Aklan Polytechnic College: Objectives General Objective

AKLAN POLYTECHNIC COLLEGE
Kalibo, Aklan
College of Nursing
OBJECTIVES
General Objective:
After the case study, the nursing students will be able to acquire new knowledge, enhance learning
skills and demonstrate desirable attitude towards the care of a client with Preeclampsia through the
utilization of the nursing process.
Specifically, we will be able to:
Knowledge
 Define terminologies related to Preeclampsia;
 Discuss and explain the etiology, clinical signs and symptoms, incidence rate, diagnostic
procedures and management of client with Preeclampsia;
 Discuss the Anatomy and Physiology of the Female Reproductive System, Cardiovascular System
and Fetal Circulation;
 Explain the Pathophysiology of Preeclampsia;
 Identify and explain the drugs used to treat Preeclampsia;
 List nursing responsibilities in caring a client with Preeclampsia;
Skills:
 Assess and classify gathered data relevant to client condition;
 Formulate nursing diagnosis specific to the identified health problem;
 Plan a care specific to the client’s identified health problems;
 Implement effectively the plan of care being identified;
 Evaluate the effectiveness of nursing care and make revisions in order to meet the objectives of
care;
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College of Nursing
 Formulate a Concept Map of care;
 Evaluate deviation of laboratory results and its significance;
 Establish rapport and promote cooperation through nurse – client interaction;
Attitude:
 Acknowledge client’s expression of feelings and emotions;
 Listen attentively to client’s queries about their health;
 Recognize client’s right for privacy and confidentiality;
 Observes courtesy at all times to the client and to all the members of the health team.
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College of Nursing
DEFINITION OF TERMS
 Abruptio Placenta: Placental bleeding after the 24th week of pregnancy, which may result in
complete or partial detachment of the placenta from the wall of the womb. The woman may go into
shock. The condition is sometimes associated with raised blood pressure and pre-eclampsia
 Aldosterone: is a hormone secreted by the adrenal cortex. It plays an important part in maintaining
the electrolyte balance of the body by promoting the reabsorption of sodium and the secretion of
potassium by the renal tubules. It is thus of primary importance in controlling the volume of the
body fluids.
 Angiotensin: is a peptide that occurs in two forms: I and II. The former results from the action of
the enzyme, renin on alpha globulin (a protein) produced by the liver and passed into the blood.
During passage of the blood through the lungs, angiotensin I is converted into an active form,
angiotensin II, by an enzyme. This active form constricts the blood vessels and stimulates the release
of two hormones – vasopressin and aldosterone – which raise the blood pressure.
 Cerebral edema: Accumulation of excessive fluid in the substance of the brain. The brain is
especially susceptible to injury from edema, because it is located within a confined space and cannot
expand.
 Diabetes Mellitus is a condition characterized by a raised concentration of glucose in the blood due
to a deficiency in the production and/or action of insulin, a pancreatic hormone made in special cells
called the islet cells of langerhans.
 Eclampsia: is an extension of preeclampsia and is characterized by the client experiencing seizures.
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College of Nursing
 Enzyme (ACE) Inhibitors: the enzyme that converts angiotensin I to angiotensin II (see
angiotensin) is called angiotensin-converting enzyme. Angiotensin II controls the blood pressure
and is the most potent endogenous pressor substance produced in the body; angiotensin I has no
such pressor activity. Inhibition of the enzyme that converts angiotensin I to angiotensin II will thus
have marked effects on lowering the blood pressure, and ACE inhibitors have a valuable role in treating
heart failure when thiazides and beta blockers cannot be used or fail to work, especially after myocardial
infarction.
 Fertilization: The process by which male and female gametes (spermatozoa and oocytes
respectively) fuse to form a zygote which develops, by a complex process of cell division and
differentiation, into a new individual of the species.
 Fetal distress: Compromise of the fetus during the antepartum period (before labor) or intrapartum
period (birth process). The term "fetal distress" is commonly used to describe fetal hypoxia (low
oxygen levels in the fetus).
 Fetal Growth Restriction (FGR): Formerly called Intrauterine Growth Restriction, refers to a
condition in which an unborn baby is smaller than it should be because it is not growing at a normal
rate inside the womb.
 Gestational hypertension: High blood pressure that you develop while you are pregnant. It starts
after you are 20 weeks pregnant.
 Glomerular filtration rate (GFR): is a test used to check how well the kidneys are working.
Specifically, it estimates how much blood passes through the tiny filters in the kidneys, called
glomeruli, each minute.
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 High blood pressure (HBP) or hypertension: Means high pressure (tension) in the arteries.
 Obesity: is a medical condition in which excess body fat has accumulated to the extent that it may
have an adverse effect on health, leading to reduced life expectancy and/or increased health
problems.
 Pre-Eclampsia: a complication of pregnancy, of unknown cause, which in severe cases may
proceed to eclampsia. It is characterised by hypertension, renal impairment, oedema, often with
proteinuria and disseminated intravascular coagulation.
 Pregnancy Induced Hypertension (PIH): High arterial blood pressure, in adults, usually defined
as pressures exceeding 140/90.
 Proteinuria: Excess protein in the urine. Some protein is normal in the urine. Too much means
protein is leaking through the kidney, most often through the glomeruli. The main protein in human
blood and the key to the regulation of the osmotic pressure of blood is albumin
 Pulmonary edema: is an abnormal build-up of fluid in the air sacs of the lungs.
 HELLP Syndrome: is a type of severe pre-eclampsia (a disorder affecting some pregnant women)
that affects various systems in the body. Hemolysis, raised concentration of the enzymes in the liver,
and a low blood platelet count are among the characteristics (and explain the name hellp); patients
are acutely ill and immediate termination of pregnancy is necessary.
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College of Nursing
INTRODUCTION
Pregnancy-induced hypertension (PIH) is defined as hypertension that exists during pregnancy after
20 weeks’ gestation with no protein in the urine or any other clinical signs of pre-eclampsia (PE). PE during
pregnancy complicates approximately 3–5% of pregnancies until now it considers one of the most leading
causes of maternal and neonatal mortality.
Pre-eclampsia is a medical condition where hypertension arises in pregnancy (pregnancy- induced
hypertension) in association with significant amounts of protein in the urine. Because pre-eclampsia refers
to a set of symptoms rather than any causative factor, it is established that there are many different causes
for the syndrome. It also appears likely that there is a substance or substances from the placenta that may
cause endothelial dysfunction in the maternal blood vessels of susceptible women.
Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects
both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive
condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden
weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly
advancing disease report few symptoms.
EPIDEMIOLOGY OF PREECLAMPSIA
A systematic review by World Health Organization indicates that hypertensive disorders account
for 16% of all maternal deaths in developed countries, 9% of maternal deaths in Africa and Asia, and as
high as 26% in Latin America and the Caribbean. Where maternal mortality is high, most of the deaths are
attributable to eclampsia, rather than preeclampsia.
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College of Nursing
Severe morbidity associated with preeclampsia and eclampsia include renal failure, stroke, cardiac
dysfunction or arrest, respiratory compromise, and liver failure. In a study of hospitals managed by Health
Care America Corporation, preeclampsia was the second leading cause of pregnancy-related intensive care
unit admissions after obstetric hemorrhage.
Pregnancy induced hypertension is a condition which effects many women in the world. This
is true even for those expecting mothers in the Philippines. Studies of preeclampsia report about 5
percent of nulliparous women develop preeclampsia and 40 to 50 percent of these women develop
severe disease worldwide. In the Philippines, according to Department of Health, Maternal Mortality
Rate (MMR) is 162 out of 10,000 live births (Family Planning Survey 2006). Maternal deaths account
for 14% of deaths among women. For the past five years all of the causes of maternal deaths exhibited
an upward trend. Preeclampsia showed an increasing trend of 6.89%; 20%; 40%; and 100%. Ten
women die every day in the Philippines from pregnancy and childbirth related causes but for every
mother who dies, roughly 20 more suffer serious disease and disability. The UNFPA office in the
Philippines declared that family planning can help prevent maternal deaths by 35%.
Various reports show that 5-8 percent of pregnancies are affected by pre-eclampsia worldwide, with
76,000 maternal and 500,000 fetal deaths yearly. In the Philippines, eclampsia was the leading cause of
maternal death (19.6 percent) based on local statistics (PSA, 2015).
SIGNS AND SYMPTOMS
Preeclampsia sometimes develops without any symptoms. Monitoring blood pressure is an
important part of prenatal care because the first sign of preeclampsia is commonly a rise in blood
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College of Nursing
pressure. Blood pressure that exceeds 140/90 millimeters of mercury (mm Hg) or greater — documented
on two occasions, at least four hours apart — is abnormal.
Other signs and symptoms of preeclampsia may include:
 Excess protein in urine (proteinuria) or additional signs of kidney problems
 Severe headaches
 Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
 Upper abdominal pain, usually under the ribs on the right side
 Nausea or vomiting
 Decreased urine output
 Decreased levels of platelets in blood (thrombocytopenia)
 Impaired liver function
 Shortness of breath, caused by fluid in the lungs
Sudden weight gains and swelling (edema) — particularly in the face and hands — may occur with
preeclampsia. But these also occur in many normal pregnancies, so they're not considered reliable signs of
preeclampsia.
CAUSES
The exact cause of preeclampsia involves several factors. Experts believe it begins in the placenta
— the organ that nourishes the fetus throughout pregnancy. Early in pregnancy, new blood vessels develop
and evolve to efficiently send blood to the placenta.
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College of Nursing
In women with preeclampsia, these blood vessels don't seem to develop or function properly.
They're narrower than normal blood vessels and react differently to hormonal signaling, which limits the
amount of blood that can flow through them.
Causes of this abnormal development may include:
 Insufficient blood flow to the uterus
 Damage to the blood vessels
 A problem with the immune system
 Certain genes
Preeclampsia is classified as one of four high blood pressure disorders that can occur during pregnancy.
The other three are:
 Gestational hypertension. Women with gestational hypertension have high blood pressure but no
excess protein in their urine or other signs of organ damage.
 Chronic hypertension. Chronic hypertension is high blood pressure that was present before
pregnancy or that occurs before 20 weeks of pregnancy.
 Chronic hypertension with superimposed preeclampsia. This condition occurs in women who
have been diagnosed with chronic high blood pressure before pregnancy, but then develop
worsening high blood pressure and protein in the urine or other health complications during
pregnancy.
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College of Nursing
RISK FACTORS
Preeclampsia develops only as a complication of pregnancy. Risk factors include:
 History of preeclampsia
 Chronic hypertension
 First pregnancy
 New paternity
 Age (Very young pregnant women ages 15-20 as well as pregnant women older than 35.)
 Race (Black women have higher risk of developing preeclampsia than women of other races)
 Obesity
 Multiple pregnancy
 Interval between pregnancies
 History of certain conditions
 In vitro fertilization
COMPLICATIONS
The more severe preeclampsia and the earlier it occurs in pregnancy, the greater the risks for the
mother and the baby. Preeclampsia may require induced labor and delivery.
Complications of preeclampsia may include:
 Fetal growth restriction. Preeclampsia affects the arteries carrying blood to the placenta. If the
placenta doesn't get enough blood, the baby may receive inadequate blood and oxygen and fewer
nutrients.
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College of Nursing
 Preterm birth. If the pregnant women have preeclampsia with severe features, the mother may
need to be delivered early, to save the life of the mother and the baby.
 Placental abruption. Preeclampsia increases the risk of placental abruption, a condition in which
the placenta separates from the inner wall of the uterus before delivery. HELLP syndrome. HELLP
— which stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low
platelet count — syndrome is a more severe form of preeclampsia, and can rapidly become life-
threatening for both the mother and the baby.
 Eclampsia. When preeclampsia isn't controlled, eclampsia — which is essentially preeclampsia
plus seizures — can develop.
 Other organ damage. Preeclampsia may result in damage to the kidneys, liver, lung, heart, or eyes,
and may cause a stroke or other brain injury.
 Cardiovascular disease. Having preeclampsia may increase the risk of future heart and blood
vessel (cardiovascular) disease.
PREVENTION
There currently are no well-established measures for preventing preeclampsia. But some
evidence does support the use of low-dose aspirin therapy and daily calcium supplementation in certain high-
risk women. Calcium supplementation has been shown to produce modest blood pressure reductions in
pregnant women who are at above-average risk for hypertensive disorders of pregnancy and in pregnant
women with low dietary calcium intake. An optimum calcium dosage for these women has not been
established. Low-dose aspirin therapy (100 mg per day or less) has been shown to reduce the incidence of
preeclampsia in women who were found to have an abnormal uterine artery on Doppler ultrasound
examination performed in the second trimester.

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College of Nursing
Women who do not receive prenatal care are seven times more likely to die from
complications related to preeclampsia-eclampsia than women who receive some level of prenatal care. Some
studies indicate that preeclampsia-related fatalities occur three times more often in black women than in
white women. Although the precise reasons for the racial differences remain elusive, the differences may be
indicative of disparities in health status, as well as access to, and quality of, prenatal care. To decrease
preeclampsia-related mortality, appropriate prenatal care must be available to all women. Early detection,
careful monitoring, and treatment of preeclampsia are crucial in preventing mortality related to this disorder.
DIAGNOSTIC TEST/ LABORATORY TEST
To diagnose preeclampsia, the pregnant women should have high blood pressure and one or more of the
following complications after the 20th week of pregnancy:
 Protein in your urine (proteinuria)
 A low platelet count
 Impaired liver function
 Signs of kidney problems other than protein in the urine
 Fluid in the lungs (pulmonary edema)
 New-onset headaches or visual disturbances
If the doctor suspects preeclampsia, the certain needs for the tests are the following:
 Blood tests. The doctor will order liver function tests, kidney function tests and also measure your
platelets — the cells that help blood clot.
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College of Nursing
 Urine analysis. The doctor will ask the pregnant women to collect the urine for 24 hours, for
measurement of the amount of protein in the urine. A single urine sample that measures the ratio of
protein to creatinine — a chemical that's always present in the urine — also may be used to make
the diagnosis.
 Fetal ultrasound. The doctor may also recommend close monitoring of the baby's growth, typically
through ultrasound. The images of the baby created during the ultrasound exam allow the doctor to
estimate fetal weight and the amount of fluid in the uterus (amniotic fluid).
 Nonstress test or biophysical profile. A nonstress test is a simple procedure that checks how the
baby's heart rate reacts when your baby moves.
 Biophysical profile uses an ultrasound to measure the baby's breathing, muscle tone, movement
and the volume of amniotic fluid in the uterus.
NURSING MANAGEMENT
The absence of definitive strategies to prevent preeclampsia limits nurses' ability to provide
anticipatory guidance and teach patients evidence-based approaches for reducing preeclampsia risk. Nurses
can, however, encourage all women planning pregnancy to work toward achieving a healthy body weight
and consume a healthy diet replete with recommended nutrients. Current guidance is to limit foods with
added sugars and those that are high in fat and to eat a variety of fruits, grains, vegetables, low-fat or fat-
free dairy, and proteins, avoiding such sources of mercury as shark, swordfish, mackerel, and tilefish, and
limiting the consumption of another source, tuna, to less than six ounces per week.
Current screening approaches include preeclampsia risk identification through the collection of
demographic information and comprehensive personal and family history.
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Warning signs of preeclampsia can occur during the second half of pregnancy and in the postpartum
period. Nurses play a key role in teaching pregnant women about these subtle, subjective warning signs.
Accurate Blood pressure measurement is crucial. Ask the patient to sit comfortably-with her back
supported, her feet flat on the floor, and her arm at heart level. Select the proper cuff size based on the
patient's arm circumference, and measure blood pressure on the same arm each time.
Changes in body weight may indicate fluid imbalance associated with generalized edema. A weight gain
of more than three to five pounds in one week, reduced urine output, or the presence of edema, including
pulmonary edema, suggest preeclampsia-associated fluid imbalance, especially during the second half of
pregnancy.
Preeclampsia diagnosis and surveillance.
Upon diagnosis of preeclampsia, maternal and fetal surveillance is initiated to determine progression
and severity. Maternal assessment includes evaluation of subjective symptoms, serial blood pressure
measurement, physical assessment, and laboratory analyses to guide intervention. Fetal surveillance
includes serial nonstress testing to evaluate fetal oxygenation, ultrasound measurement of amniotic fluid
volume as a proxy for fetal-placental perfusion, and estimation of fetal growth and gestational age.
Determining optimal timing of delivery.
Gestational age at diagnosis and severity of preeclampsia are major factors in determining optimal
timing of delivery, which is the only way to reverse preeclampsia that occurs during pregnancy. The ACOG
Task Force recommends delivery for women with preeclampsia who are at or beyond 37 weeks' gestation
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College of Nursing
or who are between 34 and 37 weeks' gestation and have preeclampsia with severe features. In women
between 20 and 34 weeks' gestation, preeclampsia with severe features is ideally managed in a facility with
adequate maternal and neonatal intensive care resources. Because of the risk of preterm birth, care includes
corticosteroid administration to enhance fetal lung maturity.
Pharmacologic treatment for severe sustained hypertension in pregnancy and the postpartum period is
instituted when systolic blood pressure rises to or above 160 mmHg or when diastolic blood pressure rises
to or above 110 mmHg.
The goal is to stabilize blood pressure at 140-150/90-100 mmHg (see Figure 241). If blood pressure
is reduced to below established goals, perfusion to maternal organs and the fetus may be insufficient.
Nursing management includes assessment of maternal response to antihypertensive therapy.
Magnesium sulfate may be used for seizure prophylaxis and control in women who have
preeclampsia with severe features, or eclampsia. Nursing management includes assessment for magnesium
toxicity, evidenced by loss of consciousness, absent deep tendon reflex activity, and a respiratory rate below
12 breaths per minute. As magnesium sulfate is excreted by the kidneys, urine output below 30 mL per hour
increases the risk of toxicity. Fluid replacement should be judicious, even with oliguria, as preeclampsia
predisposes women to fluid imbalance.
Long-term risk of cardiovascular disease.
Nurses should reinforce with patients the importance of long-term follow-up. The ACOG Task
Force recommends that women with a history of either preeclampsia and preterm delivery or recurrent
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preeclampsia undergoes yearly assessments that measure blood pressure, lipid levels, fasting blood glucose
levels, and BMI.
MEDICAL MANAGEMENT
Medication is recommended to help lower blood pressure. These medications reduce the likelihood
of serious complications, such as stroke. Some of the medications used regularly in the UK include labetalol,
nifedipine or methyldopa.
Labetalol is specifically licensed for use in pregnant women with high blood pressure. This means
the medication has undergone clinical trials that have found it to be safe and effective for this purpose.
But while methyldopa and nifedipine aren't licensed for use in pregnancy, they can be used "off-
label" (outside their licence) if it's felt the benefits of treatment are likely to outweigh the risks of harm to
the pregnant women and her baby. These medications have been used by doctors in the UK for many years
to treat pregnant women with high blood pressure.
Possible treatment for preeclampsia may include:
 Medications to lower blood pressure. These medications, called antihypertensives, are used to
lower the blood pressure if it's dangerously high. Blood pressure in the 140/90 millimeters of
mercury (mm Hg) range generally isn't treated.
Although there are many different types of antihypertensive medications, a number of them aren't
safe to use during pregnancy. It should be discussed with the doctor whether to used an
antihypertensive medicine to control blood pressure.
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 Corticosteroids. Severe preeclampsia or HELLP syndrome, corticosteroid medications can
temporarily improve liver and platelet function to help prolong the pregnancy. Corticosteroids can
also help the baby's lungs become more mature in as little as 48 hours — an important step in
preparing a premature baby for life outside the womb.
 Anticonvulsant medications. If the preeclampsia is severe, the doctor may prescribe an
anticonvulsant medication, such as magnesium sulfate, to prevent a first seizure.
SURGICAL MANAGEMENT
In most cases of pre-eclampsia, having the baby at about the 37th to 38th week of pregnancy is
recommended. This may mean that labor needs to be started artificially (known as induced labor) or may
need to have a caesarean section. This is recommended because research suggests there's no benefit in
waiting for labor to start by itself after this point.
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ANATOMY AND PHYSIOLOGY
FEMALE REPRODUCTIVE SYSTEM
The female reproductive system is made up of the internal and external sex organs that
function in reproduction of new offspring. In humans, the female reproductive system is immature at
birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full
term.
The female reproductive system provides several functions:
 The ovaries produce the egg cells, called the ova or oocytes. The oocytes are then transported
to the fallopian tube where fertilization by a sperm may occur.
 The fertilized egg then moves to the uterus, where the uterine lining has thickened in response
to the normal hormones of the reproductive cycle. Once in the uterus, the fertilized egg can
implant into thickened uterine lining and continue to develop. If implantation does not take
place, the uterine lining is shed as menstrual flow.
 The female reproductive system produces female sex hormones that maintain the reproductive
cycle.
 During menopause, the female reproductive system gradually stops making the female
hormones necessary for the reproductive cycle to work. At this point, menstrual cycles can
become irregular and eventually stop. One year after menstrual cycles stop, the woman is
considered to be menopausal.
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The main external structures of the female reproductive system include:
 Labia majora: (“large lips”) enclose and protect the other external reproductive organs.
 Labia minora: (“small lips”) They lie just inside the labia majora, and surround the openings
to the vagina and urethra. This skin is very delicate and can become easily irritated and
swollen.
 Bartholin’s glands: These glands are located next to the vaginal opening on each side and
produce a fluid (mucus) secretion.
 Clitoris: A small, sensitive protrusion. The clitoris is covered by a fold of skin. The clitoris is
very sensitive to stimulation and can become erect.
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The internal reproductive organs include:
 Vagina: The vagina is a canal that joins the cervix to the outside of the body. It also is known
as the birth canal.
 Uterus (womb): The uterus is a hollow, pear-shaped organ that is the home to a developing
fetus. The uterus is divided into two parts:
o Cervix, which is the lower part that opens into the vagina.
o Corpus - can easily expand to hold a developing baby. A canal through the cervix
allows sperm to enter and menstrual blood to exit.
 Ovaries: The ovaries are small, oval-shaped glands that are located on either side of the uterus.
The ovaries produce eggs and hormones.
 Fallopian tubes: These are narrow tubes that are attached to the upper part of the uterus.
Fertilization of an egg by a sperm normally occurs in the fallopian tubes. The fertilized egg
then moves to the uterus, where it implants to the uterine lining.

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MENSTRUAL CYCLE
Menstruation is the shedding of the lining of the uterus (endometrium) accompanied by
bleeding. It occurs in approximately monthly cycles throughout a woman's reproductive life,
except during pregnancy. Menstruation starts during puberty (at menarche) and stops permanently
at menopause.
By definition, the menstrual cycle begins with the first day of bleeding, which is counted as day
1. The cycle ends just before the next menstrual period. Menstrual cycles normally range from
about 25 to 36 days. Only 10 to 15% of women have cycles that are exactly 28 days. Usually, the
cycles vary the most and the intervals between periods are longest in the years immediately after
menarche and before menopause.
Menstrual bleeding lasts 3 to 7 days, averaging 5 days. Blood loss during a cycle usually
ranges from ½ to 2½ ounces. A sanitary pad or tampon, depending on the type, can hold up to an
ounce of blood. Menstrual blood, unlike blood resulting from an injury, usually does not clot
unless the bleeding is very heavy.
The menstrual cycle is regulated by hormones. Luteinizing hormone and follicle-stimulating
hormone, which are produced by the pituitary gland, promote ovulation and stimulate the ovaries
to produce estrogen and progesterone stimulates the uterus and breasts to prepare for possible
fertilization. The cycle has three phases: follicular (before release of the egg), ovulatory (egg
release), and luteal (after egg release).
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HORMONES AND FEMALE CYCLES
The ovarian cycle is hormonally
regulated in two phases. The follicle
secretes estrogen before the ovulation;
the corpus luteum secretes both
estrogen and progesterone after
ovulation. Hormones from the
hypothalamus and anterior pituitary
control the ovarian cycle. The ovarian
cycle covers events in the ovary; the
menstrual cycle occurs in the uterus.
Menstrual cycles vary from between 15 and 31 days. The first day of the cycle is the
first day of blood flow (day 0) known as menstruation. During menstruation, the uterine lining is
broken down and shed as menstrual flow. FSH and LH are secreted on day 0, beginning both the
menstrual cycle and the ovarian cycle. Both FSH and LH stimulate the maturation of a single
follicle in one of the ovaries and the secretion of estrogen. Rising levels of estrogen in the blood
trigger secretion of LH, which stimulates follicle maturation and ovulation (day 14, or mid
cycle). LH stimulates the remaining follicle cells to form the corpus luteum, which produces both
estrogen and progesterone.
Estrogen and progesterone stimulate the development of the endometrium and
preparation of the uterine lining for implantation of a zygote. If pregnancy does not occur, the
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drop in FSH and LH causes the corpus luteum to disintegrate. The drop in hormones also causes the
sloughing off of the inner lining of the uterus by a series of muscle contractions of the uterus.
FERTILIZATION AND PREGNANCY
If a female and male have sex within several days of the female's ovulation (egg release),
fertilization can occur. When the male ejaculates (which is when semen leaves a man's penis),
between 0.05 and 0.2 fluid ounces (1.5 to 6.0 milliliters) of semen is deposited into the vagina.
Between 75 and 900 million sperm are in this small amount of semen, and they "swim" up from
the vagina through the cervix and uterus to meet the egg in the fallopian tube. It takes only one
sperm to fertilize the egg.
About a week after the sperm fertilizes the egg, the fertilized egg (zygote) has become a
multi- celled blastocyst. A blastocyst is about the size of a pinhead, and it's a hollow ball of cells
with fluid inside. The blastocyst burrows itself into the lining of the uterus, called the
endometrium The hormone estrogen causes the endometrium to become thick and rich with
blood. Progesterone, another hormone released by the ovaries, keeps the endometrium thick with
blood so that the blastocyst can attach to the uterus and absorb nutrients from it. This process is
called implantation.
As cells from the blastocyst take in nourishment, another stage of development, the
embryonic stage, begins. The inner cells form a flattened circular shape called the embryonic
disk, which will develop into a baby. The outer cells become thin membranes that form around
the baby. The cells multiply thousands of times and move to new positions to eventually become
the embryo. After approximately 8 weeks, the embryo is about the size of an adult's thumb, but
almost all of its parts — the brain and nerves, the heart and blood, the stomach and intestines, and
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the muscles and skin — have formed.
During the fetal stage, which lasts from 9 weeks after fertilization to birth, development
continues as cells multiply, move, and change. The fetusfloats in amniotic fluid inside the
amniotic sac. The fetus receives oxygen and nourishment from the mother's blood via the
placenta, a disk- like structure that sticks to the inner lining of the uterus and connects to the fetus
via the umbilical cord. The amniotic fluid and membrane cushion the fetus against bumps and
jolts to the mother's body.
Pregnancy lasts an average of 280 days — about 9 months. When the baby is ready for
birth, its head presses on the cervix, which begins to relax and widen to get ready for the baby to
pass into and through the vagina. The mucus that has formed a plug in the cervix loosens, and with
amniotic fluid, comes out through the vagina when the mother's water breaks.
When the contractions of labor begin, the walls of the uterus contract as they are stimulated by
the pituitary hormone oxytocin (pronounced: ahk-see-toh-sin). The contractions cause the cervix
to widen and begin to open. After several hours of this widening, the cervix is dilated (opened)
enough for the baby to come through. The baby is pushed out of the uterus, through the cervix,
and along the birth canal. The baby's head usually comes first; the umbilical cord comes out with
the baby and is cut after the baby is delivered.
The last stage of the birth process involves the delivery of the placenta, which is now called
the afterbirth. After it has separated from the inner lining of the uterus, contractions of the uterus
push it out, along with its membranes and fluids.
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THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM
The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating blood
volume and systemic vascular resistance, which together influence cardiac output and arterial pressure.
As the name implies, there are three important components to this system: 1) renin, 2) angiotensin,
and 3) aldosterone. Renin, which is primarily released by the kidneys, stimulates the formation of
angiotensin in blood and tissues, which in turn stimulates the release of aldosterone from the adrenal
cortex.
Renin is a proteolytic enzyme that is released into the circulation primarily by the kidneys. Its
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release is stimulated by:
 Sympathetic nerve activation (acting via β1-adrenoceptors)
 Renal artery hypotension (caused by systemic hypotension or renal artery stenosis)
 Decreased sodium delivery to the distal tubules of the kidneys
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Juxtaglomerular (JG) cells associated
with the afferent arteriole entering the
renal glomerulus are the primary site of
renin storage and release in the body. A
reduction in afferent arteriole pressure
causes the release of renin from the JG
cells, whereas increased pressure inhibits
renin release. Beta1-adrenoceptors
located on the JG cells respond to
sympathetic nerve stimulation by releasing renin. Specialized cells (macula densa) of distal
tubules lie adjacent to the JG cells of the afferent arteriole. The macula densa senses the amount
of sodium and chloride ion in the tubular fluid. When NaCl is elevated in the tubular fluid, renin
release is inhibited. In contrast, a reduction in tubular NaCl stimulates renin release by the JG
cells. There is evidence that prostaglandins (PGE2and PGI2) stimulate renin release in response
to reduced NaCl transport across the macula densa. When afferent arteriole pressure is reduced,
glomerular filtration decreases, and this reduces NaCl in the distal tubule. This serves as an
important mechanism contributing to the release of renin when there is afferent arteriole
hypotension.
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When renin is released into the blood, it acts upon a circulating substrate,
angiotensinogen, that undergoes proteolytic cleavage to form the decapeptide
angiotensin I. Vascular endothelium, particularly in the lungs, has an
enzyme,angiotensin converting enzyme (ACE), that cleaves off two amino acids to form
the octapeptide, angiotensin II (AII), although many other tissues in the body (heart,
brain, vascular) also can form AII.
AII has several very important functions:
 Constricts resistance vessels (via AII [AT1] receptors) thereby increasing
systemic vascular resistance and arterial pressure
 Acts on the adrenal cortex to release aldosterone, which in turn acts on the
kidneys to increase sodium and fluid retention
 Stimulates the release of vasopressin (antidiuretic hormone, ADH) from the
posterior pituitary, which increases fluid retention by the kidneys
 Stimulates thirst centers within the brain
 Facilitates norepinephrine release from sympathetic nerveendings and inhibits
norepinephrine re-uptake by nerve endings, thereby enhancing sympathetic adrenergic
function
 Stimulates cardiac hypertrophy and vascular hypertrophy
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The renin-angiotensin-aldosterone pathway is regulated not only by the
mechanisms that stimulate renin release, but it is also modulated by natriuretic peptides
(ANP and BNP) released by the heart. These natriuretic peptides acts as an important
counter-regulatory system.
Therapeutic manipulation of this pathway is very important in treating
hypertension and heart failure. ACE inhibitors, AII receptor blockers and aldosterone
receptor blockers, for example, are used to decrease arterial pressure, ventricular
afterload, blood volume and hence ventricular preload, as well as inhibit and reverse
cardiac and vascular hypertrophy
THE CARDIOVASCULAR SYSTEM
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The cardiovascular system consists of the pump and vessels that distribute blood to all
areas of the body. This system allows for the delivery of needed substances to the cells of the body
as well as for the removal of wastes.
Heart is a muscular hollow organ often called the pump of the body. It is located in the
mediastinal cavity (between the lungs), behind the sternum and above the diaphragm.
3 LAYERS OF THE HEART
 ENDOCARDIUM a smooth layer of cells that lines the inside of the heart. This
allow for smooth flow of the blood.
 MYOCARDIUM the muscular middle layer, also the thickest layer .
 PERICARDIUM the double layered membrane or sac that covers the outside of
the heart.
 SEPTUM OF THE HEART a muscular wall that separates the heart into right and
left sides of the heart.
 Interatrial septum - The upper part of the septum.
 Interventricular septumthe lower part of septum.
THE HEART IS DIVIDED INTO 4 PARTS 4 CHAMBERS
 Atrium - 2 upper chamber
 Ventricles - 2 lower chambers
 Right atrium - receives blood as it returns from the body cells.
 Right ventricle - receives blood from the right atrium then pushes the blood into the
pulmonary artery, which carries it to the lungs for oxygen.
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 Left atrium - receives oxygenated blood from the lungs.
 Left ventricle - receives blood from the left atrium and pushes blood into the aorta so it
can be carried to the body cell.
HEART VALVES- one way valves in the chamber of the heart keep flowing in the right direction.
TRICUSPID VALVE
 Is located between the right atrium and ventricle.
 It closes when the right ventricle contracts and pushes the blood to the lungs.
 This prevents blood flowing backward into the right atrium.
PULMONARY VALVE
 The Pulmonary valve is located between the right ventricle and pulmonary artery, a blood
vessel that carries blood to the lungs.
 It encloses when the right ventricle has finished contracting and pushing blood into the
pulmonary artery.
 It prevents blood from flowing back into the right ventricle.
MITRAL VALVE
 Located between the left atrium and left ventricle.
 It closes when the left ventricle is contracting and pushing blood into the aorta so it can be
carried to the body.
 It prevents blood from flowing back into the left atrium.
AORTIC VALVE
 Located between the left ventricle and the aorta, the largest artery in the body.
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 It closes when the left ventricle is finished contracting and pushing blood into the aorta.
 It prevents blood from flowing back into the left ventricle.
BLOOD VESSELS
 Blood leaving the heart is carried throughout the body in blood vessel. The heart
and the blood vessels form a closed system for the flow of blood.
THREE MAIN TYPES OF BLOOD VESSELS
1) ARTERIES - Carry blood away from the heart.
AORTA - Is the largest artery in the body. It receives blood from left ventricle of the heart. It
immediately begins branching into smaller arteries.
Arterioles- are the smallest branches of the arteries and they join with capillaries.
2) CAPILLARIES
 Connect arterioles with venules, the smallest veins.
 They have thin walls that contain only one layer of cells and allow oxygen and
nutrients to pass through to the cells.
 At the same time, carbon dioxide and metabolic products from the cells enter the
capillaries.
3) VEINS
 Blood vessels that carry blood to the heart.
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 Veins are thinner than arteries and have less muscle tone. Most veins contain valves that
keep the blood from flowing in a backward direction.
 Venules are the smallest branches of veins, they connect with capillaries, then venules join
together and become larger vessels called veins.
 Superior and inferior vena cava are the two largest veins.
 Superior vena cava - brings blood from the upper part of the body.
 Inferior vena cava - brings blood from the lower part of the body. Both vena cava drain
into the right atrium.
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The blood that flows through the fetus is actually more complicated than after the baby is
born (normal heart). This is because the mother (the placenta) is doing the work that the baby's
lungs will do after birth. The placenta accepts the blood without oxygen from the fetus through
blood vessels that leave the fetus through the umbilical cord (umbilical arteries, there are two of
them). When blood goes through the placenta it picks up oxygen.
The oxygen rich blood then returns to the fetus via the third vessel in the umbilical cord
(umbilical vein). The oxygen rich blood that enters the fetus passes through the fetal liver and
enters the right side of the heart.
The oxygen rich blood goes through one of the two extra connections in the fetal heart that
will close after the baby is born. The hole between the top two heart chambers (right and left
atrium) is called a patent foramen ovale (PFO). This hole allows the oxygen rich blood to go from
the right atrium to left atrium and then to the left ventricle and out the aorta. As a result the blood
with the most oxygen gets to the brain. Blood coming back from the fetus's body also enters the
right atrium, but the fetus is able to send this oxygen poor blood from the right atrium to the right
ventricle (the chamber that normally pumps blood to the lungs).
Most of the blood that leaves the right ventricle in the fetus bypasses the lungs through the
second of the two extra fetal connections known as the ductus arteriosus. The ductus arteriosus
sends the oxygen poor blood to the organs in the lower half of the fetal body. This also allows for
the oxygen poor blood to leave the fetus through the umbilical arteries and get back to the placenta
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to pick up oxygen. Since the patent foramen ovale and ductus arteriosus are normal findings in the
fetus, it is impossible to predict whether or not these connections will close normally afterbirth in
a normal fetal heart. These two bypass pathways in the fetal circulation make it possible for most
fetuses to survive pregnancy even when there are complex heart problems and not be affected until
after birth when these pathways begin to cl
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PATHOPHYSIOLOGY
Predisposing Factors Precipitating Factors
 Maternal Age (34 years old)  Diet (High Fat, High Sodium
 History of Hypertension Diet)
 Gestational Diabetes Mellitus  Obesity (weight: 90 kgs)
Unknown Etiology
Inadequate Placentation
Uterine Spiral Arteries are poorly invaded

by cytotropoblasts
Cytotropoblasts failed to replace tunica

media
Incomplete Pseudovascularization
Decreased Placental Perfusion
Generalized Endothelial Injury
Constrictive properties of arterioles

remain causing Vasoconstriction
 Reduced Renal Plasma Flow

 Increased Vascular Resistance
 Increased Arterial Pressure
 Enhanced Pressor Response
Increased Blood Pressure
PREECLAMPSIA 36
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HEALTH ASSESSMENT
DEMOGRAPHIC DATA
Name: MS. R. M. M.
Age: 34 years
Birth date: January 1, 1986
Birthplace: Numancia, Aklan
Gender: Female
Height: 5’ 1”
Weight: 90 kgs.
Marital Status: Single
Current Address: Camanci Norte, Numancia, Aklan
Nationality/ Race: Filipino
Educational Attainment: College Graduate
Occupation: None (Housewife)
Monthly Income: P 30, 000.00
Admitting Physician: Dr. G. V.
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Attending Physician: Dr. G.V.
Date & Time of Admission: November 18, 2020 at around 10:45 A.M.
Chief Complaint: “Sige nga sinakit akong tiyan ag balakang ag sige man ro tig – a it akong
tiyan”.
Admitting Vital Signs:
Temp: 36.8 C /axilla
BP: 160/ 110 mmHg
PR: 82 bpm
tRR: 20 bpm
FHT: 140 bpm (Right Upper Quadrant)
CBG: 153 g/dl
Informant
Primary: Client
Secondary: Sister
Other Sources: Client’s Chart
Admitting Diagnosis:
 G3 P0 (0020) 31 2/7 Weeks AOG by LMP; Breech Double Footling;
 Gestational Diabetes Mellitus; Preeclampsia
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Final Diagnosis:
Pregnancy Uterine 35 Weeks delivered by Emergency CS; Breech; Primigravida;
Preeclampsia; Insulin Requiring; Gestational Diabetes Mellitus
HISTORY OF PRESENT ILLNESS:
On April 18, 2020, prior to knowing she was pregnant, she went to her obstetrician for
check –up and found out her blood pressure is above normal and has a reading of 130/90 mmHg.
It was on September 2020, during her check –up she underwent several laboratory tests
including complete blood glucose and also revealed it was elevated and has a reading of 285
g/dl. She was diagnosed to have Gestational Diabetes Mellitus and Pregnancy Induced
Hypertension. She was also prescribed to take methyldopa for her elevated blood pressure and
insulin for her gestational diabetes mellitus.
It was then on November 18, 2020 at around 3 A. M. when she starts to feel continuous
uterine contractions accompanied by severe abdominal pain radiating on her back. She also
experienced mild headache. She continued to monitor her condition but the pain got intensified
and she can’t sleep well even when she changes her sleeping positions. She was worried because
it is not yet her due date so she tried to remain calm.
On the same day at around 10 am, accompanied by her sister, she decided to go to the
hospital for admission because her contractions got intensified and the pain is also increasing and
is radiating on her back.
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Upon admission, she was seen and examined by Dr. G.V. and was scheduled for
Emergency Cesarean Section.
The following were ordered:
 Please admit to ROC under the service of Dr. G.V.
 TPR with BP every 4 hour and record.
 Diabetic Diet →NPO
Venoclysis
 PNSS x 8 hours: Hydralazine Drip (D5 W 500cc + 2 amps Hydralazine) @ 10 –
15 gtts/ minute
Laboratory Tests
 CBC
 Blood Typing
 Urinalysis
 For Pelvic Ultrasound - Hold
Medications
 MgSO4 4 gms Slow IVTT now
 MgSO4 2.4 gms Deep IM now
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Abdominal Prep patient
 For STAT CS, secure consent, inform OR.
 Dr. L for anesthesiologist.
 Dr. S. for pedia.
 Dr. G.V. inform of the admission, make rounds and gave orders.
 Admit.
Anesthesia
 NPO STAT prior to OR
 Ranitidine 1 amp slow IV 1 hour prior to OR
 Metoclopramide 1 amp slow IV 30 minutes prior to OR
 Weigh patient and record to chart.
PAST HEALTH/ MEDICAL HISTORY
MS. R. M.M. was a fully immunized. She had experienced common illnesses such as
cough, colds, fever and chicken pox during childhood.
It was year 2010 and 2019 when she was admitted in the hospital because she underwent
dilatation and curettage due to two miscarriages.
According to her she had no known food allergies, but states that she has an allergy with
Cefalexin medication.
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She had her menarche when she was 12 years old and has regular cycle of menses (30 days’
cycle) that lasts for 3 days. She uses 2-3 pads a day. She had also experienced dysmenorrhea that
lasts for 1 day. All her pregnancies were planned and had breastfeed her children. She regularly
attended her prenatal check-ups and also she and her common law husband have a good
relationship.
According to Ms. R. M. M., her mother has Diabetes and her father has Hypertension. She
doesn’t use any tobacco, drugs and alcoholic beverages.
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FAMILY GENOGRAM
Mother Father
(77 y.o.) (64 y.o.)
(+) (November 2020) (+) HPN, Alcoholic
HPN, DM
Ms.A. M. Mr. C.M.

53 years old (+) Mr. E.M. Ms. R.M.M.
47 years old
Kidney Disease Alive and well 41 years old 34 years old
,DM Polio Preeclampsia
Smoker, Alcoholic GDM
Ms.B. M. Mr. D.M. Mr. F.M.

51 years old 45 years old 40 years old
Smoker Heart Alive and well
Enlargement
Legend:
= Client
= Siblings
= Married
= Parents
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PSYCHOSOCIAL HISTORY
Ms. R.M.M. believes that self-care is important and maintaining a good health
practices makes her stronger. She sometimes goes to church every Sunday together with her
daughter. She used to wake up 5 in the morning to attend the needs of her family. And do some
household chores such as washing their clothes and gardening at their backyard.
She usually eats 2 cups of rice and vegetables for breakfast; 2 cups of rice, fish and
vegetables for lunch; and 2 cups of rice and vegetables for dinner. She consumes 8 glasses of water
per day. In addition, she drinks milk twice a day, morning and afternoon.
According to Ms. R.M.M. she used birth control pill (unrecalled) that was given by their
Barangay Health Center. She doesn’t smoke nor drink alcoholic beverages. She took OTC drugs
like biogesic for fever, neozep for colds and mefenamic acid as pain reliever. Her medication for
Gestational Diabetes is Insulin Humulin R and Methyldopa for her hypertension as prescribed by
her obstetrician.
She usually sleeps with her daughter at around 9 o’clock at night and wakes up at around 4
o’clock in the morning; she has a total sleep time of 8 hours including siestas. And she claimed
that she uses 2 pillows. She claims that she voids 5-6 times a day and has never complained of
difficulty in voiding and defecates once a day with well-formed brown stool that sometimes vary
with her food intake.
She stated that Barangay Health Center was accessible and available to their barangay.
According to Mrs. MAT, whenever she and her family experience financial difficulties or whatever
problems her brothers and sisters help them.
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STRESSORS
Physiologic (rest and comfort)
 Presence of IVF, Catheter.
 Weakness for mobility which alters the patient’s ADL.
Psychological (mental and emotional)
 Leaving home for hospitalization
 Family members are unattended due to hospitalization
 Expression of grief about her condition
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REVIEW OF SYSTEM
PHYSICAL ASSESSMENT
General Survey:
Received a 34 years old large built, Filipino mother; lying on bed in supine position
wearing green duster. Oriented, cooperative, conscious and conversant, maintains eye contact;
clear, modulated speech and responds appropriately; skin color is light brown, dry and warm; S/P
Cesarean Section, intact dressing secured by tape to hypogastric area. IVF of 0.9 NaCl 1000 liter
at the level of 400ml in right cephalic vein infusing well; foley catheter attached, intact, draining
to yellowish urine via gravity to urine bag at the level of 1000 ml hanging at the foot side of the
bed; personal items with easy reach, sister by bedside.
Integument:
Skin
 Skin is intact and dry
 Warm to touch, light brown in color
 Presence of slight non pitting edema on her lower extremities
 Presence of small moles distributed on her face, neck and arms
 Her incision is approximately 5 inches
Hair
 Has long hair that are evenly distributed to scalp
 Black in color
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 Presence of dandruff noted
 Uses shampoo everyday as claimed
Nails
 No nail polish noted
 Edges are rounded, clean and trimmed
 Capillary refill at 2 seconds
Head and Face
 Normocephalic with smooth skull contour that is appropriate to her body size
 Had experience headache
 No lesion, nodules or masses noted
Neck
 Symmetrical, proportion to head and shoulder
 Trachea is found in the midline
 No thyroid gland enlargement and jugular vein distension
 Carotid pulse is palpable
Eyes
 Eyes are coordinated; moves in unison with parallel alignment
 Eyelashes are short and evenly distributed to lid margin
 Eyebrows are evenly distributed and black in color
 Iris equally round and symmetrically aligned
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Ears
 Color is same as the facial skin, symmetrical skin, firm and non-tender
 Has normal hearing
 Light moist yellow cerumen on the ear canal noted
 With piercing on helix of both ears noted
Nose and Sinuses
 Nose is in the midline, color is same as the facial skin
 No discharge, inflammation and deformity noted
 Nostrils are patent and equal in size
 Mucous membrane is normally pint, no nasal flaring
Mouth and Throat
 Lips are dry and pale and free of lesions
 Tongue is found at midline, no redness or inflammation
 Has one decayed molar teeth at right lower
 Palatine tonsils and oropharynx are pinkish and not inflamed
 Brushes her teeth two times a day as claimed
Lungs and Thorax
 Non- cyanotic with respiratory of 20 bpm
 Chest expansion is symmetrical and proportion
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Breast and Axilla
 Presence of fine hair on axillae noted
 Skin on breast area appears lighter than extremities
 Nipple in areola are dark brown in color
 No masses or lesions noted.
Cardiovascular System
 Capillary refill at 2 seconds on the lower extremities
 No abnormalities upon auscultation
 Cardiac rate of 82 bpm upon assessment
 Blood pressure of 160/110 mmHg
Gastrointestinal
 Abdomen is non-tender to palpate
 Presence of stretch marks and linea nigra noted
 Surgical incision at hypogastric area was observed
Female Genitourinary System
 The client has foley catheter attached; intact, draining to yellowish urine via gravity to
urobag at the level of 1000 ml.
Cognition/Mental/ Emotional Status:
 Able to comprehend and answer questions appropriately.
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Neurologic
 Client is barely cooperative, oriented, and attentive all throughout the assessment.
CRANIAL NERVE
CRANIAL NERVES RESULT
Cranial Nerve – I (Olfactory) Able to smell calamansi.
Cranial Nerve – II (Optic) Able to read printed text 1 ft away.
Cranial Nerves – III, IV and VI Intact. Able to perform 6 cardinal eye
(Occulomotor, Tracheal, Abducens) movement.
Cranial Nerve- V (Trigeminal Nerve) Able to bite tongue blade and feel cold
sensation in forehead, cheeks and chin.
Cranial Nerve- VII (Facial) Symmetry of facial expression, able to do
facial sensation, corneal reflex, masseter
muscle.
Cranial Nerve- VIII (Acoustic Nerve) Ability to hear ticking sound of watch and
clicking of pen 2 ft away.
Cranial Nerve- IX and X (Glossopharyngeal Able to taste sour and sweet, movement of
and Vagus) pharynx, able to swallow.
Cranial Nerve- XI (Accessory Nerve) Able to shrug shoulders against resistance.
Cranial Nerve- XII (Hypoglossal) Able to say the letters L, N, D and T.
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GLASGOW COMA SCALE
Response
I. EYE OPENING 4- Spontaneous eye opening
3- Eyes open to speech
2- Eyes open to pain

4 (Spontaneous eye opening)
1- No eye opening
II. VERBAL RESPONSE 5- Alert and oriented
4- Confused yet coherent
speech
5 (Alert and oriented)
3- Inappropriate words
2- Incomprehensible sounds
1- No sounds
III. MOTOR RESPONSE 6- Obeys command fully
5- Localizes pain
4- Withdraws from pain
3- Abnormal flexion
6 (Obeys command fully)
(decorticate)
2- Exterior response
(decerebrate)
1- No response
Score: 15 (Best response)
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LABORATORY AND DIAGNOSTIC STUDIES
Laboratory Diagnostic Test #1: Hematology
Test performed: Complete Blood Count
Indication: To measure the condition of blood components that may indicate certain health
problems.
Date performed: November 18, 2020
Test Result Normal Values Significance
Hemoglobin 146 120-160 Normal
Hematocrit 43 37-47 Normal
Red Blood Cell 4.6 4.2-5.4 Normal
White Blood cell 9.93 4.50-11.0 Normal
Neutrophil 72 50-70 Increased: This
signifies infection.
Segmenter 72 50-70 Increased: This
signifies infection.
Lymphocyte 20 2.0-40.0 Normal
Monocyte 5 3.0-8.0 Normal
Eosinophil 3 1.0-4.0 Normal
Basophil 225 0.0-1.0 Normal
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Platelet 146 150-450 Normal
No blood chemistry in data
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Concept Map
2. Acute Pain 3. Ineffective

1. Decreased Tissue Perfusion
Cardiac Output
4. Risk for
Maternal Injury
1. Acute Pain PREECLAMPSIA 5. Readiness for

enhanced
knowledge
4. Hypothermia
2. Risk for 3. Impaired
infection physical mobility
Legend:
Pre - operative
Post - operative
 Straight Arrow: Denotes direct relationship from medical diagnosis/ chief

complaint
 Broken Arrow: Denotes Risk Nursing Diagnosis
 Dotted Arrow: or Denotes linking relationship between or among
Nursing Diagnoses
 Diamond Arrow: Denotes readiness for enhanced Wellness of Health
Promotion Diagnosis after intervention.
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NURSING CARE PLAN
PRE – OP NURSING CARE PLANS
NCP No. 1
Assessment
Subjective cue:
“Galingin ang ulo ag gasakit ang batok” as verbalized by the patient
Objective cues:
 Non pitting Edema noted on lower extremities
 Cold, clammy skin noted.
 BP: 160/110 mmHg
 Headache
 Dizziness
Diagnosis
Decreased Cardiac Output related to decreased venous return as evidenced by variations
in blood pressure secondary to preeclampsia
General objective:
The patient will display hemodynamic stability as evidenced of BP within acceptable
range.
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Specific Objective:
After 8 hours of nursing intervention, patient will demonstrate increase perfusion as
evidenced by decreased BP from 160/110 to 120/90 mmHg
Nursing Intervention with Rationale:
Independent:
1. Monitor laboratory test such as: complete blood count, sodium level, creatinine level.
Rationale: Routine blood work can provide insight into the etiology of heart failure and
extent of decompensation. A low sodium is often observed because of decreased
perfusion to the kidneys.
2. Auscultate, monitor and record patient’s heart rate and heart sounds.
Rationale: New onset of a gallop rhythm, tachycardia, fine crackles in lung bases can
indicate onset of heart failure. If patient develops pulmonary edema, there will be coarse
crackles on inspiration and severe dyspnea.
3. Monitor and record vital signs particularly blood pressure.
Rationale: To identify physical responses associated with medical conditions.
4. Observe skin color, moisture, temperature and capillary refill time.
Rationale: Presence of pallor, cool, moist skin and delayed capillary refill time may be
due to peripheral vasoconstriction.
5. Institute bed rest with client in lateral position.
Rationale: Increases venous return, cardiac output, and renal/placental perfusion.
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6. Provide calm, restful surroundings, minimize environmental activity or noise.
Rationale: Help reduce sympathetic stimulation, promotes relaxation.
7. Maintain activity restrictions
Rationale: Reduces physical stress and tension that affect blood pressure and course
of hypertension.
8. Instruct in relaxation techniques, and guided imagery.
Rationale: Can reduce stressful stimuli, produce calming effect, and thereby reduce
blood pressure.
9. Closely monitor fluid intake including IV lines and maintain fluid restriction if ordered.
Rationale: In patients with decreased cardiac output, poorly functioning ventricles may
not tolerate increased fluid volumes.
10. Monitor input and output.
Rationale: Reduced cardiac output results in reduced perfusion of the kidneys with
resulting decrease in urine output.
Dependent:
11. Administer antihypertensive drugs as ordered, noting side effects and toxicity.
Rationale: Antihypertensives help decrease and control blood pressure when adverse
effects are manifested, prompt intervention can be given.
12. Administer Magnesium sulfate as ordered.
Rationale: Magnesium sulfate prevents or controls seizures in pre-eclampsia brought
about by vasospasm secondary to vasoconstriction of blood vessels.
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Collaborative:
13. Implement dietary sodium, fat, and cholesterol restrictions as indicated.
Rationale: These restrictions can help manage fluid retention and with associated
hypertensive response, which decrease cardiac workload.
Evaluation:
Goals partially met, client’s blood pressure decreased from 160/110 mmHg to 140/90 mmHg.
NCP No. 2
Nursing Diagnosis:
Acute pain related to effects of labor and delivery process.
Assessment
Subjective cue:
“Sobrang gasinakit ang tiyan ag balakang nga medyo maunga eon ako” as verbalized by
the patient.
Objective cues:
 Increasing uterine contractions
 Facial grimace
 Uncomfortable
 Irritability
 Restlessness
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 Vital Signs: BP= 160/110 mmHg
 Pain Scale: 9 (severe)
Diagnosis:
Acute pain related to effects of labor and delivery process.
General Objective:
Patient will be able to make an informed decision regarding pain management options
she would like to use.
Specific Objectives:
After 8 hours of nursing intervention the patient will be able to:
 Demonstrate different relaxation techniques to decrease pain
 Verbalize understanding about the different non pharmacologic methods to decrease pain
 Verbalize decrease level of pain from 9 to 7 using non pharmacologic methods
Independent
1. Assess current knowledge of obstetric pain control measures.
Rationale: Allows the nurse to develop an individualized teaching plan for the patient.
2. Provide positive reinforcement and encouragement to patient and support persons as they
apply non pharmacologic techniques learned in childbirth classes
Rationale: Positive reinforcement and encouragement provide the patient and support
person a sense of control and self-confidence.
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3. Assess anxiety level and implement measures to reduce anxiety as needed.
Rationale: Allows for early intervention to decrease anxiety levels. High levels of
anxiety can increase the perception of pain, decrease ability to tolerate pain, and decrease
comprehension of verbal instruction.
4. Provide teaching between uterine contractions.
Rationale: The patient is more attentive and can better internalize information when not
in pain
5. Initiate teaching/reinforcing of non-pharmacologic comfort measures that can be used
during labor if needed (e.g., use of focal point, visual imagery, breathing and relaxation
techniques). Assist with implementation of these measures as needed.
Rationale: These non-pharmacologic comfort measures work by providing diversion
during uterine contractions.
6. Provide massage and/or counter pressure and/or assist patient to find position of
maximum comfort—standing, sitting, squatting, side lying, hands and knees—as needed.
Rationale: Changing positions and using counter pressure may help alleviate discomfort
caused by pressure of presenting parts on bony structures, ligaments, or tissues. Massage
helps relieve muscle tension and provide a diversion to inhibit pain sensations.
7. Provide comfort measures (ice chips, petroleum jelly for dry lips, dry linens, etc.)
Rationale: Enhances patient’s comfort level.
8. Monitor uterine contractions, dilation and effacement and fetal heart tones.
Rationale: To monitor progress of labor and fetal well-being.
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Dependent:
9. Administer pain medications as ordered.
Rationale: Pharmacologic intervention may be needed to alleviate discomfort when non
pharmacologic methods of pain control are perceived to be ineffective.
Evaluation:
Goals partially met, the patient was able to demonstrate different non pharmacologic
methods such as deep breathing exercises, imagery and verbalized understanding.
Patient stated that pain rating scale decreased from 9 to 8.
NCP No. 3
NCP No. 3
Nursing Diagnosis:
Ineffective Tissue Perfusion related to interruption of blood flow secondary to
Preeclampsia as evidenced by premature delivery.
Assessment
Subjective cue:
“Galingin ang ulo ag medyo nagaoy ang eawas” as verbalized by the patient
Objective cues:
 Non pitting Edema noted on lower extremities
 Cold, clammy skin noted.
 BP: 160/110 mmHg
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 CR: 82 bpm
 Headache
 Dizziness
 Fatigue
General Objective:
The patient and fetus will demonstrate increased perfusion.
After 8 hours of nursing intervention, patient will demonstrate increased perfusion as
evidenced by vital signs within normal range, and absence of edema and fetal heart tones within
acceptable range.
Nursing Interventions with Rationale:
Independent
1. Monitor and document patient’s vital signs every 2 hours.
Rationale: Decreased heart rate and blood pressure may indicate increased arteriovenous
exchange, which leads to decreased tissue perfusion.
2. Encourage patient to change position and participate in activity, as condition permits.
Rationale: To enhance vital capacity and avoid lung congestion and skin break down.
3. Encourage quiet, restful environment.
Rationale: To conserve energy, lowers tissue oxygen demands and maximize tissue
perfusion.
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4. Provide information to client/couple regarding home assessment/recording of daily fetal
movements and when to seek immediate medical attention.
Rationale: Reduced placental blood flow results in reduced gas exchange and impaired
nutritional functioning of the placenta. Potential outcomes of poor placental perfusion
include a malnourished, LBW
infant, and prematurity associated with early delivery, abruption placenta, and fetal death.
Reduced fetal activity indicates fetal compromise (occurs before detectable alteration in
FHR and indicates need for immediate evaluation/intervention.
5. Monitor FHR manually or electronically, as indicated.
Rationale: Helps evaluate fetal well-being. An elevated FHR may indicate a compensatory
response to hypoxia, prematurity.
6. Note fetal response to medications such as MgSO4
Rationale: Depressant effects of medication reduce fetal respiratory and cardiac function
and fetal activity level, even though placental circulation may be adequate
Collaborative:
7. Administer fluid as needed.
Rationale: To maintain preload.
8. Maintain oxygen therapy as ordered.
Rationale: To maximize oxygen exchange in alveoli and at the cellular level.
Evaluation:
Goals partially met, blood pressure decreased from 150/110 mmHg to 140/90, FHT 140
beats /minute and has slight edema on both extremities.
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NCP No. 4
Nursing Diagnosis: Risk for Maternal Injury related to tissue edema
Objective cues:
Vital signs as follow:
 T= 36.8°C
 CR=82 bpm
 RR=20 bpm
General Objective:
After 8 hours of intervention the patient will participate in treatment and/or environmental
modifications to protect self and enhance safety.
Independent:
1. Assess for CNS involvement (i.e., headache, irritability, visual disturbances or changes
on funduscopic examination).
Rationale: Cerebral edema and vasoconstriction can be evaluated in terms of symptoms,
behaviors, or retinal changes.
2. Stress importance of client promptly reporting signs/symptoms of CNS involvement.
Rationale: Delayed treatment or progressive onset of symptoms may result in tonic-
clonic convulsions or eclampsia.
3. Note changes in level of consciousness.
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Rationale: In progressive PIH, vasoconstriction and vasospasms of cerebral blood
vessels reduce oxygen consumption by 20% and result in cerebral ischemia.
4. Assess for signs of impending eclampsia: hyperactivity of deep tendon reflexes (3+ to
4+), ankle clonus, decreased pulse and respirations, epigastric pain, and oliguria (less
than 50 ml/hr).
Rationale: Generalized edema/vasoconstriction, manifested by severe CNS, kidney, liver,
cardiovascular, and respiratory involvement, precede convulsive state.
5. Institute measures to reduce likelihood of seizures; i.e., keep room quiet and dimly lit,
limit visitors, plan and coordinate care, and promote rest.
Rationale: Reduces environmental factors that may stimulate irritable cerebrum and
cause a convulsive state.
6. Implement seizure precautions per protocol. Document motor involvement, duration of
seizures and post seizures behavior. Position client on the side, avoid restrictive clothing,
do not restrict movements.
Rationale: If seizure does occur, reduce risk of injury. Maintaining position on the side
reduces risk of aspiration and avoiding restrictive clothing and movement prevent further
injury.
7. Monitor for signs and symptoms of labor
Rationale: Convulsions increase uterine irritability; labor may ensue.
Dependent:
8. Administer MgSO4 IM or IV as ordered.
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Rationale: MgSO4 a CNS depressant, decreases acetylcholine release, blocks
neuromuscular transmission, and prevents seizures. It has a transient effect of lowering
BP and increasing urine output by altering vascular response to pressor substances.
9. Monitor BP before, during, and after MgSO4 administration. Note serum magnesium
levels in conjunction with respiratory rate, patellar/deep tendon reflex (DTRs), and urine
output.
Rationale: A therapeutic level of MgSO4 is achieved with serum levels of 4.0–7.5
mEq/L or 6–8 mg/dL Adverse/toxic reactions develop above 10–12 mg/dL, with loss of
DTRs occurring first, respiratory paralysis between 15–17 mg/dL, or heart block
occurring at 30–35 mg/dL.
10. Have calcium gluconate available.
Rationale: Serves as antidote to counteract adverse/toxic effects of MgSO4.
11. Prepare for cesarean birth if PIH is severe, placental functioning is compromised, and
cervix is not ripe or is not responsive to induction.
Rationale: When fetal oxygenation is severely reduced owing to vasoconstriction within
malfunctioning placenta, immediate delivery may be necessary to save the fetus.
POST – OP NURSING CARE PLAN
Nursing Care Plan No. 1
Nursing Diagnosis:
Acute pain related to surgical incision manifested by verbal report of pain & guarding
behavior.
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Assessment
Subjective cue: “Masakit ta do gin operahan kakon” as verbalized by the patient
Objective cues:
 Pain rating scale of 8 in pain rating scale of 1-10.
 Facial grimace
 V/S: BP-160/100 mmHg, RR- 20 bpm, PR-82 bpm
Objectives:
General Objective:
Patient verbalizes adequate relief of pain or ability to cope with incompletely relieved pain.
After 8 hours of nursing intervention the patient will be able to:
 Verbalize lessen of pain from 8 to 3 of pain rating scale of 1-10.
 Demonstrate non pharmacotherapy such as listening to the music, imagery and
deep breathing exercise.
Nursing Interventions with Rationale
Independent
1. Assess patient’s past coping mechanism.
Rationale: To determine what measures worked best in the past.
2. Monitor and record vital signs.
Rationale: To establish baseline data and to monitor the effectiveness of interventions.
3. Teach the client about the non-pharmacotherapy such as music, imagery, etc.
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Rationale: It will decrease the possibility of drug dependence.
4. Acknowledge and assess pain: evaluate pain behavior.
Rationale: To serve as baseline data and to determine the effectiveness of the therapy
given.
5. Encouraged adequate rest period.
Rationale: To prevent exacerbation of pain and fatigue.
6. Provide a quiet environment as possible.
Rationale: Noisy environment could exacerbate the pain.
7. Evaluate patient’s response to pain and medications or therapeutics aimed to relieving
pain.
Rationale: It is important to help patients express as exactly as possible.
Dependent
8. Give analgesics as ordered, evaluating effectiveness and observing for any sign and
symptoms of untoward effect.
Rationale: Pain medication are absorbed and metabolized differently by patient, so the
effectiveness must be evaluated from patient to patient and may cause side effects that
range from mild to life threatening.
Evaluation:
Goals met. Patient’s verbalize lessen of pain from 6 to 3 of pain rating scale of 1-10 and
demonstrate non pharmacotherapy such as listening to the music, imagery and deep breathing
exercise.
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Nursing Diagnosis
Risk for infection secondary to surgical incision
Assessment
Objectives cues:
 Pallor with dry and intact dressing on the area
 Pain over the incision
 Diaphoresis
Objectives:
General Objective:
The patient will not have infection
Specific Objective:
After 4 hours of nursing interventions, the patient will be able to identify and
demonstrate intervention to prevent infection.
Rationale: To obtain baseline data and useful in detecting medical problems and are
needed to make life saving decision and confirm feedback on treatments performed.
2. Note signs and symptoms of sepsis.
Rationale: To reduce complication and monitor for infection
3. Provide wound healing such as cleaning of wound.
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Rationale: To reduce risk for infection
4. Provide care, change dressing as needed.
Rationale: To promote healing to the incision
5. Encourage intake of Vitamin C.
Rationale: To prevent infection and to increase immune resistance
6. Encourage deep breathing exercise.
Rationale: Relaxation of the patient and prevent atelectasis.
Dependent
7. Give antibiotic as ordered.
Rationale: To prevent infection.
Evaluation:
Goals met as evidenced by: The patient identified and demonstrated interventions to
prevent risk of infection.
Nursing Diagnosis
Impaired physical mobility related to Surgery
Assessment
Subjective cues:
“Nalisdan abi ako mag hueag hay ga sakit dayun akong tinahian” as verbalized by the patient.
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Objectives cues:
 Facial grimace
 Difficulty turning
 Limited range of motion
 Body weakness
General objective: To promote optimal level of functioning and prevent complications
Specific objective:
After 8 hours of nursing intervention the patient will be able to maintain body alignment
and to prevent further contractures.
1. Assess client and caregiver’s understanding of immobility and its complication.
Rationale: The risk for effects of immobility such as muscle weakness, skin breakdown,
pneumonia, thrombophlebitis, depression is also considered in patients with temporary
immobility.
2. Check for skin integrity for signs of redness and tissue ischemia especially over
shoulders, elbows, sacrum, hips, heels and ankles.
Rationale: Routine inspection of the skin especially over bony prominences will allow
for prevention, early recognition and treatment of pressure ulcers.
3. Promote and facilitate early ambulation when possible. Aid with each initial change in
dangling legs, sitting in chair, ambulation.
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Rationale: These movements keep the patient as functionally working as possible. Early
mobility increases self-esteem about acquiring independence and reduces the chance that
debilitation will happen.
4. Provide rest periods in between activities. Consider energy saving techniques.
Rationale: Rest periods are essential to conserve energy. Client must learn to accept
his/her limitations.
5. Assisted in maintaining good body alignment and supported affected body parts using
pillows/rolls.
Rationale: To maintain position of function, prevent contractures and relieve pressure.
6. Assisted and encouraged significant others to change position of the patient every 2
hours.
Rationale: To optimize circulation to all tissues and to relieve pressure.
7. Provide safety precaution such as raise side rails up, or assisting when ambulatory.
Rationale: To prevent injury.
8. Performed assistive ROM exercises to both upper and lower extremities.
Rationale: To restore body energy.
9. Turn and position client every 2 hours or as needed.
Rationale: Position changes optimize circulation to all tissues and relieve pressure.
10. Encourage coughing and breathing exercises.
Rationale: Coughing and breathing to prevent buildup of secretions and increases lung
expansion and prevent atelectasis.
11. Regulate the environment temperature or relocate the client to a warmer setting. Keep
client and linens dry.
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Rationale: These methods provide for a more gradual warming of the body. Rapid
warming can induce ventricular fibrillation. Moisture promotes evaporate heat loss.
12. Control heat source according to client’s physical response
Rationale: Body temperature should be raised no more than a few degrees per hour.
Vasodilation occurs as the patient’s core temperature increases leading to a decrease in
BP. Hypotension, metabolic acidosis and dysrhythmias are complication of rewarming
13. Give extra covering (Passive warming)
Rationale: Warm blankets provide to a passive method of rewarming.
Evaluation:
Goals met. The client was able to maintain proper body alignment with evidence of
contractures.
Nursing Diagnosis:
Hypothermia related to exposure to cold environment
Assessment
Objective cues:
 Shivering
 Body temp. of 35.0 C/ax
 Cool skin
 Skin pallor
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Objectives:
General Objective:
The patient will display core temperature within normal range.
Specific Objective:
After 2 hours of nursing intervention the patient’s body temperature will be elevated from
35.0 C/ax to 36.4 C/ax and will demonstrate behaviors to promote normothermia.
Independent
1. Monitor and record vital signs. Note for client’s temperature, heart rate and blood
pressure.
Rationale: To obtain baseline data, heart rate and blood pressure drop as hypothermia
progresses. Hypothermia increases risk for ventricular fibrillation along with other
dysrhythmias.
2. Cover the patient with warm blanket.
Rationale: To promote heat
3. Provide patient droplight.
Rationale: To minimize shivering.
Evaluation
Goals met, the patient body temperature is increased from 35.0 C/ax to 36.4 C/ax.
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Nursing Diagnosis: Readiness for enhanced Knowledge related to disease process
Assessment
Subjective cue: “Ano baea du mga dapat ubrahon?” as verbalized by the patient
Objective cues:
The client manifested:
 Cooperative
 Active
Objectives:
General Objective:
Patient demonstrates more understanding about her current condition.
At the 8 hours of nursing intervention the patient will be able to:
 Exhibit responsibility for own learning by seeking answers to questions.
 Verify accuracy of informational resources.
 Verbalize understanding of information gained.
 Use information to develop individual plan to meet healthcare needs and goals.
Independent:
1. Verify client’s level of knowledge about specific topic.
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Rationale: Provides opportunity to ensure accuracy and completeness of knowledge
base for future learning.
2. Determine motivation and expectations for learning.
Rationale: provides insight useful in developing goals and identifying information needs.
3. Assist client to identify learning goals.
Rationale: Helps to frame or focus content to be learned and provides measure to
evaluate learning process.
4. Discuss ways to verify accuracy of informational resources.
Rationale: Encourages independent search for learning opportunities while reducing
likelihood of acting on erroneous or unproven data that could be detrimental to client’s
well-being.
5. Identify available community resources/support groups.
Rationale: Provides additional opportunities for role modelling, skill training,
anticipatory problem solving, and so forth.
Evaluation:
Goals met. Patient exhibit and verbalizes understanding about new information and able
to raise questions regarding her condition.
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DRUG STUDY
PRE – OPERATIVE MEDICATIONS
MEDICATION NO. 1
Generic name: Mg SO4 (Magnesium Sulfate)
Dosage/Route/Frequency: 4 gms slow IVTT now, 2.4 gms deep IM now
Classification: Anticonvulsant, a cathartic and an electrolyte replenisher
Indication: For immediate control of life-threatening convulsions in the treatment of severe
toxemias (pre-eclampsia and eclampsia) of pregnancy and in the treatment of acute nephritis in
children.
Mechanism of Action: Thought to trigger cerebral vasodilation, thus reducing ischemia
generated by cerebral vasospasm during an eclamptic event. The substance also acts
competitively in blocking the entry of calcium into synaptic endings, thereby altering
neuromuscular transmission.
Side effects:
CNS: confusion, sedation, depressed reflexes, flaccid paralysis
INTEG: hypothermia
CV: Hypotension, heart block, circulatory collapse, vasodilation, slow and weak pulse
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GI: nausea, vomiting, anorexia, cramps, diarrhea
HEMA: prolonged bleeding time
META: electrolyte, fluid imbalances, hypocalcemia
RESPI: respiratory depression/paralysis
Adverse effects:
INTEG: hypothermia
CNS: flushing, drowsiness
EENT: visual changes
CV: circulatory collapse, depressed cardiac function, hypotension
RESPI: respiratory paralysis, hypocalcemia
Nursing responsibilities with rationale
1. Observe the ten rights in giving medication
Rationale: To prevent medical error.
2. Check for absent patellar reflex, respiration below 16 cpm and urine output of less than
1oo ml in past four hours before administering Magnesium Sulfate.
Rationale: Disappearance of Patellar reflex indicates onset of magnesium toxicity.
3. Be alert of the adverse reactions and interactions. Report promptly signs of flushing,
hypotension or hypothermia.
Rationale: These are early signs of hyper magnesia.
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4. Observe constantly when given IV. Check BP and pulse q10-15 min or often if indicated.
Rationale: Drug may cause circulatory collapse and depression of the myocardium.
5. Strictly monitor input and output.
Rationale: This drug is used with caution in clients with renal disease because
magnesium is removed from the body solely by the kidney and use in renal disease that
may cause magnesium intoxication.
6. Monitor weight, deep tendon reflexes and level of consciousness.
Rationale: To regulate muscle and nerve function.
7. Monitor plasma magnesium levels in patients receiving drug parentally (normal: 1.8-3.0
mEq/L).
Rationale: Plasma levels in excess of 4 mEq/L are reflected in depressed deep tendon
reflexes and other symptoms of magnesium intoxication (see ADVERSE EFFECTS).
Cardiac arrest occurs at levels in excess of 25 mEq/L.
8. Monitor calcium and phosphorus levels also.
Rationale: Early indicators of magnesium toxicity (hypermagnesemia) include cathartic
effect, profound thirst, and feeling of warmth, sedation, confusion, depressed deep tendon
reflexes, and muscle weakness.
9. Monitor respiratory rate closely.
Rationale: Respiratory failure may occur.
10. Test patellar reflex before each repeated parenteral dose.
Rationale: Depression or absence of reflexes is a useful index of early magnesium
intoxication.
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11. Check urinary output, especially in patients with impaired kidney function.
Rationale: Therapy is generally not continued if urinary output is less than 100 mL
during the 4 hours preceding each dose.
12. Observe patients receiving drug for hypomagnesemia.
Rationale: Drug toxicity, irritability, choreiform movements, tremors, tetany, twitching,
muscle cramps, tachycardia, hypertension, psychotic behavior may happen.
13. Have Calcium Gluconate readily available
Rationale: Calcium gluconate is an antidote for magnesium toxicity.
14. Closely monitor cardiac status
Rationale: Drugs may cause circulatory collapse, depression of myocardium, heart block
and asystole may occur
MEDICATION NO.2
Generic name: Ranitidine
Brand name: Westram
Drug classification: Histamine-2 blockers
Dosage/Route/Frequency: 1 amp slow IV 1hr prior to OR.
Indication: Gastric ulcer, Gastritis, Hyperacidity, GERD, Erosive esophagitis
Action: Inhibits histamine at H2-receptor site in parietal cells, which inhibits gastric acid
secretion
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Side Effects:
CNS: headache, sleeplessness, dizziness,
CV: Premature ventricular contractions (PVCs)
EENT: blurred vision, increased ocular pressure
GI: constipation, abdominal pain, diarrhea, nausea, vomiting, hepatotoxicity
HEPATIC: jaundice, increased alanine transaminase (ALT)
GU: impotence, acute interstitial nephritis (rare)
HEMA: thrombocytopenia, pancytopenia, aplastioanemia
INTEG: urticaria, rash, fever
RESPI: pneumonia, bronchospasm
SYST: anaphylaxis (rare)
Adverse Effects:
CNS: confusion, agitation, depression, hallucination (geriatric patients)
CV: cardiac arrest, bradycardia, tachycardia
INTEG: urticaria
RESPI: bronchospasm
CV: hypotension
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MISC: hypersensitivity, anaphylaxis
Nursing Responsibilities with Rationale:
1. Observe ten rights of medication administration.
Rationale: To prevent medication error.
2. Monitor doses carefully and administer IV slowly.
Rationale: Monitor the patient continually if giving IV doses to allow early detection of
potentially serious adverse effects, including cardiac arrhythmias.
3. Assess for potential drug-drug interactions, instruct client to report any evidence of
yellow discoloration of the eye and skin, diarrhea, bleeding, black tarry stool and rash.
Rationale: Assess the patient carefully for any potential drug-drug interactions if given in
combination with other drugs because of the drug’s effects on liver enzyme systems;
signs manifested indicates drug toxicity.
4. Instruct patient to avoid activities that require mental alertness.
Rationale: Drug may cause dizziness or drowsiness.
5. Obtain CBC, liver function test and renal test.
Rationale: To have a baseline data and to assess for infection and toxicity of the drug.
Rationale: To have a baseline data and to detect untoward adverse effects like
hypotension, bradycardia, tachycardia, fever, and prevent life threatening complications.
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MEDICATION NO. 3
Generic Name: Metoclopramide
Brand Name: Meto
Dosage/Route/Frequency: 1amp Slow IV 30 minutes prior to OR
Classification:
Func. class.: Cholinergic, antiemetic
Chem. class.: Central dopamine receptor antagonist
Mechanism of Action: Stimulates motility of upper GI tract without stimulating gastric, biliary,
or pancreatic secretions; relaxes pyloric sphincter which, when combined with effects on
motility, accelerates gastric emptying and intestinal transit; has sedative properties.
Indications: Stimulation of gastric emptying and prophylaxis of post op nausea and vomiting
when nasogastric suction is desirable.
Side Effects:
CNS: dizziness, headache, drowsiness
MUSCU: tiredness, decreased energy.
Adverse Effects:
CNS: restlessness, fatigue, insomnia, extrapyramidal reactions, anxiety, dystomia.
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CV: transient hypertension, sinus ventricular tachycardia, bradycardia
GI: nausea, diarrhea
HEMA: agranulocytosis, leukopenia, neutropenia
ENDOCRINE: amenorrhea, fluid retention due to transient elevation of aldosterone
GU: incontinence
HEPOTIC: hepatoxicity
1. Observe the ten rights of medication administration.
Rationale: To avoid medical errors.
Rationale: Vital signs provide critical information about the patient’s state of health.
3. Monitor for extrapyramidal reactions and consult physician if they occur.
Rationale: To do prompt and appropriate interventions.
4. Raise the side rails up during transfer to the operating room and place both arms on
padded arm board before the operation.
Rationale: To prevent falls and promote patient’s safety.
5. Instruct patient to perform deep-breathing exercise.
Rationale: To prevent reliee anxiety if this will occur and to prevent atelectasis.
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POST –OP MEDICATIONS
MEDICATION NO. 1
Generic name: Ketorolac
Brand name: Ketopan
Drug classification: Nonsteroidal anti-inflammatory drugs (NSAIDs)
Dosage/Route/Frequency: 30 mg slow IVTT q 6 H x3 doses
Mechanisms of action: Inhibits miosis by inhibiting the biosynthesis of ocular prostaglandins;
prostaglandins play a role in the miotic response produced during ocular surgery by constricting
the iris sphincter independently of cholinergic mechanisms
Indication: Pain and inflammation after cataract surgery, refractive surgery, seasonal allergic
conjunctivitis
Side Effects
CNS: headache
CV: vasodilation, pallor
EENT: abnormal sensation in eye, conjunctival hyperemia, ocular irritation,
ocular pain, ocular pruritus, conjunctival hyperemia, iritis, keratitis, blurred vision, transient
burning/stinging.
GI: dyspepsia, peptic ulcer, nausea.
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RESPI: bronchospasm
Adverse Effects:
CNS: fainting, confusion, depression, persistent headaches, blurred vision
CV: fast/pounding heartbeat, symptoms of heart failure (such as swelling ankles/feet, unusual
tiredness, unusual/sudden weight gain).
EENT: vision changes (such as blurred vision),
HEMA: easy bruising/bleeding,
GI: persistent sore throat
GU: signs of kidney problems (such as change in the amount of urine),
2. Do a skin test before administering the drug.
Rationale: This product may contain inactive ingredients, which can cause allergic
reactions or other problems.
3. Assess patient for previous sensitivity reactions.
Rationale: To prevent potentially allergic reactions.
4. Provide safety measures such as assisting client when ambulating or keeping side rails up
if dizziness occurs.
Rationale: To prevent injuries or falls.
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5. Monitor vital signs and record.
Rationale: To serve baseline data and provides critical information about patient’s state
of health. Ketorolac may cause adverse effects that when not attended, can threaten a
patient’s life.
MEDICATION No. 2
Generic name: Ranitidine
Brand name: Westram
Drug classification: Histamine-2 blockers
Dosage/Route/Frequency: 1 amp slow IV 1hr prior to OR.
Indication: Gastric ulcer, Gastritis, Hyperacidity, GERD, Erosive esophagitis
Mechanism of Action: Inhibits histamine at H2-receptor site in parietal cells, which inhibits
gastric acid secretion
Side Effects:
CNS: headache, sleeplessness, dizziness
CV: premature ventricular contractions (PVCs)
EENT: blurred vision, increased ocular pressure
GI: constipation, abdominal pain, diarrhea, nausea, vomiting, hepatotoxicity
GU: impotence, acute interstitial nephritis (rare)
INTEG: rash, fever
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RESPI: pneumonia
Adverse Effects:
CNS: confusion, agitation, depression, hallucination (geriatric patients)
CV: cardiac arrhythmias
INTEG: urticaria,
RESP: bronchospasm
HEMA: hypotension
MISC: anaphylaxis
2. Monitor IV doses carefully and administer slow IV.
Rationale: Monitor the patient continually if giving IV doses to allow early detection of
potentially serious adverse effects, including cardiac arrhythmias. Rapid administration
may cause life threatening complications.
3. Monitor and record vital signs
Rationale: Vital signs provide critical information about patient’s state of health.
Ranitidine when given rapidly may cause premature ventricular constrictions or cardiac
arrest.
4. Assess for potential drug-drug interactions.
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Rationale: Assess the patient carefully for any potential drug-drug interactions if given
in combination with other drugs because of the drugs effects on liver enzyme systems.
MEDICATION NO. 3
Generic Name: Metoclopramide
Brand Name: Meto
Dosage/Route/Frequency: 1amp Slow IV 30 minutes prior to OR
Classification: Cholinergic, antiemetic
Chem. class.: Central dopamine receptor antagonist
Mechanism of Action: Stimulates motility of upper GI tract without stimulating gastric, biliary,
or pancreatic secretions; relaxes pyloric sphincter which, when combined with effects on
motility, accelerates gastric emptying and intestinal transit; has sedative properties.
Indications: Stimulation of gastric emptying and prophylaxis of post op nausea and vomiting
when nasogastric suction is desirable.
Side Effects:
CNS: dizziness, headache, drowsiness
GI: nausea, vomiting, diarrhea
MUSCU: tiredness, decreased energy.
Adverse Effects:
CNS: restlessness, drowsiness, fatigue, insomnia, extrapyramidal reactions, dizziness, anxiety
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CV: transient hypertension
1. Observe the ten rights in giving medication
Rationale: To prevent medical error.
2. Monitor for extrapyramidal reactions and consult physician if they occur.
Rationale: To do prompt and appropriate interventions.
3. Raise the side rails up during transfer to the operating room and place both arms on
padded arm board before the operation.
Rationale: To prevent falls and promote patient’s safety.
4. Instruct patient to perform deep-breathing exercise.
Rationale: To relive anxiety if this will occur.
MEDICATION NO. 4
Generic Name: Cefuroxime
Brand Name: Cefuvex
Drug Classification: Cephalosporin Antibiotic, 2nd Generation
Dosage/Route/Frequency: 750 mg slow IVTT (-) ANST
Mechanisms of action: Inhibits bacterial cell wall synthesis, renders cell wall osmotically
unstable, leads to cell death by binding to cell wall membrane
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Indication: Used as prophylaxis, to prevent post-operative infection.
Side effects:
CNS: dizziness, headache, fatigue, paresthesia, fever, chills, confusion
GI: diarrhea, nausea, vomiting, anorexia, dysgeusia, glossitis, bleeding; increased AST, ALT,
bilirubin, LDH, alk phos; abdominal pain, loose stools, flatulence, heartburn, stomach cramps,
GU: vaginitis, pruritus, candidiasis, increased BUN, nephrotoxicity, renal failure, pyuria,
dysuria, reversible interstitial nephritis
HEMA: leukopenia, thrombocytopenia, agranulocytosis, anemia, neutropenia, lymphocytosis,
eosinophilia, pancytopenia, hemolytic anemia, leukocytosis, granulocytopenia
INTEG: rash, dermatitis, Stevens- Johnson syndrome
RESP: dyspnea
SYST: anaphylaxis, serum sickness, superinfection
Adverse effects:
CNS: asthenia, vertigo, insomnia, anxiety
GI: abdominal pain, vomiting, constipation.
INTEG: alopecia, pruritus, urticaria
MUSCO: Back pain
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2. Explain the use of the drug before administration.
Rationale: To promote cooperation.
3. Assess for history of allergies to cephalosporin antibiotics.
Rationale: To prevent hypersensitivity reactions.
Instruct to take the drug after meal or with full stomach.
Rationale: Drug may cause gastric irritation. (omitted)
4. Encourage to continue taking medication as ordered
Rationale: To achieve maximum drug effect.
5. Monitor liver function test, CBC, PPT, PT.
Rationale: Drug may cause an increase in alanine transaminase (ALT) aspartate
transaminase (AST), alkaline phosphatase, bilirubin levels. Drug may decrease
hemoglobin and hematocrit level. Drug may prolong PT and increase INR.
6. Instruct patient to notify caregiver/physician if evidence of superinfection is observed
(fever, diarrhea)
Rationale: To provide prompt intervention and avoid life threatening complications.
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MEDICATION NO. 5
Generic name: Piroxicam
Brand name: Feldene Flash
Drug classification: Nonsteroidal anti-inflammatory drugs (NSAIDs).
Dosage/Route/Frequency: 1 tab SL BID x 5 days then OD to BID prn for pain.
Mechanisms of action: Reversible inhibition of cyclooxygenase, causing the peripheral
inhibition of prostaglandin synthesis. The prostaglandins are produced by an enzyme called Cox-
1. Piroxicam blocks the Cox-1 enzyme, resulting into the disruption of production of
prostaglandins.
Indication: used to reduce pain, swelling, and joint stiffness from arthritis. Reducing these
symptoms helps you do more of your normal daily activities.
Side Effects:
CNS: dizziness, headache
GI: stomach pain, loss of appetite, nausea, vomiting, diarrhea, constipation
GU: difficulty urinating
Adverse Effects:
GI: flatulence, anorexia, gross bleeding/perforation, peptic ulcer
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CNS: vertigo
EENT: tinnitus
INTEG: pruritus, rash
HEMA: increased bleeding time, abnormal liver function tests
Rationale: Vital signs provide critical information about client’s health status. Serves as
baseline data. Useful for monitoring and detecting medical problems.
4. Monitor CBC, liver function tests and auditory functions.
Rationale: Drug may cause anemia, bleeding and tinnitus.
5. Assess for history of allergies to cephalosporin antibiotics.
Rationale: To prevent hypersensitivity reactions.
6. Instruct to take the drug after meal or with full stomach.
Rationale: Drug may cause gastric irritation.
Check BP before administering.
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Rationale: Piroxicam can cause high blood pressure or make your high blood pressure
worse. (omitted)
8. Assess the patient if she has asthma.
Rationale: If yes, don’t administer piroxicam. It can trigger an asthma attack.
MEDICATION NO. 6
Generic name: Paracetamol
Brand name: Panadol
Drug classification: Aniline Analgesics
Dosage/Route/Frequency: 500 m /tab 2 tabs q 6 H po x3 days then prn for pain.
Mechanisms of action: Has a central analgesic effect that is mediated through activation of
descending serotonergic pathways. Debate exists about its primary site of action, which may be
inhibition of prostaglandin (PG) synthesis or through an active metabolite influencing
cannabinoid receptors.
Indication: Has good analgesic and antipyretic properties. It is suitable for the treatment of
pains of all kinds (headaches, dental pain, postoperative pain, pain in connection with colds,
post-traumatic muscle pain). Migraine headaches, dysmenorrhea and joint pain can also be
influenced advantageously.
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Side Effects:
GI: nausea, vomiting, stomach upset
Adverse Effects:
INTEG: pinpoint red spots on the skin, skin rash, hives, itching
GI: bloody or black tarry stools, sore throat (not present before treatment and not caused by the
condition being treated), sores, ulcers or white spots on the lips or in the mouth
GU: bloody or cloudy urine, sudden decrease in the amount of urine
HEMA: Unusual bleeding or bruising, abnormal liver function tests
Rationale: Vital signs provide critical information about client’s health status. Serves as
baseline data. Useful for monitoring and detecting medical problems.
3. Monitor client’s liver function test, CBC, electrolytes, blood glucose level, prothrombin
time.
Rationale: Paracetamol may increase aspartate transaminase which may indicate liver
damage as evidenced by jaundice, severe dyspepsia, inability to eat. Paracetamol
decreases hemoglobin, hematocrit level, neutrophils, white blood cells, potassium,
magnesium, phosphorus.
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4. Warn client to take paracetamol as prescribed.
Rationale: Unsupervised, high doses of paracetamol may cause liver failure.
5. Warn client to stop the drug immediately when rash and other adverse effects occur, seek
immediate medical attention.
Rationale: Drug may cause potentially life-threatening effects.
MEDICATION NO. 7
Generic Name: Parecoxib
Brand Name: Dynastat
Dosage/Route/Frequency: 40 mg IV q12h x 3doses
Classification: Non-steroidal anti-inflammatory drugs
Mechanism of Action: Inhibits cyclo-oxygenase-2 (COX-2) mediated prostaglandin synthesis to
reduce mediators of pain and inflammation
Indications: Short term treatment of acute pain & post-op pain
Side Effects:
CNS: nausea, dizziness
CV: tachycardia
GI: abdominal pain, hypoactive vowel sound
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Adverse Effects:
CNS: agitation or sleeping difficulties
CV: hypotension, hypertension, heart failure, heart attack, bradycardia, arrhythmia, anemia
RESPI: difficulty breathing
GI: GI disturbances and bleeding, jaundice, abnormal liver function
GU: decreased urine output, kidney failure
HEMA: low platelet count
INTEG: rash, ulcerations or any other signs of an allergic reaction, pruritus, skin swelling,
blistering or peeling, Steven-Johnson syndrome, toxic epidermal necrolysis
Others: back pain, edema, numbness
Potentially Fatal: anaphylaxis
2. Monitor patient’s vital signs before, during, and after drug administration.
Rationale: To have baseline data and to monitor for any deviation from the normal
values.
3. Place the patient in Semi or High-fowler’s position.
Rationale: To facilitate breathing and promote lung expansion if the patient manifest
difficulty of breathing.
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4. Monitor intake, output and electrolytes.
Rationale: To establish baseline data because the drug can decrease urinary output.
5. Monitor for patient’s platelet count, liver and kidney studies.
Rationale: To establish baseline data and to determine any deviation from the normal
values.
6. Monitor for any allergic reactions to the drug.
Rationale: To do prompt and appropriate intervention.
MEDICATION NO. 8
Generic Name: Tramadol HCl
Brand Name: Traman
Drug Classification: Analgesic
Dosage/Route/Frequency: 50 mg IV q6h x 5doses
Mechanism of Action: A centrally-acting synthetic analgesic compound not chemically related
to opiates. Drug is thought to bind to opioid receptors and inhibit reuptake of norepinephrine and
serotonin; causes many effects similar to opioids such as dizziness, nausea, constipation, etc. but
does not have respiratory depressant effects.
Indication: Management of moderate to severe pain
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Side effects:
CNS: Dizziness, headache
EENT: Visual disturbances
GI: Anorexia, constipation, dry mouth, flatulence, nausea
Adverse Effects:
CNS: dizziness, headache, confusion, sweating, anxiety
CV: hypotension, tachycardia, bradycardia, hypertension
RESP: difficulty breathing
GI: vomiting, constipation, acute abdominal conditions, dry mouth, flatulence
Derma: sweating, pruritus, rash, pallor, urticarial
Hematologic: thrombocytopenia and leukopenia
Others: potential for abuse, anaphylactoid reactions
Nursing Responsibility with Rationale:
2. Explain assessment and monitoring process to client and family. Instruct them to
immediately report difficulty in breathing especially during initiation of dosage increase.
Rationale: Drug may cause fatal respiratory depression.
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Rationale: Drug may cause hypertension, respiratory depression vomiting.
4. Monitor kidney and liver function tests, CBC, input and output.
Rationale: Drug may increase creatinine, liver enzymes and may decrease hemoglobin
level.
5. Assess patient for previous sensitivity reactions to Tramadol.
Rationale: To prevent potentially allergic reactions.
Rationale: Hypertension or hypotension may be experience by the client as well as
tachycardia or bradycardia.
8. Instruct the client as well as the folks to report severe nausea, dizziness and constipation.
Rationale: To give prompt intervention and provide comfort.
9. Avoid performing tasks that require alertness.
Rationale: To prevent injury. Dizziness, drowsiness, impaired visual acuity maybe
experienced.
10. Observe right dosage and intake of the drug.
Rationale: Potential abuse of the drug may cause anaphylactic reactions.
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MEDICATION NO. 9
Generic Name: Losartan
Brand Name: Cozaar
Drug Classification: Angiotensin II receptor (type AT1) antagonist
Dosage/Route/Frequency: 100 mg after breastfeeding
Mechanisms of Action: Non-peptide angiotensin II receptor antagonist with high affinity and
selectivity for the AT 1 receptor. Losartan blocks the vasoconstrictor and aldosterone-secreting
effects of angiotensin II by inhibiting the binding of angiotensin II to the AT 1 receptor.
Indication: Used to treat high blood pressure (hypertension) and to help protect the kidneys from
damage due to diabetes. It is also used to lower the risk of strokes in patients with high blood
pressure and an enlarged heart. Lowering high blood pressure helps prevent strokes, heart
attacks, and kidney problems.
Side Effects:
GI: diarrhea, Stomach pain
MUSC: muscle cramps, Leg or back pain
CV: dizziness
Adverse Effects:
GU: pain or burning when you urinate; Urinating less than usual or not at all;
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INTEG: pale skin
CNS: lightheadedness, drowsiness, confusion
RESP: shortness of breath, wheezing, chest pain
CV: rapid heart rate
GI: Nausea and vomiting
OTHERS: high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling).
Nursing Responsibility with Rationale:
5. Check BP before administering. Monitor and record vital signs
Rationale: To serve baseline data and to evaluate effectiveness of therapy and to detect
untoward reaction so prompt intervention can be given.
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7. Instruct the client as well as the folks to report severe nausea, dizziness and constipation,
chest pain, hypotension.
Medication NO. 10
Generic Name: Carvedilol
Brand Name: Captopril
Drug Classification: Antihypertensive, a-/badrenergic blocker
Dosage/Route/Frequency: 6.25 mg 1 tab OD after dinner
Mechanisms of Action: A mixture of nonselective a-/b-adrenergic blocking activity; decreases
cardiac output, exercise-induced tachycardia, reflex orthostatic tachycardia; causes vasodilation,
reduction in peripheral vascular resistance
Indication: Essential hypertension alone or in combination with other antihypertensives, CHF,
LV dysfunction after MI, cardiomyopathy
Side Effects:
CNS: dizziness, lightheadedness, drowsiness
GI: diarrhea, impotence
Adverse effects:
CNS: severe dizziness, fainting
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HEMA: easy bruising/bleeding
CV: very slow heartbeat, confusion, depression
MUSC: unusual weakness
GU: signs of kidney problems (such as change in the amount of urine)
Adverse effects:
CV: very slow heartbeat, confusion, depression
CNS: severe dizziness, Fainting
MUSC: unusual weakness
GU: signs of kidney problems (such as change in the amount of urine)
HEMA: easy bruising/bleeding
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5. Check BP before administering. Monitor and record vital signs.
Rationale: To serve baseline data, drug may cause chest pain, hypotension, palpitations
av blocks, bradycardia.
7. Instruct the client as well as the folks to report severe nausea, dizziness and constipation.
8. Monitor client’s liver and kidney function tests, blood sugar, CBC, platelet PT, lipid
profile.
Rationale: Drug may cause an increase in alkaline transaminase (ALT) aspartate
transaminase (AST), BUN cholesterol and triglyceride, sodium and uric acid. Drug may
increase/decrease glucose levels. May decrease platelet count.
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DISCHARGE PLANNING
Medication
1. Advise the patient to take the medication on time as prescribed.
Rationale: To reach effectiveness of the drugs and to avoid resistance.
2. Teach the family the important signs and symptoms of the patient’s condition, side effects
of the medications and when to call the physician or nurse.
Rationale: To become aware of when to seek medical attention
3. Educate the patient about the medication and make sure the patient understands.
Rationale: To become aware of any untoward reaction if possible and know when to seek
medical attention
4. Encouraged the family to follow drug regimen as prescribed and always have a supply on
hand.
Rationale: To avoid drug resistance and provide continuous effectiveness of the
medication.
Environment
1. Encouraged the family to keep the room as quiet as possible and environmental stimuli like
noise to be kept at a minimum.
Rationale: To provide peaceful and restful environment for the patient.
2. Instruct the family to provide well- ventilated environment.
Rationale: To promote adequate rest for the patient which can contribute for faster
recovery.
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3. Educate the family to clean their house thoroughly including their surroundings.
Rationale: To prevent contracting infections.
Treatment
1. Encourage the patient to seek for follow-up checkup.
Rationale: To determine further complications.
Hygiene
1. Advise the patient to change her underwear 2-3 times a day.
Rationale: Changing underwear at least daily helps prevent jock itch, pinworms, foul
odor and other genital infestations/infections.
2. Teach client and significant others on how to perform proper wound care to incision site.
Rationale: To enhance wound care to incision site.
3. Take a bath 3-5x a day.
Rationale: Bathing, moisturizing and inspecting skin integrity will promote good muscle
tone.
Outpatient Referral
1. Advised the family to seek financial help from government officials (barangay captain,
Mayor, Kagawad, Governor) if needed.
Rationale: To reduce financial burden in case they have to return to hospital.
2. Advise the client to use their PhilHealth card to avail its benefits
Rationale: To reduce financial burden.
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Diet/Exercise/Activity
1. Encourage the client to ambulate, such as walking.
Rationale: To avoid adhesions, walking is a great way of improving and maintaining
overall health. It can increase cardiovascular fitness, strengthen bones, boost muscle
power and endurance.
2. Teach the importance of maintaining proper/adequate nutrition.
Rationale: To boost the immune system.
3. Instruct the patients to avoid engaging in vigorous activity.
Rationale: To reduce energy consumption.
Support System/Spiritual well-being
1. Encourage the family to go to church and ask for advice from their church leaders
Rationale: To strengthen their relationship to God.
2. Ask the patient to seek advice to social workers, counselors, and other member of
the barangay.
Rationale: To help her in financial difficulties and to provide emotional support.
3. Advise the patient to seek help of doctors, nurses, and other members of health care
team to answer questions about treatment, working, or other activities.
Rationale: Seeking medical advises can gain more knowledge regarding her
condition and limit risk of complications by closely monitoring existing condition.
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REFERENCES
Cleveland Clinic medical professional (2019). Female Reproductive System
Kidshealth.org (September 2018). Heart and Circulatory System
Heart.org (2021). Fetal Circulation
University of Illnois (April 07, 2020). Ranitidine, Side Effects and Adverse Effects
MIMOnline Team (May 13, 2014). Parecoxib
Medscape (2021). Magnesium Sulfate (Rx), Adverse effects
Mayo Clinic (March 19, 2020). Preeclampsia, Introduction
Medscape (2021). Metoclopromide, Post and Pre-op drug no.3
Rxlist (March 2021). Panadol, Adverse and Side Effects
Jaime Herndon, MS, MPH, MFA reviewed by Holly Ernst, PA-C (September 4, 2018)
Medscape (2021). Ketorolac, Post-op drug no. 1
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APPENDICES
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APPENDIX I. Invitation
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APPENDIX II. ATTENDANCE
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AKLAN POLYTECHNIC COLLEGE

utilization of the nursing process.

Specifically, we will be able to:

 Define terminologies related to Preeclampsia;

procedures and management of client with Preeclampsia;

and Fetal Circulation;

 Explain the Pathophysiology of Preeclampsia;

 Identify and explain the drugs used to treat Preeclampsia;

 List nursing responsibilities in caring a client with Preeclampsia;

 Assess and classify gathered data relevant to client condition;

 Formulate nursing diagnosis specific to the identified health problem;

 Plan a care specific to the client’s identified health problems;

 Implement effectively the plan of care being identified;

 Formulate a Concept Map of care;

 Evaluate deviation of laboratory results and its significance;

 Establish rapport and promote cooperation through nurse – client interaction;

 Acknowledge client’s expression of feelings and emotions;

 Listen attentively to client’s queries about their health;

 Recognize client’s right for privacy and confidentiality;

called the islet cells of langerhans.

 Eclampsia: is an extension of preeclampsia and is characterized by the client experiencing seizures.

angiotensin) is called angiotensin-converting enzyme. Angiotensin II controls the blood pressure

differentiation, into a new individual of the species.

oxygen levels in the fetus).

rate inside the womb.

after you are 20 weeks pregnant.

glomeruli, each minute.

 Pre-Eclampsia: a complication of pregnancy, of unknown cause, which in severe cases may

proceed to eclampsia. It is characterised by hypertension, renal impairment, oedema, often with

proteinuria and disseminated intravascular coagulation.

as pressures exceeding 140/90.

are acutely ill and immediate termination of pregnancy is necessary.

causes of maternal and neonatal mortality.

Pre-eclampsia is a medical condition where hypertension arises in pregnancy (pregnancy- induced

cause endothelial dysfunction in the maternal blood vessels of susceptible women.

advancing disease report few symptoms.

attributable to eclampsia, rather than preeclampsia.

unit admissions after obstetric hemorrhage.

maternal death (19.6 percent) based on local statistics (PSA, 2015).

SIGNS AND SYMPTOMS

Preeclampsia sometimes develops without any symptoms. Monitoring blood pressure is an

on two occasions, at least four hours apart — is abnormal.

Other signs and symptoms of preeclampsia may include:

 Excess protein in urine (proteinuria) or additional signs of kidney problems

 Decreased urine output

 Decreased levels of platelets in blood (thrombocytopenia)

 Impaired liver function

 Shortness of breath, caused by fluid in the lungs

and evolve to efficiently send blood to the placenta.

amount of blood that can flow through them.

Causes of this abnormal development may include:

 Insufficient blood flow to the uterus

 Damage to the blood vessels

 A problem with the immune system

The other three are:

excess protein in their urine or other signs of organ damage.

pregnancy or that occurs before 20 weeks of pregnancy.