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Case Study

INTRODUCTION
Edema is the accumulation of fluid in the intestinal cell. A person
with edema manifested swelling in different parts of the body. In
pregnant woman, edema usually occurs between the second and third
trimester. Clinically, it is divided into three degrees namely:
a. Mild Case obvious edema appears on the legs and feet but
can disappear after rest.
b. Moderate Case edema extends to thighs and vulva or even
in the abdomen.
c. General Edema accumulation of fluids in the abdomen
Swelling or normal edema during pregnancy is not really
dangerous, however, if a pregnant woman suddenly swell in the hands
and face, there is a possibility that she might be developing pre
-eclampsia. This is a serious condition that can be life threatening for
the mother and baby. Pre-eclampsia typically results in high blood
pressure during pregnancy, putting the life of both the mother and the
baby at stake. This is the reason why even a simple normal edema
should still be monitored.

OBJECTIVES
General:
This study aims to deepen our knowledge and
understanding about edema.
Specific:
After this, we should be able to:
1. Define what edema is.
2. Identify its cause.
3. Discuss its effect in the mother and baby.
4. Determine the appropriate interventions to be done.
5. Know what is/are the possible complication.

THEORETICAL FRAMEWORK
Mommy X just like any mother- to be have experienced
pregnancy discomfort like morning sickness, dizziness and tiredness.
Among all those discomfort, edema in her lower extremities is what
Edema in Pregnancy

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bothers her the most. Even though people around her keep on telling
her that it is fine and need not to worry about she still cant help but
think if it was really alright. Edema on her first and her second
pregnancy disappeared on their own. What she was worried about was
if it can possibly have any effect on her babys health.

COMPONENT OF NURSING HEALTH


HISTORY
I.BIOGRAPHICAL DATA
Name: Mommy X
Address: 426 Barangka Ibaba, Mandaluyong City
Age: 33 years old
Gender: Female
Religious Affiliation: Roman Catholic
Marital Status: Married
Occupation: Plain Housewife
Place: Mauway, Lying-in
Chief Complaint: 37 weeks, AOG G2 p1 (T1P0A0L1)
Midwives: Marieta Reyes and Milagros Nave

II. NURSING HISTORY


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A. History of Present Illness
The baby was planned together with the place of delivery, the
Mauway-Lying-In Clinic. The baby according to the mother will be
breastfeed just like their first born baby.
B. Past Health History
Mommy X has also experienced edema during her first
pregnancy. Aside from it, she had no other complaint regarding her
pregnancy. She also hasnt experienced any serious illnesses like
hypertension, diabetes and the like.

C. Family History
There are no history of diabetes, allergies and mental
disorder in the family. The only one that they identify was hypertension
in her husbands family.
D. Maternal and Obstetrical History
Mommy X have 2 beautiful daughters including the
newborn, both were born normally. She has no multiple pregnancies
and no history of abortion.
August 19, 2008 / 11:04 am
Mommy X gives birth to a healthy baby girl with the following
measurements:
Weight: 2.4 kg
Height: 31 cm
Head Circumference: 33 cm
Chest Circumference: 32 cm

III. PATTERN OF FUNCTIONING


Psychological Health

1. Coping Patterns:
Whenever she has a problem she always pray to God to give her
strength to be able to cope up and solve no matter what problem it
was.

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2. Interaction Patterns:
Mommy X is the type of person one can easily get along with for
she was very friendly and approachable.
3. Cognitive Patterns:
There are no sign of mental disturbances in Mommy X. She
seems to cope up well with the hardship of pregnancy and pain of
labor.
4. Self Concept:
She views herself as a woman, a wife to her husband and a
mother to her two beautiful daughters.
5. Emotional Pattern:
She is a positive type of person. She deals effectively with her
emotions.
6. Sexuality:
For Mommy X, being a woman is being responsible enough to
take good care of your family and keeping it intact no matter what
happen.

7. Family Coping Pattern:


If there is /are problems in the family they discuss it together
(she and her husband) and solve it together.

Socio-Cultural Health
1. Cultural Pattern:
They celebrate fiesta, Christmas and New Year and other
significant event or occasions.
2. Significant Relationship:
She does not have any complain with regards to her relationship
with her husband. She cited her husband as a responsible and loving
one.
3. Recreational Pattern:
The Family goes to church every Sunday and their favorite past
time is watching television specifically the noon time show,
Wowawee
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4. Environment:
According to Mommy X, Their place was a very quiet place to live
in although sometimes, there are quarrellings in the neighborhood
which is inevitable of course, all in all, their place was ideal for her.
5. Economic
In the family, all finances are shouldered by her husband who is
a bodyguard with a salary of P 33 per day.

Spiritual Health
1. Religious Belief
They are Roman Catholic who believed in God and the only
savior, His son Jesus Christ.
2. Values and Valuing
They practice kissing the hands of elders and value respect and
good attitude at all times.

IV. ACTIVITIES OF DAILY LIVING

Activities

Before
Hospitalizatio
n

After
Hospitalizatio
n

Mostly
vegetables and
soups

Vegetables and
soups also

Analysis

1. Nutrition

Edema in Pregnancy

The mother
prefers
nutritious and
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soupy foods for
the sake of her
baby that was
breastfeeding on
her.
2. Elimination
Every morning

Every morning

The mother still


has her normal
elimination
pattern even
after delivery.

No exercise

Do some
walking in the
morning
together with
the baby

Because of the
new born baby,
the mother now
lends time to do
little exercises
together with
her baby.

Practice good
grooming

The same

The mother still


maintains good
grooming.

8 hours of sleep
1 hour nap

3-4 hours
30 minutes nap

The mother
usually lack in
sleep at night
due to the
supervision she
was doing on
her newborn
baby

3x a week

No sex

Sexual
intercourse was
not practice
after delivery
because the
wound was still
new and not yet
completely
healed.

3. Exercise

4. Hygiene

5. Rest and
Sleep

6. Sexual
activities

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V. PHYSICAL ASSESSMENT
Day: Wednesday
19.4(normal)

A.
Measurement
s

Date: August 20, 2008

Findings

Weight

Normal
M= 78.5 7.7,

43 kilograms

F=58.8 4.1

BMI:

Interpretation/
Analysis
Normal

5 ft. tall

M=163.5 cm
(5' 4.4") F=151.8
cm (4' 11.8")

Normal

Findings

Normal

Interpretation/
Analysis

37

36.5C-37.2C

normal

69bpm

60-100bpm

Normal

24bpm

6-20bpm

normal

110/80mmgh

120/90mmgh

H
hypotensive

Height

B. Vital signs

Time: 10:43 am

Temperature
Pulse Rate
Respiratory
Rate
Blood pressure

HEAD TO TOE PHYSICAL ASSESSMENT


Body Parts
/
Technique

Actual
Findings

Head
1.Skull
Edema in Pregnancy

Normal
Findings

Interpretat
ion

Proportion to
the size of the
body, round,
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Palpation
Size, shape
or contour,
symmetry
and
curvature.

2.Scalp

Normal

Normal

Palpation
Areas for
tenderness

Normal

Normal

Normal

3.Hair
Inspection
Inspect for
the color,
distribution,
thickness,
and
lubrication or
appearance.

Normal

White, clean,
free from
masses, lumps,
scars, lice, nits,
dandruff, and
lesions.

Inspection
Carefully
separate the
hair at
various
locations.
Inspect for
color,
appearance,
and presence
of masses,
lice nits, and
dandruff.

with
prominences in
the frontal area
interior and the
occipital are
posterior,
symmetrical in
all planes,
gently curved.

Normal

Edema in Pregnancy

Normal

No areas of
tenderness.

Black evenly
distributed and
covers the
whole scalp,
thick, shiny and
free from split
ends.

Normal

Normal

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Case Study
Normal
Palpation
Palpate for
texture

Coarse of fine

4.Face
Inspection
Observe for
the
symmetry,
shape, facial
expression,
movement
and
appearance.

Normal

Normal

Normal

Oblong or oval
or round or
square or heartshape,
symmetrical,
facial
expression that
is dependent on
the mood or
true feelings,
smooth and free
from wrinkles
and no
involuntary
muscle
movements.

Normal

Normal

5.Eyes
Inspection
Observe for
placement,
symmetry,
protrusion,
clarity, and
lacrimations.
*Eyebrows
Inspection
Observe for
color,
symmetry,
and quantity
of hair,
distribution
and
placement
unparallel.

Normal

Normal

Edema in Pregnancy

Parallel and
evenly placed,
symmetrical,
non protruding,
with scant
amount of
secretions, both
eyes bright and
clear.
Black,
symmetrical,
thick, raise and
lower
symmetrically,
evenly
distributed and

Normal

Normal

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Case Study
parallel with
each other.
*Eyelashes
Inspection
Observe for
the color,
distribution

Tenderness and
pain
Black evenly
distributed and
tuned outward.

and direction
*Eyelids
Inspection
Ask the client
to close
eyes.
Observe for
position and
symmetry
and then ask
him to open
eyes again.
Palpation
Using the tip
of the index
finger,
palpate the
lacrimal
gland.

Abnormal

Pale

Upper lid covers


a small portion
of the iris and
the cornea and
sclera when the
eyes are open.
When the eyes
are closed---the
symmetrical

Abnormal

Normal
Normal
Non-palpable,
non tender.
Normal
Normal

Normal
Normal
*Lower
palpebral
conjunctiva
Inspection
Ask the client
to look up
and pull the
lower lid
Edema in Pregnancy

Salmon pink,
shiny, moist.

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Case Study
down,
Observe for
color and
appearance.

Normal
Normal
White and clear,
no visible blood
vessels.

*Sclera
Inspection
Color and
clarity

Normal
Normal

*Cornea
Inspection
Clarity and
texture
*Pupils
Inspection
Size, shape,
symmetry,
reaction to
light and
accommodati
on.

Iris
Inspection
Size, color,
shape

*Testing for
eye
movement
Inspection
Stand
directly in
front of the
client and
hold the

Normal

Normal

Normal

Edema in Pregnancy

Transparent,
shiny, smooth.
Round, equal
constrict when
light is pointed
to the eyes and
dilated when
light is
removed,
constrict when
object is close
to the eyes and
dilated when
object is
removed away.

Normal

Proportional to
the size of the
eyes, round,
black brown,
symmetrical.

Normal

Able to move
eyes in full
ranges of
motion or able
to move in all
direction.

Normal

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Case Study
finger at
about one
foot in front
of the
clients eyes.
Ask the client
to refrain
from moving
his head and
follow the
direction of
the
examiners
fingers with
his eyes only.
Move the
finger in a
slow manner
though the
cardinal
fields of
gaze.
*Testing for
visual fields
Inspection
Stand 2-3 ft.
from the
client. Ask
(one ear at a
time and
then at the
back of the
client for
both ears).
Instruct the
client not to
move his
head and to
repeat the
words that
you will say.

Normal
Normal
Able to see 60
degrees
superiority.
Normal
Normal

Normal

Midline,
symmetrical
and patent.

Normal

Normal
Normal
Able to repeat
the words
Normal
Normal

In the correct
placement,
Patent and
symmetrical

Normal

Normal

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6.Nose

Clean, pinkish,
with few cilia.

Normal

Straight.

Normal

Normal

Inspection
Placement,
symmetry
and patency.
*Internal
nares
Inspection
Appearance,
color of
mucus
membrane,
presence of
cilia.

*Septum
Inspection
Appearance

Normal

Normal
Normal
Pinkish,
symmetrical
with lip margin
well defined,
smooth and
moist.

7.Mouth
*Lips
Inspection
Observe for
color, shape,
symmetry,
lip margin
and
appearance
*Gums
Inspection
Observe for
color,
appearance,
discharge

Normal

Normal

Normal

Normal

Normal

Edema in Pregnancy

Pinkish, smooth,
moist, no
reseeding, no
swelling and no
discharge

32 permanent
teeth, wellaligned, free
from caries or
filling and no
halitosis.

Normal

Normal

Normal

Large, medium,
red or pink,
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Case Study
and swelling
or
contraction.
*Teeth
Inspection
Number,
color,
alignment,
general
condition,
breath
*Tongue
Inspection
Inspect for
size, color,
surface,

Normal

Normal

Midline, straight
end thin

Normal

Normal

Pinkish, moist
and smooth

Normal

Pinkish, moist,
smooth

Normal

Slightly pinkish

Normal

At the center
Symmetrical
and freely
movable

Normal

Normal

appearance
and
movement
*Frenulum
Inspection
Position and
appearance

Normal

*Checks
(buccal
mucosa)
Inspection
Color and
appearance

Normal

8.Palate

Normal

*Soft palate
Inspection
Color and
appearance
*Hard
palate
Inspection

slightly rough in
top, smooth
along the lateral
margins, moist
shiny and freely
movable.

Pinkish, noninflamed
Normal
Normal

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Case Study
Color and
appearance.
Proportional to
the size of the
body and head,
symmetrical
and straight.

*Uvula
Inspection
Position,
color, size,
symmetry,
And mobility

No palpable
lumps, masses
or areas of
tenderness

*Tonsils
Inspection
Detect if
there is
hoarseness
of voice

9.*Neck

Normal

Palpable

Inspection
Size,
symmetry,
position

*Palpation
Palpate for
lumps,
masses or
areas of
tenderness

Normal

Palpates the
Adams apple
(for male)

Range of motion
Chin to chest
Edema in Pregnancy

Freely movable
without
difficulty

Normal

Symmetrical
and able to
resist applied
force(both
muscle)

Able to resist
applied force
symmetrical in
structure of size
and muscular
strength
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Case Study
Ear to shoulder
Muscular
strength
Inspection
Symmetry and
strength of the
sternocleidomas
toid muscle

Normal

Force/strength
of the trapezius
muscle

10. Thorax
(Anterior and
posterior)
Inspection
Have the client
all comfortably.
Inspect for the
shape, position
of the spine,
slope of the
ribs, retraction
of the
intercostals
spaces (ICS) on
the inspiration,
and bulging of
the ICS on
experimentation
.

Observe for
symmetry of the
chest wall
during

The chest
contour is
symmetrical
and the chest is
twice as wide as
deep
(anteriposterior
diameter in a
1:2 ratio) the
spine is straight
posteriorly, the
ribs tend to
slope across
and down the
ribs are
prominent in a
thin person
there is no
bulging or
retraction of
breathing.

Normal

The chest wall


moves
symmetrically
during
respiration

Normal
Normal

Edema in Pregnancy

No lumps,
masses, areas
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Case Study
respiration

Palpation
Palpate for
lumps, masses,
areas of
tenderness.

of tenderness
sides of the
thorax expand
symmetrically.
the examiners
thumb separate
approximately 2
inches during
breathing
Normal
Normal

Normal
Normal

Measure chest
excursion (to
determine the
depth of
breathing).
Place hands on
the lower
portion of the
rib cage with
the thumbs 2
inches apart
pointing toward
the spine so a
small fold of the
skin appears
between the
thumbs.

The vibrations
are feeling most
strongly
between the
first and second
ribs along the
sternum
interiorly and
between the
scapulae
posteriorly.

Normal

Normal
Ask the client to
take a few deep
breaths.

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Case Study
Elicit lacille
fromitus (a thrill
felt by the hand
on the chest
wall while the
client is
speaking). Place
the palms of the
hands
bilaterally
symmetrical on
the chest. Start
from the top of
the chest wall
going down
.each time the
hands move
down, ask the
client to say
ninety-nine or
one-one one
with the same
intensity of
voice.

Normal
Normal

Normal
Normal

Percussion:
Anterior thorax.
The client is
preferably in a
lying position.

Normal

Posterior thorax.
The client is
sitting position
with the arms
folded forward
across the
chest. This
position will
separate
Edema in Pregnancy

Vesicular
sounds are
heard over lung
periphery
particularly at
the base of the
lungs, they are
soft intensity,
low pitched
gentle sighing
sounds created
by hair moving
through smaller
airways
bronchovessicul
ar so this are
heard at the 1st
and 2nd IC at the
sternum
interiorly and
between the
scapulae
posteriorly

Normal

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Case Study
scapulae further
to expose more
lung to
assessment.
No pulsations.

Normal

Normal
Using the direct
percussion,
percuss in the
ICS over
symmetrical
areas of the
chest starting
from the
supraclavicular
area. Compare
one side of the
chest with the
other.

Normal
Normal

Pulsations
visible and
palpable
Auscultation:
Use the flat-disc
diaphragm. Use
the systematic
zigzag
procedure used
in percussion.
Ask the client to
take slow deep
breaths through
the mouth.
Listen at each
point to the
breath sounds
during a
complete
Edema in Pregnancy

Abdominal
aortic pulsation
visible and
palpable.

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Case Study
respiration.
Compare
findings at each
point on the
opposite side of
the chest.

The 2 heart
sounds are
audible in all
areas but
loudest at apical
area..

Normal

CR ranges from
60-100 beats
per minute.

Normal

Normal

*Heart
Inspection and
palpation:
Place the client
in supine
position. Stand
in the clients
right side. Ask
client not to
talk. Inspect
and palpate the
valve areas of
the heart.

Normal

Females:
variable in size
depending on
body build,
rounded shape,
symmetrical

*Aortic areas
Around at the
2nd ICS on the
right angle of
Louis as a
dominance on
the Sternum
*Pulmonic Areaat the 2nd ICS on
the left of Louis.
Note: Observe
these areas at
an angle to the
side to improve
the chance of
seeing
pulsations.

Males: Flat,
symmytrical, if
obese, may be
slightly
rounded.

Normal

Normal

Normal
Normal

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*Tricusspid Area
move the
fingers along
the clients left
sternal border
to the 5th ICS.

*Apical Area
moves the
fingers laterally
to the left midclavicular line
(LMCL), which is
slightly below
the nipple. This
point where the
apex touches
the anterior
chest wall is
known as the
point of
maximal
impulse (PMA)

*Epigastric Area
at the tip of
the sternum.
Auscultation:
Auscultate the
hearth in all 4
anatomic sites:
aortic,
pulmonic,
tricuspid and
apical (mitral)
Eliminate all
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sources of room
noise. Heart
sounds are of
low intensity
and other noise
hinders the
nurses ability
to hear them.
Identify the first
sounds
described and
lub. Then,
identify the 2nd
sound. This is
higher pitched
that SI,
described as
dub
Use the bellshaped
diaphragm.
Once SI and S2
are identified,
count the heart
rate for one
minute. Each
combination of
S1 and S2
counts as one
heart beat.

Skin is the same


in color in the
abdomen, no
retractional
dimpling.

Normal

No masses or
lumps,
tenderness,
breast tissues
are firm and
elastic.

Normal

Normal

11.Breast
Inspection
Ask the client to
remove the top
gown or drape
to allow
simultaneous
visualization of
the breast.
Have the client
sit comfortably
Edema in Pregnancy

Round or oval,
color darker
that
surrounding
skin,
symmetrical

No masses and
tenderness.
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Case Study
with arms at the
sides. Inspect
the breast for
size, symmetry
and contour or
shape.

Inspect the skin


of breast for
color, retraction,
or dimpling.

Palpation
Assist the client
in supine
position. This
position allows
the breast
tissues to
flatten evenly
against the
chest wall
facilitating
palpation. Ask
client to false
his/her hand
and place it
under the head
palpate the
breast for lumps
or masses,
tenderness, and
consistency of
breast tissues.
The palmar
surface of the
first three
fingers is used
to compress
breast tissues
against the

Round, averted,
equal in size,
similar in color.
Both nipple
points in one
direction, no
discharge, no
lesion
No masses,
tenderness and
discharge.
Normal
Normal

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chest wall.
Perform
palpation in a
clockwise rotary
motion from the
borders going
inward.

Normal
Normal

*Areola
Inspection
Inspect for size,
shape, color and
summetry.

Palpation
Palpate for
masses and
tenderness

Normal

Normal

*Nipples
Inspection
Inspect for size,
shape, position,
discharge and
lesions.
Normal
Palpation
Use thumb and
index finger to
compress the
nipple to
determine any
discharge.

Edema in Pregnancy

Skin is
unblemished,
no scars, color
is uniform, flat,
rounded or
scapoid,
symmetrical
movement
caused by
respiration,
nortic pulsation
at epigastric are
visible thin
persons,
umbilicus is flat
or concave
positioned
midway
between the
xipoid process
and the
symphisisd
pubis, color is
the same as the
surrounding
skin.

Normal

Normal
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Case Study
12.Abdomen
Divide the
abdomen into 4
imaginary
quadrants.
Draw a vertical
line from the
xipoid process
to the
symphysis pubis
and a horizontal
line across the
umbilicus.
These
quadrants are
labeled right
upper
quadrants
(RUQ).left lower
quadrants
(LLQ), and right
lower quadrant
(RLQ)
Ask the client if
he/she needs to
void. Drape the
upper chest and
legs. Explore
the abdomen
from the xipoid
process to the
symphisis pubis.
The client lies in
supine position
with arms down
at the sides. A
small pillow
may be placed
under the head.

Rough

Normal

Abnormal
Has edema

Abnormal
Has edema

Abnormal
Has edema

Abnormal
Has edema

Edema in Pregnancy

Livers edge
feels firm and
non-tender

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Case Study
Inspection
Inspect the
abdomen for
skin integrity,
color, contour,
symmetry,
movement or
pulsations and
color and
placement of
umbilicus.

Auscultation
Warm the
diaphragm of
the
sytethoscope.
Cold
stethoscope
may cause the
client to contact
the abdominal
muscles and the
contractions
may be heard
during
auscultation.
Diaphram is
used because
intestinal
sounds are
highpitched
sounds. Place
the diaphragm
in each of the 4
Edema in Pregnancy

Tympanic
ground
predominated
because of the
air in the
stomach and
int4estines.
Percussion
sound is dull at
the livers lower
portion.

Perform with
ease

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Case Study
quadrants over
all auscultation
sites. It may
take minute to
hear bowel
sounds.
Palpation
Perform light
palpation first to
detect areas of
tenderness,
muscle
guarding
(voluntary
tightening of
muscles), lumps
or masses,
constancy, and
organomegaly.
Depress the
abdominal wall
lightly, about 1
cm with the
pads of your
fingers. Move
the finger pads
in a sight
circular motion.
Palpate all 4
quadrants.
Palpate the liver
using deep
palpation. Stand
on the clients
right side. Place
your left hand
on the posterior
thorax at about
the 11th and 12th
rib and then
apply upward
pressure. This
Edema in Pregnancy

Perform with
ease

Symmetrical in
size and length,
no
abnormalities,
fine hair equally
distributed, no
visible varicose
vein

Warm and
smooth

Clean no
lesions, 5 toes
on each foot.

Performs with
ease
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maneur makes
it easier to feel
the liver
anteriorly. With
the fingers of
the right hand
pointing
upward, place
the hand on the
RUQ well below
the livers lower
border, then
press gently
until you reach
a depth of 1 2 inches. Ask
the client to
take a deep
breath using the
abdominal
muscles. As he
inhales, try to
palpate the
livers edge as it
descends.

Performs with
ease

Performs with
ease

Performs with
ease

Percussion
Percuss each of
the 4 quadrants
starting from
the RUQ going
clockwise.

*Wrist
Ask the client to
flex and extend
hands at the
wrist and then
perform radial
and ulnar
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flexion.
*Hands and
fingers
Ask the client to
do flexion,
extension,
abduction of
fingers,

13.Lower
Extremities
Inspection
Inspect for
symmetry of
size and length
and the
presence of
abnormalities.
Note the pattern
of hair
distribution,
color and
presence of
varicose veins.
Palpation
Palpate from
thighs to logs
for temperature,
and texture.
*Feet and Toes
Inspection
Inspect for
cleanliness, skin
lesion and
number of toes

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*Hips
*Range of
Motion
Ask the client to
do flexion,
extension,
abduction,
adduction, and
internal external
rotation of the
legs
*Knees
Ask the client to
flex and extend
each leg
*Ankle
Ask the client to
do flexion,
extension,
aversion, and
inversion of
each foot.
*Foot and Toes
Ask the client to
flex, extend,
abduct and
adduct toes

VI. ANATOMY AND PYSIOLOGY


The Human Circulatory System

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BLOOD

Blood contains the fluid part called Plasma, and many blood cells
Plasma is a yellowish, slightly alkaline liquid that comprises 55%
of blood, and is a mixture of nutrients (amino acids, sugars, fatty
acids, glycerol, salts), hormones, antibodies, enzymes and some
dissolved gases in water
Red Blood Cells (Erythrocytes) are made in the bone marrow in
the centre of certain long bones. Red blood cells have nuclei
when first formed, but lose their nuclei when mature. They live
only about 4 months before being destroyed by the spleen and
the liver. Red blood cells contain red chemical called
haemoglobin that attaches either to oxygen or carbon dioxide
molecules to transport them around the body.
White Blood Cells (Leukocytes) are made in bone marrow and the
spleen. They live only 2 to 4 days, because their purpose is to
fight infection. They either surround or ingest foreign particles or
bacteria (macrophages that perform phagocytosis), or produce
chemicals such as antibodies and antitoxins to neutralise the
invading particles or bacteria.

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Platelets are small disc-shaped blood cells without a nucleus.


They are formed in bone marrow, and play an important role in
the clotting of blood.

BLOOD VESSELS

Arteries take blood away from the heart. They usually contain
blood rich in oxygen. Arteries have elastic muscular walls that
can dilate and constrict as each pulse of blood goes through.
Veins take blood back to the heart. They contain valves that
allow a one-way flow of blood. Veins are less muscular than
arteries.
Capillaries are the smallest and most numerous of blood vessels.
The capillary diameter is only the width of one red blood cell, so
blood travels slowly through capillaries. The capillary wall is only
one cell thick to allow exchange of nutrients and oxygen into,
and wastes such as carbon dioxide out of the body cells.

STRUCTURE OF THE HEART

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The heart is a strong muscular organ used to pump blood.


It has 4 blood-collecting chambers - 2 atria and 2 ventricles.
Valves between the chambers allow one-way blood flow.
The wall of the left ventricle is the thickest and strongest
because blood from here is pumped all around the body.
The heart has its own blood supply via the coronary artery. If
this is blocked, a 'heart attack' may occur.

BLOOD FLOW THROUGH THE HEART

Oxygenated Blood - contains a lot of oxygen but very little


carbon dioxide
Deoxygenated blood - contains very little oxygen bit a lot of
carbon dioxide
Direction of Blood Flow - Blood from body - Vena Cava - Right
Atrium - Right Ventricle - Pulmonary Artery - Lungs - Pulmonary
Veins - Left Atrium - Left Ventricle - Aorta - All body cells

VII. PATHOPYSIOLOGY
Growing uterus puts
pressure on pelvic and vena cava.
(Pressure slows down circulation
and causes blood to pool in legs
and forcing fluid from veins into
the tissues of feet and ankles)

Uterus enlarges, it presses


down on main veins to the legs.
( the reduces the flow of blood
returning to heart which pushes
water into the tissues into the legs
and feet)

Mild
Case

Swelling or puffiness
of tissue on skin

Edema in Pregnancy

Stretch skin or shiny

Paleness

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SUBCUTANEOUS EDEMA
commonly occurs in the legs and ankles due to the influence of
gravity in woman.

EDEMA
excessive accumulation of fluid in body tissues popularly known as
dropsy. The resultant swelling may be local or with an injuring or
inflammation.

VIII. DIAGNOSIS, LABORATORY RESULTS


AND PROCEDURE
Date: May 19, 2008
HEMATOLOGY

Examination

Results

Reference Value

Hemoglobin
(mass concentration)

128

(M) 130 180


(F) 120 -160

Erythrocytes
(volume fraction)

0.39

(M) 0.40 0.54


(F) 0.37 0.47

Leucocytes
(no. concentration)

8.7

5-10x10 9/l

Erythrocytes(no.
concentration)

4.2

(M) 4.5 6.0


(F) 4.0 -5.5x10 12/l

Thrombocytes

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Neutrophil

0.75

(F) 0.51 0.67

Lymphocytes

0.20

(N) 0.21 0.35

Monocytes

0.03

0.02 0.08

Eosinophil

0.02

0.01 0.04

URINALYSIS

Result

Analysis

Nursing Care

Light Yellow
Hazy

Normal
Normal

Health Teaching
Health Teaching

Negative
Negative

Normal
Normal

Health Teaching
Health Teaching

Microscopic
Examination:
1.Epithelial Cells

Few

Normal

Health Teaching

Few

Normal

Health Teaching

2.Mucus
Threads

Few

Normal

Health Teaching

1-2/hpf

Compromised
for infection

Hygiene
Teaching

Physical
Examination:
1.Color
2.Character /
Transparency
Chemical
Examination:
1.Albumin
2.Sugar

3.Amorphous
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Urates
0-1hpf

Normal

4.Pus Cells

Health Teaching
7.1

Normal
Health Teaching

5.RBC

1.015

Normal
Health Teaching

6.PH
7.Specific
Gravity

Diagnostic X-Ray / Ultrasound Report


Name :

Libot, Nemia

Age :

33 years old

Sex :

Female

Civil Status :

Married

O.R Number :

99661

Physician :

Luz Uy

Date :

May 19, 2008

Case Number :

08-2563
Fetal and Obstetrical Report

Number of Fetus :

Single

Presentation :

Cephalic

Biparietal Diameter :

6.21 cm 25 weeks, 2d

Femoral Length :

4.82 cm 25 weeks, 6d

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Abdominal Circumference :

20.4 cm 24 weeks, 6d

FHR :

139 beats/min.

Placental Location :

Anterior highying

Amniotic Fluid :

11.7cm AFI

Gender :

Female

Maturity grade :

Average Gestational Age :

25 weeks, 2d

Estimated Fetal Body Weight :

815 grams

Impression:
Single, Live, Intrauterine Pregnancy in Cephalic presentation of
about 25 weeks and 2 days based on bpd, FL and Ac.
GR. 1, Anterior Placenta
Normohydraminios
EDC : August 30, 2008
M.J.M. Alba MD,
DPBR
Radiologist /
Sonologist

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