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Pre-eclampsia
I. Introduction
Description of the DiseasePreeclampsia is a condition of pregnant women with marked high blood pressure
accompanied with a high level of protein in the urine. Women with preeclampsia will
often also have swelling in the feet, legs, and hands. Preeclampsia, when present, usuallyappears during the second half of pregnancy, generally in the latter part of the second or
in the third trimesters, although it can occur earlier.
The causes of preeclampsia are poor nutrition, high body fat, or insufficient blood
flow to the uterus.
The cure for preeclampsia and eclampsia is the birth of the baby. Mild preeclampsia
(blood pressure greater than 140/90) that occurs after 20 weeks of gestation in a woman
who did not have hypertension before; and/or having a small amount of protein in theurine can be managed with careful hospital or in-home observation along with activity
restriction.Severe pre-eclampsia is much less common. It affects about one mom-to-be in 200
in the Philippines. Based onextrapolations of prevalence and incidence statistics forPreeclampsia in the Philippines 46,392 out of86,241,697
2estimated population.
Preeclampsia occurs in 5 to 8 percent of pregnancies in the United States. It is not
known why some women develop preeclampsia while others do not. Currently, there are
no tests that can reliably predict who will get the disease, and there is no way to prevent
it.
II. Objectives
GeneralThe main purpose of our group is to present the case of our patients case/ condition anddisease. And also this case study will serve as guidelines for us student nurses in
assessing and providing proper nursing care to our patient with the same problem ordisease.
SpecificTo be able to meet our goal, we came up with some necessary assertion to serve as a
guide and to serve as our aim as well.
To understand condition of disease and associate it with the patient through theintroduction of the case
To know the nursing history, personal data, health history and physicalassessment of the patient.
To illustrate the anatomy and physiology and pathophysiology of the affectedorgan.
To discuss and determine manifestation and complications
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To develop an effective skill on how to manage care in patient with the disease To formulate a drug study with regards to the patients condition and correlate lab
results to its normal values.
To provide the client a nursing care plan and discharge plan to assure for clientstotal wellness during her hospitalization up to the time of her hospital discharge.
III. Patients Biographical Data
Name : XXXXXXXXAge : 34 years old
Gender : Female
Height : 53
Weight : 90kgStatus : Married
Date of Birth : April 16,1977
Nationality : FilipinoAddress : Brgy banda saminOccupation : Midwife
Admission Date : Sep. 07, 2011
Hospital : Ospital ng Makati
Percentage of Reliability : 80%
Informant : Patient
IV. Admitting Diagnosis: G2P0 (0010) PU 31-32 WEEKS
NOT IN LABOR CHRONICHYPERTENSION WITH
SUPER IMPOSED PRE-ECLAMPSIA
V. History of Present Illness:Patient is a 34 years old female with hypertension. She developed her hypertension anddiabetes 6 years ago. She was admitted G2P0 (0010) PU 31-32 weeks not in labor
chronic hypertension with super imposed pre- eclampsia. She was admitted with blood
pressure of 160/120 mmHg..
ROS (Review of Systems):
The following list illustrates the content of a complete review of systems.
General/Constitutional
Conscious and coherent, slightly easy fatigability, weight gain (90kg)
Cardiovascular
Hypertension, Obese (BMI:34.0),
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Respiratory
Orthopnea
Gastrointestinal
Abdominal pain, constipation,
Genitourinary
Proteinuria
Age of onset of menses (15 years old) , regular, G2P1 (0111)
Musculoskeletal
Hematoma in upper extremities, edema and redness in lower extremities.
Neurologic/Psychiatric
No negative findings.
Allergic/Immunologic/Lymphatic/Endocrine
No negative findings (NKA)
Past Medical History:
6 years ago when her hypertension was developed. Her first baby was aborted in 5
yrs. ago 3 months old.
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Family Health History:
Legend:
hypertension
died of old age
diabetes deceased pre eclampsia
*pink bordermother side
*blue borderfather side*violet border - patient
Grandmother
Grandfather
Mother
Grandmother
Grandfather
Father
Patient
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Personal and Social History:
The patient has no vices. She prefer to stay at home than to socialize in bars.
Physical Assessment:
Skin Through inspection, shiny in lower extremities and hematoma in upper
extremities.
Nails
Nails are clean and pinkish in tone. Hard and immobile. Nail plate is firmly attached to the nail bed. Capillary refill is 2-3 seconds.
Head
Through inspection and palpation, no evidence of Alopecia. Hair is color black and long. Scalp has no lesions and tenderness. Skull is round and has no deformity or lesion.
Face
Shape is round Trough inspection, face shape is symmetrical No involuntary muscles movement Can move facial muscles
Eyes
Through inspection and palpation, eyes are symmetrical. Upper and lower lids close easily and meet completely when closed.
They are red and moist. Skin on both eyelids is free from redness, swelling and lesions. Sclera is anecteric (no yellowish discoloration). Visual acuity is 20/20 Iris is typically round, flat and evenly colored. Pupils are equally round and 4mm in size.
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Ears
Through inspection, ears color is consistent with facial color. No lesions, swelling, and masses noted. No pain upon palpation No discharges
Symmetrical and equal in size Small amount of ear wax is visible Both ears has no hearing problems Not wearing any hearing aides
Nose
Nasal structure is smooth and symmetrical. No nasal discharges and flaring. Color is the same as the rest of the face.
Mouth
Lips are pale, smooth and moist, without lesions or swelling Have complete set of teeth. Gums are pinkish and moist. Tongue is pink, moist, moderate size with papillae present Visible tonsils and it is pinkish, moist and not flamed. Throat is pink and without lesions or redness
Neck
Symmetric with head centered and without bulging masses Trachea is midline
No bruits are auscultated
Shoulder and
upper
Neuromuscular
Scapulae are symmetric and no protruding Shoulders and scapulae are at equal horizontal positions Client is relaxed upon breathing No tenderness, pain, or unusual sensations
Breast
Examination No swelling, masses, and lesions
Heart and
Lungs
No adventitious sounds, such as crackles or wheezes are auscultated Cardiac rate is 87 bpm. No murmurs heard upon auscultation Radial and apical pulse rates are identical Equal chest expansion and clear breath sound Orthopnea BP: 160/120 mmHg
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Abdominal
Examination Incision in hypogastric region
External
Genitalia Vaginal discoloration due to poor hygiene. No swelling, masses and lesion.
NeurologicExamination
Client is alert and awake CN-I: No problem with identification of scent CN-II: Client has 20/20 vision acuity CN-III, IV & VI: Eyes move in a smooth and coordinated motion in all
directions. Bilateral illuminated pupils constrict simultaneously
CN-V: Correctly identifies a sharp and dull stimuli and light touch tothe forehead, cheeks, and chin
CN-VII: Client can smile, frown, shows teeth, purses lips, and raiseseyebrows
CN-VIII: client responds to sounds. Can hear whispers CN-IX & X: Intact gag reflex. Swallows without difficulty CN-XI: Symmetric, strong contraction of the trapezius muscles
Medical Diagnosis:The patient is diagnosed with G2P1 (0111) PU 32-33 weeks delivered by s/p LTCS
for non reassuring fetal heart rate pattern (poor beat beat variability) to a preterm livebaby boy. G2P1 PU 32-33 Chronic Hypertension Superimposed Pre-eclampsia
Differential Diagnosis:
Condition Differentiating Signs and
SymptomsDifferentiating tests
Chronic Hypertension -Pre-existing hypertension
prior to pregnancy.
-Retinopathy commonly
seen in longstanding
disease.
-Urinalysis: absence of new-
onset proteinuria
Gestational Hypertension - Blood pressure elevation Urinalysis: absence of
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(systolic >140 and diastolic
>90 mmHg), that is
detected for the first time
during midpregnancy andreturns to normal by 12
weeks postpartum.
proteinuria.
Thrombotic
thrombocytopenic purpura
-Presentation before 20
weeks gestation.
-Thrombosis, purpura, or
spontaneous bleeding.
-Fever.
-Neurological signs (e.g.,
seizures) in the absence of
signs of severe pre-eclampsia.
-ADAMTS-13 activity assay
and inhibitor titres:
decreased activity.
Haemolytic Uraemic
Syndrome
-Presentation before 20
weeks' gestation.
-Microangiopathic
haemolytic anaemia in theabsence of signs of severe
pre-eclampsia.
-Thrombosis.
-Renal failure in the
absence of signs of severe
pre-eclampsia.
-Diarrhoea (especially
bloody diarrhoea), nausea,or vomiting.
-Peripheral blood smear:
presence of schistocytes.
-FBC: anaemia,
thrombocytopenia
Anatomy of the Heart
The essential function of the heart is to pump blood to various parts of the body. The
mammalian heart has four chambers: right and left atria and right and left ventricles. The
two atria act as collecting reservoirs for blood returning to the heart while the two
ventricles act as pumps to eject the blood to the body. As in any pumping system, the
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heart comes complete with valves to prevent the back flow of blood. Deoxygenated blood
returns to the heart via the major veins (superior and inferior vena cava), enters the right
atrium, passes into the right ventricle, and from there is ejected to the pulmonary artery
on the way to the lungs. Oxygenated blood returning from the lungs enters the left atrium
via the pulmonary veins, passes into the left ventricle, and is then ejected to the aorta.
Blood vessels which group into three, the arteries which carry blood out of the heart to
the capillaries, the veins which transport oxygen-poor blood back to the heart and the
capillaries which transfer oxygen and other nutrients into the cells and remove carbon
dioxide and other metabolic waste from these body tissue
Laboratory testing
September 7,2011
Cbc
Diagnostic/
Laboratory
Procedure
Indication
purposes
Result Normal
Values
Analysis and
interpretation
1.CBC
HgB
Hct
2.WBCC
Leukoytes
Pre-operationassessment of the
patient.
Pre-operation
assessment of the
patient.
Determines anyinflammation or
infection
11.9gm/dl
0.35
12.1
12-16gm/dl
0.37-0.47
4-11 x
10^9/L
there isdecrease in
hemoglobin,
indication fordisease
Result is
within normal
range,indication of
optimal health
Has increased
WBC
indication ofinfection or
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Neutrophils
Segmenter
Determines any acute
bacterial
Infection
To asses for anyinfection or
inflammation
-
0.82
-
0.500.70
inflammation.
-
There is an
increased count
of segmenters,which indicates
inflammation
or infection
Diagnostic/
Laboratory
Procedure
Indication
purposes
Result Normal
Values
Analysis and
interpretation
Lymphocytes
Monocytes
Platelet
Determines any chronic
bacterial infection orviral infection
Determines any acute
bacterial infection
Used to measureplatelet count to assess
0.11
0.07
232x109/L
0.2-0.4
0.02-
0.05
There is an
increasedcount of
lymphocytes,
whichindicates
inflammation
or infection
There is anincreased
count of
monocytes,which
indicates
inflammationor infection
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Blood
vessel
swhich
groupinto
three,
thearterie
s
which
carryblood
out of
the
heartto the
capill
aries,the
veins
whichtransp
ort
oxyge
n-poor
blood
back to the heart and the capillaries which transfer oxygen and other nutrients into thecells and remove carbon dioxide and other metabolic waste from these body tissue
count
Bleedingtime
Clotting time
Prothrombin
for malfunction of
clotting reflex
Determines bleedingtime
Determines Clottingtime
Measures ofthe extrinsic
pathway ofcoagulation.
To determine theclotting tendency of
blood, in the measure
ofwarfarin dosage,
liver damage,and vitamin K status
300
430
011.1
150
450
x109/L
030-
900
400-
1500
11-
016
Result was
within normallevel no
indication ofmalfunction ofclotting reflex
Result was
within normal
level noindication of
malfunction of
clotting reflex
Result waswithin normal
level no
indication ofmalfunction of
clotting reflex
Result was
within normal
level no
indication ofmalfunction of
clotting reflex
http://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Vitamin_Khttp://en.wikipedia.org/wiki/Vitamin_Khttp://en.wikipedia.org/wiki/Warfarinhttp://en.wikipedia.org/wiki/Coagulation -
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September 7, 2011
Urinalysis
Clinical
microscopy
(macroscopy)Result Purpose Evaluation
Color
Transparency
Sugar
Protein
pH
Frequency test
Yellow
Slightly turbid
(-)
(trace)
5.0
(-) specimen used fortest : serum
To know thehydroxygenation of
the urine
To know the
transparancy
To know if the patient
has sugar in urine
To assess for
proteinuria
To assess the pH
balance of the
patients body
To know if the patient
is pregnant
Normal urineoutput color, no
indication of
inflammation orinfection
Normal
transparency
The patient has (-) result. Noglucose in the
urine
The patientskidney if
functioning well
Acidic urine is
normal after
delivery
The patient is
(-)pregnant
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09/07/2011 bun/creatinine
Indication Result Range Result Range Evaluation
BUN
To evaluate
kidney functionor monitor the
effectiveness
ofdialysisandother treatments
related tokidney
diseaseordamage
5.02.5
6.414.01 718.0
Normalresults,
indication of
normal
function ofthe kidney
Clinical
microscopy
(microscopic)
WBC
RBC
Epithelial
2-4/HPF
0.2/HPF
few
To assess for bacterial
infection
To assess forhematuria
To know if there isinfection in the
urinary tract
It is within
normal range,indication of noserious infection
The patient hasblood in his urine,
indication for
infection
Few cells were
found which isnormal
Clinical
microscopy
(microscopic)
Amorphousurates /
Phosphates
Bacteria
Few
Few
To assess if the
patient may develop
crystals
To identify any
bacteria in the urinary
tract
Has little chance
of forming
crystals
Has few, a good
indication of
infection potential
http://labtestsonline.org/glossary/hemodialysishttp://labtestsonline.org/glossary/hemodialysishttp://labtestsonline.org/glossary/hemodialysishttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/understanding/conditions/kidneyhttp://labtestsonline.org/glossary/hemodialysis -
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Uric acid
used to help
diagnose the
cause of
recurrent kidneystones and to
monitor peoplewith gout forstone formation.
354155-428
5.94 2.6-7.2
Normal
results,
indication ofnormal
function ofthe kidney
Creatinineassess kidney
function.89 53-115 1.01 0.06-1.3
Normalresults,
indication of
normalfunction of
the kidney
AST(SGOT)
aspartate
aminotransferase
(AST) to assessthe liver
function
31 15-37 31 15-37
Normalresults,
indication ofnormalfunction of
the liver
LDH
Lactate
dehydrogenaseis used to assess
celluar
respiration
272 81-234 272 81-234
Has above
normal
result,indication of
cell
perfusion of
glucose
09/05/2011
Indication ResultReferrence
rangeEvaluation
Glycohemoglobin
(HbA1c, A1c)
To assess theamount of
glucose
bound to ahemoglobin
6.8% 4.2-6.1%
Result is high,
indication of diabetes
mellitus
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Nursing Responsibilities During Different Laboratory Procedures
White Blood Cell Count
Before
Explain to the patient that the WBC test is used to detect an infection orinflammation.
Tell the patient that the test requires a blood sample. Explain who will performthe venipuncture and when.
Explain to the patient that he may experience slight discomfort from the needlepuncture and the tourniquet.
Inform the patient that he should avoid strenuous exercise for 24 hours before thetest. Also tell him that he should avoid eating a heavy meal before the test.
If the patient is being treated for an infection, advise him that this test will berepeated to monitor his progress.
Notify the laboratory and physician of medications the patient is taking that mayaffect test results: they may need to be restricted.
During
Ensure subdermal bleeding has stopped before removing pressure.
After
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If a hematoma develops at the venipuncture site, apply warm soaks. If thehematoma is large, monitor pulses distal the venipuncture site.
Inform the patient that he may resume his usual diet, activity and medicationsdiscontinued before the test, as ordered.
A patient with severe leucopenia, they have little or no resistance to infection andrequires protective isolation.
Red Blood Cell Count
Before
Explain to the patient that RBC count is used to evaluate the number of RBCs andto detect possible blood disorders.
Tell the patient that the test requires a blood sample. Explain who will performthe venipuncture and when.
Explain to the patient that he may experience slight discomfort from the needlepuncture and the tourniquet.
Inform the patients that he need not restrict foods and fluids
During
Ensure subdermal bleeding has stopped before removing pressure.
After
If a hematoma develops at the venipuncture site, apply warm soaks.
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Hemoglobin
Before
Explain to the patient that the hbg test is used to detect anemia or polycythemia orto assess his response to treatment.
Tell the patient that the test requires a blood sample. Explain who will performthe venipuncture and when.
Explain to the patient that he may experience slight discomfort from the needle
puncture and the tourniquet.
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During
Ensure subdermal bleeding has stopped before removing pressure.
After
If a hematoma develops at the venipuncture site, apply warm soaks.
Hematocrit
Before
Explain to the patient that hct is tested to detect anemia and other abnormalconditions
Tell the patient that the test requires a blood sample. Explain who will performthe venipuncture and when.
Explain to the patient that he may experience slight discomfort from the needlepuncture and the tourniquet.
Inform the patients that he need not restrict foods and fluids
During
Ensure subdermal bleeding has stopped before removing pressure.
After
If a hematoma develops at the venipuncture site, apply warm soaks.Discharge plan (M.E.T.H.O.D.):
Medication
mefenamic acid 500 mg/ tab q0 PRN amoxicillin 500 mg/ cap q 8 x 7days
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Exercise
Instruct client to balance activities with adequate rest periods.
Educate client on proper body mechanics to prevent muscle strain and enable client
to
relax.
Encourage client to ambulate and assume normal Encourage deep breathing exercise
Treatment
change of dressing
clean of dressing
Hygiene Keep your incision sites clean and dry.
Do not douche or put anything in your vagina, such as a tampon, until your doctor
tells you otherwise.
Encourage client to do daily hygiene Encourage client to ask assistance if needed
Outpatient ordersCall the doctor if any of the following occurs:
Develop a fever.
Become dizzy and faint.
Experience nausea and vomiting.
Become short of breath.
Have heavy bleeding.
Have leakage from the incision or the incision opens up.
Have pain when you urinate.
Have swelling, redness, or pain in your leg.
Have questions about the procedure or its result.
Diet
To promote healing, eat a balanced diet rich in fresh fruits and vegetables.
Depending on
how much blood loss occurred during surgery, you may require a daily ironsupplement.
Eat foods that are rich in carbohydrates and protein.
Sufficient intake of fluids. Eat high-fiber foods, drink plenty of water, and if necessary, use stool softeners.
Instruct client to eat foods that are high in protein and vitamins and minerals.
Spirituality
No sexual intercourse
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HEALTH TEACHING
Inform the patient about the importance of complying with the prescribedmedication.
Emphasize the proper dosage of the medications taken. Educate the client about the importance of proper nutrition. Encourage the client to have the prescribed diet for his condition. Encourage the patient to drink plenty of water and avoid being dehydrated. Rest and relax. No heavy lifting, strenuous exercise, sex, tampons or douching. The patient should not have intercourse or drive until postpartum check. Encourage the patient to love and take good care of self. Avoid or quit smoking. Quitting smoking will improve health and the health of
those around you.