Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing

Case Study on Pregnancy Induced

Hypertension (PIH)

In Partial Fulfillment of the Requirement in

Related Learning Experience
(Ilocos Sur Provincial Hospital Gabriela Silang)

Presented by:
ALEYA CRYSTINE G. NOVIDA

Presented to:
MRS. MARITES T. TALANIA, RN
S.Y. 2020-2021
 Page |2

TABLE OF CONTENTS

INTRODUCTION

BRIEF DESCRIPTION OF THE DISEASE 3

OBJECTIVES

GENERAL AND SPECIFIC 5

PATIENT’S PROFILE 6

HEALTH HISTORY 7

DIAGNOSTIC EXAM AND PROCEDURE 8

ANATOMY AND PHYSIOLOGY 17

MANAGEMENT

MEDICAL MANAGEMENT 23

SURGICAL MANAGEMENT 24

NURSING CARE PLAN 25

DRUG STUDY 33

DISCHARGE PLAN 34

UPDATES 40

BIBLIOGRAPHY 41
 Page |3

I. Introduction

Pregnancy-induced hypertension, also known as hypertensive disorders of pregnancy, is

a form of high blood pressure that occurs during pregnancy and is one of the most common

problems for mothers. PIH is a leading cause of maternal, perinatal, and neonatal morbidity

and mortality, affecting around 10% of all births. PIH includes preeclampsia, eclampsia, and

gestational hypertension. Gestational hypertension is a condition in which blood pressure

rises abnormally after the 20th week of pregnancy. In addition to hypertension, symptoms of

preeclampsia include proteinuria and edema. If the condition progresses to eclampsia, life

threatening convulsions and coma can occur.

Additionally, PIH causes vascular manifestations, endothelial damage, and oxidative

stress. Therefore, PIH may disturb placental function and subsequently result in insufficient

fetal perfusion and nutrition supply, leading to perinatal morbidity and mortality. Although

the precise pathogenesis of PIH remains uncertain, a pivotal hypothesis suggests that

trophoblast and decidual pathology, shallow endometrial invasion, and failure of the

physiologic transformation of the spiral arteries are caused by genetic and environmental

factors that disrupt pregnancy-induced immunomodulation.

Pregnancy-induced hypertension is a serious illness that can have a negative impact on

both the mother and the child. Women who have high blood pressure during pregnancy have

an increased chance of developing high blood pressure and strokes later in life. Women who

have high blood pressure during pregnancy have an increased chance of developing high

blood pressure and strokes later in life. Women who had high blood pressure during
 Page |4

pregnancy, known as gestational hypertension, were more likely to acquire high blood

pressure later in life than women who had never had it. In terms of the welfare of the child

in-utero, the fetus may be placed in distress due to the presence of the condition, and

complications from high blood pressure such as convulsions can cause dire consequences.

The case of pre-eclampsia, the condition can strike without warning causing blood pressure

to risk to dangerously high levels. Pre-eclampsia may progress to eclampsia in which high

blood pressure and convulsions could be fatal to the mother or child. Pre-eclampsia is a

leading cause of maternal death. It strikes about five percent of first time mothers and one to

two percent of mothers during subsequent pregnancies.

Thus, people with a history of PIH, chronic hypertension, lupus, alcohol, opioid, or

tobacco misuse, diabetes, being underweight or overweight, kidney disease, or expecting

twins or triplets are more likely to develop Pregnancy Induced Hypertension. Rapid weight

gains of 4-5 pounds in a week, an increase in blood pressure, protein in urine, frequent

headaches, blurry sights, severe pain over the stomach under the ribs of the mother with PIH,

and a reduction in urine volume are all warning signs of PIH in certain individuals.

Therefore, all health workers must participate in all clinical knowledge and skills, as well as

cultivate their values, in order to be able to become an efficient and successful

knowledgeable person when it comes to health evaluations in fulfilling their duties and

responsibilities.
 Page |5

II. Objectives

General Objective:

The author's main aim is to be able to present a case study of the chosen client that includes a

detailed discussion of the disease's clinical process and provides useful information for the case

study.

Specific Objectives:

 To establish rapport to the patient

 To know the treatment about the patient’s condition

 To gain comprehensive knowledge about the patient’s condition

 To define the complete diagnosis of the patient,

 To discuss the anatomy and physiology of the organ involved in the patient’s disease,

 To obtain and rationalize the doctor’s order,

 To interpret the laboratory test results of the patient,

 To discuss the nature of the drugs given to the patient,

 To discuss the surgical procedure performed to the patient

 To present a specific, measurable, attainable, realistic and time-bounded nursing care

plans for the client,

 To justify the client’s prognosis according to the different criteria,

 To provide the patient and family with proper discharge planning (M.E.T.H.O.D), and
 Page |6

outline recommendations based on the case study’s findings.

III. Patients profile

 Name of the patient: Jacky Frost

 Age: 36 y/o

 Sex: Female

 Religion: Roman Catholic

 Marital Status: Married

 Occupation: Call center agent

Clinical/ Admitting Data:

 Chief complaint/s: Severe epigastric pain, moderate headache (describes as throbbing

with a rating of 6/10)

 Hospital & Hospital Number: Ilocos Sur Provincial Hospital- Gabriela Silang

 Ward Room & Bed Numbers: OB-13

 Date of admission: N/A

 Time of admission: N/A

 Attending Physician: N/A

 Admitting Diagnosis: N/A

 Pre-Op Diagnosis: N/A

Vital signs on admission:

 Page |7

 Temperature: 37.4°C

 Pulse Rate: 67 bpm

 Respiratory Rate: 22 cpm

 Blood pressure: 220/137 mmHg

IV. Health History

History of Present Illness

The patient is in the third trimester of her pregnancy and had a full prenatal visit. She had no

history of abortion. She was diagnosed with pregnancy-induced hypertension (PIH) and given

Methyldopa 250mg three times a day to take. The patient was rushed to the hospital with severe

epigastric pain and a moderate headache that she described as throbbing and rated as a 6 on a

scale of 1 to 10. She took acetaminophen to relieve the discomfort, but it didn't help. She was

rushed to the ER, hair slightly disheveled. Upon assessment, she has edema of both hand and

feet. Bilateral edema was pitting, 3+. The edema of the hands is non-pitting, 2+. Eye assessment

suggest she has slightly impaired visual acuity, however no history of eye impairment. She is

slightly diaphoretic. No discoloration of the conjunctiva, nail beds of oral mucosa. GCS was

14/15. Her cardiovascular lungs were examined, and it was discovered that she had no murmur,

minor precordial heave, and her lungs were clear. Meanwhile, her abdominal examination

revealed a minor discomfort at the RUQ along with burning epigastric discomfort, which she

assessed as an 8/10. Her skin extremities exam revealed that she had no skin lesions, pitting
 Page |8

edema in both legs of 3+, and pitting edema in her upper extremity of 2+. Seasonal rhinitis is

also present in the patient, which is usually treated with betamethasone and loratadine. She has a

chicken allergy and no known medication allergies.

History of Past Illness

Mrs. Frost have already given birth to 2 kids. She had her first pregnancy on her 23rd year,

she delivered a female child via NSD at a birthing center. She received a thorough prenatal

check-up, including two doses of TT and Ferrous sulfate + folic acid supplements, but she was

non-compliant due to GI irritation. Then, in her 27th year, she became pregnant for the second

time. Due to mild pre-eclampsia, she delivered a boy child via CS on her 36th week of

pregnancy, which resulted in SGA. The doctor recommended methyldopa 250mg 1 tab twice a

day as a maintenance medication. During her 28th week of AOG, she was additionally given

dexamethasone. She was prescribed 1 dose of TT, calcium carbonate, and folic acid

supplements, she also took calcium and was non-compliant with ferrous sulfate, and her blood

pressure returned to normal after delivery. She completed her prenatal appointment in the third

trimester of her pregnancy and was diagnosed with PIH again, with methyldopa 250mg

prescribed three times a day. In addition, when she was 15 years old, the patient had an

appendectomy, and when she was 17 years old, she had a tonsillectomy.

Family History

The patient's mother is 72 years old and suffers from osteoarthritis and type 2 diabetes. She

is on metformin and glimepiride and is under medical and nutritional supervision. She is not a

drinker or a smoker. While her father passed away 9 years ago from chronic obstructive
 Page |9

pulmonary disease (COPD). He smoked for a long time and had no history of high blood

pressure, diabetes, heart disease, or cancer. The patient's husband is a 35-year-old man. He

smokes about a pack of cigarettes per day and drinks about 1-28 ounce beers per week.

V. Diagnostic Exams and Procedures

Diagnostic exams are utilized to gain supplementary information about the patient and these

tests may aid in confirming diagnosis when used in addition to a thorough health history taking

(Fischbach & Dunning, 2009). Further diagnostic exam/ laboratory values are as follows:

Day 1 of Examination

Test Results: Normal Values

AST 54 U/L 7-55 U/L
AST 30 U/L 8-48 U/L
ALP 45 U/L 40-129 U/L
GGT 30 U/L 8-48 U/L
Total Bilirubin 0.6mg/dL 0.2-0.8 mg/dL
Direct bilirubin 0.2mg/dL 0.1-0.4mg/dL
Indirect bilirubin 0.5mg/dL 0.2-0.7mg/dL
CBC
WBC 6000 4500-11,000
RBC 4.3 million 4.5-5.0 million
Hgb 12 grams 12-15 grams
Hct 37% 36-45%
Platelet 145,000 150,000-450,000
Urinalysis
Segmenters 2 2-5/hpf
RBC 1 Less than 2/hpf
Bacteria Few None
Protein +1 None
ABO, Rh typing A+

Day 2 of Examination
 P a g e | 10

Test Results: Normal Values

AST 67 U/L 7-55 U/L
AST 49 U/L 8-48 U/L
ALP 134 U/L 40-129 U/L
GGT 50 U/L 8-48 U/L
Total Bilirubin 1.2mg/dL 0.2-0.8 mg/dL
Direct bilirubin 0.7mg/dL 0.1-0.4mg/dL
Indirect bilirubin 0.9mg/dL 0.2-0.7mg/dL
CBC
WBC 6000 4500-11,000
RBC 3.4 million 4.5-5.0 million
Hgb 8.9 grams 12-15 grams
Hct 30% 36-45%
Platelet 90,000 150,000-450,000
Urinalysis
Segmenters 2 2-5/hpf
RBC 1 Less than 2/hpf
Bacteria Few None
Protein +3 None

Day 3 of Examination

Test Results: Normal Values

AST 50 U/L 7-55 U/L
AST 38 U/L 8-48 U/L
ALP 100 U/L 40-129 U/L
GGT 42 U/L 8-48 U/L
Total Bilirubin 0.9mg/dL 0.2-0.8 mg/dL
Direct bilirubin 0.5mg/dL 0.1-0.4mg/dL
Indirect bilirubin 0.7mg/dL 0.2-0.7mg/dL
CBC
WBC 6000 4500-11,000
RBC 4.0 million 4.5-5.0 million
Hgb 9 grams 12-15 grams
Hct 33% 36-45%
Platelet 100,000 150,000-450,000
Urinalysis
Segmenters 3 2-5/hpf
RBC 0 Less than 2/hpf
Bacteria None None
Protein +1 None
 P a g e | 11

Creatinine 1.6 0.5-1.1

BUN 35mg/dL 7-30
Serum magnesium 2.7mg/dL 1.5-2.3mg/dL

Additional laboratory test:

Test Result Normal

Creatinine 2.0 0.5-1.1
BUN 35mg/dL 7-30
Serum magnesium 2.7mg/dL 1.5-2.3mg/dL

COMPLETE BLOOD COUNT

Diagnostic Procedure Indications or Purpose Possible Results Normal Values

HGB (g/dL) To measure the May be elevated 120-160 g/dl

total amount of due to
hemoglobin in the hemoconcentration
blood. of blood.
HCT (%) To aid diagnosis May be elevated 36.0 – 47.0
of abnormal states due to
of hydration, hemoconcentration
polycythemia and of blood.
anemia and aids in
calculation of
erythrocyte
indices.
Platelet To evaluate Thrombocytocpenia 150 – 400
platelet or decreased
Count production platelet states are
(x10 often found in PIH

9/L)
 P a g e | 12

WBC (x10 9/L) To determine for WBC and 4.8 – 10.8

presence of for differential counts
further tests such may be elevated
as WBC depending upon the
differential presence of infection
infection and also for the individual
for determination case of the patient.
count
Differential To provide a WBC and 55-65%
Count: numeric estimate of differential counts
the client’s immune may be elevated
Segmenters
status. depending upon the
(%)
presence of
infection for the
individual case of
the patient.
Lymphocytes To check for WBC and 25-35%
(%) immune differential counts
responses may be elevated
depending upon the
presence of
infection for the
individual case of
the patient.
Eosinophils To determine WBC and 2-4%
(%) presence of differential counts
multicellular may be elevated
parasites and depending upon the
certain infections presence of
infection for the
individual case of
the patient.
Monocytes To determine WBC and 2-6%
(%) presence of differential counts
Chronic may be elevated
inflammatory depending upon the
disease, Parasitic presence of
infection, Viral infection for the
 P a g e | 13

infection individual case of

the patient.

URINALYSIS

Diagnostic Procedure Indications or Purpose Possible Results Normal Values

Urinalysis For general health Urinalysis reveals Color: Straw

screening to detect Proteinuria yellow to
renal and (positive albumin amber.
metabolic disease; levels) and
Transparency:
diagnosis of occasional hyaline
transparent
disease or casts.
disorders of the Sugar: negative
kidney or urinary
tract; monitoring Albumin: negative
patient’s with
Specific Gravity:
diabetes.
1.015 – 1.025

Pus cells: 5-
10/HPF

RBC: o-2 HPF

Epithelial cells:
Moderate

BLOOD CHEMISTRY
 P a g e | 14

Diagnostic Procedure Indications or Purpose Possible Results Normal Values

Creatinine This test Often normal but 0.5-1.69 mg/dl

measures the may be increased
amount of in cases of severe
preeclampsia.
creatinine in the
blood. It is used
to diagnose
impaired renal
function and
assess glomerular
filtration.

To check for water Normal in PIH, 137-145 mmo/l

Sodium (Na+)
balance. but may differ
due to comorbid
existing
conditions for
the
patient

Potassium (K+) To measure acid Normal in PIH, but 3.6-5.0 mmo/l

base balance and may differ due to
normal comorbid existing
muscle activity. conditions for the
patient

Tests for the Usually

Bilirubin presence of below 5 0.2-1.9 mg/dL
liver disease mg/dL
or dysfunction
through
evaluation of
bilirubin
levels in the
blood.
 P a g e | 15

Aspartate AST is usually 6-34 IU/L

Aminotransferase The aspartate below 500 IU
(AST) aminotransferase
(AST) test can be
used specifically
to check for liver
or heart problems,
or it can be part of
standard medical
test screening.

Alkaline A test which Alkaline phosphotase

Phosphotase evaluates the alkaline may increase 2 to 3 20-140 IU/L
phosphotase levels in fold in PIH
blood. This is an
enzyme that is
normally present in
high concentrations
in growing bone and
in bile. It is essential
for the deposition of
minerals in the bones
and teeth.

FETAL ULTRASOUND

Diagnostic Procedure Indications or Purpose Possible Results Normal Values

Fetal Ultrasound An imaging Typically, a fetal The biparietal

technique that uses ultrasound offers diameter
sound waves to reassurance that a measurement
produce images of a baby is growing and increases from
fetus in the uterus. developing normally. roughly 2.4
 P a g e | 16

Fetal ultrasound If your health care centimeters at 13

images can help your provider wants more weeks to
health care provider details about your approximately 9.5
evaluate your baby's baby's health, he or centimeters when a
growth and she might fetus is at term.
development and recommend
monitor your additional tests.
pregnancy. In some
cases, fetal
ultrasound is used to
evaluate possible
problems or help
confirm a diagnosis.

NONSTRESS TEST OR BIOPHYSICAL PROFILE

Diagnostic Procedure Indications or Purpose Possible Results

 P a g e | 17

Nonstress test or biophysical A nonstress test is a simple Reactive and Non-Reactive

profile.. procedure that checks how
your baby's heart rate reacts
when your baby moves. A
biophysical profile uses an
ultrasound to measure your
baby's breathing, muscle tone,
movement and the volume of
amniotic fluid in your uterus

VI. Anatomy and Physiology of the organ involved

HEART
The heart itself is made up of 4 chambers, 2 atria and 2 ventricles. De-oxygenated blood

returns to the right side of the heart via the venous circulation. It is pump into the right ventricle

and then to the lungs where carbon dioxide is released and oxygen is absorbed. The oxygenated

blood then travels back to the left side of the heart into the left atria, then into the left ventricle

from where it is pumped into the aorta and arterial circulation. The pressure created in the

arteries by the contraction of the left ventricle is the systolic blood pressure. Once the left

ventricle has fully contracted it begins to relax and refill with blood from the left atria. The

pressure in the arteries falls whilst the ventricle refills. This is the diastolic blood pressure. The
 P a g e | 18

atrio-ventricular septum completely separates the 2 sides of the heart. Unless there is a septal

defect, the 2 sides of the heart never directly communicate. Blood travels from right side to left

side via the lungs only. However, the chambers themselves work together. The 2 atria contract

simultaneously, and the 2 ventricles contract simultaneously.

KIDNEY

Kidneys are situated posteriorly behind the peritoneum on each side of the vertebral column

and are surrounded by adipose tissue The kidneys excrete the end products of metabolism and

excess water. Both of these actions are essential to the control of concentrations of various

substances in the body fluids, e.g. maintaining electrolyte and water balance approximately

constant in the tissue fluids. The kidneys also have endocrine functions producing and releasing

erythropoietin which affects red blood cell formation, renin which influences blood pressure,

1,25-hydroxycholecalciferol, which is involved in the control of calcium metabolism and is a

derivative of vitamin D, and perhaps modifies the action of the parathyroid hormone, and various

other soluble factors with metabolic actions.

LUNGS
Lungs are a pair of respiratory organs situated in the thoracic cavity. Each lung innervates

the corresponding pleural cavity. The right lung weighs about 700 grams, it is about 50- 100g

heavier than the left lung. The lungs are the foundational organs of the respiratory system, whose

most basic function is to facilitate gas exchange from the environment into the bloodstream.

Oxygen gets transported through the alveoli into the capillary network, where it can enter the

arterial system, ultimately to perfuse tissue.

 P a g e | 19

LIVER
The liver is the largest organ in the body, weighing approximately 1500 g. It is reddish

brown and is surrounded by a fibrous sheath known as Glisson’s capsule. The round ligament is

the remnant of the obliterated umbilical vein and enters the left liver hilum at the front edge of

the falciform ligament. These ligaments (round, falciform, triangular, and coronary) can be

divided in a bloodless plane to fully mobilize the liver to facilitate hepatic resection.

OVARIES
The two ovaries are small organs suspended in the pelvic cavity by ligaments. The

suspensory ligament extends from each ovary to the lateral body wall, and the ovarian ligament

attaches the ovary to the superior margin of the uterus. In addition, the ovaries are attached to the

posterior surface of the broad ligament by folds of the peritoneum called the mesovarium. The

ovarian arteries, veins, and nerves transverse the suspensory ligament and enter the ovary

through the mesovarium.

A layer of visceral peritoneum covers the surface of the ovary. The outer part of the

ovary is made up of dense connective tissue and contains the ovarian follicles. Each of the

ovarian follicles contains an oocyte, the female sex cell. Loose connective tissue makes up the

inner part of the ovary, where blood vessels, lymphatic vessels, and nerves are located..

FALLOPIAN TUBE

The anatomy and physiology of the human fallopian tube are described and discussed;

then, these facts are correlated with clinical considerations as they relate to tubal factor

infertility. Anatomically the human oviduct is a tubular, seromuscular organ attached distally to
 P a g e | 20

the ovary and proximally to the lateral aspect of the uterine fundus. Its length averages 11-12 cm.

The oviduct can be divided into 4 main segments: 1) the infundibulum, whose terminal end

contains the tubal ostium; 2) the ampullary region; 3) the isthmic portion; and 4) the intramural

or interstitial portion, which is contained in the wall of the uterus. 4 electron micrographs

illustrate these areas. Also discussed in this reveiw are the vascular analtomy, the lymphatics,

and neuroanatomy of the fallopian tubes. Physiologic functions discussed in this article include

the role of the fallopian tube in sperm transport, its part in sperm maintenance and capacitation,

and the tube's function in ovum transport, fertilization, and embryo transport. Clinically, the role

of the myosalpinx is undetermined, although it may affect tubal motility and ovum transport. The

dense adrenergic innervation of the oviductal isthmus, along with the myosalpinx, suggests that

innervation may be required for sphincter-like activity, although again no evidence exists for

innervation being required in normal reproduction. The mucosa provides nutrients which may or

may not be essential to normal reproduction, and its cilia seems uncritical in gamete transport

and embryogenesis. Evidence shows that the uterotubal junction and the ampullary-isthmic

junction are not necessary for conception (based on success rates of implantation procedures).

Reversal of fimbriectomy is the most difficult and up to 1-cm of ampulla may be removed and

resected and still maintain fertility.

VAGINA
The vagina is the female organ of copulation and functions to receive the penis during

intercourse. It also allows menstrual flow and childbirth. The vagina extends from the uterus to

outside the body. The superior portion of the vagina is attached to the sides of the cervix so that a

part of the cervix extends into the vagina. The wall of the vagina consists of an outer muscular
 P a g e | 21

layer and an inner mucous layer. The muscular layer is smooth muscle and contains many elastic

fibers. Thus the vagina can increase in size to accommodate the penis during intercourse, and it

can stretch greatly during childbirth. The mucous membrane is moist stratified squamous

epithelium that forms a protective surface layer. Lubricating fluid passes through the vaginal

epithelium into the vagina. In young females, the vaginal opening is covered by a thin mucous

membrane known as the hymen. The hymen can completely close the vaginal orifice in which

case it must be removed to allow menstrual flow. More commonly, the hymen is perforated by

one or several holes. The openings of the hymen are usually greatly enlarged during the first

sexual intercourse. The hymen can also be perforated during a variety of activities including

strenuous exercise. The condition of the hymen is therefore not a reliable indicator of virginity.

UTERUS
The uterus is a hollow, pear shaped muscular organ. It measures about 7.5 X 5 X 2.5 cm

and weight about 50 – 60 gm. Uterus is divided into three parts, Fundus/body of uterus, Isthmus

and cervix.

a. Body of the uterus/ fundus

The upper part is the corpus, or body of the uterus. The fundus is the part of the body above the

area where the fallopian tubes enter the uterus. Length about 5 cm.

b. Isthmus

A narrower transition zone. Is between the fundus and cervix. During late pregnancy, the isthmus

elongates and is known as the lower uterine segment.

 P a g e | 22

c. Cervix

The lowermost position of the uterus “neck”. The length of the cervix is about 2.5 t0 3 cm. The

upper part of the cervix is marked by internal os and the lower cervix is marked by the external

os.

Layers of the uterus

1. Perimetrium

The outer peritoneal layer of serous membrane that covers most of the uterus. Laterally, the

perimetrium is continuous with the broad ligaments on either side of the uterus.

2. Myometrium thick

Myometrium thick is the middle layer of muscle. Most of the muscle fibers are concentrated in

the upper uterus, and their number diminishes progressively toward the cervix. Myometrium

contains 3 types of smooth muscle fiber Longitudinal fibers /outer layer: found mostly in the

fundus designed to expel the fetus efficiently towards pelvic outlet during birth Middle fibers:

These fiber contract after birth to compress the blood vessels that pass between them to limit

blood loss. Circular fibers/inner layer: form constrictions where the fallopian tubes enter the

uterus Also prevent reflux of menstrual blood and tissue into the fallopian tubes.

3. Endometrium

The inner layer of the uterus. It is responsive to the cyclic variations of estrogen and

progesterone during the female reproductive cycle every month. This layer is shed during each

menstrual period and after child birth

 P a g e | 23

The Function of the uterus

 Menstruation -the uterus sloughs off the endometrium.

 Pregnancy -the uterus support fetus and allows the fetus to grow.

 Labor and birth-the uterine muscles contract and the cervix dilates during labor to expel

the fetus

EXTERNAL GENITALIA

The external female reproductive structures are referred to collectively as the vulva. The

mons pubis is a pad of fat that is located at the anterior, over the pubic bone. After puberty, it

becomes covered in pubic hair. The labia majora are folds of hair-covered skin that begin just

posterior to the mons pubis. The thinner and more pigmented labia min extends medial to the

labia majora. Although they naturally vary in shape and size from woman to woman, the labia

minora serve to protect the female urethra and the entrance to the female reproductive tract. The

superior, anterior portions of the labia minora come together to encircle the clitoris (or glans

clitoris), an organ that originates from the same cells as the glans penis and has abundant nerves

that make it important in sexual sensation and orgasm. The hymen is a thin membrane that

sometimes partially covers the entrance to the vagina. An intact hymen cannot be used as an

indication of “virginity”; even at birth, this is only a partial membrane, as menstrual fluid and

other secretions must be able to exit the body, regardless of penile–vaginal intercourse. The

vaginal opening is located between the opening of the urethra and the anus. It is flanked by

outlets to the Bartholin’s glands (or greater vestibular glands).

 P a g e | 24

VII. Management

Medical Management

Medications and other therapies are instituted by the physician to reverse pregnancy induced

hypertension.

 Antiplatelet therapy. There is an increased tendency for platelets to cluster along the

vessel walls, so a mild antiplatelet agent is ordered by the physician.

 Administer medications to prevent eclampsia. To avoid progression of the disease to

eclampsia, hydralazine, nifedipine, and labetalol may be prescribed to reduce

hypertension.

Surgical Management

No surgical interventions are needed to manage pregnancy induced hypertension. They can be

managed by medications and interventions imposed or ordered by the health care providers.
P a g e | 25
Assessment Diagnosis Scientific Planning Intervention Rationale Evaluation
Background

Subjective: Sudden Short term: Independent: Short term:

Decreased
weight gain 1. Assess 1. Enhances ideas to After 2-3 hours of
cardiac
prioritize things.
Objective: output r/t causes a After 2-3 hours of other nursing intervention,
altered heart hypertensiv nursing precipitati the patient shall
Hypertension rate AEB
e pregnant intervention, the ng factors. 2. Enhances sense of maintain BP within
rise in blood
woman. patient will control and aids in individually
pressure
cooperation and
Epigastric This would maintain BP 2. Involve acceptable range. Goal
220/137mmHg maintenance of
Pain rated as produce within client in independence. met
8/10 issues in the individually formulatio
acceptable range. n of plan 3. Bounding carotid, After 3-4 hours of
body since
jugular, radial,
Moderate of care at nursing interventions
the heart is femoral pulses may
headache After 3-4 hours of level of be observed or the patient will be able
pumping
palpated. Pulses in
rated as 6/10 nursing ability. to demonstrate stable
insufficient the legs or feet
interventions the may be diminished, cardiac rhythm and
blood to
3. Note reflecting effects of
fulfill the patient will be vasoconstriction rate within patient’s
Bilateral presence, and venous
metabolic able to normal range. Goal
edema: quality of congestion.
demands of demonstrate stable met.
pitting, 3+. central 4. Comparison of
the body, cardiac rhythm
and pressures provides
and her V/S and rate within a more
Edema of the peripheral completepicture of
is changing, patient’s normal
hands: non- vascular
 P a g e | 27

pitting, 2+. particularly range. pulses. involvement or Long term:

scope of the
her blood
4. Monitor problem.
Impaired pressure and After 3 days of
Long term: blood 5. Presence of pallor,
visual acuity heart rate. nursing intervention
cool, moist skin
After 3 days of pressure
As a result, and delayed the patient will
Slightly nursing of the capillary refill time
the amount participate in activities
may be due to
diaphoretic intervention the patient.
of blood peripheral that will prevent stress
patient will Measure vasoconstriction.
pumped (stress management,
participate in in both 6. May indicate heart
each minute balanced activities and
activities that will arms/thigh failure, renal or
by either rest plan
vascular
prevent stress s three impairment.
ventricle of
(stress times, 3-5
the heart is
management, min., then 7. To promote venous
reduced.
sitting, return to the heart
balanced activities
and rest plan). then 8. To improve blood
standing flow and reduce
venous stagnation
for initial
evaluation 9. To decrease
preload and reduce
. Use pulmonarycongesti
correct on

cuff size
 P a g e | 28

and 10. To promote

circulation and
accurate
vascular health
technique.

11. Can reduce

5. Observe stressful stimuli
produce calming
skin color,
effect thereby
moisture, reduces blood
pressure.
temperatur
e and 12. Help reduce
sympathetic
capillary stimulation
refill time. promotes
relaxation.
6. Note
independe
13. Reduces physical
nt or stress and tension
general that affect blood
pressure and
edema. causes
hypertension.
7. Position 14. Response to drug
the client therapy is
dependent on both
with legs individuals well as
elevated the synergistic
 P a g e | 29

effects of the
8. Encourage drugs. Because
side effects, drug
leg interactions and
exercise patient’s
motivation for
such as taking
flexion antihypertensive
medication, it is
and important to use
extension the smallest
number and lowest
of the feet, dosage of
active and medications.

relaxation
of the calf
muscles

9. Place the
client in a
high
fowler’s
position

10. Instruct
 P a g e | 30

the client
the
importanc
e of
maintainin
g regular
physical
ability

11. Provide
calm,
restful
surroundin
gs,
minimize
environme
ntal
activity or
noise.
 P a g e | 31

12. Maintain
activity
restriction
s; provide
comfort
measures,
e.g. back
and neck
massage,
elevation
of head.

13. Instruct pt.

in
relaxation
technique
and
guided
imagery.

14. Monitor
 P a g e | 32

response
to
medicatio
ns to
control
high blood
pressure.

Dependent:

Upon admission:
Methyldopa 250
mg
Hydralazine 5mg
Magnesium
sulfate 5g

Collaborative:
Laboratory orders
are as follows:
 P a g e | 33

urinalysis, pelvic
UTZ with
biophysical
screening, liver
function test,
CBC, blood
typing

VIII. Drug Study

Name of the Mechanism Indications Contraindications Adverse Effect Nursing Responsibilities

of Action
 P a g e | 34

drug

Generic Nifedipine Nifedipine  Severe aortic  Edema (fluid  use caution in heart
Name: blocks voltage capsules are stenosis. retention). block, decreased blood
Nifedipine gated L-type indicated to  Unstable Symptoms can pressure
calcium treat angina. include:  don’t consume
Brand Name: channels in vasospastic  Hypotension. o swelling in grapefruit juice while
Adalat CC, vascular angina and  Heart failure. the arms, taking medication
Afeditab CR, smooth chronic  Moderate to hands,  may cause arrhythmias
and Procardia muscle and stable severe lower legs,  may cause elevated
XL. myocardial angina. hepatic feet, or liver function tests
cells. This Extended impairment. ankles  may cause gingival
Pharmacological blockage release hyperplasia, Steven’s
class: prevents the tablets are  Allergic Johnson syndrome
Calcium channel entry of indicated to reaction.
 monitor blood pressure
blocker calcium ions treat Symptoms can
and pulse
into cells vasospastic include:
 monitor calcium levels
Route: during angina, o trouble
 instruct patient on
PO depolarization, chronic breathing
taking heart rate and
Dosage: reducing stable o trouble
blood pressure
5mg 1 tablet OD peripheral angina, and swallowing
 P a g e | 35

in the evening arterial hypertensio o rash or hives

vascular n o swelling of the
resistance and face, eyes, lips,
dilating or tongue
coronary
arteries. These o Low blood
actions reduce pressure or low
blood pressure heart rate.
and increase Symptoms can
the supply of include:
oxygen to the o lightheadedness
heart, o fainting
alleviating
angina.  Liver damage.
Symptoms can
include:
o yellowing of
the skin
o yellowing of
the whites of
 P a g e | 36

the eyes
o Chest pain
(angina) that is
worse or occurs
more often

IX. Discharge Plan (M. E. T. H. O. D.)

MEDICATIONS The medications prescribed by the physician will be continued or maintained

for faster recovery/ healing process.
 Take ferrous sulfate 500mg 1 tablet each day for 6 months preferably
before bed time; Co-amoxiclav 500mg 2 times a day for seven days
every 12 hours, 1 tablet 7AM and 1 tab in 7PM, do not take with empty
stomach; Ibuprofen 500mg 1tab for 3 days for pain only.

EXERCISE  Do light exercises like stretching or walking slowly and carefully; seek
assistance for safety measure
 Patient should have rest periods during activities.
 She should do deep breathing exercises.
 She should have adequate rest.
 P a g e | 37

 Avoid over strenuous activities.

 Encouraged the mother to keep an environment clean and conducive to
health for her rapid recovery and to avoid infection and keep
environment quiet to make the patient comfortable

TREATMENT Advise patient to take home medications regularly as prescribed.

Increase oral fluid intake to avoid dehydration.
 Explain to the client that becoming pregnant again may be difficult
because fertilization takes place only on the side of the remaining tube
after ovulation of the remaining tube of the ovary on the same side and
at higher risk for a subsequent ectopic pregnancy as well as infertility.
 Emphasized to the mother the importance of regular follow-up check-
ups and as instructed by physician
 Advised the mother to seek medical advice if any strange arises
 Encouraged the mother to let her be monitored by the health care
provider until complete recovery is met

HEALTH TEACHINGS Patient is advised to:

• Eat his meals three times a day.
 P a g e | 38

• Take her medications as prescribed strictly.

• Have an adequate rest.
• Ask assistance from significant others when moving.
• Practice slow deep breathing to promote relaxation and prevent stress.
 Emphasized to the mother the importance of proper hand washing and
proper hygiene
 Educate the client to recognize some signs and symptoms of pregnancy
if occurs, aside from the absence of menstrual period and morning
sickness she should visit her OB or nearest health center for proper
assessment & check-ups.
 Advice the client to engage in safe sexual practices like proper hygiene
before intercourse to prevent from STDs and pelvic infections that
could cause further damage to the fallopian tubes.
 Refrain from sexual intercourse for at least 6 weeks until the follow-up
appointment with the physician.

OUT PATIENT The patient should attend his follow-up checkup in order for the physician to
see the progress of the patient and to advise what to do.

 Reminded the mother that even though she feels better, it is important
 P a g e | 39

to have the doctor monitor her progress. The patient is scheduled for
her follow up check-up one week (January 1, 2021) after her discharge
from the hospital in Out-Patient Department in Pira General Hospital
(PGH) to evaluate her recovery.

DIET  Eat green leafy vegetables such as alugbati, malunggay, saluyot to

prevent constipation.
 Low salt intake to avoid fluid retention.
 Eat foods rich in vitamin C, such as homemade lemonade and oranges
to aid healing of post-surgical incision.
 Increased intake of protein because this is important for skin integrity.
 Increased intake of fruits and vegetables because this can provide
vitamins and minerals for nutrition.
 Encourage to eat nutritious food and drink natural fruit juices for fast
recovery.
 Get plenty of rest. Increase fluid intake. Keep the incision clean.

SAFETY AND SECURITY The patient should be in a safe environment upon discharge. Significant others
SPIRITUAL should support him when moving up. In addition, they should seek prayer
from God. Ask God for strength and guidance as she continues the battle of his
 P a g e | 40

life.
 Encouraged the mother to continue to seek God’s guidance and to
continue to have a positive outlook in life
 Emphasized the importance of prayers in healing
 Encouraged the mother to pray for her fast recovery and gave words of
encouragement.
 X. Updates

Pre-eclampsia is a medical condition where hypertension arises in pregnancy (pregnancy-

induced hypertension) in association with significant amounts of protein in the urine. Because

pre-eclampsia refers to a set of symptoms rather than any causative factor, it is established that

there are many different causes for the syndrome. It also appears likely that there is a substance

or substances from the placenta that may cause endothelial dysfunction in the maternal blood

vessels of susceptible women. (Black, J.M., Hawks, J. H. (2009)

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and

affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a

rapidly progressive condition characterized by high blood pressure and the presence of protein in

the urine. Swelling, sudden weight gain, headaches and changes in vision are important

symptoms; however, some women with rapidly advancing disease report few symptoms.

(Springhouse, PA. Lippincott, Williams, & Wilkins.)

Preeclampsia has been described as a disease of theories, because the cause is unknown

(Fischbach, F. & Dunning, M. (2009). Some theories include (1) endothelial cell injury, (2)

rejection phenomenon (insufficient production of blocking antibodies), (3) compromised

placental perfusion, (4) altered vascular reactivity, (5) imbalance between prostacyclin and

thromboxane, (6) decreased glomerular filtration rate with retention of salt and water, (7)

decreased intravascular volume, (8) increased central nervous system irritability, (9)

disseminated intravascular coagulation, (10) uterine muscle stretch (ischemia), (11) dietary

factors, and (12) genetic factors. The relatively new theory of endothelial injury explains many
 P a g e | 42

of the clinical findings in preeclampsia. The theory emphasizes that there is more to

preeclampsia than hypertension. The vascular endothelium

XI. Bibliography

https://www.nursingcenter.com/ce_articleprint?an=00000446-201711000-00026

https://www.researchgate.net/publication/
312198586_Pregnancy_induced_hypertension_pre_eclampsia_Pathophysiology_recent_management_t
rends_A_review

https://www.slideshare.net/vijaysmc/lung-anatomy-60602484

https://www.ncbi.nlm.nih.gov/books/NBK545177/

https://www.healthline.com/health/nifedipine-oral-tablet#:~:text=Nifedipine%20oral%20tablet%20is
%20available,Afeditab%20CR%2C%20and%20Procardia%20XL.

https://www.mayoclinic.org/diseases-conditions/preeclampsia/diagnosis-treatment/drc-20355751

https://www.stanfordchildrens.org/en/topic/default?id=gestational-hypertension-90-P02484

References:
Black, J.M., Hawks, J. H. (2009). Medicalsurgical nursing: clinical management for positive
outcomes. Vol.2. New York. Saunders.
Blanchard, R., Loeb, S. (2004) Blanchard & Loeb publishers nurse’s drug handbook.
Michigan. Blanchard & Loeb.
Fischbach, F.T., Dunning, M.B. (2008). A manual of laboratory and diagnostic tests.
Springhouse, PA. Lippincott, Williams, & Wilkins.
Gutierrez, K. J., Peterson, P.G. (2007). Saunders sursing survival guide pathophysiology.
2nd Edition. New Orleans Louisiana. Saunders & Elsevier.
Hole, J.W. (1993). Human anatomy and physiology. 6th edition. Dubuque, IA. Wm C
Fischbach, F. & Dunning, M. (2009). A manual of laboratory and diagnostic tests. Lippincott
Williams & Wilkins.