eclampsia-4-real-1223386336450556-8-090303011504-phpapp02

8/22/2019 eclampsia-4-real-1223386336450556-8-090303011504-phpapp02

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Eclampsia, a dramatic and often unpredictable complication ofpregnancy-induced hypertensive disorders, is characterized by suddenhypertension, proteinuria, edema, and seizures.

A relatively rare syndrome, eclampsia complicates approximately 3in 100 pregnancies, with higher incidence rates in preeclamptic ortwin pregnancies, women of low socioeconomic status or indeveloping countries, and nulliparous patients younger than 20 yearsor multiparous patients older than 35 years of age.

However many medical disorders can occur during pregnancy,childbirth, and in the post delivery time. One of those disorders in pregnancyis eclampsia.

Eclampsia is a major cause of perinatal morbidity and mortality andcan present during the antepartum, intrapartum, or postpartumperiods. Late postpartum eclampsia presents as convulsions, withonset occurring at more than 48 hours postpartum.


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Pregnancy Induced Hypertension is a rarecomplication that occur within 42 days after delivery. Wehave chosen this case for the reason, that we becamecurious and interested regarding the deeper medicaldiagnosis for the occurrence of the certain disease.

It is very necessary for pregnant women to haveknowledge concerning the subject matter for them to beaware and educated about the possible complications thatmay arise on their pregnancy.

Educating them to seek early and regular prenatal careis the best way to prevent complications that may lead tomaternal various diseases.


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Pregnancy-induced hypertension is defined as the development of new

arterial hypertension in a pregnant woman after 20 weeks gestation.

It occurs most often in young women with a first pregnancy. It is more

common in twin pregnancies, in women with chronic hypertension, preexisting diabetes,

and in women who had PIH in a previous pregnancy


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Symptoms seen in patient:

Blood pressure elevation (140/100)

Episodes of Two-Clonic Seizure

Blurred Vision


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Diagnostic done with the patient:

Diagnosis is often based on the increase in blood pressure levels, but other symptoms

may help establish eclampsia as the diagnosis. Tests for eclampsia may include thefollowing:

Blood pressure measurement

Urinalysis

Frequent weight measurements

Blood Chemistry

Hematology


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Treatment done with the patient:

Bed rest (either at home or in the hospital may be recommended)

Hospitalization (as specialized personnel and equipment may be necessary)

Magnesium sulfate given IV by infusion pump to prevent or limit seizures

Anti-Convulsion

Anti-Hypertensive

Foley catheter

Normal Delivery

Calcium Channel Blocker


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Reproductive System


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Functions:

1. Production of female sex cells

2. Reception of sperm cells from the male

3. Nurturing the development of and providing nourishment

for the new individual4. Production of female sex hormones.


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Baby and Placenta


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The placenta is also a kind of padding, and maintains a

unique environment in which your baby can develop andgrow. The placenta forms from the same cells as theembryo and attaches itself to the inner wall of the uterus,growing as your baby grows and the volume of youramniotic fluid increases. When it's finished growing, it iscircular and weighs about a pound; when the bodyexpels it after the birth, many women are surprised at itssize and weight.


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Blood Vessel


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Functions:

1. Carry blood2. Exchange nutrients, waste products and gases

3. Transport

4. Regulate blood pressure

5. Direct blood flow


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Structure and Functions of Blood Vessels

Structure Functions

Arteries - The walls (outer

structure) of arteries contain

smooth muscle fiber that contract

and relax under the instructions of

the sympathetic nervous system.

Transport blood away from the

heart;

Transport oxygenated blood only

(except in the case of the pulmonary

artery).

Arterioles - Arterioles are tinybranches of arteries that lead tocapillaries. These are alsounder the control of thesympathetic nervous system,and constrict and dilate, toregulate blood flow.

Transport blood from arteries tocapillaries;

Arterioles are the main regulators of

blood flow and pressure.

Venules - Venules are minute

vessels that drain blood from

capillaries and into veins. Many

venules unite to form a vein.

Drains blood from capillaries into

veins, for return to the heart


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Structure Functions

Capillaries - Capillaries are tiny

(extremely narrow) blood vessels,

of approximately 5-20 micro-

metres(one micro-metre =

0.000001metre) diameter.

There are networks of capillaries

in most of the organs and tissues

of the body. These capillaries are

supplied with blood by arterioles

and drained by venules. Capillary

walls are only one cell thick (see

diagram), which permits

exchanges of material between the

contents of the capillary and the

surrounding tissue.

Function is to supply tissues with

components of, and carried by, the

blood, and also to remove waste

from the surrounding cells ... asopposed to simply moving the blood

around the body (in the case of other

blood vessels);

Exchange of oxygen, carbon

dioxide, water, salts, etc., between

the blood and the surrounding body

tissues.

Veins - The walls (outer structure) of

veins consist of three layers of tissues

that are thinner and less elastic than the

corresponding layers of arteries.

Veins include valves that aid the return

of blood to the heart by preventing

blood from flowing in the reverse

direction.

Transport blood towards the heart;

Transport deoxygenated blood only

(except in the case of the pulmonary

vein).


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Arteries Veins

Transport blood away from the

heart;

Transport blood towards the heart;

Carry Oxygenated Blood

(except in the case of the Pulmonary

Artery);

Carry De-oxygenated Blood

(except in the case of the Pulmonary

Vein);

Have relatively narrow lumens Have relatively wide lumens (see

diagram above);Have relatively more muscle/elastic

tissue;

Have relatively less muscle/elastic

tissue;

Transports blood under higher

pressure (than veins);

Transports blood under lower

pressure (than arteries);

Do not have valves (except for the

semi-lunar valves of the pulmonaryartery and the aorta).

Have valves throughout the main

veins of the body. These are toprevent blood flowing in the wrong

direction, as this could (in theory)

return waste materials to the tissues.

Comparison between Arteries and Veins


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Normal Abnormal

Blood Vessel are tubes which carry blood.

Veins are blood vessels which carry blood

from the body back to the heart. Arteries are

blood vessels which carry blood from the

heart to the body. There are a few main blood

vessels which connect to different chambers

of the heart. The aorta is the largest artery in

our body. The left ventricle pumps blood into

the aorta which then carries it to the rest of

the body through smaller arteries. The

pulmonary trunk is the large artery which theright ventricle pumps into. It splits into

pulmonary arteries which take the blood to

the lungs. The pulmonary veins take blood

from the lungs to the left atrium. All the other

veins in our body drain into the inferior vena

cava (IVC) or the superior vena cava (SVC).

These two large veins then take the blood

from the rest of the body into the right atrium.

Narrowing of the blood vessels

resulting from contraction of the

muscular wall of the vessels,particularly the large arteries,

arterioles and veins. The process is

the opposite of vasodilation, the

widening of blood vessels. When

blood vessels constrict, the flow of

blood is restricted or slowed, thus,retaining body heat and increasing

vascular resistance. Cutaneously, this

makes the skin turn paler because

less blood reaches the surface. This

helps to prevent the radiation of heat.


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Heart


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Functions:

1. Generating blood pressure

2. Routing blood

3. Ensuring one-way blood flow

4. Regulating blood supply


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Blood flow through the Heart


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Brain

Controls the central nervous system (CNS), by way of the cranial nerves and

spinal cord, the peripheral nervous system (PNS) and regulates virtually all

human activity. Involuntary, or "lower," actions, such as heart rate, respiration,

and digestion, are unconsciously governed by the brain, specifically through the

autonomic nervous system. Complex, or "higher," mental activity, such as

thought, reason, and abstraction, is consciously controlled.


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Neurons


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Generalized seizures are caused by abnormalelectrical activity at multiple locations in the brain

and/or over a large area of the brain. This results in

loss of consciousness and body stiffening, which is

followed by shaking of the arms and legs.

Abnormal electrical activity may start in one part of

the brain and cause isolated symptoms. Sometimes

this abnormal electrical activity spreads through the

brain, resulting in a generalized seizure. Seizures can

be caused by a specific area of the brain that is

injured or inflamed, or they can be due to stress on

the brain from a more widespread systemic process,such as severely low blood sugar.


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Name: Ms. M.T

Age: 19

Sex: Female

Address: 69 Pooc Maligaya, San Vicente, San Pedro Laguna

Civil Status: Single

Occupation: None

Name of Spouse: Mr. Benigno Carpellar

Date of Admission: August 07, 2008

PATIENTS PROFILE


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Chief Complaint: Seizures

History of present Illness:

Patient delivered at San Pedro Municipal Hospital. After hours she had

2 episodes of tonic clonic seizures hence referral to our institution and

then subsequently admitted.

Physical Examination: Li open, uterus oblique, no abnormal masses

Admitting Diagnosis: NSD Day 0 Post Partum Eclampsia

G1P1(1001)

BRIEF HISTORY


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HEMATOLOGY:

Diagnostic Exam Result Normal Range Findings

Hemoglobin 136 M:140-170 / F:120-140

gml/dl

Increased

Hematocrit .41 M:0.44-0.54F:0.37-.47 Normal

WBC 9.0 5.0-10.0 Normal

Platelet 280 150-400cc/mL Normal

ABO Typing A


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DIFFERENTIAL COUNT:


Segmenter 69 40-60 Increased

Lymphocytes 31 20-40 Normal


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URINALYSIS:


Color Yellow Yellow/Amber Normal

Transparency Clear Clear Normal

Reaction 5.0 4.8-7.8 Normal

SP Gravity 1.030 1.015-1.025 Increased

Sugar Negative Negative Normal

Protein Negative Negative Normal

Pus Cells 2-3 HPF 0-4 HPF Increased

RBC 1.5-2.0 HPF 0-3 HPF Normal

Epithelial Cells Few Few Present Normal


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BLOOD CHEMISTRY:

Diagnostic

Exam

Result Normal Range Findings

BUN 12.3

mg/dl

10-50 mg/dl Normal

Creatinine 1.1 mg/dl F:0.5-1.0 mg/dl M:0.6-

1.2 mg

Increased

SGOT 26.8 1u/L 10-40 IU/L Normal

SGPT 13.9 1u/L 5-35 IU/L Normal

MEDICAL MANAGEMENT


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MEDICAL MANAGEMENTDOCTORS ORDER RATIONALE

AUGUST 08, 2008:

1.Please admit to OBW2.Secure consent

3. NPO temporarily, DAT when fully awake

4. IVF D5LRS 1L * 20 gtt/min + 10 uoxytocin.

Medication:

5. Cefuroxime 1.5 g/IV LD ANGT

Cefalexin 500 mg/cap q8 * 7 days

6. Magnesium Sulfate 4g SIVP then 5 g/ IM

on each buttocks followed by 5 g/ IM or

alternating buttock q6 * 4 doses

1. To provide maximum care to the patient2. It includes explanation of the procedure to

gain patients cooperation, and forpatients

documentation which can be used for legal

purposes.

3. To prevent aspiration that maintains

nutritional needs.

4. Fluid replacement and route forintravenous medication. Oxytocin helps

induced uterine contraction and prevents

post partum hemorrhage

5. Anti-infectives; Prevents occurrence of

infections

6. Anti-convulsants and Laxative; for

prevention of seizure. Watch out for signs

of < tendon reflex, < urine output, >

respiratory rate.

DOCTORS ORDER RATIONALE


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DOCTOR S ORDER RATIONALE

7.Nifedipine 10 mg/ tab BID (one fully

awake)

8. Insert foley catheter

9. Monitor VS q1 including Input and Output

and second please

Refer accordingly.

ADDENDUM:

Request for the ff:CBC with blood typing

Platelet

SGOT,SGPT,BUN,CREA,LDH

Urinalysis

refer to Medicine for co-management

AUGUST 09, 2008

May consume IVF once magnesium sulfate

is completely given.

Follow up all Lab Results

May remove foley catheter after last dose of

magnesium is given

Continue VS monitoring

Refer

7. Calcium channel blocker; for anti-

hypertensiveness.

8. For accurate monitoring of I and O;prevention of injury, < bladder retention

9. Deviations from baseline monitoring

CBC to facilitate possible blood transfusion,platelet count to determine bleeding

tendencies; SGOT, SGPT, BUN, CREA,

LDH; is to rule out PIH either pre-

eclampsia, chronic pregnancy. Urinalysis is

for direct quantification of protein.

Refer for hypertensive management.

Follow up laboratory results to facilitate fast

recovery.

Remove Foley Catheter to provide comfort

and adequate rest and sleep.


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Drug Name Mechanism of

Action

Indication Contraindication Side or Adverse

Effects

Nursing

Responsibilities

Generic Name

Cefuroxime

Classification:Cephalosporin,

second

generation

Dosage:

1.5 g IV LD

Cefuroxime is a

second-generation

Cephalosporin that

inhibits cell-wallsynthesis, promoting

osmotic instability;

usually bactericidal.

Infections of the

urinary and

lower

respiratorytracts.

Contraindicated in

patients

hypersensitive to

drug or othercephalosporins.

Diarrhea

Loose Stools

Abdominal pain

Nausea and

Vomiting

Double check the

doctor`s order, the

meds to be given,

the dosage, theroute, and the time

and frequency.

Monitor vital signs

Use cautiously in

patients

hypersensitive to

penicillin because of

possibility of cross-

sensitivity with otherbeta-lactam

antibiotics.

Ask patient about

past reaction to

cephalosporin or

penicillin therapy

before giving first

dose.

Identify thepatient.

If large doses are

given or if therapy is

longed, monitor

patient for

superinfection,

specially in high-

risk.


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Drug Name Mechanism of Action Indication Contraindication Side and Adverse

Effects

Nursing

Responsibilities

Generi c Name:

Nifedipine

Classification:

Calciumchannel

blocker

Dosage:

10 mg 1 tab.

BID

Unknown. Thought

to inhibit calcium

ion influx across

cardiac and

smooth-muscle

cells, decreasing

contractility and

oxygen demand.

Also may dilate

coronary arteries

and arterioles.

Vasospastic

angina, classic

chronic stable

angina pectoris.

Contraindicated

in patients

hypersensitive to

drugs.

Headache

Fatigue or

Lethargy

Edema

Weakness or

Muscle cramps

Dizziness

Disturbed

equilibrium

Flushing

identify the

patient.

double check the

doctor`s order, the

meds to be given,the dosage, the

route, and the time

and frequency.

monitor vital

signs

Use cautiously in

patients with heart

failure or

hypotension and inelderly patients.

Dont give

immediate-release

form with-in one

week of acute MI

or in acute coronary

syndrome.

Monitor blood

pressure regularly,especially in

patients who take

beta-blockers or

anti-hypertensive.

Watch for

symptoms of heart

failure.


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Action

Indication Contraindication Adverse

Effects

Nursing

Responsibilities

Generic Name

Hydralazine

Classification:

Antihypertensi

on

Unknown. A direct-

acting vasodilator

that mainly relaxes

anteriolar smooth

muscle.

Essential

hypertension

(orally, alone, or

with other anti-

hypertensives),

severe essential

hypertension

(parenterally, to

lower blood

pressure quickly)

Contraindicated

in patient

hypertensive to

drug and in those

with coronary

artery disease or

mitral valvular

rheumatic heart

disease.

Tachycardia

Edema

Angina

pectoris

Palpitations

Nausea and

Vomiting

Diarrhea

Anorexia

Constipation

Identify the

patient.

Double check the

doctor`s order, themeds to be given,

the dosage, the

route, and the time

and frequency.

Monitor vital

signs

Use cautiously in

patients withsuspected cardiac

disease, CVA, or

severe renal

impairment and in

those taking other

anti-hypertensives.

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Action

Indication Contraindication Adverse

Effects

Nursing

Responsibilities

Generic Name:

Magnesiumsulfate

Classification:

Anticonvulsant

Dosage:

4gm SIVP and;

5g IM on eachbuttocks

May decrease

acetylcholinereleased by

nerve impulses,

but its

anticonvulsant

mechanism is

unknown.

To prevent or

control seizuresin preeclampsia

or eclampsia.

Parenteral

Administrationcontraindicated in

patients with heart

block or myocardial

damage. Also

contraindicated in

patients with

toxemia ofpregnancy during 2

hours preceeding

delivery.

Drowsiness

Depressed

reflexes

flaccid

paralysis

Hypothermia

Hypotension

Identify the patient.

Double check thedoctors order, the meds

to be given, the dosage,

the route, and the time

and frequency.

Monitor vital signs

Use cautiously in

patients with impaired

renal function. Also usecautiously in woman

who are in labor.

If used to treat

seizures take

appropriate seizure

precautions.

-Monitor fluid intake

and output.

Patients Name: M.T

Age: 19


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Age: 19

Medical Diagnosis: Pregnancy Induced Hypertension

Nursing Diagnosis: Decreased Cardiac Output related to decreased venous return.Short Term Goal: At the end of my shift, patient will have a decreased blood pressure and will be able to have an adequate

rest and sleep.

Long Term Goal: At the end of hospitalization, patient will be able to maintain vital signs within acceptable range.

CUES PROBLEM SCIENTIFICRATIONALE INTERVENTIONS RATIONALE EVALUATION

SUBJECTIVE:

Hindi pa ko

makabangon nahihilo

akoas verbalized by

the patient

OBJECTIVES:

Increased Blood

Pressure (140/100)

restlessness

Weak in appearance

Dizziness

Hypertension

-Inadequate blood

pumped by the heart

to meet the metabolic

demands of the body.

[note: In a Hyper

Metabolic state

although cardiac

output and tissue

perfusion areinterrelated, altough

there are differences.

When cardiac output

is decreased tissue

perfusion problems

will develop

however, tissue

perfusion problems

can exixt withoutdecreased cardiac

output.

Monitor Blood

Pressure; every

15mins. During

critical phase; ever 1-

4hrs. As conditions

improves.

Provide adequate

rest by positioningclient.

Give information

about positive signs

of improvements,

such as decreased

edema, improvedvital signs and

circulation

.

Encourage fluid

intake.

Provide quite

environment.

-Provides baseline

for comparison to

follow trends and

evaluate response to

interventions.

-Decreases oxygen

consumption and riskfor de-compensation

and for maximum

comfort.

-To provide

Encouragement.

-To minimize

dehydration.

-To promote

adequate rest.

Goal Met.

The patient will be

able to have an

adequate rest andsleep, and the

patients blood

pressure will

decreased.

The patient will be

able to respond

well to

interventions andperformed actions.

Patients Name: M.T


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Age: 19

Medical Diagnosis: Pregnancy Induced Hypertension

Nursing Diagnosis: Impaired physical mobility related to decrease muscle strength

Short Term Goal: After rendering my nursing intervention, patient will be able to verbalize understanding of situation and individual

treatment regimen and safety measures.

Long Term Goal: Upon discharge, the patient will be able to maintain or increase strength and function of the affected and

compensatory body part.

CUES PROBLEM SCIENTIFICRATIONALE INTERVENTIONS RATIONALE EVALUATION

OBJECTIVES:

Limited ROM

(Range of Motion)

Slowed movement

Impaired Physical

Mobility

Limitation in

independent,

purposeful physical

movement of the

body or of one or

more extremities

Note situations such

as surgery, fractures,

amputations and

tubings (catheter).

Observe movements

when client is

unaware of

observations.

Support affected

body parts/joints

using pillows.

Encourage adequate

intake of fluids.

Encourage clients

involvement in

decision as much as

ibl

- It may restrict

movement

-to note any

incongruencies with

reports of abilities

-to maintain position

of function and

reduce risk of

pressure ulcers

-promotes well being

and maximizes

energy production.

-enhances

commitment to plan

optimizing outcomes

Goal Met:

The patient will be

able to verbalizeunderstanding of

situation and

individual

treatment regimen

and safety

measures.

The patient will be

able to maintain

proper function of

the part being

affected.

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