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INTRODUCTION
1
Statistics
In the district hospital where the patient was confined there were approximately 15% of
the cesarean patients were diagnosed with Pregnancy Induced Hypertension from the year 2009
up to the present.
The group had chosen the Pregnancy Induced hypertension (PIH) as the case to be
studied. The researchers agreed and decide for this case because the patient is recently admitted
at that time and the student nurses could still have a better assessment and monitoring for a
length of time. This is an advantage for the group in facilitating and scrutinizing the cause of
certain hypertension during pregnancy. Eventually, it will give us a better understanding of the
disease and know the importance of being a competent student nurses as how we provide health
teachings and perform our independent nursing functions. May this study will also be a future
reference that may help other researchers/student nurses in doing/completing their requirements.
Current Trends:
ScienceDaily (Apr. 14, 2010) — Obese women who have bariatric surgery before getting
pregnant are at significantly lower risk for developing dangerous hypertensive disorders during
pregnancy than those who don't, according to a study of medical insurance records by Johns
Hopkins experts. Hypertensive disorders in pregnancy -- which include gestational
hypertension, preeclampsia and eclampsia -- complicate an estimated 7 percent of pregnancies in
the United States. Researchers say they are much more common in obese women, who make up
a third of women of childbearing age.
"We have long known that women who have these blood pressure disorders are not only
at an increased risk for pregnancy complications in themselves and their babies, but also for
chronic diseases in the future," says Wendy L. Bennett, M.D., M.P.H., assistant professor of
medicine at the Johns Hopkins University School of Medicine and a study leader. "Can we
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prevent the development of these disorders in pregnancy with bariatric surgery? These findings
suggest the answer may be 'yes.'"
Results of the research are published online in the British Medical Journal.
For the study, Bennett and her colleagues looked at five years of data from Blue Cross
Blue Shield insurance records and identified 585 women who had bariatric surgery and delivered
a baby. The sample included 269 women who had babies some time before having weight-loss
surgery and 316 who had the surgery before getting pregnant. More than 80 percent of the
women chose gastric bypass surgery over other, less common weight-loss operations.
The researchers found an 80 percent reduction in the risk of preeclampsia and eclampsia
among women who had surgery before pregnancy, along with a 74 percent reduction in the risk
of gestational hypertension and a 61 percent reduction in the risk of chronic hypertension in
pregnancy, all of which are known to cause pregnancy complications.
Bennett cautions that not every obese woman is a candidate for bariatric surgery. And not
every obese woman wants to undergo the operation, which itself carries risks of complications.
Moreover, insurance companies don't always cover the surgery, and when they do, it's typically
not unless a woman has a body-mass index (BMI) of more than 40 or a BMI of more than 35
with a co-morbidity such as diabetes or sleep apnea, she says.
One limitation of the study is that the insurance data did not include information on fetal
outcomes, so researchers can't say what, if any, effect bariatric surgery may have on babies born
to women who have undergone the operation, Bennett says. Babies born to mothers with
preeclampsia or eclampsia may arrive prematurely which can lead to complications up to and
including fetal death.
Nevertheless, Bennett says her study suggests that insurance companies "should be
covering gastric bypass surgery in women of childbearing age because of the potential to reduce
complications if we can reduce their weight before they become pregnant." Treating the obesity
before pregnancy, she adds, also has the potential of saving a lot of money on treatment of
complications in mothers, fetuses and newborns."
Bennett says her findings are intended to open a discussion between doctors and obese
patients who wish to become pregnant about the risks and benefits associated with bariatric
surgery. Once they become pregnant, women who have undergone weight-loss surgery will need
to be closely monitored to make sure they and their fetuses are getting enough nutrition.
Prior research has shown that rates of gestational diabetes (which also causes complications in
pregnancy) decreases after bariatric surgery, and that weight loss can increase fertility in obese
women.
2. Objectives
General Objective: After three weeks of accomplishing the case study, the student nurses will
be able to apply the concepts of nursing process on the care of the patient with pregnancy
induced hypertension.
Learning Objectives: After a week of accomplishing this case study, the student nurses will be
able to:
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Cognitive:
Affective:
Psychomotor:
1. Personal History
a. Demographic Data
Mrs. X is a 40 year old, Filipino citizen, plain housewife and married. She is born on
December 25, 1969 at Balanga Bataan, and the youngest daughter among the seven siblings. She
is currently living in Lubao, Pampanga together with her husband, and their two sons, ages
twelve and five years old.
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She was admitted at a district hospital in Pampanga last August 01, 2010 with an
admitting diagnosis of mild pre-eclampsia and cough. She was discharged last August 6, 2010.
b. Antepartal/Prenatal preparation
During Mrs. X’ pregnancy, she had her monthly check-up in order to monitor her
condition as well as the baby’s condition . She eats mostly vegetables like togue, fruits like
papaya, fishes and meat products such as skinless chicken as well as fatty and salty foods
especially pork with salted shrimp (binagoongang baboy) . She does not drink coffee ever since
instead she drinks milk and water. She uses ordinary soap for her perineal hygiene. She was
taking Aldomet 250 mg TID, Cefalexin and ferrous sulfate since March 4,2010 as advised by her
doctor.
During the first trimester of Mrs. X’s pregnancy, she experienced frequent headaches and
dizziness which continued until the third trimester. She usually sleeps in order to relieve her from
the said conditions. On the end of her first trimester she experienced an increased in her blood
pressure which is 170/120 mmHg, this is the reason for prescribing the Aldomet. During the
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course of her second trimester of pregnancy her blood pressure went down to 160/90 mmHg.
And the blood pressure of the patient in the third trimester improved to 140/100 mmHg. Right
after the surgery Aldomet was changed into Hydralazine as ordered by the physician.
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Family health illness and history
58 52 51 50 47 Brother A 42 Brother B
Sister A Sister B Sister C Sister D PT 40
Legend:
Female
Male
Deceased (due to old age)
Deceased (unknown)
Deceased (due to heart attack)
Deceased (due to Diabetes Mellitus)
Deceased (accident)
PT Patient
Hypertension
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3. History of Past Illness
Mrs. X had an appendectomy last July 10, 2009. She experienced cough and colds once a
year. She does not experienced PIH during her first and second pregnancy. She has a complete
shot of Tetanus Toxoid vaccine.
August 3, 2010
General Appearance
Seen patient on a supine position with an ongoing IVF of # 1 D5 LRS at 200 cc level
regulated at 30 gtts/ min infusing well at her left arm. Patient is conscious, awake and coherent.
She wearing gray shirt without sleeves and diaper and was drape from waist below.
B – engorge, lactating
U – 1 fingerbreadth below umbilicus
B – 25 cc level
B – 2 times flatus
L – rubra, minimal amount, 1 diaper since after the operation, scanty
E – abdominal midline incision
S – striae gravidarum at both thigh
H – no presence of Homan’s sign
E – taking hold phase as evidence by touching the baby and let the baby stay with her side at all
times
Vital Signs:
Temperature – 37.1 °C
Respiratory rate – 19 breaths per minute
Pulse rate – 87 beats per minute
Blood pressure – 130/70
8
CEPHALOCAUDAL ASSESSMENT
SKIN
• Dark brown skin
• Dark armpit
• Symmetrical in shape
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• Eyelashes are evenly space
• Pale conjunctive
• With eyebags
• Tongue is pink
• Presence of striae
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• Slightly tender upon palpation
• No palpable masses
CARDIOVASCULAR
• Absence of murmurs
ABDOMEN
• Presence of transverse incision
MUSCULOSKELETAL/EXTREMITIES
• Head can be turned laterally against resistance
General Appearance
Seen patient sitting on bed with an ongoing IVF of # 2 D5LRS at 400 cc level regulated
at 30 gtts/min. She is conscious, awake and coherent. The patient is wearing red sando and
checkered short. She is also breastfeeding her child.
B - engorge, lactating
U – 2 fingerbreadth below umbilicus
B – voided 2 times
B – has her bowel movement (1)
L – rubra, minimal amount, 1 diaper since after the operation,and 1 sanitary napkin, scanty
E – abdominal midline incision
S – striae gravidarum at both thigh
H – no presence of Homan’s sign
E – taking hold phase as evidence by touching the baby and let the baby stay with her side at all
times
Vital Signs:
Temperature – 36.7 °C
Respiratory rate – 17 breaths per minute
Pulse rate – 80 beats per minute
Blood pressure – 130/70
CEPHALOCAUDAL ASSESSMENT
SKIN
• Dark brown skin
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• Has fair complexion
• Dark armpit
• Symmetrical in shape
• Pink conjunctive
• With eyebags
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• With droopy eyelids
EARS
• Symmetrically aligned to eyes
• Tongue is pink
• Presence of striae
• No palpable masses
CARDIOVASCULAR
• Absence of murmurs
ABDOMEN
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• Presences of transverse incision
MUSCULOSKELETAL/EXTREMITIES
• Head can be turned laterally against resistance
To monitor
ongoing bleeding
to check its
severity.
14
2010 deficiency.
Nursing Responsibilities:
• Explain the procedures; explain that slight discomfort may be felt when skin is punctured.
• Avoid stress if possible because altered physiologic status influences and changes normal
hemogram values.
• Dehydration can dramatically alter values, for example large volume of IV fluids can
dilute the blood and values will appear as lower counts. The presence of either of these
states should be communicated to the laboratory.
• Fasting is not necessary; however fat meals may alter some test result as a result of
lipidemia.
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• Apply manual pressure and dressings to the puncture site on removal of the needle.
• Monitor the puncture site for oozing or hematoma formation. Maintain pressure dressings
on the site if necessary. Notify physician of unusual problems with bleeding.
• Bruising on the puncture site is not uncommon; signs of inflammation are usual and
should be reported if the inflamed area appears larger, if red streaks develop or if
drainage occurs.
16
Specific 1.003 to It means that
gravity: 1.010 1.030 the
concentration
of solutes in
the urine is
normal
Before:
Verify the doctor’s order.
Explain to the patient the importance of the procedure.
The first morning sample is the most valuable because it is more concentrated and
more likely to yield abnormal results
Assist the patient.
During:
Provide privacy.
Advise the patient to catch the midstream of the urine.
Transport time for culture specimen must be minimized.
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Handle specimen carefully.
After:
Relay the results to the attending physician.
Before:
1. Check doctor’s orders
2. Ask for the patient’s identification
3. Explain the procedure properly to the SO.
4. Instruct the client not to void prior the procedure.
During:
1. The patient lies on an examining table with the part of the body to be examined exposed.
2. A conductive gel is applied to the skin over the area under examination.
3. You lie quietly as the person performing the examination moves the transducer over the
skin surface while watching the monitor.
4. You may be asked to shift positions to obtain other views of the organ(s) under study.
After:
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1. Wait for the further results.
2. The patient can void.
3. Wait for the physician to interpret the results
When most people hear the term cardiovascular system, they immediately think of the
heart. We have all felt our own heart "pound" from time to time, and we tend to get a bit nervous
when this happens. The crucial importance of the heart has been recognized for a long time.
However, the cardiovascular system is much more than just the heart, and from a scientific and
medical standpoint, it is important to understand why this system is so vital to life.
Most simply stated, the major function of the cardiovascular system is transportation.
Using blood as the transport vehicle, the system carries oxygen, nutrients, cell wastes, hormones,
and many other substances vital for body homeostasis to and from the cells. The force to move
the blood around the body is provided by the beating heart. The cardiovascular system can be
compared to a muscular pump equipped with one-way valves and a system of large and small
plumbing tubes within which the blood travels.
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HEART:
The heart is a muscular organ found in all vertebrates that is responsible for pumping
blood throughout the blood vessels by repeated, rhythmic contractions.
The heart is enclosed in a double-walled sac called the pericardium. The superficial part of this
sac is called the fibrous pericardium. This sac protects the heart, anchors its surrounding
structures, and prevents overfilling of the heart with blood. It is located anterior to the vertebral
column and posterior to the sternum. The size of the heart is about the size of a fist and has a
mass of between 250 grams and 350 grams. The heart is composed of three layers, all of which
are rich with blood vessels. The superficial layer, called the visceral layer, the middle layer,
called the myocardium, and the third layer which is called the endocardium. The heart has four
chambers, two superior atria and two inferior ventricles. The atria are the receiving chambers and
the ventricles are the discharging chambers. The pathway of blood through the heart consists of a
pulmonary circuit and a systemic circuit. Blood flows through the heart in one direction, from
the atrias to the ventricles, and out of the great arteries, or the aorta for example. This is done by
four valves which are the tricuspid atrioventicular valve, the mitral atrioventicular valve, the
aortic semilunar valve, and the pulmonary semilunar valve.
Systemic circulation is the portion of the cardiovascular system which carries oxygenated blood
away from the heart, to the body, and returns deoxygenated blood back to the heart. The term is
contrasted with pulmonary circulation.
Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-
depleted blood away from the heart, to the lungs, and returns oxygenated blood back to the heart.
The term is contrasted with systemic circulation. A separate system known as the bronchial
circulation supplies blood to the tissue of the larger airways of the lung.
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Arteries are blood vessels that carry blood away from the heart. All arteries, with the
exception of the pulmonary and umbilical arteries, carry oxygenated blood.
Pulmonary arteries
The pulmonary arteries carry deoxygenated blood that has just returned from the body to
the heart towards the lungs, where carbon dioxide is exchanged for oxygen.
Systemic arteries
Systemic arteries can be subdivided into two types – muscular and elastic – according to
the relative compositions of elastic and muscle tissue in their tunica media as well as their size
and the makeup of the internal and external elastic lamina. The larger arteries (>10mm diameter)
are generally elastic and the smaller ones (0.1-10mm) tend to be muscular. Systemic arteries
deliver blood to the arterioles, and then to the capillaries, where nutrients and gasses are
exchanged.
The Aorta
The aorta is the root systemic artery. It receives blood directly from the left ventricle of the
heart via the aortic valve. As the aorta branches, and these arteries branch in turn, they become
successively smaller in diameter, down to the arteriole. The arterioles supply capillaries which in
turn empty into venules. The very first branches off of the aorta are the coronary arteries, which
supply blood to the heart muscle itself. These are followed by the branches off the aortic arch,
namely the brachiocephalic artery, the left common carotid and the left subclavian arteries.
Aorta the largest artery in the body, originating from the left ventricle of the heart and extends
down to the abdomen, where it branches off into two smaller arteries (the common iliacs). The
aorta brings oxygenated blood to all parts of the body in the systemic circulation.
The aorta is usually divided into five segments/sections:
Ascending aorta—the section between the heart and the arch of aorta
Arch of aorta—the peak part that looks somewhat like an inverted "U"
Descending aorta—the section from the arch of aorta to the point where it divides into the
common iliac arteries
o Thoracic aorta—the half of the descending aorta above the diaphragm
o Abdominal aorta—the half of the descending aorta below the diaphragm
Arterioles
Arterioles, the smallest of the true arteries, help regulate blood pressure by the variable
contraction of the smooth muscle of their walls, and deliver blood to the capillaries.
Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood
from the tissues back to the lungs; exceptions are the pulmonary and umbilical veins, both of
which carry oxygenated blood. Veins differ from arteries in structure and function; for
example,arteries are more muscular than veins and they carry blood away from the heart.
Veins are classified in a number of ways, including superficial vs. deep, pulmonary vs. systemic,
and large vs. small.
Superficial veins
Superficial veins are those whose course is close to the surface of the body, and have no
corresponding arteries.
Deep veins
Deep veins are deeper in the body and have corresponding arteries.
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Pulmonary veins
The pulmonary veins are a set of veins that deliver oxygenated blood from the lungs to the
heart.
Systemic veins
Systemic veins drain the tissues of the body and deliver deoxygenated blood to the heart.
Atrium sometimes called auricle, refers to a chamber or space. It may be the atrium of the lateral
ventricle in the brain or the blood collection chamber of a heart. It has a thin-walled structure that
allows blood to return to the heart. There is at least one atrium in animals with a closed
circulatory system.
Right atrium is one of four chambers (two atria and two ventricles) in the human heart. It
receives deoxygenated blood from the superior and inferior vena cava and the coronary sinus,
and pumps it into the right ventricle through the tricuspid valve. Attached to the right atrium is
the right auricular appendix.
Left atrium is one of the four chambers in the human heart. It receives oxygenated blood
from the pulmonary veins, and pumps it into the left ventricle, via the atrioventricular valve.
Ventricle is a chamber which collects blood from an atrium (another heart chamber that is
smaller than a ventricle) and pumps it out of the heart.
Right ventricle is one of four chambers (two atria and two ventricles) in the human heart.
It receives deoxygenated blood from the right atrium via the tricuspid valve, and pumps it into
the pulmonary artery via the pulmonary valve and pulmonary trunk.
Left ventricle is one of four chambers (two atria and two ventricles) in the human heart. It
receives oxygenated blood from the left atrium via the mitral valve, and pumps it into the aorta
via the aortic valve.
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Synthesis of the Disease
Eclampsia is the final and most severe phase of preeclampsia and occurs when
preeclampsia is left untreated. Eclampsia involves convulsions (seizures) occurring with
pregnancy-associated high blood pressure and having no other cause. Eclampsia can cause coma
and even death of the mother and baby and can occur before, during or after childbirth. In short,
eclampsia means seizure or coma accompanied by signs and symptoms of pre-eclampsia.
The etiology of preeclampsia is not fully understood. The exact causes of preeclampsia
and eclampsia are not known, although some researchers suspect poor nutrition, high body fat or
insufficient blood flow to the uterus as possible causes. Other causes may include altered
cardiovascular reactivity, increased capillary permeability, widespread vasospasm and
hypertension.
Risk factors may include the following: previous history of preeclampsia, relative with a
history of preeclampsia, multiple fetuses, teenaged patient or patient older than 35 years,
primigravida, lower socioeconomic status, gestational diabetes, history of renal disease and
obesity prior to pregnancy.
C. PATHOLOGICAL CHANGES
The symptoms of preeclampsia affect almost all organs. The effects of preeclampsia are
primarily due to the vasospasm of blood vessels. Vascular spasm maybe caused byt the increased
cardiac output that injures the endothelial cells of the arteries and imbalance between
prostacyclin (vasodilator) and thromboxane (vasoconstrictor) leading to vasoconstriction of
blood vessels and blood pressure increases. Because of this, peripheral resistance increases and
the heart is forced to pump rapidly to supply blood to peripheral organs.
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Peripheral resistance reduces blood supply to organs especially to the kidneys, brain and
placenta. Because of low blood and oxygen supply, degenerative changes occur within the
organs manifested by various symptoms. The effects of vasospasm are more on vascular, kidney
and interstitial effects. If accompanied by seizures, it is eclampsia.
In preeclampsia, edema accumulates in the upper part of the body (face and hands).
Cerebral edema (swelling of the brain tissue due to an accumulation of fluid) can also occur as a
result of fluid retention in the brain. Symptoms of cerebral edema include blurred vision and
severe headache. Cerebral edema can lead to seizure which is the hallmark of eclampsia.
Rapid weight gain (over 2 lbs per week in the second trimester, 1 lb per
week in the third trimester)
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a decreased in glomerular filtration leads to a lowered urine output
Puffy face, numb hands, and dependent areas such as ankles and lower
legs
Caused by fluid retention in the upper portion of the body including the brain
(cerebral edema)
Severe headache
Blurring of vision
Spasm of the arteries in the retina leads to vision changes and the presence of
cerebral edema
Thrombocytopenia
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28
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B. SYNTHESIS OF THE DISEASE (Client-Based)
• history of hypertension
• age (40 years old)
• high fat and high salt diet
1. Medical Management
A. IVF
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Ringer’s often used for DD: August other than the
Solution fluid 3,2010 IV insertion
Belongs to the resuscitation and medication
hypertonic after a blood administration
solutions; a loss due to upon the
combination of trauma, course of this
two solutions surgery, or a IV therapy.
(D5W and burn injury.
LR).
NURSING RESPONSIBILITIES:
Before:
• Verify doctor’s order.
After:
• Press the site where the needle was inserted and secure it with micropore.
• Check the site of hand where the needle is inserted if bulging is not visible. If so,
reinsertion is to be undertaken.
• Advise patient to avoid scratching the site less movement of the hand where the needle
was inserted to keep it in place.
• Instruct patient and significant others to inform the nurse on duty if bulging of the site is
visible.
• Observe the IV site at least every hour for signs of infiltration or other complications
fluid or electrolyte overload and air embolism.
• Always check the doctor’s order for new orders regarding the IVF supplement of the
patient.
• Always check if the IVF is infusing well and intact and monitor skin integrity.
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B. Drugs
NURSING RESPONSIBILITIES:
Before:
During:
After:
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Generic Name General Action Indications/Purpose Date Client’s
and Brand Ordered/Date Response to
Name Performed/Date Treatment
Changed or
Discontinued
Diclofenac Inhibits Acute or long-term DO: August After taking the
Voltaren prostaglandin treatment of mild to 2,2010 medicine, the
synthetase to moderate pain. -continued as of client’s pain
cause the day of our was relieved.
antipyretic and duty.
anti-
inflammatory
effects; the
exact
mechanism is
unknown
NURSING RESPONSIBILITIES:
Before:
• Check the doctor’s order.
• Explain the procedure to the patient’s SO, the importance of the drug, its uses, and
effects.
• Prepare the right medication at the right time and with the right dosage.
During:
• Adhere to standard precautions.
• Administer at the right route.
After:
• Document what has been done.
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Generic Name General Action Indications/Purpose Date Client’s
and Brand Ordered/Date Response to
Name Performed/Date Treatment
Changed or
Discontinued
Cefuroxime Bactericidal: To reduce the DO: August 2, There were no
Ceftin Inhibits development of 2010 signs of
synthesis of drug-resistant -continued as of infection seen in
bacterial cell bacteria and the day of our the patient.
wall, causing cell maintain the duty.
death effectiveness tablets
and other
antibacterial drugs,
Cefuroxime Axetil
tablets should be
used only to treat or
prevent infections
that are proven or
strongly suspected to
be caused by
susceptible bacteria.
NURSING RESPONSIBILITIES:
Before:
During:
After:
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• If you get severe or watery diarrhea, do not treat yourself. Call your prescriber or health
care professional for advice.
• Document what has been done.
NURSING RESPONSIBILITIES:
Before:
During:
After:
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• Document what has been done.
NURSING RESPONSIBILITIES:
Before:
During:
After:
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NPO Nothing by This was ordered DO: August 2, Patient was able to
mouth, no till the patient 2010 comply with the diet
foods or has no (+) flatus. DD: August 3, regimen.
drinks is 2010
allowed to be
given to the
patient, also a
type of diet
modification
and fluid
restriction
Nursing responsibilities:
• Check doctor’s order
• Identify the type of diet
• Explain the reason of such diet to the patient, as well as with the patient’s significant
other.
• Remove all foods bedside.
• If the client eats or drinks, the physician should be notified at once
Soft Diet Very similar To prepare the DO: August 3, Patient was able to
to the regular body to assume a 2010\ comply with the diet
diet except regular diet and DD: August 4, regimen.
that the texture to determine if 2010
of the foods the body can
has been now tolerate
modified. solid foods
The soft diet
consists of
foods that are
easily
digestible,
mildly
seasoned and
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tender.
Nursing responsibilities:
Diet as The patient Ordered when DO: August 4, Patient was able to
Tolerated can take the client’s 2010 comply with the diet
anything by appetite, ability regimen.
mouth as long to eat and
as she can tolerance for
tolerate it. certain foods
Adequate in may change; For
all nutrients increase body
according to resistance,
the standards muscle strength
and is used for and regular
patients functioning of
requiring no the body; to meet
dietary the needed daily
modifications. requirements of
nutrition of the
patient
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Nursing responsibilities:
D. Activity
Nursing responsibilities:
• Check for the physician’s order.
• Explain the procedure and the reason to the patient.
• Assist the patient in assuming the position ordered.
• Check for any complications like bed sores
• Remove all unnecessary objects to the patient’s bed to provide comfort
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Date Changed the Activity
or discontinued
Turn side to side Patient may To prevent DO: August 3, Patient was able
change position venous stasis. 2010 to tolerate the
periodically and DD: August 3, activity
gradually 2010
Nursing responsibilities:
• Check doctor’s order.
• Explain the procedure and the reason to the patient.
• Assist the patient in assuming the position ordered.
• Remove all unnecessary objects to the patient’s bed to provide comfort
• Observe if the patient can tolerate it.
Type of General Indication or Date ordered/ Client’s
activity/Exercise description purpose Date Response and/
Performed/ or Reaction to
Date Changed the Activity
or discontinued
Ambulate A patient can do To have adequate DO: August 3, The pt. was able
the things she muscle strength 2010 to ambulate after
can like standing and promote slowly rising
and sitting circulation from the bed to
sitting position
Nursing responsibilities:
• Explain to the client how you are going to assist, why ambulation is necessary, and
how she can cooperate.
• Ensure the client is appropriately dressed to walk
• Prepare the client for ambulation.
• Ensure safety while assisting client to ambulate.
• Encourage client to ambulate independently if she is able.
• Remain physically close to the client in case assistance is needed at any point
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A C-section delivery is performed when a vaginal birth is not possible or is not safe for the
mother or child.
Surgery is usually done while the woman is awake but numbed from the chest to the feet. This is
done by giving her apidural or spinal anesthesia.
The surgeon makes a cut across the belly just above the pubic area. The uterus and amniotic sac
are opened, and the baby is delivered.
The health care team clears the baby’s mouth and nose of fluids, and the umbilical cord is
clamped and cut. The pediatrician or nurse makes sure that the infant’s breathing is normal and
that the baby is stable.
The mother is awake, and she can hear and see her baby.
The decision to have a C-section delivery can depend on the obstetrician, the delivery location,
and the woman’s past deliveries or medical history. Some reasons for having C-section instead
of vaginal delivery are:
• Severe illness in the mother, including heart disease, toxemia, preeclampsia or eclampsia
Tubal ligation for woman seeking out a safe, effective, permanent and convenient form of
contraception may be a good option. The most common form of surgical sterilization procedure
used for woman today is called a tubal ligation, often referred to as “having your tubes tied”. A
tubal ligation procedure prevents the egg and sperm from meeting and you from becoming
pregnant.
Tubal ligation is a permanent and highly effective form of birth control. If you have the desired
number of children and never will desire more, permanent sterilization is worth considering.
A tubal ligation typically is performed via a small incision in your belly button. It can either be
performed after delivery or at a latter time. When a tubal ligation is performed after delivery it is
called a post-partum tubal ligation and does not require laparoscopy. If you have a tubal ligation
and you are not pregnant, it is usually performed by laparoscopic surgery. All forms of tubal
ligation require either burning, cutting, clamping or tying the mid section of your fallopian tubes.
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B. instrument and/or Equipment Used
Instruments quantity
Curve clamps 6
Allis 3
Bobcock 2
Thumb forcep 1
Tissue forcep 1
Needle holder 2
Metzenbaum 1
Straight scissor 1
Bandage scissor 1
Blade holder(#3) 1
Blade(#21) 1
Chromic 1/0 2
Chromic 2/0 1
Vicryl 2/0 1
Plain Gut 2/0 1
Cotton Tie 4
Abdo Pack 4
During:
After:
1. Assess the vital signs of the patient every 30 minutes.
2. Monitor the patient’s urine output and vaginal discharge.
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VII. NURSING CARE PLAN
PROBLEM # 1 Acute Pain r/t disruption of skin, tissue and muscle integrity, secondary to surgical procedure (CS)
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coughing and and dehiscence provided?
deep breathing on operative
by splinting site.
using a pillow.
>Schedule >Prevents
adequate rest fatigue and
periods. conserves
energy for
faster healing.
>Administer >To
analgesic as decrease/reduce
indicated by the the pain
physician immediately.
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PROBLEM # 2 DISTURBED SLEEP PATTERN R/T PAIN DUE TO POST SURGICAL PROCEDURE (CS)
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>provide calm,
quiet To promote
environment by sleep and
minimizing relaxation
noise and
visitors
>provide
diversional >To promote
activities such sleep and
as providing relaxation
back rub, head
massage and
music
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PROBLEM # 3 Risk for INFECTION r/t destruction of microbial barriers secondary to surgical procedure (CS)
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> Administer >To inhibit >Did she
Cefuroxime synthesis of cooperate
500mg 1 cap bacterial cell with the
every 6 hours wall, causing intervention
as ordered after cell death provided?
meals
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III. DISCHARGE PLAN
M: Instructed Mrs. X to take Ferrous Sulfate 300mg once a day, Methyldopa 500mg every 6
hours, Multivitamin 1 capsule BID, Buscopan 10mg TID, Cefuroxime axetil 500mg TID,
Azithromycin 500mg BID. All of these are per orem.
E: Exercise as tolerated
T:
H:
Instructed patient to relax and not think about problem.
Instructed to promote adequate rest and they should provide a quiet environment
Complied to the diet of soft diet with low salt, low fat, low sodium, low calorie, and with
frequent small feedings
She should maintain adequate nutrition and fluid balance
She should not do strenuous activities
Instructed to keep fluids within clients reach and encourage frequent intake of fluid
Instructed patient to change position slowly
Instructed patient to take a bath regularly, to provide optimal skin care
Instructed patient to take frequent oral care as well as eye care to prevent injury from
dryness
Encouraged patient to loose weight
O:
D: Her diet first is nothing per orem, followed by a soft diet with low salt, low fat, low sodium,
low calorie with frequent small feedings.
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IX. LEARNING DERIVED FROM THE STUDY
Case Study is not that easy since it takes a lot of effort, thinking and especially
patience. As I reach the another step of our level, I’m taking more responsibilities for finding
authoritative and reliable information, also taking more accurate information from general to
specific.
We chose our patient because we believe that she needs more attention regarding his
health status and as student nurses, we had the opportunity to apply all the nursing skills that we
have learned from the school. The deep analysis of etiologies, mechanisms, and manifestations
of disease and functional changes in abnormal conditions made me more challenged.
Through this case study, we have developed our level of self confidence, skills and our
level of understanding to build good relationship to our patient and her SO at the same time, to
share insights too. We won’t be able to finish it without the unity of each and everyone of our
group and through the support and guidance of our clinical instructor. And through this, we came
up with this we so called “fruit of our work”. May this paper will illustrate a clearer meaning of
Pregnancy induced hypertension that may contribute a unique and valuable method of eliciting
phenomena of interest to nursing.
Emmalyn B. Azarcon
In our hospital duty, we are assigned to do a case study. I learned a lot in this case study
and I became more independent than before. I learned how important to value the things that we
have now. As a group, we have to give our best shot and we must do our responsibilities to finish
this case study. I learned also in this case study, like the concepts regarding the complications of
Pregnancy Induced Hypertension, how to prevent it and many more. Through this case study, we
have practiced what we have learned like the physical assessment, vital signs taking, therapeutic
communication and more. And to end this, I would like to thank GOD for always guiding and
helping us.
Rudora N. Badeo
Another journey starts this semester, this journey has full of requirements one of this was
this case study. At first it’s like we’re not yet ready to make this requirement but we have to. On
our first day of our duty we already saw a pt. with an interesting case to be studied. We have
picked this because we think it was easier than the other case. But I think the more harder you
think the more challenging it is. It will sharpen your knowledge about it. Another thing is that,
this case study makes us realize how important discipline and cooperation is. Cooperation of the
team members was a big factor even though this group was just new we did our best to cooperate
with each other. Our group will not come up with this kind of requirement without discipline and
cooperation. This study help me to be more aware of what may happen to us and to our relatives
we can help them prevent to have such disease.
Jasper Lance Bautista
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In our hospital duty we are assigned and required to do a case study for the whole group.
I learned a lot in this case study I became more serious in every task and I become more
independent than before. It made me realized how important our life and we need to value the
things that we have. I learned also on this case study, like concepts regarding the disease
Pregnancy Induced Hypertension, the complications of it, how to prevent it, and many more.
Being a group, all we need is cooperation, trust, unity, and respect with one another. As a
group we have to work hard and give our best shot we must do our responsibilities and task to
finish this Case Study. Through this study we have practice what we have learned like physical
assessment, vital signs taking, therapeutic communication, and much more.
And to end this, I would like to thank GOD for always guiding, and helping us. Without
his supervision I think we wouldn’t make it. Thank you Lord!
For this case study, I have learned that one cannot do such accomplishments without the
help of others. Group effort makes everything different, we do not only finish a project, but more
than that we build a relationship, a relationship not only bounded because of certain projects but
also by the love and care for each other. And the most important, is that the knowledge that we
have attained from here will be used not only for the betterment of us, students, but also for other
people who suffers from this disease that we can help through the knowledge that we have
gained from here.
Case study is not just a requirement to be passed or submitted for this subject but it is a
learning and experience to us to be a good nurse someday. For this case study, I learned to be
responsible for the task they gave me and I learned also how to cooperate with them.
As a student nurse, I have the knowledge on how to gain the trust of our patient by
having a good interaction with her. As a student nurse, we must learn to be patient and calm
always when doing some procedure and most of all, to have confidence when doing it. I thank
God for helping us finish this case study. Without His supervision, we would not finish and make
it. Thank you God!
Jenzie Jea J. Elevazo
In doing this case study it was not that easy, we don’t have enough time so we have to
make time and give extra effort. But in doing this requirement I learned so many things such as
understand one another, we tested our patience when we where about to meet the deadline for
this requirement. We practiced our cooperation and compiled our knowledge base on what we
experienced. Aside from that, the patient that we choose in our case study gave us knowledge
and learning experience in doing this study. I realize how thankful I am of having this kind of
experience even if it was a tiring one and at least I could say that we exerted all our efforts and
gave our time to conceptualize this requirement.
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The case we handled was quite familiar since we have already tackled it on our past
subjects. Doing the case study was not that difficult because we only need to manage our time
finish it.
I always believe in the saying that if you have a chance or an opportunity to take
something take you know will be memorable, and then grab it, because you may never know on
just how it may transform you, on how it will change and touch people around you and this
experience will teach a lot of life saving task that a student nurse must do. Same thing goes with
the accomplishment of our last case study. During the time of nurse-patient interactions,
conducting interview and assessment, I learned that it’s not only the physical and the mental
aspect that should be applied but the emotional aspect as well and I learned how to be closer or
establish a deeper rapport to our patient. With this case study, where our chosen patient is
suffering from a gallbladder problem, gave me awareness n to how economic, environmental and
health problems goes hand in hand. Having the sense of awareness thus moved me to further
study of the disease so to provide the appropriate nursing intervention towards promoting
wellness and especially to be able to inform other as well of to what I know so to reduce or
lessen the occurrence of such disease. Other than that, this case study accomplishment gave me
the sense of self-fulfillment because I am assured that it is not only the knowledge, skills and our
time tried to instill and/or provide them, but also indeed made a direct influence to them and left
a significant mark that can eventually make a big impact in their lives more so with regards to
health and wellness aspect that can help to live their life to the better.
Group activity/work is a challenging one. There are a lot of things that is needed to be
considered. If one fails to do his/her part, everything else will follow.
But, on the other hand, group activities give us an opportunity to know other people
better and have new friends. It molds our personality to be matured enough to understand other
people and to have an initiative to help our groupmates.
Cooperation is what I really observed to be the most important factor that will help a
group to work properly and finish the activity successfully. With the help of each member of the
group, the difficult part of the activity will be easier. Despite of some problems that had occurred
while we are doing the video, I am glad that it was done.
Working with your groupmates can be considered a memorable one. We are all sharing
memories which are all worth remembering. And I do believe that we had enjoyed each other’s
company. And I think that’s the essence of the groupwork, to be responsible in the assigned task
to us but at the same time, learns to enjoy every single moment.
At the end of this case study, I have learned a lot about pregnancy induced hypertension.
May this study help me in the future.
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For this case study, I learned a lot because our rotation is already in the operating room I
learn to recall the concepts that our previous C. I thought us about normal and abnormal delivery.
It is so fun and exciting to be expose on OB ward and at the same time in OR because you will
appreciate it. This time doing this case study is not that difficult unlike before because we need
only to apply what was thought to us. But also we need to do our part just to finish this case
study and be very patient in doing this.
Joelyn L. Tongol
I was able to learn a lot about our chosen case, breech presentation. We were able to help
the patient by giving some health teachings such as the importance of breastfeeding and
performing necessary interventions about the proper way of cleaning of her wound. Case study
was proven to be not just a mere requirement thing for us to pass. I had learned its importance as
a part of related learning experience in delivering care outside the school where in we are already
to rend care in the hospital proper. It made me realized how important the role of a student-nurse
is performs in bridging the gap between the health care provider and the patient. I felt the unity
within our group and we are happy to the fact that we were able to finish our second case study
which is one of our requirements. I am hoping that we will able to defend our case study well.
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X. REFERENCES
Burton, Gwendolyn and Engelkirk, Paul.Microbiology for the health sciences 8th ed. 2007. Lippincott
William and Wilkins
Black and Hawks. Medical and surgical Nursing 8th ed. 2008 Elsevier and Saunders
Doenges, Mariloyn,et.al. Nurse’s Pocket Guide 11th ed.2006. LA. Davis Company
Karch, Amy Nursing Drug Guide 2010 Lippincott Williams and Wilkins
Seeley, Rod, et.al Essentials of Anatomy and Physiology 6th ed.2007 Mc. Graw Hill Int’l.
Pillitteri, Adele, Maternal & Child Health Nursing Vol.2 5th ed.2007. Lippincott Williams and Wilkins
Caudal, Ma. Lourdes Basic Nutrition & Diet Therapy revised ed,2008.
Online Sources:
http://www.cureresearch.com/p/preeclampsia/stats-country.htm
http://www.nursingcrib.com
http://pregnancy.about.com/od/cesareansection/a/csectionrisks
http://www.cdc.gov/nip/publications/vis/vis-ppv.pdf
http://wiki.answers.com
http://www.sciencedaily.com
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