Saint Mary’s University

Bayombong, Nueva Vizcaya

SCHOOL OF HEALTH SCIENCES

PRE-ECLAMPSIA

A case study presented to:

Joman J. Baliton, R.N.

Patrick M. Lannu, R.N.
Joy Lyzette R. Carreon, RN.
PANELIST

PRESENTED BY:
Princess Anne A. Andres
Philip Jerome A. Flores
Chantilly Mercedez C. Rosario
Krizzadora B. Tumaneng
John Mark R. Garma
Madel L. Ramos
Rutchie C. Magdirila
Von Ian Viemer M. Dulnuan
Benjamin Clifford V. Cuisia, Jr.
Bendita S. de Guia
Christian Dave A. Bongolan
GROUP-15
 October 2006
I. PERSONAL DATA

Patient’s Initial: N.O.

Address: Paracelis, Mountain Province
Birthday: May 08, 1973
Birthplace: Lamo, Dupax del Norte, Nueva Vizcaya
Age: 33 years old
Gender: Female
Religion: Roman Catholic
Nationality: Filipino
Civil Status: Married
Educational Attainment: College Undergraduate (1st yr)
Occupation: Housewife

Name of Husband: Roy

Occupation: Government Employee (Messenger)

Date of Admission: September 30, 2006

Time of Admission: 1:30 p.m.

Attending Physician: Dr. Fernandez

Chief Complaint: persistent high blood pressure

Admitting Diagnosis: G8P6 (6-0-1-6) PUFT, 40 2/7 wk. AOG NIL, PIH T/C CHVD

II. HISTORY OF PRESENT ILLNESS

2 days PTA, a 33 year old 8 month old pregnant for female together with her husband went to Mountain
Province Provincial Hospital with complaints of headache, dizziness, loss of hearing and difficulty of breathing.
She had an initial BP of 160/120mm Hg, on and off headache and no edema noted. She was diagnosed with
“T/C pre eclampsia” by Dr. Mariano. The doctor ordered methyldopa tablet for her medication due to her
persistent high BP. An advised she to undergo caesarean operation but due to lack of facilities needed for the
procedure, a referral was made which prompted consultation at VRH.
A Few hours PTA the Patient has an initial BP of 130/90 mm Hg and a temperature of 37.1 ºC.
At around 1:30 p.m, she was then admitted at Veterans Regional Hospital. She was seen and examined by Dr.
Fernandez.

III. HISTORY OF PAST ILLNESS (PAST HEALTH PROBLEM)

According to the patient, two years ago, while having her 7th pregnancy, she started experiencing
dizziness and difficulty of breathing. She was admitted at Mountain Province Provincial Hospital and was
diagnosed of Pregnancy Induced Hypertension. When she was asked about the cause of her hypertension, she
narrated that she is fond of eating fatty foods.

Furthermore, she never had serious heath problems except for common colds, abdominal pain, mild
fever and cough. Whenever she experiences these minor health problems, she doesn’t seek for medical advise.
She only takes Paracetamol for mild fever and Mefenamic acid to relieve intolerable pain.
IV. FAMILY HISTORY

No noted heredo-familial diseases.

V. BRIEF DESCRIPTION OF THE DISEASE

Pre-eclampsia, also called toxemia of pregnancy is a serious disorder that occurs in about 1 in every 20
pregnancies. This disorder is characterized by the onset of acute hypertension after the 24 weeks, accompanied
by proteinuria and edema. The causes of pre-eclampsia are largely unknown, despite intense research efforts.
Pre-eclapsia can result in complications such as abruptio placenta, stroke, hemorrhage, fetal malnutrition and
low birth weight. This condition can progress to eclampsia, a life threatening form of toxaemia that causes
severe convulsion, coma, kidney failure and perhaps death of fetus and mother.

Typically, pre-eclampsia occurs after 20 weeks gestation, though it can occur earlier. Proper prenatal
care is essential to diagnose and manage pre-eclampsia. A woman is said to be mildly pre-eclampsia when her
blood pressure rises to 140/90 mm Hg, taken on two occasions at least 6 hours apart. The diastolic value of
blood pressure is extremely important to note because it is the pressure that best indicates the degree of
peripheral arterial spasm present. A second criterion is systolic blood pressure greater than 30 mm Hg and
diastolic pressure greater than 15 mm Hg above pre-pregnancy values. A woman has past from mild to severe
pre-eclampsia when her blood pressure has risen to 160 mm Hg systolic and 110 mm Hg diastolic or above on
at least two occasions 6 hours apart at bed rest or her diastolic pressure is 30 mmHg above the pre-pregnancy
level. With severe pre-eclampsia, the extreme edema will be noticeable in the woman’s face and hands as
puffiness.

The only known cure for pre-eclampsia is to induce delivery as soon as the baby can survive outside the
uterus thus; if pre-eclampsia occurs, administration of magnesium sulfate is the standard treatment.
VIII. LABORATORY ANALYSIS

Urinalysis September 30, 2006

Color: Yellow Epithelial cells: ++
Transparency: Slightly turbid Pus cells: 1-2
Reaction: Acidic Red Blood Cells: 6-8
Protein: Positive Amorphous substance urates: +
Sugar: Negative
Specific gravity: 1.030

Immunology Laboratory Test Result September 30, 2006

TEST METHOD RESULT
HBS Ag Immuchromatography Non-reactive

Hematology September 30, 2006

TEST RESULT NORMAL VALUES IMPLICATION
Hemoglobin 147.0 M: 140-175 g/L Normal
F: 123-153 g/L
Hematocrit 0.45 M: 0.41 – 0.50 Increased
F: 0.35-0.44
Leukocyte no. conc. 9.6 4.4-11.3 x 10 g/L Normal
Leukocyte no. fraction
Neutrophils 0.7 0.56 Increased
Lymphocytes 0.28 0.34 Decreased
Thrombocyte no. conc. 286.0 150-450 x 10 g/L Normal
Blood Type “O”

Blood Chemistry October 1, 2006

TEST RESULT NORMAL VALUES IMPLICATION
BUN 10 7-18 mg/dL Normal
CREA 0.7 0.6-1.3 mg/dL Normal
CHOL 249 HI 0-200 HI Increased
AST 44 HI 15-37 HI Increased

Ultrasound October 2, 2006

Report of Boiphysical Profile Placenta
BPD 8.8 36W2D Location: Posterior
FOD 11.2 36W3D Grade: - 3
HC 31.9 35W3D
AC 28.2 32W3D Biophysical Profile Scoring
FL 6.4 33W3D AFP 2/2
FHB 133 BPM F.tone: 2/2
F. breathing 2/2
AOG 39 weeks 5 days F. Mov’t: 2/2
EFW 2146 grms Total: 8/8
Diagnosis: I.U.P. LIVE Singleton at 34W5D by average biometrycephalic placenta posterior G-3
 no previa
 BPS 8/8
IX. PHYSICAL ASSESSMENT
ASSESSMENT PATHOPHYSIOLOGICAL BASIS
FORMAT
  Level of consciousness: awake and
alert
P  Stage of psychological development:
Psychosocial Middle age
 Coping mechanism: resting, sleeping,
taking to her husband, watching,
listening to radio
 Significant others: husband
 Religion: Pentecost
 to conserve energy and divert
attention
 the pt. needs emotional support from
persons whom she trusts because she
might have fears to overcome with
the help of trusted persons
 each individual is granted the right to
choose what she wishes to believe
and join with.

 Primary Language: Igorot  the fluency of a person to a dialect or

language depends on the
environment she is exposed with.

 Primary Source of Health Care: Brgy.

Health Centers
 Financial Resources related to income:
family income; PHILHEALTH
 Occupation: Housewife
 Education: college undergraduate  indicates pt’s level of understanding
 General appearance: pale looking,  unable to take good care of her self ,
pale due to fatigue and abdominal
guarding behavior due to pain
 Affect: euthymic  she is in good psychological state
 Speech:
 Quantity - expansive
 Rate - normal
 Volume – soft
 Fluency and rhythm – clear

 Orientation: oriented regarding self,

person, place and time
 Memory: intact, can recall past and
previous events
 Non-verbal behavior: nodding and
shaking
 one can determine possible defects
on the memory and that a constant
reminder may be needed
 Nodding means an affirmation and
shaking implies a negative answer.
 E  Stool: 0  A person’s stool consistency and
Elimination Pattern: pattern depends on the amount of
Color: food and fluid taken in
Consistency:

 Urine output: 1 during the shift  the quantity and frequency of

Quantity: 90-100 cc per voiding urination depends on the amount of
pt’s intake of fluid and the integrity
of renal system to eliminate

 yellowish color of urine is due to

Color: yellowish the hemolysis of hemoglobin that
release urochrome as its byproduct

Transparency: clear
Specific gravity: 1.30
 Abdomen:
Contour: distended  due to pregnancy
 Toileting Ability: without assistance

R  Current Activity level: limited  she needs to have rest in order for
Rest and Activity  ADLs: can eat, sit, ambulate with her to conserve energy
assistance

 Sleep: 4-6hrs of interrupted sleep  due to easy fatigue and limited

ROM
 she needs rest to decrease energy
requirement thus facilitating
gaining her strength
 Body Built: mesomorph  due to disease process
 Muscle Strength:

5/5 5/5

5/5 5/5

 Muscle tone: norrmotonic

S  Allergy: No history of allergies on

Safe Environement food and medicines
 Position assumed: semi-fowlers

 Eyes and vision: PERRLA  the pupils are round, reactive to

 light and accommodation

 Hearing: Intact (can understand

whispers) with no hearing aids
 Skin integrity: has scars on her right
leg, no surgical incision
 Mucous membrane: dry
 Temp: 36.8 ºC
Route: axilla

O  Activity Tolerance: limited  due to dizziness whenever she

Oxygen walks
 Airway clearance: clear
 Mouth: clear
 Respiratory rate: 24 cpm  compensatory mechanism due to
Rhythm: fast increased metabolic demand
Depth: shallow

 Color:  there is an inadequate blood

Skin: brown circulation
Nail bed: pale
Lips: pale
 Capillary refill: 1-2 seconds

 Peripheral pulses:
Location: radial
Rate: 64 bpm
Rhythm: normal
Strength: weak
 Edema: none
 Blood Pressure: 160/90mm Hg

N  Hospital diet: temporary NPO

Nutrition  56.2kg (123.64lbs)
 153cm (5 ft)
 IVF: D5LR 1L
 Tissue turgor: normal
 Ability to:
Chew: able
Swallow: able
Feed self: able
X. COURSE IN THE WARD

Last September 30, 2006 at around 1:30 pm, a 33 year old, 8 th month old pregnant female with
chief complaints of high BP, dizziness, on and off headache and loss of hearing. No edema noted. Initial vital
signs taken as baseline data, her BP-130/90 mmHg, temp- 37.1 ºC. She was seen and examined by Dr.
Fernandez and diagnosed her with PIH t/c Chronic Hypertensive Vascular Disease. She was advised to be
admitted for further evaluation and treatment. Consent for admission was secured and signed by her husband.
An IVF of D5LRS 1 L regulated at KVO was inserted at her left hand. On NPO. Medication ordered and carried
out were Magnesium Sulfate 4meqs slow IV then 5meqs deep IM on each buttocks and Hydralazine 5mg IV
now. Diagnostic request were CBC blood typing, APC, HBS Ag, urinalysis, BUN, Crea, SGOT, SGPT, AST
Cholesterol and TABS. Transferred from ER to OB ward with same IVF on, infusing well. After that, she was
placed on bed comfortably. At 7:30 pm, her BP was 140/100, so, she was given Hydralazine 5mg IV and
Paracetamol 500 mg 1 tab. She was also given a sidedrip of D5W 500cc + 4 amps Hydralazine and 4 amps
Clonidine. Sidedrip was discontinued when BP was less than 140/90 mmHg. Urinalysis, HBS Ag, CBC, blood
typing and APC done. For blood chem.. in the morning. The patient was instructed NPO post dinner and
ncouraged to have complete bed rest. She was endorsed with the LBP of 120/80 mmHg.

October 1, 2006, first day of hospitalization, received patient lying on bed with same IVF of
D5LRS 1L approximately 250 cc regulated KVO infusing well at her left hand. Complaints of headache. Blood
chem. was done. Still for TABS. Seen and examined by MROD during rounds, new orders of Mefenamic acid
500mg 1 cap stat to relieve headache and UTZ and was carried by the Nurse on duty. At 1:15pm, above IVF
consumed and followed-up with D5LRS 1L regulated at KVO. Needs attended. Endorsed with LBP of 130/80
mmHg.

October 2, 2006, second day of hospitalization,, received patient lying on bed with same IVF of
D5LRS 1L approximately 200cc regulated KVO infusing well at her left hand. Complaints of nausea. UTZ
done in the morning. Seen and examined by MROD during rounds, ordered to monitor BP every 1 hour and
refer once BP is persistently increased and was carried by the Nurse on duty. Above IVF consumed and
followed-up with D5LRS 1L regulated at KVO. At 3:30pm, Dexamethasone 12mg IV every 12 hours for 2
doses was ordered additionally. By 6:00pm, her BP was 160/90mmHg, side drip was continued and BP was
ordered to monitor every 15 mins. Discontinued when BP was less than 140/90mmHg. Meds continued. Needs
attended. Endorsed with LBP of 120/90 mmHg.

October 3, 2006, third day of hospitalization, received patient sitting on chair with same IVF of
D5LRS 1L approximately 100cc regulated KVO infusing well at her left hand. Seen and examined by MROD
during rounds with new orders of fetal heart tone and BP monitoring every 1 hour, refer if BP is persistently
increased, ECG, AST and was carried by the Nurse on duty. Above IVF consumed and followed-up with
D5LRS 1L regulated at KVO. Meds continued. Endorsed with LBP of 130/90mmHg.