1. POLYTECHNIC COLLEGE OF DAVAO DEL SUR
MacArthur Highway, Digoc City
A CASE STUDY OF
Pregnancy Induced Hypertension: Mild
IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS IN
RLE/NCM 102
Presented to
Mr. Roberto C. Osol, RN
Presented by
Radee King R. Corpuz
February, 2009

2. INTRODUCTION
Pregnancy (latin graviditas) is the carrying of one or more offspring, known as a
fetus or embryo, inside the uterus of a female. In a pregnancy, there can be multiple
gestations, as in the case of twins or triplets. Human pregnancy is the most studied of all
mammalian pregnancies. Obstetrics is the surgical field that studies and cares for high
risk pregnancy. Midwifery is the non-surgical field that cares for pregnancy and pregnant
women.
Childbirth usually occurs about 38 weeks after fertilization (conception), i.e.,
approximately 40 weeks from the last normal menstrual period (LNMP) in humans. The
date of delivery is considered normal medically if it falls within two weeks of the
calculated date. The calculation of this date involves the assumption of a regular 28-day
period. Thus, pregnancy lasts almost nine months. The exact definition of the English
word “pregnancy” is a subject of political controversy, but it is not a matter of substantial
controversy in the medical community.
Pregnancy occurs as the result of the female gamete or oocyte being penetrated
by the male gamete spermatozoon in a process referred to, in medicine, as quot;fertilizationquot;,
or more commonly known as quot;conceptionquot;. After the point of quot;fertilizationquot; it is referred to
as an egg. The fusion of male and female gametes usually occurs through the act of
sexual intercourse. However, the advent of artificial insemination and in vitro fertilisation
have also made achieving pregnancy possible in cases where sexual intercourse does
not result in fertilization (e.g. through choice or male/female infertility).
Incidence of Preeclampsia: High blood pressure problems occur in 6 percent to 8
percent of all pregnancies in the U.S., about 70 percent of which are first-time
pregnancies. In 1998, more than 146,320 cases of preeclampsia alone were diagnosed
Prevalence of Preeclampsia: Preeclampsia is the most common hypertensive
disorder during pregnancy, affecting an estimated 5-8% of pregnant women annually in
the United States, and has the greatest effect on maternal and infant outcome.
(http://www.wrongdiagnosis.com/p/preeclampsia/stats.htm)
In the Philippines, according to the Department of Health (DOH), that in the
Leading Causes of Maternal Mortality Rate per 1,000 live birth, Preeclampsia is the
number 3, either Mild or Severe with a percentage of 40%, surveyed last January,
2008(DOH.gov.ph/calabarzon)

3. Pre-eclampsia (US: preeclampsia from Greek eklampsia, to shine forth, term
used by Hippocrates to suggest a sudden development) is a medical condition where
hypertension arises in pregnancy (pregnancy-induced hypertension) in association with
significant amounts of protein in the urine. Because pre-eclampsia refers to a set of
symptoms rather than any causative factor, it is established that there are many different
causes for the syndrome. It also appears likely that there is a substance or substances
from the placenta that may cause endothelial dysfunction in the maternal blood vessels
of susceptible women.[1] While blood pressure elevation is the most visible sign of the
disease, it involves generalized damage to the maternal endothelium and kidneys and
liver, with the release of vasopressive factors only secondary to the original damage.
Pre-eclampsia may develop from 20 weeks gestation (it is considered early onset
before 32 weeks, which is associated with increased morbidity) and its progress differs
among patients; most cases are diagnosed pre-term. Apart from abortion, Caesarean
section, or induction of labor, and therefore delivery of the placenta, there is no known
cure. It may also occur up to six weeks post-partum. It is the most common of the
dangerous pregnancy complications; it may affect both the mother and the fetus.[1]

4. IDENTIFICATION OF THE CASE
A. PERSONAL PROFILE
Name : Madam O
Address : NAPO, Paquibato (Pob), Davao City
Age : 29y/o
Gender : Female
Civil status : Married
Occupation : Housewife
Admitting Doctor : Dr. Oribello, Libnan
Admitting Diagnosis : Pregnancy Uterine, 39 4/7 wks AOG, cephalic
in labor, G2P1, PreEclampsia: Mild
Religion : Roman Catholic
Nationality : Filipino
Educational Attainment: High School Graduate
Spouse name : Mr. R
Occupation : Pedicab driver
Date of admission : February 04, 2009; 10:15pm
B. Background/History
DM HPN CA ASTHMA
Maternal
Paternal

5. C. Medical History
The patient had her second prenatal check-up at their barangay
hall. According to her, she had was hospitalized due to hypertension, but it
last for a week because the medicines given. The patient had completed
her immunization, and they used herbal medicine aside from low cost
medicine sponsored by the government. Our patient was not a non-
smoker and non-alcoholic.
D. History of Present Illness
The patient has a hypertensive condition, she experienced this in
the second birth, and she had a follow up check-up, for several times.
Six days prior to admission, patient experienced headache and dizziness,
but no consult was made. Instead, patient self-medicated with Aldomet
which afforded relief.
Three days prior to admission, headache persisted with increased
severity, which prompted patient to seek medical assistance at DMC
hospital, patient was given anti-hypertensive medication..
E. Socio-economic background
Patient O, had her second pregnancy and one sibling. Her family
was in average status, wherein they can provide the basic needs for their
patient. Her spouse was a pedicab driver, where his income had a
maximum of Php 500.00 a day, depends on a day.

6. DEFINITION OF TERMS
Age of Gestation – is the age of an embryo or fetus (or newborn infant). In
humans, a common method of calculating gestational age starts counting either
from the first day of the woman's last menstrual period (LMP) [1] or from 14 days
before conception (fertilization). Counting from the first day of the LMP involves
the assumption that conception occurred 14 days later. If the day of conception is
known, the 14th day before conception is used in place of the LMP. Although this
quot;LMP methodquot; of calculating gestational age is convenient, other methods are in
use or have been proposed.
Angiotensin – causes blood vessels to constrict, and drives blood pressure up.
It is part of the renin-angiotensin system, which is a major target for drugs that
lower blood pressure. Angiotensin also stimulates the release of aldosterone
from the adrenal cortex. Aldosterone promotes sodium retention in the distal
nephron, which also drives blood pressure up.
Hypertension – is a medical condition in which the blood pressure is chronically
elevated. In current usage, the word quot;hypertensionquot;[1] without a qualifier normally
refers to systemic, arterial hypertension
PreEclampsia – is diagnosed when a pregnant woman develops high blood
pressure (two separate readings taken at least 4 hours apart of 140/90 or more)
and 300 mg of protein in a 24-hour urine sample (proteinuria).
Prostacyclin (PGI2) – chiefly prevents formation of the platelet plug involved in
primary hemostasis (a part of blood clot formation). It is also an effective
vasodilator
Thromboxane – is a vasoconstrictor and a potent hypertensive agent, and it
facilitates platelet aggregation. It is in homeostatic balance in the circulatory
system with prostacyclin,

7. ANATOMY AND PHYSIOLOGY
The Circulatory System
The
Circulatory
System is the main
transportation
and cooling system for the
body. The Red Blood Cells act like billions of little UPS trucks carrying all sorts of
packages that are needed by all the cells in the body. Instead of UPS, I'll call them
RBC's. RBC's carry oxygen and nutrients to the cells. Every cell in the body requires
oxygen to remain alive. Besides RBC's, there are also White Blood Cells moving in the
circulatory system traffic. White Blood Cells are the paramedics, police and street
cleaners of the circulatory system. Anytime we have a cold, a cut, or an infection the
WBC's go to work.
The highway system of the Circulatory System consists off a lot of one way
streets. The superhighways of the circulatory system are the veins and arteries. Veins
are used to carry blood *to* the heart. Arteries carry blood *away* from the heart. Most
of the time, blood in the veins is blood where most of the oxygen and nutrients have
already been delivered to the cells. This blood is called deoxygenated and is very *dark*
red. Most of the time blood in the arteries is loaded with oxygen and nutrients and the
color is very *bright* red. There is one artery that carries deoxygenated blood and there
are some veins that carry oxygenated blood. To get to the bottom of this little mystery we
need to talk about the Heart and Lungs.
The Heart
This is a subject that is near and dear to my heart. The heart is a two sided, four
chambered pump. It is made up mostly of muscle. Heart muscle is very special. Unlike

8. all the other muscles in the body, the heart muscle cannot afford to get tired. Imagine
what would happen if every 15 minutes or so the pump got tired and decided to take a
little nap! Not a pretty sight. So, heart muscle is always expanding and contracting,
usually at between 60 and 100 beats per minute.
The right side of the heart is the low pressure side. Its main job is to push the
RBC's, cargo bays mostly empty now, up to the lungs (loading docks and filling stations)
so that they can get recharged with oxygen. Blood enters the right heart through a
chamber called the Right Atrium. Atrium is another word for an 'entry room.' Since the
right atrium is located *above* the Right Ventricle, a combination of gravity and an easy
squeeze pushes the blood though the Tricuspid Valve into the right ventricle. The
tricuspid valve is a valve made up of three 'leaflets' that allows blood to go from top to
bottom in the heart but closes to prevent the blood from backing up into the right atrium
when the right ventricle squeezes.
After the blood is in the right ventricle, the right ventricle begins its contraction to
push the blood out toward the lungs. Remember that this blood is deoxygenated. The
blood leaves the right ventricle and enters the *pulmonary artery.* This artery and its two
branches are the only arteries in the body to carry deoxygenated blood. Important:
Arteries carry blood *away* from the heart. There is nothing in the definition that says
blood has to be oxygenated.
When the blood leaves the pulmonary arteries it enters *capillaries* in the lungs.
Capillaries are very, very small blood vessels that act as the connectors between veins
and arteries. The capillaries in the lungs are very special because they are located
against the *alveoli* or air sacks. When blood in the capillaries goes past the air sacks,
the RBC's pick up oxygen. The alveoli are like the loading docks where trucks pick up
their load. Capillaries are so small, in some places, that only *one* RBC at a time can
get through!
When the blood has picked up its oxygen, it enters some blood vessels known as
the *cardiac veins.* This is fully oxygenated blood and it is now in veins. Remember:
Veins take blood to the heart. The cardiac veins empty into the *left atrium.* The left side
of the heart is the high pressure side, its job is to push the blood out to the body.
The left atrium sits on top of the *left ventricle* and is separated from it by the
*mitral valve*. The mitral valve is named this because it resembles, to some people, a
Bishop's Mitered Hat. This valve has the same function as the tricuspid valve, it prevents
blood from being pushed from the left ventricle back up to the left atrium.
The left ventricle is a very high pressure pump. Its main job is to produce enough
pressure to push the blood out of the heart and into the body's circulation. When the
blood leaves the left ventricle it enters the Aorta. There are valves located at the opening
of the Aorta that prevent the blood from backing up into the ventricle. As soon as the
blood is in the aorta, there are arteries called *coronary arteries* that take some of the
blood and use it to nourish the heart muscle.
The Aorta and the Arterial System
The aorta leaves the heart and heads toward, what else, the head. We have to
keep our brains well nourished so we can make good grades in school. The arteries that
take the blood to the head are located on something called the *aortic arch.* After the
blood passes through the aortic arch it is then distributed to the rest of the body. The
*descending aorta* goes behind the heart and down the center of the body.

9. Sometimes, if you are lying flat on your back, you can look down toward your feet
and actually see your abdomen pulsate with each heart beat. This pulsation is really the
aorta throbbing with each heart beat. Do not be alarmed, this is normal.
From the aorta, blood is sent off to many other arteries and arterioles (very small
arteries) where it gives oxygen and nutrition to *every* cell in the body. At the end of the
arterioles are, guess what, capillaries. The blood gives up its cargo as it passes through
the capillaries and enters the venous system.
The Venous System
The venous system carries the blood back to the heart. The blood flows from the
capillaries, to venules (very small veins), to veins. The two largest veins in the body are
the *superior* and *inferior* vena cavas. The superior vena cava carries the blood from
the upper part of the body to the heart. The inferior vena cava carries the blood from the
lower body to the heart. In medical terms, *superior* means above and *inferior* means
under. Many people believe that the blood in the veins is *blue*; it is not. Venous blood
is really dark red or maroon in color. Veins do have a bluish appearance and this may be
why people think venous blood is blue. Both the superior and inferior vena cava end in
the right atrium. The superior vena cava enters from the top and the inferior vena cava
enters from the bottom.
This completes our little journey through the circulatory system. I hope the blood
has continued to flow to your brain as you read this and you managed to stay awake. If
you dozed off, it's o.k., I doze off myself from time to time when I read really boring stuff.
There are lots of things that I did not talk about, such as how the cooling system works,
but I thought that you might like to look some of this stuff up by yourself. As usual, I
know you will have questions for me. I can't wait to hear from you.

10. During pregnancy, the fetal circulatory system works differently than after birth:
• The fetus is connected by the umbilical cord to the placenta, the organ that
develops and implants in the mother's uterus during pregnancy.
• Through the blood vessels in the umbilical cord, the fetus receives all the
necessary nutrition, oxygen, and life support from the mother through the
placenta.
• Waste products and carbon dioxide from the fetus are sent back through the
umbilical cord and placenta to the mother's circulation to be eliminated.

11. Blood from the mother enters the fetus through the vein in the umbilical cord. It goes to
the liver and splits into three branches. The blood then reaches the inferior vena cava, a
major vein connected to the heart.
Inside the fetal heart:
• Blood enters the right atrium, the chamber on the upper right side of the heart.
Most of the blood flows to the left side through a special fetal opening between
the left and right atria, called the foramen ovale.
• Blood then passes into the left ventricle (lower chamber of the heart) and then to
the aorta, (the large artery coming from the heart).
• From the aorta, blood is sent to the head and upper extremities. After circulating
there, the blood returns to the right atrium of the heart through the superior vena
cava.
• About one-third of the blood entering the right atrium does not flow through the
foramen ovale, but, instead, stays in the right side of the heart, eventually flowing
into the pulmonary artery.
Because the placenta does the work of exchanging oxygen (O2) and carbon dioxide
(CO2) through the mother's circulation, the fetal lungs are not used for breathing. Instead
of blood flowing to the lungs to pick up oxygen and then flowing to the rest of the body,
the fetal circulation shunts (bypasses) most of the blood away from the lungs. In the
fetus, blood is shunted from the pulmonary artery to the aorta through a connecting
blood vessel called the ductus arteriosus.
Blood circulation after birth:
With the first breaths of air the baby takes at birth, the fetal circulation changes. A larger
amount of blood is sent to the lungs to pick up oxygen.
• Because the ductus arteriosus (the normal connection between the aorta and the
pulmonary valve) is no longer needed, it begins to wither and close off.
• The circulation in the lungs increases and more blood flows into the left atrium of
the heart. This increased pressure causes the foramen ovale to close and blood
circulates normally.

12. ETIOLOGY AND SYMPTOMATOLOGY
Etiology
Ideal Actual Justification
pregnant woman develops high blood
pressure (two separate readings taken at
Pregnancy (+) least 4 hours apart of 140/90 or more)
and 300 mg of protein in a 24-hour urine
sample (proteinuria).
Symptomatology
Ideal Actual Justification
a woman who normally has
a low baseline blood
pressure, such as 90/60,
could be considered
hypertensive at a blood
pressure of less than that -
Hypertension (+) especially if she has other
symptoms. A rise in the
diastolic (lower number) of
15 degrees or more, or a
rise in the systolic (upper
number) of 30 degrees or
more is cause for concern.
-because of is the
accumulation of excess
fluid. It is particularly
concerning when it
accumulates in the face
Swelling or Edema (+)
(eyes) or hands. It is normal
to have trouble wearing
rings throughout pregnancy.
-due to In general, eat
normally and make every
Sudden Weight Gain effort to include fresh raw
(+) fruit and vegetables, your
prenatal vitamin, and a folic
acid supplement in your diet
(+) because of Dull, throbbing

13. headaches, often described
Headaches
as migraine-like
- Nausea or vomiting is
particularly significant when
Nausea or Vomiting
(+) the onset is sudden and in
the second or third
trimesters.
-Vision changes include
temporary loss of vision,
sensations of flashing
lights, auras, light
Changes in Vision (+)
sensitivity, and blurry vision
or spots. For some women
who are farsighted, vision
may actually improve.
Lower back pain is a very
common complaint of
pregnancy. However,
sometimes it may indicate a
Lower Back Pain (+)
problem with the liver,
especially if it accompanies
other symptoms or
preeclampsia.

14. COMPLICATION
Most women with preeclampsia deliver healthy babies. The more severe your
preeclampsia and the earlier it occurs in your pregnancy, however, the greater the risks
for you and your baby. Complications of preeclampsia may include:
 Lack of blood flow to the placenta. Preeclampsia affects the arteries carrying
blood to the placenta. If the placenta doesn't get enough blood, the baby may
receive less oxygen and nutrients. This can lead to slow growth, low birth weight,
preterm birth or stillbirth.
 Placental abruption. Preeclampsia increases the risk of placental abruption, in
which the placenta separates from the inner wall of the uterus before delivery.
Severe abruption can cause heavy bleeding, which can be life-threatening for
both mother and baby.
 HELLP syndrome. HELLP — which stands for hemolysis (the destruction of red
blood cells), elevated liver enzymes and low platelet count — syndrome can
rapidly become life-threatening for both mother and baby. Symptoms of HELLP
syndrome include nausea and vomiting, headache and upper right abdominal
pain. HELLP syndrome is particularly dangerous because it can occur before
signs or symptoms of preeclampsia appear.
 Eclampsia. When preeclampsia isn't controlled, eclampsia — which is
essentially preeclampsia plus seizures — can develop. Symptoms of eclampsia
include upper right abdominal pain, severe headache, vision problems and
change in mental status, such as decreased alertness. Eclampsia can
permanently damage a mother's vital organs, including the brain, liver and
kidneys. Left untreated, eclampsia can cause coma, brain damage and death for
both mother and baby

15. PATHOPHYSIOLOGY
Predisposing factors Precipitating factors
Age Pregnancy
Hx of Pre-Ec, DM,
Large placental mass
Nitric Oxide production Placenta partially
Produced prostacyclin & thromboxane
Changes in the ratio between the
prostaglandins
Prostacyclin (potent vasodilator)&
thromboxane (potent vasocontrictor
&platelet aggregator)
Prostacyclin
Thromboxane
Effects of thromboxane dominates
Renin-Angiotensin-
Gradual loss of resistance to Aldosterone
mechanism
Angio II (potent vasoconstriction)
Increased
Sensitivity to
Angio II
Concurrent maternal vasospasm
HPN
Loss of Normal vasodilation of
Uterine arteriols Renal perfusion
S/Sx
Effects on fetus: Urea
Placental perfusion Growth restriction BUN
Chronic hypoxia Uric acid
Fetal distress U.O. GFR
Na+ retention
In amounts
Extracellular
volume
Large protein
molecules allowed S/Sx S/Sx
S/Sx: to escape in the Edema Hct
Proteinuria uterine
Colloidal osmotic
pressure Further movement
Intravascular
of fluid to Viscosity of blood
volume
extracellular spaces

16. In normal pregnancy the lowered peripheral vascular resistance and the
increased maternal resistance to the pressor effects of angiotensin II result in
lowered blood pressure. In preeclampsia, blood pressure begins to rise after 20
week’s gestation, probably in response to a gradual loss of resistance to
angiotensin II. This response has been linked to the ration between the
prostaglandins prostacyclin and thromboxane.
Prostacyclin is a potent vasodilator. It is decreased in preeclampsia, often
several weeks before symptoms develop. This changes the ratio between the
two prostaglandins, allowing the potent vasoconstriction and platelet-aggregating
effects of thromboxane to dominate. These hormones are produced partially by
the placenta, which helps explain the reversal of the condition when the placenta
is removed and why the incidence is increased when there is a larger than
normal placental mass.
Nitric oxide, a potent vasodilation, plays a role in the pregnant woman’s
resistance to vasopressors. Decreased nitric oxide production in women with
preeclampsia may contribute to the development of hypertension. The loss of
normal vasodilation of uterine arteriols and the concurrent maternal vasospasm
result in decreased placental perfusion. The effect on the fetus may be growth
restriction, decrease in fetal movement, and chronic hypoxia or fetal distress.
Normal renal perfusion is decreased. With a reduction of the glomerular
filtration rate, serum levels of creatinine, BUN, and uric acid begin to rise from
normal pregnant levels, while urine output decreases. Sodium is retained in
increased amounts, which results in increased extracellular volume, increased
sensitivity to angiotensin II, and edema. Stretching of the capillary walls of the
glomerular endothelial cells, allows the large protein molecules, primarily albumin
to escape in the urine, decreasing serum albumin levels. The decreased serum
albumin concentration causes decreased plasma colloid osmotic pressure. This
lowered pressure results in further movement of fluid to the extracellular spaces,
which also contributes to the development of edema.
The decreased intravascular volume causes increased viscosity of the
blood and a corresponding rise in hematocrit.

17. MEDICAL MANAGEMENT
01/06/09
Referred to Dr. Armando
8:30am
 For repeat cranial CT scan STAT
 Monitor NVS every hour and record
 Refer
01/07/09
10:30am
 NPO
 Start Ranitidine 50mg IVTT every 8 hours
 Shave full head
 Refer
01/08/09
 May have DAT
 Continue medz
 Continue IVF: PLR 1L to run at 130cc/hr
 D/C PNSS
 D/C omepirazole
 Open dressing
 Keep Jackson’s Pratt drain in negative
5:55pm
 D/C all medz
 Change dressing
 Refer
01/09/09
5:30
 DAT
 Continue medz
 Change dressing
 Keep Jackson’s Pratt Drain in negative
 Full body bath
 Remove FBC
01/10/09
 DAT with SAP
 ROM:
Laboratory

18. Normal Clinical
Test Result Remarks
Values Significance
CBC Hemoglobin 115-155 Decreased in -decresed-
– L 97.0 various anemias,
pregnancy, severe or
prolonged
hemorrhage, and
with execessive fluid
intake
Hematocrit – 0.30-0.48 Severe anemias, -decreased-
L 0.37 anemia of
pregnancy, acute
massive blood loss
RBC – L 3.66 4.20-6.10 Adequate number of -decreased-
Red Blood Cell
primarily to ferry
oxygen in blood to all
cells of the body
WBC – 5.0-10.0 Infection, leukemia, -increased-
H 15.78 tissue necrosis
Neutrophil – 55-75 -normal range-
71
Lymphocyte 0.2-0.4 Aplastic anemia, -decreased-
s – L .18 SLE,
immunodeficiency
including AIDS
Monocytes – 2-10 -normal range-
10
Eosinophil – 1-8 -normal range-
1
Basophil – 0 0-1 -normal range-
MCV - 88.8 84-96 cubic -normal range
µm/red cell
MCH - 26.5 26-34 pg/cell -normal range
MCHC – 31-37 g Hgb/ Severe hypochromic -decreased-
L29.8 dl anemia
Albumin (+)
Sugar (+)

19. NURSING ASSESSMENT
Physical Assessment
Assessment Normal Findings Yes No
Body Build, Proportionate, varies 
Height and with lifestyle
Weight
Posture and Clean, neat 
Gait
Body and No body or breath odor 
Breath odor
Signs of No distress noted 
Distress
Signs of Health Healthy appearance 
or Illness
Attitude Cooperative 
Affect/Mood Appropriate to situation 
Quantity, Understandable, 
Quality and moderate pace,
Organization of exhibits thought
Speech association
Relevance and Logical sequence, 
Organization of makes sense, has
Thoughts sense of reality

20. Assessment Normal Findings Yes Poor
Uniformity of Uniformity except in 
skin color areas exposed to the
sun
Edema No edema 
Skin Lesions No freckles, No 
birthmarks, no
abrasions or lesions
Skin Moisture Moisture in skin folds 
and the axillae
Skin Uniform, within normal 
Temperature range
Skin Turgor Skin springs back to 
previous state when
pinched
Assessment Normal Findings Yes No
Scalp Evenly distributed 
Hair Thickness Thick hair 
Hair Texture Silky, resilient hair 
Amount of Body Variable 
Hair

21. Assessment Normal Findings Yes No
Nail Plate Convex curvature 
Shape
Texture Smooth 
Nail Bed Color Highly vascular, 
pink, prompt return
of pink color
Assessment Normal Good Fair Poor
Findings
A. Skull and Face
Head Rounded, 
symmetrica
l, smooth
skull
contour, no
nodule
B. Eyes and Vision
Eyebrows Hair evenly 
distributed,
symmetrical,
skin intact
Eyelid Skin intact, no 
discharges, no
discolorations,
symmetrical
Eyelashes Equally
distributed,

slightly curved
outward

22. Conjunctiva Transparent,
sometimes
appear white, 
shiny, smooth,
pink or red
Lacrimal No edema or

Gland tearing
Cornea Transparent,
shiny and
smooth, blinks 
when cornea
is touched
Pupils Black color,

equal size
Near Vision Able to read

newsprint
C. Ears and Hearing
Auricles Color is 
uniform,
symmetric,
mobile,
firm, pinna
recoils
when
folded
Response to Normal 
Normal Voice voice tone
Tone audible
D. Nose and Sinuses
Nares Symmetric 
and
straight, no
discharges,
no swelling,

23. uniform
color, not
tender
Lining of nose Nasal 
septum in
midline
E. Mouth
Lips Buccal Uniform 
Mucosa pink, soft,
symmetrica
l
Teeth and Complete 
Gums child teeth,
smooth,
white tiny
tooth
enamel,
pink gums,
moist, firm,
no
retractions
Tongue Centrally 
located,
pink in
color, freely
movable
Palates, Light pink, 
Uvula, Tonsils smooth, no
discharges,
present
gag reflex

24. Assessment Normal Findings Good Fair Poor
Shape and Symmetrical 
Symmetry
Spinal Spine vertically 
Deformities aligned
Assessment Normal Findings Good Fair Poor
Inspect Neck Symmetrical with head 
Muscles centered
Observe Head Coordinated, smooth, 
Movement movement with no
discomfort, equal
strength

25. Assessment Normal Findings Good Fair Poor
Muscle Size is symmetrical, no 
contracture, normally
firm
Movement Smooth coordinated 
movements, equal
strength
Bones No deformities, no 
swelling or tenderness
Joints No swelling, tenderness 
Range of Varies to some degree 
motion

26. NURSING MANAGEMENT
NURSING ASSESSMENT AND DIAGNOSIS
Take and record the blood pressure during each antepartal visit. If the blood
pressure rises, or if the normal decrease in blood pressure expected between 8
to 28 weeks of pregnancy does not occur, the woman should be followed closely.
Also check the woman’s urine for proteinuria at each visit.
If hospitalization becomes necessary, asses the following:
• Blood pressure. Asses every 1 to 4 hours, or more frequently if indicated
by medications or other changes in the woman’s status.
• Temperature. Take every 4 hours, or every 2 hours if elevated.
• Pulse and respiration. Determine pulse rate and respiration along with
blood pressure.
• Fetal heart rate. Check the fetal heart rate with the blood pressure, or
monitor cotinuously with the electronic fetal monitor if the situation
indicates.
• Urinary output. Measure every voiding. Te woman frequently has
indwelling catheter. In this case, urine output can be assessed hourly.
Output should be 700mL or greater in 24 hours, or at least 30mL/hour.

27. • Urine protein. Evaluate urinary protein hourly if an indwelling catheter is
in place or with each voiding. Reading of 3+ or 4+ indicates loss of 5g or
more of protein in 24hours.
• Urine specific gravity. Check specific gravity of the urine hourly or with
each voiding. Readings over 1.040correlate with oliguria and proteinuria.
• Weight. Weight the woman daily at the same robe or gown and slippers.
Weighing may be omitted if the woman is to maintain strict bed rest.
• Pulmonary edema. Observe the woman for coughing. Auscultate the
lings for moist respirations.
• Deep tendon reflexes. Assess the woman for evidence of hyperflexia in
the brachial, wrist, patellar, or Archilles tendons.
• Placental separation. Assess hourly for vaginal bleeding and uterine
rigidity.
• Headache. Ask about any visual blurring or changes or scotomata. The
results or the daily funduscopic examination should be recorded on the
chart.
• Epigastric pain. Ask about any epigastric pain. It is important to
differentiate it from simple heartburn, which tends to be familiar and less
intense.
• Laboratory blood test. Daily test of hematocrit to measure
hemoconcentration; BUN, creatinine, and uric acid levels to assess kidney
function; clotting studies for sings of thrombocytopenia or DIC; liver
enzymes; and electrolytes are all indicated. Magnesium levels are monitor
regularly in women receiving magnesium sulfate.
• Levels of consciousness. Observe the woman for alertness, mood
changes, and any signs of impending convulsion.
• Emotional response and level of understanding. Carefully assess the
woman’s emotional response so that support and teaching can be planned
accordingly.

28. In addition assess the effects of any medications administered. Become familiar
with the more commonly used medications and their purpose, implications, and
associated untoward or toxic effects.
NURSING THEORIES
Florence Nightingale
Her Notes on Nursing emphasized that a clean environment, warmth,
ventilation, sunlight, and a quiet environment lead to good health.
Reaction: a non-stimulating environment is essential especially for our patient, in
a way that it promotes faster recovery on our patient through minimizing external
and stressful stimuli such as limiting visitors during resting periods that may
worsen the situation of our client.
Virginia Henderson
Virginia Henderson defined nursing as quot;assisting individuals to gain
independence in relation to the performance of activities contributing to health or
its recoveryquot;
Reaction: we can relate this theory in the case of our patient because our patient
will soon be discharged from the unit. In order for her to gain independence in
nourishing her child, we, student nurses, must render health teachings such as
the importance of breast feeding, the proper positioning of the child during
breastfeeding and Mothers who breastfeed longer than eight months also benefit
from bone re-mineralization and breastfeeding diabetic mothers require less
insulin.
Hildegard Peplau
Hildegard Peplau used the term, psychodynamic nursing, to describe the
dynamic relationship between a nurse and a patient. She identified nursing roles
of the nurse and in our case this three roles fitted us for our client:
• Counseling Role - working with the patient on current problems

29. • Teaching Role - offering information and helping the patient learn
Reaction: As a nursing student, we had many roles to perform to our patient.
One of these roles is being a councilor. As a councilor, it is our duty to lessen if
not alleviate the client’s problem.
As an educator it is our obligation to render knowledge to our patient. In
our client’s case, who just delivered her baby, our co-student nurse taught the
patient about performing self-care by means of proper perennial care.
HEALTH TEACHINGS
PRIMARY
1. Instruct the patient to have a proper diet that she can tolerate, such as
fruits, to help promote wellness.
2. Instruct the patient to have deep breathing exercise, to promote non-
pharmacological treatment
3. Advice the patient to have fluid intake or adequate hydration, to help
her body re-hydrate to prevent fluid imbalance.
4. Assist patient to perform self-care activities she cannot tolerate, to help
her maintain her activities of daily living.
5. Encourage patient to perform self care activities within her level of own
ability.
6. Initiate and encourage patient to perform bed exercises to improve
circulation ( ROM to arms, hands and fingers, feet and legs; leg flexion
and leg lifting; abdominal and gluteal contraction)
7. Ask patient to perform as much as possible and then to call for
assistance. Collaborate with patient for progressive activity before and
after schedule activity.
SECONDARY
1. Administer medications as ordered by the physician
2. Advice patient to have proper nutrition to enhance immune system
TERTIARY
1. Instruct patient to comply for medication regimen
2. Discuss the importance of having a regular check-up with his physician

30. DISCHARGE PLAN
When the doctor noted that the patient is for discharge it is very important
to continue the medication depending on the duration the doctor ordered for the
total recovery of the patient. Patient with Post Normal Spontaneous Vaginal
Delivery needs to have a light exercise such as motor development in both arms
and feet, clear verbalization and spontaneous with the duration of 10-15 minutes
and must get enough rest. It is also important to maintain proper hygiene to
prevent further infection that may happen to the. She also needs to minimized
smoking and drinking alcoholic beverages.
She must have to relax in order to recover her present condition and
minimal exposure to a pressure and positive atmosphere can be a high risk
factor that may cause severity of her condition. The diet of the patient is also a
factor for fast recovery. She is encourage to eat nutritious foods such as fresh
fruits with vitamin C and fresh vegetables. The family of the patient plays a big
role for the fast recovery.
Regular consultation to the physician can be factor for recovery to assess
and monitor her condition
M- advice patient not to skip the meds that the doctor ordered
E- encourage patient to have exercise early in the morning at lease
twice a day
T-

31. H- separate utensils for the mother and other personal things that will
be use for the whole family
O- provide information about how to control or prevent the spread of
the disease
D- encourage patient to eat nutritious food such as vegetable and
fruits especially those that contains vitamin C
S- provide emotional support and provide care for the mother
PROGNOSIS
Good Fair Poor Justification
Duration of Duration of illness is
Illness good since the incident
- was and she was given
ample treatment.
Onset of The onset is since right
Illness after the she was
diagnosed, she was
- automatically brought to
the Delivery room for a
Post NSVD
Compliance Patient can afford to
to Medication sustain the needed
- laboratory exams and
the feasibility of having
the condition
Family The family members
Support supported the patient
- both financially and
emotionally.
Environment The hospital setting is
not well ventilated and
- may promote for further
infection of the patient’s
current situation.
Age Patient is 29 years old
- therefore she has a
moderate chance of
recovering for her
immune system is still
generating in the

32. process of development.
Precipitating The patient manifested
Factors all the factors that may
lead to Pregnancy
Induced Hypertension
- which urged the family
and the health provider
to set-up the proper
action
EVALUATION
Through our hardship in preparing for this research, tried to interact
and communicate our patient in good manner for us to gather the specific and
accurate data that we need that could help us in studying the disease which
could lead us into successful research.
The patient’s condition is in recovery period as she had already
undergone medication for certain, which thereby prevented occurrence of
complications. They are financially capable in sustaining such pregnancy
condition and the medications after. Her husband is the one taking good care
of her in throughout her hospitalization, giving emotional and moral support.

33. IMPLICATION
Nursing Practice
- this can be used as a guide for practice by other nurses. They
may get many relevant ideas in giving proper care and
interventions to patients with related illness or those who have
the same illness (Post Normal Spontaneous Vaginal Delivery,
with Pregnancy Induced Hypertension)
Nursing Education
- this study may serve as a helpful learning tool for student
nurses. They may utilize this complied study as their reference
for research; this will also give them good examples on nursing
managements, and nursing diagnoses, which will be a very
useful guide when they will be making their own Nursing Care
Plans.
Nursing Research
- students may use this compilation as their guide for research. This
will hand them good views and factual ideas which will be very
essential for their added learning on knowledge for Post Normal
Spontaneous Vaginal Delivery with Pregnancy Induced
Hypertension condition

34. REFERENCES
• http://en.wikipedia.org/wiki/Preeclampsia
• http://en.wikipedia.org/wiki/Glascow_Coma_Scale
• http://en.wikipedia.org/wiki/Placenta
• http://hes.ucfsd.org/gclaypo/circulatorysys.html
• http://www.brooksidepress.org/Products/OBGYN_101/MyDocu
ments4/Lab/hemoglobin.htm
• Fundamentals of Maternal and Child Nursing Care, 2nd Ed., Vol
1, pp 354-358
• Brunner and Suddarth’s Medical-Surgical Nursing, 11th Ed,. Vol
2, pp.2578-2580, Diagnostic Studies and Interpretation