Nursing care for mothers in premature labor with hypertension.

Abstract

     This study was case study aimed to present a study on nursing care for mothers with preterm birth combined with hypertension, which is a significant obstetric complication. It carries a high severe risk and is commonly found. If not treated, the progression of the disease becomes more severe and is a major cause that increases morbidity and mortality rates for both pregnant women and infants. Data were collected from medical history interviews, symptom assessment, physical examinations, and information from patient and family medical records. The gathered data were analyzed and nursing diagnoses were determined based on Gordon’s 11 Functional Health Patterns to plan nursing care and systematically evaluate nursing outcomes.

     Study Results:  Case Study 1: A 19-year-old Thai female patient, experiencing her first pregnancy, at 36+2 weeks of gestation, presented with labor pain and uterine hardness for 20 minutes before coming to the hospital. Upon admission, she was found to have regular uterine contractions every 4 minutes and had entered the active phase of labor. She was managed by fasting, receiving intravenous fluids, and being given medications to control uterine contractions, including Bricanyl, as well as Dexamethasone. Subsequently, the patient delivered vaginally and was given Syntocinon after delivery to stimulate uterine contractions and prevent postpartum hemorrhage. The patient had no fever, no wound pain, the wound was not swollen, lochia was red and normal, the breasts were not engorged, the uterus was well involuted, and there were no complications. Breastfeeding was promoted to stimulate milk secretion. The patient was in generally good condition throughout the postpartum period and was able to be discharged within 48 hours, with a postpartum follow-up appointment, along with medications to take home. Case study 2: An 18-year-old Thai female patient, primigravida, with a gestational age of 34+1 weeks, attended her scheduled antenatal care and was found to have high blood pressure of 161/113 mmHg. The doctor admitted her to the hospital with a suspected preeclampsia condition. Upon admission, her blood pressure was 168/112 mmHg and the NST was reactive. The patient was transferred to the labor room for close monitoring. Subsequently, her blood pressure remained high (170/110 mmHg), so Magnesium sulfate was started to prevent seizures, and Nicardipine was administered to control blood pressure. The patient had no complications from the medication, but her blood pressure continued to be high, so delivery was planned. The patient underwent a cesarean section along with an appendectomy. After surgery, the patient was alert, able to eat, ambulate, had mild wound pain, and showed no warning signs of preeclampsia, but still had intermittent high blood pressure. Additional antihypertensive medications, including Adalat, Hydralazine, and Nicardipine, were given. Subsequently, the patient showed continuous improvement, had no complications, was able to breastfeed, and her blood pressure gradually decreased. Nicardipine was gradually reduced and eventually discontinued, replaced with oral Amlodipine. The patient’s general condition was good, and the surgical wound was in good condition.