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Transcript of 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:
Diagnostic Exam Result Normal Range Findings
Segmenter 69 40-60 Increased
Lymphocytes 31 20-40 Normal
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URINALYSIS:
Diagnostic Exam Result Normal Range Findings
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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Drug Name Mechanism of
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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Drug Name Mechanism of
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.