3).

MATERNITY
Mrs Ernie is a 28 year-old woman,gravida 3 ,para 2 .who presents to the clinic today for
her initial prenatal examination. she state that her last menstrual period (LMP) is 9/15/98 .she
has not received prenatal care before today because lack of transportation. however,she does
verbalize the importance of early prenatal care to ensure the well-being of her new born she
states that things have gone well so far.she eats fast food and drink soda frequently. she lives
with husband and two son in -law, who are very supportive .her husband works full time at a fast
food chain store. he is is looking for another job that pay more money. she states that it hard to
make financial ends meet at time. she stay at home with children.
The past medical history is unremarkable exept for two pregnancies ,which were both
term gestation,delivered vaginally. during the last pregnancy, she was diagnosed pregnancy
induced hypertension and gestational diabetes and was induced at 38 weeks gestation. she states
that she gained 60 pound and that her son weighed 9 pound 2 ounces
KEY WORD

Mrs .Ernie is a 28 year-old

Last Menstrual 9/15/98
Eats Fast Food and Drink Soda Frequently
hypertension and gestational diabetes and was induced at 38 weeks gestation
on weighed 9 pound 2 ounces

ANSWER

 Hypertension (HTN)
Chronic hypertension is defined as blood pressure exceeding 140/90 mm Hg before
pregnancy or before 20 weeks' gestation. When hypertension is first identified during a woman's
pregnancy and she is at less than 20 weeks' gestation, blood pressure elevations usually represent
chronic hypertension.
In contrast, new onset of elevated blood pressure readings after 20 weeks' gestation
mandates the consideration and exclusion of preeclampsia. Preeclampsia occurs in up to 5% of
all pregnancies, in 10% of first pregnancies, and in 20-25% of women with a history of chronic
hypertension. Hypertensive disorders in pregnancy may cause maternal and fetal morbidity, and
they remain a leading source of maternal mortality.

Hypertension in Pregnancy

During pregnancy, hypertension can affect blood flow to the kidneys, liver, brain,
placenta, and other organs. Possible types of hypertension include preeclampsia, eclampsia, and
gestational pregnancy. Treatment options involve bed rest, more frequent prenatal visits, and
early delivery (after 36 weeks). Even though high blood pressure and related disorders can be
serious, most women with high blood pressure during pregnancy (and those who develop
preeclampsia) have successful pregnancies.

Types of Pregnancy-Related Hypertension

Types of hypertension in pregnancy include:

Chronic hypertension

Eclampsia or preeclampsia

Chronic hypertension with preeclampsia

Late hypertension (also referred to as gestational hypertension).

Preeclampsia

Preeclampsia, a condition that can occur during pregnancy, results from a

narrowing of the blood vessels. Because of this narrowing, women with this
condition can have decreased blood flow to the kidneys, brain, liver, retina,
and placenta. Symptoms include high blood pressure, swelling of the hands
and face, and protein in the urine. The only definite cure is delivering the
fetus. However, if the condition occurs early in a pregnancy, treatment will
involve careful monitoring of the mother and the fetus until the fetus can be
delivered.

Gestational Hypertension

Gestational hypertension is high blood pressure that develops after the twentieth week of
pregnancy. The causes of this condition are unknown, but it is clear that the condition affects
blood flow to organs such as the kidneys, placenta, brain, and liver. There is no way of
preventing this type of hypertension, but regular prenatal care will usually catch it early, reducing
the chances of complications.

What Causes It?

High blood pressure research scientists do not yet know the cause or causes of hypertension
in pregnancy; however, they do know that it can affect blood flow to organs such as the:

Kidneys

Placenta

Liver

Retina

Brain.

Prevent Pregnancy Hypertension

1. Know your blood pressure level before getting pregnant. Make an appointment for a
checkup with your primary care doctor or ob-gyn and make a note of your blood
pressure. You can also stop by a health fair for a free evaluation, or check you blood
pressure at a pharmacy that has a self-service machine.
2. Kick the salt habit. High salt, or sodium, intake can raise blood pressure. If you
typically sprinkle salt on every dish, now is the time to break the habit. Most adults
should keep salt intake to 1 teaspoon per day that includes what comes out of the
shaker as well as the hidden sodium in processed foods.
3. Get off the couch. Get up and get moving before you conceive. If youre already
pregnant, ask your doctor about starting a regular exercise program. Sedentary
women are likely to gain weight, which can increase the risk of hypertension during
pregnancy, as well as before and after. Try to start your pregnancy at a healthy body
weight.
4. Pay attention to medication. Make sure you aren't taking medication that can raise
blood pressure levels check with your doctor to see what's safe. You may not
realize that popping a decongestant, such as pseudoephedrine (Sudafed and others),
for something minor like a stuffy nose can cause an increase in blood pressure. Think
twice about using any medication unless your doctor approves. If you already have
high blood pressure, talk to your doctor about medication use before and during
pregnancy. It is very important to have your blood pressure under control and stable
before becoming pregnant, as those nine months are not the best time to try new or
additional medication. Work with your doctor to make sure that you are taking a
medication that will be safe to continue during pregnancy.
5. Get regular prenatal checkups. If your blood pressure starts to rise during pregnancy,
you want to catch it early. Make sure to keep all appointments and consider buying a
home blood pressure monitor to check your blood pressure more frequently.