Case Presentation: Preeclampsia

Introduction

a. What is Preeclampsia

Pregnancy is divided into three trimesters: 1st, 2nd and 3rd trimester. Hypertension during
pregnancy can be very serious and concludes problems and therefore a pregnant woman with
hypertension is often a high-risk patient. There are different types of hypertensive disorders in
pregnancy which is important to us with how we can define what pre-eclampsia is and how it
differs from the other hypertensive disorders during pregnancy. The 20 th week age of gestation
which is around the second trimester is an important mark to remember and the reason is that
week 20 is where the different hypertensive disorders during pregnancy is classified into.

Hypertension diagnosed before week 20 of pregnancy is called chronic hypertension which

is a hypertension diagnosed before pregnancy or before 20 weeks age of gestation during
pregnancy. Cases of increase in BP after the 20 th week age of gestation can either be,
Gestational Hypertension or Pre-eclampsia. The difference between gestational hypertension
and preeclampsia, which is a more serious form of hypertension during pregnancy, is that there
is an increase in blood pressure which occurs after 20 weeks pregnancy and there is a presence
of proteins in urine or characterized by proteinuria or systemic features such as vision problems,
liver problems and kidney problems. Meanwhile, gestational hypertension is also an increase in
BP after 20 weeks AOG but not manifested by any systemic features.

Specifically, preeclampsia is defined as an elevation in blood pressure (systolic blood

pressure >140 mm Hg or diastolic pressure >90 mm Hg) and proteinuria (≥300 g in 24 hours)
developing after 20 weeks of gestation.

b. Types of Preeclampsia

Mild Pre-ecclampsia - Blood pressure 140/90 or systolic pressure elevated 30 mm Hg or

diastolic pressure elevated 15 mm Hg above prepregnancy level; proteinuria of 1–2% on a
random sample; weight gain over 2 lb per wk in second trimester and 1 lb per wk in third
trimester; mild edema in upper extremities or face.

Severe Pre-eclampsia - Blood pressure of 160/110; proteinuria 3–4% on a random sample and 5
g on a 24-hour sample; oliguria (500 mL or less in 24 hours or altered renal function tests;
elevated serum creatinine more than 1.2 mg/dL); cerebral or visual disturbances (headache,
blurred vision); pulmonary or cardiac involvement; extensive peripheral edema; hepatic
dysfunction; thrombocytopenia; epigastric pain.

Eclampsia - Seizure or coma accompanied by signs and symptoms of pre-eclampsia.

c. Epidemiology
 Hypertensive disorders in pregnancy are one of the leading causes of morbidity, long-term
disability and death during pregnancy and postpartum and account for approximately 14% of all
maternal deaths worldwide (WHO, 2018). Specifically, Pre-eclampsia complicates 2–8% of
pregnancies globally and in Asia, 9% of maternal deaths are attributed to pre-eclampsia (WHO
Systematic Analysis). From a global perspective, most deaths due to hypertensive disorders of
pregnancy occur in developing countries. In 2018, eclampsia was the leading cause of maternal
death in 2018 with 284 deaths and comprised 17.6 percent of maternal deaths (PSA, 208).

d. Etiology and Pathophysiology

The symptoms of PIH affect almost all organs. The vascular spasm may be caused by the
increased cardiac output that occurs with pregnancy and injures the endothelial cells of the
arteries or the action of prostaglandins (notably decreased prostacyclin, a vasodilator, and
excessive production of thromboxane, a vasoconstrictor and stimulant of platelet aggregation).
Normally, blood vessels during pregnancy are resistant to the effects of pressor substances such
as angiotensin and norepinephrine, so blood pressure remains normal during pregnancy. With
PIH, this reduced responsiveness to blood pressure changes appears to be lost. Vasoconstriction
occurs and blood pressure increases dramatically. With hypertension, the cardiac system can
become overwhelmed because the heart is forced to pump against rising peripheral resistance.
This reduces the blood supply to organs, most markedly the kidney, pancreas, liver, brain, and
placenta. Poor placental perfusion may reduce the fetal nutrient and oxygen supply. Ischemia in
the pancreas may result in epigastric pain and an elevated amylase–creatinine ratio. Spasm of the
arteries in the retina leads to vision changes. If retinal hemorrhages occur, blindness can result.
Vasospasm in the kidney increases blood flow resistance. Degenerative changes develop in
kidney glomeruli because of back-pressure. This leads to increased permeability of the
glomerular membrane, allowing the serum proteins albumin and globulin to escape into the urine
(proteinuria). The degenerative changes also result in decreased glomerular filtration, so there is
lowered urine output and clearance of creatinine. Increased kidney tubular reabsorption of
sodium occurs. Because sodium retains fluid, edema results. Edema is further increased because
as more protein is lost, the osmotic pressure of the circulating blood falls and fluid diffuses from
the circulatory system into the denser interstitial spaces to equalize the pressure (Fig. 21.8).
Extreme edema can lead to cerebral and pulmonary edema and seizures (eclampsia). Yet another
effect is that arterial spasm causes the bulk of the blood volume in the maternal circulation to be
pooled in the venous circulation, so a woman has a deceptively low arterial intravascular
volume. In addition, thrombocytopenia or a lowered platelet count occurs as platelet cluster at
the sites of endothelial damage. Measuring hematocrit levels helps to assess the extent of plasma
loss to the interstitial space or the extent of the edema (the higher the hematocrit, the more is
being lost). A hematocrit level above 40% suggests significant fluid loss into interstitial spaces.
e. Clinical Manifestation

PIH tends to occur most frequently in women of color or with a multiple pregnancy,
primiparas younger than 20 years or older than 40 years, women from low socioeconomic
backgrounds (perhaps because of poor nutrition), those who have had five or more pregnancies,
those who have hydramnios (overproduction of amniotic fluid; refer to discussion later), or those
who have an underlying disease such as heart disease, diabetes with vessel or renal involvement,
and essential hypertension.

The presence of a systolic blood pressure of 160 mm Hg or higher or a diastolic pressure of

110 mm Hg or higher, proteinuria greater than 2 g in 24 hours, serum creatinine greater than 1.2
mg/dL, platelet counts less than 100,000 cells/mm3, elevated liver enzymes (alanine
aminotransferase [ALT] or aspartate aminotransferase [AST]), persistent headache or cerebral or
visual disturbances, and persistent epigastric pain serves to reinforce the diagnosis.

f. Complications

Preeclampsia has a plethora of manifestations. Beyond the clinical triad of hypertension,

edema, and proteinuria, patients also can have increased deep tendon refexes, or placental
abruption. Hepatic periportal congestion, hemorrhage, and necrosis can lead to elevated liver
function tests and ultimately result in rupture of the hepatic capsule. Severe preeclampsia also
can produce renal changes, including glomerular endothelial cell swelling, mesangial
proliferation, and marked narrowing of glomerular capillary lumens. The renal cortex displays
signifi cant cortical ischemia that may progress to frank necrosis and acute kidney injury.
Thrombocytopenia and disseminated intravascular coagulopathy (DIC) as well as cerebral
vascular accidents also may occur eclampsia, or maternal seizure resulting from cerebral
ischemia and petechial hemorrhage, can occur in this setting or can appear as the fi rst
manifestation of this disease. Preeclampsia-eclampsia also carries risks for the fetus. Placental
deterioration and insufficiency can result in intrauterine growth restriction (IUGR) and fetal
hypoxia. Delivery of the fetus and placenta is the only definitive cure for this syndrome, which
carries a high morbidity and mortality for both mother and child.

g. Assessment and Diagnostic Findings

a. Blood Pressure - Blood pressure is a measure of the force of blood on artery walls (main
blood vessels) as it flows through them.
b. Blood tests. Your doctor will order liver function tests, kidney function tests and also
measure your platelets — the cells that help blood clot.
c. Urine analysis. Your doctor will ask you to collect your urine for 24 hours, for measurement
of the amount of protein in your urine. A single urine sample that measures the ratio of
protein to creatinine — a chemical that's always present in the urine — also may be used to
make the diagnosis.
d. Fetal ultrasound. Your doctor may also recommend close monitoring of your baby's
growth, typically through ultrasound. The images of your baby created during the ultrasound
 exam allow your doctor to estimate fetal weight and the amount of fluid in the uterus
(amniotic fluid).
e. Nonstress test or biophysical profile. A nonstress test is a simple procedure that checks
how your baby's heart rate reacts when your baby moves. A biophysical profile uses an
ultrasound to measure your baby's breathing, muscle tone, movement and the volume of
amniotic fluid in your uterus.

h. Management and Treatment

Early prenatal care is important in the detection of high blood pressure during pregnancy. It
is recommended that all pregnant women, including those with hypertension, refrain from
alcohol and tobacco use. Salt restriction usually is not recommended during pregnancy because
pregnant women with hypertension tend to have lower plasma volumes than normotensive
pregnant women and because the severity of hypertension may reflect the degree of volume
contraction. The exception is women with preexisting hypertension who have been following a
salt-restricted diet. In women with preeclampsia, delivery of the fetus is curative. The timing of
delivery becomes a difficult decision in preterm pregnancies because the welfare of both the
mother and the infant must be taken into account. Bed rest is a traditional therapy.
Antihypertensive medications, when required, must be carefully chosen because of their
potential effects on uteroplacental blood flow and on the fetus.
 Patient History

I. Demographic Profile

Patient Name: Mrs. X

Sex: Female
Age: 32
Address: Tacloban City
Marital Status: Married
Nationality: Filipino
Religion: Roman Catholic
Educational attainment: College
Gravida: 4
Parity: 1
No. of Living children: 1
Blood type: AB
Rh: +
Weight: 68 kg
Height: 156 cm.
Occupation: Teacher
Age of Gestation: 34 weeks

II. Chief Complaints

Severe head ache and diplopia.

III. History of Present Illness

Patient complained of head ache with pain rating scale of 8/10. Blood pressure elevated and
noted to be at 160/100 mmHg. Just took her maintenance of methyldopa 500 mg and
Hydralazine 50 mg and Paracetamol 500 mg. BP was repeated and noted to be at 140/100 mmHg
with slightly improvement of symptoms. Upon waking up, head ache is more severe and
pulsating in character associated with diplopia with pain rating scale of 10/10.

IV. Past Medical or Surgical History

She is currently diagnosed with severe preeclampsia and have tested positive for pre-
eclampsia during her first pregnancy and delivered prematurely at 35 weeks’ age of gestation via
emergency caesarian section. Client had dilation and curettage due to spontaneous abortion twice
during 2nd and 3rd pregnancy.

V. Family History

Client’s family had history of diabetes and hypertension. Also, her mother delivered to both
children via emergency caesarian section due to preeclampsia.
 VI. Gynecologic History

She had her menarche at 12 years old with a 28-day cycle. The amount is moderate with a
duration of 6 days with no pain reported. Her last menstrual period was on June 27, 2020 with
moderate amount and a duration of 5 days.

VII. Obstetric History

Total pregnancies: 4
Full term: 0
Abortion: 2
Alive: 1

Weeks Length Type Weight Fate of Place Attended Complications

Date
Gestation Labor Delivery Baby Baby Delivery by Remarks
Bleeding Intra
G1 35 Weeks 2016 “E” CS 2.1 kg Alive RTRH Male
OP
G2 5 Weeks 2018 Spontaneous Abortion D&C
G3 8 Weeks 2019 Spontaneous Abortion D&C
G4 Present Pregnancy

VIII. Present Pregnancy

LMP: 6/27/20
Date of First Fetal Movement: 16 Weeks
Date of Lightening: 24 Weeks
AOG: 34
EDC: 4/3/21

IX. Physical Examination

Vital Signs: Upon admission: BP: 190/110; T: 37.6; Pulse: 110; RR: 24
General appearance and condition: Patient is mesomorphic
Skin: Skin has no lesions, no hypothyperpigmentation, and has a good turgor
Head: the head is proportional and symmetrically round and in midline to the client’s body
without lesion and no tenderness upon palpation. Scalp is clean and dry.
Neck: the neck is supple
Lungs: Symmetrical chest expansion
Breast: Engorged
Nipples: Inverted
Abdomen: the contour is globular with a fundal height of 28 cm. Striae and and scar is present.
The presentation is in cephalic presentation and the fetal heart beat is at 148 beats/minute.
Pelvic Examination
Vagina: nulliparous
Uterus: gravid
Adnexae: non-palpable
 Cervix: dilation is closed
Bag of water: intact
Presentation and position: cephalic
Estimated fetal weight: 2.0 kg

X. Gordon’s Typology of 11 Functional Health Unit

a. Health Perception/Health Management: The patient takes her medication. She does
regular exercise every morning and she always goes to hospital for her annual check-ups.

b. Nutritional-Metabolic: The patient eats 3 times a day and 3 times snack interval in
between meals. She brushes her teeth 3 times a day after a meal. The patient had a good
skin turgor with no lesions and no hypothyperpigmentation.

c. Elimination: The patient defecates every day and urinates 4 to 5 times a day.

d. Activity-exercise: The patient does regular exercises every morning. Her hobbies are
watching televisions and reading magazines.

e. Cognitive-Perceptual: The patient does not show any mental disorder. The speech
patterns, constructions of words are normal.

f. Sleep-rest: The patient sleep around 10 in the evening and wake up around 8 in the
morning. The patient has no difficulty in sleeping.

g. Self-perception/self-concept: The patient sees herself as a

h. Role Relationship: The patient cooks for her family. She do household chores.

i. Sexuality-Reproductive: The patient had 4 pregnancies. She only had one children alive
and her present pregnancy. She tested positive for preeclampsia in her first pregnancy and
delivered prematurely at 35 weeks’ age of gestation via emergency caesarian section.

j. Coping/Stress Tolerance: The patient usually watch television.

k. Value-Belief: The patient is a roman catholic. She goes to church every Sunday and she
always pray every night.
Signs and Symptoms
Laboratory and diagnostic results
 Pathophysiology

The symptoms of PIH affect almost all organs. The vascular spasm may be caused by the
increased cardiac output that occurs with pregnancy and injures the endothelial cells of the
arteries or the action of prostaglandins (notably decreased prostacyclin, a vasodilator, and
excessive production of thromboxane, a vasoconstrictor and stimulant of platelet aggregation).
Normally, blood vessels during pregnancy are resistant to the effects of pressor substances such
as angiotensin and norepinephrine, so blood pressure remains normal during pregnancy. With
PIH, this reduced responsiveness to blood pressure changes appears to be lost. Vasoconstriction
occurs and blood pressure increases dramatically. With hypertension, the cardiac system can
become overwhelmed because the heart is forced to pump against rising peripheral resistance.
This reduces the blood supply to organs, most markedly the kidney, pancreas, liver, brain, and
placenta. Poor placental perfusion may reduce the fetal nutrient and oxygen supply. Ischemia in
the pancreas may result in epigastric pain and an elevated amylase–creatinine ratio. Spasm of the
arteries in the retina leads to vision changes. If retinal hemorrhages occur, blindness can result.
Vasospasm in the kidney increases blood flow resistance. Degenerative changes develop in
kidney glomeruli because of back-pressure. This leads to increased permeability of the
glomerular membrane, allowing the serum proteins albumin and globulin to escape into the urine
(proteinuria). The degenerative changes also result in decreased glomerular filtration, so there is
lowered urine output and clearance of creatinine. Increased kidney tubular reabsorption of
sodium occurs. Because sodium retains fluid, edema results. Edema is further increased because
as more protein is lost, the osmotic pressure of the circulating blood falls and fluid diffuses from
the circulatory system into the denser interstitial spaces to equalize the pressure (Fig. 21.8).
Extreme edema can lead to cerebral and pulmonary edema and seizures (eclampsia). Yet another
effect is that arterial spasm causes the bulk of the blood volume in the maternal circulation to be
pooled in the venous circulation, so a woman has a deceptively low arterial intravascular volume.
In addition, thrombocytopenia or a lowered platelet count occurs as platelet cluster at the sites of
endothelial damage. Measuring hematocrit levels helps to assess the extent of plasma loss to the
interstitial space or the extent of the edema (the higher the hematocrit, the more is being lost). A
hematocrit level above 40% suggests significant fluid loss into interstitial spaces.
 Pharmacologic Study

Mechanism Of Contraindication And Side Effects /

Name Of Drug Indications Nursing Responsibilities
Action Caution Adverse Effects
Generic name: May inhibit the central ● HTN, hypertensive ● Contraindicated in CNS: decreased mental
Methyldopa vasomotor centers, crisis patients hypersensitive to acuity, sedation, ● Monitor periodic counts to
decreasing drug and in those with headache, weakness, detect adverse hematologic
sympathetic outflow to active hepatic disease dizziness, paresthesia, reactions.
Brand name: the heart, kidneys, and (such as acute hepatitis) parkinsonism, ● Monitor liver function test and
peripheral vasculature. or active cirrhosis. involuntary check for signs and symptoms
Aldomet, Apo- choreoathetoid of hepatic dysfunction.
Methyldopa, Dopamet, movements, psychic ● Check for edema or weight
Novomedopa ● Contraindicated in those disturbances, gain to help determine if
whose previous depression, nightmares. diuretic should be added to
methyldopa therapy regimen.
caused liver problems ● Monitor blood pressure.
Dosage: 500 mg
and in those taking MAO ● If unpleasant adverse reactions
inhibitors. CV: orthostatic
hypotension, edema, occur, advise patient not to
Frequency: TID bradycardia, HF, suddenly stop taking drug but
● Use cautiously in patients myocarditis, to notify prescriber.
with history of impaired aggravated angina, ● Instruct patient to report signs
hepatic function or sulfite paradoxical pressor and symptoms of infection,
Route: Oral
sensitivity. response with I.V. use, yellowing of the skin, flu-like
pericarditis. symptoms, and muscle aches.
● Inform patient that low BP and
dizziness upon rising can be
minimized by rising slowly
EENT: nasal
and avoiding sudden position
congestion
changes.

GI: dry mouth,

pancreatitis, nausea,
vomiting, diarrhea,
constipation, flatus,
sore or “black” tongue,
abdominal distention,
colitis.
 GU: galactorrhea, dark
urine

Hematologic:
thrombocytopenia,
leukopenia, bone
marrow depression,
hemolytic anemia.

Hepatic: hepatic
necrosis, hepatitis,
jaundice.

Musculoskeletal:
arthralgia

Skin: rash

Other: drug-induced
fever, gynecomastia,
hyperprolactinemia.

Generic name: A direct-acting ● Essential hypertension ● Contraindicated in CNS: headache, ● Obtain B/P, pulse immediately
Hydralazine peripheral vasodilator ● Severe essential patients hypertensive to dizziness, peripheral, before each dose, in addition
that relaxes arteriolar hypertension drug. neuritis to regular monitor ing (be alert
smooth muscle. ● HF to fluctuations).
Brand name: ● Monitor B/P, pulse.
● Drug may contain ● Monitor for headache,
tartrazine and cause CV: angina pectoris,
Apresoline palpitations, palpitations, tachycardia.
allergic reactions, ● Assess for peripheral edema of
especially in patients tachycardia, orthostatic
hypotension, edema, hands, feet.
hypersensitive to aspirin. ● To reduce hypotensive effect,
Dosage: 50 mg flushing go from lying to standing
slowly.
● Contraindicated in those ● Report muscle/joint aches,
with CAD or mitral fever (lupus-like reaction), flu-
Frequency: TID valvular rheumatic heart EENT: conjunctivitis,
nasal congestion like symptoms.
disease. ● Limit alcohol use.
Route: Oral
● Use cautiously in patients GI: nausea, vomiting,
with suspected cardiac diarrhea, anorexia,
disease, stroke, or severe constipation, paralytic
renal impairment and in ileus
those taking other anti
hypersensitives.
GU: difficult urination
● May cause blood
dyscrasias. Discontinue if
they occur. Hematologic:
neutropenia,
leukopenia,
agranulocytosis,
eosinophilia,
thrombocytopenia with
or without purpura.

Musculoskeletal:
muscle cramps,
arthralgia

Respiratory: dyspnea

Skin: rash

Other: hypersensitivity
reactions, chills
Generic name: Thought to inhibit ● Vasospastic angina ● Contraindicated in
calcium ion influx (Prinzmetal or patients hypersensitive to
Nifedipine across cardiac and variant angina), drug, in those taking
smooth muscle cells, classic chronic stable strong CYP450 inducers
decreasing angina pectoris (rifampin), and in
Brand name: contractility and ● HTN patients with cardiogenic
oxygen demand. Drug ● Ureteral calculi shock or ST-segment
Adalat CC, Adalat XL,
may also dilate (distal) elevation MI.
Afeditab CR,
coronary arteries and
Procardia, Procardia
arterioles.
XL ● Increased angina and MI
have occurred at start of
therapy or with dosage
Dosage: 10 mg titration of
dihydropyridine calcium
channel blockers. Reflex
tachycardia may occur,
Frequency: TID
resulting in angina or MI
in patients with
obstructive coronary
Route: Oral
disease, especially in the
absence of concurrent
beta blockade.
● BP must be lowered at a
rate appropriate for
patient’s clinical
condition to avoid
symptomatic hypotension
with or without syncope.
The use of immediate-
release nifedipine in
hypertensive emergencies
and urgencies is neither
safe nor effective.
Serious adverse events
CNS: dizziness, light- ● Concurrent therapy with
headedness, giddiness, sublingual nitroglycerin may
headache, weakness, be used for relief of anginal
nervousness, mood pain.
changes, shakiness, ● Record onset, type (sharp,
sleep disturbances, dull, squeezing), radiation,
fever location, intensity, duration of
anginal pain; precipitating
factors (exertion, emotional
CV: flushing, heat stress).
sensation, peripheral ● Check B/P for hypotension
immediately before giving
edema, palpitations,
transient hypotension. medication.
● Assist with ambulation if light-
headedness, dizziness occurs.
● Assess for peripheral edema.
EENT: nasal
● Assess skin for flushing.
congestion, sore throat,
● Monitor LFT.
blurred vision
● Observe for signs/symptoms
of HF.
● Go from lying to standing
GI: nausea, heartburn, slowly.
diarrhea, constipation, ● Report palpitations, shortness
cramps, flatulence of breath, pronounced
dizziness, nausea,
exacerbations of angina.
Musculoskeletal: ● Avoid alcohol; concomitant
muscle cramps, tremor, grapefruit product use.
inflammation, joint
stiffness
Respiratory: dyspnea,
cough, wheezing, chest
congestion, shortness
 have been reported. of breath.
Don’t use immediate-
release nifedipine for
acute BP reduction or to Skin: dermatitis,
manage primary HTN. pruritus, urticaria,
sweating
● Avoid use in patients
with HF; drug may
worsen symptoms. Other: difficulties in
balance, chills, sexual
difficulties.
● Use with extreme caution
in patients with severe
aortic stenosis. Drug may
reduce coronary
perfusion, resulting in
ischemia.

● Use cautiously in patients

with hypertrophic
cardiomyopathy and
outflow tract obstruction
because reduction in
afterload may worsen
symptoms.

● Use cautiously before

major surgery.
Cardiopulmonary bypass,
intraoperative blood loss,
or vasodilating anesthesia
may result in severe
hypotension or increased
fluid requirements.
Consider withdrawing
nifedipine more than 36
hours before surgery if
possible.
 ● Rare reversible
elevations in BUN and
serum creatinine levels
have been reported in
patients with preexisting
chronic renal
insufficiency.

● Use cautiously in patients

with hepatic impairment.
Clearance of nifedipine is
reduced in cirrhotic
patients, leading to
increased systemic
exposure and possibly
increasing toxicity;
monitor patient and
consider dosage
adjustments.

Generic name: Replaces magnesium ● Mild ● Contraindicated in CNS: toxicity, weak or ● Keep I.V. calcium available to
and maintains hypomagnesemia patients with myocardial absent deep tendon reserve magnesium
Magnesium Sulfate magnesium level; as ● Symptomatic severe damage, heart block, or reflexes, flaccid intoxication.
an anticonvulsant, hypermagnesemia, coma. paralysis, ● Test knee-jerk and patellar
reduces muscle with magnesium ● Use cautiously in patients drowsiness,stupor. reflexes before each additional
Brand name: contractions by level of 0.8 mEq/L or with impaired renal dose. If absent, notify
interfering with less function. prescriber and give no more
release of ● Magnesium CV:slow, weak pulse, magnesium until reflexes
Dosage: 4 gm acetylcholine at supplementation in arrhythmias, return; otherwise, patient may
myoneural junction. total parenteral hypotension; develop temporary respiratory
nutrition (TPN) circulatory collapse, failure and need
Frequency: q 4h ● Seizures in flushing. cardiopulmonary resuscitation
preeclampsia or or I.V. administration of
 eclampsia calcium.
● Check magnesium level after
Route: IVTT, IM GI: diarrhea repeated doses.
● 500Monitor fluid intake and
output. Output should be 100
Metabolic: mL or more during a 4-hour
hypocalcemia period before dose.
● Monitor renal function.
● Drug may contain aluminum.
Respiratory: Premature neonates are at
respiratory paralysis higher risk for aluminum
toxicity due to immature renal
function. Aluminum exposure
Skin:diaphoresis of more than 4 ti 5 mcg/kg/day
is associated with CNS and
bone toxicity.
● Patients with prolonged
Other: hypothermia
exposure to magnesium sulfate
who have impaired renal
function are at risk for
aluminum toxicity.

Generic name: Unclear. Decreases ● Cerebral edema ● Contraindicated in CNS: euphoria, ● Assess for hypersensitivity to
Dexamethasone inflammation, mainly ● Palliative patients hypersensitivity insomnia, psychotic any corticosteroids.
by stabilizing management of to drug or its ingredients, behavior, pseudotumor ● Obtain baselines for height,
leukocyte lysosomal recurrent or in those with systemic cerebri, vertigo, weight, B/P, serum glucose,
Brand name: membranes; inoperable brain fungal infections, and in headache, paresthesia, electrolytes.
suppresses immune tumors those receiving seizures, depression. ● Question medical history as
response; stimulates ● Inflammatory immunosuppres- listed in Precautions.
bone marrow; and conditions, sive doses together with ● Monitor I&O, daily weight,
Dosage: 6 mg
influences protein, fat, neoplasias live-virus vaccines. I.M. CV: HF, HTN, edema, serum glucose.
and carbohydrate ● Acute, self-limited administration is arrhythmias, ● Assess for edema.
metabolism. allergic contraindicated in thrombophlebitis, ● Evaluate food tolerance.
Frequency: STAT, q disorders;acute patients with ITP. ● Monitor daily pattern of bowel
thromboembolism.
12h exacerbations of activity, stool consistency.
chronic allergic ● Report hyperacidity promptly.
disorders ● Use cautiously in patients EENT: ● Check vital signs at least twice
cataracts,
Route: IM ● Shock with recent MI. daily.
glaucoma
● Dexamethasone ● Be alert to infection (sore
suppression test for throat, fever, vague
 Cushing syndrome ● Use cautiously in patients
● Adrenocortical
insufficiency
● Acute exacerbation
of MS
● Adjunctive therapy
for short term
administration in
synovitis of
osteoarthritis, RA,
bursitis, acute gouty
arthritis,
epicondylitis, acute
nonspecific
tenosynovitis,
posttraumatic
osteoarthritis; lesions
(keloids; localized,
● Because some forms
hypertrophic,
infiltrated,
inflammatory lesions
of lichen planus,
psoriatic plaques,
granuloma annulare,
or lichen simplex
chronicus; discoid
lupus erythematosus;
necrobiosis lipoidica
diabeticorum;
alopecia areata;
cystic tumors of an
aponeurosis or
tendon)
symptoms).
with GI ulcer, renal ● Monitor serum electrolytes,
disease, HTN, GO: peptic ulceration, esp. for hypercalcemia,
osteoporosis, diabetes GI irritation, increased hypokalemia, paresthesia (esp.
mellitus, hypothyroidism, appetite, pancreatitis, lower extremities,
cirrhosis, diverticulitis, nausea, vomiting. nausea/vomiting, irritability),
nonspecific ulcerative Hgb, occult blood loss.
colitis, recent intestinal ● Assess emotional status,
anastomoses, GU: menstrual ability to sleep.
thromboembolic irregularities, increased Abrupt withdrawal may cause
disorders, seizures, urine glucose and adrenal insufficiency; taper
myasthenia gravis, HF, calcium levels. dose gradually.
TB, active hepatitis,
Metabolic: ● Do not change dose/schedule
ocular HSV infection,
hypokalemia, or stop taking drug.
emotional instability, or
hyperglycemia, ● Must taper off gradually under
psychotic tendencies.
carbohydrate medical supervision.
intolerance, ● Report fever, sore throat,
hypercholesterolemia, muscle aches, sudden weight
contain sulfite hypocalcemia, sodium gain, edema, exposure to
preservatives, also use retention, weight gain measles/chickenpox.
cautiously in patients ● Severe stress (serious
sensitive to sulfites. infection, surgery, trauma)
Musculoskeletal: may require increased dosage.
growth suppression in ● Inform dentist, other
children, muscle physicians of dexamethasone
weakness, therapy within past 12 mos.
osteoporosis, tendon ● Avoid alcohol, limit caffeine.
rupture, myopathy.
Skin: hirsutism,
delayed wound healing,
acne, various skin
eruptions, atrophy at
I.M. injection site, thin
fragile skin.
Other: cushingoid
 state, susceptibility to
infections, acute
adrenal insufficiency
after increased stress or
abrupt withdrawal after
long-term therapy,
angioedema.

After abrupt
withdrawal: rebound
inflammation, fatigue,
weakness, arthralgia,
fever, dizziness,
lethargy, fainting,
orthostatic
hypotension, dyspnea,
anorexia,
hypoglycemia. After
prolonged use, sudden
withdrawal may be
fatal.

Generic name: Co- Co-amoxiclav is an ● Pre & post-surgical ● History of penicillin GI: ● Ensure that the patient has
Amoxiclav antibacterial procedures hypersensitivity. adequate fluid intake during
combination ● Bone & joint, ● Superinfections Diarrhea,Nausea and any diarrhea attack.
consisting of infections involving Pseudomonas vomiting ● Ice chips and crackers to
Dosage: 625 mg amoxicillin ● Skin & soft tissue or candida. prevent nausea and vomiting
(assodium) and the infections ● The drug must be taken in
beta-lactamase ● UTI ● Pregnancy & lactation equal doses around the clock
inhibitor, clavulanic to maintain level in the blood.
Frequency: BID Hematology:
acid (as potassium ● This could indicate allergy to
clavulanate).Amoxicill Anemia, Neutropenia drug and it should be reported.
in is the 4-hydroxy ● Dose with caution and monitor
Route: Oral analogue of hepatic function at regular
ampicillin. Allergic reactions: intervals
Amoxicillin hinders itching,rashes,wheezin
the cell wall synthesis g,cholestatic jaundice
of sensitive bacteria
 and is bactericidal
against many Gram-
positive and Gram-
negative bacteria

Generic name: Unknown. Thought to ● Moderate to ● Contraindicated in ● CNS: ● Assess onset, type, location,
Tramadol bind to opioid moderately severe patients hypersensitive to dizziness, duration of pain.
receptors and inhibit chronic pain drug or opioids, in headache, ● Assess drug history, esp.
reuptake of patients with severe renal somnolence, carBAMazepine, analgesics,
Brand name: ConZip, norepinephrine and or hepatic impairment, vertigo, CNS depressants, MAOIs.
Durela, Ralivia, serotonin. suicidal patients, and in seizures, ● Review past medical history,
Tridural, Ultram, those with acute anxiety, esp. epilepsy, seizures.
Zytram XL intoxication from alcohol asthenia, CNS ● Assess renal function, LFT.
, hypnotics, centrally stimulants, ● Monitor pulse, B/P,
acting analgesics, confusion, renal/hepatic function.
opioids, or psychotropic coordination ● Assist with ambulation if
Dosage: 200 mg +
drugs. disturbance, dizziness, vertigo occurs.
PNSS 1L
● Contraindicated in euphoria, ● Dry crackers, cola may relieve
patients with GI malaise, nausea.
obstruction, including nervousness, ● Palpate bladder for urinary
Frequency: 24 H x 2 paralytic ileus. sleep disorder, retention.
cycles ● Contraindicated with fever, ● Monitor daily pattern of bowel
concomitant use or paresthesia, activity, stool consistency.
within 14 days of MAO tremor, ● Sips of water may relieve dry
Route: IV inhibitor therapy. depression, mouth.
● Contraindicated in agitation, ● Assess for clinical
patients with significance apathy. improvement, record onset of
respiratory depression relief of pain.
acute or severe bronchial ● May cause dependence.
asthma or hypercapnia in ● CV: ● Avoid alcohol, OTC
unmonitored settings or vasodilation, medications (analgesics,
where resuscitative HTN, sedatives).
equipment isn’t peripheral ● May cause drowsiness,
available. edema dizziness, blurred vision.
● Avoid tasks requiring
● EENT: visual alertness, motor skills until
disturbances, response to drug is established.
nasopharyngitis ● Report severe constipation,
, pharyngitis, difficulty breathing, excessive
 rhinitis, sedation, seizures, muscle
sinusitis. weakness, tremors, chest pain,
palpitations.
● GI:
constipation,na
usea, vomiting,
abdominal
pain, anorexia,
diarrhea, dry
mouth,
dyspepsia,
flatulence.

● GU:
menopausal
symptoms,
proteinuria,
urinary
frequency,
urine retention,
pelvic pain,
UTI, prostate
disorder.

● Metabolic:
weight loss

● Musculoskelet
al: hypertonia,
arthralgia, neck
pain, myalgia.

● Respiratory:
bronchitis,
respiratory
depression.
 ● Skin:
diaphoresis,
pruritus, rash.
● Other: chills,
withdrawal
syndrome,
accidental
injury.

Generic name: Aspirin-like drug that ● Relief of pain ● Contraindicated in pts CNS: dizziness, ● Assess pt’s pain before
Mefenamic Acid has analgesic, including muscular, hypersensitivity to drug headache,nervousness, therapy: location,duration,
antipyretic and anti- rheumatic,traumatic, or other NSAIDs tremors frequency, precipitating and
inflammatory dental, postoperative ● Contraindicated in those aggravating factors
Dosage: 500 mg activities.These and postpartum pain, who have experienced ● Tell pt to report history of
activities appear to be headache migraine, asthma,urticaria or CV: congestive heart allergic reactions to NSAIDs
due to its ability to fever. allergic-type reactions failure,hypertension,tac before starting therapy
inhibit after taking aspirin hycardia, syncope ● Prepare food to intake with
Frequency: BID
cyclooxygenase & ● Contraindicated in pts drug
also antagonize certain with acute active ● Assess if the pt has taken drug
effects of ulceration or chronic that may decrease the
Route: Oral GI: gas pain,
prostaglandins. inflammation of either medication’s effectiveness
diarrhea/constipation,
upper or lower GI tract. ● Inform the patient need and
vomiting,dyspepsia,
● Use cautiously in pts importance of the drug to her.
peptic ulceration,
with a history of ulcers or ● Administer with food or milk
nausea
GI bleeding,asthma, to decrease gastric symptoms
epilepsy, kidney or liver ● Do not increase dose without a
disease. physician's order.
Metabolic: weight ● Administer drug with full glass
changes of water to enhance
absorption.
● Do not crush, dissolve or chew
Respiratory: capsules/tablets.
● Caution in pts with history of
asthma, dyspnea
peptic ulcer or GI bleeding,
epilepsy or liver disease.
 ● Instruct pt not to take drug for
more than 7days.
Skin: rash, ● Advise pt to immediately
alopecia,photosensitivit report persistence or failure to
y, pruritus relieve pain.
● Tell pt to report occurrence of
drug induced adverse reactions
Urogenital: Cystitis, ● Teach pt that all NSAIDs,
dysuria,hematuria, including mefenamic acid,
interstitial may harm the liver.
nephritis,oliguria/polyu ● Discuss in detail all aspects of
ria, renal failure the drug therapy: reason for
taking the drug & expected
results

Generic name: Competes with ● Rhinitis, allergy ● Contraindicated in CNS: drowsiness, ● If pt is having acute allergic
Diphenhydramine Histamine for H1- symptoms, motion patients hypersensitive to sedation, sleepiness, reaction, obtain history of
receptor sites. sickness, Parkinson drug and other similar dizziness, recently ingested foods, drugs,
Prevents, but doesn’t disease antihistamines, in incoordination, environmental exposure,
Brand name: reverse, histamine- ● Nighttime sleep aid newborns, and in seizures, confusion, emotional stress.
Allerdryl, Banophen, mediated responses, ● Nonproductive cough premature neonates. insomnia, headache, ● Monitor B/P rate; depth,
Benadryl, Benadryl particularly those of ● Use cautiously in patients vertigo, fatigue, rhythm, type of respiration;
Children’s Allergy, the bronchial tubes, GI with angle-closure restlessness, tremor, quality, rate of pulse.
tract, uterus, and blood glaucoma, stenosing nervousness. ● Assess lung sounds for
Diphen, Diphenhist, vessels. peptic ulcer, rhonchi, wheezing, rales.
symptomatic prostatic ● Monitor for sedation.
Genahist, Nytol
hyperplasia, bladder neck CV: palpitations, ● Tolerance to antihistaminic
obstruction, hypotension, effect generally does not
pyloroduodenal tachycardia. occur; tolerance to sedative
obstruction, or asthma. effect may occur.
Dosage: 50 mg ● Avoid use in patients ● Avoid tasks that require
taking MAO inhibitors. alertness, motor skills until
EENT: diplopia,
● Use with caution in response to drug is established.
blurred vision, nasal
patients with prostatic ● Dry mouth, drowsiness,
Frequency: q 8h congestion, tinnitus.
hyperplasia, asthma, dizziness may be an expected
COPD, increased IOP, response to drug.
hyperthyroidism, CV ● Avoid alcohol.
Route: IVTT disease, and HTN. GI: dry mouth, nausea,
● Children younger than epigastric distress,
age 12 should use drug vomiting, diarrhea,
 only as directed by the constipation, anorexia.
prescriber.

GU: dysuria, urine

retention, urinary
frequency, early
menses.

Hematologic:
thrombocytopenia,
agranulocytosis,
hemolytic anemia.

Respiratory:
thickening of bronchial
secretions.

Skin: urticaria,
photosensitivity, rash
Other: anaphylactic
shock.

Generic name: Replaces calcium and ● Hypocalcemia ● Contraindicated in cancer ● CNS: tingling ● Assess B/P, EKG and cardiac
maintains calcium ● Adjunctive treatment patients with bone sensations, sense rhythm, renal function, serum
Calcium Gluconate level. of magnesium metastases and in those of oppression or magnesium, phosphate,
intoxication with ventricular heat waves with calcium, ionized calcium.
● During exchange fibrillation, I.V. use, syncope ● Monitor serum BMP, calcium,
Dosage: 500 mg transfusion hypercalcemia, with rapid I.V. use. ionized calcium, magnesium,
● Hyperphosphatemia hypophosphatemia, or phosphate; B/P, cardiac
● Dietary supplement renal calculi. rhythm, renal function.
● Hyperkalemia with ● CV: bradycardia, ● Monitor for signs of
Frequency: OD
secondary cardiac arrhythmias, hypercalcemia.
toxicity cardiac arrest with ● Do not take within 1–2 hrs of
rapid I.V. use, mild other oral medications, fiber-
Route: Oral drop in BP, containing foods.
 vasodilation. ● Avoid excessive use of
alcohol, tobacco, caffeine.
● GI: constipation,
irritation, chalky
taste, hemorrhage,
nausea, vomiting,
thirst, abdominal
pain.

● GU: polyuria,
renal calculi

● Metabolic:
hypercalcemia

● Skin: local
reactions,
including burning,
necrosis, tissue
sloughing,
cellulitis, soft
tissue calcification
with I.M. use.
Nursing Care Plan