PREECLAMPSIA INTRODUCTION Preeclampsia is a major cause of maternal and perinatal morbidity and mortality. It accounts to 28.

4% of maternal morbidity and mortality in the Philippines according to DOH (as of Feb. 2008). The condition — sometimes referred to as pregnancy-induced hypertension — is defined by high blood pressure and excess protein in the urine after 20 weeks of pregnancy. Often, preeclampsia causes only modest increases in blood pressure. Left untreated, however, preeclampsia can lead to serious — even fatal — complications for both mother and baby. The only cure for preeclampsia is delivery of the baby. If preeclampsia develops near the end of your pregnancy, delivery is the obvious solution. If you're diagnosed with preeclampsia earlier in your pregnancy, you and your doctor face the delicate task of prolonging your pregnancy to allow your baby more time to mature, without putting you or your baby at risk of serious complications. The signs of preeclampsia are elevated blood pressure (hypertension) and the presence of excess protein in your urine (proteinuria) after 20 weeks of pregnancy. The excess protein is related to problems with your kidneys. Your doctor may identify these signs of preeclampsia at one of your regular prenatal visits. Other signs and symptoms of preeclampsia — which can develop gradually or strike suddenly, often in the last few weeks of pregnancy — may include: • Severe headaches • Changes in vision, including temporary loss of vision, blurred vision or light sensitivity • Upper abdominal pain, usually under the ribs on the right side • Nausea or vomiting • Dizziness • Decreased urine output • Sudden weight gain, typically more than 2 pounds a week Swelling (edema), particularly in the face and hands, often accompanies preeclampsia as well. Swelling isn't considered a reliable sign of preeclampsia, however, because it also occurs in many normal pregnancies. CAUSES Preeclampsia used to be called toxemia because it was thought to be caused by a toxin in a pregnant woman's bloodstream. Although this theory has been debunked, researchers have yet to determine what causes preeclampsia. Possible causes may include: • Insufficient blood flow to the uterus • Damage to the blood vessels • A problem with the immune system RISK FACTORS Preeclampsia develops only during pregnancy. Risk factors include: • History of preeclampsia. A personal or family history of preeclampsia increases your risk of developing the condition. • First pregnancy. The risk of developing preeclampsia is highest during your first pregnancy or your first pregnancy with a new partner. • Age. The risk of preeclampsia is higher for pregnant women who are older than age 35. • Obesity. The risk of preeclampsia is higher if you're obese. • Multiple pregnancy. Preeclampsia is more common in women who are carrying twins, triplets or other multiples. • Gestational diabetes. Women who develop gestational diabetes have a higher risk of developing preeclampsia as the pregnancy progresses. • History of certain conditions. Having certain conditions before you become pregnant — such as chronic high blood pressure, diabetes, kidney disease or lupus — increases the risk of preeclampsia.

OBJECTIVES GENERAL 1. To enhance skills in handling patient with pre-eclampsia. 2. To have an additional knowledge and information about pre-eclampsia. 3. To perform appropriate management by utilizing the nursing process. SPECIFIC

1. To define what is pre-eclampsia.
2. To discuss the anatomy and physiology of pre-eclampsia. 3. To know the etiology, risk factors and its complication. 4. To plan and execute appropriate nursing interventions. 5. To evaluate the effectiveness of discharge planning. 6. To create awareness about pre-eclampsia to the client and to the family members.

DEMOGRAPHIC A. PERSONAL DATA Name:XY Age:31 Sex: FEMALE Date of birth: NOVEMBER 1, 1977 Place of birth: MONTALBAN, RIZAL Civil status: MARRIED Religion: CATHOLIC Nationality: FILIPINO ADMISSION Date: NOVEMBER 22, 2008 Room: 3016-F2 Diagnosis: G5P4, 32 WEEKS AOG Attending physician:DR. ALMA F. FONTE-RAMIREZ ADMITTING HISTORY XY was 8th month pregnant when she was rushed to East Avenue Hospital in Quezon City on the November 22, 2008. Upon admission, she had pain, headache, bloodshow but no signs of seizure. She was conscious and coherent, not in cardio respiratory distress. With Bp of 190/110, afebrile, with retractions with clear breath sounds and positive bipedal edema. She had a previous consultation in Infirmary hospital in Montalban. She had a normal spontaneous delivery last November 22, 2008, she delivered twin boys. Past Medical Hospitalization Appendectomy 1999

Family Medical History The patient has a family history of hypertension. According to XY, both her parents have hypertension. Social History XY, 31 years old, who resides with her husband in Montalban Rizal. According to her though their income is still insufficient for them, she is still happy and contented. With regard to their community, she said that the environment is peaceful and their neighbors are very accommodating. According to her that part of her leisure is chatting with her neighbors.

GORDON’S PATTERN Person Approach PSYCHOLOGICAL • Self Perception Pattern XY is a very jolly individual. She seems very satisfied to the life that she has. Just being with her partner she feels complete and secure. She is very appreciative even on the simple things being done to her, especially with her husband. Though they’re having some problems on their finances she maintains the composure of being fine and happy. Her family, especially her twins is her inspiration right now. She entrusts everything on the Lord. She sees problems as test of courage and faith to Him. • Role Relationship Pattern XY resides with her family including her parents in Montalban, Rizal. With regard to decision making, it is both of them who decide on whatever actions to be done. She owned a house with 2 bedrooms .She lives in a community of very friendly and accommodating neighborhood.. In fact in her free time, she chats with her neighbors. Health center in their place is very accessible for them. Unlike the wet market, it will take them 15-20 mins to get there. • Coping Perceptual Pattern XY has a good vision & hearing. In regards to her mental status, she’s being forgetful at time. She feels pain and discomfort due to her recent delivery. • Coping Stress Tolerance Pattern She is a jolly person that is why coping with stress is not a problem with her. She manages it by simply diverting it to other things like talking to friends, watching TV, listening to radio, etc… Her husband has always been the first person she asks for help when she is stressed out or feeling down. Also, they just keep a positive outlook and a strong faith to the Lord whenever things are going really bad. PSYCHOSOCIAL Intimacy vs. Isolation Characterized by the development of an intimate loving relationship with another. PSYCHOSEXUAL has reached the stage of genital COGNITIVE has reached the stage of formal operations. Value Belief Pattern XY is a catholic. Her husband was an Iglesia ni Cristo member, but was later on was converted when they got married. With her family, they hear mass every Sunday. She has observed the closeness of their family when she was still young. Now that she has her own, she wants that close family ties be observed. She always tells her kids to be a good person, study well and be God-fearing. She is very satisfied with her life especially now that their twins. ELIMINATION •

No discomfort or any pain being felt. This is enough for her to do her tasks for the next day. There are times that quantity and quality of food is being sacrificed because of tight budgeting. In terms of hygiene. . She eats three times a day with snacks in the afternoon. In regards to the amount and character. everything is regular and normal. SAFE ENVIRONMENT The patient has no allergies on any medications and/ foods. She cooks her food but when she has no time she just buys outside.She has a regular bowel movement and she micturates regularly. These keep her in good shape. Her favorite foods would be anything with fish and vegetables. Their place is just a room with bathroom. In regards with her skin integrity there are no evident lesions. The usual food intake would be composed of fish and vegetables. She has 8 hours of sleep everyday. She has a big appetite. Making use of any aids is not needed anymore. listening to radio and chatting with her neighbors. It appears to be some how smooth. There is nothing in particular that she dislikes. She takes a bath everyday. OXYGENATION XY has no difficulty in breathing. She wakes up early around 4am to prepare things for her kids. NUTRITION XY cooks their food but there would be times that she buys outside. She is clean and seems to practice good hygiene routine. REST AND ACTIVITY • Activity Exercise Pattern Doing household chores and her work are the only form of exercise she has. • Sleep Rest Pattern XY has a regular bed time. she observes good hygienic practice all the time. Her leisure activities are just watching TV.

Manner of speaking is quite unclear. absence of nodules or masses Smooth contour No lesions No mass No area of tenderness Evenly distributed No gray hair No Seborrhea.occurred when she was 5y/o.8 C HEIGHT 5’1” WEIGHT 140 lbs Patient conscious and coherent. She also has asymmetrical facial features. No odor of body and breath noted. mass. no involuntary movements shown. Dressed in a simple red/ black duster. SPECIFIC ASSESMENT: NORMAL FINDINGS ACTUAL FINDINGS Proportional to body size Smooth. She covers her mouth the whole time of the conversation. However. appear to be neat. no discoloration Lids close symmetrically Clear No shrunken eyeballs Skin intact No discharge No discoloration Lids close symmetrically Clear Protruding/ bulging eyeball (R) Normal Findings Sclera Inspection Normal Findings Bell’s Palsy (facial hemiparesis due to oedema of 7th /facial cranial nerve) . fingers on both hands and feet are noticeably unclean. Skin appears to be dry with some visible scars at both upper and lower extremities. no discharge. uniform consistency. and area of tenderness Evenly distributed with a number of gray hair No seborrhea. She has a medium built frame. able to understand and respond to questions appropriately and reasonably quickly.PHYSICAL ASSESSMENT GENERAL ASSESMENT: VITAL SIGNS (11/23/08): BP 180/100 PR 83 RR 22 TEMP 36. due to her Bell’s Palsy/ facial hemiparesis. conscious of her uneven lower teeth and the absence of upper incisors. No signs of respiratory distress. dermatitis Smooth and shiny Asymmetrical PARTS TECHNIQUE HEAD AND FACE Skull Inspection Palpation Scalp Inspection Palpation Inspection INTERPRETATION Normal Findings Normal Findings Normal Findings Normal Findings Normal Gray hair is influenced by decreased in melanocytes due to aging process Normal Findings Normal Findings Bell’s Palsy (facial hemiparesis due to oedema of 7th /facial cranial nerve) . dermatitis Smooth and shiny Symmetrical facial feature Proportional to the patients size Absence of nodules or masses Smooth contour Absence in lesions. no continuous treatment / therapy done Hair Condition Face Inspection EYES Eye Condition Inspection Skin Intact. short stature with apparent globular abdomen. She sat comfortably with a slouched posture.

EMMETROPIA Both eyes focus on objects clearly whether near or distant EMMETROPIA MOUTH EARS Lips Auricle Inspection Inspection Hearing Tongue Activity Nose Teeth Whisper Test Inspection Inspection Inspection Symmetry of contour Color same as facial skin Symmetrical Aligned with outer canthus of eye Pinna recoils after it is folded Responds to normal voice Pinkish to reddish in color Patent and symmetrical With frenulum at the center No dental caries No plaque or cavities Gums with no lesions 32 permanent teeth Absence of bleeding Proportional to the size of the body No palpable lymph nodes Asymmetrical offacial skin Bell’s Palsy (facial Color same as contour Normal Findings hemiparesis due to oedema Symmetrical Normal Findings th of 7 Aligned with outer canthus of eye /facial cranial nerve) Normal Findings .upper incisors missing Absence of bleeding Proportional to the size of the body No palpable lymph nodes Normal Findings Normal Findings Dental carries. plaque and cavities due to poor dental hygiene. capillaries sometimes evident. Normal findings Conjuctiva Inspection Vision Inspection Both eyes focus on objects clearly whether near or distant . Normal Findings Poor dental hygiene led to cavities and decay. Constricts with close light Dilates with distant light Extremely pale .occurred when she was 5y/o.occurred when she was 5y/o. no continuous treatment Pinna recoils after it is folded Normal Findings / therapy done Able to hear normal voice clearly Normal Findings Pinkish to reddish in color Normal Findings Patent and symmetrical With frenulum at the center With dental caries With plaque and cavities No lesions .28 permanent teeth with irregularities in growth . Pupil Inspection Constrict with close light Dilates with distant light (PERLA) Pinkish in color and moist With slightly dark circles under the eyes Sclera is white w/ prominences of capillaries. Normal Findings Normal Findings Normal Findings Neck Inspection Palapation .No dark circles under the eye white and clear. no continuous treatment / therapy done Lack of sleep Normal Findings Normal Findings Normal Findings There is paleness due to anemia because liver is already damage thus production of globin (which is a type of proteins) that is essential in forming hemoglobin is altered.

no lesions. convex curvature Five fingers on both hands Pallor.98cm Normal Findings Normal Findings Distention is present because of portal hypertension resulting to accumulation of fluid in the peritoneal cavity thus. smooth.CHEST Inspection Respiratory rate of 1620 breaths per min RR – 22 bpm The RR was taken on a sitting position. mass and area of tenderness Warm moist skin.presence of scars noted Dry and scaly skin. rounded(convex). or scaphoid(concave) Absence of mass and are of tenderness Diminish breath sounds Absence of adventitious and bronchial breath sounds Symmetric contour. especially over the liver and spleen. there was shortness of breath due to mechanical impingement on the diaphragm. Palpation tenderness noted. dullness. no lesions. Normal findings Pallor is due to poor circulation Unclean nails due to poor body hygiene Slight delay in Fingers Nails Inspection Inspection Complete number of digits Shiny. the weight of fluid pushes against the side walls. or full bladder No tenderness. abdominal girth of 93. increase tension There is discomfort upon palpation because of abdominal distention. The tympany over the umbilicus occurs in ascites because bowel floats to the top of the abdominal fluid at the level of the fluid meniscus. consistent tension Absence of bowel sounds Absence of arterial bruits Absence of friction rub Tympanitic over the umbilicus and dull over the lateral abdomen and flank areas. UPPER EXTREMITIES Arms and Inspection Hands Palpation Symmetric. smooth. absence of lesions. pules palpable bilateral 2+ Symmetric. absence of mass and area of tenderness . scars and rashes Unblemished skin Uniform color Distended (bulging flanks). Palpable bilateral pulses Normal findings Presence of dry and scaly skin is due to the restriction of fluid intake and excessive fluid loss. convex Nails are unclean Palpation of Capillary Refill time less Capillary refill time is about 4 . Normal Findings Auscultation Percussion Audible bowel sounds Absence of arterial bruit Absence of friction rub Tympany over the stomach and gas filled bowels. scars and rashes Unblemished skin Uniform color Flat. Normal Findings Shallow breath may produces diminish breath sounds due to pleural effusion Normal Findings Palpation Auscultation Lungs Abdomen Auscultation Inspection No mass and are of tenderness Vesicular and bronchovesicular breath sounds Absence of adventitious and bronchial breath sounds Symmetric contour.

Serum creatinine level: levels are elevated due to decreased intravascular volume and decreased glomerular filtration rate (GFR).000 Hemoconcentration may occur in severe preeclampsia. CBC count Microangiopathic hemolytic anemia (HELLP) Thrombocytopenia / Platelet count less than 100. • Serial levels may be useful to indicate disease progression. Liver function tests: Transaminase levels are elevated from hepatocellular injury and in HELLP syndrome. Alternatively. Urinalysis • Proteinuria is one of the diagnostic criteria for preeclampsia. Uric acid • Uric acid levels are increased in preeclampsia. aPTT. • Proteinuria is also defined as 300 mg or more of protein in a 24-hour urine sample. 2. • Proteinuria is defined as greater than or equal to 1+ protein on urine dipstick. and decreased fibrinogen 6.Capillary Refill Test LOWER EXTREMITIES Skin Inspection than 3 seconds seconds capillary refill time is due to circulatory impairment Normal findings Legs Palpation Inspection Absence of coldness and clamminess No lesions No bleeding No mass Complete legs (left and right leg) No mass and lesions Pinkish in color Absence of coldness and clamminess No lesions No bleeding Absence of masses Both two legs are complete (left and right) Bipedal edema Weak popliteal pulse noted Pallor Hard Complete toe nails Nails are unclean Capillary refill time is about 4 seconds Normal findings Normal findings increased plasma volume and sodium retention Pallor is due to poor circulation Normal findings Normal findings Unclean nails due to poor body hygiene Slight delay in capillary refill time is due to circulatory impairment Nails Inspection Hard Complete toe nails Palpation in capillary refill time Capillary Refill time less than 3 seconds DIAGNOSTIC EXAMINATION 1. 5. 4. protein concentration of 300 mg/L or more on urine dipstick. fibrin split products. Disseminated intravascular coagulopathy testing 7. Increase in blood pressure CLINICAL MICROSCOPY • • • . 3. Elevated PT. 8.

Sugar Cloudy 1.7 Negative Negative Abnormal Normal Normal Abnormal Normal Indicator of kidney dysfunction.amber Abnormal Often associated with bile pigments chiefly retention of bilirubin Suggestive of pyuria and slight hematuria. Color Laboratory result Normal value Interpretation of result Remarks Yellow Light yellow . Reaction E. Leukocyte IV.1. Cost III. WBC(White Blood Cell) C. 15 – 20/hpf Many Moderate Moderate Few none 0-5/hpf Moderate Few present Few present A. Urates . Blood D. Specific Gravity D.015. Conclusive of renal disease. Transparency C. Bacteria F.8-7. Mucus Threads E.Few none .20 Negative Negative Negative Negative Negative 1 . Physical A.030 pH -4. B. Bilirubin E.Laboratory Test I. Remarks --------------1. Crystals G. Epithelial Cells D. Urobilinogen B. RBC( Red Blood Cell) B. Nitrate C. Ketone F. Protein F.0 Positive Negative Clear 1. suggestive of pre-eclampsia II.3/hpf 0-2/hpf Above the normal range Above the normal range Abnormal Abnormal Abnormal Normal Normal Slight increase is suggestive of bleeding but assumption is to be renal in origin. Biochemical A. Microscopic A. Seen in cases of acute tubular necrosis Suggestive of advanced renal disease Urinary tract infection is present.015 6.

5. . and other parts of your body. which is a muscular pumping device. and metabolic waste products have to be removed. the tissues need a continuous supply of oxygen and nutrients. Its function is vital because. While blood is the transport medium. Blood Blood is actually a tissue. The vital role of the cardiovascular system in maintaining homeostasis depends on the continuous and controlled movement of blood through the thousands of miles of capillaries that permeate every tissue and reach every cell in the body. and capillaries. Heart The heart is a muscular pump that provides the force necessary to circulate the blood to all the tissues in the body.7 Normal Value 2. letting the heart move as it beats. and a closed system of vessels called arteries. A double-layered membrane called the pericardium surrounds the heart like a sac. diaphragm. Nutrients and other essential materials pass from capillary blood into fluids surrounding the cells as waste products are removed. yet still be attached to your body. Deprived of these necessities.Ca oxalate crystalates --- CLINICAL CHEMISTRY Laboratory Test BUN (Blood Urea Nitrogen) Creatinine Alp SGOT (AST) SGPT (ALT) Laboratory Results 3. behind and slightly to the left of the breastbone (sternum). each having a different job. In fact. As the name implies. cells soon undergo irreversible changes that lead to death. It is thick because it is made up of a variety of cells. the heart is the organ that keeps the blood moving through the vessels.5. It is located between the lungs in the middle of the chest. veins.1mmol/L Interpretation of Result Normal Remarks 69umol/L --48 HIGH 37 53-115 umol/L 35-125 u/L 15–37 u/L 30-65 u/L Normal Normal Abnormal Normal Transaminase levels are elevated from hepatocellular injury ANATOMY CARDIOVASCULAR SYSTEM The cardiovascular system is sometimes called the blood-vascular or simply the circulatory system. It is in the microscopic capillaries that blood performs its ultimate transport function. It consists of the heart. A coating of fluid separates the two layers of membrane. The inner layer of the pericardium is attached to the heart muscle. The outer layer of the pericardium surrounds the roots of the heart's major blood vessels and is attached by ligaments to your spinal column. to survive. blood is actually about 80% water and 20% solid. blood contained in the circulatory system is pumped by the heart around a closed circle or circuit of vessels as it passes again and again through the various "circulations" of the body.

About 10 percent of the total blood volume is in the systemic arterial system at any given time. The other system. Of the 3 types of blood cells. transports blood from the right ventricle to the lungs and back to the left atrium. Most healthy adults have about 700 times as many red blood cells as white ones. which carry oxygen. proteins. White blood cells are also called leukocytes. The vessels make up two closed systems of tubes that begin and end at the heart. a. Veins . b. When the body is fighting off infection. the tunica intima (also called tunica interna). The body creates these cells at a rate of about 2. is primarily smooth muscle and is usually the thickest layer. Red blood cells are also called erythrocytes. which attaches the vessel to the surrounding tissue. is the tunica externa or tunica adventitia. red blood cells are the most plentiful. the systemic vessels. In fact. The arterioles play a key role in regulating blood flow into the tissue capillaries.) Blood also • Helps keep your body at the right temperature • Carries hormones to the body’s cells • Sends antibodies to fight infection • Contains clotting factors to help the blood to clot and the body’s tissues to heal Blood Vessels Blood vessels are the channels or conduits through which blood is distributed to body tissues. which ward off infection. The wall of an artery consists of three layers. The primary function of capillaries is the exchange of materials between the blood and tissue cells. c. Pulmonary arteries transport blood that has low oxygen content from the right ventricle to the lungs. The connective tissue in this layer is quite dense where it is adjacent to the tunic media. The middle layer. It not only provides support for the vessel but also changes vessel diameter to regulate blood flow and blood pressure. Red blood cells. Capillaries Capillaries. and they each have a life span of about 120 days. which come in many shapes and sizes. It also carries away carbon dioxide and all of the waste products that the body does not need. Platelets are also called thrombocytes. White blood cells. it makes them in ever-increasing numbers. carries blood from the left ventricle to the tissues in all parts of the body and then returns the blood to the right atrium. blood vessels are classified as arteries.4 million a second. Blood is pumped from the ventricles into large elastic arteries that branch repeatedly into smaller and smaller arteries until the branching results in microscopic arteries called arterioles. the tunica media. Still. compared to the number of red blood cells in the body. Clotting stops the blood from flowing out of the body when a vein or artery is broken.• • • Platelets. Based on their structure and function. These cells. Blood also contains hormones. Systemic arteries transport oxygenated blood from the left ventricle to the body tissues. form the connection between the vessels that carry blood away from the heart (arteries) and the vessels that return blood to the heart (veins). fats. One system. a healthy adult has about 35 trillion of them. carbohydrates. is simple squamous epithelium surrounded by a connective tissue basement membrane with elastic fibers. Arteries Arteries carry blood away from the heart. or veins. This layer is connective tissue with varying amounts of elastic and collagenous fibers. which help the blood to clot. the smallest and most numerous of the blood vessels. but it changes to loose connective tissue near the periphery of the vessel. The outermost layer. the pulmonary vessels. capillaries. (The kidneys filter and clean the blood. the number of white blood cells is low. The innermost layer. are vital to the immune system. Blood carries oxygen from the lungs and nutrients from the digestive tract to the body’s cells. Smooth muscle cells in the arterioles where they branch to form capillaries regulate blood flow from the arterioles into the capillaries. and gases.

the pulmonary veins transport blood from the lungs to the left atrium of the heart.Veins carry blood toward the heart. Systemic circulation carries oxygenated blood from the left ventricle. the velocity of flow decreases. After blood passes through the capillaries. In blood vessels. which allows time for exchange of gases and nutrients. Resistance is a force that opposes the flow of a fluid. It carries oxygen and nutrients to the cells and picks up carbon dioxide and waste products. Pressure is a measure of the force that the blood exerts against the vessel walls as it moves the blood through the vessels. respiratory movements. blood pressure also increases. The left ventricle is the pump for the systemic circuit. The rate. Blood flow is slowest in the capillaries. Blood Flow Blood flow refers to the movement of blood through the vessels from arteries to the capillaries and then into the veins. Pulmonary Circuit Pulmonary circulation transports oxygen-poor blood from the right ventricle to the lungs where blood picks up a new blood supply. Very little pressure remains by the time blood leaves the capillaries and enters the venules. This blood has a high oxygen content because it has just been oxygenated in the lungs. and viscosity. Systemic veins transport blood from the body tissue to the right atrium of the heart. b. the resistance increases and blood flow decreases. . the term blood pressure refers to arterial blood pressure. called venules. Instead. or velocity. The pump for the pulmonary circuit. Systemic Circuit The systemic circulation provides the functional blood supply to all body tissue. blood volume. Blood pressure is measured with a sphygmomanometer and is recorded as the systolic pressure over the diastolic pressure. Pulse pressure is the difference between systolic pressure and diastolic pressure. From the tissue capillaries. When these factors increase. through the arteries. It can be felt where an artery is close to the surface and rests on something firm. The walls of veins have the same three layers as the arteries. to the capillaries in the tissues of the body. and constriction of smooth muscle in venous walls. there is less smooth muscle and connective tissue. which provides the blood supply for the tissue cells of the body. venous return depends on skeletal muscle action. Because the walls of the veins are thinner and less rigid than arteries. This blood has a reduced oxygen content because the oxygen has been used for metabolic activities in the tissue cells. Pulse and Blood Pressure Pulse refers to the rhythmic expansion of an artery that is caused by ejection of blood from the ventricle. Blood flows in the same direction as the decreasing pressure gradient: arteries to capillaries to veins. it enters the smallest veins. of blood flow varies inversely with the total cross-sectional area of the blood vessels. Diastolic pressure occurs during cardiac relaxation. As vessel diameter decreases. Like all fluids. As the total cross-sectional area of the vessels increases. blood flows from a high pressure area to a region with lower pressure. a. is the right ventricle. which is related to the fact that blood in the veins has less pressure than in the arteries. peripheral resistance. the deoxygenated blood returns through a system of veins to the right atrium of the heart. In common usage. Blood flow through the veins is not the direct result of ventricular contraction. it flows into progressively larger and larger veins until it reaches the heart. Then it returns the oxygen-rich blood to the left atrium. most of the resistance is due to vessel diameter. Systolic pressure is due to ventricular contraction. the pressure in the aorta and its branches. From the venules. veins can hold more blood. The blood vessels of the body are functionally divided into two distinctive circuits: pulmonary circuit and systemic circuit. Although all the layers are present. This makes the walls of veins thinner than those of arteries. which circulates blood through the lungs. Four major factors interact to affect blood pressure: cardiac output. In the pulmonary circuit.

Hormone secretion The kidneys secrete a variety of hormones. which then affects the renal tubules. regulation of electrolyte concentrations. which communicates directly with the posterior pituitary gland. KIDNEY The kidneys are organs that filter wastes (such as urea) from the blood and excrete them. In humans. Acid-base balance The kidneys regulate the pH. control of blood volume. along with water. converting it to angiotensin I (10 amino acids). The kidney communicates with these organs through hormones secreted into the bloodstream. It produces bile. This organ also is the largest gland in the human body. When blood pressure becomes low. Homeostasis The kidney is one of the major organs involved in whole-body homeostasis. resulting in water reabsorption by the kidney and an increase in urine concentration. urodilatin. The kidneys accomplish these homeostatic functions independently and through coordination with other organs. plasma protein synthesis. the right kidney sits just below the liver. It also performs and regulates a wide variety of high-volume biochemical reactions requiring very specialized tissues. by eliminating H ions concentration called augmentation mineral ion concentration. Plasma volume Any significant rise or drop in plasma osmolality is detected by the hypothalamus. There is one on each side of the spine. The two factors work together to return the plasma osmolality to its normal levels. ANGIOTENSIN . A rise in osmolality causes the gland to secrete antidiuretic hormone. It plays a major role in metabolism and has a number of functions in the body. d. Renin acts on a blood protein. a. Angiotensin I is then converted by the Angiotensinconverting enzyme (ACE) in the lung capillaries to Angiotensin II (8 amino acids). as urine. a proteolytic enzyme called Renin is secreted by cells of the juxtaglomerular apparatus (part of the distal convoluted tubule) which are sensitive to pressure. c. and regulation of blood pressure. an alkaline compound which aids in digestion. the left below the diaphragm and adjacent to the spleen. decomposition of red blood cells. and detoxification. Aldosterone stimulates an increase in the reabsorption of sodium ions from the kidney tubules which causes an increase in the volume of water that is reabsorbed from the tubule. via the emulsification of lipids. angiotensinogen. including erythropoietin. Blood pressure Sodium ions are controlled in a homeostatic process involving aldosterone which increases sodium ion reabsorption in the distal convoluted tubules. b. renin and vitamin D. Above each kidney is an adrenal gland (also called the suprarenal gland). Among its homeostatic functions are acidbase balance. particularly those of the endocrine system. It lies below the diaphragm in the thoracic region of the abdomen. including glycogen storage. the kidneys are located in the posterior part of the abdomen. and water composition of the blood. The asymmetry within the abdominal cavity caused by the liver results in the right kidney being slightly lower than the left one while the left kidney is located slightly more medial. This increase in water reabsorption increases the volume of blood which ultimately raises the blood pressure.LIVER The liver is an organ present in vertebrates and some other animals. which stimulates the secretion of Aldosterone by the adrenal cortex.

which is one way to measure remaining kidney function. c. or kinase). Angiotensin I Angiotensin I is formed by the action of renin on angiotensinogen. It is derived from the precursor molecule angiotensinogen. removing excess wastes and fluids. it estimates how much blood passes through the tiny filters in the kidneys. Renin cleaves the peptide bond between the leucine (Leu) and valine (Val) residues on angiotensinogen. Angiotensin II increases blood pressure by stimulating the Gq protein in vascular smooth muscle cells (which in turn activates contraction by an IP3-dependent mechanism).Angiotensin is an oligopeptide in the blood that causes vasoconstriction. like angiotensin III. Renin is produced in the kidneys in response to both decreased intrarenal blood pressure at the juxtaglomerular cells. or decreased delivery of Na+ and Cl. Glomerular filtration rate (GFR) is a calculation that determines how well the blood is filtered by the kidneys. If more Na+ is sensed. increased blood pressure. ACE is actually found all over the body. ACE inhibitor drugs are major drugs against hypertension. creating the ten amino acid peptide (des-Asp) angiotensin I. renin release is decreased. and intracrine hormone. which decrease the rate of angiotensin II production. but has its highest density in the lung due to the high density of capillary beds there. Glomerular filtration is the process by which the kidneys filter the blood. Renin's primary function is therefore to eventually cause an increase in blood pressure. has some lesser activity. autocrine/ paracrine. but 100% of the aldosterone-producing activity. Types of Angiotensin a. Angiotensin II acts as an endocrine. Although it slightly inhibits glomerular filtration by indirectly (through sympathetic effects) and directly stimulating mesangial cell constriction. and release of aldosterone from the adrenal cortex. Angiotensin IV Angiotensin IV is a hexapeptide which. ACE is a target for inactivation by ACE inhibitor drugs. Angiotensin II causes the release of prostaglandins from the kidneys. Cardiovascular effects It is a potent direct vasoconstrictor. b. It plays an important role in the renin-angiotensin system. HYPERTENSION Vasospasm  effects on vascular system  vasoconstriction  impaired organ perfusion  hypertension . leading to restoration of perfusion pressure in the kidneys.to the macula densa. d. a serum globulin produced in the liver. Angiotensin III Angiotensin III has 40% of the pressor activity of Angiotensin II. each minute. its overall effect is to increase the glomerular filtration rate by increasing the renal perfusion pressure via efferent renal arteriole constriction. Specifically. It is a powerful dipsogen. Angiotensin II Angiotensin I is converted to angiotensin II through removal of two terminal residues by the enzyme Angiotensin-converting enzyme (ACE. Renal effects Angiotensin II has a direct effect on the proximal tubules to increase Na+ absorption. Glomerular filtration rate (GFR) Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. which is found predominantly in the capillaries of the lung. constricting arteries and veins and increasing blood pressure. called glomeruli.

In the first situation. The heavy loss of protein in the urine (over 3. attempt to retain salt. When one is pregnant. Vasospasm  effects on the interstitial tissues  fluid diffusion from vascular space into interstitial space  edema ALBUMINURIA/ PROTEINURIA The presence of excessive protein (chiefly albumin but also globulin) in the urine. muscular vessels. a reduction of fluid in the blood vessels occurs. Since albumin helps to maintain blood volume in the blood vessels. to more flaccid tubes to accommodate a 10-fold increase in uterine blood flow to support the pregnancy Uterine spiral artery remodeling takes place by the invasion of trophoblast cells into the uterine lining. or excessive or sudden swelling of feet or ankles could be a sign of preeclampsia. A certain amount of edema is normal in the ankles and feet during pregnancy. thereby causing pitting edema. This increased pressure is relieved when you lie on your side. The pressure slows down circulation and causes blood to pool in your legs. These trophoblasts enter the arterial walls and replace parts of the vascular endothelium so that smooth muscle is lost and the artery dilates An immune response facilitates normal placental development:  In the uterine decidua. the people have normal or fairly normal kidney function. Vasospasm  effects on renal system  reduced glomerular filtration rate. a serious condition. therefore.EDEMA It is the medical term for when excess fluid collects in your tissue. usually a symptom of kidney disorder. . swelling in of face or puffiness around the eyes. However. And since the vena cava is on the right side of your body. fluid moves into the interstitial spaces. forcing fluid from your veins into the tissues of your feet and ankles. People who have kidney diseases that impair renal function develop edema because of a limitation in the kidneys' ability to excrete sodium into the urine. and certain changes in your blood chemistry cause some fluid to shift into your tissue. It's normal to have a certain amount of this swelling during pregnancy because you retain more water while you are pregnant.0 grams per day) is termed the nephrotic syndrome and results in a reduction in the concentration of albumin in the blood (hypoalbuminemia). the growing uterus puts pressure on the pelvic veins and on the vena cava (a large vein on the right side of your body that receives blood from your lower limbs and carries it back to the heart). more than slight swelling of the hands. Thus. people with kidney failure from whatever cause will develop edema if their intake of sodium exceeds the ability of their kidneys to excrete the sodium. maternal lymphocytes and macrophages assist the trophoblasts to invade into the uterine myometrium and the spiral arteries. The kidneys then register that there is depletion of blood volume and. Consequently. left-sided rest works best. A Edema forms in people with kidney disease primarily for one of two reasons: either a heavy loss of protein in the urine or impaired kidney (renal) function. increased glomerular membrane permeability  increased serum blood urea nitrogen and creatinine levels  oliguria and protenuria PATHOPHYSIOLOGY BOOK BASED NORMAL PLACENTAL DEVELOPMENT From 9-12 weeks gestation the uterine spiral arteries are transformed from thick-walled.

which may result because the uteroplacental spiral arterioles are abnormally formed. resistance. Preeclampsia is into the high systemic vascular resistance with normal or relatively low intravascular volume. Oliguria develops as the endothelial cells. and the diagnosis may represent a diversity of pathophysiologies that proceed to a common final pathway. causing them increases peripheral vascular disease worsens to become more permeable. Both maternal and paternal factors have been implicated in the development of preeclampsia. > Production failure of endothelial adhesion > Remodeling either absent or molecules from trophoblasts or > Remodeling limited to the superficial > Failure of/ or weak signaling of immune portion of the artery located in the decidua. Poor placentation. allowing STAGE 2 vasodilators. * Vasospasm and endothelial > Decreased plasma volume. vasoconstriction. leaving them highly sensitive to vasoconstriction. hypercoagulability. Placental hypoperfusion leads by an unclear pathway to the release of systemic vasoactive compounds that cause an exaggerated inflammatory response. causing tissue and organ edema Poor tissue perfusion to all maternal organs Increases total peripheral resistance resulting in elevated blood pressure . to be lost into the vessels causes damage to vasoconstriction. The inciting event is believe to be placental hypoperfusion. resulting in Fluid “leaks” out of the blood hypertension vessels into the tissues. all of which contribute to organ dysfunction and appear. (“leaky capillaries”) fluid shifts from intravascular to intracellular * Vasospasm causes poor space resulting in: tissue perfusion to all organs. mainly * Vasospasm of maternal blood causes generalized albumin. and platelet Stage 2 begins when maternal clinical features the various dysfunction. endothelial damage. This imbalance protein. leading to organ dysfunction. Increases endothelial cell permeability. factors a state of maternal circulation resulting from cell death. or a decreased capacity of the uteroplacental circulation. MATERNAL SYNDROME > Generalized tissue and organ kidney results in decreased vasoconstrictors and edema (EVIDENCE OF MATERNAL DISEASE PROCESS) glomerular filtration. causing vascular damage TWO-STAGE MODEL OF THE PATHOPHYSIOLOGY OF PREECLAMPSIA Perfusion is reduced to virtually every organ With maternal endothelial damage: > Decreased production of vasodilators (prostacyclin and nitric oxide) > Inactivation of circulating nitric oxide (vasodilator) PLACENTAL PATHOPHYSIOLOGY STAGE 1 Trophoblasts fail to completely remodel the uterine Theoretical basis for incomplete remodeling: spiral arteries. which urine. This causes placental hypoxia. These factors target > Cause is most likely related to the hypoxic and dysfunctional placenta releasing the maternal endothelium. capillary leak. resulting in oxidative stress. damage upset the delicate increased hematocrit * Decreased perfusion to the balance between MULTISYSTEMIC.The mechanism by which preeclampsia occurs is not certain. ratherVASOSPASM cells by trophoblasts prevents deep invasion than extending into the inner third of the necessary for normal artery remodeling. clinical features of the disease. myometrium.

The risk of preeclampsia is higher if you're obese. • Age. Diabetes mellitus 2:1 Twin gestation 4:1 . triplets or other multiples. • Multiple pregnancy. Women who develop gestational diabetes have a higher risk of developing preeclampsia as the pregnancy progresses. Having certain conditions before FACTOR RISK RATIO you become pregnant — such as chronic high blood pressure. The risk of developing preeclampsia is highest during your first pregnancy or your first pregnancy with a new partner. A personal or family history of preeclampsia increases your risk of developing the condition. • Gestational diabetes. • First pregnancy. • History of certain conditions. • Obesity. kidney disease or lupus — increases the risk of preeclampsia. The risk of preeclampsia is higher for pregnant women who are older than age 35. Preeclampsia is more common in women who are carrying twins. Family history of PIH 5:1 diabetes.CLIENT BASED: Risk factors of Pre-eclampsia includes: • History of preeclampsia.

causing high blood pressure. The placenta doesn't grow normally in the first half of pregnancy/ blood vessels that go to the placenta don't grow properly. The placental mass is large in multiple pregnancy. and swelling. problems with the kidneys. This means not enough blood reaches the placenta in the second half of pregnancy/ placenta doesn't get enough blood from the client. The chemicals damage the lining of the blood vessels.Client reported of having chronic HPN before pregnancy Family history also reveals HPN of both parents Client is also in multiple pregnancies/ carrying twins > Multiple pregnancy doubles the risk of preeclampsia. The unhealthy placenta sends harmful chemicals back into the client’s bloodstream. Hypoxia or reperfusion injury during placentation might account for the endothelial damage that is increasingly recognized as playing a part in the client’s pathogenesis of preeclampsia. .

. • Measure accurate intake and output. thereby promoting perfusion. as ordered. NURSING INTERVENTION Independent: • Take v/s every 1 – 2 hours initially. • To keep the carotid flow unobstructed. • To promote venous drainage reducing cerebral edema. Dependent: • Administer diuretics such as mannitol. • To prevent increased ICP. then every 4 hours after the patient becomes stable. Objective: BP:180/100 RR:28 PR:114 Goal met. • Reduce increase in ICP. • Keep patients head in neutral alignment. • Elevate head of patient’s bed 30 degrees. RATIONALE EVALUATION • To detect early signs of decreased cerebral perfusion or ICP.NURSING CARE PLAN CUES Subjective: NURSING DIAGNOSIS Altered Tissue Perfusion r/t vasoconstriction of blood vessels INFERENCE Increased cardiac output Injury of endothelial cells of the arteries Reduced responsiveness to blood pressure changes Vasoconstriction NURSING PLANNING After 8 hours of continuous nursing intervention patient will maintain or improve current LOC. • To prevent volume overload or deficit. • Keep the environment and patient quiet. After 8 hours of continuous nursing intervention patient’s LOC improved as evidenced by the latter regaining sense of orientation.

• Teach mother to squeeze buttocks together before sitting. RATIONALE EVALUATION Goal met. • To verify extent of wound. Dependent: • Administer analgesic as ordered. • Kegel exercise is deisgned to strengthen pubococcygeal muscles.remove for at least 10mins. Before reapplying. • Encourage mother to practice kegel exercise. NURSING INTERVENTION Independent: • Assess perineum for edema. Objective: Facial Grimacing Pain scale of 7 BP:180/100 RR:28 PR:114 NURSING DIAGNOSIS Acute pain r/t to episiotomy. • Apply ice pack for 20mins. • Relief of pain. After 8 hours of continuous nursing intervention the mother stated that discomfort has decreased as evidenced by absence of facial grimace pain scale of 0.”as verbalized by the patient. • Cold compress constricts blood vessels therefore reduces pain. INFERENCE Episiotomy Cellular Injury Vasodilation Vasoconstriction Increase Vascular permeability Inflammation Pain NURSING PLANNING Short term: After 8 hours of continuous nursing intervention the mother will state that discomfort has decreased. • To prevent pressure on the area.CUES Subjective: “Masakit pa rin po ang sugat ko. . release after sitting.

heart rate and rhythm. • Which will improve physical and psychosocial wellbeing. . • Provides comparative baseline. • Evaluate current limitations/degree of deficit in light of usual status. • This helps develop the patient’s independence.CUES Subjective: “Konting galaw ko lng po kinakapos na po ako ng hininga”as verbalized by the client. brain) Tissue hypoxia NURSING PLANNING Short term: After 8 hours of continuous nursing intervention the patient will report measureable increase in activity intolerance NURSING INTERVENTION Independent: • Discuss with patient the need for activity. • To prevent overexertion. RATIONALE EVALUATION Goal met. • Adjust activities. Objective: RR:28 PR:114 NURSING DIAGNOSIS Activity intolerance related to imbalance oxygen supply and demand. After 8 hours of continuous nursing intervention the patient expresses satisfaction with increase in activity level. pancreas. Liver. INFERENCE Increase Cardiac output Increased Peripheral resistance vasoconstriction Decreased Blood Supply To organs(kidney. and blood pressure). • Support and encourage activity to patient’s level of tolerance. • Monitor physiologic responses to increased activity (including respirations. • To ensure return to normal a few minutes after exercising.

• Patient involvement encourages compliance. After 8 hours of continuous nursing intervention the patient verbalized understanding of fluid and dietary restrictions as evidenced by patient plans own menu and selects food low in sodium and potassium. Dependent: • Administer medications. • To decrease thirst and improve taste. INFERENCE Vasoconstriction Increase hydrostatic pressure Fluid from the capillaries accumulate into interstitial space Edema formation NURSING PLANNING Short term: After 8 hours of continuous nursing intervention patient will verbalize understanding of individual dietary and fluid restrictions. • To promote fluid excretion. • To enhance patients understanding and compliance. • Explain the reasons for fluid and dietary restrictions. RATIONALE EVALUATION Goal met. Objective: Urine output of <30ml/hr Pitting Edema:3 seconds Lower extremities: Bipedal Edema • Changed parameters may indicate altered fluid or electrolyte status. • If oral fluids are allowed. • To prevent dehydration. record and report changes. NURSING INTERVENTION Independent: • Monitor v/s and breath sounds at least every 4 hours. . help patient make a schedule for fluid intake . • Provide sour hard candy.CUES Subjective: NURSING DIAGNOSIS Excess fluid volume r/t to increased isotonic fluid retention. • Provide mouth care every 4 hours.

scheduling activities to conform to patient’s usual schedule.CUES Subjective: “Hndi pa. • Promote client’s relative’s participation in problem identification and desired goals and decision making • Plan time for listening to patient’s concerns • Practice and promote short-term goal setting and achievement RATIONALE EVALUATION Goal met Within 1 hour of continuous nursing intervention the patient demonstrated techniques to meet self care needs. • To encourage patient and build on success • Provide privacy and equipment within easy reach during personal care activities. wash body and dry oneself ↓ Self care deficit on hygiene PLANNING Short term: Within 1 hour of continuous nursing intervention the patient will demonstrate techniques to meet self care needs. NURSING INTERVENTION Independent: • Assist within meeting client’s needs when he is unable to meet own needs • Develop plan of care appropriate to patient’s situation. . • To enhance coordination and continuity of care. Ang hirap din kasi tumayo papuntang CR kaya minsan ngpapapunas na lang ako”. • To discover barriers to participation in regimen and to work on problem solutions • To recognize that today’s success is as important as any long-term goal. and conceptualization of self-care in a broader scene. • To assist in dealing with current situation • To enhance commitment to plan. as verbalized by the patient. Objective: • Inability to wash body • Inability to access bathroom • Inability to dry body NURSING DIAGNOSIS Self care deficit: bathing/hygiene related to pain INFERENCE Delivery ↓ (Tissue trauma) Pain ↓ Hesitation to move ↓ Inability to access bathroom. optimizing outcomes and supporting recovery and health promotion. accepting ability to do one thing at a time. • Provide for communication among those who are involved in caring /assisting for patient.

CUES Subjective: "Hay. position changes • Assist patient to identify helpful behaviors e. focused breathing.Sympathetic stimulation e.Voice quivering . • Explain disease process and procedures within level of patient's ability to understand and handle the information. e.g back rub. In the early phases of the illness. Review current situations and the measures being taken to remedy the problems • Stay with the patient or make arrangements for someone else to be there during acute attack • Provide comfort measures. pano ba yan. Inform patient/SO that feelings are normal and encourage expression of feelings RATIONALE EVALUATION • Understanding that feelings (which are based on stressful situation plus an oxygen imbalance that is being treated) are normal may help the patient regain some feeling of control over emotions • Allays anxiety related to the unknown and reduces the fears concerning personal safety." As verbalized by the patient Objective: Restlessness .g assuming position of comfort. relaxation techniques • Support patient/SO in . PLANNING Short term: After 2 hours of nursing intervention patient’s anxiety will be reduce NURSING INTERVENTION Independent: • Note degree of anxiety and fear. After an hour of nursing intervention patient’s anxiety was reduced as evidence by relaxed voice and absence of tension.Irritability .g sweating NURSING DIAGNOSIS Anxiety:mild related to treat to health status INFERENCE The anxiety of the patient is brought about the threat to her health status because of being preeclamptic during the latter part of pregnancy. explanations need to be short and repeated frequently because the patient will have a reduced attention span • Helpful in reducing anxiety associated with perceived abandonment in presence of severe dyspnea/feelings of impending doom • Aids in reducing stress and redirecting attention to enhance relaxation and coping abilities • Gives patient measure of control to reduce anxiety and muscle tension Goal met. Ang taas nga ng presyon ko.

constipation. GI: Severe diarrhea. ulceration. and bleeding. abdominal cramps. ADVERSE EFFECT CNS: drowsiness. NURSING RESPONSIBILITY > Administer with meals. Caution use in: history of renal or hepatic disease. or milk to minimize GI adverse effects. unsteady gait. and in nursing mothers not established. status epilepticus with overdose. asthma. analgesic. > Use of drug for a period exceeding 1 wk is not recommended > Patients who develop severe diarrhea and vomiting should be assessed for dehydration and electrolyte imbalance. diabetes mellitus. blood dyscrasias. especially in planning for long recovery period. Involve patient in planning and participating in care • Develop activity program within limits of physical ability • Coping mechanisms and participation in treatment regimen may be enhanced as patient learns to deal with the outcomes of the illness and regains some sense of control • Provides a healthy outlet for energy generated by feelings DRUG STUDY DRUG NAME Mefenamic Acid 500 mg/cap D: q6 for pain Drug Class: NSAID Brand names: Apo-Mefenamic Ponstan Ponstel ACTION Anti-inflammatory. hypersensitivity to aspirin. confusion. Safe use in children < 14y. food. headache. flatus. or ulceration. nausea. vomiting. GI inflammation. and antipyretic activities related to inhibition of prostaglandin synthesis. vertigo. insomnia. dizziness. GI inflammation. . INDICATION Short-term relief of mild to moderate pain CONTRAINDICATION Contraindicated in: hypersensitivity to drug.dealing with the realities of the situation. nervousness. during pregnancy (Category C).

Other: Eye irritation.Hematologic: prolonged prothrombin time. albuminuria. agranulocytosis. Hct and Hgb. epistaxis. or rash occur and should not be used thereafter. Renal: nephrotoxicity. palpitation. hematemesis. Thrombocytopenic purpura. loss of color vision (reversible). megaloblastic anemia. perspiration. eosinophilia. >Mefenamic acid should be discontinued promptly if diarrhea. and renal function tests. . hematuria. Skin: Urticaria. > Advise patient to notify physician if persistent GI discomfort. ecchymoses. bronchoconstriction (in patients sensitive to aspirin). leucopenia. facial edema. rash. hepatic toxicity. severe autoimmune hemolytic anemia (long-term use). fever. Advise patients to report these signs to the physician. blurred vision. sore throat. acute exacerbation of asthma. or malaise occurs. dyspnea. increased need for insulin in diabetic patients. ear pain. > Patients on long-term therapy should have periodic blood counts. dysuria. elevation of BUN. bone marrow hypoplasia. dark stool.

anorexia. unusual tiredness. pseudomembranous colitis Hematologic: Bone marrow depression Hypersensitivity: Ranging from rash to fever to anaphylaxis Other: Superinfections > Give drug with meals (avoiding milk. peptic ulceration. abdominal pain. unusual bleeding/ bruising . causing cell death > Respiratory tract infections caused by Streptococcus Pneumoniae > Skin and skin structure infections (Staphylococcus and streptococcus) > Otitis Media > Bone infections > GU infections Contraindicated in patients hypersensitive to cephalosporins or penicillins Caution: renal failure. constipation > Ask patient about post reaction to cephalosporins or penicillin therapy before giving 1st dose > Obtain specimen for culture and sensivity tests before giving 1st dose. pregnancy GI: Nausea. ulcerative colitis or regional enteritic and in those receiving repeated blood transfusion CNS: coma and death with overdose GI: GI upset. vomiting. hemolytic aneuria (unless patient also has IDA). Therapy may begin while awaiting results. constipation Cephalexine HCl (Cephalexine Monohydrae) D: 1 tab OD Drug Class: Antibiotic Cephalosporin (first generation) Brand names: Apo-Cephalex Keflex Novo-Lexin Bactericidal: Inhibits synthesis of bacterial cell wall. which helps to form Hgb or trapped in reticuloendothelial cells for storage and eventual conversion to usable form of iron > Iron deficiency > Iron Supplement Contraindicated in patients with hemosiderosis primary hemochromatosis. lactation. flatulence. diarrhea. lethargy. slowly increase to build up tolerance > Warn patient that stool may be dark or green > Arrane for periodic monitoring of Hct and Hgb levels > Report severe GI upset. anorexia. eggs. coffee and tea) if GI discomfort is severe. nausea and vomiting. fatigue. > Take drug with food > Complete full course of drug even if feel better > Report: severe diarrhea with blood. rapid respirations.Ferrous Sulfate D: 1 tab OD Drug Class: Iron Preparation Brand names: Apo-FeSO4 Feosol Fer-Gen-Sol Fer-In-Sol Elevate serum iron concentration. DOB. rash/ hives.

sore throat. sore mouth. rash. fever. causing cell death > Infections due to susceptible strains of Haemophillus influenza. wheezing. diarrhea. abdominal pain Hypersensitivity: rash. nausea. vomiting. anaphylaxis Other: Superinfections > Give in oral preparations only.Amoxi Dispermox Novamoxin Nu-Amoxi Trimox Bactericidal: Inhibits synthesis of bacterial cell wall. fever. hives. cephalosporins or other allergens Caution: renal disorders. severe diarrhea. not affected by food > Take full course of therapy > Report: unusual bleeding/ bruising.Amoxicillin Trihydrate 500 mg/cap D: q8 for 7 days Drug Class: Antibiotic (penicillin – ampicillin type) Brand names: Amoxil Apo. lactation GI: glossitis. DOB . stomatitis. Escherichia Coli > Helicobacter pylori infection in combination with other agents > Chlamydia Trachomatis in pregnancy Contraindicated with allergies to penicillins. gastritis.

lactation CNS: Headache. butdrug can be given with some foods. pregnancy Caution: sepsis. perianal irritation. it increases the strength. cathartic dependence o Between-meal doses are preferable. cough syrup). although absorption may be decreased. rhein anthrone. intraoperative. toxaemia. amebicidal Contraindicated with hypersensitivity to metronidazole. regional enteritis. subinvolution of uterus > Uterine stimulation during the second stage of labor following the delivery of the anterior shoulder. hepatic disease. fever. numb/ cold extremities. and frequency of uterine contractions > Routine management after delivery of the placenta > Treatment of postpartum atony and hemorrhage. hepatic encephalopathy. candidiasis. nausea. abdominal cramps. unusual fatigue/ weakness.Methylergonovine Maleate 125 mg/tab D: q8 for 3 days Drug Class: Oxytoxic Brand names: Methergine A partial agonist or antagonist at alpha receptors. antiprotozoal – trichomonacidal. ulcerative colitis. obliterative vascular disease. abdominal surgery. ataxia GI: unpleasant metallic taste. under strict medical supervison > Acute infection with susceptible anaerobic bacteria > Acute intestinal amebiasis > Amebic liver abscess > Trichomoniasis > Preoperative. . Exlax. weakness. primary hemochromatosis or haemolytic anemia and in those receiving repeated blood transfusion Excessive bowel activity. This Contraindicated in px with peptic ulceration. take drug with food if GI upset occurs > Don’t drink alcohol (beverages containg alcohol. hepatic or renal impairment CNS: Dizziness. to remove ingested poisons from the lower GI. diarrhea GU: darkening of the urine > Monitor postpartum women for BP changes and amount and character of vaginal bleeding > Drug should not be needed for longer than one week > Discontinue if signs of toxicity occurs > Report: DOB. o Check for constipation. dizziness. o Enteric-coated products reduce GI upset but also reduce amount of iron absorbed. Senokot Bactericidal: Inhibits DNA synthesis in specific (obligate) anaerobes. dizziness. to prevent straining. as adjunct in anthelmintic therapy Contraindicated with allergy to methylergonovine. hypertension. postoperative prophylaxis for patients undergoing colorectal surgery > Prophylaxis for patients undergoing gynaecologic. blood dyscrasias. which increases the volume and pressure of the intestinal contents.Senna-Gen. hemosiderosis. chills The laxative effect is due to the action of sennosides and their active metabolite. severe reactions my occur > Urine may be darker in color > Report: svere GI upset. causing cell death. dizziness. severe abdominal cramping > Take full course of drug therapy. headache. in the colon. The laxative effect is realized by inhibition of water and electrolyte absorption from the large intestine. to evacuate the bowel for diagnostic procedures. duration. as a result. headache CV: Transient hypertension GI: Nausea Metronidazole 500 mg/tab D: q8 for 7 days Drug Class: Antibiotic Antibacterial Amebicide Antiprotozoal Brand names: Apo-metronidazole Flagyl MetroGel NidaGel Noritate Protostat Senna Concentrate D: HS for 2 weeks Drug Class: Stimulant laxative Brand Name: Black-Draught. antibiotic associated pseudomembranous colitis Short term relief of constipation. vomiting. pregnancy Caution: CNS diseases. lactation. anorexia.

.will stimulate the colon motility resulting in propulsive contractions record color and amount of stools o Tell patient to take tablets with juice (preferably orange juice) or water. but not with milk or antacids.

visual disturbances. level of consciousness. because of the risk of eclampsia during the first 24 to 48 hours. therapeutic regimen understood Participating in care with plan in place for home monitoring/management DISCHARGE SUMMARY OF PATIENT: • • • • Age: 31 G5P4 BP: 180/100 HR: 83 . meal preparation. and continue throughout the intrapartum and postpartum period. lightings. surgery neighbors & friends.DISCHARGE PLANNING Discharge Planning is a process of preparing a client to leave one level of care for another DISCHARGE CONSIDERATION: Starts from the moment patient is admitted to the hospital. to protect the woman from damage during fits. However. The only definitive therapy for preeclampsia is delivery. bathroom/ hallways/ floorings. schedules of examination • Referrals Either in written form or verbally depending on clients or family members level of education & maturity. careful monitoring of vital signs. ostomies. prognosis. Community health nurses have the opportunity to have ongoing assessments as well as caregivers in their environment. transportation wound care assistance. After birth. They can provide support and resources as needed. Discharge teaching should begin during the perinatal period. Nursing Responsibilities such as: • Instructions of care • Health teachings • Advices on follow up. special foods required • • • MANAGEMENT & NURSING RESPONSIBILITIES: Pre-eclampsia occurs only in the presence of a placenta. and to arrange transport to a hospital or referral centre in case of a serious rise of blood pressure combined with these symptoms. The main tasks of the caregiver who attends the postpartum period is to measure and record blood pressure after delivery. community health care & facilities stairways. tubes. free-of-seizure activity Condition. and DTRs and laboratory assessments are continued. Attention should also be given to signs of emotional and physical fatigue and other problems that might arise from them. medications. most women will stabilize within 48 hours. supplies. ambulatory devices ambulating. DISCHARGE GOALS: • • • Hemodynamically stable. where length of stays are considerably shortened. epigastric pain). INVOLVES THE FOLLOWING: • • • • Ongoing assessment to obtain comprehensive information about the clients ongoing needs current health status. prognosis. to swiftly identify symptoms that could be indicative of preeclampsia (headache. IV medications equipment. The management of pre-eclampsia is complicated by the presence of the fetus.

Severe hypertension should be treated. schedule & cycle. desirable outcomes often compete for the resources. Laboratories were done. Explain medicines administration procedure (if any per Rx) Uses.8 C Pale palpebral conjuctiva. anicteric sclera Supple neck.98cm (+) bipedal edema Upon admission. This can be discontinued when the blood pressure returns to normal levels. no clads Symmetrical chest expansion Clear breath sounds Globular abdomen with abdominal girth of 93. action of medicine. High blood pressure and protein in the urine resolve after delivery. intervention to side effects Alternative therapeutic medicines Recognizing that there are finite limits to the amount of money and health care providers available. q8 for 7 days 1 tab. and some women will require a high blood pressure medication after being discharged from the hospital. q8 for 3 days 1 tab. the patient was placed on NPO temporarily and was hooked to IVF. frequency. usually within six weeks. HS for 2 weeks . Advice to report unusual manifestations and side effects of drugs to physician. usually within a few days. Monitor and evaluate effectiveness of medication regimen. Vital signs were monitored. Patient underwent NSD. Patient eventually transferred to ward and eventually cleared for discharged. Patient tolerated the procedure well and had routine post-op care. Blood pressure that continues to be elevated beyond 12 weeks after delivery is unlikely to be related to preeclampsia and may require long-term treatment. q6 for pain 1 tab OD 1 tab OD 1 tab. 3. Reinforce importance of medication compliance to patient and her relatives. 2. DISCHARGE INSTRUCTIONS: M MEDICATION E EXERCISE/ ENVIRONMENT T TREATMENT H HYGIENE/ HEALTH TEACHINGS O OUT-PATIENT FOLLOW-UPS D DIET S SPIRITUAL MEDICATION REGIMEN 1. MEDICATION Mefenamic Acid 500 mg/cap Ferrous Sulfate Cephalexine HCl (Cephalexine Monohydrae) Amoxicillin Trihydrate 500 mg/cap Methylergonovine Maleate 125 mg/tab Methergine Metronidazole 500 mg/tab Senna Concentrate DOSAGE 1 tab. duration dosage and route.• • • • • • • • RR: 22 Temp: 36. its time. q8 for 7 days 1 tab.

in and out of car 4. Low blood pressure may indicate hypovolemia. most normal activities can be resumed. Refers to Transportation 6. Abnormally high blood pressure can indicate late-onset pre-eclampsia.  The first time she gets up. in and out of bath c. eat c. Breathing 2. although strenuous physical activity is usually restricted until after 6 weeks. TREATMENT • • Management of adverse effects of medicines  Knowledgeability of drugs Alternative therapeutic medicines  Nursing care process and procedure. Blood pressure should also be checked several times during the first day and periodically thereafter. dressing up b. from bed to chair b. • Prolonged bedrest is neither necessary nor desirable. the uterine lining is normally completely healed and a new endometrium regenerated. Refers to shopping . Refers to transferring (assistance/ aide) a. Refers to meal preparation 5. After 3 weeks. or referral to seek community health services. • Maintain safe environment. Refers to client’s ability a. sponge) 2. • Institute seizure precaution. strenuous physical activity will increase her bleeding and is not a good idea. toilet activity d. shower. • Encourage the patient to do some exercise every morning such as a simple walking. Relaxation After delivery. HYGIENE AND HEALTH TEACHING 1.4 twice over at least 6 hours) indicates the possibility of infection and should be investigated. Calisthenics 4. • Teach patient to perform passive range of motion exercises on patient’s extremities. Any persistent fever (>100. sleep. Reading & other 5. At this point. the mother needs time to rest.EXERCISE & ENVIRONMENT Incorporating regimen to ADL such as: 1. or to the hospital. someone should be with her to assist in getting her back down if she feels light-headed. Walking 3. • Education about abdominal muscle tone and exercises is explained. Mental exercises 6. • Provide environment within normal room and body temperature. and regain her strength. • • Maternal temperature should be periodically assessed. Refers to ambulating (with or without aids) 3. bathing (tub. There are a few cautionary notes:  While she may be up walking.

Mother and her support person are informed of abnormal signs or symptoms to watch for in the first several days following discharge and given written instructions on how to receive assistance if questions or emergencies arise. SPIRITUAL ASPECT • • • • Belief Faith Hope Verbalization with significant others . encourage the woman to void early and often. Appointment schedule for follow-up checks 2. and to pass immunities and other benefits to the baby. can reduce postpartum bleeding/hemorrhage in the mother. Refer to dietician for dietary instructions. Instructions or requirements (if any) on scheduled follow-up 4. Because bladder distention due to post partum bladder atony or urethral obstruction is common. It is important to establish bladder function early in the post partum phase. iron and vitamin C. iron provides formation of Red blood cells and ascorbic acid for helping absorption of iron. Stress on proper oral and body hygiene. Clinic Schedules DIET (collaborative) Advice client to eat proper diet. 3.Encourage and explain the importance of breast feeding to the client. Advise her to eat food which are rich in protein. Encourage her to eat more vegetables and frequent intake of liquids. Provide information to enhance self-care OUT-PATIENT 1. Breastfeeding especially the first milk. Advice client to let her child expose to mild sunlight in order to balance and avoid excess bilirubin in the blood. colostrum. Protein helps to repair body tissues. Inform relatives regarding importance of compliance on follow-up check up.

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