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Care Study:PUFT with Gestational Hypertension

Updated on September 26, 2010
The product of our Successful Handle of Pregnancy
The product of our Successful Handle of Pregnancy

Care Study: Pregnancy Uterine Full Term with Gestational Hypertension

INTRODUCTION

“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.

PATHOPHYISOLOGY

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.

MEDICAL MANAGEMENT

A. IDEAL

Initial Assessment

  • The 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 disease.

     

  • Physical 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 Urinalysis

Ø lipid panel test

Ø electrocardiogram (EKG)

Diet Modification.

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%

 

 

 

NURSING MANAGEMENT

A. IDEAL

  • 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.

 

 

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    • profile image

      gale 

      5 years ago

      hi, am gabriella! im a 2nd yr student cn you pls post a case presentation of PROM plsss and am expecting a lot from u guyzzz

    • Nurzing Studz profile imageAUTHOR

      Cid Rusiana 

      7 years ago from Cebu.Philippines

      Thanks for appreciating our piece...i hope to make more soon in the future..just keep in touch..ive been busy these days working..

    • profile image

      ester 

      7 years ago

      galing poh nakakaproud keu..tnkx po nakakuha po ako ng info...xalammmaaattt...

    • profile image

      carl 

      7 years ago

      nice!! very informative not only to nursing students but also to mothers who may be viewing this...not to mention, this is actually not a rare case.cud actually happen to mothers who even least expect this condition to happen to them..at least if they read this, they wouldn't be so much surprised...there are nursing inerventions mentioned in this article to...great job! more power!

    • Nurzing Studz profile imageAUTHOR

      Cid Rusiana 

      7 years ago from Cebu.Philippines

      thanks kurinai...we will really try our best!..hehehe

    • profile image

      kurinai 

      8 years ago

      hahaha....lou...g.post jud nmo....ill pray 4 u lou na ma.top ka dis coming board...gudluck future RN....HEHEHE

    • Nurzing Studz profile imageAUTHOR

      Cid Rusiana 

      8 years ago from Cebu.Philippines

      yes..thanks guys! we are now about to take the december board exam..pls pray for us guys!..thanks..LOu here!

    • profile image

      aerloy 

      8 years ago

      .....galing ng care study nyo timing my case study pa naman ako nxt week...salamat ng marami....my natutunan akohh....

    • profile image

      dingdong 

      8 years ago

      hi.. i viewed ur case.. i'm a 3rd yr nsg student.. it really helped me a lot.

    • profile image

      venz 

      8 years ago

      nice case.....godbless'

    • Nurzing Studz profile imageAUTHOR

      Cid Rusiana 

      8 years ago from Cebu.Philippines

      Hi...im ack..soory for not replying my dear frens..:-)...yup. thank you for appreciating our work...me and my fren beside here are now busy and not able to continue our hubs..but if i have time..i will continue it..i will post our achievemnet during college days..pls. continue for supporting...thanks!

    • profile image

      rhoze 

      8 years ago

      hi. Im 2ndyr student. thankyou for the nice info about PUFT,nadagdagan ang knowledge ko about my case study.thank you, thank you, gud luck.

    • profile image

      kashe 

      8 years ago

      buti pa kayo ang dali ng case study niyo

    • profile image

      jam2x 

      8 years ago

      i love u

      thanks

    • Nurzing Studz profile imageAUTHOR

      Cid Rusiana 

      8 years ago from Cebu.Philippines

      thank you for your support guys..

      ..please continue supporting us..

      PUFT means that the baby was born at exactly 9mos duration of pregnancy in the uterus..via NSVD

    • profile image

      seKreto 

      9 years ago

      nYc onE!!!!

    • profile image

      Layzie Bone 

      9 years ago

      i like this site.. if you wouldn't mind.. wat is the meaning of pregnancy uterine full term? thanx.. im a 3rd year nursing..

    • profile image

      katrin 

      9 years ago

      ur site was really fruitful.

      thanks for sharing these infos.

      this really help nursing students.

      god bless

    • profile image

      welldone.. 

      9 years ago

      nyaikzzz!!!! timing au gestational hypertension among R.U na ghatag ni ms. angel sa amoh lou.. ehehehe tnx sa info... naa jud mey ikapuno,,, ehehehe

    • Nurzing Studz profile imageAUTHOR

      Cid Rusiana 

      9 years ago from Cebu.Philippines

      well, thank you jhenny? we really like to share our care studies to other nursing studz..thaks for the comment..by the way, from what school where you?

    • profile image

      jhenny 

      9 years ago

      hope i can meet you guyz

    • profile image

      jhenny 

      9 years ago

      hi....i have read your case stud... i am a second year nursing student... it is a great help to others who will be reading your case. enhancing everyones knowledge is a great commitment. thank you and i really appreciate your written output.gud luck

    • profile image

      jhenny 

      9 years ago

      hi....i have read your case stud... i am a second year nursing student... it is a great help to others who will be reading your case. enhancing everyones knowledge is a great commitment. thank you and i really appreciate your written output.gud luck

    • Nurzing Studz profile imageAUTHOR

      Cid Rusiana 

      9 years ago from Cebu.Philippines

      hello my dear readers..we would like to thank you for viewing our hub, we hope to impart some of our knowledge on the needed information of yours..we wish you to come back again and say something anout our hub..any comment will do to help us improve our hubs..thanks a lot and GOdbless..

    • profile image

      daniel 

      9 years ago

      this is very helpful in the studynig OBcases.,.

      especially to the college of nursing!!!!

    • profile image

      joana 

      9 years ago

      i like the care study

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