University of Northern Philippines

Tamag, Vigan City, Ilocos Sur

College of Nursing

A CASE STUDY ON

PREGNANCY- INDUCED HYPERTENSION

In Partial Fulfillment of the Requirement in

Related Learning Experience (Virtual Duty)
(Ilocos Sur District Hospital Magsingal OB Ward)

Presented by:
Claudio, Tanya Victoria Lean T.
BSN II- B

Presented to:
Mrs. Reah Golden R. Savella RN, MAN
Clinical Instructor

2022
 TABLE OF CONTENT

I. Introduction and objectives……………………………………1-3

II. Nursing HPPI…………………………………………….…..4-9

III. PEARSON Assessment……………………………..…….10-12

IV. Diagnostics…………………………………………………13-26

5.1 Ideal………………………………………………..

5.2 Actual………………………………………………….

V. Anatomy and Physiology……………………………………27-31

VI. Pathophysiology……………………………………………32-34

7.1 Algorithm…………………………………....……...

7.2 Ex planation……………………………………..

VII. Management………………………………………………

1.1 Medical and Surgical…………………………….………….34-36

1.1.1 Ideal………………………………………….....

1.1.2 Actual………………………………………......

8.2 Nursing Care Plan……………………………………….37-48

8.3Promotive and Preventive……………………..…….......49-50

VIII. Drug Study………………………...……..………………51-69

IX. Discharge Plan…………………....…..……………………70-72

X. Updates………………………………………………………73-74

XI. Bibliography…………………………………………............75

XII.Grading System…………………………………….............76
 1

I. INTRODUCTION

Pregnancy-induced hypertension (PIH) was defined as new hypertension that

appears at 20 weeks or more gestational age of pregnancy with or without proteinuria,

which includes gestational hypertension, pre-eclampsia, and eclampsia. Hypertension

is defined as a sustained systolic BP ≥140 mmHg or diastolic BP ≥ 90 mmHg based

on the average of at least two measurements, using the same arm. Globally, PIH is a

significant public health threat both in developed and developing countries

contributing to high perinatal deaths. PIH complicates 2–8% of pregnancies in the

Western world. However, the magnitude of PIH in developing countries reaches up to

16.7%. Additionally, the available literature in Ethiopia showed a high burden of PIH

which ranges from 2.23 to 18.25%. Similarly, according to the finding of a study

conducted in Tigray regional state, PIH was among the leading obstetric causes of

maternal mortality in the region and the prevalence of PIH reported in this study was

8.1%, this was higher than the national pooled prevalence of PIH (6.29%).

Severe preeclampsia in pregnancy is a systolic blood pressure ≥160 mmHg or

diastolic blood pressure ≥110 mmHg or both. Eclampsia is a severe type of pregnancy

induced hypertension, and it happens in about one in 1,600 pregnancies and develops

near the end of pregnancy The three primary characteristics of pregnancy induced

hypertension conditions are high blood pressure, protein in the urine and pathologic

edema.

Different studies conducted in developed and developing countries on adverse

perinatal outcomes of pregnancy-induced hypertension showed that PIH was

associated with higher rates of morbidity and mortality such as preterm delivery, low

birth weight, birth asphyxia, stillbirth and early neonatal death. Similarly, studies

conducted in Africa revealed that adverse perinatal outcomes such as perinatal death,
 2

low birth weight, preterm birth, and birth asphyxia were associated with PIH.

However, the risk and incidence of adverse perinatal outcomes of PIH vary across

countries, populations and ethnic-geographic areas.

Mrs. Ana Cruz is a 34 year-old, pregnant woman. She was rushed to the

hospital due to severe epigastric pain, moderate headache. She was rushed to the ER

wearing her pajamas, 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. On her current pregnancy she was dignosed with

Pregnancy-Induced Hypertension.

A.GENERAL OBJECTIVES
The main objective of this case study is enabling students to develop

knowledge regarding the normal reproductive process, and skill and practice in

providing nursing care, provide advices, health teaching to patient and family for

management of the disease.

 3

B.SPECIFIC OBJECTIVES

 To identify factors of having pregnancy induced hypertension.

 To develop a teaching program that will educate patients specially those who are

susceptible of pregnancy induced hypertension

 To understand the disease process, its etiology, signs and symptoms,

pathophysiology and diagnostic procedure.

 To promote awareness to individual by imparting knowledge so they could learn

and understand more about pregnancy induced hypertension

 To discuss and describe interventions for health promotion, prevention and

treatment of patient pregnancy induced hypertension.

 4

II. NURSING HISTORY OF PAST AND PRESENT ILLNESS

A. BIOGRAPHIC DATA

Mrs. Ana Cruz a 34 year-old pregnant woman.

B. CHIEF COMPLAINTS

Rushed to the hospital due to severe epigastric pain, moderate

headache, which she describes as throbbing and rated it as 6/10.

C. MEDICAL DIAGNOSES

Pregnancy-Induced Hypertension

D. HISTORY OF PRESENT ILLNESS

She was rushed to the hospital due to severe epigastric pain, moderate headache,

which she describes as throbbing and rated it as 6/10. She took acetaminophen for the

pain, but no relief was availed. She was rushed to the ER wearing her pajamas, hair

slightly dishelve. 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, nailbeds of oral

mucosa. GCS was 14/15. Vital are as follows: BP: 220/137 PR: 67bpm, bounding and

full (4+/4+) RR: 22 cpm, rhythmic but mildly labored T: 37.4c

 5

Eyes, Nose, and Ears:

 Slightly impaired visual acuity

Cardiovascular/Lungs:

 No Murmur

 With Mild precordial heave

 Lung sounds are dear

Abdomen:

 Slight tenderness at the RUQ upon palpation

 With burning epigastric pain rated as 8/10

Extremities:

 No skin lesions

 With pitting edema of both legs 3+

 Upper extremity edema pitting 2+

E. OB HISTORY

G3P2 (2002)

G1: on her 23rd year, delivered a female child via NSD at a birthing clinic. Term.

With complete pre-natal check-up. 2 doses of TT given. Ferrous sulfate + folic acid

supplementation given, but non-compliant because of GI upset.

G2: ON 27th year. Delivered a male child via CS due to mild pre-eclampsia. Was

maintained on methyldopa 250mg 1 tablet twice a day. Given dexamethasone at her

28th week AOG. Child delivered on his 36th week, small-for-gestational age. One

dose of TT given. Calcium carbonate and ferrous sulfate + folic acid supplementation

given. Took calcium, non-compliant on ferrous sulfate. BP returned to normal after

delivery.
 6

G3: Current pregnancy. Complete prenatal visit. Diagnosed with PIH. Maintained on

methyldopa 250mg three times a day.

Nutritional Intake: Usually eats fast-food when duty. While at home, usually orders

food via delivery. Rarely eat homecooked food. Usual intake of sweetened beverages,

3-4 8-ounces of soda a day.

F. PAST AND PRESENT MEDICAL HISTORY

Patient had undergone appendectomy when she was 15 years old and tonsillectomy

when she was 17 years old.

No history of DM, asthma, cardiovascular disease. Has seasonal rhinitis, usually

controlled with betamethasone and loratadine. Allergic to chicken. No known

allergies to medications.

G. PSYCHOSOCIAL AND FAMILIAL HISTORY

Patient is working as a call center agent, usually working on graveyard shift.

Admitted smoking even when pregnant, usually 3-4 sticks a day. Consumes about 2-3

12 ounce of brewed coffee. No alcohol intake.

Paternal Hx: Died 9 years ago of COPD. Chronic smoker. No hx of HTN, DM,

cardiovascular disease or cancer.

Maternal Hx: 72 years old. Has a history of DM type 2. On medication with

metformin and glimepiride. Compliant to both medical and nutritional management.

Non-smoker, non-drinker. With osteoarthritis.

 7

Patient was a practicing Catholic. She is living with her husband and 2 kids.

Husband: 35 years old. Working also as call center agent. Smokes about a pack per

day. Drinks alcohol 1-2 8-ounce of beer a week. Described as caring and loving

husband.
 8

FAMILY GENOGRAM

LEGEND:

-husband
-deceased

-father -daughter

-mother -son

-Patient
 9

PSYCOSOCIAL HISTORY

Work Status: Worker Occupation: Call Center Agent

Time on current Job: N/A

Current Living Status: N/A Custody Status: N/A

Source of Income: N/A Financial Pressures: N/A

Highest Grade Level Completed: N/A Military Status: N/A

Support Systems:

Family Professionals Neighbors

Friends Children Co-Workers

Religion Hotlines Other

 10

III. PEARSON ASSESSMENT

ASSE DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6

SS
MENT
 Mrs. Ana  Suffered  The  Patient  Patient  She
Cruz is a 2 patient Expresse was was
34 year- episodes bilateral s her transferre about
old, of edema grief and d to to be
pregnant seizures has sadness regular dischar
woman. describe subsided over the room ged.
d a tonic- to 2+ and death of  Patient  Still
 Rushed clonic. edema of the baby has expres
to the  3 hours the upper and her emotiona ses
hospital post-op extremiti conditio l outburst some
P with a had a es, pitting n.  Vital degree
S chief seizure at 1+.  She signs of
Y complain episode,  Vital often shows a anger
C t of as tonic signs expresse high toward
severe in shows a s her blood herself
H epigastri character high guilt and pressure  She
O c pain, lasting blood blames said
L moderate about 10 pressure herself. she
O headache seconds.  Edema deeply
G , which  Vital further grieves
she signs subsided for the
I describes shows a  Vital loss of
C as high signs her
A throbbin blood shows a child
L g and pressure high
rated it blood
as 6/10. pressure

 Patient
has
edema
on both
hand and
feet

 mild
tenderne
ss on the
RUQ
 Vital
signs
shows a
high
blood
pressure
 Mild
oligohyd
ramnios
was
noted.

 (-) BM  (-) BM  (-) BM  (-) BM  (-) BM  (-) BM

E  (-)  Vomited  (-)  (-)  (-)  (-)
L vomiting Once vomiting vomiting vomiting vomiti
ng
 11

I
M
I
N
A
T
I
O
N

A  She was  She was  Patient  Patient  Has  Patient

C hooked put on was was limited now is
to CTG complete wheeled transferr communi talking
T and was bedrest to the ed to cation to her
I transport with ICU for Step- with her husban
V ed to a bathroo further down husband. d.
I private m observati unit.  Patient
T room privilege on. complain
 She was s. ed of
Y put on  Patient difficulty
complete was of
A bed rest wheeled sleeping
N with to the
D bathroo OR
m assist. immediat
 Encoura ely upon
R ged to the
E assume decision
S left-side of the
T  lying SOs.
position  After the
at all procedur
times e, patient
was
transferr
ed to
PACU.

S  Patient  With  With  With  No  No

A has no bedside bedside bedside bedside bedsid
known rails rails rails rails e rails
F allergies
E to foods
T and
Y medicine
AND s.
 With
S bedside
E rails
U
R
I
T
Y
 12

O  Maintain  Without  SaO2:  Without  Without  Witho

X ed on difficulty 99% via difficulty difficulty ut
oxygen of nasal of of breathing difficul
Y supplem breathing cannula breathin ty
G entation . at 3 liters g. of breathing
E at 5 LPM per
N of minute of
A oxygen oxygen.
via
T nonrebre
I ather
O mask.
N  SaO2:
99%
N  Saline  NPO  IV line  Patient  Patient  Patient
U lock was was wasn’t wasn’t was
shifted to maintaine still able still able able to
T plain d on to eat to eat eat
R lactated lactated normally normally normal
I Ringer’s Ringer’s ly.
T solution solution
I to be run in 5%
at 60cc dextrose
O per hour at KVO
N via rate.
infusion
pump.
 13

IV. DIAGNOSTIC PROCEDURE

A. Ideal diagnostic

COMPLETE BLOOD CELL (CBC) COUNT WITH DEFFERENCIAL

A complete blood count or CBC is a blood test that measures many different parts and

features of your blood, including:

 Red blood cells, which carry oxygen from your lungs to the rest of your

body

 White blood cells, which fight infection. There are five major types of

white blood cells. A CBC test measures the total number of white cells in

your blood. A test called a CBC with differential also measures the number

of each type of these white blood cells

 Hemoglobin, a protein in red blood cells that carries oxygen from your

lungs and to the rest of your body

 Hematocrit, a measurement of how much of your blood is made up of red

blood

 Platelets, which help your blood to clot and stop bleeding

A complete blood count may also include measurements of chemicals and other

substances in your blood. These results can give your health care provider important

information about your overall health and risk for certain diseases.
 14

URINALYSIS (UA)

A urinalysis is a test of your urine. A urinalysis is used to detect and manage a

wide range of disorders, such as urinary tract infections, kidney disease and diabetes.

A urinalysis involves checking the appearance, concentration and content of

urine. Abnormal urinalysis results may point to a disease or illness.

For example, a urinary tract infection can make urine look cloudy instead of

clear.Increased levels of protein in urine can be a sign of kidney disease. Unusual

urinalysis results often require more testing to uncover the source of the problem.

LIVER FUNCTION TESTS (ASPARTATE AMINOTRANSFERASE [AST],

ALANINE AMINOTRANSFERASE [ALT] AND GAMMA-GLUTAMYL

TRANSFERASE [GGT] )

Liver blood tests are some of the most commonly performed blood tests.

These tests can be used to assess liver functions or liver injury. An initial step in

detecting liver damage is a simple blood test to determine the level of certain liver

enzymes (proteins) in the blood.

Among the most sensitive and widely used liver enzymes are the

aminotransferases. They include aspartate aminotransferase (AST or SGOT), alanine

aminotransferase (ALT or SGPT) and Gamma-glutamyl transferase. These enzymes

are normally predominantly contained within liver cells and to a lesser degree in the

muscle cells. If the liver is injured or damaged, the liver cells spill these enzymes into

the blood, raising the AST, ALT and GGT enzyme blood levels and signaling liver

disease.
 15

ULTRASOUND WITH BIOPHYSICAL PROFILE (BPS)

A prenatal test used to check on a baby's well-being. The test combines fetal

heart rate monitoring (nonstress test) and fetal ultrasound to evaluate a baby's heart

rate, breathing, movements, muscle tone and amniotic fluid level.

B. Actual Diagnostic

ULTRASOUND

Pelvic UTZ with BPS report shows good fetal activity. Amniotic fluid index

was satisfactory. Mild oligohydromnios was noted.

Upon laboratory analysis, it presented the following:

DAY 1 [UPON ADMISSION]

Test Results: Normal Values Interpretation

ALT 54 U/L 7-55 U/L NORMAL
AST 30 U/L 8-48 U/L NORMAL
ALP 45 U/L 40-129 U/L NORMAL
GGT 30 U/L 8-48 U/L NORMAL
Total Bilirubin 0.6 mg/dl 0.2 - 0.8 mg/dl NORMAL
Direct Bilirubin 0.2 mg/dl 0.1-0.4 mg/dl NORMAL
Indirect Biliburin 0.5 mg/dl 0.2-0.7 mg/dl NORMAL
CBC
WBC 6,000 4,500-11,000 NORMAL
RBC 4.3 million 4.5-5.0 million A low red blood
cell count can be a
sign of: Anemia.
Leukemia, a type
of blood cancer.
Malnutrition, a
condition in which
your body does not
get the calories,
vitamins, and/or
minerals needed for
good health.
Hgb 12 grams 12-15 grams NORMAL
Hct 37% 36-45% NORMAL
Platelet 145,000 150,000-450,000 People with
thrombocytopenia
 16

have low platelet

levels. Platelets aid
blood clotting
(stopping
bleeding). When
platelet levels are
low, you may
bruise and bleed
excessively.
Certain cancers,
cancer treatments,
medications and
autoimmune
diseases can cause
the condition.
Urinalysis
Segmenters 2 2-5/hpf NORMAL
RBC 1 Less than 2/hpf NORMAL
Bacteria Few None Bacteria in the
urine mean a
urinary tract
infection (UTI).
Yeast cells or
parasites (such as
the parasite that
causes
trichomoniasis) can
mean an infection
of the urinary tract.
Protein +1 None NORMAL
ABO, Rh typing A+

A.Ideal diagnostic

COMPLETE BLOOD CELL (CBC) COUNT WITH DEFFERENCIAL

A complete blood count or CBC is a blood test that measures many different parts and

features of your blood, including:

 Red blood cells, which carry oxygen from your lungs to the rest

of your body
 17

 White blood cells, which fight infection. There are five major

types of white blood cells. A CBC test measures the total number

of white cells in your blood. A test called a CBC with differential

also measures the number of each type of these white blood cells

 Hemoglobin, a protein in red blood cells that carries oxygen

from your lungs and to the rest of your body

 Hematocrit, a measurement of how much of your blood is made

up of red blood

 Platelets, which help your blood to clot and stop bleeding

A complete blood count may also include measurements of chemicals and other

substances in your blood. These results can give your health care provider important

information about your overall health and risk for certain diseases.

URINALYSIS (UA)

A urinalysis is a test of your urine. A urinalysis is used to detect and manage a wide

range of disorders, such as urinary tract infections, kidney disease and diabetes.

A urinalysis involves checking the appearance, concentration and content of urine.

Abnormal urinalysis results may point to a disease or illness.

For example, a urinary tract infection can make urine look cloudy instead of

clear.Increased levels of protein in urine can be a sign of kidney disease. Unusual

urinalysis results often require more testing to uncover the source of the problem.
 18

LIVER FUNCTION TESTS (ASPARTATE AMINOTRANSFERASE [AST],

ALANINE AMINOTRANSFERASE [ALT] AND GAMMA-GLUTAMYL

TRANSFERASE [GGT] )

Liver blood tests are some of the most commonly performed blood tests.

These tests can be used to assess liver functions or liver injury. An initial step in

detecting liver damage is a simple blood test to determine the level of certain liver

enzymes (proteins) in the blood.

Among the most sensitive and widely used liver enzymes are the

aminotransferases. They include aspartate aminotransferase (AST or SGOT), alanine

aminotransferase (ALT or SGPT) and Gamma-glutamyl transferase. These enzymes

are normally predominantly contained within liver cells and to a lesser degree in the

muscle cells. If the liver is injured or damaged, the liver cells spill these enzymes into

the blood, raising the AST, ALT and GGT enzyme blood levels and signaling liver

disease.

CT SCAN

A computerized tomography (CT) scan combines a series of X-ray images

taken from different angles around your body and uses computer processing to create

crosssectional images (slices) of the bones, blood vessels and soft tissues inside your

body. CT scan images provide more-detailed information than plain X-rays do

B.Actual Diagnostic

Suffered 2 episodes of seizures described a tonic-clonic. The first lasting for

15 seconds, with post-ictal unconsciousness.

Upon laboratory analysis, it presented the following:

 19

Test Results: Normal Values Interpretation

ALT 67 U/L 7-55 U/L High levels of ALT
may indicate liver
damage from
hepatitis, infection,
cirrhosis, liver
cancer, or other
liver diseases.
Other factors,
including
medicines, can
affect your results.
AST 49 U/L 8-48 U/L High levels of AST
in the blood may be
a sign of hepatitis,
cirrhosis,
mononucleosis, or
other liver diseases.
High AST levels
may also be a sign
of heart problems
or pancreatitis.
ALP 134 U/L 40-129 U/L High levels of ALP
may indicate liver
disease or certain
bone disorders.
GGT 50 U/L 8-48 U/L High levels of GGT
in your blood may
indicate liver
disease or damage
to your liver's bile
ducts.
Total Bilirubin 1.2 mg/dl 0.2 - 0.8 mg/dl High bilirubin
levels are usually a
sign that something
is not working as
expected in your
liver or gallbladder.
Direct Bilirubin 0.7 mg/dl 0.1-0.4 mg/dl Higher than normal
levels of direct
bilirubin in your
blood may indicate
your liver isn't
clearing bilirubin
properly.
Indirect Biliburin 0.9 mg/dl 0.2-0.7 mg/dl Indirect bilirubin
may be too high
when the liver is
unable to
adequately process
 20

(conjugated)
bilirubin or when
there is abnormal
destruction of red
blood cells
(hemolysis).
CBC
WBC 6,000 4,500-11,000 NORMAL
RBC 3.4 million 4.5-5.0 million A low red blood
cell count can be a
sign of: Anemia.
Leukemia, a type
of blood cancer.
Malnutrition, a
condition in which
your body does not
get the calories,
vitamins, and/or
minerals needed for
good health.
Hgb 8.9 grams 12-15 grams Low hemoglobin
levels lead to
anemia, which
causes symptoms
like fatigue and
trouble breathing.
Hct 30% 36-45% Low hematocrit
can indicate: An
insufficient supply
of healthy red
blood cells
(anemia) A large
number of white
blood cells due to
long-term illness,
infection or a white
blood cell disorder
such as leukemia or
lymphoma.
Vitamin or mineral
deficiencies.
Recent or long-
term blood loss.
Platelet 90,000 150,000-450,000 People with
thrombocytopenia
have low platelet
levels. Platelets aid
blood clotting
(stopping
bleeding). When
 21

platelet levels are

low, you may
bruise and bleed
excessively.
Certain cancers,
cancer treatments,
medications and
autoimmune
diseases can cause
the condition.
Urinalysis
Segmenters 2 2-5/hpf NORMAL
RBC 1 Less than 2/hpf NORMAL
Bacteria Few None
Protein +1 None NORMAL

Additional test laboratory were done

Test Result Normal Interpretation

Creatinine 2.0 0.5-1.1 Elevated creatinine
level signifies
impaired kidney
function or kidney
disease.
BUN 35mg/dL 7-30 A high BUN level
means your
kidneys aren't
working well.
Serum magnesium 2.7 mg/dL 1.5-2.3 mg/dL Higher than normal
amount of
magnesium, it may
be a sign of:
Addison disease, a
disorder of the
adrenal glands.
Kidney disease.
Dehydration, the
loss of too much
bodily fluids.

In the evening, since the husband and the SOs cannot decide to forego with the C-

section, the BP of the patient spiked to 300/167mmHg. She was given with verapamil

5mg slow IV push, furosemide 40mg slow IV push and nicardipine drip at 15

microdrops per minute. Which lowered her BP to 230/156mmHg. NO fetal heart tone
 22

was appreciable. Patient was wheeled to the OR immediately upon the decision of the

SOs. A repeat CBC was ordered prior to OR which revealed that platelet has

plummeted to 56,000.3 units of platelet concentrate was put on standby. After the

procedure, patient was transferred to PACU. 3 hours post-op had a seizure episode, as

tonic in character lasting about 10 seconds. Diazepam 5mg IV was given as stat dose.

She was referred to neurologist and was ordered for contrast CT scan of the head.

Neurologist started the patient on phenobarbital IV piggyback at 1mg/hr via infusion

pump. Post-op medications are nalbuphine 5mg every 6 hours, cefazolin 1 gram IV

every 12 hours for 4 doses, ranitidine 50mg IV every 8 hours, ondansetron 4mg IV for

vomiting. CT scan report showed small infarct on the lacuna of the patient. Piracetam

1 gram every 12 hours was started. Maintained on nicardipine drip at 5 microdrops

per minute.

A.Ideal diagnostic

COMPLETE BLOOD CELL (CBC) COUNT WITH DEFFERENCIAL

A complete blood count or CBC is a blood test that measures many different parts and

features of your blood, including:

 Red blood cells, which carry oxygen from your lungs to the rest

of your body

 White blood cells, which fight infection. There are five major

types of white blood cells. A CBC test measures the total number

of white cells in your blood. A test called a CBC with differential

also measures the number of each type of these white blood cells
 23

 Hemoglobin, a protein in red blood cells that carries oxygen

from your lungs and to the rest of your body

 Hematocrit, a measurement of how much of your blood is made

up of red blood

 Platelets, which help your blood to clot and stop bleeding

A complete blood count may also include measurements of chemicals and other

substances in your blood. These results can give your health care provider important

information about your overall health and risk for certain diseases.

URINALYSIS (UA)

A urinalysis is a test of your urine. A urinalysis is used to detect and manage a wide

range of disorders, such as urinary tract infections, kidney disease and diabetes.

A urinalysis involves checking the appearance, concentration and content of urine.

Abnormal urinalysis results may point to a disease or illness.

For example, a urinary tract infection can make urine look cloudy instead of

clear.Increased levels of protein in urine can be a sign of kidney disease. Unusual

urinalysis results often require more testing to uncover the source of the problem.

LIVER FUNCTION TESTS (ASPARTATE AMINOTRANSFERASE [AST],

ALANINE AMINOTRANSFERASE [ALT] AND GAMMA-GLUTAMYL

TRANSFERASE [GGT] )
 24

Liver blood tests are some of the most commonly performed blood tests.

These tests can be used to assess liver functions or liver injury. An initial step in

detecting liver damage is a simple blood test to determine the level of certain liver

enzymes (proteins) in the blood.

Among the most sensitive and widely used liver enzymes are the

aminotransferases. They include aspartate aminotransferase (AST or SGOT), alanine

aminotransferase (ALT or SGPT) and Gamma-glutamyl transferase. These enzymes

are normally predominantly contained within liver cells and to a lesser degree in the

muscle cells. If the liver is injured or damaged, the liver cells spill these enzymes into

the blood, raising the AST, ALT and GGT enzyme blood levels and signaling liver

disease.

B.Actual Diagnostic

Upon laboratory analysis, it presented the following

Test Results: Normal Values Interpretation

ALT 50 U/L 7-55 U/L NORMAL
AST 38 U/L 8-48 U/L NORMAL
ALP 100 U/L 40-129 U/L NORMAL
GGT 42 U/L 8-48 U/L NORMAL
Total Bilirubin 0.9 mg/dl 0.2 - 0.8 mg/dl High bilirubin
levels are usually a
sign that something
is not working as
expected in your
liver or gallbladder.
Direct Bilirubin 0.5 mg/dl 0.1-0.4 mg/dl Higher than normal
levels of direct
bilirubin in your
blood may indicate
your liver isn't
clearing bilirubin
properly.
Indirect Biliburin 0.7 mg/dl 0.2-0.7 mg/dl NORMAL
 25

CBC
WBC 6,000 4,500-11,000 NORMAL
RBC 4.0 million 4.5-5.0 million A low red blood
cell count can be a
sign of: Anemia.
Leukemia, a type
of blood cancer.
Malnutrition, a
condition in which
your body does not
get the calories,
vitamins, and/or
minerals needed for
good health.
Hgb 9 grams 12-15 grams Low hemoglobin
levels lead to
anemia, which
causes symptoms
like fatigue and
trouble breathing.
Hct 33% 36-45% Low hematocrit
can indicate: An
insufficient supply
of healthy red
blood cells
(anemia) A large
number of white
blood cells due to
long-term illness,
infection or a white
blood cell disorder
such as leukemia or
lymphoma.
Vitamin or mineral
deficiencies.
Recent or long-
term blood loss.
Platelet 100,000 150,000-450,000 People with
thrombocytopenia
have low platelet
levels. Platelets aid
blood clotting
(stopping
bleeding). When
platelet levels are
low, you may
bruise and bleed
excessively.
Certain cancers,
cancer treatments,
 26

medications and
autoimmune
diseases can cause
the condition.
Urinalysis
Segmenters 3 2-5/hpf NORMAL
RBC 0 Less than 2/hpf NORMAL
Bacteria None None NORMAL
Protein +1 None NORMAL
Creatinine 1.6 0.5-1.1 Elevated creatinine
level signifies
impaired kidney
function or kidney
disease.
BUN 35mg/dL 7-30 A high BUN level
means your
kidneys aren't
working well.
Serum Magnesium 2.7 mg/dL 1.5-2.3 mg/dL Higher than normal
amount of
magnesium, it may
be a sign of:
Addison disease, a
disorder of the
adrenal glands.
Kidney disease.
Dehydration, the
loss of too much
bodily fluids.

GCS was 15/15. Conversant but noted to be having some episode of trance. Expresses

her grief and sadness over the death of the baby and her condition. She often

expresses her guilt and blames herself. No slurring of speech noted. Edema further

subsided. Nicardipine was discontinued. NGT was discontinued. Blood pressure

ranges from 130/78mmHg to 154/109mmHg. Nifepidine 5mg 1 tablet OD was added.

IV pain medication was shifted to oxycodone + acetaminophen 5mg/325mg tablet

three times a day for moderate to severe pain.

 27

V.ANATOMY AND PHYSIOLOGY OF ORGAN INVOLVED

The Heart. The heart itself is made up of 4 chambers, 2 atria and 2 ventricles

The heart is a muscular organ found in all vertebrates that is responsible for pumping

blood throughout the blood

vessels by repeated, rhythmic

contractions. The heart is

responsible for maintaining

adequate circulation of

oxygenated blood around the

vascular network of the body. It is a four-chamber pump, with right side receiving

deoxygenated blood from the body at low pressure and pumping it to the lungs. And

at the left side receiving oxygenated blood form the lungs and pumping at the high

pressure around the body. The myocardium is the specialized form of muscle,

consisting of individual cells joined by electrical connections. The contraction of as

each cell is produced by a rise in intracellular leading to spontaneous depolarization

and contraction across the myocardium. This depolarization and contraction of the

heart is controlled by a specialized group of cells localized in the sino-atrial mode in

the right atrium pacemaker cells.

Kidney. The kidney is the reponsible for the volume and concentration of

fluids in the body by producing urine.

Urine is produce ina process called

glomerular filtration, which remove as

the waste products, minerals and water

from the blood. The kidney maintains

the volume of the fluid in the body and

 28

also the concentration of urine by filtering the waste product and reabsorbing useful

substance and water from the blood. The kidney also performs detoxification of

harmful substance increase absorption of calcium by producing calcitrol (form of

vitamin D) and also secretes rennin (hormone that regulates blood pressure and

electrocyte.

Liver. The liver is the largest solid organ in the body. It removes toxins from

the body’s blood supply, maintains healthy blood sugar levels, regulates blood

clotting, and performs hundreds

of other vital functions. It is

located beneath the rib cage in

the right upper abdomen. The

liver has two large sections,

called the right and the left

lobes. The gallbladder sits

under the liver, along with parts

of the pancreas and intestines. The liver and these organs work together to digest,

absorb, and process food. The liver regulates most chemical levels in the blood and

excretes a product called bile. This helps carry away waste products from the liver.

All the blood leaving the stomach and intestines passess through the liver. The liver

process this blood and breaks down, balances and creates the nutrients and also

metabolizes drugs into forms that are easier to use for the body or that are nontoxic.

The liver is reddish-brown and shaped approximately like a cone or a wedge, with the

small end above the spleen and stomach and the large end above the small intestine.
 29

Brain. The brain is a complex organ that controls thought, memory, emotion,

touch, motor skills, vision, breathing,

temperature, hunger and every process

that regulates our body. Together, the

brain and spinal cord that extends from it

make up the central nervous system, or

CNS. Weighing about 3 pounds in the

average adult, the brain is about 60% fat.

The remaining 40% is a combination of

water, protein, carbohydrates and salts. The brain itself is not a muscle. It contains

blood vessels and nerves, including neurons and glial cells. The brain is also divided

into several lobes:

• The frontal lobes are responsible for problem solving and judgment and motor

function.

• The parietal lobes manage sensation, handwriting, and body position.

• The temporal lobes are involved with memory and hearing.

• The occipital lobes contain the brain's visual processing system.

The brain is surrounded by a layer of tissue called the meninges. The skull

(cranium) helps protect the brain from injury.

 30

Uterus. The uterus is a thick-walled

muscular structure that lies in the

midline of the abdominal pelvic cavity.

It contains three layers: the

endometrium (innermost layer),

myometrium, and the perimetrium

(outermost layer). The endometrium’s.

The uterus, also known as the womb, is the hollow, pear-shaped organ in the female

pelvis in which fertilization of an ovary (egg), implantation of the resulting embryo,

and development of a baby take place. It is a muscular organ that both stretches

exponentially to accommodate a growing fetus and contracts in order to push a baby

out during childbirth. The lining of the uterus, the endometrium, is the source of the

blood and tissue shed each month during menstruation.thickness and structure vary

based on hormonal stimulation

The uterus has four parts: the fundus, corpus, isthmus, and cervix. The corpus

is the largest segment and connects to the cervix via the isthmus. The cervix connects

the uterine body to the vaginal lumen. The uterus sits posterior to the bladder and

anterior to the rectum.

As a pregnancy progresses, the uterus grows and the muscular walls become

thinner, like a balloon being blown up, to accommodate the developing fetus and the

protective amniotic fluid produced first by the mother and later by urine and lung

secretions of the baby.

During pregnancy, the muscular layer of the uterus begins contracting on-and-

off in preparation for childbirth. These "practice" contractions, Braxton-Hicks

contractions, resemble menstrual cramps; some women don't even notice them. They
 31

are not the increasingly powerful and regular contractions that are strong enough to

squeeze the baby out of the uterus and into the vagina

Placenta. A vascular (supplied blood vessels) organ in most mammals that

unites the fetus to the fetus to the uterus of the mother. It mediates the metabolic

exchanges of the developing individual through an intimate association of embryonic

tissue and of certain uterine tissues,

serving the fucntions of nutrition,

respiration and excretion. A placenta is

an organ of oval round shape that

relatively flat. It is about 20 cm in length

and has an average weight of 600g.

These numbers can vary according the

weight of the fetus. It is said that the

placenta weighs about one-sixth of that of the fetus.

The placenta is composed of two different surfaces, the maternal surface,

facing the towards the outside, and the fetal surface, facing towards the inside, or the

fetus. On the fetal surface, we can observe the umbilical cord, the link between the

placenta and the uterus.

 32

VI.PATHOPHYSIOLOGY

A. Algorithm

RISK FACTORS

Modifiable Risk Factors Non- Modifiable Risk Factors

 Obesity  Age
 Nulliparity  Genetic Factors
 Diabetes Mellitus

Abnormality of integrins
Cytotrophobiast apoptosis

INADEQUATE CYTROPHOBLASTIC INVASION OF MATERNAL

SPIRAL ARTERIES

Uteroplacental malperfusion

PLACENTAL ISCHEMIA

NO Placental cytokines
PGI2 IL-6
EDHF Endothelin

GENERALIZED ENDOTHELIAL CELL INJURY

Increased maternal serum
Markers of endothelial injury

REDUCED RENAL INCREASED INCREASED ENHANCED

PLASMA FLOW VASCULAR ARTERIAL PRESSOR
RESISTANCE PRESSURE RESPONSE

Hypertension
Proteinuris
Edema

PREGNANCY-INDUCED HYPERTENSION
 33

B. Explanation

Any hypertensive disorder of pregnancy can result in preeclampsia. It occurs

in up to 35% of women with gestational hypertension and up to 25% of those with

chronic hypertension. The underlying pathophysiology that upholds this transition to,

or superposition of, preeclampsia is not well understood; however, it is thought to be

related to a mechanism of reduced placental perfusion inducing systemic vascular

endothelial dysfunction. This arises due to a less effective cytotrophoblastic invasion

of the uterine spiral arteries. The resultant placental hypoxia induces a cascade of

inflammatory events, disrupting the balance of angiogenic factors, and inducing

platelet aggregation, all of which result in endothelial dysfunction manifested

clinically as the preeclampsia syndrome.

Angiogenic imbalances associated with the development of preeclampsia

include decreased concentrations of angiogenic factors such as the vascular

endothelial growth factor (VEGF) and placental growth factor (PIGF) and increased

concentration of their antagonist, the placental soluble fms-like tyrosine kinase 1

(sFlt-1). Impeding the binding of VEGF and PIGF to their receptors is a factor in the

reduction of nitric oxide synthesis, a crucial factor in vascular remodeling and

vasodilation, which may otherwise be able to ameliorate placental ischemia.

Early-onset preeclampsia (EOPE), occurring before 34 weeks of gestation, is

thought to be primarily caused by the syncytiotrophoblast stress leading to poor

placentation, whereas late-onset preeclampsia (LOPE), occurring at or after 34 weeks,

is understood to be secondary to the placenta outgrowing its own circulation. It is

worth mentioning that EOPE is more frequently associated with fetal growth

restriction than LOPE, due to a longer duration of placental dysfunction.

 34

During the postpartum period, up to 27.5% of the women may develop de

novo hypertension. This is due to several factors, including mobilization of fluid from

the interstitial to intravascular space, administration of fluids and vasoactive agents.

The shift of fluids increases the stroke volume and cardiac output up to 80%, followed

by a compensatory mechanism of diuresis and vasodilation, which softens the rise in

blood pressure.

The pathophysiology of hypertension in pregnancy becomes particularly

relevant when reviewing the current state of adjunct therapies to antihypertensives

that may help prevent preeclampsia.

VII.MANAGEMENT

This section presents the ideal and actual medical and surgical interventions

that provides direction for the care of the patient to adequately address needs, the

nursing care plans, and the promotive and preventive management of the overall

health and well-being of the patient.

A. Medical and Surgical Management

 Medical

A. Ideal

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.

Ultrasound with biophysical profile (bps). A prenatal test used to check on a

baby's well-being. The test combines fetal heart rate monitoring (nonstress test) and
 35

fetal ultrasound to evaluate a baby's heart rate, breathing, movements, muscle tone

and amniotic fluid level.

Continued laboratory testing of urine and blood. For changes that may

signal worsening of PIH.

B. Actual

Fetal monitoring. To check the health of the fetus when mother has

PIH this include:

Fetal movement counting - keeping track of fetal kicks and

movements. A change in the number or frequency may mean the fetus is

under stress.

Nonstress testing - a test that measures the fetal heart rate in response

to the fetus' movements.

Biophysical profile- a test that combines nonstress test with

ultrasound to observe the fetus.

Doppler flow studies- type of ultrasound that uses sound waves to

measure the flow of blood through a blood vessel.

Insertion of intravenous catheter. To provide access for fluids and to

administer medications.

Pharmacologic Treatment

Drugs for Pregnancy induced Hypertension:

 36

Methyldopa. is used to treat high blood pressure. Methyldopa is in a

class of medications called antihypertensives. It works by relaxing the blood vessels

so that blood can flow more easily through the body.

Hydralazine. is used to treat high blood pressure (hypertension). It is

also used to control high blood pressure in a mother during pregnancy (pre-

eclampsia or eclampsia) or in emergency situations when blood pressure is

extremely high (hypertensive crisis).

Magnesium Sulfate. is an electrolyte injection commonly used to treat

low magnesium levels in your blood. It is also used to prevent or control

seizures in women with preeclampsia or eclampsia.

Losartan. used alone or together with other medicines to treat high

blood pressure (hypertension). High blood pressure adds to the workload of

the heart and arteries. If it continues for a long time, the heart and arteries may

not function properly.

Verapamil. used alone or together with other medicines to treat heart

rhythm problems, severe chest pain (angina), or high blood pressure

(hypertension). High blood pressure adds to the workload of the heart and

arteries. If it continues for a long time, the heart and arteries may not function

properly.

SURGICAL MANAGEMENT

The patients has not undergone any surgical treatment. 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

provider
 37

ASESSMENT NURSING SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS BACKGROUND INTERVENTION
Independent:
 Monitor urine output  Kidney function is
Subjective Data: Excessive Fluid volume excess Short term: directly correlated to Short term:
Patient Reported fluid volume refers to an isotonic circulatory fluid
some relief from related to expansion of the After 8 hours of volume, so that if After 8 hours of
her headache increased ECF due to an nursing fluid is trapped in nursing
fluid retention increase in total intervention the third spaces, output intervention the
Objective Data: as manifested body sodium content patient’s edema decreases and patient’s edema
 Mild by the and an increase in will be specific gravity was decreased
tenderness presence of total body water. decreased as increases. by pitting edema
on the RUQ edema in This fluid overload evidenced by (1-2 seconds)
 Edema on hands and usually occurs from pitting edema  Monitor BP  Change parameters
both feet compromised (1-2 seconds) may indicate altered Long Term
extremities regulatory fluid or electrocyte
2+/4+ mechanisms for status. After 2 days of
 Vital Signs sodium and water as Long Term:  Elevate edematous  Helps to reduce tissue nursig
taken as seen commonly in extremities, change pressure and risk of intervention, the
follows: heart failure (CHF), After 2 days of position frequently skin breakdown, to patient had
kidney failure, and nursing increase venous stabilized fluid
BP: liver failure. intervention, the blood return volume as
210/145mmHg patient will have evidenced by
PR: 67bpm Wayne (2022) Fluid stabilized fluid  Discuss the  Helps the client to balanced
RR: 19 Volume Excess volume as importance of fluid understand the input/output and
TEMP: 37.6 Retrieved From: evidenced by restrictions relationship of food free of signs of
SaO2: 99% https://nurseslabs.co balanced restriction to her edema.
m/excess-fluid- input/output and Dependent: condition
volume/ free of signs of  Insert indwell  Provides accurate
 38

edema urinary catheter as hourly totals of urine

per doctors order output and monitors
client for developing
renal problems or
oliguria
 39

ASESSMENT NURSING SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS BACKGROUND INTERVENTION
Independent:

Subjective Data: Short term:  Stay with the client  Promotes client Short term:
None Risk for during and after a safety and reduces
Injury as Seizure occurs when After 30 seizure. Do not leave the sense of isolation GOAL MET
there is sudden minutes of the bedside and call during the event.
evidence by
abnormal electrical nursing for assistance. After 30 minutes
Objective Data: seizure activity that intervention the  Keep padded side  Women with of nursing
 Seizure episode temporarily patient will be rails up pillows or eclampsia are prone intervention the
Episode interrupts normal maintain a folded blankets. Set to sustaining patient
 Post-ictal brain function. Large treatment the bed in the lowest fractures from falling controlled or
unconsciuos groups of neurons regimen to position. out of bed during eliminate seizure
ness fire at the same time control or seizures. Minimizes activity.
 Vital taken like an electrical eliminate injury should
as follows: storm inside the seizure activity. frequent or
BP: Ranges from brain that usually generalized seizures
250/150mmHg to lasts from 30 occur while the client
278/168mmHg seconds to two is in bed.
PR: 56 bpm, full minutes.  Do not attempt to  Cradle the client’s
and bounding restrain or restrict head, place it on a
RR: 17 cpm, the client’s soft area and assist to
slow and shallow movements during the floor if out of
Temp: 38.9c the seizure. bed. Gentle guiding
FHT: non- of extremities
reassuring, 100- reduces risk or
127bpm physical injury when
the client lacks
 40

voluntary muscle
control. If an attempt
is made to restrain
the client during the
seizure, erratic
movements may
increase, and the
client may injure
themselves or others.
 Note the time of  Helps localize the
onset and duration of cerebral area of
the seizure. involvement and may
Document motor be useful in helping
involvement, the client and family
duration of seizure, members manage
and post-seizure seizure activity.
behavior.
Dependent
 Administer  Magnesium sulfate is
magnesium sulfate the drug of choice for
(MgSO4) treating eclamptic
intramuscularly or seizures and
IV using an infusion preventing repeated
pump. seizures. MgSO4 is a
CNS depressant that
decreases
acetylcholine release,
blocks neuromuscular
transmission, and
prevents seizures.
 41

ASESSMENT NURSING SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS BACKGROUND INTERVENTION
Independent:
 Provide frequent  .Improves venous
Subjective Data: Short term: rest periods with bed return, cardiac Short term:
None Decrease Decreased cardiac rest. Restrict activity output, and renal-
cardiac output output may result in After 1 hour of rather than placental perfusion.
Objective Data: Related to insufficient blood nursing instituting complete Help the client
altered heart supply and intervention the bed rest. understand the
 Vital Signs rate compromise vital patient will be importance of
taken as reactions. This can reduced activity and
follows: result in transition frequent rest periods
towards anaerobic and plan ways to
BP: 195/100mmHg metabolic pathways manage them.
PR: 58bpm, weak which lead to  Check for peripheral  Weak pulses are
and thread production of lactic pulses. Perform present in reduced
RR: 19
TEMP: 37.6
acid, reduced capillary refill test stroke volume and
SaO2: 99% cellular pH, enzyme (CRT). cardiac output.
denaturation, and Capillary refill is
altered membrane sometimes slow or
potential. If not absent.
addressed, decreased  Check for any  Decreased cerebral
cardiac output can alterations in level of perfusion and
lead to tissue and consciousness. hypoxia are reflected
organ damage. Most in irritability,
common diagnoses restlessness, and
associated with difficulty
decreased cardiac concentrating
output is heart
 42

failure.  Assess for reports of  Fatigue and

fatigue and reduced exertional dyspnea
activity tolerance. are common
problems with low
cardiac output states.
Close monitoring of
the patient’s response
serves as a guide for
optimal progression
of activity.
 43

ASESSMENT NURSING SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS BACKGROUND INTERVENTION
Independent:

Subjective Data: Long term: Long term:

None Dysfunctional Grief causes the  Asess the stage of  To determine how the
Grieving due brain to send a After 2 days of grief of the parent. nurse can approach After 2 days of
to PIH as cascade of stress nursing Check the anxiety and speak to the nursing
evidenced by hormones and other intervention the level, anxiety parent. To establish intervention the
Objective Data: grief, sadness signals to the patient will be triggers and the baseline patient proceed
 Noted to be and guilt cardiovascular and able to proceed symtoms by asking observation of the with the
having some immune systems with the open-ended anxiety level of the acceptance of
episode of that can ultimately acceptance of questions. patient. losing the child
trance change how those losing the child
 Expressess systems function.  Allow time for the  To help the parent/s
her giref and parent/s to hold their grieve and say
sadness child to say goodbye goodbye.
 Expressess
her guilt and  Re-assure that the  To ensure the
 44

blames healthcare team are parent’s safety

herself here to help him/her.
 BP: Do not leave him/her
130/78mmH especially when the
g anxiety levels are
high.
 45

ASESSMENT NURSING SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS BACKGROUND INTERVENTION
Independent:
 Assess sleep pattern  .A high percentage of
Subjective Data: Short term: disturbances that are sleep disruptions will Short term:
Disturbed Physiological associated with impede the patient’s
Patient sleep pattern variation of a After 4 hours of internal and external recovery. After 4 hours of
complained of related to character permits nursing factors. nursing
difficulty of physiologic the establishment of intervention the intervention the
sleeping variations as populations at client will client
evidenced by environmental demonstrate  Take note  This provides demonstrate
Objective Data: emotional limits and thus relaxation skills observations of baseline data for the relaxation skills
outburst predisposes a race and other sleep-wake evaluation of and other
 With for genetic fixation methods to behaviors. Take insomnia. methods to
emotional of a character promote sleep. down notes on the promote sleep.
outburts (Baldwin effect). number of hours the
 Vital Signs Such variation is Long Term: patient is asleep. Long Term:
taken as primary in
follows: providing one After 1 day of After 1 day of
mechanism of nursing nursing
BP: 144/89mmHg reproductive intervention the intervention the
PR: 89 full isolation. client will be client able to
RR: 20 cpm able to sleep at sleep at least 8
TEMP: 37.2
least 8 hours a hours a day
day  Conduct health  To improve sleeping
teaching about quality and avoid
sleeping positions pain due to pressure.
(side-lying on left)
 46

 Observe and  Following

evaluate the timing medication schedules
or effects of that requires a lot of
medications that can attention may affect
affect sleep the sleeping pattern
of the patient
especially in the
hospital setting.
 47

ASESSMENT NURSING SCIENTIFIC PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS BACKGROUND INTERVENTION
Independent:

Subjective Data: Short term:  Anticipate increased  During this time, all Short term:
She said she Dysfunctional Grief causes the or exaggerated affective behavior
deeply grieves grieving brain to send a After 1 hour of affective behavior. may seem increased After 1 hour of
for the loss of her related to cascade of stress nursing or exaggerated. nursing
child losing the hormones and other intervention the Displaced anger and intervention the
infant due to signals to the patient will be resentment may patient proceed
PIH as cardiovascular and able to proceed transpire when the with the
evidenced by immune systems that with the loss does not occur as acceptance of
anger can ultimately acceptance of anticipated by those losing the child.
change how those losing the child. grieving. Regression
Objective Data: systems function. may transpire during
 Expressses this time.
of anger  Communicate  Sharing feelings with
towards therapeutically with a healthcare provider
herself patient and family may help the patient
members and allow find significance in
them to verbalize the experience of
feelings. loss.
 Strengthen the  Allow the patient and
patient’s efforts to family to feel that
go on with his or her they are enabled to
life and normal do this by supporting
routine. them.
 Provide a supportive  The patient has a
approach by giving limited attention span
 48

simple and short and is irritable or

directions or restless during a
information. Re- panic attack, thus
assure her and the simple and short
partner that it is directions are
normal to grieve and important in helping
allow time to heal. is the patient cope with
the situation.
 49

PROMOTIVE AND PREVENTIVE

1. Go to prenatal visits. The best way to keep you and your baby healthy throughout

your pregnancy is to go to all your scheduled prenatal visits so your doctor can check

your blood pressure and any other signs and symptoms of preeclampsia.

Throughout your pregnancy, your doctor will check:

 Your blood pressure

 Your blood

 Levels of protein in your urine

 How your baby is growing and gaining weight

2. Get moving. Exercise is one key to a healthy pregnancy. A small study showed

that when overweight pregnant women walked on a regular basis, they lowered their

blood pressure. Just be sure to talk with your doctor before exercising. There may be

limits on what you can do.

3. Eat healthy foods. Make sure the foods you choose are nutritious. Try to put fruits,

veggies, whole-grain breads, lean meats, and low-fat dairy products on your plate

every day. Ask your doctor whether you should lower your salt intake. And learn

what a healthy weight gain is for you during pregnancy.

4. Avoid alcohol and cigarettes. Doctors don't know if there is a safe amount for a

pregnant woman to drink, so it's best to steer clear. The same goes for smoking.

Stopping smoking or drinking alcohol may not be easy. But this is a surefire way to

improve the chances for a healthy baby. If you can't stop on your own, get help.
 50

5. Track your weight and blood pressure. If you had high blood pressure before

you were pregnant, be sure to tell your doctor at your first appointment. Your doctor

may want you to track your weight and blood pressure in between visits.

6. Ease blood pressure. To help ease your blood pressure, you doctor may

recommend taking extra calcium or aspirin, or lying on your left side when you rest.

They may also recommend you to check your diet to be sure you're getting plenty of

fruits and veggies and that it is low in salt.

7. Primary Prevention. Primary prevention involves avoiding pregnancy in women

at high risk for PE, modifying lifestyles or improving nutrients intake in whole

population in order to decrease the incidence of the disease. Therefore, probably the

majority of cases of PE are unpreventable

8. Secondary Prevention. Secondary prevention is based on interruption of known

pathophysiological mechanisms of the disease before its establishment. Recent efforts

have focused on the selection of high risk women and have proposed an effective

intervention, as early as it is possible, in order to avoid the disease or its severe

complications

9. Tertiary Prevention. Tertiary prevention relies on using treatment to avoid PE

complications. Magnesium sulfate, for example, is the drug of choice for reducing the

rate of eclampsia
 51

NAME AND DOSE, ROUTE, MECHANISM OF INDICATION CONTRAINDICAT ADVERSE/SIDE NURSING

CLASSIFICATI FREQUENCY AND ACTION ION EFFECTS RESPONSIBILITIES
ON OF DRUG DURATION OF
ADMINISTRATION
Before:
Generic Name: Dose: Is decarboxylated in the  Active hepatic CNS: DEcreased  Check doctor’s order
Methyldopa 250 mg body to produce disease, concenration, depression,  Assess sensitivity to
alpha- For pregnancy- dizziness, drowsiness, methyldopa, hepatic
Frequency: methylnorepinephrine, a induced  hypersensitivity fever, disease, renal failure,
Brand Name: Three times a day metabolite hypertension to headache, involuntary dialysis
Aldomet that stimulates central methyldopa or its motor activity,  Educate client about
inhibitory components, memory loss (transient), the drug, its purpose
Pharmacologic: Route: alphaadrenergic impaired nightmares, and importance
Oral receptors. This action paresthesia, Parkinsonism,
may  hepatic sedation, During:
Therapeutic: reduce blood pressure by function from vertigo, weakness  Check the label twice
Antihypertensiv Duration of decreasing previous  Administer at the
e Administration: sympathetic stimulation methyldopa CV: Angina, bradycardia, right dose and in the
of heart and edema, right time
peripheral vascular  therapy, use heart failure, myocarditis,  Do not crush nor
system. within 14 days orthostatic chew tablets,
of MAO Hypotension swallow whole
inhibitor
EENT: Black or sore After:
tongue, dry mouth,  Monitor blood counts
Source: 2018 Jones & nasal congestion periodically to detect
Bartlett Learning NDH haemolytic anemia
ENDO: Gynecomastia
GI: Constipation, diarrhea,
flatulence,
hepatic necrosis, hepatitis,
 52

jaundice, nausea,
pancreatitis, vomiting

GU: Decreased libido,

impotence

HEME: Agranulocytosis,
hemolytic anemia,
leukopenia, positive
Coombs’ test, positive
tests for ANA and
rheumatoid factor,
Thrombocytopenia

SKIN: Eczema, rash,

urticaria
Other: Weight gain
 53

NAME AND DOSE, ROUTE, MECHANISM OF INDICATION CONTRAINDICATI ADVERSE/SIDE EFFECTS NURSING
CLASSIFICATION FREQUENCY AND ACTION ON RESPONSIBILITIES
OF DRUG DURATION OF
ADMINISTRATIO
N

Generic Name: Dose: Blocks binding of  Concurrent CNS: Dizziness, fatigue,  Know that in some
Losartan 100mg angiotensin II to receptor To manage aliskiren therapy headache, patients, losartan is
sites in many tissues, hypertension (in patients with insomnia, malaise more effective when
Frequency: including adrenal glands diabetes or renal given in 2 divided doses
Brand Name: Once a day and vascular smooth impairment CV: Hypotension daily; it may be used
Cozaar muscle. Angiotensin II is a [GFR less than EENT: Nasal congestion with other
Route: potent vasoconstrictor 60 ml/min]), antihypertensives.
Oral that also stimulates the GI: Diarrhea, indigestion,  Monitor blood pressure
Pharmacologic: adrenal cortex to  hypersensitivity nausea, vomiting and renal function
Angiotensin II Duration of secrete aldosterone. The to losartan or its studies, as ordered, to
receptor Administration: inhibiting effects components HEME: Thrombocytopenia evaluate drug
antagonist of angiotensin II reduce effectiveness.
blood pressure. MS: Back pain, leg pain,  Periodically monitor
Decreases left ventricular muscle spasms patient’s serum
Therapeutic: mass index in potassium level, as
Antihypertensive patients with left RESP: Cough, upper ordered, to detect
ventricular hypertrophy respiratory tract hyperkalemia
who also have Infection  Monitor patient for
hypertension. By targeting muscle pain; rarely,
the renin–angiotensin SKIN: Erythroderma rhabdomyolysis has
system, a developed in patients
renoprotective action Other: Angioedema, taking other angiotensin
occurs through the hyperkalemia, II receptor blockers.
lowering of the albumin hyponatremia  Instruct patient to avoid
excretion rate in potassiumcontaining
patients with type 2 salt substitutes because
diabetes. they may increase risk
of hyperkalemia
 54

 Advise patient to avoid

Source: 2018 Jones & exercising in hot
Bartlett Learning NDH weather and drinking
excessive amounts of
alcohol; instruct her to
notify prescriber if she
has prolonged diarrhea,
nausea, or vomiting
 55

NAME AND DOSE, ROUTE, MECHANISM OF INDICATION CONTRAINDICA ADVERSE/SIDE EFFECTS NURSING
CLASSIFICATIO FREQUENCY ACTION TION RESPONSIBILITIES
N OF DRUG AND DURATION
OF
ADMINISTRATI
ON

Generic Name: Dose: May slow movement of  Hypersensitivit CNS: Anxiety, ataxia,  Know that when
Nifedipine 5mg calcium into y to nifedipine confusion, dizziness, starting and stopping
myocardial and vascular To manage or its drowsiness, headache, nifedipine therapy,
Brand Name: Frequency: smooth-muscle hypertension components, nervousness (possibly taper it, as prescribed,
Once a day (In the cells by deforming  second- or extreme), nightmares, over 7 to 14 days.
evening) calcium channels in cell third-degree paresthesia, psychiatric  Keep in mind that
Pharmacologic: membranes, inhibiting AV block disturbance, syncope, because of drug’s
Dihydropyridine Route: ion-controlled without tremor, weakness negative inotropic
derivative Oral gating mechanisms, and artificial effect on some
disrupting calcium pacemaker, CV: Arrhythmias patients, frequently
Therapeutic: Duration of release from  Sick sinus (bradycardia, tachycardia), monitor heart rate
Antianginal, Administration: sarcoplasmic reticulum. syndrome chest pain, heart failure, and rhythm, as well
antihypertensive Decreasing intracellular hypotension, palpitations, as blood pressure,
calcium level peripheral edema especially in patients
inhibits smooth-muscle who take a beta
cell contraction and EENT: Altered taste, blurred blocker or have heart
dilates arteries, which vision, dry failure, significant
decreases myocardial mouth, epistaxis, gingival left ventricular
oxygen demand, hyperplasia, nasal dysfunction, or tight
peripheral res congestion, pharyngitis, aortic stenosis
sinusitis, tinnitus  Instruct patient to
swallow E.R. tablets
Source: 2018 Jones & ENDO: Gynecomastia, whole, not to break,
Bartlett Learning NDH hyperglycemia chew, or crush them.
Inform her that their
 56

GI: Anorexia; constipation; empty shells may

diarrhea; appear in stool
dyspepsia; elevated liver  Urge patient to take
enyzmes; nifedipine exactly as
gastrointestinal bleeding, prescribed, even
irritation, or when she’s feeling
obstruction; hepatitis; well.
nausea; vomiting  Advise her to notify
prescriber if she
GU: Dysuria, nocturia, misses two or more
polyuria, sexual doses
dysfunction, urinary  Instruct patient to
frequency notify prescriber
immediately about
HEME: Anemia, chest pain, difficulty
leukopenia, positive breathing, ringing in
Coombs’ test, ears, and swollen
thrombocytopenia gums.
 Emphasize the need
MS: Joint stiffness, muscle to comply with
cramps prescribed lifestyle
changes, such as
RESP: Chest congestion, alcohol moderation,
cough, dyspnea, low-fat or lowsodium
respiratory tract infection, diet, regular exercise,
wheezing smoking cessation,
stress reduction, and
SKIN: weight reduction.
Acute generalized
exanthematous
pustulosis, diaphoresis,
erythema multiforme,
 57

exfoliative dermatitis,
flushing, photosensitivity,
pruritus, rash, Stevens–
Johnson syndrome,
toxic epidermal necrolysis,
urticaria
 58

NAME AND DOSE, ROUTE, MECHANIS INDICATION CONTRAINDICATIO ADVERSE/SIDE NURSING

CLASSIFICATIO FREQUENCY AND M OF N EFFECTS RESPONSIBILITIE
N OF DRUG DURATION OF ACTION S
ADMINISTRATIO
N
Generic Name: Dose:
Clopidogrel 75 mg Binds to To reduce  Active CNS: Confusion,  History:Allegy
adenosine thrombotic pathological depression, to clopidogel,
Frequency: diphosphate events, such bleeding, dizziness, fatal pregnancy,
Brand Name: Once a day (After (ADP) as including peptic intracranial bleeding, lactation,
Plavix Lunch) receptors on MI and ulcer and fatigue, fever, bleeding
the surface of stroke, in intracranial hallucinations, disorders,
Pharmacologic: Route: activated patients with hemorrhage; headache recent surgery,
Thienopyridine Oral platelets. This atherosclerosi hepatic
derivative action blocks s documented  hypersensitivity to CV: Chest pain, impairment,
Duration of ADP, which by recent clopidogrel or its edema, peptic ulcer.
Administration: deactivates MI, components hypercholesterolemi  Provide comfort
Therapeutic: nearby peripheral a, hypertension, mesures and
Platelet glycoprotein artery disease, hypotension, arrange for
aggregation IIb/IIIa or stroke Vasculitis analgestics if
inhibitor receptors and headache
prevents To reduce EENT: Altered taste; occurs.
fibrinogen thrombotic conjunctival, ocular,  Advise patient
from events, such or retinal bleeding; it may take
attaching to as MI epistaxis; rhinitis; longer than
receptors. and stroke, in stomatitis; taste usual to stop
Without patients with disorders bleeding. Tell to
fibrinogen, acute GI: Abdominal pain; refrain from
platelets can’t coronary acute liver failure; activities in
aggregate and syndrome colitis; diarrhea; whch trauma
 59

form thrombi. duodenal, gastric, or and bleeding

peptic ulcer; elevated occur.
liver enzymes;
Source: 2018 gastritis;
Jones & gastrointestinal and
Bartlett retroperitoneal
Learning hemorrhage,
NDH indigestion;
nausea;
noninfectious
hepatitis; pancreatitis

GU: Elevated serum

creatinine level,
glomerulopathy, UTI

HEME: Acquired
hemophilia A,
agranulocytosis,
aplastic anemia,
neutropenia,
pancytopenia,
prolonged
bleeding time,
thrombocytopenic
purpura,
thrombotic
thrombocytopenic
purpura,
unusual bleeding or
 60

bruising

MS: Arthralgia, back

pain,
musculoskeletal
bleeding, myalgia

RESP: Bronchitis,
bronchospasm,
cough,
dyspnea,
eosinophilic
pneumonia,
interstitial
pneumonitis,
respiratory
tract bleeding, upper
respiratory tract
Infection

SKIN: Acute
generalized
exanthematous
pustulosis, bullous
dermatitis, drug rash
with eosinophilia
and systemic
symptoms
(DRESS), eczema,
erythema
 61

multiforme,
exfoliative rash,
lichen planus,
pruritus,
purpura, rash, skin
bleeding, Stevens–
Johnson syndrome,
toxic epidermal
necrolysis, urticaria
 62

NAME AND DOSE, ROUTE, MECHANISM INDICATI CONTRAINDIC ADVERSE/SIDE NURSING

CLASSIFICATION FREQUENCY AND OF ACTION ON ATION EFFECTS RESPONSIBILITIES
OF DRUG DURATION OF
ADMINISTRATION
Generic Name: Dose: Binds with mu  Alcohol CNS: Agitation, anxiety,
Tramadol 50mg receptors and Relief of intoxication asthenia depression,  Assess onset,
inhibits the moderate to dizziness, emotional type, location,
Brand Name: Frequency: reuptake of severe pain  Excessive lability, euphoria, duration of pain
Ultram Every 8 hours norepinephrine use of fatigue, fever,  Asess drug
and serotonin, central-acting hallucinations, history, esp
Pharmacologic: Route: which may analgesics, headache, hypertonia, carbamezepine,
Cychohexamol IV account for hypoesthesia, analgesics, CNS
tramadol’s  hypnotics, insomnia, lethargy, depressants,
Therapeutic: analgesic opioids, or nervousness, MAOIs.
Analgesic Duration of effect. other paresthesia, restlessness,  Review past
Administration: psychotropic rigors, seizures, medical history
drugs; serotonin syndrome, esp. Epilepsy,
Source: 2018 somnolence, suicidal seizures
Jones &  ideation, tremor, vertigo,  Asess
Bartlett hypersensitiv weakness renal/hepatic
Learning NDH ity to functionlab
tramadol or CV: Chest pain, values.
its orthostatic hypotension,  Monitor patient
components; Vasodilation for seizures.
use within 14 May occur
days of MAO EENT: Blurred vision, within
inhibitor dry mouth, nasal or recommended
therapy sinus congestion, sore dose range
throat, vision changes
 63

ENDO: Adrenal
insufficiency, hot flashes

GI: Abdominal pain,

anorexia,
constipation, diarrhea,
indigestion, nausea,
Vomiting

GU: Decreased libido,

erectile dysfunction,
impotence, infertility,
lack of menstruation,
urinary frequency, urine
retention

MS: Arthralgia; back,

limb, or neck pain

RESP: Cough, dyspnea

SKIN: Diaphoresis,
dermatitis, flushing,
pruritus, rash

Other: Flu-like illness,

physical and
psychological
dependence
 64

NAME AND DOSE, ROUTE, MECHANISM INDICATI CONTRAIND ADVERSE/SIDE NURSING

CLASSIFICATION FREQUENCY AND OF ACTION ON ICATION EFFECTS RESPONSIBILITIES
OF DRUG DURATION OF
ADMINISTRATION
Generic Name: Dose: Inhibits basal  Acute CNS: Dizziness,  Administer
Ranitidine 50 mg and nocturnal porphyria, drowsiness, fever, medication following
secretion of head ache, insomnia the 14 rights of drug
Brand Name: Frequency: gastric acid Used to  hypersens CV: Vasculitis administration
Zantac Every 8 hours and pepsin by prevent itivity to GI: Abdominal distress,
competitively ulcer ranitidine constipation,  Inform patient that
Pharmacologic: Route: inhibiting the while or its diarrhea, nausea, the medication may
Aminoalkyl- IV action of patient is componen vomiting cause drowsiness,
substituted histamine at npo ts GU: Acute interstitial dizziness, or fatigue
furan derivative Duration of H2 nephritis, impotence
Administration: receptors on MS: Arthralgia, myalgia  Instruct patient to
Therapeutic: gastric parietal RESP: Bronchospasm avoid taking any new
Antiulcer agent, cells. This SKIN: Alopecia, medication during
gastric action reduces erythema multiforme, therapy without
acid secretion total volume rash consulting prescriber
inhibitor of gastric Other: Anaphylaxis,
juices angioedema  Instruct patient to
and, thus, move slowly and
irritation of GI have an assisstance
mucosa. in rendering
activities
Source: 2018
Jones &
Bartlett
Learning NDH
 65

NAME AND DOSE, ROUTE, MECHANISM INDICATION CONTRAINDI ADVERSE/SIDE NURSING

CLASSIFICATION FREQUENCY AND OF ACTION CATION EFFECTS RESPONSIBILITIES
OF DRUG DURATION OF
ADMINISTRATION
Generic Name: Dose: Binds with
Nalbuphine 5 mg and stimulates  Moderate  Hypersensit CNS: Confusion,  Reassess
kappa and mu to severe ivity to depression, dizziness, patient’s level of
Brand Name: Frequency: opiate pain nalbuphine euphoria, fatigue, pain at least 15-
Nubain Every 6 hours receptors in or its hallucinations, 30 min. After
the spinal cord  Adjunct components headache, parenteral
Pharmacologic: Route: and to nervousness, administration
Phenanthrene IV higher levels balanced  Use restlessness, seizures,  Monitor
derivative in the CNS. In anesthesia cautiosly in syncope, circulatory,
Duration of this way, patient with tiredness, weakness respiratory,
Therapeutic: Administration: nalbuphine GI distress CV: Hypertension, bladder and
Analgesic, alters the and in those hypotension, bowel function.
anesthesia perception of with other tachycardia If breath is <12
adjunct and drug EENT: Blurred vision, cpm withhold
emotional allergies diplopia, dry mouth drug.
response to ENDO: Adrenal  Caution
pain. insufficency ambulatory
GI: Abdominal cramps, patient about
Source: 2018 anorexia, constipa tion, getting out of
Jones & nausea, vomiting bed or walking
Bartlett GU: Decreased libido,  Teach the patient
Learning NDH decreased urine how to manage
output, impotency, troublesome
infertility, lack of adverse effects
menstruation, ureteral of constipation.
 66

spasm
RESP: Dyspnea,
pulmonary edema,
respiratory depression,
wheezing
SKIN: Diaphoresis,
flushing, pruritus, rash,
sensation of warmth,
urticaria
Other: Injection-site
burning, pain,
redness, swelling, and
warmth
 67

NAME AND DOSE, ROUTE, MECHANISM OF INDICATION CONTRAINDI ADVERSE/SIDE NURSING

CLASSIFICATIO FREQUENCY ACTION CATION EFFECTS RESPONSIBILITI
N OF DRUG AND DURATION ES
OF
ADMINISTRATIO
N
Generic Name: Dose: Interferes with gastric  Treatment of  Hypersens CNS: Agitation,  Assess for
Esomeprazole 40 mg acid secretion by GERD- itivity to aggression,depression, hypersensitivit
inhibiting the
hydrogen–potassium–
heartburn and esomepraz dizziness,encephalopa y to any proton
Brand Name: Frequency: adenosine other ole, thy (hepatic), fever, pump inhibitor
Nexium Once a day triphosphatase (H+– symptoms substitute headache,hallucinatio or hepatic
K+–ATPase) enzyme  Short-term d ns, hepatic impairment
Pharmacologic Route: system, or proton treatment for benzimida encephalopathy
pump, in gastric
: IV parietal
erosive zoles, or EENT: Blurred vision,  Obtain
Substituted cells. Normally, the esophagitis their dry mouth, mucosal baseline liver
benzimidazole Duration of proton pump uses  As part of componen discoloration, function tests
Administration: energy combination ts sinusitis, stomatitis, and monitor
Therapeutic: from hydrolysis of treatment for taste disturbance periodically
ATPase to drive H+
and
duodenal ENDO: Gynecomastia during the
chloride (Cl−) out of GI: Abdominal pain; course of
parietal cells and into Barrett’s esophagus; therapy
the benign polyps or  Instruct patient
stomach lumen in nodules; candidiasis; to report secere
exchange for
potassium
Clostridium difficile- headache,
(K+), which leaves the associated diarrhea; worsening and
stomach lumen and constipation; diarrhea; symptoms,
enters parietal cells. duodenitis; dyspepsia; fever, shills,
After this exchange, esophagitis; darkening of
H+ and Cl− combine
in the stomach to form
esophageal stricture, the skin,
hydrochloric acid ulceration, changes in
 68

(HCl). Esomeprazole or varices; flatulence; color of urine

irreversibly inhibits the gastric ulcer; gastritis; or stool.
final step in gastric
acid production by
hepatic failure;  Instruct patient
blocking exchange of hepatitis; jaundice; limit activities
intracellular H+ and microscopic colitis; to those that do
extracellular K+, thus nausea; pancreatitis not require
preventing H+ from GU: Interstitial alertness and
entering the stomach
and
nephritis precision as the
additional HCl from HEME: drug may
forming Agranulocytosis, cause vertigo
pancytopenia and dizziness.
Source: 2018 Jones MS: Bone fracture,
& Bartlett muscle weakness,
Learning NDH myalgia
RESP: Bronchospasm,
respiratory tract
Infection
SKIN: Alopecia,
cutaneous lupus
erythematosus,
diaphoresis, erythema
multiforme,
photosensitivity,
pruritus,
Stevens–Johnson
syndrome, toxic
epidermal necrolysis
Other: Anaphylaxis,
cyanocobalamin
deficiency (prolonged
 69

use),
hypomagnesemia with
or without
hypocalcemia and/or
hypokalemia,
infusion-site redness
or pruritus, systemic
lupus erythematosus,
vitamin B12
deficiency
 70

X. DISCHARGED PLAN

MEDICATION  Advise patient not to skip the medication

that the doctor ordered

 Instruct patient to take prescribed

medications regularly and comply with

the treatment regimen prescribed by the

physician.

 Teach patient regarding the names of the

drug, its dosage, time of administration,

its contraindication and side effects.

 Inform patient and significant others not

to take drugs not prescribed by the

physician, especially OTC drugs.

 Losartan 100mg OD

 Nifedipine 5mg 1 tablet OD in the

evening

 Clopidogrel 75mg 1 tablet OD after

lunch

 Piracetam 1.2 grams 1 tablet OD

 Multivitamins 1 capsule OD

EXERCISE/ENVIRONMENT  Enough rest

 Elevate feet several times a day during

the day

TREATMENT  Daily wound care with chlorhexidine

skin prep twice daily after bath time

 71

 Use of drugs

 Catheterization

 Obtaining labs (CBC, PLATELETS

COUNT, LIVER FUNCTION)

 Instruct client to seek medical help if

any unusualties are felt such as tingling

sensation or paresthesia, fatigue and

body malaise, dizziness, headaches,

irritability, tremors, diaphoresis, etc.

HEALTH TEACHING

 Encourage patient for sodium restriction

 Encourage to avoid foods rich in oils and

fats

 Encourage patient to limit her daily

activities and exercise

 Encourage to avoid Salty, high fat diet,

instead eat healthy foods.

 Advise to continue medicine as

prescribed

 Separate utensils for the mother and

others things that will be used for the

whole family

 Encourage eat high protein foods,

calcium, magnesium, zinc, vitamin c and

 72

 Health Teachings for symptoms mild

and severe pre-ecampsia

OPD FOLLOW UP  Observe carefully for symptoms

 Give instruction about what symptoms

to watch for so she can alert clinician if

additional symptoms occur between

visits.

 Provide information about how to

control the disease.

 Weekly visit with physical therapist

DIET  Instruct client to avoid simple sugars.

Take energy from complex

carbohydrates like unpolished rice, bread

and vegetables.

 Low fats and sodium diet, restriction if

possible

 High in protein, calcium and iron

 Adequate fluid intake

 Eat fresh green healthy leafy vegetables

and fresh fruits

SPIRITUAL  Provide spiritual and eotional support

 Encourage patient to always pray for

fast recovery and attend masses and

never forget to give time for God.

 73

X. UPDATES AND ORGANIZATION

Pregnancy-induced hypertension (PIH) complicates 6-10% of pregnancies. It

is defined as systolic blood pressure (SBP) >140 mmHg and diastolic blood pressure

(DBP) >90 mmHg. It is classified as mild (SBP 140-149 and DBP 90-99 mmHg),

moderate (SBP 150-159 and DBP 100-109 mmHg) and severe (SBP ≥ 160 and DBP ≥

110 mmHg). PIH refers to one of four conditions: a) pre-existing hypertension, b)

gestational hypertension and preeclampsia (PE), c) pre-existing hypertension plus

superimposed gestational hypertension with proteinuria and d) unclassifiable

hypertension. PIH is a major cause of maternal, fetal and newborn morbidity and

mortality. Women with PIH are at a greater risk of abruptio placentae,

cerebrovascular events, organ failure and disseminated intravascular coagulation.

Fetuses of these mothers are at greater risk of intrauterine growth retardation,

prematurity and intrauterine death. Ambulatory blood pressure monitoring over a

period of 24h seems to have a role in predicting deterioration from gestational

hypertension to PE. Antiplatelet drugs have moderate benefits when used for

prevention of PE. Treatment of PIH depends on blood pressure levels, gestational age,

presence of symptoms and associated risk factors. Non-drug management is

recommended when SBP ranges between 140-149 mmHg or DBP between 90-99

mmHg. Blood pressure thresholds for drug management in pregnancy vary between

different health organizations. According to 2013 ESH/ESC guidelines,

antihypertensive treatment is recommended in pregnancy when blood pressure levels

are ≥ 150/95 mmHg. Initiation of antihypertensive treatment at values ≥ 140/90

mmHg is recommended in women with a) gestational hypertension, with or without

proteinuria, b) pre-existing hypertension with the superimposition of gestational

hypertension or c) hypertension with asymptomatic organ damage or symptoms at any

 74

time during pregnancy. Methyldopa is the drug of choice in pregnancy. Atenolol and

metoprolol appear to be safe and effective in late pregnancy, while labetalol has an

efficacy comparable to methyldopa. Angiotensin-converting enzyme (ACE) inhibitors

and angiotensin II antagonists are contraindicated in pregnancy due to their

association with increased risk of fetopathy.

 75

XII. BIBLIOGRAPHY

Berhe A. et al. (2019) Effect of pregnancy induced hypertension on adverse perinatal

outcomes in Tigray regional state, Ethiopia: a prospective cohort study. Retrieved
from:

https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-
2708-6#:~:text=Introduction,1%2C2%2C3%5D.

Gudeta T. & Regassa T. (2019) Pregnancy Induced Hypertension and Associated

Factors among Women Attending Delivery Service at Mizan-Tepi University
Teaching Hospital, Tepi General Hospital and Gebretsadik Shawo Hospital,
Southwest, Ethiopia. Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341446/

Belleza M. (2017) Pregnancy Induced Hypertension. Retrieved from:

https://nurseslabs.com/pregnancy-induced-hypertension/

Wayne G. (2022) 6 Preeclampsia & Gestational Hypertensive Disorders Nursing

Care Plans Retrieved from:

https://nurseslabs.com/preeclampsia-gestional-hypertensive-disorders-nursing-care-

plans/

RNpedia (2022) Pregnancy- Induced Hypertension (PIH; preeclampsia and eclampsia)

Nursing Care Plan & Management Retrieved from:

https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/pregnancy-

induced-hypertension-pih-preeclampsia-eclampsia/

Children Wisconsin (2022) Pregnancy induced hypertension Retrieved from:

https://childrenswi.org/medical-care/fetal-concerns-center/conditions/pregnancy-

complications/pregnancy-induced

Kintiraki E. (2015) Pregnancy Induced Hypertension Retrieved from:

https://pubmed.ncbi.nlm.nih.gov/26158653/
 76

Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unpnursingvc@yahoo.com
CP# 09177148749, 09175785986

Grading System (Case Study)

PARAMETER PERCENTAGE ACTUAL COMPUTATION

WEIGHT GRADE
Introduction and 5%
Objectives
Personal Data
History of Past and Present 5%
Illness
PEARSON Assessment 15%
Diagnostic Procedure
a. Ideal 2.5%

b. Actual 2.5%

Anatomy and Physiology 5%

Pathophysiology
a. Algorithm 7.5%

b. Explanation 7.5%

Management
a. Medical and 5%
Surgical
Management
b. NCP 25%

c. Promotive and 5%
Preventive

Drug Study 5%
Discharge Plan 5%
Updates and Organization 2.5%
Bibliography 2.5%
Total 100%