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Don Mariano Marcos Memorial State University

South La Union Campus

Agoo, La Union
Tel. 072.710.03098




Corpuz, Rachel Ann S.

Marinduque, Regina L.
Narvarte, Clarisa N.

S.Y. 2018-2019

This case presentation entitled GHPN VS PE T/C DM prepared by Corpuz, Rachel

Ann S., Marinduque, Regina L., Narvarte, Clarisa N., in the partial fulfilment of the
requirements for the degree of Bachelor of Science in Nusing is hereby accepted by the
Oral Examination Committee (OREC)

Composed of:







GENERAL OBJECTIVES Client-centered objectives:

After 30 minutes of Nursing-Patient Interaction, the student nurses will
Student-Centered Objectives: be able to establish rapport and trust to help them assess the patient properly
We, the student nurses aim to learn the disease of the patient chosen and get reliable information.
during the rotation of our duty to be able to discuss and share what we have To be able to decrease possible risks that may complicate their current
learned in the process of studying the patient’s case; with this, we can provide condition by teaching them proper self-care management and ensuring their
better safe keeping of patients diagnosed with this disease, and be able to give safety always.
the proper management and nursing interventions that the patient might need. To conduct a health teaching which would help them properly understand
On the other hand, we can enhance our critical thinking skills needed in their own condition while taking in consideration their learning capability so
interpreting and analysing the data we gathered during our thorough they can personally and actively involve themselves in the treatment process.
assessment. This would also help us, as students, to take risks, make To be able to provide specific management on each different complaint the
judgements in uncertain situations, and to propose and select from multiple patient is experiencing in relation with her condition.
possible options because case study is a case as is true in real-world, on-the-
job setting. And lastly, we want to enhance our communicating skills to be
effective healthcare providers.

Name: Ms. X Chief Complaint: Hypogastric pain and occasionally having a mild blurry
Address: Paratong #3, Bangar, La Union vision and headache, as claimed by the patient.
Sex: Female
Age: 35 years old
Birthdate: January 16, 1983 Current Health Status: Four days prior to admission, the patient experiences
Birthplace: Bangar, La Union pain in the abdominal area and a mild blurry vision occasionally, she
Race: Asian: described the pain as non-radiating and gnawing pain. She rated the pain as
Nationality: Filipino 3/10 (10 as the greatest pain felt). She resisted until 3 days and the pain felt in
Civil Status: Single the abdominal area increases from 3/10 to 5/10 (10 as the greatest pain felt)
Dependents: Amethyst, age 15 yrs old with a mild difficulty in breathing, headache and contraction in abdominal
Religion: Roman Catholic area but may lessen with activities like walking and washing dishes. One hour
Education: College Undergraduate prior to admission, the pain felt in the abdomen increases from 5/10 to 7/10
Occupation: Housewife (10 as the greatest pain felt) and is having blurry visions more often with
Blood Type: O+ headache at a rate of 5/10 (10 as the greatest pain felt). The patient was then
Weight: 84 kgs admitted to ITRMC on March 28, 2018 at 5:16 pm with an admitting
Time of Admission: 5:16 pm diagnosis of G2P1 (1001) Pregnancy Uterine 35 5/7 weeks, Not in Labor;
Date of Admission: March 28, 2018 Previous CS (2003, ITRMC) For ACD; Gestational Hypertension VS
Admitting Diagnosis: G2P1 (1001) Pregnancy Uterine 35 5/7 weeks, Not in Preeclampsia T/C Diabetes Mellitus.
Labor; Previous CS (2003, ITRMC) For ACD; Gestational Hypertension VS
Preeclampsia T/C Diabetes Mellitus PAST HEALTH HISTORY
Date of Discharge: April 4, 2018 The patient had measles, mumps and chicken pox when she was a
Final Diagnosis: G2P2 (2002) Pregnancy Uterine Delivered Term Cephalic to child. She was hospitalized at the age of 17 years old. She delivered to her
a Live Baby Girl with BW: 3.3 kg, BL: 53 cm, Apgar Score of 8, 9, PA: 38 first child via cesarean section last 2003, had no complications from that.
via repeat LTCS under SAB Patient X claims that she was completely immunized and stated that she has
no allergies.
Ms. X has a family history of Hypertension and Diabetes.

Ms. X doesn’t abuse drugs, smoke and drink, she only drinks
occasionally but some of her neighborhoods are heavy smokers and drinkers

Ms. X had her first menstrual period when she was 13 years old. Her
menstrual periods are irregular with a duration of 3-5 days. She had two
pregnancies including this, no miscarriages and two living children including
this birth. She had no abortions and no preterm births. Her mode of delivery is
cesarean section. She had five prenatal check-ups. Five shots of tetanus toxoid
and vitamins like ferrous sulfate and calcium. She was 71.3 kilograms before
pregnancy. Her last menstrual period was July 1, 2017, her expected date of
confinement was on April 8, 2018.

60 X

30 28 39 35 LEGEND:

- Female

X - Deceased
15 HPN - Hypertension

GHPN - Gestational Hypertension

DM - Diabetes Mellitus
COURSE OF CONFINEMENT VS are taken and recorded after drug is taken by the patient (7:00 am).
Capillary Blood Glucose (CBG) monitoring is done with a result of 87 mg
March 28, 2018 5:16 pm /dL, normal AF index (TID before meals).
The patient came from the Emergency room with initial vital signs of:
1:00 pm
blood pressure-140/100 mmHg, cardiac rate-109 beats per minute, respiratory VS are taken and recorded. Medication is given and taken by the
rate-27 breaths per minute, temperature-35.1 degree Celsius, Oxygen patient (Methyldopa q6).
saturation of 92% and weighs 84 kgs. She was then brought to the LR/DR 7:00 pm
under red service. She complained of a mild hypogastric pain, headache and Medications are given and taken by the patient (Methyldopa q6, Ca
blurred vision. The patient was seen and examined by Dr. Irapta and was BID).
advised to be admitted due to her high blood pressure and term of 35 5/7
weeks AOG in breech presentation. The patient signed consent for admission March 30 2018 7:00 am
and was admitted, conscious and responsive, placed comfortable on bed and Medications are taken by the patient (Methyldopa q6, FeSO4- OD, Ca
ensured side rails for safety. Vital signs and fetal heart tone were taken and – BID). NST done. FHT and VS were taken and recorded every hour. With a
recorded every hour. Hooked to CTG with a diet of Diet As Tolerated and was diet of DAT. The patient signed consent for IV insertion and was inserted IVF
referred. with PLRS x 8 hours x 30 ggts/min.
7:00 pm 9:40 am
Non Stress Test and Fetal Biometry done with an impression of Fetal Biometry and BPS done. Patient was informed that she might
single, live, intrauterine pregnancy in breech presentation with composite have a repeat CS at 38 weeks AOG.
AOG of 35 weeks and 5 days (+/-3 weeks) by BPD, HC, AC, and FL,
normohydramnios, placenta anterior, high lying grade 2-3. Daily medications March 31, 2018 7:00 am
that are prescribed by Dr. Irapta for high blood pressure of 140/110, and Patient was still for FB and BPS, AFI Determination. Continued
vitamins are given and taken by the patient such as: Methyldopa 2 tab 250mg medications (Methyldopa 2 tab 250 mg q6, FeSO4 1 tab OD, Ca 1 tab BID),
q6, FeSO4 1 tab OD, Ca 1 tab BID. hydration, and line of PLRS x 8 hrs and maintained at 30 ggts/min. NST done,
VS taken and recorded every hour and referred BP of 110-130/ 70-90.
March 29, 2018 8:45 am
7:20 am CBG monitoring continued with a result of 89 mg/dL, monitored 24
hour urine protein. IFC insertion consent was signed by the patient. Patient
was inserted with IFC aseptically to collect urine for urine protein collection 13 AREAS OF ASSESSMENT
and to be removed afterwards.
1. Psychosocial Status
March 31, 2018 1:00 am Ms. X is a 35 years old female client, single and a Filipino
VS taken and recorded. Continued medications, given and taken by the citizen. She was born on the 16th day of January, year 1983. She is
patient residing at Paratong #3 Bangar, La Union and staying with her future
11:20 am family in-laws that gives support and guidance to her and also helps her
Urine protein collection started at 11 pm. financially. Ms. X is a Roman Catholic and they do believe in some
superstitious beliefs. According to her, they seek for medical interventions
April 1, 2018 4:00 am whenever she and her family gets sick and they also seek for manghihilot
Repeated CBG-PC, BUN, AST, ALT, LDH. or albularyo if one of their family members has a “pilay”.
7:00 am Their house is an old 2-storey house with 4 bedrooms (2
Ongoing 24 hour urine protein collection. FB + BPS done. Continued upstairs and 2 downstairs). They have a comfort room which is 3 ft. away
medications (Methyldopa q6, Fe 1 tab OD, Ca 1 tab BID). NST done, VS and from their house. The house is surrounded by fruit bearing trees like
FHT taken and recorded every hour. guava, pomelo, papaya, and they also have a sitaw, bataw, kamatis, talong,
April 2, 2018 7:00 am upo, and many more. Their house is located near in a planting field,
FB with BPS done. Continued medicines, NST done, monitored VS, exposed in a good environment with a good temperature because of the
FHT taken and recorded every hour. The patient’s BP was 120-130/ 70-90 relaxing wind.
mmHg. She does few chores around the house like washing dishes,
sweeping, cooking, and she takes good care of her daughter Amethyst.
Has good relationship with her family but sometimes have conflict with
her live in partner.

2. Mental and Emotional Status

Before admission, she drinks medicine immediately whenever
she’s feeling unwell.
Ms. X is conscious and at the time of the assessment, she was The patient was admitted at the labor room-delivery room and
oriented to time, place, and persons around him. The patient can respond was put at bed 3. They have a cold environment, a fully air-conditioned
to verbal stimuli, response to noise and light, response to touch, painful room with electric fans. The patient is having rest on her bed with side
stimuli, and spontaneous activity. States she doesn’t want wasting her rails up because of the pain she feels. She believes that a clean and
time, wants good and natural environment, wants person who can easily conducive environment shall be highly valued. She needs physical
understand her. Has ability to read and right, has good vocabulary, ability assistance. No presence of infectious disease or infected wounds in
to comprehend and follow directions, has good attention span and memory patients, family, or watchers inside the room. Isolation techniques, hand-
span, has ability to understand abstraction. She is satisfied with health care washing, distancing from infected persons are their barriers to cross
providers and states that she seeks medical attention whenever she feels infection. She states that they should always be aware of infectious
like she has a health problem. She also states that diseases are caused by diseases.
the improper actions and bad environment towards health. The patient
believes that a clean and conducive environment should be highly valued. 4. Sensory Status
She states her current condition, hypertension, is stressing her and her Visual
baby. Patient’s pupil is equally round and reactive to light and
accommodation where in pupils constrict when exposed to light and
The patient states that she is serious but has a good sense of dilates when away. Has no tearing, has pink palpebral conjunctiva.
humor, hot tempered, easily gets irritated, friendly and kind. Stress makes With dark eye bags but denies use of glasses and contacts. Has a mild
her sick but can cope up immediately. Her patterns of relating to others are blurred vision and photophobia due to her hypertension. No eye
being approachable and friendly. Her special concerns or fears are having drainage, blood shoot eyes, pain, blind spots and flushing eyes. Has
serious diseases. Patient X also states that she’s concern about her families normal field of vision. No unusual sensation.
and to anyone that is part of her family and she’s also worried about her Auditory
baby because of her current condition. Has ability to distinguish voice by whispering (distance,
loudness). No ringing and buzzing as verbalized by Ms. X. No hearing
3. Environmental Status problems. Patient is not using any hearing aids.
Their house has drainage with stagnant water at the side of their Gustatory
house. They use alcohol as disinfectant at home and they also practice Since Ms. X is on a diet as tolerated diet, we asked if what kind
handwashing. She organizes toxic substances that can harm their health. of food does the patient eat before her hospitalization and say that she
eats everything except for the internal organs of a pig. Has the ability does fasting every Ash Wednesday and Good Friday. Her weight was
to discriminate sweet, sour, salty, and bitter by letting the patient taste 71.3 kilograms and a height of 5 feet 2 inches.
different kinds of food and drinks. Has no unusual sensation. Upon her admission, she was on diet as tolerated status. She
Olfactory was in an intravenous therapy of PLRS x 8 hours x 30 ggts/min. She
She’s able to determine foul smell and pleasant smell by letting does not use any prosthetic devices on her teeth. Her gums are pinkish
her smell perfume and spoiled foods. and moist. Her height is 5’1 ft. Patient appears overweight in general
Tactile appearance. She states that healthy foods are very important to achieve
Has the ability to distinguish sharp and dull, light and firm a healthy lifestyle. She weighs 84 kilograms with a height of 5 feet and
touch, to perceive heat, cold, and pain in proportion to stimulus, has 2 inches. Her body mass index is 28.74 kilograms per square meters
ability to differentiate common objects by touch, intact body image which is overweight.
and no abnormal sensation. When one of us slightly pinched her skin,
she immediately withdraws and looks at us but she is experiencing 7. Elimination Status
numbness on her leg due to her pitting edema. She has a bowel movement of 3-4 times a week before she was
put on diet as tolerated status. She urinates only few times a day before
Sensory Environment
Ms. X is conscious during the shift but is having a mild blurred her confinement, 100-150 ml in 8 hours. The color of her stool is
visions brownish and the color of her urine is light yellow. Has normal odor of
urine and stool. No artificial orifices used.
5. Motor Status Upon admission, she urinates few times a day, 100-200 ml in 8
Ms. X stays only at her bed. Sometimes she sits and goes to the hours. Has a brownish color of stool and light yellow color of urine.
bathroom with assistance due to her vision. She easily gets tired No artificial orifices used.
because of her hypertension and body weight. She also experiences
weakness on her lower extremities because of her edema. 8. Fluid and Electrolyte Status
Patient’s fluid intake is normal, usually 8-10 glasses of
6. Nutritional Status fluids/day with diet as tolerated status upon admission. Patient has
Ms. X was able to consume meals 5 times a day and she normal skin turgor on upper extremities (goes back immediately) and a
sometimes have snacks before her confinement. Ms. X eats anything grade of +2 on one her leg due to her pitting edema . Her lips, oral
except for the internal organs of a pig before confinement. She cooks cavity and mucuos membrane are moist and intact. Her nails beds are
for herself and sometimes her live-in partner is the one cooking. She
pale but with capillary refill of 1-2 seconds and has no edema (upper 12. Integumentary Status
extremeties). Patient’s complexion is fair with a good skin turgor on upper
extremities but has edema on lower extremity. Regarding intactness of
9. Circulatory Status skin condition, Ms. X has no wounds noted all over her body. She has
Patient’s cardiac rate is irregular with a number of 75-109 beats pale nails and equally distributed black hair, no scaling and lice noted.
per minute, strong regular rhythm upon assessment. She has a good He has a capillary refill of 2-3 seconds, upon assessment, nails are not
capillary refill of 1-2 seconds with pale nail beds noted. There is clean. Patient goes to the comfort room to wash and to take a bath. She
pitting edema observed on her left leg. Her pulse rate is at 68-71 beats has no skin allergies. Pressure of edema is present on lower extremity.
per minute, the beating is strong, regular and palpable, taken on the Has a scar in midline abdomen. Hair and scalp is not oily, takes a bath
right radial pulse. Her blood pressure was 120-150/70-100 mmHg, every day, and brushes her teeth 3x a day. No odor and secretions.
taken on the right arm in supine position.
13. Comfort and Rest Status
10. Respiratory Status Prior to patient’s confinement, she used to sleep 7-8 hours but
Patient has a respiratory rate of 27-30 breaths per minute taken during her hospitalization, her sleep pattern was interrupted or
upon assessment. She claims that no one in the family is smoking. Has disturbed because of environment, pain experienced, medications and
difficulty in breathing with 87-92% oxygen saturation. routine monitoring of the nursing students and staffs. No aids for sleep.
11. Temperature Status
Her temperature is not in a normal range of 35.1-36 degree
Celsius. Skin is cold to touch and clammy.

Name: Ms. X Date: October 26, 2017

Requested by: Dr. Age/ sex: 34 F

Case Number: 20171026-008


 The liver is within normal size exhibiting slight diffuse increase in parenchymal echogenicity. Intrahepatic ducts are not dilated. Proximal common
duct measure about 0.5cm which is normal size. Portal vein and its tributaries are unremarkable.
 The gallbladder is distended measuring about 6.4cm x 2.3cm (IxAP) Lumen is echofree. The wall is not thickened.
 The pancreas and spleen are intact.
 Both kidneys are normal in size, the right measuring about 1.9 x 4.0 x 4.0cm (LxWxAP) and the left measures approximately 12.0 x 4.0 x 5.0cm
(LxWxAP). No evident lithiasis The parenchymal echopattern is homogenous. Both pelvocaliccal systems are not dilated.
 The urinary bladder is distended showing smooth contour. No evident lithiasis seen. The wall is not thickened.
 Scanning of the para-aortic region iron proximal to distal portion shows no evident lymphadenopathies.
 Negative for Intraperitoncal fluid.
 Within the gravid uterus is a single live fetus with CRL measuring about 7.91cm equivalent to 13 weeks and 6days (+/-8days) AOG, showing good
cardiac activity located high lying FHT = 140 bpm
 Amniotic fluid is of normal amount. Placema is anteriorly located high lying.



Name: Ms. X Date: March 01, 2018

Requested by: Dr. Age/ sex: 35 F

Case Number: 20180301-014

ULTRASOUND REPORT Estimated fetal weight (grams): 2594 grams EDD by UTZ: 04-01-
Average age: 35w4d Fetal heart rate: 142
Within the gravid uterus is a single live fetus showing good cardiac activity Fetal number: single Fetal presentation: breech
and gross movement. Placenta: anterior, high lying grade 2-3 Gender: female
BPD 8.70cm 35w1d
No definite mass in the cranium, thorax and abdomen.
HC 31.91cm 36w0d
No fetal ascites or pleural effusion noted.
AC 29.88cm 33w6d
FL 7.24cm 37w0d Impression:
Single, live, instrauterine pregnancy in breech presentation with
AOG of 35weeks and 4days (+/-3weeks) by BPD, HC, AC and FL.
Placenta, anterior, high lying grade 2-3.
Laboratory Accession No: 2198 Date: MARCH 28, 2018

NAME: Ms. X Age: 35 Gender: F WARD: IN-OB

Address: Room No.: Bed No.: Hospital No.:
Requesting Physician:



MICROSCOPAL EXAMINATION: pH: 7.0 Specific Gravity : 1. 025
White Blood Cells: 3–5 /hpf KETONE: BILIRUBIN:
Red Blood Cells: 0 – 1 /hpf Other/s:
Epithelial Cells: Moderate /hpf
Mucus Threads: Few /hpf CRYSTAL REMARK/S:
Amorphous: /S:
Calcium Oxalate: /lpf
Urates/Phosphates: Moderate /lpf Triple Phosphate: /lpf
Bacteria: Few /lpf Uric Acid: /lpf
Yeast: /lpf Other/s: /lpf
Other/s: /lpf PREGNANCY TEST
/lpf BRAND:
CLINICAL CHEMISTRY SECTION /lpf Laboratory Accession No: I 8

A normal urine color generally ranges from pale-yellow color to deep amber, a bright-yellow urine may also be a sign of pregnancy.

Slightly turbid urine of the patient is due to moderate epithelial cells, red blood cells, mucus threads phosphates and bacteria that cause cloudiness in the

WBC count in urine may indicate that there is inflammation in the urinary tract or kidneys. The most common cause for WBCs in urine (leukocyturia) is
a bacterial urinary tract infection (UTI), such as a bladder or kidney infection.

A normal result is 4 red blood cells per high power field (RBC/HPF) or less when the sample is examined under a microscope.

Epithelial cells naturally slough off from the body. It’s normal to have one to five squamous epithelial cells per high power field (HPF) in the urine. Having
a moderate number or many cells may indicate: a yeast or urinary tract infection (UTI), kidney or liver disease and certain kinds of cancer.

It’s common to find mucus in your urine and is typically thin, fluid, and transparent. It may also be cloudy white or off-white. These colors are usually signs
of normal discharge.

Moderate phosphates in the urine are normal. Kidneys filter extra phosphates from the blood, and they go out of the body in urine.

Presence of bacteria in the urine may indicate bacterial infection. Any amount of bacteria in the urine may suggest UTI.

Laboratory Accession No. Ih

Name: Ms. X Age: 35 Sex: F Ward: OB

Test Result Reference Value

Oral Glucose Tolerance Test (OGTT)

(75 grams Glucose dose)

FASTING 5.09 3.88 – 6.38 mmol/L

60 MINUTES 7.41 ≤11.10 mmol/L
120 MINUTES 8.0 ≤ 7.77 mmol/L

DATE: 29 MAR 2018 @ 7:20 am


Having blood glucose raised beyond normal levels may indicate impaired glucose tolerance but not high enough to warrant a diabetes diagnosis.
With impaired glucose tolerance patient is in much greater risk of developing diabetes and cardiovascular disease.
Name: Ms. X Age: 35Y Sample ID: 03282018 – 179

Dept: IN – OB Mode: WB CBC+DIFF

Birthday: HEMATOLOGY RESULT Run Time: 04-01-2018 05:16

Gender: Female

Parameter Result Unit Ref. Range Parameter Result Unit Ref. Range

WBC 8.60 x 10^9/L 4.00 – 10.00 MCV 87.5 fL 80.0 – 100.0

Neu% 70.7 % 50.0 – 70.0 MCH 29.7 pg 27.0 – 34.0
Lym% 20.5 % 20.0 – 40.0 MCHC 339 g/L 320 – 360
Mon% 6.5 % 3.0 – 12.0 RDW – CV 15.0 % 11.0 – 16.0
Eos% 2.0 % 0.5 – 5.0 RDW – SD 54.4 fL 35.0 – 56.0
Bas% 0.3 % 0.0 – 1.0
PLT 224 x 10^9/L 150 - 450
MPV 8.4 fL 6.5 - 12.0
RBC 4.33 x 10^12/L 3.50 – 5.00
PDW 15.9 9.0 – 17.0
HGB 119 g/L 110 - 150
PCT 0.188 % 0.108 – 0.282
HCT 35.1 % 37.0 – 47.0

Blood Type: O POSITIVE

Bleeding Time: (1 - 3 minutes)
Clotting Time: (2 – 4 minutes)

Interpretation: Having a high percentage of neutrophils in your blood is called neutrophilia. This is a sign that your body has an infection. Neutrophilia can
point to a number of underlying conditions and factors, including: infection, most likely bacterial.
Name: Ms. X Age: 35 Sex: F Ward: OB Date: 04-01-18

[ / ] Routine [ ] Specimen [ ] Serum [ ] Plasma [ ] CSF [ ] Hemolysate [ ] Other’s

Test Reference Value Result

24 hour urine protein <140 mg/24 hr 453.36 mg/24 hr


In normal pregnancy, urinary protein excretion increases substantially; hence, total protein excretion is considered abnormal in pregnant women when it
exceeds 300 mg/24 hours and may indicate proteinuria.


1. Ineffective breathing pattern Difficulty of breathing with Physiological needs Breathing Overt
related to alteration of shortness of breath, tachypnea with
patient’s usual Oxygen/ respirations of 27-30 breaths per
Carbon dioxide ratio, minute, Oxygen saturation of 87-
decreased energy, fatigue and 92% and pain (headache)
2. Excess fluid volume related Decreased urine output of 100-200 Physiological needs Circulation Overt
to decreased urine output, ml for 8 hours, high blood pressure
sodium and water retention as (130-150/ 90-100 mmHg), edema
manifested by edema.
3. Disturbed sleeping pattern Dark circles in the eyes, weakness, Psychological needs Covert
related to stress, external fatigue, irritability, frequent yawning
factors; noise and noxious
4. Risk for injury related to Blurred visions, fatigue with Safety and Security Overt
sensory dysfunction respirations of 27-30 breaths per
minute, irritability
5. Activity intolerance related to Muscle weakness, fatigue, abnormal Safety and Security Overt
general weakness blood pressure of 120-150/ 70-100
6. Risk for Infection related to Laboratory result of 70.7% Physiological needs Overt
obesity and medication neutrophils, IV infiltration,
therapy malnutrition (BMI of 28.74
7. Risk for Impaired Skin Edema Physiological needs Covert
Integrity related to altered
circulation, fluid imbalances
and nutritional deficits

In his influential paper of 1943, A Theory of Human Motivation, The American

psychologist Abraham Maslow proposed that healthy human being have a certain number of
needs, and that these needs are arranged in a hierarchy, with some needs (such as physiological
and safety needs) being more primitive or basic than others (such as social and ego needs).
Maslow’s so-called ‘hierarchy of needs’ is often presented as a five- level pyramid, with higher
needs coming into focus only once lower, more basics needs are met. Maslow called the bottom
four levels of the pyramid ‘deficiency needs’ because the person does not feel anything if they
are met, but becomes anxious if they are not. Thus, physiological needs such as eating, drinking
and sleeping are deficiency needs, as are safety needs, social needs such as friendship and sexual
intimacy, and ego needs such as self-esteem and recognition. In contrast, Maslow called the fifth
level of the pyramid a ‘growth need’ because it enables a person to ‘self-actualize or reach his
fullest potential as human being, once a person has met his deficiency needs, he can turn his
attention to self-actualization; however, only a small minority of people are able to self-actualize
because self-actualization requires uncommon qualities such as honesty, independence,
awareness, objectivity, creativity, and originality.

Pregnancy a dynamic process associated with significant physiological Cardiac output increases throughout pregnancy. Invasive measuring
changes in the cardiovascular system. These changes are mechanisms that the techniques are rarely used during pregnancy, so echocardiography is most
body has adapted to meet the increased metabolic demands of the mother and commonly used to assess hemodynamics in pregnancy. Cardiac output
fetus and to ensure adequate uteroplacental circulation for fetal growth and measurements are usually made with the mother in the left lateral decubitus
development. Insufficient hemodynamic changes can result in maternal and position to avoid positional variation. The sharpest rise in cardiac output
fetal morbidity, as seen in preeclampsiaand intrauterine growth retardation. In occurs by the beginning of the first trimester, and thereis a continued increase
addition, maternal inability to adapt to these physiological changes can expose into the second trimester. After the second trimester, there is debate as to
underlying, previously silent, cardiac pathology, which is why some call whether cardiac output increases, decreases, or plateaus. By 24 weeks, the
pregnancy nature’s stress test. increase in cardiac output can be up to 45% in a normal, singleton pregnancy.
Echocardiography and cardiac magnetic resonance imaging estimates of
Maternal Hemodynamic Changes cardiac output trend similarly in pregnancy. In a comparative study of 34
Pregnancy is associated with vasodilation of the systemic vasculature and the normal pregnant women with images taken in the third trimester and at least 3
maternal kidneys. The systemic vasodilation of pregnancy occurs as early as months postpartum, both modalities demonstrated an increase in left
at 5 weeks and therefore precedes full placentation and the complete ventricular end-diastolic volume, an increase in left ventricular mass, and an
development of the uteroplacental circulation. In the first trimester, there is a increase in cardiac output during pregnancy, but the values were consistently
substantial decrease in peripheral vascular resistance, which decreases to a underestimated by transthoracic echocardiography. Cardiac output in a twin
nadir during the middle of the second trimester with a subsequent plateau or pregnancy is 15% higher than that of a singleton pregnancy, and a
slight increase for the remainder of the pregnancy. The decrease is ≈35% to significantly larger increase in left atrial diameter is seen, consistent with
40% of baseline. Systemic vascular resistance increases to near-prepregnancy volume overload. Cardiac output early in gestation is thought to be mediated
levels postpartum, 4 and by 2 weeks after delivery, maternal hemodynamics by the increase in stroke volume, whereas later in gestation, the increase is
have largely returned to nonpregnant levels. Increased vascular distensibility, attributable to heart rate. Stroke volume increases gradually in pregnancy until
or compliance, has been observed in normal human pregnancy starting in the the end of the second trimester and then remains constant or decreases late in
first trimester. Systemic vascular resistance increases to near prepregnancy pregnancy.
levels postpartum.
Blood Pressure contribute to the variations in the data, and importantly, largely unexplained
but substantial ethnic differences exist in blood pressure levels observed
There is a decrease in arterial pressures, including systolic blood pressure during pregnancy and the risk of gestational hypertension.
(SBP), diastolic blood pressure (DBP), mean arterial pressure, and central
SBP during pregnancy. DBP and mean arterial pressure decrease more than Heart Rate
SBP during the pregnancy. Arterial pressures decrease to a nadir during the Heart rate increases during normal gestation. Unlike many of the prior
second trimester (dropping 5–10 mm Hg below baseline), but the majority of parameters that reach their maximum change during the second trimester,
the decrease occurs early in pregnancy (6- to 8-week gestational age) heart rate increases progressively throughout the pregnancy by 10 to 20 bpm,
compared with preconception values. Because many of these changes occur reaching a maximum heart rate in the third trimester. The overall change in
very early in pregnancy, they emphasize the importance of comparing heart rate represents a 20% to 25% increase over baseline.3,4,12,17
hemodynamic measurements with reconception values rather than early
pregnancy values when changes have already occurred. Arterial pressures Contractility
begin to increase during the third trimester and return close to preconception Although multiple cardiovascular parameters are altered during pregnancy,
levels postpartum. In a longitudinal study of blood pressure at 16 weeks myocardial contractility and left ventricular and right ventricular ejection
postpartum, both brachial and central SBPs remained lower than fractions do not appear to change during pregnancy
preconception values but similar to early pregnancy levels. Although a
decrease in blood pressure during pregnancy has been found in most studies12
(Figure 2), a recent study challenged this “dogma” and demonstrated a
progressive increase in blood pressure throughout gestation. Women with a
body mass index >25 kg/m2 before pregnancy have been shown by some to
have significantly higher SBP, DBP, and mean arterial pressure (measured by
an automated oscillometric device) at any point during the pregnancy and
postpartum than women with lower body mass.In a population-based cohort
study (The Generation R Study), with blood ressure measured by an
automated digital oscillometric sphygmomanometer, obese and overweight
women had a higher blood pressure in the first trimester than normal-weight
women, and this difference was sustained throughout pregnancy. Others have
shown no difference in hemodynamic changes based on weight before
pregnancy or total weight gain during pregnancy. The differing methods of
assessing blood pressure in these studies (automated oscillometric devices
versus finger arterial pressure based on the volume clamp method) may
DISEASE ENTITY  Mother’s age younger than 20 or older than 40
 Multiple pregnancy
Gestational Hypertension  African-American race
Gestational hypertension is a form of a high blood pressure in
pregnancy. It is diagnosed when blood pressure readings are higher than Diagnostics/ Laboratory Examinations
140/90 mmHg in a woman who had normal blood pressure prior to 20 weeks Diagnosis is often based on the increased in blood pressure levels, but
and has no proteinuria (excess protein in the urine). other symptoms may help establish gestational hypertension as the diagnosis.
Tests for gestational hypertension may include the following:
Signs and Symptoms:  Blood pressure measurement
 Increased blood pressure  Urine testing to rule out preeclampsia
 Absence or presence of protein in the urine (to diagnose gestational  Assessment of edema
hypertension or preeclampsia)  Frequent weight measurements
 Edema (swelling)  Liver and kidney funtioc tests to rule out preeclampsia
 Sudden weight gain  Blood clotting tests to rule out preeclampsia
 Visual changes such as blurred or double vision  Fetal monitoring (to check the health of the fetus which may include:
 Nausea and vomiting fetal monitoring counting, non-stress testing, biophysical profile,
 Right sided upper abd’l pain or pain around the stomach doppler flow studies
 Urinating small amounts
 Changes in liver or kidney function tests
Etiology  Recommend bed rest either at home or in the hospital, with left-side
The cause of gestational hypertension is unknown. Some conditions lying to take the weight of the baby off the blood vessels.
may increase the risk of developing the condition, including the following:  Promote proper diet
 Existing hypertension (high blood pressure)  Monitor closely
 Kidney disease  Administer prescribed medicines
 Diabetes  Provide comfort
 Hypertension with a previous pregnancy  Improve respiratory status; turning the client
 Maintain skin integrity
 Observe for infections
 Note and report abd’l pain, nausea, vomiting, changing in VS and
other irregular status
 Watch out for pain, abd’l distention and temperature elevation
 Monitor VS
 Assess rigidity and tenderness of the abdomen
 Assess color of the stool, sclera, urine
 Refer promptly
 Monitor and manage potential complication

 Nutritional therapy: improve nutritional status. Avoid patient to eat
excessive fats, consume less salts, drink 6-8 glasses of water a day
 Hospitalization (as specialized personnel and equipment may be
 Magnesium sulfate or other anti-hypertensive mediactions for
gestational hypertension if blood pressure readings are in the severe

 Fetal delivery

Predisposing Factors: Precipitating Factors:

Diet and Nutrition
Etiology Unknown Pre-existing and history of hypertension


Endothelial cell rejection Altered Vascular activity due to pregnancy Natural Hypertensive processes

Production of endothelial-delivered Decreased glomerular filtration rate with Diet and/or the presence of
relaxing factor or nitric oxide, retention of salt and water co-morbid and pre-existing conditions
endothel in-1, prostacyclin, and tissue (i.e.diabetes) which activate RAAS
plasminogen activator

Vasospasm/ Vasoconstriction

Endothelial cells modify the

Contractile response of smooth muscle

Decreased Placental Perfusion

Endothelial cell activation

Activation of the coagulation cascade Intravascular fluid redistribution
Decreased organ perfusion

Decreased placental perfusion

Endothelial damage Vasopasms

Increased thromboxane Fluid shifts Increased Intravascular Increased

to Prostacydin from Intravascular endothelin and coagulation sensitivity to
to Intracellular decreased nitric angiotensin II
Space oxide

Generalized Retinal Glomerular Cortical Pulmonary edema

Vasoconstriction Arteriolar damage brain
Spasms spasms

Hypertension Blurred vision Proteinuria Headache Dyspnea

Edema of the leg




Subjective: Short term Independent -After 30 minutes of

“han akpaynakaanges nursing intervention, the
Launay”, as verbalized -After 30 minutes of Assess the patient For baseline data client manifested
nursing intervention, the lessened difficulty of
by the patient client will experienced -Elevated head of the bed -Elevation of the bed breathing as manifested
lessened difficulty of for about 30 degrees and ask facilities respiratory by decreased in RR
Objective: breathing as manifested the client to assume dorsal function by use of gravity. from 27 breaths per
Tachypnea with a by decreased in RR from recumbent position. It also decreases pressure minute to 20 breaths per
RR :27-30 breaths per 27 breaths per minute to on the abdomen when minute and increase in
minute 20 breaths per minute assuming the position. oxygen saturation of
SPO2 : 87-92 % and increased oxygen 87% to normal range
And shortness of saturation of 87 to 95% -Encouraged deep breathing -Promote chest expansion. (95 – 100 %)
Breath. until 100 % with calm exercises.
Diagnosis: -Kept environmental -Precipitators of allergic
Ineffective breathing pollution to a minimum. type of respiratory
pattern related to alteration reactions that can trigger or
of patients usual O2/CO2 exacerbate onset of acute
ratio, decreased energy, episode.
fatigue and pain
-Monitored respiratory -Assess the condition of
patterns, including rate, the client.
depth and effort.


-Gave supplemental oxygen -helps in giving adequate

as ordered (2 LPM via nasal oxygen to the client.


-Obtained blood specimen -assess the condition of the

for Arterial Blood Gas client.
Subjective: Short term: After 8 hours of Goal partially met as
nursing intervention, the  Assess patient For baseline data manifested by the client
Objectives: client shall demonstrate condition. was able to
 Leg edema behaviors to monitor fluid demonstrate behaviors
(+2) pitting volume status and reduce to monitor fluid status
 Monitor and record Accurate I & O is
 V/S taken as recurrence of fluid excess. intake and output. and reduce recurrence
follows: necessary for of fluid excess.
BP:120-150/70- Long term: After 48-72 determining renal
100 mmHg hours of nursing function and fluid
PR:68-71 bpm intervention, the client will replacement needs and
RR: 27-30 bpm manifest stabilized fluid reducing fluid overload.
SPO2: 87-92% balanced I & O, normal V/S
 Oliguria and free from signs of
 Monitor occurrence To determine fluid
 100-200 ml of edema
of dyspnea. retention/congestion
UO after 8 hr
 Monitor presence of May indicate increase in
Nursing Diagnosis: edema. fluid retention.
Excess fluid volume
related to sodium and  Encouraged client to Fluid management is
water retention as do leg raising. usually calculated to
manifested by
prevent further fluid
decreased urine Dependent: retention
output and edema.
 Encouraged to limit To promote venous
fluid intake as circulation.
prescribed by the

 Encouraged client to Increased sodium in

restrict sodium intake cells attracts water
as prescribed by the retention.
Subjective: Short Term: INDEPENDENT:
“Agkakapsut datoy After the nursing
bagik, ken naglaka ak interventions, the patient  Assess patient For baseline data The patient responded
mabannog, gapos will be able to walk and condition. to the interventions,
datoy maritritnak nga do simple exercises. teachings and actions
sakit” as verbalized performed and was
by the patient Long Term:  Ask client about usual To identify potential able to perform
After the nursing level of energy problems and or activities of daily
Objective: intervention, The patient client’s perception living in a shorter span
 Weakness will be able to activities of client’s energy of time throughout the
 Discomfort of daily living without and ability to hospitalization Goal
perform needed or
 Inability to feeling weak in a shorter met.
span of time throughout desired activity.
carry objects
 V/S taken as the hospitalization.
 Identify factors, such as To assess what could
follows: age , functional decline, block /affect desired
BP:120150 / client resistive to efforts, level of activity.
70-100 mmHg painful conditions,
PR:68-71 bpm breathing problems,
RR: 27-30 vision or hearing
bpm impairments, climate or
SPO2: 87%- weather, unsafe areas to
92% exercise, and need for
mobility assistance.
Nursing Diagnosis:
Activity intolerance
Refer to appropriate To sustain activity
related to general level.
resources of assistance
and equipemtns , as
 Discuss with client or Understanding this
significant others the relationship can help
relationship of the with acceptance of
illness or debilitating imitations or reveal
condition and ability to opportunity for
perform desired changes of practical
activities value
Subjective: Goal Independent Goal particularly
“Hannak makaturog After the nursing met. After the
nga naimbag gamin intervention, the  Assess patient For baseline data nursing
nagangut ken nalaaw client will be able condition interventions, the
ditoy” as verbalized to report improved client was able to
by the patient sleep and feeling  Provide quiet This provides a understand ways
rested. environment and conducive of improve sleep
Objective: adjust ambient environment for pattern such as
 V/S taken as Objective: lightings. the client to relax. providing quiet
follows: environment and
BP:150/100 Short term: After 2  Provide comfort This soothes and comfort
PR:68 hours of nursing measures such as relaxes the client. measures.
RR: 30 interventions, the straightening the
SPO2: 87% client will state bed sheets.
 Irritable understand ways of
restlessness improve sleep  Arrange care to To promote
 Weakness and pattern such as provide wellness
fatigue providing quiet uninterrupted sleep
 Dark eye bags environment and
comfort measures  Provide safety such To prevent further
Nursing Diagnosis: as increased side injuries such as
Disturbed Sleeping Long term: After 3 rails. falls
Pattern related to days of nursing
external factors noise intervention the  Encouraged to limit
and noxious odors client will report intake of caffeine Caffeine inhibits
improvement of and chocolate prior sleep
quality of sleep to sleep.
 Explore other sleep
To promote
aids, such as warm
bath or milk.
 Refer to
physician for For advice and
medication and further explanation
treatment when
Subjective Data: Short term: INDEPENDENT: After giving safety
“Muntik na akong After giving measures and proper
bumangga sa pinto instructions and Therapeutic: knowledge, the patient
pagpasok dito sa DR teachings, the Secure bed side rails and To reduce the risk of was able to explain
gawa nung bigla nan patient explains watch out for bed, chair accidentally slipping, methods to prevent
labo paningin ko” methods to prevent and other equipment sliding, rolling or falling injury and identify
injury. malfunctions for safety. from bed. factors that increase risk
Objective Data: for injury. Goal met.
 Pregnancy of 35 Thoroughly conform The patient must get
5/7 weeks Long term: patient to surroundings. used to the layout of the After giving proper care
 BP Reading of After giving proper Keep items that the environment to avoid and management, the
140/100 care and patient always use at a accidents. Items that are patient able to relate
 Fatigue with management, the place that is easy to reach. too far from the patient intent to practice selected
respirations of patient will be free may cause hazard. prevention measures.
27 beats per of injuries Goal met.
minute throughout the Eliminate or drop all To prevent the patient
irritability. hospitalization. possible hazards in the from any unpleasant
room such as razors, experience due to
Nursing Diagnosis: medications, and matches. dangerous objects.
Risk for injury related to
sensory dysfunction Educative:
Ask family or significant To prevent the patient
others to be with the from accidentally falling
patient to prevent her or pulling out tubes.
from accidentally falling
or pulling out tubes.

Educate patient about Patient’s knowledge

safety ambulation, about her condition is
including the use of safety vital to safety and
measures such as recovery
handrails in the bathroom.


Generic Name: injectable Stimulates Management Contraindicated in: CNS: Drug- Drug: Monitor blood pressure
Methyldopa solution: CNS alpha- of moderate to Hypersensitivity; Active sedation, Additive and pulse frequently
Brand Name: 50mg/mL adrenergic severe liver disease; Oral decreased hypotension with during initial dose
Aldomet, Apo- receptors, hypertension suspension contains actual other adjustment and
Methyldopa, producing a (with other alcohol and bisulfites and acuity, antihypertensives, periodically during
 250mg
Dopamet, decrease in agents). should be avoided in depression. acute ingestion of therapy. Report
Novamedopa,  500mg sympathetic patients with known EENT: alcohol, anesthesia, significant changes.
NuMedopa Hypertension outflow to intolerance. Use nasal and nitrates. Monitor frequency or
Initial: 250 mg heart, kidneys, Cautiously in: Previous stuffiness. Amphetamines, prescription refills to
PO q8-12hr for and blood history of liver disase; CV: barbiturates, determine compliance.
Therapeutic: vessels. Result Geri: Increase risk of myocarditis, tricyclic, Monitor intake and
Antihypertensive 2 days, increase
is decreased adverse reaction; consider bradycardia, antidepressants, output ratios and weight
Pharmacologic : q2Days PRN
blood pressure age-related impairment of edema, NSAIDs, and and assess for edema
Centrally acting Maintenance: and peripheral hepatic, renal and orthostatic, phenothiazines daily, especially at
anti-adrenergic 250-1000 resistance, a cardiovascular function as hypotension. may decrease beginning of therapy.
mg/day divided slight decrease well as other chronic GI: drug- antihypertensive Report weight gain or
Category: B
q6-12hr PO, in heart rate, illnesses. Appears on induced effect of edema; sodium and
usually no and no change Beers list. May cause hepatitis, methyldopa. water retention may be
Dosage: in cardiac bradycardia and diarrhea, dry Increase effects and treated with diuretics.
PO – 250 to 500 more than 3
output. exacerbate depression in mouth. GU: risk of psychoses Assess patient for
mg/day divided g/day
Therapeutic geriatric patients; OB: erectile with haloperidol. depression or other
q6-12 IV Effects: Pregnancy (has been used dysfunction. Excess rent use of alterations in mental
(methyldopate): Lowering of safely); Lactation. HEMAT: MAO inhibitors or status. Notify health care
250-1000 mg blood pressure. eosinophilia, other adrenergic. professional promptly if
infusion over hemolytic May increase these symptoms develop.
30-60 minutes anemia. effects of Monitor temperature
MISC: tolbutamide. May during therapy. Drug
q6-8hr PRN;
fever. increase lithium fever may occur shortly
no more than 4 toxicity. Additive after initiation of therapy
Hypertensive hypotension and and may be
Crisis CNS toxicity with accompanied by
20-40 levodopa. Additive eosinophilia and hepatic
CNS depression function changes.
may occur with Monitor hepatic function
divided IV alcohol, test if unexplained fever
q6hr antihistamines, occurs. Monitor renal
No more than sedative/ and hepatic function and
65 mg/kg/day hypnotics, some CBC before and
or 3 g/day antidepressants, periodically during
(whichever is and opioid therapy. Monitor direct
analgesics. ‘Coombs test before and
Concurrent use with after 6 and 12 months of
Renal nonselective beta therapy. May cause a
Impairment blockers may rarely positive direct Coombs’
Adjust dosage cause paradoxical test, rarely associated
frequency with hypertension. with hemolytic anemia.
renal May cause increase
impairment BUN, serum creatinine,
potassium, sodium,
CrCl >50
prolactin, uric acid,
mL/min: q8hr AST, ALT, alkaline
CrCl 10-50 phosphatase, and
mL/min: q8- bilirubin concentrations.
12hr May caused prolonged
CrCl <10 prothrombin times.
May interfere with
mL/min: q12-
serum creatinine and
24hr AST measurements.

Generic Name: Caplets: 160 An essential As a supplement Contraindicated in nausea, Drug to drug: Tell patient to take
Ferrous Sulfate mg mineral found in during patients with epigastric pain, antacids, tablets with juice
Brand Name: Capsules: 190 haemoglobin, pregnancy hemosiderosis, primary vomiting, chloestyramine (preferably orange
Feosol, mg myoglobin and hemochromatosis. constipation, resin, H2 juice) or water,
Fergensol, Drops: 125 many enzymes. Hemolytic anemia (unless black stools, antagonist, proton but not milk or
Ferinsol, FerIron, ml/mg Enters the patient also has iron diarrhea, pump inhibitors: antacids.
MolIron Elixir: 220 bloodstream and deficiency anemia), peptic anorexia, may decrease iron
Classification: mg/5 ml is transported to ulceration, ulcerative temporarily absorption. Instruct patient not
Pharmacologic: Liquid: 150 the organs of the colitis, or regional stained teeth Separate doses if to crush or chew
Hematinic mg/5 ml, 300 reticulo- enteritis and in those from liquid possible. extended release
Category:A mg/5 ml endothelial receiving repeated blood forms. form.
Tablets: 195 system (liver, transfusion. Use Drug to food:
Dosage: mg, 200 mg, spleen, bone cautiously on long term cereals, cheese, Alert: inform
15-30 mg/PO 300 mg, 325 marrow) where it basis. coffee, eggs, milk, patients that as
elemental iron mg is separated out tea, whole grain few as 5-6 high
daily in last 2 and becomes part breads, yogurt: potency tablet can
semesters of iron stores. may decrease iron cause fatal
absorption. poisoning in a
Discourage use child.
Caution patient
not to substitute 1
iron salt for
another because
amounts of
elemental iron
Reduces total Contraindicated in
Generic Name: Capsules: Essential for acid load in patients with ventricular Syncope, Drug-drug: Advice patient not
Calcium 1250 mg nervous, muscular, GI tract. fibrillation or tingling, Antibiotics to take calcium
Carbonate Chewing and skeletal Elevates hypercalcemia. Use cardiac arrest, (Tetracyclines) carbonate
Brand Name: gum: 300 mg, systems. Maintain gastric ph. To cautiously if at all, if arrhythmias, hydantoins, iron salts, indiscriminately or
Alka-mints, 450 mg, 500 cell membrane and reduce pepsin patient takes a cardiac bradycardia, isoniazid, salicylates: to switch antacids
Amitone mg/piece capillary activity, glycoside or has constipation, May decrease effects of without prescriber’s
Pharmacologic: Lozenges: permeability. Act strengthens sarcoidoisis or renal or nausea, these drugs because may advice.
calcium salt 600 mg as an activator in gastric cardiac disease. vomiting, impair absorption.
Category: C Oral the transmission of mucosal calculi, Separate doses by 2 Tell patient who
suspension: nerve impulses and barrier and hepercalciuruia hours. takes chewable
Dosage: 1250 mg, contraction of increases , phlebitis (IV Drug-Food: Milk, Other tablets to chew
350 mg to 1.5 1500 mg cardiac, skeletal esophageal only) foods high in Vitamin D: thoroughly before
grams/PO or 2 Tablets: 500 and smooth sphincter May cause milk-alkali swallowing and to
pieces of chewing mg, 600 mg, muscles. It is tone. syndrome(headache, follow with a glass
gum 1 hour after 650 mg, 1000 essential for bone confusion, distaste for of water.
meals and at bed mg, 1250 mg, formation and food, nausea, vomiting,
time if needed. 1500 mg blood coagulation. hypercalcemia, Tell patient who
It is also used as a hypercalsuria). uses suspension
replacement of Discourage use together form to shake well
calcium in and take with a
deficiency states. It small amount of
controls of water to facilitate
hyperphosphatemia passage.
in end-stage renal
disease without








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