CP FINAL-- Pre-eclampsia

7/28/2019 CP FINAL-- Pre-eclampsia

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Bukidnon State University

COLLEGE OF NURSING

Malaybalay City

A Case Presentation on

PRE - ECLAMPSIA

As Part of the Requirements in NCM 102

CARE OF MOTHER, CHILD, FAMILY AND POPULATION GROUP AT-RISK OR

WITH PROBLEMS

Submitted by:

Alberto, Dani Michaela B.

Antivo, Jovelyn L.

Auguis, Fe B.

Biao, Kathlene Joy O.

Casite, Nielmark L.

Gomez, Junfelm M.

Jacutin, Sushmita Ann J.

Jamis, Kieth G.

Rellita, Jezza S.

Submitted to:

Hazel Paloma-Agbayani RN, MN

Clinical Instuctor

March 11-12, 2013


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TABLE OF CONTENTS

I. Objectives

II. Introduction

III. Assessment

a. Demographic Data

b. History of Past illness

c. History of Present illness

d. Systems Involved

IV. Anatomy and Physiology

V. Pathophysiology

VI. Actual Treatment

a. Laboratory Exam

b. Drug Study

VII. Ideal Treatment

a. Treatment

b. Surgical Management

VIII. Nursing Care Plan

a. Actual Nursing Care Plan

b. Ideal Nursing Care Plan

IX. Discharge Plans

X. Doctors Order

XI. Prognosis

XII. Research Update

XII. References


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I. OBJECTIVES

General Objectives:

During our 3-hour discussion, we will be able to present our case about Pre-

Eclampsia accordingly. This case presentation seeks to share and enhance our knowledge

with regards to the patients general health condition and her needs. This also seeks to

comprehend our skills through application of several nursing interventions and medical

management. Furthermore, this case presentation intends to improve the students attitude

by conveying open-mindedness and utilizing therapeutic communication all throughout

the activity.

Specific Objectives:

During our 3-hour discussion, we aim to achieve the following objectives with

regards to Pre-Eclampsia:

1. Present a thorough general health assessment of the client which includes physical

assessment.

2. Correctly provide concise and complete information with regards to the patients

condition.

3. Discuss an overview of Anatomy and Physiology of the Cardiovascular System,

Exocrine System, Endocrine System, Integumentary System and Reproductive

System.

4. Efficiently provide appropriate and proper nursing diagnosis in line with the

clients medical condition.

5. Identify and discuss the ideal and actual nursing care plans for the different

problems identified.

6. Skilfully formulate appropriate nursing interventions according to the standards of

nursing practice.

7. Impart the outcome of the nursing interventions.

8. Convey the significance of clients response to the rendered nursing interventions.

9. Discuss the health teachings intended for the patient.


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II. INTRODUCTION

Pregnancy-induced hypertension (PIH) is a condition in which vasospasm occurs

during pregnancy in both small and large arteries. Signs of hypertension, proteinuria, and

edema develop. It is unique to pregnancy and occurs in 5% to 7% of pregnancies (Bailis

& Witter, 2007). Despite years of research, the cause of the disorder is still unkonown

although it is highly correlated with the antiphospholipid syndrome or the presence of

antiphospholipid antibodies (Clark, Silver, & Branch, 2007). Originally it was called

toxemia because researchers pictured a toxin of some kind being produced by a woman in

response to the foreign protein of the growing fetus, the toxin leading to the typical

symptoms.

A condition separate from chronic hypertension, PIH tends to occur most

frequently in women of color or with a multiple pregnancy, primiparas younger than 20

years or older than 40 years, women from low socioeconomic backgrounds, those who

have had five or more pregnancies, those who have hydramnios, or those who have an

underlying disease such as heart disease, diabetes, and essential hypertension

PIH is classified as gestational hypertension, mild pre-eclampsia, severe pre-

eclampsia, and eclampsia, depending on how far development of the syndrome has

advanced.

A woman has passed from mild to severe pre-eclampsia when her blood pressure

rises to 160 mm Hg systolic and 110 mm Hg diastolic or above on at least two occasions

6 hours apart at bed rest or her diastolic pressure is 30 mm Hg above her prepregnancy

level. Marked proteinuria, 3+ or 4+ on a random urine sample or more than 5g in a 24-

hour sample, and extensive edema are also present.

With severe pre-eclampsia, the extreme edema is most readily palpated over bony

surfaces, such as over the tibia on the anterior leg, the ulnar surface of the forearm, and

the cheekbones, where the sponginess of fluid-filled tissue can be palpated against bone.

In addition, symptoms of preeclampsia can include:

Rapid weight gain caused by a significant increase in bodily fluid

Abdominal pain

Severe headaches


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A change in reflexes

Reduced output of urine or no urine

Dizziness

Excessive vomiting and nausea

The only real cure for preeclampsia and eclampsia is the birth of the baby. Severe

preeclampsia (blood pressure greater than 160/110) that occurs after 20 weeks of

gestation in a woman who did not have hypertension before; and/or having a small

amount of protein in the urine can be managed with careful hospital or in-home

observation along with activity restriction.

The group chose the case for the reason that they wanted to show the readers the

process on how pre-eclampsia occurs and for them to fully understand and be reminded

on one of the complications associated with pregnancy.

III. ASSESSMENT

A. Demographic Data

Name: Mrs. Pre Eclampsia Sex: Female Age: 27 years old

Address: Purok-4 Kapitan Bayong, Impasug-ong Bukidnon

Date of Birth: July 25, 1985 Place of Birth: Lumbayao, Valencia City

Nationality: Filipino Civil Status: Married

Occupation: Housewife Religion: Roman Catholic

Dependents: John Harley 9 Year Old

Christian 7 Year Old

Lyka 4 Year Old

Charlyn and Charmaine 1 Month & 11 days

Usual Source of Medical Care: Health Center

Food Allergy: No known food allergy

Drug Allergy: No known drug allergy


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Admitting Diagnosis: Pregnancy Uterine Full Term, Cephalic/Breech Multiple

Pregnancy G4P3 (3003)

Final Diagnosis:

1. G4P5 (4005)

2. Pregnancy Uterine Delivered Term Live Births Baby Girl I & II in Breech-

Cephalic Presentation via Low Segment Transverse Caesarean Section for Multi

fetal Pregnancy. Severe Pre-eclampsia. Baby girl I birth weight- 2.2 Kilogram,

Baby girl II birth weight-2.4 Kilogram.

Surgical Procedure: Low Segment Transverse Caesarean Section with Bilateral

Tubal Ligation

Date and Time of Operation: January 28, 2013 / 2:00 pm

Attending Physician: Gaye Emerald Oribello M.D

Chief Complaint: Labor pains

Date of Admission: January 27, 2013

Time of Admission: 4:50PM

Vital signs upon admission: Temp: 36.4C

BP: 120/80mmHg

PR: 81 bpm

RR: 21 cpm


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B. History of Past Illness

Mrs. Pre-eclampsia completed her immunization during childhood. She

experienced mumps when she was a child. She also experienced diarrhea, fever, cough,

colds and she self-medicated it with over the counter medications like paracetamol and

other medications before she became pregnant. When she was 16 year old she was

admitted to the hospital due to accidental intake of kerosene. She stayed at the hospital

for almost a week and then recovered. She had completed all her immunizations and

including two shots of tetanus toxoid during her prenatal visits. She had no known food

and drug allergies.

C. History of Present Illness

Seven hours prior to admission, thepatient experienced labor pains. Four hours

after, the midwife advised her to deliver the baby in the hospital because she had high

blood pressure. The midwife called an ambulance to fetch her in their place. The patient

arrived at Bukidnon Provincial Medical Center three hours after. She was admitted for

further evaluation and tests. She manifested some problems such as headache that lasted

for a minute and pain in the nape. Her Blood Pressure rose up to 180/120 mm Hg. The

contractions lasted for about a minute until it became frequent. After being seen and

examined by her attending physician, high blood pressure and pitting edema prior to her

admission were noted.

Environmental Factors


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Mrs. Pre-Eclampsia resides at Purok-4 Kapitan Bayong, Impasug-ong Bukidnon.

The family is composed of the parents and their three children respectively. Their house

was made of bamboo walls, wooden floors and cellophane roof. The house is divided into

two divisions, kitchen and room. The house is located near a slope. They were able to

clean the house on a regular basis. They had a common source of water and comfort

rooms which they shared with neighbors. The location of their house is not easily

accessible to hospitals and also kilometers away from the health center.

Socio-Economic and Cultural Factors

Mrs. Pre-eclampsia is a plain housewife and her husband is a packer in a factory.

She hasnt pursued her Secondary level due to financial constraints.

Mrs. Pre-eclampsia was raised as a Roman Catholic where she learned her

religious values but also, she still believes in superstitious beliefs. When it comes to

health matters, she uses herbal medicines to treat any member of the family who has an

ailment, but when serious matters arise she still refer it to health care providers for help.

D. Systems Involved

Cardiovascular/Circulatory System

Objective Data:

Temperature: 37C Radial pulse: 88bpm

Blood Pressure: 160/100mmHg Edema: Pitting

Nail bed color : Pink Capillary refill: 1 second

Subjective Data:

Comments: The patient stated

Remarks: Patient has normal heart sounds and rhythm. Patient

has high blood pressure accompanied by pitting edema.

Nursing Diagnosis:


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Integumentary System

Elimination

Objective Data:

Skin: Warm and moist Hair: Even distribution of hair

Turgor: Edema Nails: Clean nails and

pinkish in color

Temperature: 37C Capillary refill: 1 second

Subjective Data:


Objective Data:

Mobility and Dexterity: Ambulatory Abdomen: Soft

Edema: Yes, Lower extremities

Urine Color:

Subjective Data:


Remarks: Patient has normal skin color, temperature, hair

distribution and nails. Patient is noted of pitting edema withdisturbed skin integrity in abdomen.

Nursing Diagnosis:

Remarks:

Nursing Diagnosis:


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Metabolic/Nutrition

Physical Assessment

The Cephalocaudal assessment was done last February 25, 2013

1. Skin

Brown skin in areas exposed to the sun

When pinched, skin readily springs back to previous state

2. Head

Absence of nodules or masses

Symmetric facial features and movements

Evenly distributed black hair

Objective Data:

General Appearance: 37C

Blood Pressure: 160/100mmHg

Radial pulse: 88bpm

Nail bed color : Pink

Capillary refill: 1 second

Edema: Pitting

Subjective Data:


Remarks: Patient has high blood pressure accompanied by pitting

edema.

Nursing Diagnosis:


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3. Cardiovascular

Blood pressure of 130/90 mmHg

Pulse rate of 90 bpm

4. Gastrointestinal/Abdomen

Striae present at hypogastric and iliac regions

Linea nigra present

Presence of surgical incision

5. Reproductive

Regular menstrual cycle

Gravida 4 Para 5

IV. ANATOMY AND PHYSIOLOGY

Cardiovascular System

1. Heart

The heart is located within the bony thorax and is flanked on each side by the

lungs approximately. The apex is directed toward the left hip and rests on the diaphragm,

approximately at the level of the fifth intercostal space. Its base, from which the great

vessels of the body emerge, points toward the right shoulder and lies beneath the second

rib. The heart is divided into four chambers namely the two atria and two ventricles

separated by the septums. There are three types of blood vessels: the arteries, the veins

and the capillaries. An artery is a vessel that carries blood away from the heart and carries

oxygenated blood. Small arteries are called arterioles. Veins, on the other hand are

vessels that carries blood toward the heart and contains deoxygenated blood. Small veins

are called venules. Lastly, capillaries are microscopic vessels that carry blood from small

arteries to small veins (arterioles to venules) and back to the heart.

The walls of the blood vessels, the arteries and veins have three main layers:

tunica adventitia, tunica media and tunica intima. Tunica adventitia which is a fibrous


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type of vessel is a connective tissue that helps hold vessels open and prevents tearing of

the vessel wall during body movement. Tunica media permits changes of the blood

vessel diameter. It allows the constriction and dilation of the vessels. Last but not the

least is the tunica intima. Tunica intima, which in Latin means innercoat, is made up of

endothelium that is continuous with the endothelium that lines the heart. In arteries, it

provides a smooth lining. However in veins it maintains the one-way flow of the blood.

The endothelium, which makes up the thin coat of the capillary, is important because the

thinness of the capillary wall allows the exchange of materials between the blood plasma

and the interstitial fluid of the surrounding tissues.

There are two circulatory routes of blood as it flows through the blood vessels: the

systemic and the pulmonary circulation. In systemic circulation, blood flows from the left

ventricle of the heart through blood vessels to all parts of the body (except gas exchange

tissues of lungs) and back to the atrium. In pulmonary circulation on the other hand,

venous blood moves from the right atrium to right ventricle to pulmonary artery to lung

arterioles and capillaries where gases exchange; oxygenated blood returns to the left

atrium via pulmonary veins; from left atrium, blood enters the left ventricle.

2. Vasomotor Control Mechanism

Blood distribution patterns, as well as BP can be influenced by factors that control

changes in the diameter of arterioles. Such factor might be said to constitute the

vasomotor control mechanism. Like most physiological control mechanisms, it consists

of many parts. An area in the medulla called vasomotor center/ vasoconstrictor center

will, when stimulated initiate an impulse outflow via sympathetic fibers that ends in

smooth muscle surrounding resistance vessels, arterioles, and veins of the blood

reservoir causing their constriction thus the vasomotor control mechanism plays an

important role both in the maintenance of the general BP and in the distribution of blood

to areas of special need.

3. Venous Return of the Blood

Venous return refers to the amount of blood that is returned to the heart by the

way of veins. Various factors influence venous return, including the operation of venous

pumps that maintains the pressure gradients necessary to keep blood moving into the

central veins and from there the atria of the heart. Changes in the total volume of blood


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vessels can also alter the venous return. The return of venous blood to the heart can be

influenced by the factors that change the total volume of blood in the circulatory

pathway. Stated simply, the more the total volume of blood, the greater the volume of

blood returned to the heart. The mechanism that change the total blood volume most

quickly, making them most useful in maintaining constancy of blood flow, are those that

cause water to quickly move into the plasma or out of the plasma.

Most of the mechanisms that accomplish such changes in plasma volume operate

by altering the bodys retention of the water. The primary mechanisms for altering the

water retention in the body are the endocrine reflexes in the body. One is the ADH

mechanism is released in the neurohypophysis and acts on the kidneys in a way that

reduces the amount of water lost by the body. ADH does this by increasing the amount of

water that kidneys reabsorb from urine before the urine is excreted from the body. The

more ADH is secreted, the more water will be reabsorbed into the blood, and the greater

the blood plasma volume will become.

Another mechanism that changes the blood plasma volume is the

renninangiotensin mechanism of aldosterone secretion. Renin is an enzyme that is

released when the blood pressure in the kidney is low. Renin triggers a series of events

that leads to the secretion of aldosterone. Aldosterone promotes sodium retention by the

kidney, which in turn stimulates the osmotic flow of water to the kidney tubules back into

the blood plasma- but only when ADH is present to permit the movement of water. Thus,

low blood pressure increases the secretion of aldosterone, which in turn stimulates the

retention of water and thus an increase in blood volume. Another effect of

reninangiotensin is the vasoconstriction of blood vessels caused by an intermediate

compound called angiotensin II. This complements the volume-increasing effects of the

mechanism and thus also promotes an increase in overall blood flow. Precision of blood

volume control contributes to the precision in controlling venous return, which in return

yields to the precise overall control of blood circulation

Exocrine System


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The exocrine systems main function is to regulate the volume and composition of

body fluids and excrete unwanted materials, but it is not the only system in the body that

is able to excrete unnecessary substances.

1. Kidneys

The average-sized kidney measures around 12cm long, 6 cm wide, and 3cm thick.

The left kidney is often larger than the right. The kidneys are highly vascular organs.

Approximately, one-fifth of the blood pumped from the heart goes to the kidneys. The

kidneys process blood plasma and form urine from waste to be excreted and removed

from the body. These functions are vital because they maintain the homeostatic balance

of the body. The kidneys maintain the fluid-electrolyte and acid-base balance. In

addition, they also influence the rate of secretion of the hormones ADH and aldosterone.

Microscopic functional units called nephrons make up the bulk of the kidney.

The nephron is uniquely suited to its function of blood plasma processing and urine

function. A nephron contains certain structures in which fluid flows through them and

they are as follows: renal corpuscle, Bowmans capsule, proximal convulted tubule,

Loop of Henle, distal convoluted tubule and the collecting tube. The Bowmans capsule

is a cup-shaped mouth of a nephron. It is usually formed by two layers of epithelial cells.

Fluids, electrolytes and waste products that pass through the porous glomerular

capillaries and enter the space that constitute the glomerular filtrate, which will be

processed in the nephron to form urine. The Glomerulus is the bodys well-known

capillary network and is surely one of the most important ones for survival. Glomerulus

and Bowmans capsule together are called renal corpuscle. The permeability of the

glomerular endothelium increases sufficiently to allow plasma proteins to filter out into

the capsule.

Endocrine System

The endocrine system performs their regulatory functions by means of chemical

messenger sent to specific cells. The endocrine glands secrete their products, hormones,

directly into the blood. There are two classifications of hormones: steroid hormones and

non-steroid hormones. The steroid hormones which are manufactured by the endocrine

cells from cholesterol, is an important lipid in the human body. Non-steroid hormones are


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synthesized primarily from amino acids rather from the cholesterol. Non-steroid

hormones are further subdivided into two: protein hormones and glycoprotein hormones.

1. Aldosterone

Its primary function is the maintenance of the sodium homeostasis in the blood by

increasing the sodium reabsorption in the kidneys. It is secreted from the adrenal cortex;

it triggers the release of ADH which results to the conservation of water by the kidney.

Aldosterone secretion is controlled by the renninangiotensin mechanism.

2. Anti-diuretic hormone (ADH)

It is secreted in the neurohypophysis (posterior pituitary); it literally opposes the

formation and production of a large urine volume. It helps the body to retain and

conserve water from the tubules of the kidney and returned to the blood.

Integumentary System

Also called the integument which simply means covering, the skin is much

more than an external body covering. It is absolutely essential because it keeps water and

other molecules in the body. The skin has many functions; most, but not all, are

protective. It insulates and cushions the deeper body organs and protects the entire body

from mechanical damage, thermal damage, ultraviolet radiation, and bacteria. The

uppermost layer of the skin is full of keratin and cornified in order to prevent water loss

from the body surface.

The skin is composed of two kinds of tissue. The outer epidermis is made up of

stratified squamous epithelium that is capable of keratinizing. The underlying dermis is

made up of dense connective tissue. Deep to the dermis is the subcutaneous tissue which

anchors the skin to underlying organs. Subcutaneous tissue serves as a shock absorber

and insulates the deeper tissues from extreme temperature changes occurring outside the

body.

Reproductive System

The female reproductive system produces gametes may unite with a male gamete

to form the first cell of the offspring. The female reproductive system also provides

protection and nutrition to the developing offspring. Conception, the fertilization of an

egg by a sperm, normally occurs in the fallopian tubes. The next step for the fertilized
http://www.webmd.com/baby/guide/understanding-conceptionhttp://www.webmd.com/baby/guide/understanding-conception


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egg is to implant into the walls of the uterus, beginning the initial stages ofpregnancy. If

fertilization and/or implantation does not take place, the system is designed to

menstruate. In addition, the female reproductive system produces female sex hormonesthat maintain the reproductive cycle.

The female reproductive anatomy includes parts inside and outside the body. The

function of the external female reproductive structures (the genitals) is twofold: To

enable sperm to enter the body and to protect the internal genital organs from infectious

organisms.

The main external structures of the female reproductive system include:

Labia majora: The labia majora enclose and protect the other external

reproductive organs

Labia minora: The labia minora lie just inside the labia majora, and surround theopenings to the vagina and urethra.

Bartholin's glands: These glands are located beside the vaginal opening and

produce a fluid (mucus) secretion.

Clitoris: The two labia minora meet at the clitoris, a small, sensitive protrusion

that is comparable to thepenis in males.

Mons Pubis: A pad of adipose tissue located over the symphisis pubis, the pelvic

bone joint. Its purpose is to protect the junction of the pubic bone from trauma.

Vestibule: Flattened smooth surface inside the labia.

The internal reproductive organs in the female include:

Vagina: The vagina is a canal that joins the cervix to the outside of the body. It

also is known as the birth canal.

Uterus : The uterus is a hollow, pear-shaped organ that is the home to a

developing fetus. The uterus is divided into two parts: the cervix, which is the

lower part that opens into the vagina, and the main body of the uterus, called the

corpus. The corpus can easily expand to hold a developing baby.
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Ovaries: The ovaries are small, oval-shaped glands that are located on either side

of the uterus. The ovaries produce eggs and hormones.

Fallopian tubes: These are narrow tubes that are attached to the upper part of the

uterus and serve as tunnels for the ova to travel from the ovaries to the uterus.

Conception, the fertilization of an egg by a sperm, normally occurs in the

fallopian tubes. The fertilized egg then moves to the uterus, where it implants into

the lining of the uterine wall.

During the last few weeks of pregnancy, estrogen reaches their highest levels in

the mothers blood. This has two important consequences: it causes the myometrium

to form abundant oxytocin receptors and it interferes with progesterones quieting

influence on the uterine muscle. As a result, weak and irregular uterine contractions

occur. These contractions, called Braxton Hicks contractions. As birth nears, two

more chemical signals cooperate to convert these false labor pains into true labor.

Certain cells of the fetus begin to produce oxytocin, which in turn stimulates the

placenta to release prostaglandins. Both hormones stimulate more frequent and

powerful contractions of the uterus. The combined effects of the rising levels of

oxytocin and prostaglandins initiate the rhythmic expulsive contractions of true labor.

Once the hypothalamus is involved, a positive feedback mechanism is propelled intoaction: stronger contraction cause the release of more oxytocin, which causes even

more vigorous contractions, forcing the baby ever deeper into the mothers pelvis.


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V. PATHOPHYSIOLOGY

Pre -

Predisposing factors:

Family history

of Pre

Eclampsia

Socioeconomic

status

Precipitating

factors:

Multiple

gestation

Labor

Vasospasm

Reduced blood supply to

Vascular Kidney Effects Interstitial Placenta

Vasoconstricti

Poor organ

perfusion

IncreasedBlood Pressure

Decreased

Glomeruli

filtration rate &

increased

permeability of

Increased serumblood urea nitrogen,

uric acid and

Decreased

urine output

Diffusion of fluid

from bloodstream

into interstitial

Edema

Poor placental

perfusion

Reduced fetal

nutrient and

Oxygen supply


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VI. ACTUAL TREATMENT OR MANAGEMENT

A. Laboratory and Diagnostic Exams

January

23,2013

Ultrasound Twin, live, intrauterine pregnancy as described.

Non-biometric parameters and suggestive of

pulmonary maturity but fetus is not yet term.

Single anterochondal placenta grade II.

Normohydramnios.

No growth discorday noted.

Frank breech presentation

-36 weeks and 4 days AOG

-Single nuchal cord seen

Cephalic presentation

-36 weeks and 3 days AOG-No nuchal cord

Single placenta is antherofundal in location,

grade II maturity.

January 27,

2013

Physical exam General status:

- Conscious, coherent, cooperative.

Abdomen:

-L1-breech L3-cephalic L4-engaged

Pelvic exam:

-Vagina-parallel, uterus-globular.

Date

ordered

Laboratory and

diagnostic

Results Normal findings Significance

01/27/13 CBC

White cell count

17,900

5,000-10,000/mm3

Hemoglobin 11.2 11.7-14.5 g/dl

Hematocrit 34.5 34.1-44.3 volumes

%

Platelet 364,000 174,000-390,000Segmenters 89 43.4-76.2

Lymphocytes 11 17.4-46.2

Proteinuria


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Cervical length/dilatation/effacement:

-8cm, STO, cephalic, 1st twin, 80% effaced.

Cervical position:

-anterior

Presentation:

-cephalic Membranes:

-intact

January 27,

2013

Clinical

Pelvimetry

Adequate


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B. Drug Study

PO Medications


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PO Medications

POSTOPERATIVE DRUGS


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Name ofdrug

Generic

(Brand)

Classification Dose/Frequency/

Route

Mechanism ofaction

Indication Contraindication Nursing precaution

Oxytocin Hormone

Oxytoxic

35 u and 20

u

Synthetic form of

an endogenous

hormone producedin thehypothalamus and

stored in posteriorpituitary;

stimulates the

uterus, especiallythe gravid uterus

just before theparturition, and

causes

myoepithelium ofthe lacteal glands

to contract, whichresults in milk

ejection inlactating women.

Lactation deficiency

Antepartum; toinitiate or improveuterine contraction s

to achieve earlyvaginal delivery;

stimulation or

reinforcement oflabor in selected

cases of uterineinertia; management

of inevitable or

incomplete abortion;second trimester

abortion.

Postpartum;To pro produce

uterine contraction

during the third stageof labor and to

control postpartumbleeding or

hemorrhage.

Contraindicated

with significant

cephalopelvicdisproportion,unfavorable fetal

positions orpresentations,

obstetric

emergencies thatfavor surgical

intervention,prolonged use in

severe toxemia,

uterine inertia,hypertonic uterine

patterns,induction or

augmentation oflabor when

vaginal delivery

iscontraindicated,

previous cesareansection,

pregnancy.

Use cautiously with

renal impairment.


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Name ofdrug

Generic(Brand)


Route

Mechanism ofaction


Ketorolac Analgesic 30mg IVTTQ8 x 24

Unknown; mayinhibit

prostaglandin

synthesis.

Short-termmanagement of pain

Contraindicatedin patients

hypersensitive to

drug and in thosewith a history of

syndrome ofnasal polyps,

angioedema,bronhospastic

reactivity, or

allergic reactionto aspirin or other

NSAIDS;in thosewith advance

renal impairment;

and in those atrisk for renal

failure as a resultof volume

depletion. Alsocontraindicated in

patients with a

with suspected orconfirmed

cerebrovascularbleeding,

hemorrhage

diathesis, andincomplete

homeostasis.Not

recommended forintrathecal or

epidural

administrationbecause of its

alcohol content.

Use cautiously inwomen, patients in

the perioperative

period; and patientswith hepatic or

renal impairment,history of serious

GI events of pepticulcer disease,

cardiac

decompensation,Hypertension or

coagulationdisorders.


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Name ofdrug

Generic

(Brand)


Route

Mechanism ofaction


Hydralazine Antihypertensive,

vasodilator(peripheral)

10mg

IVTT

Acts directly

on vascular

smoothmuscle tocause

vasodilatation,primarily

arteriolar,

decreasingreticular

resistance;maintenance

or increases

renal orcerebral blood

flow.

Essential

hypertension

alone or incombinationwith other

drugs.

Reducing

after load inthe treatment

of heartfailure,

severe aortic

insufficiency,and after

valvereplacement

(doses up to800mg tid)

Contraindicated

with

hypersensitivityto hydralazine,tartrazine (in

100 mg tabletsmarketed as

apresoline);

CAD, mitralvalvular

rheumatic heartdisease

(implicated with

MI).

Use cautiously with CVAs;increase

intracranial pressure(drug-induced BP

decrease increases risk of cerebralischemia);severe hypertension withuremia; advanced renal damage; slow

acytelators (higher plasma levels may beachieved)higher plasma levels may be

achieved; lower dosage may be

adequate);lactation,pregnancy,pulmonaryhypertension


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Name ofdrug

Generic

(Brand)


Route

Mechanism ofaction



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Name ofdrug

Generic

(Brand)


Route

Mechanism ofaction


Nifedipine Antianginal,

Antihypertensive,Calcium channel

blocker.

30 mg 1 tab,

OD

Inhibits the

movement ofcalcium ions

across themembranes of

cardiac andarterial muscle

cells; inhibition

oftransmembrane

calcium flowresults in the

depression of

impulseformation in

specializedcardiac

pacemaker cells,in slowing of the

velocity of

conduction ofthe cardiac

impulse, in thedepression of

myocardial

contractility, andcardiac work,

decreasedcardiac energy

consumption,and increased

delivery of

oxygen tomyocardial cells.

Angina pectoris due

to coronary arteryspasm(Prinzmetals

variant angina)

Chronic stableangina (effort-

associated angina)

Treatment of

hypertension

Unlabeled uses:

Anal fissures,urethral stones,

topical use toimprove wound

healing, preventionof migraine,

Reynaud

phenomenon.

Contraindicated

with allergy tonifedipine.

Use cautiously with

lactation, pregnancy,HF, aortic stenosis.

Allergy to

nifedipine,pregnancy,Lactation.

Skin lesions, color,Edema; orientation,

reflexes;P,BP,baselineECG,auscultation;R,

Adventitious sounds.


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OTHER MEDS. GIVEN:

Name of

drugGeneric

(Brand)

Classification Dose/

Frequency/Route

Mechanism of

action


Tramadol Analgesic 1 tab 3x day

for 5 days,PO

Unknown;

Certainly actingsynthetic analgesic

Compound not

Chemically relatedTo opioids that is

thought to bind toopioids receptors

and inhibit

reuptake to norepinephrine and

serotonin.

Moderate-to-

moderately severepain.

Contraindicated

in patientshypersensitive to

drug and in those

with acuteintoxication from

alcohol,hypnotics,

centrally acting

analgesics,opioids, or

psychotropicdrugs.

Use cautiously in

patients at risk forseizures or

respiratory

depression; patientswith increased

intracranialpressure or head

injury, acute

abdominalconditions, or renal

hepatic impairment;and patients

physicallydependent on

opioids.


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Name of

drugGeneric

(Brand)

Classification Dose/

Frequency/Route

Mechanism

of action


Clindamycin Lincosamide

antibiotic

300mg cup

3x day for7 days

Inhibits

proteinsynthesis in

susceptiblebacteria,causing cell

death.

Topical

dermatologicsolution:

Treatment ofacne vulgaris.

Systemicadministration:

Serious

infectionscaused by

susceptiblestrains of

anaerobes,streptococci,

staphylococci,

pneumococci;

reserve use forpenicillin isinappropriate;

less toxic

antibiotics(erythromycin)

should beconsidered.

Vaginal

Contraindicated with

allergy toclindamycin,

lactation.

Use caution with history of

regional enteritis or ulcerativecolitis; history of antibiotic

associated colitis.

Allergy to clindamycin, history

of asthma or other allergies,hepatic or renal impairment;

lactation; history of antibiotic-

associated colitis.

Site of infection or acne; skincolor,lesions;BP,R,adveventitous

sounds; bowelsounds,output,liver evaluation;

complete blood

count,LFTs,renal function tests


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preparation:

Treatment ofbacterial

vaginosis.


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VII. IDEAL TREA


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37/44

DATA NURSING

Diagnosis

OBJECTIVES NURSING

INTERVENTIONS

RATIONALE EVALUATION

Ineffective tissue

perfusionrelated to

vasoconstriction of blood

vessels

After 8 hours of

nursingintervention

s, thepatient will

be able tomaintain

normal

blood

pressure.

INDEPENDENT:

1. Support bed rest

2. Monitor maternal

well being. Take bloodpressure frequently.

3. Monitor output byinserting urinary

catheter; and measureurinary proteins and

specific gravity

4. Support a nutritiousdiet

Bed rest provide, relaxation tothe patient, and it prevents from

any stress that may trigger to

increase the patients bloodpressure

To detect any increase, which is

a warning that patientscondition is worsening

To allow accurate recording ofoutput and comparison with

intake; urinary output should bemore than 600mL/24hrs

(>30mL/hr). A 24hr urine

sample may be collected toevaluate kidney function; mild

pre-eclampsia 0.5g

protein/24hrs , and severe

pre-eclampsia 5g/24hrs

Patient needs a diet moderate to

high in protein and moderate in

sodium to compensate for theprotein lost in the urine.


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Advised patient to have adequate sleep (6-8 hours).

Refrain doing strenuous activities like lifting heavy objects such as fetching

water.

Advised client to take her medications regularly.

Implement ROM exercises

Eat nu t r i t i ous f oods e s pec i a l l y t hos e l ow i n f a t and s od i um

such as fruits, milk and vegetables.

Health Teachings

MEDICATION:

Continue taking medications which includes the following:

Nifedifine 30mg 1 tab OD

Ascorbic acid 1 tab OD

Multi. Vitamins + Fe 1 tab OD (Supplement)

Clindamycin 300mg 1 cap 3days (Antibiotic for pain , for 7 days)

Tramadol w/ Paracetamo 1 tab 3x day for 5days

EXERCISE:

Do Activities of Daily Living (ADLs) as tolerated.

Instructed the client to limit the ascending stairs for at least first week after

delivery at home.

Instructed the client to avoid strenuous activities and practice deep breathing

exercise

TREATMENT:

Do daily dressing at home and follow-up after 1 week at OPD

Advised client to monitor blood pressure


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Instructed patient to take prescribe medications

Instructed the patient to take a bath everyday

Educated patient on expected lochial discharge.

OUT-PATIENT:

Instructed the client to go on follow-up check-ups

Recommended client to attend counseling seminars to assist her in coping

with her daily life

DIET:

Instructed the patient to take a balance diet w/ high protein, low fat, and low

sodium.

Instructed the patient to increase fluid intake.

X. DOCTORS ORDER


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DATE DOCTORS ORDERS RATIONALE

January 27, 20135:00 PM

8:00 PM

10:00 PM

10:45 PM

Admit under OB

NPO

TPR q 4* hr.

Secure consent

Labs CBC, UA, HBSAG,

BLOOD TYPE, stat

Start IV; D5LR 1L @ 30

gtts/min To Labor Room

FHT q hourly

Refer accordingly

Hydralazine 10 mg IVTTnow

Start hydralazine drip D5W

250 cc + 2 days form @ 20gtts/ min

BP q 30*min, refer it >

160/100

Monitor FHT

Schedule for E CS

Refer for OR andAnesthesia

Secure 1 u FBC for OR

use

Ampicillin 1g IVTT, must

give once q 6* h

Insert FBC attached toUrobag

-To monitor patient

condition and to identify

some problems regarding tothe mother and fetal health

before and after delivery.

-To prepare the GI tract

-To monitor anyabnormalities within the

hospital admission

-For the patient to be awarefor any actions that may be

performed while she is in

the ward-To find out if there are

abnormal findings

regarding the patient.

-To balance fluid volume in

the body

-To prepare the patient fordelivery.

-To monitor heart rate

activity of the fetus.-To report any unusualities

and complications during

labor will happen.-Reduces BP mainly by

direct effect on vascular

smooth muscles or arterial

resistance vessels, resultingin vasodilation.

-To prevent increase of BP

-To monitor the rising of

blood pressure and to

anticipate actions.

-To deliver the baby as

soon and as safe as possible

-To prepare the patient for

cesarean section

- to prepare patient for

cesarian section

- Prophylaxis in cesarean

section-To monitor the patient

output

-To prepare patient foroperation.

-To prepare patient for


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XI. PROGNOSIS

The outlook for full recovery from preeclampsia is very good. Most women begin to

improve within one to two days after delivery, and blood pressure returns to the normal

pre-pregnancy range within the next 6 to 12 weeks. Prenatal care can dramatically reduce

the complications and deaths of preeclampsia, because women who are diagnosed while

preeclampsia is mild can receive treatment without any delay. Between 5% and 8% of

pregnant women in the United States develop preeclampsia. Progress in treating

eclampsia has saved the lives of both mothers and their newborns. In the United States

and Britain, between 1% and 2% of women who developed eclampsia die and 3% of their

babies die during or shortly after birth. The maternal death rate from eclampsia in

locations where health care is not easily available can exceed 13%.

Risks to the fetus from preeclampsia include intrauterine growth retardation and lowbirth weight, placental abruption, and stillbirth. The fetus may be delivered prematurely if

the condition of the mother deteriorates. Risks to the mother include vascular organdamage; the additional risks of eclampsia include convulsions and accompanying oxygen

deprivation, hemorrhage in the brain, temporary blindness, permanent neurological

damage, liver or kidney damage, cerebrovascular and cardiovascular complications, andeven death. The prognoses for both the fetus and mother are excellent in mild

preeclampsia. If blood pressure readings are within normal limits after several weeks

postpartum, the mother may still be at increased risk of hypertension later in life, and

should have her blood pressure checked yearly.

The long-term prognosis for children born to preeclamptic mothers is not yet known.These individuals do, however, appear to be at increased risk of chronic disease in adult

life. Sign and symptoms of preeclampsia usually go away within 6 weeks after delivery.However, the high blood pressure sometimes gets worse the first few days after delivery.

If you have had preeclampsia, you are more likely to develop it again in another

pregnancy. However, it is not usually as severe as the first time. If you have high blood

pressure during more than one pregnancy, you are more likely to have high bloodpressure when you get older.

XII. RESEARCH UPDATE

RESEARCH UPDATES


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One in 20 Cases of Pre-Eclampsia May Be Linked to Air Pollutant

Feb. 6, 2013 One in every 20 cases of the serious condition of pregnancy, pre-eclampsia, may be linked to increased levels of the air pollutant ozone during the first

three months, suggests a large study published in the online journal BMJ Open.

Mothers with asthma may be more vulnerable, the findings indicate. Thousands ofwomen and babies die or get very sick each year from a dangerous condition called

preeclampsia, a life-threatening disorder that occurs only during pregnancy and the

postpartum period. Preeclampsia and related disorders such as HELLP syndrome and

eclampsia are most often characterized by a rapid rise in blood pressure that can lead toseizure, stroke, multiple organ failure and death of the mother and/or baby.

Pre-eclampsia is characterised by raised blood pressure and the presence of protein in the

urine during pregnancy. It can cause serious complications, if left untreated.

The authors base their findings on almost 121,000 singleton births in Greater Stockholm,Sweden, between 1998 and 2006; national data on the prevalence of asthma among the

children's mothers; and levels of the air pollutants ozone and vehicle exhaust (nitrogen

oxide) in the Stockholm area.

There's a growing body of evidence pointing to a link between air pollution andpremature birth, say the authors, while pregnant women with asthma are more likely to

have pregnancy complications, including underweight babies and pre-eclampsia.

In all, 4.4% of the pregnancies resulted in a premature birth and the prevalence of pre-

eclampsia was 2.7%.

There was no association between exposure to levels of vehicle exhaust and

complications of pregnancy, nor were any associations found for any air pollutants and

babies that were underweight at birth.

But there did seem to be a link between exposure to ozone levels during the first threemonths of pregnancy and the risk of premature birth (delivery before 37 weeks) and pre-

eclampsia, after adjusting for factors likely to influence the results and seasonal

variations in air pollutants, although not spatial variations in exposure.

Each rose by 4% for every 10 ug/m3 rise in ambient ozone during this period, the

analysis indicated.

XIII. REFEERENCES

Pilliteri, Adele.


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Maternal and Child Health Nursing: Care of the childbearing and childrearing

family/Adele Pilliteri. 6th edition. Copyright 2010 Lippincott Williams & Wilkins.

ISBN 9781451108798

Marieb, Elaine.

Essentials of Human Anatomy and Physiology, 7 th edition by Marieb, Elaine N.,

Published by Pearson Education Inc., Copyright 2003. San Francisco, CA 94111 Original

ISBN 0805353860

Doenges, Marilynn

Nursing care plans : guidelines for individualizing client care/ Marilynn E.

Doenges, Mary Frances Moorhouse, Alice C. Murr.-Ed. 7. ISBN 080361294X. Copyright

2006 by F.A. Davis Company

Wilson, Billie Ann

Prentice Halls Nurses Drug Guide 2004, 1st Edition by Wilson, Billie Ann;

Shannon, Margaret, Stang, Carolyn. Published by Pearson Education Inc. Copyright 2004

Doenges, Marilynn

Nurses Pocket Guide : Diagnoses, Prioritized Interventions, and Rationales/

Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Murr.-Ed. 7. ISBN

9789746520423. Copyright 2008 by F.A. Davis Company

Documents

CP FINAL-- Pre-eclampsia