NORTHERN LUZON ADVENTIST COLLEGE

Artacho, Sison, Pangasinan, PHILIPPINES

A SEVENTH-DAY ADVENTIST INSTITUTION
School of Nursing

www.nlac.edu.ph

Name: Joshua Carmelo I. Aquino

Year Level: II
Section: A
Problem: Pregnancy Induced Hypertension

ASSESSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION

DIAGNOSIS

SUBJECTIVE: Gestational After 1 day of -Monitor vital signs, -Blood pressure GOAL MET
“Madalas po akong Hypertension nursing especially blood may fluctuate and
nahihilo at interventions, the pressure spike quickly; After 1 day of
nanlalabo mata ko, patient will be able monitor for nursing
sumasakit din dito to: changes and interventions, the
sa bandang kanan elevations patient was able to:
ng tyan ko” as -remain
verbalized by the normotensive -Monitor fetal -Observe for signs -remain
patient throughout the heart rate (FHR) and symptoms of normotensive
remainder of the fetal distress due to throughout the
pregnancy maternal blood remainder of the
OBJECTIVE: pressure, pregnancy
BP – 150/110 mmHg -have effective decreased
PR – 95 bpm breathing pattern placental blood -have an effective
RR – 15 cpm flow and lack of breathing pattern
SPO2 – 95% -have a pain scale oxygenation
T – 36.8°C rating of 3/10 -have a pain scale
 NORTHERN LUZON ADVENTIST COLLEGE
Artacho, Sison, Pangasinan, PHILIPPINES
A SEVENTH-DAY ADVENTIST INSTITUTION
School of Nursing

www.nlac.edu.ph

rating of 3/10
-Pain scale rating of -have a decreased -Assess for signs of -Some swelling is
7/10 swelling of face, progressive or normal in -have a decreased
hands, feet excessive edema pregnancy, but swelling of face,
-Swelling of face, pitting edema is hands, feet
hands, feet different and can
be a significant sign
of decreased
cardiac output

-Provide frequent -Improves venous

rest periods with return, cardiac
bed rest. Restrict output, and renal-
activity rather than placental perfusion.
instituting Help the client
complete bed rest understand the
importance of
reduced activity
and frequent rest
periods and plan
ways to manage
them

-Administer -Antihypertensive
antihypertensive may help decrease
medications as diastolic pressure
ordered. Observe and increase blood
 NORTHERN LUZON ADVENTIST COLLEGE
Artacho, Sison, Pangasinan, PHILIPPINES
A SEVENTH-DAY ADVENTIST INSTITUTION
School of Nursing

www.nlac.edu.ph

for side effects of flow to vital organs

antihypertensive
drugs