Saint Gabriel College

Old Buswang, Kalibo, Aklan

Flexible Alternative Learning Activities for the Related

Learning Experience during the Covid -19 General
Community Quarantine

BSN-2 SECOND SEMESTER AY 2022-2023

2nd Shifting

Case Presentation

In

NCM 109: CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS

(ACUTE AND CHRONIC)

Pregnancy induced hypertension (Mild pre eclampsia)

Presented by: Rainier T. Ibarreta

Presented to: Mrs. Elfa R. Tubao RN, MAN

 INTRODUCTION

Preeclampsia (PE) is a most frequently encountered renal complication of

pregnancy and it is characterized by hypertension, proteinuria and edema, usually
by the last trimester of pregnancy. The rate of incidence varies upon the study
population but generally ranges from 3% to 7% of all pregnancies. It occurs manly
in the women in their first pregnancies or to those who carry twins. PE when
remains untreated, it moves towards more serious condition known as eclampsia,
and is still one of the leading causes of maternal and neonatal mortality. It takes
place only in the presence of placenta even without fetus (hydatidiform mole), and
typically improves postpartum. Hypoperfusion and ischemic conditions evidently
show the abnormal placenta. PE is known to be originated from disordered
vascular development of the placenta which further widely spreads anti-angiogenic
factors into the maternal circulation and causes a systemic endothelial cell
dysfunction and microangiopathy. Upon kidneys these endothelial damages result
in glomerular endotheliosis and proteinuria in which the endothelial cells of the
glomerulus swell and endothelial fenestrations are lost

As mentioned above, the untreated complication of PE is eclampsia. It is defined

by the presence of seizures for which women are often treated with magnesium
sulfate prophylaxis.The clinical findings of sever PE are assorted by the presence
of systemic endothelial dysfunction and microangiopathy, the liver (hemolysis,
elevated liver function tests and low platelet count, namely HELLP syndrome) and
the kidney (proteinuria).

Hypertensive disorders of pregnancy account for 36.7% of all maternal deaths in

the Philippines, which is much higher than the worldwide rate of 18%. Included
among these hypertensive diseases affecting pregnant women is preeclampsia, a
severe and diverse disorder that is associated with life-threatening multi-organ
maternal complications and which causes serious feto-placental problems. It
accounted for 22.5% of hypertensive patient admissions at the hospital where this
study was conducted.
 Saint Gabriel College
Old Buswang, Kalibo, Aklan

Case Study for BSN 2, 2nd Shifting

CASE SCENARIO

Rica, a 16-year-old female G1P0 at 33 weeks gestation, residing at barangay old

Buswang, Kalibo Aklan. She was late to receive prenatal care and has only her Mom
as a support person. She is under weight for her current gestation. The father of her
baby is in and out of her life and cannot be relied upon for support.

She was admitted yesterday to labor and delivery with a BP of 150/ 90 mm Hg ,

HR 82 beats per minute, RR 20 breaths per minute , T= 97.9 degrees Fahrenheit, FHR
150's. No complains of uterine contractions and membranes are intact. On admission,
she denied headache, visual changes and epigastric pain. She had mild pedal edema.
She was admitted with a diagnosis of Preeclampsia and was started on Magnesium
sulfate with a 4gm loading dose followed by 2/gm/hr. maintenance dose. She was
transferred to the post- partum unit this morning, for continued observation and
completion of a 24-hour urine collection.

Based on the scenario stated above, answer the following questions.

1. What is the final medical diagnosis? Discuss your answer. = 5%

2. Discuss the pathophysiology of the health condition identified. Present your
pathophysiology in schematic diagram. = 15%
3. Formulate 2 NCP (top priority problem) after having identified 5 nursing problem.
= 20 %
4. Make a drug study as mentioned in the case scenario. = 10 %
5. What is the purpose of the 24 hour urine collection? = 5%
6. What will be your health teachings appropriate to patient’s health needs =. 5%
General Objective:

At the end of the 2nd shifting, I will be able to acquire knowledge, basic skills,
developed demonstrate right attitude towards giving care and utilizing the nursing
process giving care on regarding high risk care patient

Specific Objective:

After the online oral revalida I will be able to:

Knowledge:

 Define terminologies related to our concept.

 Identify health problems on the given scenario.
 Formulate appropriate nursing care plan for a high risk patient and evaluate
outcome of achievement and effectiveness of care.

Skills:

 Enhance my critical thinking analysis and skills on demonstrating on how to

perform Intra muscular and subcutaneous injection.
 Develop my researching skills using books and technology.
 Improve my oral and written communication skills

Attitude:

 Enhance/ develop self confidence to present the case study thru oral
revalida

 Show a proper positive attitude on achieving the objectives of this case

study.

 Develop time management in doing this case study and submit the output on
time.
BIOGRAPGHICAL DATA

Name: Rica

Age: 16

Gender: Female

Address: Baranggay Old Buswang, Kalibo, Aklan

Vital Signs:

BP: 150/90mmHg

RR: 20breaths/min

PR: 82beats/min

Temperature: 97.9 degrees Fahrenheit

Chief complaint:
“Medjo namamanas yung dalawang paa ng anak ko” as reported by her mother and the
patient was underweight.

History of present illness:

The patient was admitted yesterday to labor and delivery with a BP of 150/ 90 mm Hg , HR 82
beats per minute, RR 20 breaths per minute , T= 97.9 degrees Fahrenheit, FHR 150's. No
complains of uterine contractions and membranes are intact. On admission, she denied
headache, visual changes and epigastric pain. She had mild pedal edema. She was admitted
with a diagnosis of Preeclampsia and was started on Magnesium sulfate with a 4gm loading dose
followed by 2/gm/hr.

Obstetric History:

The patient Rica is 16-year-old female G1P0 at 33 weeks gestation

Nursing Problems

1. Decrease cardiac output

2. Deficient knowledge

3. Risk for Deficient Fluid Volume

4. Imbalanced Nutrition: Less than Body Requirements

5. Risk for injury

1. What is the final medical diagnosis? Discuss your answer.
The patient was admitted yesterday to labor and delivery with a BP of 150/ 90 mm Hg, T= 97.9
degrees with slight mild edema and was Diagnosed of Pre eclampsia.

The final diagnosis is Mild Pre eclampsia

Mild preeclampsia: high blood pressure, water retention, and protein in the urine.

2. Discuss the pathophysiology of the health condition identified. Present your

pathophysiology in schematic diagram.

5. What is the purpose of the 24 hour urine collection?

A 24-hour urine collection helps diagnose kidney problems. It is often done to see how much
creatinine clears through the kidneys. It’s also done to measure protein, hormones, minerals, and
other chemical compounds.

6. What will be your health teachings appropriate to patient’s health needs?

Maintaining a regular exercise routine
Promote bed rest
Eating healthy foods that are low in salt and
avoiding caffeine.
Exercise helps reduce the risks associated with
hypertension and preeclampsia
Staying in bed and lying on her left side will
increase her need to urinate.
Caffeine could block a hormone that helps keep
your arteries widened.

Promote nutritious intake Patient needs a diet moderate to high in protein

and moderate in sodium to compensate for the
protein she is losing in the urine.
REFERENCES:

 Maternal & Child health nursing (care of the child bearing &childrearing family) Eight
edition
 https://www.mayoclinic.org/diseases-conditions/preeclampsia/diagnosis-treatment/drc-20355751
 Nurse’s pocket guide 15th edition
 https://www.themedicalcity.com/index.php/news/pre-eclampsia-screening-new-
studies#:~:text=In%20the%20Philippines%2C%20preeclampsia%20and,for%20both%20mother
%20and%20baby.
 https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/pregnancy-induced-
hypertension-pih-preeclampsia-eclampsia/