82085243 case-study-on-pregnancy-induced-hypertension-eclampsia

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Our Lady of Fatima University
College of Nursing
Regalado, Quezon City
A Case Study on
Pregnancy-Induced Hypertension
In Partial Fulfillment
of the Requirements in
Nursing Care Management
Related Learning Experience

Presented by:
BSN 2A1-2
Group 10
Espellogo, Leizel Y.
Falle, Mery Ann M.
Gianchand, Olivia E.
Hinanay, Ely John
Maglaoy, Manuel David B.
Manuel, Janine M.
Mateo, Donna Marie
First Semester
S.Y 2011-2012
I. Introduction
Hypertensive disorders of pregnancy also known as Pregnancy Induced Hypertension are
high blood pressure disorders of pregnancy which is one of the major problem for mother in
pregnancy.PIH is common in pregnant teens and in women over age 40 but it also develops
during the second half of the pregnancy and usually after the 20th week of gestation.PIH is
usually present to those person with a previous history of PIH, chronic hypertension, lupus,
alcohol, drug or tobacco abuse, presence of diabetes, underweight or overweight, kidney disease
and expected twins or triplets. The warning signs of PIH those people are rapid weight gain, 4-5
lbs in a single week, a rise in blood pressure, protein in urine, severe headaches, blurry visions,
severe pain over the stomach under the ribs of the mother who have PIH and decrease in amount
of urine. PIH can prevent prematurity and death of the baby through the following closely by the
medical professional and attending pre-natal checkup. PIH can cause low birth weight of the
baby.

Therefore, it is necessary to all health worker engaged on themselves all about clinical
knowledge and skills and to develop their values to be able to become an efficient and effective
competent individual when it comes health assessment in performing their duties and
responsibilities when it comes to health assessments.
II. Objectives
General:
This study aims to improve our skills, knowledge and attitude in performing our duties
and responsibilities to give an efficient and effective outcome especially to the health of the
patients.
Specific:
1. To identify factors if having pregnancy induced hypertension.

2. To develop a teaching program that will educate patients specially those who are susceptible
of pregnancy induced hypertension.
3. To understand the disease process, its etiology, signs and symptoms, pathophysiology and
diagnostic procedure.
4. To promote awareness to individual by imparting knowledge so they could learn and
understand more about pregnancy induced hypertension.
5. To discuss and describe interventions for health promotion, prevention and treatment of
patient pregnancy induced hypertension.
III. Patient’s Profile
A. Biographical Data
1. Name: Mrs. R.E.R.
2. Address: Sto. Nino 1 Sapang Palay, SJDM
3. Age: 30
4. Birthdate: June 19,1981
5. Sex: Female
6. Race: Filipino
7. Marital status: Married
8. Occupation: Housewife
9. Religion: Catholic
10. Health Care financing and usual source of Medical Care:
Supported by the patient’s parents since the patient and his husband doesn’t have
source of income

A. Working Diagnosis
Postpartum Hypertension (pre-eclampsia)
B. Chief Complaint and Reason for Visit:
Hypertension
C. History of Present Illness:
Our patient had 3 pregnancies; all children were born at right gestational age. She had no
history of abortion and multiple births. All children are living. According to the patient she has
been experiencing intrapartal and PIH every time she gets pregnant. She got complete pre-natal
check-ups from the health center. Her blood pressure started to get elevated on the 3rd trimesters
of each pregnancy and continues even after she gave birth. After she gave birth to her youngest
son at home, the attending midwife decided to bring her to the hospital for referral since her
blood pressure went up to 200/140 mmHg. This was her first time to be admitted to the hospital
due to postpartum hypertension.
D. Past History:
Mrs. R.E.R. already gave birth to 3 boys. Her first child was born April 23, 2003 and the
next child was born March 14, 2008 and just on September 25, 2011 she gave birth to another
baby boy. All children were born full term. She gave birth to her children at home by normal
delivery and was attended by a midwife.
E. Family History of Illness:
The patient has a family history of hypertension. According to her, both of her parents
have hypertension.
IV. Physical Assessment

Assessment Normal Findings Actual Findings Interpretation
Body Build,
Height & Weight
Proportionate
Varies With
Lifestyle
Proportionate Varies
With Lifestyle
Proportionate body there
is no evidence of physical
problems
Posture And Gait Stands normally Stands normally Relaxed, erect posture;
coordinated movement
Body And Breath
Odor
No Body Or Breath
Odor
No Body Or Breath
Odor
Proper hygiene
maintenance
Signs Of Distress No Distress Noted distress noted Because of lack of sleep,
distress noted
Attitude Cooperative Cooperative Thinks normally, proper to
the situation
Affect Or Mood Appropriate To The
Situation
Appropriate To The
Situation
She acts and think
normally appropriate to
the situation
Quantity, Quality
And Organization
Of Speech
Understandable,
Moderate Pace,
Thought
Association
Understandable,
Moderate Pace,
Thought Association
Can speak normally, with
normal voice tone
Relevance And
Association
Thought Exhibits
Logical Sequence
Make Sense, Has
Sense Of Reality
Logical Sequence
Make Sense, Has Sense
Of Reality
Talking with sense means
she thinking normally
Skin
Assessment Normal Findings Actual Findings Interpretation
Uniformity Of
Skin Color
Uniformity Except
In Areas Expose To
The Sun
Uniformity Except In
Areas Expose To The
Sun
Uniformity of skin, except
areas expose to light and
some areas of lighter
pigmentation(conjunctivas
, palms, lips, nail beds)
Edema No Presence Of
Edema
Presence of edema on
feet 1+
Swollen, shiny and taut
and tends to blanch the
skin color
Skin Lesion Freckles, some
birthmarks, some
flat and raised
nevi;no abraisions
or other lesions
Freckles,some
birthmarks,some flat
and raised nevi;no
abraisions or other
lesions
No lesion noted in the
body
Skin Moisture Moisture In Skin
Folds & Axillae
Moisture In Skin Folds
& Axillae
Some body parts that
having sebaceous glands
are moisture
Skin Temperature Uniform, Within
Normal Range
Uniform, Within
Normal Range
Normal temperature
uniformity
Skin Turgor Skin Springs Back
To Previous State
Skin Springs Back To
Previous State When
Skin stays pinched or
tented or moves back

When Pinched Pinched, except the
part with edema
slowly
Skull and Face
Assessment Normal Findings Actual findings Interpretation
Head Rounded And
Symmetrical,
Smooth Skull
Contour, No
Nodules
Rounded And
Symmetrical, Smooth
Skull Contour, No
Nodules
Normal, no signs of any
deformities and signs of
skull contour and nodules
Eyes and Vision
Eyebrows Evenly Distributed,
Symmetrical, Skin
Intact
Evenly Distributed,
Symmetrical, Skin
Intact
Properly distributed, equal
Eyelids Skin Intact, No
Discharges, No
Discoloration,
Symmetrical
Skin Intact, No
Discharges, No
Discoloration,
Symmetrical
Can blink normally
Eyelashes Equally
Distributed,
Slightly Curved
Outward
Equally Distributed,
Slightly Curved
Outward
Turned outward, equally
distributed, muscle
normally contract
Conjunctiva Shiny, Smooth
,Sometimes Appear
Red Or Pink
Pale conjunctiva Pale, possible anemia
Lacrimal Gland No Edema Or
Tearing
No Edema Or Tearing Normal no evidence of
any swelling or tenderness
Cornea Transparent, Shiny,
Smooth, Blinks
When Cornea Is
Touched
Transparent, Shiny,
Smooth, Blinks When
Cornea Is Touched
Corneal sensitivity test
active,trigeminal nerve is
intact,cornea clarity and
texture normal.
Pupils Black Color,smooth
border,PERRLA
Black Color, smooth
border,PERRLA
Pupils are equal,constrict
to light dilate in the dark
Eyes(Visual
Acuity)
Can see without
using eyeglasses
Can’t see without
eyeglasses
Nearsightedness, can see
only when objects are near
Ears and Hearing
Auricles Color Is Uniform,
Symmetric, Mobile,
Firm pinna Recoils
When Folded
Color Is Uniform,
Symmetric, Mobile,
Firm pinna Recoils
When Folded
Color same as facial
skin,auricle aligned with
outer canthus of the eye.
Response To
Normal Voice
Tone
Normal Voice Tone
Audible
Cannot hear Normal
Voice Tone
Abnormal cannot hear
Normal voice, normal
voice tones

Nose and Sinuses
Nares Symmetric,
Straight, No
Discharges, Non
Swelling, Uniform
Color, Not Tender
Symmetric, Straight,
No Discharges, Non
Swelling, Uniform
Color, Not Tender
No presence of lesions,air
moves freely as the client
breaths
Lining Of Nose Nasal Septum In
Midline
Nasal Septum In
Midline
Normal and in midline
Mouth
Lips And Buccal
Mucosa
Pink, Soft,
Symmetrical
Pale lips and buccal
mucosa
Abnormal, possible
anemia
Teeth And Gums Complete Complete No tooth decay,smooth
shiny tooth enamel,no
dentures
Tongue In Midline, Freely
Movable, Pink
In Midline, Freely
Movable, Pink
In Central
position,moist,slightly
rough ;thin whitish
coating,normal,can move
freely
Palates And Uvula,
Tonsils
Light Pink, No
Discharges, Present
Gag Reflex
Light Pink, No
Discharges, Present
Gag Reflex
No discoloration, palates
are lighter pink hard
palate
Neck and Musculoskeletal System
Shape And
Symmetry
Symmetrical Symmetrical Positioned in midline
Spinal Deformities Vertically Aligned Vertically Aligned Normal, no deformities
Inspect Neck
Muscles
Symmetrical With
Head Centered
Symmetrical With
Head Centered
No swelling or
masses,coordinated,smoot
h movements with no
discomfort
Observe Head
Movement
Coordinated,
Smooth, Movement
With No
Discomfort, Equal
Strength
Coordinated, Smooth,
Movement With No
Discomfort, Equal
Strength
No discomfort, can hyper
extends, laterally flexes
and rotates
Muscle Size Is
Symmetrical, No
Contracture,
Normally Firm
Size Is Symmetrical,
No Contracture,
Normally Firm
Equal strength,
symmetrical, normal
Bones No Deformities,
No Swelling Or
Tenderness
No Deformities,
No Swelling Or
Tenderness
Normal, can move freely,
no swelling, deformities
or tenderness

Joints No Swelling, No
Tenderness
No Swelling, No
Tenderness
Normal, no signs of
swelling in area, no
tenderness
Range Of Motion Varies To Some
Degrees
Limited range of
motionin one or more
joints
Can stand and walk, but
limited range of motions.
V. Activities of Daily Living
Functional Health
Pattern
Before her present
condition
During her present
condition
Interpretation
Health Perception
and Health
Management
Complies easily with health
care provider’s suggestion.
Practices health promotion
activities such as healthy
diet and breastfeeding
Visits the health center for
check-up when sick.
Does not have traditional
health beliefs and
Same perception about
health
Complies with
medications
Follows the nurses or
doctor’s suggestion
The patient has a
good health
perception and
practices proper
health
management
Nutritional and
Metabolic
Eats 3 times daily. The
usual food intake would be
composed of fish and
vegetables, seldom eats
meat
Drinks 5 glasses of water
and 2 cups of coffee a day
Takes vitamins as a
supplement
Skin color was fair, height
proportional to body weight
Same amount and
quality of food is
taken
Coffee was eliminated
Discontinued taking
vitamins
Pale color of skin,
height still
proportional to body
weight
Patient’s diet had
no change so it
can’t be directly
inferred that skin
pallor was due to
diet.
Elimination Moves bowel once a day
without difficulty
Same bowel
movement frequency
Bowel movement
was affected

Soft firm stool
Voids fair amount of urine
without difficulty in normal
frequency
Clear, yellow urine
Difficulty moving
bowels although stool
quality is soft and firm
More frequency in
voiding urine in the
lesser amount and
same quality
because patient
can’t exert
enough effort to
expel stool.
Activity – Exercise Considers doing household
chores as an exercise
Leisure time spent by
chatting with friends and
playing with kids
No exercise done due
to confinement
Leisure time spent by
chatting with husband
Exercise was
eliminated since
she cannot do
household chores
while in the
hospital and she
didn’t replace it
by another form
of exercise.
Sleep-Rest Has 6 - 8 hours of sleep
everyday
Deep, uninterrupted sleep
Gets enough energy from
sleep
Doesn’t need any sleep aids
Has maximum of 3
hours of interrupted
sleep
Takes nap in the
afternoon to
compensate lost
sleeping hours
Inadequate sleep
due to noisy
environment,
Cognitive-
Perceptual
Normal hearing acuity and
does not use hearing aid
Uses eyeglasses
Able to comprehend easily
Asks to repeat the
questions during the
interview
Eyeglasses left at
home
Comprehension
has changed
because patient
can’t hear clearly.
Self-Perception and
Self-Concept
Pattern
Feels good about herself
Has ability to do normal
activities without help
Doesn’t have anything that
causes anger, anxiety and
depression
Had worried about her
child’s nutrition since
the newborn was left
at home but now feels
better because the
newborn is already
with her
Anxiety is no
longer an issue
since her baby is
already with her.

VI. Development Tasks
Generativity vs. Stagnation
At the age of 30, the significant task of the patient is to perpetuate culture and transmit
values of culture through the family and working to establish a stable environment. In her age,
success is achieved by contributing to the world by being active in their home and community or
society. Mrs. R.E.R. is a full time housewife since she got married so she only had continued to
build her life focusing on her family. Although she shows self fulfillment in terms of being a
mother and wife, she manifested the feeling of lack of accomplishment because she mentioned
that she also wants to play a different role in the society by having a career or job someday.
VII. Laboratory/Diagnostic Findings
Date Procedure Norms Result Analysis Interpretation
September
25, 2011
Hemoglobin 115-155 95 Due to blood loss which
causes decreased RBC
resulting to low Hgb
Decreased
Hematocrit 0.40-0.48 0.30 Due to blood loss which
causes decreased RBC
resulting to low Hgb
Decreased
WBC Count 5.0-10.0 12.9 Urinary tract infection Increased
Lymphocytes 0.2-0.4 0.25 No viral or chronic bacterial
infection
Normal
Gabriel J. Cruz , MD, DPSP
PATHOLOGIST
ROUTINE URINALYSIS September 25, 2011
Urine Result Analysis Interpretation
Color Amber Normal urine concentration Normal
Transparency Turbid Bacterial Infection Abnormal
Reaction Acidic Due to the amount of sodium
and excess acid retained by
the body
Abnormal

Specific Gravity 1.02 Normal urine concentration Normal
Protein + + + + Hypertension affects filtration
that can cause excessive
protein in urine
Abnormal
Sugar Negative No diabetes Normal
RBC 3-5/HPF No bleeding in urinary system Normal
Pus Cells 8-10/HPF Bacterial infection in urinary
tract
Abnormal
Epithelial Cells + Inflammation within urinary
tract
Abnormal
Bacteria + Infection on urinary tract Abnormal
Mucus Threads + Inflammation within urinary
tract
Abnormal
Amorphous Urates + Uric acid crystals Abnormal
Gabriel J. Cruz , MD, DPSP
PATHOLOGIST
VIII. Anatomy and Physiology (Affected Organ)
HEART
The heart is responsible for maintaining adequate circulation of oxygenated blood around
the vascular network of the body. It is a four-chamber pump, with right side receiving
deoxygenated blood from the body at low pressure and pumping it to the lungs. And at the left
side receiving oxygenated blood form the lungs and pumping I at the high pressure around the
body. The myocardium is a specialized form of muscle, consisting of individual cells joined by
electrical connections. The contraction of each cell is produced by a rise in intracellular leading
to spontaneous depolarization, and as each cell electrically connected to its neighbor, contraction
of one cell leads to wave of depolarization and contraction across the myocardium. This
depolarization and contraction of the heart is controlled by a specialized group of cells localized
in the sino-atrial node in the right atrium pacemaker cells.
KIDNEY

The kidney is the responsible for the volume and concentration of fluids in the body by
producing urine. Urine is produce in a process called glomerular filtration, which remove as the
waste products, minerals and water from the blood. The kidney maintains the volume of the fluid
in the body and also the concentration of urine by filtering the waste product and reabsorbing
useful substances and water from the blood. The kidney also performs detoxification of harmful
substances increase absorption of calcium by producing calcitrol (form of vitamin D) and also
secretes rennin (hormone that regulates blood pressure and electrolyte.)
IX. Pathophysiology (Flowchart)
(Predisposing) (Precipitating)
Age: 30 Lifestyle: drinks occasionally
Stress (Financial
needs of the family)
Gender: F
Eating habits
Race: Filipino
Family History: both parents have hypertension.

VASOSPASM
VASCULAR EFFECT KIDNEY INTERSTITIAL EFFECT
VASOCONSTRICTION KIDNEY EFFECT EDEMA
DECREASE URINE
INCREASE OF BP OUTPUT AND PROTENURIA
(160/120) (150ml)
Who is at risk for Pregnancy induced hypertension?
-PIH is more common during a woman’s first pregnancy and in women whose mothers or sisters
had PIH. The risk of PIH is higher in women carrying multiple babies, in teenage mothers and in
women older than 40 years of age. Other women at risk include those who had high blood
pressure or kidney disease before they became pregnant.
How does vasospasm affects the Heart?
Vasospasm happens by increased cardiac output that injures the endothelial cells of the arteries.
The blood vessels during pregnancy are resistant to the effects of pressors substances such as
angiotensin and norepinephrine, so blood pressure remain normal during pregnancy.
How does vasospasm affects the Kidney?
Vasospasm in the kidney increases blood flow resistance. Degenerative changes develop in the
kidney glomeruli because of back-pressure. This leads to increased permeability of the
glomerular membrane, allowing the serum proteins albumin and globulin to escape into the urine

the degenerative changes also results in decreased glomerular filtration, so there is a decrease
urine output and clearance of creatinine.
X. Course in the Ward
Mrs. R.E.R. a 30 year old postpartum who gave birth to her baby at home attended by a
midwife was suspected to have a postpartum hypertension was admitted to the Ospital ng
Lungsod ng San Jose Del Monte.
DAY 1 (Sept. 25 2011, 7pm-7am)
As the client admitted by Dr. Roberto Enriquez to the OB ward, she was given a liter of
intravenous fluid of D5LR solution at 20 gtts/min. She was inserted a Foley catheter connected
to the urine bag and Vital signs were taken. She was instructed for NPO. And as of 4pm she was
given an initial dose of MgSO4, 4grams infused 250ml 5% of dextrose solution, her blood
pressure was monitored 200/100. At 5pm she had given MgSO4 5grams diluted in 10ml of
sodium chloride in each buttock deep intramuscular and she was asked by the nurse if she didn’t
experience abdominal pain, nausea or vomiting before the medication was administered. After
that her Blood pressure was 170/100, and after 30 minutes she had given Hydralizine 5ml every
6 hours intravenous, it was administered slowly. And as of 2am she was given Amlodipine 5mg
twice a day as ordered by the physician.
DAY 2 (Sept. 26 2011, 7am-7pm)

Her Blood pressure was 140/100 and had continued MgSO4. As ordered by the physician the
dose of Amlodipine increased to 10mg twice a day. And once she completed the MgSO4 , the
nurse may remove the inserted Foley catheter. Her hemoglobin count was 95, and urinalysis
result was +4 as seen and examined by Dra. Garza who ordered to discontinue antibiotics and to
start Cephalexine 500mg/cap every 6 hours in 7 days and FeSO4 twice a day . and the patient
was told she may go home if she completed MgSO4 and was controlled her Blood pressure with
Amlodipine . She was also instructed to take Diazepam 5g twice a day in 1 week continuously
even she’s at home.
DAY 3 (Sept. 27 2011, 7pm-7am)
Her blood pressure was150/100 and was referred to Dra. Comia, then her oral medications
were given and then were referred to OB.
DAY 4 (Sept. 28 2011, 7am-7pm)
She walked slowly with an intravenous fluid and was referred to MS-OBand vital signs were
taken. Her medications were given; her Blood pressure was monitored and was referred to Dr.
Nieto.
DAY 5(Sept. 29 2011, 7pm-7am)
She was taken a low sodium low fat diet and still taking her medication, vital signs were
taken. Her Blood was monitored. Clonidine 5g was given sublingual as instructed by the
physician. Then her blood pressure became 150/90 after an hour. She was referred to Dr.
Gonzales with orders in and carried out.
DAY 6 (Sept. 30 2011, 7am-7pm)
Oral medications were given, uterus was firm and contracted, her vital signs were taken and
blood pressure was monitored 150/100. She was advised to breastfeed.

XI. Nursing Care Plans
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective:
None
Objective:
Pitting
Edema:3
seconds
Lower
extremities:
Bipedal
Edema
UO:150 cc per
hour
VS:
BP: 160/120
BT: 36.4
PR: 104
RR: 18
Excessive
fluid volume
related to
increased
fluid retention
as manifested
by the
presence of
edema in the
feet.
Short Term
Goal:
After 8 hours of
nursing
intervention the
patient’s edema
will be decreased
as evidenced by
pitting edema (1-
2 seconds)
Long Term
Goal:
After 2 days of
nursing
intervention, the
patient will have
stabilized fluid
volume as
evidenced by
balanced
input/output, vital
signs within
client’s normal
limits and free of
signs of edema
Independent
>Monitor urine output
>Monitor BP
>Encourage the patient to
eat fruits and vegetables
that has high diuretic
property
>Elevate edematous
extremities, change in
position frequently
>Discuss the importance
of fluid restrictions
Dependent:
>Insert indwelling urinary
catheter as per doctors
order
>Restrict sodium and fluid
intake as indicated
>Kidney function is directly correlated to
circulatory fluid volume, so that if fluid is
trapped in third spaces, output decreases
and specific gravity increases.
>Changed parameters may indicate altered
fluid or electrolyte status.
>Helps to increase urine output thus decreases
fluid retention
>Helps to reduce tissue pressure and risk of
skin breakdown. to increase venous blood
return
>Helps the client to understand the
relationship of food restriction to her
condition
>Provides accurate hourly totals of urine
output, and monitors client for developing
renal problems or oliguria.
>Restricting the sodium in the diet will
favor the renal excretion of excess fluid.
Fluid restriction may decrease intravascular
volume and myocardial workload
Short Term Goal:
After 8 hours of
nursing
intervention the
patient’s edema
was decreased as
evidenced by
pitting edema (1-2
seconds
Long Term Goal:
After 2 days of
nursing
intervention, the
patient had
stabilized fluid
volume as
evidenced by
balanced
input/output, vital
signs within
client’s normal
limits and free of
signs of edema

Subjective:
“Di ko alam kung
bakit nakaconfine
pa ako, mataas
nga ang bp ko
pero feeling ko
okay naman ako
dahil wala naman
akong masakit na
nararamdaman”
as verbalized by
the client.
Objective:
>Observed
confusion when
patient was asked
about her
condition
>Lack of
information
source ( no
television and
radio at home)
Knowledge
regarding
condition,
prognosis Related
to lack of
exposure/unfamili
arity with
information as
manifested by
statement of
misconceptions
Short Term Goal:
After 4 hours of
nursing intervention,
client will identify
signs/symptoms
requiring medical
evaluation.
Long Term Goal:
After 1 day of nursing
intervention, the client
will verbalize
understanding of
disease and
appropriate treatment
plan.
Independent:
>Assess client’s
knowledge of the
disease process.
>Provide information
about the disease and
the complications that
it can cause.
>Provide information
about signs/symptoms,
and instruct client
when to notify
healthcare provider.
>Keep client informed
of health status, results
of tests.
>Establishes data base
and provides information
about areas in which
learning is needed.
>Makes the client know
the importance of
treatment and
management of her
condition.
>Helps ensure that client
seeks timely treatment
indicating worsening of
condition or additional
complications.
>Fears and anxieties can
be compounded when
client does not have
adequate information
about the state of the
disease process.
Short Term Goal:
After 4 hours of
nursing
intervention, client
was able to identify
signs/symptoms
requiring medical
evaluation.
Long Term Goal:
After 1 day of
nursing intervention,
the verbalized
understanding of
disease process and
appropriate
treatment plan.

Subjective:
> "Hindi ako
makatulog ng
maayos, halos
tatlong oras lang
na deretsong
tulog sa isang
araw tapos putol-
putol na". As
verbalized by the
client.
Objective:
>Pale
conjunctiva, lips,
palm and skin
>Frequent
yawning
>Dark circles
under the eyes
VS:
BP: 160/120
BT: 36.4
PR: 104
RR: 18
>Disturbed sleep
pattern related to
uncomfortable
environment as
manifested by
pale conjunctiva,
lips, palm and
skin frequent
yawning and
dark circles
under the eyes.
Short Term Goal:
>After 4 hours of
nursing intervention
the client will
demonstrate
relaxation skills and
other methods to
promote sleep.
Long Term Goal:
>After 1 day of
the client will be
able to sleep at least
8 hours a day.
Independent:
>advise to establish
regular bedtime and
wakeup time and a
short daytime nap.
>Advise to take warm
bath before bedtime.
>Advise to wear loose-
fitting shirts.
>Advise to drink 1
glass of warm milk
before sleeping.
>encourage voiding
before going to sleep.
Collaborate:
>Advise the roommates
to lower their voices
and prevent noise at
bedtime.
>To promote good
sleeping pattern
>To promote feeling
of freshness before
sleeping.
>To promote comfort
while sleeping.
>Milk contains
tryptophan, a
precursor of
serotonin, which is
thought to induce and
maintain sleep.
>To avoid
interruption in the
middle of sleep.
>To reduce noise
destruction for the
comfortable sleep of
the patients.
Short Term Goal:
>After 4 hours of
the client was able to
demonstrate
relaxation skills and
other methods to
promote sleep.
Long Term Goal:
>After 1 day of
the client was able to
sleep at least 8 hours
a day.

XII. Drug Study
Name of
Drug
Classification Mechanism of Actions Indication Contraindication Adverse Effect Drug to Drug
Interaction
Nursing
Consideration
Amlodipine Antianginal
Antihypertens
ive
Calcium
Channel
Blocker
Inhibits the movement
of calcium ions across
the membranes of
cardiac and arterial
muscle cells; inhibits
transmembrane calcium
flow, which result in the
depression of impulse
formation in specialized
cardiac pacemaker cells,
slowing of the velocity
of conduction of the
cardiac impulse,
depression of
myocardial contractility
, and dilation of
coronary arteries and
arterioles and peripheral
arterioles; these effects
lead to decreased
cardiac work, decreased
cardiac oxygen
consumption, and in
patients with vasospastic
(Prinzmetal’s)
angina,increased
delivery of oxygen to
cardiac cells.
 Angina pectoris due
to coronary artery
spasm
(Prinzmetal’s
variant angina)
 Chronic stable
angina, alone or in
combination with
other drugs
 To reduce the risk
of hospitalization
due to angina and
to reduce the need
for coronary
revascularization
procedures in
patients with
angiographically
documented CAD
without heart
failure or ejection
fraction less than
40%
 Essential
hypertension, alone
or in combination
with other
antihypertensives
 Contraindicate
d with allergy
to amlodipine,
impaired
hepatic or renal
function, sick
sinus
syndrome,
heart block
(second or
third degree),
and lactation.
 Use cautiously
with heart
failure,
pregnancy.
 CNS:
Dizziness,li
ght-
headedness,
headache,
asthenia,
fatigue,letha
rgy
 CV:
Peripheral
edema,
arrhythmias
 Dermatologi
c: Flushing,
rash
 GI: Nausea,
abdominal
discomfort
 Monitor BP
very
carefully if
patient is
also on
nitrates.
 Monitor
cardiac
rhythm
regularly
during
stabilization
of dosage
and
periodically
during long-
term
therapy.
 Administer
drug
without
regard to
meals.

Name of
Drug
Classification Mechanism of
Actions
Indication Contraindication Adverse Effect Drug to Drug
Interaction
Nursing
Consideration
Cephalexin Antibiotic
Cephalosporin
(first
generation)
Bactericidal:
Inhibits synthesis
of bacterial cell
wall, causing cell
death.
 Respiratory tract
infections caused
by Streptococcus
pneumonia, group
A beta hemolytic
streptococci.
 Skin and skin
structure infections
caused by
staphylococcus,
streptococcus
 Otitis media
caused by S.
pneumonia,
Haemophilusinflue
nzae,
streptococcus,
staphylococcus,
Moraxella
catarrhalis
 Bone infections
caused by
staphylococcus,
Proteus mirabilis
 GU infections
caused by
Escherichia coli, P.
mirabilis,
Klebsiella
 Contraindicat
ed with
allergy to
cephalosporin
s or
penicillins.
 Use
cautiously
with renal
failure,
lactation,
pregnancy.
 CNS: Headache,
dizziness,
lethargy,
paresthesia
 GI: Nausea,
vomiting,
diarrhea,
anorexia,
abdominal pain,
flatulence,
pseudomembrano
us colitis,
hepatotoxicity
 GI:
Nephrotoxicity
 Hematologic:
Bone marrow
depression
 Hypersensitivity:
Ranging from
rash to fever to
anaphylaxis;
serum sickness
reaction
 Other: Super
infections
 Increased
nephrotoxici
ty with
amino
glycosides
 Increased
bleeding
effects with
oral
anticoagula
nts
 Disulfiramli
ke reaction
may occur if
alcohol is
taken within
72 hr after
cephalexin
administrati
on
 Arrange for
culture and
sensitivity
tests of
infection
before and
during
therapy if
infection
does not
resolve.
 Give drug
with meals;
arrange for
small,
frequent
meals if GI
complication
s occur.
 Refrigerate
suspension,
discard after
14 days.

Name of
Drug
Classification Mechanism
of Actions
Indication Contra
indication
Adverse Effect Drug to Drug
Interaction
Nursing
Consideration
Cefuroxime Antibiotic
Cephalosporin
Bactericidal
: Inhibits
synthesis of
bacterial
cell wall,
causing cell
death.
 Pharyngitis, tonsillitis,
caused by Streptococcus
pyogenes
 Otitis media caused by
Stretococcus pneumonia,
S.pyogenes,
Haemophilus influenza,
Moraxella catarrhalis
 Acute bacterial maxillary
sinusitis caused by S.
pneumonia, H. influenza
 Lower respiratory
infections caused by S.
pneumonia, Haemophilus
parainfluenza, H.
influenza
 UTIs caused by
Escherichia coli,
Klebsiella pneumonia
 Uncomplicated
gonorrhea (urethral and
endocervical)
 Skin and skin structure
infections, including
impetigo caused by
Streptococcus aureus, S.
pyogenes
 Treatment of early Lyme
disease
 Contrain
dicated
with
allergy
to
cephalos
porins or
penicilli
ns.
 Use
cautious
ly with
renal
failure,
lactation
,
pregnan
cy
 CNS: Headache,
dizziness, lethargy,
paresthesias
 GI: Nausea,
vomiting, diarrhea,
anorexia,
abdominal pain,
flatulence,
pseudomembranous
colitis,
hepatotoxicity
 GU: Nephrotoxicity
 Hematologic: Bone
marrow depression
Ranging from rash
to fever to
anaphylaxis; serum
sickness reaction
 Local: Pain, abscess
at injection site,
phlebitis,
inflammation at IV
site
 Other: Super
infections,
disulfiram-like
reaction with
alcohol
 Increased
nephrotoxi
city with
amino
glycosides
 Increased
bleeding
effects
with oral
anticoagul
ant
 Risk of
disulfiram
-like
reaction
with
alcohol;
avoid this
combinati
on during
and for 3
days after
completio
n of
therapy
 Culture infection
site, and arrange
for sensitivity test
before and during
therapy if
expected response
is not seen.
 Give oral drug
with food to
decreased GI
upset and enhance
absorption.
 Give oral tablets
to children who
can swallow
tablets; crushing
the drug results in
a bitter,
unpleasant taste.
Use solution for
children who
cannot swallow
tablets.
 Have vitamin K
available in case
hypoprothrombin
emia occurs.
 Discontinue if
hypersensitivity
reaction occurs.

Name of
Drug
of Actions
Interaction
Nursing
Consideration
Clonidine Antihypertensive
Central analgesic
Sympatholytic
Stimulates
CNS
alpha2-
adrenergic
receptors,
inhibits
sympathetic
cardioaccele
rator and
vasoconstric
tor centers,
and
decreases
sympathetic
out flow
from the
CNS.
 Hypertension,
used alone as part
of combination
therapy
 Treatment of
severe pain in
cancer patients in
combination with
opiates; epidural
more effective
with neuropathic
pain (Duralcon)
 Unable uses:
tourette
syndrome;
migraine,
decreases severity
and frequency;
menopausal
flushing,
decreases
severity and
frequency of
episodes; chronic
methadone
detoxification;
rapid opiate
detoxification (in
doses up to 17
mcg/kg/day);
alcohol and
benzodiazepine
withdrawal
 Contraindicat
ed with
hypersensitivi
ty to clonidine
or any
adhesive layer
components
of the
transdermal
system.
 Use
cautiously
with severe
coronary
insufficiency,
recent IM,
cerebrovascul
ar disease;
chronic renal
failure;
pregnancy,
lactation.
 CNS: Drowsiness,
sedation, dizziness,
headache, fatigue that
tend to diminish within
4-6 wks, dreams,
nightmares, insomnia,
hallucination,delirium,
nervousness, restlessness,
anxiety, depression,
retinal degeneration
 CV: Heart failure,
orthostatic hypotension,
palpitations, tachycardia,
bradycardia, Raynaud’s
phenomenon, ECG
abnormalities manifested
as Wenckebach period or
ventricular trigeminy
 Dermatologic: Rash,
angioneurotic edema,
hives, urticaria, hair
thinning and alopecia,
pruritis, dryness, itching
or burning of the eyes,
pallor
 GI: Dry mouth,
constipation, anorexia,
malaise, nausea,
vomiting, parotid pain,
paroritis, mild transient
abnormalities in LFTs
 GU: Impotence, sexual
dysfunction, nocturia,
 Decreased
antihyperte
nsive effect
with TCAs
(imipramin
e)
 Paradoxical
hypertensio
n with
propranolol
; also
greater
withdrawal
hypertensio
n when
abruptly
discontinue
d and
patient is
taking
beta-
adrenergic
blocking
agents
 Additive
sedation
with CNS
depressants
, alcohol
 Do not
discontinue
transdermal
therapy
prior to
surgery;
monitor BP
carefully
during
surgery;
have other
BP -
controlling
drugs
readily
available.
 Continue
oral
clonidine
therapy to
within 4 hr
of surgery
then resume
as soon as
possible
thereafter.

treatment;
management of
hypertensive
“urgencies” (oral
clonidine
“loading” is used;
initial dose of 0.2
mg then 0.1 mg
every hour until a
dose of 0.7 mg is
reached or until
BP is controlled);
atrial fibrillation;
attention deficit
hyperactivity
disorder; post-
herpetic
neuralgia,
smoking
cessation
(transdermal)
difficulty in micturition,
urinary retention
 Other: Weight gain,
transient hyperglycemia
or elevated serum
creatine phosphokinase
level, gynecomastia,
weakness, muscle or joint
pain, cramps of the lower
limbs, dryness of the
nasal mucosa, fever

Name of Drug Classification Mechanism of
Actions
Indication Contraindication Adverse
Effect
Drug to Drug
Interaction
Nursing Consideration
Ferrous sulfate Iron
preparation
Elevates the
serum iron
concentration,
and is then
converted to
Hgb or trapped
in the
reticuloendothe
lial cells for
storage and
eventual
conversion to a
usable form of
iron.
 Prevention
and treatment
of iron
deficiency
anemia
 Dietary
supplement
for iron
 Unlabeled
use:
Supplementa
l use during
epoetin
therapy to
ensure proper
hematologic
response to
epoetin
 Contraindicate
d with allergy
to any
ingredient;
sulfite allergy;
hemochromato
sis,
hemosiderosis,
hemolytic
anemia.
 Use cautiously
with normal
iron balance;
peptic ulcer,
regional
enteritis,
ulcerative
colitis.
 CNS: CNS
toxicity,
acidosis,
coma and
death with
overdose
 GI: GI
upset,
anorexia,
nausea,
vomiting,
constipatio
n, diarrhea,
dark stools,
temporary
staining of
the
teeth(liquid
preparation
s)
 Decreased
anti-infective
response to
ciprofloxacin,
norfloxacin,
ofloxacin;
separate doses
by at least 2 hr
 Decreased
absorption
with antacids,
cimetidine
 Decreased
effects of
levodopa if
taken with iron
 Increased
serum iron
levels with
chloramphenic
ol
 Decreased
absorption of
levothyroxine;
separate doses
by at least 2 hr
 Confirm that patient
does have iron
deficiency anemia
before treatment.
 Give drug with
meals (avoiding
milk, eggs, coffee,
and tea) if GI
discomfort is severe;
slowly increase to
build up tolerance.
 Administer liquid
preparations in water
or juice to mask the
taste and prevent
staining of teeth;
have the patient
drink solution with a
straw.
 Warm patient that
stool may be dark or
green.
 Arrange for periodic
monitoring of Hct
and Hgb levels.

Name of
Drug
of Actions
Interaction
Hydralazine Antihypertensive
Vasodilator
Acts
directly on
vascular
smooth
muscle to
cause
Vasodilatio
n, primarily
arteriolar,
decreasing
peripheral
resistance;
maintains or
increases
renal and
cerebral
blood flow.
 Oral:
Essential
hypertens
ion alone
or in
combinat
ion with
other
drugs
 Parentera
l: Severe
essential
hypertens
ion when
drug
cannot be
given
orally or
when
need to
lower BP
is urgent
 Unlabele
d uses:
Reducing
afterload
in the
treatment
of heart
failure,
 Contraindicate
d with
hypersensitive
ty to
hydralazine,
tartrazine (in
100-mg tablets
marketed as
Apresoline);
CAD, mitral
valvular
rheumatic
heart disease
(implicated in
MI).
 Use cautiously
with CVAs;
increased in
tracranial
pressure (drug-
induced BP
decrease
increases risk
of cerebral
ischemia);
severe
hypertensionwi
th uremia;
advanced renal
damage; slow
 CNS: Headache,
peripheral neuritis,
dizziness, tremors,
psychotic reactions
characterized by
depression,
disorientation, or
anxiety
 CV: Palpitation,
tachycardia, angina
pectoris,
hypotension,
paradoxical pressor
response,
orthostatic
hypotension
 GI: Anorexia,
nausea, vomiting,
diarrhea,
constipation,
paralytic ileus
 GU: Difficult
micturition,
impotence
 Hematologic:
Blood dyscrasias
Rash, urticaria,
pruritis; fever,
chills, arthralgia,
 Increased
pharmacolo
gic effects
of beta-
adrenergic
blockers and
hydralazine
when given
concomitant
ly; dosage
of beta
blocker
may need
adjustment
 Give oral drug with
food to increase
bioavailability (drug
should be given in a
consistent relationship
to ingestion of food
for consistent response
to therapy).
 Drug may cause a
syndrome resembling
SLE. Arrange for
CBC, lupus
erythematosus (LE)
cell preparations, and
ANA titers before and
periodically during
prolonged therapy,
even in the
asymptomatic patient.
Discontinue if blood
dyscrasias occur.
Reevaluate therapy if
ANA or LE tests are
positive.
 Arrange for
pyridoxine therapy if
patient develops
symptoms of
peripheral neuritis.
 Monitor patient for

severe
aortic
insufficie
ncy, and
after
valve
replacem
ent
(doses up
to 800
mg tid)
acetylators
(higher plasma
levels may be
achieved;
lower dosage
may be
adequate);
lactation,
pregnancy,pul
monary
hypertension.
eosinophilia; rarely,
hepatitis,
obstructive jaundice
 Other: Nasal
congestion,
flushing, edema,
muscle cramps,
lymphadenopathy,
splenomegaly,
dyspnea, lupus-like
syndrome, possible
carcinogenesis,
lacrimation,
conjunctivitis
orthostatic
hypotension, which is
most marked in the
morning and in hot
weather, and with
alcohol or exercise

Name of
Drug
Classification Mechanism of
Actions
Interaction
Magnesium
Sulfate
Antiepileptic
Electrolyte
Laxative
Cofactor of
many enzyme
systems
involved in
neurochemical
transmission
and muscular
excitability;
prevents or
controls
seizures by
blocking
neuromuscular
transmission;
attracts and
retains water in
the intestinal
lumen and
distends the
bowel to
promote mass
movement and
relieve
constipation.
 Acute
nephritis
(children), to
control
hypertension
 IV:
Hypomagnese
mia,
replacement
therapy
 IV or IM:
Preeclampsia
or eclampsia
 PO: Short-
term
treatment of
constipation
 PO:
Evacuation of
the colon for
rectal and
bowel
examinations
 To correct or
prevent
hypomagnese
mia in
patients on
parenteral
nutrition
 Contraindicat
ed with
allergy to
magnesium
products;
heart block,
myocardial
damage;
abdominal
pain, nausea,
vomiting, or
other
symptoms of
appendicitis;
acute surgical
abdomen,
fecal
impaction,
intestinal and
biliary tract
obstruction,
hepatitis. Do
not give
during 2 hr
preceding
delivery
because of
risk of
magnesium
toxicity in the
 CNS:
Weakness,
dizziness,
fainting,
sweating (PO)
 CV:
Palpitations
 GI: Excessive
bowel
activity,
perianal
irritation (PO)
 Metabolic:
Magnesium
intoxication(fl
ushing,
sweating,
hypotension,
depressed
reflexes,
flaccid
paralysis,
hypothermia,
circulatory
collapse,
cardiac and
CNS
depression-
parenteral);
hypocalcemia
 Potentiation
of
neuromuscula
r blockade
produced by
non-
depolarizing
neuromuscula
r relaxants
 Reserve IV use in
eclampsia for
immediate life-
threatening situations
 Give IM route by
deep IM injection of
the undiluted (50%)
solution for adults;
dilute to a 20%
solution for children.
 Give oral magnesium
sulfate as a laxative
only as a temporary
measure. Arrange for
dietary measures
(fiber, fluids),
exercise, and
environmental
control to return to
normal bowel
activity.
 Do not give oral
magnesium sulfate
with abdominal pain,
nausea, or vomiting.
 Monitor bowel
function; if diarrhea
and cramping occur,
discontinue oral drug.
 Maintain uterine

 Unlabeled
uses:
Inhibition of
premature
labor
(parenteral),
adjust
treatment of
exacerbations
of acute
asthma;
treatment
torsades de
pointes,
atypical
ventricular
arrhythmias
neonate.
 Use
cautiously
with renal
insufficiency.
with tetany
(secondary to
treatment of
eclampsia-
parenteral)
output at a level of
100 ml every 4 hr
during parenteral
administration.

Name of
Drug
of Actions
Interaction
Nursing
Consideration
Methyldopa Antihypertensive
Sympatholytic
Mechanism
of action not
conclusively
demonstrated
; probably
due to drugs
metabolism,
which lower
arterial BP
by
stimulating
CNS alpha2-
adrenergic
receptors,
which in turn
decreases
sympathetic
outflow from
the CNS,
 Hypertension
 IV
methyldopate
: Acute
hypertensive
crisis; not
drug of
choice
because of
slow onset of
action
 Unlabeled
uses:
Hypertension
of pregnancy
 Contraindicat
ed with
hypersensitivi
ty to
methyldopa,
active hepatic
disease,
previous
methyldopa
therapy
associated
with liver
disorders.
 Use
cautiously
with previous
liver disease,
renal failure,
dialysis,
bilateral
cerebrovascul
ar disease,
pregnancy,
RR lactation.
 CNS: Sedation, headache
,asthenia, weakness
(usually early and
transient), dizziness, light-
headed
symptoms of
cerebrovascular
insufficiency, paresthesias,
parkinsonism, Bells
palsy,decreased mental
acuity, involuntary
choreoathetotic
movements, psychic
disturbances
 CV: Bradycardia, prlonged
carotid anus
hypersensitivity,
aggravation of angina
pectoris,paradoxical
pressor response,
pericarditis, myocarditis,
orthostatic hypotension,
edema
 Dermatologic:
Rash seen as eczema or
lichenoid eruption, toxic
epidermal necrolysis fever,
lupus like syndrome
 Endocrine: Breast
enlargement,
 Potentiatio
n of the
pressor
effect of
sympathom
imetic
amines
 Increased
hypotensio
n with
levodopa
 Risk of
hypotensio
n during
surgery
with
central
anesthetic;
monitor
patient
carefully
 Administer
IV slowly
over 30-60
min;
monitor
injection
site
 Add
athiazide to
drug
regimen or
increase
dosage if
methyldopa
tolerance
occurs

gynecomastia, lactation,
hyperprolactinemia,
amenorrhea, galactorrhea,
impotence, failure to
ejaculate, decreased libido
 GI: Nausea, vomiting,
distention, constipation,
flatus, diarrhea, colitis, dry
mouth, sore or black
tongue, pancreatitis,
sialadenitis, abnormal liver
function tests, jaundice,
hepatitis, hepatic necrosis.
 Hematologic: Positive
Coombs test, hemolytic
anemia, bone marrow
depression leucopenia,
granulocytopenia,
thrombocytopenia, positive
tests for antinuclear
antibody, lupus like
syndrome, and rheumatoid
factor

XIII. Discharge Planning
MEDICATION  Advise patient not to skip the medication that the
doctor ordered
EXERCISE/ENVIRONMENT  Enough rest
 Elevate feet several times a day during the day
TREATMENT
 Use of drugs
 Catheterization
 Obtaining labs(CBC,PLATELETS COUNT,LIVER
FUNCTION)
HEALTH TEACHING
 Encourage patient for sodium restriction
 Encourage to avoid foods rich in oils and fats
 Encourage patient to limit her daily activities and
exercise
 Encourage to avoid Salty, high fat diet, instead eat
healthy foods.
 Advise to continue medicine as prescribed
 Separate utensils for the mother and other things that
will be used for the whole family
 Encourage eat high protein foods, calcium,
magnesium, zinc, vitamin c and e
 Health teachings for symptoms mild and severe pre-
eclampsia
OPD FOLLOW UP
 Observe carefully for symptoms
 Give instruction about what symptoms to watch for so
she can alert clinician if additional symptoms occur
between visits
 Provide information about how to control the disease
DIET
 Low fats and sodium diet, restriction if possible
 High in protein, calcium and iron
 Adequate fluid intake
 Eat fresh green healthy leafy vegetables and fresh
fruits
SPIRITUAL/SEX  Limit sexual activity
 Provide spiritual and emotional support
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82085243 case-study-on-pregnancy-induced-hypertension-eclampsia

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82085243 case-study-on-pregnancy-induced-hypertension-eclampsia