OUR LADY OF FATIMA UNIVERSITY

CASE STUDY PREGNANCY INDUCED HYPERTENSION

Nursing Management of Patient with Pregnancy Induced Hypertension H.S, a 22 year old female named Maria Krystal Carreon Cabral who lives at Hagonoy, Sta. Monica Bulacan has been diagnosed of Pregnancy Induced Hypertension (PIH). When the patient was in labor she began to feel these symptoms: dizziness, frequent contractions and headache. The patient was put in the Philhealth OB ward. She was already on fullterm, AOG 41/7 weeks and in cephalic labor; Gravida one and Para zero with labor contraction around 09:00 pm on July 11, 2011. She was inserted a poly catheter and was infused with an IV solution of D5 water with oxytocine injected. On 08:18 am, her blood pressure was 150/100 which was abnormally high for a pregnant woman, her pulse rate was 70 BPM; respiration rate 17 CPM; and temperature is 36.5 Celsius. It is said there are many complication when you have PIH, it may even affect the fetus. Some doctors say that there are many risk for PIH one of this is it may be your first baby or you have a family history of PIH.

Pathophysiology The simple answer is doctors and scientists dont know what causes PIH. Some studies suggest that PIH may be caused by the mothers poor diet, an allergy to the placenta and fetus or even family history. But after many years of research, there is no clear answer to what triggers PIH. There are, however, risk factors for who is more likely to get PIH, as follows:

Risk Factors for Pregnancy Inducted Hypertension if this is your first pregnancy if you had PIH with an earlier pregnancy

 if you have a family history of PIH if you had high blood pressure before you became pregnant if you are younger than 20 or older than 34 if you have lupus, diabetes or kidney disease if you were obese before pregnancy if you are pregnant with more than one baby if you did not have regular pre-natal care and/or a poor diet if you have a hydatiform mole if you are African-American if there is something wrong with your baby (e.g., chromosomal abnormality) or with your placenta (e.g., maternal serum alpha feto protein MSAFP)

History H.S, a 22 year old female named Maria Krystal Carreon Cabral who lives at Hagonoy, Sta. Monica Bulacan has been diagnosed of Pregnancy Induced Hypertension (PIH). When the patient was in labor she began to feel these symptoms: dizziness, frequent contractions and headache. She stated that it was her first time to be diagnosed with PIH while having her pregnancy. Moreover we have found out that she was delivered by her mother through caesarean section because according to the doctor the vaginal canal of her mother wasnt wide enough for the baby to be delivered as NSD. And also her father was diagnosed with both Diabetes Mellitus and Hypertension. When she was admitted to the hospital she was infused with hypotonic solution D5 water in vinyl form. She was also inserted a poly catheter for ease of urination.

Nursing Physical Assessment We have noted for the patients vital signs and all as such are as follows; Blood Pressure: 150/100 (abnormal) Temperature: 36.5 Celcius (normal) Respiratory Rate: 17 CPM (normal) Pulse Rate: 70 BPM (normal)

Related Treatments The doctor ordered to infuse a 5mg Hydralazine through IV solution for every 15 minutes. Furthermore, through slow IV push, she was given a 4g magnesium sulfate (MgSO4) then 5g on each buttocks IM, maintaining 5g alternately on buttocks at 4 doses every 6 hours.

Nursing Care Plan and Diagnosis *Short Term Goals a. to reduce the pain that our patient experiencing before or during true labor *Long Term Goals a. to prevent the abnormal decrease of blood pressure caused by PIH

Nursing Interventions *If you are considered high risk for PIH If you are considered high risk for PIH (for example, you have diabetes or a family history of preeclampsia), your health care provider may: Recommend more frequent office visits after 24 weeks of pregnancy. If you develop any warning signs of preeclampsia (weight gain or swelling), tell your doctor right away.

 Have you check your weight and blood pressure at home. Prescribe one baby aspirin per day throughout your pregnancy, which may protect you from developing preeclampsia. Send you to a perinatologist, an obstetrician who specializes in high-risk pregnancies. Remind you that a good diet should include: *Daily Food Guide During Pregnancy Food Group Protein Foods Servings 6 Choose From (1 serving equals) 1 oz. Lean beef, pork, lamb, veal, chicken, fish or cheese cup cottage cheese 1 egg 1 tbsp. peanut butter Milk Products Breads & Cereals 6 cup cereal cup cooked rice or pasta 1 slice bread 6 crackers Fruits 5 cup (4 oz.) fresh fruit or juice cup dried fruits such as raisins or prunes 1 whole small apple, pear or 4 8 oz. Low fat milk or yogurt

orange Vegetables 5 cup cooked vegetables such as broccoli, carrots or greens 1 cup raw vegetables

Be sure to follow all dietary advice your doctor gives you. You may be put on a low sodium diet to reduce the amount of salt you eat or the DASH Diet which has been shown to lower blood pressure. You should avoid foods and drinks that contain caffeine like sodas, coffee and chocolate. You may need to restrict your salt intake by eliminating table salt from your meals and avoiding foods high in salt. To find out if a food is high in salt, read the label of any foods before you eat them and look for sodium content. Be sure to take your prenatal vitamins. *If you get mild preeclampsia and your baby is not in danger There are several things your health care provider may recommend if you get mild pregnancy-induced hypertension (preeclampsia) and your baby is not in danger. Bed Rest Rest often. Many women can reduce their high blood pressure by resting in bed for a few days. Lying on your left side helps to improve blood flow. Add Protein to Your Diet If the disease is causing you to lose protein in your urine, you may be helped by a high-protein diet to replace the lost protein. Check you and your baby - A visiting nurse can check your weight, your blood pressure, your urine for protein and listen to the babys heart rate in your own home. You can even be trained to do these things for yourself with a scale, blood pressure monitor, urine test strips and an external fetal heart rate monitor. Test your blood If your health care provider becomes concerned, you may need to have a blood test in the office to check for poor kidney function, abnormal liver

function and/or a drop in the amount of platelets in your blood. Test you further in the hospital If your symptoms and test results show that you are developing severe preeclampsia, your health care provider may want to put you in the hospital for more tests for you and the baby, as well as around-the-clock monitoring. *If you get severe preeclampsia If your mild preeclampsia becomes more serious preeclampsia, you will be hospitalized and prepared to deliver your baby. The goal of your doctors, nurses and other specialists at this time is to stop your condition from getting worse, while making sure your baby is not in distress before its time to deliver. Heres what you can expect in the hospital: A doctor or specialist will take your medical history and perform a physical exam. Blood tests will be done for the latest findings. A fetal monitor will check your babys heart rate and you may have an ultrasound for further evaluation of your baby. If you are delivering your baby before the due date, you may have an amniocentesis; this is a test that uses a needle to draw amniotic fluid from around the baby to measure if your babys lungs are mature. You will probably be given medicines to help you and your baby come through labor and delivery in the safest way possible.

Evaluation Every mother wants the best for her baby as well as the nurse/s wants the best for his/her patient. After two days of performing nursing interventions for PIH, the patient has been responding well to the medication that the doctor ordered. Her blood pressure has also decreased. The baby is doing well after the delivery. As well as the APGAR scoring is concerned, it scored a satisfactory point of 8.

Recommendations Every nurse must follow the doctors order, every move should have a rationale, one mistake may cause an innocent life to perish. They should be considerate to the situation of each patient they handle in this same case. They should always monitor the patients vital signs, securing also what they feel physiologically like headache or dizziness., and also their emotional needs.