Colegio de Kidapawan

Quezon Boulevard, Kidapawan City

Paramedical Department

Gestational Hypertension

Submitted to:

Mariecor Kane Libranza, RN

Paul Andre A. Lumiguid RN, MAN, PhD, CAN.

Submitted by:

Irigan, Elaine Joyce

Kamid, Armin

Lariba, Jeliemae

Lomanog, Lindon

Lumna, Nasra

Macabato, Sittie Hafza

Submitted on:

October 25, 2022

Introduction

In this case study, a 26-year-old woman with Gestational Hypertension is the

subject.

According to American Pregnancy, Gestational Hypertension also referred to as

Pregnancy-Induced Hypertension (PIH) is a condition characterized by high blood
pressure during pregnancy. Gestational Hypertension can lead to a serious condition
called Preeclampsia, also referred to as Toxemia. Hypertension during pregnancy
affects about 6-8% of pregnant women.

Hypertensive disorders of pregnancy (HDP) is one of the leading causes of

maternal and fetal morbidity and mortality worldwide and potentially a critical threat to
maternal and infant health. According to the 2021 data from BMC Pregnancy and
Childbirth, globally, the prevalence of hypertensive disorders of pregnancy rose from
16.30 million to 18.08 million, an increase of 10.92 percent overall from 1990 to 2019.
With an estimated annual percent change of -0.68 (95 percent confidence interval [CI] -
0.49 to -0.86), the age-standardized incidence rate declined. About 27.83 thousand
women died in 2019 from hypertensive disorders of pregnancy, which is a 30.05%
decrease from 1990. According to incidence and prevalence, the age groups of 30-34
and 20-24 years had the highest number of deaths and years with disabilities, while the
age group of 25-29 years had the lowest estimated incidence rate and the youngest and
oldest groups had the highest incidence rates.

Compared to the global rate, hypertensive disorders of pregnancy account for

36.7% of all maternal deaths in the Philippines. Gestational hypertension, a severe and
varied disorder that is linked to life-threatening multi-organ maternal complications and
that results in serious feto-placental issues, is one of these hypertensive diseases that
affect pregnant women. It was responsible for 22.5% of admissions for hypertensive
patients at the hospital where this study was done. (Amosco, 2019)

However, according to the Philippine Statistics Authority, the three leading causes
of maternal mortality rate as of November 25, 2019 in Davao Region included toxemia
of pregnancy/pre-eclampsia, complication of labor and delivery, and postpartum
hemorrhage with an average of 5.8, 2.9, and 1.9 rate per 100,000 live births,
respectively.

Preventing some of the disease's complications may require early detection of

women who are at risk for gestational hypertension. Education about the warning signs
is essential because early detection may enable women to receive treatment and stop
the disease from getting worse.
 General Objectives

To be able to come up with an understanding of the condition and formulate a

nursing care plan using the specific objectives.

Specific Objectives

1. To conduct a nurse-patient interview to gather organized health history

2. To thoroughly assess the patient about the patient’s condition
3. To formulate nursing process as a framework in making the nursing care plan
A. BIOGRAPHICAL DATA

Name of the Client: Angel Mangonday Lakina

Age: 26 years old

Gender: Female

Home/Address: Puriada Village, Basiawan, Sta. Maria, Davao Occidental

Birth Date: June 23, 1996

Place of Birth: Basiawan

Nationality: Filipino

Marital Status: Single

Education Level: College graduate

Occupation: Self-employed

Religion: United Pentecostal Church

B. ADMISSION HISTORY

i. Chief Complaint: Labor Pain and Vaginal Bleeding

ii. Admission Date: October 18, 2022

iii. Ward/ Room/ Bed Number: Room 101, Bed 2

iv. Attending Physician: Dr. Lorena Amasol

v. Doctor’s Diagnosis: G1P0, Pregnancy Uterine, 34 weeks AoG, Preterm Labor,

Gestational Hypertension.

C. HISTORY OF PRESENTING ILLNESS

The patient was admitted on October 18, 2022 at 11:53 in the evening. During
admission, the patient complained of labor pain and vaginal bleeding. Her vital sign
showed that she was afebrile, pulse rate of 78 beats per minute and blood pressure was
noted to be 170/120 mmHg.
She denied having pre-eclampsia symptoms including blurred vision, epigastric pain,
and vomiting. There was also no dizziness, shortness of breath, chest pain, decreased
frequency of urination, or leg swelling.

Patient is Gravida 1 Para 0, pregnancy uterine, 34 weeks age of gestation, pre-term

labor, and Gestational Hypertension.

She was admitted to the ward for further management.

D. PAST HEALTH HISTORY

The patient claims that she wasn’t diagnosed with anything related to her present
condition since it was her first pregnancy. The patient was engaged in stressful activities
like rigid studying for her LET, which happened last October 2, 2022. She also stated
that she has been working as a supervisor in the marketplace.

E. FAMILY HEALTH HISTORY

 Male Female Deceased Patient

Cardiac Arrest Diabetes hypertension

F. GORDON’S HEALTH PATTERN

Health Perception/Health Management The patient makes sure to fill her plate
Pattern with healthy options like fruits,
vegetables, and fish on a regular basis.
The patient reported that she has been
visiting her OB-Gynecologist and is on
her regular checkup. She constantly
follows her doctor’s advice. No smoking,
drinking, or drug usage is present, and
there have been no recent accidents
involving the patient.

Nutritional/Metabolic Pattern The patient is taking vitamins and eating

three healthy meals a day. Consumes
more water than the recommended daily
intake of eight glasses. The patient has a
normal, pink, lesion-free oral mucosa. At
55 kg and 153 cm, the patient is
considered to be normal according to the
Body Mass Index. Typically hovers
around 36.4 degrees Celsius.

Elimination Pattern Three to four bowel movements per day

are normal, with five to six urinations per
day. Urine has a hazy appearance and
little bubbles. Patient has no problems
with bowel or bladder elimination.

Activity and Exercise Pattern The patient reported undertaking mild

exercise like walking at least 3 times a
week. She enjoys reading and studying
for her board exam from 6-10 in the
evening. She also spends her time with
 her work in the marketplace as a
supervisor.

Sleep-Rest Pattern Patient reported that she’s able to sleep

from 11 in the evening and wakes up 5 in
the morning. She is unable to get the
necessary rest and complete 8 hours of
sleep due to her work.

Cognitive/Perceptual Pattern Hearing is completely normal for the

patient. Patient reports difficulty reading
print from afar but does not wear
corrective lenses.

Self-perception/Self-concept pattern This patient seems confident and at ease.

Roles/Relationship Pattern The patient has said that she has no

problems in her family and that she is not
married but has a live-in partner. She
continued by saying that she helps out
around the house for her family. While her
loved ones worry about her health
because she’s pregnant, she assures that
she and her family are getting along fine.
She maintains close ties with her loved
ones by being in constant contact with
them.

Sexual/Reproductive Pattern The patient insisted that she had no

problems with reproduction.

Coping-Stress Tolerance Pattern In order to relax and recover from her

tiredness, the patient reports that she
enjoys wandering around and walking in
the mall.

Values-Beliefs Pattern The patient’s religion is United

Pentecostal Church. On a weekly basis,
she attends worship services. She says
that prayer helps her overcome difficulties
 in life.

PHYSICAL ASSESSMENT I

GENERAL SURVEY

When taking the patient's vital signs, the patient was lying in a semi-fowler position on
the bed. A 153-centimeter-tall, 55-kilogram-heavy woman. The patient is in a complete
bed rest. The patient appears to be clearheaded and is following the directions given.

VITAL SIGNS

Result Normal Range

Temperature 36.4 °C 35.6 - 37 °C

Pulse Rate 78 bpm 60 - 100 bpm

Respiratory Rate 23 breaths/pm 12 - 20 breaths/pm

Blood Pressure 170/120 mmHg 120/80 mmHg

SKIN

The patient has white skin of a consistent tone. A healthy turgor (or firmness) can be felt
in the skin. The skin is heated and oily. The patient did not show any signs of lesion,
edema, or ulceration.

NAILS

The nails are neatly cut, have a pinkish hue, and are glossy.

HEAD
Normal head shape and development are present in this patient. There is symmetry
between the two sides of the skull. The patient's hair is very thick. Her hair is a naturally
black. Palpation revealed no evidence of lice, lesions, lacerations, or edema, but did
reveal dandruff. Patient has healthy levels of jaw muscle strength.

EYES

Eyebrows are thick, straight, and move symmetrically. Both lids are identical and free of
edema.

EARS

There is no soreness or asymmetry in the pinna. The amount of cerumen and

discharges in the external canal are both negligible.

NOSE

The crease between the nose and the cheeks is perfectly symmetrical. The nasal
mucosa is pink in color, and there is no outward flaring of the nostrils or perforation of
the nasal septum. It is not sensitive and there is no sign of a visible lesion. When a
person takes in through their nose, the air is able to flow unrestrictedly.

MOUTH

It has symmetrical, pale, and moist lips. No discharges or lesions were detected. The
tongue sits in its usual position in the middle of the mouth. Yellowed teeth and gaps in
the smile. The gums and mucosa are slightly pink, whereas the palate is reddish.

PHARYNX

The uvula sits in the centre of the mouth. There is no redness, swelling, or ulceration of
the mucosa. Patients have a positive gag reflex and no tonsillar inflammation.

NECK

There was no scar, lump or dilated veins noted around the area of the neck. Trachea of
the patient is centered. When palpated, lymph nodes is not painful. There is no
soreness or palpability in the thyroid gland. There is no jugular vein, and the power of
the muscles is typical.
PHYSICAL ASSESSMENT II

THORAX

The thoracic spine of this patient is properly aligned and symmetrical. In the absence of
any protrusions, sensitive spots, or abnormalities, the posterior thorax felt normal. The
patient has good skin turgor and a relaxed breathing pattern. The patient's respiratory
excursion and tactile fremitus are both normal. On auscultation, we found that
percussion was resonant, produced vesicular breath sounds, and lacked any obtrusive
breath noises.

HEART

No soreness in the precordium upon probing. There is a lack of volume in the aortic,
pulmonic, tricuspid, and apical regions. Auscultation did not reveal any unusual noises.
Carotid pulse was strong although the temporal pulse was modest. Heart rate at the
apex is a steady 78 beats per minute. There is a brisk radial and brachial pulse. Strong
pulsations are also felt in the popliteal region, the dorsalis pedis, and the posterior tibia.
Both feet do not have calf discomfort.

BREAST

On inspection, both breast were symmetrical and bilaterally in size. Both her nipple
were not hyper pigmented or retracted. There was no nipple discharge. Her breast were
non tender and no mass was palpable.

ABDOMEN

On inspection, the abdomen was distended by gravid uterus as evidenced by cutaneous

signs of pregnancy such as linea nigra and striae gravidarum. The umbilicus is centrally
located and flat. No scars noted and no dilated veins seen. On palpation, her abdomen
was soft and non-tender and uterus was not irritable.

GENITO-URINARY SYSTEM

The pubic hair on this patient is typical. Vaginal discharge have been observed.
PHYSICAL ASSESSMENT III

MUSCLE

The patient's muscles are a similar size and shape. Upon examination, no anomalies,
contractures, tremors, or fasciculation were found. Muscle tonicity is typical, with a
firmness that is consistent with health. Flexion and extension are not elicited from the
patient's muscles in a smooth, coordinated manner. Feelings of weakness or spasticity
are present. The patient's muscle strength is low all around. The patient feels discomfort
in the muscles while palpating.

BONES

Neither tenderness nor edema were detected by palpation.

JOINTS

Joint alignment and symmetry are normal, although edema was found during
examination. When the patient's joints were examined, there was no evidence of
soreness, crepitation, or nodules.

NEUROLOGICAL ASSESSMENT

The patient don’t have trouble keeping track of time, locations, and identities. The
patient was able to give clear, concise responses to all of the questions posed to her.

CRANIAL NERVES

a. Cranial Nerve I – Olfactory Since the patient can close her eyes and
still distinguish between distinct scents,
her olfactory nerves are functioning
normally.

b. Cranial Nerve II – Optic The patient's visual fields are normal and
 doesn’t have visual defects. The patient's
Snellen's chart scores are normal in both
eyes.

c. Cranial Nerve III - Oculomotor The patient's eye movement has regular
movements and symmetrical. Pupils
aren't always spherical, and they react
differently to different lights and require
different amounts of time to adjust. Light
and isocoric materials do not limit its
flexibility.

d. Cranial Nerve IV - Trochlear ; Cranial The patient's eyes move in a normal

Nerve VI – Abducens fashion.

e. Cranial Nerve V – Trigeminal The patient's BLINK reflex is operational.

While shutting her eyes, the patient felt a
little tingling when she wiped a cotton ball
around his forehead and paranasal area.
She also felt a deep tingling when she
tested the pen's blunt edge on her
forehead.

f. Cranial Nerve VII – Facial When the patient is asked to grin, lift her
eyebrows, frown, and close her eyes, no
anomalies in facial nerve function are
seen.

g. Cranial Nerve VIII - Acoustic Patient was able to hear clearly the
(Vestibulocochlear) spoken words on both ears.

h. Cranial Nerve IX - Glossopharyngeal When examined, the patient's uvula

remains in the midline while the soft
palate moves medially and up
symmetrically. The patient's gag reflex is
currently being activated.

i. Cranial Nerve X – Vagus There was no evidence of hoarseness in

the patient's speech.

j. Cranial Nerve XI - Spinal Accessory The patient's shoulder muscles are

 equally strong when she shrugs. The
trapezius and sternocleidomastoid
muscles were well developed and
symmetrical.

k. Cranial Nerve XII - Hypoglossal The patient's tongue appears to be

healthy and located in the middle of her
mouth. The patient's tongue is able to
move freely from side to side.

G. CONCLUSION

The patient's excessive bleeding are relevant findings given the patient's major
complaint. During the evaluation, some irregularities were noted.

In summary, the patient was diagnosed with Gestational Hypertension. The patient
currently has a chief complaint of labor pain and vaginal bleeding. According to the
patient, she eats healthy foods such as vegetables, and fruits. She does not smoke,
drink alcohol, or use recreational drugs which can help to manage her pregnancy. The
patient also stated that she did an excessive time studying for the Licensure
Examination for Teachers that happened last October 2, 2022. Upon our 8 hours of
nursing shift, the patient received medications as per doctor's order. Medications that
was given to the patient includes Hydralazine 5mg IVTT for high blood pressure,
Dexamethasone 6mg IM q12, and MgSO4 4 grams slow IVTT. These medications help
the patient to stabilize her vital signs, keeping the fetus safe and reduce the bleeding.
The patient's condition has deteriorated since she was first diagnosed with diabetes.

Being our first experience with a full examination, assessing a patient's condition is
challenging. However, we believe that this opportunity will help us learn more, and we
appreciate that this will be a great practice for us as student nurses. When you're a
nursing student, and especially when you become a practicing nurse, it's crucial that
you learn how to do a comprehensive patient health evaluation. A nurse's duties often
include doing health evaluations. By doing an evaluation, we can find out more about
the patient's problems, symptoms, and general health (Wyatt, 2019). Critical to the
success of the nurse and the patient alike is the assessment process, which is also
when the nurse has the opportunity to begin developing a rapport with the patient.
We must remember that we are managing not just one life, but two when caring for
obstetric patients. Consequently, extra care must be taken. Particularly with Madam
Angel’s condition, hypertension during pregnancy can easily turn into something terrible
very quickly if it is not well controlled and monitored.

We believed that our patient was treated fairly and that she received the proper
counseling regarding the potential complications of pregnancy-related hypertension for
both the mother and the fetus. She also had a thorough understanding of the findings of
all the investigations done into her and her present management.

Case Study: Hypertension in Pregnancy. (n.d.). NursingAnswers.net. Retrieved October

22, 2022, from https://nursinganswers.net/essays/the-long-case-hypertension-in-
pregnancy-nursing-essay.php

Gestational Hypertension. (2018, April 27). American Pregnancy Association.

https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/gestational-
hypertension/

Amosco, M.D., Tavera, G.R., Villar, V.A.M. et al. Non-additive effects of ACVR2A in
preeclampsia in a Philippine population. BMC Pregnancy Childbirth 19, 11 (2019).
https://doi.org/10.1186/s12884-018-2152-z