Gestational

Hypertension
GROUP 4
 Introduction
Gestational Hypertension is a form of high blood pressure during
pregnancy, this condition is very common and normalization of blood
pressure is followed after giving birth.
Incidence of hypertensive disorders during pregnancy has increased
from 16.30 million to 18.08 million globally, with a total increase of
10.92 % from 1990 to 2019
2%–3% of deliveries in Karachi, Pakistan, 6.6% in south India, and
28.9% in southwest Nigeria.
In the Philippines, hypertensive disorders of pregnancy accounts for
36.7% of all maternal deaths and prevalence rate of gestational
hypertensiois 18.26%.
Nursing Process
ASSESSMENT
Environmental Status
• Rural area a bit far from the city
• House is in good condition
• Lives with live-in partner and two
children
• Proper waste segregation is
observed
• Deep well source of drinking
water
• No dangerous environmental
factors
 Lifestyle Status
• Housewife
• Spends her day by taking care of her
children and cleaning the house
• Goes to bed at 10 pm and wakes up
at 7 am for morning walk
• Wakes up in the middle of the night to
urinate, other discomforts
• MTV, Ferrous sulfate, folate
• Took methyldopa for 1 week; stopped
• No vices
 Family
History of
Health and
Illness
 History of Past Illness
The client has no history of previous hospitalization nor surgery. She completed her
childhood immunization and received two shots of a COVID vaccine. She denied
presence of allergic reactions to foods and medications other than antibiotics,
specifically Cotrimoxazole. She does not take any maintenance medications to
treat a specific illness. She gave birth to her first two children in a health center.
History of Present Illness
• A month PTA, went to a private clinic for a monthly check-up
> diagnosed with Gestational Hypertension (BP: 160/100)
> prescribed with Methyldopa
• A week after chek-up, stopped taking med, neighbors told her the
"effect" to the baby.
• Three days PTA, she cannot feel her baby's movement
> UTZ: no cardiac activity
> EPO Gel to ripen cervix
• A few hours PTA, felt regular contractions, went to the hospital
> Upon assessment: BP: 150/110 mmHg, PR: 90 bpm, RR: 20 cpm,
Temperature: 36.6 °C
> IE: fully dilated and effaced cervix, cephalic presentation, (-) BOW
13 Areas of Assessment
Social Status Mental Status
• has a good relationship • Appears lethargic and in pain
with family, friends, due to labor contractions
neighbors • Facial grimace and pain
• lacks knowledge scale of 8/10
regarding her situation, • Conscious, coherent, aware
of her surroundings
got easily influenced by
• Takes some pauses, has
the beliefs of her
little difficulty speaking due
neighbors
to pain
13 Areas of Assessment
Emotional Status Sensory Perception
• Seems to suppress tears • Does not have visual
and emotions disturbances nor eye problems
• Did not express through • Has a good sense of taste and
words but guilt and regret no deviations were found on the
were observed mouth structures
• Does not say a word when • No ears issues observed
not asked, just staring on the • Sense of smell is in good
wall condition
• Refused to look at her child • Can feel what touches her skin
and reacts appropriately to
stimuli
13 Areas of Assessment
Motor Stability Body Temperature
• Can walk properly with • Body temperature:
assistance 36.6 °C
• Short but wide steps, • Skin is warm to touch
• Diaphoretic
slower velocity
• Hand supports the
lower back
 13 Areas
of
Assessment
13 Areas of Assessment
Respiratory Status Nutritional Status
RR: 20 cpm Before Pregnancy (June, 2022)
• No use of accessory • Ht.: 154 cm, Wt.: 61 kg, BMI: 25.7
kg/m²
muscles During Pregnancy
• No abnormal breath • Ht.: 154 cm, Wt.: 71 kg, BMI: 29.9
kg/m²
sounds • Likes seafoods and vegetables
• Lung sounds are clear • Eats 3-4 times a day, good appetite
bilaterally • Drinks 8-9 glasses of water each day
13 Areas of Assessment
Elimination Status Reproductive Status
• Defecates at least • G3P2 (2002) at 37 5/7
once a day weeks AOG
• Menarche: 11 years old; lasts
• Brown in color;
for 5-7 days
soft but formed • LMP: July 20, 2022
• Urinates at least 6x • EDD: April 27, 2023 (LMP)
a day; yellowish in • EDD: May 30, 2023 (UTZ)
color • 1st pregnancy: 2014 (NSD)
• 2nd pregnancy: 2016 (NSD)
IE:fully dilated and effaced
FH: 33 cm
13 Areas of Assessment
Sleep and Rest Pattern Skin Appendages Status
• Sleeps for an average of • Has a dark complexion
8 hours a day • Presence if grade +2
• Goes to bed at 10 pm edema on both feet
and wakes up at 7 am for • Skin warm to touch
morning walk • Had lacerations which
• Has discomforts and the were repaired immediately
need to urinate in the
middle of the night
• Does not have quality
sleep due to discomforts
 Laboratory and
Diagnostic Procedures
COMPLETE BLOOD COUNT
Date Performed: May 5, 2023
Result: NORMAL
PROTIME AND APTT
Date Performed: May 5, 2023
Result: NORMAL
 URINALYSIS
Date Performed: May 5, 2023
Results:
Color- Dark Yellow
Slightly Turbid
Increased number of PUS cells
Presence of Epithelial cells and Mucus Threads
ABDOMINAL ULTRASOUND
Date Performed: May 5, 2023
Results: NO CARDIAC ACTIVITY
Anatomy &Physiology
Anatomy &Physiology
Stages of Labor
Book-based Pathophysiology
Book-based Pathophysiology
Client-based Pathophysiology
Nursing Care Plans
NCP 1: Decreased cardiac output related
to increased vascular resistance
Subjective data: Objective data:
No verbal cues was Elevated blood pressure:
noted from patient 150/110 mmHg
HR: 90bpm
Cardiac output: 3,600
ml/min
+2 pitting edema
 Planning
Within 2 hours of rendering nursing
intervention, the client’s blood pressure will
be appropriate for the stage of labor from
150/110 mmHg to 130/70 mmHg
INTERVENTIONS
Independent:
1. Maintain activity restriction (bedrest)
2. Encourage the client to use relaxation techniques such deep breathing
exercises, guided imagery, and distractions. Provide instructions as necessary
3. Provide comfort measures such as back and neck massages, or elevation
of head
4. Provide calm, restful surroundings, minimize environmental activity and
noise. Limit the number of visitors and length of stay
5. Provide assistance with self-care activity as indicated
Dependent:
6. Administer oxygen supplement via nasal cannula at 2 LPM as ordered
 Evaluation
Within 2 hours of rendering nursing intervention, the
client was able to have blood pressure on an
appropriate level for the stage of labor from 150/110
mmHg to 130/70 mmHg

GOAL MET
NCP 2: Acute pain related to
mechanical pressure on presenting part
Subjective data: Objective data:
“Ang sakit sakit Facial grimace
manganak, 8 out of 10 Moaning
ang sakit,” as Diaphoretic
verbalized by the
client.
 Planning
Within 30 minutes to 1 hour of proper nursing
intervention, the client will utilize appropriate
techniques that will help reduce the pain.
INTERVENTIONS
Independent:
1. Assist the patient in a comfortable position.
2. Teach and assist in using appropriate relaxation techniques such as
deep breathing exercises.
3. Provide comfort measures such as back or leg rubs and massage.
4. Encourage the client to relax all muscles and rest between
contractions.
Dependent:
1. Administer oxygen supplement via nasal cannula at 2 LPM as
ordered
 Evaluation
Within 30 minutes to 1 hour of proper nursing intervention, the client
utilized appropriate techniques that helps to reduce the pain as evidenced
by:
Demonstration of relaxation and breathing techniques.

GOAL MET.
NCP 3: Dysfunctional Grieving related
to stillbirth
Subjective data: Objective data:
“Ayaw ko pong makita Suppressing emotions
yung anak ko,” as Staring distress
verbalized by the Facial expression shows
client. . guilt and regret.
 Planning
Within 4 hours of rendering nursing
intervention, the patient will express feelings
of grief.
INTERVENTIONS
Independent:
1. Establish rapport with client and significant others, communicate
therapeutically by allowing them to verbalize feelings.
2. Provide calm, restful surroundings, minimize environmental activity
and noise.
3. Provide comfort measures such as back and neck massages, elevation
of head)
4. Acknowledge the patient’s need to review the loss experience.
5. Consider the patient’s or family’s denial about the loss.
6. Know the availability of support systems for the patient.
Dependent:
1. Refer the patient and family to community services.
 Evaluation
Within 4 hours of rendering nursing intervention, the patient has
expressed feelings of grief.

GOAL MET.
NCP 4: Deficit knowledge
related to misinformation
Subjective data: Objective data:
“Sabi kasi nung mga kapitbahay ko wag Verbalization of inaccurate
na daw ako magtake ng methyldopa na information.
prinescribed ng doctor, nakakasama raw Inability to follow healthcare
sa bata,” as verbalized by the client. ,” as workers' and prescription of
verbalized by the client. drug to take.
Different perception to her own
problem that is experiencing
 Planning
Within 30 minutes of rendering nursing
intervention, the patient will able to
participate in the learning process.
INTERVENTIONS
Independent:
1. Consider the patient’s learning style, especially if the patient has
learned and retained new information in the past.
2. Provide an atmosphere of respect, openness, trust, and
collaboration.
3. Include the patient in creating the teaching plan, beginning with
establishing objectives and goals for learning at the beginning of the
session.
4. Explore reactions and feelings about changes.
5. Encourage Questions
6. Note the progress of teaching and learning.
 Evaluation
Within 30 minutes of rendering nursing intervention, the patient has able
to participate in the learning process.

GOAL MET.
IMPLEMENTATION
DRUGS
METHYLDOPA
Antihypertensive

April 08, 2023

Oral / 2 tabs (250

To manage
hypertension
EVENING PRIMROSE OIL
oxytocic agent

May 05, 2023

IV incorporation / 10
units

Inducton of labor
CARBOPROST
Prostaglandin

May 08, 2023

IM / 1 ampule

To minimize blood
loss or postpartum
uterine bleeding
OXYTOCIN
oxytocic agent

May 08, 2023

IV incorporation / 10
units

Inducton of labor
LIDOCAINE
Anesthetic

May 08, 2023

10mg/ml

To prevent pain
MEDICAL MANAGEMENT
D5LR with oxytocin

May 08, 2023

To induct labor
Oxygen Administration via Nasal
Cannula 2 LPM
May 08, 2023

To supplement or
increase availability
of patient’s available
oxygen
SURGICAL MANAGEMENT
Perineal Repair

May 08, 2023

To repair lacerations
acquired during the
delivery
DIET
 DIET
HIGH IRON DIET LOW SODIUM DIET
The major purpose of the Low sodium diet
mineral iron, which also has helps reduce blood
other beneficial uses, is to pressure and risk of
transport oxygen throughout cardiovascular
the body an element of the disease.
red blood cell. Fatigue is a
symptom of iron deficiency,
which can induce anemia.
 DIET
LOW CALORIE DIET LOW FAT DIET
Low calorie diet is an eating Low-fat dairy
plan used to help people lose products appear to
weight in some form of be especially
caloric restriction has beneficial for
considerable success in lowering systolic
lowering blood pressure blood pressure.
ACTIVITY/EXERCISE
 ACTIVITY/EXERCISE
STRETCHING
BED REST EARLY WALKING EXERCISE
It is a method where a A morning walk This promotes body firming and
pregnant person restricts provides you a clear muscle recovery; make you feel
their mobility both before and mind, an active less worn out by increasing your
after giving birth. body, and is a great energy and enhancing your sense
way to get some of wellness.
exercise.
Discharge planning
Given the patient’s condition, we, as student nurses must observe and
monitor and provide appropriate instructions to prevent or avoid
further complications. We need to educate the patient together with
the significant other with enough information as well as
demonstrations that will possibly help a lot in ensuring the betterment
of our patient and quality care at home.
 General Condition Before
Discharge
Patient MD did not express her feelings through words after the procedure, but
it can be seen that there is sadness on her face as she grieves the loss of her child.
However, aftercare and proper assistance was given especially when transferred
to the stretcher. The patient and her significant other received proper education
with regards to her condition. Her vital signs prior to discharge are as follows: BP:
120/80 mmHg, PR: 87 bpm, RR: 18 cpm, and temperature of 36.7 °C. The client
did not have any complications and is in the process of recovering from the
delivery and the loss of her baby.
 METHODS OF APPROACH
Medication
The patient was advised to strictly follow her medication regimen
which includes:
·Metoprolol 50mg 1 tab BID
·Mefenamic for pain
·Ferrous 1 tab OD
·Co-Amoxiclav 625mg per tab BID
 Exercise
The patient was advised to have bed rest but can also do early walking
and stretching exercises which might help in improving blood flow and can
possibly reduce postpartum depression and lowers stress.
Treatment
The patient was reminded to take the recommended medications
including the time and frequency of administration at home, to ensure
compliance with the treatment.
Health teachings
Health teachings include:
·Education about the importance of the medications she needs to take.
·Instruction in taking time to relax, get enough rest and sleep.
·Reminder in monitoring her blood pressure after discharge.
·Instruction to clean her perineal area every time she urinates or have
bowel movement, from front to back.
·Reminder that she may urinate more than usual on second and third
days and expect normal bowel movement after 3 to 4 days after
delivery.
·Advice about consuming High Iron, Low Sodium, Low Calorie, and Low-
Fat foods.
 OPD follow-up
The patient MD was discharged on May 9, and was scheduled for
check-up after a week. (May 16, 2023)
Diet
The patient was advised to consume High Iron, Low Sodium, Low
Calorie, and Low-Fat foods which will help in managing her condition.
 CONCLUSION
Gestational hypertension is high blood pressure that begin during pregnancy,
usually in the second or third trimester and typically diagnosed after 20 weeks of
pregnancy or close to delivery. It usually goes away after you give birth, but there
is a high risk of developing chronic hypertension for some.
In line with that, we, student nurses were able to create three nursing
diagnosis wherein decreased cardiac output was prioritized, followed by acute
pain, and dysfunctional grieving. These care plans were made based on the
situation of the patient of which we have provided effective care and
implemented those interventions for the betterment of the patient.
 CONCLUSION
As a result, goals were met within the period of time that was allotted in our plan.
The patient was able to demonstrate breathing techniques which helped in
decreasing the pain she feels. Her blood pressure was also reduced with the help of
those interventions provided, also she was able to express her feelings of grief,
understand the situation, and slowly developing strategies with regards in
managing her emotions and coping up with the loss.
 CONCLUSION
This case study aimed to enhance researchers’ analytical thinking and analyzing
abilities, judgement, and familiarity regarding gestational hypertension, so that they
may be able to provide effective and efficient care to patients, by collecting and
analyzing patients’ data and information, formulating priority nursing diagnoses,
creating care plans, and providing appropriate nursing interventions which could
possibly help patients achieve their ideal health and predetermined outcomes. Having
this case helped the group to develop a better understanding, of which we can share
especially in educating patients for prevention and through interventions that we could
provide.
RECOMMENDATION
RECOMMENDATION
We encourage nursing students to use this study to broaden their
knowledge, skills, and learn how to treat patients with Gestational
Hypertension. With the help of this, they may teach their clients the
vital information they need to know as well as the dos and don'ts of
the disease.
This is also important for families to determine what are the
appropriate interventions for pregnant woman experiencing
Gestational Hypertension and how to prevent from having it.
RECOMMENDATION
We recommend that the officials in the community implement
programs which aim to provide useful and relevant information on the
prevention and management of Gestational Hypertension and to
know how to decrease the risk of having cases in the community.
 REVIEW OF RELATED LITERATURE:
FOREIGN
Hypertensive pregnancy problems are thought to complicate roughly 6-8% of pregnancies and result in
severe maternal and fetal morbidity and mortality. Worldwide, 6.3% of pregnant women have gestational
hypertension (Nawaz et.al). According to the study of Valamarthi et.al that one of the frequent complications of
pregnancy is hypertension, which may be followed by eclampsia, acute renal failure, maternal mortality, preterm
delivery, intrauterine growth restriction, and other conditions. The findings suggest that perinatal problems are more
common among hypertensive moms who are younger and have babies that are smaller at birth. The unfavorable
outcomes of pregnancy-related hypertension justify the demand for education, routine prenatal care, early
detection and treatment of hypertension at earlier stages of pregnancy, and postpartum monitoring. On the study of
Boucheron et.al, one of the primary causes of maternal and fetal morbidity and mortality is hypertensive disorders of
pregnancy (HDP). They conducted the study to determine how HDP affected primiparous women's early postpartum
development of chronic hypertension. It was concluded that the chance of developing chronic hypertension in the
first few years after delivery was significantly enhanced by exposure to hypertensive conditions during pregnancy.
 REVIEW OF RELATED LITERATURE:
LOCAL
The most significant modifiable risk factor for lost disability-adjusted life-years globally is hypertension,
which is a leading cause of premature death worldwide. Although it has been observed that the prevalence of
hypertension is rapidly increasing in low- and middle-income nations, the Philippines. According to the Food and
Nutrition Research Institute's (FNRI's) most recent National Nutrition Survey (NNS), the prevalence of hypertension
among people aged 20 to 59 decreased from 23.9% in 2013 to 19.2% in 2018. Although it is also declining, the
prevalence among people 60 and older is still 35% in 2018 compared to 41.2% in 2015. However, only 67.8% of
Filipinos are aware that they have hypertension, and of those who are, only 75% receive treatment, and just 27% of
those who receive treatment have it under control. According to the study of Santos et.al (2022), it has been noted
that the burden of maternal morbidity and mortality from the numerous hypertensive diseases of pregnancy falls
disproportionately on low- to middle-income countries (LMICs). According to WHO recommendations, providing
high-quality prenatal care throughout the first four months of pregnancy is an effective strategy that can lower
maternal and newborn mortality and morbidity from pregnancy-related hypertension diseases.
Thank you!