Pre Eclampsia.final

I. INTRODUCTION

1. Description of the Disease

Pre-eclampsia is a medical condition where hypertension arises during pregnancy (pregnancy-induced hypertension) in association with significant amounts of protein in the urine. Because pre-eclampsia refers to a set of symptoms rather than any causative factor, it is established that there are many different causes for the syndrome. It also appears likely that there is a substance or substances from the placenta that may cause endothelial dysfunction in the maternal blood vessels of susceptible women. While blood pressure elevation is the most visible sign of the disease, it involves generalized damage to the maternal endothelium and kidneys and liver, with the release of vasopressive factors only secondary to the original damage.

Pregnancy induced hypertension (PIH) is a condition in which vasospasm occurs during pregnancy in both small and large arteries. It is usually developed during the first 20 weeks. It is unique to pregnancy and occurs in 5% to 7% of pregnancies in the United States (Pillitteri, 2003 p. 426). Despite years of research, the cause of the disorder is still unknown. Originally it was called toxemia because researchers’ pictures a toxin of something being produced by a woman in response to the foreign protein of the growing fetus, the toxin leading to the typical symptoms. No such toxin has ever been identified.

PIH is further classified as gestational hypertension, mild preeclampsia, severe preeclampsia and eclampsia. Gestational hypertension develops when a woman is said to have an elevated blood pressure (140/90 mmHg) but has no edema or proteinuria. A woman is said to be mildly preeclamptic when the blood pressure rises to 140/90 mmHg, taken on tow occasions at least 6 hours apart. The diastole value of blood pressure is extremely important because it best indicates the degree of peripheral arterial spasms. Aside from hypertension, she has also proteinuria and edema. This mild preeclamptic passes through severe when the blood pressure has risen to 160/110 mmHg or over. Proteinuria and extensive edema are also present. Eclampsia is the most severe classification of PIH. Degeneration of a woman’s condition from severe preeclampsia to eclamspia occurs when cerebral irritation from increasing cerebral edema becomes so acute that seizures occur.

Pre-eclampsia, as stated above is the combination of high blood pressure (hypertension), swelling (edema), and protein in the urine (albuminuria, proteinuria) developing after the 20th week of pregnancy. This disease can cause the blood pressure to rise and puts the pregnant woman at risk of stroke or impaired kidney function, impaired liver function, blood clotting problems, pulmonary edema (fluid on the lungs), seizures and, in severe forms, maternal and infant death.

1

http://en.wikipedia.org/wiki/Liver

http://en.wikipedia.org/wiki/Kidney

http://en.wikipedia.org/wiki/Endothelium

http://en.wikipedia.org/wiki/Blood_pressure

http://en.wikipedia.org/wiki/Blood_pressure

http://en.wikipedia.org/wiki/Endothelial_dysfunction

http://en.wikipedia.org/wiki/Placenta

http://en.wikipedia.org/wiki/Protein

http://en.wikipedia.org/wiki/Pregnancy-induced_hypertension

http://en.wikipedia.org/wiki/Hypertension

http://en.wikipedia.org/wiki/Medical_condition

Statistics

Hypertensive diseases in pregnancy, particularly pre eclampsia remain important causes of maternal mortality and morbidity worldwide. The prevalence of PIH is 43.1 per 1,000 single ton pregnancies in a retrospective population based study of 200,000 live births in North Carolina, USA. For the past ten years, PIH was the major cause of maternal mortality in England and wales, and 56% of deaths due to PIH were attributable to pre eclampsia. The Philippine Obstetrical and Gynecological Society Committee on Nationwide 2003 statistics reported that 18.42 percent of maternal deaths were due to PIH and one of the top3 causes of prenatal mortality was PIH. Clearly, any attempt to curb maternal and perinatal mortality and morbidity was due to hypertensive states will not only result in less deprivation of financial and maternal sources.

In the district hospital where the patient was confined there were approximately 15% of the cesarean patients were diagnosed with Pregnancy Induced Hypertension from the year 2009 up to the present.

Reasons for Choosing the Case:

The group had chosen the Pregnancy Induced hypertension (PIH) as the case to be studied. The researchers agreed and decide for this case because the patient is recently admitted at that time and the student nurses could still have a better assessment and monitoring for a length of time. This is an advantage for the group in facilitating and scrutinizing the cause of certain hypertension during pregnancy. Eventually, it will give us a better understanding of the disease and know the importance of being a competent student nurses as how we provide health teachings and perform our independent nursing functions. May this study will also be a future reference that may help other researchers/student nurses in doing/completing their requirements.

Current Trends:

Weight-Loss Surgery Significantly Reduces Risk of Hypertensive Disorders in Pregnancy

ScienceDaily (Apr. 14, 2010) — Obese women who have bariatric surgery before getting pregnant are at significantly lower risk for developing dangerous hypertensive disorders during pregnancy than those who don't, according to a study of medical insurance records by Johns Hopkins experts. Hypertensive disorders in pregnancy -- which include gestational hypertension, preeclampsia and eclampsia -- complicate an estimated 7 percent of pregnancies in the United States. Researchers say they are much more common in obese women, who make up a third of women of childbearing age.

"We have long known that women who have these blood pressure disorders are not only at an increased risk for pregnancy complications in themselves and their babies, but also for chronic diseases in the future," says Wendy L. Bennett, M.D., M.P.H., assistant professor of medicine at the Johns Hopkins University School of Medicine and a study leader. "Can we

2

prevent the development of these disorders in pregnancy with bariatric surgery? These findings suggest the answer may be 'yes.'"

Results of the research are published online in the British Medical Journal.

For the study, Bennett and her colleagues looked at five years of data from Blue Cross Blue Shield insurance records and identified 585 women who had bariatric surgery and delivered a baby. The sample included 269 women who had babies some time before having weight-loss surgery and 316 who had the surgery before getting pregnant. More than 80 percent of the women chose gastric bypass surgery over other, less common weight-loss operations.

The researchers found an 80 percent reduction in the risk of preeclampsia and eclampsia among women who had surgery before pregnancy, along with a 74 percent reduction in the risk of gestational hypertension and a 61 percent reduction in the risk of chronic hypertension in pregnancy, all of which are known to cause pregnancy complications.

Bennett cautions that not every obese woman is a candidate for bariatric surgery. And not every obese woman wants to undergo the operation, which itself carries risks of complications. Moreover, insurance companies don't always cover the surgery, and when they do, it's typically not unless a woman has a body-mass index (BMI) of more than 40 or a BMI of more than 35 with a co-morbidity such as diabetes or sleep apnea, she says.

One limitation of the study is that the insurance data did not include information on fetal outcomes, so researchers can't say what, if any, effect bariatric surgery may have on babies born to women who have undergone the operation, Bennett says. Babies born to mothers with preeclampsia or eclampsia may arrive prematurely which can lead to complications up to and including fetal death.

Nevertheless, Bennett says her study suggests that insurance companies "should be covering gastric bypass surgery in women of childbearing age because of the potential to reduce complications if we can reduce their weight before they become pregnant." Treating the obesity before pregnancy, she adds, also has the potential of saving a lot of money on treatment of complications in mothers, fetuses and newborns."

Bennett says her findings are intended to open a discussion between doctors and obese patients who wish to become pregnant about the risks and benefits associated with bariatric surgery. Once they become pregnant, women who have undergone weight-loss surgery will need to be closely monitored to make sure they and their fetuses are getting enough nutrition.

Prior research has shown that rates of gestational diabetes (which also causes complications in pregnancy) decreases after bariatric surgery, and that weight loss can increase fertility in obese women.

2. Objectives

General Objective: After three weeks of accomplishing the case study, the student nurses will be able to apply the concepts of nursing process on the care of the patient with pregnancy induced hypertension.

Learning Objectives: After a week of accomplishing this case study, the student nurses will be able to:

3

Cognitive:

Define pregnancy induced hypertension. Analyze and interpret laboratory results and relate them to the pathology of the diseases.

Grasp knowledge about the advancement of the complication, their effects and manifestations.

Identify the modifiable and non-modifiable factors as well as the signs and symptoms of the stated complication, treatment and preventions of pregnancy induced hypertension.

Identify the treatment modalities available.

Formulate nursing diagnoses related and significant to patient’s condition.

Affective:

Empathize with the patient’s current condition. Provide comfort to the client as she copes up with her current situation.

Psychomotor:

Perform cephalocaudal assessment. Interview the patient and significant others of the disease condition.

Formulate nursing care plan.

Demonstrate to the significant other the appropriate interventions to the patient.

Assist the significant other on how to be acquainted with the patient’s actual condition.

Provide health teachings to the support people that would help improve the patient’s condition and administer medications as ordered and explain the need and purpose of the treatment.

Document pertinent data and information about the patient.

II. NURSING HISTORY

4

1. Personal History

a. Demographic Data

Mrs. X is a 40 year old, Filipino citizen, plain housewife and married. She is born on December 25, 1969 at Balanga Bataan, and the youngest daughter among the seven siblings. She is currently living in Lubao, Pampanga together with her husband, and their two sons, ages twelve and five years old. She was admitted at a district hospital in Pampanga last August 01, 2010 with an admitting diagnosis of mild pre-eclampsia and cough. She was discharged last August 6, 2010.

b. Socioeconomic and Cultural Factors

Mrs. X has finished her primary education in Bataan Elementary School. She was not able to finished high school due to financial constraints. She is married to Mr. X who is 40 years old. He finished 2nd year college and currently working as a laborer and had a monthly income of Php 6,000. Mr. X’ vices were smoking and drinking occasionally. They were both a Roman Catholic and attend mass every Sunday together with their two sons. Their expenses are approximately Php 3,000 for food, Php 2,000 for food, Php 500 for water bill, Php 500 for electric bill and the money left was for their savings and some left for their medical needs.

According to Mrs. X, she often visits the nearest health center in case one of the family members got sick and also for the immunization of her children. She often eats vegetables, fish, fatty and salty foods especially pork with salted shrimp (binagoongang baboy).She is not selective in terms of food, but one thing that she does not eat is the chicken skin. Every time she wakes up at 5am in the morning, she cleans their house, cooks food and does other household chores. She takes a bath twice a day. She does not have any vices and manages her stress by simply watching television and by playing with her younger son. She sleeps usually sleeps at 10pm.

MATERNAL-CHILD HEALTH HISTORY

a. Maternal Obstetric Record Mrs. X is married since she was 27 years old. Her last menstruation was November

15, 2009. Upon the day of assessment, she has a GPTPALM of Gravida (2), Para (3), Term (3), Preterm (0), Abortion (0), Living children (2), Multiple Gestations (0). She is currently 38weeks and 5 days pregnant on the day of assessment. She is expected to deliver her baby on August 22, 2010. Her first delivery was NSD (Normal Spontaneous Delivery). On her second child, she was CS (Caesarian Section) due to nuccal cord at the same district hospital last August 3, 2005.

b. Antepartal/Prenatal preparation

During Mrs. X’ pregnancy, she had her monthly check-up in order to monitor her condition as well as the baby’s condition . She eats mostly vegetables like togue, fruits like papaya, fishes and meat products such as skinless chicken as well as fatty and salty foods especially pork with salted shrimp (binagoongang baboy) . She does not drink coffee ever since instead she drinks milk and water. She uses ordinary soap for her perineal hygiene. She was

5

taking Aldomet 250 mg TID, Cefalexin and ferrous sulfate since March 4,2010 as advised by her doctor.

c. Significant trimestral changes (1st TO 3rd trimester)

During the first trimester of Mrs. X’s pregnancy, she experienced frequent headaches and dizziness which continued until the third trimester. She usually sleeps in order to relieve her from the said conditions. On the end of her first trimester she experienced an increased in her blood pressure which is 170/120 mmHg, this is the reason for prescribing the Aldomet. During the course of her second trimester of pregnancy her blood pressure went down to 160/90 mmHg. And the blood pressure of the patient in the third trimester improved to 140/100 mmHg. Right after the surgery Aldomet was changed into Hydralazine as ordered by the physician.

2. Family Health History

Mrs. X said that both of her grandparents on her father’s side, and grandmother on her mother’s side died unknowingly. Her grandfather on her mother’s side died because of accident. The eldest brother of her father died due to diabetes mellitus and old age. Her father’s 2nd brother and sister died due to old age too. On her mother’s side, all of them are still alive and doesn’t have any diseases. All of the patient’s brothers and sisters are healthy too and doesn’t have any diseases.

6

Lolo A Lola A Lolo B

1st Uncle 2nd Uncle

Lola B

Auntie CFather

PT 40

42 Brother B47 Brother A50Sister D

51Sister C

52Sister B

58Sister A

Family health illness and history

7

Legend:

Female

Male

Deceased (due to old age)

Deceased (unknown)

Deceased (due to heart attack)

Deceased (due to Diabetes Mellitus)

Deceased (accident)

PT Patient

Hypertension

81Auntie A

78Mother

74Auntie B

3. History of Past Illness

Mrs. X had an appendectomy last July 10, 2009. She experienced cough and colds once a year. She does not experienced PIH during her first and second pregnancy. She has a complete shot of Tetanus Toxoid vaccine.

4. History of Present Illness

She was diagnosed with Pregnancy Induced Hypertension on the third trimester of pregnancy on her third baby. Prior to admission she complained of having pain on the nape and cough. She was admitted to Escolastica Romero District Hospital last Aug. 01, 2010 at around 11:45 pm. She was admitted in the OB Ward. She was diagnosed to have a mild pre-eclampsia and a cough.

III. PHYSICAL ASSESSMENT (IPPA-CEPHALOCAUDAL APPROACH)

August 3, 2010

General AppearanceSeen patient on a supine position with an ongoing IVF of # 1 D5 LRS at 200 cc level

regulated at 30 gtts/ min infusing well at her left arm. Patient is conscious, awake and coherent. She wearing gray shirt without sleeves and diaper and was drape from waist below.

B – engorge, lactatingU – 1 fingerbreadth below umbilicusB – 25 cc levelB – 2 times flatusL – rubra, minimal amount, 1 diaper since after the operation, scantyE – abdominal midline incisionS – striae gravidarum at both thighH – no presence of Homan’s signE – taking hold phase as evidence by touching the baby and let the baby stay with her side at all times

Vital Signs:

Temperature – 37.1 °CRespiratory rate – 19 breaths per minutePulse rate – 87 beats per minuteBlood pressure – 130/70

8

CEPHALOCAUDAL ASSESSMENT

Day 1 August 3, 2010 SKIN

Dark brown skin Has fair complexion Dark armpit Presence of scars on her extremities Skin goes back after 2 seconds

HAIR Hair is black in color Long and evenly distributed With no presence of dandruff and flakes

NAILS Long and dirty nails in both extremities Hard and immobile Smooth and firm nailbeds in both extremities With capillary refill of less than 2 seconds

HEAD Round and with no nodules or masses palpated Symmetrical facial features

NECK With normal range of motion Symmetrical in shape Centered head position Absence of swollen lymph nodes upon palpation

EYES Symmetrically aligned to ears Thick, and evenly distributed eyebrows Eyelashes are evenly space Pale conjunctive Pupil equally round and reactive to light and accommodation (PERRLA) With eyebags With droopy eyelids

EARS Symmetrically aligned to eyes With no presence of cerumen on both ears Pinna recoils after being folded No tenderness felt when palpated

MOUTH AND THROAT

9

Outer lips is pale and dry Uvula is positioned in the midline Tongue is pink No noted sores and lesions

NOSE Smooth and symmetrical in appearance With no pain and lesions upon palpation

THORAX AND BACK With equal chest symmetry No pain felt when palpated With no presence of adventitious sound (crackles/rales) upon auscultation

BREAST Relatively equal with right breast is slight variation Presence of striae Smooth skin surface Dark brown areolas and nipples With whitish discharge Slightly tender upon palpation No palpable masses

CARDIOVASCULAR Absence of murmurs

ABDOMEN Presence of transverse incision

MUSCULOSKELETAL/EXTREMITIES Head can be turned laterally against resistance Able shrug shoulder against resistance Non pitting edema (Grade 1) on both extremities

August 4, 2010

General AppearanceSeen patient sitting on bed with an ongoing IVF of # 2 D5LRS at 400 cc level regulated

at 30 gtts/min. She is conscious, awake and coherent. The patient is wearing red sando and checkered short. She is also breastfeeding her child.

B - engorge, lactatingU – 2 fingerbreadth below umbilicusB – voided 2 timesB – has her bowel movement (1)L – rubra, minimal amount, 1 diaper since after the operation,and 1 sanitary napkin, scantyE – abdominal midline incisionS – striae gravidarum at both thigh

10

H – no presence of Homan’s signE – taking hold phase as evidence by touching the baby and let the baby stay with her side at all times

Vital Signs:

Temperature – 36.7 °CRespiratory rate – 17 breaths per minutePulse rate – 80 beats per minuteBlood pressure – 130/70

CEPHALOCAUDAL ASSESSMENT

Day 2 August 4, 2010

SKIN Dark brown skin Has fair complexion Dark armpit Presence of scars on her extremities Skin goes back after 2 seconds

HAIR Hair is black in color Long and evenly distributed With no presence of dandruff and flakes

NAILS Short and clean nails Hard and immobile Smooth and firm nailbeds in both extremities With capillary refill of less than 2 seconds

HEAD Round and with no nodules or masses palpated Symmetrical facial features

NECK With normal range of motion Symmetrical in shape Centered head position Absence of swollen lymph nodes upon palpation

EYES Symmetrically aligned to ears Thick, and evenly distributed eyebrows Eyelashes are evenly space Pink conjunctive

11

Pupil equally round and reactive to light and accommodation (PERRLA) With eyebags With droopy eyelids

EARS Symmetrically aligned to eyes With no presence of cerumen on both ears Pinna recoils after being folded No tenderness felt when palpated

MOUTH AND THROAT Outer lips is pink and moist. Uvula is positioned in the midline Tongue is pink No noted sores and lesions

NOSE Smooth and symmetrical in appearance With no pain and lesions upon palpation

THORAX AND BACK With equal chest symmetry No pain felt when palpated With no presence of adventitious sound (carackles/rales) upon auscultation

BREAST Relatively equal with right breast is slight variation Presence of striae Smooth skin surface Dark brown areolas and nipples With whitish discharge Slightly tender upon palpation No palpable masses

CARDIOVASCULAR Absence of murmurs

ABDOMEN Presences of transverse incision

MUSCULOSKELETAL/EXTREMITIES Head can be turned laterally against resistance Able shrug shoulder against resistance Non pitting edema (Grade 1) on both extremities

IV. DIAGNOSTIC AND LABORATORY PROCEDURES

12

Diagnostic /

Laboratory

Procedures

Indications or

Purpose

Date

Ordered

Date

Results

were

released

Results Normal

Values

(units used

in the

hospital)

Analysis and

Interpretation of

the Results

Hemoglobin

Hematocrit

WBCLeukocytes

Neutrophils or

To measure of the total amount of hemoglobin in the blood. The hgb is the main intracellular protein of erythrocytes, it carries oxygen to and removes carbon dioxide from RBC’s.

To monitor ongoing bleeding to check its severity.

This is done to determine the presence of infection and inflammation.

To determine any acute bacterial infection

To determine any

D.O. August 1, 2010D.R.August 2, 2010



D.O.

106 gm/L

0.32

8.0x10 gm/L

0.64

140-180 gm/L

0.37-0.47

5-9x10 gm/L

0.40-0.60

Below-normal hemoglobin levels. This may lead to anemia that can be result of excessive bleeding.

Decreased hematocrit level this may indicates anemia that can be caused by iron deficiency.

WBC count is at normal level. This shows absence of infection and inflammation.

Increased level of

13

polymorphonuclear cells (Polys)

Lymphocytes

acute bacterial infection or viral infection.

To determine any chronic bacterial infection or viral infection.

.

August 1, 2010D.R.August 2, 2010


0.36 0.20-0.40

neutrophils. May indicate presence of acute bacterial infection.

Within normal range.

Nursing Responsibilities: Explain the procedures; explain that slight discomfort may be felt when skin is punctured.

Avoid stress if possible because altered physiologic status influences and changes normal hemogram values.

Dehydration can dramatically alter values, for example large volume of IV fluids can dilute the blood and values will appear as lower counts. The presence of either of these states should be communicated to the laboratory.

Fasting is not necessary; however fat meals may alter some test result as a result of lipidemia.

Apply manual pressure and dressings to the puncture site on removal of the needle.

Monitor the puncture site for oozing or hematoma formation. Maintain pressure dressings on the site if necessary. Notify physician of unusual problems with bleeding.

Bruising on the puncture site is not uncommon; signs of inflammation are usual and should be reported if the inflamed area appears larger, if red streaks develop or if drainage occurs.

Diagnostic / Laboratory Procedures

Indications or Purpose

Date Ordered/Date Results were

released

Results Normal Values

Analysis and interpretation of the results

14

Urinalysis It is used to detect urinary tract infections (UTI) and other disorders of the urinary tract.

May 20, 2010 Color: yellow

Transparency: turbid

Sugar: negative

Albumin: positive

Reaction: acidic (6.9)

Specific gravity: 1.010

Pus cells: 3.5

Epithelial cells: positive

It can vary in color from pale (almost colorless) yellow to dark yellow.

Urine should be clear.

normally negative (absent)

Negative.

Acidic (6.9-7)

1.003 to 1.030

0-5/hpf

Few

Normal urine color.

Cloudy urine or urine with a high level of sediment may be present in cases of urinary tract infection.

Absence of glucose in the urine means it did not indicate diabetes.

Positive albumin in the urine may indicate may indicate kidney disease.

Normal urine ph.

It means that the concentration of solutes in the urine is normal

Within normal value

Increased amount of

15

http://www.labtestsonline.org/understanding/conditions/uti.html



Amorphous urates: positive

Mucus Threads: positive

Normally found in acidic urine.

This is a common finding in urine since the entire urine system is filled with mucus

epithelial cells indicate inflammation or infection of urogenital tract

Normal

Normal

NURSING RESPONSIBILITIES FOR URINALYSIS:

Before: Verify the doctor’s order. Explain to the patient the importance of the procedure. The first morning sample is the most valuable because it is more concentrated and

more likely to yield abnormal results Assist the patient.

During: Provide privacy. Advise the patient to catch the midstream of the urine. Transport time for culture specimen must be minimized. Handle specimen carefully.

After: Relay the results to the attending physician.

Diagnostic / Laboratory Procedures

Indications or Purpose

Date Ordered/Date Results were

released

Results Normal Values

Analysis and interpretation of

the results

Pelvic Ultrasound

For a better visualization of the fetus as

July 19, 2010 Within the enlarged uterus is a

A single live male fetus in breech presentation of

16

well as to know if there are any abnormalities occurring inside the uterus.

single live fetus in breech presentation. The biparietal diameter is measured as 84mm, a femoral length of 69mm and an abdominal circumference of 313mm in dm,

about 35 weeks and 0 AOG. Normohydramnios.

Nursing Responsibilities for ULTRASOUND (Pelvic)

Before:1. Check doctor’s orders2. Ask for the patient’s identification3. Explain the procedure properly to the SO.4. Instruct the client not to void prior the procedure.

During:1. The patient lies on an examining table with the part of the body to be examined exposed. 2. A conductive gel is applied to the skin over the area under examination.3. You lie quietly as the person performing the examination moves the transducer over the

skin surface while watching the monitor. 4. You may be asked to shift positions to obtain other views of the organ(s) under study.

After:

1. Wait for the further results.2. The patient can void.3. Wait for the physician to interpret the results

V. THE PATIENT AND HER ILLNESS

ANATOMY AND PHYSIOLOGY

17

When most people hear the term cardiovascular system, they immediately think of the heart. We have all felt our own heart "pound" from time to time, and we tend to get a bit nervous when this happens. The crucial importance of the heart has been recognized for a long time. However, the cardiovascular system is much more than just the heart, and from a scientific and medical standpoint, it is important to understand why this system is so vital to life.

Most simply stated, the major function of the cardiovascular system is transportation. Using blood as the transport vehicle, the system carries oxygen, nutrients, cell wastes, hormones, and many other substances vital for body homeostasis to and from the cells. The force to move the blood around the body is provided by the beating heart. The cardiovascular system can be compared to a muscular pump equipped with one-way valves and a system of large and small plumbing tubes within which the blood travels.

18

HEART:The heart is a muscular organ found in all vertebrates that is responsible for pumping

blood throughout the blood vessels by repeated, rhythmic contractions. The heart is enclosed in a double-walled sac called the pericardium. The superficial part of this sac is called the fibrous pericardium. This sac protects the heart, anchors its surrounding structures, and prevents overfilling of the heart with blood. It is located anterior to the vertebral column and posterior to the sternum. The size of the heart is about the size of a fist and has a mass of between 250 grams and 350 grams. The heart is composed of three layers, all of which are rich with blood vessels. The superficial layer, called the visceral layer, the middle layer, called the myocardium, and the third layer which is called the endocardium. The heart has four chambers, two superior atria and two inferior ventricles. The atria are the receiving chambers and the ventricles are the discharging chambers. The pathway of blood through the heart consists of a pulmonary circuit and a systemic circuit. Blood flows through the heart in one direction, from the atrias to the ventricles, and out of the great arteries, or the aorta for example. This is done by four valves which are the tricuspid atrioventicular valve, the mitral atrioventicular valve, the aortic semilunar valve, and the pulmonary semilunar valve. Systemic circulation is the portion of the cardiovascular system which carries oxygenated blood away from the heart, to the body, and returns deoxygenated blood back to the heart. The term is contrasted with pulmonary circulation.

Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-depleted blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. The term is contrasted with systemic circulation. A separate system known as the bronchial circulation supplies blood to the tissue of the larger airways of the lung.

Arteries are blood vessels that carry blood away from the heart. All arteries, with the exception of the pulmonary and umbilical arteries, carry oxygenated blood.Pulmonary arteries The pulmonary arteries carry deoxygenated blood that has just returned from the body to the heart towards the lungs, where carbon dioxide is exchanged for oxygen.Systemic arteries Systemic arteries can be subdivided into two types – muscular and elastic – according to the relative compositions of elastic and muscle tissue in their tunica media as well as their size and the makeup of the internal and external elastic lamina. The larger arteries (>10mm diameter) are generally elastic and the smaller ones (0.1-10mm) tend to be muscular. Systemic arteries deliver blood to the arterioles, and then to the capillaries, where nutrients and gasses are exchanged.

19

The Aorta The aorta is the root systemic artery. It receives blood directly from the left ventricle of the heart via the aortic valve. As the aorta branches, and these arteries branch in turn, they become successively smaller in diameter, down to the arteriole. The arterioles supply capillaries which in turn empty into venules. The very first branches off of the aorta are the coronary arteries, which supply blood to the heart muscle itself. These are followed by the branches off the aortic arch, namely the brachiocephalic artery, the left common carotid and the left subclavian arteries.Aorta the largest artery in the body, originating from the left ventricle of the heart and extends down to the abdomen, where it branches off into two smaller arteries (the common iliacs). The aorta brings oxygenated blood to all parts of the body in the systemic circulation. The aorta is usually divided into five segments/sections:

Ascending aorta—the section between the heart and the arch of aorta

Arch of aorta—the peak part that looks somewhat like an inverted "U"

Descending aorta—the section from the arch of aorta to the point where it divides into the common iliac arteries o Thoracic aorta—the half of the descending aorta above the diaphragm o Abdominal aorta—the half of the descending aorta below the diaphragm

Arterioles Arterioles, the smallest of the true arteries, help regulate blood pressure by the variable contraction of the smooth muscle of their walls, and deliver blood to the capillaries. Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the lungs; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood. Veins differ from arteries in structure and function; for example,arteries are more muscular than veins and they carry blood away from the heart. Veins are classified in a number of ways, including superficial vs. deep, pulmonary vs. systemic, and large vs. small.Superficial veins Superficial veins are those whose course is close to the surface of the body, and have no corresponding arteries.Deep veins Deep veins are deeper in the body and have corresponding arteries.Pulmonary veins The pulmonary veins are a set of veins that deliver oxygenated blood from the lungs to the heart.Systemic veins Systemic veins drain the tissues of the body and deliver deoxygenated blood to the heart. Atrium sometimes called auricle, refers to a chamber or space. It may be the atrium of the lateral ventricle in the brain or the blood collection chamber of a heart. It has a thin-walled structure that allows blood to return to the heart. There is at least one atrium in animals with a closed circulatory system.

Right atrium is one of four chambers (two atria and two ventricles) in the human heart. It receives deoxygenated blood from the superior and inferior vena cava and the coronary sinus,

20

and pumps it into the right ventricle through the tricuspid valve. Attached to the right atrium is the right auricular appendix.

Left atrium is one of the four chambers in the human heart. It receives oxygenated blood from the pulmonary veins, and pumps it into the left ventricle, via the atrioventricular valve. Ventricle is a chamber which collects blood from an atrium (another heart chamber that is smaller than a ventricle) and pumps it out of the heart. Right ventricle is one of four chambers (two atria and two ventricles) in the human heart. It receives deoxygenated blood from the right atrium via the tricuspid valve, and pumps it into the pulmonary artery via the pulmonary valve and pulmonary trunk. Left ventricle is one of four chambers (two atria and two ventricles) in the human heart. It receives oxygenated blood from the left atrium via the mitral valve, and pumps it into the aorta via the aortic valve.

21

Synthesis of the Disease

A. DEFINITION OF THE DISEASE

Pregnancy-induced hypertension (PIH) is a condition in which vasospasm occurs during pregnancy. Signs of hypertension, proteinuria, and edema develop. It is classified as gestational hypertension, pre-eclampsia (mild and severe) and eclampsia. The cause of this disorder is still unknown despite of the years of research.

23

Pre-eclampsia is an abnormal condition of pregnancy characterized by the onset of acute hypertension after the twenty-fourth week of gestation. The classic triad of pre-eclampsia is characterized by abrupt hypertension (a sharp rise in blood pressure), proteinuria (the presence in the urine of abnormally large quantities of protein, usually albumin) and edema (swelling) of the hands, feet, and face. Pre-eclampsia is the most common complication of pregnancy. It occurs in 5% to 7% of pregnancies, most often in primigravidas.

Eclampsia is the final and most severe phase of preeclampsia and occurs when preeclampsia is left untreated. Eclampsia involves convulsions (seizures) occurring with pregnancy-associated high blood pressure and having no other cause. Eclampsia can cause coma and even death of the mother and baby and can occur before, during or after childbirth. In short, eclampsia means seizure or coma accompanied by signs and symptoms of pre-eclampsia.

B. PREDISPOSING AND PRECIPITATING FACTORS

The etiology of preeclampsia is not fully understood. The exact causes of preeclampsia and eclampsia are not known, although some researchers suspect poor nutrition, high body fat or insufficient blood flow to the uterus as possible causes. Other causes may include altered cardiovascular reactivity, increased capillary permeability, widespread vasospasm and hypertension.

Risk factors may include the following: previous history of preeclampsia, relative with a history of preeclampsia, multiple fetuses, teenaged patient or patient older than 35 years, primigravida, lower socioeconomic status, gestational diabetes, history of renal disease and obesity prior to pregnancy.

C. PATHOLOGICAL CHANGES

The symptoms of preeclampsia affect almost all organs. The effects of preeclampsia are primarily due to the vasospasm of blood vessels. Vascular spasm maybe caused byt the increased cardiac output that injures the endothelial cells of the arteries and imbalance between prostacyclin (vasodilator) and thromboxane (vasoconstrictor) leading to vasoconstriction of blood vessels and blood pressure increases. Because of this, peripheral resistance increases and the heart is forced to pump rapidly to supply blood to peripheral organs.

Peripheral resistance reduces blood supply to organs especially to the kidneys, brain and placenta. Because of low blood and oxygen supply, degenerative changes occur within the organs manifested by various symptoms. The effects of vasospasm are more on vascular, kidney and interstitial effects. If accompanied by seizures, it is eclampsia.

In the kidneys, vasospasm leads to increased permeability of the glomerular membrane, allowing albumin to escape into the urine (proteinuria). Other changes include a decreased glomerular filtration leading to oliguria and increased kidney tubular reabsorption of sodium leading to edema. Also, the osmotic pressure of the circulating blood falls and fluid diffuses from

24

the circulatory system into bodily fluid, rapid weight gain occurs. Poor placental perfusion may reduce the fetal nutrient and oxygen supply putting the fetus at risk.

In preeclampsia, edema accumulates in the upper part of the body (face and hands). Cerebral edema (swelling of the brain tissue due to an accumulation of fluid) can also occur as a result of fluid retention in the brain. Symptoms of cerebral edema include blurred vision and severe headache. Cerebral edema can lead to seizure which is the hallmark of eclampsia.

D. SIGNS AND SYMPTOMPS WITH RATIONALE

Triad of Symptoms (3 classic signs of preeclampsia)

1. Hypertension (systolic BP greater than 160 mm Hg or diastolic BP greater than 110 mm Hg)

Vasospasm of blood vessels causes vasoconstriction and increased peripheral resistance leading to an increase in blood pressure.

2. Proteinuria Vasospasm in the kidneys increases blood flow resistance leading to

increased permeability of the glomerular membrane because of back pressure. This allows protein (albumin) to escape into the urine.

3. Edema Caused by an increased kidney tubular reabsorption of sodium and

sodium retains fluid causing edema. Fluid diffuses from the circulatory system into the interstitial spaces because of decreased osmotic pressure causing extensive edema.

Other symptoms associated with eclampsia:

Rapid weight gain (over 2 lbs per week in the second trimester, 1 lb per week in the third trimester)

Caused by a significant increase in bodily fluid.

Oliguria (decreased urine output)

a decreased in glomerular filtration leads to a lowered urine output

Puffy face, numb hands, and dependent areas such as ankles and lower legs

Caused by fluid retention in the upper portion of the body including the brain (cerebral edema)

Severe headache

25

caused by the swelling of the brain tissue due to an accumulation of fluid(cerebral edema) which increases pressure on the cerebral arteries

Blurring of vision

Spasm of the arteries in the retina leads to vision changes and the presence of cerebral edema

Epigastric pain and nausea

caused by the vascular congestion and ischemia of the liver

Impaired liver function (elevated hepatic enzymes-alanine aminotransferase (ALT) or aspartate aminotransferase (AST)

due to decreased hepatic perfusion

Thrombocytopenia

due to platelet aggregation Fetal growth restriction

due to decreased uteroplacental perfusion or placental ischemia

26

B. SYNTHESIS OF THE DISEASE (Client-Based)

b.1 Predisposing Factors and Precipitating Factors: history of hypertension age (40 years old) high fat and high salt diet

b.2 Signs and symptoms with rationale

28

Hypertension- August 1, 2010 ( 140/110mmHg) - vasoconstriction of blood vessels force he heart to pump blood and its also due to the increase in the peripheral resistance; as a compensatory mechanism there will be an increase in the heart rate because if the blood deficiency and then hypertension occurs.

Proteinuria- May 25, 2010 (1+) - this was brought about by the increase permeability of glomerular membranes that causes the albumin (a type of protein) to be excreted in the urine

Edema- August 3,2010 (Non-pitting edema Grade 1 in the bipedal area)- Due to the increased kidney tubular absorption of sodium, fluid shift to the

interstitial spaces and there by fluid retention happens, causing edema.

VI. THE PATIENT AND HIS CARE

1. Medical Management

A. IVF

Medical Management General Description

Indications/ Purpose

Date ordered/Date performed/ Date changed or discontinued

Client’s Response to Treatment

D5LRS D5LRS (5% dextrose in Lactated Ringer’s Solution Belongs to the hypertonic solutions; a combination of two solutions (D5W and LR).

Lactated Ringer’s Solution is often used for fluid resuscitation after a blood loss due to trauma, surgery, or a burn injury.

DO: August 2,2010

DD: August 3,2010

The patient did not experience any discomfort other than the IV insertion and medication administration upon the course of this IV therapy.

NURSING RESPONSIBILITIES:Before:

Verify doctor’s order.

29

Explain the procedure and the need for IV infusion.

Prepare necessary materials needed.

Check IVF as prescribed.

During: Instruct patient to relax especially the hand where the needle is to be inserted (to avoid

reinsertion and facilitate easy insertion).

Check IV level and the patency of the tubing if it is infusing.

After: Press the site where the needle was inserted and secure it with micropore.

Check the site of hand where the needle is inserted if bulging is not visible. If so, reinsertion is to be undertaken.

Advise patient to avoid scratching the site less movement of the hand where the needle was inserted to keep it in place.

Instruct patient and significant others to inform the nurse on duty if bulging of the site is visible.

Observe the IV site at least every hour for signs of infiltration or other complications fluid or electrolyte overload and air embolism.

IVF regulation should be checked and monitored upon receiving patient.

Always check the doctor’s order for new orders regarding the IVF supplement of the patient.

Always check if the IVF is infusing well and intact and monitor skin integrity.

B. Drugs

Generic Name and Brand Name

General Action

Indications/Purpose Date Ordered/Date Performed/Date Changed or Discontinued


HydralazineApresoline

Acts directly on vascular smooth muscle to cause

Essential hypertension alone or in combination with other drugs.

DO: August 2,2010-continued as of the day of our duty.

The patient’s blood pressure decreased from 140/100

30

vasodilatation, primarily arteriolar, decreasing peripheral resistance; maintains or increases renal and cerebral blood flow

mmHg to 130/70 mmHg.


Check Doctor’s Order Explain the procedure to the patient’s SO, the importance of the drug, its uses and effects. Prepare the right medication at the right time and with the right dosage.

During: Adhere to standard precautions Administer at the right route. Take with food

After: Document what has been done.


General Action Indications/Purpose Date Ordered/Date Performed/Date Changed or Discontinued


DiclofenacVoltaren

Inhibits prostaglandin synthetase to cause antipyretic and anti-inflammatory effects; the exact mechanism is

Acute or long-term treatment of mild to moderate pain.

DO: August 2,2010-continued as of the day of our duty.

After taking the medicine, the client’s pain was relieved.

31

unknown

NURSING RESPONSIBILITIES:

Before: Check the doctor’s order. Explain the procedure to the patient’s SO, the importance of the drug, its uses, and

effects. Prepare the right medication at the right time and with the right dosage.

During: Adhere to standard precautions. Administer at the right route.





32

CefuroximeCeftin

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death

To reduce the development of drug-resistant bacteria and maintain the effectiveness tablets and other antibacterial drugs, Cefuroxime Axetil tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.

DO: August 2, 2010-continued as of the day of our duty.

There were no signs of infection seen in the patient.


Check Doctor’s Order Explain the procedure to the patient’s SO, the importance of the drug, its uses and effects. Prepare the right medication at the right time and with the right dosage.

During: Adhere to standard precautions Administer at the right route.

After: If you get severe or watery diarrhea, do not treat yourself. Call your prescriber or health

care professional for advice. Document what has been done.




NifedipineCalcibloc

Inhibits the movement of calcium ions

Used to treat high blood pressure and some forms of chest

DO: August 2, 2010-continued as of

The patient did not experience chest pains.

33

across the membranes of cardiac and arterial muscle cells; lead to decreased cardiac work, decreased cardiac energy consumption and increased delivery of oxygen to myocardial cells

pain known as angina. This medication works by relaxing blood vessels and decreasing the pressure on the heart.

the day of our duty.


Before: Check Doctor’s Order Explain the procedure to the patient’s SO, the importance of the drug, its uses and effects. Prepare the right medication at the right time and with the right dosage.

During: Adhere to standard precautions Administer at the right route. May be taken with or without food.





SalbutamolVentolin

Selective beta2-adrenoreceptor stimulant drug. This has a relaxant effect

Treat shortness of breath in patients with severe breathing difficulty

DO: August 2, 2010-continued as of the day of our duty.

After taking the medication the client is relieve from difficulty of breathing.

34

on the smooth muscle in the medium and smaller airways.


Before: Check Doctor’s Order Explain the procedure to the patient’s SO, the importance of the drug, its uses and effects. Prepare the right medication at the right time and with the right dosage.

During: Adhere to standard precautions Administer at the right route.


C. Diet

Type of Diet General Description

Indication or Purpose

Date Ordered/Date Performed/Date Changed or discontinued

Client’s Response and/or reaction to the diet

NPO Nothing by mouth, no foods or drinks is allowed to be given to the patient, also a type of diet modification and fluid restriction

This was ordered till the patient has no (+) flatus.

DO: August 2, 2010DD: August 3, 2010

Patient was able to comply with the diet regimen.

Nursing responsibilities: Check doctor’s order Identify the type of diet Explain the reason of such diet to the patient, as well as with the patient’s significant

other. Remove all foods bedside. If the client eats or drinks, the physician should be notified at once

35





Soft Diet Very similar to the regular diet except that the texture of the foods has been modified.The soft diet consists of foods that are easily digestible, mildly seasoned and tender.

To prepare the body to assume a regular diet and to determine if the body can now tolerate solid foods

DO: August 3, 2010\DD: August 4, 2010


Nursing responsibilities:

Check for the physician’s order.

Explain the reason of such diet to the patient, as well as with the patient’s significant

other.

Instruct the patient on what specific foods she can take.

Serve small, frequent meals to avoid overwhelming the client with large amount of

foods.

Offer alternatives in terms the client cannot or will not eat.





Diet as Tolerated

The patient can take anything by

Ordered when the client’s appetite, ability

DO: August 4, 2010


36

mouth as long as she can tolerate it. Adequate in all nutrients according to the standards and is used for patients requiring no dietary modifications.

to eat and tolerance for certain foods may change; For increase body resistance, muscle strength and regular functioning of the body; to meet the needed daily requirements of nutrition of the patient


Check doctor’s order. Explain the reason of such diet to the patient, as well as with he patient’s significant

other. Instruct the patient on what specific foods she can take. Serve small, frequent meals to avoid overwhelming the client with large amount of

foods. Offer alternatives in terms the client cannot or will not eat.

D. Activity

Type of activity/Exercise

General description

Indication or purpose

Date ordered/ Date Performed/ Date Changed or discontinued

Client’s Response and/ or Reaction to the Activity

Flat on bed This is the usual position ordered for post-op. patient is positioned flat on bed; the head is erect or slightly flexed.

The purpose of this is to prevent spinal headache


Patient maintained a flat-on-bed position


37

Check for the physician’s order.

Explain the procedure and the reason to the patient.

Assist the patient in assuming the position ordered.

Check for any complications like bed sores

Remove all unnecessary objects to the patient’s bed to provide comfort


General description




Turn side to side Patient may change position periodically and gradually

To prevent venous stasis.


Patient was able to tolerate the activity

Nursing responsibilities: Check doctor’s order. Explain the procedure and the reason to the patient. Assist the patient in assuming the position ordered. Remove all unnecessary objects to the patient’s bed to provide comfort Observe if the patient can tolerate it.


General description




Ambulate A patient can do the things she can like standing and sitting

To have adequate muscle strength and promote circulation

DO: August 3, 2010

The pt. was able to ambulate after slowly rising from the bed to sitting position

Nursing responsibilities: Explain to the client how you are going to assist, why ambulation is necessary, and

how she can cooperate.

38

Ensure the client is appropriately dressed to walk Prepare the client for ambulation. Ensure safety while assisting client to ambulate. Encourage client to ambulate independently if she is able. Remain physically close to the client in case assistance is needed at any point

SURGICAL MANAGEMANT (Cesarean Section Delivery)Date Performed: August 2, 2010

A. Description

A C-section delivery is performed when a vaginal birth is not possible or is not safe for the mother or child.

Surgery is usually done while the woman is awake but numbed from the chest to the feet. This is done by giving her apidural or spinal anesthesia.

The surgeon makes a cut across the belly just above the pubic area. The uterus and amniotic sac are opened, and the baby is delivered.

The health care team clears the baby’s mouth and nose of fluids, and the umbilical cord is clamped and cut. The pediatrician or nurse makes sure that the infant’s breathing is normal and that the baby is stable.

The mother is awake, and she can hear and see her baby.

The decision to have a C-section delivery can depend on the obstetrician, the delivery location, and the woman’s past deliveries or medical history. Some reasons for having C-section instead of vaginal delivery are:

Reasons related to the baby:

Abnormal position of the baby in the uterus feet-first (breech presentation)

Reasons related to the mother:

Severe illness in the mother, including heart disease, toxemia, preeclampsia or eclampsia

Bilateral Tubal Ligation

Tubal ligation for woman seeking out a safe, effective, permanent and convenient form of contraception may be a good option. The most common form of surgical sterilization procedure used for woman today is called a tubal ligation, often referred to as “having your tubes tied”. A

39

tubal ligation procedure prevents the egg and sperm from meeting and you from becoming pregnant.

Tubal ligation is a permanent and highly effective form of birth control. If you have the desired number of children and never will desire more, permanent sterilization is worth considering.

A tubal ligation typically is performed via a small incision in your belly button. It can either be performed after delivery or at a latter time. When a tubal ligation is performed after delivery it is called a post-partum tubal ligation and does not require laparoscopy. If you have a tubal ligation and you are not pregnant, it is usually performed by laparoscopic surgery. All forms of tubal ligation require either burning, cutting, clamping or tying the mid section of your fallopian tubes.

B. instrument and/or Equipment UsedInstruments quantityCurve clamps 6Allis 3Bobcock 2Thumb forcep 1Tissue forcep 1Needle holder 2Metzenbaum 1Straight scissor 1Bandage scissor 1Blade holder(#3) 1Blade(#21) 1Chromic 1/0 2Chromic 2/0 1Vicryl 2/0 1Plain Gut 2/0 1Cotton Tie 4Abdo Pack 4

C. Nursing Responsibilities before, during and after the Procedure Before:

1. Proper draping of the client2. Prepare the instruments needed for the procedure3. Provide emotional support to the mother

During:

1. Skin preparation of the client2. Maintain the sterility of the area.3. Assist the surgeon in the operation4. Make sure all the instruments are all ready.

40

5. The instrument should be complete before closing of the incision.

After:1. Assess the vital signs of the patient every 30 minutes.2. Monitor the patient’s urine output and vaginal discharge.

D. Client’s Response to the Surgery The patient did not have any abnormal bleeding and other abnormalities. The

patient only felt pain in the incision site.

41

VII. NURSING CARE PLAN

PROBLEM # 1 Acute Pain r/t disruption of skin, tissue and muscle integrity, secondary to surgical procedure (CS)

Assessment Nursing Diagnosis

Scientific Explanation

Objectives Nursing Interventions

Rationale Evaluation

Subjective:

“Minsan sumusumpong ang sugat sa tahi ko, sobrang mahapdi”

Objective:

Pain scale of 5/10

Facial grimace

Guarding behavior

Excessive perspiration

Vital signs taken as follow:

BP–130/70mmHg

Acute pain related to disruption of skin, tissue and muscle integrity.

Unpleasant sensory and emotional experience arising from actual or potential tissue damage due to post abdominal surgery that results to acute pain.

After 4 hours of NI, the patient pain will be reduced or controlled from pain scale of 5/10 to 2/10.

>Evaluate pain regularly noting characteristics, location, intensity (0-10 scale).

>Assist patient to find position of relief.

>Provide diversional activities such as listening to music and back rubbing.

>Encourage early ambulation

>Support lower abdomen during

>Provides information about need for or effectiveness of interventions.

>Positioning affects the ability to rest and relax.

>Promotes relaxation and may relieve pain and enhance circulation.

>Promotes good circulation and faster wound healing.

>Prevents undue strain

>Did the patient pain reduced from 5/10 to 2/10?

>Did the patient agree with the interventions provided?

>Did the patient was able to express herself through communication of how importance rest is?

>Did the patient comply with health teachings

42

coughing and deep breathing by splinting using a pillow.

>Schedule adequate rest periods.

>Discuss the importance of nutritious diets and adequate fluid intake.

>Administer analgesic as indicated by the physician

and dehiscence on operative site.

>Prevents fatigue and conserves energy for faster healing.

>Provides elements necessary for tissue regeneration or healing.

>To decrease/reduce the pain immediately.

provided?

43

PROBLEM # 2 DISTURBED SLEEP PATTERN R/T PAIN DUE TO POST SURGICAL PROCEDURE (CS)





Cues:

Subjective: “ Mangaga ku nabengi kasi masakit ini”

( I was crying last night because of the pain I was experiencing)

Objective:

Appeared drowsy

With eye bags Seen patient

yawning With droopy

eyelids With pain scale

of 5/10 With facial

grimaces With guarding

behavior in the abdomen

Appeared irritable

Disturbed sleep pattern related to pain due to post surgical procedure (CS)

Due to the actual tissue damage that was brought about by the post surgical procedure done, the patient manifest pain and irritability that contributed to the disturbance of sleep and relaxation.

After 4 hours of nursing interventions, the pain scale will reduce from 5/10 to 2/10 and the client will sleep

>Provide her new and clean linen

>Assist her in changing position from side to side every 1-2 hours

>Place pillow on the client’s back while on lateral position

>Assist in leg exercises such as rotating legs, flexion, extension of lower extremities

>demonstrate deep pursed-lip breathing exercise while splinting the incision site

>To promote sleep and relaxation

>To promote circulation of blood

>To support her body

>To prevent venous stasis

>To promote venous return and relaxation

> Did she feel the urge to sleep

>How many hours did she sleep?

>Was the pain reduced?

>Did she cooperate with the interventions provided??

44

>provide calm, quiet environment by minimizing noise and visitors

>provide diversional activities such as providing back rub, head massage and music

>Administer mefenamic acid 500mg TID after meals as ordered

To promote sleep and relaxation

>To promote sleep and relaxation

>To reduce her pain

45

PROBLEM # 3 Risk for INFECTION r/t destruction of microbial barriers secondary to surgical procedure (CS)





Cues:

Subjective: Ø

Objective:

Incision site on the lower abdominal midline

Risk for infection r/t destruction of microbial barriers secondary to surgical procedure ( CS)

Broken Skin due to CS results to exposure to environment where pathogens can penetrate the skin easily leading to risk for infection.

After 4 hours of nursing interventions, the patient will be able toIdentify interventions to reduce risk for infection and demonstrate proper wound care

>Teach mother to wash hands often and after administering self-care.

>Discuss to the mother the following signs of infection: redness, swelling, increased pain or purulent drainage on the site and fever

>Demonstrate and allow return demonstration of wound care

>demonstrate and encourage proper dressing

> Hand washing reduces the risk for infection

>To impart to the patient when wound becomes infected and when to sought medical care

>To know if the patient really understand the principle of wound care

>To prevent exposure to the environment

>Did she perform proper hand washing?

>Was she able to identify signs of infection?

>Did she perform proper wound care?

>Was she able to do proper wound dressing?

46

> Administer Cefuroxime 500mg 1 cap every 6 hours as ordered after meals

>To inhibit synthesis of bacterial cell wall, causing cell death

>Did she cooperate with the intervention provided?

47

III. DISCHARGE PLAN

M: Instructed Mrs. X to take Ferrous Sulfate 300mg once a day, Methyldopa 500mg every 6 hours, Multivitamin 1 capsule BID, Buscopan 10mg TID, Cefuroxime axetil 500mg TID, Azithromycin 500mg BID. All of these are per orem.

E: Exercise as tolerated

T:

H: Instructed patient to relax and not think about problem. Instructed to promote adequate rest and they should provide a quiet environment Complied to the diet of soft diet with low salt, low fat, low sodium, low calorie, and with

frequent small feedings She should maintain adequate nutrition and fluid balance She should not do strenuous activities Instructed to keep fluids within clients reach and encourage frequent intake of fluid Instructed patient to change position slowly Instructed patient to take a bath regularly, to provide optimal skin care Instructed patient to take frequent oral care as well as eye care to prevent injury from

dryness Encouraged patient to loose weight

O:

D: Her diet first is nothing per orem, followed by a soft diet with low salt, low fat, low sodium, low calorie with frequent small feedings.

48

IX. LEARNING DERIVED FROM THE STUDY

Case Study is not that easy since it takes a lot of effort, thinking and especially patience. As I reach the another step of our level, I’m taking more responsibilities for finding authoritative and reliable information, also taking more accurate information from general to specific.

We chose our patient because we believe that she needs more attention regarding his health status and as student nurses, we had the opportunity to apply all the nursing skills that we have learned from the school. The deep analysis of etiologies, mechanisms, and manifestations of disease and functional changes in abnormal conditions made me more challenged.

Through this case study, we have developed our level of self confidence, skills and our level of understanding to build good relationship to our patient and her SO at the same time, to share insights too. We won’t be able to finish it without the unity of each and everyone of our group and through the support and guidance of our clinical instructor. And through this, we came up with this we so called “fruit of our work”. May this paper will illustrate a clearer meaning of Pregnancy induced hypertension that may contribute a unique and valuable method of eliciting phenomena of interest to nursing.

Emmalyn B. Azarcon

In our hospital duty, we are assigned to do a case study. I learned a lot in this case study and I became more independent than before. I learned how important to value the things that we have now. As a group, we have to give our best shot and we must do our responsibilities to finish this case study. I learned also in this case study, like the concepts regarding the complications of Pregnancy Induced Hypertension, how to prevent it and many more. Through this case study, we have practiced what we have learned like the physical assessment, vital signs taking, therapeutic communication and more. And to end this, I would like to thank GOD for always guiding and helping us.

Rudora N. Badeo

Another journey starts this semester, this journey has full of requirements one of this was this case study. At first it’s like we’re not yet ready to make this requirement but we have to. On our first day of our duty we already saw a pt. with an interesting case to be studied. We have picked this because we think it was easier than the other case. But I think the more harder you think the more challenging it is. It will sharpen your knowledge about it. Another thing is that, this case study makes us realize how important discipline and cooperation is. Cooperation of the team members was a big factor even though this group was just new we did our best to cooperate with each other. Our group will not come up with this kind of requirement without discipline and cooperation. This study help me to be more aware of what may happen to us and to our relatives we can help them prevent to have such disease.

Jasper Lance Bautista

49

In our hospital duty we are assigned and required to do a case study for the whole group. I learned a lot in this case study I became more serious in every task and I become more independent than before. It made me realized how important our life and we need to value the things that we have. I learned also on this case study, like concepts regarding the disease Pregnancy Induced Hypertension, the complications of it, how to prevent it, and many more.

Being a group, all we need is cooperation, trust, unity, and respect with one another. As a group we have to work hard and give our best shot we must do our responsibilities and task to finish this Case Study. Through this study we have practice what we have learned like physical assessment, vital signs taking, therapeutic communication, and much more.

And to end this, I would like to thank GOD for always guiding, and helping us. Without his supervision I think we wouldn’t make it. Thank you Lord!

Caren Cheenee Cabrera

For this case study, I have learned that one cannot do such accomplishments without the help of others. Group effort makes everything different, we do not only finish a project, but more than that we build a relationship, a relationship not only bounded because of certain projects but also by the love and care for each other. And the most important, is that the knowledge that we have attained from here will be used not only for the betterment of us, students, but also for other people who suffers from this disease that we can help through the knowledge that we have gained from here.

Riel Nico Cao

Case study is not just a requirement to be passed or submitted for this subject but it is a learning and experience to us to be a good nurse someday. For this case study, I learned to be responsible for the task they gave me and I learned also how to cooperate with them.

As a student nurse, I have the knowledge on how to gain the trust of our patient by having a good interaction with her. As a student nurse, we must learn to be patient and calm always when doing some procedure and most of all, to have confidence when doing it. I thank God for helping us finish this case study. Without His supervision, we would not finish and make it. Thank you God!

Jenzie Jea J. Elevazo

In doing this case study it was not that easy, we don’t have enough time so we have to make time and give extra effort. But in doing this requirement I learned so many things such as understand one another, we tested our patience when we where about to meet the deadline for this requirement. We practiced our cooperation and compiled our knowledge base on what we experienced. Aside from that, the patient that we choose in our case study gave us knowledge and learning experience in doing this study. I realize how thankful I am of having this kind of experience even if it was a tiring one and at least I could say that we exerted all our efforts and gave our time to conceptualize this requirement.

Mary Grace Lagman

50

The case we handled was quite familiar since we have already tackled it on our past subjects. Doing the case study was not that difficult because we only need to manage our time finish it.

Achilles Mikael M. Naeg

I always believe in the saying that if you have a chance or an opportunity to take something take you know will be memorable, and then grab it, because you may never know on just how it may transform you, on how it will change and touch people around you and this experience will teach a lot of life saving task that a student nurse must do. Same thing goes with the accomplishment of our last case study. During the time of nurse-patient interactions, conducting interview and assessment, I learned that it’s not only the physical and the mental aspect that should be applied but the emotional aspect as well and I learned how to be closer or establish a deeper rapport to our patient. With this case study, where our chosen patient is suffering from a gallbladder problem, gave me awareness n to how economic, environmental and health problems goes hand in hand. Having the sense of awareness thus moved me to further study of the disease so to provide the appropriate nursing intervention towards promoting wellness and especially to be able to inform other as well of to what I know so to reduce or lessen the occurrence of such disease. Other than that, this case study accomplishment gave me the sense of self-fulfillment because I am assured that it is not only the knowledge, skills and our time tried to instill and/or provide them, but also indeed made a direct influence to them and left a significant mark that can eventually make a big impact in their lives more so with regards to health and wellness aspect that can help to live their life to the better.

Mary Clarisse V. Parico

Group activity/work is a challenging one. There are a lot of things that is needed to be considered. If one fails to do his/her part, everything else will follow.

But, on the other hand, group activities give us an opportunity to know other people better and have new friends. It molds our personality to be matured enough to understand other people and to have an initiative to help our groupmates.

Cooperation is what I really observed to be the most important factor that will help a group to work properly and finish the activity successfully. With the help of each member of the group, the difficult part of the activity will be easier. Despite of some problems that had occurred while we are doing the video, I am glad that it was done.

Working with your groupmates can be considered a memorable one. We are all sharing memories which are all worth remembering. And I do believe that we had enjoyed each other’s company. And I think that’s the essence of the groupwork, to be responsible in the assigned task to us but at the same time, learns to enjoy every single moment.

At the end of this case study, I have learned a lot about pregnancy induced hypertension. May this study help me in the future.

Jane Kamille B. Pineda

51

For this case study, I learned a lot because our rotation is already in the operating room I learn to recall the concepts that our previous C. I thought us about normal and abnormal delivery. It is so fun and exciting to be expose on OB ward and at the same time in OR because you will appreciate it. This time doing this case study is not that difficult unlike before because we need only to apply what was thought to us. But also we need to do our part just to finish this case study and be very patient in doing this.

Joelyn L. Tongol

I was able to learn a lot about our chosen case, breech presentation. We were able to help the patient by giving some health teachings such as the importance of breastfeeding and performing necessary interventions about the proper way of cleaning of her wound. Case study was proven to be not just a mere requirement thing for us to pass. I had learned its importance as a part of related learning experience in delivering care outside the school where in we are already to rend care in the hospital proper. It made me realized how important the role of a student-nurse is performs in bridging the gap between the health care provider and the patient. I felt the unity within our group and we are happy to the fact that we were able to finish our second case study which is one of our requirements. I am hoping that we will able to defend our case study well.

Sheila Marie T. Yumul

52

X. REFERENCES

Burton, Gwendolyn and Engelkirk, Paul.Microbiology for the health sciences 8th ed. 2007. Lippincott

William and Wilkins

Black and Hawks. Medical and surgical Nursing 8 th ed. 2008 Elsevier and Saunders

Doenges, Mariloyn,et.al. Nurse’s Pocket Guide 11 th ed. 2006. LA. Davis Company

Karch, Amy Nursing Drug Guide 2010 Lippincott Williams and Wilkins

Seeley, Rod, et.al Essentials of Anatomy and Physiology 6 th ed. 2007 Mc. Graw Hill Int’l.

Pillitteri, Adele, Maternal & Child Health Nursing Vol.2 5 th ed. 2007. Lippincott Williams and Wilkins

Caudal, Ma. Lourdes Basic Nutrition & Diet Therapy revised ed,2008.

Online Sources:

http://www.cureresearch.com/p/preeclampsia/stats-country.htm

http://www.nursingcrib.com

http://pregnancy.about.com/od/cesareansection/a/csectionrisks

http://www.cdc.gov/nip/publications/vis/vis-ppv.pdf

http://wiki.answers.com

http://www.sciencedaily.com

53

http://www.sciencedaily.com/

http://wiki.answers.com/

http://pregnancy.about.com/od/cesareansection/a/csectionrisks

http://www.nursingcrib.com/

http://www.cureresearch.com/p/preeclampsia/stats-country.htm

Pre Eclampsia.final

Documents

Transcript of Pre Eclampsia.final