TABLE OF CONTENTS

CASE STUDY

GENERAL OBJECTIVES

SPECIFIC OBJECTIVES

OVERVIEW OF THE CASE STUDY

A. TERMINILOGIES

B. INTRODUCTION

C. ANATOMY AND PHYSIOLOGY

D. PATHOPHYSIOLOGY

E. MEDICAL AND SURGICAL MANAGEMENT

F.NURSING MANAGEMENT

G.NURSING CARE PLAN

H. DRUG STUDY

I.LABORATORY FINDINGS AND INTERPRETATIONS

J.READINGS WITH SUMMARY AND REACTION

GENERAL OBJECTIVES

Within 2 hours of case presentation that was designed to developed a holistic and patient
centered nursing care and responsibilities . This is to be broaden my knowledge as the
presenters as well as the audience with regards to Pneumonia ; this is also designed to
enhance skills and attitudes in the application of nursing process and management and disease.

SPECIFIC OBJECTIVES

After 30 minutes of case presentation , I will be able to have a better understanding of the
disease processes.

1. To be familiarize with the role of the Nurse in having a patient with pregnancy induced
hypertension

2. Acquire knowledge and skills that can be used in the future as nurse.

3. To practice some procedures related to the condition of the patient.

4. Identify the factors that causes the Disease.

5. To be able to formulate nursing care plan for pregnancy induced hypertension

6. To enhance our skills as a student nurse.

 JOVERVIEW OF THE STUDY

A. TERMINOLOGIES

Pregnancy Induced Hypertension - is a unique disorder that occurs with pregnancy with three classic
symptoms, hypertension , edema , and proteinuria . It is categorized as preeclampsia or eclampsia.

Premature cervical dilation - occurs when the cervix dilate early in pregnancy before viability of the
fetus .
B. INTRODUCTION

The Pregnancy- Induced Hypertension (PIH) is a condition in which vasospasm occurs during pregnancy
in both small and large arteries.

Pregnancy Induced Hypertension it occurs 5 to 7 percent of pregnancies. Originally it was called

toxaemia because researchers pictured a toxin of some kind being produced by a woman in response to
the foreign of the growing fetus, the toxin of some kind being produced by a woman in response to the
foreign protein of the growing fetus , the toxin leading to the typical symptoms. No such toxin has ever
been identified.

PIH is known as HELLP syndrome defined by hemolysis ,elevated liver enzymes, and low platelet count
which occurs in about 2% of clients with PIH.

CLASSIFICATION

Gestational Hypertension

 A woman is said to have gestational hypertension when she develops an elevate blood pressure
(140/(90 mm Hg) but has no proteinuria or edema.
 Perinatal Mortality is not increased with simple gestational hypertension, So no drug therapy is
necessary.
Mild Preeclampsia

 A woman said to be mildly preeclampsia when her blood pressure rises 140/90mm Hg, taken on
two occasions at least 6 hours apart.
 A second criterion is systolic blood pressure greater than 30mm Hg and diastolic pressure
greater than mm Hg.

Severe Preeclampsia

 a woman passed from mild to severe preeclampsia when her blood pressure has risen to 160
mm Hg systolic and 110 mm Hg Diastolic or above on at least two occasions 6 hours apart at
bed rest.
 With severe preeclampsia the extreme edema will be noticeable as puffiness in a womans face
and hands.

Eclampsia

 The most severe classification of PIH. A woman passed into the stage when cerebral edema is so
acute that a a seizure or coma occurs.
 With eclampsia the maternal mortality rate is high as 20% from causes such as cerebral
haemorrhage, circulatory collapse , or renal failure.

RISK FACTORS

 Women of color. Hypertension is most common to these women due to genetic make up their
race.
 Multiple Pregnancies. Women who have undergone multiple pregnancies are more
compromised with hy\pertension.
 Primiparas who are 20 years and older. This group has a increased risk for pregnancy induced
ypertension than women who are old and above.
 Women from low socioeconomic backgrounds. These women may have a poor diet due to their
low socioeconomic background , which could greatly to hypertension.
 Underlying disease. This might contribute to the occurrence of pregnancy induced
hypertension.
 Etiology

 Exact mechanism not known

 Immunologic
 Genetic
 Placental ischemia
 Endothelial cell dysfunction
 Vasospasm
 Hyper-responsive response to vasoactive hormones
(e.g. angiotensin II epinephrine)

Signs and symptoms

 Increased blood pressure
 Absence or presence of protein in the urine to diagnose gestational hypertensions or
preeclampsia
 Edema or swelling
 Sudden weight gain
 Visual changes such as blurred or double vision
 Nausea , vomiting
 Urinating small amounts

Causes
Pre existing hypertension ( high blood pressure)
Kidney disease
Diabetes
Mother’s age younger than 20 or older than 40
Gestational Hypertension
Mild preeclampsia
Severe preeclampsia
Eclampsia
 Complications

Complications of PIH:
1. Intrauterine growth restriction (IUGR) – an abnormally restricted
symmetric or asymmetric growth of fetus
2. Oligohydramnios – abnormally low volume of amniotic fluid
3. Risk of placental abruption – premature separation of a normally situated
placenta from the wall of uterus
4. Risk of preterm delivery (often iatrogenic) – delivery before 37 weeks of
gestation
5. Coagulopathy
6. Stillbirth
7. Seizures
8. Coma
9. Renal failure
10. Maternal hepatic damage
11. Hemolysis
12. Elevated liver enzymes levels
13. Low platelet count (HELLP syndrome)
Anatomy and Physiology
 Vasospasm

Vascular effects Kidney effects Interstitial

effects

Vasoconstriction Decreased glomeruli filtration

rate and increased Diffusion of fluid from
permeability of glomeruli bloodstream into
membranes interstitial tissue

Poor organ
perfusion
Increased serum blood urea
nitrogen,uric acid,and
creatinine Edema

Increased
blood pressure
Decreased urine output and
proteinuria
Drug study

Drug Indication Dosage

Magnesium Sulfate Muscle relaxant , Loading dose 4-6 g Infuse loading dose
Pregnancy risk prevents seizures maintenance dose 1- slowly over 15 -30
Category B 2 g/h IV min.
Always administer
piggyback infusions.
Assess respiratory
rate , urine , output ,
deep tendon reflexes
, and clonus every
hour .
Keep in mind that
urine output should
be over 30 mL \Hour
respiratory rate over
12/min . Serum
magnesium level
should remain below
7.5 mEq/L
Observe for CNS
depressions and
hypotonia in infant at
birth.

Hydralazine Antihypertensive 5-10 mg\IV Administer slowly to

(Apresoline ) ( peripheral avoid sudden fall in
Pregnancy risk vasodilator ) used to blood pressure.
category C decrease
hypertension Maintain diastolic
pressure over
90mmhg to ensure
adequate placental
filling .
Diaezepam Admineter slowly .
( Valium ) Halt seizure Dose may be
Pregnancy risk repeated q 5-10 min (
category D up to 30 mg /hour

Observe for
respiratory
depressions or
hypotension in
mother and
respiratory
depression and
hypotonia in an
infant birth.

Calcium gluconate Antidote for 1 g/IV ( 10 mL of a Have prepared at

Pregnancy risk magnesium 10% solution ) bedside whe
Category C Intoxication administering
magnesium sulphate

Administer at 5 mL /
min.
 Nursing Care Plan

ASSESSMENT NURSING PLANNIING NURSING RATIONALE EVALUATION

DIAGNOSIS INTERVENTION
Assess vital signs *Ineffective *Promote Bed *Recumbent * To avoid
especially blood tissue perfusion Rest position, uterine pressure
pressure of related to sodium tend to on the vena cava
140/90 mm Hg vasoconstriction be excreted at and p revent
of blood vessels a faster rate supine
than during hypotension
activity. Bed syndrome.
rest is the best
 method of
aiding
increased
evacuation of
sodium.

*Deficient fluid *Provide Good * A patient *assess if a

volume related Nutrition needs to woman has
to fluid loss to continue her someone to help
subcutaneous usual her prepare
tissue pregnancy food or either
nutrition. At bed restor
one time nutrition may be
restriction of compromised.
salt was
advised in
order to reduce
edema.

*Risk for fetal * Provide

injury related to Emotional
reduced support
placental
perfusion
secondary to
vasospasm