ACKNOWLEDGEMENT

We, the students of BSN-3E Group 3 would like to give our heartfelt gratitude to

the following people who have been part of the success of this Case Presentation.

First and foremost, for the Administration for giving us an opportunity to be

exposed in different areas in the hospital that would definitely increase the knowledge of

each student concerning the nursing profession. To our Clinical Instructors, especially,

Ma’am Nancy Bargamento RN, Ma’am Lory Anne H. David RN, and Ma’am Brenda A.

Morales, RN for their patience in guiding and imparting knowledge to us especially for

being there to guide us in every step of our Clinical exposure. Also to the staff of DR in

Davao Regional Hospital, for their patience and help during our DR duty.

A special thanks to our client and her family for allowing us to conduct an

extensive interview with her.

For our family and friends who have been so supportive to us throughout this

whole experience. For being there to give us encouragement when it was needed the

most. And lastly our sincerest thanks to the Lord Almighty who has been there in every

step of our lives especially at this time of so much pressure in our chosen field.

1
 INTRODUCTION

Motherhood is what women most often dream about. Conception and giving birth
to a child is the greatest gift we could ever imagine. Despite the risks and associated
complications, a mother could jeopardize it all for a safe and healthy delivery. In our
exposure and duty we had in the Delivery Room of Davao Regional Hospital, we have
encountered and interacted with these mothers whose life had been to a great peril. As
we have seen the plight of our patients, we have realized the importance of a healthy
conception and lifestyle that may have contributed to the most common complications of
pregnancy. The exposure enhanced our skills holistically and effectively in dealing and
addressing to the different needs of our client. By doing research, our knowledge
broadens and we were able to dig deeper and discover the nature, etiology and
background of our client’s condition, thus proper management was also known.

As student nurses of Ateneo, we believe in the principle of magis. We do not only

confine ourselves and be merely satisfied with the plain folded facts, instead we strive to
know the truth and seize for the best. We also kept in mind and inculcated within us to
be men and women for others. That is why we would like to grab this opportunity to
study a case related to Maternal and child nursing so that by the time that we would
encounter same case, we could effectively render the appropriate nursing care and
promote optimum wellness to that patient. We believe that by choosing Venus Raj to be
the case of our study, we would be able to advance our knowledge and skills and extend
our promise of devoting ourselves to those committed of our care.

After being exposed with some common complications of pregnancy of unknown

etiologies, we decided to study the case, Gestational Hypertension. Hypertension or high
blood pressure is a chronic medical condition in which the blood pressure in the arteries
is elevated. Gestational Hypertension which is a common complication of pregnancy is
characterized by the development of new arterial hypertension only during pregnancy
after 20 weeks AOG. As of 2008 based on WHO report, about 20% is affected globally
and 13% for the whole Philippines with a maternal mortality rate of less than 1% in the
developed world. The treatment may vary from the severity of the patient’s condition but
the greatest cure for the said disease is to deliver the baby and hope for the best.
OBJECTIVES
2
General Objectives:

This case study aims to make the group formulate and deliver a specific,

measurable, attainable, realistic, and time-bounded plan of care that would help us gain

new and deeper understanding about Gestational Hypertension and the management of

this disorder by presenting the substantial and comprehensive study conducted to Venus

Raj, a patient diagnosed with Gestational Hypertension admitted on January 10, 2011 at

the Davao Regional Hospital.

Specific Objectives:

That within 3 days span of exposure in OB Ward, the group will be able to:

a. Select a patient to be the subject of their case study;

b. Establish a good patient-nurse relationship as well as with the patient’s

significant others;

c. Present an introduction regarding their patient and her condition, gestational

hypertension, including its common complications, and its nursing implications to

nursing research, education, and practice;

d. Formulate objectives to serve as a guide in the completion of this case study;

e. Present the necessary and pertinent data about the patient including the patient’s

comprehensive health history;

f. Trace and discuss any hereditary disease or disorder that could have

precipitated the patient to such condition through the genogram;

g. Present a complete definition of the diagnosis from 3 different sources in order

for readers to understand the patient’s disorder;

3
 h. Present the developmental data of the patient and present at least 3 Nursing

Theories applicable to the case presented;

i. Conduct and present a thorough head-to-toe assessment of the patient;

j. Discuss the anatomy and physiology of the affected system

k. Trace the Pathophysiology of the disease process, including the etiology,

precipitating and the predisposing factors that could have contributed to the

disease process as well as the Symptomatology of the disease;

l. Present the actual laboratory and diagnostic examinations conducted on the

patient with its corresponding results and normal values, clinical significance and

nursing responsibilities before and after the examination; as well as the possible

examinations that can be done;

m. Discuss the pharmacologic treatment given to the patient from the time she has

been admitted;

n. Discuss the actual medical management that was done to the patient to manage

her condition; and present the possible management that can be performed to

the to her;

o. Formulate and present individualized nursing care plans for the patient;

p. Create a discharge plan by using the METHOD system which is applicable to the

patient;

q. Identify and present the prognosis of the patient and the justification for this; and

r. Enumerate the references utilized in the making of this case study.

PATIENT’S DATA

4
Patient’s Code Name: Venus Raj

Age: 25 years old

Birthday: June 10, 1985

Civil Status: Single

Address: Prk. 5 San Miguel ( Comp 4 ), Tagum City, Davao Del Norte

Nationality: Filipino

Religion: Catholic

Occupation: Internet Café Attendant

Educational Attainment: High school graduate

Economic Status: Low

CLINICAL DATA

Admitting Date: January 10, 2011

Admitting Diagnosis: G1P0, Pregnancy Uterine, 37 4/7 weeks age of gestation, Cephalic
in labor, Gestational Hypertension

Vital signs upon Admission: BP – 140/100 mmHg

Attending Physician: Dr. Dokdokan

Last Menstrual Period (LMP): March, 2009

Source of information/ Informants: Patient and Patient’s Chart

FAMILY BACKGROUND AND HEALTH HISTORY

5
 Venus and the father of her baby are not yet married but they planned to be

married after the baptism of their child. Venus lives in her partner’s house in Tagum City

and only the both of them lives inside the house because Venus’s partner Coco owns

the house.

Venus stated that she never had hypertension before and claimed she was

healthy enough; it was only when she got pregnant she experienced blurry vision and

hypertension. As she traced her family history of sicknesses, She admitted that her

mother and the brothers and sisters of her mother are all hypertensive including the her

mother’s father or her grandfather died because of cardiac arrest at her father’s side, her

father’s siblings only had arthritis and her grandfather and grandmother died because of

an unknown cause. Venus only has one sister Jupiter and Venus believes that her sister

is also hypertensive because her family sometimes experiences blurry vision.

Diet

Venus eats fish, meat, egg, hotdogs and barbeques. She admitted that she

seldom eats vegetables because she doesn’t like the taste especially ampalaya because

of its bitterness.

Lifestyle

Venus and her partner usually wakes up at 6:00 in the morning. Venus prepares

for breakfast and her child’s necessities while her partner prepares for work. Venus

before she was pregnant works as a internet café attendant in Downtown Tagum, but as

soon as she knew that she was pregnant she then immediately decided to stop working

6
and just stay in her partner’s house to focus herself on her 1st pregnancy, and her

partner works as a craftsman; making necklaces made up of clay and sells them

anywhere around the region. Mostly Venus and her partner Coco bonds on weekends

touring around the park of downtown Tagum and always goes to church every Sunday

morning.

Menstrual History

Venus’s menarche occurred when she was around 14 years old. She has regular

monthly cycles. Usually her monthly period lasts for 5 to 7 days. It is usually heavy for

the first three days of menstruation. According to her, she does not feel any painful

menstruation or dysmenorrhea. Her last menstrual period (LMP) was last March 2009.

History of Past Illness

Venus does not have any allergies. Her past illnesses are fever, cough, and

colds. According to her, she had chickenpox and measles during her childhood and

never has had any worse condition before.

History of Present Illness

Venus felt mild to moderate uterine contractions and told her partner about it.

They did not immediately go to the hospital since Venus can still tolerate the pain. It was

when Venus felt dizzy that they went to the hospital. When they arrived at the Davao

7
Regional Hospital, it was then she knew that she was hypertensive because her Doctor

told her and she was diagnosed with Gestational Hypertension.

Effects/ Expectations of Present Illness to Self and Family

Venus and her partner Coco was so positive about her 1st pregnancy, Venus and

Coco’s Family are in full support of Venus’s pregnancy. When we interviewed Venus,

she admitted that she was partly excited with the child and was anxious because of the

severe pain she might feel while delivering her child. Nevertheless, she was very

optimistic that the child would bring more than happiness but rather give her a sense of

purpose to herself.

8
 Genogram

Grand Grandpa Grand Grandpa

Grandpa
Grandpa
ma ma
1
1 2
2
1 2

Father
Father Uncle Aun Aun Aun
Uncle
Uncle Uncle
Uncle Uncle
Uncle Aun Aun Aun Aun Uncle
11 22 33 t1 t2 t3 t4 Moth 11 t1 t2 t3
er

Venu Coco
Coco
Jupit s Martin
Martin
er Raj

9
 Developmental Data

Theorist Theory Developmental Task Result and Justification

Developmental Task Our patient is 25 years
Robert Theory, based on old and belong to the Our patient has achieved
Havighurst learning and learned early adulthood (21 to some of the tasks in early
behaviors, called 40 years) and the adulthood
developmental tasks, following are the tasks:
which emanate from
Our patient has achieved
biologic, psychological
*selecting a life partner this stage of development.
and social origins
She found a live in partner
during lifespan. Specific
developmental tasks
are assigned to the
various stages of life. She has already achieved
Failure to complete the *Choosing an this stage of development
tasks assigned to each occupation or career although currently she only
stage may lead to is an attendant in an internet
failure in tasks in café.
subsequent stages. She has achieved this

According to this *Establishing stage. She is staying in the

theory, success in independence from house of her partner. They

achieving the parents do not live in the same roof

developmental tasks with their parents. She says

leads to success with that she and her partner are

tasks in later stages of not dependent on their

life. parents in terms of financial

matters.
She has achieved this stage
*Establishing intimate of development. She and
relationships her partner are planning to
get married right after the
christening of their 1st baby

10
 She does not have any
*Establishing social social groups and does not
network participate in any social
activities.

She is yet a new mother but

*Rearing children she is already taking care of
her baby. She says that she
will become a responsible
mother for her child.
She is planning to learn
*Managing a home more about taking care of a
family since she now have a
baby.
She has achieved this stage
*Starting a family although she is still planning
on how to start managing
their family
Psychosocial
Erik Erickson development theory Our patient belongs to Our patient did not achieve

describes eight the stage of young this stage because though

developmental stages adult (20 to 34 years she already had a live in

through which a old): Intimacy vs. partner but still they did not

healthily developing Isolation get married.

human should pass

from infancy to late
adulthood. In each
stage the person
confronts, and hopefully
masters new
challenges. Each stage
builds on the successful
completion of earlier
stages. The challenges
11
 of stages not
successfully completed
may be expected to
reappear as problems
in the future.

Result and
Theorist Theory Stage
Justification

Sigmund Psychosexual Venus achieved this

Freud Development Our patient belongs to stage since she has now
Theory, it is a the genital stage. her own family and has
theory of how our During the final stage of a new born baby.
sexuality starts from psychosexual
a very young age development, the
individual develops a
12
 and develops
through various strong sexual interest in
fixations. If these the opposite sex. Where
stages are not in earlier stages the
psychologically focus was solely on
completed and individual needs, interest
released, we can be in the welfare of others
trapped by them grows during this stage.
and they may lead If the other stages have
to various defense been completed
mechanisms to successfully, the
avoid the anxiety individual should now be
produced from the well-balanced, warm and
conflict in and caring. The goal of this
leaving of the stage. stage is to establish a
balance between the
various life areas.

DEFINITION OF COMPLETE DIAGNOSIS

Diagnosis: G1P1, Pregnancy Uterine, 37 4/7 weeks, Age of Gestation, Cephalic in

Labor, PROM, Gestation Hypertension.

Uterine Pregnancy
A normal pregnancy occurs when a fertilized egg is implanted in the uterus (womb) and
an embryo grows.
Source: (Harrison’s Principles of Internal Medicine 2)

13
Age of Gestation
It is usually considered to be the age of an embryo or fetus (or newborn infant) from the
first day of the woman's last menstrual period (LMP). This standard system of counting
the progression of pregnancy starts approximately two weeks before fertilization takes
place.

Source: (Miller, B. & Keane, C. Encyclopedia and Dictionary of Medicine and

Nursing. W.B. Saunders)

Cephalic
Presentation of any part of the fetal head, usually the upper and back part as a result of
flexion such that the chin is in contact with the thorax in vertex presentation; there may
be degrees of flexion so that the presenting part is the large fontanel in sincipital
presentation, the brow in brow presentation, or the face in face presentation.

Source: (Harrison’s Principles of Internal Medicine 2)

Gestational Hypertension

A woman is said to have a gestational hypertension when she develops an elevated

blood pressure (140/90 mmHg) but has no protienuria or edema. Perinatal mortality is
not increased with simple gestational hypertension, so no drug therapy is necessary

Source: Pillitteri, A.,(2007).Maternal and Child Health Nursing 5th edition. Lippincott
William and Wilkins. Page 427

Premature rupture of membranes (PROM)

is a condition that occurs in pregnancy when there is rupture of the membranes (rupture
of the amniotic sac and chorion) more than an hour before the onset of labor. Risk
factors for PROM can be a bacterial infection, smoking, or anatomic defect in the
structure of the amniotic sac, uterus, or cervix.

Source: (Mosby’s Dictionary of Medicine , Nursing, & Allied Health)

14
PHYSICAL ASSESSMENT

Patient’s Code Name: Venus Raj

Age: 25 years old

Gender: Female

General Survey

15
 Received on bed on moderate high back rest, awake, conscious, and coherent

as evidenced by the patient’s ability to comprehend words uttered by the student nurse,

and responsive as evidenced by her prompt responses to the student’s questions and

statements. She was oriented to the time (verbalized it was in the afternoon), place

(identified the hospital as her current location), person (identified the student nurse as

the person she is to and uttered the name of the watcher when asked to do so), and

reason for admission (admitted that delivery is her reason of going to the hospital).

Patient is in respiratory distress.

The patient had a cooperative attitude towards the student nurse as evidenced

by her willingness to participate in the physical assessment that was to be performed.

Her mood and affect was appropriate to the situation. Her speech was understandable,

clear, and in moderate pace. She also exhibited thought association and relevance in

her statements.

Vital Signs

Vital signs taken and had the following results: Blood pressure=140/90mmHg;

Temperature=36.9 degree Celsius, Pulse rate=86 beats per minute; Respiratory rate=33

breaths per minute,FHT= 142.

Skin

16
 The patient’s skin color was generally light brown and uniform all throughout the

body except under her axillae, which is darker than normal. Upon inspection, no pallor,

cyanosis, jaundice, or erythema was noted Her axillae are excessively moist and

accumulated dirt was observed. Skin temperature was uniform in all extremities upon

palpation. Skin turgor was good as manifested by skin immediately springing back to

previous state when pinched.

Hair

Upon inspection, hair was long and slightly brown in color. Her hair is thick, oily,

and evenly distributed as evidenced by the absence of areas of alopecia along the scalp.

No infection or infestations were noted upon inspection and palpation of the patient’s

hairline and scalp. Scalp was smooth and without lesions, lumps, or masses upon

palpation.

Nails

Nail bed was pale pink in color. Nail body had a convex curvature. Upon

palpation, nail base was firm and fingernails had a smooth texture. Epidermis

surrounding the nails was intact and no lesions or paronychia were noted. Prompt return

of usual color, which is less than 2 seconds, was noted when blanch test was performed

on fingernails.

Skull and Face

Skull was rounded, normocephalic, and symmetrical. Frontal, parietal and

occipital lobes were prominent upon inspection and palpation. Skull was smooth upon

palpation, and uniform in consistency as evidenced by absence of nodules or masses.

Symmetry in anatomy and movement were noted in facial features as evidenced by

17
eyebrows moving simultaneously when patient was asked to raise eyebows, cheeks

moving in unison when she was asked to puff her cheeks and was asked to smile and

show the teeth, and eyelids closing simultaneously when asked to close and open eyes

voluntarily.

Eyes and Vision

Hair of eyebrows were evenly distributed and periorbital skin was intact without

swelling or inflammation. Eyebrows were symmetrically aligned and exhibited equal

movement when patient was asked to raise eyebrows and frown. Eyelashes were also

evenly distributed and were slightly curled outward. Upon inspection, skin of eyelids was

intact and no discharges and discolorations were present. Lids close symmetrically both

voluntarily and blinking (bilateral). Cornea was transparent, shiny and smooth in surface

with details of the iris visible upon inspection. Blinking was present when cornea was

attempted to be touched. Pupils were black in color, equal in size and had a round,

smooth border. Pupillary response to illumination was brisk and equal as evidenced by

constricting of both illuminated and non-illuminated pupils upon illumination.

Ears and Hearing

Upon inspection, auricles were of the same color with facial skin, were

symmetrically aligned with each other, and were aligned with the outer canthus of each

eye. Cerumen was present but was not impacted or excessive in amount. Upon

palpation, auricles were mobile, firm, and not tender as evidenced by the auricle being

pulled upward, downward, and backward without resistance, and the pinna being folded

forward without resistance and recoiling after folding. She can response to normal voice

tones as manifested by answering the questions raised by the student nurse.

18
Nose and Smell

Upon inspection, external nose was symmetric. No abnormal discharges or

flaring were noted. Also, the nose was with uniform color with facial skin. The mucosa of

the nasal passages was pink and no lesions were present along the passages. Nasal

septum was intact and in midline. Upon palpation, tenderness or lesions were not noted.

Nasal patency was present as evidenced by air moving freely when she was asked to

breath in air through each nares when the other nares and mouth are closed.

Mouth

Upon inspection, outer lips were dark, moist, smooth in texture and symmetrical

in contour. Patient exhibited ability to purse lips when asked to do so. Teeth were

properly aligned. Missing tooth was noted on her right upper molar. Teeth were smooth,

pale yellow, and shiny. Gums were pinkish and were moist and firm. No tenderness or

bleeding was noted.

Tongue was in central position and pink in color. Thick whitish coating on the

surface of the tongue was noted. Tongue was able to move freely from side to side, and

was easily raised by the patient. Tongue base was smooth with prominent veins. No

swelling or ulcerations were noted. Uvula was positioned in midline of soft palate when

patient was asked to say “ah”. She was able to swallow without difficulty. Moreover, it

was observed that she has slightly bad breath.

Neck

Upon inspection, neck veins were not distended or visible. Her neck muscles

were functional as evidenced by her ability to hold the head erect and centered. Head

movement was coordinated when patient was asked to flex, hyperextend, flex laterally

19
and rotate head laterally. Shoulder muscles were of equal strength when asked to raise

the shoulders. Lymph nodes were not palpable. Upon palpation, trachea was at midline

of the neck.

Thorax and Lungs

The shape of the thorax from posterior and lateral views is symmetric. The skin

over the posterior thorax was intact, uniform in temperature and color with the rest of the

body. The spinal column is straight, and the right and left shoulders and hips are of the

same height when the patient was asked to stand erect. Normal breath sounds were

auscultated over the periphery of the posterior lung lobes.

Upon inspection of the anterior thorax, quiet, rhythmic and effortless respirations

were noted. Also, chest expansion was symmetrical upon inspection and palpation.

Upon auscultation over the trachea and anterior lung lobes, normal breath sounds were

noted. Respiratory rate was 33 cpm and was within the normal range (12-20 cpm).

Cardiovascular and Peripheral Vascular

Upon auscultation, heart sounds were normal. Cardiac rhythm was regular and

cardiac rate was 86 bpm and within normal range (60-100 bpm). Peripheral pulses were

present on all four extremities and had symmetrical pulse volumes. Peripheral pulses

were regular and were within normal range. Prompt return of usual color was noted

when blanch test was performed on fingernails.

Breasts

The breasts of the patient are round in shape and look engorged. However, the

left breast is slightly larger than the right breast. The skin is uniform in color with the

abdomen and chest. The areolas are round, bilaterally the same, and darker than the
20
usual color. The nipples are round, everted, equal in size, similar in color and point on

the same direction. There are no discharges observed except for the colostrum, which is

extracted in scanty amount.

Abdomen

Upon inspection, stretch marks and linea nigra were noted. The abdomen looks

distended since her uterus did not yet return to its pre-pregnancy state.

Extremities

Muscle sizes were equal on both sides of the body. The muscles and tendons

have no contractures and no tremors were noted. Muscle tone was firm with smooth and

coordinated movements were observed. Muscles have equal strength on both sides.

Joints move smoothly and were within full range of motion in all extremities. Presence of

edema noted on lower extremities with a grade of +2 upon inspection.

Anatomy and Physiology

The Endocrine System

21
 The nervous system sends electrical messages to control and coordinate the
body. The endocrine system has a similar job, but uses chemicals to “communicate”.
These chemicals are known as hormones. A hormone is a specific messenger molecule
synthesized and secreted by a group of specialized cells called an endocrine gland.
These glands are ductless, which means that their secretions (hormones) are released
directly into the bloodstream and travel to elsewhere in the body to target organs, upon
which they act. Note that this is in contrast to our digestive glands, which have ducts for
releasing the digestive enzymes.

Pheromones are also communication chemicals, but are used to send signals to
other members of the same species. Queen bees, ants, and naked mole rats exert
control of their respective colonies via pheromones. One common use for pheromones is
as attractants in mating. Pheromones are widely studied in insects and are the basis for
some kinds of Japanese beetle and gypsy moth traps. While pheromones have not been
so widely studied in humans, some interesting studies have been done in recent years
on pheromonal control of menstrual cycles in women. It has been found that
pheromones in male sweat and/or sweat from another “dominant” female will both
22
influence/regulate the cycles of women when smeared on their upper lip, just below the
nose. Also, there is evidence that continued reception of a given man’s pheromone(s) by
a woman in the weeks just after ovulation/fertilization can significantly increase the
chances of successful implantation of the new baby in her uterus. Pheromones are also
used for things like territorial markers (urine) and alarm signals.

Each hormone’s shape is specific and can be recognized by the corresponding

target cells. The binding sites on the target cells are called hormone receptors. Many
hormones come in antagonistic pairs that have opposite effects on the target organs. For
example, insulin and glucagon have opposite effects on the liver’s control of blood sugar
level. Insulin lowers the blood sugar level by instructing the liver to take glucose out of
circulation and store it, while glucagon instructs the liver to release some of its stored
supply to raise the blood sugar level. Much hormonal regulation depends on feedback
loops to maintain balance and homeostasis.

There are three general classes (groups) of hormones. These are classified by chemical
structure, not function.

• steroid hormones including prostaglandins which function especially in a variety

of female functions (aspirin inhibits synthesis of prostaglandins, some of which
cause “cramps”) and the sex hormones all of which are lipids made from
cholesterol,
• amino acid derivatives (like epinephrine) which are derived from amino acids,
especially tyrosine, and
• peptide hormones (like insulin) which is the most numerous/diverse group of
hormones.

The major human endocrine glands which play major roles in pregnancy are:

1. the hypothalamus

23
 The hypothalamus is located in the lower central part of the brain. This part of
the brain is important in regulation of satiety, metabolism, and body temperature. In
addition, it secretes hormones that stimulate or suppress the release of hormones in the
pituitary gland. Many of these hormones are releasing hormones, which are secreted
into an artery (the hypophyseal portal system) that carries them directly to the pituitary
gland. In the pituitary gland, these releasing hormones signal secretion of stimulating
hormones. The hypothalamus also secretes a hormone called somatostatin, which
causes the pituitary gland to stop the release of growth hormone.

2. The pituitary gland

24
 The pituitary gland is located at the base of the brain beneath the
hypothalamus and is no larger than a pea. It is often considered the most
important part of the endocrine system because it produces hormones that control
many functions of other endocrine glands. When the pituitary gland does not
produce one or more of its hormones or not enough of them, it is called
hypopituitarism.

The pituitary gland is divided into two parts: the anterior lobe
(adenohypohysis) and the posterior lobe (neurohypophysis). The anterior lobe
produces the following hormones, which are regulated by the hypothalamus:

• Growth hormone - Stimulates growth of bone and tissue (growth hormone

deficiency in children results in growth failure. Growth hormone deficiency in
adults results in problems in maintaining proper amounts of body fat and muscle
and bone mass. It is also involved in emotional well-being.)

• Thyroid-stimulating hormone (TSH) - Stimulates the thyroid gland to produce

thyroid hormones (A lack of thyroid hormones either because of a defect in the
pituitary or the thyroid itself is called hypothyroidism.)

• Adrenocorticotropin hormone (ACTH) - Stimulates the adrenal gland to

produce several related steroid hormones

• Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) - Hormones

that control sexual function and production of the sex steroids, estrogen and
progesterone in females or testosterone in males

• Prolactin - Hormone that stimulates milk production in females

The posterior lobe produces the following hormones, which are not regulated by the
hypothalamus:

• Antidiuretic hormone (vasopressin) - Controls water loss by the kidneys

• Oxytocin - Contracts the uterus during childbirth and stimulates milk

production

25
 The hormones secreted by the posterior pituitary are actually produced in the
brain and carried to the pituitary gland through nerves. They are stored in the
pituitary gland.

3. Gonads

Ovaries

Two groups of female sex hormones are produced in the ovaries, the
estrogens and progesterone. These steroid hormones contribute to the
development and function of the female reproductive organs and sex
characteristics. At the onset of puberty, estrogens promotes:

• The development of the breasts

• Distribution of fat evidenced in the hips, legs, and breast
• Maturation of reproductive organs such as the uterus and vagina

Progesterone causes the uterine lining to thicken in preparation for

pregnancy. Together, progesterone and estrogens are responsible for the
changes that occur in the uterus during the female menstrual cycle.

The Female Reproductive System

Our overview of the reproductive system begins at the external genital area— or
vulva—which runs from the pubic area downward to the rectum. Two folds of fatty,
fleshy tissue surround the entrance to the vagina and the urinary opening: the labia
majora, or outer folds, and the labia minora, or inner folds, located under the labia
majora. The clitoris, is a relatively short organ (less than one inch long), shielded by a
hood of flesh. When stimulated sexually, the clitoris can become erect like a man's

26
penis. The hymen, a thin membrane protecting the entrance of the vagina, stretches
when you insert a tampon or have intercourse.

The Vagina

The vagina is a muscular, ridged sheath connecting the external genitals to the
uterus, where the embryo grows into a fetus during pregnancy. In the reproductive
process, the vagina functions as a two-way street, accepting the penis and sperm
during intercourse and roughly nine months later, serving as the avenue of birth
through which the new baby enters the world.

The Cervix

The vagina ends at the cervix, the lower portion or neck of the uterus. Like the
vagina, the cervix has dual reproductive functions.

After intercourse, sperm ejaculated in the vagina pass through the cervix, then
proceed through the uterus to the fallopian tubes where, if a sperm encounters an
ovum (egg), conception occurs. The cervix is lined with mucus, the quality and quantity
of which is governed by monthly fluctuations in the levels of the two principle sex
hormones, estrogen and progesterone.

When estrogen levels are low, the mucus tends to be thick and sparse, which
makes it difficult for sperm to reach the fallopian tubes. But when an egg is ready for
fertilization and estrogen levels are high the mucus then becomes thin and slippery,
offering a much more friendly environment to sperm as they struggle towards their goal.
(This phenomenon is employed by birth control pills, shots and implants. One of the
ways they prevent conception is to render the cervical mucus thick, sparse, and hostile
to sperm.)

HOW THE SYSTEM FITS TOGETHER

27
 Deep within the pelvic region lie the specialized female organs that make
conception and pregnancy possible. In this cutaway view, you can see how the cervix
acts as the gateway between the vagina and the uterus, where an egg, if fertilized, will
be nurtured and, over the course of nine months, grow to be a newborn child. Riding
atop the uterus are the two ovaries, storehouse of all a woman's eggs. The fallopian
tubes, where fertilization by a sperm will occur, are narrow conduits connecting each
ovary to the uterus.

Later, at the end of pregnancy, the cervix acts as the passage through which
the baby exits the uterus into the vagina. The cervical canal expands to roughly 50
times its normal width in order to accommodate the passage of the baby during birth.

The Uterus

The uterus is the muscular organ which holds the developing baby during the
nine months after conception. Like the cervical canal, the uterus expands considerably
during the reproductive process. In fact, the organ grows to from 10 to 20 times its
normal size during pregnancy.

A CLOSER LOOK AT THE UTERUS

28
 Note the thick muscular walls—crucial when the baby is ready for delivery—and the
lush inner lining, or endometrium, which nurtures the developing egg. From this angle,
you can also see how the fallopian tubes cradle the ovaries in their feathery fimbria, ready
to conduct a mature egg away from the ovary and on into the uterus.

Each month the uterus goes through a cyclical change, first building up its
endometrium or inner lining to receive a fertilized egg, then, if conception does not
occur, shedding the unused tissue through the vagina in the monthly process called
menstruation.

The Fallopian Tubes

Beyond the uterus, the fallopian tubes connect the rest of the system to the
ultimate source of the eggs, the two ovaries. Each of these tubes is roughly five inches
long and ranges in width from about one inch at the end next to the ovary, to the
diameter of a strand of thin spaghetti.

The trumpet-shaped part near the ovary has about 20 to 25 feathery projections
called fimbria, one of which is attached to the ovary. It is the fimbria that each month
urge an egg to exit the ovary and begin its trip towards the uterus.

The Ovaries

29
 The ovaries are a woman's storehouse of egg cells. They are among the first
organs to be formed as a female baby develops in the uterus. At the 20-week mark, the
structures that will become the ovaries house roughly 6 to 7 million potential egg cells.
From that point on, the number begins to decrease rapidly. A newborn infant has
between 1 million to 2 million egg cells. By puberty the number has plummeted to
300,000. For every egg that matures and undergoes ovulation, roughly a thousand will
fail, so that by menopause, only a few thousand remain. During the course of an
average reproductive lifespan, roughly 300 mature eggs are produced for potential
conception.

The egg cells remain inactive until puberty, when the reproductive system is
activated by a cascade of substances called sex hormones. Then, each month about 20
egg cells, each encased in a sac called a follicle, begin to ripen. Responding selectively
to the sex hormones, one follicle becomes dominant while the others shrink away. The
egg within the dominant follicle continues ripening to maturity. Then, helped by the
feathery fimbria, it exits the ovary and enters the adjacent fallopian tube to be either
fertilized or, if conception fails to occur, expelled from the body during menstruation.

If fertilization is to occur, it usually happens when the egg's journey is about one-
third complete. Once a sperm unites with the egg, its surrounding gelatinous coat
releases substances that prevent more sperm from entering.

The Corpus Luteum

The fertilized egg then continues on its journey through the fallopian tube. About
four or five days after fertilization, it enters the uterus and implants itself on the
endometrium, which has been primed by the sex hormones to accept and nurture it.

FROM FOLLICLE TO “YELLOW BODY”

30
 Host to a lifetime supply of eggs, the ovaries each month launch about 20
contenders towards potential conception. Each ripens in a supporting follicle, growth of
which is triggered by the aptly named “follicle-stimulating hormone.” In turn, the winning
follicle gives off increasing amounts of the hormone estrogen, which prepares the lining of
the uterus for pregnancy. Once a mature egg has begun its trip through the fallopian tube,
remnants of the winning follicle form the corpus luteum, or “yellow body.” Progesterone
from the corpus luteum halts development of the remaining follicles and brings the lining of
the uterus to peak preparedness.

Meanwhile, the follicle that held the egg still has a critical role to play. First it
shrinks markedly, then begins to accumulate fatty substances, or lipids, that give it a
yellowish tinge. The resulting structure, now called the corpus luteum (yellow body),
produces progesterone and estradiol, two of the hormones critical to reproduction.

In a non-pregnant woman, the corpus luteum lasts for about 14 days, after which
it shrinks and dries up, eventually becoming a speck of fibrous scar tissue. If conception
occurs, however, a hormone from the developing placenta, which surrounds the baby in

31
the uterus, stimulates the corpus luteum to maintain its production of progesterone
during the first trimester of pregnancy.

Reproduction: The Role of Hormones

Conception and pregnancy are governed by the egg and flow of sex hormones
that each month prompt crucial changes in your reproductive system. Production of these
hormones depends, in turn, on the changes they themselves produce, so that an elegant
cycle of feedback and response dictates their levels.

The most notable outward sign of this carefully balanced interplay is, of course,
your monthly menstrual cycle or period. This cycle begins with your first day of menstrual
bleeding and ends at the start of the next period. The average cycle is from 25 to 34 days
and the average menstrual flow lasts from 3 to 5 days

The menstrual cycle has two distinct phases: the follicular (proliferative) phase
during which the egg grows and gets ready to enter the fallopian tube; and the luteal
(secretory) phase when the corpus luteum is prepared to help maintain a possible
pregnancy. The endometrium, or uterine lining, starts to grow, and reaches its greatest
thickness during the luteal phase. If conception fails to occur, the lining is then discarded
in the menstrual flow, and the cycle begins anew. This entire circle of changes is directed
by the on/off production of six key hormones.

Estrogen, Progesterone, Androgen

While many hormones interact in the reproductive process, perhaps the three
most well-known are estrogen, progesterone, and androgen.

There are several forms of estrogen but the one most important for reproduction
is estradiol, a substance secreted by the ovary. In addition to being responsible for the
development of sexual characteristics in women, estrogen governs the monthly
thickening of the endometrium and the quantity and quality of cervical and vaginal mucus
so important to the successful passage of the sperm.

Progesterone, the principle hormone secreted by the corpus luteum, is chiefly

responsible for preparing the endometrium to accept a fertilized egg. The corpus luteum
continues to secrete progesterone during the first three months of pregnancy until the

32
placenta can fend for itself.

Androgen is produced by follicle cells in the ovary and is converted into additional
estrogen. Androgen causes the disappearance of all of the follicles not destined to
produce an egg during a given monthly cycle.

Gonadotropin Releasing Hormone

Called “GnRH” for short, this is the hormone that governs the level of estrogen in
your body. It is produced by the hypothalamus, a gland located at the base of the brain.

At the end of your mentstrual cycle, declining levels of estrogen in your

bloodstream spark the hypothalamus into a burst of activity, doubling or even tripling
productin of GnRH. Production occurs in pulses. During the first, or follicular, phase of
your cycle, when production is highest, the pulses come at hourly intervals. Later, during
the luteal phase, they slack off to about once every two or three hours. Finally, as the
luteal phase ends and estrogen levels reach their lowest ebb, the cycle starts again.

Gonadotropins

GnRH does its work through two intermediaries: follicle stimulating hormone
(FSH for short) and luteinizing hormone (LH for short). These two hormones, known as
gonadotropins, are produced by the pituitary gland. When levels of GnRH rise in your
bloodstream, the pituitary responds by increasing its release of FSH and LH. The two
hormones are then free to begin working changes in the ultimate target, the ovary and
the egg-containing follicles.

KEY PLAYERS IN THE MONTHLY HORMONAL CYCLE

33
Two master hormones govern all the others. Gonadotropin Releasing Hormone (GnRH)
from the hypothalamus in the brain sparks release of follicle stimulating hormone and
luteinizing hormone from the pituitary gland, which in turn prompt production of estrogen and
progesterone in the ovaries. If conception occurs, Human Chorionic Gonadotropin (HCG)
from the developing placenta takes over, perpetuating production of progesterone. High
progesterone levels shut down production of GnRH, leaving HCG in control for the duration
of the pregnancy.

ETIOLOGY

Predisposing Remarks Rationale Justification

34
 factors
Age X PIH is more common in pregnant The patient is
women over age 40. Many times, PIH currently
develops during the second half of 25years old.
pregnancy, usually after the 20th Age is not a
week, but it can also develop at the predisposing
time of delivery or right after delivery. factor in the
Source: http://www.emaxhealth. patient’s case
com/40/1197.html because the
gestational
Citation: Women over age 35 may be hypertension
less fertile than younger women only affects
because they tend to ovulate (release pregnant
an egg from the ovaries) less women ages
frequently. Certain health conditions 35 and above,
that are more common in this age and 20 years
group also may interfere with below.
conception.
Source: http://www.marchofdimes.
com/professionals/14332_1155.asp
History of  Women with pre-existing, or chronic, According to
Hypertension high blood pressure are more likely to the patient’s
have certain complications during family
pregnancy than those with normal background,
blood pressure. However, some history of
women develop high blood pressure hypertension is
while they are pregnant (often called present
gestational hypertension). because her
Source: http://www.nhlbi.nih.gov mother is also
/health/public/heart/hbp/hbp_preg.htm hypertensive.
Race  Brown race had the highest risk of Our patient
gestational belongs to the
hypertension/preeclampsia. brown race so
Source: http://www.ncbi.nlm.nih. this factor is
gov /pubmed/ 16949421 considered to
35
 be a
contributory to
her illness.
`

Precipitating Remarks Rationale Justification

Factors
Pregnancy  Gestational hypertension occurs The patient is
in up to 5% of all pregnancies pregnant
Source:
http://emedicine.medscape
.com/article/261435-overview
Primigravida  A woman who is pregnant for the The patient is a
first time has the possibility of primigravida.
having gestational hypertension. Since this is the
Source: http://cancerweb.ncl. first time that the
ac.uk/cgi-bin/omd?primigravida patient got
pregnant
Diet  Eating a balanced diet and The patient’s diet
keeping your weight within healthy consists of instant
levels may help to reduce the noodles, dried
chances of you developing fish, barbecues
complications. which are not
Source: Maternal & Child Health nutritious.
Nursing, 4th Edition by Adele
Pillitteri

SYMPTOMATOLOGY

Symptom Rationale Remarks Justification

This happens because the heart  The patient
is forced to pump against the encountered
Hypertension rising peripheral vascular hypertension during
resistance due to vasospasm, her pregnancy
therefore increasing the blood
36
 pressure. A pregnant woman
with gestational hypertension
Precipitating Factors
Predisposing who is experiencing
Hypertension Pregnancy
factor hypertension has a blood Primigravida Diet
Hereditary
pressure of 140/90 mm Hg and
above.
Increase cardiac
Visual output
Increased blood pressure due to  The patient stated
Disturbances cerebral hypertension which will that whenever her

Interrupts the lead to the damage of cerebral blood pressure

Injures
action of cortex, the visual center in the increases she
endothelial cells
prostaglandin
brain. experience
Headache An increase in headaches X The patient did not
Decrease Increase
during the first trimester is experience
prostacycli thromboxa
n nebelieved to be caused by the headache
surge of hormones along with
an increase in the blood volume
circulating Vascular
throughout your Increase blood
body. spasm flow
Edema Increased in interstitial fluid  Patient has edema
Heart is force to
volume ≥ 2.5pump
to 3 L may be on lower extremities.
caused by increased capillary
Vasoconstricti
filtration pressure
on and capillary
permeability.
Decrease blood
flow
Pathophysiology
Lack of nutrients
Increase blood
distribution into the
pressure
placenta

GESTATION
AL
HYPERTENS
ION

If treated
Prolonged life If not treated:
Maternal
Death 37
Medications: Fetal Death
Methyldopa
Nifedipine
Magnessium Sulfate
38
DOCTOR’s ORDERS

39
 Date
Doctor’s Order Rationale Remark
Ordered
Jan. 10, Admit patient to DR > To monitor and give proper treatment Done.
2011 and medication for the patient during labor Admitted 1/10/11
9:20AM and delivery.
Secure consent > To document patient’s agreement for Done.
admission and management Placed in Patient’s
Chart
Monitor VS q1° > Regular monitoring of patient’s condition Done
and to determine any abnormalities or VS recorded in
deviations from normal range patient’s chart
FHT q30¹ > To closely monitor baby’s Fetal Heart Done
Rate and determine deviation from normal
range.
Diagnostic procedures: Done.
• CBC > assess blood & blood forming tissue Refer to Table of
functioning Results
• Blood Typing > serves as reference for future procedures Done.
involving blood products, i.e. transfusion Refer to Table of
> avoid blood related complications Results
• Urine Albumin > evaluates urine for the presence of Done.
albumin Refer to Table of
Results
• HBsAg > used to screen for and detect HBV Done.
infections Refer to Table of
Results
EFM > to keep track of the heart rate of the Done.
baby (fetus) and the strength and duration
of the contractions of the uterus.
Venoclysis with D5LR 1L > To provide sufficient electrolytes and Done.
at 30gtts/min calories and as a source of water for Documented in IV
hydration. sheet
Medications: > Bactericidal action against sensitive Done.
• Ampicillin 1g q6° organisms; Documented in
> inhibits synthesis of bacterial cell wall, Medication Sheet
causing cell death.
• Hydralazine 5mg IVTT > For the treatment of essential Done.
PRN for hypertension Documented in Meds
DBP>100mmHg Sheet
• Nifedipine 5mg q8° > Inhibits the influx of calcium through the Done.
cell membrane, resulting in a depression of Documented in Meds 40
contraction. Sheet
> For the management of hypertension.
Refer > Proper referral for any unusual change in Done
patient’s condition or problems with
 DIAGNOSTIC EXAMS

Date Nursing
Normal Patient’ Clinical
Ordere Type of Test Responsibili
Value s Result Significance
d ty
CBC Hemoglobin 115 – 155 119
Jan. 10, * RBC’s, Hgb, Hct are important g/L > patient
2011 indicators of the oxygen-carrying RBC Count 4.20 – 4.88 education
capacity of the blood 6.10 to reduce
* WBC’s are an indicator of immune x10^6/uL anxiety
function WBC Count 5.0 – 18.0 17.8 related to
* Platelet is indicator clotting capacity x10^3/uL > indicate the
of the blood Neutrophil 0.55 – 0.85 - infection procedure
Differential Count 0.65 H
*indicator of bacterial or viral infection Lymphocyte 0.25 – 0.15 - > low resistance
*provides detailed percentage of the s 0.35 L to infection
major types of WBC ( detailed status of
immune function)

41
 Date Patient’s Nursing
Type of Test Clinical Significance
Ordered Result Responsibility
Blood Type A > serves as reference for future > patient education
Jan. 10,
Blood procedure involving blood about the
2011 Blood Type
Typing Positive products, i.e. transfusion procedure
Rh > avoid blood related complications

Date Patient’s Nursing

Type of Test Clinical Significance
Ordered Result Responsibility
Urinalysis > No presence of > Instruct patient to
Jan. 10, (albumin) Negative albumin which obtain midstream.
2011 * evaluates urine for the presence of indicates proteinuria.
albumin

Date Patient’s Nursing

Type of Test Clinical Significance
Ordered Result Responsibility
HbsAg (hepatitis B surface antigen) Nonreactive > patient is currently > patient education
Jan. 10, * used to screen for and detect HBV not infected with about the procedure
2011 infections hepatitis B

42
 Drug Study

Generic Name Nifedipine

Brand Name Adalat CC, Afeditab

Classification Calcium channel blocker

Antianginal
Antihypertensive
Suggested dose 5mg 1 cap q8°

Mode of Action Inhibits the influx of calcium through the cell

membrane, resulting in a depression of contraction.

Dilates coronary vessels in both normal and ischemic

tissues and inhibits spasms of coronary arteries

Indication For the management of vasospastic angina, chronic

stable angina and hypertension.

Contraindication Hypersensitivity.

Adverse reaction • CV: peripheral and pulmonary edema,

hypotension, palpitations.
• CNS: dizziness, sleep disturbances, headache.
• Respiratory: dyspnea, cough, respiratory
infection, chest congestion.
Drug interaction • Barbiturates / ↓ Nifedipine effects
• Cimetidine / ↑ Bioavailability of nifedepine

Nursing • Ensure that patients do not chew or divide SR

intervention tablets.
• Monitor patient carefully (BP, cardiac rhythm,
and output) while drug is being adjusted to
therapeutic dose
• Note any hypotensive response, increased HR
that result from peripheral vasolidations
• If therapy is to be discontinued, gradually
decrease dosage to prevent withdrawal
syndrome
• Maintain fluid intake of 2-3 L/day to avoid
constipation
43
 • Avoid activities that require mental alertness
until drug effects realized; may cause dizziness
or lightheadedness.
• Inform patient for possible side effects: Nausea,
vomiting (eat frequent small meals); dizziness,
light-headedness, vertigo (avoid driving,
operating dangerous machinery; take special
precautions to avoid falling); muscle cramps,
joint stiffness, sweating, sexual difficulties
(reversible)
• Report persistent headache, flushing, nausea,
palpitations.

Generic Name Ampicillin

Brand Name Ampicillin sodium

Oral:Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin

(CAN), Nu-Ampi ( CAN), Penbritin (CAN), Principen

Classification Antibiotic, Penicillin

Suggested dose 1g q6° IVTT

Mode of Action Bactericidal action against sensitive organisms; inhibits

synthesis of bacterial cell wall, causing cell death.

Indication • Treatment of infections caused by susceptible

strains of Shigella, Salmonella, E. coli, H.
influenzae, P. mirabilis, N. gonorrhoeae,
enterococci, gram-positive organisms (penicillin
G–sensitive staphylococci, streptococci,
pneumococci)
• Meningitis caused by Neisseria meningitidis
• Unlabeled use: Prophylaxis in cesarean section in
certain high-risk patients
Contraindication • Contraindicated with allergies to penicillins,
cephalosporins, or other allergens.
• Use cautiously with renal disorders.
Adverse reaction • CNS: Lethargy, hallucinations, seizures
• CV: CHF
44
 • GI: Glossitis, stomatitis, gastritis, sore mouth,
furry tongue, black "hairy" tongue, nausea,
vomiting, diarrhea, abdominal pain, bloody
diarrhea, enterocolitis, pseudomembranous
colitis, nonspecific hepatitis
• GU: Nephritis
• Hematologic: Anemia, thrombocytopenia,
leukopenia, neutropenia, prolonged bleeding
time
• Hypersensitivity: Rash, fever, wheezing,
anaphylaxis
• Local: Pain, phlebitis, thrombosis at injection site
(parenteral)
• Other: Superinfections—oral and rectal
moniliasis, vaginitis

Drug interaction • Increased ampicillin effect with probenecid

• Increased risk of rash with allopurinol
• Increased bleeding effect with heparin, oral
anticoagulants
• Decreased effectiveness with tetracyclines,
chloramphenicol
• Decreased efficacy of hormonal contraceptives,
atenolol with ampicillin
Nursing • Check IV site carefully for signs of thrombosis or
intervention drug reaction.
• Do not give IM injections in the same site;
atrophy can occur. Monitor injection sites.
• Administer oral drug on an empty stomach, 1 hr
before or 2 hr after meals with a full glass of
water; do not give with fruit juice or soft drinks.
• Take this drug around-the-clock.
• Take the full course of therapy; do not stop
taking the drug if you feel better.
• You may experience these side effects: Nausea,
vomiting, GI upset (eat frequent small meals),
diarrhea.

Generic name Hydralazine

45
Brand name
Apresoline

Classification Antihypertensive Agents; Vasodilator Agents

Suggested Dose 5mg IVTT PRN for DBP > 100mmHg

Mode of Action A vasodilator, hydralazine works by relaxing blood

vessels (arterioles more than venules) and increasing
the supply of blood and oxygen to the heart while
reducing its workload.

Indication • For the treatment of essential hypertension,

alone or as an adjunct.
• Also for the management of moderate to severe
hypertension, congestive heart failure, and
hypertension secondary to pre-
eclampsia/eclampsia.
Contraindication Coronary artery disease; mitral valvular rheumatic heart
disease.

Adverse Reaction • Diarrhea

• Headache
• Nausea or Vomiting

Drug Interaction  Indomethacin/decrease hydralazine effects

 Sympathomimetics (epinephrine,
norepinephrine / increase tachycardia, angina
 Aconite / Increase Toxixity, death
Nsg.  Weight daily, I&OLE prep, ANA titer before
Responsibilities starting therapy and during treatment.
 Assess for fever, joint pain, rash, soar throat
(lupus like symptoms); notify prescriber.
 Check for , tachycardia, palpitations, headache,
nausea

Generic Name Oxytocin

46
Brand Name Pitocin
Classification • Uterine – active agents
• Antihemorrhagic, postabortion uterine bleeding
• Antihemorrhagic, postpartum uterine bleeding
• Diagnostic aid, placental reserve
• Diagnostic aid, utero-placental insufficiency
• Lactation stimulant
• Oxytocic
Ordered Dosage 7 “U” at 10 gtts /min to incorporate on present IVF
Mechanism of It stimulates uterine contractions by acting via receptors
Action in uterine muscles in induction and augmentation of
labour.
Indication Initiation or improvement of uterine contractions to
achieve early vaginal delivery for maternal or fetal
reasons (IV); as adjunctive therapy in the management of
inevitable or incomplete abortion (IV); stimulation of
uterine contractions during third stage of labor (IV);
stimulation reinforcement of labor, as in selected cases of
uterine inertia (IV); control of postpartum bleeding or
hemorrhage (IV, IM); induction of labor in patients with a
medical indication for the initiation of labor (eg, Rh
problems, maternal diabetes, preeclampsia at or near
term) when in the best interest of mother and fetus or
when membranes are prematurely ruptured and delivery
is indicated (IV).
Contraindications
Hypersensitivity to the drug; significant cephalopelvic
disproportion; inadequate, undeliverable fetal position;
obstetric emergencies in which surgical intervention is
preferred; cases of fetal distress in which delivery is not
imminent; prolonged use in uterine inertia or severe
toxemia; hypertonic or hyperactive uterine patterns;
when adequate uterine activity fails to achieve
satisfactory response; when vaginal delivery is
contraindicated (eg, invasive cervical carcinoma, active
herpes genitalis, total placenta previa, vasa previa,

47
 prolapse of the cord).

Drug Interactions: Droxidopa because its actions and side effects may be
increased by Oxytocin , possibly resulting in high blood
pressure.
Oxytocin when given with vasopressors increases their
vasconstricting effect – resulting in hypertensive crisis.
Side/Adverse Nausea; vomiting; more intense or abrupt contractions
Reaction of the uterus.
Allergic reaction: (shortness of breath; closing of the
throat; hives; swelling of the lips, face, or tongue; rash;
or fainting);
• Difficulty urinating;
• Chest pain or irregular heart beat;
• Difficulty breathing;
• Confusion;
• Sudden weight gain or excessive swelling;
• Severe headache;
• Rash;
Excessive vaginal bleeding; or seizures.
Nursing • Monitor vital signs and uterine contractions
Responsibilities • Assess patient for hypersensitivity / contraindications
before use.
• Instruct patient to report immediately if difficulty of
breathing, rash, continued bleeding or changes in
heart rate.
• Advise patient to check with their physician the risks of
using oxytocin during pregnancy and breastfeeding.
• If Oxytocin contains particles or is discoloured, or if the
vial is cracked or damaged in any way, do not use it.
• Instruct patient to keep this product, as well as
syringes and needles, out of the reach of children.
• Do not reuse materials. Dispose it properly after use.
• Administer by IV infusion only. Not for intradermal,
subcutaneous, IM, IV bolus, or intra-arterial
administration in this situation.

Generic Name Hyoscine NBB

48
Brand Name Ascopen
Classification Belladona alkaloid, antimuscarinic
Ordered Dosage 1amp IVTT q2° x 3doses
Mechanism of Inhibits muscarinic actions of acetylcholine on autonomic
Action effectors innervated by postganglionic cholinergic
neurons. May effect neural pathways originating in the
inner ear to inhibit nausea and vomiting.
Indication - Spastic states
- Delirium, preanesthetic sedation and obstetric amnesia
with analgesics
- To prevent nausea and vomiting from motion sickness
- Spasms of the delivery pathways during the parturition;
manual extraction of the placenta.
Contraindications • Contraindicated in patients with angleclosure
glaucoma, obstructive uropathy, obstructive disease of
the GI tract, asthma, chronic pulmonary disease,
myasthenia gravis, paralytic ileus, intestinal atony,
unstable CV status in acute hemorrhage, tachycardia
from cardiac insufficiency, or toxic megacolon.
• Contraindicated in patients with hypersensitive to
belladonna or barbiturates.
• Use cautiously in patients with autonomicneuropathy,
hyperthyroidism, coronary artery disease, arrhythmias,
heart failure, hypertension, hiatal hernia with ferlux
esophagitis, hepatc or renal disease, known as
suspected GI infection, or ulcerative colitis.
• Use cautiously in children.

• Use cautiously in patients in hot or humid

environments; drug can cause heat stroke.
Side/Adverse Overdose may produce temporary paralysis of ciliary
Reaction muscle; papillary dilation; tachycardia; palpitations;
hot, dry, or flushed skin; absence of bowel sounds;
hyperthermia; increased respiratory rate; EKG
abnormalities; nausea; vomiting; rash over face or
upper trunk; CNSstimulations; and psychosis (marked
by agitation, restlessness, rambling speech, visual
hallucinations, paranoid behavior, and delusions,
49
 followed by depression).

Nursing • Advise patient to apply patch the night before a

Responsibilities planned trip. Transdermal method releases a
controlled therapeutic amount of drug. Transderm-
Scop is effective if applied 2 or 3 hours before
experiencing motion but is more effective if applied
12 hours before.
• Instruct patient to remove one patch before
applying another
• Instruct patient to wash and dry hands thoroughly
before and after applying the transdermal patch (on
dry skin behind the ear) and before touching the eye
because pupil may dilate. Tell patient to discard
patch after removing it and to wash application site
thoroughly.
• Tell patient that if patch becomes displaced, he
should remove it and apply another patch on a fresh
skin site behind the ear.
• Alert patient to possible withdrawal signs or
symptoms (nausea, vomiting, headache, dizziness)
when transdermal system is used for longer than 72
hours.
• Advice patient that eyes may be sensitive to light
while wearing patch. Advice patient to wear
sunglasses for comfort
 Urge patient to report urinary hesitancy or urine
retention

Nursing Theories

Florence Nightingale

Florence Nightingale’s work is closely related to her philosophical orientation of

the patient-environment interaction and the principles and rules on which nursing
practice was founded. Nightingale’s emphasis on surroundings reflected a predominant
concern when sanitation was a major health problem in the late 1800s. Nightingale
50
believed that disease was a reparative process and that the manipulation of the patient’s
surroundings- ventilation, warmth, light, diet, cleanliness, and noise – would contribute to
the reparative process and the health of the patient. She recorded her directions
regarding ventilation, warmth, light, diet, cleanliness, and noise in Notes on Nursing:
What It Is and What Is Not. She did not subscribe to the germ theory that was being
postulated during her lifetime. Nightingale’s beliefs regarding nursing formed the
foundation for professional nursing and distinguished nursing from the work of domestic
servants. She contributed to nursing theory by explicating a philosophical approach to
nursing with a focus on nursing and the patient-environment relationship. She is also
renowned for pioneering statistical analysis, which she applied to health and
professional nursing.

Relation to the Patient:

Cleanliness was promoted only through the bed side care that the student nurses
can provide and the utilized resources that can be found in the hospital. The floors were
mopped. Health teachings on cleanliness were also done by the student nurses to help
the patient promote a healthy process of wellness.

Lydia Hall

(Core Care Cure)

“Nursing is a distinct body knowledge that provides nursing care to patients who
are in need of nursing care in support of medical interventions, in collaboration with other
members of the health team or exclusively and independently by the nurse herself”

51
 Lydia Hall’s theory of nursing involves three interlocking circles, each
representing one aspect of nursing. The care aspect represents intimate bodily care of
the patient. The core aspect deals with the innermost feelings and motivations of the
patient. The cure aspect tells how the nurse helps the patient and family through the
medical aspect of care. The main tool the nurse uses to help the patient realize his or
her motivations and to grow in self-awareness is that of reflection.

Relation to Patient:

Care is given by the nurses through providing comfort, giving necessary

interventions and health teachings, and having a good nurse-patient relationship .To
help the patient fully recover, the patient’s therapeutic self-care is very important. If the
patient is determined to be cured，cooperation is needed and if she is eager to comply
with her treatment, then there is a better chance of getting better. It is also important the
nurse is part of the Core because we are the one who assists not only through our
hands and knowledge but also through our heart. We are also involved in her Cure, we
serve as advisers guiding her on her health. As nurses, it is also important that we
become an advocate which means that we are there as a friend to her, listening to her
problems and empathizing with her.

King’s Goal Attainment Theory

This theory wants to incorporate the concept of the nurse and the patient
mutually communicating information, establishing goals, and taking action to attain
goals. It describes a situation in which two people, usually strangers, come together in a
health care organization to help or be helped to maintain a state of health. The focus of
the nurse is to help the individual maintain health and function in an appropriate role.

52
The Goal Attainment Theory addresses interaction, perception, time, space,
communication, transaction, role, stress and growth and development.

Relation to Patient:

Our patient had great rapport with the group and was able to establish goals and
attain them. Since it’s the role of the nurse to assess the patient and discuss the
problems, it is also the role of the patient to cooperate with the nurse not only with the
assessment but in the interventions as well, so that they will be able to accomplish their
desired goal. It is important that it is not only the nurse who will identify the problem but
the patient should acknowledge it as well so that there will be cooperation between
them. So in this case, the patient was able to identify and cooperate with the group.

53
 Date / Cues Need Nsg Objective of Care Nursing Intervention Evaluation
Time Diagnosis

Subjective: N Fluid volume Within 8hr of care 1. Record accurate intake and output January 10,
excess the patient will be ® Accurate I&O is necessary for 2010
J “hubag akong U related to able to: determining renal function and fluid
tiil saw tuo decrease replacement needs and reducing 8:00 pm
A nako na tiil, T oncotic -understand the risk of fluid overload.
wala ko pressure importance of
N kabalo ngano R prescribed fluid 2. Assess skin, face, and dependent
secondary to GOAL MET
U ni” I proteinuria. amounts. areas for edema.
® Edema occurs primarily in
A T ® Increase - verbalize dependent tissues of the body
isotonic fluid understanding of Patient
R Objective: I retention. individual 3. Plan oral fluid replacement with understands the
dietary/fluid patient, within multiple restrictions importance of
Y Presence of O (GORDON’S) restrictions. ®Helps avoid periods without fluids,
edema on prescribed fluid
minimize boredom of limited amounts.
10, lower N -stabilize fluid choices, and reduces sense
extremities. volume deprivation and thirst.
2 A “ok sir! Dili
-demonstrate mulapas og 1.5
4. Administer/restrict fluids as ka litro akong
0 L behavior to indicated. imnum sa isa ka
monitor fluid status ® Fluid management is usually
1 adlaw” as
and reduce calculated to replace output from
recurrence of fluid verbalized by the
1 M all sources plus estimated client.
excess. insensible losses.
E
-list signs that 5. Auscultate for a third sound, and
T requires further assess for bounding peripheral Patient stabilized
evaluation. pulses. fluid volume as
4:00 pm A ®These are signs of fluid overload. evidenced by
B balanced I and
6. Assess for crackles in lungs, O, vital signs
changes in respiratory pattern,

54
O shortness of breath, and within client
orthopnea. normal limits,
L ® These are early signs of pulmonary stable weight.
congestion.
I
7. Restrict sodium intake as
C prescribed.
®Sodium diets of 2 to 3 g are usually
prescribed.
P
8. Administer or instruct patient to
A take diuretics as prescribed.
®Diuretic therapy may include
T several different types of agents
for optimal therapy, depending on
T the acuteness or chronicity of the
problem. For chronic patients,
E
compliance is often difficult for
R patients trying to maintain a normal
lifestyle.
N
9. Elevate edematous extremities.
® This increases venous return and,
in turn, decreases edema.

10. Use appropriate garments,

avoid crossing of legs or ankles.
®This prevents venous pooling.

55
 Date Cues Need Nursing Diagnosis Objective of Interventions Evaluation
& Care
Time
J N
S: Breastfeeding, Within 1-2 hours 1. Suggest moist heat to be GOAL MET
A U of nursing care applied 3-5 minutes prior to
“gamay man ineffective related to and management, feeding. After 1 hour of
N lang ang T Low Milk Supply our patient will: ®This will improve perfusion nursing care and
mulabas na management:
U gatas sa R ®low milk supply is 1. Participate in 2. to the area and enhance milk-
ako…” as caused by activities that ejection reflex (let-down). 1) Patient
A I ineffective or
verbalized by would 3. Recommend avoidance or was able to
R the patient T infrequent emptying promote overuse of supplemental feedings explain the
of milk that will lead effective and pacifier unless indicated. significance of
Y O: I to a chemical breastfeeding. ®use of supplemental feedings may breastfeeding
inhibitor in residual 2. learn the lessen infant’s desire for and able to
• Use of O milk accumulates importance of breastfeed demonstrate
commercial and decreases breastfeeding the proper
11, infant N further milk 4. Explain the benefits of breast breastfeeding
uses alternative
formula production. resources in feeding, the mechanisms involve technique
Improper A
breastfeeding the in lactation, the proper breast care The use of
breastfeeding infant breastfeeding
2011 L
technique is and most especially the proper supplements is
demonstrated www.lutvita.wordpre breast feeding position. minimize
-
ss.com
10:00 AM M ®to promote breast feeding because
breasmilk contains all the
E necessary

T nutrients a baby needs for the first

A 6 months of life

5. Encourage the use of breast

56
Date Cues Need Nursing Diagnosis Objective of Interventions Evaluation
& Care
Time
B pump with bilateral collection
chamber
O ®using this device increases the
milk supply.
L
6. Encourage frequent rest
I periods.
C ®to limit fatigue and promotes
relaxation

7. Support the patient and

P provide information to correct
breastfeeding techniques, such as
A changing positions from one
feeding to next
T ® to distribute sucking pressure,
prevent sore nipple, and the
T
knowledge of correct technique
E lessen discomfort during
breastfeeding and contributes to
R successful or effective
breastfeeding.
N
8. Discuss importance of
adequate nutrition/ fluid intake,
prenatal vitamins, or other vitamin/
mineral supplements such as
vitamin C, as indicated.
®vitamin C is a water soluble
vitamin that usually increase

57
Date Cues Need Nursing Diagnosis Objective of Interventions Evaluation
& Care
Time
breastmilk levels.
9. Suggest moist heat to be
applied 3-5 minutes
prior to feeding.

®This will improve perfusion

10. to the area and enhance milk-

ejection reflex
(let-down).

11. Recommend avoidance or

overuse of supplemental feedings
and pacifier unless indicated.
®use of supplemental feedings may
lessen infant’s desire for
breastfeed

12. Explain the benefits

of breast feeding, the mechanisms
involve in lactation, the proper
breast care and most especially

the proper breast feeding position.

®to promote breast feeding because

breast milk contains all the
necessary nutrients a baby needs
for the first 6 months of life

13. Encourage the use of breast

58
Date Cues Need Nursing Diagnosis Objective of Interventions Evaluation
& Care
Time
pump with bilateral collection
chamber
®using this device increases the
milk supply.

14. Encourage frequent rest

periods.
®to limit fatigue and promotes
relaxation

15. Support the patient and

provide information to correct
breastfeeding techniques, such as
changing positions from one
feeding to next
® to distribute sucking pressure,
prevent sore nipple, and the
knowledge of correct technique
lessen discomfort during
breastfeeding and contributes to
successful or effective
breastfeeding.

16. Discuss importance of

adequate nutrition/ fluid intake,
prenatal vitamins, or other vitamin/
mineral supplements such as
vitamin C, as indicated.
®vitamin C is a water soluble
vitamin that usually increase

59
Date Cues Need Nursing Diagnosis Objective of Interventions Evaluation
& Care
Time
breastmilk levels

60
Date/ Cues Need Nursing Diagnosis Objectives/ Nursing Intervention Evaluation
Plan
Time with Rationale with Rationale

Subjective Cue: H Risk for infection

related to episiotomy
J “bago paning E secondary to NSVD After 2-4 hours 1.) Perform meticulous hand washing by January
tahi akong span of care, caregivers and patient.
A kinatawo, basa- A ® Persons at risk for the patient will
basa ang infection are those be able to:
N L 11,
samad” whose natural ® Prevent cross contamination or bacterial
U T defense mechanisms colonization.
are inadequate to a. Identify
A H protect them from the probable cause 2011
Objective Cue:
inevitable injuries and of infection
R P 2.) Maintain aseptic techniques with @ 12:00
- T= exposures that occur
procedures towards patient. pm
Y 36.7’C E throughout the
-1 day post course of living.
vaginal R Infections occur when
delivery an organism (e.g., ® Reduce the risk of infection.
11, C
bacterium, virus,
-w/ diaper Goal Met.
E fungus, or other
parasite) invades a After 4
3.) Monitor the vital signs.
2011 P susceptible host. hours span
Breaks in the of care, my
T
integument, the patient was
body’s first line of ® To know the baseline data of the patient. able to:
@ I
defense, and/or the
10:00 O mucous membranes a. Identify
AM allow invasion by things that
4.) Observe performance of personal hygiene
N pathogens. might
practices.
Nutritional expose her
H
deficiencies, either to infection
E qualitative or
quantitative, may ® To protect against infection.
A alter to different
degrees humoral and
L
cell mediated 5.) Discuss to patient and family members to
T immune responses, limit number of visitors. 61
thereby representing
H the most common of
secondary
M ® Limits exposure to bacteria / infections.
immunodeficiency.
Date/ Cues Need Nursing Objectives of Care Nursing Interventions Evaluation
Diagnosis
Time

62
January Subjective: Coping-Stress Ineffective After the 3-hour -Introduce self to patient GOAL met
10, Tolerance Coping teaching, the client will
Pattern related to be able to meet the ®establish rapport January 10,
2011 inadequate needs of the situation
“Naguol ko ba resources as evidenced by: -Be eager to listen 2011
kay naa nay available
baby tapos (Gordon’s) ® encourages the patient to share 7:oo pm
4:00 gamay ra her feelings
pm baya ang -expression of feelings
sweldo sa -Acknowledge feelings as
expressed The patient was able
akoang bana. to share her emotions
Unsa kaya Financial
constraints -identification of other ® Acknowledging will enable with regards to the
namo ni patient to deal more appropriately situation.
pagbudget ani greatly affect options to solve the
the patient’s problem such as use of with situation
ron.”
way of living other resources - Determine previous methods of
and can be dealing with life problems The patient verbalized,
stressful to “Paningkamotan nako
Objective: some people. ® to identify successful na mapadako ug
-poor eye techniques that can be used in tarong ang amoang
contact current situation anak. Maski wala mi
kwarta, okey lang
-Ascertain client’s understanding basta kompleto ang
Nurse’s of current situation and its impact pamilya. Maski wala
-second Pocket Guide koy trabaho,
thoughts of ® to assess coping abilities and makatabang man
by Doenges, skills
sharing Moorhouse gihapon ko sa akong
and Murr -Stay with the patient bana. Kung
magkakwarta mi,
® Continuous support may help magnegosyo na lang
patient to cope easily ko, aron naa mi pang
pp. 180-184

63
-Tell patient that she can be of bac-up sa gastoson”
help to her husband even if she
does not go to work.

® encourages the patient

-Tell patient that her ability to

cope is beneficial to the whole
family and not just for her

® Makes the patient more willing

to cope with the problem

-Allow client to react in own way

without judgment

® To correct her if ever she has a

wrong way of dealing with the
situation

64
Date Cues Need Nursing Diagnosis Objective of Care Interventions Evaluation
&
Time

Subjective: C Ineffective role Within 1-2 hours of 1.) Establish rapport with January 10,
J O performance related to nursing care and the patient. 2011
A “Una pa man nako ni G inadequate role management, our ® To gain trust and 5:30 pm
N na anak. Wala pa N preparation. patient will cooperation of the patient.
A kaayo ko kabalo kung I “Goal Met”
U T ® pattern of behavior 1.) Verbalize realistic 2.) Provide an environment
R unsa ang buhaton.” I and self expression that perception and conducive to learning. Verbalized
Y V do not match the acceptance of self. ® This will facilitate understanding
E environmental context, learning. of perception
10, “mao ni akong pinaka norms and expectations. 2.) verbalized and acceptance
2 una na P understanding of 3.) Identify type of role of self as
0 baby,magkalisod E role expectations dysfunctions; e.g. evidenced by:
1 pakog adjust ani” R and obligations. developmental, situational
1 -as verbalized by the C Bibliography: or health illness transition. “magtinabangay
@ patient. E 3.) talk with family ® Patient must have a nalang mi anis
4:00 P about situations and comprehensive sa akong ka
PM Objective: T changes that have understanding of the live-in sa
● feeling of Doenges, Marillyn E.
U occurred and problem. among
concern A Nurse’s Pocket Guide limitations imposed. mahimong
● inadequate
L 10th Edition. F.A. Davis 4.) provide opportunities for anak”
self-confidence Company. Philadelphia. patient to exercise control
P Copyright 2006. Pages over as much as possible. “ kayanon namo
A 403 ® enhances self concept ni no?!basta dili
T and promote commitment lang ko niya
T to goals. byaa”
E
R 5.) Use the technique of -Identified areas
N role rehearsals to help the of

65
Date Cues Need Nursing Diagnosis Objective of Care Interventions Evaluation
&
Time

patient develop new skills. weakness/need

® to cope with changes. s.

6.) encourage and give

positive feedback for
changes and goals
achieved.
® To provide
reinforcement and facilitate
continuing of efforts

7.) make information

available for patient to
learn about role
expectations or demand
that may occur.
®provide opportunity to be
proactive in dealing with
changes.

8.) identify how patient see

self as a woman in usual
life style or role functioning.
® To promote self
awareness.

66
 PROGNOSIS

FACTORS POOR FAIR GOOD RATIONALE

Onset of Illness  She only knew that she had

hypertension when she
was admitted

Duration of illness  Patient’s illness only occur

during her pregnancy.

Precipitating Factors  The patient is willing to

change her diet in order to
improve her health status
and she already
understands causes and
effects of pregnancy.

Family support  The patient’s family is very

supportive especially her
partner who was with her
most of the time during her
pregnancy and
hospitalization

Attitude and willingness to  The patient and her

take medications and significant others tried their
treatment best to comply with all her
needed medications. Every
time, the doctor gave a new
prescription of drugs, her
partner immediately finds
ways to provide necessary
medications and other
needs to achieve faster
recovery.

Environment  During her stay in the

hospital, the room was
67
 good in which the staff
maintained the cleanliness
for the benefit of their
patients

Age  The patient’s age is 25 yrs

old .Gestational
hypertension is common
with ages 35 and above as
well as 20 and below.

Total 2 0 5 Computation:

 Poor: (2*1)/7
=.2857

 Fair: (0*2)/7
=0

 Good: (5*3)/7
Grandma = 2.1428
2
Total:
2.4285 = Good

Scoring for General Prognosis:

1-1.6 = POOR
1.7-2.3 = FAIR
2.4-3.0 = GOOD

General Prognosis:
The general prognosis of the client is good. This means that the client has
a good chance of recovering from her illness.
DISCHARGE PLAN

Medication

• Educate the patient about the importance of strict compliance to the therapeutic
regimen.

68
 • Instruct the patient to take the medication as prescribed by the doctor.
• Compliance of medicines is needed. Instruct patient and significant others to
continue home medications as prescribed.
• Check the medication bottle for name, dose, and frequency (how often its
supposed to be taken). Check the expiration date on all medications that will be
administered.
• Give patient some tips in the proper administration of the drug---read medication
labels carefully, before taking doses, discard outdated medications, never take
someone else’s medication, and don’t stop taking medication unless instructed
by the physician.
• Encourage the patient to contact his physician if a new or unexpected symptom
or another problem appears.
Exercise
• Instruct patient to avoid strenuous activities for at least a week or a month until
fully recovered.
• Encourage early ambulation.
• Promote exercise to the patient especially ROM.
• Practice deep breathing exercise.
Treatment
• Explain need of treatment after discharge and must take it seriously to prevent
complication.

• Inform patient as well as the family the danger of non compliance to treatment
regimen.

• Encourage patient to do recommended exercise. Avoid doing strenuous activity

which could slow down her recovery.

Health Teaching
• Encourage proper hygiene like taking a bath, and brushing of teeth every
meal.

• Encourage the family to maintain a clean surrounding at all times.

69
 Out Patient Order
• Inform the patient that follow-up check-ups are important to have
continuous monitoring and care even after attainment of the course
medical therapy.

• Advise the patient and family to carry out follow-up diagnostic

examinations.

• Instruct the family to report any unusual signs and symptoms experienced
by the patient.

Diet
• Encourage patient to eat a variety of nutritious food like fruits and
vegetables once instructed by the physician.

• Instruct patient to take vitamins as ordered.

RECOMMENDATION

70
To the patient:

Advise patient to have a healthy lifestyle.

Client must stop drinking alcohol.

Proper diet must be emphasized especially on the proper distribution of

carbohydrates, protein and fats.

 Encourage the patient express any concerns and talk to health professionals.

Continue to comply with the prescribed medications and treatment plans instructed by

the attending physician.

Encourage patient to have check-ups regularly.

To the Family:

• Give full support to the patient.

• Guide patient to follow doctor’s orders or prescribed medications, instructions and

proper diet.

• Ensure the patient’s safety needs.

• Assist the patient’s physiological and physical needs.

To the student nurses:

• Give health teaching and information regarding healthy lifestyle

Reference
71
 Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales

 2010 Edition Delmar Nursing Drug Handbook

 http//:www.wikepedia.com

 Nursing Theories Book

 2005 Lippincott’s Nursing Drug Guide

 Mosby’s Pocket Dictionary of Medicine, Nursing, & Health Professions, Fifth Edition
by Mosby Elsevier

 Erbs, Kozier. Fundamentals of Nursing Eighth Edition.Pearson Education,

Inc., publishing. Copyright 2007
 Mosby’s Dictionary of Medicine , Nursing, & Allied Health

 Harrison’s Principles of Internal Medicine 2

 Miller, B. & Keane, C. Encyclopedia and Dictionary of Medicine and Nursing. W.B.
Saunders

 Pillitteri, A.,(2007).Maternal and Child Health Nursing 5th edition. Lippincott William
and Wilkins. Page 427

72