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PROM( Premature Rupture of Membrane)

_________________________________________

A Care Study

Presented to

The Faculty of the College of Nursing

University of Cebu – Lapulapu and Mandaue

Mandaue City

__________________________________________

In Partial Fulfillment

Of the Requirement in

Nursing Care Management

501201

___________________________________________

By:

Janice B. Omolon

BSN III-A

August 2008
TABLE OF CONTENTS

I INTRODUCTION……………………………………………………………..

II GENERAL DATA…………………………………………………………….

III HISTORY OF PRESENT ILLNESS…………………………………………..

IV PAST HEALTH HISTORY…………………………………………………...

V NURSING REVIEW OF SYSTEMS………………………………………….

VI FAMILY, PERSONAL, SOCIAL AND ENVIRONMENTAL HISTORY

A. Family history………………………………………………………………

B. Personal and Social history………………………………………………...

C. Environmental history……………………………………………………..

VII PHYSICAL ASSESSMENT…………………………………………………..

VIII DEVELOPMENTAL DATA………………………………………………….

IX ANATOMY, PHYSIOLOGY AND RELATED PATHOPHYSIOLOGY

A. Anatomy and Physiology of the systems involved…………………………

B. Theoritical and Conceptual Framework of

Gestational Hypertension …………………………………………..

C. Discussion of the Pathophysiology…………………………………………

D. Symptomatology……………………………………………………………

X MEDICAL MANAGEMENT………………………………………………….

A. Diagnostic Studies and Findings…………………………………………….

B. Treatment and Procedures…………………………………………………..

C. Medications………………………………………………………………….
D. Diet………………………………………………………………………….

XI NURSING MANAGEMENT………………………………………………….

A. Actual Care Given…………………………………………………………..

B. Problems Encountered during the implementation of Nursing Care…….....

C. Restorative Measures Used…………………………………………………

D. Evaluation…………………………………………………………………...

E. Patient Teaching…………………………………………………………….

XII CONCLUSIONS AND RECOMMENDATION………………………………

XIII IMPLICATIONS OF THE STUDY TO……………………………………….

A. Nursing Education…………………………………………………………..

B. Nursing Practice……………………………………………………………..

C. Nursing Research……………………………………………………………

APPENDICES…………………………………………………………………..

Appendix A: Permit Letter

Appendix B: NCP

Appendix C: Discharge Plan

Appendix D: Drug Study

Appendix D: Other forms of documentation

BBLIOGRAPHY
I INTRODUCTION

The term gestational hypertension refers to a relatively benign condition of

elevated BP during pregnancy without the signs proteinuria and edema. There is no

evidence of preeclampsia or previous hypertension. Following delivery, the BP returns to

normal prepregnancy values.

Gestational hypertension (GH) is high blood pressure that develops after the

twentieth week of pregnancy and returns to normal after delivery, in women with

previously normal blood pressure.GH may be an early sign of either preeclampsia or

chronic hypertension. If these complications do not develop, or if chronic hypertension

develops but remains mild, the outcome of pregnancy is usually good for both the mother

and newborn. GH has been shown to occur more frequently in women who are obese1 or

in those who are glucose-intolerant.2 3 4


Name: Joan P. Cacanog

Age: 37 years old

Civil Status: Married

Residence: 391-1C V. Rama Ave. Guadalupe Cebu City

Nationality: Filipino

Date of Admission: June 30, 2008

Attending Physician: Dr. Evelyn Tam

Hospital number: 1P

Room number: OB-224

OB Score: G4P1 1021

Chief Complaints: Labor Pains

Admitting Diagnosis: Pregnancy Uterine 40 1/7 weeks age of gestation

Final Diagnosis: Pregnancy Uterine Full Term delivered a live baby girl by 1°

LSTCS 2° to prolonged deceleration phase and with gestational

hypertension.
III HISTORY OF PRESENT ILLNESS

One week prior to admission noted irregular uterine contraction and mild sought

result with AP and was advised condition persisted. She has an OB score of G4P1 1021.

IV PAST HEALTH HISTORY

At the age of 13 years old the patient had her menarche, three to five days of

duration for twenty eight to thirty days of menstrual cycle. She claimed to use three pads

of sanitary napkin per day and does not experience dysmenorrheal.

She had her first menstrual contact at the age of twenty five with her husband as

her sole partner.

She had her first delivery through normal spontaneous delivery on 1999 baby girl

with nine months gestation at Visayas Community Medical Center.


V NURSING REVIEW OF SYSTEMS

HEENT: Patient claims to have no complain.

Cardiovascular: “Wala man koy gi pamati pero taas ang ako BP” as verbalized by the

patient.

Respiratory: “Wala man ko maglisod og ginhawa” as verbalized by the patient.

Gastrointestinal: “Mag sige pa og sakit akong tinahi-an sa tiyan” as verbalized by the

patient.

Genitourinary: “Gibutangan ko og diaper sa OR” as verbalized by the patient.

Musculoskeletal: “Kapoy ako lawas’ as verbalized by the patient.

Neurological: “Makakontrol man ko sa akong lihok, dili ko maglisod” as verbalized by

the patient.

Reproduction: “Naa pa gihapon dugo sa akong diaper” as verbalized by the

patient.
VI FAMILY, PERSONAL, SOCIAL AND ENVIRONMENTAL HISTORY

A. FAMILY HISTORY

Patient claims to have no known medical problem. No vices. No hereditary

diseases such as diabetes mellitus, hypertension and bronchial asthma.

B. PERSONAL AND SOCIAL HISTORY

She does not drink alcohol and does not smoke. She is a college level and now is

a housewife. Her religious affiliation is Baptist. She seldom travel to any places. She was

able to take over the counter drug like neozep, biogesic, and advil.

C. ENVIRONMENTAL HISTORY

The house is a bungalow type and made of concrete and no gate. It has three

rooms. She lived together with her parents and her eldest daughter. Her husband is a

seaman .The garbage is collected every Monday and the drainage is an open type.
VII PHYSICAL ASSESSMENT

The patient seems to be exhausted and in pain in an attempt to walking and

standing as evidence by grimaced face and verbal expression of pain. She is cooperative

and can follow simple commands.

Integument: Patient has affair complexion . The skin is warm and in good turgor.

Face: Facial features are symmetrical.

Head: Scalp is free from lesion and hair is shiny.

Eyes: Pupils are equal round and react to light and accommodation.

Ears: Ears are symmetrical and free from lesions.

Nose: Patient is able to identify common scents.

Throat: Dry lips are noted.

Thorax: Patient has equal chest expansion.

Cardiovascular: No thrill is palpated in cardiac landmark.

Abdomen: Tender when palpated in the incision site.

Extremities: Extremities are symmetrical. No edema noted.

Musculoskeletal: Weak movement are evident.

Neurological: Coordination of movement is noted.

Reproductive: Lochia rubra is noted in less amounts.


VIII DEVELOPMENTAL DATA

According to Erik Eriksons Psychosocial Development

Stage and Age Central Task Indicators of Positive Patient’s Resolution


Resolution
Infancy Trust versus Exchanges with parents Patient was breastfeed by
Birth-18 months Mistrust lay basis for trust or her mother.
mistrust of others in
later life. (Bellack,
1988)

Toddler Autonomy versus -self control Her every move was


18 months- 3 years Shame and Doubt -personal independence guarded and has
and self-worth develop. limitations.
(Bellack, 1988)

Preschool Initiative versus -sharing, competing, She played with her


3-6 years Guilt self-motivation playmates like hide and
-learns to control seek.
jealousy rage, envy,
guilt. (Bellack, 1988)

School age Industry versus -skill mastery She was not an honor
6-12 years Inferiority -work and play in student but is highly
groups appreciated by her parents.
-intellectual growth.
(Bellack, 1988)

Adolescence Identity versus .-sense of self and She had her first crush at
12-20 years Role Confusion identity apart from the age of 12.
parents. (Bellack, 1988)

Young adult Intimacy versus -learn to establish She was married to her
20-40 years Isolation relationships with husband at the age of 26.
partner, gratifying
social relationships.
(Bellack, 1988
IX ANATOMY, PHYSIOLOGY AND RELATED PATHOPHYSIOLOGY

A. Anatomy and physiology of

If you develop high blood pressure after 20 weeks of pregnancy but don't have

protein in your urine, you'll be diagnosed with gestational hypertension,

sometimes called pregnancy-induced hypertension. Women who develop high

blood pressure after midpregnancy and have protein in their urine have a complex

disorder called preeclampsia, and those who had high blood pressure before

pregnancy, or are diagnosed with it before 20 weeks, have what's called chronic

hypertension.

High blood pressure is generally defined as a reading of 140/90 or higher, even if

only one of the numbers is elevated. It doesn't usually cause any noticeable

symptoms unless it's really high.

Because high blood pressure can affect blood flow to the placenta, if the

diagnosed with gestational hypertension, the caregiver will order an ultrasound

to be sure that the baby has been growing well and to see if the mother have a

normal amount of amniotic fluid. The patient may also have a biophysical profile

(BPP) done at the same time to check on the baby's well-being. And in certain

cases, the patient have a Doppler ultrasound to check blood flow to her baby.

The caregiver may also order a set of blood tests and ask you to collect urine for

24 hours to check for protein (this is a more sensitive test than the urine dip done

at each prenatal visit). These lab tests will help her determine whether the patient

have preeclampsia and allow her to gauge any later changes in the mother’s

condition.
B. Theoritical and Conceptual Framework of Gestational Hypertension

The woman’s body react to


The woman’s body react to
Tropoblastic tissue early
Tropoblastic tissue early
In pregnancy (cause unknown)
In pregnancy (cause unknown)

Generalized
Vasopasm

Endothelial
Vasoconstriction
damage

Abnorml
clotting
occurs
Decrease Fkuid moves out on
bkood flow blood stream and in
interstitial spaces

Small clots cause


organ damge
(particulary affects
the liver
Elevated Decrease Generalized
blood oxygen to edema and
pressure every organ edema
organ
C. DISCUSSION OF THE PATHOPYSIOLOGY

It depends on how far along you are in pregnancy when you develop gestational

hypertension and how high your blood pressure gets. The more severe your hypertension

and the earlier in pregnancy it appears, the greater your risk for problems. The good news

is that most women who get gestational hypertension have only a mild form of the

condition and don't develop it until near term (37 weeks or later). If you're in this

category, you still have a somewhat higher risk of being induced or having a c-section,

but other than that, you and your baby are likely to do as well as you would if you had

normal blood pressure.

However, about 1 in 4 women with gestational hypertension go on to develop

preeclampsia during pregnancy or labor, or soon after giving birth. And the chances of

getting preeclampsia are 1 in 2 if you develop gestational hypertension before 30 weeks.

Having gestational hypertension also puts you at increased risk for a number of other

pregnancy complications, including intrauterine growth restriction, preterm birth,

placental abruption, and stillbirth.

D. SYMPTOMATOLOGY

SYMPTOMS FOUND ON SYMPTOMS THE SCIENTIFIC BASIS


TEXTBOOKS PATIENT DEVELOPS

-Symptoms, which appear - Patient was advised for -A physical indication such
after the twentieth week of cesarean section. She as elevated blood pressure
pregnancy, include swelling claimed that the doctor should be documented
of the face and hands, scheduled her for cesarean before a cesarean procedure
visual disturbances, section because of elevated can be performed.
headache, high blood blood pressure
pressure, and a yellow
discoloration of the skin
and eyes.
X. MEDICAL MANAGEMENT

PROCEDURE

IDEAL ACTUAL

Pre operative Diagnostic Procedures

Vital Signs Determination


• Vital Signs Determination

• Urinalysis Temperature: 37.2°C

Respiratory Rate: 24 cpm


• Complete blood count
Pulse Rate: 72 bpm
• Coagulation profile
Blood Pressure: 160/90 mmHg
(prothrombine time, partial

Thromboplastin time) Urinalysis

• Serum electrolytes and ph Macroscopic

• Blood typing and cross-matching Color: yellow

Appearance: clear
• Sonogram to determine fetal
Ph: 6.2
Presentation and maturity.
Specific gravity: 1.010

Protein: negative
(Pilliteri,2007)
Glucose: negative

Microscopic

RBC: 0.14 hpf

WBC: 0.21 hpf

Epithelial cells: few


TREATMENT

IDEAL ACTUAL

A physical indication for a cesarean Patient was schedule for an emergency

Section is hypertension. esarean section

(Pilliteri,2007)

MEDICATIONS

IDEAL ACTUAL

A minimum of preoperative medications Preoperative medications

Is used with a woman having cesarean • Cefazolin

section, to prevent compromising the • Ranitidine


fetal blood supply and to ensure that the
• Metoclopramide
newborn is wide awake at birth and can
Postoperative medications
initiate respirations simultaneously.
• Misoprostol 1 tab/ rectum every

6 hours
(Pilliteri,2007)
• Mathergine 1 amp IM every 8

hours def BP > 130/90 mmHg

• Cefazolin 500mg IVTT every 8

hours

• Tramadol 1 tab po every 6 hours

prn
DIET

IDEAL ACTUAL

Standard Diet after cesarean section • NPO for 8 hours after surgery

• Nothing y mounth for 8 hours • Ordered for clear liquid if

after cesarean section tolerated and then regular diet

• Sips of water after 8 hours when flatus or bowel movement

windows

• Advance to clear liquid as

tolerated

• Advance to regular diet when

flatus or bowel movement


XI NURSING MANAGEMENT

A. Actual Care Given

Care Given Rationale

Monitoring vital signs every 4 hours -- to detect earliest sign of bleeding


( Pillitteri, 2007)

Monitoring of intake and output every 4 -- to ascertain whether an adequate fluid


hours balance has been achieved.
( Pillitteri, 2007)

Assessment of the patient’s incision site -- to know whether infection has occur
and to assess the wound healing.

B Problems encountered during the implementation of nursing care

The patient is cooperative during the implementation of nursing care.

C. Restorative measure used

Careful explanation was provided o the patient to establish rapport and gain

cooperation.

D. Evaluation

The patient was cooperative and was responsive to the care given.
E. Patient Teaching

OBJECTIVE TOPIC CONTENT METHODOLOGY


To decrease the Wound Care Purposes of Wound Lecture-discussion
patient’s risk for Care
infection - aid in the
prevention of
infection from
entering the wound
- absorb secretions
-protect the area
from trauma.

To decrease the Prevention of Encourage the Lecture-discussion


patient’s risk of thromboembolism patient to ambulate
developing as soon as possible
thromboembolism to decrease
formation of blood
clots

To lessen the Prevention of -advise patient to Lecture-discussion


patient’s risk to constipation increased fluid
constipattion intake

To decrease the risk Providing safety Provide side rails to Lecture-discussion


of injury measures to the the patient
patient
XIII IMPLICATION OF THE STUDY

A. Nursing Education

This study implies learning about what is gestational hypertension and its causes.

It will provide brief information about the anatomy and physiology of the systems

involved. It presents a simple comparative pathophysiology on the theoretical and actual

data.. It also gives us more knowledge about gestational hypertension.

B. Nursing Practice.

In caring for postoperative patients who undergone cesarean section, it will

enhance our skills in performing skills such as monitoring vital signs and measuring

intake and output. Enhance skills in assessing incision site. and implies a positive attitude

in caring patient .

C. Nursing Research

This study will provide data in doing future research related to gestational

hypertension.

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