Republic of the Philippnes

Mountain Province State Polytechnic College

Bontoc Campus
Poblacion,Bontoc Mtn. Province
Department of Nursing

PREGNANCY- INDUCED HYPERTENSION

In Partial Fulfillment of the Requirement In The Clinical Duty At Luis Hora Memorial Regional Hospital
on December 5-9,2022

Submitted by:
Alida ,Shellane
Analog,Jennette
Ayangwa, Hanannaiah
Besetan,Mheggie
Danagen,Glenn Mark
Fagyan,Decibeth
Garcia,Clery Jean
Lopez,Clarette
Magsino,Fae-chi
Mi-ing,Dexter
Purificacion , Rose Ann
Tulan,Jeziel

Date Submitted:
December 21,2022

I. DEMOGRAPHIC DATA
Name: _OMAS MAY_____

Permanent Address: _________BOTOAN,CATLUBONG,BUGUIAS, BENGUET_______

Sex: __F_______

Civil /status: _____MARRIED____

Birth Date: ___May 11,1981______________

Age: _41___

Nationality: __FILIPINO____________

Religion: ___Assembly of God_(Born Again)

Occupation: __DRIVER_____________

Father’s Name: ___Johnson Palonan__________

Mother’s Name: _______Elizabeth Sicwaten Palonan_____________

Spouse Name: ____HENRY OMAS_____

Ethnic Background: _______Igorot___________

Dare of admission: __NOVEMBER 30,2022__

Introduction:

Pregnancy-induced hypertension is also called a form of high blood pressure in pregnancy. It

occurs in women who had PIH in a previous pregnancy. The case of PIH is unknown. Some conditions
 may increase the risk of developing PIH, including: pre-existent hypertension, kidney disease diabetes, PIH
with a previous pregnancy, mother’s age younger than 20 or older than 40 and multiple fetuses.
It can occur at anytime during pregnancy and up to 6 weeks after birth. It is most common after 20
weeks of pregnancy ad in first pregnancies. It can develop gradually over many weeks, or come on
suddenly over a few hours.AS pregnancy induced hypertension develops, it can cause fluid retention
(edema). which often causes sudden swelling of the feet, ankles, and hands.AS it progresses, it may cause;
severe pain in the upper abdomen; Excessive weight gain due to fluid retention; feeling generally unwell.
However, it is possible to have it without symptoms.
One pre-eclampsia develops, it does not go away until after the baby is born. Treatment may start
with rest at home since women need to be admitted to hospital and to take medicines that lower high blood
pressure and control the amount of fluid in the baby. You may also have medication to prevent seizures.
Occasionally, the only way to treat pre-eclampsia is to deliver the baby early, either by induction or
caesarean section.
If left untreated-eclampsia can increase the risk of stroke, impaired kidney and liver function, blood
clotting problems, fluid in the lungs and seizures, there is also an increased risk that the placenta will
separate from the wall of the uterus, causing bleeding (called placental abruption). The baby may be born
small, prematurely or maya even be stillborn.

Medical Diagnosis: Pregnancy-induced hypertension

History of present illness:

A 41 41 year old female admitted 7 months pregnant with an intial blood pressure of 100/140.Patient has presence
of bipedal edema in both lower extremities/Facial frimaces and restlessness noted due to headache and pain caused
byburinary retention.IFC was inserted on the second day of the duty which is on December 6 ,2022 .Blood pressure
was constantly high as 190/140.The last menstrual period of the patient is May 10,2022.Patient perceived stopped
fetal movement on the second day of admission.Drugs taken are
amlodipine,losartan,furosemide,Feso4,clonidine,calcium+vitamin D3.

Obstetric History:

Gravida: G-5
Parity: P5

Term: T3

Preterm:0

Abortion:0

Live:3

Past Medical history: Patient history of one intra uterine fetal death due to pregnancy-induced hypertension. All 4
past pregnancies have pregnancy-induced hypertension. Prenatal consultations of patient is done every month of
pregnancy at the barangay health center..

Family History:

Familial genetic disorder within the family significant hypertension in the mother’s side whereas two of her siblings
including her inherited the disease

Personal Development and Social History:

The patient is married and had 3 children with her deceased husband. She currently lives together with her second
husband who is a gardener in their farm. May is working as vegetable truck driver. She travels every day from La
union to Vizcaya. She stated that during her travels she retained her urine and prefer to drink soft drinks to satisfy
her thirst. According to her she is popular and loved by the people in their community.

ASSESSMENT:

Psychosocial: The patient is residing at Buguias, Benguet. As of now the patient is a truck driver and negotiator to
their business. She is in good relationship with her husband and children. She is open and communicative to the
people around her. She’s also cooperative during the taking of vital signs and assessment in connection with her
treatment and diagnosis.

Elimination: The color of the urine in the catheter bag is dark yellow and within our shift she urinate 600 ml.

Activity & Mobility:

During the admission at the hospital the patient requires assistance in her daily activities like walking, standing and
sitting. After delivery at the 5th day of our shift she needs assistance during urination

Rest

The patient stated that she can’t sleep and is easily disturbed due to impaired urinary retention and pain after the
delivery of the baby.

Safety:

The safety and security of the patient is ensured through constant assistance in her every activity and taking her vital
signs for monitoring.

Oxygenation:

The patient respiratory rate ranges from 17-20 cycle per minute. The SPO2 of the patients ranges 95-100 %.

Nutrition:

BEFORE HOSPITALIZATION,
the patient eats 3 times a day but with limited amount of food. She prefers to drink carbonated fluids.

During Hospitalization,

The patient only consumes soft foods or porridge and abstain from fatty and salty foods. She refuses to drink
adequate amount of water.

PATHOPHYSIOLOGY

Pregnancy

Blood volume increases Hypertension

Increased blood
Increased amount of vasopressin serum,nitrogen,uric Increased blood
acid and creatinine
Extra fluid in the body pressure

Bipedal edema Decreased urine causes

output and proteinuria vasoconstriction

Interstitial effect

Vascular effect
Kidney effects
 systemic effect

Precipitating Factor
Pre-disposing factor
-Present to the client
Present to the client
-Multi-gravida
Age: 41
-OB score: G5T3P0A1L3
Sex: female
-Lifestyle: soft drink intake of about
Family history: Mother’s 1.5 liters and above a day
side(hypertension) (4.32g/serving)
Past Medical History : PIH on her -Diet risk of increased sodium that
second child of about 6 months leads to extra pressure in blood
ended on spontaneous abortion ;BP vessel walls which causes
ranges from 140/90-180/1120 vasoconstriction
mmHg
-Placenta perfusion is decreased
: Hypertensive every pregnancy; BP fetal death.
ranges from 140/90 to 180/130

PLAN OF CARE

Headache

ASSESSMENT NURSING DX. PLANNING INTERVENTIO RATIONALE EVALUATION

N

Subjective: Acute pain Short term: Perform -To determine

“Nasakit ti ulok” related to After 1hour of assessment to underlying of After 1 hr. of
As verbalized by headache by nursing evaluate pain or nursing
the patient. stress pulsating intervention the characteristics of development of intervention,
sensation and client will be pain. complications patient verbalized
pain scale of able to report decrease of pain
4/10. decrease of pain. from 4/10 to 3/10
-To distract
-Encourage in attention from After 8-hour
relaxation pain and decrease intervention the
technique tension patient verbalized
Like rhythmic absence of pain
 breathing and there is no
Objective: -To prevent non-verbal
Pain scale of 4/20. fatigue indicators of
Facial grimaces pain/discomfort
noted Long term: -Encourage present.
Restlessness After 8 hours of adequate rest Goal is met
nursing
intervention the
client will be -To help relieve
able to verbalize pain
absence of pain -Administer
paracetamol as
ordered

Plan of Care

Edema

Assessment Nursing Planning Nursing Rationale Evaluation

Diagnosis Intervention

Subjective: Risk for impaired Short term goal: Independent - To reduce Short term
“ Minmanmanas nan skin integrity After 1 day of -Position patient in preload and Evaluation:
sakak” related to the nursing semi-fowlers to high ventricular filling After 1 day of
onset of skin intervention the fowler’s -To monitor nursing
breakdown client will be able -Monitor and note the cardiac output in intervention the
Objective: related to bipedal to demonstrate client’s input and perfusion of the goal demonstrates
edema adequate cardiac output kidneys through adequate cardiac
output as -Auscultate heart urine. output. Goal is
Presence of edema in evidenced by: sounds and note rate met.
both lower extremities -normal blood rhythm presence of
pressure S3, S4 and lung
-normal urinary sound. Long Term
output -Fluid retention Evaluation:
 decreases After 2-3 days of
Long term goal: Dependent: extracellular fluid nursing
After 2-3 days of -Limit fluids and volume and intervention the
nursing sodium as ordered reduces demands goal to
intervention the on the heart. demonstrate an
client will be able increase in
to demonstrates -Promotes renal activity tolerance
an increase in excretion of is observed. Goal
activity tolerance water to reduce is met.
as evidenced by bipedal edema
- Administer
-decreased
furosemide
occurrence of
as ordered.
fatigue
ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION
Dx. INTERVENTION

Elevated After 8 hr. of - Monitor and -Early detection, -After 8 hr. of

Subjective: Blood nursing record BP, measure identification and nursing
Pressure interventions, the in both arms and treatment of life- intervention, the
Patient client will have no thigh three times ,3- threatening client had no
verbalized “ elevation in blood 5 mi apart while the conditions elevation in blood
maululuwak” pressure above patient is at rest, pressure above
Pain rated as normal limits of then sitting, normal limits and
7/10, stabbing 120/80 mmHg standing for well maintain blood
pain at the evaluation. pressure within
temporal area. - Noted dependent acceptable limits of
and general edema 120/80 mmHg. Pain
-May indicate heart
Objective: - Provide calm and scale of 4/10 being
failure, renal or
Facial grimace restful surroundings the highest. Still
vascular impairment
noted - Monitor response observed facial
-T promote
Sighing to medication s to grimaces. Goal is
relaxation
Edema noted control blood partially met
-Response to drug
Vital sign pressure.
therapy usually
BP 190/80 - Administer
consisting of several
mmHg medications as
drugs including
indicated
diuretics.
#Furosemide
-To reduce BP in
# feso4
patients with
#Clonidine
relatively normal
#calcium + vitamin
renal functions
D3
-Educate the client
on diet therapy like
salt and cholesterol -Help the client to
restriction. comply with the
diet changes by
adopting in dietary
practices.
 DRUG STUDY RELATED TO CASE:

DRUG DOSAGE CLASSIF MECHANISM OF CONTR SIDE INDICATION NURSING

ICATIO ACTION AINDIC EFFECTS CONSIDERA
N ATION AND TIO
ADVERSE N/
EFFECT INTERVENTI
ON
Amlodi 10mg 1 Calcium Inhibits the Hypersen CNS: Hypertension Monitor Bp
pine tab OD Channel movement of sitivity to headache, chronic stable and pulse
Blockers calcium ions across drug dizziness, angina before therapy
For the membranes of fatigue Monitor intake
Pregnancy cardiac and arteria, GI: and output
risk muscle cells. abdominal
category discomfort
C Skin:
flushing

Lozarta 5mg tablet Anti Block substance in Hypersen CNS: To prevent stroke in -Monitor blood
n OD hypertensi the body that causes sitivity to insomnia, hypertensive patients pressure to
ve blood vessels to drug or headache with left ventricular evaluate drug
tighten its GI: hypertrophy (LVH) efficacy
compone abdominal
nt pain -Instruct patient
Musculoskel to avoid
etal: back potassium
pain supplement and
salt substitutes
containing
potassium

Furose 40-80 mg Loop Increases potassium Hypersen CNS; Treatment Monitor daily
mide daily diuretics excretion and sitivity to headache for weight, intake
plasma volume, drug or restlessness hypertension edema, and output
promoting renal other light- chronic ratios, amount
excretion of water, sulfonami headedness renal impair, and location
sodium chloride, des GI: Acute of edema, lung
magnesium, Constipation pulmonary edema sounds, skin
hydrogen and turgor, and
 calcium mucous
membranes.
Feso 4 Oral iron Receiving To provide Do not increase
bivalent frequent iron supplement or double dose
preparatio blood during pregnancy
ns transfusio
n
Clonidi Antihyper Decrease Disorder Indicated for Monitor blood
ne tensive transmission of pain of cardiac the treatment pressure and
signals at the spine. of hypertension pulse rate
Can affect alone or frequently
regulators of blood in combination
pressure in the with other
ventromedial and medications
rostral-ventrolateral
areas of medulla
Calcium 600 mg . Prenatal Calcium intake Sarcoidos Nausea, Vitamins -Assess patient
Vitamin suppleme during pregnancy is Headache, supplement calcium
+ D3 nt leads to elevated - less appetite used to intake
serum levels of Metastati prevent following its
vitamin d and folate c bone conditions dosage and
in mothers and also disease of low calcium route
reduced the and vitamin d if any allergic
incidence of reaction,
pregnancy induced -Assess for
hypertension and - signs of
eclampsia. constipation
Paraceta 500 Analgesic Relieve mild to Contraind Flushing Temporary relief of Observe acute
mol mg/tab moderate pin such icated to minor aches and pains, toxicity and
as headache, pains patient headache overdose
with
allergy to
acetamin
ophen
 Computation Score Justification
1. Nature of the 3/3X1 1 Elevated blood pressure is
Problem a health deficit since this
may affect bodily
functions especially the
patient is pregnant .
2. Modifiability of 2/2x 2 2 It is easily modified due
the problem to past medical history
and the presence of health
centers and being
knowledgeable about the
condition .
3. Preventive 2/3X1 1 Increased blood pressure
Potential can be prevented through
proper health teaching
and proper health
management.
4. Salience of the 2x2x1 1 The patient perceived the
problem problem that needed
immediate action
Total 5
1. Elevated Blood Pressure

2. Acute pain

Computation Score Justification

1. Nature of the 3/3X1 1 Acute pain is a health
Problem deficit since they may
affect bodily functions.
2. Modifiability 2/2x 2 2 It is easily modified due
of the to the presence of the
problem student nurse, staff and
being at the hospital.
3. Preventive 3/3X1 1 It is easily prevented
Potential since patient is currently
admitted.
4. Salience of 1/2x2x1 .5 The problem is not
the problem perceived as a problem
that needed immediate
action since hypertension
is more important.
Total 4.5
 3.Bipedal Edema

Computation Score Justification

1. Nature of the 2/3X1 .67 It is a health threat since
Problem it can possibly threaten
diseases especially the
patient is pregnant.
2. Modifiability 2/2x 2 2 It is easily modified due
of the to presence of student
problem nurse and staff.
3. Preventive 3/3X1 1 It is easily prevented
Potential since patient is admitted
and through proper health
interventions and proper
health management.
4. Salience of 1/2x1 .5 It is not perceived as a
the problem health problem since
hypertension is more
crucial.
Total 4.17

4.Headache

Computation Score Justification

1. Nature of the 3/3X1 1 IT is a health deficit since
Problem it may affect bodily
function especially the
patient is pregnant..
2. Modifiability 2/2x 2 2 The resources and
of the interventions needed to
problem solve the problem are
available to the patient.
3. Preventive 3/3X1 1 It is easily prevented
Potential through health teaching
and proper health
management.
4. Salience of 1/2x1 .5 It is not perceived as a
the problem problem needing
immediate action since it
can be managed through
bedrest and since other
medical health problem is
more important
Total 4.5
4.Headache

5.Ineffective health management

 Computation Score Justification
1. Nature of the 2/3X1 .67 It is a health threat since
Problem it can possibly threaten
diseases especially due
to the presence the
patient is pregnant.
2. Modifiability 1/2x 2 1 It is easily modified due
of the to the presence of
problem student nurses and staff..
3. Preventive 2/3X1 .67 It is easily prevented
Potential since patient is admitted
and through proper
health interventions and
proper health
management.
4. Salience of 1/2x1 .5 It is not perceived as a
the problem health problem since
hypertension is more
important.
Total 2.84

Listing of the Problems

1. Elevated Blood Pressure 5 1

2. Acute Pain 4.5 2
3. Bipedal Edema 4.17 4
4. Headache 4.17 3
5. Ineffective Health 2.84 5
Management

Laboratory results and interpretation

Diagnostic Description of Significance of Significant Nursing Implication
Procedure Procedure Purpose of the Findings or interpretation
Procedure

Complete Blood A complete blood CBC is used to Hemoglobin count is Elevation of the
Count (CBC) count (CBC) is a check the levels of 167 g/t (Normal hemoglobin level
blood test used to potassium, sodium, range 120-160 g/t) increases blood
evaluate a person’s creatinine, blood viscosity thus
overall health and glucose, total, Hematocrit count is increases blood
detect a wide range cholesterol and 0.49 (Normal range pressure.
of disorders triglycerides, among 37-47)
including anemia, others. Elevation of the
infection an Erythrocyte count is hematocrit level also
leukemia. 5.6x 10^12/L increases blood
(Normal range 4.0- viscosity thus
5.4) increases blood
pressure.

Erythrocytosis makes
blood thicker than it
should be and it could
increase the risks for
blood clot.

Elevated WBC count

is associated with
incident hypertension
among women and
men independent of
smoking and most
traditional
cardiovascular risk
factors in this
predominantly white
cohort.
Differential Counts Detects immature To check white Neutrophil count is It has been reported
WBCs and blood cell levels, 67.0% (Normal that low grade
abnormalities both that indicates the range is 55.0-65.0) inflammation
of which are signs of presence of enhances development
potential issues. infection, disease or of hypertension, as
an allergic reaction. high blood pressure is
linked with high
neutrophils.

Low level of
Lymphocyte count is
lymphocyte in the
23.0 % (Normal
blood signifies a
range is 25.0-35.0)
higher risk of
infection.

Elevated level of
monocyte count in
women with a
previous hypertensive
 Monocyte count is pregnancy generates a
6.8% (Normal range hypothesis that these
is 3.0-6.0) cells may link
hypertension in future
cardiovascular risk.

Elevated RDW-CV
indicates that there is a
major difference
between the size of
your smallest and
largest red blood cells.
RDW-CV is 17%
(Normal range is 11-
16)
Low level of PCT may
indicate another cause
other than bacterial
infection such as viral
infection.

PCT is 0.18 mL/L

(1.08-2.82)
Urinalysis A urinalysis is a test Urinalysis is used to Urine Elevated RBCs in the
that examines that screen for causes of Flowcytometry urine may due to
visual chemical secondary -RBC count is 28/uL kidney and other
microscopic aspect hypertension and to (Normal range is 0- urinary tract problems
of your urine. It can look for damage to 11) such as infection or
include a variety of the kidneys as a stones, kidney
test that detect a result of untreated inflammation or injury
measure various hypertension
compounds that pass
through your urine
using a single High levels of protein
sample of urine. during pregnancy
Chemical Analysis
-2+ protein indicates pre-
eclampsia.

Blood in the urine also

known as hematuria
-1+ blood
that is caused by high
blood pressure. It also
indicates presence of
damage in the kidney
due to high blood
pressure.
Clinical Chemistry Clinical Chemistry Clinical chemistry is AST/SGOT is 41.87 Elevated St is
uses chemical used to analyze u/L (Normal range is explained by the effect
processes to measure samples from <31) of hypoxia o the liver
levels of chemical patients to support in pre-eclamptic
components in body the diagnosis and pregnancy.
fluids ad tissues treatment of disease

Elevated LDH
LDH is 298.46 u/L indicates that there is
(Normal range is cellular death
<247

Conclusion

- In conclusion, patient Omas, a 41 yr. old female patient confined at the OB/ Gyne ward is suffering
from hypertension crisis which led to the fetal death of the utero. The patient suffers from impaired
urinary tract retention and bipedal edema. Moreover, post-partum anxiety is also evident in regards to
the impact of the fetal death uterine.

Recommendation
This paper studied existing health of patient of having pregnancy induced hypertension, the
signification in nursing profession and nursing education is to take for proper intervention that can
reduce this medical complication. As student nurses, we recommend the cliet to have adequate rest to

References:
https;//childrenswi.org
https://www.ncbi.n/m.nih.gov