This document provides a physical examination report of a postpartum patient. The summary includes:
- Vital signs were within normal limits. On examination, the patient had fair skin with stitches from a recent lower abdominal incision.
- A full physical examination was conducted including assessments of all body systems. The cranial nerves examination found the patient's nerves to be functioning properly.
- The anatomy and physiology section describes the external female genital structures. It identifies and describes the mons pubis, labia majora and minora, clitoris, vestibule, Skene's and Bartholin's glands, fourchette, perineum, urethral meatus,
Case Study Report on PIH and Severe Pre eclampsiaRashmi Regmi
it is a case study report on PIH and Severe Pre eclampsia
I did when I was posted on Kist Medical TEaching Hospital for Midwifery Practicum
Prepared by:
Rashmi Regmi
B Sc Nursing
Manmohan Memorial Institute Of health Sciences
The document describes a case of a 30-year-old female patient who was admitted to the hospital due to abruptio placenta and severe preeclampsia. She experienced vaginal bleeding and abdominal pain at 37 weeks and 5 days of gestation. Upon admission, she was found to have high blood pressure of 190/120 mmHg and her baby was in fetal distress. She underwent an emergency c-section but unfortunately her baby was stillborn. Her medical history included a previous pregnancy, hypertension since age 20 that was untreated, and a family history of hypertension and other conditions. She was confined for 14 days following the c-section.
Postpartum hemorrhage (PPH) is the second leading cause of maternal mortality worldwide, accounting for over 30% of maternal deaths in Africa and Asia. In Tanzania, almost 7,900 mothers die each year from childbirth or pregnancy complications, with PPH being one of the direct causes in 14.9% of cases. This case study examines a 33-year old woman admitted to Mnazi Mmoja Hospital in Tanzania suffering from PPH, as evidenced by a hemoglobin level of 8.4 and excessive vaginal bleeding. She received IV fluids, oxytocin, uterine massage and monitoring to manage her fluid deficit, stabilize her vital signs and prevent infection at the placental attachment site.
The document provides information about homework help resources and a case study on abruptio placentae (placental abruption). It includes an introduction to abruptio placentae, objectives of studying the case, patient profile, assessments of the patient's health history and tests, anatomy and pathophysiology of the condition, and a nursing care plan. The case study aims to increase understanding of abruptio placentae, including diagnosing and treating the condition, administering appropriate drugs and transfusions, and formulating a nursing care plan.
A 27-year-old woman was admitted to the hospital with severe pre-eclampsia at 35 weeks and 3 days of gestation. She had a blood pressure of 180/110 mmHg, proteinuria, edema, headache, and blurred vision. She received magnesium sulfate and antihypertensive medications. She later had a cesarean section under general anesthesia and delivered twins weighing 1.8 kg and 1.6 kg. The nursing care focused on monitoring her vital signs and symptoms, managing her blood pressure and fluids, providing rest and medications, and health education. Recommendations included improving equipment, guidelines, and staff training for managing severe pre-eclampsia.
A 32-year-old woman, G3P2L2, presented with 9 months of amenorrhea and abdominal pain for 2 hours. She had a history of two previous cesarean sections. On examination, the uterus was enlarged corresponding to 32 weeks with a single fetus in cephalic presentation. An emergency cesarean section was performed under spinal anesthesia due to scar tenderness, delivering a healthy male baby. The postoperative period was uneventful.
This document presents the case of a 17-year-old pregnant woman, Ms. X, who is 38 weeks gestation and was admitted to the hospital after experiencing 4 tonic-clonic seizures at home. Her medical history includes high blood pressure during pregnancy and protein in her urine. Initial differential diagnoses included eclampsia, epilepsy, and severe hypoglycemia. Initial management involved diazepam and magnesium sulfate. Investigations showed elevated blood pressure, creatinine, uric acid, and liver enzymes consistent with preeclampsia. The diagnosis was determined to be eclampsia. Ms. X's management included magnesium sulfate, labetolol to lower her blood pressure, and an emergency c-
The document discusses preeclampsia, including its signs, symptoms, risk factors, diagnostic tests, pathophysiology, and treatment. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems. It is caused by abnormal development of the placenta leading to reduced blood flow and endothelial cell dysfunction systemically. Proper management involves monitoring blood pressure, delivering the baby to resolve symptoms, and potentially using antihypertensive medications.
Case Study Report on PIH and Severe Pre eclampsiaRashmi Regmi
it is a case study report on PIH and Severe Pre eclampsia
I did when I was posted on Kist Medical TEaching Hospital for Midwifery Practicum
Prepared by:
Rashmi Regmi
B Sc Nursing
Manmohan Memorial Institute Of health Sciences
The document describes a case of a 30-year-old female patient who was admitted to the hospital due to abruptio placenta and severe preeclampsia. She experienced vaginal bleeding and abdominal pain at 37 weeks and 5 days of gestation. Upon admission, she was found to have high blood pressure of 190/120 mmHg and her baby was in fetal distress. She underwent an emergency c-section but unfortunately her baby was stillborn. Her medical history included a previous pregnancy, hypertension since age 20 that was untreated, and a family history of hypertension and other conditions. She was confined for 14 days following the c-section.
Postpartum hemorrhage (PPH) is the second leading cause of maternal mortality worldwide, accounting for over 30% of maternal deaths in Africa and Asia. In Tanzania, almost 7,900 mothers die each year from childbirth or pregnancy complications, with PPH being one of the direct causes in 14.9% of cases. This case study examines a 33-year old woman admitted to Mnazi Mmoja Hospital in Tanzania suffering from PPH, as evidenced by a hemoglobin level of 8.4 and excessive vaginal bleeding. She received IV fluids, oxytocin, uterine massage and monitoring to manage her fluid deficit, stabilize her vital signs and prevent infection at the placental attachment site.
The document provides information about homework help resources and a case study on abruptio placentae (placental abruption). It includes an introduction to abruptio placentae, objectives of studying the case, patient profile, assessments of the patient's health history and tests, anatomy and pathophysiology of the condition, and a nursing care plan. The case study aims to increase understanding of abruptio placentae, including diagnosing and treating the condition, administering appropriate drugs and transfusions, and formulating a nursing care plan.
A 27-year-old woman was admitted to the hospital with severe pre-eclampsia at 35 weeks and 3 days of gestation. She had a blood pressure of 180/110 mmHg, proteinuria, edema, headache, and blurred vision. She received magnesium sulfate and antihypertensive medications. She later had a cesarean section under general anesthesia and delivered twins weighing 1.8 kg and 1.6 kg. The nursing care focused on monitoring her vital signs and symptoms, managing her blood pressure and fluids, providing rest and medications, and health education. Recommendations included improving equipment, guidelines, and staff training for managing severe pre-eclampsia.
A 32-year-old woman, G3P2L2, presented with 9 months of amenorrhea and abdominal pain for 2 hours. She had a history of two previous cesarean sections. On examination, the uterus was enlarged corresponding to 32 weeks with a single fetus in cephalic presentation. An emergency cesarean section was performed under spinal anesthesia due to scar tenderness, delivering a healthy male baby. The postoperative period was uneventful.
This document presents the case of a 17-year-old pregnant woman, Ms. X, who is 38 weeks gestation and was admitted to the hospital after experiencing 4 tonic-clonic seizures at home. Her medical history includes high blood pressure during pregnancy and protein in her urine. Initial differential diagnoses included eclampsia, epilepsy, and severe hypoglycemia. Initial management involved diazepam and magnesium sulfate. Investigations showed elevated blood pressure, creatinine, uric acid, and liver enzymes consistent with preeclampsia. The diagnosis was determined to be eclampsia. Ms. X's management included magnesium sulfate, labetolol to lower her blood pressure, and an emergency c-
The document discusses preeclampsia, including its signs, symptoms, risk factors, diagnostic tests, pathophysiology, and treatment. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to other organ systems. It is caused by abnormal development of the placenta leading to reduced blood flow and endothelial cell dysfunction systemically. Proper management involves monitoring blood pressure, delivering the baby to resolve symptoms, and potentially using antihypertensive medications.
This document outlines nursing care during the prenatal period. It discusses assessment of the pregnant woman including estimating due date, gestational age, obstetric history and physical assessment. Common diagnostic tests are described like ultrasound, amniocentesis, non-stress test and biophysical profile. The nursing care plan involves nutrition assessment, prenatal exercises, hygiene, travel advice, immunizations, managing discomforts, and regular prenatal visits. The goal is to monitor the health of the mother and fetus during pregnancy.
The document provides guidance on the immediate care of newborns. It outlines objectives like ensuring respiration, preventing infection, caring for the umbilical cord and eyes, stabilizing temperature, and identifying the infant. Procedures covered include gentle delivery to prevent injury, establishing breathing, applying eye ointment, clamping the cord, providing warmth, and recording observations. The Apgar score is described to evaluate breathing, heart rate, muscle tone, reflexes and color. Maintaining sterility and the health of both mother and baby are primary goals of immediate newborn care.
This document provides information about a case study on a 30-year-old female patient who was admitted to the hospital for postpartum hypertension. It includes her medical history, physical assessment findings, laboratory results, nursing diagnoses of postpartum hypertension and urinary tract infection. Her hemoglobin, hematocrit and urine tests showed abnormalities consistent with her conditions. The case study aims to improve nursing students' skills and knowledge in caring for patients with pregnancy-induced complications.
This document summarizes the case of a 27-year-old female patient admitted with complaints of mild abdominal pain and expulsion of fleshy mass per vaginum. Upon examination, the patient was found to have excessive vaginal bleeding and partial expulsion of products of conception. She underwent dilatation and curettage to remove the remaining products of gestation. The patient had an incomplete abortion at 8 weeks of gestation and was treated according to guidelines for managing incomplete abortion cases. Nursing care involved close monitoring, administration of antibiotics and uterotonic drugs, and counseling to prevent complications and support recovery.
It usually takes about 6 weeks to recover from your c-section but this will depend on your individual situation. If you had any problems during or after your c-section, or if you’re looking after other children at home, you may feel you need more time to recover.
1. Cesarean delivery is a surgical procedure to deliver babies through incisions in the mother's abdomen and uterus.
2. The most common type of cesarean incision is a low transverse incision in the lower uterine segment.
3. Indications for cesarean delivery include cephalopelvic disproportion, fetal distress, breech presentation, and previous uterine surgeries.
This document summarizes a case study on anemia in pregnancy conducted at Muembe Ladu Maternity Hospital. The patient, a 22-year-old pregnant woman, presented with headaches, dizziness, weakness, and fatigue. Her hemoglobin level was initially 8.0 g/dl. She was diagnosed with anemia in pregnancy and prescribed iron supplements. Nursing assessments identified risks of nutritional imbalances, ineffective breathing, activity intolerance, and infection due to low hemoglobin. The patient received counseling and showed gradual improvement in symptoms and hemoglobin levels with treatment. The case study notes recommendations to improve care, such as ensuring adequate treatment duration and monitoring, as well as increasing health education and physician support at rural clinics.
Mdm. JT, a 40+9 week primigravida, presented with leaking liquor for 6 hours and irregular tightening for 2 hours. She was diagnosed with Group B Streptococcus (GBS) at 12 weeks via routine vaginal swab. She received antibiotics as prophylaxis. On examination, she had an open os at 2cm. She was started on IV penicillin as GBS prophylaxis and later delivered via emergency c-section for arrest of labor. Her baby was admitted to the nursery for presumed sepsis due to maternal GBS status. The document then discusses GBS screening recommendations, treatment guidelines, and outcomes based on the ORACLE studies.
A 32-year-old woman presented with 6 weeks of amenorrhea and diffuse abdominal pain. An ultrasound found gallstones, an intrauterine gestational sac without a fetal heartbeat, and a fibroid. A follow-up ultrasound showed a gestational sac with a yolk sac but no fetal cardiac activity and hemoperitoneum. This led to a provisional diagnosis of a heterotopic pregnancy, with differential diagnoses including an intrauterine pregnancy with a ruptured hemorrhagic cyst or ruptured luteal cyst, or a ruptured ectopic pregnancy. The classic triad of symptoms for an ectopic pregnancy are abdominal pain, vaginal bleeding, and an adnexal mass, but the differential diagnosis
This case presentation describes a 24-year-old woman who presented with complaints of amenorrhea for 21+ weeks, per vaginal bleeding for two days, and passage of grape-like substances for one day. Her medical history and examination findings were presented. Initial diagnosis of a molar pregnancy was made based on her history and ultrasound findings. She underwent suction and evacuation surgery, which confirmed the diagnosis of a molar pregnancy based on histopathology. She was discharged with advice for follow up, contraception, and monitoring of beta hCG levels. The case discussion then provides an overview of gestational trophoblastic diseases including classification, etiology, pathogenesis, clinical features and management of hydatidiform mole.
This document provides an overview of obstetrics exam questions, cases, and notes on topics like fetal monitoring, biophysical profile (BPP) scoring, Doppler ultrasound, fetal heart rate patterns, and fetal assessment tests. It includes 26 multiple choice questions on these topics, along with brief explanations of answers. The key points covered are the criteria for normal vs abnormal test results on non-stress tests (NST), BPP, oxytocin challenge test (OCT), and definitions of different types of fetal heart rate decelerations and their clinical significance.
A complete overview of pregnancy for student nurses, paramedics, and ancillary healthcare. Covers the major disorders and emergencies of pregnancy.
Brought to you by Tentance.
The EINC initiative of the Philippine Department of Health- Non Communicable Diseases Prevention and Control-Family Health Office (DOH-NCDPC-FHO) and DOH Center for Health Promotions (NCHP), supported by the Joint Programme on Maternal and Neonatal Health (JPMNH), and being funded by AusAID, was piloted in 11 hospitals in the Philippines, and has yielded favorable results.
The recommended EINC practices during the intrapartum period include continuous maternal support by having a companion of choice during labor and delivery, freedom of movement during labor, monitoring progress of labor using the partograph, non-drug pain relief before offering labor anesthesia, position of choice during labor and delivery, spontaneous pushing in a semi-upright position, non-routine episiotomy, and active management of the third stage of labor (AMTSL).
For newborns, four core steps were recommended in a time bound sequence. A social marketing handle, “The First Embrace,” accompanied the initiative for practice change among health workers.
1. The document provides information on examining patients in labor, including frequency of examinations, symbols used on partographs, and examples of completed partographs for different patients.
2. It includes details on vaginal examinations like cervical dilation, fetal position and heart rate, membrane status, and descent/moulding that should be recorded regularly during labor.
3. Examples of partographs show progression of labor over time for patients with details on vital signs and fetal/maternal status.
This document summarizes guidelines for vaginal birth after cesarean (VBAC) based on recommendations from the American College of Obstetricians and Gynecologists (ACOG). It states that over 60-80% of women with one previous low transverse cesarean section can successfully have a VBAC, and lists criteria for candidates, including no prior uterine scarring or ruptures. It notes risks of VBAC like uterine rupture are low at 1% but serious, and benefits include shorter recovery over repeat cesarean. The document provides information on risks, benefits and factors to consider for VBAC.
The patient presented with a scanty brownish vaginal discharge and a missed menstrual period. Diagnostic tests revealed an enlarged uterus, increased beta-hCG levels, and an ultrasound showing a "honeycomb" pattern suggestive of a hydatidiform mole. The patient was started on prophylactic methotrexate chemotherapy and underwent suction curettage to evacuate the molar pregnancy tissue.
The document describes a medical case report for a 3-day-old female infant admitted to the NICU for neonatal jaundice. She presented with yellowish discoloration of the skin and eyes. Her vital signs were normal except for occasional hypothermia. Her physical exam found jaundice, poor nutrition, and abnormal neurological responses. She was treated and discharged after her jaundice improved over a few days.
The document provides instructions for examining the skull, scalp, hair, nose and paranasal sinuses, ears, eyes, abdomen, and vestibulocochlear nerve. Key steps include observing the skull shape and scalp, checking for lice or lesions on the scalp, examining the nose shape and drainage, checking the ear canals and eardrums, observing the eyelids and testing tear drainage, listening to bowel sounds in the abdomen, and assessing hearing through voice and watch tests and tuning fork tests. Normal findings are described for each area examined.
Health assessment or clinical examination (more popularly known as a check-up) is the process by which a doctor investigates the body of a patient for signs of disease.
This document outlines nursing care during the prenatal period. It discusses assessment of the pregnant woman including estimating due date, gestational age, obstetric history and physical assessment. Common diagnostic tests are described like ultrasound, amniocentesis, non-stress test and biophysical profile. The nursing care plan involves nutrition assessment, prenatal exercises, hygiene, travel advice, immunizations, managing discomforts, and regular prenatal visits. The goal is to monitor the health of the mother and fetus during pregnancy.
The document provides guidance on the immediate care of newborns. It outlines objectives like ensuring respiration, preventing infection, caring for the umbilical cord and eyes, stabilizing temperature, and identifying the infant. Procedures covered include gentle delivery to prevent injury, establishing breathing, applying eye ointment, clamping the cord, providing warmth, and recording observations. The Apgar score is described to evaluate breathing, heart rate, muscle tone, reflexes and color. Maintaining sterility and the health of both mother and baby are primary goals of immediate newborn care.
This document provides information about a case study on a 30-year-old female patient who was admitted to the hospital for postpartum hypertension. It includes her medical history, physical assessment findings, laboratory results, nursing diagnoses of postpartum hypertension and urinary tract infection. Her hemoglobin, hematocrit and urine tests showed abnormalities consistent with her conditions. The case study aims to improve nursing students' skills and knowledge in caring for patients with pregnancy-induced complications.
This document summarizes the case of a 27-year-old female patient admitted with complaints of mild abdominal pain and expulsion of fleshy mass per vaginum. Upon examination, the patient was found to have excessive vaginal bleeding and partial expulsion of products of conception. She underwent dilatation and curettage to remove the remaining products of gestation. The patient had an incomplete abortion at 8 weeks of gestation and was treated according to guidelines for managing incomplete abortion cases. Nursing care involved close monitoring, administration of antibiotics and uterotonic drugs, and counseling to prevent complications and support recovery.
It usually takes about 6 weeks to recover from your c-section but this will depend on your individual situation. If you had any problems during or after your c-section, or if you’re looking after other children at home, you may feel you need more time to recover.
1. Cesarean delivery is a surgical procedure to deliver babies through incisions in the mother's abdomen and uterus.
2. The most common type of cesarean incision is a low transverse incision in the lower uterine segment.
3. Indications for cesarean delivery include cephalopelvic disproportion, fetal distress, breech presentation, and previous uterine surgeries.
This document summarizes a case study on anemia in pregnancy conducted at Muembe Ladu Maternity Hospital. The patient, a 22-year-old pregnant woman, presented with headaches, dizziness, weakness, and fatigue. Her hemoglobin level was initially 8.0 g/dl. She was diagnosed with anemia in pregnancy and prescribed iron supplements. Nursing assessments identified risks of nutritional imbalances, ineffective breathing, activity intolerance, and infection due to low hemoglobin. The patient received counseling and showed gradual improvement in symptoms and hemoglobin levels with treatment. The case study notes recommendations to improve care, such as ensuring adequate treatment duration and monitoring, as well as increasing health education and physician support at rural clinics.
Mdm. JT, a 40+9 week primigravida, presented with leaking liquor for 6 hours and irregular tightening for 2 hours. She was diagnosed with Group B Streptococcus (GBS) at 12 weeks via routine vaginal swab. She received antibiotics as prophylaxis. On examination, she had an open os at 2cm. She was started on IV penicillin as GBS prophylaxis and later delivered via emergency c-section for arrest of labor. Her baby was admitted to the nursery for presumed sepsis due to maternal GBS status. The document then discusses GBS screening recommendations, treatment guidelines, and outcomes based on the ORACLE studies.
A 32-year-old woman presented with 6 weeks of amenorrhea and diffuse abdominal pain. An ultrasound found gallstones, an intrauterine gestational sac without a fetal heartbeat, and a fibroid. A follow-up ultrasound showed a gestational sac with a yolk sac but no fetal cardiac activity and hemoperitoneum. This led to a provisional diagnosis of a heterotopic pregnancy, with differential diagnoses including an intrauterine pregnancy with a ruptured hemorrhagic cyst or ruptured luteal cyst, or a ruptured ectopic pregnancy. The classic triad of symptoms for an ectopic pregnancy are abdominal pain, vaginal bleeding, and an adnexal mass, but the differential diagnosis
This case presentation describes a 24-year-old woman who presented with complaints of amenorrhea for 21+ weeks, per vaginal bleeding for two days, and passage of grape-like substances for one day. Her medical history and examination findings were presented. Initial diagnosis of a molar pregnancy was made based on her history and ultrasound findings. She underwent suction and evacuation surgery, which confirmed the diagnosis of a molar pregnancy based on histopathology. She was discharged with advice for follow up, contraception, and monitoring of beta hCG levels. The case discussion then provides an overview of gestational trophoblastic diseases including classification, etiology, pathogenesis, clinical features and management of hydatidiform mole.
This document provides an overview of obstetrics exam questions, cases, and notes on topics like fetal monitoring, biophysical profile (BPP) scoring, Doppler ultrasound, fetal heart rate patterns, and fetal assessment tests. It includes 26 multiple choice questions on these topics, along with brief explanations of answers. The key points covered are the criteria for normal vs abnormal test results on non-stress tests (NST), BPP, oxytocin challenge test (OCT), and definitions of different types of fetal heart rate decelerations and their clinical significance.
A complete overview of pregnancy for student nurses, paramedics, and ancillary healthcare. Covers the major disorders and emergencies of pregnancy.
Brought to you by Tentance.
The EINC initiative of the Philippine Department of Health- Non Communicable Diseases Prevention and Control-Family Health Office (DOH-NCDPC-FHO) and DOH Center for Health Promotions (NCHP), supported by the Joint Programme on Maternal and Neonatal Health (JPMNH), and being funded by AusAID, was piloted in 11 hospitals in the Philippines, and has yielded favorable results.
The recommended EINC practices during the intrapartum period include continuous maternal support by having a companion of choice during labor and delivery, freedom of movement during labor, monitoring progress of labor using the partograph, non-drug pain relief before offering labor anesthesia, position of choice during labor and delivery, spontaneous pushing in a semi-upright position, non-routine episiotomy, and active management of the third stage of labor (AMTSL).
For newborns, four core steps were recommended in a time bound sequence. A social marketing handle, “The First Embrace,” accompanied the initiative for practice change among health workers.
1. The document provides information on examining patients in labor, including frequency of examinations, symbols used on partographs, and examples of completed partographs for different patients.
2. It includes details on vaginal examinations like cervical dilation, fetal position and heart rate, membrane status, and descent/moulding that should be recorded regularly during labor.
3. Examples of partographs show progression of labor over time for patients with details on vital signs and fetal/maternal status.
This document summarizes guidelines for vaginal birth after cesarean (VBAC) based on recommendations from the American College of Obstetricians and Gynecologists (ACOG). It states that over 60-80% of women with one previous low transverse cesarean section can successfully have a VBAC, and lists criteria for candidates, including no prior uterine scarring or ruptures. It notes risks of VBAC like uterine rupture are low at 1% but serious, and benefits include shorter recovery over repeat cesarean. The document provides information on risks, benefits and factors to consider for VBAC.
The patient presented with a scanty brownish vaginal discharge and a missed menstrual period. Diagnostic tests revealed an enlarged uterus, increased beta-hCG levels, and an ultrasound showing a "honeycomb" pattern suggestive of a hydatidiform mole. The patient was started on prophylactic methotrexate chemotherapy and underwent suction curettage to evacuate the molar pregnancy tissue.
The document describes a medical case report for a 3-day-old female infant admitted to the NICU for neonatal jaundice. She presented with yellowish discoloration of the skin and eyes. Her vital signs were normal except for occasional hypothermia. Her physical exam found jaundice, poor nutrition, and abnormal neurological responses. She was treated and discharged after her jaundice improved over a few days.
The document provides instructions for examining the skull, scalp, hair, nose and paranasal sinuses, ears, eyes, abdomen, and vestibulocochlear nerve. Key steps include observing the skull shape and scalp, checking for lice or lesions on the scalp, examining the nose shape and drainage, checking the ear canals and eardrums, observing the eyelids and testing tear drainage, listening to bowel sounds in the abdomen, and assessing hearing through voice and watch tests and tuning fork tests. Normal findings are described for each area examined.
Health assessment or clinical examination (more popularly known as a check-up) is the process by which a doctor investigates the body of a patient for signs of disease.
This document provides information on conducting a health assessment. It defines a health assessment as collecting and analyzing client data through interaction. The purposes of an assessment are to collect physical, mental and social well-being data to identify problems, determine health status, nature of treatment needed, and contribute to research. Types of assessments include initial, focused, emergency, and time-lapsed. Techniques include observing, viewing, examining using inspection, palpation, percussion, auscultation and olfaction. Systems covered include integumentary, cardiovascular, respiratory, and abdominal with normal findings and deviations listed for each.
The examination of the thyroid gland involves inspection to observe the size, shape, and movement of the gland, palpation to evaluate the texture, mobility, and presence of nodules, and synthesizing the findings from inspection and palpation to characterize the condition of the gland. Symptoms of thyroid disorders vary depending on whether the gland is underactive, overactive, or cancerous and include changes in heart rate, weight, mood, and appearance of the eyes and skin. The sex, age, occupation, and place of residence of the patient provide clues about their risk for developing different thyroid conditions.
Feel the pulse with the tips of your fingers.
3. Dorsalis pedis artery:
Ask the patient to:
Sit with legs hanging over the edge of the table
Flex and dorsiflex the ankle
Feel the pulse on the dorsal aspect of the foot
4. Posterior tibial artery:
Ask the patient to:
Sit with legs hanging over the edge of the table
Flex and dorsiflex the ankle
Feel the pulse behind the medial malleolus
5. Brachial artery:
Ask the patient to:
Sit with arms
This document provides a consensus on methods for clinical examination from the Department of Internal Medicine at a medical college. It includes sections on general examination, examination of the respiratory system, cardiovascular system, nervous system, and signs relevant to specific systems. The respiratory system examination section outlines how to inspect and palpate the chest, examine the upper respiratory tract, and assess various parameters such as respiratory rate, rhythm, and intercostal retraction.
Lecture 2 by Dr.Mohammed Hussien clinical pharmacy ( kafrelsheikh University)Kafrelsheiekh University
This document provides guidance on techniques for physical assessment of the head and neck, chest, and lungs. It describes how to inspect, palpate, percuss, and auscultate each area. Inspection of the head and neck involves examining the skull, hair, scalp, face, neck, lymph nodes, nose, ears, mouth, and eyes. Palpation feels for lumps on the skull, texture of hair, size of the thyroid and lymph nodes. The chest is assessed through inspection of chest wall movement and percussion to evaluate lung density. Palpation feels for masses or pulsations. Auscultation listens to breath sounds over each lobe.
Normal newborn care, by Dr Amal Khalil, Dean of Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Physical examination for the examin .pptgj17092003
1. The document provides details on performing a physical examination, including inspection, palpation, percussion, and auscultation of various body systems such as the lungs, heart, abdomen, breasts, muscles and nerves.
2. Specific assessment techniques are described for different anatomical areas, including assessing breath sounds in the lungs, heart sounds and pulses in the cardiovascular system, bowel sounds and liver size in the abdomen, and strength and range of motion of muscles.
3. Neurological assessment includes testing cranial nerves, memory, attention, and reflexes.
Thyroid Examination - General Surgery Sana Rasheed
The document provides instructions for examining the thyroid gland. It begins with introducing oneself to the patient and obtaining consent. It describes the anatomy of the thyroid gland and its location. The examination involves inspection of the thyroid from the front and back while palpating and feeling for nodules or irregularities. Signs of hyperthyroidism like eye signs, tremors, and moist skin are also checked. The examination is concluded by checking reflexes and the heart before thanking the patient.
This is the first part of my Neonatology Powerpoint series.
It comprises an illustrative demonstrations of:-
Introduction to neonatology.
The APGAR score
General are of the newborn.
Neonatal examination & assessment.
1. The document defines the neonatal period as the time from birth to 4 weeks postnatal. During this period, newborns are observed and stabilized in the normal newborn nursery or on the maternity floor.
2. The roles of nurses and physicians in the normal newborn nursery include admission care like assessments, history taking, and ensuring identification; ongoing assessments using tools like the APGAR score; and providing routine neonatal care like maintaining temperature and establishing breastfeeding.
3. Physical examinations of newborns assess various body systems and features like reflexes, fontanels, skin characteristics, and vital signs to evaluate overall health and normalcy. Any abnormalities are noted.
A neurological examination involves assessing the nervous system through physical examination and medical history review. It evaluates sensory and motor functions like reflexes to determine if the nervous system is impaired. The exam includes tests of cranial nerves, motor skills, coordination, strength, reflexes, and sensory functions. It is used as both a screening and investigative tool to diagnose neurological conditions and plan treatment.
General History taking and physical examinatinaneez103
This document provides information on performing a general history and physical examination. It discusses collecting a health history, which includes data on a patient's wellness, family history, and sociocultural background. The objectives of a health history are to identify patterns of health/illness, risk factors, and available resources. Physical examination involves inspection, palpation, percussion, and auscultation of the entire body from head to toe. Proper preparation, patient positioning, and use of appropriate instruments and techniques are emphasized. The document outlines examination of major body systems and common abnormal findings.
The document provides guidance on performing a thorough physical examination, beginning with inspection, palpation, percussion, and auscultation. It describes examining major body systems from head to toe, including the respiratory, cardiovascular, gastrointestinal and neurological systems. Specific examination techniques are outlined, such as assessing the chest shape and expansion, listening to breath sounds, and examining the mouth, abdomen, and other areas. Maintaining patient comfort and clear communication during the physical exam is emphasized.
The physical examination of a newborn baby aims to:
1. Identify any abnormalities or injuries at birth.
2. Ensure normal development by checking things like weight, body proportions, and reflexes.
3. Look for signs of conditions like Down syndrome by examining the face, eyes, and other features.
The assessment involves a full-body examination checking multiple areas like the head, chest, abdomen, genitals, back, and extremities to evaluate the baby's health and rule out any issues.
This document provides instructions for physically examining a patient's head, neck, and related lymphatic structures. It describes how to inspect and palpate the head, scalp, face, eyes, ears, nose, mouth, oropharynx, and neck. It also provides details on testing visual acuity, peripheral vision, hearing, and examining the thyroid gland. The examination involves inspection for symmetry and abnormalities, as well as gentle palpation while observing for pain or unusual findings.
The document discusses the assessment of normal newborns. It describes how a complete physical assessment is performed at birth and throughout the hospital stay to check for any problems or complications. This includes assessing various body systems and measurements like weight, height, temperature. It also describes the transitional periods that newborns go through and the typical appearance, reflexes, and measurements of a healthy newborn.
The document discusses the assessment of a normal newborn infant. It describes the initial Apgar scoring at birth and transitional assessments during the first hours and days. A full physical examination is outlined assessing various body systems and measurements. Key reflexes and behaviors are also described including feeding, sleeping, and excretion that provide information on the infant's wellbeing. The summary provides an overview of the important aspects of newborn assessment covered in the document.
This document provides an overview of the business process outsourcing (BPO) industry. It discusses the growth of the global BPO market, with India emerging as a major hub due to its large English-speaking workforce and lower costs compared to countries like the US. The document outlines the advantages that have made India and other countries like the Philippines competitive locations for BPO. It also notes some of the challenges that countries face in attracting BPO work, such as China's smaller English-speaking population.
This case study examines the success of IKEA's expansion into the American market. Key factors in IKEA's success include its Scandinavian designs, cost efficiency through flat packaging and customer assembly, and structured product strategy using a pricing matrix. While shopping at IKEA has downsides like durability issues and assembly requirements, the company aims to build partnerships with customers. IKEA plans to open 50 stores in the US by 2013, which some see as optimistic but achievable given their value proposition. Minor adjustments to the pricing matrix and additional product styles and price points could support IKEA's continued growth goals. Expanding into smaller "IKEA Lite" stores is also proposed to increase accessibility and impulse purchases.
- Judge Adoracion Angeles charged lawyer Thomas Uy with violating his fiduciary duties by failing to promptly return 16,500 pesos paid to him in trust for his client, Primitiva Del Rosario. During a court hearing, Del Rosario said she did not receive the money from Uy. Uy was then ordered to return the money but failed to do so.
- In his comment, Uy explained that the money was paid to his office by Norma Trajano on December 14, 1998 to settle the civil aspect of a criminal case. He claims Primitiva Del Rosario asked for the money to be kept in his office until further payments were made. However, during a February 10,
Understanding Inductive Bias in Machine LearningSUTEJAS
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1. 16
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B. PHYSICAL EXAMINATION
Vital Signs: Temperature: 36.5 oC Pulse Rate: 88bpm.
Respiratory Rate: 21 cpm Blood Pressure: 150/90 mmHg.
General Observations:
Received patient lying in bed, conscious, coherent and mentally-oriented
to time, people and place. Patient has fair skin with stitches on the incision site
of the lower abdomen. Overall, patient is in a normal appearance.
Skin: Patient has fair, moist warm and smooth skin. Its turgor is within 1 to 2
seconds.
Hair: Patient has long, black hair. It is distributed evenly. It is smooth and silky.
2. 17
Scalp:The scalp is free from lesions. Tenderness and masses are not noted.
Nails: Nails of patient are pinkish in color. It is a bit square. It is smooth. Capillary
refill is 2 to 3 seconds. No lesions found.
Skull: Patient has a normocephalic head, symmetrical and no masses were found.
Face: The face is able to do any impressions or expressions. It is oblong-shaped,
symmetrical and free from edema and/or masses.
Eyes: Eyes are functioning properly. No inflammation on the eyelids, lacrimal
glands and other surrounding the eyes. The eyes are wet and moist. Sclera on
both sides is dirty white. Conjuctiva has small blood vessels.
Ears: Ears are symmetrical, fair, and no noted discharge and swelling. The
ears can hear perfectly.
Nose and Sinuses: Nose is symmetrical with no inflammation and discharges
noted. Airway patency is present. Sinuses are palpable and resonant when
percussed.
Mouth and Pharynx:Patient has good breathe. Lips are pinkish and smooth
with moist. Buccal mucosa, gums and tongue are pinkish in color, teeth are
dirty white, and the hard and soft palate are pinkish in color as well.
Neck: The neck is symmetrical. Lymph nodes are palpable. Bruit sounds are
heard on the trachea. It isfelt and palpable. Thyroid gland is palpable. No
inflammation or lesions noted.
3. 18
Posterior Chest:The posterior chest is symmetrical with the anteroposterior
diameter at a ratio of 2:1. Tenderness and masses are not found. Thoracic
expansion is 2 to 3 cm. vibrations were felt during tactile fremitus. Resonance
upon percussion, and no wheezing or crackling sounds upon auscultation.
Anterior Chest: Pulsations are felt. No wheezing or crackle sounds are heard
upon auscultation.
Heart: Heart is positioned right and correctly with the cardiac landmarks.
Heartbeats are heard during auscultation.
Vascular System: Carotid arteries are present with pulsations felt. It is
palpable and no lumps are felt. Blood pressure is within normal range.
Lymphatic system:Epitochlear nodes are palpable, as well as, the superficial
inguinal nodes. No tenderness noted.
Breast: The breasts are big due to lactation. There are no dimplings, nipple
discharges, tenderness nor lumps noted. Patient is aware of breast self-
examination and learned it.
Abdomen:Abdomen is round. The umbilicus is inverted. Respiration and
surface motion are present. Pulsations on the abdomen are felt. The abdomen
is palpable.
Female External Genitalia and Anus:Patient has stitches on her perineum.
4. 19
Musculoskeletal System: Patient has grip strength. Temporomandibular joint
is felt. The neck, shoulder, hip, spine, knees, feet, ankles, hands, elbow and
wrists can do the different ranges of motion easily.
Deep Tendon Reflexes: Biceps, triceps, Brachioradialis, patellar, Achilles and
plantar reflexes are present.
Neurologic Screening Assessment: Patient is conscious, coherent and alert.
She has good memory and is mentally-oriented with people, place and time.
She has goos speech patterns and walks properly.
Cranial Nerves Assessment
Cranial Nerve Function Method Client’s Responses
I Olfactory Smell reception and
interpretation
Ask client to close eyes
and identify different mild
aromas such alcohol,
powder and vinegar.
(Weber&Kelley; 2011).
The Client is able to
distinguish different
smells
II Optic Visual acuity and
fields
Ask client to read
newsprint and determine
objects about 20 ft.
away(Weber&Kelley; 2011).
The Client is able to
read newsprint and
determine far objects
III Oculomotor Extraocular eye
movements, lid
elevation, papillary
constrictions lens
shape
Assess ocular movements
and pupil reaction
(Weber&Kelley; 2011).
The Client is able to
exhibit normal EOM
and normal reaction of
pupils to light and
accommodation
5. 20
IV Trochlear Downward and
inward eye
movement
Ask client to move eyeballs
obliquely
(Weber&Kelley; 2011).
The Client is able to
move eyeballs obliquely
V Trigeminal Sensation of face,
scalp, cornea, and
oral and nasal
mucous
membranes.
Chewing movements
of the jaw
Elicit blink reflex by lightly
touching lateral sclera; to
test sensation, wipe a wisp
of cotton over client’s
forehead for light
sensation and use
alternating blunt and
sharp ends of safety pin to
test deep sensation
Assess skin sensation as
of ophthalmic branch
above
Ask client to clench teeth
(Weber&Kelley; 2011).
The Client blinks
whenever sclera is
lightly touched; able to
feel the wisp of cotton
over the area touched;
able to discriminate
blunt and sharp stimuli
The Client is able to
sense and distinguish
different stimuli
The Client is able to
clench teeth
VI Abducens Lateral eye
movement Ask client to move eyeball
laterally( Weber&Kelley; 2011).
The Client is able to
move eyeballs laterall
VII
Facial Taste on anterior
2/3 of the tongue
Facial movement,
eye closure, labial
speech
Ask client to do different
facial expressions such as
smiling, frowning and
raising of eyebrows; ask
client to identify various
tastes placed on the tip
and sides of the mouth:
sugar, salt and coffee
(Weber&Kelley; 2011).
The Client is able to do
different facial
expressions such as
smiling, frowning and
raising of eyebrows;
able to identify different
tastes such as sweet,
salty and bitter taste
VIII Acoustic Hearing and
balance
Assess client’s ability to
hear loud and soft spoken
words; do the watch tick
test(Weber&Kelley; 2011).
Client is able to hear
loud and soft spoken
words; able to hear
ticking of watch on both
ears
IX Glossophar
yngeal
Taste on posterior
1/3 of tongue,
pharyngeal gag
reflex, sensation
Apply taste on posterior
tongue for identification
(sugar, salt and coffee);
ask client to move tongue
Client is able to identify
different tastes such as
sweet, salty and bitter
taste; able to move
6. 21
from the eardrum
and ear canal.
Swallowing and
phonation muscles
of the pharynx
from side to side and up
and down; ask client to
swallow and elicit gag
reflex through sticking a
clean tongue depressor
into client’s mouth
(Weber&Kelley; 2011).
tongue from side to side
and up and down; able
to swallow without
difficulty, with (+) gag
reflex
X Vagus Sensation from
pharynx, viscera,
carotid body and
carotid sinus
Ask client to swallow;
assess client’s speech for
hoarseness(Weber&Kelley; 2011).
The Client is able to
swallow without
difficulty; has absence
of hoarseness in speech
XI Spinal
accessory
Trapezius and
sternocledomastoid
muscle movement
Ask client to shrug
shoulders and turn head
from side to side against
resistance from nurse’s
hands(Weber&Kelley; 2011).
The Client is able to
shrug shoulders and
turn head from side to
side against resistance
from nurse’s hands
XII Hypoglossal Tongue movement
for speech, sound
articulation and
swallowing
Ask client to protrude
tongue at midline, then
move it side to side
(Weber&Kelley; 2011).
The Client is able to
protrude tongue at
midline and move it
side to side
Janet Weber & Jane Kelley; 2011
IV. ANATOMY AND PHYSIOLOGY
7. 22
A. External Structures:
1. Mons Veneris/Pubis – Pad of fat which lies over the symphysis pubis where
dark and curly hair grow in triangular shape that begins 1-2 years before the
onset of menstruation. It protects the surrounding delicate tissues from
trauma. (Marieb; 2011).
2. Labia Majora – Two (2) lengthwise fatty folds of skin extending from mons
veneris to the perineum that protect the labia minora, urinary meatus and
vaginal orifice. (Marieb; 2011).
3. Labia Minora – 2 thinner, lenghtwise folds of hairless skin extending from
clitoris to fourchette(Marieb; 2011).
Glands in the labia minora lubricates the vulva
4. Very sensitive because of rich nerve supply Space between the labia is called
the Vestibule(Marieb; 2011).
5. Clitoris – small, erectile structure at the anterior junction of the labia
minora that contains more nerve endings. It is very sensitive to temperature
8. 23
and touch, and secretes a fatty substance called Smegma. It is comparable
to the penis in it’s being extremely sensitive(Marieb; 2011).
6. Vestibule – the flattened smooth surface inside the labia. It encloses the
openings of the urethra and vagina. (Marieb; 2011).
7. Skene’s Glands/Paraurethral Glands – located just lateral to the urinary
meatus on both sides. Secretion helps lubricate the external genital during
coitus. (Marieb; 2011).
8. Bartholin’s Gland/Vulvovaginal Glands – located lateral to the vaginal
opening on both sides. It lubricates the external vulva during coitus and the
alkaline pH of their secretion helps to improve sperm survival in the vagina.
(Marieb; 2011).
9. Fourchette – thin fold of tissue formed by the merging of the labia majora
and labia minora below the vaginal orifice. (Marieb; 2011).
10. Perineum – muscular, skin-covered space between the vaginal opening
and the anus. It is easily stretched during childbirth to allow enlargement of
vagina and passage of the fetal head. It contains the muscles (pubococcygeal
and levator ani) which support the pelvic organs, the arteries that supply
blood and the pudendal nerves which are important during delivery under
anesthesia. (Marieb; 2011).
9. 24
11. Urethral meatus – external opening of the urethra. It contains the
openings of the Skene’s glands which are often involved in the infections of
the external genitalia. (Marieb; 2011).
12. Vaginal Orifice/Introitus – external opening of the vagina, covered by a
thin membrane called Hymen.(Marieb; 2011).
B. Internal Structures:
10. 25
1. Fallopian tube/Oviduct – 4 inches long from each side of the uterus (fundus).
It transports the mature ova form the ovaries to the uterus and provide a place
for fertilization of the ova by the sperm in it’s outer 3rd or outer half.
Parts:(Marieb; 2011).
Interstitial – lies within the uterine wall
Isthmus – portion that is cut or sealed in a tubal ligation.
Ampulla – widest, longest portion that spreads into fingerlike
projections/fimbriae and it is where fertilization usually occurs.
Infundibulum - rim of the funnel covered by fimbriated cells (hair
covered fingerlike projections) that help to guide the ova into the
fallopian tube.(Marieb; 2011).
2. Ovaries – Oval, almond sized, dull white sex glands on either side of the
uterus that measures 4 by 2 cm in diameter and 1.5 cm thick. It is responsible
11. 26
for the production, maturation and discharge of ova and secretion of estrogen
and progesterone. (Marieb; 2011).
3. Uterus – hollow, pear-shaped muscular organ, 3 inches long, 2 inches
wide, weighing 50-60 grams held in place by broad and round ligaments, and
abundant blood supply from the uterine and ovarian arteries. It is located in
the lower pelvis, posterior to the bladder and anterior to the rectum. Organ of
menstruation, site of implantation and provide nourishment to the products of
conception. (Marieb; 2011).
Layers:
1. Perimetrium – outermost layer of the uterus comprised of connective
tissue, it offers added strenght and support to the structure. (Marieb; 2011).
2. Myometrium – middle layer, comprised of smooth muscles running in 3
directions; expels fetus during birth process then contracts around blood
vessels to prevent hemorrhage. (Marieb; 2011).
3. Endometrium – Inner layer which is visibly vascular and is shed during
menstruation and following delivery. (Marieb; 2011).
Divisions of the Uterus:
1. Fundus – upper rounded, dome-shaped portion that can be palpated to
determine uterine growth during pregnancy and the force of contractions
and for the assessment that the uterus is returning to it’s non-pregnant
state following child birth. (Marieb; 2011).
12. 27
2. Corpus – body of the uterus. (Marieb; 2011).
3. Isthmus – area between corpus and cervix which forms part of the lower
uterine segment. It enlarges greatly to aid in accommodating the fetus. The
portion that is cut when a fetus is delivered by a caesarian section. (Marieb;
2011).
4. Cervix – lower cylindrical portion that represents 1/3 of the total uterus.
Half of it lies above the vagina; half of it extends to the vagina. (Marieb; 2011).
5.Vagina – a 3-4 inch long dilatable canal located between the bladder and
the rectum, it contains rugnae which permit considerable stretching without
tearing. It acts as a organ of intercourse/copulation and passageway for
menstrual discharges and fetus. (Marieb; 2011).
V. CONCEPTUAL FRAMEWORK OF THE PATHOPHYSIOLOGY OF PREGNANCY
Sexual intercourse
MALE FEMALE
Release of FSH by the anterior Pituitary Gland
Development of the graafian follicle
Production of estrogen
(thickening of the endometrium)
13. 28
Release of the Luteinizing Hormone
Ovulation
(release of mature ovum from the graafian follicle)
Ovum travels into the graafa tube
Fertilization
(union of the ovum and sperm in the ampulla)
Zygote travels from the fallopian tube to the uterus
Implantation
Development of the fetus/ embryo and placental structure until full term
Preliminary signs of labor
Lightening Braxton Hicks Contraction Ripening of the cervix
(descent of the fetal wherein (or false labour or practice (the softened, effaced and
head into the pelvis softer like contractions) dilated condition of theearlobe)
cervix just prior to labor)
True labor
Uterine contractions Show Rupture of the membranes
14. 29
(at regular intervals that begin (After the discharge of the mucous (rupture of the amniotic sac at the onset
before the fetus is mature, plug that has filled the cervical canal of, or during, labor.)
usually before the due date during pregnancy, the pressure
of delivery) of the descending presenting part
of the fetus causes the minute
capillaries in the cervix to rupture. )
Pregnant woman with blood pressure higher than 140/90 mmHg
Before 20 weeks Gestation After 20 weeks Gestation
No/stable Proteinuria increase blood pressure Proteinuria No Proteinuria
/ HEELP syndrome
Preeclampsia Gestational HPN
Preeclampsia
Eclampsia
VI . EXPLANATION OF THE PATHOPHYSIOLOGY OF THE DISEASE
CONDITION / SYMPATHOMATOLOGY
The current concepts regarding the pathophysiology of eclampsia
recognize that eclampsia is a multisystem disorder characterized by
vasoconstriction, metabolic changes, endothelial dysfunction, and activation
of the coagulation cascade in conjunction with an inflammatory response.
Women with underlying microvascular disease, such as diabetes,
hypertension, and collagen vascular disease, have a higher incidence of
eclampsia.
Normal placental development involves progressive loss of the
musculoelastic tissue in the spiral arteries that feed the vessels of the
15. 30
intervillous spaces, which results in uterine blood flow increases of nearly
25% during the first trimester. This process of remodeling the maternal
spiral arteries that branch from the uterine artery is typically completed
by 18-20 weeks' gestation.
This physiologic dilatation of the spiral arteries does not occur because
the placental trophoblast cells do not invade the spiral arteries, resulting in
maintenance of narrow vessels with resultant placental hypoperfusion and
ischemia. In severe cases, not only do the spiral arteries maintain their
muscular structure, but other pathologic changes also occur.
Accumulation of fat-laden macrophages with fibrinoid necrosis (ie, acute
atherosis), disruption of the basement membranes, platelet deposition,
mural thrombi, and proliferation of intimal and smooth muscle cells all
decrease the luminal diameter.
The narrowed and damaged spiral arteries become thrombosed,
resulting in placental infarction and necrosis. Uteroplacental blood flow is
then reduced by 50-75%. The anatomical reduction in blood flow may be
complicated by vasospasm of the uteroplacental bed.
The primary defect in preeclampsia appears to originate at the
maternal-fetal interface (the placenta). Decreased placental perfusion is
thought to lead to fetoplacental ischemia. The ischemic placenta may
produce circulating antiangiogenic factors that promote generalized
maternal vascular endothelium dysfunction, leading to systemic
16. 31
manifestations of preeclampsia. Associated abnormalities in clotting and
platelet function contribute to vasoconstriction and platelet adhesion and
aggregation, as well as to the activation of coagulation factors that increase
the risk of thromboembolic formation.
The primary feature of clampsia, development of hypertension, occurs when
normally extreme vasodilatation does not occur. Although cardiac output
increases 30-50%, the decreased peripheral vascular resistance (PVR) results
in decreased BP, even in women with chronic hypertension. Women who
develop preeclampsia experience an increase in PVR and alterations in
vascular sensitivity to endogenous hormones (eg, angiotensin II,
catecholamines, vasopressin). This increase in vascular reactivity to
pressor hormones may be mediated, at least in part, through damage to
vascular endothelial cells, disrupting the normal prostaglandin balance.
The normal expansion of blood volume by 50% that occurs with
pregnancy is decreased by 15-20% in patients with preeclampsia. This is
the result of diminished plasma volume, leading to the relative
hemoconcentration observed in preeclampsia. The plasma volume
abnormality involves a redistribution of extracellular fluid, such that
interstitial fluid volume is increased while the plasma volume is
decreased. The hematocrit increases as the severity of preeclampsia increases.
Circulating blood volume is maintained by the increased vascular tone.
(Pillitteri; 2011)
17. 32
VII. CLINICAL MANAGEMENT
A. MEDICAL MANAGEMENT
A.1 LABORATORY AND DIAGNOSTIC EXAMINATIONS
Diagnostic
or
Laboratory
Procedure
Indication or
Purpose
Results Normal
Values
Analysis and
Interpretation
of Results
WBC Count
To determine infection
or
Inflammation Pre-
operation
Assessment of the patient.
19.5 H 108/L 3.5-10.0 H
109/L
No infection or
inflammation
is present.
RBC Count
Pre-operation
assessment of
The patient.
4.23 1012/L 3.80-5.80
Decreased RBC count on
pregnant is normal
because of the increase in
plasma volume during
pregnancy.
18. 33
Hemoglobin
Pre-operation
assessment of
the patient.
133 g/L 110-165 L g/L
The result indicates that a
1000 ml sample of
blood contains 96 g of
hemoglobin. Decreased
hemoglobin on pregnant is
normal because of their
increase in plasma.
Hematocrit
Pre-operation
assessment of
the patient.
.
366 L 1/1 .350-.500 L
1/1
The result indicates that a
1000 ml sample of
blood contains .29 g of
hemoglobin. Decreased
hematocrit on pregnant is
normal because of their
increasein plasma volume.
URINALYSIS
TEST NAME RESULT SIGNIFICANCE
MACROSCOPIC
color
pH
protein
glucose
MICROSCOPIC
RBC
WBC
Epithelial cells
Mucus Threads
Amorphous
material
Yellow
6.0
(+)
(-)
0-1
0-2
Few
Few
Few
Few
Normal
Normal
High
Low
Low
Low
Low
Low
Low
Low
19. 34
Bacteria
A.2 Treatment and Procedures
1. Vitals Signs Taking
vital signs will be continually monitored while recovering. The Client’s
Respiratory rate, Pulse rate, blood pressure, and temperature are typically
tracked while recovering.(Pillitteri; 2011).
2. Intake and Output Monitoring
Intake Is any measurable fluid that goes into the patient's body. Intake
includes fluids (such as water, soup, and fruit juice) and "solids" composed
primarily of liquids (such as ice cream and gelatin) that are taken by mouth
20. 35
(orally), fluids that are introduced by IV, and fluids that are introduced by
irrigation (through a tube)(Pillitteri; 2011).
Output Is any measurable fluid that comes from the body. Water given off in
the form of perspiration and water vapor (exhaled breath) is also output, but it
is not recorded on the DD Form 792, since it cannot be accurately measured.
(An adult usually looses about 500 milliliters (ml) a day through perspiration
and moisture exhaled in breathing.) The major forms of output recorded on the
worksheet are urine, drainage, vomitus (matter vomited), and stools (fecal
discharge from the bowels).(Pillitteri; 2011).
3. Perineal Care
Cleaning of perineum and the materials it uses is inb accordance to the policy
of the institution. In SVGH, the perineum is clean with lukewarm water and an
antiseptic agent like betadine solution before birth. Following delivery of the
placenta, the perineal area of the mother is washed with tap water as vaginal
canal is clean manually.(Pillitteri; 2011).
4. Delivery
Before the cesarean section procedure, the patient was given anesthesia to
numb the pain. The doctor then made horizontal incision in the abdomen and
uterus. After the incision was made, the baby was delivered through it, and the
placenta was removed. After the cesarean section procedure, the incision was
21. 36
closed with stitches.When the cesarean section was started, the doctor made a
6- to 8-inch incision in the abdomen directly over the uterus. The incision was
horizontal, which was side to side. The baby was then delivered through this
opening.(Pillitteri; 2011).
5. New born Care
The umbilical cord was cut, and the baby was handed to the healthcare
provider, who took him to a small, warmly lit plastic crib called a warmer. Then
the baby was cleaned and dried and eventually checked by the pediatrician.
After the baby had been delivered, the placenta was carefully removed from the
uterus. At that time, the patient received oxytocin, a drug that causes the
uterus to contract and helps prevent serious bleeding. The doctor then closed
the incision on the uterus, and the incisions in the skin were closed with
stitches that would dissolve on their own.(Pillitteri; 2011).
A.3 Medications
See Appendix E
22. 37
A.4 DIET
1. NPO
After the surgery the doctor ordered the NPO diet. NPO is a type of diet
people are placed on by their medical professionals. A NPO diet is most often
seen in a hospital setting. Some patients can be placed on a NPO diet for just a
short time while others may have to stay on it for a much longer time. Patient
cannot have anything that would go in the mouth including food, beverages and
oftentimes medications. Patient can be made NPO for a variety of reasons
including an upcoming surgery, medical procedure or test. She cannot have
anything to eat or drink prior to surgery to honoring the NPO status is very
important.
2. Clear Liquid/ General Liquid
Patient is on a clear liquid diet consists of clear liquids, such as water and plain
gelatin, that are easily digested and leave no undigested residue in your intestinal
tract. The doctor may prescribe a clear liquid diet before certain medical procedures or
have certain digestive problems. Because a clear liquid diet can’t provide with
adequate calories and nutrients, it shouldn’t be continued for more than a few days. A
clear liquid diet is often used before tests, procedures or surgeries that require no food
in the stomach or intestines, such as before colonoscopy.
BREAKFAST ½ cup of oatmeal & 1 glass of milk
LUNCH ½ cup of corn soup & 1 glass of water
DINNER ½ cup of chicken soup & 1 glass of juice
3. Soft Diet
After the clear liquid the doctor ordered a soft diet. A soft diet is recommended in
many situations, including surgery involving the mouth or gastrointestinal tract, and
23. 38
pain from newly adjusted dental braces. A soft diet can include many foods if they are
mashed, pureed, combined with sauce or gravy, or cooked in soups, chili, or curries.
BREAKFAST 1 cup of rice, 1 bacon & 1 glass of milk
LUNCH 1 cup of rice, 1 serving of chicken soup, 1 banana & 1 glass of
water
DINNER 1 cup of rice, I serving of vegetable soup with 1 ripe of mango & 1
glass of water
4. Full Diet
After the soft diet, the patient is ordered DAT. Diet is tolerated is a term that indicates
that the gastrointestinal tracts is tolerating food and is ready for achievement to the
next stage. Therefore, this statement is most effectively in regard to the diet after
abdominal or gastrointestinal surgery, signifying the patient’s wellness of her diet.
BREAKFAST 1 cup of rice, 1 hotdog & 1 cup of milk
LUNCH ½ of rice, 1 slice of meat, & glass of juice
DINNER ½ cup of rice, 1 fish, & glass of water
B. NURSING MANAGEMENT
B.1 Nursing Care Plan
See Appendix C
B.2 Discharge Plan
See Appendix D
ACTUAL CARE GIVEN
1. Vitals Signs Taking
Monitoring of vital signs was done every shift, intake and output measurement
were not strict operating procedure yet we were required t monitor the client’s
intake and output.
2. Administration of Medication
24. 39
Medications were administered via oral route TID as prescribed by the
physician with a full stomach to decrease GI upset.
3. Bedside Care
Giving optimal health both to the mother and client served as our goal as we
performed some nursing interventions like promoting a conducive environment
through bedmaking and adjusting the room temperature. We as well assisted
the client with her needs such as changing of position and guiding her as she
walked.
4. Health Teaching
As a health care provider, I discussed the concept of Family Planning to the
client and gave her information on the proper newborn care & the importance
of proper nutrition and exercise to promote health and prevention of disease
See Appendix F
PROBLEMS ENCOUNTERED DURING THE CARE
The patient was very cooperative as I deal with her. She was a bit shy and aloof
at first but as the establishing rapport progresses she was able to manage the
timidity and shared her predicaments of pregnancy and delivery. When I was
about to give the medications due for 6pm. I wasn’t able to do it on time for the
25. 40
client never had her lunch yet. She was still waiting for her SO to arrived whom
brought her meals. For 2 days of nursing care, there were no aberration
present; hence, nursing care was done spontaneously.
IX. CONCLUSION AND RECOMMENDATION
Conclusion
Nurses can help the nation achieve National Health Goals. These goals
speak directly to both fetus and the mother because pregnancy is a high risk
factor for them. Close monitoring in pregnant women and health teaching as
much as possible about pregnancy could definitely reduce life threatening
complications.
Studies show that there is no certain facts that will give us the idea
where Eclampsia arise. But there so many factors that could prevent this
complication such as diet modifications, proper compliance with the health
care providers, proper exercise.And if the complication is already present,
proper monitoring, proper diet and drug compliance should be ruled in.
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The main purpose of the study was successfully met. The major
reason why the patient underwent a surgical procedure called LSTCS was due
to Eclampsia. The baby exhibited non-recessing fetal heart tone as uterine
contractions occur. The operation was done to resolve the risk of pregnancy
and eventually save the baby’s life.
Further run through of the study showed that there are many
other complications that would pose a risk to pregnant women. These were
more complicated and rare. Unlike those, Pre-eclampsia are seen most
commonly in pregnant women experiencing labor.
Recommendation
As a nursing student, it is a responsibility to give a pregnant patient the
proper recommendation so she can make herself ready if any problem will
arise. She should be monitored frequently—her blood pressure, medical history
and also check the baby inside if he/she is doing well or in the proper position.
The most important one is the mother’s health. The mother should be given
the proper care for herself and for the baby. There is a possibility that a
caesarean delivery might be planned advance if a medical reason is needed or it
might be unplanned and take place during the labor if some problems occur.
The mother must be given the proper knowledge regarding a vaginal or
caesarean delivery right from her first pregnancy. For caesarean section, it is
very complicated operation which can have some risks like death for the
27. 42
mother, sometimes have some initial trouble breathing for the newborn babies
and will make them drowsy from the pain medication administered to the
mother. Breastfeeding maybe difficult due to the limited mobility of the mother
after the operation. A pregnant woman must be well cared by a nurse with her
personal attending obstetrician.
With this study, the student nurses were able to gain more knowledge
and wider view and perspective of the complication of pregnancy which is
Eclampsia. Thus, the student nurses would like recommend and share some
pointers on how to deal with different diseases with pregnancy specifically
Eclampsia.
To the health care team, they should righteously implementing basic and
ideal procedures regardless of the health care facilities where they belong. They
must observe and always remember to keep in line with their duties towards
both the mother and the child during the pregnancy.
X. IMPLICATIONS OF THE STUDY TO
A. Nursing Education
This study helps in enriching the knowledge base of the nurses
regarding the concepts of this kind of complication. This would greatly help in
determining the risk factors that would possibly be prevented from occurring
once there is an application of this study. This can cater all the questions
28. 43
regarding how and why this certain kind of operation is performed. The best
thing about this study is that there is a comprehensive explanation of the
relationship between the surgery performed and the cause of this high-risk
pregnancy. The cause is highly fatal if not given attention so this gave
motivation to performing CS. This broad information would really enhance the
previously learned concepts of the nurse so as to help him/her in becoming a
competent nurse.
B. Nursing Practice
This study helps in giving care to a woman experiencing high-risk
pregnancy. Appropriate measures and interventions can be taken which are
very useful in promoting the health status of the client. The nurse’s skills are
further guided as to how he/she manages the implementation of nursing
procedures in order to meet the varying needs of his/her patient. This study
alarms the nurses when to act immediately in cases of unexpected or unusual
situations which might pose a risk to the mother or the baby or maybe both.
Having competency in performing the procedures is the most effective way of
responding the needs of the client. That is why this study is equipped with
numerous appropriate and effective interventions that would somehow guide
and develop the nurse in his/her nursing practice.
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C. Nursing Research
As it is a comprehensive compilation, this study greatly helps in the
development of nursing profession. It typically shows how an individual was
able to cope up with this kind of complication. As we all know, each individual
has a unique adaptive mechanism. This study gives relevant contribution to
modern studies at it is of a high-technologically based study. Modern facilities
are used in the performance of care to the patient, monitoring and as well as
the operation. Moreover, there is a good complementation since the patient is
at high risk. It shows the beneficial relationship of our technological advances
to science nowadays. This study will further be a basis of improving the
nursing approach to high-risk pregnancies.
BIBLIOGRAPHY
Book Sources:
Doenges, Marilyn E., et al. Nurse’s Pocket Guide. 7th edition. F.A. Davis
Company, Philadelphia, 2009.
Kozier et al Fundamentals of Nursing: Concepts, Processes, and Practice. 5th
ed. Addison – Wesley Publishing Co. Inc.
Pillitteri, A. Maternal and Child Health Nursing: Care of the Childbearing and
Childrearing Family. 6th ed. Lippincott Williams and Wilkins, 2008
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Tate, P., et al Seeley’s Principles of Anatomy & Physiology. McGraw-Hill
Companies, Inc., 2009
Internet Sources:
www.nursingcrib.com/nursing-notes-reviewer/ectopicpregnancy/
Retrieved (March19, 2012)
www.wikipedia.com/eclampsia/pregnancy/
Retrieved (March 20, 2012)
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