PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)

A Case Study of Post Partum Eclampsia

Submitted By: Del Rosario, Thad Niko Dizon, Kathleen Zyrelle Esteves, Christian Enriquez, John Raphael Fernandez, Dianne May Guiao, Gianne Nicole Hidalgo, Jedd Jose Mickael Lavarro, Vianca Louriele Llanes, Ralph Donovan

Submitted to: Prof. Jacqueline G. Licaros, RN Clinical Instructor

August 26, 2010

INTRODUCTION
Postpartum Eclampsia is a severe complication that results when a pregnant woman previously diagnosed with preeclampsia, high blood pressure and presence of protein in the urine, develops seizures or coma. In some cases, seizures or coma may be the first recognizable sign that a pregnant woman has preeclampsia. The cause of eclampsia is not known yet but it is more common in young women and those older than age 35. The following increase a womens chance for getting eclampsia: being 35 or older, being African American, first pregnancy, history of diabetes, high blood pressure, or kidney disease, multiple pregnancies, and teenage pregnancy. The most common symptom of preeclampsia is high blood pressure. This may be the first or only symptom. Blood pressure may be only minimally elevated initially or can be dangerously high; symptoms may or may not be present. Other signs and symptoms include fatigue, reduced urine output, sudden weight gain, swelling of the face and hands, visual impairment, headaches, nausea and vomiting, and if it becomes severe, there will be occurrence of seizures.

NURSING HEALTH HISTORY

NAME: MANILYN RICAFRANCA ADDRESS: 55 QUIRINO STREET, TONDO, MANILA, D1, Z9,BRGY. NO.116 AGE: 18 y/o GENDER: FEMALE NATIONALITY: FILIPINO RELIGION: ROMAN CATHOLIC STATUS: SINGLE PLACE OF BIRTH: MINDORO PROVINCE: MINDORO EDUCATIONAL ATTAINMENT: COLLEGE UNDERGRADUATE OCCUPATION: BAKERY EMPLOYEE (BREAD SELLER) HEIGHT: 5 WEIGHT: 55 Kg.

HISTORY OF PRESENT ILLNESS On the 14th of august 2010 the patient, Marilyn Ricafranca, had a seizure. Everything happened so sudden. According to the client it started with just a headache. After that her vision blackened and then she lost consciousness. Then she was brought to the hospital.

PAST MEDICAL HISTORY According to the patient she never remember herself being brought to the hospital before until she gave birth last 6th of august of this year (2010). She also does not have a good recall of her childhood immunizations. She didnt speak about her previous. And she also denies any food and drug allergies.

FAMILY HISTORY In terms of her family history, the patient does not share that much.

Father

Father

Mother

Sister 1

Brother 1

PatientX

Brother2

Brother3

Son

Figure 1. Genogram of Patient X LIFESTYLE 1. PERSONAL HABITS According to the patient, she does not have any habits like drinking alcoholic drinks, smoking cigarettes or using any illicit or recreational drugs.

2. DIET According to the patient, she does not have a big appetite for food since she only earn a little. Most of the time she ate biscuit and drink water only. But since

she became pregnant she needs to adjust for the sake of her child causing her to change her diet and gaining some weight.

3. SLEEP AND REST PATTERN Because of the patients work, she does not sleep very well. Most of the time she go to bed at 11pm and then woke up at 1am in the morning to go to work.

4. ACTIVITIES OF DAILY LIVING Upon waking up at 1am in the morning the patient usually eat her breakfast then prepare for her work. Then after preparing she goes to her work. Most of the time she spend the whole day at work to earn money. Then after work, at 11pm, she goes back to her house. The patient does not have any difficulties following this everyday routine. She enjoys life using this routine of daily activities. But because she gave birth lately she needs to change her daily set of activities to give time for her child.

SOCIAL DATA 1. FAMILY RELATIONSHIP The patients family, just like the tradition of a typical Filipino family, practices a strong family ties. They experience problems but still enjoy the company of each other. They chat with each other whenever they find time. The family of the patient may not have that much, but they make it to a point that whenever someone in their family needs some help, they are there to help in any way they can.

2. ETHNIC/RELIGIOUS AFFILIATION The patient was born in Mindoro but grew up here in Manila, she is very aware of the different events happening around the city. In terms of health customs,

she does not believe in faith healers and quack doctors. In terms of her religious affiliation, she is a pure believer of the Roman Catholic Church.

3. EDUCATIONAL HISTORY The patient is a college undergraduate. She was not able to finish her course up until her 1st year. The patient does not show any problems in terms of her learning and communication abilities because she can express herself well in both tagalong and English language.

4. OCCUPATIONAL HISTORY Since the time she stopped going to school, she started to work to earn money to support her personal needs. And since she is starting her own family now, she wants to double her effort to support the increasing needs of her growing family. As of now she is working as a seller in a bakery.

5. ECONOMIC STATUS In terms of the patients economic status, the patient is on the middle class. she pays for her own expenses and helps her family when she have some spare money.

PSYCOLOGIC DATA 1. MAJOR STRESSORS Just like any typical Filipino, the patient got stressed whenever the problem is about money. Specially in terms of paying electric and other bills. Another is in terms of what food to prepare for her family. Another major stressor of the patient is in terms of emotional and family problems. But just like a normal Filipino she just choose to laugh on the problem and not let it grow.

2. USUAL COPING MECHANISM

In times of problems, she shares her problems to her family so that she will not be alone in solving the problem. And just what others do she usually have fun with her family to forget all her problems in life.

GORDONS TYPOLOGY
PATTERN BEFORE HOSPITALIZATION Patient is well aware of her health Perceives health as not a high priority and if there is a problem involving health, patient would rest and takes over-the-counter DURING HOSPITALIZATION Patient is not aware of her present health condition Starts to take prescript medications

HEALTH PERCEPTION PATTERN

medications Prior to pregnancy, does not seek medical attention whenever she have health problem During pregnancy, seeks for medical attention Prior to pregnancy: Patient eats at least 4 times a day. 3 meals and 1 merienda NUTRITIONAL-METABOLIC PATTERN She has higher intake of vegetables than meat products. She eats biscuits for merienda. She drinks at least 8 glasses of water per day The patient voids at least 3-5 times a day. She moves her bowel at once a day. The patient usually do walking as a form of exercise She cleans the house

Patient eats at least 6 times a day. She has higher intake of vegetables than meat products. She eats biscuits for merienda. She drinks at least 8 glasses of water per day

He voids at least 3-7 times in a day. She moves her bowel at once a day. The patient does walking.

ELIMINATION PATTERN

ACTIVITY/EXERCISE PATTERN

 The patient does not have enough time to sleep. SLEEP/REST PATTERN She is in bed by 11:00 pm She wakes up at around 1:00 am The patient is oriented to the time, place and person COGNITIVE-PERCEPTUAL PATTERN She responds to verbal stimuli She can recall the information regarding her family SELF PERCEPTION/ SELFCONCEPT PATTERN The patient always thinks of herself She could converse with other people The patient lives with her husband and mother-in-law She had a good relationship with her family She maintains the role of being a wife by doing the household chores The patient has regular menstruation. sometimes experience dysmenorrhoea

The patient have enough time to sleep.

No changes

The patient accepted herself that she is a mother and she cares for the baby. The patient is confined at the hospital and her husband is her companion throughout the hospitalization

ROLE-RELATIONSHIP PATTERN

SEXUALITY/REPRODUCTIVE PATTERN

The patient is experiencing amenorrhoea.

COPING/STRESS TOLERANCE PATTERN

In times of problem, she usually talks it out and shares it to the family. Sometimes, hanging out is her way to cope to the problem. The patient is a Roman Catholic. She does not believe in quack doctors and hula.

She is not able to talk with the family because of her confinement in the hospital.

No changes

VALUE/BELIEF PATTERN

REVIEW OF SYSTEMS
General The patient had lost weight after delivery. Night sweats are frequent. Patient is afebrile and chills are absent. Skin The patient is not experiencing any itching over her body. There are no rashes present. Head/Eyes/Ears/Nose/Mouth/Throat

The patient experienced headache before she had seizure. No injuries present. The patient experienced a darkened vision before she lost her consciousness. There is no double vision, blurred vision, or visual loss. The nasal airways are clear. Mouth sores, toothaches, and bleeding gums are absent. Respiratory The patient stated that she didnt experienced any chest pain and shortness of breath. Cardiovascular The patient is hypertensive. Her last blood pressure reading was 140/100mmhg. Gastrointestinal The patient stated that she has no abdominal pain. She moves her bowel two times per day. Genitourinary The patient voided at least 9 times per day. There are no discharges from vagina. Musculoskeletal The patient is not experiencing difficulty while moving. Psychiatric The patient is experiencing emotional distress because she misses her baby nevertheless she is expecting that she will be discharged as soon as possible.

PHYSICAL ASSESMENT
GENERAL APPEARANCE The client is awake, coherent and conversant upon interview. VITAL SIGNS Temperature: 36.80 C Pulse Rate: 63 bpm INTEGUMENT Skin The patient has a brownish skin color without areas of hyper pigmentation. No skin lesions noted. When palpated, the patient skin has uniform temperature on normal range. The patient has good skin turgor. 4:00 pm, August 19, 2010 Respirations: 17 bpm Blood Pressure: 140/100 mmHg

Hair The patient has evenly distributed hair, black in color. No infestations noted. HEAD Face The patients face is symmetrical and no lesions present. Eyes The patients eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are slightly curled outward. The cornea is shiny and smooth. The pupils are equally round and reactive to light. Upon palpation there was no tenderness and edema noted over the lacrimal gland, lacrimal sac and the nasolacrimal duct. Ears The patients ears are symmetrical and aligned with the outer canthus. There are no lesions and tenderness noted. Nose The nose is aligned and symmetrical. Upon palpation and percussion no tenderness of the sinuses are noted. Breast The clients breast are symmetrical. The areola is brown in color and there are no lesions noted. There are no retractions noted and no nodules are palpated. Cardiovascular and Peripheral Vascular System Upon Palpation, there are no abnormal pulsations, lifts, or heaves. Upon auscultation, the rhythm is regular. The peripheral pulses are felt. There is an absence of jugular vein distention. Neck The patients neck muscles are equal in size, head centered. Her head flexes 45, with head movements coordinated, smooth and no discomfort. Her muscle strength was equal. Upon palpation, no enlarged lymph nodes were noted. When the trachea was palpated for deviations, it was noted that it is placed in midline of neck and the spaces are equal on both sides. Thorax and Lungs The patients skin on posterior thorax is intact and uniform in temperature. The chest wall is intact and has no tenderness and masses. Chest expands when respiratory excursion was assessed. Her vocal fremitus was bilaterally symmetric. It was heard most clearly at the apex of the lungs. When auscultated, no crackles were heard. When palpated, the anterior chest has full symmetric excursion.

Abdomen The patients abdomen has unblemished skin, uniform in color and concave. There were no evidence of enlargement of liver and spleen. When auscultated, audible sounds were heard, there is an absence of arterial bruits and friction rub were not noted. When palpated, there was no tenderness and relaxed abdomen with smooth and consistent tension. She was using her abdominal muscles to improve diaphragmatic contraction. Neurologic System The patient has an upright posture and a steady gait with opposing arm swing, maintaining her balance. She can perform all the tests regarding body coordination. She can rapidly touch each finger to the thumb with the right hand. She was able to discriminate sharp and dull sensations. She can recognize common objects.

ANATOMY AND PHYSIOLOGY

FEMALE REPRODUCTIVE SYSTEM Mons Veneris a pad of adipose tissue located over the symphysis pubis, the pubic bone joint. The purpose of mons veneris is to protect the junction of the pubic bone from trauma. Labia minora before menarche, theses folds are fairly small; by childbearing age, they are firm and dull; after menopause, they atrophy and again become much smaller. Labia majora serve as protection for the external genitalia and the distal urethra and vagina. Clitoris a small (approximately 1-2 cm) rounded organ of erectile tissue at the forward junction of the labia minora. The clitoris is sensitive to touch and temperature and is the center of sexual arousal and orgasm in female.

Skene's gland (paraurethral glands) located just lateral to the urinary meatus. Bartholin's glands (vulvovaginal glands) located just lateral to the vaginal opening. Fourchette the ridge of tissue formed by the posterior joining of the two labia minora and labia majora. This is the structure that is sometimes cut (episiotomy) during childbirth to enlarge the vaginal opening. Perineal muscle (perineal body)- it is easily stretched during childbirth to allow enlargement of the vagina and passage of the fetal head. Hymen a tough but elastic semicircle of tissue that covers the opening to the vagina in childhood. It is often torn during the time of 1st sexual intercourse. Breasts (mammary glands) arise from ectodermic tissue early in utero. They remain, however, in a halted stage of development until a rise in estrogen at puberty produces a marked increase in size from increased connective tissue and deposition of fat in girls and a transient increase in boys. Areola darkly pigmented area of epithelium approximately 4 cm in diameter.

OVARIES Matures and discharge Ova Produces estrogen and Progesterone o Absence of estrogen: prevent breast maturation, pubic hair on a male formation o Lack of estrogen (menopause): uterus, breast and ovaries undergo atrophy (reduction of sight) o Estrogen prevents osteoporosis and cardiovascular disease Cardiovascular disease is incorporated in estrogen production. The production of estrogen keeps the decrease of cholesterol in the blood. Thus, preventing atherosclerosis. Necessary for secondary female characteristics Size: 4cm long, 2in in diameter and 1.5cm width = shape of an almond Grayish white in color or appear pitted with minute indentations on the surface

Graafian Follicle (an ova about to be discharged: unruptured, glistening, clear, fluid-filled), corpus luteum (structure after the ovum had been discharged) is often seen on the surface of the ovary. Close to and on both sides of the uterus at the lower abdomen Hard to palpate: so low: tenderness present at lower left or right: abnormality Held in suspended position by 3 strong supporting ligaments o Not fixed: tumor can grow twice as much as the organ before pressure on other organ appear Three divisions: o Layer of surface epithelium o Cortex-filled with ovarian and graafian follicle; immature follicles mature into ova and produce estrogen and progesterone.

FALLOPIAN TUBE Extends outward and backward of the uterine body Approximately 10cm Ovaries to uterus; fertilization of ova by the sperm Four parts: o Intersitial- most proximal: within the uterine wall; 1cm length; lumem: 1mm in diameter o Isthmus-extremely narrow; 2cm length; cut during tubal ligations o Ampulla- 5cm; fertilization of ovum o Infudibulum- 2cm; fimbria (hair-like structure which guides ova towards the fallopian tube) Covered with mucous membrane with mucous secreting and ciliated cells- beneath is a connective tissue and muscular lining. o Mucous secreting and ciliated cells- lubricant and nurturer (with protein, water and salt) o Muscular lining- peristaltic movement Pathways of the fallopian tube (vagina/uterus/external organs) o Conception possible o Disease/infection of the peritoneum (tubesperitoneum) UTERUS Hollow, muscular , pear-shaped organ located in the lower pelvis: posterior to the pelvis and anterior to the uterus Childhood: size of an olive; 8yrs: starts to increase: 17yrs: largest size 5cm to 7cm long, 5cmwide, 2.5cm (widest) 60g (non-pregnant state) Receive ova from the uterus, implantation and nourishment during fetal growth, expel from the womans body After birth: 9cm lng, 6cm wide, 3cm thick and 80g

Three parts: Corpus, Cervix and Isthmus (Cornua) o Corpus extends upto fallopian tube Fundus- point if attachment; expands during pregnancy to contain the growing fetus palpated to determine uterine growth during pregnancy and force uterine contraction during labor; assessing uterus returning after childbirth Isthmus- 1-2cm(non-pregnant woman); enlargement in size during pregnancy; cut during cesarean birth Cervix- 1/3 in size; 2-5cm long; cavity is cervical canal; junction at the Isthmus: internal os; junction towards the vagina (at the level of the ischial spines): external os Ischial spines- important relationship in estimating the level of the fetus in birth canal before birth Uterine and cervical coats: endometrium (innermost of the mucous membrane), myometrium (muscle fibers) and perimetrium (outerconnective tissue), mucous membrane is the endocervix Endometrial layer o Two layers: Basal layer- closed to the uterine wall (not much influenced by hormones) Glandular layer- greatly influenced by estrogen and progesterone; becomes so thick every month to support pregnancy; if not pregnant, it sheds as a menstrual flow Cells of the cervical lining secrete mucus that lubricates the pathway of the spermatozoa through the cervix. The mucus production depends on the amount of hormones being produced. At the point of menstrual cycle, as much as 700ml of mucus per day are produced (because of estrogen production). The mucus is alkaline in nature, thereby decreasing the acidity of vagina for the sperm to live Lower one third of the cervix is lined with stratified squamous epithelium (important in obtaining a Papanicolaou smear because its the origin of cervical cancer) Myometrium (muscle layer of the uteru)- 3 smooth layers (longitudinal, transmits and oblique) o Extreme strength to the organ; equal pressure in pushing the baby out o Constriction of the tubal ligation and preventing regurgitation of menstrual flow into the tubes o Holds the internal cervical os closed during pregnancy o After childbirth, constrict blood to reduce bloodloss; myomas/benign arise from the myometriium o Preimetrium- outermost layer of the uterus Uterine blood supply o Descanding abdominal aorta -> 2 iliac arteries:h Hypogastric Arteries (main division) -> uterine arteries and ovarian arterie

o Uterus receives adequate amount for the fetus since it is not far removed from the aorta o Blood vessels are tortuous I non- pregnant women; but in pregnancy, it unwinds to maintain adequate blood suplly as the organ enlarges o Empty in the internal iliac veibs o Uterus and uterine vessels Uterus pass directly in the back of the ovarian vessels near the fallopian tube; may be injured by a clamp is bleeding is controlled by clamping the uterine or ovarian vessels Uterine nerve supply o Afferent (sensory) T11-T12 spinal ganglia Anesthesia o Efferent T5-T10 spinal ganglia o Principle of anesthesia: lower afferent than efferent = controlling pain in labor without stopping motor contraction: hitting T11- T12 but not T5-T10 Uterine Supports- uterus is suspended in the pelvic cavity o Supported by muscle and combination of fascia o Not fixed in one location = it can freely extend o If supports enlarge too much during pregnancy, it may not be able to support the bladder Bladder can herniated into anterior vagina (cytocele); rectum pouches toward the vagina (rectocele) Posterior ligament- fold of peritoneum behind the uterus Forms the Douglas cul-de-sac between the rectum and the uterus Uterine deiviationso bicornuete uterus (the septum formed during the formation of the fetus is not removed even after the fetus had already matured o Malformation decreases the ability to conceive or to carry pregnancy to term o Positional deviations: (uteus is tipped slightly forward Anterversion Retroversion Anteflexion Rertoflexion

VAGINA Posterior to the bladder; anterior to the rectum; extends from the cervix to the internal vulca; organ of intercourse

Woman lying- inward and downward; anterior wall is 6-7am, posterior 89cm Uterine end -> fornices: behind the cervix posterior cervix;: posterior fornix; infront: anterior fornix; sides: lateral fornix o Posterior fornix- pool of sperm after coitus Thin wall -> bladder and rectum can be palpated o With folds and rugae to allow expansion during pregnancy Bulbocavernosus o External opening of the vegina o Voluntary spincter o Kegels exercise- relax and tnse to make it supple Internal iliac artery -.vaginal artery o Tends to tear during childbirth and makes healing rapidly Has parasympathetic and sympathetic nerve innervations (S1-S3) Placenta 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. CARDIOVASCULAR SYSTEM The circulatory system is an organ system that passes nutrients (such as amino acids and electrolytes), gases, hormones, blood cells, etc. to and from cells in the body to help fight diseases and help stabilize body temperature and pH to maintain homeostasis. This system may be seen strictly as a blood distribution network, but some consider the circulatory system as composed of the cardiovascular system, which distributes blood, and the lymphatic system, which distributes lymph. While humans, as well as other vertebrates, have a closed cardiovascular system (meaning that the blood never leaves the network of arteries, veins and capillaries), some invertebrate groups have an open cardiovascular system. The most primitive animal phyla lack circulatory systems. The lymphatic system, on the other hand, is an open system. Two types of fluids move through the circulatory system: blood and lymph. The blood, heart, and blood vessels form the cardiovascular system. The lymph, lymph nodes, and lymph vessels form the lymphatic system. The cardiovascular system and the lymphatic system collectively make up the circulatory system. The heart is a myogenic muscular organ found in all animals with a circulatory system, that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions. The human heart is about the size of a fist and has

a mass of between 250 and 350 grams. It is located anterior to the vertebral column and posterior to the sternum. It is enclosed in a double-walled sac called the pericardium. The superficial part of this sac is called the fibrous pericardium. This sac protects the heart, anchors its surrounding structures, and prevents overfilling of the heart with blood. The outer wall of the human heart is composed of three layers. The outer layer is called the epicardium, or visceral pericardium since it is also the inner wall of the pericardium. The middle layer is called the myocardium and is composed of muscle which contracts. The inner layer is called the endocardium and is in contact with the blood that the heart pumps. Also, it merges with the inner lining (endothelium) of blood vessels and covers heart valves. The human heart has four chambers, two superior atria and two inferior ventricles. The atria are the receiving chambers and the ventricles are the discharging chambers. The right ventricle discharges into the lungs to oxygenate the blood. The left ventricle discharges its blood toward the rest of the body via the aorta. The pathway of blood through the human heart consists of a pulmonary circuit and a systemic circuit. Blood flows through the heart in one direction, from the atria to the ventricles, and out of the great arteries, or the aorta for example. This is done by four valves which are the tricuspid valve, the mitral valve, the aortic valve, and the pulmonary valve The function of the right side of the heart is to collect de-oxygenated blood, in the right atrium, from the body (via superior and inferior vena cava) and pump it, through the tricuspid valve, via the right ventricle, into the lungs (pulmonary circulation) so that carbon dioxide can be dropped off and oxygen picked up (gas exchange). This happens through the passive process of diffusion. The left side (see left heart) collects oxygenated blood from the lungs into the left atrium. From the left atrium the blood moves to the left ventricle, through the bicuspid valve, which pumps it out to the body (via the aorta). On both sides, the lower ventricles are thicker and stronger than the upper atria. The muscle wall surrounding the left ventricle is thicker than the wall surrounding the right ventricle due to the higher force needed to pump the blood through the systemic circulation. Starting in the right atrium, the blood flows through the tricuspid valve to the right ventricle. Here, it is pumped out the pulmonary semilunar valve and travels through the pulmonary artery to the lungs. From there, oxygenated blood flows back through the pulmonary vein to the left atrium. It then travels through the mitral valve to the left ventricle, from where it is pumped through the aortic semilunar valve to the aorta. The aorta forks and the blood is divided between major arteries which supply the upper and lower body. The blood travels in the arteries to the smaller arterioles and then, finally, to the tiny capillaries which feed each cell. The (relatively) deoxygenated blood then travels to the venules, which coalesce into veins, then to the inferior and superior venae cavae and finally back to the right atrium where the process began. The heart is effectively a syncytium, a meshwork of cardiac muscle cells interconnected by contiguous cytoplasmic bridges. This relates to electrical stimulation of one cell spreading to neighboring cells. Some cardiac cells are selfexcitable, contracting without any signal from the nervous system, even if removed from the heart and placed in culture. Each of these cells have their own intrinsic contraction rhythm. A region of the human heart called the sinoatrial node, or

pacemaker, sets the rate and timing at which all cardiac muscle cells contract. The SA node generates electrical impulses, much like those produced by nerve cells. Because cardiac muscle cells are electrically coupled by inter-calated disks between adjacent cells, impulses from the SA node spread rapidly through the walls of the artria, causing both artria to contract in unison. The impulses also pass to another region of specialized cardiac muscle tissue, a relay point called the atrioventricular node, located in the wall between the right atrium and the right ventricle. Here, the impulses are delayed for about 0.1s before spreading to the walls of the ventricle. The delay ensures that the artria empty completely before the ventricles contract. Specialized muscle fibers called Purkinje fibers then conduct the signals to the apex of the heart along and throughout the ventricular walls. The Purkinje fibres form conducting pathways called bundle branches. This entire cycle, a single heart beat, lasts about 0.8 seconds. The impulses generated during the heart cycle produce electrical currents, which are conducted through body fluids to the skin, where they can be detected by electrodes and recorded as an electrocardiogram (ECG or EKG). The events related to the flow or blood pressure that occurs from the beginning of one heartbeat to the beginning of the next can be referred to a cardiac cycle. The SA node is found in all amniotes but not in more primitive vertebrates. In these animals, the muscles of the heart are relatively continuous and the sinus venosus coordinates the beat which passes in a wave through the remaining chambers. Indeed, since the sinus venosus is incorporated into the right atrium in amniotes, it is likely homologous with the SA node. In teleosts, with their vestigial sinus venosus, the main centre of coordination is, instead, in the atrium. The rate of heartbeat varies enormously between different species, ranging from around 20 beats per minute in codfish to around 600 in hummingbirds. Cardiac arrest is the sudden cessation of normal heart rhythm which can include a number of pathologies such as tachycardia, an extremely rapid heartbeat which prevents the heart from effectively pumping blood, fibrillation, which is an irregular and ineffective heart rhythm, and asystole, which is the cessation of heart rhythm entirely. NERVOUS SYSTEM It is an organ system containing a network of specialized cells called neurons that coordinate the actions of an animal and transmit signals between different parts of its body. In most animals the nervous system consists of two parts, central and peripheral. The central nervous system of vertebrates contains the brain, spinal cord, and retina. The peripheral nervous system consists of sensory neurons, clusters of neurons called ganglia, and nerves connecting them to each other and to the central nervous system. These regions are all interconnected by means of complex neural pathways. The enteric nervous system, a subsystem of the peripheral nervous system, has the capacity, even when severed from the rest of the nervous system through its primary connection by the vagus nerve, to function independently in controlling the gastrointestinal system. Neurons send signals to other cells as electrochemical waves travelling along thin fibres called axons, which cause chemicals called neurotransmitters to be

released at junctions called synapses. A cell that receives a synaptic signal may be excited, inhibited, or otherwise modulated. Sensory neurons are activated by physical stimuli impinging on them, and send signals that inform the central nervous system of the state of the body and the external environment. Motor neurons, situated either in the central nervous system or in peripheral ganglia, connect the nervous system to muscles or other effector organs. Central neurons, which in vertebrates greatly outnumber the other types, make all of their input and output connections with other neurons. The interactions of all these types of neurons form neural circuits that generate an organism's perception of the world and determine its behavior. Along with neurons, the nervous system contains other specialized cells called glial cells, which provide structural and metabolic support. Neurons send signals via their axons, although some types are capable of dendrite-to-dendrite communication. (In fact, the types of neurons called amacrine cells have no axons, and communicate only via their dendrites.) Neural signals propagate along an axon in the form of electrochemical waves called action potentials, which produce cell-to-cell signals at points where axon terminals make synaptic contact with other cells. Spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain (the medulla specifically). The brain and spinal cord together make up the central nervous system. The spinal cord extends down to the space between the first and second lumbar vertebrae; it does not extend the entire length of the vertebral column. It is around 45 cm (18 in) in men and around 43 cm (17 in) long in women. The enclosing bony vertebral column protects the relatively shorter spinal cord. The spinal cord functions primarily in the transmission of neural signals between the brain and the rest of the body but also contains neural circuits that can independently control numerous reflexes and central pattern generators. The spinal cord has three major functions: A. Serve as a conduit for motor information, which travels down the spinal cord. B. Serve as a conduit for sensory information, which travels up the spinal cord. C. Serve as a center for coordinating certain reflexes.

PATHOPHYSIOLOGY

Figure 2 Pathophysiology of Post partum Eclampsia

SURGICAL MANAGEMENT and NURSING MANAGEMENT

Intervention 1. Establishment of NPO status NPO, which means non per orem, is a status of a patient wherein any type of food or liquid is not allowed. During this period, IV fluids are usually given to provide nutrition and prevent dehydration. Nursing Management: Explained the purpose of establishing NPO status to patients significant others. Restricted the significant other from giving the patient anything by mouth. Administered IV fluids are prescribed by the physician. Rationale To decrease the possibility of gastric content aspiration.

Ensured that IV fluids are infusing well. Monitored and recorded I/O every hour.

2. Insertion of Foley Catheter A Foley Catheter is a rubber catheter with a balloon tip to be filled with sterile liquid after it has been placed in the bladder. This kind of catheter is used when continuous drainage of the bladder is desired. Nursing Management: Explained the purpose of inserting a Foley catheter to patients significant others. Drain/empty the urine bag once it is almost full. Monitored and recorded I/O every hour.

To allow drainage and monitoring of fluid output.

3. Infusion of D5LR, 1L, 30 gtts/min D5LR is a treatment for persons needing extra calories and cannot tolerate fluid overload. It is also used for treatment of Shock. Nursing Management: Do not administer unless solution is clear and container is undamaged. Monitor Vital Signs Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin. Solution containing acetate should be used with caution as excess administration may result in metabolic alkalosis. Solution containing dextrose should be used with caution in patients with known subclinical or overt diabetes mellitus. Discard unused portion.

To provide nutritional and fluid needs for patients in NPO status

In very low birth weight infants, excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage.

To provide needed fluid and electrolyte requirement of the patient.

4. Infusion of D5NM, 1L, 20 gtts/min D5NM is indicated for parenteral maintenance of routine daily fluid and electrolyte requirements with minimal carbohydrate calories from dextrose. Magnesium in the formula may help to prevent iatrogenic magnesium deficiency in patients receiving prolonged parenteral therapy. Nursing Management: Do not administer unless solution is clear and container is undamaged. Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions to patients receiving corticosteroids or corticotrophin. Solution containing acetate should be used with caution as excess administration may result in metabolic alkalosis. Solution containing dextrose should be used with caution in patients with known subclinical or overt diabetes mellitus. Discard unused portion. In very low birth weight infants, excessive or rapid administration of dextrose injection may result in increased serum osmolality and possible intracerebral hemorrhage.

DISCHARGE PLANNING
Teaching the patient and the family home monitoring of weight, pulse and or blood pressure, as appropriate, to detect change and allow timely intervention. Discussing significant signs and symptoms that require prompt reporting healthcare provider that may be signs of drug toxicity and or mineral loss especially potassium. o EXAMPLES: Muscle cramps, headaches, dizziness or skin rashes Arrange time with dietician to determine or adjust individually appropriate diet plan. Encouraging relaxing environment, using relaxation on techniques, massage therapy, soothing music, quiet activities. Instructing stress management techniques, as medicated, including appropriate exercise program.

Family bonding initiated. Positive self-appraisal regarding birth and parenting role expressed.