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a group presentation on eclampsia, its definiton, and nursing management...

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  1. 1. CASE STUDY
  2. 2. Pregnancy Induced Hypertension
  3. 3. Introduction <ul><li>Eclampsia, a dramatic and often unpredictable complication of pregnancy-induced hypertensive disorders, is characterized by sudden hypertension, proteinuria, edema, and seizures. </li></ul><ul><li>A relatively rare syndrome, eclampsia complicates approximately 3 in 100 pregnancies, with higher incidence rates in preeclamptic or twin pregnancies, women of low socioeconomic status or in developing countries, and nulliparous patients younger than 20 years or multiparous patients older than 35 years of age. </li></ul><ul><li>However many medical disorders can occur during pregnancy, childbirth, and in the post delivery time. One of those disorders in pregnancy is eclampsia. </li></ul><ul><li>Eclampsia is a major cause of perinatal morbidity and mortality and can present during the antepartum, intrapartum, or postpartum periods. Late postpartum eclampsia presents as convulsions, with onset occurring at more than 48 hours postpartum. </li></ul>
  4. 4. Demographic Data
  5. 5. Eclampsia was found to be more common among young and adolescent women . Age Distribution Age group [ years ] 22 [46.80%] 19 [40.42%] 3 [6.38% ] 3 [ 6.38%] 19 or less 20-24 25-29 30 or more
  6. 6. Significance of the Study <ul><li>Pregnancy Induced Hypertension is a rare complication that occur within 42 days after delivery. We have chosen this case for the reason, that we became curious and interested regarding the deeper medical diagnosis for the occurrence of the certain disease. </li></ul><ul><li>It is very necessary for pregnant women to have knowledge concerning the subject matter for them to be aware and educated about the possible complications that may arise on their pregnancy. </li></ul><ul><li>Educating them to seek early and regular prenatal care is the best way to prevent complications that may lead to maternal various diseases. </li></ul>
  7. 7. Study of the Subject Matter
  8. 8. What is Pregnancy-induced Hypertension? <ul><li>Pregnancy-induced hypertension is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks gestation . </li></ul><ul><li>It occurs most often in young women with a first pregnancy. It is more common in twin pregnancies, in women with chronic hypertension, preexisting diabetes, and in women who had PIH in a previous pregnancy </li></ul>
  9. 9. <ul><li>Symptoms seen in patient: </li></ul><ul><ul><li>Blood pressure elevation (140/100) </li></ul></ul><ul><ul><li>Episodes of Two-Clonic Seizure </li></ul></ul><ul><ul><li>Blurred Vision </li></ul></ul>
  10. 10. <ul><li>Diagnostic done with the patient: </li></ul><ul><li>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: </li></ul><ul><ul><li>Blood pressure measurement </li></ul></ul><ul><ul><li>Urinalysis </li></ul></ul><ul><ul><li>Frequent weight measurements </li></ul></ul><ul><ul><li>Blood Chemistry </li></ul></ul><ul><ul><li>Hematology </li></ul></ul>
  11. 11. <ul><li>Treatment done with the patient: </li></ul><ul><ul><li>Bed rest (either at home or in the hospital may be recommended) </li></ul></ul><ul><ul><li>Hospitalization (as specialized personnel and equipment may be necessary) </li></ul></ul><ul><ul><li>Magnesium sulfate given IV by infusion pump to prevent or limit seizures </li></ul></ul><ul><ul><li>Anti-Convulsion </li></ul></ul><ul><ul><li>Anti-Hypertensive </li></ul></ul><ul><ul><li>Foley catheter </li></ul></ul><ul><ul><li>Normal Delivery </li></ul></ul><ul><ul><li>Calcium Channel Blocker </li></ul></ul>
  12. 12. Anatomy and Physiology
  13. 13. Reproductive System
  14. 14. <ul><li>Functions: </li></ul><ul><li>Production of female sex cells </li></ul><ul><li>Reception of sperm cells from the male </li></ul><ul><li>Nurturing the development of and providing nourishment for the new individual </li></ul><ul><li>Production of female sex hormones. </li></ul>
  15. 15. Baby and Placenta
  16. 16. <ul><li>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. </li></ul>
  17. 17. Blood Vessel
  18. 18. <ul><li>Functions: </li></ul><ul><li>Carry blood </li></ul><ul><li>Exchange nutrients, waste products and gases </li></ul><ul><li>Transport </li></ul><ul><li>Regulate blood pressure </li></ul><ul><li>Direct blood flow </li></ul>
  19. 19. Structure and Functions of Blood Vessels Structure Functions Arteries - The walls (outer structure) of arteries contain smooth muscle fiber that contract and relax under the instructions of the sympathetic nervous system. Transport blood away from the heart; Transport oxygenated blood only (except in the case of the pulmonary artery). Arterioles - Arterioles are tiny branches of arteries that lead to capillaries. These are also under the control of the sympathetic nervous system, and constrict and dilate, to regulate blood flow. Transport blood from arteries to capillaries; Arterioles are the main regulators of blood flow and pressure. Venules - Venules are minute vessels that drain blood from capillaries and into veins. Many venules unite to form a vein. Drains blood from capillaries into veins, for return to the heart
  20. 20. Structure Functions Capillaries - Capillaries are tiny (extremely narrow) blood vessels, of approximately 5-20 micro-metres (one micro-metre = 0.000001metre) diameter. There are networks of capillaries in most of the organs and tissues of the body. These capillaries are supplied with blood by arterioles and drained by venules. Capillary walls are only one cell thick (see diagram), which permits exchanges of material between the contents of the capillary and the surrounding tissue. Function is to supply tissues with components of, and carried by, the blood, and also to remove waste from the surrounding cells ... as opposed to simply moving the blood around the body (in the case of other blood vessels); Exchange of oxygen, carbon dioxide, water, salts, etc., between the blood and the surrounding body tissues. Veins - The walls (outer structure) of veins consist of three layers of tissues that are thinner and less elastic than the corresponding layers of arteries. Veins include valves that aid the return of blood to the heart by preventing blood from flowing in the reverse direction. Transport blood towards the heart; Transport deoxygenated blood only (except in the case of the pulmonary vein).
  21. 21. Comparison between Arteries and Veins Arteries Veins Transport blood away from the heart; Transport blood towards the heart; Carry Oxygenated Blood (except in the case of the Pulmonary Artery); Carry De-oxygenated Blood (except in the case of the Pulmonary Vein); Have relatively narrow lumens Have relatively wide lumens (see diagram above); Have relatively more muscle/elastic tissue; Have relatively less muscle/elastic tissue; Transports blood under higher pressure (than veins); Transports blood under lower pressure (than arteries); Do not have valves (except for the semi-lunar valves of the pulmonary artery and the aorta). Have valves throughout the main veins of the body. These are to prevent blood flowing in the wrong direction, as this could (in theory) return waste materials to the tissues.
  22. 23. Narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. When blood vessels constrict, the flow of blood is restricted or slowed, thus, retaining body heat and increasing vascular resistance. Cutaneously, this makes the skin turn paler because less blood reaches the surface. This helps to prevent the radiation of heat. Blood Vessel are tubes which carry blood. Veins are blood vessels which carry blood from the body back to the heart. Arteries are blood vessels which carry blood from the heart to the body. There are a few main blood vessels which connect to different chambers of the heart. The aorta is the largest artery in our body. The left ventricle pumps blood into the aorta which then carries it to the rest of the body through smaller arteries. The pulmonary trunk is the large artery which the right ventricle pumps into. It splits into pulmonary arteries which take the blood to the lungs. The pulmonary veins take blood from the lungs to the left atrium. All the other veins in our body drain into the inferior vena cava (IVC) or the superior vena cava (SVC). These two large veins then take the blood from the rest of the body into the right atrium. Abnormal Normal
  23. 24. Heart
  24. 25. <ul><li>Functions: </li></ul><ul><li>Generating blood pressure </li></ul><ul><li>Routing blood </li></ul><ul><li>Ensuring one-way blood flow </li></ul><ul><li>Regulating blood supply </li></ul>
  25. 26. Blood flow through the Heart
  26. 27. Brain Controls the central nervous system (CNS), by way of the cranial nerves and spinal cord, the peripheral nervous system (PNS) and regulates virtually all human activity. Involuntary, or &quot;lower,&quot; actions, such as heart rate, respiration, and digestion, are unconsciously governed by the brain, specifically through the autonomic nervous system. Complex, or &quot;higher,&quot; mental activity, such as thought, reason, and abstraction, is consciously controlled.
  27. 28. Neurons
  28. 29. 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.
  29. 30. Name: Ms. M.T Age: 19 Sex: Female Address: 69 Pooc Maligaya, San Vicente, San Pedro Laguna Civil Status: Single Occupation: None Name of Spouse: Mr. Benigno Carpellar Date of Admission: August 07, 2008 PATIENT’S PROFILE
  30. 31. Chief Complaint: Seizures History of present Illness: Patient delivered at San Pedro Municipal Hospital. After hours she had 2 episodes of tonic clonic seizures hence referral to our institution and then subsequently admitted. Physical Examination: Li open, uterus oblique, no abnormal masses Admitting Diagnosis: NSD Day 0 Post Partum Eclampsia G1P1(1001) BRIEF HISTORY
  32. 33. HEMATOLOGY: Diagnostic Exam Result Normal Range Findings Hemoglobin 136 M:140-170 / F:120-140 gml/dl Increased Hematocrit .41 M:0.44-0.54 – F:0.37-.47 Normal WBC 9.0 5.0-10.0 Normal Platelet 280 150-400cc/mL Normal ABO Typing “ A”
  33. 34. DIFFERENTIAL COUNT : Diagnostic Exam Result Normal Range Findings Segmenter 69 40-60 Increased Lymphocytes 31 20-40 Normal
  34. 35. URINALYSIS: Diagnostic Exam Result Normal Range Findings Color Yellow Yellow/Amber Normal Transparency Clear Clear Normal Reaction 5.0 4.8-7.8 Normal SP Gravity 1.030 1.015-1.025 Increased Sugar Negative Negative Normal Protein Negative Negative Normal Pus Cells 2-3 HPF 0-4 HPF Increased RBC 1.5-2.0 HPF 0-3 HPF Normal Epithelial Cells Few Few Present Normal
  35. 36. BLOOD CHEMISTRY: Diagnostic Exam Result Normal Range Findings BUN 12.3 mg/dl 10-50 mg/dl Normal Creatinine 1.1 mg/dl F:0.5-1.0 mg/dl M:0.6-1.2 mg Increased SGOT 26.8 1u/L 10-40 IU/L Normal SGPT 13.9 1u/L 5-35 IU/L Normal
  37. 38. MEDICAL MANAGEMENT DOCTOR’S ORDER RATIONALE <ul><li>AUGUST 08, 2008: </li></ul><ul><li>Please admit to OBW </li></ul><ul><li>Secure consent </li></ul><ul><li>3. NPO temporarily, DAT when fully awake </li></ul><ul><li>4. IVF D5LRS 1L * 20 gtt/min + 10 u oxytocin. </li></ul><ul><li>Medication: </li></ul><ul><li>5. Cefuroxime 1.5 g/IV LD ANGT Cefalexin 500 mg/cap q8 * 7 days </li></ul><ul><li>6. Magnesium Sulfate 4g SIVP then 5 g/ IM on each buttocks followed by 5 g/ IM or alternating buttock q6 * 4 doses </li></ul><ul><li>To provide maximum care to the patient </li></ul><ul><li>It includes explanation of the procedure to gain patients cooperation, and for patient’s documentation which can be used for legal purposes. </li></ul><ul><li>To prevent aspiration that maintains nutritional needs. </li></ul><ul><li>Fluid replacement and route for intravenous medication. Oxytocin helps induced uterine contraction and prevents post partum hemorrhage </li></ul><ul><li>Anti-infectives; Prevents occurrence of infections </li></ul><ul><li>Anti-convulsants and Laxative; for prevention of seizure. Watch out for signs of < tendon reflex, < urine output, > respiratory rate. </li></ul>
  38. 39. DOCTOR’S ORDER RATIONALE <ul><li>Nifedipine 10 mg/ tab BID (one fully awake) </li></ul><ul><li>8. Insert foley catheter </li></ul><ul><li>9. Monitor VS q1 including Input and Output and second please </li></ul><ul><li>Refer accordingly. </li></ul><ul><li>ADDENDUM: </li></ul><ul><li>Request for the ff: </li></ul><ul><li>CBC with blood typing </li></ul><ul><li>Platelet </li></ul><ul><li>SGOT,SGPT,BUN,CREA,LDH </li></ul><ul><li>Urinalysis </li></ul><ul><li>refer to Medicine for co-management </li></ul><ul><li>AUGUST 09, 2008 </li></ul><ul><li>May consume IVF once magnesium sulfate is completely given. </li></ul><ul><li>Follow up all Lab Results </li></ul><ul><li>May remove foley catheter after last dose of magnesium is given </li></ul><ul><li>Continue VS monitoring </li></ul><ul><li>Refer </li></ul><ul><li>7. Calcium channel blocker; for anti-hypertensiveness. </li></ul><ul><li>8. For accurate monitoring of I and O; prevention of injury, < bladder retention </li></ul><ul><li>9. Deviations from baseline monitoring </li></ul><ul><li>CBC to facilitate possible blood transfusion, platelet count to determine bleeding tendencies; SGOT, SGPT, BUN, CREA, LDH; is to rule out PIH either pre-eclampsia, chronic pregnancy. Urinalysis is for direct quantification of protein. </li></ul><ul><li>Refer for hypertensive management. </li></ul><ul><li>Follow up laboratory results to facilitate fast recovery. </li></ul><ul><li>Remove Foley Catheter to provide comfort and adequate rest and sleep. </li></ul>
  39. 40. Drug Study
  40. 41. <ul><li>Double check the doctor`s order, the meds to be given, the dosage, the route, and the time and frequency. </li></ul><ul><li>Monitor vital signs </li></ul><ul><li>Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other beta-lactam antibiotics. </li></ul><ul><li>Ask patient about past reaction to cephalosporin or penicillin therapy before giving first dose. </li></ul><ul><li>Identify the patient. </li></ul><ul><li>If large doses are given or if therapy is longed, monitor patient for superinfection, specially in high-risk. </li></ul><ul><li>Diarrhea </li></ul><ul><li>Loose Stools </li></ul><ul><li>Abdominal pain </li></ul><ul><li>Nausea and </li></ul><ul><li>Vomiting </li></ul>Contraindicated in patients hypersensitive to drug or other cephalosporins. Infections of the urinary and lower respiratory tracts. Cefuroxime is a second-generation Cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Generic Name Cefuroxime Classification: Cephalosporin, second generation Dosage: 1.5 g IV LD Nursing Responsibilities Side or Adverse Effects Contraindication Indication Mechanism of Action Drug Name
  41. 42. <ul><li>identify the patient. </li></ul><ul><li>double check the doctor`s order, the meds to be given, the dosage, the route, and the time and frequency. </li></ul><ul><li>monitor vital signs </li></ul><ul><li>Use cautiously in patients with heart failure or hypotension and in elderly patients. </li></ul><ul><li>Don’t give immediate-release form with-in one week of acute MI or in acute coronary syndrome. </li></ul><ul><li>Monitor blood pressure regularly, especially in patients who take beta-blockers or anti-hypertensive. </li></ul><ul><li>Watch for symptoms of heart failure. </li></ul><ul><li>Headache </li></ul><ul><li>Fatigue or Lethargy </li></ul><ul><li>Edema </li></ul><ul><li>Weakness or Muscle cramps </li></ul><ul><li>Dizziness </li></ul><ul><li>Disturbed equilibrium </li></ul><ul><li>Flushing </li></ul><ul><li>Contraindicated in patients hypersensitive to drugs. </li></ul>Vasospastic angina, classic chronic stable angina pectoris. Unknown. Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arterioles . Generic Name: Nifedipine Classification: Calcium channel blocker Dosage: 10 mg 1 tab. BID Nursing Responsibilities Side and Adverse Effects Contraindication Indication Mechanism of Action Drug Name
  42. 43. <ul><li>Identify the patient. </li></ul><ul><li>Double check the doctor`s order, the meds to be given, the dosage, the route, and the time and frequency. </li></ul><ul><li>Monitor vital signs </li></ul><ul><li>Use cautiously in patients with suspected cardiac disease, CVA, or severe renal impairment and in those taking other anti-hypertensives. </li></ul><ul><li>- </li></ul><ul><li>Tachycardia </li></ul><ul><li>Edema </li></ul><ul><li>Angina </li></ul><ul><li>pectoris </li></ul><ul><li>Palpitations </li></ul><ul><li>Nausea and </li></ul><ul><li>Vomiting </li></ul><ul><li>Diarrhea </li></ul><ul><li>Anorexia </li></ul><ul><li>Constipation </li></ul>Contraindicated in patient hypertensive to drug and in those with coronary artery disease or mitral valvular rheumatic heart disease. Essential hypertension (orally, alone, or with other anti-hypertensives), severe essential hypertension (parenterally, to lower blood pressure quickly) Unknown. A direct-acting vasodilator that mainly relaxes anteriolar smooth muscle. Generic Name Hydralazine Classification: Antihypertension Nursing Responsibilities Adverse Effects Contraindication Indication Mechanism of Action Drug Name
  43. 44. <ul><li>Identify the patient. </li></ul><ul><li>Double check the doctors order, the meds to be given, the dosage, the route, and the time and frequency. </li></ul><ul><li>Monitor vital signs </li></ul><ul><li>Use cautiously in patients with impaired renal function. Also use cautiously in woman who are in labor. </li></ul><ul><li>If used to treat seizures take appropriate seizure precautions. </li></ul><ul><li>-Monitor fluid intake and output. </li></ul><ul><li>Drowsiness </li></ul><ul><li>Depressed </li></ul><ul><li>reflexes </li></ul><ul><li>flaccid paralysis </li></ul><ul><li>Hypothermia </li></ul><ul><li>Hypotension </li></ul><ul><li>Parenteral Administration contraindicated in patients with heart block or myocardial damage. Also contraindicated in patients with toxemia of pregnancy during 2 hours preceeding delivery. </li></ul>To prevent or control seizures in preeclampsia or eclampsia. May decrease acetylcholine released by nerve impulses, but its anticonvulsant mechanism is unknown. Generic Name : Magnesium sulfate Classification: Anticonvulsant Dosage: 4gm SIVP and; 5g IM on each buttocks Nursing Responsibilities Adverse Effects Contraindication Indication Mechanism of Action Drug Name
  44. 45. Nursing care Plan
  45. 46. Patient’s Name: M.T Age: 19 Medical Diagnosis: Pregnancy Induced Hypertension Nursing Diagnosis: Decreased Cardiac Output related to decreased venous return . Short Term Goal: At the end of my shift, patient will have a decreased blood pressure and will be able to have an adequate rest and sleep. Long Term Goal: At the end of hospitalization, patient will be able to maintain vital signs within acceptable range. CUES PROBLEM SCIENTIFIC RATIONALE INTERVENTIONS RATIONALE EVALUATION <ul><li>SUBJECTIVE: </li></ul><ul><li>“ Hindi pa ko makabangon nahihilo ako”as verbalized by the patient </li></ul><ul><li>OBJECTIVES: </li></ul><ul><li>Increased Blood Pressure (140/100) </li></ul><ul><li>restlessness </li></ul><ul><li>Weak in appearance </li></ul><ul><li>Dizziness </li></ul>Hypertension -Inadequate blood pumped by the heart to meet the metabolic demands of the body. [note: In a Hyper Metabolic state although cardiac output and tissue perfusion are interrelated, altough there are differences. When cardiac output is decreased tissue perfusion problems will develop however, tissue perfusion problems can exixt without decreased cardiac output. <ul><li>Monitor Blood Pressure; every 15mins. During critical phase; ever 1-4hrs. As conditions improves. </li></ul><ul><li>Provide adequate rest by positioning client. </li></ul><ul><li>Give information about positive signs of improvements, such as decreased edema, improved vital signs and circulation </li></ul><ul><li>. </li></ul><ul><li>Encourage fluid intake. </li></ul><ul><li>Provide quite environment. </li></ul>-Provides baseline for comparison to follow trends and evaluate response to interventions. -Decreases oxygen consumption and risk for de-compensation and for maximum comfort. -To provide Encouragement. -To minimize dehydration. -To promote adequate rest. Goal Met. The patient will be able to have an adequate rest and sleep, and the patient’s blood pressure will decreased. The patient will be able to respond well to interventions and performed actions.
  46. 47. Patient’s Name: M.T Age: 19 Medical Diagnosis: Pregnancy Induced Hypertension Nursing Diagnosis: Impaired physical mobility related to decrease muscle strength Short Term Goal: After rendering my nursing intervention, patient will be able to verbalize understanding of situation and individual treatment regimen and safety measures. Long Term Goal: Upon discharge, the patient will be able to maintain or increase strength and function of the affected and compensatory body part. CUES PROBLEM SCIENTIFIC RATIONALE INTERVENTIONS RATIONALE EVALUATION <ul><li>OBJECTIVES: </li></ul><ul><li>Limited ROM (Range of Motion) </li></ul><ul><li>Slowed movement </li></ul>Impaired Physical Mobility Limitation in independent, purposeful physical movement of the body or of one or more extremities <ul><li>Note situations such as surgery, fractures, amputations and tubings (catheter). </li></ul><ul><li>Observe movements when client is unaware of observations. </li></ul><ul><li>Support affected body parts/joints using pillows. </li></ul><ul><li>Encourage adequate intake of fluids. </li></ul><ul><li>Encourage client’s involvement in decision as much as possible. </li></ul>- It may restrict movement -to note any incongruencies with reports of abilities -to maintain position of function and reduce risk of pressure ulcers -promotes well being and maximizes energy production. -enhances commitment to plan optimizing outcomes Goal Met: The patient will be able to verbalize understanding of situation and individual treatment regimen and safety measures. The patient will be able to maintain proper function of the part being affected.
  47. 48. Presented by: Dave Jay S. Manriquez RN.