Comprehensive Case Study Format

‫مالحظة المادة العلمية ألجل االستفادة و ليس ألجل نقل‬

1. Personal information:
(2 Marks)

Patient initials:

Age: 23 Address: Boushar Hospital NO:

Date of Admission/ OPD Visit: 15/3/2021 Date of Discharge: 18/3/2021

2. Family History: (1 Mark)

Diabetes mellitus: patient’s mother and grandmother.

Hypertension: patient’s mother, uncle and grandmother.
Obesity : -
Heart diseases : -
Anemia: patient’s uncle and his sons.

3. Medical and Surgical

History: (2 Marks)

Mrs H, she is primigravida mother (G1, P0, L0, A0) diagnosed with pregnancy-induced
hypertension.

4. Obstetrical History (Fill for ANC/PNC cases. If newborn case fills for the
newborn’s mother): (2 Marks)

 Gravida: 1 Para: 0 Abortion: 0 Fetal death: 0

 Died: 0 Alive: 0
 L.M.P: 5/8/2020 EDD (Scan): 13/5/2021 EDD (history): 13/5/2021

5. Medical Diagnosis: (2 Marks)

(Example: G4, P3, L3, A0, 38weeks with PIH)

Primigravida mother, G1, P0, L0, A0, 31 weeks and 5 days of gestation with PIH.

6. Chief Complaint:
(Admission and present complain with duration) (2 Marks)

The mother admitted to Royal hospital in 15/3/2021 due to high blood pressure during pregnancy.
When I was assessing her she told me “I feel headache, dizziness and imbalance sometimes. I also
suffer from low back pain, especially when I sit or stand for a long period.

7. Definition of final diagnosis: (3 Marks)

(Example: A mother is G4, P3, L3, A0, 39 weeks with PIH, Oligohydramnios,
delivered by LSCS. In this case define PIH, Oligohydramnios and LSCS)

A mother is primigravida G1, P0, L0, A0, 31 weeks and 5 days of gestation with PIH. PIH is
pregnancy- induced hypertension which is a condition in which vasospasm occurs during pregnancy
in both small and large arteries. It is unique to pregnancy and occurs in 5% to 7% of pregnancies.
 8. Etiology of the disease: (4 Marks)
(Example: A mother is G4, P3, L3, A0, 39 weeks with PIH, Oligohydramnios,
delivered by LSCS. In this case write the etiology for PIH, Oligohydramnios and
LSCS)

SI. According to text book In your patient

NO
Occur most frequently in:
- Having blood pressure before - Family history.
pregnancy or with a past pregnancy.
- Family history.
- Having kidney disease.
- Having diabetes.
- Women of African American.
- Women with multiple pregnancies.
- Primiparas younger than 20 years or
older than 40 years.
- Women from low socioeconomic
backgrounds (perhaps because of
poor nutrition).
- Those who have had five or more
pregnancies.
- Those who have hydramnios
(overproduction of amniotic fluid).
- Those who have an underlying
disease such as heart disease,
diabetes with vessel or renal
involvement, and essential
hypertension.
 9. Clinical manifestations: (4 Marks)
(Example: A mother is G4, P3, L3, A0, 39 weeks with PIH, Oligohydramnios,
delivered by LSCS. In this case write the clinical manifestations for PIH,
Oligohydramnios and LSCS)

SI. NO According to text book In your patient

- Proteinuria. - Proteinuria.
- Edema. - Edema in the lower extremities.
- Hypertension. - Hypertension.
- Vision changes. - Dizziness.
- Dizziness. - Headache.
- Headache.

10. Management: (4 Marks)

(Example: A mother is G4, P3, L3, A0, 39 weeks with PIH, Oligohydramnios,
delivered by LSCS. In this case write the management for PIH, Oligohydramnios and
pre or post LSCS).
SI. According to text book In your patient
NO

- Magnesium sulfate. - Antihypertensive medications such as

- Antihypertensive medication such
as Labetolol, Methyl Dopa, and
Nifedipine.
- Delivery of fetus and placenta if not
controlled by treatment.
- Change lifestyle (limited sodium
intake).
- Monitoring the blood pressure.
Labetalol, Methyl Dopa, and
Nifedipine.
- Change lifestyle (limited sodium
intake).
- Monitoring blood pressure.

Pathophysiology of the disease: (4 Marks)

 (If no Pathophysiology, focus on the effect of disease on woman & fetus)
(Example: A mother is G4, P3, L3, A0, 39 weeks with PIH, Oligohydramnios,
delivered by LSCS. In this case correlate the diseases and their process to each other,
correlate PIH with Oligohydramnios with LSCS)

Causes

Endocrine Vascular Obesity (BMI Family history Chronic renal

diseases like diseases like more than 30). of disorder like
diabetes. aortic hypertension. hydronephrosis
coarcitation. Women with
Having blood multiple Primiparas Those who
pressure before Having kidney pregnancies. younger than have had five
pregnancy or disease. 20 years or or more
with a past Those who older than 40 pregnancies.
pregnancy. Women of have years.
African hydramnios Women from
American. low
socioeconomic
backgrounds.

Inadequate vascular remodeling.

Decrease placenta perfusion and

hypoxia.
Endothelial cell dysfunction

Defects in renal sodium Vasospasm. Defects in vascular

hemostasis. sm`ooth muscle growth
and structure.
Inadequate sodium 1. Decrease uteroplacental
Increases vascular
excretion. perfusion.
wall thickness.
Salt and water retention. 2. Glomerular damage.

3. Cortical brain spasm. Increase total

peripheral resistance.
Increase plasma and ESF 4. Retinal arteriolar spasm.
volume.
5. Liver ischemia.

Increase cardiac output.

Clinical manifestation
 Headache and Edema and
dizziness. Vision changes Proteinuria. high blood
pressure.

Pregnancy – induced
hypertension

11. Investigation: (8 Marks)

(In case of antenatal case study, include booking and resent investigations)

Investigation Findings Normal findings Interpretation

CBC: CBC in a routine
Heamoglobin 11.5g/dL 11 – 14.5 investigation. Decrease
Heamatocrit of blood 35.6% 34 – 43 mean cell volume and
Red blood cells 4.98 10*12/L 4.1 – 5.4 mean cell Hb indicate
Mean cell volume 71.5fL (decrease) 78 – 95 that the patient have Iron
Mean cell Hb 23.1pg (decrease) 26 – 33 deficiency anemia, which
Mean cell Hb conc 32.3g/dL 31 – 35 common during
RBC distribution width 14.6% 11.5 – 16.5 pregnancy.
Platelet count 208 10*9/L 150 – 450
Mean platelet volume 8.65fL 7 – 10.5 The increase production
White blood cells. 12.1 10*9/L (increase) 2.4 – 9.5 of WBC is to fight
infection.
LFT:
Bilirubin total 6umol/L 5 – 21 Decrease the albumin
ALT (alanine 21[iU]/L 10 – 49 level indicates that the
transaminase). liver is not function well.
Alkaline phosphatase 110[IU]/L 46 – 116
Protein total 58g/L 57 – 82
Albumin 27g/L (decrease) 34 – 50
Globulin Gap 31g/L -
Urea and electrolyte and
GFR, panel: The increase in chloride
Sodium 137mmol/L 136 – 145 indicates that the patient
Potassium 4.6mmol/L 3.5 – 5.1 is dehydrated.
Carbon dioxide 24mmol/L 20 – 31
Chloride 108mmol/L (increase) 98 – 107
Urea 3.9mmol/L -
Creatinine 49umol/L -
eGFR (estimated >90mL/min/1.73m2 -
glomerular filtration
rate).
Protein creatinine ratio in The findings are all
urine, panel: within normal ranges
Protein 1.85g/L - which indicate that the
Creatinine urine 20.21mmol/L - kidney is functioning
Protein / Creatinine 91.6mg/mmol - well.
(ratio).
 12. Physical assessment (Head to toe): (5 Marks)

Area Findings Interpretation

Hair and scalp Patient’s hair is black, dry, and well Hair loss indicates alopecia.
distributed with slight dandruff and hair
loss.
Face Patient’s face looks tired, dry with some The pigmentation on patient’s face is due
kind of pigmentation around her mouth to pregnancy and increase melanocyte
and forehead, no melasma noted. hormone.
Eyes -Both eyes are equal and symmetric. The edema of patient’s eyelid indicate that
-The sclera is white. the patient have pregnancy induced
-The conjunctiva appeared white. hypertension.
-There is no edema in eyelid. Headache and dizziness are symptoms of
-The cornea is transparent, smooth and high blood pressure.
shiny.
-Patient doesn’t wear eyeglasses, she have
equal vision and size on both eyes. Also,
she doesn’t have any abnormal color or
injury in her both eyes.
The patient said that she has dizziness and
headache sometimes.
Ears The auricles are symmetrical and have Ear assessment is done to see if the patient
same color with patient facial skin. The has any ear conditions like ear infection.
auricles are aligned with the outer canthus For example ear fullness is usually result
of eye. No discharge or fullness noted from from cold or flu and can lead to ear
both ears. When I talked to her during the
 assessment, the patient was able to hear
from her both ears.
Nose The nose appeared symmetric, straight and
uniform in color with no presence of
discharge. The patency is good and there is
no presence of drainage.
Sinuses Sinuses are not tender and the patient does
not have pain during palpation.
Mouth, teeth and throat The lips are pink and moist. The teeth are
white with no discoloration and the patient
does not lose any tooth. The tongue is
centrally positioned and it is pink in color
and moist. The gums are pink and not
bleed.
Neck and lymph nodes The neck appeared dark. The lymph nodes
are not palpable during palpation.
Breast The breast is enlarged, equal and round
with dark areola, some pigmentation and
there is no scars noted. Both nipples are
erect. Present of colostrum and there is no
abnormal discharge. No lumps noted
during palpation.
Abdomen The abdomen is round and symmetric with
linea nigra, striae gravidarum and no
presence of scars. The fundus is 29 cm
infection.
Nose assessment is done to check patient
condition, to see if she has any respiratory
problems like allergic rhinitis, flu, or sore
throat.
I checked the sinuses of the patient to see
if she has sinusitis.
I checked patient’s mouth, teeth and throat
to see if the patient has gingivitis,
periodontitis or oral cancer. Also, to check
if the patient has sensitive teeth and this
can be identified when the patient eat cold
or hot food, she feel pain or discomfort.
The darkness of the neck is a physiologic
change happens during pregnancy due to
increase melanocyte hormone production.
Breast assessment is done to check any
breast problem. The pigmentation and dark
areola are physiological changes during
pregnancy. Palpation of the breast is done
to check if there is any presence of lumps
which indicate breast cancer.
The shape of the abdomen indicates the
fetal lie. Linea nigra indicates the
hormonal changes of pregnancy. Striae
 long and it’s appropriate for gestational
age. The lie of fetus is longitudinal, the
position is LOA, the presenting part is
cephalic and it’s still not engaged. During
auscultation the fetal heart rate is
152pits/min. The patient can feel her fetal
movement.
Elimination (Urinary pattern): The last void before 45
minutes may be as patient said. Her
frequency in voiding 3-4 times per day.
She does not feel itching. And there is no
pain or burning sensation while voiding.
(Bowel movement): the last bowel
movement is yesterday. There is no
constipation, diarrhea or hemorrhoids with
the patient.
Vagina No vaginal bleeding, spotting or vaginal
discharge with offensive smell noted.
Extremities Both legs are symmetrical and equal. No
gravidarum is due to over stretch of
abdominal muscle due to progress of
pregnancy. Measure the fundal height to
compare size of uterus with period of
amenorrhea. Fetal lie indicates the
relationship of long axis of the fetus with
the long axis of the uterus. Auscultation of
fetal heart rate is done to monitor fetal
wellbeing. Asking the mother about fetal
movement to ensure fetal wellbeing.
Urinary assessment is done to rule out any
urinary tract infection and to indicate the
need for teaching the mother about
physiological changes which occur during
pregnancy.
Constipation occurs due to hormonal
changes and iron supplementations.
Hemorrhoids occur due to pressure of
pregnant uterus on the pelvic veins.
Vaginal bleeding is need to differentiate
between bleeding due to implantation of
embryo or it may be suggestive of
miscarriage. Offensive smell of vaginal
discharge suggests infection.
Presence of edema is indicative of
 edema noted in calf muscle. No varicose physiological at times or may be due to
veins noted. Both legs are warm in pregnancy induced hypertension. Presence
temperature and there is no pain. The of varicose veins indicates DVT (deep vein
patient has edema in her feet. thrombosis).

15. Focused physical examination: (5 Marks) (Include abdominal examination for

ANC case, BUBBLE for postnatal case, Head to toe assessment for newborn and gynecological case)

Health Subjective data Objective data Suggested Health problems

assessment
system
Neurological Client verbalized " I When I assessed her eyes she has pale and white
assessment feel headache and conjunctiva. Pregnancy – induced
dizziness sometimes” hypertension.

Cardiovascular Client verbalized “ both When I assessed her legs, she has edema in her feet. The edema of the patient’s feet
assessment of my legs are indicates pregnancy induced
edematous “ hypertension.
Abdominal Client verbalized “ I a. Inspection: -All of the changes in the
assessment have this brown line Gestational age: 31 weeks. abdomen it’s physiological
from the umbilicus tell Size: appropriate for gestational age. changes happens during
near the bladder” Shape: round. pregnancy.
Skin changes: there are linea nigra and striae -The fundal height is appropriate
gravedarum. for the gestational age.
Fetal movement: visible
b. palpation:
 fundal height:29cm
fundal: buttocks (irregular, soft and broad)
lateral:
right: extremities (irregular and I felt gabs in
between)
left: back (smooth, firm and regular)
position: LOA
lie: longitudinal
pelvic:
presentation: cephalic (round, smooth, firm and hard)
engagement: not engaged
c. Auscultation:
fetal heart rate: 142 beats/minutes and it’s regular.

15. Medications: (8 Marks)

Drug Dose Route Freque Indicatio Classificati Action Side Nursing responsibility
name ncy n on effect
Heparin 4000unit Inj OD To Anticoagul Promotes the Injection 1-Instruct patients to report any blood in urine
low mol wt prevent ant inactivation of site or stools or bleeding from gums, nose, vagina,
clixane blood factor X, reactions or wounds.
clots Category B which, in turn, such as 2--Check concentration of heparin carefully (-
prevents the redness, Use of the wrong concentration for the route of
conversion of irritation administration is a common medication error
prothrombin and with serious/potentially life-threatening
 to thrombin. bruising. ramifications).
Also has an
effect on
fibrin, limiting
the formation
of a stable
clot.
Paracetamo 1000mg Inj STAT To reduce Non obioid Inhibits the Nausea 1-Assess patient for medical conditions that
l pain. analgesics synthesis of Rash contradict the use of acetaminophen.
prostaglandins Urticarial 2-Remind patient that the maximum adult dose
Category A that may serve is 4g in 1 day, and that exceeding this dose may
as mediators cause acute liver disease or kidney disease.
of pain and
fever,
primarily in
the CNS.

Nifedipine 20mg Tab BID Treat Antihyperte Inhibits the Headache 1-Check BP before administering the
hypertensi nsive movement of Fatigue medication.
on during calcium ions Nausea 2-Inspect gums visually. Changes in gingivae
pregnancy Category C across the Diarrhea may be gradual, and bleeding may be exhibited
membranes of only with probing.
cardiac and
arterial muscle
cells.
Labetalol 200mg Tab TID Treat Antihyperte Competitively Depressio 1- Do not administer the dose if the patient is
 hypertensi nsive blocks alpha1, n bradycardic or hypotensive.
on during beta1 and Nausea 2-Teach the patient not to stop taking her
pregnancy Category C beta2. Alpha Vomiting medication on her own and to be certain not to
and beta allow her prescriptions to run out.
bloking actions 3-Teach the patient or her family how to check
contribute to her pulse and blood pressure at home, and what
the blood to do if there is a problem.
pressure
lowering effect.
Fefol 1cap Capsul OD It’s iron Vitamin Elevates the Nausea 1-Instruct the patient to take the drug at bed
capsule e supplemen serum iron Vomiting time and with empty stomach.
t, to Category A concentration Anorexia 2-Teach the patient strategies to deal with
prevent or which then Constipati constipation.
treat Iron helps to form on 3-Instruct the patient to take the drug with fresh
deficiency hemoglobin. fruit juice especially with fruit with vitamin C.
anemia.

16. List of all nursing diagnosis with prioritization use PES format: (4 Marks) Note: Include appropriate nursing
diagnosis for the mother and newborn in case of postnatal case study.
Problem Etiology Signs and symptoms
Ineffective tissue perfusion Related to vasoconstriction of Edema, Skin temperature
blood vessels changes, Skin discolorations,
Bp changes, Positive
Homans’ sign.
Deficient fluid volume Related to fluid loss to Dry skin, increase body
 subcutaneous tissue temperature (T=37.9), thirst,
alteration in skin turgor,
decrease in urine output (3-4
times).
Risk for fetal injury Related to reduced placental There were no signs and
perfusion secondary to symptoms in the risk
vasospasm diagnosis.
Social isolation Related to prescribed bed rest Patient verbalized “I’m bored
here, all the time I’m in this
bed”.

17. Nursing care plan: (20 Marks)

Assessment Diagnosis Planning Intervention Rational Evaluation

Subjective: Ineffective tissue Goal: increase blood 1-Assess for signs of 1-Particular clusters At the end of
Patient verbalized “I perfusion related to supply to the decreased tissue of signs and nursing
have edema in my vasoconstriction of extremities. perfusion. symptoms occur with intervention, the
both legs and I feel blood vessels. differing causes. patient was:
that I can’t walk like Outcomes: Evaluation of 1-Able to identify
usual, I have some As evidence by: 1-The patient will be Ineffective Tissue factors that improve
difficulty”. 1-Patient verbalized able to identify Perfusion defining circulation.
“I have edema in my factors that improve characteristics 2-Able to identify
Objective: both legs”. circulation. provides a baseline necessary lifestyle
Edema in the both 2- Positive homans’ 2-The patient will be 2-Assess lower for future comparison. changes.
legs sign. able to identify extremities, noting 2- These may indicate 3-Able to verbalize
necessary lifestyle skin texture, presence normal sensations and
Skin discoloration 3- BP changes. changes. of edema, ulcerations. DVT. movement as
BP changes 3-The patient will be 3-Measure appropriate.
Skin temperature Definition: able to verbalize or circumference of
changes Decrease in oxygen demonstrates normal extremities as 3-Useful in
Positive homans’ sign resulting in the failure sensations and indicated. identifying edema in
to nourish the tissues movement as 4-Check for calf involved extremity.
at the capillary level appropriate. tenderness (Homans’
[Tissue perfusion sign), swelling, and 4-Which may indicate
problems can exist Redness. thrombus formation.
without decreased 5- Administer heparin
cardiac output; medication as
however, there may prescribed. 5- To prevent
be a relationship thrombus formation.
between cardiac
output and tissue
perfusion.]

Assessment Diagnosis Planning Intervention Rational Evaluation

Subjective: Deficient fluid Goal: 1-Assess for signs of 1-Provide baseline of At the end of
Patient verbalize “I volume related to Maintain fluid fluid volume the problem. nursing intervention,
feel thirst even I drink fluid loss to volume. deficient. 2- Fluid deficit can the patient was:
water and my skin subcutaneous tissue. 2- Emphasize cause a dry, sticky 1-Able to explain the
become dry Outcomes: importance of oral mouth. Attention to measures that can be
sometimes”. As evidence by: 1- The patient will be hygiene. mouth care promotes taken to treat or
1-Patient verbalized able to explain interest in drinking prevent fluid volume
Objective: “I feel thirst even I measures that can be and reduces loss.
Dry skin. drink water and my taken to treat or discomfort of dry 2-Able to verbalize
Decrease urine output skin become dry prevent fluid volume mucous membranes. understanding of
(3-4times). sometimes. loss. 3- Signs of causative factors and
Thirst. 2-Increase skin 2- The patient will be 3- Assess skin turgor dehydration are also purpose of individual
Alteration in skin temperature. able to verbalize and oral mucous detected through the therapeutic
turgor. 3-Decrease urine understanding of membranes for signs skin. interventions and
Increase skin output. causative factors and of dehydration. 4- Febrile states medications.
temperature (T=37.9) purpose of individual 4- Monitor and decrease body fluids 3-Able to demonstrate
Definition: therapeutic document by perspiration and lifestyle changes to
Decreased interventions and temperature. increased respiration. avoid progression of
intravascular, medications. This is known as dehydration.
interstitial, and/or 3-The patient will be insensible water loss.
intracellular fluid; able to demonstrate 5- Oral fluid
refers to dehydration, lifestyle changes to 5-Urge the patient to replacement is
water loss alone avoid progression of drink prescribed indicated for mild
without change in dehydration. amount of fluid. fluid deficit and is a
sodium. cost-effective method
for replacement
 treatment.

Assessment Diagnosis Planning Intervention Rational Evaluation

Risk for fetal injury Goal: 1-Assess for maternal 1-In PIH and
related to reduced Prevent fetal injury. conditions that would chorioamnionitis, steroid
placental perfusion contraindicate therapy may
secondary to Outcomes: steroid therapy to aggravate hypertension an
vasospasm. 1-The patient will be facilitate fetal lung d mask signs of infection.
able to identify maturity. 2- Tocolytics can increase
measures that help to 2-Assess FHR; note FHR. Delivery may be
control PIH. presence of uterine extremely rapid with small
2-The patient will be activity or cervical infant if persistent uterine
able to maintain changes. contractions are
pregnancy at least to unresponsive to tocolytics,
the point of fetal or if cervical changes
maturity. continue.
3- The patient will 3-Administer 3-In the event
be able to recognize antibiotics, as of PROM and fetal lung
the importance of indicated. immaturity, antibiotics
controlling PIH. may be used to prevent or
4- Monitor Maternal reduce risk of infection.
Well-being. 4- Take blood pressure
frequently at least every 4
hours or with a continuous
monitoring device to detect
any increase, which is a
 warning that a woman’s
condition is worsening.
5- Monitor Fetal 5- Single Doppler
Well-being. auscultation at
approximately 4-hour
intervals is sufficient.

18. Health education plan: (4 Marks)

Include health teaching points under heading which is appropriate for all the needs of the mother and newborn with
rational.

Priority topic for health teaching: control or lower the high blood pressure during pregnancy.

Rationale: the patient is hypertensive patient so she needs to know the measurements of reducing blood pressure
during pregnancy.
Summary points Scientific rational / explanation

Decrease the salt in your diet.
Even a small reduction in the sodium in your diet can
improve your heart health and reduce blood pressure about
5 to 6 mmHg. The effect of sodium intake on blood
pressure varies among groups of people. In general, limit
sodium to 2300 mg a day or less. However, a lower sodium
intake 1500 mg a day or less is ideal for most adults.

Eat healthy food. Eat fruits, vegetables, whole grains, poultry, fish and low
fat dairy foods. Also, get plenty of potassium, which can
help prevent and control high blood pressure. Eat less
saturated and trans fat.

Reduces the amount of caffeine drinking Caffeine may cause a small rise in blood pressure.
per day. Drinking a moderate amount of caffeine (less than 2 cups
of coffee per day) does not increase the risk of high blood
pressure in most people.

Exercise regularly. Regular aerobic exercise such as walking for 20 to 30

minutes most days of the week can lower your blood
pressure. Doing exercise for about 150 minutes a week, or
about 30 minutes most days of a week can lower your
blood pressure by 5 to 8 mmHg.

Managing stress. Reduce stress as much as possible is help to lower your

blood pressure. Practice healthy coping techniques, such as
muscle relaxation, deep breathing exercise or meditation.

Maintain healthy weight. Keeping a healthy weight and losing weight if you are
overweight or obese can help control the high blood
pressure.
19. Reflection: (Use Gibbs reflective cycle) (3 Marks)

Introduction:

On Wednesday, March 17th, I was in the maternity ward 4. The teacher chose one patient for me to
do the antenatal assessment and to be my patient for the case study. I went to the patient and asked
her permission that I would like to ask her some questions and I want to see her breast and abdomen.
At first, I was worried that she would not agree because in the day before I looked for more than one
patient, and all of them did not agree, but I was very happy because she agreed and did not say no
and did not refuse my request. At the beginning I asked her some questions and she answered all the
questions well. It is true that she was feeling a little tired, but that did not prevent her from allocating
some time to me. This patient was cooperative with me and did not refuse to answer any questions
or refuse the examination that I did for her.

Feelings and thought:

Through this situation I was very happy because the patient agreed, as in such situations and
requests most of the patients do not allow as to do so, we may face some difficulties in convincing
the patient. This patient was cooperative and understanding me. I felt happy and reassured about her
and I did the antenatal assessment well with my teacher.

Evaluation:

In my opinion, that situation happened well, as I did not take mush time to convince the patient to
agree. When I took permission from her, she quickly agreed and did not hesitate to do so. She is
very good at dealing and her approval made me feel happy because I tried a lot before to convince
more than one patient, but all of them refused. On the other hand, it can be said that there are some
things that happened a little wrongly, I did my job completely in about 10 to 15 minutes. The patient
was cooperative and responsive to me, and when I asked her, for example, to lift her clothes, she
does that quickly and does not ask questions. In the end, I thanked her for her approval.

Analysis:

Surely, this situation happened very well. Why? Because the patient helped me a lot in doing
antenatal assessment, as she understood that must of the patients do not agree to my request, so I
will lose my time convincing a patient. This patient agreed quickly because I mentioned to her that
yesterday I searched for more than one patient to do this assessment but all of them refused. I think
what made this situation go well was that I used good therapeutic communication and techniques
which made the patient agree to my request. In the end, I can improve such situations like this with
patients through the use of therapeutic communication skills, and to speak with the patient clearly
with a smile. Also, an explanation of what I will do must be provided to the patient because the
patient deserves to know about the procedure will be done for her.

Conclusion:

I learned from this situation that not all patients will refuse if we ask them for something. I learned
positively from my experience that I can persuade the patient to do a procedure for her by using
therapeutic communication and explaining the procedure to the patient, so that she is understood of
what I will do. My strengths are that I was able to convince the patient in a simple and fast way. I
was able to achieve some of my goals as I was able to do the antenatal assessment.

Reflection on action:

Through this experience, I see that as student, we will encounter many patients who may reject our
request in making a procedure for them so we must know and understand all the strategies that we
can use in convince the patient. For example, we must be calm and avoid negative language by
talking to the patient calmly and not raising our voice. Also, we should avoid arguing with the
patient and talk to her with respect. In the end, I felt that I did a good job and that I was able to
achieve my goals. I felt happy in doing the procedure after many attempts with more than one
patient.
 20. References: (3
Marks)

- Pillitteri A (2010) Maternal & Child Health Nursing: Care of the Childbearing &
childrearing family (6th edn) Philadelphia: Lippincott Williams and Wilkins
- Hinkle ,J.L,&Checver, K.H. (2012). Brunner and Suddarth’s text book of Medical Surgical
Nursing (13 ed). Philadelphia, PA: J.B.Lippincott Williams & Wilkins, pp,862-863.

- Karen J.& Linda K.(2007), Nursing Diagnosis Reference Manual, 7th Edition, Philadelphia:
Judith A, Chapter5(369 370), (394-397).4

- Gestational hypertension. (2021). Retrieved 31 March 2021, from

https://www.stanfordchildrens.org/en/topic/default?id=gestational-hypertension-90-P02484

- 10 ways to control high blood pressure without medication. (2021). Retrieved 31 March 2021, from
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-
20046974

- Patange, R., V. Rokadhe, A., R. Shinde, G., N. Jadhav, S., & Bahulekar, A. (2020). ORAL NIFEDIPINE
VERSUS ORAL LABETALOL IN THE TREATMENT OF PREGNANCY INDUCED
HYPERTENSION. Retrieved 31 March 2021, from https://ejmcm.com/article_5748.html

- 6 Preterm Labor Nursing Care Plans. (2021). Retrieved 31 March 2021, from
https://nurseslabs.com/preterm-labor-nursing-care-plans/4/
21. Organization of case study: (2 Marks)

Follow the general guidelines of case study.

Marks obtained = X 35
100

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