Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City, Ilocos Sur

COLLEGE OF NURSING

A Study on the Case of

Obstetric Client

In Partial Fulfillment of the Requirement in

Related Learning Experience
(Ilocos Sur Provincial Hospital Gabriela Silang)

Presented by:
NEO KYLE R. QUARTO

Presented to:
MRS. MARITES T. TALANIA, RN

2021
 Table of Contents
I. Introduction……………………………………………………

II. Objectives (General & Specific)……………………………….

III. Patient’s Data…………………………………………………..

IV. Health History………………………………………………..

V. Diagnostic Exams and Procedures…………………………….

VI. Anatomy and Physiology…………………………..................

VII. Nursing Care Plan…………………………….…………..

VIII. Drug Study…………………………………………………….

IX. Discharge Plan (M. E. T. H. O. D.)…………………………...

X. Updates………………………………………………………..

XI. Bibliography…………………………………………………..
I. INTRODUCTION

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, a high blood pressure that is present before

pregnancy begins.

Pregnancy-induced hypertension is also called toxemia or preeclampsia. It

occurs most often in young women with a first pregnancy. It is more common in twin

pregnancies, and in women who had PIH in a previous pregnancy.

Women with pregnancy-induced hypertension (PIH) are at increased risk for

preeclampsia, cesarean delivery, renal dysfunction, and placental abruption.

Associated risks to the fetus include intrauterine growth restriction, preterm delivery,

low birth weight, and neonatal ICU admission. Ongoing monitoring for increased

hypertension and proteinuria, consideration of expectant management or labor

induction, and appropriate use of antihypertensive therapy are essential components in

the management of women with PIH.

Preeclampsia is a pregnancy complication characterized by high blood

pressure and signs of damage to another organ system, most often the liver and

kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose

blood pressure had been normal. Preeclampsia can also lead to eclampsia, a serious

condition that can have health risks for mom and baby and, in rare cases, cause death.

If preeclampsia leads to seizures, you may have eclampsia. The only cure for

preeclampsia is to give birth. Even after delivery, symptoms of preeclampsia can last

6 weeks or more.
II. OBJECTIVES

General Objectives:

The main goal of this study is to educate nursing students about the risks of

multiparous women. It focuses on Pregnancy Induced Hypertension and Cesarean

Delivery in particular. It aims to strengthen the student’s critical thinking and analysis

skills to prepare them in a hospital situation. This will guide the student nurse to gain

a better understanding of Multiparous women in order to provide a personalized

nursing care and attain high quality care for the patient as well as the entire family.

Specific Objectives:

The following are the specific objectives of the study:

Student-Centered Objectives:

● To develop and maintain a positive relationship between the student and the

patient to provide high-quality care.

● To identify minor and major discomfort related to Pregnancy Induced

Hypertension.

● To gain specific information and develop expertise in identifying critical

problems.

● To evaluate overall nursing care and interventions given to the patient.

Patient-Centered Objectives:

● To be able to assess the patient properly.

● To acknowledge the signs and symptoms of complications in the course of

pregnancy.
 ● To be able to gather the patient’s past and present health history taking into

account the patient’s confidentiality,

● To be able to provide nursing care that aids in the improvement of the

patient’s condition.

● To provide health teachings that would help the patient understand the

condition and take steps to prevent further complications.

Family-Centered Objectives:

● To provide health teachings to patient’s family in order for them to understand

the patients situation.

● To provide emotional support to the patient’s family.

III. PATIENT’S PROFILE

Name: Jacky Frost

Gender: Female

Age: 36

Birthdate: N/A

Place of Birth: N/A

Address: N/A

Status: Married

Religion: Roman Catholic

Height: N/A

Weight (present): N/A

Educational Attainment: N/A

Occupation: Call Center Agent

Clinical/ Admitting Data:

Chief complaint/s: Severe epigastric pain, moderate headache

(describes as throbbing with a rating of 6/10)

Date of admission: N/A

Time of admission: N/A

Hospital & Hospital Number: Ilocos Sur Provincial Hospital- Gabriela Silang
Ward [Room & Bed Numbers]: OB-13

Attending Physician: N/A

Admitting Diagnosis: N/A

Pre-Op Diagnosis: N/A

Vital signs on admission:

Temperature: 37.4°C

Pulse Rate: 67 bpm

Respiratory Rate: 22 cpm

Blood pressure: 220/137 mmHg

Glasgow Coma Scale: 14/15

IV. HISTORY OF PAST AND PRESENT ILLNESS

History of Present Illness

The patient is currently on her third pregnancy and had a complete prenatal

visit. She is diagnosed with pregnancy-induced hypertension (PIH) and was

prescribed with Methyldopa 250mg to be taken three times a day. The patient was

rushed to the hospital due to severe epigastric pain, moderate headache, which she

describes as throbbing and rated it as 6 on a scale of 1 to 10. She took acetaminophen

to relieve the pain, but no relief was availed. Upon assessment, the patient has edema

on both hands and feet. Bilateral edema was pitting, with a score of 3+. The edema of

the hands is non-pitting, with a score of 2+. Eye assessment suggests that she has

slightly impaired visual acuity but the patient has no history of eye impairment. She is

slightly diaphoretic. No discoloration of the conjunctiva, nail beds of oral mucosa.

Glasgow Coma Scale was 14/15. The following are the vital signs at the time of

admission: BP: 220/137mmHg, PR: 67bpm, bounding and full (4+/4+) RR: 22cpm,

rhythmic but mildly labored, T: 37.4 °C. Upon the assessment on her cardiovascular

or lungs, it was shown that there was no murmur, with mild precordial heave and her

lungs are clear. Meanwhile on her abdominal assessment, it shows that it has slight

tenderness at the RUQ upon Palpation with burning epigastric pain, rated as 8/10. The

patient’s skin and extremities showed no lesions but has a pitting edema of both legs

at 3+ and on upper extremity edema, pitting 2+.

History of Past Illnesses

The patient has an obstetrical score of G3P2 and had her first

pregnancy when she was 23. She delivered a full-term female child at a birthing

center via normal spontaneous delivery. She had a complete prenatal check-up with 2

doses of Tetanus Toxoid. Ferrous sulfate and folic acid supplementation was
prescribed, however due to GI upset, the patient did not comply. At the age of 27, she

had her second child, however due to mild Pre-eclampsia she delivered a male child

via cesarian section. Methyldopa 250mg tablet was maintained taken twice a day. She

was also given dexamethasone at her 28 th week Age Of Gestation. Child was born at

36 weeks gestational age and was classified small for gestational age. Tetanous

Toxoid was administered in one dose. Supplements of calcium carbonate, ferrous

sulfate, and folic acid were prescribed. Calcium was taken, but patient was non-

compliant to ferrous sulfate. After birth, patient’s blood pressure returned to normal.

Moreover, the patient also has undergone appendectomy when she was 15 years old

and tonsillectomy when she was 17 years old. Patient also has seasonal rhinitis, which

is normally managed with betamethasone and loratadine. She is allergic to chicken

and has no known medication allergies.

Family History

V. DIAGNOSTIC EXAMS AND PROCEDURE

COMPLETE BLOOD COUNT

A complete blood count, also known as a full blood count, is a set of medical

laboratory tests that provide information about the cells in a person's blood. The CBC
indicates the counts of white blood cells, red blood cells and platelets, the

concentration of hemoglobin, and the hematocrit.

URINALYSIS

A urinalysis is a test of your urine. A urinalysis is used to detect and manage a

wide range of disorders, such as urinary tract infections, kidney disease and diabetes.

A urinalysis involves checking the appearance, concentration and content of urine.

Abnormal urinalysis results may point to a disease or illness.

FETAL ULTRASOUND

A fetal ultrasound (sonogram) is an imaging technique that uses sound waves

to produce images of a fetus in the uterus. Fetal ultrasound images can help your

health care provider evaluate your baby's growth and development and monitor your

pregnancy.

NONSTRESS TEST

A nonstress test is a common prenatal test used to check on a baby's health.

During a nonstress test, the baby's heart rate is monitored to see how it responds to the

baby's movements. The term "nonstress" refers to the fact that nothing is done to

place stress on the baby during the test.

RENAL PANEL

A renal panel is a group of tests that may be performed together to evaluate

kidney (renal) function. The tests measure levels of various substances, including

several minerals, electrolytes, proteins, and glucose (sugar), in the blood to determine

the current health of your kidneys.

V. ANATOMY AND PHYSIOLOGY OF THE ORGAN

Heart - The heart itself is made up of 4 chambers, 2 atria and 2 ventricles. De-

oxygenated blood returns to the right side of the heart via the venous circulation. It is

pumped into the right ventricle and then to the lungs where carbon dioxide is released

and oxygen is absorbed. The oxygenated blood then travels back to the left side of the
heart into the left atria, then into the left ventricle from where it is pumped into the

aorta and arterial circulation.

Lungs - The lungs are pyramid-shaped, paired organs that are connected to the

trachea by the right and left bronchi; on the inferior surface, the lungs are bordered by

the diaphragm. The diaphragm is the flat, dome-shaped muscle located at the base of

the lungs and thoracic cavity. The lungs are enclosed by the pleurae, which are

attached to the mediastinum. The right lung is shorter and wider than the left lung,

and the left lung occupies a smaller volume than the right. The cardiac notch is an

indentation on the surface of the left lung, and it allows space for the heart. The apex

of the lung is the superior region, whereas the base is the opposite region near the

diaphragm. The costal surface of the lung borders the ribs. The mediastinal surface

faces the midline.

Liver - The liver holds about one pint (13%) of the body's blood supply at any

given moment. The liver consists of 2 main lobes. Both are made up of 8 segments

that consist of 1,000 lobules (small lobes). These lobules are connected to small ducts

(tubes) that connect with larger ducts to form the common hepatic duct.

Kidneys - The kidneys lie retroperitoneally (behind the peritoneum) in the

abdomen, either side of the vertebral column. They typically extend from T12 to L3,

although the right kidney is often situated slightly lower due to the presence of the

liver. Each kidney is approximately three vertebrae in length. It regulates plasma

osmolarity by modulating the amount of water, solutes, and electrolytes in the blood.

It ensures long term acid-base balance and also produces erythropoietin which

stimulates the production of red blood cell.

 Ovaries – The ovaries are the female pelvic reproductive organs that

house the ova and are also responsible for the production of sex hormones. They are

paired organs located on either side of the uterus within the broad ligament below the

uterine (fallopian) tubes. The ovary is within the ovarian fossa, a space that is bound

by the external iliac vessels, obliterated umbilical artery, and the ureter. The ovaries

are responsible for housing and releasing ova, or eggs, necessary for reproduction. At

birth, a female has approximately 1-2 million eggs, but only 300 of these eggs will

ever become mature and be released for the purpose of fertilization.

Fallopian tubes – Fallopian tube, also called oviduct or uterine tube,

either of a pair of long narrow ducts located in the human female abdominal cavity

that transport male sperm cells to the egg, provide a suitable environment for

fertilization, and transport the egg from the ovary, where it is produced, to the central

channel (lumen) of the uterus.

Uterus - The uterus is a thick-walled muscular organ capable of expansion to

accommodate a growing fetus. It is connected distally to the vagina, and laterally to

the uterine tubes. The uterus has three parts; Fundus - top of the uterus, above the

entry point of the uterine tubes.

Vagina – The vagina is a fibromuscular tube which extends from the vestibule

to the cervix. It is lined with nonkeratinizing stratified squamous epithelium over a

thin loose connective tissue layer, the lamina propria. The epithelium is thrown into

folds, or rugae when supported by estrogen.

External Genitalia – also called vulva or pudendum of the vestibule and its

surrounding structures. The vestibule is the space into which the vagina and urethra

open. The vestibule is bordered by a pair of thin, longitudinal skin folds called the
labia minora. A small erectile structure called clitoris. The two labia minora unite

over the clitoris to form a fold skin called the prepuce. Lateral to the labia minora are

two prominent, rounded folds skin called labia majora. The space between the labia

majora is called the pudendalV

 VI. NURSING CARE PLAN

ASSESMENT DIAGNOSIS SCIENTIFIC PLANNING INTERVENTION RATIONALE EVALUATION

BACKGROUND
Subjective: Ineffective tissue Pre-eclampsia is a After 8 hours of INDEPENDENT: After 8 hours of
perfusion related medical condition nursing nursing interventions,
“Nahihilo ako at - Monitor vital signs -To identify physical
to in which interventions, the the client was able to
masakit ang ulo particularly blood responses associated
vasoconstriction hypertension arises client will be able manifest increased
ko”, as verbalized pressure. with medical conditions.
of blood vessels. in pregnancy to manifest tissue perfusion as
by the patient.
(pregnancy- increased tissue evidenced by:
induced perfusion as
- Perform assistive -ROM promotes
hypertension) in evidenced by:
Objective: passive range of motion. improved blood
association with • blood pressure
circulation.
- Pain Scale: significant amounts within normal range
6/10 of protein in the • blood pressure
urine. Pre- within normal
- Bilateral -It conserves
eclampsia refers to range - Provide quiet and • Pain scale at 0/10 or
edema was energy/lowers tissue
a set of symptoms no pain at all.
pitting restful environment. oxygen demand.
rather than any
(grade 3+)
causative factor, • Pain scale at 0/10
- Edema of and there are or no pain at all. • Glasgow Coma Scale
hands is many different at 15/15
non-pitting causes for the DEPENDENT -Antihypertensive drugs
(grade 2+) condition. It • Glasgow Coma help decrease and
- Administer
appears likely that Scale at 15/15 control blood pressure. • absence of edema
antihypertensive drugs
VS taken as follows: there are as ordered.
substances from
BP: 220/137 mmHg • absence of - Magnesium sulfate
the placenta that
edema prevents or controls
PR: 67 bpm can cause - Administer Magnesium
seizures in pre-eclampsia
endothelial sulfate as ordered
RR: 22 cpm brought about by
dysfunction in the
vasospasm secondary to
T: 37.4 °C maternal blood
vasoconstriction of blood
vessels of
GCS: 14/15 vessels.
susceptible
women. While
blood pressure
elevation is the
most visible sign of
the disease, it
involves
generalized
damage to the
maternal
endothelium,
kidneys, and liver,
with the release of
vasoconstrictive
factors being
secondary to the
original damage.
 VII. DRUG STUDY

NAME OF DRUG INDICATIONS CONTRAINDICATIONS MECHANISM ADVERSE REACTION NURSING RESPONSIBILITIES

OF ACTION
Generic Name: Aldomet Methyldopa is Alpha- ● dizziness, ● Check BP and pulse at least
methyldopa contains the contraindicated in methyldopa is q30 min until stabilized
● lightheadedness
active patients: converted to during IV infusion and
substance called methyl ● drowsiness, observe for adequacy of
Brand Name: methyldopa. norepinephrine urinary output. Monitor fluid
● headache,
Aldomet This belongs to ● with active hepatic centrally to and electrolyte balance and
a group of disease, such as decrease the ● stuffy nose, and I&O.
medicines acute hepatitis and adrenergic weakness,
● Weigh patient daily, and
Classification: called active cirrhosis. outflow by especially when
check for edema
antihypertensiv 'antihypertensiv alpha-2 starting this
es es'. Methyldopa ● with liver disorders agonistic action medication and (methyldopa favors
is changed previously from the central when dosage is sodium and water
inside your associated with nervous system, increased. retention).
Dosage: 250 mg body to a methyldopa leading to
● vomiting, ● Be alert to and report
natural therapy reduced total
symptoms of mental
substance that peripheral ● stomach pain,
● with depression (e.g., anorexia,
Frequency: 250 lowers blood resistance and
hypersensitivity to ● swollen or insomnia, inattention to
mg every 8 pressure. Your decreased
any component of "black" tongue, personal hygiene,
hours doctor has systemic blood
this product. withdrawal).
prescribed pressure ● constipation,
Aldomet to ● on therapy with ● Be alert that rising BP
● diarrhea,
Route: Oral treat high blood monoamine indicating tolerance to drug
pressure oxidase (MAO) ● numbness or effect may occur during
(hypertension). inhibitors. tingly feeling, week 2 or 3 of therapy.

● breast swelling
or discharge.
VIII. DISCHARGE PLANNING

MEDICATIONS The medications prescribed by the

physician will be maintained for
faster recovery.

● Losartan 100mg OD

● Nifedipine 5mg 1 tablet

OD in the evening

● Clopidogrel 75mg 1 tablet

OD after lunch

● Piracetam 1.2 grams 1

tablet OD

● Multivitamins 1 capsule
OD

● Daily wound care with

chlorhexidine skin prep
twice daily after bath
time.
EXERCISE ● Encourage immediate
relatives to facilitate
regular exercise such as
brisk walking but not
making herself too much
tired.

● Encourage her not to carry

heavy loads and do not
force herself too much in
doing household chores.

● Encourage patients on
 deep breathing exercises.
Move extremities when
lying.

● Elevate the head part when

sleeping, to promote
increased peripheral
circulation Exercises like
tailor sitting, squatting,
kegel exercise, pelvic
rocking, and abdominal
muscle contraction will
promote easy delivery.

● Strenuous activities are

given precautions to
prevent increase of blood
pressure. Patient should
have adequate rest periods
TREATMENT ● Daily wound care with
chlorhexidine skin prep
twice daily after bath time.

● Maintain medications as
prescribed by the
physician.

● Weekly visit with the

physical therapist.

● Increase oral fluid intake to

avoid dehydration.

● Encourage patient to be
monitored by a health care
provider until recovery is
 complete.
HEALTH TEACHINGS • Maintain medications as
prescribed by the
physician.

• Take adequate rest and

have a well-balanced diet.

• Monitor blood pressure.

• Encourage patients on
deep breathing exercises.

• Increase fluid intake

• Improve lifestyle practices

• Promote regular physical

activities.

• Avoid alcohol intake and

smoking.

• Reduce stress as much as

possible. Practice healthy
coping techniques, such as
muscle relaxation, deep
breathing or mindfulness.
Getting regular physical
activity and plenty of sleep
can help, too.

• Maintain a healthy weight.

Keeping a healthy weight,
or losing weight if you're
overweight or obese, can
help you control your high
blood pressure and lower
your risk of related health
problems. In general, you
may reduce your blood
pressure by about 1 mm Hg
 with each kilogram (about
2.2 pounds) of weight you
lose.
OUT PATIENT ● Maintain medications as
prescribed by the
physician.

● Maintain a healthy weight

and monitor blood
pressure regularly.

● Make dietary changes such

as foods that are good for
the heart or by reducing
sodium intake and
increasing potassium
intake.

● Avoid smoking and alcohol

intake.

● Have a regular check-up or

visit to your physician.
DIET ● Avoid Salt (Sodium)

● A high-sodium diet
increases blood pressure in
many people. In fact, the
less sodium you eat, the
better blood pressure
control you might have.Low
salt intake to avoid fluid
retention.

● Avoid canned foods,

processed foods, lunch
meats, and fast foods.
 ● Know What to Eat

● Potassium, magnesium,
and fiber, on the other
hand, may help control
blood pressure. Fruits and
vegetables are high in
potassium, magnesium,
and fiber, and they’re low
in sodium. Stick to whole
fruits and veggies. Juice is
less helpful, because the
fiber is removed. Also, nuts,
seeds, legumes, lean
meats, and poultry are
good sources of
magnesium.

● Start DASH diet

- Dietary Approaches to
Stop Hypertension (DASH)
is an eating plan rich in
fruits, vegetables, whole
grains, fish, poultry, nuts,
legumes, and low-fat dairy.
These foods are high in key
nutrients such as
potassium, magnesium,
calcium, fiber, and protein.
SAFETY AND SECURITY ● Encourage the patient to
appreciate God’s presence
SPIRITUAL
and trust the importance of
 prayers.

● Teach the patient and her

family to include God and
their faith as a source of
connection between them
and to improve family
connection and bond.

● Help patient to understand

the importance of
spirituality as a foundation
of physical health and well-
being.

IX. UPDATES

Preeclampsia (PE) is a hypertensive disorder that appears during pregnancy.

PE is a major obstetric complication that causes 15–20% of maternal mortality

worldwide, especially in developing countries (Report of the National High Blood

Pressure Education Program American Journal of Obstetrics and Gynecology, 2000).

It is characterised by the presence of high BP (> 140/90 mmHg) and proteinuria (>

300 mg/dL) beyond 20 weeks of pregnancy. The finding of higher values of BP

before this stage of pregnancy is considered chronic hypertension, which can also

worsen in the second half of pregnancy, with what we call superimposed

preeclampsia. The physiopathology of this multisystemic disorder still remains

unknown.

Numerous studies proposed several risk factors to classify a specific group of

women who are at a high risk of developing preeclampsia, including nulliparity, older

age, chronic hypertension, and diabetes mellitus (Ruano R, et al., 2005). Other studies

indicate that, after adjusting for other cofounders, women of advanced maternal age

are 1.5 times more likely to have preeclampsia compared to those under 35 years of

age (Lamminpää R, et al., 2008). Multiple pregnancy is a moderate risk factor for the

development of pre-eclampsia during pregnancy. Women with multiple pregnancy,

who have any of the other moderate risk factors for pre-eclampsia (first pregnancy,

age 40 years or older, pregnancy interval of more than 10 years, BMI of 35 kg/m2 or

more at first visit, or family history of preeclampsia), should receive a daily aspirin

dose (National Institute for Clinical Excellence. Hypertension in Pregnancy, 2010) .

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