- K.A, a 23 year old pregnant woman (G2P1+0), was admitted presenting with epigastric pain for 3 days that radiated to her chest. She reported loss of appetite, headache, and vomiting. - On examination, she had mild pallor, pitting edema of the lower limbs, and her vital signs were abnormal with elevated blood pressure. Laboratory tests showed anemia, high urine proteins, and abnormal kidney and liver function. - She was diagnosed with preeclampsia based on her symptoms, exam findings, and abnormal lab results. Her pregnancy was at 32 weeks and 2 days.

1. GRAND ROUND PRESENTION
BY: HIV/ TB DEPARTMENT

2. Introduction
• We are presenting K.A, a 23 year G2P1+0 from
Rutwe Butogota, protestant by religion,
mukiga by tribe, peasant whose next of kin is
tumusiime(mother) who was admitted
11/12/2017 as a referral in from kambuga
hospital.

3. P/C
• Epigastric pain ×3/7

4. Hx of P/C
• KA was relatively well until 3 days prior to admission when
she developed epigastric pain that was gradual onset and
radiate to the chest.
• Pain would be associated with mild headache, loss of
appetite, visual blurring and vomiting. However she
reports that the episode of vomiting which was bloody
came in after she had reached kambuga hospital. She
reports no associated fevers, seizures, cough, difficult in
breathing, diarrhea, and constipation.
• In kambuga , she reports to have been given some
treatment of which she is not sure however there was no
improvement and that is why she was referred to here for
further management.

5. REVIEW OF OTHER SYSTEMS
CVS
Swelling of lower limbs.
Nocturnal dyspnea.
Difficult in breathing while lying flat in bed.
 No palpitations.
No heart murmurs.

6. Urinary system.
• Reduced urine out put.
• No painful micturition.
• No urine incontinence.
• No blood in urine.
CNS.
Mild headache.
No numbness.
No dizziness.
No paralysis of lower limbs.

7. Past medical history.
• This is her 3rd admission. The 1st admission
was in kambuga due to malaria. ie; when she
was in P3. Her 2rd admission was still in
kambuga due to malaria still. ie; in P7 .
• However she reports that she would improve
well on treatment for the above condition.
• No allergies.
• No use of local herbs.
• No DM.

8. Past surgical history.
• No fractures.
• No blood transfusion.
• No major operations.
FAMILY HISTORY.
. She is the 4th born among 5 children. 4 girls
and 1 boy.
. No familial illnesses except the mother who
has HTN.

9. Obstetric history.
• This is her 2nd pregnancy. T he 1st pregnancy
was 2014 and delivered the baby girl at term
by SVD.
• Reports to have been using oral
contraceptives for 5 months however she
was on DEPO before but because of side
effects she changed.
• No history of abortions.
• WOA was 33weeks and 3 days.

10. Social history.
• She is a peasant, married to one husband.
• Stopped in S6.
• Live in a permanent house with 2 rooms and is
separate from kitchen.
• Commonly feed on rice, matoke, emondi,
g.nuts and meat at least twice a week.
• Fetch water from tap and boil before drinking.
• No smoking and alcoholism.

11. Menstrual history.
• She started her menarche at 13 years.
• Spend 4 days in her menses . Reports
associated abdominal pain however no
excessive bleeding.
• Her cycle is 28 days .

12. Summary.
• K.A, G2P1+0, admitted on 11/12/17 as a
referral from Kambuga, presenting with
epigastric pain×3/7 gradual onset that radiate
to the chest. It was associated with headache,
loss of appetite, visual blurring and vomiting.
However no fever, cough, seizures and difficult
in breathing.

13. DIFRENTIALS.

14. EXAMINATON
• General.
We noticed a sick young mother in semi recumbent position.
• Hair well distributed on the scalp
• Eyes were symmetrical to each other
• No discharge from ears and nose
• Mouth looked dry
• There was equal chest movements
• Breasts symmetrical to each other and were firmly attached to the
chest wall
• The abdomen looked distended with signs of pregnancy
• No visible scars
• Edema of both limbs ( grade 2)

15. Vitals per examination
• Bp =144/101 mmHg {normal is SBP 100-140, DBP 60-90}
• Pulse=70 b/m{normal is 60-100}
• RR= 21c/m[normal is 16-20]
• Temp= 36.0𝑜𝑐 [normal is 35.5-37.2 under the arm pit]
 There was no jaundice
 Mild pallor of conjunctiva and sclera
 No bluishness of the mucus membranes and skin
 There was bilateral pitting edema of both limbs (grade 2)
 No lymphadenopathy
 Skin pitch returned with in less than 2 seconds.

16. Systemic examination
CVS
• There was mild pallor of mucus membranes
• No bluishness discoloration of skin and mucus
membranes
• No distended jugular vein
• No finger clubbing
• Pitting edema of both limbs (grade 2)
• Bp-144/101 mmHg ,Pulse- 70b/m
• No heart murmurs
• S1 & S2 were heard between 4th and 5th intercostal
space along the mid clavicular line

17. P/A
• Abdomen looked distended with linear nigra
below the umbilicus
• No surgical scars
• Abdomen moves with respiration
• Multiple fetal poles were palpated.
• FH is 37/40, W.O.A= 33+3/7
• Two fetal heart rates were auscultated
FHR1=146b/m
• FHR2=138b/m

18. • Respiratory system
• Equal chest movements
• No visible scars on the chest wall
• A resonant sound was heard on percussion
• Bilateral equal air entry
P/V
• V+V= thick and moist
• No bleeding and discharge
• Os= only a tip of the finger
• Membranes= intact.

19. • Breast examination
• Well attached on the chest wall
• Symmetrical to each other
• No palpable masses
• No discharge from the nipples
Final diagnosis after lab investigations

20. Lab investigations
11/12/2017
• U.S.Scan:- two intrauterine fetuses
• Normal cardiac activity for both fetuses
• One placenta posterior high
• A thin septum separating the fetuses
• Cervix closed
• At 32 weeks + 2 days
12/12/2017
Blood group=B+
Urinalysis:- proteins(++), glucose(-ve)
CBC:- Hb(11.7g/dl)[normal 12-16]
RFT:- creatinine=2.11[0.5-0.9], albumin=2.9[normal 3.8-5],
proteins=5.29[normal 6.6-8.7], total bilirubin=0.98[normal o.1-0.2]
15/12/2017
Urinalysis:- proteins(++++), blood(++)
CBC:- Hb-11.0 g/dl
RFT:- Creatinine=1.73, cholesterol=196[normal 0-190], proteins=5.6, total
bilirubin=0.54

21. Nursing care