CP FINAL-- Pre-eclampsia
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Transcript of 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:
Comments: The patient stated
Objective Data:
Mobility and Dexterity: Ambulatory Abdomen: Soft
Edema: Yes, Lower extremities
Urine Color:
Subjective Data:
Comments: The patient stated
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:
Comments: The patient stated
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 rennin- angiotensin 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.
http://www.webmd.com/baby/default.htmhttp://women.webmd.com/picture-of-the-vaginahttp://men.webmd.com/picture-of-the-penishttp://www.webmd.com/baby/guide/your-pregnancy-week-by-week-weeks-1-4http://www.webmd.com/baby/default.htmhttp://women.webmd.com/picture-of-the-vaginahttp://men.webmd.com/picture-of-the-penishttp://www.webmd.com/baby/guide/your-pregnancy-week-by-week-weeks-1-4 -
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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)
Classification Dose/Frequency/
Route
Mechanism ofaction
Indication Contraindication Nursing precaution
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)
Classification Dose/Frequency/
Route
Mechanism ofaction
Indication Contraindication Nursing precaution
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)
Classification Dose/Frequency/
Route
Mechanism ofaction
Indication Contraindication Nursing precaution
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Name ofdrug
Generic
(Brand)
Classification Dose/Frequency/
Route
Mechanism ofaction
Indication Contraindication Nursing precaution
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
Indication Contraindication Nursing precaution
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
Indication Contraindication Nursing precaution
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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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