SCHOOL OF HEALTH SCIENCES

KAPKATET CAMPUS
DEPARTMENT OF NURSING

COURSE TITLE: OBSTETRICS NURSING 1

COURSE CODE: NUS 211

PRESENTED BY: KIRUI TITIAN CHEPKEMOI

REG NO: NUR/K/0517/2022

PRESENTED TO: MRS. AGNES CHEBOCHOK

TASK: CASE STUDY (ABNORMAL PREGNANCY)

DATE OF SUBMISSION: 9TH NOVEMBER 2023

CASE STUDY ON PREECLAMPSIA IN PREGNANCY

DEMOGRAPHIC DATA.
Name: Lydia Kemunto
Age: 29 yrs
Religion: Christian
Marital Status: Married
Residence: Nyamira
Telephone number: 0726503855
Next of kin: Joseph Osuku (Husband)
Telephone Number: 0723019282
Education: Secondary

HISTORY OF CURRENT PREGNANCY

Lydia Kemunto is 30 years old, gravida 4 , para 3+0. Gestation by dates is 39weeks
and 0 days. She experienced her last menstrual periods on 5 th February 2023, and her
estimated date of delivery will be on 12 th November 2023 She has no malaria attacks,
and in addition, she is not involved in habits like smoking tobacco. She experienced
the first fetal fluttering movements at around 11 weeks of pregnancy. Her weight is
88 kilograms, and her height 167 centimeters.

OBSTETRIC HISTORY
Birth Year No of Place Maturi Durati Type Birth Sex Outco Puerpe
order ANC of ty on of of weight me rium
visits deliver labour deliver
y y
1st 2014 3 Hospita Term 3hrs SVD 2.8kg F Alive Normal
l
nd
2 2016 3 Hospita Term 1hr SVD 3.8kg M Alive Normal
l
rd
3 2019 3 Hospita Term 1hr SVD 2.1kg F Alive Normal
l

SPECIAL MATERNAL COMPLICATIONS.

The client had no complications during the previous pregnancies. No history of
recurrent abortion obstructed labor-induced abortion or any other complication. She
had normal pregnancies.

OBSTETRICAL OPERATIONS.
The client has had no history of cesarean delivery or any other related operation, and
she had normal spontaneous vertex deliveries in all the previous pregnancies.

SPECIAL PERINATAL COMPLICATIONS AND EVENTS IN THE

PREVIOUS PREGNANCY.
The mother has no obstetrical history of twins or higher-order multiples. She has
a history of being born with a low birth weight of 2.1kg irrespective of the pregnancy
being to term. The baby was received by the newborn intensive care unit and was put
on care. The mother has no history of neonatal or infant death, no malformed or
chromosomally abnormal children, and no macrosomic children.
HISTORY OF PRESENT ILLNESS
Lydia was relatively well with her pregnancy until 4days ago when she began
experiencing edema on the lower limbs and facial puffiness. She reports of gradual
increase in swelling of both lower limbs which is aggravated with prolonged sitting
and incents on pressure application with no pain. This got accompanied by dawn
facial swelling which subsides as the day goes on with no headache, no blurring of
vision, no history of jerky movements, no abdominal pains, no jaundice. She got
newly diagnosed with PET following blood pressure measurements of 144/37mmHg
(1st measurement), 143/96mmHg (2nd measurement) and a 3rd measurement of
160/108mmHg.

MEDICAL HISTORY
Lydia Kemunto had the following previous medical history:
 There is no history of tuberculosis, heart disease, renal disease, epilepsy and
hypertension
 No blood transfusion undertaken.
 HIV and AIDS status is negative.
 No history of twins.
 No history of surgical operations.
 She is not allergic to any medical drug.

PHYSICAL EXAMINATION

A complete and organized collection of objective and subjective data using a

head-to-toe and systematic approach was done to confirm pregnancy, gestational age
and evaluate the general health state of the pregnant woman and the fetus. This
information would be important in drawing appropriate interventions for monitoring
pregnancy and normal fetal growth. The findings were as follows:
• On general observation the client had a good level of hygiene, no signs of
malnutrition, a normal gait and posture with no symptoms of kyphosis,
lordosis, or scoliosis, the client had regular pulses with regular normal
breathing. no-pallor, no jaundice.
• • Several measurements were taken and recorded: Weight- 88kg., height-
167 centimeters, temperature- 37.50C Pulse - 92 beats/minute,
Respirations-18 breaths per minute and Blood pressure- 110/76 mmHg,
117/66mmHg, 119/69mmHg and a fourth reading of 144/101mmHg.
• Head examination showed coarse hair, cleanliness and smooth texture. The
mouth, nose, ears, eyes and face had a normal symmetry, shape, and normal
functioning.
• Neck examination showed normalcy in range of motion, non-distended
jugular veins, normal lymph nodes (impalpable) and thyroid gland.
• Upper extremities examination showed facial puffiness, capillary refill was
normal and normal range of skeletal movement.
• On chest and breast examination, inspection, auscultation and palpation were
done. The breasts showed positive pregnancy with a darkened nipple,
sensitivity and tenderness. There were no masses, scars, or dimpling.
• On abdominal examination, the client had normal abdominal symmetry,
normal striae gravidarum and normal lineanigra .The fetal movements were
positive. There were palpable fetal parts on palpation, and the fundal height
was 39/40 with a cephalic presentation and a longitudinal lie. On fetal
auscultation, there were positive regular heartbeats recording
142beats/minute.
• Lower limbs presented with edema.
ANTENATAL PROFILE
The mother presented with the following:
 Hemoglobin levels of 11.2/dl.
 Blood group B
 Rhesus- Positive.
 Urinalysis- protein and glucose both nil, pH 7.0.
 She had previous counseling and underwent a HIV test and the results were
non-reactive.
 VDRL test was done and the results came out negative.

INTERVENTIONS GIVEN DURING THE VISIT

Blood pressure was monitored. P.O nifedipine 20mg were administered to lower the
blood pressure. The patient was given methyldopa 750mg in order to manage the
pressure. IM dexamethasone 12mg to aid in the maturity of the fetal respiration
system. Ceftriaxone 1g which is an antibiotic. The mother was given a health talk on
preventing infection, balancing rest and activity.

DEVELOPMENT OF AN INDIVIDUAL BIRTH PLAN (IBP)

Among the interventions, the mother was advised and assisted in making an
individual birth plan focusing on several elements;
• Expected date of delivery- The clients EDD was 12th November 2023 .The
mother was advised to be ready 1 weeks before the time is reached. Before that
time, the mother should know the danger signs, including paleness, severe
headache, vaginal bleeding, fever, convulsions, severe abdominal pains, and
reduced or no baby movements. In case she experiences this, she should get to a
hospital. The newborn danger signs include ceased breastfeeding, difficulty
breathing, fever, reduced activity, and yellowish skin with pale eyes, palms and
soles. Postpartum danger signs include heavy bleeding and fever. The client is
advised to return to the hospital in case she observes the signs.
• Name of health facility to deliver- The client decided that she was to give
birth at Kericho Referral County Hospital and is already in the hospital
following admission.
• Plan for transport to a health facility- the client is already in the hospital and
there will be no need to plan for transport to a health facility.
• Supplies to take to the health facility- The client was advised to purchase
warm clothing for the newborn.
• The accompaniment while going to the health facility- there’s no need of
having an accompaniment to the health facility because the mother is currently
in the hospital.
• Skilled attendant- The client said she knew a nurse in the hospital who would
assist her during delivery. She was advised to contact her for readiness before
the EDD.
• Funds- The mother said that her husband would facilitate any expenses during
her antenatal and postnatal period and any extras that could arise in case of
emergencies.
• Postpartum contraceptive plan- the client was advised on contraceptives,
and she said that she would use discuss with her husband the appropriate
technique.

HEALTH PROMOTION AND SCHEDULING NEXT APPOINTMENT

• We counsel the mother to take food rich in vitamin C to help the body to
absorb more iron, like tomatoes, strawberries and citrus fruits. Also, eat food
with high folate to prevent folate deficiency like leafy greens, vegetables and
citrus fruits. We also advised her to take iron and folic supplement. Also, eat a
diet rich in proteins like meat, eggs, dairy products, beans, nuts, cereal and fish.
• We advised the mother to sleep for 8-10hrs a night and at least 2hrs a day and
should lie on the left side to allow proper blood flow from the inferior vena
cava.
• We counseled the mother about family planning on the needs of family
planning and how it can be done. The necessity of family planning clones of
pregnancy, reduce multiples of pregnancy this help reduce anaemia induced
pregnancy.
• We advised mother to stop any drug abuse, i.e., tobacco, alcohol, or any other
harmful substance, that is if in any case she is using them.
• We advised on the need for early initiation and exclusive breastfeeding. We
urged the mother to breastfeed for six months then continued breastfeeding
combined with solid food for two years.
• We counsel on danger signs that may require medical attention. These signs
include vaginal bleeding, convulsions, severe abdominal pain, severe headache,
paleness, and fever, reduced or no fetal movement, swelling of head and arms
and breathlessness.
• We advised on signs of labour like vaginal discharge, stronger and more
frequent contraction, dilation of the cervix, lower abdominal pains, water
breaks, getting tired easily, swelling of face and hands and breathlessness.
 NURSING CARE PLAN:
LYDIA KEMUNTO, AGE :30 YEARS

Assessment Nursing Diagnosis Goal/ Expected Outcome Nursing Intervention Scientific Rationale Implementation Evaluation
Data

On the Impaired tissue Reduction in edema, with a 1. Elevation of the legs 1. Elevation of the legs 1. Nurse Dennis The edema is
assessment perfusion. decrease in swelling in the 2. Compression on therapy promotes venous return provided the patient reduced
the mother The diagnosis reflects lower extremities, improved such as stocking and reduces edema with a health talk on

had edema the impaired blood circulation in the affected 3. Ensuring the patient 2. Compression therapy the importance of the

flow and oxygen extremities, reducing the risk maintains adequate fluid helps improve elevation of the leg and

delivery to the lower of complications like skin intake circulation and reduction assisted in elevating it.

extremes due to the breakdown and venous of swelling in the lower 2.Nurse Judy gave a

odema insufficiency extremities health talk on

3. Ensuring the patient compression therapy

maintains adequate fluid 3. Nurse Judy ensured

intake as dehydration there was adequate

can worsen edema fluid intake

On 1. Hypertensi 1. To control 1. Educate the patient 1. To assess the Nurse Judy The blood pressure
assessing on pressure with about lifestyle effectiveness of administered the was controlled at
the patient 2. Risk for targeted ranges. modification treatment and medications 123/78 mm/hg
had complicati 2. Reduced 2. Monitor blood ensure blood Nurse Judy monitored

elevated ons related cardiovascular pressure regularly pressure is within the blood pressure

blood to risk factors a safe range Nurse Judy gave the

pressures hypertensi 3. Rest, counseling 2. Promote a healty health take to

of 163/87 on and support diet; exercise thepatient on health

mm/hg 3. Anxiety which will help diet exercise.

related to lower blood

elevated pressure

blood

pressure

On the Headach 1. To 1. Administer 1.Paracetamol is a Nurse Mercy The mother reported

assessment can be one alleviate paracetamol commonly used administered ease of pain in her
the mother of the pain 1 g TDS per pain relieve it paracetamol tablets, frontal part of the head
reports symptoms within 1 oral helps to reduce 1g, per oral

headache of hour 2. Encourage headache and Nurse Mercy also

on the proclamps 2. To ease the mother to provide relief ensured the mother had

frontal part ia, a the drink a lot of 2. Proper taken enough water

of the head serious headache water, about hydration and Nurse Emmah gave the

in the past pregnancy after 1 eight glasses relieve headaches mother a health talk on

week related hour per day. spending some time

condition 3. To encourage for a rest and some

characteriz the patient to time for a small

ed by high rest and have physical activity.

blood some time of

pressure activity

and

damage to

organs

like the

liver and

kidneys
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