2
P.O BOX: 875, BAMENDA.
MOTTO: HOPE IS THE KEY
SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS
FOR THE AWARD OF THE HIGHER NATIONAL DIPLOMA (HND) IN
NURSING
CASE STUDY REPORT ON PREECLAMPSIA
CARRIED OUT DURING AN INTERNSHIP AT THE
REGIONAL HOSPITAL BAMENDA 7 DECEMBER
2017 TO 7 JANUARY 2018
APRIL 2018
REPUBLIQUE DU CAMEROUN
---------------------------
PAIX-TRAVAIL-PATTIE
----------------------------------
MINISTERE DE L’ENSEIGNEMENT
SUPERIEUR
----------------------------
DIRECTION DE L’ENSEIGNEMENT
SUPERIEUR PRIVE
---------------------------------------
REPUBLIC OF CAMEROON
-----------------------------
PEACE-WORK-FATHERLAND
-------------------------------------
MINISTRY OF HIGHER
EDUCATION
---------------------------------
DEPARTMENT OF PRIVATE
EDUCATION
-----------------------------------
PRESENTED BY:
AMINATOU LEKA SUPERVISED BY: MFONFU DANIEL
3
CERTIFICATION
This to certify that this case study was carried out during an internship at the
Bamenda Regional Hospital by Aminatou Leka from 7 December 2017 to 7
January 2018 for the award of Higher National Diploma [HND] in Nursing
STUDENT: AMINATOU LEKA SIGNATURE_______________DATE_______________
SUPERVISOR: DR. MFONFU DANIEL SIGNATURE__________DATE_______________
DEAN OF STUDIES: DR. MFONFU DANIEL SIGNATURE__________DATE __________
PRESIDENT OF JURY: Dr Mfonfu Daniel SIGNATURE________DATE 25 May 2018
4
DEDICATION
This piece of work is dedicated Dr. Mfonfu Daniel who guided me throughout my
studies, my parents and mates who provided me with the means to enhance my
success.
5
ACKNOWLEDGEMENT
My sincere gratitude goes to late Mr Ngalla Edward, the founder of Capitol
Higher Institute of health science and Beauty Therapies Bamenda.
My gratitude goes to my supervisor Dr Mfonfu Daniel for his patience and
guidance on editing this piece of work and the entire Capital staffs for their
support.
Enormous thanks goes to the General supervisor of the general hospital and
the entire staff who in their effort collaborated with us to participate in health
activities of the hospital.
Finally sincere appreciation goes to my entire family and friends who gave
me a helping hand socially and financially throughout my internship.
Honour and praise goes to God Almighty for his guidance and a sound
health to be able to carry out this work.
6
LIST OF ABBREVIATIONS
MmHg………………………………………………...Millimetre of Mercury
GIT…………………………………………………....Gastro intestinal track
CNS……………………………………………………Central nervous system
EDD…………………………………………………...Expected date of delivery
LMP…………………………………………………...last menstrual period
IWC…………………………………………………...Infant welfare clinic
ANC………………………………………………..... Antenatal clinic
WHO……………………………………………….... World health organization
HIV………………………………………………….... Human immune deficiency
ATS………………………………………………….…Anti tetanus serum
SRN…………………………………………………….State registerrd nurses
NSAIDS…………………………………….Non-steroidal anti-inflammatory drugs
G2P2………………………………………………...... Gravida 2 para 2
DOA..........................................................................Date of admission
DOD..........................................................................Date of discharge
HND..........................................................................Higher National Diploma
7
TABLE OF CONTENTS
Certification ---------------------------------------------------------------------------2
Dedication------------------------------------------------------------------------------3
Acknowledgement---------------------------------------------------------------------4
List of abbreviation--------------------------------------------------------------------5
Table of contents-----------------------------------------------------------------------6
CHAPTER ONE - General introduction ---------------------------------------7-10
CHAPTER TWO - Literature review of the disease -------------------------11-17
CHAPTER THREE – PRESENTATION OF CASE -------------------- 18-31
CHAPTER FOUR – REVIEW OF DRUGS ---------------------------------32-35
CHAPTER FIVE - DISCHARGE SUMMARY----------------------------36
CHAPTER SIX – CONCLUSION -----------------------------------------37-38
Reference-----------------------------------------------------------------------------------39
8
CHAPTER ONE – GENERAL INTRODUCTION
1.1 Definition of Preeclampsia:
Preeclampsia is a pregnancy complication characterized by high blood pressure
and signs of damage to another organ system, often the kidneys – pitting oedema
and proteinuria. Preeclampsia usually begins after 20 weeks of pregnancy in a
woman whose blood pressure had been normal. Even a slight rise in blood pressure
may be a sign of preeclampsia (Mayo Clinic Staff) Pre-eclampsia or preeclampsia
(PE) is a disorder of pregnancy characterized by high blood pressure and a large
amount of protein in the urine. (http://en.wikipedia.org/wiki/Pre-eclampsia)
1.2 MOTIVATION FOR THE CASE
Literature on preeclampsia says pre-eclampsia occurs at about 20 weeks of
pregnancy but in this case preeclampsia started when the pregnancy was at term.
This preeclampsia at term motivated me to study it.
1.3 GENERAL OBJECTIVE (GOAL)
Successfully manage the case of preeclampsia as amember of the medical and
nursing team and submit the report of this case study in partial fulfilment to obtain
the HND in nursing.
1.4 SPECIFIC OBJECTIVES
a) Identify the patient
b) Describe the circumstances of arrival of the patient
c) Admit the patient
d) State the provisional diagnosis on admission, state source
e) Administer any emergency medications
f) Clerk/Assess the patient
g) Administer the medications prescribed by the medical officer, monitor
and record side effects on the patient
h) Establish daily drug chart
i) State results of confirmatory diagnostic tests
j) Develop and implement nursing care plans
k) Describe the evolution of the patient and vital signs
l) Revue the medications administered
m) Write the discharge summary
9
n) Identify positive findings, weaknesses; make recommendations; make
conclusions
1.4 BRIEF DESCRIPTION OF PLACE OF STUDY
The Bamenda Regional Hospital is located in Bamenda II Sub-Division, in the
North West Region precisely in the mankon on a well-ventilated topographical
area suited for the prevention and preservation of good health. This establishment
is to the left of the GMI police camp Bamenda and 100m away from hospital
round-about. It acts as a referral hospital for District hospitals, research centre and
a teaching hospital for student doctors, nurses, midwives and laboratory technician.
Inflow rate of patients is enormous.
The BRH comprises of many units/services where various activities are been
carried out. They include;
- M and F medical word
- M and Female surgical ward
- Paediatric ward
- Gynaecological ward
- Maternity
- Reanimation unit
- Ophthalmology department
- operating theatre
- X-ray department
- Dialysis department
- Diabetic unit
- Dental unit
- Tuberculosis unit
- Pharmacy
10
- Emergency unit
- Outpatient department
1.4.1 Administrative Staffs and Their Job Description
There are about two hundred workers as both skilled and unskilled. This
total number of workers makes sure that the hospital runs well. The health care
team is made up of:
THE DIRECTOR: the director who supervises doctors, nurses, he record and direct
the functioning of the hospitals
THE GENERAL SUPERVISOR: who attains to various problems in wards,
make routine control, supervise activities in the hospital and evaluate students on
internship
DOCTORS: Refer patients to other hospitals, gives instructions to nurses, do
rounds, prescribe drugs, operate and attend to patients in the consultation room
THE WARD CHARGE: draw the duty roster, supervise the nurses, give
account on shortage and damages, evaluate the performance of the unit and is
responsible of the management in the ward
THE NURSE: these are those who actually perform routine tasks. They
assist doctors during rounds, give health talks and educate patients and guardians
and evaluate nursing care given to patients
NURSING ASSISTANCS: assist nurses in their duties
PHAMACIST: dispense drugs to wards
LABORATORY TECHNICIANS: collect specimen for examination
AUILARY STAFF: Maintain hygiene of the hospital
11
ORGANIGRAM OF REGIONAL HOSPITAL
Director
Medical adviser General Supervisor
Chief or Service Ward charge
Doctor Nurses
Assistant Nurses
Auxiliary workers
Source: General supervisor
1.5.2 SHIFT SYSTERM
The BRH is made up of 2 shifts that is morning shift from 7am to 5pm and night
shift from 5 PM to 7am
12
CHAPTER TWO – REVIEW OF LITERATURE ON PREECLAMPSIA
2.0. Classification of Preeclampsia (The women’s the royal women’s hospital)
Classification Blood Pressure Range
Mild 140-149 mmHg systolic 90-99 mmHg diastolic
Moderate 150-159 mmHg systolic 100-109 mmHg diastolic
Severe >160 mmHg systolic >110 diastolic
Blood pressure is defined in the above table: measured on at least two occasions
over several hours, combined with proteinuria >300 mg total protein in a 24-hour
urine collection, or ratio of protein to creatinine >30 mg/mmol
2.1 Causes (Mayo clinic)
Some causative factors include:
Abnormal placentation (formation and development of the placenta)
Immunologic factors
Pre-existing hypertension,
Obesity,
Dietary factors, e.g. low calcium in the body
Environnemental factor, e.g. air pollution
2.2 Pathophysiology
13
During normal pregnancy, the placenta undergoes process of
vascularization to allow for blood flow between the mother and fetus
(http://en.wikipedia.org/wiki/Pre-eclampsia)
14
Abnormal development of the placenta leads to poor placental perfusion. The
placenta of women with preeclampsia is abnormal and characterized by poor
trophoblastic invasion. It is thought that this results in oxidative stress, hypoxia,
and release of factors that promote endothelial dysfunction, inflammation, and
other possible reactions The clinical manifestations of preeclampsia are associated
with general endothelial dysfunction, including vasoconstriction and end-organ
ischemia (http://en.wikipedia.org/wiki/Pre-eclampsia)
2.3 Risk factors (By Mayo Clinic Staff)
Known risk factors for preeclampsia include:
First pregnancy
Diabetes mellitus
Kidney disease
Chronic hypertension
Prior history of preeclampsia
Family history of preeclampsia
Advanced maternal age (>35 years)
Obesity
15
Multiple gestation
Having donated a kidney.
New paternity
2.4 Complications (By Mayo Clinic Staff)
Complications of preeclampsia may include:
Lack of blood flow to the placenta. Preeclampsia affects the arteries
carrying blood to the placenta. If the placenta doesn't get enough blood, the
baby may receive less oxygen and fewer nutrients. This can lead to slow
growth, low birth weight or preterm birth.
Placental abruption. Preeclampsia increases the risk of placental abruption,
in which the placenta separates from the inner wall of your uterus before
delivery. Severe abruption can cause heavy bleeding and damage to the
placenta, which can be life-threatening for both the mother and the baby.
HELLP syndrome. HELLP — which stands for haemolysis (the destruction
of red blood cells), elevated liver enzymes and low platelet count —
syndrome can rapidly become life-threatening for both you and your baby.
Symptoms of HELLP syndrome include nausea and vomiting, headache, and
upper right abdominal pain. HELLP syndrome is particularly dangerous
because it represents damage to several organ systems. On occasion, it may
develop suddenly, even before high blood pressure is detected.
Eclampsia. When preeclampsia isn't controlled, eclampsia — which is
essentially preeclampsia plus seizures — can develop.
Cardiovascular disease. Having preeclampsia may increase your risk of
future heart and blood vessel (cardiovascular) disease.
2.5 Signs and symptoms (By Mayo Clinic Staff)
i. Sudden weight gain and swelling (pitting edema)
ii. Blood pressure that is 140/90 millimetres of mercury (mm Hg) or greater —
documented on two occasions, at least four hours apart — is abnormal
iii. Headaches
iv. Changes in vision, including temporary loss of vision, blurred vision or light
sensitivity
v. Upper abdominal pain, usually under your ribs on the right side
16
vi. Nausea or vomiting
vii. Decreased urine output
viii. Shortness of breath, caused by fluid in the lungs
2.6 Diagnosis
It is diagnosed from the above signs and symptoms. It can also be diagnosed
in the laboratory by carrying out the following tests:
o Excess protein in urine (proteinuria)
o Decreased levels of platelets in the blood (thrombocytopenia)
o Impaired liver function
2.7 Treatments (Denis Palmer et al)
Strict bed rest/admit. Encourage patient to lie on the left side.
If foetus is viable, cervix ripe, head down, pelvis adequate, induce.
If foetus viable, cervix not ripe, pelvis inadequate, do CS.
If foetus not viable, mother stable or improving, monitor.
If foetus not viable, mother deteriorating, deliver anyway.
Administer MgSo4 5g stat IM.
Continue MgSo4 24hours after delivery
Drug of choice for hypertension should be administer if available (Labetalol
and Hydralazine).
IV fluids at 60 -150ml/hr unless there are excessive losses of fluids or blood.
2.7 Prognosis
If not treated preeclampsia can lead to eclampsia that may result in the death
of mother or the baby, or both
2.8 Preventions
Frequent prenatal visit
Encourage the woman to attend ANC regularly for frequent monitoring
of her weight, BP and urine testing.
Encourage the woman to do light sport
Encourage the woman to avoid excessive salts intake
Encourage the woman to eat a well-balanced diet and much vegetable.
17
2.9 Definition of nursing care plan
A nursing care plan outlines the nursing care to be provided to an individual,
family and the community.
It is a set of action that the nurse will implement to resolve and support
nursing process. It guides in the ongoing provision of nursing care and assists in
the evaluation of the care W.H.O (3 November, 2015).
2.10 VIRGINAL HENDERSON’S 14 BASIC FUNDAMENTAL HUMAN
NEEDS
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body waste
4. Move and maintain desirable posture
5. Sleep and rest
6. Maintain body temperature within normal range by adjusting clothing and
modifying the environment
7. Keep the body clean and well groomed and protect the integument
8. Avoid dangers in the environment and avoid injuring others
9. Communicate with others in expressing emotion, needs, fears or options
10. Worship according to one’s faith
11. Work in such a way that there is a sense of accomplishment
12. Play or participate in various form of recreation
13. Learn, discover, or satisfy the curiosity that leads to normal development
and health and use the available health facilities.
18
2.11 Nurses’ responsibilities in the administration of drug
1. The nurse must respect the seven rights of drug administration also
known as the seven rules.
- The right patient
- The right drug
- The right dose
- The right time
- The right route
- The right procedure
- The right documentation
2. If a prescription is not clear, never assume what it could be. Always
Consult with the prescriber to verify that it is correct. Also, if you think
a B prescription is not appropriate, do not change it without consulting the
prescriber.
3. In case a prescription is order over the phone, document the
prescription and indicate that it was done through the phone. Sign below the
prescription and make sure that the prescriber signs immediately he is available
4. Read the medication label three times that is before removing
medication cupboard, before removing from the container and before returning it
after administration. This makes certain of what has been administered.
5. Never administer medication from drug container whose labels are not
visible.
19
CHAPTER THREE- PRESENTATION OF CASE
3.1 DEMOGRAPHIC IDENTITY OF THE CASE ON ADMISSION
Name: patient x
Age: 19 years
Sex: female
Address: mile 90
Occupation: student
Religion: Presbyterian
Ward: Postnatal in private room one
Bed num ber: 2
Blood group O
Nationality: Cameroonian
LMP 09/03/2017
EDD 16/12/2017
DOA: 19/12/17
Gravida1
3.2 CONDITION ON ARRIVAL OF THE PATIENT IN THE HOSPITAL/ WARD AND
WHAT WAS DONE ON HER BERFORE ADMISSION.
From the casualty assessment, the 19 years old female gravida1 accompanied by
her mother at 3pm with complained of 4oweeks +3days gestational age . From the
Dr`s consultation, she has severe preeclampsia with blood pressure of
160/87mmHg,pulse of 104b/m, swelling legs and ankles. An induction of labour
was recommended 1/4cytotec by the Doctor . The fundal height of 40cm and foetal
heart beat of 134b/m.
20
3.3 PROVISIONAL DIAGNOSIS BY MEDICAL DOCTOR AT
CASUALTY ON ADMISSION.
The provisional diagnosis on admission from clinical presentation was
Severe Preeclampsia.
3.4 PRELIMINARY LAB RESULTS.
Hemoglobin: 11.2g/dl
Blood Group O, Rhesus factor negative
3.5 MEDICAL PRESCRIPTION AND TREATMENT ON ADMISSION BY
THE DOCTOR AT THE CASUALTY.
The medical prescription was as follows:
Ringer lactate
Magnesium sulfate
¼ cytotec
3.6 CLERKING AND ASSESSMENT BY THE NURSE
History taking and examination:
Patient came into the ward with full consciousness from doctor’s consultation at
3pm accompanied by her mother with post term pregnancy, severe preeclampsia
and cervical dystocia. She had swollen hands and leg with blood pressure of
160/87mmhg. LMP-09 March 2017-EDD-16 December 2017.
HEAD TO TOE EXAMINATION
Head: clean and dark hair.
Eye: black pupil and she see well.
Nose: on inspection no nasal discharge.
Mouth: no swollen gums.
Chest on observation: no abnormality discovered
21
Abdomen: patient had dark linear nigra
3.7 PAST MEDICAL HISTORY
Patient had once been admitted for appendicitis.
3.8 PAST SURGICAL HISTORY
Patient had once been operated for appendicitis.
3.9 FAMILY HISTORY
Hypertension is so common in their family.
3.10 SOCIAL HISTORY
Patient doesn’t smoke, does not drink alcohol but takes little of sweet drunks.
On Nutritional status
She does not have any nutritional dislike and her favourite is water fufu and erru
with enough meat which she eat often.
Patients love taking fruits such as bananas oranges, and pawpaw, no allergy to
food. She eats at least twice daily but 2 sometimes.
On health maintenance pattern
Patients take her drugs regularly whenever she is sick and usually buys from
hospital pharmacies.
On Elimination Pattern
Patient could pass out stool at least 3 times daily and urinate at least 4 times .
Sleep and Rest Pattern
Patient usually sleeps during the day and less in the night because of lower
abdominal pain.
22
Gynaecologic obstetrics History
Patient started menstruating at the age of 15year old. Has never had any abortion.
This is her first pregnancy, regular menstrual bleeding of 28days cycle with 4days
of duration. Patient used at least 3 pads daily her menses, no cramps during
bleeding. She attended her first antenatal clinic at 5months and did an echography,
reviewed a male child that is G1pooo.
On Perceptive Pattern
Mental status, patient was oriented in her present condition. She understands
English, speak it well and able to communicate her worries and feelings to her
family.
3.11 Vital Signs On Physical Examination
BP 159/90mmHg
P 100b/min
R 24cy
W 76kg
Bowel 2 times
Urine 3times
Vomitus Nil
Intake about 2liter of water.
23
Table1: Daily Drug chart; Date: 19/12/2017 – induction of labour
Table2: Daily Drug chart; Date: 20/12/2017
Time
8;15 Am
Drug Dose Route Frequency Remark Identity of
nurse
Morning magnesium 4g im 4hourly served SRN
Noon
12:15 pm/ 4:15
pm
magnesium 4g im 4hourly served SRN
Evening
9:15 Pm
magnesium 4g im 4hourly served SRN
Time
Drug Dose Route Frequency Remark Identity of
nurse
Noon Magnesium
sulphate
5g IM stat served HND
3:30 pm magnesium
sulphate
5g IM stat
Magnesium
sulphate
4g IVD stat
Ringer
lactec
+¼ cytotec
500cc IV stat served
Evening
7:30 Pm
Magnesium
sulphate
4g IM 4hourly served HND
11:30 Pm Magnesium
sulphate
4g IM 4 hourly served
24
Table3: Daily Drug chart; Date: 21/12/2017
Time Drug Dose Route Frequency Remark Identity of
nurse
Morning
1:15 Am
Magnesium
sulphate
4g IM 4hrs served
6: 00 Am Ampicilin 1g IV 8hrs served
8: Am Novalgin 1amp IV 8hrs served
Noon Novalgin
Ampicilin
Magnesium
sulphate
1amp
1g
4mg
IVD
IV
IM
8hourly
4 hrs`
served HND
Evening
5:15 pm
Magnesium
sulphate
Novalgin
4g
1amp
IM
IV
4hrs
8hrs
Served
served
The induction failed and the doctor recommended a CS that was done on
21/12/2017.
Description of the Caesarean Section:
The CS was done under general anaesthesia. A live male baby was extracted with
an Apgar score of 10.
Post-operative prescription:
a) Magnesium
b) Novalgin
c) Ampicillin
25
Table4: Daily Drug chart; Date: 22/12/2017
Time Drug Dose Route Frequency Remark Identity of
nurse
Morning
10 am
Novalgin
1amp IVD 8hourly served HND
Evening
6:00 pm
Novalgin 1amp IVD 8hourly served HND
Table1: Daily Drug chart; Date: 23/12/2017
Time Drug Dose Route Frequency Remark Identity of
nurse
Noon
12 PM
Novalgin
1 amp IVD 8 hrs served SRN
Table5: Daily Drug chart; Date: 24/12/2017
Time Drug Dose Route Frequency Remark Identity of
nurse
Morning
8 Am
Rapiclav
antalge
1TAB
1TAB
PO
PO
BD
TID
Taken
Taken
26
19/12/17, Nursing care plan 1: Need to prevent elamptic state.
Nursing diagnosis: Risk of eclampsia related to as evidence by hypertension.
(160|87mmhgh)
Objectives Nursing intervention. Rationale Evaluation.
Reduce blood
pressure to
normal:
120/80mmgh.
To reduce the
risk of
eclampsia.
Restrict salt intake and
encourage water
intake.
To prevent fluid
and sodium
retention.
Patients risk for
eclampsia is reduced,
as evidenced by
reduced blood
pressure.
Administer
medications as
prescribed. E.g
Magnesium sulfate
Prevents seizures
In pregnant women
with conditions
such as
preeclampsia.
Patient blood pressure
reduced
Regularly monitor
blood pressure.
To assess the
effectiveness of
medications.
Regular blood
pressure monitoring
gives a baseline for
assessing effectiveness
of treatment.
27
20/12/17, Nursing care plan 2: Need: Need to be comfortable.
Nursing diagnosis: Discomfort related to caesarian section as evidenced as pain
and tenderness at the operation site.
Objectives Nursing intervention. Rationale Evaluation.
Reduce
pain to the
acceptance
within two
days
level of
Encourage her to lie on the
supine position and help to
ambulate patient.
This helps to relieve
pain on incision site
by relaxing the
Patient
verbalization of
less pain after
muscles and also to
prevent pressure
sores.
nursing
management.
Advice patient to take sitz
bath.
To maintain
intactness of the
stitches.
Stitches should
not fall off
before due date
Monitor vital signs hourly
for the first two days post-
operative and twice every
day until discharge date.
To exclude heart
problems,
respiratory tract
abnormalities, the
presence of
infection that can be
indicated through
hyper psyrexia.
Normal
findings
throughout
hospitalization.
28
21/12/17, nursing care plan 3; Need to reduce excess fluid.
Nursing diagnosis: Fluid volume excess related to preeclampsia as evidenced by
edema over the legs and ankle and decreased urine output.
Objectives Nursing intervention. Rationale Evaluation.
Maintenance
of ideal
body weight
Without
excess fluid
through
nursing
intervention
Explained to patient and
family the rationale of
fluid limitation
Fluid limitation is
done according to
urine out of the
patient
Upon evaluation,
patient has
reduced fluid
volume
Assess location and
extent of edema, and
type
To assessed crees in
pressure of edema
daily
Patient has
reduced edema
29
22/17/17: Nursing care plan 4: Need to keep the body clean and protected.
Nursing diagnosis: Risk of infection related to presence of urinary catheter and
intra venous cannula.
Objectives Nursing intervention. Rationale Evaluation.
To reduce
level of
infection so
that patient
do not have
any
complication
through out
the hospital
stay and
beyond.
Taught patient about
self care
Help to reduce
level of infection
Infection is reduce
as evidence by
reduced redness
Removed urinary
catheter and cannula
Administered
antibiotics as ordered
Enhances healing
process by
providing comfort
to the patient.
Antibiotics help to
reduced infection
Patient felt satisfied
Assessed operated site
and vital signs daily
To reduce the level
of infection and the
progressive state of
the patient
Normal finding of
the general state of
the patient
23/12/17 , Nursing care plan 5: Need to eat adequately
Nursing diagnosis: Imbalanced nutrition less than the body requirement related to
anorexia, nausea and dietary restriction and altered oral mucus membrane
Objectives Nursing
intervention.
Rationale Evaluation.
To maintain adequate
nutrition status by reducing
nausea and increased appetite
Assess intake and
output of patient
Increase dietary
intake maintain
Patient maintain normal
nutritional status
according to lactation
30
Table No 3, Daily evolution chart of the patient
Date Time Observation Identity of nurse
19/12/2017
3:30pm Patient was presenting with lower
abdominal pain, edema of the legs
and ankle and 4oweeks and 3days
of gestational age.
HND
2O/12/2017 7:30am Blood pressure reduced. SRN
5:30pm Patient has lost of appetite SRN
21/12/2017 7:3Oam She complained of pain , edema
and stiffness around the injection
site
SRH
2am Patient was received from the
theatre on a stretcher with normal
saline infusion and a urinary
catheter in a semi conscious state
HND
23/12/2017 7:30am
Patient was calm with ,mild lower
abdominal pain ,blood pressure
and edema reduced
Mid wife
5:30pm Calm on shift and ambulate out of
bed
SRN
31
Date Time Observation
Identity of
nurse
24/12/2017 7:30am Patient was calm and
satisfied after removal of
urinary catheter
HND
5:30pm No complain HND
25/12/2017 7:30am No reduced edema ,blood
pressure body weight and no
infection on discharged
Mid wife
TABLE NO4: VITAL SIGNS CHART
Date Period To
C
BP Body
weig
ht
Pulse Respirati
on
Bow
el
Urin
e
Vomit
us
Inta
ke
19/12/
17 Evenin
g
37.
4
159/87mmH
g
76kg 104b/
m
24 2 3 1 0
20/12/
17
Morni
ng
37.
5
158/86mmH
g
76kg 9ob/
m
23 1 3 0 0
Evenin
g
37.
1
158/87mmH
g
76kg 90b/
m
21 2 5 0 0
21/12/
17
Morni
ng
37.
1
150/90mmH
g
76kg 84b/
m
25c/m 1 4 0 0
Evenin
g
36.
6
153/80mmH
g
71kg 86b/
m
24c/m 0 700
cc
0 0
22/12/
17
Morni
ng
37 145/80mmH
g
67kg 85b/
m
22c/m 0 8oo
cc
0 0
Evenin
g
37.
2
130/75mmH
g
69kg 82b/
m
20c/m 0 500
cc
0 0
23/12/
17
Morni
ng
36.
4
133/67mmH
gHg
69kg 82b/
m
23c/m 1 3 0 0
32
Date Period To
C
BP Body
weig
ht
Pulse Respirati
on
Bow
el
Urin
e
Vomit
us
Inta
ke
Evenin
g
37 136/70mmH
g
69kg 82b/
m
18c/m 2 3 0 0
23/12/
17
Morni
ng
36.
4
133/67mmH
g
67kg 81b/
m
23c/m 2 2 0 0
Evenin
g
37 136/70mmH
g
67kg 80b/
m
18c/m 2 4 0 0
24/12/
17
Morni
ng
37 140/76mmH
g
67kg 81b/
m
21c/m 2 3 0 0
Evenin
g
37.
1
137/70mmH
g
67kg 86b/
m
20c/m 1 2 0 0
33
CHAPTER FOUR – REVIEW OF MEDICATIONS
MEDICATION 1 Novalgin
Generic Name: Novalgin
Trade Name: Novalgin metaizem
Drug Class: Antispasmodic
Mechanism of action: it alters the mechanism of the heart regulating centre
and raises pain threshold. It help to relax the smooth muscle
Indication. Labour pains, cystitis, spastic, dysmenorrhea, post operative
romatic conditions, biliary colic, neuralgia, myocardia infection.
Dosage: Adults, one ample 3times daily, rout of administration, orally,
IV,IM, rectal or suppository
Side effect, vertigo, hypersensitivity, an anaphylactic reaction
Contraindication, allergic pregnancy, intermittent porphyria
Note, infants less than four months shouldn’t be given novalgin. The IV
injection should be given.
It must not be mixt with another for injection
Patient did not experience any side effect
MEDICATION2 oxytocin
Generic Name: oxytocin
Trade Name: Pitocin, syntocinony,
Drug Class:
Mechanism of action: selective stimulant on uterine muscle especially
towards term, during labour and post-partum. Sensitivity of the uterus to
oxytocin increases throughout the pregnancy reaching the maximum term.
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Oxytocin is a hormone used to help start and continue labour and to
control bleeding after delivery. It is also sometimes used to help milk
secretion in the breast feeding,
Dosage, Adult, 10units injected slowly into the vein or muscle.
Side effects, abdominal pain, nausea and vomiting, prostaglandin and risk of
uterine rupture and cervical laceration. Ergotamine, synergistic effect in
control of post-partum haemorrhage.
Contraindications, injection of an IV bolus should be avoided because it
may cause short term hypotension with flush and reflex tachycardia
Precaution: it must be administered in a hospital and under qualified
medical monitoring.
Administration of excessive doses of oxytocin may lead to foetal distress
asphyxia.
MEDICATION 3 Ampicillin
Generic Name: Ampicillin
Trade Name: Omnipen
Mechanism of action: Acts as an irreversible inhibits or of the enzyme
transpeptidasa which is needed by bacteria to make the cell wall inhibit the
third and final stage of bacteria cell wall synthesis in binary fission, which
ultimately leads to cell lysis, therefore ampicillin is usually bacteriolytic
Dose and mode of administration, Ampicillin 1gram and 2grams are
primarily for IV use, they may be administered IM. When the 250mg or
500mg vials are unavailable, ampicillin 125mg is intended primarily for
paediatric use.
It can be administered IV, IM, IVD, Orally.
Side effects Nausea, vomiting, rashes, diarrhoea, swelling of the tongue,
thrush and yeast infection.
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Contraindication, a history of previous hypersensitivity reaction to any
of the penicillin is a contraindication. Ampicillin is also contraindicated
in infections caused by penicillin as a producing organism.
Precaution, the possibility of supper infection mycitic organism or
bacterial pathogens should be kept in mind during therapy. In such cases,
discontinue the drug and substitute appropriate treatment
Patient did not experience any side effect.
MEDICATION 4 Magnesium sulphates
Generic Name: Mag NEE see um sulphate
Trade Name: Magnesium sulphate| sodium chloride, mgso4
Mechanism of action: it is use to prevent seizures in pregnant women with
conditions such as preeclampsia or toxaemia of pregnancy.
It is also used to treat hypomagnesaemia( low level of magnesium in blood)
Mode of administration, magnesium sulphate is injected into the muscle or
into the vein and must be received in the hospital or clinic setting. So that
breathing, BP, Oxygen levels will be watched while receiving magnesium
sulphate.
Dosage, for severe preeclampsia or eclampsia, initial dose 4g to 5grams in
250ml of appropriate diluent, with simultaneous IM administration of up to
5grams (10ml)
Magnesium maintenance dose 4 to 5grams IM in to alternate buttocks every
4hours as needed.
Side effects, difficult breading, swollen of the face, lips, tongue, diarrhoea
or upset stomach.
Contraindication, hypersensitivity, myocardia damage, diabetic coma,
heart block. Hypermagnasemia, hypocalcaemia.
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Administration during 2hours presiding delivery of mother with toxaemia of
pregnancy.
Precaution, patients with renal impairment ensure that renal excretory
capacity is not excided.
Foetal skeletal, hypocalcaemia and hypermagsema abnormalities reported
with continues term use (i.e. longer than 5.7days use) for off lable treatment
of preterm labour in pregnant women, the effect on the developing foetus
may result in neonates with skeletal abnormalities.
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CHAPTER FIVE - DISCHARGE SUMMARY
5. 1 Date of admission 19 12 2017
5.2 Date of discharge 2412 2018
5.3 Treatment received
Noualgin, magnesium sulphate, ampicilline, oxytocin,
5.4 Response to treatment: the induction failed. She had a CS; a live male baby
was delivered with Apgar 10.
5.5 CONDITION ON DISCHARGE
Patient after receiving her medications was in good and satisfactory condition with
no complain .the patient left the hospital with her baby ,thus in a healthy condition
5.6 Home Treatment
Oral rapiclav and antalgex
5.7 Advice on discharge
Patient was advised on hygiene, proper, breast feeding of the baby and to come
back if she has any complain.
And also to go for family planning
5.8 Appointment after six weeks for post partum examination
5.9 Follow up:
After patient was discharged, he went for appointment and was in good condition,
on calling she was very happy and satisfied for nursing care given to her in the
hospital and at home.
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CHAPTER SIX
6.1 Positive findings
The environment is good and contusive for learning; the nurses are very
welcoming and collaborative.
The hospital equipment are good.
Standard precaution are effective perform by the nurses.
6.2 Difficulties encountered
Inadequate bed for nursing mothers in the ward
Inadequate babies cot in the ward
Treatment are not always given on time
Lack of health personnel in the hospital, for that reason patient is not
properly care for.
Visitor does not respect visiting time in the hospital, hence disturbs patient
sleeping pattern
6.3 Proposed solutions:
The government should employ enough trained staff reduce work load on
the nurses and promote effectiveness.
Discipline should be placed on visitors to respect visiting time.
Recommendations:
The hospital lacks surgical equipment, dressing forceps and drapes are out
dated, the hospital need to purchase new ones and to also to improve on the
working condition of the staff.
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Conclusion:
Despite all the problems encountered, the case study carried at the
Bamenda Regional Hospital was a successful one because my case was well
managed .the secrete to its management is early prenatal visit.
Finally, the internship was a successful one because we did not only nurse a
patient with preeclampsia but other normal delivery mother and their babies.
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