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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 preeclampsia. 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.



Inform the patients that he need not restrict foods and fluids

During


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.


Explain to the patient that he may experience slight discomfort from the needle

puncture and the tourniquet.

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During


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



Inform the patients that he need not restrict foods and fluids

During


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.

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