Nursing Care for Mother with Pregnancy Induced Hypertension

Abstract

Background: Hypertension during pregnancy is a serious complication in obstetrics that causes an increase in the amount of disabled and deceased. A nurse who provides nursing care must have knowledge and competencies for patients safety, continually notice the patient’s changing symptoms and a nurse must practice nursing process in the most technically correct ways, such as observation,analysis and provide nursing care effectively and correctly in practical terms and nursing care. These skills reduce complication and dangerous signs to the pregnant women and infant. This study shows a comparison of nursing care for mother with Pregnancy Induced Hypertension 2 cases.

Results of study :  (Case 1) Thai female, Primigravida, 38 years old, coming to the hospital with GA 38⁺² wks. with labor pain with hypertension BP 161/112 mmHg. Doctors diagnosed severe PIH and admitted to Chonburi Hospital from June 12, 2017 to June 14, 2017. In attend room, the range of blood pressure were 161/112 mmHg. to 187/119 mmHg. Then, the doctor ordered 50% MgSO₄ 5 mg + 0.9% NaCl 100 ml IV drip in 30 min then 50% MgSO₄ 20 mg + 0.9% NaCl 1,000 ml IV drip 50 ml /hr. Pregnant woman received electronic fetal monitoring and the range of fetal heart rate (FHR) 130-140/min. Pregnant woman with a MgSO₄ Infusion should be closely monitored by nurse. Nursing care of monitoring pregnant woman with a MgSO₄ Infusion were preventing leakage from the blood vessels to the surrounding tissue, monitoring blood pressure, monitoring FHR, and observing side effect of MgSO4 .  In this case, the blood pressure was reduced after receiving MgSO₄ and no side effect of MgSO₄. Finally, this case had vaginal delivery with vacuum extraction and discharge June 14, 2017.

               (Case 2) Thai female, 38 years old, Primigravida with GA 32⁺⁵ wks. She came to the antenatal clinic, Phanat Nikom hospital with appointment on April 28, 2017. At the antenatal clinic in Phanat Nikom hospital, the doctor found anemia and Plt.count 87,000 cells / mm3 . Then, doctor refer her to Chon Buri hospital for proper management. On May 2, 2017, she came to Prenatal care in Chon Buri hospital with headache, blurred vision, dizziness, hypertension BP 187/112 mmHg. and DTR 2+. Then, the doctor sent a blood test and found that Hct 25.4 %, Plt.count 112,000 cells / mm3. The doctor diagnosed severe PIH R / O HELLP syndrome. On delivery room, the doctor ordered 50% MgSO₄ 5 mg + 0.9% NaCl 100 ml IV drip in 30 min then 50% MgSO₄ 20 mg.+ 0.9% NaCl 1,000 ml IV drip 50 ml / hr. (Mg 1 gm / hr.) and PRC 1 unit. All the time in delivery room, the patient's condition did not improve so that the doctor plan to terminate labor. Then, the doctor order Dexamethasone 6 mg IM q 12 hr. to stimulate the surfactant in infant’s lungs. The doctor set emergency cesarean section on May 4, 2017 and baby born at 3 pm. Apgar score 1 '= 6 points, 5' = 9 points, 10 '= 9 points. The baby was sent to SNB. The pregnant was sent to MICU for proper management. All the time in MICU, the patient's condition improved and sequelae returned home. Be aware of consequence of PIH that may occur after delivery. Giving advice on how to behave when you return to home.  Introduce emergency symptoms to see a doctor before the appointment. This case stay in hospital for 7 days.

               This study shows that nurses play an important role in caring for pregnant woman with hypertension during pregnancy. Make sure patients do not complicate and satisfy the service received.