Adventist Medical Center Collage
San Miguel, Iligan City
School of Nuring
Level 2 RLE
Case Study
Patient Scenario, Chapter 20, Nursing Care of a Family Experiencing
a Pregnancy Complication from a Preexisting or Newly Acquired
Illness
A WOMAN WITH GESTATIONAL HYPERTENSION/PREGNANCY-INDUCED
HYPERTENSION AND IRON-DEFICIENCY ANEMIA
Madam Siti is a 31 year old Indonesian with OB index of Gravida 3 para 2 at 38
weeks. She was noted to have elevated blood pressure.
CHIEF CONCERN:
She was referred from antenatal clinic for follow up during which her vital sign
showed she was afebrile, pulse rate of 90beats per minute and blood pressure was
noted to be 160/100mmHg and no abnormality was found in the urine. She
reported feeling out of breath.
HISTORY OF CHIEF CONCERN:
During her previous prenatal check ups, her blood pressure was noted to be
100/70mmHg and she was normotensive throughout the pregnancy up until at 38
weeks.
She complained to have frontal headache and nausea 2 days prior to
admission. She denied symptoms of impending eclampsia such as blurring of
vision, epigastric pain and vomiting. There was also no dizziness, shortness
of breath, chest pain, reduced urine frequency and leg swelling. She also
had vaginal discharge which was whitish and creamy in nature, no foul
smelling and no pruritus vulvae. There was no urinary tract infection
symptoms such as urgency and dysuria.
Fetal movement was good.
She was admitted to the ward for further management.
FAMILY PROFILE:
She has been married for 12years and came to Malaysia on 2006 which was
4years ago.
She lives in a terrace house at Cheras and worked as a maid.
Her husband came to Malaysia 5years ago but had recently go back to
Indonesia 2months ago. He previously worked as a contractor for the same
employer. He planned to return to Malaysia after his permit is renewed.
Both of them does not smoke or consumed alcohol.
Both of their children were in Indonesia and are taken care by her mother.
PRENATAL/ANTENATAL HISTORY:
This is an unplanned but wanted pregnancy. Her urine pregnancy test (UPT) was
positive at 6weeks.
Antenatal screening done showed that:
Blood Pressure : 110/70mmHg
Haemoglobin level : 12.8g/dL
Height : 158cm
Weight : Pre : 62kg Current : 69kg
Blood Group : O Positive
VDRL/HIV/HEP B : Non Reactive
Urine Albumin/Sugar : Nil
Latest scan done at 38 weeks and all parameters correspond to date. It was a
singleton fetus on longitudinal lie and cephalic presentation. Fetal heart and fetal
movement are seen. Estimated fetal weight was 3.3kg and placenta was on anterior
upper segment.
PAST OBSTETRIC HISTORY:
On 1999, she had a full term normal pregnancy and delivered a baby girl by
Spontaneous Vaginal Delivery (SVD) at a hospital in Indonesia and weight of the
baby was 2.6kg and is alive and well.
On 2007, she also had a full term normal pregnancy and delivered a baby boy by
spontaneous vaginal delivery also at Indonesia. The baby weight 2.3kg and
currently is alive and well.
Both of her children stays with her mother in Indonesia.
GYNAECOLOGY HISTORY:
She attained her menarche at the age of 13year old with 28 to 30days regular cycle
with 7days of menses. She denied dysmenorrhoea, menorrhagia, intermenstrual
bleeding, dyspareunia and postcoital bleeding.
As for contraception, she uses Implanon for 4years from 2002 to 2006 between the
first and the second pregnancy. She was then on Oral Contraceptive Pills for
2months and had stop taking them afterward until today. After this pregnancy, she
is keen to take Intrauterine Contraceptive Device (IUCD).
She had never had pap smear done before.
FAMILY HISTORY:
Her mother is alive and was diagnosed to have diabetes mellitus and hypertension
and currently on medication. Her father died on 2007 due to renal failure.
She had 3siblings and currently all of them are alive and well.
DAY HISTORY:
Nutrition: 24-hour recall:
Breakfast: 1 serving oatmeal with raisins; 1 glass orange juice; 1 cup coffee
Lunch: 1 tuna fish sandwich; 1 serving salad; 1 cup coffee
Dinner: 1 pork chop; 1 serving potatoes; 1 serving spinach; 1 cup coffee
Snacks: Eats ice cubes almost constantly to relieve heartburn; has a craving
to eat the “lead” in pencils
Sleep: Tries to sleep 8 hours a night but receives only 3 to 4 hours because of
constant waking with shortness of breath
Recreation: Enjoys talking to chat room on Web site
REVIEW OF SYMPTOMS:
She has had three colds since beginning pregnancy; otherwise negative except for
symptoms of chief concern.
PHYSICAL EXAMINATION:
General
On examination, she was alert, conscious and she was not pale or jaundiced. Her
Blood Pressure was 142/92mmHg lying and 152/104mmHg standing. Her pulse rate
was 90beats per minute and respiratory rate was 20breath per minute. She was
afebrile. Her current weight was 69kg. There was no pedal oedema noted.
Thyroid Gland
There was no scar, lump or dilated veins noted around the area of the neck. There
was no lymphadenopathy noted.
Breast
On inspection, both breast were symmetrical and bilaterally in size. Both her nipple
were not hyperpigmented or retracted. There was no nipple discharge. Her breast
were non tender and no mass was palpable.
Cardiovascular System
On inspection of the hand, there was no clubbing and peripheral cyanosis.
Inspection of the mouth showed that there was no central cyanosis and hydration
status was good. There was no surgical scar and no notable abnormalities detected
on the praecordium. Jugular Venous Pressure was not raised. Peripheral pulses
were present with normal rhythm and good volume. There was no radio-radial
delay or radio femoral delay. There was no collapsing pulse.
On auscultation, the first and second heart sounds were heard with no murmur or
added sound heard.
Respiratory System
On inspection, the chest moved bilateral symmetrically with inspiration. There was
no scars and deformities noted. She did not use accessory muscles on breathing.
Neurological System
She was orientated to time, place, and person. All cranial nerves were intact. Both
her upper and lower limbs were normal. Muscle tones, power, and reflexes were all
good and normal.
Abdominal Examination
On inspection, the abdomen was distended by gravid uterus as evidenced by
cutaneous signs of pregnancy such as linea nigra and striae gravidarum. The
umbilicus is centrally located and flat. No scars noted and no dilated veins seen.
On palpation, her abdomen was soft and non tender and uterus was not irritable.
Clinical fundal height revealed that the uterus was 38weeks in size and was
correspond to date. Symphysiofundal height was 37cm.
Palpation of the fetus showed that it was a singleton in longitudinal lie with cephalic
presentation. The head was 3/5 palpable and not engaged. The fetal back was on
the maternal left side. The liquor was adequate and estimated fetal weight was 3.2
to 3.4kg.
LABORATORY RESULTS:
Urinalysis (24-hr urine collection) shows no proteinuria.
Madam Siti is diagnosed with gestational hypertension. She is prescribed
methyldopa and bed rest as well as modifications in her diet and stress
management.
