NCM 106 SY 2020-2021

Union Christian College

School of Health and Sciences
City of San Fernando
La Union

CASE
STUDY:
PREECL
AMPSIA
 NCM 106 SY 2020-2021

Submitted by:

ACENA, JOBELLE C

I. Introduction

One of the toxemias of pregnancy is preeclampsia which is characterized by an increased

blood pressure, proteinuria and edema.It usually occurs in the late part of second trimester or
during the third trimester but it may also appear during the first trimester in some women.
Interestingly, many women who suffered preeclampsia have said that the first thing they noticed
was their wedding rings which have gone tight as they reached their second trimester.

The exact cause of preeclampsia is unknown however several risk factors have been
identified. This is most common among women who are pregnant for the first time or what is
called as primigravida. Other factors that may predispose a woman in developing such condition
would include the following:  age of less than 17 or more than 35, previous history
of hypertension, little to no prenatal checkup and genetics also play a certain role in the
development of such condition.

Preeclampsia can lead to a more serious condition known as eclampsia where the patient will
be manifesting the above stated signs and symptoms of preeclampsia plus convulsive seizures.
One significant thing to consider in either preeclampsia or eclampsia is the treatment which is
the delivery of the baby.  This is why monitoring the patient is very essential because termination
of pregnancy cannot be done at any time unless there is an assurance that the baby can already
withstand extra-uterine life.

It must be noted that preeclampsia and eclampsia post serious health risks to both the fetus
and the mother and oftentimes may result to fatality if not controlled or prevented.

II. Anatomy and Physiology

The Circulatory System

 NCM 106 SY 2020-2021

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:
 The right atrium, which is a chamber which receives oxygen- poor blood from the veins.
 The right ventricle which pumps the oxygen-poor blood from the right atrium to the
lungs.
 The left atrium which receives the now oxygen-rich blood that is returning from the
lungs.
 The 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 transport 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 waste from these body tissues.

Blood Pressure

Blood pressure is the force exerted by the blood against the walls of the blood vessels. The
output 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 between the blood
and the wall of the blood vessel.
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Blood pressure = blood flow x resistance.

III. Pathophysiology

Predisposing Factor
 Family Hx – HTN in Precipitating factor
maternal side  Lifestyle
 Age  Hypertension

Unknown Etiology

Inadequate placentation

Uterine spiral arteries are poorly invaded by

cytotrophoblast

Incomplete Cytotrophoblast failed

pseudovascularization to replace tunica media

Decreased placental
perfusion Vasoconstriction Endothelial
Incomplete dysfunction
pseudovascularization

Increase BP
Constrictive properties
of the arterioles Glomerular
remained endothelial is
damaged

Filtration
capacity fails

Proteinuria
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Edena

IV. Laboratory and Diagnostic Examination

Complete Blood Count and Serum Chemistries

Reference Range Preeclampsia
Hemoglobin 12-16g/dL Elevated
Hematocrit 37%-47% Elevated
Platelets 150,000-400,000/mm3 Decreased
Fibrinogen 200-400mg/dL Elevated
Blood Urea Nitrogen (BUN) 10-20 mg/dL Elevated
Creatinine 0.5-1.1 mg/dL Elevated
LDH 45-90 u/L Elevated
AST 4-20 u/L Elevated
ALT 3-21 u/L Elevated
Creatinine Clearance 80-125 mL/min Elevated
Uric Acid 2-6.6 mg/dL Elevated
Bilirubin 0.1-1 mg/dL Elevated
Renal function studies:
 Proteinuria 0.3 g or more in a 24-hr urine specimen is diagnostic for preeclampsia. With
kidney involvement, blood tests may show rising serum creatinine, uric acid, and blood
urea nitrogen (BUN). Elevated creatinine clearance in a 24-hr urine collection indicates
reduced renal function.

Liver function tests:

 ALT, AST, and LDH rise with severe preeclampsia and rise even further with HELLP
syndrome.

Coagulation studies:
 Platelet count decreases in severe preeclampsia and HELLP syndrome. Intrinsic or
extrinsic factors may induce clot formation.

Obstetric ultrasound:
 Serial ultrasounds are commonly used to estimate fetal growth and amniotic fluid index
(AFI).

Daily fetal activity monitoring, nonstress testing (NST), and biophysical profile (BPP):
 These tests assess uteroplacental perfusion.

V. Medical/Surgical/Nursing Management

VI. Evaluation

After rendering holistic care, the patient will be discharged with an improved condition as
evidenced by having the sufficient knowledge, attitude, and skill in managing her disease
 NCM 106 SY 2020-2021

condition. She will be given discharge health teaching about her diet and discharge medication
will also be given.

VII. Implication

Nursing Practice

This case study provides information about Preeclampsia and nursing interventions and
therapeutic techniques used with patients who have this condition. It also provides information
about the plan of care for patients who have this disease condition for efficient nursing care.

Nursing Education

To nursing education, this case study would help by providing information about the
disease condition Preeclampsia. The student nurses, as well as the teachers could gain additional
information about this disease that is common in children, so that it could better equip them for
efficient nursing care in the future.

Nursing Research

To the research team, that they will be able to come up with a new and better interventions,
whether medical or nursing, to treat the disease at an early duration as well as knowing the latest
facts to prevent the occurrence of the disease.

VIII. Recommendations

https://rnspeak.com/preeclampsia-pathophysiology-and-schematic-diagram/
https://nursekey.com/high-risk-perinatal-care-gestational-conditions/
https://nursekey.com/preeclampsia/