Case Study

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INTRODUCTION
Hypertensive disorders of pregnancy, previously known as Pregnancy Induced Hypertension (PIH), are high blood pressure disorders of pregnancy. It has long been one of the major problems for mothers in pregnancy, along with infection and postpartum hemorrhage. PIH is classified as gestational hypertension, mild preeclampsia, severe preeclampsia and eclampsia, depending on how far development advances. A woman is said to be preeclamptic when her blood pressure increases and shows protein in her urine that typically starts after the 20th weeks of pregnancy. It affects the placenta that can cause fetal complications which include low birth weight, premature birth, and still birth. The cause of mild preeclampsia is unknown, but may be related to immune factors. It may result from fetal antigens elements of the fetus that trigger an immune response in the mother. Geographic, ethnic, racial, nutritional, immunologic, and familial factor and pre- existing vascular disease may also contribute to its development. Age is also a factor, common in those with age of below 17 years and primiparas who are older than age of 35 are at high risk for preeclampsia. Signs and symptoms includes: blood pressure of 140/90 or systolic pressure elevated 30mmHg or diastolic elevated 15mmHg above pregnancy level; proteinuria of 1-2+ on a random sample; weight gain over 2lbs per week in 2nd trimester and 1lb per week in 3rd trimester, mild edema in upper extremities or face. Patient diagnosed with mild preeclampsia may undergone examinations like urinalysis, blood pressure test, complete blood cell test and platelet count. Pharmacological treatment include an antihypertensive, such as methyldopa or hydralazine, and Magnesium sulfate to promote diuresis, and reduce blood pressure. Nursing management for clients with mild preeclampsia includes monitoring of blood pressure, minimizing external stimuli by promoting bed rest and relaxation, measuring and recording urine output, weighing the client daily and having good nutrition and providing emotional support. Preeclampsia is the 3rd leading pregnancy- related cause of death, after hemorrhage and embolism. Around 400,000 maternal morbidities, there are 214,220 who developed PIH and estimated 790 maternal deaths per 100,000 live births as of 2005. Preeclampsia is most common in pregnant women of 35 years of age.

Reference: (http://www.scribd.com/doc/48885155/Fact-Sheet-Health-Benefits-of-Reproductive-Health-and-Family-Planning)

OBJECTIVES
GENERAL OBJECTIVE:
At the end of the case study, the students will be able to acquire extensive knowledge, skills and appropriate attitudes utilizing nursing processes to promote the health of patient with a case of pregnancy induced hypertension. The family of the patient will able to adopt appropriate measures, interventions, preventions, and further complication of the said condition. This study will serve as a basis for further study of the case not only for the students but also for the people of the community.

SPECIFIC OBJECTIVES
Specifically this case study aims to:
1. Define PIH and its signs and symptoms.
2. Acquire comprehensive nursing history.
3. Conduct thorough physical assessment.
4. Discuss the anatomy and physiology involved, as well as to understand its pathophysiology. 5. Review different Laboratory and Diagnostic Procedures related to the disease of the patient. 6. Formulate appropriate nursing care plans and demonstrate health teachings to promote the patient’s wellness.

NURSING HISTORY
Informant: Patient

Reliability: 95%

General Information:

This is the case of patient J.B, 21 years old, female, single, Filipino, Roman Catholic, and is presently residing at San Jose del Monte, Bulacan, admitted for the first time at Ospital ng Lungsod ng San Jose del Monte (OLSJDM) last January 4, 2011 at around 2 o’clock in the morning with the chief complain of severe vaginal...
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