BACHELOR OF SCIENCE IN NURSING

LIMITED FACE TO FACE | WEEK 02

PREGNANCY INDUCED HYPERTENSION (PIH)

 Read course and laboratory unit objectives

 Read study guide prior to class attendance
 Read required learning resources; refer to course unit terminologies for jargons
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. Apply the nursing process in the care of groups of clients across the lifespan with conditions and/or
in situations experiencing complications related to pregnancy induced hypertension (PIH):
a. Assess the mother’s total health condition and resources.
b. Formulate nursing diagnoses based on the given scenario.
c. Develop a plan of care for pregnant client with PIH.
d. Implement a plan of care applying the appropriate principles, guidelines, and steps in managing
the client.
e. Evaluate the outcomes(s) of care.
2. Demonstrate competencies of a beginning staff nurse, nurse leader, and researcher.
3. Promote personal and professional growth by showing independence in performing varied tasks
and responsibilities.

To facilitate the practice of students’ nursing skills, the following rules must be implemented:
1. The use of the Nursing Skills laboratory equipment and materials appropriate of the given case
scenario are allowed.
2. Use resources from the required readings.
3. Students must perform the tasks in the worksheet at a given period.

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 Key Areas of
Competency
Responsibility
Demonstrates knowledge about the clients’
health status and set priorities in nursing care
based on clients’ needs
Provides sound decision making in the care of
1. Safe and
individual/ family considering their beliefs and
Quality Values
Nursing Care
Promotes safety, comfort, and privacy
Administers medications and other health
therapeutics safely (accurately and correctly)
Organizes workload to facilitate client care.
2. Management of
Resources
Utilizes resources to support client care by
ensuring proper functioning of equipment
3. Health Develops health education plan based on
Education assessed learning needs
Adheres to practices in accordance with the
4. Legal
nursing law, institutional policies and
Responsibility
protocols, and other relevant legislation.
Adheres to Code of Ethics of Nurses and
5. Ethico-moral
respect rights of the client and other
responsibility
individuals involved in the care of the client.
6. Personal and
Professional Project a professional image of the nurse
Development
7. Quality Identifies and reports variances and
Improvement recommends appropriate solutions.
Enhances competency level in the utilization
of different forms of data gathering and
8. Research principles of assessment and nursing care.
Analyzes and interprets data, disseminate
findings and apply recommend actions.
Maintains accurate and updated
9. Records documentation of client care observing legal
Management imperatives in documentation and record
keeping.
Identifies verbal and non-verbal cues
10. Communication Uses appropriate information technology to
facilitate communication.
11. Collaboration Collaborates plan of care with the other health
and Teamwork care team members.
Expected Performance and Criteria
Identifies the mother’s health status in determining the
need for treatment and management.
Gathers and analyzes data relevant to the client’s health
condition perform the correct nursing procedure.
Maintains a safe environment and performs age-specific
procedures and protocols safely ensuring privacy in all
aspects of care.
Conforms to the 10Rs of medication administration and
health therapeutics
Identifies nursing tasks and performs them based on
priorities.
Finishes tasks on time.
Observes appropriate protocols and institutional policies.
Ensures availability, completeness, and functionality of
equipment and nurse’s paraphernalia relevant to the
performance of need procedures.
Implements applicable age-appropriate health education
activities to the client based on needs assessment
Acts and performs appropriate nursing tasks and
procedures in accordance with established norms of
conduct expected of a nurse and an OLFU student as
well as with the other relevant legislation.
Maintain the privacy and confidentiality of client’s
information.
Accepts responsibility and accountability on the
decisions made relating to the client’s care.
Performs nursing tasks according to professional
standards.
Demonstrates good manners and right conduct at all
times.
Observes proper grooming and hygiene.
Adapts to changes willingly by being open to new
strategies or approaches relevant to the performance of
applicable nursing procedures.
Identifies and reports inadequacies and problem(s)
encountered in the provision of nursing procedures and
processes.
Recommends practical and appropriate solutions.
Specifies researchable problems related to PIH and
related client care.
Gather, analyze, and interpret relevant data.
Utilizes findings in research in the provision of PIH
related measures and client care.
Records outcome of client care.
Submits legible, accurate and updated documentation
and/or information regarding the client care.
Interprets and validates client’s body language and facial
expressions
Utilizes appropriate means and/or channels of
communication to support the delivery of care to clients
with PIH.
Respects the role of other members of the health care
team in administering proper measures to the client.
Refers the client to the appropriate allied health team
partners.
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THE CASE OF MRS. R.J.
Mrs. R. J. is a 28 years old, lives in Novaliches, QC, admitted to the obstetric emergency department at
DJMR Hospital in January 02, 2022, referred from Nova Gen Hospital, “antenatal care department,” she
is a known case of high-risk pregnancy, previously admitted to the obstetrics department with the mild
lower abdomen, pain, and headache; gestational age was 17 weeks and discharged after 3 days.
In the first admission “January 02, 2022” at 9:00 AM, she was presented with edema in the face and
upper and lower extremities along with a severe headache and severe lower abdominal pain, absence
of fetal movement. Regarding the previous obstetric history of the Mrs. R.J it was reported that past she
had two miscarriages, one was at 8 weeks and the other was ectopic pregnancy a year and a half ago at
10 weeks of her previous pregnancy. Mrs. R.J reported past obstetric history of remarkable recurrent
miscarriages. Vital signs were measured and recorded as follows: BP was elevated at 180/120 mmHg.
Her pulse was 100 (bpm), respiratory rate was 21 breaths per minute, and the temperature was 37.8°C.
Her urine sample showed ++ 2 proteinuria (more than 200 mg in the blood). There was observable edema
in her face and upper and lower extremities hyperreflexia, and mild vaginal bleeding. She looked pallor
and fatigue. Abdominal examination was done by U/S showed that, the present case had single fetus,
transverse position, oligohydramnios and low lying placenta (suspected placenta accrete) insertion.
On briefly reviewing medical history of Mrs. R.J, she has a history of a chronic episode of asthma, in
which she uses salbutamol inhaler to relieve her symptoms.
Related to psychological history, Mrs. R.J has a history of depression. Regarding her family history, she
reported that her father suffers from chronic hypertension as well as liver cirrhosis and her mother has a
medical history of hypertension, angina, and transient ischemic attack. Both her maternal grandparents
had a history of Type II diabetes mellitus. With regard to her social history, Mrs. R.J works as a teacher
and has a limited relationship with others.
Mrs. R.J is demonstrating key cardinal symptoms of severe PE including hypertension, proteinuria,
edema, severe headache, increased reflexes, epigastric pain, and blurred vision, but she was conscious,
oriented. The final diagnosis was severe PE. Mrs. R.J was admitted to the obstetric ward, intravenous
(IV) cannula was inserted. The initial laboratory investigations were done, blood group and Rh: B+,
complete blood count: hemoglobin (Hb): 9.4 mg/dl, white blood cells: 8800, platelets: 328, chemistry: liver
enzymes: alanine aminotransferase: 14, aspartate aminotransferase: 20, glucose: 66, urea: 17, and
creatinine: 0.7; however, the protein:creatinine ratio was (0.8 mg/mmol); levels were elevated, normal
range up to 0.3. As management in the labor room, the goal of treatment is to:
1. Prevent seizures
2. Lowering BP
3. Establishing an adequate renal function
4. Protect the mother and the fetus from complications.
Later after hours definitely at 1:00 PM, BP became 170/120 mmHg, urine analysis showed +++3 albumin
with a severe headache and blurred vision, the specialized doctor was notified by the midwife, but there
medical decision and intervention started after 2 hours. At that time, the BP became 180/120 mmHg, with
severe hyperreflexia and severe epigastric pain Mg sulfate 5 g IV in 100 cc normal saline was given as
a loading dose in 20 min, then maintenance dose: 1.5 g IV/hour until, 24 h post-delivery, hydralazine 5
mg/15 min IV bolus, for 3 doses, “total 15 mg,” Adalat: 10 mg once, catheter was inserted for calculating
UOP. Due to low Hb level, 2 units of packed red blood cells (RBCs) were given.
In the 2nd day, January 03, 2022, BP became 130/80 mmHg, UOP: 800 cc/24 hos; Mrs. R.J was prepared
for CS at 10:00 AM; consent form and checklist were completed, routine laboratory. Investigations were
prepared before the operation, CS started at 10:15 AM and finished at 11:45 AM. Due to placenta accreta,

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uterine repair was done, another two packed RBCs were given, the delivery outcome was a female baby,
gestational age: 32 weeks., wt. 1700 g, Apgar score assessment at the 1st min recorded 5 of 10 and in
the second 5 min recorded 7 of 10, the newborn was referred to the neonatal intensive care unit due to
respiratory distress.
Post op condition After CS showed that the first BP reading was 160/100mmHg so initial management
was as follow:
1. Ceftriaxone 1 g/12 h
2. Metronidazole 500 mg/8 h
3. Heparin 5000 IU/12 h
4. IV fluids normal saline 500 cc/8 h
5. Mg sulfate 6 mg IV in 100 cc N.S over 20 min, then 6 mg/5 h then 1.5 mg/h until 24 h post-
delivery
6. Adalat 10 mg/12 h
7. Continuous observation for the level of consciousness
8. Continuous monitoring for BP every 15min for 1 h, then every 1/2 h for an hour, then continuous
monitoring every 4 h
9. Monitor and calculation intake and output
10. Check Mg toxicity.
In the 4th day, January 05, 2022, general condition was good, stable, no vaginal bleeding, conscious,
oriented, and active; BP was 140/85 mmHg, mild headache, edema started to release, urine output: 1200
cc/24 h, normal renal and liver function test, urine free from proteinuria; instructions were provided about:
Incisional dressing and hygiene, frequent follow-up for BP in the primary clinics, lifestyle modification for
diet, exercise and stress avoidance, and drug compliance; psychological support was provided by the
doctors and midwives.

https://innovareacademics.in/journals/index.php/ijhs/article/download/34806/20925

TASKS: Complete the assessment data to provide high quality, individualized care for the patient.
1. Quick Assessment (5 minutes) – You are one of the EMS team arriving at the scene. Collect,
organize and document information about the patient. Data will be used to:
a. Inform the emergency hotline of the situation.
b. For you to be able to implement the necessary and appropriate interventions.
2. Implementing Care (20 minutes)
a. Perform compression-only CPR (single-rescuer)
b. Prepare to administer Epinephrine IV bolus of 0.01 mg/kg and then for infusion:
0.2mcg/kg/minute (Recall correct procedure in medication administration of epinephrine to
pediatric clients.)
3. Ongoing Care (15 minutes) – Document the care that has been provided as follows:
a. Using the CHART (Complaint, History, Assessment, Rx – Drugs, Treatment) format – so that
this is communicated with other healthcare professionals.
b. Discharge instructions (METHOD)

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 OBSERVATIONS CHART
Patient Profile: Age/ Sex:
Date/
Time
Subjective Data: Objective Data:

Quick Assessment: Critical Points to check:

IMPLEMENTING CARE

ONGOING CARE

Name: Section & Group:

Grade:
Signature over Printed Name of Clinical Instructor Date:

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OBSTETRICAL HISTORY

G P T P A L
LMP: AOG (by LMP): AOG (by UTZ):
Pregnancy Pregnancy AOG In Birth Present
Year Gender
Order Outcome Weeks Weight Status

Name: Section & Group:

Grade:
Signature over Printed Name of Clinical Instructor Date:

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