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Case Study

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Pregnancy Induced Hypertension

By Artyom Granovskiy 4945131

vGestational age 36+3 weeks vDx: Pregnancy Induced Hypertension vFocus on Gestational hypertension and its effect on mother and fetus vDiscus in 2 parts: Theory & Case Study  .Introduction vThe Patient is 36 years old Thai female.

Circulatory system  .

Systemic or arterial blood pressure. Diastolic pressure is the minimal pressure exerted against the arterial walls at all times  . the blood pressure in the system of arteries in the body. When the ventricle relax the blood remaining in the arteries exert to minimum or diastolic pressure. The peak of maximum pressure when ejection occurs is the systolic blood pressure.Definition of Blood Pressure Blood pressure is the lateral force on the walls of an artery by the pulsing blood under pressure front the heart. is a good indicator of cardiovascular health.

4. 2. Cardiac output Peripheral vascular resistance Blood volume Blood viscosity Artery elasticity . 5. 3.Physiology of Arterial Blood Pressure Blood pressure reflects the interrelationships of      1.

Hypertension Is the most common alteration in blood pressure is hypertension. . Hypertension is an often asymptomatic disorder characterized by persistently elevated blood pressure. The diagnosis of hypertension in adults is made when an average of two or more diastolic readings on at least two subsequent visits is 90 mmHg (diastolic hypertension) or higher or when the average of multiple systolic blood pressures on two or more subsequent visits is consistently higher than 135 mmHg (systolic hypertension).

complicating 2-3% of pregnancies. Hypertensive disorders during pregnancy are classified into 4 categories Chronic hypertension Preeclampsia Eclampsia Gestational hypertension .Hypertension in Pregnancy Hypertension is the most common medical problem encountered during pregnancy.

blood pressure elevations usually represent chronic hypertension.Chronic hypertension ØChronic hypertension is defined as blood pressure exceeding 140/90 mm Hg before pregnancy or before 20 weeks' gestation. When hypertension is first identified during a woman's pregnancy and she is at less than 20 weeks' gestation. .

proteinuria 3+ to 4+ or 5 g in 24 hrs. altered kidney function. proteinuria 1+ to 2+. weight gain 2 kg week at third trimester. extensive peripheral edema.  Severe preeclampsia: BP 160/110 mm Hg. mild edema in upper extremities or face. Preecl p si am a S e i re s o r co m a a cco m p a n i d b y si n s a n d sym p to m s o f zu e g p re e cl m p si a a . blurred vision) pulmonary or cardiac involvement. oliguria (500 cc or less in 24 hrs). serum Creatinine elevated more than 1. thrombocytopenia. Mild preeclampsia:  Preeclampsia BP 140/90 or systolic pressure elevated 30 mm Hg or diastolic pressure 15 mm Hg above pre pregnancy level. CNS or visual disturbances (headache. hepatic dysfunction. epigastric pain.2 mg/dL.

Gestational hypertension  Blood Pressure 140/90 mm Hg or systolic pressure elevated 30 mm Hg or diastolic pressure elevated 15 mm Hg above pre pregnancy level. blood pressure returns to normal after birth. no proteinuria or edema. .

Case Study  Name :  Sex : Female  Age : 36  Visit to ANC clinic : 3 November 2010  Diagnosis : PIH  Nationality : Thai  Language : Thai  Religion : Buddhist  Marital status : Married  Occupation : N/A  Allergic : N/A  Education : bachelor degree  Family disease : not applicable  .

Date of delivery. with baby’s weight 1. The last pregnancy was 3 and a half years ago. During second pregnancy she had spontaneous abortion at GA around 6 months. abortion 15.900 gm Healthy Spontaneous abortion NL 3 17.Health history :  Family history : no  Past history: no  Past surgery / accident: no  Allergies / reaction : no known allergies  Obstetrical history : The patient had her first child at 29+ weeks gestation.2003 Abnormal antepartum Gestational age Place/ type Complication Baby’s Sex/ weight Infant labor condition at health birth 29+ Glarng Underweight Girl 1.03.700 gm. Preg.03.700 gm Healthy remark 1 NL 2 2004 Around 6 months 40 weeks Ngaung Jok Nopparat Girl 3.2007 .  No.

= 160/90 mmHg  Edema : legs and ankles  Breasts. 2010 (by U/S)  Date of quickening : at around fifth month  Current symptoms  : no have Physical examination  Height: 159 cm.: present  Vaginal examination: - .  E.S.H. duration 3 days  L.  Weight before pregnancy: 60 kg  Weight of today 79 kg  B.M.P. nipples : normal  Abdominal examination  Height of fundus: 3/4 above umbilicus  Position: LOA  Engagement: engage  F.C. November 21st.D.P.Assessment  Current pregnancy:  Menstrual period every 28 days.

2. Bed rest  ** observing point: elderly gravida. 3. 170. NST: to a monitor and evaluates the fetal heart rate with fetal movement. Gestational age: 36+3 weeks  2. Fetal position: normal  3. 148. the fetus may not be receiving enough oxygen.4% Urine (protein and sugar): negative VDRL (RPR): non reactive  HBSAg: negative  GLT  OGTT: 70.Laboratory finding Anti HIV: non reactive Blood group: A+ Hct: 34. Consulting with physician about PIH and fetus. Gestational Hypertension  Treatment: 1. grand multipara. If they're absent. 134  Diagnosis: 1.      .

height of presentation ache ea r mov orrh nal mp ary syste vissi eme ea blee syste m on nt din m g fundus FHS GA (week) diagnosis& next visit examinati (mmHg ) on Alb/Sug.P. head naus blur fetal leuk edema vigi cra urin G.5 79 N/N 150/80 142/79 160/90 neg N/N N/N 134/74 152/8 9 treatment 2/3>PS - 19 20 =O= ¾>O 4/4>O 3/4>O LOA LOA LOA LOA 22 NST = R 32 36 NST = R NST = R .ANC Date weight urine B.I. 10/06/10 17/06/10 1/07/10 6/09/10 13/10/10 27/10/10 75 75.1 78.7 76.7 78.

no proteinuria or edema. -Treatment No treatment necessary Rest No restriction in sodium intake .Signs and symptoms .Comparing the case to the theory Theory Case study Pregnancy Induced Pregnancy Induced Hypertension Hypertension .Cause and risk factors Multiparity * Multiparity Elderly pregnancy * Elderly pregnancy     .Signs and symptoms Blood Pressure 140/90 mm Hg or systolic Elevated Blood pressure 160/90 pressure elevated 30 mm Hg or diastolic No proteinuria pressure elevated 15 mm Hg above pre Edema at feet and ankle 1+ pregnancy level.Cause and risk factors . blood pressure returns to normal after birth.

3. Promote positive maternal/fetal outcome.    . 2. Prevent or reduce progressive fluid accumulation and other complications. 4. and placental status. fetal. Monitor maternal. Provide information to enhance self-care and therapeutic management.Nursing care plan Nursing priorities 1.