Iloilo Doctors’ College

College of Nursing
West Avenue, Molo, Iloilo City
NCM 109 RLE
Care of Mother, Child at Risk
Or with Problems (Acute and Chronic)

Case Scenario #4 PREGNANCY INDUCED HYPERTENTION (PIH)

This is a case of patient E.L. 29-year-old, married, G2P1L1 37 4/7 gestation was admitted to OB unit due
to increase of BP 180/110, in two occasion, sudden onset of severe headache and vomiting.
Upon assessment vital signs show T-37.4 ͦC, PR-84 bpm, RR-18 cpm, BP160/110 mmHg at right arm
supine. She is oriented to time and place, looks apprehensive, epigastric pain noted, no visual
disturbances, no vaginal bleeding, no known drug allergies, positive moderate pedal and peri-orbital
edema. She was given Labetalol (Trandate) 200mg PO Stat as ordered. A few hours later her BP
decreases to 150/110mmHg. The patient was advised for blood pressure stabilization and possible
induction of labor.
Physical examination: Breast is normal in size and shape; Heart and lungs are normal, abdomen is
globular and distended, umbilicus is inverted, linea negra is prominent, fundal height upon palpation
corresponds to 36 weeks gestation about 34 cm., uterus was relaxed & non tender with single life fetus
in cephalic presentation, FHT is 144 bpm via doppler. DTR hyperreflexia +3 noted.
2 days PTA she complained of frontal headache but was relieved by rest. She has a history of increase
blood pressure in her previous pregnancy but controlled which spontaneously she delivered full term.
E.L. is a housewife who loved to cook and fun of eating salty food. Her mother is known diabetic and her
father died in renal failure. E.L. started her menarche at the age 14-year-old with 28 to 30 days regular
cycle at 7 days duration of menses.
During admission Dr. Luis ordered venoclysis of PLR 1L @ 8 hrs. with side drip of D5W 500 cc + 2
ampules of Apresoline and 2 ampules of clonidine 150 mcg/1ml ampule regulated @ 10 drops per
minute to titrate for BP of 140/90mmHg. She is for BP monitoring every 2h for 24 hours and place on
bed rest.

Laboratory test requested. Result shows: Hgb 14.5g/dl; WBC 10; Neutrophil = 60; Lymphocytes =38;
Eosinophil = 02; Hb = 9mg/dl; Platelet count = 86,000/cumm; Blood typing = “A” negative. Coagulation
Profile: BT = 10 min; CT = 14 min; INR = 9.0. Biochemistry: Urea = 25 mg/dl; Creatinine = 1.1 mg/dl;
Sodium = 142 mmol/dl; Potassium = 2.9 mmol/dl; Bilirubin Total = 4.76 mg/dl; Bilirubin Direct = 3.2
mg/dl; SGOT(AST) = 1837 u/l; SGPT (ALT) = 913 u/l; Total Protein = 7.2 gm/dl; Albumin = 4.8 gm/l; LDH =
2057 iu/l; RBS = 83 mg/dl; Uric acid = 4.7 mg/dl. Urinalysis: Reaction: Alkaline; Color = yellow; Epi cells =
16 – 18/hpf; RBC = 10 – 12/hpf; WBC = 14 – 16/hpf; Albumin = 3+. 24-hour urine protein: positive. Latest
scan at 38 1/7 weeks shows all parameters are corresponding to date. it was a singleton fetus on
longitudinal lie and cephalic presentation. Fetal heart rate is 150 and fetal movements are seen.
Amniotic fluid index is 11. Estimated fetal weight was 3.3 kg and placenta were on anterior upper
segment.

On the next day, 7:15am, Bishop’s Score was done and result was 2/13. First 3mg of Prostin tablet was
inserted into the posterior fornix. CTG was then done after 1hour. The abdomen and cervix will be
reassessing in 6hours time. Labetalol 200mg was continued and signs and symptoms of impending
eclampsia (IE) were monitored.
Six hours later, she had 2 contractions in 10 minutes and it was moderate. Her BP on lying was 110/90
mmHg and 120/90mmHg on sitting, well controlled BP. Vaginal examination revealed cervix dilated to
1cm, os was 3cm membrane intact and at station -2.

2 hours later, the contraction was 3 in 10minutes and no leaking liquor. Vaginal examination showed
1cm cervix, 4cm os. Artificial Rupture of Membrane (ARM) was done. Clear liquor was noted. Patient
was in active phase of labor and was sent to the labor room for delivery. One and a half hour later,
patient complained of having strong contraction and felt the urge to bear down.IE done revealed fully
dilated at 10cm.

She delivered to a baby boy weighing 2.53kg with Apgar score of 8 in 1minute and 9 in 5minutes. The
patient developed first degree tear; placenta was complete weighing 590gm.

In the ward, day 1 post SVD she was alert, conscious, and comfortable and was not pale. Her BP was
120/80mmHg which was normal and her pulse rate was 96beats per minute. She was afebrile.
Abdominal examination showed that her abdomen soft and non-tender. The uterus was well contracted
at 18weeks in size. The lochia was normal. Breastfeeding was established and she was ambulating well.
The patient can tolerate orally and had pass urine and bowel movement.

BP was stabilized, discontinued from labetalol. She was then discharged with the Final diagnosis of Pre –
eclampsia with HELLP syndrome. She was advised to come back for follow – up after 2 weeks. Take
medications of Ferrous sulfate 1 tablet OD; Ponstan 1 tablet Q8H PRN and Lactulose syrup15 ml.

Diagnostic Laboratory:

A Blood test and Urinalysis was done to the client. Blood test are used to measure or examine
cells, chemicals, proteins, or other substances in the blood. Client’s laboratory results confirm
Pregnancy-Induced Hypertension (PIH). Showing abnormal results her Creatine level is above
normal 1.1mg/dl. Platelet count is low Platelet count = 86,000/cumm SGOT(AST) is high
showing = 1837 u/l. She is Positive in 24-hour urine protein.

Questions:

1. What is the meaning of PIH?

- Pregnancy-induced hypertension (PIH) is a form of high blood pressure in
pregnancy. It occurs in about 7 to 10 percent of all pregnancies. Another type of
high blood pressure is chronic hypertension - high blood pressure that is present
before pregnancy begins.
2. What are the classification of PIH?
 - PIH is classified as gestational hypertension (GH), preeclampsia (PE),
superimposed preeclampsia (S-PE) or eclampsia (E).
3. What are the contributing factors that lead to the development of this
condition?
Preexisting diseases before pregnancy can predispose to PIH. These diseases
are diabetes, high blood pressure, kidney disease, and family history.

4. What are the significant laboratory findings results presented that confirm
the diagnosis? Correlate with the case of the patient.
The significant laboratory results that confirmed client’s PIH are: Creatine level is above normal
1.1mg/dl. Platelet count is low Platelet count = 86,000/cumm SGOT(AST) = 1837 u/l; And she is
positive in 24-hour urine protein.
5. What are the signs and symptoms of PIH and at what age in weeks does it
appear?
- The signs and symptoms of PIH are high blood pressure, excess protein in urine,
decreased level of platelets in blood Shortness of breath, caused by fluid in the
lungs and sudden onset of severe headache and vomiting.
6. Discuss the pathophysiology of the disease. Make a schematic diagram
7. What are the complication of PIH?
8. What is HELLP Syndrome?
9. E.L. is advised for induction of labour. What does it mean?
10. What is the significance of Bishop Score in pregnancy?
11. The patient verbalize her feelings “I am worried to loss my baby”. What
would be your response?
12. What the recommended treatment for PIH?
13. What are the nursing management for PIH?
14. Identify at least two nursing diagnosis and make a nursing care plan.