College of Health Sciences Education

3rd Floor, DPT Building

Matina Campus, Davao City
Telefax: (082) Phone No.: (082)300-5456/300-0647 Local 117

CASE PRESENTATION
NCM 107n/L- RLE
Concept: Care of the Mother and the Fetus during the Perinatal Period

Case No. 2
PREGNANCY INDUCED HYPERTENSION

Bed No. 199

Sani Maya Tamang, 26 years old, female, residing at Mati Davao Oriental, religion Islam, working as a plain
housewife. Her husband is a farmer. Both did not go to school for formal education and is married. She was
admitted on the 15th of November 2022 at 3 PM from the OPD. Her chief complaints are cessation of
menstruation for 8 months, swelling of both lower limbs for 15 days, headache for 4days, epigastric pain for 3
days and decreased fetal movement for 3 days. She confirmed her pregnancy by urine pregnancy test after 2
months of cessation of menstruation at a medical store. She also mentions that she has done 2 ANC visits till
date. The first ANC visit during 2nd trimester and 2nd ANC visit in the 3rd trimester.

According to Sani Maya, in her 1st trimester she experiences few episodes of vomiting in the morning which
subsided on its own. There is increased frequency of micturition and no fever or flu like symptoms, rashes, per
vaginal bleeding, pain abdomen. In the 2nd trimester she perceived fetal movement at 4 months. No fever,
urinary symptoms, per vaginal bleeding or leaking. She is taken 1 dose of TT and deworming was also done
including Iron tablets for 1 month. During her 3rd trimester, there has no vaginal bleeding or leaking, no dyspnea,
palpitation or blurring of vision.

She also mentions that she has swelling of both lower limbs for last 15 days and its gradual in onset. It started
1st around the ankle and gradually progressing up to shin if tibia. She al had headache for 4 days and its gradual
in onset and describes as intermittently occurring, localizing to frontal region, and aggravated on doing her daily
activities and is relieved only when taking rest. She does not experienced blurring of vision, has not taken any
medicines for it.

Additionally, she also mentions abdominal pain for 3 days localizing at the epigastric region and it is burning in
nature, intermittent type but non radiating. There have no aggravating or relieving factors, and it just subsides
on its own. Not associated with fever, nausea or vomiting or altered bowel habit and no vaginal bleeding or
leaking she added. She also noticed decreased fetal movement since last 3 days and previously perceived fetal
movements throughout the day but for last few days only 2-3 times a day.

Nurse Patrick recorded all the information every time he obtained an information. Patient Sani Maya also has
no urinary symptoms such as decreased output, burning micturition or passage of frothy urine. And no
palpitation, dyspnea or blurring vision and no history of abnormal body movements and loss of consciousness
including bowel movements habits.

She has been married for 1 year and is now to give birth for her 1 st born. During the admission, Nurse Patrick
obtains the following information also; Patient Sani Maya’s first menstruation was at her 13 years old, duration
lasted for 4 days she mentioned and the length of cycle is 28 days and is regular, with 2-3 partially soaked pads,
no clots, no post-coital bleeding, no intermenstrual bleeding, no dyspareunia. And have not use any of
contraceptives. Nurse Patrick also gathered patient Sani Maya’s history, she mentions that they have no history
of diabetes mellitus, hypertension, epilepsy, tuberculosis, thyroid disorders, blood transfusion and even
surgeries in the past. She also stressed out that they don’t have diabetes mellitus, hypertension, tuberculosis,
female genital tract malignancy, congenital anomalies but they do have a twin history in the family. She is a
non-smoker, doesn’t consume alcohol, non-vegetarian, and no kwon allergies. And she has not been under any
medications.

Patient Sani Maya is fair, conscious, cooperative, well oriented to time, place and person. She has average built
and well hydrated. She also weighs 60 kgs. Have bilateral pedal pitting edema, no pallor, icterus, cyanosis,
clubbing, no palpable lymph nodes. Vital Signs are BP- 160/120 mm of HG in Right arm supine, 180/110 mm of
Hg in Left arm supine; Pulse- 86 beats per minute, regular, normal volume, and character; temperature- 98
degrees Fahrenheit; Respiratory rate of 20 per minute. Thyroid non tender and not enlarged. Breast exam was
not done. Bilateral normal vesicular breath sounds and no added sounds during the checking of her respiratory.
First and second heart sounds and no murmur when examining her cardiovascular. In the abdominal area upon
inspection, abdomen distended till the level of umbilicus, the umbilicus is centrally placed and inverted, no scars
or pigmentation, no Linea nigra, no striae gravidarum or albicans, no visible pulsations or venous prominences,
hernial orifices are intact. Upon palpation, abdominal wall edema is present, temperature not raised and no
tenderness. Fundal height is 24 weeks size, abdominal girth is 32 inches, fundal grip is broad, firm, irregular,
mass felt, most probably buttock, left lateral grip is smooth, curved, resistant feel, most probably back. Right
lateral grip is multiple knobs like structure, most probably limbs. Pelvic grip 1st is smooth, hard, globular mass,
most probably head. 2nd is smooth, hard, globular mass felt, most probably head, mobile from side to side, head
is not engaged. Fetal heart sound is 136 beats per minute at left spinoumbilical line, regular. Pelvic Exam is not
done.

Diagnosis is primigravida at 36 weeks and 3 days of gestation with pre-eclampsia with intrauterine grown
retardation.

At the time of admission, investigations are as follows; HB: 12.8 gm/dl; blood group: A +; Platelets:
559,000/cumm; VDRL/HIV I, II/HbsAg is Non-reactive; RBS: 96 mg/dl; Urine R/E: Color is light yellow, reaction is
acidic, albumin is ++, WBC is 22-25/HPF, RBC 2-4/HPF, Epithelial cells is 12-15. USG abdomen and pelvis;
singleton pregnancy of 30 weeks and 1 day of gestation, Oligohydramnios, AFI at 6.4 cm and findings suggestive
of IUGR.

Other investigations-
 LDH-1023 IU/L (<480)
 Serum Urea: 22 mg/dl (10-40)
 Serum Creatinine: 0.8 mg/dl (0.5-1.4)
 Sodium: 141 mEq/L (135-146)
 Potassium: 3.9 mEq/L (3.5-5.2)
 Serum Uric Acid: 6.9 mg/dl (2.4-5.7)
 SGPT: 33 IU/L (0-40)
 SGOT: 56 IU/L (0-40)
 ALP: 534 IU/L (80-306)
 BT: 3 min (2-6)
 CT: 7 min (5-12)
  PT: 14 sec
 INR: 0.96

On Admission, BP monitoring was done half hourly with range from 130-180/90-110 mm of HG, the Urine
protein 12 hourly, 24-hour urine protein, foley’s catheter inserted, keep NPO from 10 PM next day, Daily weight
measurement, counsel the patient and the patient party regarding the condition and EmLCS if to be done.

Treatment – Tab Nifedipine 10 mg PO stat and TDS, Tab Iron 1 tab PO OD, L-arginine 1 sachet in 1 glass of water,
Injection Dexamethasone 6 mg IM 12 hourly (4 doses), Tab Methyldopa 250 mg PO TDS.

Prepared by: Noted by :

MICHAEL PAT M. BADEON, RN GAMELA KATE MOSTERO, RN MAN

Clinical Instructor Program Head - Nursing