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.

1. Presented By
Abdulla Khamis Ngwali
ZU/FHS/4674/13

3. INTRODUCTION
• Some women experience significant problems
during the months of gestation that can greatly
affect pregnancy outcome.
• The syndrome of pre-eclampsia can affect all
maternal organ systems, but it is usually detected
by the presence of new hypertension, proteinuria,
and edema in pregnancy (Douglas & Redman, 1994).

4. THE STATUS OF THE PATIENT
Demographic data
Patient’s particulars
• Name: M. M. A.
• Permanent address: Chumbuni, Unguja.
• Age: 27years
• Sex: Female
• Occupation: House Wife
• Marital Status: Married
• Husband’s name: Mohd Hassan
• Date of admission: 02/03/2016
• Time: 10:35am

5. MEDICAL HISTORY
Patient’s Present History/ chief complain
• A 27-years old primigravida patient was admitted at
Maternity Ward at Mnazi Mmoja Hospital on 2nd
of March,
2016 with 35 Weeks and 3 days of gestation age with a
diagnosis of severe pre-eclampsia.
• She complained that, she feels pain in the epigastric
region and feel dizziness. She was pale and fairly looking
and had a BP of 180/110mmHg measured, a dipstick
Proteinuria of 2+, oedema +++, a severe headache and
visual blurring.

6. Patient’s Present History/ chief complain cont’
• Subsequently she undergo delivery by cesarean section
under general anesthesia and twins’ baby boys’ one with
weighing 1.8kgs and 1.6kgs was delivered with APGAR
scores of 7 and 9 respectively.

7. Previous Medical history
• No previous hospitalization history, family background
shows a history of hypertension.
• During Her first and second prenatal visits had been
normal in all parameters including BP, which was
recorded as 120/80 to 110/70mmHg.
• From her third visit showed a slight risen of her Blood
Pressure which reads 140/90 mmHg, slight proteinuria
of 2+ with slight edema of the lower limb.

8. Previous Medical history Cont’
• The woman was seen on the next week with slight
decrease of vital signs and laboratory investigation.

9. CURRENT DIAGNOSIS AND
TREATMENT
Diagnosis
• Severe Pre-eclampsia.
Treatment:
• Medication such as antihypertensive and MgSO4
infusion was started with a loading dose 4g in 250mL
N/SIV, run over 15minutes (slowly), 5g + 1 Ml
Lignocaine IM in R or L buttock.
• Followed by a maintenance dose of Magnesium Sulfate
2g/h as a continuous intravenous infusion for 24h.
• Tablet Aldoment 800mg t.d.s 2/7
• Syrup Haemovit 15ml t.d.s 2/5.

10. NURSING ASSESSMENT OF THE PATIENT
• Subjective data
• Objective data

11. VITAL SIGNS AND TEST RESULTS
Vital sign
The vital signs were done, where by the results shows that:-
Date Time Vital Signs
02/03/2016 10: 50am
BP: 180/110mmHg, Temp: 37.5ºC, Resp
rate: 21b/min, Pulse rate: 75b/min, SP02:
97%
03/03/2016 10:55am
BP: 165/85mhhmHg, Temp: 37.7ºC, Resp
rate: 22b/min
Pulse rate: 73b/min, SP02: 98%

12. Test Results
The doctor was suspect pre- eclampsia to the patient, the
certain tests were needed and the result shows that:-
• Blood tests :- Full blood picture was done and the
results shows:-
Hemoglobin/hematocrit: - 12 g/dl, Platelets:-
< 100,000/mm3
and Bilirubin 3mg/dl

13. • Urine analysis:- A single urine sample that was used
to measure the ratio of; Creatinine >1.2 mg/dl, and
Protein 2+
• Ultrasound: - The ultrasound shows that; the Fetal
heart rate was 132b/min, fetal weight first twin is
1.8kg and second twin is 1.6kg, and the amount of
fluid in the uterus (amniotic fluid) was adequate.

14. NURSING OBSERVATION
• General state of health
Patient was well groomed with cleanness of the body,
conscious and aware of one’s self and environment
and she can move by herself.
• Mental Status
The patient is alert, conscious, and aware of the
environment.

15. NURSING DIAGNOSIS
1. Risk of developing eclampsia related to severe pre-
eclampsia as evidence by BP of 180/110mmHg measured,
a dipstick Proteinuria of 2+, oedema +++, a severe
headache and visual blurring.
2. Excess fluid volume related to increase fluid intake as
evidence by edema and frequency urination.
3. Activity intolerance related to hypertension as evidence by
feels dizziness, slight headache and abdominal pains.

16. NURSING DIAGNOSIS
4. Sleep pattern disturbance related to feeling of birth
process as evidence by patient complained that she
having irregular sleep.
5. Fear related to hospitalization as evidence by increased
tension, increased systolic blood pressure
183/100mmHg

17. NURSING CARE PLAN
DATE ASSESSMENTS EXPECTED
OUTCOME
INTERVENTION EVALUATION
Subjective Data
Severe headache
and visual
blurring
Objective Data
BP of
180/110mmHg
measured, a
dipstick
Proteinuria of
2+, oedema +++
To decrease
blood pressure
within 3hrs
-Provide the patient
with prescribed
analgesic
medication such as
tablets Paracetamol
500mg tds x 3/7
-Provide the patient
with MgSO4
infusion with a
loading dose 4g in
250mL N/SIV, run
over 15minutes
(slowly)
Blood Pressure
was improved
within 1hrs

18. NURSING CARE PLAN
DATE ASSESSMENTS EXPECTED
OUTCOME
INTERVENTION EVALUATION
Subjective
Data
Frequency
urination.
Objective
Data
Edema
To decrease
fluid volume
within 7days
-Encourage the
patient to
decrease fluid
intake from 1.5L
to 750ml
After 3 days
the fluid
volume was
reduce.

19. NURSING CARE PLAN
DATE ASSESSMENTS EXPECTED
OUTCOME
INTERVENTION EVALUATION
Subjective
Data
Dizziness,
slight headache
and abdominal
pains.
To maintain
normal activity
to the patient
during
hospitalization
with 2 days
-Encourage
patient to have
bed rest
-Provide the
patient with
prescribed anti
pyretic
medication such
as tablets
Paracetamol
500mg tds x 3/7
Body activities
was maintained
during
hospitalization

20. NURSING CARE PLAN
DATE ASSESSMENTS EXPECTED
OUTCOME
INTERVENTION EVALUATION
Subjective Data
Patient
complained that
she having
irregular sleep
To maintain
normal sleep of
the patient
during
hospitalization
within a day.
-Counsel the patient
and Health
education due to her
condition.
-Encourage patient
to decrease stress.
-Provide good
ventilation in the
room, minimize
environmental
activity or noise
Sleep pattern
was maintained
within a day

21. NURSING CARE PLAN
DATE ASSESSMENTS EXPECTED
OUTCOME
INTERVENTION EVALUATION
Subjective Data
Increased tension
Objective Data
Increased
systolic blood
pressure
183/100mmHg
To reduce fear of
the patient due to
hospitalization
within a day
Monitor blood
pressure of the
patient so as not to
continuing
increasing.
-Administer
antihypertensive
drugs.
-Counsel the patient
from free of
hospitalized fear.
During
assessment,
Fear was reduce
during
hospitalization
within a day

22. CARE PROVIDED OF THE PATIENT WITH
SEVERE PRE-ECLAMPSIA
(Nursing care and management)
• Nursing care was done to the patient to prevent serious
consequence to the mother’s and fetus’s health,
including eclampsia, stillbirth, and liver and kidney
failure.
• The patient was carefully monitored on high blood
pressure and convulsions, and was treated with
medication such as with antihypertensive and MgSO4
infusion.

23. • A woman will be advised to follow a prescribed
medication regularly.
• She should take enough rest, small exercises, eat
balanced diet and proper hygiene.
• Continue with post partum care schedule visit to
evaluate her condition and should send her children for
immunization, continue with breast feeding.
HEALTH EDUCATION TO THE PATIENT
ACCORDING TO HER CONDITION

24. • Should as well be counseling for informed choice of
post partum family planning.
• Next pregnancy should attend ANC services early to
prevent and identify and appropriate management of
pre-eclampsia.

25. RECOMMENDATIONS FOR CHANGES OF THE
CURRENT CARE PLAN
1. In the attempt to improve care of women with severe pre-
eclampsia efforts should be made by hospital
administrators to ensure that there are adequate equipment
and supplies for assessing and managing patients
(example cardio pulmonary monitor, oxygen, suction and
BP machine) with severe pre-eclampsia.

26. RECOMMENDATIONS FOR CHANGES OF THE
CURRENT CARE PLAN
2. Hospital administration should formulate operational
team that will assess and ensure the adherence of
checklist/Guideline use in managing women with severe
pre-eclampsia.
This will help in improving quality of care in the
management of severe pre-eclampsia.

27. RECOMMENDATIONS FOR CHANGES OF THE
CURRENT CARE PLAN
3. Hospital administrators should make sure improvement of
Nurse-midwives knowledge and practice should be
parallel with the improvement of resuscitative equipment
and essential drugs for managing severe pre-eclampsia.
This should be done through continuing education,
seminars and in service training.