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CASESTUDY Eclampsia
CASESTUDY Eclampsia
IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS
IN NCM 102 RLE
CASE STUDY
ECLAMPSIA
SUBMITTED TO:
SUBMITTED BY:
DATE SUBMITTED:
MARCH 3, 2016
TABLE OF CONTENTS
A. Medication .......................................................................................................... 36
B. Exercise ............................................................................................................. 37
C. Treatment........................................................................................................... 37
D. Health Teaching ................................................................................................. 37
E. Out-patient order ................................................................................................ 37
F. Diet ..................................................................................................................... 37
pregnancy are caused by chronic hypertension, and 70% are caused by gestational
hypertension. The spectrum of disease ranges from mildly elevated blood pressures
conditions. Although geographic and racial differences in incidence have been reported,
preeclampsia in different populations. For patients with a twin gestation, the incidence
and severity are higher than in those with singleton pregnancy.2 In addition, the
incidence is significantly higher in patients with previous preeclampsia and in those with
previous preeclampsia remote from term.3 Patients older than age 35 years also have
chronic hypertension in this group of patients. Understanding the disease process and
because these disorders remain a major cause of maternal and perinatal morbidity and
mortality worldwide.
1
SIGNIFICANCE OF THE STUDY
being in regardless of race, gender and age is our primary goal. In fact, giving
unfathomable care to the sick is not only our sole responsibility but promoting health,
preventing illness, and alleviating suffering are some of our various obligations we need
to carry out in order to meet clients needs. Basically, catering ones need is a fulfillment
We had interest and choose the attention-grabbing case for its atypical trait. We
appreciate this case since it is rare and challenging to our part as a student nurse. We
apprehend that this case study requires critical thinking and scientific method which will
probably enable us relate our knowledge gained from our instructors and studying.
2
OBJECTIVES
GENERAL OBJECTIVE:
At the end of our two-week exposure in the Southern Philippines Medical Center
Gynecology ward, we will be able to come up with a case study regarding a patient who
has eclampsia. This covers learning additional knowledge on what eclampsia is all
about, what are the different types and causes of it, how the disease progresses and
manifests its signs and symptoms, how does it affect the patient and the significant
others. In return, we, as health care personnel, may impart health teaching regarding
maintenance of current health status, prevention of potential problems and promotion
family support and emotional support for the patients wellbeing.
SPECIFIC OBJECTIVES:
This case study is made to achieve the following reasons:
1. Establish rapport with our patient as well as her significant others to gain trust
and cooperation.
3
8. Identify the different signs and symptoms, as well as the presentation of its
etiology and contributing factors in the development of pyelonephritis for future
purpose.
9. Make effective nursing care plans that address the present and possible needs.
4
HEALTH HISTORY
Patient had headache for 1 week, after CS, BTL for fetal distress.
PATIENT PROFILE
Name: Barney
Sex: Female
Age: 35 years old
Status: Married
Address: Agdao, Davao City
Nationality: Filipino
Religion: Roman Catholic
Occupation: None
Birthdate: August 8, 1980
Mother: Edna
Father: Jaunito
Spouse: Marlot
Birth Place: Davao City
Chief Complaint: Seizures
5
GENOGRAM
Fathers side
Mothers
Side
Grandfather Grandmothe
Grandfather Grandmothe 70, dead r
64, alive r 60, alive
50, alive
Son
Younges (husband of Daught
Patient Second Eldest
t the patient) er
35 eldest 38, alive
22, alive 35, alive 28, alive
eclampsi 36, alive
a
Male
Female
Patient
6
DEVELOPMENTAL TASK
This stage give back to society through raising children, being productive at work, and becoming
involved in community activities and organizations.
By failing to achieve these objectives, this become stagnant and feel unproductive. Success in
this stage will lead to the virtue of care.
Generativity is the concern of guiding the next generation. Socially-valued work and disciplines
are expressions of generativity.
The adult stage of generativity has broad application to family, relationships, work, and society.
Generativity, then is primarily the concern in establishing and guiding the next generation... the
concept is meant to include... productivity and creativity."
During middle age the primary developmental task is one of contributing to society and helping
to guide future generations. When a person makes a contribution during this period, perhaps by
raising a family or working toward the betterment of society, a sense of generativity- a sense of
productivity and accomplishment- results. In contrast, a person who is self-centered and unable
or unwilling to help society move forward develops a feeling of stagnation- a dissatisfaction with
the relative lack of productivity.
7
ASSESSMENT
Skin
She has an even skin tone to the rest of her body. Good skin turgor noted and warm to
touch.
Head
She has a normocephalic head ,she has a symmetrical facial features and her facial
movements are well coordinated. She has dark thick hair which are evenly distributed to
her clean scalp.
Eyes
Her pupils are symmetrically equal, has a brisk reaction to light and a uniform
accommodation.
Ears
Mild tenderness was noted upon palpation on both ears, hearing is present on both
ears.
Mouth
She has symmetrical lips. Moist and fair pinkish in color. Tongue is at midline able to
move accordingly.
Abdomen
She has a good skin integrity and symmetrically fair and round.
8
Extremities
Both her hands are normal with regular peripheral pulses on her extremities. She is able
to move her extremities accordingly. She has no spinal deformities with good skin
turgor. Skin discoloration not noted.
9
ANATOMY AND PHYSIOLOGY
The Circulatory system is designed to deliver oxygen and nutrients to all parts of the body and pick up
waste materials and toxins for elimination. This system is made up of the heart, the veins, the arteries,
and the capillaries.
Circulation is achieved by a continuous one way movement of blood throughout the body. The network
of blood vessels that flow through the body is so extensive that blood flows within close proximity to
almost every cell.
Heart The heart is a muscular pump that propels blood throughout the body. The heart is located
between the lungs, slightly to the left of center in the chest. The heart is broken down into four
chambers including:
RIGHT ATRIUM which is a chamber which receives oxygen poor blood from the veins.
RIGHT VENTRICLE which pumps the oxygen poor blood from the right atrium to the lungs.
LEFT ATRIUM which receives the now oxygen rich blood that is returning from the lungs.
LEFT VENTRICLE which pumps the oxygenated blood through the arteries to the rest of the
body.
Blood Vessels
Blood vessels are broken down into three groups: the arteries which carry blood out of the heart to the
capillaries, the veins which transports oxygen poor blood back to the heart, and the capillaries which
transfer oxygen and other nutrients into the cells and removes carbon dioxide and other metabolic
wastes from these body tissues.
Blood Pressure
Blood pressure is the force exerted by the blood against the walls of the blood vessels. The ooutput or
direct pumping of the heart and the resistance to blood flow in the vessels determines blood pressure.
Resistance is determined by blood viscosity and by friction.
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Renal System
The urinary system, also known as the renal system, consists of the kidneys, ureters, bladder, and the
urethra. Each kidney consists of millions of functional units called nephrons.
Antidiuretic hormone. ADH is produced by the hypothalamus and released from the posterior
pituitary in response to dehydration or decreased blood volume. Among other actions, ADH
causes vasoconstriction, which increases blood pressure.
Atrial Natriuretic Peptide. Released by cells in the atria of the heart, ANP lowers blood
pressure by causing vasodilation and by promoting the loss of salt and water in the urine, which
reduces blood volume.
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DEFINITION OF TERMS
1. Kidney -The kidneys are bean-shaped organs that serve several essential
regulatory roles in vertebrates.
2. Ureters- the duct by which urine passes from the kidney to the bladder or
cloaca.
3. Bladder - a membranous sac in humans and other animals, in which urine is
collected for excretion.
4. Urethra - the duct by which urine is conveyed out of the body from the bladder,
and which in male vertebrates also conveys semen
5. Nephrons - each of the functional units in the kidney, consisting of a glomerulus
and its associated tubule, through which the glomerular filtrate passes before
emerging as urine.
6. juxtaglomerular cells- (JG cells, or granular cells) are cells in the kidney that
synthesize, store, and secrete the enzyme renin.
7. Renin (angiotensinogenase) an enzyme that participates in the body's renin-
angiotensin aldosterone system (RAAS)also known as the renin-angiotensin-
aldosterone axisthat mediates extracellular volume (i.e., that of the blood
plasma, lymph and interstitial fluid), and arterial vasoconstriction. Thus, it
regulates the body's mean arterial blood pressure.
8. Angiotensin - is a peptide hormone that causes vasoconstriction and a
subsequent increase in blood pressure. It is part of the renin-angiotensin system,
which is a major target for drugs that lower blood pressure.
9. Aldosterone - a steroid hormone, "the main mineralocorticoid hormone
produced by the outer section (zona glomerulosa) of the adrenal cortex in the
adrenal gland.
10. Beta human chorionic gonadotrophin (beta-hCG) - Human chorionic
gonadotropin (hCG) is a hormone produced by the embryo following
implantation.
11. Circulation - The movement of blood through the body that is caused by the
pumping action of the heart.
12
12. Blood vessels- a tubular structure carrying blood through the tissues and organs;
a vein, artery, or capillary.
13. Blood - a bodily fluid in humans and other animals that delivers necessary
substances such as nutrients and oxygen to the cells and transports metabolic
waste products away from those same cells
14. Oxygen poor blood- deoxygenated blood
15. Oxygen rich blood- oxygenated blood
16. Arteries- any of the muscular-walled tubes forming part of the circulation system
by which blood (mainly that which has been oxygenated) is conveyed from the
heart to all parts of the body.
17. Capillaries - A capillary is an extremely small blood vessel located within the
tissues of the body, that transports blood from arteries to veins. Capillaries are
most abundant in tissues and organs that are metabolically active.
18. Blood viscosity - is the thickness and stickiness of blood. It is a direct measure of
the ability of blood to flow through the vessels.
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19. ETIOLOGY
after the 20th week of pregnancy. If your preeclampsia worsens and affects your brain,
Doctors dont know what causes preeclampsia. The following explains how the
Preeclampsia can cause your blood pressure (the force of blood against the walls of
your arteries) to become high enough to damage your arteries and other blood vessels.
Damage to your arteries may restrict blood flow and produce swelling in the blood
vessels of your brain. If this swelling interferes with your brains ability to function,
Proteinuria
Preeclampsia commonly affects kidney function. Protein in your urine, also known as
proteinuria, is a key sign of the condition. Your kidneys filter waste from your blood but
retain beneficial nutrients, such as protein, in the blood for redistribution to your body. If
the kidneys filters (glomeruli) sustain damage, protein can leak through these filters and
14
PATHOPHYSIOLOGY
Predisposing Precipitating
Nulliparity Lower socio-economic
Family History status
Poor outcome of Obesity
previous pregnancy Nutrition
Hydatid mole Dietary deficiency or
Teen pregnancy excess
Age (>35 years old)
Gestational diabetes
15
Damage the cells specifically
the endothelial cells
Fetal growth
Contracted labor
16
eclampsia
death
17
PROGNOSIS
Most women will have good outcomes for their pregnancies complicated by
preeclampsia or eclampsia. Some women will continue to have problems with their
blood pressure and will need to be followed closely after delivery. About 25% of women
who have had eclampsia will have elevated blood pressure in a subsequent pregnancy,
and about 2% will also have eclampsia in subsequent pregnancies.
Most babies will do well. Babies born prematurely will usually stay in the hospital longer.
A rule of thumb is to expect the baby to stay in the hospital until their due date.
18
SYMPTOMATOLOGY
19
but your blood pressure remains high,
doctors call this "hypertensive urgency." It's
important to seek medical attention for
hypertensive urgency, so that doctors can
help bring your blood pressure down over a
period of hours to days.
Oliguria is the low output of urine. In humans, it is
clinically classified as an output more than
80 ml/day but less than 400ml/day] The
decreased output of urine may be a sign of
dehydration, kidney failure, hypovolemic
shock, HHNS hyperosmolar Hyperglycemic
Nonketotic Syndrome, multiple organ
dysfunction syndrome, urinary
obstruction/urinary retention, DKA, pre-
eclampsia, and urinary tract infections,
among other conditions.
Declining kidney function predicts increasing
Proteinuria cardiovascular risk in people with
hypertension. Microalbuminuria is a marker
for cardiovascular risk and declining kidney
function. Agents that block the renin-
angiotensin-aldosterone system (RAAS),
notably angiotensin-converting enzyme
(ACE) inhibitors and angiotensin receptor
blockers (ARBs), reduce proteinuria and
microalbuminuria, lower blood pressure and
slow the progression of proteinuric kidney
disease. Evidence is accumulating that the
combination of an ACE inhibitor and an ARB
is the optimal means of RAAS blockade in
this setting, slowing the progression of
nephropathy independently of blood
pressure lowering to a greater degree than
can be achieved using maximum approved
doses of either agent alone. However, the
emerging therapeutic potential of ACE
inhibitor/ARB combination therapy in
hypertensive kidney disease requires further
characterization. The Irbesartan in the
Management of PROteinuric patients at high
risk for Vascular Events trial aims to
determine definitively whether the
combination therapy of an ARB, irbesartan
and an ACE inhibitor, ramipril, is more
effective than ramipril alone in reducing the
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urinary albumin excretion rate in patients at
high cardiovascular risk with hypertension
and proteinuria or microalbuminuria.
Creatinine is a chemical waste molecule that
Elevated serum is generated from muscle metabolism.
creatinine Creatinine is produced from creatine, a
(>1.2mg/dL) molecule of major importance for energy
production in muscles. Approximately 2% of
the body's creatine is converted to creatinine
every day. Creatinine is transported through
the bloodstream to the kidneys. The kidneys
filter out most of the creatinine and dispose
of it in the urine.
21
MEDICAL TREATMENT
Generic name:
Metoprolol
Brand name:
Lopressor
Classification:
Dosage:
100mg
Route:
PO
Frequency:
TID
22
MECAHNISM OF ACTION
Unknown. A selective beta blocker that selectively blocks beta1 receptors; decreases
cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses
rennin secretion.
INDICATIONS
Hypertension
Acute MI
Angina Pectoris
CONTRAINDICATIONS
Hypersensitive to drug.
NURSING RESPONSIBILITIES
Monitor BP
Inform patient about the side effects and adverse effects of the medication.
23
Tell patient to report if he/she feels shortness of breath.
Generic Name:
MgSO4
Route
PO
Dosage
6 doses
Frequency
q4
Indications
Treatment/prevention of hypomagnesemia. Treatment of hypertension. Anticonvulsant
associated with severe eclampsia, pre-eclampsia, or acute nephritis. Unlabeled uses:
Preterm labor. Treatment of Torsade de pointes. Adjunctive treatment for
bronchodilation in moderate to severe acute asthma.
Mechanism of Action
Essential for the activity of many enzymes. Plays an important role in neurotransmission
and muscular excitability. Therapeutic Effects: Replacement in deficiency states.
Resolution of eclampsia.
Contraindications/Precautions
24
Contraindicated in: Hypermagnesemia; Hypocalcemia; Anuria; Heart block; Active labor
or within 2 hr of delivery (unless used for preterm labor). Use Cautiously in: Any degree
of renal insufficiency; Digitalized patients.
Nursing Management
Before
- Assess for contraindicatedconditions.
- Monitor knee-jerk reflex beforerepeated parenteral administration.
- Give as laxative as temporarymeasure.
- Reserve IV use in eclampsia forlife-threatening situations.
- Observe the 15 rights in drugadministration.
During
- Give IM route by deep IM injection.
- Monitor serum magnesium levels.
- Do not give oral MgSO4 with abdominal pain, nausea, or vomiting.- Do not administer
if knee-jerk reflexes are suppressed- Monitor bowel function.
After
- Arrange to discontinue administration as soon as levels are within normal limits and
desired clinical response is obtained.
- Discontinue if diarrhea or cramping occurs.
- Arrange for dietary measures, exercise and environmental control to return to normal
bowel activity.
- Report sweating, flushing, muscle tremors or twitching, inability to move extremities.
- Maintain urine output at a level of 100 mL every 4 hr during parenteral administration.
25
DIAGNOSTIC TEST
26
indicates macrocytic (large
average RBC size).
MCHC L 27.8 32.20 35.50 g/dL The mean corpuscular
hemoglobin concentration, a
measure of the concentration of
hemoglobin in a given volume of
packed red blood cells. It is
reported as part of a standard
complete blood count.
Differential The blood differential test
count measures the percentage of
each type of white blood cell
(WBC) that you have in your
blood. It also reveals if there are
any abnormal or immature cells.
Neutrophil H 79 55.00 75.00 % It is important to realize that an
abnormal increase in one type of
white blood cell can cause a
decrease in the percentage of
other types of white blood cells.
An increased percentage of
neutrophils may be due to: Acute
infection. Acute stress.
Lymphocyte L 16 20 35% Lymphocytopenia is an
abnormally low number of
lymphocytes (a type of white
blood cell) in the blood. Many
disorders can decrease the
number of lymphocytes in the
blood, but viral infections
(including AIDS) and
undernutrition are the most
common.
Monocyte 4 2 10 % A blood differential test, also
called a white blood cell count
differential, measures the
number of each of the five types
of white blood cells present in
your blood: neutrophils.
lymphocytes. monocytes.
Eosinophil 1.000 18% Eosinophils have two distinct
functions in your immune
system. They destroy invading
germs like viruses, bacteria, or
parasites such as Giardia and
pinworm. Eosinophils also create
27
an inflammatory response,
especially if an allergy is
involved.
Basophil Basophils are produced in your
bone marrow, circulate in the
blood and are the least abundant
of all leukocytes. They are
classified as immune cells and
categorized a granulocytes.
Therefore, the basic function of
this white blood cell is release of
its substances in response to a
foreign invasion.
Platelet Count 319 150 400 x10^3/uL A platelet count is a lab test to
measure how many platelets you
have in your blood. Platelets are
parts of the blood that help the
blood clot. They are smaller than
red or white blood cells.
28
will form. In short, your
urine pH is an indicator
of your overall health
and gives your doctor
important clues as to
what is going on in
your body.
Glucose Negative The glucose urine test
measures the amount
of sugar (glucose) in a
urine sample. The
presence of glucose in
the urine is called
glycosuria or
glucosuria.
Protein Negative Urine protein testing is
used to detect protein
in the urine, to help
evaluate and monitor
kidney function, and to
help detect and
diagnose early kidney
damage and disease.
Urine
Flowcytometry
WBC 8.0 0 27 /uL Leukocyte esterase is
an enzyme present in
most white blood cells
(WBCs). Normally, a
few white blood cells
(see microscopic
examination) are
present in urine and
this test is negative.
When the number of
WBCs in urine
increases significantly,
this screening test will
become positive.
29
cause for WBCs in
urine (leukocyturia) is a
bacterial urinary tract
infection (UTI), such as
a bladder or kidney
infection.
RBC H 40 0 28 /uL This test is used to
detect hemoglobin in
the urine
(hemoglobinuria).
Hemoglobin is an
oxygen-transporting
protein found inside
red blood cells (RBCs).
Its presence in the
urine indicates blood in
the urine (known as
hematuria). The small
number of RBCs
normally present in
urine usually result in a
"negative" test.
However, when the
number of RBCs
increases, they are
detected as a "positive"
test result.
Epithelial Cells H 14 0 7/uL Epithelial cells in urine
may be a cause for
concern if the numbers
are higher than normal.
The sloughing of
epithelia is quite a
normal process of the
body sheddingdead
cells and creating new
ones. If epithelial cells
are high in your urine it
could signal a problem
with your kidneys or an
infection in your urinary
system. This article will
examine some
possible causes of
epithelial cells in urine
and what urinalysis
30
means.
Cast Urinary casts are
formed only in the
distal convoluted
tubule (DCT) or the
collecting duct (distal
nephron). The proximal
convoluted tubule
(PCT) and loop of
Henle are not locations
for cast formation.
Hyaline casts are
composed primarily of
a mucoprotein (Tamm-
Horsfall protein)
secreted by tubule
cells.
Bacteria 4 Urine is normally
sterile, which means
that it contains no
bacteria. A small
number of bacteria
may be found in the
urine of many healthy
people. This is usually
considered to be
harmless. However, a
certain level of bacteria
can mean that the
bladder, urethra, or
kidneys are infected.
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NCP
Assessment Diagnosis Planning Intervention Evaluation
Objective: Activity After 8 hours of Assess patients Patient reveals an
Hemoglobin : 68 intolerance nursing ability to do increase in activity
related to intervention the normal tasks tolerance
weakness patient will be To know if
able to: the Demonstrating a
patient reduction on
Report that she is needs physiologic signs
able to ambulate assistance of activity
within the room intolerance
Note changes in
Demonstrate a muscle weakness
decrease in
physiologic signs
of intolerance Recommend bed
rest and quiet
atmosphere
Provide assistance
on activities and
ambulation when
necessary
Instruct patient to
wash hands before
eating.
32
DISCHARGE PLANNING
33
Exercise Discuss to the client importance or
help client develop a program of
exercise and relaxation techniques
as tolerated.
34
RECOMMENDATIONS
As nurses, our vital role is to provide health care and deliver services in the
hospital to improve the health status of each individual. This nursing care study is
important for us because it in enables to give the proper health teaching to our chosen
client.
We recommended this case to the following persons and institution for the further
improvement of the study.
TO THE FAMILY:
This study for the family of our patient to follow the treatment prescribed such as
to take the medications as on time and right dosage and other recommended measures
by the physicians, encourage having adequate rest to hasten the recovery of the
patient. Through the adherence of fulfillment of the suitable medical management, for
the fast recovery of the patient.
TO THE STUDENT:
We recommended this study for the students as a reference for the future cases,
in order to have some based line datas to refer.
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BIBLIOGRAPHY/REFERENCES
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