Case Presentation

Post Partum Preeclampsia
Presented to the Clinical Instructors of Notre Dame of Tacurong College Nursing Department Mrs. Xenia A. Diaz, RN In Partial Fulfilment of the Course Requirement in Nursing Care Management 101 Presented by: Arriola, Carlo L. Bonilla, Princess C. Cabarlo, Roelyn A. Demitillo, Daylene B. Mangelen, Muamar Samad D. Pabilona, Sheena Mae S. Perocho, Ivory Joy N. Tueres, Margaret G. Vallesfino, Joreyfee C. August 4,2009

Introduction 

This is a case of Mrs. I.R, a 21 years old, female a Mrs. primi gravida, who lives in Polomolok, South Cotabato and was admitted last July 6, 2009 in South Cotabato Provincial Hospital w/ the diagnosis of PU, 39 1/7 weeks AOG, CIL, G1P1 and after 1 day of delivery she was diagnosed w/ post partum preeclampsia w/ a BP of 150/100 mmHg under 150/ the service of Dr. Vencer. Medical Management given. Dr. Vencer. given. Preeclampsia is a disorder of widespread vascular endothelial malfunction that occurs beyond the 20th week 20th of gestation. It is characterized by increased blood pressure gestation. (BP) in an individual who was normotensive prior to the pregnancy, and proteinuria or excessive edema. Although edema. women with preexisting hypertension may also develop preeclampsia, hypertension in preeclampsia in the usually normotensive patient is defined by a systolic BP greater than 140 mm Hg and diastolic BP greater than 90 mm Hg on two successive measurements 4-6 hours apart. apart. 



Diagnostic criteria for severe preeclampsia include at least one of the following: systolic BP greater than 160 mm Hg or diastolic BP following: greater than 110 mm Hg on two occasions 6 hours apart with the patient at bed rest; proteinuria, oliguria; cerebral or visual rest; oliguria; disturbance; disturbance; pulmonary edema or cyanosis; abdominal pain; cyanosis; pain; impaired liver function; thrombocytopenia; or decreased fetal growth. function; thrombocytopenia; growth. In general population, data are difficult to estimate however Preeclampsia occurs in approximately 5% of all pregnancies internationally. internationally. It is the third leading pregnancy-related cause of pregnancydeath, after hemorrhage and embolism. Statistically, it is the cause embolism. in an estimated 790 maternal deaths per 100,000 live births. 100, births. This condition is commonly occurs (more frequently) in women at the extremes of reproductive age. Younger women (<20 y) have age. (<20 a slightly increased risk. Primigravid patients in particular seem to be risk. predisposed. predisposed. Older women (>35 y) have a markedly increased risk. (>35 risk. Asking the question of how this condition occurs, this case study will provide information that may help the attendees understand the cause of the condition. This case study will enhance condition. the knowledge and skills in dealing with patient who suffer from this preeclampsia. preeclampsia.   

proper action is provided and intervention is rendered. important the health care provider developed a skills and proper management of the client having the condition. We choose this case study because we wanted to have a thorough understanding about preeclampsia.  . Further complications will be prevented if immediate. condition. Therefore it is rendered. mother. why does it occurs to the pregnant women and what are the other complications that could possibly lead to death of the mother.

3. Present the Anatomy and Physiology of organ involve in the condition of patient correctly. . condition. Present the Developmental Data of patient thoroughly 4. Present the vital information of the patient clearly 2.. develop skills in discussing it among the group and a positive attitude in recognizing ways to treat the said condition. the presenter & listener will be able to identify the underlying cause of mild preeclampsia.Objectives General Objectives: After 8 hours of discussion. Enumerate and discuss the signs and symptoms of Post partum Preeclampsia briefly 5. accurately. correctly. Specific Objectives: Objectives: This case presentation aims to achieve the following: following: 1. Identify the present and past history of illness of the patient accurately.

7. State the importance of Physical Assessment of Patient Correctly. Discuss the Pathophysiology of the said condition of patient accurately. 9. Present prognosis of patient accurately. Discuss the Nursing Care Plan of the patient thoroughly. 8.6. 10. . Present the list of problems of patient correctly.

E Educational Attainment: High School Graduate Occupation: Construction Worker Name of parents: Age Educational Attainment Mr. Old Sex: Female Address: Polomolok.R Age: 21 yrs. Post partum Preeclampsia Reason for Admission: For Delivery Physician: Dr. Vencer Name of the Institution: South Cotabato Provincial Hospital Name of Spouse: Mr.m Admitting Diagnosis: PU 39 1/7 weeks AOG CIL G1P1. South Cotabato Citizenship: Filipino Tribe: Cebuano Religion: Roman Catholic Educational Attainment: High School Graduate Occupation: Housewife Date admitted: July 6. 2009 Time admitted: 10:30 p.Patients Vital Information Patients Name: Mrs. A 44 High School Graduate . S 42 High School Graduate Mrs. I.

R. . delivery she was diagnosed of post partum preeclampsia w/ the BP of 150/100 150/ mmHg. MgSO4 was ordered and given by the NOD and strictly monitored her v/s especially the BP for every 15 mins.History of Present illness According Mrs. one day after Mrs. preeclampsia. She mins. MgSO4 mmHg. was not expecting that she had a hypertension and result to preeclampsia. I.

works. Her menarche was when she was 12 years of age with irregular succeeding menstrual cycle. drugs. . 02. According to her she was able to receive complete immunizations. She immunizations. baby was undergone normal delivery. she fails meds. was fully immunized when she was a child. alaxan. As Mrs.R stated her childhood years. Her first precheckpregnancy. During her adulthood she said that her menstrual flow sometimes normal and she experienced also progressive dysmenorrhoea. She also experienced common childhood illnesses cycle. 2008. mefenafic. checksources. but also fan of using herbal meds. to admit herself for medical check-up in relation to inadequate financial sources. cough and fever and was treated only with over the counter drugs depending on the illness experienced. 2008. It was her first pregnancy and her Last menstrual period was October 02. such as biogesic. did not undergone blood transfusion and surgery nor experienced any accidents and denies of having allergies on foods and any of the drugs.History of Past illness The patient experienced nausea and vomiting in the past few months especially during her first trimester. child. And a day after the delivery her BP raised delivery. child. up to 150/100 mmHg which is high blood and find out that she is a hypertensive 150/ and was diagnosed of preeclampsia. neosep and other more. She also stated that she experienced trimester. she had encountered diseases Mrs. such as mumps and chicken pox and other common illness experienced by a normal child. preeclampsia. such as colds. but usually occur during and after doing household works. She had undergone pre-natal check-up during her pregnancy. I. headache occasionally. According to her she dysmenorrhoea.

They have their meals three times a day with dried fish and eggs most of the time. The family source of income is from her husbands work only. Mr. She used to belong in a nuclear type of family . after she got married she moved with his husbands family and they were blessed with one child as in the present. She is the eldest among 3 siblings. As of now.E engage in gambling and does it together with his friends on leisure time usually after a long day work in the construction site accompanied with drinking and smoking. Hypertension is both present to his mother and father¶s side as hereditary condition. her father is hypertensive but her mother having no known disease. Mrs. IR is a 21 y. but get well in next succeeding months. they are still residing at the same place.Family Background Mrs.o. but they also serving meat some of the time. o construction worker. . E considered those habits as a means of relaxation. Mr. plain housewife and married to a 22 y. Both her parents are still alive. IR diet before was poor due to nausea sensation before and after eating.

According to her when any of the family members get sick they usually use over the counter drugs as management depending on the kind of illness present such as paracetamol for fever.In some other unexpected situation such as money matters they depend on the contributions of their parents. .R is a practice catholic. The family believes in quack doctors but they seldom use of herbal medicines. I. They have a good and harmonious relationship with their neighbours and family feuds or conflicts are not present as verbalized by his wife. But her husband tends not to go the same because he is too busy working in the farm. Mrs.

love. baby. But when she was diagnosed of having preeclampsia she does not expect it but it is in their blood line that they are high blood. it is her responsible to take care of her baby. I.R has mixed emotions when she knew that she was pregnant for the first time. When Mr. prepares all the necessary things that would be use for their first baby he was so exited and gives all support. Mrs.Effects of illness to Self and Family Mrs. . and care for his wife up to the day of the delivery of their child and specially when she knew that his wife is having preeclampsia. preeclampsia. E knew that her wife is pregnant he Mr. blood. But she knew that time.

child.Expectation to Self and Family Mrs. Mrs. . she would have a fast recovery and also have a good health to the child. fast as it can be so that she can take care of baby.R Mrs. especially her husband expected that after she delivers the baby and having a preeclampsia. baby.R did not expect that after she delivered a normal baby she was diagnosed of having preeclampsia. I. I. She wants to be cured as preeclampsia. The family of Mrs.

Genogram .

hooked at left cephalic vein. hair is not fixed and she wear clean and comfortable clothes. 2009 Time: 5:00 pm General appearance: The patient is female adult. The patient is sitting in bed with IVF of D5LR 1L with 10u of Oxytocin at 200cc regulated at 20cc/min.PHYSICAL ASSESSMENT: Date: July 7. . not well groomed. She does have any body odor. place and people around her. She speaks well with clear and audible voice and was able to understand instructions and health teachings. she is conscious and well oriented by the time.

82bpm RRRR.22rpm .Vital signs: BPBP.36ºC PRPR.100/80 mmHg temptemp.

Also chloasma noted. No lesions noted.  Nose: Inspection: External nose are symmetrical. Palpation: no tenderness and lesions noted upon palpation of maxillary and frontal sinuses.  Ears: Inspection: Ears are symmetrical to the head. eyebrows and eyelashes are equally distributed. curly and not properly fixed. Palpation: no tearing of lacrimal sac during palpation. uniform in color and no discharges noted.  Face: Inspection: normal muscle movement are performing like smiling and yawning. No lesions noted. pimples noted with flaccid grimace noted. hair is black in color. Head/Hair/Scalp: Inspection: head is proportional to the body and skull is rounded with symmetrical flaccid movement. smooth. No dandruff noted. no deformities noted as well as discharges. . uniform.

The gums is pink in color. Complete set of adult teeth. Auscultation: no abnormal sound was heard. . Yellow in color with two dental carries noted.  Respiratory: Inspection: normal chest wall able to breath when lying in bed. tongue is pink and has white pigment and moves freely. Lips/mouth/ teeth/throat: Inspection: dry lips noted. no retraction noted and no gums bleeding noted. neck muscles are equal in size with head centered. No respiratory distress noted.  Neck: Inspection: jugular veins are not inflamed and no stiffness noted.

 Cardiovascular: Inspection: no irregularities noted. Auscultation: normal heart beat was heard. The areolas on both breast are black in color and discharges noted. Palpation: no tenderness noted. Neither one . Extremities: Inspection: both feet are symmetrical and no varicose veins noted muscles have moderate strength and. poor in perineal care. black in color and increase in size.  Breast: Inspection: nipples are symmetrical to each other.   Genitalia: Inspection: female genitalia is bleeding.

 Hair: patient claims that she have a dandruff and denies of having head lice. sores and itching of the skin. lumps. . 2009 Time: 5:00 pm General: the patient denies that she does not experienced fever or any common illnesses before the admission but she claimed that she experienced weight changes. bleeding and radiation. Integumentary:  Skin: patient denies of having rashes.REVIEW OF SYSTEM Date: July 7. body weakness and fatigue but she denies heat or cold intolerance.

epistaxis and discharges but claimed that she experienced colds. eyes. But the patient claimed of having headache.  Nose: patient denies loss of smell. pain. glaucoma and cataracts. Eyes: patient denies of having blurry vision. She also denies of having impact cerumen and any ear injury before the admission. obstruction. discharges and used of hearing aid. nor abnormal growth. injury. redness. sore. She also denies of using eyeglasses. Head: patient denies of having any head injury and syncope prior to the admission. . pain.  Ears: patient denies of hearing loss. trauma.   Nails: patient denies of having dirty and long nails. infection.

    Neck: patient denies goiter and stiffness of neck.  Gastrointestinal: patient denies of having constipation and bowel irregularity. Denies also of having hoarseness of voice and gum problems. . Respiratory: patient denies cyanosis. back pain. having cough and dyspnea. Muscoskeletal: patient denies joint stiffness but claims weakness. fatigue and leg cramps. sore tongue but claimed of having dental carries. Cardiovascular: patient denies of having chest pain and palpitations. And denies smoking. Mouth and throat: patient denies of having sore throat.

 

Endocrine: patient denies of having enlargement of thyroid
glands and denies that she has diabetes.

Female Reproductive: patient reported that no
deformities about to her vagina, and the patient also reported that there was an episiotomy done. 



Breast: patient denies of having breast sore and lumps. Genitourinary: patient denies of having dysuria, urgency and
hematuria. 



Hematology: patient denies of having any bruises in both
extremities and,

Psychiatric: patient denies mood changes, difficulty
concentrating and suicidal thought.

DEVELOPMENTAL DATA Name of patient: Mrs. I.R. Age: 21y.o According to Havighurst·s Developmental data Task Theory Stage of the patient: Early Adulthood Theory: Development task Theory

Description of the theory:  

Robert Havighurst believed that learning is basic to life that people continue to learn throughout life. He described growth and developmental as accruing during six ages, each associated with 6-10 tasks to be learned. Havighurst 6promoted the concept of developmental tasks in the 1950·s. he studied human behavior in terms of developmental tasks like; skills or approved behavior pattern, which arise at or about a certain period of life. In addition, he noted that the successful achievement will lead to happiness while failure leads to unhappiness and difficulty with later tasks. Havighurst·s developmental tasks, provides a framework that the nurse to evaluate a person·s general accomplishments. However, some nurses find that the broad categories limit its usefulness as a tool in assessing specific accomplishments, particularly those infant and childhood.

states that even though they have an early marriage of her chosen husband.R.Age periods and development al task Selecting a mate Remarks Justification MRS. I. she does not regret that she ACHIEVED .

Achieved According to Mrs.R. even though they married early at their age they will live happy with their family through sickness and in health and at times of crisis. I. .Learning to live with partner.

R has a baby. . They said that they will take care of their baby as it grows and start a happy family.Starting a family Achieved Now that Mr. E and Mrs. I.

I. E is at work and she is also performs all the household chores but sometimes Mr.Managing Home Achieved Mrs. .R is the one who manages their home if Mr. E is also helping.

she only depends on her husband.Getting started in an occupation. . I.R don¶t have any occupation attended. Not achieved Mrs.

Taking on Civic Responsibility Achieved Mrs. I. .R is aware of her responsibility as an adult and as a parent to their community in terms of participation.

I. .Finding a congenial social group Achieved According to Mrs.R they interact and have bonding with their neighbors and helps each other in times of needs.

phallic) are called pregenital stages. Therefore.  . The libido changes. Conflict or stress. it¶s location of emphasis within the body from one stage to another. anal.Sigmund Freud Psychosexual Theory Description of theory: According to Freud¶s theory of psychosexual development. ego and sub ego. The 1st three stages ( oral. a particular stage. The culminating stage is the genital stage. Ideally an individual progress through the task of each stage and balance is achieved between the id. however can delay or prolong progression through a stage or cause a person to regress to a previous stage. the personality develops in five overlapping stages of birth to adulthood.

It is a progressive of mental ability from illogical to logical thinking from simple to complex problem solving and from understanding ideas to understanding concepts.Task Genital (Puberty and After) Remarks Achieved Justification Mrs. I. Theory: COGNITIVE THEORY Theorist: JEAN PIAGET (1896-1980) Definition of Theory: Refers to the manner in which people learned to and refuse of language it involves a person·s intelligence.R now is having a family. perceptual ability and the ability to process information. achieve in dependency and maturity. .

.TASK Uses Rational Thinking REMARKS Achieved JUSTIFICATIONS Pt is able to rationalize her own beliefs such as her superstitious beliefs.

Viewing the future of her family to be stable someday as stated by the pt.Reasoning is deductive and futuristic Achieved The pt view life as a changing process. . addresses the mistakes done and change it for good.

high blood pressure and the presence of protein in the urine. Occasionally.Textbook Discussion A. There are medications and treatments to keep from becoming more ill with the disease. This disease can also be chronic. This may include taking blood pressure medication and frequent follow-up visits followwith tour care provider. whether it¶s sudden or gradual. but no medications will make the disease go away entirely. Complete Diagnosis Preeclampsia A disease that only occurs during pregnancy. It may be mild or severe. This disease is characterized by swelling. and it is unlikely that it will be suffer any long terms effects of the disease. anytime throughout pregnancy. the disease eventually goes away. It can appear suddenly. the only cure is delivery of the baby.com/hypertensionhttp://www. without warning. But no matter how ill it become with this disease.com/hypertension-highblood . http://www. gradually becoming worse over a period of time.webmd. labor or in the early postpartum period. After delivery. It occurs in 5 to 10 percent of all pregnancies.webmd. there are complications that will require medical attention for a time after the delivery.

It is characterized by increased blood pressure (BP) in an individual who was normotensive prior to the pregnancy. MD. Staff Physician.A disorder of widespread vascular endothelial malfunction that occurs beyond the 20th week of gestation. and proteinuria or excessive edema. Patlon 2nd Edition page 834) . Department of Emergency Medicine. Suny Downstate Medical Center. Anatomy and Physiology (G Tribodeau and R. MD. Mosby¶s Pocket Dictionary of Medicine. and Allied Health (4th Edition) This is characterized by the onset of acute hypertension after the 24th week accompanied by proteinuria and edema. Nursing. proteinuria. and edema. Kings County Hospital Center An abnormal condition of pregnancy characterized by the onset of acute hypertension after the twenty-fourth twentyweek of gestation. Dawn C Jung. The classic triad of this complication is hypertension.

without regard to pregnancy outcome.reduction in the no. .after birth. ThrombocytopeniaThrombocytopenia.Definition of Terms         GravidaGravida.a woman who been pregnant.weeks that the fetus stayed inside of Gestationthe mothers womb.a gestational process. OliguriaOliguria.buildEdema. Edema. PostpartumPostpartum. of platelets in the bld.small frequent urination.a presence of protein in the urine. ProteinuriaProteinuria.a build-up of excess serous fluid between tissue cells. PregnancyPregnancy. Age of Gestation. comprising the growth and development with a woman of a new individual from conception the embryonic and fetal periods of birth. which is usually an indication of disease.

.EstrogenEstrogen.a hormone that controls females secondary sex characteristics.

B. Anatomy and physiology .

if a fertilized egg is present it becomes embedded in the occurs. receives the penis and the sperm ejaculated from it during sexual intercourse. and into the womb. The embryo also forms the amniotic sac within which it develops. In the human female reproductive system. secrete. then passes down the fallopian tube. include the clitoris. form the placenta. or fallopian tube. or uterus. which are composed of elongated folds glands. offspring. or mammary glands. uterus. uterus. a pear-shaped organ specialized for development of a fertilized egg. ova are produced in the ovaries. The vagina. egg. within the tube. The endometrium is ovaries. peartube. it passes into the uterine tube. develops. aided by cilia in the tube. two small organs set in the pelvic cavity below and to either side of the navel. the organ in which gas. clitoris. food. and external genitalia that function in the procreation of offspring. and waste exchange between mother and embryo takes place. trophoblastic cells and these. that responds to sexual stimulation. If no fertilized egg is present menstruation. endometrium about a week after fertilization. These include (internal) the ovaries. along with cells from the endometrium. erectile tissue birth. the hormones estrogen and progesterone (see menstruation). which skin. After birth the infant is fed with milk from the breasts. of skin. The external genitals. the endometrium. the thickened endometrium degenerates and sloughs off and menstruation occurs. fertilization occurs insemination. in cyclic fashion. Function: Function: ovaries. (external) vagina. It also serves as an exit passageway for menstrual blood and for intercourse. either fertilized or unfertilized. undergoes cyclic changes as a result of the changing levels of the hormones secreted by the ovaries. are also sometimes considered part of the reproductive system. fallopian tubes. The ovaries also navel. the uterus with the external genitals. or vulva. system. The lower end of the uterus is called the cervix. the baby during birth. thickest during the part of the menstrual cycle in which a fertilized ovum would be expected to enter the uterus and is thinnest just after menstruation. An inner uterine layer of tissue. The developing embryo produces fertilization. toward the end of the cycle. . place. vulva. If sperm are tube. present as a result of sexual intercourse or artificial insemination. and vulva. The ovum.Internal Reproductive System The female gonad associated ducts and glands. menstruation) After an ovum matures. and the labia. a passage connecting cervix.

.

ANATOMY AND PHYSIOLOGY OF THE HEART .

and blood passes through the tricuspid valve into the right ventricle. ventricle. When this chamber contracts. pear-shaped organ about the size pearof a fist. atrium. it atrium. Blood returning from the lungs to the heart collects in ventricle. it starts to contract. closes. After the blood in the left ventricle has been forced out. the left ventricle contracts and forces blood into the aorta. aorta. the ventricle begins to relax.The human heart is a hollow. and the mitral valve between the two chambers closes. contracts. In the final phase of blood closes. blood flows through atrium. flow through the heart. the mitral valve into the left ventricle. When the atrium fills. The left ventricle fills and begins to contract. the left atrium. it forces blood into the pulmonary artery. which carries blood to the lungs to pick up fresh oxygen. As the right ventricle contracts. the ventricle relaxes and the pulmonary valve shuts. When the ventricle becomes full. beats. and the tricuspid valve closes to prevent blood from moving back into the atrium. When blood exits the right ventricle. the inferior vena cava and the superior vena cava. pumping blood throughout the body. oxygen. . OxygenOxygen-poor blood from the body enters the heart from two large blood vessels. body. preventing blood from passing back into the ventricle. and collects in the right atrium. or fist. and the aortic valve at the opening of the aorta closes. The heart is made of muscle that rhythmically contracts. ventricle.

Renal papilla 17. Efferent vessel 3. Renal vein 5. Renal pyramid 2. Major calyx 16. Renal column . Superior renal capsule 12. Renal pelvis 7. Nephron 14.Anatomy and Physiology of the Kidney Parts of the kidney: 1. Renal capsule 10. Renal artery 4. Renal hilum 6. Inferior renal capsule 11. Afferent vessel 13. Minor calyx 9. Minor calyx 15. Ureter 8.

. blood. body. salts.Functions The kidneys filter the blood and eliminate wastes in the urine through a complex filtration network and resorption system comprising more than 2 million nephrons. removing urea. composed of glomeruli and ranal tubules that filter blood under high pressure. More than 1183 L of blood pass through the kidneys everyday. water as urine and return water that has been filtered to the blood plasma. The kidneys remove everyday. The nephrons are nephrons. thus helping to maintain the water balance of the body. and other soluble wastes from blood plasma and returning the purified filtrate to the blood.

(2) left lobe. (3) caudate lobe.Anatomy and Physiology of the Liver (1) right lobe. 5) hepatic artery and portal vein. (6) hepatic lymph nodes. (7) gall bladder . (4) quadrate lobe.

urea. toxication. .Functions The liver produces and excretes bile (a greenish liquid) required for emulsifying fats. V. X and XI. vitamin B12. some is stored in the gallbladder. glycogen. precursor. Some of the bile drains directly into the duodenum. task. II (prothrombin). and copper. VII. IX. protein S and antithrombin. bile as pigment (bilirubin and biliverdin). as well as protein C. XI. By the 32nd week of gestation. including glucose in the form of glycogen. the liver is the main site of red blood cell production. system. when the metabolite is more toxic than its precursor. antithrombin. 12. biliverdin) The liver breaks down toxic substances and most medicinal products in a process called drug metabolism. acting as a 'sieve' for antigens carried to it via the portal system. The liver performs several roles in carbohydrate and lipid metabolism The liver produces coagulation factors I (fibrinogen). and fats. fetus. IX. VII. iron. metabolism. creating metabolites that are added to hemoglobin. This sometimes results in toxication. production. The liver is responsible for immunological effects. gallbladder. iron. The liver breaks down hemoglobin. In the first trimester fetus.the effectsreticuloendothelial system of the liver contains many immunologically active cells. copper. duodenum. The liver converts ammonia to urea. the bone marrow has almost 32nd completely taken over that task. The liver stores a multitude of substances.

Anatomy and Physiology of the Placenta .

pregnancy. relaxin. fetus. estrogen. This results in increased HCG. blood. estrogen. Many substances are not filtered out. this barrier. somatomammotropin (also known as placental lactogen). The placental barrier does NOT allow the two bloods from the mother and embryo to mix because if the blood types don't match then the baby will be destroyed. transfer of these nutrients to the fetus and is also the main cause of the increased blood sugar levels seen in pregnancy. which is important in maintaining the pregnancy. cigarettes. which acts to increase the amount of glucose and lipids in the maternal blood. may also cross virus. the waste. relaxin. oxygen. this often leads to various degrees of birth defects in the infant. such as Human Cytomegalovirus. antibodies and hormones from the mother's blood and passes out waste. Metabolic and endocrine activity In addition to the transfer of gases and nutrients. placental barrier. barrier. Several types of virus. It produces. or belly-button. The site of the former pregnancy. It forms a barrier. and human chorionic gonadotrophin HCG. . destroyed. however. umbilicus. the placenta also has activity. navel. including alcohol and some chemicals associated with smoking cigarettes. progesterone. which filters out some substances which could harm the fetus.Functions Filtration and transfer The placenta receives nutrients. amongst other hormones progesterone. metabolic and endocrine activity. infant. belly-button. Cytomegalovirus. umbilical cord attachment in the center of the front of the abdomen is known as the umbilicus.

Anatomy and Physiology of the Nervous system .

which carry impulses to and from the brain and spinal cord. and the peripheral nervous system. which includes all nerves. pain. intricate network of structures that activates. coordinates. and controls all the functions of the body. our sense of taste.Functions The nervous system is the extensive. These include our sense cord. . as well as our ability to feel pain. The nervous system is broken down into two major parts: the central nervous system. the ears. organs. which parts: includes the brain and spinal cord. body. smell and touch. the eyes.

Nursing Management 1. 2. Promote bed rest Promote good Nutrition Monitor the blood pressure If not treated: > seizures > coma > death Treatment:  Magnesium  MgSO4 as ordered by the physician  wellness . 3.

-During transfusion the blood is allowed to drip. filtered to removed bubbles and small blood clots and to return into one of the pt¶s veins through a drip. veins.the injection if a volume of blood obtained from a Transfusionhealthy person (donor) into the circulation if a patient which is the patient recipient whose blood is deficient in quantity. .Medical Management Blood Transfusion. collected blood by suction during the operation . -through a needle inserted into one of the recipient¶s veins. necessary. performed. drip. through accident. In addition. diseases or other instances that may cause a person to be blood transfuse. operation. -BT is routine during major surgical operation in which blood is likely to be lost during operation. or reintroduction. under gravity. They operation. gravity. reintroductionthis may be blood previously drawn and stored in the blood bank or blood that has been lost from the pt¶s circulation during surgical operation. there is another way in blood transfusion so called autotransfusion addition.it is the reintroduction into a patient of her own blood. usually packs of carefully stored blood of different groups are kept in blood banks for use as necessary. -Direct transfusion from one person to the another is rarely performed. transfuse.

College of Obstetricians and Gynecologists as well as a host of other experts now agree that the procedure shouldn't be done routinely. as the largest part of the baby's labor. canal.OB Procedure Episiotomy. to widen the birth outlet and prevent perineal tearing. there is no good evidence showing that episiotomy offers case. . Many experts also believed that tear. and the procedure may actually cause problems. mainly for women giving birth for the first time. particularly during a first vaginal delivery. For this reason. made during the second stage of labor. your vaginal tissue and pelvic floor muscles any real protection. incision made in the perineum (the tissue bridging the vagina and rectum) to facilitate childbirth and prevent tearing of the vagina. head begins to emerge from the birth canal. But many studies over the last 20 years have shown that this is not the case. routinely.An episiotomy is a surgical cut in the muscular area anesthetic. The incision is tearing. RATIONALE: RATIONALE: Obstetricians used to do episiotomies routinely to speed delivery and to prevent the vagina from tearing. in the belief that the "clean" incision of an episiotomy would heal more easily than a spontaneous tear. the American problems. opening. between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening. An episiotomy may be necessary. An episiotomy is quickly repaired using absorbable stitches under local anesthetic. vagina. such as incontinence. incontinence. an episiotomy might help prevent later complications. In fact.

R delivers a single baby girl The patient did not experience any history of high blood pressure and other possible disease before that may cause as a factor for Preeclampsia. most Africans acquire the disease. kidney disease or diabetes/heart disease Age Sex Heredity Not present Not present Not present Present Present Race Not present . REMARKS Present Multiple Pregnancy Previous history of high blood pressure. The patient is 21 years old. Only female bore child in womb. I.Etiology PREDISPOSING FACTOR First Pregnancy RATIONALE The disease most occurs in Primi mothers Mrs. There is a member in the patient¶s family who has hypertension. According to studies.

Reference: present Not present Diet present Malnutrition Not present Poverty Present . not enough to accommodate all their needs.PRECIPITATING FACTORS Smoking RATIONALE REMARKS Obesity Mrs.but her husband is a chain smoker. I. Mrs. The patient eats vegetables and other foods that is rich in nutrients. having a good appetite. I.R is a mesomorphic type of body The patient loves to eat vegetables and but also fan eating salty foods. The patient belongs to a family with low income.R did not have any vices such as smoking and drinking liquors.

hands and feet The patient experiences headache Patient experiences blurred vision or seeing spots. Not present The patient didn¶t experience blurred vision at all . Not present The patient does not experienced headache. and feet. Remarks present Justification There is swelling of face.Symptomatology Symptoms The patient experience swelling of face. hands.

heartburn. Remarks Not present Justification The patient didn¶t experience heartburn.Symptoms The patient experiences painful heartburn. Not present Reference: The patient didn¶t experience nausea and vomiting. . Present The patient blood pressure is 150/100. The patient experiences elevation of blood pressure The patient experiences nausea and vomiting.

Pathophysiology Predisposing factor : 1. Sex 3. Obesity 3. Age 2. Malnutrition 5. Smoking 2. increased glomerular membrane permeability Increased serum blood Effects on Interstitial Diffusion from filtration filtration vascular space into interstitial space Edema Preeclampsia . Race Precipitating factor: 1. Poverty Vasospasm Effects on vascular Vasoconstriction Impaired organ perfusion Increased BP Effect on renal decreased glomerular filtration rate. Heredity 4. Diet 4.

symptoms. and chronic urinary tract infections. This microchemistry dipstick. system has been available for many years and allows qualitative and semi-quantitative analysis within one semiminute by simple but careful observation. nurse. change occurring on each segment of the strip is compared to a color chart to obtain results. results. The most cost-effective device used to screen costurine is a paper or plastic dipstick. or assistant is entirely capable of misreading or misinterpreting the results. a careless doctor. infections.Laboratory and Diagnostic Examination Urinalysis   Urinalysis can reveal diseases that have gone unnoticed because they do not produce striking signs or symptoms. results. various forms of glomerulonephritis. . Microscopic urinalysis requires only a relatively inexpensive light microscope. Examples include diabetes mellitus. However. microscope. The color observation.

0-7. Maintain proper nutrition Maintain proper nutrition Maintain/ Promote good nutrition 8-10 .010-1. A large number of pus cells indicated infection in the large genitourinary tract.06.005 Normal A low specific gravity is a result of low fluid intake or the disease affecting the kidney. Yellow 1. 2009 Component Results Color Appearance Specific gravity Normal Value Pale yellow 1.025 Interpretation Nursing Consideration Encourage the patient to increase fluid intake Encourage patient to drink fluid in a normal amount. Normal Sugar Albumin Reaction PUS cells Negative Negative 6.0101.Date: July 6.0 none Normal Normal The patient has an infection as indicated.0 Negative Negative 6.

Component Result Normal Value Interpretation Nursing Consideration Encourage patient to eat vegetables such as rich in iron like ampalaya. RBC 2-3 None This maybe associated to infection. A large number of RBC indicates bleeding from some point the genitourinary tract. Epithelial Cells none none Normal Maintain good nutrition and good healthy habits . The patient has an infection.

Complete Doctors Order Date/Time 07-0607-06-09 10:30 PM Orders of Physician Please admit to ward TPR every 4 hours Rationale for the Doctor For management To have baseline data and to monitor Progress and to prevent further complication like edema Remarks Done Done Low fat. low Salt Diet To determine patients condition and disease process To determine patients condition and disease progress. Done Lab: UA Done .

gtts/min. gtts/min. Done M.M q 4 hrs. To prevent and treat postpartum hemorrhage caused by uterine atony or subinvolution. To provide a medication that helps lower patients blood pressure. subinvolution. Done Mefenamic Acid 500mg/1 cap q 6 hrs. To relieve pain To prevent/control seixures in preeclampsia Done IVF with D5LR @ 30 gtts/min. PRN Done .Date/Time 07-0707-07-09 BP:150/100 Order of the Physician Lab: Hematology Rationale for the Order To determine pt¶s condition and disease progress Remarks Not Done Start venoclysis with D5LR 1L @ 30 gtts/min. To provide route for IVTT medication and to promote additional nutrient through dextrose. MgSO4 4-6 g. Maleate 5mg/ 1 tab TID q 5 hrs. deep 4I.

To provide baseline data of patients condition. Secure 2 units of blood to obtain enough blood quantity and quality that have been in deficiency after the delivery. Done . To continue The treatment Done Continue medication Done Vital signs every 15 mins.Start BT.

O P.List of Drugs Drug M.O Frequency 110 q 5 hrs. .prn. q 6 hrs. Maleate Mefenamic acid Magnesium sulfate Dosage 5mg/1 tab 500mg/1cap Route P. 4-6g Deep IM q40.

Drug Study .

Sleep disturbance r/t noise and changes in environment as manifested by the patients verbalization ³Hindi ako nakatulog. 4. Sedentary lifestyle r/t deficient knowledge of health benefits of physical exercise. Pain r/t traumatized tissue secondary to episioraphy as evidence by patients verbalization of ³medyo na lang man ang sakit sa akong tahi.´ SelfSelf-care deficit r/t inability to perceive body part/ spatial relationship [bathing/hygiene].Five Nursing Diagnosis 1. 5. 3. masyado kasi maingay. . 2. Knowledge deficit r/t unfamiliarity with information and resources about breastfeeding as manifested by the patients verbalization ³Ano ang makuha sa gatas ng nanay?´.

Nursing Care Plan .

When she was admitted to the ward.Prognosis Prognosis Onset of illness Duration of illness Hygiene Good = = Fair Bad Justification The illness was easily diagnosed right after the delivery. After 8 hours of rendering nursing intervention the patient was able to move properly and perform some simple task. In terms of ADL the patient experience weakness and she cannot perform it very well. she was experiencing body weakness. her physician advised her to have a low fat and low salt diet. Diet Age Performance level . Illness was diagnosed 4 hours after the delivery and appropriate nursing management immediately given When she was hospitalized. The age of the client is 21 yrs. On the day of handling the patient. And it was then manage by medications and some nursing intervention. Old the age of the client is capable of striving. she became dependent to her husband in performing some simple task.

although sometimes problems that arouses. But her father was not able to visit her because there is conflict between them. since the patient undergone the treatment process completely and religiously followed every treatment regimen.Willingness to undergo treatment The reason why she was brought to hospital is for proper management. Patient and the family are very much willing to let the patient undergo the treatment.5% Interpretation: Therefore the patient¶s prognosis is good. Although their financial status is not that stable they are supportive for the maintenance of the patient. and already managed her situation based on her current status. Family Support Good: 3/8 x 100= 37. . The husband of the patient is very much supportive to her hospitalization and therapies despite of the expenses. related to the said condition came.5% Fair: 4/8 x 100= 50% Poor: 1/8 x 100= 12.

Hypertension disorders of pregnancy. Emerg Med Clin North Am 1987 Aug.Dawn C. the tree encyclopedia .Mosby¶s Pocket Dictionary of Medicine.Lew M. Am Emerg Med 2003 May.Doan-Wiggins L.Anatomy and Physiology (G Tribodean and R. Moorhouse and Murr .htm . Nursing and Allied Health (4th edition) .webmd. Lee CC.Doan.5 :495-508 [Medline].Nurses Drug Handwork. References: http:// www.http:// www. Department of Emergency Medicine.Nurses Pocket Guide with diagnosis. staff physician.Pallon 2nd edition page 834 .wikipedia. Kings Country Hospital Center . Emerg Med (Fremantle) 2003 Aug.com / anatomy.From Wikipedia. Suny Downstate Medical Center. Interventions and Rationales 2007 edition by: Doenges. Maternal and Child Health Nursing (care of the childbearing and childbearing family) by: Adele Pilliten . 361.www. 15 : 361-8 [Medline]. Klonis E: Emergency management of eclampsia and severe pre eclampsia.soulhealer. MD.ner.. 223. Crupi RS: A current concept of eclampsia. 2007 edition . 21 : 223-6 [Medline].com .com/ hypertension-high blood hypertension- . Jung.Lipstein H. :495.