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Care Study:PUFT with Gestational Hypertension
Care Study: Pregnancy Uterine Full Term with Gestational Hypertension
“Blood and Sweat was offered by our mothers just to give birth to all of us, time effort was spent every moment upon delivering us, yet some us only take for granted and often forget that they are our mother that without them we are nothing in this world.”
Pregnancy is one of the most crucial events of a human’s life. It is where our mother strives hard and exerts a priceless effort just to expel a fetus inside her womb. It is where our fathers tremble and so anxious to what might happen to her love one upon delivery, and it is where a new member of there family appears just in a sudden after nine months of caring in the belly. But beside from that, it is where our mother also become so weak that every pavements taken and mistake done will surely put her and her baby both to danger and risk for accidents. An example of this factors that might change the expected behavior during pregnancy is having complication like gestational hypertension.
Gestational hypertension is a type of hypertension that only occurs during pregnancy, were mostly blood pressure level is equal or higher than 130mmhg and usually resolves following pregnancy, but not always. Because it can cause serious increases in blood pressure, and lead to problems for the mother and baby, it is usually treated aggressively.
The case was all about Pregnancy Uterine Full Term (PUFT) in a Normal Spontaneous Vaginal Delivery ( NSVD), what made me to choose this case it is because it tries to give us the deviation of a NSVD case through hypertensive condition of the mother. The complications might bring the baby at risk but it is still delivered in a normal way. We might find often that hypertension is not that kind of alarming condition to us but in the case of pregnancy, it might got into something that might cause death to both of them. So we better focus ourselves in this simple complication for the reason why there is a big hole it is because it started in a small hole left unnoticed yet now became a huge problem.
HISTORY OF PRESENT ILLNESS:
A day prior to admission (September 30, 2008), patient had her regular prenatal check-up with attending physician. Blood pressure taken 150/110 mmHg, ultrasound done, showed a Pregnancy Uterine 38W 5D by fetal biometry, live, cephalic presentation, singleton, beginning low to normal amniotic fluid volume, placenta anterior, high in location. Grade II – III, no obvious structural anomaly.
On the following day, October 1, 2008, morning prior to admission, she decided to be admitted with a complaint of having an elevated blood pressure and labour pains. Vital signs were taken showing slightly tachycardic, and blood pressure was 150/100mmhg. She was afebrile, conscious and coherent in answering every questions asked. First impression by the doctor concluded as Pregnancy Uterine 42 2/7 weeks Age Of Gestation(AOG) by Last Menstrual Period(LMP), cephalic, G6P4 (4014), 35 6/7 wks. AOG by ultrasound result.
PAST HEALTH HISTORY:
Patient’s first prenatal check-up was started at three month with attending physician and with regular prenatal check-ups thereafter. At 8 months Age of Gestation, patient had increase blood pressure with highest BLOOD pressure of 150/110 mmHg, usual BP was 110/80mmHg.
Meds taken were methyldopa (Aldomet) twice a day per orem, and nifedifine (Normadil) once a day per orem. Other meds taken were vitamin C and ferrous sulfate, negative for papsmear test, and did not undergone for any tetanus toxoid vaccine during pregnancy. No other significant maternal illness encountered a negative for any major anomalies in both the physical and mental status.
The client had undergone a proper diet modification appropriate for her pregnancy. No known vices and avoidance of alcoholic beverages was observed by the client. Regular exercise was also done to promote comfort and no known exposure to teratogenic factors was noted upon pregnancy.
Gestational hypertension (GH) is high blood pressure that develops after the twentieth week of pregnancy and returns to normal after delivery, in women with previously normal blood pressure.
I mainly started at the different risk factors like early pregnancy that resulted to hormonal imbalanced of the mother it can also start from the history of hypertension that runs in the blood of the family. Also having multiparity of 5 or more than children can induced hypertension during pregnancy.
The etiology is still unknown but it occurs when there is an imbalanced of the prostaglandin ratio resulting to placental vasoconstrictions, when disturbed by some factors that will induced hypertension, it will lead to reduction in tissue perfusion thus stimulating the uterine to release rennin and stimulating the angiotensin I, then through the enzyme angiotensinogen it will be converted to angiotensin II resulting into generalized vasoconstriction. Then since all the vessels had constricted already, hypertension will occur, if no intervention done, it can lead to headache and visual disturbances and the worst is seizures.
objectives of the initial evaluation are to assess lifestyle, cardiovascular
risk factors, and concomitant disorders, reveal identifiable causes of
hypertension, and check for target organ damage and cardiovascular
examination: 2 or more blood pressure (BP) measurements using regularly
calibrated equipment with the appropriate sized cuff and separated by at
least 2 minutes, verification in contralateral arm, funduscopic exam, neck
exam (bruits), heart and lung exam, abdominal exam for bruits or aortic
aneurysm, and extremity pulses.
- Laboratory and diagnostic study findings:
Ø Potassium test
Ø Creatinine test
Ø Glucose test
Ø Hematocrit level test
Ø Calcium test
Ø lipid panel test
Ø electrocardiogram (EKG)
Þ Diet for patient with Gestational hypertension must be Low in Sodium, Low in Cholesterol to avoid severe hypertension. Diet must also be low in carbohydrate to minimize increase glucose level in the blood.
· Protein 10-20%
· Saturated fat <10%
· Cholesterol ≤300 mg/day
· Na 2,400-3,000 mg/day
· Fiber 20-35 g/day
· CHO 55%-60%
· Fat <30%
- Vital Signs monitored every 15minutes for the first 2 hours and hourly there after.
- Intake and Output monitoring.
- Blood glucose monitoring.
- Medication given as prescribed by the physician.
- Facilitate completion of diet required.
- Blood Pressure Monitoring prior to medication
- Assessment for any alterations in body comfort and report immediately to the physician.
- Perilite treatment
- Assessment for any profuse vaginal bleeding and note for the color discharge, include odor.
- Perineal care
- Education for the significance of medication given
- Encouraging the client to do exercise at a minimal level to promote circulation.
Conclusion and Recommendation
Therefore I conclude that in order to prevent and avoid the complications of the condition, the client needs further examination. Proper information dissemination is highly needed in order to prevent a problem in the future this includes precautionary actions prior to the reoccurrence of the condition.
Preeclampsia and gestational hypertension shared many risk factors, although there are differences that need further evaluation. Both conditions significantly increased morbidity and mortality. Conversely, preeclampsia and unexplained intrauterine growth restriction, often assumed to be related to placental insufficiency, seem to be independent biologic entities.
We highly recommend diet modification of a hypertensive client to prevent from further complication especially to pregnant women since they carry also the baby inside. If symptoms of hypertension occur, immediately consult your primary health care provider, regular prenatal check-up is also needed. Refrain from eating foods that will induce hypertension during pregnancy. Regular exercise is also needed because it will promote a good circulation of the blood in our body thus making your blood flow in a better one.