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BUKIDNON STATE UNIVERSITY

COLLEGE OF NURSING

MALAYBALAY CITY

A Grand Case Presentation

On

Presentors:

Jennifer P. Barroso

Angelo A. Lumahang III

Fave Danielle Villegas

Princess Obrique

Ma. Luisa Durog

Golda-Ria Torayno

And NCM102-cluster II Students

March 25, 2010


TABLE OF CONTENTS

I. Introduction

II. Objectives

III. Assessment

a. Demographic Data

b. History of Past Illness

c. History of Present Illness

d. Systems Involve

IV. Anatomy and Physiology

V. Pathophysiology

VI. Actual Treatment

a. Diagnostic Exam

b. Laboratory Exam

c. Drug Study

VII. Ideal Treatment

a. Diagnostic Exam

VIII. Nursing Care Plan

a. Actual Nursing Care Plan


b. Ideal Nursing Care Plan

IX. Discharge Plan/ Health Teachings

X. Prognosis

XI. Doctors Order

XII. Reference

I. INTRODUCTION

Pregnancy- Induced Hypertension (PIH) is a condition in which vasospasm occurs

during pregnancies in both small and large arteries. Signs of hypertension, proteinuria,

and edema develop. It is a unique to pregnancy and occurs in 5% to 7% of pregnancies in

the United States (Moldenhauer & Sibai, 2003). Despite of years of research, the cause of

the disorder is still unknown. Originally it was called toxaemia because the researchers

pictured a toxin of some kind being produced by a woman in response to the foreign

protein of the growing fetus, the toxin leading to the typical symptoms. No such toxin has

ever been identified. A condition separate from chronic hypertension, PIH tends to occur

most frequently in women of color or with a multiple pregnancy, primiparas younger than

20 years of age and older than 40 years old, women from low socioeconomic

backgrounds (perhaps of poor nutrition), those who have had five or more pregnancies,

those who have hydramnios, or those who have an underlying disease such as heart

disease, diabetes with vessel or renal involvement, and essential hypertension.

Eclampsia is commonly defined as new onset of gradual seizure activity and/or

unexplained coma during pregnancy or postpartum in a woman with signs or symptoms


of preeclampsia. Nonetheless, eclampsia in the absence of hypertension with proteinuria

has been demonstrated to occur in 38% of cases reported in the United Kingdom.

Similarly, hypertension was absent in 16% of cases reviewed in the United States. Most

cases of eclampsia present in the third trimester of pregnancy, with about 80% of

eclamptic seizures occurring intrapartum or within the first 48 hours following

delivery. Rare cases have been reported prior to 20 weeks' gestation or as late as 23 days’

postpartum. Other than early detection of preeclampsia, no reliable test or symptom

complex predicts the development of eclampsia. In developed countries, most of recent

reported cases have been classified as unpreventable (Michael G. Ross, MD, MPH,

2009).
II. OBJECTIVES

Nurse- Centered objectives

At the end of 4 hours presentation, the student nurse should be able to:

1. Identify the risk factor contributing to the occurrence of the disease.

2. Formulate significant nursing diagnosis, with the significantly related nursing care

plan.

3. Identify the different medications administered for this disease, their indications,

contraindications, side effect, and specific responsibility.

4. Identify the laboratory and diagnostic procedure done with the eclamptic patient,

their indication and purposes, and specific nursing responsibilities.


III. ASSESSMENT

DEMOGRAPHIC DATA

a. Name of the patient : Jandy Shinwa

b. Age : 39 years old

c. Sex : Female

d. Date of Birth : January 25, 1971


e. Address : P-16A, Valencia City, Bukidnon

f. Religion : Roman Catholic

g. Nationality : Filipino

h. Civil Status : Single

i. Occupation : Cook

j. Informant : Sailor Moon

k. Relationship to patient : Sister

l. Date of Admission : February 3, 2010

m. Time of Admission : 10:30 am

n. Attending Physician : Dr. Leonora Leyson

o. Admitting Vital Signs : Temp.: 37.2oC PR: 80 bpm

RR: 20 cpm BP: 240/180 mmHg

p. Food Allergy : No known allergy

q. Drug Allergy : No known allergy

r. Educational Attainment : High School level

s. Monthly Income : ₱ 7, 440.00

t. Chief Complaint : Seizures

u. Admitting Diagnosis : Eclampsia, Gravida 1 Para 0 31.2 weeks of

gestation

v. Final Diagnosis : 1. Delivered a stillborn baby boy 1.3 kilograms,

cephalic

2. Eclampsia, Severe, Elderly primi

3. Gravida 1 Para 0
HISTORY OF PAST ILLNESS

Patient is hard working and responsible adult. She works for hours and she works

hard for her family. Like any other normal adult, she experiences stress from work. She

also feels pain and body aches, for she tries to do any kind of work to help sustain her

family.
In the year 2005, the patient was hospitalized at Bukidnon Provincial Hospital ( BPH )

Malaybalay, City because of Urinary Tract Infection (UTI). She stayed confined for a

couple of days and she got better. After that incidence she hadn’t have any medical

problems since then her present illness occurred.


HISTORY OF PRESENT ILLNESS

Last February 01, 2010 the patient already experienced discomfort. The patient

interpreted this discomfort as a result of stress from her work. So, she decided to take a

leave and will be back after she will deliver her first baby. Along with her discomfort,

she already knew that her blood pressure is increasing. From her last check-up last

January 25, 2010 it was 220/160mmHg. Since then, she took an antihypertensive drug

(methyldopa) aiming to lower down her blood pressure. A day prior to admission, she

experienced pain in the abdomen with the pain scale of 6/10. On the following day, she

kept on asking her sister to accompany her to Bukidnon Provincial Medical Center.

Along their way, the patient suffered from seizure until they reached ER of the said

hospital. She was admitted and diagnosed as Eclampsia G1P0 31.2 weeks gestational age.

Patient has been working as a cook under Atecle’s Grill as her occupation to support

her family. She has mostly spent her time in her work during weekdays and she could

only rest and give time for comfort during weekends. Accordingly, patient has history of

hypertension. Patient also experienced neck pain, during long hours of work. The patient

was asked about her parent’s disease, she stated that they are hypertensive and maintain

no medicine for hypertension. In addition, the patient’s lower extremities are very evident

for pitting edema due to long hours of standing.


SYSTEMS INVOLVE

A. Cardiovascular/ Circulatory System

Objective Data:

Temperature: 37.2 ̊ C

Blood Pressure: Right: 150/100mmhg Left: 150/100mmhg

Pulses

Carotid pulse: Strong, Right: 80bpm Left: 83bpm

Apical: Regular, 80bpm

Radial pulse: Regular, Right: 80bpm Left: 81bpm

Dorsalis Pedis: Regular, Right: 80bpm Left: 80bpm

Posterior tibia: Regular, Right: 78bpm Left: 80bpm

Jugular veins distention: veins not distended

Nail bed color: Pink

Capillary refill: 2 seconds

Edema: Pitting, on both lower extremities


Varicosities: No varicosities found

Calf tenderness (homan’s sign): Right: negative Left: negative

Subjective Data:

Previous/ Recent Illness: “Naa na sa among kaliwat ang taas ug BP” as verbalized

by the patient.

>Patient verbalized that she experienced light headedness, fatigue and weakness.

>“Gapang- luya ko” as verbalized by the patient.

Remarks:

Patient’s body temperature is within normal range, blood pressure is above normal

(240/180 mmHg), pulses are also within normal range (80 bpm), nail bed color is pinkish

with capillary refill of 2 seconds, pitting edema is also being observed on both lower

extremities, no varicosities seen, and Calf tenderness is negative. Patient also verbalizes

that they have a family history of hypertension. Patient also experienced light

headedness, fatigue and weakness.

Nursing Diagnosis:

Fatigue related to stress, anxiety, and depression.


B. Elimination

Objective Data:

Mobility and Dexterity: ambulatory

Tubes/drainage/stoma: indwelling catheter

Abdomen: firm abdomen

Bowel sounds: Hypoactive

Measurement: Intake: 930 cc Output: 330cc

Edema: pitting edema noted on the lower extremities and swelling on the IV site.

Present Urine Color: Dark Amber

Odor: (catheter)

Subjective Data:

Medication Taken: “wala paman pud ko nag inom ug tambal kibahin sa pampa-daghan

ug ihi” as verbalized by the patient

Fluid Intake per Day: “murag 2 ka-litro sa akong pag-estimate” as verbalized by the

patient
Excessive perspiration and odor problem: “dili man kaayo ko gapanington” as verbalized

by the patient

Remarks:

Patient is ambulatory, with indwelling catheter, she has firm abdomen, bowel sounds

is hypoactive then she has pitting edema on both lower extremities. Her urine color is

dark amber.

Nursing Diagnosis:

*Self care deficit related to personal belief as manifested by poor hygiene.

*Decreased cardiac output related to fluid retention


IV. ANATOMY AND PHYSIOLOGY

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 individual

4. Production of female sex hormones.


Functions:

1. Carry blood

2. Exchange nutrients, waste products and gases

3. Transport

4. Regulate blood pressure

5. Direct blood flow


Structure and Functions of Blood Vessels

Structure Functions

Arteries - The walls (outer structure) of Transport blood away from the heart;

arteries contain smooth muscle fiber that Transport oxygenated blood only (except in the

contract and relax under the instructions of the case of the pulmonary artery).

sympathetic nervous system.


Arterioles - Arterioles are tiny branches of Transport blood from arteries to capillaries;

arteries that lead to capillaries. These are also Arterioles are the main regulators of blood flow

under the control of the sympathetic nervous and pressure.

system, and constrict and dilate, to regulate

blood flow.
Venules - Venules are minute vessels that Drains blood from capillaries into veins, for

drain blood from capillaries and into veins. return to the heart

Many venules unite to form a vein.

Structure Functions
Capillaries - Capillaries are tiny (extremely Function is to supply tissues with components of,

narrow) blood vessels, of approximately 5- and carried by, the blood, and also to remove

20micro-metres (one micro-metre = waste from the surrounding cells ... as opposed to

0.000001metre)diameter. simply moving the blood around the body (in the

There are networks of capillaries in most of case of other blood vessels);

the organs and tissues of the body. These Exchange of oxygen, carbon dioxide, water,

capillaries are supplied with blood by salts, etc., between the blood and the surrounding

arterioles and drained by venules. Capillary body tissues.

walls are only one cell thick (see diagram),

which permits exchanges of material between

the contents of the capillary and the

surrounding tissue.
Veins - The walls (outer structure) of veins Transport blood towards the heart;

consist of three layers of tissues that are Transport deoxygenated blood only (except in

thinner and less elastic than the corresponding the case of the pulmonary vein).

layers of arteries.

Veins include valves that aid the return of

blood to the heart by preventing blood from

flowing in the reverse direction.

Comparison between Arteries and Veins

Arteries Veins
Transport blood away from the heart; Transport blood towards the heart;

Carry Oxygenated Blood Carry De-oxygenated Blood

(except in the case of the Pulmonary Artery); (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 Transports blood under lower pressure (than

veins); arteries);
Do not have valves (except for the semi-lunar Have valves throughout the main veins of the

valves of the pulmonary artery and the aorta). body. These are to prevent blood flowing in the

wrong direction, as this could (in theory) return

waste materials to the tissues.

NORMA ABNORMA
THE CARDIOVASCULAR SYSTEM
V. ANATOMY AND PHYSIOLOGY OF CARDIOVASCULAR SYSTEM
The cardiovascular system is the lifeline of the body. Its primary function is to as a

transport system, delivering oxygen by way of the red blood and delivering nutrients,

metabolites, and hormones to every cell in the body. At the same time, it transports

metabolic wastes for detoxification and excretion. The cardiovascular system also

contains white blood cells, whose main function is to fight infection.

 Heart- a cone shaped muscle with four chambers; a double pump about the size of

a clenched fist (12cm long and 9cm wide). Weighs 250-390g (8.8-13.8oz) in adult males

and 200-275g (7.0-9.7oz) in adult females. Pumps blood throughout the circulatory

system.

RIGHT SIDE

 Right atrium- upper chamber of right heart. Receives unoxygenated blood form

superior and inferior vena cava.

 Tricuspid valve- right AV valve with three cusps (tricuspid). Attached by

chordate tendineae to papillary muscles, which are attached to inner heart muscle. Valve

between right atrium and right ventricle.

 Right ventricle- lower chamber of right heart. Receives blood from right atrium

and pumps it into pulmonary circuit.

 Pulmonary semilunar valve- composed of three cusps. Valve between right

ventricle and main pulmonary artery.


 Main pulmonary artery- artery leading from right ventricle to lungs. Divides into

right and left branches supplying respective lungs. Carries unoxygenated blood from right

ventricle to lungs.

 Pulmonary veins- veins leading from lungs to left atrium. Carry oxygenated blood

to left atrium.

LEFT SIDE

 Left atrium- upper chamber of left heart. Receives oxygenated blood from lungs

through pulmonary veins.

 Mitral valve- AV valve with two cusps (bicuspid) attached by chordate tendineae

to papillary muscles, which are attached to inner heart muscle. Valve between left atrium

and left ventricle.

 Left ventricle- lower chamber of left half of heart. Receives blood from left

atrium and pumps oxygenated blood through systemic circulation.

 Aortic valve- composed of three cusps. Valve between left ventricle and aorta.

 Interventricular septum- wall between left and right ventricles. Vertically

separates left and right sides of heart.


SYSTEMIC CIRCULATION

The systemic circulation is responsible for supplying oxygen to every cell in the

body through the arterial system and then returning unoxygenated blood to the heart

through the venous system. Oxygenated blood flows into the left atrium from the

pulmonary circulation. The left atrium the pumps the oxygenated blood into the left

ventricle, which in turn expels the oxygenated blood through the aorta into the arterial

systemic circulation. From the aorta, blood then flows through smaller arterioles to the

systemic capillaries. The systemic capillaries link the arterial and venous systems. At this

point, exchange of oxygen, nutrients and wastes occurs. From the capillaries,

unoxygenated blood then flows through the venules, into the larger veins, and then to the

superior and inferior vena cavae. Unoxygenated blood then enters the right atrium and is

pumped to the right ventricle into the pulmonary circulation to continue the cycle.

The placenta is also a kind of padding, and maintains a unique environment in which

your baby can develop and grow. The placenta forms from the same cells as the embryo

and attaches itself to the inner wall of the uterus, growing as your baby grows and the

volume of your amniotic fluid increases. When it's finished growing, it is circular and
weighs about a pound; when the body expels it after the birth; many women are surprised

at its size and weight.

FETAL CIRCULATION

Since the lungs and digestive system are not yet functioning in a fetus, all

nutrient, excretory, and gas exchanges occur through the placenta. Nutrients and oxygen

move from the mother’s blood into the fetal blood, and fetal wastes move in the opposite

direction. The umbilical cord contains three blood vessels: one large umbilical vein and
two smaller umbilical arteries. The umbilical vein carries blood rich in nutrients and

oxygen to the fetus. The umbilical arteries carry carbon dioxide and debris-laden blood

from the fetus to the placenta. As blood flows superiorly toward the heart of the fetus,

most of it bypasses the immature liver through the ductus venosus and enters the superior

vena cava, which carries the blood to the right atrium of the heart.

Since fetal lungs are non-functional and collapsed, two shunts see to it that they

are almost entirely bypassed. Some of the blood entering the right atrium is shunted

directly into the left atrium through the foramen ovale, a flaplike opening in the interatrial

septum. Blood that does manage to enter the right ventricle is pumped out the pulmonary

trunk, where it meets a second shunt, the ductus arteriosus, a short vessel that connects

the aorta and the pulmonary trunk. Because the collapsed lungs are a high-pressure area,

blood tends to enter the systemic circulation through the ductus arteriosus. The aorta

carries blood to the tissues of the fetal body and ultimately back to the placenta through

the umbilical arteries.

At birth, or shortly after, the foramen ovale closes, and the ductus arteriosus

collapses and is converted to the fibrous ligamentum arteriosum. As blood stops flowing

through the umbilical vessels, they become obliterated, and the circulatory pattern

converts to that of an adult.


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.
Generalized seizures are caused by abnormal electrical 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.


XIII. Actual Treatment

a. Diagnostic Exam

Radiologic Opinion Report

Chest

Requesting MD: Dr. Galang Date Ordered: February 8, 2010

Findings: There is no evidence of active parenchymal infiltrates cardiomediastinal

silhotte appears enlarged with a CT ratio of 0.54. Aorta, trachea, diaphragm, and sinuses

are unremarkable. Included osseous structures are intact.

Impressions: Minimal cardiomegaly

Radiologist: Vincent Troy A. Del Mundo, M.D

X- Ray report
Pregnancy Evaluation Date ordered: February 24, 2010

History: Eclampsia, G1P0

Requesting M.D: Dr. Chavez

Findings: Within the gravid uterus is a single uterine fetus in breech presentation with

femoral length of 6.0 cm. Equivalent to 31.2 weeks of gestational age.

Fetal somatic and cardiac activities are not appreciated on real time.

Impressions: Intrauterine fetal demise at 31.2 weeks gestational age by femoral length.

Ultrasound Report
b. Laboratory Exam

Date Components Result Normal Significance


Ordered Findings
Feb. 3, 2010 Complete Blood
Count
White Cell Count 23.0/mm3 3.8-10.8/mm3 Infection
Haemoglobin 15.1 12-16% Within normal range
Hematocrit 42.6 37-46% Hemoconcentration
Platelet Adequate 130,000- Within normal range
400,000
platelets/mm3
Differential Count Infection
Segmenters 89% 52-82%
Lymphocytes 11% 18-48%
HBsAg Non reactive Non reactive normal
Clotting Factor 4 min 03 sec 3-5 min Within normal range
Bleeding Time 1 min 16 sec 1-3 min Within normal range
Feb. 3, 2010 Urinalysis Presence of blood
Color Dark Brown Yellow to amber
Transparency Turbid Clear to slightly Presence of blood and
hazy bacteria
Sugar Negative Negative normal
Specific Gravity 1.030 1.016-1.025 Within normal range
pH 6.0 4.5-8.0 Within normal range
Albumin 4 30-50 g/L If decreased there is
hypertension
Ketones 4 Negative Ketonuria
Blood 4 Negative Hematuria
Pus Cells Too numerous negative infection
to count
RBC Plenty 0-2 /hpf Presence of blood in
urine.
Epithelium Plenty Few Normal
Bacteria Few None GUT
infection/contamination
of external genitalia
Feb. 4, 2010 Clinical Chemistry 95 mg/dL Within normal values
FBS 94.1mg/dL
Creatinine 1.0 0.5-1.4 mg/dL Within normal range
Lipid Profile Increased risk of heart
Triglycerides 317.0 50-250 mg/dL attack and stroke
Cholesterol 275.0 120-200 mg/dL Increased risk of heart
attack and stroke
HDL 87.4 Less than 130 Within normal range
mg/dL

LDL 124.0 Less than 130 Within normal range


mg/dL

Alkaline 132.7 44-147 IU/L Within normal range


Phosphate
SGOT 56.1 10-42U/L Liver abnormality
SGPT 25.1 5-35 IU/L Within normal range
XIV. Ideal Treatment

a. Diagnostic Exam

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 the following:

 Blood pressure measurement

 Urinalysis

 Frequent weight measurements

 Blood Chemistry

 Hematology
c. Ideal Nursing Care Plan

• Support bed rest. - with severe pre-eclampsia most women are hospitalized so

that bed rest can be in forced and the woman can be observed more closely than she can

be on home care. Visitors are usually restricted to support people. Because a loud noise

such as a crying baby or a dropped tray of equipment may be sufficient to trigger a

seizure initiating eclampsia, man with severe pre-eclampsia should be admitted to a

private room so she can rest as undisturbed as possible. Raise side rails to help prevent

injury if a seizure should occur. Darken the room if possible because a bright light can

trigger seizures. However, the room should not be so dark that caregivers need to use a

flash light to make assessments. Shining a flashlight beam into a woman’s eyes is the

kind of sudden stimulation to be avoided. Stress is another stimulus capable of increasing

blood pressure and evoking seizures in a woman receives clear explanations of what is

happening and what is planned. Clear explanations help her accept the need for visitor

restrictions and not to cheat on bedrest. allow her opportunities to express her feelings

about what is happening or how bewildered she is because the few simple symptoms she

noticed 2 weeks ago have now developed into a syndrome that may be lethal for her baby

and possibly even to her.


• Monitor maternal well-being.- take blood pressure frequently ( at least q4h ) or

with a continuous monitoring device to detect any increase, which is a warning that

woman’s condition is worsening. Obtain blood studies as ordered to assess for renal and

liver function and the development of DIC, which often accompanies severe vasospasm.

Because she is at higher risk for premature separation of the placenta and resulting

haemorrhage, a blood sample for type and cross- matched is usually also drawn.

Obtain daily hematocrit levels as ordered to monitor blood concentration. This

level will rise if increase fluid is leaving the bloodstream for interstitial tissue or edema.

Also, anticipate the need for frequent plasma estriol levels and electrolyte levels. A

woman’s optic fundus is assessed daily for signs of arterial spasms, edema or

haemorrhage. Obtain daily weights at the same time each day to evaluate tissue fluid

retention. Ensure that a woman is wearing approximately the same amount of clothing at

each weighing so any change in weight is not influence by change in the weight of her

clothing.

An indwelling urinary catheter may be inserted to allow accurate recording of

output and comparison with intake. Urinary output should be more than 600mL/24hours

or more than 30mL/hour; an output lower than this suggests oliguria. Urinary proteins

and specific gravity should be measured and recorded with voiding or hourly if an

indwelling catheter is present. A 24-hour urine sample may be collected for protein and

creatinine clearance determinations to evaluate kidney functions. A woman with mild

pre-eclampsia spills between 0.5g and 1g of protein in every 24hours;


• Monitor fetal well-being. –generally, single Doppler auscultation at

approximately 4-hour intervals is sufficient at this stage of management. However, the

fetal heart rate may be assessed continuously with an external fetal monitor. A woman

may have an nonstress test or biophysical profile done daily to assess utero-placental

sufficiency. Oxygen administration to the mother may be necessary to maintain adequate

fetal oxygenation and prevent fetal bradycardia

• Support a nutritious diet.- a woman needs a diet moderate to high in protein and

moderate in sodium to compensate for the protein she is losing in urine. An intravenous

fluid line should be initiated and maintained to serve as route for drug administration as

well as to administer fluid to reduce hemoconcentration and hypovolemia.

• Administer medications to prevent eclampsia.- a hypotensive drug such as

hydralazine or labetalol may be prescribed to reduced hypertension. These drugs act to

lower blood pressure by peripheral dilatation and thus do not interfere with placental

circulation. They can cause tachycardia. Therefore, assess pulse and blood pressure after

administration. Diastolic pressure should not be lowered below 80-90mmHg or

inadequate placental perfusion could occur.

Despite these new drugs, MgSO4 remains the drug of choice to prevent

eclampsia. This drug, classified as a cathartic, reduces edema by causing a shift in fluid

from the extracellular spaces into the intestine. It also has a central nervous system

depressant action.

To achieve immediate reduction of the blood pressure, MgSO4 is first given

intravenously in a loading or bolus dose. Given intravenously over 15min, the drug acts
almost immediately; unfortunately, the effect lasts only 30-60 min, so administration

must be continuous.

For MgSO4 to act as an anticonvulsant blood serum levels must be maintained at

5-8mg/100mL.if the blood serum level rises above this, respiratory depression, cardiac

arrhythmias and cardiac arrest can occur.

The most evident symptoms of overdose from MgSO4 administration include

decreased urine output, depressed respiration, reduced consciousness, and decrease deep

tendon reflexes. Because Magnesium is excreted from the body almost entirely through

the urine, urine output must be monitored closely to ensure adequate elimination. If

severe oliguria should occur, excessively high serum levels of magnesium can result.

Before you administer further MgSO4, therefore, ensure that urine output is above 25-

30/hour, with a specific gravity of 1.010 or lower.


XV. Discharge Plan/ Health Teachings

The patient should be advised and educated on the course of the disease and any

residual problems.

The patient should be educated on the importance of adequate prenatal care in

subsequent pregnancies.

If the patient has pre-existing hypertension, she should have good control prior to

conception and throughout pregnancy. Her case should be followed for recognition and

treatment of preeclampsia.
Follow up 1-2 weeks after delivery to evaluate for blood pressure control and any

residual deficits from the eclamptic seizure. Patients with persistent hypertension past 8

weeks' puerperium or neurologic changes may need medical referral.

XVI. Prognosis

• About 25% of women with Eclampsia have hypertension in subsequent

pregnancies.

• 5% of patients with hypertension develop severe preeclampsia.

• About 2% of women with Eclampsia develop Eclampsia with future pregnancies.

• Multiparous women with Eclampsia have the following:

o A higher risk for development of essential hypertension

o A higher mortality rate in subsequent pregnancies as compared with

primiparous women

XVII. Doctors Order

February 03, 2010

 Admit to Ob

To provide medical management and further monitoring

 TPR q4
To assist vital signs

 NPO temporarily

To prevent aspiration that maintains nutritional needs.

 CBC, BT, CTBT

Complete blood count is ordered to check the abnormalities of blood

 UA

Urinalysis is ordered to check for the presence of bacteria, molecules that are

abnormally found in the urine

 HBsAg

To determine whether the woman is protected against rubella if exposure should

occur during pregnancy and whether in newborn will have a chance in

developing hepatitis B.

 FBS, Creatinine, Alkaline PO4, AST

Serum Creatinine is ordered to evaluate renal function

 D5LR 1L @ 30gtts

For medication route and for nutrition of the patient


 Hydralazine 5 mg IVTT now

To lower down blood pressure of the patient; hydralazine is an anti-hypertensive

drug

 O2 inhalation 3L/L

To aid the patient in oxygenation

 Tongue depressors

To prevent the tongue from biting during seizures

 CBR without toilet privilege

To prevent patient from further complications

 I and O q4

Deviations from baseline monitoring

To monitor the amount of fluids the patient takes in and the amount of output

 Refer accordingly

To have proper monitoring

Feb 04, 2010

 Hydralazine 5mg IVTT q4

to lower down blood pressure of the patient; hydralazine is an anti-hypertensive

drug
 Methyldopa 500mg 1tab q6

Calcium-channel blocker; anti-hypertensive

 Diet: Low salt, low fat

To decrease amount of sodium intake of the patient

 To follow D5LR 1L 20gtts/min

For medication route and for nutrition of the patient

Feb 05, 2010

 For pelvic UTZ today

To evaluate urinary function through a non-invasive test that uses reflected sound

waves to visualize kidney

 Continue medication

To continue course of treatment

 Continue BP monitoring every hour

Evaluate underlying changes associated with the condition.

 To follow IVF D5LR 1L @ KVO rate

For medication route and for nutrition of the patient


Feb 06, 2010

 Continue meds

To continue course of treatment

 Give nifedipine 30mg tab PO OD

Calcium channel blocker; anti-hypertensive

 Pravastatin 40mg tab OD/PO

Pravastatin is a lipid lowering agent

 Continue other antihypertensive medication

To continue treatment

Feb 07, 2010

 Continue medication

To follow proper course of treatment

 Continue BP monitoring

Evaluate underlying changes associated with the condition.

 Refer to any unusual findings


For proper monitoring

 IVFTF: D5LR 1L @KVO rate

For medication route and for nutrition of the patient

 Give methyldopa q8

To lower down patients blood pressure

Feb 09, 2010

 Continue medication as prescribed

To continue course of treatment

 Start Cefuroxime 750mg IVTT-ANST q8

Anti-infective; Prevents occurrence of infections

 To follow D5LR 1L@20gtts/min

For medication route and for nutrition of the patient

Feb 10, 2010

 Low salt, low fat


Low intake of sodium helps lower down the fluid in the body because if there is

more sodium intake there is also more fluid retain in the body contributing to

increased fluid volume that results to increased blood pressure.

 Continue antihypertensive meds

to lower down the patient’s blood pressure

 Infuse 5% oxy to D5LR 1L @20gtts/min

To help muscle contract and facilitate labor

 Refer accordingly

For proper monitoring

Feb 11, 2010

 Continue meds

To follow proper course of treatment

 (-)labor : give Hydralazine 5g 1V PRN for DBP ≥ 110mmhg

To lower down blood pressure since Hydralazine is an antihypertensive drug

Feb 13, 2010

 Continue meds as prescribed


To continue treatment

Feb 14, 2010

 Give Hydralazine 10mg IVTT now

To lower down blood pressure; Hydralazine is an anti-hypertensive drug

 Back to ward

For further monitoring

 DAT

To regain proper nutrition

 Meds:

o Cefuroxime IVT to consume

Anti-infective; Prevents occurrence of infections

o Cefadroxil 500mg cap 2x daily for 7 days

o Mefenamic acid 500mg q8

To relieve pain that patient is suffering; Mefenamic acid is a pain reliever

o Multivitamins + Fe tab OD

This is to prevent anemia since this medication is an antianemics


 To continue other antihypertensive meds

To maintains normal value of patient’s blood pressure.

 Infuse 10 units oxy to present IVF @ 30gtts/min

For medication route and for nutrition of the patient; oxytocin promotes

contraction.

 IVFTF; D5LR 1L + 10 units oxy @ 30gtts/min

For medication route and for nutrition of the patient; oxytocin promotes

contraction.

 Keep uterus well contracted

To prevent bleeding

 Daily perineal care

To prevent infection

 Refer accordingly

For proper monitoring

Feb 15, 2010

 Continue meds
To follow proper course of treatment

 For billing

Feb 16, 2010

 For billing

 Meds:

o Methyldopa 250mg tab Qid x 2 weeks

This medication is for lowering the patient’s blood pressure

o Cefadroxil 500mg q8 x 3 days

This is to prevent the patient from getting infected since Cefadroxil is an anti-

infective

o Multivitamins + Fe OD

This prevents the patient from anemia

o OPD- follow up check up in 2 weeks

To note for development and to check treatment’s effectiveness

o Advised

Feb 18, 2010


 Give captopril 25g SL;OD

To lower down the patient’s blood pressure; captopril is an anti-hypertensive

drug

Feb 22, 2010

 Continue meds as ordered

To follow proper course of treatment

Feb 23, 2010

 Continue meds at home

To continue the course of treatment

 For billing

MGH as ordered
XVIII. References

A. Books

1. One Author only

a. Dillon, Patricia M. Nursing Health Assessment. A Critical Thinking Case Studies

Approach. Philadelphia, Pennsylvania. 2nd Edition, 2007.

b. Adele. Maternal & Child Health Nursing: Care of the Childbearing and

Childrearing Family. 5th Edition. Philippines: Lippincott Williams & Wilkins,

2007.

c. Porth, Carol Mattson. Pathophysiology Concepts of Altered Health States.

Philadelphia, Pennsylvania. 7th Edition, 1998.

d. Marieb, Elaine N. Essentials of Human Anatomy and Physiology. Jurong

Singapore. 8th edition, 2006.

2. Two Authors only

a. Doenges, Marilynn E. et.al. Nursing Pocket Guide: Diagnoses, Prioritized

Interventions and Rationales. 11th Edition, Philadephia: F.A. Davis Company,

2008.

b. Gulanick, Meg et.al. Nursing Care Plans: Nursing Diagnosis and Intervention. 6th

Edition. Philippines: Elsevire Ltd., 2007.


c. Sparks, Shiela Ralph and Taylor, Cynthia M. Nursing Diagnosis: Reference

Manual. 6th edition. Philippines: Lippincott Williams & Wilkins, 2005.

3. Three or More Authors only

a. Doenges, Marilynn. et.al. Nursing Care Plans: Guidelines for Individualizing

Patient Care. 6th Edition. Philadephia: F.A. Davis Company, 2002.

b. Gulanick, Meg. et.al. Nursing Care Plans: Nursing Diagnosis and Intervention. 3rd

Edition. United States of America: Mosby-, Year Book. 1994.

B. Journals

a. Michael G Ross, Michael G. April 2009.


as.medscape.com/js.ng/Params.richmedia=yes&transactionID=61610269&site
=1&affiliate=2&ssp=0&artid=10030633&env=0&tile=6161026
9&cg=ckb&pub=280&pubs=280&ct=ph&pf=17&usp=-
1&amp;st=null&amp;occ=0&amp;tid=null&amp;pos=101"></script>

b.Tuffnell DJ, Shennan AH, Waugh JJ, Walker JJ. The management of severe pre-
eclampsia/eclampsia. London (UK): Royal College of Obstetricians and Gynaecologists;
2006 Mar.

c. Magpie Trial Collaboration Group : Do women with preeclampsia

and their babies benefit from MgSO4 ? The Magpie

Trial. A randomized placebo controlled trial. Lancet 2002

d. Report of the National High Blood Pressure Education Program Working Group on
High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000

e.ACOG Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin.


Diagnosis and management of preeclampsia and eclampsia. Number 33, January
2002. Obstet Gynecol. 2002

f.Sibai BM.Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005


g.Sibai BM, Barton JR.Expectant management of severe preeclampsia remote from term:
patient selection, treatment, and delivery indications. Am J Obstet Gynecol. 2007

h.Altman D, Carroli G, Duley L, et al:Magpie Trial Collaboration Group. Do women


with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie
Trial: a randomised placebo-controlled trial. Lancet. 2002

i.Fonseca JE, Méndez F, Cataño C, Arias F.Dexamethasone treatment does not improve
the outcome of women with HELLP syndrome: a double-blind, placebo-controlled,
randomized clinical trial. Am J Obstet Gynecol. 2005