82085243 case-study-on-pregnancy-induced-hypertension-eclampsia

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Our Lady of Fatima University

College of NursingRegalado, Quezon City

A Case Study onPregnancy-Induced Hypertension

In Partial Fulfillment of the Requirements in

Nursing Care ManagementRelated Learning Experience



http://www.homeworkping.com/





Presented by:BSN 2A1-2Group 10

Espellogo, Leizel Y.Falle, Mery Ann M.Gianchand, Olivia E.

Hinanay, Ely JohnMaglaoy, Manuel David B.

Manuel, Janine M.Mateo, Donna Marie

First SemesterS.Y 2011-2012

I. Introduction

Hypertensive disorders of pregnancy also known as Pregnancy Induced Hypertension are

high blood pressure disorders of pregnancy which is one of the major problem for mother in

pregnancy.PIH is common in pregnant teens and in women over age 40 but it also develops

during the second half of the pregnancy and usually after the 20th week of gestation.PIH is

usually present to those person with a previous history of PIH, chronic hypertension, lupus,

alcohol, drug or tobacco abuse, presence of diabetes, underweight or overweight, kidney disease

and expected twins or triplets. The warning signs of PIH those people are rapid weight gain, 4-5

lbs in a single week, a rise in blood pressure, protein in urine, severe headaches, blurry visions,

severe pain over the stomach under the ribs of the mother who have PIH and decrease in amount

of urine. PIH can prevent prematurity and death of the baby through the following closely by the

medical professional and attending pre-natal checkup. PIH can cause low birth weight of the

baby.

Therefore, it is necessary to all health worker engaged on themselves all about clinical

knowledge and skills and to develop their values to be able to become an efficient and effective

competent individual when it comes health assessment in performing their duties and

responsibilities when it comes to health assessments.

II. Objectives

General:

This study aims to improve our skills, knowledge and attitude in performing our duties

and responsibilities to give an efficient and effective outcome especially to the health of the

patients.

Specific:

1. To identify factors if having pregnancy induced hypertension.

2. To develop a teaching program that will educate patients specially those who are susceptible

of pregnancy induced hypertension.

3. To understand the disease process, its etiology, signs and symptoms, pathophysiology and

diagnostic procedure.

4. To promote awareness to individual by imparting knowledge so they could learn and

understand more about pregnancy induced hypertension.

5. To discuss and describe interventions for health promotion, prevention and treatment of

patient pregnancy induced hypertension.

III. Patient’s Profile

A. Biographical Data

1. Name: Mrs. R.E.R.

2. Address: Sto. Nino 1 Sapang Palay, SJDM

3. Age: 30

4. Birthdate: June 19,1981

5. Sex: Female

6. Race: Filipino

7. Marital status: Married

8. Occupation: Housewife

9. Religion: Catholic

10. Health Care financing and usual source of Medical Care:

Supported by the patient’s parents since the patient and his husband doesn’t have

source of income

A. Working Diagnosis

Postpartum Hypertension (pre-eclampsia)

B. Chief Complaint and Reason for Visit:

Hypertension

C. History of Present Illness:

Our patient had 3 pregnancies; all children were born at right gestational age. She had no

history of abortion and multiple births. All children are living. According to the patient she has

been experiencing intrapartal and PIH every time she gets pregnant. She got complete pre-natal

check-ups from the health center. Her blood pressure started to get elevated on the 3rd trimesters

of each pregnancy and continues even after she gave birth. After she gave birth to her youngest

son at home, the attending midwife decided to bring her to the hospital for referral since her

blood pressure went up to 200/140 mmHg. This was her first time to be admitted to the hospital

due to postpartum hypertension.

D. Past History:

Mrs. R.E.R. already gave birth to 3 boys. Her first child was born April 23, 2003 and the

next child was born March 14, 2008 and just on September 25, 2011 she gave birth to another

baby boy. All children were born full term. She gave birth to her children at home by normal

delivery and was attended by a midwife.

E. Family History of Illness:

The patient has a family history of hypertension. According to her, both of her parents

have hypertension.

IV. Physical Assessment

Assessment Normal Findings Actual Findings InterpretationBody Build,

Height & WeightProportionate Varies With

Lifestyle

Proportionate Varies With Lifestyle

Proportionate body there is no evidence of physical

problemsPosture And Gait Stands normally Stands normally Relaxed, erect posture;

coordinated movementBody And Breath

OdorNo Body Or Breath

OdorNo Body Or Breath

OdorProper hygiene

maintenanceSigns Of Distress No Distress Noted distress noted Because of lack of sleep,

distress notedAttitude Cooperative Cooperative Thinks normally, proper to

the situationAffect Or Mood Appropriate To The

SituationAppropriate To The

SituationShe acts and think

normally appropriate to the situation

Quantity, Quality And Organization

Of Speech

Understandable, Moderate Pace,

Thought Association

Understandable, Moderate Pace,

Thought Association

Can speak normally, with normal voice tone

Relevance And Association

Thought Exhibits

Logical Sequence Make Sense, Has Sense Of Reality

Logical Sequence Make Sense, Has Sense

Of Reality

Talking with sense means she thinking normally

SkinAssessment Normal Findings Actual Findings Interpretation

Uniformity Of Skin Color

Uniformity Except In Areas Expose To

The Sun

Uniformity Except In Areas Expose To The

Sun

Uniformity of skin, except areas expose to light and

some areas of lighter pigmentation(conjunctivas

, palms, lips, nail beds)Edema No Presence Of

EdemaPresence of edema on

feet 1+Swollen, shiny and taut and tends to blanch the

skin colorSkin Lesion Freckles, some

birthmarks, some flat and raised

nevi;no abraisions or other lesions

Freckles,some birthmarks,some flat and raised nevi;no abraisions or other

lesions

No lesion noted in the body

Skin Moisture Moisture In Skin Folds & Axillae

Moisture In Skin Folds & Axillae

Some body parts that having sebaceous glands

are moistureSkin Temperature Uniform, Within

Normal RangeUniform, Within Normal Range

Normal temperature uniformity

Skin Turgor Skin Springs Back To Previous State

When Pinched

Skin Springs Back To Previous State When Pinched, except the

Skin stays pinched or tented or moves back

slowly

part with edema

Skull and FaceAssessment Normal Findings Actual findings Interpretation

Head Rounded And Symmetrical, Smooth Skull Contour, No

Nodules

Rounded And Symmetrical, Smooth

Skull Contour, No Nodules

Normal, no signs of any deformities and signs of

skull contour and nodules

Eyes and VisionEyebrows Evenly Distributed,

Symmetrical, Skin Intact

Evenly Distributed, Symmetrical, Skin

Intact

Properly distributed, equal

Eyelids Skin Intact, No Discharges, No Discoloration, Symmetrical

Skin Intact, No Discharges, No Discoloration, Symmetrical

Can blink normally

Eyelashes Equally Distributed,

Slightly Curved Outward

Equally Distributed, Slightly Curved

Outward

Turned outward, equally distributed, muscle normally contract

Conjunctiva Shiny, Smooth ,Sometimes

Appear Red Or Pink

Pale conjunctiva Pale, possible anemia

Lacrimal Gland No Edema Or Tearing

No Edema Or Tearing Normal no evidence of any swelling or tenderness

Cornea Transparent, Shiny, Smooth, Blinks When Cornea Is

Touched

Transparent, Shiny, Smooth, Blinks When

Cornea Is Touched

Corneal sensitivity test active,trigeminal nerve is intact,cornea clarity and

texture normal.Pupils Black Color,smooth

border,PERRLABlack Color, smooth

border,PERRLAPupils are equal,constrict to light dilate in the dark

Eyes(Visual Acuity)

Can see without using eyeglasses

Can’t see without eyeglasses

Nearsightedness, can see only when objects are near

Ears and HearingAuricles Color Is Uniform,

Symmetric, Mobile, Firm pinna Recoils

When Folded

Color Is Uniform, Symmetric, Mobile, Firm pinna Recoils

When Folded

Color same as facial skin,auricle aligned with outer canthus of the eye.

Response To Normal Voice

Tone

Normal Voice Tone Audible

Cannot hear Normal Voice Tone

Abnormal cannot hear Normal voice, normal

voice tones

Nose and SinusesNares Symmetric,

Straight, No Discharges, Non

Swelling, Uniform Color, Not Tender

Symmetric, Straight, No Discharges, Non Swelling, Uniform Color, Not Tender

No presence of lesions,air moves freely as the client

breaths

Lining Of Nose Nasal Septum In Midline

Nasal Septum In Midline

Normal and in midline

MouthLips And Buccal

MucosaPink, Soft,

SymmetricalPale lips and buccal

mucosaAbnormal, possible

anemiaTeeth And Gums Complete Complete No tooth decay,smooth

shiny tooth enamel,no dentures

Tongue In Midline, Freely Movable, Pink

In Midline, Freely Movable, Pink

In Central position,moist,slightly

rough ;thin whitish coating,normal,can move

freelyPalates And Uvula,

TonsilsLight Pink, No

Discharges, Present Gag Reflex

Light Pink, No Discharges, Present

Gag Reflex

No discoloration, palates are lighter pink hard

palate

Neck and Musculoskeletal SystemShape And Symmetry

Symmetrical Symmetrical Positioned in midline

Spinal Deformities Vertically Aligned Vertically Aligned Normal, no deformities

Inspect Neck Muscles

Symmetrical With Head Centered

Symmetrical With Head Centered

No swelling or masses,coordinated,smoot

h movements with no discomfort

Observe Head Movement

Coordinated, Smooth, Movement

With No Discomfort, Equal

Strength

Coordinated, Smooth, Movement With No Discomfort, Equal

Strength

No discomfort, can hyper extends, laterally flexes

and rotates

Muscle Size Is Symmetrical, No

Contracture, Normally Firm

Size Is Symmetrical, No Contracture, Normally Firm

Equal strength, symmetrical, normal

Bones No Deformities,No Swelling Or

Tenderness

No Deformities,No Swelling Or

Tenderness

Normal, can move freely, no swelling, deformities

or tendernessJoints No Swelling, No No Swelling, No Normal, no signs of

Tenderness Tenderness swelling in area, no tenderness

Range Of Motion Varies To Some Degrees

Limited range of motionin one or more

joints

Can stand and walk, but limited range of motions.

V. Activities of Daily Living

Functional Health Pattern

Before her present condition

During her present condition

Interpretation

Health Perception and Health Management

Complies easily with health care provider’s suggestion.

Practices health promotion activities such as healthy diet and breastfeeding

Visits the health center for check-up when sick.

Does not have traditional health beliefs and

Same perception about health

Complies with medications

Follows the nurses or doctor’s suggestion

The patient has a good health perception and practices proper health management

Nutritional and Metabolic

Eats 3 times daily. The usual food intake would be composed of fish and vegetables, seldom eats meat Drinks 5 glasses of water and 2 cups of coffee a day

Takes vitamins as a supplement

Skin color was fair, height proportional to body weight

Same amount and quality of food is taken

Coffee was eliminated

Discontinued taking vitamins

Pale color of skin, height still proportional to body weight

Patient’s diet had no change so it can’t be directly inferred that skin pallor was due to diet.

Elimination Moves bowel once a day without difficulty

Same bowel movement frequency

Bowel movement was affected because patient

Soft firm stoolVoids fair amount of urine without difficulty in normal frequency

Clear, yellow urine

Difficulty moving bowels although stool quality is soft and firm

More frequency in voiding urine in the lesser amount and same quality

can’t exert enough effort to expel stool.

Activity – Exercise Considers doing household chores as an exercise

Leisure time spent by chatting with friends and playing with kids

No exercise done due to confinement

Leisure time spent by chatting with husband

Exercise was eliminated since she cannot do household chores while in the hospital and she didn’t replace it by another form of exercise.

Sleep-Rest Has 6 - 8 hours of sleep everyday

Deep, uninterrupted sleep

Gets enough energy from sleepDoesn’t need any sleep aids

Has maximum of 3 hours of interrupted sleep

Takes nap in the afternoon to compensate lost sleeping hours

Inadequate sleep due to noisy environment,

Cognitive-Perceptual

Normal hearing acuity and does not use hearing aid

Uses eyeglasses

Able to comprehend easily

Asks to repeat the questions during the interview

Eyeglasses left at home

Comprehension has changed because patient can’t hear clearly.

Self-Perception and Self-Concept Pattern

Feels good about herselfHas ability to do normal activities without helpDoesn’t have anything that causes anger, anxiety and depression

Had worried about her child’s nutrition since the newborn was left at home but now feels better because the newborn is already with her

Anxiety is no longer an issue since her baby is already with her.

VI. Development Tasks

Generativity vs. Stagnation

At the age of 30, the significant task of the patient is to perpetuate culture and transmit values of culture through the family and working to establish a stable environment. In her age, success is achieved by contributing to the world by being active in their home and community or society. Mrs. R.E.R. is a full time housewife since she got married so she only had continued to build her life focusing on her family. Although she shows self fulfillment in terms of being a mother and wife, she manifested the feeling of lack of accomplishment because she mentioned that she also wants to play a different role in the society by having a career or job someday.

VII. Laboratory/Diagnostic Findings

Date Procedure Norms Result

Analysis Interpretation

September 25, 2011

Hemoglobin 115-155 95 Due to blood loss which causes decreased RBC

resulting to low Hgb

Decreased

Hematocrit 0.40-0.48

0.30 Due to blood loss which causes decreased RBC

resulting to low Hgb

Decreased

WBC Count 5.0-10.0 12.9 Urinary tract infection IncreasedLymphocyte

s0.2-0.4 0.25 No viral or chronic bacterial

infectionNormal

Gabriel J. Cruz , MD, DPSPPATHOLOGIST

ROUTINE URINALYSIS September 25, 2011

Urine Result Analysis InterpretationColor Amber Normal urine concentration Normal

Transparency Turbid Bacterial Infection AbnormalReaction Acidic Due to the amount of sodium

and excess acid retained by the body

Abnormal

Specific Gravity 1.02 Normal urine concentration NormalProtein + + + + Hypertension affects filtration

that can cause excessive protein in urine

Abnormal

Sugar Negative No diabetes NormalRBC 3-5/HPF No bleeding in urinary system Normal

Pus Cells 8-10/HPF Bacterial infection in urinary tract

Abnormal

Epithelial Cells + Inflammation within urinary tract

Abnormal

Bacteria + Infection on urinary tract AbnormalMucus Threads + Inflammation within urinary

tractAbnormal

Amorphous Urates + Uric acid crystals Abnormal

Gabriel J. Cruz , MD, DPSPPATHOLOGIST

VIII. Anatomy and Physiology (Affected Organ)

HEART

The heart is responsible for maintaining adequate circulation of oxygenated blood around

the vascular network of the body. It is a four-chamber pump, with right side receiving

deoxygenated blood from the body at low pressure and pumping it to the lungs. And at the left

side receiving oxygenated blood form the lungs and pumping I at the high pressure around the

body. The myocardium is a specialized form of muscle, consisting of individual cells joined by

electrical connections. The contraction of each cell is produced by a rise in intracellular leading

to spontaneous depolarization, and as each cell electrically connected to its neighbor, contraction

of one cell leads to wave of depolarization and contraction across the myocardium. This

depolarization and contraction of the heart is controlled by a specialized group of cells localized

in the sino-atrial node in the right atrium pacemaker cells.

KIDNEY

The kidney is the responsible for the volume and concentration of fluids in the body by

producing urine. Urine is produce in a process called glomerular filtration, which remove as the

waste products, minerals and water from the blood. The kidney maintains the volume of the fluid

in the body and also the concentration of urine by filtering the waste product and reabsorbing

useful substances and water from the blood. The kidney also performs detoxification of harmful

substances increase absorption of calcium by producing calcitrol (form of vitamin D) and also

secretes rennin (hormone that regulates blood pressure and electrolyte.)

IX. Pathophysiology (Flowchart)

(Predisposing) (Precipitating)

Age: 30 Lifestyle: drinks occasionally

Stress (Financial needs of the family)

Gender: F

Eating habits

Race: Filipino

Family History: both parents have hypertension.

VASOSPASM

VASCULAR EFFECT KIDNEY INTERSTITIAL EFFECT

VASOCONSTRICTION KIDNEY EFFECT EDEMA

DECREASE URINE

INCREASE OF BP OUTPUT AND PROTENURIA (160/120) (150ml)

Who is at risk for Pregnancy induced hypertension?

-PIH is more common during a woman’s first pregnancy and in women whose mothers or sisters

had PIH. The risk of PIH is higher in women carrying multiple babies, in teenage mothers and in

women older than 40 years of age. Other women at risk include those who had high blood

pressure or kidney disease before they became pregnant.

How does vasospasm affects the Heart?

Vasospasm happens by increased cardiac output that injures the endothelial cells of the arteries.

The blood vessels during pregnancy are resistant to the effects of pressors substances such as

angiotensin and norepinephrine, so blood pressure remain normal during pregnancy.

How does vasospasm affects the Kidney?

Vasospasm in the kidney increases blood flow resistance. Degenerative changes develop in the

kidney glomeruli because of back-pressure. This leads to increased permeability of the

glomerular membrane, allowing the serum proteins albumin and globulin to escape into the urine

the degenerative changes also results in decreased glomerular filtration, so there is a decrease

urine output and clearance of creatinine.

X. Course in the Ward

Mrs. R.E.R. a 30 year old postpartum who gave birth to her baby at home attended by a midwife was suspected to have a postpartum hypertension was admitted to the Ospital ng Lungsod ng San Jose Del Monte.

DAY 1 (Sept. 25 2011, 7pm-7am)

As the client admitted by Dr. Roberto Enriquez to the OB ward, she was given a liter of intravenous fluid of D5LR solution at 20 gtts/min. She was inserted a Foley catheter connected to the urine bag and Vital signs were taken. She was instructed for NPO. And as of 4pm she was given an initial dose of MgSO4, 4grams infused 250ml 5% of dextrose solution, her blood pressure was monitored 200/100. At 5pm she had given MgSO4 5grams diluted in 10ml of sodium chloride in each buttock deep intramuscular and she was asked by the nurse if she didn’t experience abdominal pain, nausea or vomiting before the medication was administered. After that her Blood pressure was 170/100, and after 30 minutes she had given Hydralizine 5ml every 6 hours intravenous, it was administered slowly. And as of 2am she was given Amlodipine 5mg twice a day as ordered by the physician.

DAY 2 (Sept. 26 2011, 7am-7pm)

Her Blood pressure was 140/100 and had continued MgSO4. As ordered by the physician the dose of Amlodipine increased to 10mg twice a day. And once she completed the MgSO4 , the nurse may remove the inserted Foley catheter. Her hemoglobin count was 95, and urinalysis result was +4 as seen and examined by Dra. Garza who ordered to discontinue antibiotics and to start Cephalexine 500mg/cap every 6 hours in 7 days and FeSO4 twice a day . and the patient was told she may go home if she completed MgSO4 and was controlled her Blood pressure with Amlodipine . She was also instructed to take Diazepam 5g twice a day in 1 week continuously even she’s at home.

DAY 3 (Sept. 27 2011, 7pm-7am)

Her blood pressure was150/100 and was referred to Dra. Comia, then her oral medications were given and then were referred to OB.

DAY 4 (Sept. 28 2011, 7am-7pm)

She walked slowly with an intravenous fluid and was referred to MS-OB and vital signs were taken. Her medications were given; her Blood pressure was monitored and was referred to Dr. Nieto.

DAY 5(Sept. 29 2011, 7pm-7am)

She was taken a low sodium low fat diet and still taking her medication, vital signs were taken. Her Blood was monitored. Clonidine 5g was given sublingual as instructed by the physician. Then her blood pressure became 150/90 after an hour. She was referred to Dr. Gonzales with orders in and carried out.

DAY 6 (Sept. 30 2011, 7am-7pm)

Oral medications were given, uterus was firm and contracted, her vital signs were taken and blood pressure was monitored 150/100. She was advised to breastfeed.

XI. Nursing Care Plans

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIONSubjective:None

Objective:PittingEdema:3secondsLowerextremities:BipedalEdema

UO:150 cc per hour

VS:BP: 160/120BT: 36.4PR: 104RR: 18

Excessive fluid volume related to increasedfluid retention as manifested by the presence of edema in the feet.

Short Term Goal:After 8 hours of nursing intervention the patient’s edema will be decreased as evidenced by pitting edema (1-2 seconds)

Long Term Goal:After 2 days of nursing intervention, the patient will have stabilized fluid volume as evidenced by balanced input/output, vital signs within client’s normal limits and free of signs of edema

Independent>Monitor urine output

>Monitor BP

>Encourage the patient to eat fruits and vegetables that has high diuretic property

>Elevate edematous extremities, change in position frequently

>Discuss the importance of fluid restrictions

Dependent:>Insert indwelling urinary catheter as per doctors order

>Restrict sodium and fluid intake as indicated

>Kidney function is directly correlated to circulatory fluid volume, so that if fluid is trapped in third spaces, output decreases and specific gravity increases.

>Changed parameters may indicate altered fluid or electrolyte status.

>Helps to increase urine output thus decreases fluid retention

>Helps to reduce tissue pressure and risk of skin breakdown. to increase venous blood return

>Helps the client to understand the relationship of food restriction to her condition

>Provides accurate hourly totals of urine output, and monitors client for developing renal problems or oliguria.

>Restricting the sodium in the diet will favor the renal excretion of excess fluid. Fluid restriction may decrease intravascular volume and myocardial workload

Short Term Goal:After 8 hours of nursing intervention the patient’s edema was decreased as evidenced by pitting edema (1-2 seconds

Long Term Goal:After 2 days of nursing intervention, the patient had stabilized fluid volume as evidenced by balanced input/output, vital signs within client’s normal limits and free of signs of edema

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIONSubjective:

“Di ko alam kung bakit nakaconfine pa ako, mataas nga ang bp ko pero feeling ko okay naman ako dahil wala naman akong masakit na nararamdaman” as verbalized by the client.

Objective:

>Observed confusion when patient was asked about her condition

>Lack of information source ( no television and radio at home)

Knowledge regarding condition, prognosis Related to lack of exposure/unfamiliarity with information as manifested by statement of misconceptions

Short Term Goal:After 4 hours of nursing intervention, client will identify signs/symptoms requiring medical evaluation.

Long Term Goal:After 1 day of nursing intervention, the client will verbalize understanding of disease and appropriate treatment plan.

Independent: >Assess client’s knowledge of the disease process.

>Provide information about the disease and the complications that it can cause.

>Provide information about signs/symptoms, and instruct client when to notify healthcare provider.

>Keep client informed of health status, results of tests.

>Establishes data base and provides information about areas in which learning is needed.

>Makes the client know the importance of treatment and management of her condition.

>Helps ensure that client seeks timely treatment indicating worsening of condition or additional complications.

>Fears and anxieties can be compounded when client does not have adequate information about the state of the disease process.

Short Term Goal:After 4 hours of nursing intervention, client was able to identify signs/symptoms requiring medical evaluation.

Long Term Goal:After 1 day of nursing intervention, the verbalized understanding of disease process and appropriate treatment plan.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATIONSubjective:

> "Hindi ako makatulog ng maayos, halos tatlong oras lang na deretsong tulog sa isang araw tapos putol-putol na". As verbalized by the client.

Objective:

>Pale conjunctiva, lips, palm and skin

>Frequent yawning

>Dark circles under the eyes

VS:BP: 160/120BT: 36.4PR: 104RR: 18

>Disturbed sleep pattern related to uncomfortable environment as manifested by pale conjunctiva, lips, palm and skin frequent yawning and dark circles under the eyes.

Short Term Goal:>After 4 hours of nursing intervention the client will demonstrate relaxation skills and other methods to promote sleep.

Long Term Goal:>After 1 day of nursing intervention the client will be able to sleep at least 8 hours a day.

Independent:>advise to establish regular bedtime and wakeup time and a short daytime nap.

>Advise to take warm bath before bedtime.

>Advise to wear loose-fitting shirts.

>Advise to drink 1 glass of warm milk before sleeping.

>encourage voiding before going to sleep.

Collaborate:>Advise the roommates to lower their voices and prevent noise at bedtime.

>To promote good sleeping pattern

>To promote feeling of freshness before sleeping.

>To promote comfort while sleeping.

>Milk contains tryptophan, a precursor of serotonin, which is thought to induce and maintain sleep.

>To avoid interruption in the middle of sleep.

>To reduce noise destruction for the comfortable sleep of the patients.

Short Term Goal:>After 4 hours of nursing intervention the client was able to demonstrate relaxation skills and other methods to promote sleep.

Long Term Goal:>After 1 day of nursing intervention the client was able to sleep at least 8 hours a day.

XII. Drug Study

Name of Drug

Classification Mechanism of Actions Indication Contraindication Adverse Effect Drug to Drug Interaction

Nursing Consideration

Amlodipine Antianginal

Antihypertensive

Calcium Channel Blocker

Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells; inhibits transmembrane calcium flow, which result in the depression of impulse formation in specialized cardiac pacemaker cells, slowing of the velocity of conduction of the cardiac impulse, depression of myocardial contractility , and dilation of coronary arteries and arterioles and peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac oxygen consumption, and in patients with vasospastic (Prinzmetal’s) angina,increased delivery of oxygen to cardiac cells.

Angina pectoris due to coronary artery spasm (Prinzmetal’s variant angina)

Chronic stable angina, alone or in combination with other drugs

To reduce the risk of hospitalization due to angina and to reduce the need for coronary revascularization procedures in patients with angiographically documented CAD without heart failure or ejection fraction less than 40%

Essential hypertension, alone or in combination with other antihypertensives

Contraindicated with allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block (second or third degree), and lactation.

Use cautiously with heart failure, pregnancy.

CNS: Dizziness,light-headedness, headache, asthenia, fatigue,lethargy

CV: Peripheral edema, arrhythmias

Dermatologic: Flushing, rash

GI: Nausea, abdominal discomfort

Monitor BP very carefully if patient is also on nitrates.

Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy.

Administer drug without regard to meals.

Name of Drug

Classification Mechanism of Actions

Indication Contraindication Adverse Effect Drug to Drug Interaction


Cephalexin Antibiotic

Cephalosporin (first generation)

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

Respiratory tract infections caused by Streptococcus pneumonia, group A beta hemolytic streptococci.

Skin and skin structure infections caused by staphylococcus, streptococcus

Otitis media caused by S. pneumonia, Haemophilusinfluenzae, streptococcus, staphylococcus, Moraxella catarrhalis

Bone infections caused by staphylococcus, Proteus mirabilis

GU infections caused by Escherichia coli, P. mirabilis, Klebsiella

Contraindicated with allergy to cephalosporins or penicillins.

Use cautiously with renal failure, lactation, pregnancy.

CNS: Headache, dizziness, lethargy, paresthesia

GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, hepatotoxicity

GI: Nephrotoxicity

Hematologic: Bone marrow depression

Hypersensitivity: Ranging from rash to fever to anaphylaxis; serum sickness reaction

Other: Super infections

Increased nephrotoxicity with amino glycosides

Increased bleeding effects with oral anticoagulants

Disulfiramlike reaction may occur if alcohol is taken within 72 hr after cephalexin administration

Arrange for culture and sensitivity tests of infection before and during therapy if infection does not resolve.

Give drug with meals; arrange for small, frequent meals if GI complications occur.

Refrigerate suspension, discard after 14 days.

Name of Drug


Indication Contra indication

Adverse Effect Drug to Drug Interaction


Cefuroxime Antibiotic

Cephalosporin

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

Pharyngitis, tonsillitis, caused by Streptococcus pyogenes

Otitis media caused by Stretococcus pneumonia, S.pyogenes, Haemophilus influenza, Moraxella catarrhalis

Acute bacterial maxillary sinusitis caused by S. pneumonia, H. influenza

Lower respiratory infections caused by S. pneumonia, Haemophilus parainfluenza, H. influenza

UTIs caused by Escherichia coli, Klebsiella pneumonia

Uncomplicated gonorrhea (urethral and endocervical)

Skin and skin structure infections, including impetigo caused by Streptococcus aureus, S. pyogenes

Treatment of early Lyme disease

Contraindicated with allergy to cephalosporins or penicillins.

Use cautiously with renal failure, lactation, pregnancy

CNS: Headache, dizziness, lethargy, paresthesias

GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, hepatotoxicity

GU: Nephrotoxicity Hematologic: Bone

marrow depression Hypersensitivity:

Ranging from rash to fever to anaphylaxis; serum sickness reaction

Local: Pain, abscess at injection site, phlebitis, inflammation at IV site

Other: Super infections, disulfiram-like reaction with alcohol

Increased nephrotoxicity with amino glycosides

Increased bleeding effects with oral anticoagulant

Risk of disulfiram-like reaction with alcohol; avoid this combination during and for 3 days after completion of therapy

Culture infection site, and arrange for sensitivity test before and during therapy if expected response is not seen.

Give oral drug with food to decreased GI upset and enhance absorption.

Give oral tablets to children who can swallow tablets; crushing the drug results in a bitter, unpleasant taste. Use solution for children who cannot swallow tablets.

Have vitamin K available in case hypoprothrombinemia occurs.

Discontinue if hypersensitivity reaction occurs.

Name of Drug Classification Mechanism of Actions

Indication Contraindication Adverse Effect

Drug to Drug Interaction


Ferrous sulfate Iron preparation

Elevates the serum iron concentration, and is then converted to Hgb or trapped in the reticuloendothelial cells for storage and eventual conversion to a usable form of iron.

Prevention and treatment of iron deficiency anemia

Dietary supplement for iron

Unlabeled use: Supplemental use during epoetin therapy to ensure proper hematologic response to epoetin

Contraindicated with allergy to any ingredient; sulfite allergy; hemochromatosis, hemosiderosis, hemolytic anemia.

Use cautiously with normal iron balance; peptic ulcer, regional enteritis, ulcerative colitis.

CNS: CNS toxicity, acidosis, coma and death with overdose

GI: GI upset, anorexia, nausea, vomiting, constipation, diarrhea, dark stools, temporary staining of the teeth(liquid preparations)

Decreased anti-infective response to ciprofloxacin, norfloxacin, ofloxacin; separate doses by at least 2 hr

Decreased absorption with antacids, cimetidine

Decreased effects of levodopa if taken with iron

Increased serum iron levels with chloramphenicol

Decreased absorption of levothyroxine; separate doses by at least 2 hr

Confirm that patient does have iron deficiency anemia before treatment.

Give drug with meals (avoiding milk, eggs, coffee, and tea) if GI discomfort is severe; slowly increase to build up tolerance.

Administer liquid preparations in water or juice to mask the taste and prevent staining of teeth; have the patient drink solution with a straw.

Warm patient that stool may be dark or green.

Arrange for periodic monitoring of Hct and Hgb levels.

Name of Drug




Hydralazine Antihypertensive

Vasodilator

Acts directly on vascular smooth muscle to cause Vasodilation, primarily arteriolar, decreasing peripheral resistance; maintains or increases renal and cerebral blood flow.

Oral: Essential hypertension alone or in combination with other drugs

Parenteral: Severe essential hypertension when drug cannot be given orally or when need to lower BP is urgent

Unlabeled uses: Reducing afterload in the treatment of heart failure, severe

Contraindicated with hypersensitive ty to hydralazine, tartrazine (in 100-mg tablets marketed as Apresoline); CAD, mitral valvular rheumatic heart disease (implicated in MI).

Use cautiously with CVAs; increased in tracranial pressure (drug-induced BP decrease increases risk of cerebral ischemia); severe hypertensionwith uremia; advanced renal damage; slow acetylators

CNS: Headache, peripheral neuritis, dizziness, tremors, psychotic reactions characterized by depression, disorientation, or anxiety

CV: Palpitation, tachycardia, angina pectoris, hypotension, paradoxical pressor response, orthostatic hypotension

GI: Anorexia, nausea, vomiting,diarrhea, constipation, paralytic ileus

GU: Difficult micturition, impotence

Hematologic: Blood dyscrasias

Hypersensitivity: Rash, urticaria, pruritis; fever, chills, arthralgia,

Increased pharmacologic effects of beta-adrenergic blockers and hydralazine when given concomitantly; dosage of beta blocker may need adjustment

Give oral drug with food to increase bioavailability (drug should be given in a consistent relationship to ingestion of food for consistent response to therapy).

Drug may cause a syndrome resembling SLE. Arrange for CBC, lupus erythematosus (LE) cell preparations, and ANA titers before and periodically during prolonged therapy, even in the asymptomatic patient. Discontinue if blood dyscrasias occur. Reevaluate therapy if ANA or LE tests are positive.

Arrange for pyridoxine therapy if patient develops symptoms of peripheral neuritis.

Monitor patient for orthostatic

aortic insufficiency, and after valve replacement (doses up to 800 mg tid)

(higher plasma levels may be achieved; lower dosage may be adequate); lactation, pregnancy,pulmonary hypertension.

eosinophilia; rarely, hepatitis, obstructive jaundice

Other: Nasal congestion, flushing, edema, muscle cramps, lymphadenopathy, splenomegaly, dyspnea, lupus-like syndrome, possible carcinogenesis, lacrimation, conjunctivitis

hypotension, which is most marked in the morning and in hot weather, and with alcohol or exercise

Name of Drug




Magnesium Sulfate

Antiepileptic

Electrolyte

Laxative

Cofactor of many enzyme systems involved in neurochemical transmission and muscular excitability; prevents or controls seizures by blocking neuromuscular transmission; attracts and retains water in the intestinal lumen and distends the bowel to promote mass movement and relieve constipation.

Acute nephritis (children), to control hypertension

IV: Hypomagnesemia, replacement therapy

IV or IM: Preeclampsia or eclampsia

PO: Short-term treatment of constipation

PO: Evacuation of the colon for rectal and bowel examinations

To correct or prevent hypomagnesemia in patients on parenteral nutrition

Contraindicated with allergy to magnesium products; heart block, myocardial damage; abdominal pain, nausea, vomiting, or other symptoms of appendicitis; acute surgical abdomen, fecal impaction, intestinal and biliary tract obstruction, hepatitis. Do not give during 2 hr preceding delivery because of risk of magnesium toxicity in the

CNS: Weakness, dizziness, fainting, sweating (PO)

CV: Palpitations

GI: Excessive bowel activity, perianal irritation (PO)

Metabolic: Magnesium intoxication(flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and CNS depression-parenteral); hypocalcemia

Potentiation of neuromuscular blockade produced by non-depolarizing neuromuscular relaxants

Reserve IV use in eclampsia for immediate life-threatening situations

Give IM route by deep IM injection of the undiluted (50%) solution for adults; dilute to a 20% solution for children.

Give oral magnesium sulfate as a laxative only as a temporary measure. Arrange for dietary measures (fiber, fluids), exercise, and environmental control to return to normal bowel activity.

Do not give oral magnesium sulfate with abdominal pain, nausea, or vomiting.

Monitor bowel function; if diarrhea and cramping occur, discontinue oral drug.

Maintain uterine

Unlabeled uses: Inhibition of premature labor (parenteral), adjust treatment of exacerbations of acute asthma; treatment torsades de pointes, atypical ventricular arrhythmias

neonate. Use

cautiously with renal insufficiency.

with tetany (secondary to treatment of eclampsia-parenteral)

output at a level of 100 ml every 4 hr during parenteral administration.

Name of Drug




Methyldopa Antihypertensive

Sympatholytic

Mechanism of action not conclusively demonstrated; probably due to drugs metabolism, which lower arterial BP by stimulating CNS alpha2-adrenergic receptors, which in turn decreases sympathetic outflow from the CNS,

Hypertension IV

methyldopate: Acute hypertensive crisis; not drug of choice because of slow onset of action

Unlabeled uses: Hypertension of pregnancy

Contraindicated with hypersensitivity to methyldopa, active hepatic disease, previous methyldopa therapy associated with liver disorders.

Use cautiously with previous liver disease, renal failure, dialysis, bilateral cerebrovascular disease, pregnancy, RR lactation.

CNS: Sedation, headache ,asthenia, weakness (usually early and transient), dizziness, light-headed symptoms of cerebrovascular insufficiency, paresthesias, parkinsonism, Bells palsy,decreased mental acuity, involuntary choreoathetotic movements, psychic disturbances

CV: Bradycardia, prlonged carotid anus hypersensitivity, aggravation of angina pectoris,paradoxical pressor response, pericarditis, myocarditis, orthostatic hypotension, edema

Dermatologic: Rash seen as eczema or lichenoid eruption, toxic epidermal necrolysis fever, lupus like syndrome

Endocrine: Breast enlargement, gynecomastia, lactation, hyperprolactinemia, amenorrhea, galactorrhea,

Potentiation of the pressor effect of sympathomimetic amines

Increased hypotension with levodopa

Risk of hypotension during surgery with central anesthetic; monitor patient carefully

Administer IV slowly over 30-60 min; monitor injection site

Add athiazide to drug regimen or increase dosage if methyldopa tolerance occurs

impotence, failure to ejaculate, decreased libido

GI: Nausea, vomiting, distention, constipation, flatus, diarrhea, colitis, dry mouth, sore or black tongue, pancreatitis, sialadenitis, abnormal liver function tests, jaundice, hepatitis, hepatic necrosis.

Hematologic: Positive Coombs test, hemolytic anemia, bone marrow depression leucopenia, granulocytopenia, thrombocytopenia, positive tests for antinuclear antibody, lupus like syndrome, and rheumatoid factor

XIII. Discharge Planning

MEDICATION Advise patient not to skip the medication that the doctor ordered

EXERCISE/ENVIRONMENT Enough rest Elevate feet several times a day during the day

TREATMENT Use of drugs Catheterization Obtaining labs(CBC,PLATELETS COUNT,LIVER

FUNCTION)

HEALTH TEACHING

Encourage patient for sodium restriction Encourage to avoid foods rich in oils and fats Encourage patient to limit her daily activities and

exercise Encourage to avoid Salty, high fat diet, instead eat

healthy foods. Advise to continue medicine as prescribed Separate utensils for the mother and other things that

will be used for the whole family Encourage eat high protein foods, calcium,

magnesium, zinc, vitamin c and e Health teachings for symptoms mild and severe pre-

eclampsia

OPD FOLLOW UP Observe carefully for symptoms Give instruction about what symptoms to watch for so

she can alert clinician if additional symptoms occur between visits

Provide information about how to control the disease

DIET

Low fats and sodium diet, restriction if possible High in protein, calcium and iron Adequate fluid intake Eat fresh green healthy leafy vegetables and fresh

fruits

SPIRITUAL/SEX Limit sexual activity Provide spiritual and emotional support

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