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Adamson University

College of Nursing


At the end of the case presentation our audience and co-learners in the field of health will be able to

enhance their knowledge, skills and attitudes in properly initiating the actual duties and responsibilities of a

hospital nurse by participating in the reduction of the mortality, morbidity, disability and further complications

of Gestational Hypertension in order to be an effective and proficient nurses in the future



 Review the proper physical assessment (IPPA) and expected findings in a woman with gestational


 Understand the disease process: the causes, effects, management, treatment, and possible preventions.

 Determine the pathophysiology of the condition with their rationale for occurrence of each


 Determine why certain management and medications are given and provided for the condition.

 Understand how and why certain diagnostic tests are done for the condition.

 Review the concepts about the anatomy and physiology with regards to the condition.


 Identify the appropriate health teachings in which to provide to future patients with the said condition.


 Share the learning acquired to co-student-nurses to increase awareness and help them if ever they will

encounter patient with the same condition.

Gestational Hypertension: Case study 1

Adamson University
College of Nursing



Gestational Hypertension or Pregnancy Induced Hypertension is a condition in which vasospasm occurs in

both small and large arteries during pregnancy, causing signs of increased blood pressure, proteinuria and

edema. An older term for the condition was toxemia of pregnancy because researchers pictured the symptoms

as being caused by women producing a toxin of some kind of response to the foreign protein of growing fetus.


The cause of the disorder is unknown, although it is highly correlated with the antiphospholipid syndrome

or the presence of antiphospholipid antibodies in the maternal blood. The condition tends to occur most

frequently in women of color, those with multiple pregnancy, primiparas younger than 20 years old and older

than 40 years of age, women from low socioeconomic backgrounds (perhaps because of poor nutrition), those

who have had five or more pregnancies, those who have hydramnios, or those who have an underlying disease

such as heart disease, diabetes with vessel or renal involvement, and essential hypertension.


In the UK, gestational hypertension and pre-eclampsia complicate around 5% to 6% of pregnancies.

Reports of the prevalence of gestational hypertension and pre-eclampsia in the US range from 2% to 12%.

Healthy nulliparous women may experience higher rates of gestational hypertension (6% to 17%) compared

with multiparous women (2% to 4%).

Gestational Hypertension: Case study 2

Adamson University
College of Nursing


 Increase Blood Pressure (140/90  Vision Changes, such as blurred or double

mmHG) vision

 Proteinuria  Nausea or Vomiting

 Headache  Pain in the upper right side of your belly or

 Edema pain around your stomach

 Sudden Weight Gain  Making small amounts of urine


Applying the Dorothea Orem’s theory of self-care deficit the Patient has inability to maintain the ideal

nutrition related to inadequate intake of nutritious food and often eat high in cholesterol food. The supportive

educative system is useful to be able for the patient to understand the importance of maintaining an optimum

nutrition and the self-care deficit in terms of food will be decrease with the initiation of the nutritional intake.

Self-care is the performance or practice of activities that individuals initiate and perform on their own behalf to

maintain life, health and well-being.

Nutritional health and support may have greater success when a clinician takes a holistic approach to the

assessment process. Watson’s (1999) Theory of Caring supports this approach. This theory, extended into the

nutritional assessment, invites the clinician to expand the plan for intervention outside of simply the physical

aspect. It becomes incumbent on the nurse to accurately assess the patient’s physical needs and combine those

needs with the patient’s preferences, social environment, nutrition availability, and emotional needs.

Gestational Hypertension: Case study 3

Adamson University
College of Nursing


Patient’s name: Mrs. EM

Age : 31

Date Of Birth: June 25, 1985

Sex: Female

Marital Status: Married

Nationality: Filipino

Occupation: House Wife

Religion: Roman Catholic

Address: Tondo Manila



“Hindi ako makatulog saka kinakabahan ako” as verbalized by the patient


As for her present illness, she was admitted into this hospital because of delivering a child and

diagnosed Gestational Hypertension. She was admitted last February 07, 2017. According to Mrs.

EM her Blood Pressure was increased if she is in Labor but in normal days her Blood Pressure is

120/80mmHg. Upon admission she had undergone some laboratory examination such as CBC,

Urinalysis. Her initial medication was MgSo4, Hydralazine and Oxytocin.

Gestational Hypertension: Case study 2

Adamson University
College of Nursing


This is the third time Mrs. EM been admitted into hospital. On her first admission on Dr. Fabella

Memorial Hospital she had undergone Normal Spontaneous Delivery which is almost 9 years ago. On

her second admission at Dr. FAbella Memorial Hospital she had undergone also a Normal Spontaneous

Delivery which is almost 6 years ago. She had not experience any accident and injuries. She also added

that she has Sinusitis. She also verbalize that her mother has hypertension.


Mrs. EM is a plain housewife in a concrete house with her husband and two daughters. A middle

class family. She always sleeps around 9 in the evening and wakes up at 6 in the morning. She always

taking care her husband and two daughters. She is also the one who is cleaning their house and washing

their clothes.


Mrs. EM is a Gravida 3 Para 3, her last menstrual period was on May 04, 2016 her age of gestation

is 39 6/7 weeks.


Mrs. EM reflects on her lives and feels a sense of satisfaction and a sense of failure. She feel proud

of their accomplishments feel sense of integrity and she look his past with some regrets.

Gestational Hypertension: Case study 3

Adamson University
College of Nursing


She is the one who prepare her family the breakfast, lunch, snack and dinner. She usually eats rice

and some fried dishes (egg,sausage) for breakfast, rice and some meal with soup or sarsa (pork), fried

chicken at lunch and at dinner and bread and butter or margarine and cheese for snack. And she said she

is not picky when it comes in food to eat she mention . She drinks about 3 cup of coffee a day but when

she became pregnant she only drink 2 cups a day. She drinks alcohol occasional when she is not



According to Mrs. EM she has been receive smallpox, Diphtheria,Tetanus,Pertussis,Polio

(OPV),Measles,Mumps, and Rubella for immunization when she was born and receive first and second

dose of Tetanus Toxoid on her first child, and another dose on her second child.


Vital Signs Findings Analysis

36.8 Celsius Normal

Respiratory Rate 24 cpm tachypnea

Pulse Rate 96 bpm Normal

Bp 160/90 mmHg Normal

FHT 133 bpm Normal

Gestational Hypertension: Case study 4

Adamson University
College of Nursing

Height Weight BMI Findings

162.56 cm 86 kg 32.5 Obese

Parts to be assessed Actual Findings

General Appearance Clean, no unusual odor

Skin Normal Color (light Brown), Dry skin and warm to touch

Hair Normal distribution, silky

Nails Smooth and intact epidermis, convex with a good capillary refill time of 2 secs.

Head Symmetrical

Eyes Symmetrical, no discharge

Ears Pinna recoils back, symmetrical

Mouth Dry Mouth (because she is on NPO)

Abdomen Surface is not uniform in color and in dark pigmentation. There is a presence of

striae gravidarum and stretch marks

Fundic Height 35 cm measurement of fundic height of 39 6/7 weeks age of gestation.

Feet Warm to touch, +1 pedal edema

Gestational Hypertension: Case study 5

Adamson University
College of Nursing


 Patient was placed on NPO

 Patient was given IVF D5LR 1L with 10 units of oxytoxcin to run 10-15gtts/min.

 Patient was given IVF PNSS 1L with 10 grams of MgSO4 to run for 33gtts/min.

 Fetal heart monitor attached

 With folly catheter connected to urine bag with 1200cc output

 Bag of water ruptured

 Vital Signs were monitored q4h, intake and output

 Encouraged deep breathing exercise

 Teaches proper breathing and relaxation technique

 Deliver alive baby girl via NSD

 Placenta out; inspected for completeness

 Fundal massage done

 Administered 10 units of oxytocin via IVF as ordered

 Perineal care done

 Transfer to recovery room safely

 Continue Fundal massage

 Lochial discharge: moderate

 Encourage breastfeeding

 Urine output measured and recorded q2hours

 Rooming in practice

 Latch on done

 Endorsed

Gestational Hypertension: Case study 6

Adamson University
College of Nursing


When most people hear the term cardiovascular system, they immediately think of the heart. We have all

felt our own heart "pound" from time to time, and we tend to get a bit nervous when this happens. The crucial

importance of the heart has been recognized for a long time. However, the cardiovascular system is much more

than just the heart, and from a scientific and medical standpoint, it is important to understand why this system is

so vital to life.

Most simply stated, the major function of the cardiovascular system is transportation. Using blood as the

transport vehicle, the system carries oxygen, nutrients, cell wastes, hormones, and many other substances vital

for body homeostasis to and from the cells. The force to move the blood around the body is provided by the

beating heart. The cardiovascular system can be compared to a muscular pump equipped with one-way valves

and a system of large and small plumbing tubes within which the blood travels.

Gestational Hypertension: Case study 7

Adamson University
College of Nursing

The Heart is a muscular organ found in all vertebrates that is responsible for pumping blood throughout

the blood vessels by repeated, rhythmic contractions.

The heart is enclosed in a double-walled sac called the pericardium. The superficial part of this sac is

called the fibrous pericardium. This sac protects the heart, anchors its surrounding structures, and prevents

overfilling of the heart with blood. It is located anterior to the vertebral column and posterior to the sternum.

The size of the heart is about the size of a fist and has a mass of between 250 grams and 350 grams. The heart is

composed of three layers, all of which are rich with blood vessels. The superficial layer, called the visceral

layer, the middle layer, called the myocardium, and the third layer which is called the endocardium. The heart

has four chambers, two superior atria and two inferior ventricles. The atria are the receiving chambers and the

ventricles are the discharging chambers. The pathway of blood through the heart consists of a pulmonary circuit

and a systemic circuit. Blood flows through the heart in one direction, from the atrias to the ventricles, and out

of the great arteries, or the aorta for example. This is done by four valves which are the tricuspid atrioventicular

valve, the mitral atrioventicular valve, the aortic semilunar valve, and the pulmonary semilunar valve.

Systemic circulation is the portion of the cardiovascular system which carries oxygenated blood away from the

heart, to the body, and returns deoxygenated blood back to the heart. The term is contrasted with pulmonary


Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-depleted blood

away from the heart, to the lungs, and returns oxygenated blood back to the heart. The term is contrasted with

systemic circulation. A separate system known as the bronchial circulation supplies blood to the tissue of the

larger airways of the lung.

Gestational Hypertension: Case study 8

Adamson University
College of Nursing

Arteries are blood vessels that carry blood away from the heart. All arteries, with the exception of the

pulmonary and umbilical arteries, carry oxygenated blood.

Pulmonary arteries carry deoxygenated blood that has just returned from the body to the heart towards

the lungs, where carbon dioxide is exchanged for oxygen.

Systemic arteries can be subdivided into two types – muscular and elastic – according to the relative

compositions of elastic and muscle tissue in their tunica media as well as their size and the makeup of the

internal and external elastic lamina. The larger arteries (>10mm diameter) are generally elastic and the smaller

ones (0.1-10mm) tend to be muscular. Systemic arteries deliver blood to the arterioles, and then to the

capillaries, where nutrients and gasses are exchanged.

The Aorta is the root systemic artery. It receives blood directly from the left ventricle of the heart via

the aortic valve. As the aorta branches, and these arteries branch in turn, they become successively smaller in

diameter, down to the arteriole. The arterioles supply capillaries which in turn empty into venules. The very

first branches off of the aorta are the coronary arteries, which supply blood to the heart muscle itself. These are

followed by the branches off the aortic arch, namely the brachiocephalic artery, the left common carotid and the

left subclavian arteries.

Aorta the largest artery in the body, originating from the left ventricle of the heart and extends down to

the abdomen, where it branches off into two smaller arteries (the common iliacs). The aorta brings oxygenated

blood to all parts of the body in the systemic circulation.

Gestational Hypertension: Case study 9

Adamson University
College of Nursing

The aorta is usually divided into five segments/sections:

 Ascending aorta—the section between the heart and the arch of aorta

 Arch of aorta—the peak part that looks somewhat like an inverted "U"

 Descending aorta—the section from the arch of aorta to the point where it divides into the common iliac


o Thoracic aorta—the half of the descending aorta above the diaphragm

o Abdominal aorta—the half of the descending aorta below the diaphragm

Arterioles the smallest of the true arteries, help regulate blood pressure by the variable contraction of the

smooth muscle of their walls, and deliver blood to the capillaries.

Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the

tissues back to the lungs; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated

blood. Veins differ from arteries in structure and function; for example, arteries are more muscular than veins

and they carry blood away from the heart. Veins are classified in a number of ways, including superficial vs.

deep, pulmonary vs. systemic, and large vs. small.

Superficial veins are those whose course is close to the surface of the body, and have no corresponding


Deep veins are deeper in the body and have corresponding arteries.

Gestational Hypertension: Case study 10

Adamson University
College of Nursing

The pulmonary veins are a set of veins that deliver oxygenated blood from the lungs to the heart.

Systemic veins drain the tissues of the body and deliver deoxygenated blood to the heart.

Atrium sometimes called auricle, refers to a chamber or space. It may be the atrium of the lateral ventricle in the

brain or the blood collection chamber of a heart. It has a thin-walled structure that allows blood to return to the

heart. There is at least one atrium in animals with a closed circulatory system.

Right atrium is one of four chambers (two atria and two ventricles) in the human heart. It receives

deoxygenated blood from the superior and inferior vena cava and the coronary sinus, and pumps it into the right

ventricle through the tricuspid valve. Attached to the right atrium is the right auricular appendix.

Left atrium is one of the four chambers in the human heart. It receives oxygenated blood from the

pulmonary veins, and pumps it into the left ventricle, via the atrioventricular valve.

Ventricle is a chamber which collects blood from an atrium (another heart chamber that is smaller than a

ventricle) and pumps it out of the heart.

Right ventricle is one of four chambers (two atria and two ventricles) in the human heart. It receives

deoxygenated blood from the right atrium via the tricuspid valve, and pumps it into the pulmonary artery via the

pulmonary valve and pulmonary trunk.

Left ventricle is one of four chambers (two atria and two ventricles) in the human heart. It receives

oxygenated blood from the left atrium via the mitral valve, and pumps it into the aorta via the aortic valve.

Gestational Hypertension: Case study 11

Adamson University
College of Nursing


Gestational Hypertension: Case study 12

Adamson University
College of Nursing



Complete Hemoglobin: 120g/L 120 – 170 g/L WBC is slightly elevated This is to determine blood Increased WBC and
Blood Count Hematocrit : 0.37 0.37 – 0.54 based on the normal value components and the Neutrophil-check
(CBC) RBC: 4.29 x10^12/L 4.1 – 5.1 x10x12/L of 4.3-10 g/l and response to inflammatory temp., s/s of infection/
MCV: 86.7fL 80 – 96 fl Neutrophil is slightly process and infection. inflammation, assess
MCH: 28pg 27 – 31 pg elevated based on the for any treatment-
MCHC: 34g/dl 34 -36 g/dl normal value 0.55-0.65 antibiotics. And
WBC: 11.1 x10^9/L 4.5 – 11 x10x9/L which confirms the increased platelet
Neutrophil: 0.66 0.55 – 0.65 presence of infection. count assess for
Lymphocytes: 0.26 0.25 – 0.35 Platelet count is also anemia and any ferrous
Basophil: 0.00 0.00 – 0.01 elevated base on the sulfate.
Monocytes: 0.06 0.03 – 0.06 normal value 150-
Eosinophil: 0.02 0.02 – 0.04 400x10^9/L which
Platelet Count: 414 150 – 400 x10^9/L confirms iron deficiency
x10^9/L anemia
Urinalysis Color: Yellow The transparency result Urinalysis yields a large Collect specimen
Transparency: Slightly Clear slightly turbid and the pH amount of information correctly, assess intake
Turbid 4.6 – 6.5 level is elevated from the about possible disorders of and output
pH: 7.5 1.016 – 1.022 normal that possibility may the kidney and lower
Specific Gravity: 1.020 Negative have infection in urinary urinary tract, and
Glucose: Negative Negative tract. The result is has +1 systematic disorders that
Protein: +1 Negative Protein means she has alter urine composition.
Bilurubin: Negative Negative Protenuria, there is a Urinalysis data include
Ketone: Negative Negative presence of pus cells in the color, specific gravity, pH,
Blood: Negative Normal urine which means that and the presence of
Urobilinogen: Normal Negative there is also the presence of protein, RBC’s, WBC’s,
Nitrite: Negative None infection bacteria, Leukocyte,
Pus Cell: 0.1 /hpf esterase, bilirubin, glucose,
ketones, casts and crystals

Gestational Hypertension: Case study 1

Adamson University
College of Nursing



Magnesium Sulfate Hizon magnesium May decrease Prevention and control 10 gms via IVF  Check for Doctors order
sulfate Injection acetylcholine released of seizures in toxemia of PNSS 1L to  Assess patient’s
by nerve impulses (preeclampsia or run for condition before therapy
eclampsia) 33gtts/min. and reassess regularly
thereafter to monitor
drug effectiveness
 Monitor respiration: RR
16cpm/min. watch for
respiratory depression
and signs of heart block
 Monitor renal status.
Assess intake and output
 Monitor for possible
drug induced adverse
 Monitor for signs of
magnesium toxicity:
disappearance of knee-
jerk and patellar reflex
are signs of early
magnesium toxicity.
 Stress importance of
immediate reporting of
any adverse reaction

Gestational Hypertension: Case study 2

Adamson University
College of Nursing


Hydralazine Apresoline Direct-acting Essential 5mg IV  Check for Doctors order
peripheral vasodilator hypertension, severe  Monitor patient’s blood
which relaxes smooth essential hypertension, pressure every 5mins
muscle, reduces blood preeclampsia, for 2 hours, the every 2
pressure with reflex eclampsia and heart hours, then every 4
increase in heart rate, failure hours
stroke volume  Assess pulse, jugular
venous distention every
4 hours
 Monitor weight, intake
and output; edema in
feet; check skin turgor,
dryness of mucous
membranes for
hydration status
 Check for fever, joint
pain, rash sore throat
(lupus like symptoms)
notify physician
 Assess therapeutic
effectiveness of the
medication and possible
adverse response
periodically during

Gestational Hypertension: Case study 3

Adamson University
College of Nursing


Oxytocin Elin Oxytocin Acts directly on Initiation or 10 units via IVF  Check for Doctors order
myofibrils, producing improvement of of D%LR 1L to  Monitor blood pressure,
uterine contractions: uterine contractions to run for 10- fluid intake and output
stimulates milk achieve early vaginal 15gtts/min. and labor closely if using
ejection by the breast delivery for maternal for induction; fetal
or fetal reasons. monitoring is strongly
Control post partum recommended
bleeding or  Assess labor
hemorrhage. contractions: fetal heart
tone, frequency,
duration, intensity of
 Watch for fetal distress,
deceleration, fetal
presentation, pelvic
 Advise patient that
contractions will be
similar to menstrual
cramps, gradually
increasing in intensity

Gestational Hypertension: Case study 4

Adamson University
College of Nursing



Subjective: -distributed: sleep -with 3 hours of -provide rapport to the -to gain trust and full -After 3 hours of
pattern related to nursing intervention patient cooperation of the patient nursing intervention
-“Hindi ako uncomfortable the patient will the patient will able
nakakatulog ng environment enumerate -advised to establish -to promote comfort and to enumerate
maayos at tsaka conditions that regular bedtime (11pm) easiness conditions that
ninenerbyos ako” as promote sleep and wake up (6am) and a promote sleep.
verbalized by the short daytime nap (30
patient min.)

Objective: -advised to wear a loose -to promote comfortable

-restlessness and not to tight night wear and good circulation of
-irritability body
-pale conjunctiva, lips,
palm and skin -advised to take a warm -milk contains
bath before bedtime tryptophan, a precursor
-advised to drink 1 glass of of serotonin which is
warm low-fat milk before taught to induce and
sleeping maintain sleep

Gestational Hypertension: Case study 5

Adamson University
College of Nursing


Objective: -altered tissue -after 6 hours of -blood pressure monitoring -to know if there’s any -After 6
perfusion: renal nursing intervention alteration of the blood hours the
-Bp- 160/90mmHg the patient’s Bp will pressure patient
-(+1) pedal edema reduce from blood
-(+1) proteinuria 160/90mmHg to -hourly intake ad output -to know the level and pressure
-urine output 200ml 130/90mmHg monitoring measure of the I&O decreased
every hours from 160/90
-promoted bed rest -aid to increase mmHg to
evacuation of sodium and 130/90
encouraging diuresis mmHg

-instructed the patient to -to prevent seizures

take medication as

-emphasized diet restriction -to compensate for the

as high in protein moderate protein losing in urine

-follow up laboratory -to know the status of

examinations as needed protein

-provided emotional -to elicit anxiety


Gestational Hypertension: Case study 6

Adamson University
College of Nursing


M: Instructed the patient to continue medication as ordered

1. Cephalexin 500 mg/tablet, 1 tablet every 6 hours for 7 days

2. Ferrous sulfate tablet, 1 tablet daily for 30 days

E: Instructed the patient to limit exercise

T: Instructed the patient to continue the medication

H: 1. Encourage patient for sodium restriction.

2. Encourage to avoid foods rich in oil and fats.

3. Increase fluid intake.

4. Encourage patient to limit her daily activities and exercises.

O-Instructed to come back for follow-up check-up on March 07, 2017,Tuesday.

D: 1. low fats and sodium diet, restriction if possible.

2. High in protein, calcium and iron.

3. Adequate fluid intake

S: Limit Sexual Activity

Gestational Hypertension: Case study 1

Adamson University
College of Nursing


Nursing Research

There are new discoveries that were dogged out and have great helped to the people.

Nursing is evolving. Great discoveries are waiting to be discovered. Students should not stop

studying nursing, reading new discoveries should be encouraged so that being an efficient

nurse someday can be achieved. It takes time, patience and right attitude to achieve one’s goals

and we should be willing to sacrifice anything in order to reach our dreams in becoming a

health care giver. We should always bear in mind that we are dealing with real lives, with real

hearts and real feelings and real emotions

Nursing Education

This study deals with the importance of the concept in giving optimal care. It is being

emphasized the basic knowledge of Gestational Hypertension and the important details in

preventing the disease. This study further encourage the health team to enrich themselves with

adequate knowledge and attitude in preparation of giving care to patients with Gestational


Nursing Practice

This study focuses on the skill that is necessary to provide optimum care. Knowledge

should be supported with skills and positive attitudes. Skills are designed to be polished with

constant practice and an open mind for corrections that would open doors for improvements.

That is Important in dealing with a fast-changing and updating world like ours.

Gestational Hypertension: Case study 2

Adamson University
College of Nursing



Adele Pillitteri, PhD, RN, PNP “Maternal & Child Health Nursing: Care of the Childbearing &

Childrearing Family” Volume 1, 7th edition, pg.572-580.

PPD’s Nursing Drug Guide, 2nd edition

Doenges, Moorhouse, & Murr,” Nurse’s pocket guide” 11th edition.

Online Resources

Gestational Hypertension: Case study 3