Gestational Hypertension and Gestational Hypertension .

Posted: November 2nd, 2022

Gestational Hypertension and Gestational Hypertension .

Assignment 1: Practicum – Journal Entry
Reflect on a patient who is beyond 20 weeks gestation and presented with a health problem that commonly arises during pregnancy. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care. Then, explain the implications of the patient’s health problem. If you did not have an opportunity to evaluate a patient with this background during the last eight weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.Gestational Hypertension and Gestational Hypertension .

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Gestational Hypertension at 24 Weeks in a 28 Year-Old Nulliparous African American Woman: Treatment, Follow Up, and Long-Term Implications
This was a 28 year-old African American woman who presented with a chief complaint of on and off headache for the past one week. She had been attending her antenatal clinic appointments without missing and did not have any abnormal findings in terms of fetal heart rate and maternal well-being. The fetal growth pattern was also normal. She was a non-smoker and did not drink alcohol. A housewife, she did not have any significant past medical or surgical history. She had no known drug allergies and was not on any medication at the time of presentation. On examination her vital signs were: T = 98.9°F, P = 80 b/m, RR = 21 breaths/ min, and BP = 140/95 mmHg. Suspecting hypertension of pregnancy, the blood pressure measurement was repeated after four hours and the reading was 145/90 mmHg. She was then diagnosed with gestational hypertension. up to the time of diagnosis, she had been normotensive.Gestational Hypertension and Gestational Hypertension .
Treatment, Follow Up, and Implications
Gestational hypertension can be defined as a blood pressure of equal to or more than 140/90 mmHg on two different occasions that are not less than four hours apart in a gravid woman post twenty weeks gestation. The potential mother must have no previous history of hypertension and no other symptoms suggestive of pre-eclampsia (Hammer & McPhee, 2018; Carson, 2018; Huether & McCance, 2017).Gestational Hypertension and Gestational Hypertension . To exclude the possibility of pre-eclampsia, gestational diabetes, and other organ involvement, several laboratory tests were done including urinalysis, a complete blood count, renal function tests, and liver function tests (Carson, 2018). For immediate lowering of the blood pressure, she was given the calcium channel blocker nifedipine (Adalat) 20 mg STAT, to be repeated after eight hours if the blood pressure was still above 140/90 mmHg (Katzung, 2018). It did not have to be repeated though. She was sent home with oral methyldopa (Aldomet) 250 mg mane and 500 mg nocte for one week before review (Katzung, 2018). However, she would have to come to the clinic daily for blood pressure monitoring. Also, she was advised to reduce salt intake in her diet.Gestational Hypertension and Gestational Hypertension .
The main implication of this first time potential mother’s diagnosis was that gestational hypertension has the potential of morphing into pre-eclampsia, which is more serious in terms of fetal and maternal mortality.Gestational Hypertension and Gestational Hypertension .
Postpartum Depression in a 32 Year-Old Para 1+0 African American Woman: Treatment, Follow Up, and Long-Term Implications

This was a 32 year-old African American woman who presented with a chief complaint of withdrawal and loss of interest in day-to-day activities and her newborn. The symptoms had lasted for a period of about three weeks after the birth of her child. She did not feel like doing anything or talking to anybody most of the time, and had started preferring to lock herself in the house and sleep. Sometimes she would just lock herself up and cry. Her medical history was significant in that she had been treated for tuberculosis three years before. She also had a significant psychiatric history in that two of her first degree relatives have been treated for recurrent episodes of bipolar disease. At presentation, she was not on any medication and had also stopped breastfeeding herself.Gestational Hypertension and Gestational Hypertension .

Treatment, Follow Up, and Implications

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5, what this woman was suffering from was peripartum depression. Specifically, it was Unspecified Bipolar and Related Disorder with peripartum onset, 296.80(F31.9). Peripartum depression is defined by the DSM-5 as episodes of depression happening most recently in pregnancy and within a period of one month after giving birth (APA, 2013; Segre & Davis, 2013).Gestational Hypertension and Gestational Hypertension . Treatment involves psychotherapy alone or in combination with antidepressant medication. If mild to moderate, the preferred evidence-based therapy involves the two psychotherapeutic treatments of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT).Gestational Hypertension and Gestational Hypertension . If moderate to severe, treatment involves selective serotonin reuptake inhibitors (SSRIs) such as sertraline or citalopram in combination with either of the above psychotherapeutic approaches (Guille et al., 2013; Stahl, 2017). Follow up involves successive sessions of psychotherapy of up to 12 sessions, and a monthly comprehensive review of all treatment. Implications of this condition are long-term as far as the client, the child, and her family are concerned. She is at risk of relapse, the child risks delayed milestones, and the family suffers stigma (Guille et al., 2013).Gestational Hypertension and Gestational Hypertension .

Postpartum Depression in a 32 Year-Old Para 1+0 African American Woman: Treatment, Follow Up, and Long-Term Implications

This was a 32 year-old African American woman who presented with a chief complaint of withdrawal and loss of interest in day-to-day activities and her newborn. The symptoms had lasted for a period of about three weeks after the birth of her child. She did not feel like doing anything or talking to anybody most of the time, and had started preferring to lock herself in the house and sleep. Sometimes she would just lock herself up and cry. Her medical history was significant in that she had been treated for tuberculosis three years before. She also had a significant psychiatric history in that two of her first degree relatives have been treated for recurrent episodes of bipolar disease. At presentation, she was not on any medication and had also stopped breastfeeding herself.Gestational Hypertension and Gestational Hypertension .

Treatment, Follow Up, and Implications

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM-5, what this woman was suffering from was peripartum depression. Specifically, it was Unspecified Bipolar and Related Disorder with peripartum onset, 296.80(F31.9). Peripartum depression is defined by the DSM-5 as episodes of depression happening most recently in pregnancy and within a period of one month after giving birth (APA, 2013; Segre & Davis, 2013). Treatment involves psychotherapy alone or in combination with antidepressant medication. If mild to moderate, the preferred evidence-based therapy involves the two psychotherapeutic treatments of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT).Gestational Hypertension and Gestational Hypertension . If moderate to severe, treatment involves selective serotonin reuptake inhibitors (SSRIs) such as sertraline or citalopram in combination with either of the above psychotherapeutic approaches (Guille et al., 2013; Stahl, 2017). Follow up involves successive sessions of psychotherapy of up to 12 sessions, and a monthly comprehensive review of all treatment. Implications of this condition are long-term as far as the client, the child, and her family are concerned. She is at risk of relapse, the child risks delayed milestones, and the family suffers stigma (Guille et al., 2013).Gestational Hypertension and Gestational Hypertension .