REPUBLIQUE DU CAMEROUN REPUBLIC OF CAMEROON

--------------------------- -----------------------------
PAIX-TRAVAIL-PATTIE PEACE-WORK-FATHERLAND
---------------------------------- -------------------------------------
MINISTERE DE L’ENSEIGNEMENT MINISTRY OF HIGHER
SUPERIEUR EDUCATION
---------------------------- ---------------------------------
DIRECTION DE L’ENSEIGNEMENT DEPARTMENT OF PRIVATE
SUPERIEUR PRIVE EDUCATION
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P.O BOX: 875, BAMENDA.

MOTTO: HOPE IS THE KEY

CASE STUDY REPORT ON PREECLAMPSIA

CARRIED OUT DURING AN INTERNSHIP AT THE
REGIONAL HOSPITAL BAMENDA 7 DECEMBER
2017 TO 7 JANUARY 2018

SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS

FOR THE AWARD OF THE HIGHER NATIONAL DIPLOMA (HND) IN
NURSING

PRESENTED BY: SUPERVISED BY:

AMINATOU LEKA MFONFU DANIEL

APRIL 2018
2
 CERTIFICATION

This to certify that this case study was carried out during an internship at the
Bamenda Regional Hospital by Aminatou Leka from 7 December 2017 to 7
January 2018 for the award of Higher National Diploma [HND] in Nursing

STUDENT: AMINATOU LEKA SIGNATURE_______________DATE_______________

SUPERVISOR: DR. MFONFU DANIEL SIGNATURE__________DATE_______________

DEAN OF STUDIES: DR. MFONFU DANIEL SIGNATURE__________DATE __________

PRESIDENT OF JURY: Dr Mfonfu Daniel SIGNATURE________DATE 25 May 2018

3
 DEDICATION

This piece of work is dedicated Dr. Mfonfu Daniel who guided me throughout my
studies, my parents and mates who provided me with the means to enhance my
success.

4
 ACKNOWLEDGEMENT

My sincere gratitude goes to late Mr Ngalla Edward, the founder of Capitol

Higher Institute of health science and Beauty Therapies Bamenda.

My gratitude goes to my supervisor Dr Mfonfu Daniel for his patience and

guidance on editing this piece of work and the entire Capital staffs for their
support.

Enormous thanks goes to the General supervisor of the general hospital and
the entire staff who in their effort collaborated with us to participate in health
activities of the hospital.

Finally sincere appreciation goes to my entire family and friends who gave
me a helping hand socially and financially throughout my internship.

Honour and praise goes to God Almighty for his guidance and a sound
health to be able to carry out this work.

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LIST OF ABBREVIATIONS

MmHg………………………………………………...Millimetre of Mercury

GIT…………………………………………………....Gastro intestinal track

CNS……………………………………………………Central nervous system

EDD…………………………………………………...Expected date of delivery

LMP…………………………………………………...last menstrual period

IWC…………………………………………………...Infant welfare clinic

ANC………………………………………………..... Antenatal clinic

WHO……………………………………………….... World health organization

HIV………………………………………………….... Human immune deficiency

ATS………………………………………………….…Anti tetanus serum

SRN…………………………………………………….State registerrd nurses

NSAIDS…………………………………….Non-steroidal anti-inflammatory drugs

G2P2………………………………………………...... Gravida 2 para 2

DOA..........................................................................Date of admission

DOD..........................................................................Date of discharge

HND..........................................................................Higher National Diploma

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 TABLE OF CONTENTS

Certification ---------------------------------------------------------------------------2

Dedication------------------------------------------------------------------------------3

Acknowledgement---------------------------------------------------------------------4

List of abbreviation--------------------------------------------------------------------5

Table of contents-----------------------------------------------------------------------6

CHAPTER ONE - General introduction ---------------------------------------7-10

CHAPTER TWO - Literature review of the disease -------------------------11-17

CHAPTER THREE – PRESENTATION OF CASE -------------------- 18-31

CHAPTER FOUR – REVIEW OF DRUGS ---------------------------------32-35

CHAPTER FIVE - DISCHARGE SUMMARY----------------------------36

CHAPTER SIX – CONCLUSION -----------------------------------------37-38

Reference-----------------------------------------------------------------------------------39

7
 CHAPTER ONE – GENERAL INTRODUCTION

1.1 Definition of Preeclampsia:

Preeclampsia is a pregnancy complication characterized by high blood pressure

and signs of damage to another organ system, often the kidneys – pitting oedema
and proteinuria. Preeclampsia usually begins after 20 weeks of pregnancy in a
woman whose blood pressure had been normal. Even a slight rise in blood pressure
may be a sign of preeclampsia (Mayo Clinic Staff) Pre-eclampsia or preeclampsia
(PE) is a disorder of pregnancy characterized by high blood pressure and a large
amount of protein in the urine. (http://en.wikipedia.org/wiki/Pre-eclampsia)

1.2 MOTIVATION FOR THE CASE

Literature on preeclampsia says pre-eclampsia occurs at about 20 weeks of
pregnancy but in this case preeclampsia started when the pregnancy was at term.
This preeclampsia at term motivated me to study it.

1.3 GENERAL OBJECTIVE (GOAL)

Successfully manage the case of preeclampsia as amember of the medical and
nursing team and submit the report of this case study in partial fulfilment to obtain
the HND in nursing.

1.4 SPECIFIC OBJECTIVES

a) Identify the patient

b) Describe the circumstances of arrival of the patient
c) Admit the patient
d) State the provisional diagnosis on admission, state source
e) Administer any emergency medications
f) Clerk/Assess the patient
g) Administer the medications prescribed by the medical officer, monitor
and record side effects on the patient
h) Establish daily drug chart
i) State results of confirmatory diagnostic tests
j) Develop and implement nursing care plans
k) Describe the evolution of the patient and vital signs
l) Revue the medications administered
m) Write the discharge summary
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 n) Identify positive findings, weaknesses; make recommendations; make
conclusions

1.4 BRIEF DESCRIPTION OF PLACE OF STUDY

The Bamenda Regional Hospital is located in Bamenda II Sub-Division, in the

North West Region precisely in the mankon on a well-ventilated topographical
area suited for the prevention and preservation of good health. This establishment
is to the left of the GMI police camp Bamenda and 100m away from hospital
round-about. It acts as a referral hospital for District hospitals, research centre and
a teaching hospital for student doctors, nurses, midwives and laboratory technician.
Inflow rate of patients is enormous.

The BRH comprises of many units/services where various activities are been
carried out. They include;

- M and F medical word

- M and Female surgical ward
- Paediatric ward
- Gynaecological ward
- Maternity
- Reanimation unit
- Ophthalmology department
- operating theatre
- X-ray department
- Dialysis department
- Diabetic unit
- Dental unit
- Tuberculosis unit
- Pharmacy
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 - Emergency unit
- Outpatient department

1.4.1 Administrative Staffs and Their Job Description

There are about two hundred workers as both skilled and unskilled. This
total number of workers makes sure that the hospital runs well. The health care
team is made up of:

THE DIRECTOR: the director who supervises doctors, nurses, he record and direct
the functioning of the hospitals

THE GENERAL SUPERVISOR: who attains to various problems in wards,

make routine control, supervise activities in the hospital and evaluate students on
internship

DOCTORS: Refer patients to other hospitals, gives instructions to nurses, do

rounds, prescribe drugs, operate and attend to patients in the consultation room

THE WARD CHARGE: draw the duty roster, supervise the nurses, give
account on shortage and damages, evaluate the performance of the unit and is
responsible of the management in the ward

THE NURSE: these are those who actually perform routine tasks. They
assist doctors during rounds, give health talks and educate patients and guardians
and evaluate nursing care given to patients

NURSING ASSISTANCS: assist nurses in their duties

PHAMACIST: dispense drugs to wards

LABORATORY TECHNICIANS: collect specimen for examination

AUILARY STAFF: Maintain hygiene of the hospital

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1.5.2 SHIFT SYSTERM

The BRH is made up of 2 shifts that is morning shift from 7am to 5pm and night
shift from 5 PM to 7am

ORGANIGRAM OF REGIONAL HOSPITAL

Director

Medical adviser General Supervisor

Chief or Service Ward charge

Doctor Nurses

Assistant Nurses

Auxiliary workers

Source: General supervisor 11

CHAPTER TWO – REVIEW OF LITERATURE ON PREECLAMPSIA

2.0. Classification of Preeclampsia (The women’s the royal women’s hospital)

Classification Blood Pressure Range
Mild 140-149 mmHg systolic 90-99 mmHg diastolic
Moderate 150-159 mmHg systolic 100-109 mmHg diastolic
Severe >160 mmHg systolic >110 diastolic

Blood pressure is defined in the above table: measured on at least two occasions
over several hours, combined with proteinuria >300 mg total protein in a 24-hour
urine collection, or ratio of protein to creatinine >30 mg/mmol

2.1 Causes (Mayo clinic)

Some causative factors include:

 Abnormal placentation (formation and development of the placenta)

 Immunologic factors
 Pre-existing hypertension,
 Obesity,
 Dietary factors, e.g. low calcium in the body
 Environnemental factor, e.g. air pollution

2.2 Pathophysiology
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 During normal pregnancy, the placenta undergoes process of
vascularization to allow for blood flow between the mother and fetus
(http://en.wikipedia.org/wiki/Pre-eclampsia)

13
Abnormal development of the placenta leads to poor placental perfusion. The
placenta of women with preeclampsia is abnormal and characterized by poor
trophoblastic invasion. It is thought that this results in oxidative stress, hypoxia,
and release of factors that promote endothelial dysfunction, inflammation, and
other possible reactions The clinical manifestations of preeclampsia are associated
with general endothelial dysfunction, including vasoconstriction and end-organ
ischemia (http://en.wikipedia.org/wiki/Pre-eclampsia)

2.3 Risk factors (By Mayo Clinic Staff)

Known risk factors for preeclampsia include:

 First pregnancy
 Diabetes mellitus
 Kidney disease
 Chronic hypertension
 Prior history of preeclampsia
 Family history of preeclampsia
 Advanced maternal age (>35 years)
 Obesity
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  Multiple gestation
 Having donated a kidney.
 New paternity

2.4 Complications (By Mayo Clinic Staff)

Complications of preeclampsia may include:

 Lack of blood flow to the placenta. Preeclampsia affects the arteries

carrying blood to the placenta. If the placenta doesn't get enough blood, the
baby may receive less oxygen and fewer nutrients. This can lead to slow
growth, low birth weight or preterm birth.
 Placental abruption. Preeclampsia increases the risk of placental abruption,
in which the placenta separates from the inner wall of your uterus before
delivery. Severe abruption can cause heavy bleeding and damage to the
placenta, which can be life-threatening for both the mother and the baby.
 HELLP syndrome. HELLP — which stands for haemolysis (the destruction
of red blood cells), elevated liver enzymes and low platelet count —
syndrome can rapidly become life-threatening for both you and your baby.
Symptoms of HELLP syndrome include nausea and vomiting, headache, and
upper right abdominal pain. HELLP syndrome is particularly dangerous
because it represents damage to several organ systems. On occasion, it may
develop suddenly, even before high blood pressure is detected.
 Eclampsia. When preeclampsia isn't controlled, eclampsia — which is
essentially preeclampsia plus seizures — can develop.
 Cardiovascular disease. Having preeclampsia may increase your risk of
future heart and blood vessel (cardiovascular) disease.

2.5 Signs and symptoms (By Mayo Clinic Staff)

i. Sudden weight gain and swelling (pitting edema)

ii. Blood pressure that is 140/90 millimetres of mercury (mm Hg) or greater —
documented on two occasions, at least four hours apart — is abnormal
iii. Headaches
iv. Changes in vision, including temporary loss of vision, blurred vision or light
sensitivity
v. Upper abdominal pain, usually under your ribs on the right side
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 vi. Nausea or vomiting
vii. Decreased urine output
viii. Shortness of breath, caused by fluid in the lungs

2.6 Diagnosis
It is diagnosed from the above signs and symptoms. It can also be diagnosed
in the laboratory by carrying out the following tests:
o Excess protein in urine (proteinuria)
o Decreased levels of platelets in the blood (thrombocytopenia)
o Impaired liver function

2.7 Treatments (Denis Palmer et al)

 Strict bed rest/admit. Encourage patient to lie on the left side.

 If foetus is viable, cervix ripe, head down, pelvis adequate, induce.
 If foetus viable, cervix not ripe, pelvis inadequate, do CS.
 If foetus not viable, mother stable or improving, monitor.
 If foetus not viable, mother deteriorating, deliver anyway.
 Administer MgSo4 5g stat IM.
 Continue MgSo4 24hours after delivery
 Drug of choice for hypertension should be administer if available (Labetalol
and Hydralazine).
 IV fluids at 60 -150ml/hr unless there are excessive losses of fluids or blood.

2.7Prognosis
If not treated preeclampsia can lead to eclampsia that may result in the death
of mother or the baby, or both

2.8 Preventions

 Frequent prenatal visit

 Encourage the woman to attend ANC regularly for frequent monitoring
of her weight, BP and urine testing.
 Encourage the woman to do light sport
 Encourage the woman to avoid excessive salts intake
 Encourage the woman to eat a well-balanced diet and much vegetable.

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2.9 Definition of nursing care plan

A nursing care plan outlines the nursing care to be provided to an individual,

family and the community.

It is a set of action that the nurse will implement to resolve and support
nursing process. It guides in the ongoing provision of nursing care and assists in
the evaluation of the care W.H.O (3 November, 2015).

2.10 VIRGINAL HENDERSON’S 14 BASIC FUNDAMENTAL HUMAN

NEEDS
1. Breathe normally
2. Eat and drink adequately
3. Eliminate body waste
4. Move and maintain desirable posture
5. Sleep and rest
6. Maintain body temperature within normal range by adjusting clothing and
modifying the environment
7. Keep the body clean and well groomed and protect the integument
8. Avoid dangers in the environment and avoid injuring others
9. Communicate with others in expressing emotion, needs, fears or options
10. Worship according to one’s faith
11. Work in such a way that there is a sense of accomplishment
12. Play or participate in various form of recreation
13.Learn, discover, or satisfy the curiosity that leads to normal development
and health and use the available health facilities.

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2.11 Nurses’ responsibilities in the administration of drug

1. The nurse must respect the seven rights of drug administration also
known as the seven rules.
- The right patient
- The right drug
- The right dose
- The right time
- The right route
- The right procedure
- The right documentation
2. If a prescription is not clear, never assume what it could be. Always
Consult with the prescriber to verify that it is correct. Also, if you think
a B prescription is not appropriate, do not change it without consulting the
prescriber.
3. In case a prescription is order over the phone, document the
prescription and indicate that it was done through the phone. Sign below the
prescription and make sure that the prescriber signs immediately he is available
4. Read the medication label three times that is before removing
medication cupboard, before removing from the container and before returning it
after administration. This makes certain of what has been administered.
5. Never administer medication from drug container whose labels are not
visible.

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 CHAPTER THREE- PRESENTATION OF CASE

3.1 DEMOGRAPHIC IDENTITY OF THE CASE ON ADMISSION

Name: patient x

Age: 19 years

Sex: female

Address: mile 90

Occupation: student

Religion: Presbyterian

Ward: Postnatal in private room one

Bed num ber: 2

Blood group O

Nationality: Cameroonian

LMP 09/03/2017

EDD 16/12/2017

DOA: 19/12/17

Gravida1

3.2 CONDITION ON ARRIVAL OF THE PATIENT IN THE HOSPITAL/ WARD AND

WHAT WAS DONE ON HER BERFORE ADMISSION.

From the casualty assessment, the 19 years old female gravida1 accompanied by
her mother at 3pm with complained of 4oweeks +3days gestational age . From the
Dr`s consultation, she has severe preeclampsia with blood pressure of
160/87mmHg,pulse of 104b/m, swelling legs and ankles. An induction of labour
was recommended 1/4cytotec by the Doctor . The fundal height of 40cm and foetal
heart beat of 134b/m.

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3.3 PROVISIONAL DIAGNOSIS BY MEDICAL DOCTOR AT
CASUALTY ON ADMISSION.

The provisional diagnosis on admission from clinical presentation was

Severe Preeclampsia.

3.4 PRELIMINARY LAB RESULTS.

Hemoglobin: 11.2g/dl

Blood Group O, Rhesus factor negative

3.5 MEDICAL PRESCRIPTION AND TREATMENT ON ADMISSION BY

THE DOCTOR AT THE CASUALTY.

The medical prescription was as follows:

 Ringer lactate
 Magnesium sulfate
 ¼ cytotec

3.6 CLERKING AND ASSESSMENT BY THE NURSE

History taking and examination:

Patient came into the ward with full consciousness from doctor’s consultation at
3pm accompanied by her mother with post term pregnancy, severe preeclampsia
and cervical dystocia. She had swollen hands and leg with blood pressure of
160/87mmhg. LMP-09 March 2017-EDD-16 December 2017.

HEAD TO TOE EXAMINATION

Head: clean and dark hair.

Eye: black pupil and she see well.

Nose: on inspection no nasal discharge.

Mouth: no swollen gums.

Chest on observation: no abnormality discovered

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Abdomen: patient had dark linear nigra

3.7 PAST MEDICAL HISTORY

Patient had once been admitted for appendicitis.

3.8 PAST SURGICAL HISTORY

Patient had once been operated for appendicitis.

3.9 FAMILY HISTORY

Hypertension is so common in their family.

3.10 SOCIAL HISTORY

Patient doesn’t smoke, does not drink alcohol but takes little of sweet drunks.

On Nutritional status

She does not have any nutritional dislike and her favourite is water fufu and erru
with enough meat which she eat often.

Patients love taking fruits such as bananas oranges, and pawpaw, no allergy to
food. She eats at least twice daily but 2 sometimes.

On health maintenance pattern

Patients take her drugs regularly whenever she is sick and usually buys from
hospital pharmacies.

On Elimination Pattern

Patient could pass out stool at least 3 times daily and urinate at least 4 times .

Sleep and Rest Pattern

Patient usually sleeps during the day and less in the night because of lower
abdominal pain.

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Gynaecologic obstetrics History

Patient started menstruating at the age of 15year old. Has never had any abortion.
This is her first pregnancy, regular menstrual bleeding of 28days cycle with 4days
of duration. Patient used at least 3 pads daily her menses, no cramps during
bleeding. She attended her first antenatal clinic at 5months and did an echography,
reviewed a male child that is G1pooo.

On Perceptive Pattern

Mental status, patient was oriented in her present condition. She understands
English, speak it well and able to communicate her worries and feelings to her
family.

3.11 Vital Signs On Physical Examination

BP 159/90mmHg
P 100b/min
R 24cy
W 76kg
Bowel 2 times
Urine 3times
Vomitus Nil
Intake about 2liter of water.

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 Table1: Daily Drug chart; Date: 19/12/2017 – induction of labour

Time Drug Dose Route Frequency Remark Identity of

nurse
Noon Magnesium 5g IM stat served HND
sulphate
3:30 pm magnesium 5g IM stat
sulphate
Magnesium 4g IVD stat
sulphate
Ringer 500cc IV stat served
lactec
+¼ cytotec

Evening Magnesium 4g IM 4hourly served HND

7:30 Pm
sulphate
11:30 Pm Magnesium 4g IM 4 hourly served
sulphate
Table2: Daily Drug chart; Date: 20/12/2017
Time Drug Dose Route Frequency Remark Identity of
8;15 Am nurse

Morning magnesium 4g im 4hourly served SRN

Noon magnesium 4g im 4hourly served SRN
12:15 pm/ 4:15
pm
Evening magnesium 4g im 4hourly served SRN
9:15 Pm

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 Table3: Daily Drug chart; Date: 21/12/2017

Time Drug Dose Route Frequency Remark Identity of

nurse
Morning Magnesium 4g IM 4hrs served
1:15 Am
sulphate
6: 00 Am Ampicilin 1g IV 8hrs served

8: Am Novalgin 1amp IV 8hrs served

Noon Novalgin 1amp IVD 8hourly served HND

1g IV
Ampicilin
4mg IM 4 hrs`
Magnesium
sulphate
Evening Magnesium 4g IM 4hrs Served
5:15 pm 1amp IV 8hrs served
sulphate
Novalgin

The induction failed and the doctor recommended a CS that was done on
21/12/2017.

Description of the Caesarean Section:

The CS was done under general anaesthesia. A live male baby was extracted with
an Apgar score of 10.

Post-operative prescription:

a) Magnesium
b) Novalgin
c) Ampicillin

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Table4: Daily Drug chart; Date: 22/12/2017

Time Drug Dose Route Frequency Remark Identity of

nurse
Morning Novalgin 1amp IVD 8hourly served HND
10 am
Evening Novalgin 1amp IVD 8hourly served HND
6:00 pm

Table1: Daily Drug chart; Date: 23/12/2017

Time Drug Dose Route Frequency Remark Identity of
nurse
Noon Novalgin 1 amp IVD 8 hrs served SRN
12 PM

Table5: Daily Drug chart; Date: 24/12/2017

Time Drug Dose Route Frequency Remark Identity of
nurse
Morning Rapiclav 1TAB PO BD Taken
8 Am antalge 1TAB PO TID Taken

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19/12/17, Nursing care plan 1: Need to prevent elamptic state.
Nursing diagnosis: Risk of eclampsia related to as evidence by hypertension.
(160|87mmhgh)
Objectives Nursing intervention. Rationale Evaluation.
Reduce blood Restrict salt intake and To prevent fluid Patients risk for
pressure to encourage water and sodium eclampsia is reduced,
normal: intake. retention. as evidenced by
120/80mmgh. reduced blood
To reduce the pressure.
risk of Administer Prevents seizures Patient blood pressure
eclampsia. medications as In pregnant women reduced
prescribed. E.g with conditions
Magnesium sulfate such as
preeclampsia.
Regularly monitor To assess the Regular blood
blood pressure. effectiveness of pressure monitoring
medications. gives a baseline for
assessing effectiveness
of treatment.

26
20/12/17, Nursing care plan 2: Need: Need to be comfortable.
Nursing diagnosis: Discomfort related to caesarian section as evidenced as pain
and tenderness at the operation site.
Objectives Nursing intervention. Rationale Evaluation.
Encourage her to lie on the This helps to relieve Patient
supine position and help to pain on incision site verbalization of
Reduce
ambulate patient. by relaxing the less pain after
pain to the
muscles and also to nursing
acceptance
prevent pressure management.
within two
sores.
days
Advice patient to take sitz To maintain Stitches should
level of
bath. intactness of the not fall off
stitches. before due date
Monitor vital signs hourly To exclude heart Normal
for the first two days post- problems, findings
operative and twice every respiratory tract throughout
day until discharge date. abnormalities, the hospitalization.
presence of
infection that can be
indicated through
hyper psyrexia.

27
21/12/17, nursing care plan 3; Need to reduce excess fluid.
Nursing diagnosis: Fluid volume excess related to preeclampsia as evidenced by
edema over the legs and ankle and decreased urine output.
Objectives Nursing intervention. Rationale Evaluation.
Maintenance Explained to patient and Fluid limitation is Upon evaluation,
of ideal family the rationale of done according to patient has
body weight fluid limitation urine out of the reduced fluid
Without patient volume
excess fluid
through Assess location and To assessed crees in Patient has
nursing
intervention extent of edema, and pressure of edema reduced edema
type daily

28
22/17/17: Nursing care plan 4: Need to keep the body clean and protected.
Nursing diagnosis: Risk of infection related to presence of urinary catheter and
intra venous cannula.
Objectives Nursing intervention. Rationale Evaluation.
To reduce Taught patient about Help to reduce Infection is reduce
level of self care level of infection as evidence by
infection so reduced redness
that patient Removed urinary Enhances healing Patient felt satisfied
do not have catheter and cannula process by
any Administered providing comfort
complication antibiotics as ordered to the patient.
Antibiotics help to
through out
reduced infection
the hospital
stay and Assessed operated site To reduce the level Normal finding of
beyond.
and vital signs daily of infection and the the general state of
progressive state of the patient
the patient

23/12/17 , Nursing care plan 5: Need to eat adequately

Nursing diagnosis: Imbalanced nutrition less than the body requirement related to
anorexia, nausea and dietary restriction and altered oral mucus membrane
Objectives Nursing Rationale Evaluation.
intervention.
To maintain adequate Assess intake and Increase dietary Patient maintain normal
nutrition status by reducing output of patient intake maintain nutritional status
nausea and increased appetite according to lactation

29
Table No 3, Daily evolution chart of the patient
Date Time Observation Identity of nurse

19/12/2017 3:30pm Patient was presenting with lower HND

abdominal pain, edema of the legs
and ankle and 4oweeks and 3days
of gestational age.
2O/12/2017 7:30am Blood pressure reduced. SRN
5:30pm Patient has lost of appetite SRN
21/12/2017 7:3Oam She complained of pain , edema SRH
and stiffness around the injection
site
2am Patient was received from the HND
theatre on a stretcher with normal
saline infusion and a urinary
catheter in a semi conscious state
23/12/2017 7:30am Patient was calm with ,mild lower Mid wife
abdominal pain ,blood pressure
and edema reduced
5:30pm Calm on shift and ambulate out of SRN
bed

30
Date Time Observation Identity of
nurse
24/12/2017 7:30am Patient was calm and HND
satisfied after removal of
urinary catheter
5:30pm No complain HND
25/12/2017 7:30am No reduced edema ,blood Mid wife
pressure body weight and no
infection on discharged

TABLE NO4: VITAL SIGNS CHART

Date Period To BP Body Pulse Respirati Bow Urin Vomit Inta

C weig on el e us ke
ht
19/12/
17 Evenin 37. 159/87mmH 76kg 104b/ 24 2 3 1 0
g 4 g m

20/12/ Morni 37. 158/86mmH 76kg 9ob/ 23 1 3 0 0

17 ng 5 g m
Evenin 37. 158/87mmH 76kg 90b/ 21 2 5 0 0
g 1 g m
21/12/ Morni 37. 150/90mmH 76kg 84b/ 25c/m 1 4 0 0
17 ng 1 g m
Evenin 36. 153/80mmH 71kg 86b/ 24c/m 0 700 0 0
g 6 g m cc
22/12/ Morni 37 145/80mmH 67kg 85b/ 22c/m 0 8oo 0 0
17 ng g m cc
Evenin 37. 130/75mmH 69kg 82b/ 20c/m 0 500 0 0
g 2 g m cc
23/12/ Morni 36. 133/67mmH 69kg 82b/ 23c/m 1 3 0 0
17 ng 4 gHg m
31
Date Period To BP Body Pulse Respirati Bow Urin Vomit Inta
C weig on el e us ke
ht
Evenin 37 136/70mmH 69kg 82b/ 18c/m 2 3 0 0
g g m
23/12/ Morni 36. 133/67mmH 67kg 81b/ 23c/m 2 2 0 0
17 ng 4 g m
Evenin 37 136/70mmH 67kg 80b/ 18c/m 2 4 0 0
g g m
24/12/ Morni 37 140/76mmH 67kg 81b/ 21c/m 2 3 0 0
17 ng g m
Evenin 37. 137/70mmH 67kg 86b/ 20c/m 1 2 0 0
g 1 g m

32
 CHAPTER FOUR – REVIEW OF MEDICATIONS
MEDICATION 1 Novalgin
 Generic Name: Novalgin
 Trade Name: Novalgin metaizem
 Drug Class: Antispasmodic
 Mechanism of action: it alters the mechanism of the heart regulating centre
and raises pain threshold. It help to relax the smooth muscle
 Indication. Labour pains, cystitis, spastic, dysmenorrhea, post operative
romatic conditions, biliary colic, neuralgia, myocardia infection.
 Dosage: Adults, one ample 3times daily, rout of administration, orally,
IV,IM, rectal or suppository
 Side effect, vertigo, hypersensitivity, an anaphylactic reaction
 Contraindication, allergic pregnancy, intermittent porphyria
 Note, infants less than four months shouldn’t be given novalgin. The IV
injection should be given.
 It must not be mixt with another for injection
 Patient did not experience any side effect

MEDICATION2 oxytocin
 Generic Name: oxytocin
 Trade Name: Pitocin, syntocinony,
 Drug Class:
 Mechanism of action: selective stimulant on uterine muscle especially
towards term, during labour and post-partum. Sensitivity of the uterus to
oxytocin increases throughout the pregnancy reaching the maximum term.

33
  Oxytocin is a hormone used to help start and continue labour and to
control bleeding after delivery. It is also sometimes used to help milk
secretion in the breast feeding,
 Dosage, Adult, 10units injected slowly into the vein or muscle.
 Side effects, abdominal pain, nausea and vomiting, prostaglandin and risk of
uterine rupture and cervical laceration. Ergotamine, synergistic effect in
control of post-partum haemorrhage.
 Contraindications, injection of an IV bolus should be avoided because it
may cause short term hypotension with flush and reflex tachycardia
 Precaution: it must be administered in a hospital and under qualified
medical monitoring.
 Administration of excessive doses of oxytocin may lead to foetal distress
asphyxia.
MEDICATION 3 Ampicillin
Generic Name: Ampicillin
 Trade Name: Omnipen
 Mechanism of action: Acts as an irreversible inhibits or of the enzyme
transpeptidasa which is needed by bacteria to make the cell wall inhibit the
third and final stage of bacteria cell wall synthesis in binary fission, which
ultimately leads to cell lysis, therefore ampicillin is usually bacteriolytic
 Dose and mode of administration, Ampicillin 1gram and 2grams are
primarily for IV use, they may be administered IM. When the 250mg or
500mg vials are unavailable, ampicillin 125mg is intended primarily for
paediatric use.
 It can be administered IV, IM, IVD, Orally.
 Side effects Nausea, vomiting, rashes, diarrhoea, swelling of the tongue,
thrush and yeast infection.

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  Contraindication, a history of previous hypersensitivity reaction to any
of the penicillin is a contraindication. Ampicillin is also contraindicated
in infections caused by penicillin as a producing organism.
 Precaution, the possibility of supper infection mycitic organism or
bacterial pathogens should be kept in mind during therapy. In such cases,
discontinue the drug and substitute appropriate treatment
 Patient did not experience any side effect.

MEDICATION 4 Magnesium sulphates

 Generic Name: Mag NEE see um sulphate
 Trade Name: Magnesium sulphate| sodium chloride, mgso4
 Mechanism of action: it is use to prevent seizures in pregnant women with
conditions such as preeclampsia or toxaemia of pregnancy.
 It is also used to treat hypomagnesaemia( low level of magnesium in blood)
 Mode of administration, magnesium sulphate is injected into the muscle or
into the vein and must be received in the hospital or clinic setting. So that
breathing, BP, Oxygen levels will be watched while receiving magnesium
sulphate.
 Dosage, for severe preeclampsia or eclampsia, initial dose 4g to 5grams in
250ml of appropriate diluent, with simultaneous IM administration of up to
5grams (10ml)
 Magnesium maintenance dose 4 to 5grams IM in to alternate buttocks every
4hours as needed.
 Side effects, difficult breading, swollen of the face, lips, tongue, diarrhoea
or upset stomach.
 Contraindication, hypersensitivity, myocardia damage, diabetic coma,
heart block. Hypermagnasemia, hypocalcaemia.

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 Administration during 2hours presiding delivery of mother with toxaemia of
pregnancy.
 Precaution, patients with renal impairment ensure that renal excretory
capacity is not excided.
 Foetal skeletal, hypocalcaemia and hypermagsema abnormalities reported
with continues term use (i.e. longer than 5.7days use) for off lable treatment
of preterm labour in pregnant women, the effect on the developing foetus
may result in neonates with skeletal abnormalities.

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 CHAPTER FIVE - DISCHARGE SUMMARY

5. 1 Date of admission 19 12 2017

5.2 Date of discharge 2412 2018

5.3 Treatment received

Noualgin, magnesium sulphate, ampicilline, oxytocin,

5.4 Response to treatment: the induction failed. She had a CS; a live male baby
was delivered with Apgar 10.

5.5 CONDITION ON DISCHARGE

Patient after receiving her medications was in good and satisfactory condition with
no complain .the patient left the hospital with her baby ,thus in a healthy condition

5.6 Home Treatment

Oral rapiclav and antalgex

5.7 Advice on discharge

Patient was advised on hygiene, proper, breast feeding of the baby and to come
back if she has any complain.

And also to go for family planning

5.8 Appointment after six weeks for post partum examination

5.9 Follow up:

After patient was discharged, he went for appointment and was in good condition,
on calling she was very happy and satisfied for nursing care given to her in the
hospital and at home.

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 CHAPTER SIX

6.1 Positive findings

 The environment is good and contusive for learning; the nurses are very
welcoming and collaborative.
 The hospital equipment are good.
 Standard precaution are effective perform by the nurses.

6.2 Difficulties encountered

 Inadequate bed for nursing mothers in the ward

 Inadequate babies cot in the ward
 Treatment are not always given on time
 Lack of health personnel in the hospital, for that reason patient is not
properly care for.
 Visitor does not respect visiting time in the hospital, hence disturbs patient
sleeping pattern

6.3 Proposed solutions:

 The government should employ enough trained staff reduce work load on
the nurses and promote effectiveness.
 Discipline should be placed on visitors to respect visiting time.

Recommendations:

 The hospital lacks surgical equipment, dressing forceps and drapes are out
dated, the hospital need to purchase new ones and to also to improve on the
working condition of the staff.

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Conclusion:
Despite all the problems encountered, the case study carried at the
Bamenda Regional Hospital was a successful one because my case was well
managed .the secrete to its management is early prenatal visit.
Finally, the internship was a successful one because we did not only nurse a
patient with preeclampsia but other normal delivery mother and their babies.

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