Holy Angel University Angeles City College of Nursing

Pre-Eclampsia

Submitted to: Norina Ponio Turingan, R.N M.A.N

Submitted by: GROUP 3/ N-306 Cuellar, Jenny Rose Gatpolintan, John Arzen Leonen, Jay-Renz Lumanlan, Ralp Lauren Magabo, Jan Vincent Magat, Meriel Muoz, Jennifer Nain, Irien Pabustan, Nathaniel Roque, Jill Santos, Kristine Ann Tayag, Paula Angeli

December 05, 2008

I. INTRODUCTION

Description of the Disease Preeclampsia, also referred to as toxemia, is a condition that pregnant women can get. It is marked by high blood pressure accompanied with a high level of protein in the urine. Women with preeclampsia will often also have swelling in the feet, legs, and hands. Preeclampsia, when present, usually appears during the second half of pregnancy, generally in the latter part of the second or in the third trimesters, although it can occur earlier. In addition symptoms of preeclampsia can include:

Rapid weight gain caused by a significant increase in bodily fluid Abdominal pain Severe headaches A change in reflexes Reduced output of urine or no urine Dizziness Excessive vomiting and nausea

The exact causes of preeclampsia are not known, although some researchers suspect poor nutrition, high body fat, or insufficient blood flow to the uterus as possible causes.

The only real cure for preeclampsia and eclampsia is the birth of the baby. Mild preeclampsia (blood pressure greater than 140/90) 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. In developing countries: preeclampsia/eclampsia impact 4.4% of all deliveries (1) and may be as high as 18% in some settings in Africa (2) If the rate of life threatening eclamptic convulsions (0.1% of all deliveries) is applied to all deliveries from countries considered to be the least developed, 50,000 cases of women experiencing this serious complication can be expected each year. According to Safe Motherhood.org of the 585,000 maternal annually (3), 13%, or 76,050, are due to eclampsia.

Nurse-Centered Objectives Upon completion of this case study, the student nurse should be able to: 1. Identify the risk factor contributing to the occurrence of the disease. 2. Formulate significant nursing diagnosis, with the significantly related nursing care plan. 3. Identify the different medications administered for this disease their indications, contraindications, side effect, and specific responsibility .4. Identify the laboratory and diagnostic procedure done with the pre-eclamptic

patient, their indication and purposes, and specific nursing responsibilities. Client-Centered Objectives Upon completion of this case study, the client should be able to: 1. Understand awareness of her disease.2. Know the possible causes of the disease.

3. Learn and understand why such laboratory examinations are being

done.

II. NURSING HISTORY a.) Demographic Data

Mrs. Ob, a 39 years old housewife and first time mother, who currently resides at Guagua Pampanga with her husband Mr. Gyne. She was born a Filipina on November 9, 1969 in Sta. Rita Guagua Pampanga. The patient was admitted at a Regional Hospital with a chief complaint of abdominal pain, last November 15, 2008 at around 3:00 p.m.

b.) Socio-Economic and Cultural Factors

Mrs. Ob is plain housewife and her husband is an extra laborer on a construction site. She graduated at a Public High School. And she didnt continue her college level due to financial problem.

Mrs. Ob was raised as a Roman Catholic, were she learned about religious values but she still believes in super natural forces and superstitious beliefs. When it comes in health matters, she seeks the help of a albularyo and uses herbal medicines to treat any member of the family who has an ailment. But when serious matters arise she still refers to medical professionals for help.

c.) Environmental factors

Ms. Ob resides at Guagua Pampanga and occupies the ancestry house of her family. The location of their house is not easily accessible to hospitals, health centers and other government institutions. Mrs. Ob did not report any problems regarding her environment which interfered to her pregnancy.

Maternal-child Health History

a.)

Maternal Obstetric record (for OB cases) Mrs. Ob was married to Mrs. Gyne at the age of 33 years old. She has a record of T1P0A0L1M0 at her 39th week of gestation. She underwent low transverse ceasarian section under a certain obstetrician at the regional hospital last November 18, 2008 at around 10:00 in the evening, she delivered her 1st child who is term baby with hyperbilirubinemia.

b.) Antepartal/ Prenatal Preparation

When Mrs. Ob was still pregnant, she only consulted once in a district hospital all throughout.

c.)

Significant Trimestral Changes (1st to 3rd trimester)

Mrs. Ob rxperienced some changes in her pregnancy, such as striae gravidarum, linea nigra, and melasma. She also experienced nausea and vomiting, dizziness, and headache.

Family Health Illness History

Grandmother

Grandfather

Grandmother

Grandfather

Father Mother

Patient

Legend:

hypertension died of old age pneumonia asthma deceased

pre eclampsia*pink border mother side *blue border father side *violet border - patient

Both the grandparents from the mothers side died from old age. From the fathers side, the grandmother died from Hypertension and the father was died from Pneumonia. The mother is not experiencing any health problems but the father has hypertension and asthma. The patient, upon admission has elevated blood pressure and is suffering from aggravating factors like anxiety, nervousness and fear.

PHYSICAL ASSESSMENT November 27, 2008

SKIN

brown skin generally uniform in color except in areas exposed to the sun skin temperature uniform and within the normal range (37C) when pinched, skin readily springs back to previous state moist skin folds nails with smooth texture nail beds pink prompt capillary refill time (2 seconds) bipedal non-pitting edema

HEAD

absence of nodules or masses symmetric facial features and movements symmetric nasolabial folds evenly distributed black hair no infestations

EYES

eyebrows symmetrically aligned with equal movement eyelashes equally distributed and curled slightly outward skin of eyelids intact with no discoloration lids close symmetrically

bilateral blinking exhibited no discharge, edema or tearing white sclera pink palpebral conjunctiva iris black in color pupils equal in size with smooth borders illuminated pupils constricts pupils converge when near object is moved toward the nose when looking straight ahead, the client can see objects in the periphery both eyes coordinated, move in unison with parallel alignment

EARS

color same as facial skin symmetrically aligned pinna immediately recoils after it is folded pinna is not tender no lesions or discoloration dry cerumen, grayish-tan color normal voice tones audible able to hear ticking of a watch in both ears

NOSE

symmetric and straight no discharge or flaring absence of lesions and tenderness nasal septum intact and in the midline

MOUTH AND THROAT

outer lips uniform pink color with symmetric contour, soft and moist buccal mucosa is of uniform pink color gums are pink tongue pink, moist, at central position

NECK

head centered lymph nodes not palpable

BREAST

firm generally symmetric in size

CARDIOVASCULAR

BP 180/100 mmHg PR 114 reported palpitations symmetric pulse strength

RESPIRATORY/CHEST

chest symmetric chest wall intact, no tenderness, no masses symmetric chest expansion and excursion RR: 29 breaths per minute

GASTROINTESTINAL/ABDOMEN

striae present at hypogastric and iliac regions linea nigra present no tenderness presence of surgical incision

URINARY

absence of nocturia, dysuria, urgency, hesitancy, light yellow urine

REPRODUCTIVE

regular menstrual cycle G1P1

MUSCULOSKELETAL/EXTREMITIES

muscle equal size on both sides of the body no bone deformities no tenderness

NEUROLOGIC

can respond to verbal commands oriented conscious displayed anxiety

PHYSICAL ASSESSMENT November 28, 2008 SKIN

brown skin generally uniform in color except in areas exposed to the sun skin temperature uniform and within the normal range (37C) good skin turgor moist skin folds nails with smooth texture nail beds pink prompt capillary refill time bipedal non-pitting edema

HEAD

rounded smooth skull contour symmetric facial features symmetric nasolabial folds symmetric facial movements

HAIR

thick black hair

evenly distributed no infestations

EYES

eyebrows symmetrically aligned eyelashes curled slightly outward exhibited bilateral blinking both eyes coordinated, move in unison and with parallel alignment white sclera pink palpebral conjunctiva pupils equally round and reactive to light and accommodation iris black in color pupils equal in size with smooth borders illuminated pupils constricts no discharge

EARS

color same as facial skin symmetrically aligned pinna immediately recoils after it is folded pinna is not tender no lesions or discoloration dry cerumen, grayish-tan color normal voice tones audible

NOSE AND SINUSES

symmetric and straight no discharge absence of lesions and tenderness nasal septum intact and in the midline sinuses not tender

MOUTH AND THROAT

outer lips uniform pink color symmetric contour buccal mucosa is of uniform pink color no abrasions and ulcerations gums are pink tongue pink, moist, at central position tongue moves freely with no tenderness palate surface intact uvula positioned in midline palatine tonsils pink and smooth and not swollen

NECK

head centered head movement coordinated and smooth with no discomfort lymph nodes not palpable

BREAST AND AXILLAE

rounded, generally symmetric areola rounded and the same shape nipples round, everted and equal in size milk letdown

CARDIOVASCULAR

BP 160/100 mmHg PR 106 prompt capillary refill time (less than 1 second) symmetric pulse strength

RESPIRATORY/CHEST

chest symmetric chest wall intact, no tenderness, no masses full symmetric chest expansion and excursion respiratory rate of 22 breaths per minute

GASTROINTESTINAL/ABDOMEN

striae present at hypogastric and iliac regions symmetric movement caused by respiration tender because of suture from cesarean operation

URINARY

yellowish urine

REPRODUCTIVE

regular menstrual cycle G1P1 (1-0-0-1-0)

MUSCULOSKELETAL/EXTREMITIES

muscle equal size on both sides of the body equal strength no bone deformities no tenderness no tenderness on calf muscle when dorsiflexed

NEUROLOGIC

can respond to verbal commands oriented conscious

PHYSICAL ASSESSMENT November 29, 2008 SKIN

brown skin generally uniform in color except in areas exposed to the sun skin temperature uniform and within the normal range (37.2C) when pinched, skin readily springs back to previous state moist skin folds nails with smooth texture nail beds pink nail plate angle about 160 prompt capillary refill time bipedal non-pitting edema

HEAD

rounded smooth skull contour no masses, tenderness in the scalp

symmetric facial features symmetric nasolabial folds symmetric facial movements

HAIR

thick, evenly districbuted black hair no infestations

EYES

eyebrows symmetrically aligned exhibited bilateral blinking anicteric sclera pink palpebral conjunctiva pupils equally round and reactive to light and accommodation no discharge

EARS

symmetrically aligned pinna not tender and immediately recoils after folded no lesions or discoloration dry cerumen, grayish-tan color normal voice tones audible able to hear ticking of a watch in both ears

NOSE AND SINUSES

symmetric and straight no discharge or flaring absence of lesions and tenderness nasal septum intact and in the midline both nares patent

MOUTH AND THROAT

outer lips uniform pink color symmetric contour buccal mucosa is of uniform pink color gums are pink tongue pink, moist, at central position palate surface intact uvula positioned in midline palatine tonsils pink and smooth and not swollen gag reflex present 30 adult teeth, 2 molars missing, 1 with black discoloration of the enamel

NECK

neck muscles equal in size, head centered head movement coordinated and smooth with no discomfort lymph nodes not palpable

BREAST AND AXILLAE

areola rounded and the same shape nipples round, everted and equal in size milk letdown

CARDIOVASCULAR

BP 150/100 mmHg PR 96 strong, regular rhythm

prompt capillary refill time (less than 1 second)

RESPIRATORY/CHEST

chest symmetric right and left shoulders and right and left hips are at the same height chest wall intact, no tenderness, no masses full symmetric chest expansion and excursion respiratory rate is 28 breaths per minute

GASTROINTESTINAL/ABDOMEN

striae present at hypogastric and iliac regions rounded contour symmetric movement caused by respiration tender because of suture form cesarean operation

URINARY

yellowish urine

REPRODUCTIVE

regular menstrual cycle G1P1 (1-0-0-1-0)

MUSCULOSKELETAL/EXTREMITIES

muscle equal size on both sides of the body smooth coordinated movements

equal strength no tenderness walks aided to maintains balance no tenderness on calf muscle when dorsiflexed

NEUROLOGIC

can respond to verbal commands oriented conscious

DIAGNOSTIC AND LABORATORY PROCEDURES

Diagnostic or Laboratory Procedure

Indication or Purpose

Date Ordered and Date Results Results were released November 16, 2008 8.0

Normal Values

Analysis and Interpretation of Results

WBC Count

To determine infection or inflammation Pre-operation assessment of the patient.

5-10 x 109/L

No infection or inflammation is present.

RBC Count

Pre-operation assessment of the patient.

November 16, 2008

3.3

4.2-5.4 x Decreased 1012 /L RBC count on pregnant is normal because of the increase in plasma volume during pregnancy. The result indicates that a 1000 ml sample of blood contains 96 g of hemoglobin. Decreased

Hemoglobin

Pre-operation assessment of the patient.

November 16, 2008

96

120160g/L

hemoglobin on pregnant is normal because of their increase in plasma volume. 0.37-0.47 The result g/L indicates that a 1000 ml sample of blood contains .29 g of hemoglobin. Decreased hematocrit on pregnant is normal because of their increase in plasma volume.

Hematocrit (%)

Pre-operation assessment of the patient.

November 16, 2008

0.29

Nursing Responsibilities During Different Laboratory Procedures

White Blood Cell Count

Before Explain to the patient that the WBC test is used to detect an infection or inflammation. Tell the patient that the test requires a blood sample. Explain who will perform the venipuncture and when. Explain to the patient that he may experience slight discomfort from the needle puncture and the tourniquet. Inform the patient that he should avoid strenuous exercise for 24 hours before the test. Also tell him that he should avoid eating a heavy meal before the test. If the patient is being treated for an infection, advise him that this test will be repeated to monitor his progress. Notify the laboratory and physician of medications the patient is taking that may affect test results: they may need to be restricted.

During Ensure subdermal bleeding has stopped before removing pressure.

After If a hematoma develops at the venipuncture site, apply warm soaks. If the hematoma is large, monitor pulses distal the venipuncture site. Inform the patient that he may resume his usual diet, activity and medications discontinued before the test, as ordered. A patient with severe leucopenia, they have little or no resistance to infection and requires protective isolation.

Red Blood Cell Count Before

Explain to the patient that RBC count is used to evaluate the number of RBCs and to detect possible blood disorders. Tell the patient that the test requires a blood sample. Explain who will perform the venipuncture and when. Explain to the patient that he may experience slight discomfort from the needle puncture and the tourniquet. Inform the patients that he need not restrict foods and fluids

During Ensure subdermal bleeding has stopped before removing pressure.

After If a hematoma develops at the venipuncture site, apply warm soaks.

Hemoglobin Before Explain to the patient that the hbg test is used to detect anemia or polycythemia or to assess his response to treatment. Tell the patient that the test requires a blood sample. Explain who will perform the venipuncture and when. Explain to the patient that he may experience slight discomfort from the needle puncture and the tourniquet.

During Ensure subdermal bleeding has stopped before removing pressure.

After If a hematoma develops at the venipuncture site, apply warm soaks. Hematocrit Before Explain to the patient that hct is tested to detect anemia and other abnormal conditions Tell the patient that the test requires a blood sample. Explain who will perform the venipuncture and when. Explain to the patient that he may experience slight discomfort from the needle puncture and the tourniquet. Inform the patients that he need not restrict foods and fluids

During Ensure subdermal bleeding has stopped before removing pressure.

After If a hematoma develops at the venipuncture site, apply warm soaks.

III. THE PATIENT AND HIS ILLNESS

Efforts to unravel the pathogenesis of pre-eclampsia have been hampered by the lack of clear diagnostic criteria for the disease and its subtypes. Consequently, several studies have included a variety of other conditions that do not necessarily reflect an adverse pregnancy outcome.

Abnormal placentation (stage 1), particularly lack of dilatation of the uterine spiral arterioles, is the common starting point in the genesis of pre-eclampsia, which compromises blood flow to the maternalfetal interface. Reduced placental perfusion activates placental factors and induces systemic hemodynamic changes. The maternal syndrome (stage 2) is a function of the circulatory disturbance caused by systemic maternal endothelial cell dysfunction resulting in vascular reactivity, activation of coagulation cascade and loss of vascular integrity. Pre-eclampsia has effects on most maternal organ systems, but predominantly on the vasculature of the kidneys, liver and brain.

V. THE PATIENT AND HIS CARE 1. Medical Management a. IVFs, BT, NGT feeding, Nebulization, TPN, Oxygen Therapy

Medical Management IVF

Date Ordered

General

Indication &

Client Response to Treatment The patient

Date Ordered November 15,

Description Purpose 5% dextrose in D5NM is

lactated ringers administered by responded well solution intravenous with no signs of irritation and adverse reactions.

D5LRS 1L 2008 30gtts/min (Osmolarity of infusion for Date d/c 527-hyprtonic, parenteral November 20, pH of 4.9) 2008 -provides routine daily fluid maintenance of

calories and free and electrolyte water, provides requirement with electrolytes. Also contains minimal carbohydrates

sodium lactate calories and to which is used in correct or replace treating mild to fluid losses due to moderate metabolic acidosis. change in the patients diet (NPO) and during the cesarean operation. Nursing Responsibilities:

Check the doctors order

Explain the procedure to the patient Tell the patient that she might feel a discomfort from the tourniquet and the IV insertion Check and monitor IVF regulation and level of fluid Check if there is a need for removal and replacement of fluid Check if the tube is in the vein and signs of edema Check if there is a back-flow of blood Check if there is bubbles present in the tube Always Monitor V/S.

b. Pharmacotherapy

Brand name and Date ordered/ Generic name Date started/ Date changed/

Route of Administration, Dosage and Frequency of Administration P.O., 500mg, TID for pain

General action

Client response

Mefenamic Acid

11-19-08

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation of prostaglandin

Patient was relieved from pain.

Cephalosporin

11-19-08

precursors I.V., 750mg, q8 Inhibits bacterial The patient did

Cefuroxime sodium

cell wall synthesis by

not acquire infection and

binding to one or did not more of the penicillinexperience any adverse

binding proteins reaction. (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is

arrested.

Ferrous Sulfate 11-19-08

P.O., O.D.

Replaces iron, found in hemoglobin,

The patient responded well to treatment

myoglobin, and and did not other enzymes; experience any allows the adverse

transportation of reaction. oxygen via hemoglobin. P.O., 10mg, BID Inhibits calcium The patient ion from entering the responded well to treatment

Nifedipine

11-19-08

"slow channels" and did not or select experience any

voltage-sensitive adverse areas of vascular reaction. smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases

myocardial oxygen delivery in patients with vasospastic angina

c. Diet

Type of Diet Date Ordered, Date Performed, Date Administer 11-17-08 11-19-08

General Description

Indication & Purpose

Client Response to

NPO

Treatment The patient is not This is done to The patient allowed to take any oral food or liquid prevent complied with

alteration of the the prescribed result of the fasting blood sugar.bcs intake of food can increase glucose level This diet reduce The patient stimulation of the digestive system, and complied with the prescribed diet. diet.

Clear Liquid Diet

11-19-08 11-20-08

A diet of clear liquids maintains vital body fluids, salts, and

minerals; and also leave no residue gives some energy in the intestinal for patients when tract. This is normal food intake why a clear must be liquid diet is

interrupted. Clear often prescribed liquids are easily absorbed by the body. by mouth (NPO) for a long time. This diet is also used in preparation for in preparation for surgery, and is generally the first diet given by mouth after surgery. Clear liquids are

medical tests such given when a as sigmoidoscopy, person has been colonoscopy, or certain x-rays. without food by mouth (NPO) for a long time.

d. Exercise

Activity

General Description

Purpose

Date Order

Client Response

Complete Bed Prescribed Rest maternal complication of pregnancy

To provide adequate rest

11-18-08

The client adhered to the order without complaints.

VI. NURSING CARE PLAN

Cues S-sumasakit nga daw ung tahi niya at sumusigaw siya as the SO verbalized

Nursing diagnoses Acute pain related to postparum

Scientific Explanation Unpleasant sensory experience

Objective After 2-4 hr of nursing intervention, the

Nursing intervention - Provide quite environment

Expected outcomes -to promote pain Goal Partially management. met AEB pt rated the pain

Rationale

arising from post pt rate the pain surgical incision from 8 to 3 in a from cesarean section. pain scale of 110

-Encouraged to do deep breathing exercise

-to reduce tension from 8 to 5 in a pain scale of 110

O- facial grimaces Rated pain as 8 in a pain scale of 1-10, 10 being the highest - Encouraged to - Encouraged adequate rest period

-to prevent fatigue

-to reduce pressure on the

Guarding behavior

support the affected area upon movement

affected area

Cues S-ayoko na muna dapat mabuntis kc papangit ung katawan ko tsaka bat ang itim ng pek-pek ko as pt verbalized

Nursing diagnoses Disturbed body

Scientific Explanation Severity of the

Objective After 2-4 hrs of nursing

Nursing intervention -Encouraged

Rationale -to begin to

Expected outcomes Goal met the patient recognized and verbalized understanding of

image related to abdominal pregnancy AEB changes in appearance wound due to surgery, a new type of tissues develops that eventually will causes scar formation

client to looked/ incorporate changes into body image.

intervention, the touch the patient will able affected body to understand thearea change of body image. -Encourage the client to have a daily exercise.

-to bring back the usual physical images.

body changes.

-to feel that the

O-presence of melasma -presence of bipedal edema

-Advised the SO patient still to give support to the pt (especially emotional feelings) -to aid in recovery. -Assist pt to identify positive behavior worthy.

Cues S: bumibilis nga tibok ng puso ko verbalized by the patient

Nursing diagnoses Decreased cardiac output

Scientific Explanation Pregnancy Induced

Objective After 4 hrs of nursing

Nursing intervention -Keep client on bed and in

Rationale - decreases oxygen consumption

Expected outcomes Goal Met AEB within 4 hrs. of nursing intervention the pt. HR

related to altered Hypertension is a intervention, the position of heart rate (111 bpm) AEB condition in which patient will display hemodynamic -decrease stimuli; provide comfort

tachycardia, pts vasospasms report of palpations; (r/t) decreased venous return -facial grimaces AEB edema -BP= 160/100 mmhg (ankle), SOB (28)

-to promote adequate rest

decreased from 111 bpm to 100 bpm, BP from

O: -with the tenderness of abdominal are

occur. It is caused stability (heart

by altered cardiac rate will decrease quiet envt output that injures from 111 bpm to endothelial cells of the arteries. Blood vessels become less resistant to -Encouraged 100 bpm, BP -Encouraged -to reduce anxiety

140/100 to 120/80 (Normal BP)

from 140/100 to deep breathing 120/80) exercise -to reduce risk for orthostatic

RR= 28 cycles per min.

pressor substances. This results to

changing positions slowly

hypotension

-to provide -give information about positive signs of improvement -to prevent in changes in cardiac pressures -Instruct client to or impede blow avoid or limit activities that may stimulate valsalva response (rectal stimulation, flow encouragement

PR= 111 bpm

vasoconstriction and increases BP dramatically

bearing down B.M)

Cues S-

Nursing diagnoses Risk for

Scientific Explanation Constipation

Objective After 4 hrs of

Nursing intervention - Educate

Rationale - Information

Expected outcomes Goal Met AEB

constipation O- decreased ambulation of the patient bcs of pain and the complete bed rest ordered of the physician. related to post CS delivery.

may happen due nursing

patient/ SO

can help client to the patient make beneficial verbalized choices when need arises. understanding about constipation and gained

to disturbance of intervention, the about safe and normal bowel movements because intestines were patient will verbalize understanding the etiology and risky practices for managing constipation.

displaced during appropriate surgical procedure. intervention if

- Instruct balance - To improve fiber and bulk in consistency of stool and

knowledge of appropriate intervention.

constipation may diet and fiber occur. supplements.

facilitate passage through colon.

- Promote adequate fluid intake, also - To promote soft stool and

suggest drinking stimulate bowel warm fluids. activity.

- Encourage activity within limits of individual ability. -To stimulate constrictions of the intestines

Cues O- postpartum surgery

Nursing diagnoses Impaired Skin

Scientific Explanation The incision

Objective After 2-4 hrs of nursing

Nursing intervention -stress proper hand hygiene.

Rationale - to control the spread of

Expected outcomes Goal Met AEB the patient was

Integrity related from the

to surgery

cesarean section intervention, the altered the skin patient will able integrity making to know the it more susceptible to pathogens and even the pts normal flora preventive measures of wound healing -Encouraged proper clothing -Encouraged to increase foods that are rich in protein

infection.

able to knew the preventive

- to aid in tissue repair

measures of wound healing

-to maintained the proper skin moisture.

-Apply appropriate dressing -to help in wound healing

VIII. Discharge Plan

General Condition of client upon discharge

During nurse-patient interaction upon discharge, the patient was wearing a comfortable pair of white shirt and white pajama and a pair of flat slip-ons while being sealed on a chair cuddling her baby boy. Her hair was untidy and up in a ponytail with visible infestations. She was oriented enough to follow instructions and answers questions asked by the student nurse.

Methods

M- Instructed the patient to take the following home medication as ordered by the physician:

Mefenamic Acid 500mg PRN

Ferrous Sulfate OD

Nifedipine 10mg BID

E- Instructed patient to avoid strenuous activities. And practice deep breathing exercise.

T- n/a

H- Instructed patient to take a bath everyday. Emphasize the importance of breast feeding.

O- Advice to visit or have a follow up check-up with her attending physician. D- Low fat, Low salt diet.

IX. Conclusion

Nurses can help the nation achieve National Health Goals. These goals speak directly to both fetus and the mother because pregnancy is a high risk factor for them. Close monitoring in pregnant women and health teaching as much as possible about pregnancy could definitely reduce life threatening complications.

Studies shows that there is no certain facts that will give us the idea where preeclampsia arise. But there so many factors that could prevent this complication such as diet modifications, proper compliance with the health care providers, proper exercise. And if the complication is already present, proper monitoring, proper diet and drug compliance should be ruled in.

X. Recommendations

With this study, the student nurses were able to gain more knowledge and wider view and perspective of the complication of pregnancy which is pre-eclampsia. Thus, the student nurses would like recommend and share some pointers on how to deal with different diseases with pregnancy specifically preeclampsia.

To the government, primarily they should allocate sufficient budget to sustain and provide better facilities. They must be responsible enough to create awareness program for care and management for all the Filipino people.

To the health care team, they should righteously implementing basic and ideal procedures regardless of the health care facilities where they belong. They must observe and always remember to keep in line with their duties towards both the mother and the child during the pregnancy.

To the community and the family, that they must be insufficient coordination with the government and the health care team regarding promotion of health before, during, and after the delivery of the baby.

XI. BIBLIOGRAPHY

http:// www.nursingcrib.com http:// www.medicinenet.com http:// www.wrongdiagnosis.com http:// www.umm.edu.com http:// www.doh.gov.ph