without severe With proteinuria (1+ to 2+ on random urine sampling)
features Weight gain over 2 pounds/ week (2nd trimester); 1 pound/ week (3rd
(Mild trimester)
Preeclampsia) Mild edema (upper extremities/ face)
3 Preeclampsia with Blood pressure of at least 160/110 mmHg
severe features With proteinuria (3+ to 4+ on random urine sampling; or 5 g in 24-hour
(Severe urine collection)
Preeclampsia) Urine output is less than 500 ml over 24 hours
Elevated serum creatinine (more than 1.2 mg/dl)
Neurologic disturbances (headache, blurred vision)
Hepatic dysfunction (epigastric pain)
4 Eclampsia Seizure/ coma with signs and symptoms of preeclampsia (edema,
hypertension, proteinuria)
Poor fetal prognosis. It even becomes graver when there is premature
separation of the placenta
DIAGNOSIS
The choice of nursing interventions is influenced by the nurse’s assessment
of the client’s presenting clinical manifestations and the effects that both the
mother and the growing fetus can encounter. Depending on the client’s
manifestations, diagnoses generally include:
1. Ineffective tissue perfusion related to vasoconstriction of blood
vessels
This is identified as the vasospasm can greatly affect perfusion of the
uterus, brain, liver, and kidneys in the pathogenicity of PIH. Decreasing
perfusion of tissues in PIH is responsible for causing fetal hypoxia,
neurologic disturbances (headache, visual changes, clonus, seizure),
epigastric pain, and renal damage.

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2. Deficient fluid volume related to fluid loss in subcutaneous tissues/
interstitial space
While edema formation commonly requires fluid volume excess as a
nursing diagnosis, deficient fluid volume is applicable in the context of loss
of the intravascular fluid since shifting of fluid into the interstitial space has
occurred. This greatly diminishes the perfusion of major organs since water
is a major component of blood volume.
3. Risk for fetal injury related to reduced placental perfusion secondary
to vasospasm
The presence of uterine artery vasospasm can greatly decrease the
amount of blood flow into the placenta for fetal oxygenation. Fetal distress
can occur owing to hypoxia and the risk for fetal organ damage increases
with poorly controlled PIH.
4. Social isolation related to prescribed bed rest
The environment that is suitable for a preeclamptic mother (especially
for severe type) should be dimmed with minimal interruptions and noise level
is kept to a minimum. Due to the required environmental manipulation to
prevent seizures to occur, a feeling of being socially isolated is possible and
the nurse must be able to carefully plan interventions to address this
problem.
PLANNING
The plan of care should be directed at an interplay between pharmacologic
and non-pharmacologic measures; and a combination of independent,
dependent, and interdependent nursing functions. Consistent with the identified
priority problems, the plan of care should be directed at:
1. improving major organ perfusion
2. correcting fluid imbalance at the intravascular and interstitial compartments
3. preventing fetal injury
4. managing social isolation
IMPLEMENTATION
While the interventions can be influenced by the identified plan of care and
diagnoses and the classification of a PIH, the following are the strategies that
nurses should expect in the care of these clients with this high-risk pregnancy
condition:
1. Bed Rest
The nurse must prescribe a recumbent position for bed rest as this
position tends to excrete more sodium ions that have been implicated in the
development of edema. The lateral recumbent position can prevent uterine
pressure and can relieve the pressure on the mother’s vena cava,
preventing supine hypotension syndrome.

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In the presence of preeclampsia with severe features, bed rest is
facilitated by confining the client in a private room to minimize noise and
confining visitors to support people only (husband/ partner, mother, older
children). This is necessary as the client should be prevented from having
an eclamptic episode (e.g. seizure). The client may be allowed to have
bathroom privileges, if able.
2. Optimal Nutrition
While sodium restriction may be indicated for edema, sodium restriction
in a PIH is found to be unnecessary in the treatment of clients. Protein may
be increased (moderate to high) in the presence of proteinuria to
compensate for the loss. Intravenous fluids may be initiated especially
among clients with preeclampsia with severe features as an emergency
route for medications (e.g. magnesium sulfate, diazepam) in the event that
seizure occurs. Intravenous fluids may also help prevent hemoconcentration
and hypovolemia secondary to edema formation. The nurse must properly
regulate these fluids as the client’s fluid balance is crucial in PIH due to
existing edema and intravascular fluid volume deficit.
3. Monitoring of Maternal Well-Being
The mother’s well-being can greatly influence the success of
interventions. Provision of emotional support after careful inquiry on the
client’s knowledge of the condition, housing, and economic conditions,
financial capacity, and presence of available children at home is necessary
in order to holistically provide individualized care. Other than emotional
support, monitoring of the client’s physiological responses to the disease is
essential. Parameters to monitor should be inclusive of:
a. Blood pressure. The nurse should measure blood pressure at least
every 4 hours. The frequency of checking increases when the client is
maintained on magnesium sulfate infusion as this medication can
decrease the blood pressure.
b. Blood studies. Complete blood count with platelet count, liver enzymes,
blood urea nitrogen, and creatinine is ordered to evaluate hepatic and
renal function and possible development of disseminated intravascular
coagulation (a potential complication of PIH).
c. Daily weights. Daily monitoring of weight at the same time, same
clothes and weight scale determine the client’s progress and response
to treatment.
d. Urine output. An indwelling urinary catheter is inserted to accurately
monitor urine output. Accurate documentation of intake and output (I &
O) determines the fluid infusion rates. The urine output per hour should
be at least 30 ml (less than 30 ml suggests oliguria). Report to the
physician right away once urine output is recorded less than 30 ml.
e. Urinary proteins. Depending on the physician’s method for urinary

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protein checking (e.g. random urine sampling, 24-hour urine collection),
the nurse should carefully document the degree of proteinuria as it
facilitates the physician’s diagnosis and evaluation of the client’s
response to treatment.
4. Monitoring of Fetal Well-Being. Non-stress test or biophysical profile may
be ordered to assess for uteroplacental insufficiency. The presence of fetal
distress requires maternal oxygen administration.
5. Antiplatelet Therapy. Due to associated vasospasm, platelet aggregation
may occur. In line with this, an order for anti-platelets (e.g. baby aspirin 81
mg) may be indicated. Monitoring the client while on antiplatelet therapy
should be directed at compliance to intake, and monitoring for bleeding as
possible adverse effects.
6. Anti-Hypertensive Therapy. Due to the presence of hypertension in a PIH,
anti-hypertensive medications such as hydralazine (peripheral vasodilator),
betalol (beta-adrenergic blocker), or nifedipine (calcium channel blocker)
can be ordered to lower blood pressure without interfering with placental
circulation. The nurse should carefully monitor blood pressure and heart rate
as maternal tachycardia and hypotension can occur.
7. Magnesium Sulfate Therapy. The drug of choice for clients with either
preeclampsia with a high risk for seizure or eclampsia is magnesium sulfate.
Since the medication is considered a central nervous system (CNS)
depressant, this medication is effective to clients with increased neuronal
irritability/ excitability in the case of eclampsia/ pre-eclampsia with high risk
for convulsion. This medication is also classified as cathartic, by moving
fluid from the cerebral cells’ interstitial spaces into the intestine for excretion.
The nurse that administers this high-risk medication should be reminded of
the following important considerations:
a. The drug is generally given as an infusion. The initial (bolus) dose,
however, can be given as a bolus, administered intravenously over a
period of 15 to 30 minutes. The maintenance dose (after the bolus
dose) is administered as a piggyback infusion.
b. The serum therapeutic range for magnesium sulfate therapy in
preeclampsia ranges between 5 and 8 mg/100ml.
c. Blood pressure, urine output, respiratory rate, and patellar reflex
should be assessed before, during, and after therapy. Low blood
pressure, decreased urine output (less than 30ml/hour), decreased
respiratory rate (less than 12 bpm), and hypoactive patellar reflex, if
present requires discontinuation of infusion and notification to the
physician.
d. Decreasing sensorium/ consciousness also requires notification to
the physician as overdosing on magnesium can have profound CNS
depression.

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e. Calcium gluconate 10% (10 ml) administered as a slow intravenous
push is the antidote for magnesium sulfate toxicity. It is therefore a
requirement for nurses to have calcium gluconate available in the unit
(bedside, depending on hospital policy) if the client is started on
magnesium sulfate infusion.
f. If the client has been maintained on long-term magnesium sulfate
therapy, oral calcium can be continued in the post-partal period to
prevent osteoporosis, a potential complication of long-term magnesium
therapy.
8. Seizure/ Convulsion Precautions. A severe form of preeclampsia
increases the risk for the client to develop eclampsia. Since the difference
of the two (2) conditions mainly relies on the presence or absence of a
seizure, it is essential that nurses provide seizure precautions to prevent
life-threatening eclampsia. Precautionary measures for seizure include the
following:
a. Environmental manipulation. The room is darkened (dimmed)
because bright light can trigger seizures. This is different with turning the
lights off as nurses are required to use a flashlight for assessment which
therefore triggers a seizure. Shining a flashlight beam into a woman’s
eyes is a form of sudden stimulation to be avoided.
b. Restriction of visitors. Close family members are only allowed to visit
the client as excessive stimulation triggers seizures. Providing emotional
support as social isolation is a potential concern, other than the fact that
the client is placed in a private room. The client is encouraged to rest as
undisturbed as possible.
c. Minimize stress. The client must be aware as to why necessary
treatment, restrictions, and instructions are required of her. Allowing
herself to express concerns can help alleviate anxiety.
d. Fall precautions. Raise the side rails should a seizure occur.
e. Treatment measures during a seizure. The priority of care in an
eclamptic seizure is the maintenance of a patent airway. Measures
include the following:
▪ Report any complaints of epigastric pain as it is believed to be an
aura for seizure.
▪ To establish an airway, the client’s head is turned to the side to allow
drainage of secretions from her mouth.
▪ As an emergency measure, diazepam or magnesium sulfate may be
administered.
▪ To protect fetal oxygenation, the mother receives oxygen by face
mask. Monitor for oxygen saturation using a pulse oximeter.
▪ Apply an external fetal heart monitor to determine fetal distress.
▪ Provide extreme post ictal observation particularly assessing for
Page 15
vaginal bleeding every 15 minutes (indicative of early placental
separation) as the sensation of labor contractions may not be felt by
the client at this period.
9. Intra-partal Considerations (Birth)
The decision to deliver the baby to a client with PIH largely depends on
the fetal viability (the ability of the baby to survive in the extrauterine life).
Usually performed 12 to 24 hours from the onset of a seizure, a viable fetus
is delivered via vaginal birth with minimal use of anesthesia. Caesarian
delivery may not be favorable due to high maternal blood pressure, and
reduced intravascular fluid volume secondary to edema. If labor induction is
ineffective for a vaginal birth, however, caesarian birth becomes the birth
method of choice because of the imminent danger of the baby.
10. Post-partal Considerations (After Birth)
The client may continue to have magnesium sulfate 12 to 24 hours after
birth to prevent eclampsia at this period where the dose is tapered and is
eventually discontinued. It is also important for nurses to include in their
endorsement that if the client receives magnesium sulfate (especially if
given within 2 hours of a baby’s birth), the baby may suffer severe
respiratory depression secondary to the drug’s ability to cross the
placenta.
Postpartum preeclampsia may occur up to 10 to 14 days after birth
(most symptoms occur within 48 hours after birth). It is therefore essential
that the client is instructed to have her blood pressure monitored for at least
2 weeks in this period.
EVALUATION
Evaluation should be directed at determining the outcomes of care with
respect to the resolution of significant clinical manifestations, achievement of
plans of care, timely and precise execution of implementation measures to
alleviate or solve identified nursing diagnoses. Parameters must include but
should not be limited to evaluation of both maternal (renal, cerebral, hepatic
functions) and fetal (fetal heart tone, uteroplacental perfusion) functioning.
IV. NURSING SKILL: INSERTION OF FOLEY CATHETER

Foley catheters have an inflatable balloon that anchors the catheter in the
bladder. The catheter has two channels – one drains urine while the other
is used to inflate and deflate the balloon.
Balloons are inflated with sterile water/or using liquid in syringes supplied
by manufacturers. The water is usually inserted and removed using a
syringe that is attached to a valve on the catheter.
Balloons vary in size but adults usually require a 5-10ml balloon. Always
check manufacturers’ instructions. Balloons must not be overinflated as
they can rupture, leaving fragments in the bladder (Dougherty and Lister,
2015).
Insertion of an indwelling urethral catheter (IDC) is an invasive procedure

Page 16
that should only be carried out using aseptic technique, Insertion of an
indwelling urethral catheter (IDC) is an invasive procedure that should
only be carried using aseptic technique, either by a nurse, or doctor if
complications or difficulties with insertion are anticipated.
Catheterization of the urinary tract should only be done when there is
a specific and adequate clinical indication, as it carries a risk of
infection.

Page 17
In this video viewing activity, you will be able to appreciate the step-by-
step Preparation of a Foley Catheter Kit | Set-up a Foley for Insertion
https://www.youtube.com/watch?v=P29UJm33GKE
In this video viewing activity, you will be able to appreciate the step-by-step
procedure on how to insert foley catheter:
https://www.youtube.com/watch?v=OsOiTf2A36E
V. NURSING SKILL: REMOVAL OF FOLEY CATHETER

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In this video viewing activity, you will be able to appreciate the step-by-
step procedure on how to remove foley catheter:
https://www.youtube.com/watch?v=3x7HV-IuCfc
VI. Video Conference No. 3

Introduction on GDM as a High-Risk Pregnancy Condition
Gestational diabetes mellitus is a pregnancy-related type of diabetes. It
causes elevated blood sugar levels which can be detrimental to both mother and
fetus’ health during pregnancy. Most women’s blood sugar level remains normal
during pregnancy, but if their blood sugar levels go above a certain value, they
are considered to have gestational diabetes. The body’s metabolism changes
during pregnancy. It takes longer for sugar in the bloodstream to be absorbed by
the body’s cells after a meal. These levels generally return to normal after
childbirth.
With GDM, the woman’s body has trouble producing the extra insulin needed,
hence the Blood Sugar level is higher than normal, while extra glucose is passed
on to the developing fetus. About 3-5 percent of pregnant women develop GDM.
Since GDM doesn’t cause any noticeable symptoms, pregnant women are often
surprised to find out they have it. They may worry about their baby’s condition
and be concerned that they may have diabetes after the baby is born. These
kinds of concerns can be distressing during pregnancy. The symptoms in GDM
fade again after birth but the risk of developing type 2 diabetes may be as high
as 50%-60%. Women with GDM are more likely to develop type 2 diabetes later
in life.
During pregnancy, important hormones that are needed for the baby’s growth
interfere with insulin. Insulin is the hormone secreted by the pancreas and results
in the lowering of blood sugar levels in the bloodstream. In pregnancy, the
hormones that are secreted by the placenta make the mother’s body less
responsive to insulin. This is known as insulin resistance. During pregnancy, the
pancreas secretes an increasing amount of insulin to overcome the body’s
increasing insulin resistance. The presence of estrogen, progesterone, cortisol,
catecholamine, and human placental lactogen blocks the effect on insulin
(contra-insulin effect) which usually begins about 20 to 24 weeks into the
pregnancy.
VII. Video Viewing Activity No. 2

NURSING SKILL: Blood Glucose Monitoring
More than understanding the development of hyperglycemia as one of the
classic manifestations of gestational diabetes, it is required of nurses to become
skillful in the monitoring of blood glucose ranging from the performance of

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required skill, when to report such abnormal reading, what to expect as a
treatment measure to combat such imbalance. In this video viewing activity, you
will be able to appreciate the step-by-step instruction on how to check blood sugar
on clients that require such monitoring through this link:
https://www.youtube.com/watch?v=28oRB1LWWEw&t=3
People with diabetes require regular monitoring of their blood glucose to help them
achieve as close to normal blood glucose levels as possible for as much of the time as
possible. The benefits of maintaining a blood glucose level that is consistently within the
range of 4-7 mmol/L will reduce the short-term, potentially life-threatening complications
of hypoglycemia as well as the occurrence rate and severity of the long-term
complications of hyperglycemia.
It is usually the responsibility of the nurse to perform blood glucose readings. As with
any clinical procedure, ensure that you understand the patient’s condition, the reason for
the test, and the possible outcomes of the procedure. Prior to performing a blood
glucose test, ensure that you have read and understood the manufacturer’s instructions
and your agency’s policy for the blood glucose monitoring machines (see Figure 9.1)
used in your clinical setting, as these vary. It is also important that you determine the
patient’s understanding of the procedure and the purpose for monitoring blood glucose
levels. Before you begin, you should also determine if there are any conditions present
that could affect the reading. For example, is the patient fasting? Has the patient just had
a meal? Is the patient on any medications that could affect the reading (e.g.,
anticoagulants)? In these situations, draw on your knowledge and understanding of
diabetes, the medication you are administering, the uniqueness of your patient, and the
clinical context. Use your knowledge and critical thinking to make a clinical judgment.
Figure 9.1 A blood glucose monitoring machine with cotton balls, lancets, and
reagent strips
Inspect the area of skin that will be used as the puncture site and ask the patient if they
are in agreement with the site you have identified to use for the skin puncture. Your
patient may have a preference for the puncture site. For example, some patients prefer
not to use a specific finger for skin puncture. Or a particular site may be contraindicated.
For example, you shouldn’t use the hand on the same side as a mastectomy.
Patients who do their own blood glucose testing at home may prefer to handle the skin-
puncturing device themselves and continue self-testing while they are in the hospital.
The steps for taking a skin-puncture blood sample and using a blood glucose monitor

Page 20
(glucometer) to measure a patient’s blood glucose level.
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Safety considerations:
● Perform hand hygiene.

● Check room for additional precautions.
● Introduce yourself to the patient.
● Confirm patient ID using two patient identifiers (e.g., name and date of birth).
● Check the allergy band for any allergies.
● Complete necessary focused assessments and/or vital signs and document on MAR.
● Provide patient education as necessary.
STEPS ADDITIONAL INFORMATION
1. Review the patient’s medical history for Thorough knowledge of the patient’s medical
diabetes type, medications, and/or history is important even when the test
anticoagulant therapy. performed is a relatively simple procedure.
Anticoagulant therapy may result in prolonged

bleeding at the skin-puncture site and require
pressure to the site.
2. Determine if the test requires special Blood glucose levels are affected by diet, and
timing; for example, before or after meals. the test may be scheduled at very specific
Blood glucose monitoring is usually done intervals.
prior to meals and the administration of
antidiabetic medications.
Diet and medication orders are based on the
assumption that the test results are accurate.

Page 21
3. Gather equipment needed: Having equipment prepared and available
promotes organization, safety, and timeliness.
● Disposable latex-free gloves

● Alcohol swab
● Lancet or automatic lancing device
● 2 x 2 gauze
● Reagent strips
● Blood glucose meter
Gloves, alcohol swab, lancet, gauze, reagent strips,

glucometer
4. Determine if blood glucose meter needs Calibration should be done regularly according to
to be calibrated. agency policy to ensure accuracy of readings.
5. Assess the patient’s sites for skin Skin integrity at the puncture site minimizes the
puncture. risk of infection and promotes healing.
6. Perform hand hygiene. Hand hygiene prevents the transfer of

microorganisms.
Hand hygiene with ABHR

Page 22
7. Have the patient wash hands with soap Washing reduces the transmission of
and warm water, and position the patient microorganisms and increases blood flow to the
comfortably in a semi-upright position in puncture site.
bed or upright in a chair. Encourage
patients to keep his hands warm.
Hospital policy may require the use of an

alcohol swab only, not water, to clean the
puncture site.
Ensure that the puncture site is completely

dry prior to skin puncture.
Have patient wash hands with warm water or clean

with an alcohol swab if that is agency policy
8. Remove a reagent strip from the Tight closure of the container keeps strips from
container and reseal the container cap. Do damage due to environmental factors.
not touch the test pad portion of the reagent
strip.
Remove reagent strip from container and close

container tightly
9. Follow the manufacturer’s instructions to This prepares the meter for accurate readings.
prepare the meter for measurement.
Prepare the glucometer

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10. Place the unused reagent strip in the
glucometer or on a clean, dry surface (e.g.,
paper towel) with the test pad facing up.
This step is dependent on the
manufacturer’s instructions.
Prepare the reagent strip according to the

manufacturer’s instructions
Moisture may alter the test results.
11. Apply non-sterile gloves.
Apply non-sterile gloves
Gloves protect health care providers from

contamination by blood.
12. Keep the area to be punctured in a The dependent position will increase blood flow
dependent position. Do not milk or to the area. Milking or massaging the finger may
massage finger site. introduce excess tissue fluid and hemolyze the
specimen.
Avoid having the patient stand during the

procedure to reduce the risk of fainting.

Page 24
13. Select an appropriate puncture site and Your patient may have a preference for the site
perform skin puncture. used. For example, the patient may prefer not to
use a specific finger for the skin puncture. Or the
site may be contraindicated. For example, do not
use the hand on the same side as a
mastectomy. Avoid fingertip pads; use sides of
the finger.
Perform skin puncture using a lancet
14. Gently squeeze above the site to Do not contaminate the site by touching it.
produce a large droplet of blood.
The droplet of blood needs to be large enough to

cover the test pad on the reagent strip.
Gently squeeze site to produce a large droplet of

blood

Page 25
15. Transfer the first drop of blood (or The test pad must absorb the droplet of blood for
second drop if indicated by agency policy or accurate results. Smearing the blood will alter
manufacturer’s instructions) to the reagent results.
strip and apply following the manufacturer’s
instructions.
The test pad must absorb the droplet of blood for

accurate results
The timing and specific instructions for

measurement will vary between blood glucose
meters. Be sure to read the instructions carefully
to ensure accurate readings.
16. Immediately press the timer on the Timing is critical to producing accurate results.
meter (unless it starts automatically with the
insertion of the reagent strip). Always check the manufacturer’s instructions
because the technique varies between meters.
17. Apply pressure, or ask the patient to

apply pressure, to the puncture site using a
2 x 2 gauze pad or clean tissue.
Apply pressure to the puncture site
This will stop the bleeding at the site.

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18. Read the results on the unit display. Each meter has a specified time for the reading
to occur.
Read the blood glucose results on the glucometer
19. Turn off the meter and dispose of the This reduces contamination by blood to other
test strip, 2 x 2 gauze, and lancet according individuals.
to agency policy.
20. Remove non-sterile gloves and place This reduces the transmission of
them in the appropriate receptacle. microorganisms.
Remove non-sterile gloves
21. Perform hand hygiene. This reduces the transmission of

microorganisms.
Hand hygiene with ABHR

Page 27
22. Review test results with the patient. This promotes patient participation in health
care.
23. Document results according to agency Results will be used to determine the patient’s
policy. treatment plan.
Data source: BCIT, 2015; Hortensius et al., 2011; Pagana & Pagana, 2011; Perry, Potter, &
Ostendorf, 2014; VCH & PHC Professional Practice, 2013; Weiss Behrend, Kelley, &
Randoloph, 2004
VIII. Video Conference No. 4

Nursing Care Management of Clients with a GDM through the Application
of the Nursing Process
APPLICATION OF THE NURSING PROCESS

ASSESSMENT
Approximately 2%-3% of all women who do not have diabetes during the
first trimester of pregnancy will usually develop diabetes at the midpoint or second

Page 28
trimester of pregnancy. Factors that increase the chance of a person developing
gestational diabetes are of utmost importance to be able to correlate the events
that are going on with the client with gestational diabetes. The following factors
are identified:
1. overweight (BMI>25) or obesity (BMI>30)
2. age over 25
3. history of the following conditions: large babies (10 lbs or more),
unexplained fetal or perinatal loss, congenital anomalies in previous
pregnancies, polycystic ovary syndrome, a family history of diabetes,
hypertension, and a member of a population with a high risk for diabetes
4. Race: Asian, Native American, Hispanic
Signs and symptoms usually include the following:

1. Hyperglycemia. In a woman with GDM insulin level is insufficient, therefore
the glucose cannot be used by the body cells, and therefore more glucose
stays in the bloodstream. Signs and symptoms of hyperglycemia include
increased thirst (polydipsia), frequent urination (polyuria), increased hunger
(polyphagia), glycosuria, confusion, weakness, dry mouth, blurry vision,
headache, and nausea.
2. Glycosuria. Hormonal changes during pregnancy allow for increased blood
flow to the kidneys at the same time begin to excrete quantities of the urine
(glycosuria)
3. Hypoglycemia. At the same time, the continuous use of glucose by the
fetus may lead to lowered glucose levels (hypoglycaemia). Signs and
symptoms of hypoglycemia include sweating (diaphoresis), pallor,
irritability, palpitations, light-headedness, nausea or vomiting, shaking, and
tingling around the mouth.
4. Dehydration. Dehydration occurs due to the concentration of blood serum
and a decline in blood volume.
5. Macrosomia. Macrosomia develops because the fetus continuously
receives glucose through the placenta.
A routine screening test for gestational diabetes is usually done on the 20th-
24th week of pregnancy. It consists of an initial glucose challenge test, where
the woman is required to drink a 50-gram glucose solution. One hour later, if the
result of the glucose level is more than 140 milligrams per deciliter, she is
scheduled for a 100-gram fasting glucose tolerance test, then another blood
sample will be taken after 1 hour, 2 hours, and 3 hours respectively. If two (2) of
the four (4) blood samples collected are abnormal, or if the fasting value is above
95mg/dL, a diagnosis of gestational diabetes is made. The other values that

Page 29
confirm gestational diabetes:1 hour after fasting,180mg/dL, 2 hours 155mg/dL,
and after 3 hours 140mg/dL.
Glycosylated hemoglobin (also referred to as A1c or HbA1c). Hemoglobin
is the substance in the red blood cells that carries oxygen to the cells of the body.
Glucose, a type of sugar molecule in the blood normally becomes stuck to
hemoglobin molecules. This means that hemoglobin becomes glycosylated.
Measuring glycosylated hemoglobin is advantageous since it reflects the
average blood glucose level over the past 2-6 weeks.
Eye screening. Diabetic retinopathy is the most common pre-existing ocular
condition that may be worsened by pregnancy. An eye examination should be
done in each trimester.
Tests for Placental Function and Well Being. An alpha-fetoprotein level
blood test is used to check the incidence of birth anomalies and genetic
disorders, usually done at 15-17 weeks of pregnancy.
Ultrasound. Performed approximately to detect gross abnormalities and
placental changes.
Creatinine clearance. This test may be ordered each trimester to determine
the condition of the vascular system. A normal creatinine clearance suggests that
the kidney function is normal.
DIAGNOSIS (See Later Discussion)
IMPLEMENTATION
Insulin injection. If diet and exercise are not successful in regulating glucose
values, insulin will be required especially in the latter part of pregnancy. The type
of insulin recommended in GDM is usually short-acting insulin (regular, clear in
consistency), combined with an intermediate type (NPH, cloudy). Regular insulin
lowers blood glucose level within 30 minutes after breakfast with a 1 hour peak
time while the onset of action in NPH insulin is 1-4 hours with a peak of 6-10
hours, and its duration is about 10-16 hours. Human insulin is recommended
because it has a lesser antibody response than beef or pork insulin.
NURSING SKILL: Withdrawing insulin from the bottle and

injecting insulin
There are different ways to take insulin, including syringes, insulin pens, insulin
pumps, and jet injectors. The doctor will help the patient decide which technique is
best for her. Syringes remain a common method of insulin delivery. They’re the least
expensive option, and most insurance companies cover them.
Syringes
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Syringes vary by the amount of insulin they hold and the size of the needle. They’re
made of plastic and should be discarded after one use.
Traditionally, needles used in insulin therapy were 12.7 millimeters (mm) in length,
but nowadays there are commercially made needles that are smaller 8 mm, 6 mm,
and 4 mm needles that are just as effective, regardless of body mass. This means
insulin injection is less painful than it was in the past.
Where to inject insulin
Insulin is injected subcutaneously, which means into the fat layer under the skin.
In this type of injection, a short needle is used to inject insulin into the fatty layer
between the skin and the muscle.
Insulin should be injected into the fatty tissue just below the patient’s skin. If you
inject the insulin deeper into your muscle, the body will absorb it too quickly, it
might not last as long, and the injection is usually more painful. This can lead to
low blood glucose levels.
People who take insulin daily should rotate their injection sites. This is important
because using the same spot over time can cause lipodystrophy. In this
condition, fat either breaks down or builds up under the skin, causing lumps or
indentations that interfere with insulin absorption.
Insulin sites can rotate to different areas of the abdomen, keeping injection sites
about an inch apart. Or you can inject insulin into other parts of your body, including
your thigh, arm, and buttocks.

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Abdomen
The preferred site for insulin injection is your abdomen. Insulin is absorbed more
quickly and predictably there, and this part of your body is also easy to reach.
Select a site between the bottom of the patient’s ribs and the pubic area, steering
clear of the 2-inch area surrounding the navel.
Avoid areas around scars, moles, or skin blemishes. These can interfere with the
way the body absorbs insulin. Stay clear of broken blood vessels and varicose
veins as well.
Thigh
You can inject into the top and outer areas of the patient’s thigh, about 4 inches
down from the top of her leg and 4 inches up from her knee.
Arm
Use the fatty area on the back of the patient’s arm, between her shoulder and
elbow.

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For you to better understand how to draw insulin from a vial and how to inject
insulin please watch this video.
https://www.youtube.com/watch?v=6buCd7-nt_0
https://www.youtube.com/watch?v=RyGx--K75wM
Insulin pump therapy. The use of an insulin pump is the best assurance to
keep the serum glucose constant. An insulin pump is automatic about the size of
an mp3 player attached to a woman’s lower abdomen or thigh.
Watch this video to learn more about an insulin pump.
https://www.youtube.com/watch?v=ZoH8U5HqyWE
Caesarian section. Complications of gestational diabetes such as preterm

birth and large size fetus are indications for cesarean section.
Nursing Interventions
Nurses should provide accurate and up-to-date information about the client’s

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condition to come up with appropriate interventions and management.
1. Nursing assessment
a. Assess the client’s history to determine if there are risk factors related
to the diagnosis of gestational diabetes, lifestyle, cultural and economic
factors.
b. Perform physical and neurologic examination
c. Assess for laboratory results ( fasting/glucose tolerance test, urinalysis,
serum creatinine)
d. Assess for signs and symptoms presented and observed
2. Related Nursing Diagnoses
a. Deficient knowledge related to therapeutic regimen necessary during
pregnancy
b. Deficient knowledge related to complex health problems
c. Ineffective peripheral tissue perfusion related to excessive glucose in
the bloodstream
d. Fatigue
e. Health seeking behavior related to the verbalized need to learn home
glucose monitoring
f. Risk for infection related to concentration of blood serum
3. Nursing Measures
a. Education regarding nutrition during pregnancy. Diet should include a
reduced amount of saturated fats and cholesterol and an increased
amount of dietary fiber. Increased fiber decreases postprandial
hyperglycemia thus lowering insulin requirement. An 1800-2400 calorie
diet is divided into 3 meals and three snacks are usually prescribed. Of
these dietary calories, 20% is from protein, 40-50% carbohydrates and
up to 30% fats. Weight gain should be maintained at approximately 25-
30 lbs.
b. Education regarding exercise during pregnancy. Exercise is another
way of decreasing the serum glucose level and thereby the need for
insulin. Low impact aerobic exercises are good for pregnant women with
gestational diabetes such as walking for 30 minutes, swimming,
gardening, doing light household chores. During exercise, insulin is
released quickly and can cause hypoglycemia. To prevent this from
occurring, the client should be instructed to eat a snack consisting of
protein or complex carbohydrates before exercising.
c. Education regarding home glucose monitoring to determine the serum
glucose level. This is done by means of a finger prick technique. Using
a lancet, prick one fingertip, place a drop of blood on a test strip. The
strip then is inserted into a glucometer.

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d. Review factors in glucose instability. Review client’s common situations
that contribute to glucose instability such as missing a meal, infection,
and other illnesses.
e. Discuss how the client’s anti-diabetic medication work. Educate the
client on the functions of her medications because there are
combinations of drugs that work in different ways.
f. Check the injection site periodically. Insulin absorption can vary day to
day in healthy sites and is less absorbable in lipohypertrophic tissues.
g. Educate the client about the need for rest until the condition is stable.
h. Encourage the client to assume a recumbent position to prevent
i. Monitor fetal well-being.
j. The nurse should watch out for possible maternal complications such
as:
▪ Hypertension. Elevated blood sugar can lead to serious
complications such as preeclampsia that may put the mother and the
baby’s life at risk.
▪ Polyhydramnios
▪ Delivery via C-Section. Macrosomia can cause the baby to become
wedged in the birth canal causing difficulty in vaginal delivery.
▪ Diabetes. It can either develop on the succeeding pregnancy or later
in life.
k. Similarly, the nurse should also monitor the baby for possible
complications such as:
▪ Fetal macrosomia. This term used for excessive birth weight typically
weighing 9 lbs or more makes them at risk for birth injuries. It also
increases the need for a cesarean section.
▪ Preterm birth. High blood sugar levels may precipitate early labor
and delivery prior to the expected delivery date.
▪ Serious breathing disorders such as newborn respiratory distress
syndrome are common in preterm newborns.
▪ Hypoglycemia. Low blood sugar after birth and risk for having type
2 diabetes and obesity later in life.
▪ Stillbirth or fetal death before or shortly after delivery.
ASSESSMENT ACTIVITIES
IX. Case Scenario No. 1 PIH

ASSESSMENT ACTIVITY 1 PBL:
A case of a patient with PIH will be given to the students. Their task is to use
Problem based learning as a tool for them to gain knowledge about the topic.
While case scenarios may not fully present in themselves all distinct concepts
related to a particular health condition, learners are motivated to capture details of
scenarios that become references for active learning, researching, and

Page 35
collaborating with other learners within a group. PBL is different from question-
aided scenarios where the learners are required to formulate an output (e.g.
nursing care plan, care map) or make an analysis of the situation based on what
the guide questions or instructions ask them to accomplish. The direction of
learning in a PBL is based on learner-motivation and curiosity as there are no
guide or follow-up questions. To acquire learning through a PBL, principles
threaded in this strategy can be summarized into (1) activation of prior knowledge,
(2) elaboration of knowledge, (3) encoding specificity, (4) epistemic curiosity, and
(5) contextual dependency of learning
PURPOSES OF PBL:
1. PBL embraces the principles of good learning and teaching (Chen, et
al., 2006).
2. PBL has distinct characteristics as a student-centered learning
approach/method (Stern, et al., 2005).
3. It gives the teachers /instructors the chance to develop the students they
say they want – independent, self-motivated, drawing on a wide range
of resources, challenging the parameters of the course, and producing
interesting work (Kiley, 2000).
4. It is student-directed, fosters intrinsic motivation, promotes active
learning and deep learning, and develops collegial learning skills
(Felder, 2005).
5. Taps into students’ existing knowledge, encourages reflection on the
teaching/learning process (Kiley, 2000).
6. It is conducive to a research-oriented curriculum, involves timely
feedback, and can support student self-assessment and peer
assessment (Chen, et al., 2006).
7. Students are encouraged to be active rather than become passive
learners and to cooperate rather than compete. They are given greater
control over their learning as they move from dependency to
independence (Kiley, 2000).
GENERAL INSTRUCTIONS: In this activity, the learners will be able to acquire

learning using PBL as a learner-centered strategy in the context of nursing care
management of clients with high-risk pregnancy conditions. To accomplish this,
the following are the guidelines for completion:
1. This is a group, graded activity. The class will be divided accordingly into
RLE groups.
2. This activity is posted in myClass’ Assignment tab.
3. There will be a clinical case scenario to work on. Remember that there are
no guide questions to answer.
4. Please make sure that all members of the group shall participate. Here is
the list of every member’s roles: ROLES and RESPONSIBILITIES.
A. Facilitator -Moderates team discussion, keeps the group on task, and
distributes work.
B. Recorder -Takes notes summarizing team discussions and decisions
and keeps all necessary records.
C. Reporter -Serves as group spokesperson to the group or a mini-
instructor, summarizing the group’s activities and/or conclusions.
D. Timekeeper -Keeps the group aware of time constraints and deadlines
and makes sure meetings start on time
E. Devil’s Advocate -Raises counterarguments and constructive
objections; introduces alternative explanations and solutions.
F. Checker -Checks to make sure all group members understand the
concepts and the group’s conclusions.
G. Technologist - Prepares the presentation using the most appropriate
application; determines the application; and prepares the link for the
synchronous discussion if needed.
4. The Problem-based Learning Session 1 has seven (7) steps. Please be
guided.
Step 1: Identify the problem

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Step 2: Activate prior knowledge (what do we know?)
Step 3: Brainstorm
Step 4: Generate learning questions and explanatory hypotheses.
Step 5: Formulate learning issues
Step 6: Identify learning resources
Step 7: Feedback on group process
5. A rubric is available for reference. Be mindful of the criteria that serve to
evaluate the output.
6. Formatting guidelines: Arial, font-size: 10, tabular, landscape orientation,
PDF
7. Submission of work for this activity will be accomplished via file upload in
my class Assignment tab on (date/time).
8. The Clinical Instructors will facilitate the presentation and defense
scheduled on (date/ time) as a form of evaluating learning and feedback.
Clinical
9. For the guidance of the group please use this template:
ASSESSMENT ACTIVITY 2: FDAR

As a nursing student and new nurse, you will be required to chart in the FDAR
format (the is usually the charting standard in most healthcare facilities) .
It is a method of charting nurses use, along with other disciplines, to help focus
on a specific patient problem, concern, or event. It is geared to save time and
decrease duplicate charting. It is a great charting method for nurses who have a
lot of patients and is easier to read by other professionals. It gives other
professionals a snapshot of what went on during your shift in a concise manner.
It is used not only by nurses but other disciplines like nutritionists, occupational
therapy, case management etc. Most health care settings are requiring
disciplines to now document in the F-Dar format.
PURPOSES OF FDAR:
● To easily identify critical patient issues/concerns
● To facilitate communication among all discipline
● To improve time efficiency with documentation
● To improve concise entries that would not duplicate patient information

already provided on flowsheet/checklist
FDAR stands for Focus (F), Data (D), Action (A), and Response (R ).
What does the FDAR stand for?
F (Focus): The focus can be:
● Nursing diagnosis
● Event (admission, transfer, discharge teaching etc.)
● Patient Event or Concern
D (Data): This is written in the narrative and contains only subjective (what the
patient says and things that are not measurable) & objective data (what you
assess/findings, vital signs, and things that are measurable) which are relevant
assessment for the focus. This lays the supporting evidence for why you are
writing the note. You are letting the reader know “this is what the patient is saying
and what I’m seeing”.

Page 37
A (Action): This is the “verb” area. In this section, you are going to write here
what you did about the findings you found in the data part of the note. This
includes your nursing interventions (Assessment, Independent, dependent and
interdependent actions, and Health teachings)
R (Response): This is where you write how the patient responded to your action.
GENERAL GUIDELINES:
● Focus charting must be Evident at least once every shift.
● Focus charting must be patient-oriented not nursing task-oriented.
● Indicate the date and time of entry in the first column.
● Separate the topic words from the body of notes:
⮚ Focus note written on the second column.
⮚ Data, Action, and Response on the third column.
● Sign name (e.g. M. Aquino, RN) for every time entry.
● Document only patient’s concern and/or plan of care e.g. health per shift,
hence, general notes are allowed.
● Document patient’s status on admission, for every transfer to/from another
unit or discharge.
INSTRUCTIONS:
1. This is an individual activity.
2. Citation of sources in terms of searched related literature and studies is required
using American Psychological Association (APA) 6th edition.
3. The student must read and understand the case scenario; have research on
terms that they are not familiar with.
4. Based on the assessment data of the patient in the case scenario, formulate a
focus charting using the FDAR format.
For review on how to make a FDAR charting watch this 16-minute video for your
guide. https://www.youtube.com/watch?v=BXf7wj9Wmfc
5. Format: font: Arial, font size 12, tabular form To be passed on the
Assignment tab in MyClass as a FILE UPLOAD
6. The due date is on :
7. There will be a synchronous discussion with group members and the clinical
instructor following the submission of this module assessment activity as a form of
feedback.
X. Case Scenario No. 2 GESTATIONAL DIABETES MELLITUS
ASSESSMENT ACTIVITY 2: Gestational Diabetes Mellitus
Nursing Care Map
GENERAL DESCRIPTION:
High-risk pregnancy care is defined as the identification and management of a

high-risk pregnancy to promote healthy outcomes for the mother and baby.
Special monitoring or care is required throughout pregnancy, as is an

understanding of the risk factors associated with a high-risk pregnancy. As a
result, your role as a Health Care Provider is critical in identifying pregnancy-

Page 38
related danger signs and mitigating their unfavorable effects on mothers and
newborns.
OBJECTIVES: After completion of this activity the students will be able to:
● Identify the factors related to poor pregnancy outcomes, including

medical risk factors, past pregnancy risk factors, and social and
demographic risk factors.
● Identify and explain the occurrence of these signs and symptoms
experienced by the high-risk pregnant mother
● Identify the indication and appropriate nursing intervention to
laboratory and diagnostic tests done as part of the care for the high-
risk pregnancy.
● Identify the indication and appropriate nursing intervention to the
medications given to the patient as part of the care for the high-risk
pregnancy.
● Provide health teaching with rationale on how to manage the different
signs and symptoms
● Formulate acceptable nursing diagnosis based on the presented signs
and symptoms of the patient
● Formulate with the client a plan of care by means of accepted NANDA
in order to address the health conditions, and care needed by a client
in high-risk pregnancy.
● Identify appropriate evidence-based nursing care with rationale
● Identify safe and quality interventions in collaboration with the client to
address the health care needs
● Provides health education to the client (OB patient) based on the
identified problem in a patient-centered approach
INSTRUCTIONS:
1. This is a group activity in which students are given one case scenario to
work with.
2. Citation of sources in terms of searched related literature and studies is
required using American Psychological Association (APA) 6th edition.
3. The student must read and understand the case scenario; have research
on terms that they are not familiar with.
4. After reading the scenario, make a Nursing Care Map that will summarize
the care needed by the high-risk pregnant mother
Nursing Care Map is like a Concept Map but more particularly with the use of the
nursing process when giving care to the patient.
5. Make the map as creative, concise, and artistic as possible.

6. The output will be passed in the Assignment tab of MY CLASS, as FILE
UPLOAD,
7. The due date is on: TO BE ANNOUNCED
8. There will be a synchronous discussion with group members and the
clinical instructor following the submission of this module assessment
activity as a form of feedback.
ASSESSMENT ACTIVITY 3: FDAR

As a nursing student and new nurse, you will be required to chart in the FDAR
format (the is usually the charting standard in most healthcare facilities).

Page 39
It is a method of charting nurses use, along with other disciplines, to help focus
on a specific patient problem, concern, or event. It is geared to save time and
decrease duplicate charting. It is a great charting method for nurses who have a
lot of patients and is easier to read by other professionals. It gives other
professionals a snapshot of what went on during your shift in a concise manner.
It is used not only by nurses but other disciplines like nutritionists, occupational
therapy, case management etc. Most health care settings are requiring
disciplines to now document in the F-Dar format.
PURPOSES OF FDAR:
● To easily identify critical patient issues/concerns
● To facilitate communication among all discipline
● To improve time efficiency with documentation
● To improve concise entries that would not duplicate patient information

already provided on flowsheet/checklist
FDAR stands for Focus (F), Data (D), Action (A),

and Response (R ).
What does the FDAR stand for?
F (Focus): The focus can be:
● Nursing diagnosis
● Event (admission, transfer, discharge teaching etc.)
● Patient Event or Concern
D (Data): This is written in the narrative and contains

only subjective (what the patient says and things that
are not measurable) & objective data (what you
assess/findings, vital signs, and things that are
measurable) which are relevant assessment for the
focus. This lays the supporting evidence for why you
are writing the note. You are letting the reader know
“this is what the patient is saying and what I’m seeing”.
A (Action): This is the “verb” area. In this section, you are going to write here
what you did about the findings you found in the data part of the note. This
includes your nursing interventions (Assessment, Independent, dependent and
interdependent actions, and Health teachings)
R (Response): This is where you write how the patient

responded to your action.
GENERAL GUIDELINES:
● Focus charting must be Evident at least once every shift.
● Focus charting must be patient-oriented not nursing task-oriented.
● Indicate the date and time of entry in the first column.
● Separate the topic words from the body of notes:
⮚ Focus note written on the second column.
⮚ Data, Action, and Response on the third column.
● Sign name (e.g. M. Aquino, RN) for every time entry.

Page 40
● Document only patient’s concern and/or plan of care e.g. health per shift,
hence, general notes are allowed.
● Document patient’s status on admission, for every transfer to/from another
unit or discharge.
INSTRUCTIONS:
To accomplish the said activity, you will have to follow these guidelines:
1. This is an individual
2. Citation of sources in terms of searched related literature and studies is required using
American Psychological Association (APA) 6th edition.
3. The student must read and understand the case scenario; have research on terms that
they are not familiar with.
4. Based on the assessment data of the patient in the case scenario, formulate a focus
charting using the FDAR format.
For review on how to make an FDAR charting watch this 16-minute video for
your guide. https://www.youtube.com/watch?v=BXf7wj9Wmfc
5. Format: font: Arial, font size 12, tabular form To be passed on the Assignment
tab in MyClass as a FILE UPLOAD
6. The due date is on: TO BE ANNOUNCED
7. There will be a synchronous discussion with group members and the clinical
instructor following the submission of this module assessment activity as a form of
feedback.
Summary and Conclusion

Pregnancy Induced-Hypertension (PIH)
Previously referred to as the toxemia of pregnancy, pregnancy-induced
hypertension (PIH) is described as hypertension that is acquired in pregnancy
usually beginning at the 20th week of pregnancy, and may even persist two (2)
weeks postpartum. Depending on the extent of proteinuria, edema, and
hypertension, as the classical manifestations of PIH, classification by the
physician is somewhat useful in determining the course of action and the client’s
prognosis. Ultimately, the application of the nursing process is always geared
towards the maintenance of both maternal and fetal well-being.
Clinical manifestations may range from the effect of systemic organs that
include but are not limited to the involvement of the cerebral, renal, and hepatic
functions. The plan of care is aimed at improving organ tissue perfusion,
correction of fluid balance, preventing fetal compromise, and managing social
isolation. Implementation is focused on enhancing maternal cooperation with
prescribed treatment for hypertension, platelet aggregation, seizure, nutrition,
and fetal health. The role of the nurse in clients with PIH is critical as the client is
to receive a high-risk medication in the form of magnesium sulfate, the drug of
choice for severe preeclampsia, other than the possibility of a convulsion in
eclampsia. Precautionary measures related to seizure are of equal importance

Page 41
as clients with poorly controlled preeclampsia can greatly shift to eclampsia.
The care for clients with a PIH greatly spans the moment that manifestations
arise in the course of pregnancy and continues with the post-partal stage. The
application of the nursing process is essential in the care of this high-risk
pregnancy condition.
Gestational Diabetes Mellitus (GDM)
Diabetes mellitus is an endocrine disorder in which the pancreas cannot
produce adequate insulin to regulate body glucose levels. The disorder affects
3%-5% of all pregnancies and is the most frequently seen medical condition. .The
incidence of Type 2 diabetes in adolescents has increased dramatically in the last
decade related to obesity. Gestational diabetes affects systemic circulation thus
presenting various signs and symptoms. Medical and nursing management is
geared towards maintaining the serum blood glucose to be able to prevent the
occurrence of other disorders. Early screening, diagnosis, and management of
gestational diabetes are important to prevent or reduce complications during and
post-pregnancy for both the mother and the baby.
Reflection Questions
Look at the following statements made by a client with a PIH as useful
assessment indicators when determining the presence and extent of symptoms.
Consider these for reflection:

“My rings are so tight I can’t get them off.”
“When I wake up in the morning, my eyes are swollen shut.”
“My tongue is so swollen I can’t talk until I walk around awhile.”
Assessment
Posttest
Multiple Choice. Choose the best answer.
1. The underlying difference between eclampsia and preeclampsia lies in

the presence of:
A. A seizure
B. Blood pressure reading
C. High urine specific gravity
D. Proteinuria
2. The nurse understands that if the client is to be started on magnesium

sulfate infusion, which item should also be available in the unit for
emergency use?

Page 42
A. Calcium gluconate
B. Diazepam (Valium)
C. Endotracheal tube
D. Suction apparatus
3. The nurse implements which of the following as a priority key area on a

client during a seizure caused by eclampsia?
A. Airway
B. Breathing
C. Circulation
D. Fetal well being
4. A pregnant client with a blood pressure reading of 150/90 mmHg taken on

two occasions who does not exhibit proteinuria and edema is classified as
having:
A. Eclampsia
B. Gestational hypertension
C. Preeclampsia with severe features
D. Preeclampsia without severe features
5. While receiving a client with ongoing magnesium sulfate infusion, the

nurse considers which of the following, when noted, as requiring
immediate infusion discontinuation and notification to the physician?
A. Diminished responsiveness
B. Heart rate of 51 bpm
C. Shallow rapid respirations
D. Shooting blood pressure reading
6. When does the increase in serum glucose usually develop during

pregnancy?
A. 14- 16 weeks
B. 20-24 weeks
C. 20-26 weeks
D. 26-28 weeks
7. A pregnant woman with gestational diabetes asks the nurse what she’s
going to feel in case, she omits her meals. The nurse informs her that
she’s going to experience the following:

Page 43
A. Diaphoresis, pallor, headache, dry mouth
B. Increase thirst, frequent urination, increased hunger, irritability
C. Diaphoresis, pallor, light-headedness, tingling around the mouth
D. Glycosuria, weakness, headache, confusion
8. Which of the following results of the glucose tolerance test will confirm
the diagnosis of gestational diabetes?
1. Fasting of more than 95mg/dL
2. Fasting of less than 95mg/dL
3. After 1 hour, more than 180mg/dL
4. After 3 hours, less than 140mg/dL
A. 1 and 3
B. 1 and 4
C. 2 and 3
D. 2 and 4
9. During a glucose tolerance test how much concentration of glucose will

the nurse give to the pregnant woman?
A. 50 grams
B. 75 grams
C. 100 grams
D. 150 grams
10. The patient is scheduled for an alpha-fetoprotein level test. She feels
anxious about what this test is. The nurse explains that this test is done
to determine:
A. the daily amount of protein

B. the size of the fetus
C. the gross abnormalities and condition of the placenta
D. birth anomalies and genetic disorders.
Note: You may refer to the last page of this module where you can see the
answers of the Posttest on the Feedback page.
Feedback
Feedback on the Pretest

1. C

Page 44
2. D
3. A
4. A
5. B
6. C
7. D
8. C
9. D
10. D
Evaluation
You need to get at least five correct answers to proceed with reading this module.
However, if you obtained a score lower than five (5) points, you are advised to read
supplemental materials first then return to try again taking the test.
Feedback on the Posttest
1. A
2. A
3. A
4. B
5. A
6. B
7. C
8. A
9. C
10. D
Evaluation
You need to get at least eight (8) correct answers to proceed to Module 3.
However, if you obtained a score lower than eight (8) points, you have to read the
whole module again.
From internet:
https://medicalguidelines.msf.org/viewport/ONC/english/8-2-early-postpartum-
haemorrhage51417782.html#:~:text=Early%20postpartum%20haemorrhage%20is%20define
d,ml%20third% 20stage%20blood%20loss. Commented [1]: (sgd)Milagros Si
Prepared By:
(SGD)Milagros Si, RN, MAN.
Contributor:
Ivan Degohermano, RN, MAN. Commented [2]: Signed
Level II Clinical Instructors
Peer Evaluated by:
Jeffrey Esteron, PTRP, RN, MAN, LPT. Commented [3]: signed

Clinical Instructor, College of Nursing
Reviewed by:

Page 45
Brenda B. Policarpio RN,RM,MN. Commented [4]: Signed
Level II RLE Coordinator
Debbie Q. Ramirez, RN., PhD. Commented [5]: signed

Assistant Dean, College of Nursing
Approved by:
Zenaida S. Fernandez, RN., PhD. Commented [6]: signed

Dean, College of Nursing

Page 46

Nursing Care of Pregnancy Conditions

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ANGELES UNIVERSITY FOUNDATION

NURSING CARE MANAGEMENT OF CLIENTS WITH

Instructions to the Learner:

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

Time Allotment for Discussion and Activities

PART OF THE MODULE ESTIMATED TIME FOR

4. Video Conference No. 3 on introducing GDM as a high- 30 minutes

ASSESSMENT ACTIVITIES ESTIMATED TIME FOR

Nursing Care Map 4 hours

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

Quiz: 30 Items, Multiple Choice 40 minutes

PREDISCUSSION: Module Pretest (not graded)

Multiple Choice. Choose the best answer.

1. Which of the following is not a classic manifestation of pregnancy-induced

A. First pregnancy at the age of 17 years old

3. When administering hydralazine on a client with PIH, the nurse

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

4. Which of the following, if noted on a client taking aspirin 81 mg PO OD for

A. Black tarry stool

5. To which assessment finding, if noted should the nurse be most concern

A. Blood pressure of 170/110 mmHg

6. When are pregnant patients tested for gestational diabetes?

8. A patient who is 35 weeks pregnant has gestational diabetes. Which

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

9. A 32-year-old pregnant female is diagnosed with gestational diabetes at

A. 1- hour glucose tolerance test

10. When do most patients tend to develop GDM during pregnancy?

A. 1st to 3rd month

I. Video Conference No. 1

PREGNANCY-INDUCED HYPERTENSION (PIH)

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

III. Video Conference No. 2

APPLICATION OF THE NURSING PROCESS

1. Antiphospholipid Syndrome (APS). Clients with APS often exhibit the

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

Symptomatology in PIH emerges beginning about the 20th week of

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

Table 1: Classification of Pregnancy-Induced Hypertension (PIH)

Hypertension Type Symptoms

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

IV. NURSING SKILL: INSERTION OF FOLEY CATHETER

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

V. NURSING SKILL: REMOVAL OF FOLEY CATHETER

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

VI. Video Conference No. 3

VII. Video Viewing Activity No. 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

● Perform hand hygiene.

STEPS ADDITIONAL INFORMATION

Anticoagulant therapy may result in prolonged

RELATED LEARNING EXPERIENCE (RLE) 0109 MODULE 2

● Disposable latex-free gloves

Gloves, alcohol swab, lancet, gauze, reagent strips,

6. Perform hand hygiene. Hand hygiene prevents the transfer of