1-2-2

PRE
ECLAMPSIA
GROUP 1
MEMBERS:
LINDZY MARELL AMURAO
ALEXANDRA VICTORIA ANTIPORDA
GILLIANNE RHEI BERE
RIGIL MAE CALANTOG
CRISTINE MAE CUEVAS
JHELAINE ROSE GALAGATA
WINCHELL ISABELLE LAYOLA
ALLANISON MESA
KRIZIA MAE OCON
RHICAMAE RIVERA
JIUN YUN
 CASE SCENARIO:
Maria is a 36-year-old gravida 1, para 0 at 33 weeks of gestation, who is visiting her
physician for a routine prenatal visit. When weighing Maria, the nurse finds that she
gained 6 lb in the past 2 weeks.

The nurse obtains a clean-catch urine specimen from Maria and gales her vital signs
(temperature, 37 C; pulse, 82bpm; respirations, 20bpm; blood pressure 190/110; the FHR is
144 to 150 bpm. Deep tendon reflexes (2+), and no clonus is present. Maria shared that her
rings are tighter than usual and sees spots in front of her eyes and blurring of vision for
the last 3 hours but severe headache for almost 2 days now, this morning, she cannot
stand her upper abdominal pain and nauseated.
Laboratory results were as follows:
✓ Clean-catch urine +1 (protein)
✓ Protein-to creatine ratio: .3mg
✓ Platelets: 80,000/uL
✓ Creatine: 2.1mg/dL
Doctor’s order were as follows:
• Start D5W500cc + 4amps (2mg/1ml each ampule) hydralazine 10uggts/min with
increment of 5-10uggts if bp 150/90start
• Duvadilan drip: 4 ampule Duvadilan 5mg in D5 water in 10-15ugtts to titrate 5ugtts if
with contractions.
• Mgso4 po 5gms IM on each buttock then 4gms TIV. Loading dose then MgSO4 20meq
in PNSS 1 liter for 12hrs with 5 drops titration for blood pressure 200/100.
• Tramadol 50mg TIV q8
• dexamethasone 12mg initially then 8mg TIV every 12hrs for 2 doses.
• Insert indwelling catheter and connect to urine bag
• For Strict intake and output monitoring
 PREECLAMPSIA
PATHOPHYSIOLOGY
Describe the importance of diagnostic and
laboratory test in the given scenario.
 Clean-Catch Urine

One of the least invasive procedures for a urine culture or urinalysis is a

clean catch urine sample or specimen. The clean catch procedure is
designed to keep microorganisms from the penis or vaginal area from
contaminating the urine sample. To get accurate findings from an
uncontaminated sample, make sure to follow the clean catch procedure.

Due to the influence of progesterone on the smooth muscle of the ureter,

which causes minor physiologic hydroureterers, the patient is more prone
to get UTI during pregnancy.
Urine tests are chemical and microscopic tests of urine.

what we need is sample of middle urine

for the patient is normal because she had +1 normal protein range is 50~80

mg + 1mean is 30~100 mg of protein

why we need to urinalysis: healthcare providers order urinalysis tests for

several reasons since a urine sample can provide many insights into your

health your provider may order a urinalysis for you for reasons such as:

1. as part of your routine medical exam to screen for early signs of certain

health conditions

2. if you're experiencing and signs and symptoms of certain health conditions

such as diabetes or kidney disease

3. to monitor certain health conditions you're receiving treatment for , such as

diabetes or kidney disease

 STEPS:

1. Wash your hands.

2. Remove sterile container from packaging and write your name on the
label, if provided.
3. Females should use a packaged, moist towel to clean the vulva and
perianal areas starting from front to back. Repeat with a second moist
towel.
4. Males should retract the foreskin from the penis if necessary and use the
packaged towel to clean the penis from the tip to the base. Repeat with
second towel.
5. Females should then spread their labia with one hand and start urinating
into the toilet. With the other hand, they should put the urine container
under the genital area to catch the stream of urine without touching any
skin.
6. Males should retract the foreskin if necessary with one hand and start
urinating into the toilet. Then, position the urine container with the other hand
to catch the stream without touching any skin.
7. Don’t fill urine to the top of the sterile container. No more than half a
container is necessary.
8. Place the lid on the container and set it on the sink or someplace stable
while you finish urinating into the toilet.
9. Screw the lid securely on the container and wipe it off. Wash your hands
and drop off the container to the lab as instructed.
 CREATININE

It's a waste product produced by your muscles as a result of normal, daily

activity. Your kidneys normally filter creatinine from your blood and excrete it
in your urine. If your kidneys aren't working properly, creatinine can build up
in the blood and less creatinine is excreted in the urine.

Moderate to severe CKD increases the risk of pregnancy problems and infant
morbidity: more than 70% of women who become pregnant with a blood
creatinine level of >2.5 mg/dl will deliver prematurely, and more than 40% will
develop preeclampsia.
Creatinine levels can be measured in both blood and urine. A
health care expert will collect a blood sample from a vein in your
arm using a tiny needle for a creatinine blood test. A small
amount of blood will be collected into a test tube or vial once the
needle is inserted.
 PROTEIN TO CREATININE

a commonly utilized first step in estimating daily protein excretion in urine

Because the diagnosis and management of proteinuric renal diseases, as
well as the staging of chronic kidney disease, rely on the accurate
identification and quantification of proteinuria, the use of a 24-hour urine
collection is the most accurate method for determining urinary protein
excretion in practice.

Proteinuria, or the presence of a large amount of protein in one's urine, is a

symptom of renal disease. When paired with elevated blood pressure after
20 weeks of pregnancy, it is an indicator of preeclampsia.
 Kidneys aren't functioning properly (high creatinine levels) {0.6 to 1.1
mg/dL (53 to 97.2 µmol/L) for women. During pregnancy normally
results in a decrease in concentration of serum creatinine, which falls
by an average of 0.4 mg/dl to a pregnancy range of 0.4 to 0.8 mg/dl.}
 PLATELETS

Platelet test is to test platelets, which are blood cells essential for blood
coagulation.
The test method includes testing platelet levels in the blood and testing platelet
function.

1. Platelet function test measures the time it takes for a blood sample
to block the hole of a small tube.
2. Viscoelasticity measurement This test measures the intensity of clots when
they form (because blood clots must be strong to stop bleeding).
3. Platelet aggregation method This is used to measure how well platelets clump
together.
4. The lumiagregometry method can determine whether platelets are
defective
by the amount of light generated when a specific substance is added.
5. Fluid cell measurement This is shooting a laser to find protein on the
platelet surface.
This helps you find platelet disease.
6. Blooding time Measure the time at which bleeding stops after
wounding the forearm.
What they need for platelet test is citrated blood

Normal range is 140,000 to 450,000 per microliter

so the patient seems to have low platelets counts/level

Since blood coagulation does not work well, tests are

performed to ensure that blood coagulates well and
hemostasis occurs when pregnant women give birth.
Nursing Care Plan (Priority)
Nursing Care Plan (Potential)
Drug Study
What nursing assessments should be made
for the woman with preeclampsia? Why?
What measures maybe initiated to
prevent or manage seizures?
 PREVENTION

Take prescribed medications

Avoid consuming alcohol or drugs (increases risks of seizures)
Practice stress management and avoid mental strain (avoiding
complex problems, exercising, getting enough sleep, taking time to
relax)
Keep consistent meal schedule and healthy diet
Avoid things that may overstimulate senses (videogame, flashing
lights, watching tv, using phone screens or computer screens)
Protection from head injuries
Incase an infant has high fever contact a medical professional
immediately (risk of developing febrile seizures) *Febrile Seizures-
convulsions caused by fever mainly on young children
Considering surgery
 MANAGEMENT

1. Remain calm
2. Place a pillow or a cushion under the head and if cushion is not
available put the person with seizure on a lateral recumbent position
(laying them on their side)
3. Create a safe space for the you and the person (make sure there is
nothing in the way or anything that make cause injury to you or the
person with seizures)
4. Note the beginning and the ending time of the seizures
5. Make sure to keep an eye on the person with seizures the whole time
 How can injury during seizure be
prevented?
A seizure occurs when the electrical activity in your brain is disrupted, preventing brain cells from
effectively communicating with one another. Brain injuries, also called traumatic brain injuries, are a
frequent cause of epilepsy.

To avoid injury during seizure, we must apply the following:

1. Ride safely. Use safety belts,child passenger seats, airbags, bicycle helmets, and motorcycle
helmets to reduce motor vehicle and traffic injuries.
2. Take each step cautiously. Falls are by far the most common cause of brain injury. Elderly persons
and children are more likely to sustain brain damage as a result of falls.
3.Seek medical attention for traumatic brain injuries if they occur. Severe brain damage increase the
risk of epilepsy. Taking care of the injury properly may help prevent epilepsy.
4. Stay calm and take in the situation.
5. Keep an eye on the clock, and get help if the seizure lasts for more than 5 minutes.
6. Lay them down and cushion their head, place a jacket or pillow under their head.
7.Remove hazards in order to prevent injuries.
8. Loosen any tight clothing around their neck and remove his/her glasses.
9. Wait until the seizure is over.
10. Get help if the seizure lasts longer than 5 minutes.

Nursing care must incorporate close perception of both maternal health and fetal well-
being, instruction for the patient and her family about special danger signs to observe
for during pregnancy, and activities to minimize complications at whatever point
possible. Establishing as thorough a database as possible in pregnancy makes a
difference to foresee the risks a patient may be exposed to when pregnancy is
influenced by physical or cognitive challenges, an unintentional injury, or an unhealthy
lifestyle.

For all patients, should be treated to reduce seizure happenings. Must take all the
doctor’s order as needed. Patients at higher risk should minimize burn risks, and avoid
high places and with dangerous surroundings. Aside from those, Maria can keep good
seizure control to lessen or avoid injuries for her and the baby. Also, patient can be
monitored by her family, friends or her partner while doing her routine or activities.
 What are the signs of magnesium toxicity? How
should it be managed?

Signs of magnesium toxicity include the following:

A significant drop in blood pressure
Urinary output of less than 30 ml /hour
Decreased respirations, with a rate less than 12 breaths per minute respiratory or
cardiac arrest
Urinary output of less than 30 ml /hour
Absence of DTRs: hyporeflexia
Decreasing maternal pulse oximeter values:
Less than 95% during pregnancy
Less than 92% during postpartum phase
Chest pain
Altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented)
Blurred vision
Serum magnesium level beyond the therapeutic range
Management for Magnesium Toxicity:

If toxicity occurs, discontinue the drug and notify the physiciann additional
magnesium will make the condition worse.
Administer Calcium gluconate as ordered by the physician, as it is an antidote for
magnesium toxicity and should be immediately available. (IV administration of 1 g
(10 mL of 10% solution) of calcium gluconate over 3 minutes).
 What are the major complications of
eclampsia?

Eclampsia is the most severe classification of pregnancy related to hypertensive disorders.

If a woman has passed into this stage when cerebral edema is acute a grand mal seizure or
coma has occured.
Grand Mal (Tonic-clonic seizures)
An eclamptic seizure is a tonic-clonic type that occurs in stages.
Tonic Stage
All muscles of the woman's body contract.
Her backaches
arms and legs stiffen
Jaw closes so abruptly that she may bite her tongue
Respirations halt because her thoracic muscles are held in contraction.
 What are the major complications of
eclampsia?

Second (clonic) Stage

Patients bladder and bowel muscles contract; incontinence of urine and feces may occur.
Patient begins to breath during this stage. However, the breathing is not entirely effective so
she may remain cyanotic.
Postictal Stage
Patient cannot be awakened except by painful stimuli for 1 to 4 hours
Assess uterine contractions during this stage, the patient will be unable to report sensation of
contractions
The painful stimulus of contractions may initiate another seizure.

The Fetal prognosis with eclampsia is also poor because of hypoxia, possibly caused by the seizure,
with consequent fetal acidosis
 REFERENCE/S:
Silbert-Flagg, J., Pilliteri, A. (2018). Maternal & Child Nursing; Care of the childbbearing
& childrearing family. (pp.551 & 554)

Sharon Murray, Emily McKinney, Karen Holub, Renee Jones. (2019). Foundations of
Maternal-Newborn and Women’s Health Nursing, 7th edition. Elsevier. (page 228)
 Thank You
Do you have any questions for me before we go?