UNIVERISIT OF KABIANGA

SCHOOLOF HEALTH SCIENCES

DEPARTMENT OF NURSING

COURSE CODE :NUS 211

CORSE TITLE : OBSTRETIC NURSING 1

TASK:CASE STUDY 2 (ABNORMAL PREGNANCY)

LECTURER:MRS AGNES

STUDENT: GIDEON KIPLANGAT

REG NO:NUR/K/0518/2022

DATE OF SUBMISSION:09/11/2023
 CASE STUDY OF PREECLAMPSIA IN PREGNANCY

DEMOGRAPHIC DATA

Name: Jolly chepkemoi

Age: 35 years

Religion: Christian

Address: Bomet

Marital status: married

Education level: College

Economic resource: Teacher

Telephone number: 0725423894

HISTORY OF PRESENT PREGNACY

Jolly chepkemoi is 35 years old, gravida 3, para 2+0 and gestation of 34 weeks and five days. She
experienced her last menstrual periods on 15 of January 2023, and her estimated date of delivery
will be on December 28, 2023. She has no malaria attacks, and in addition, she is not involved in
habits like smoking tobacco. She is on folic acid drugs. She experienced the first fetal movements at
around four weeks of pregnancy. Her weight was 67 kilograms, and her height 156 centimetres. She
reported of high blood pressures of 163/93 mm/hg and on repeat she had a blood pressure of
145/90 and headache.

OBSTETRIC HISTORY

Pregnancy Year Number Place of Maturity Duration Type of Birth Sex Outcome Puerperium
order of ANC delivery of labour delivery weight
attended
1st 2012 7 Hospital Term Short SVD 3.1 kg Male Alive Normal
2nd 2018 8 Hospital Term Short SVD 3.2 kg Female Alive Normal

SPECIAL COMPLICATIONS.

She has not had any complication in previous pregnancy and had normal deliveries. No history
of any perinatal complications therefore she had normal pregnancy.
 OBSTETRICAL OPERATIONS.

She has not had caesarian section.

SPECIAL PERINATAL COMPLICATIONS AND EVENTS IN THE PREVIOUS

PREGNANCY.

The mother has no obstetrical history of twins or higher-order multiples. The mother has no

history of neonatal or infant death, no malformed or chromosomally abnormal children, and

no macrosomic children.

HISTORY OF PRESENT ILLNESS

Jolly Para 2+0 , gravida 3 has no history of high blood pressure in the previous pregnancies .she had
head ache frontal throbbing ,acute on and off alleviated by painkillers and has no aggregating
factor .No laps ,no upper abdominal pain ,no blurring of vision as well as convulsion. Furthermore
there is no per vaginal bleeding and no dysuria.

MEDICAL HISTORY

The mother had the following previous medical history.

 No history of tuberculosis
 No history heart disease
 No history renal disease
 No history diabetes mellitus.
 No blood transfusion undertaken.
 No history of surgeries
 No history of twins.
 PHYSICAL EXAMINATION

During a complete and organized collection of objective and subjective data using a
head-to-toe and systematic approach, the findings were as follows:

 On a general observation, the patient is generally conscious, alert, and oriented.

 Vitals signs were taken and were as follows :

Blood pressure: 163/93 mm/hg
Pulse rate: 92beats/minute
Temperature: 36.5
Weight: 67KG

 Head examination showed coarse hair, cleanliness and smooth texture. The mouth,
nose, ears, and face had a normal symmetry, shape, and normal functioning. She
complained of blurred vision.

 The examination of the neck revealed no limitations in range of motion, non-distended

jugular veins, normal lymph nodes that were not palpable, and a normal thyroid gland.
 On chest and breast examination, inspection, auscultation and
palpation were done.. There were no masses, scars, or dimpling.

 There were no abnormal per vaginal discharge, or varicosities.

 On abdominal examination, the client observed normal striae

gravidarum, linea nigra, and normal abdominal symmetry around the abdomen. There
were, fetal movements were positive.. There were palpable fetal parts on palpation,
and the fundal height was 34/40 with a cephalic presentation and a longitudinal lie.
On fetal auscultation, there were positive regular heartbeats recording 154
beats/minute.

 On the upper extremities there were no edema, but in the lower

extremities there were edema in the feet. .
 ANTENATAL PROFILE

The mother presented with the following:

 Hemoglobin levels of 13.0g/dl

 Blood group O+
 Rhesus- Positive.
 Urinalysis- normal
 HIV non-reactive.
 STI (Syphilis) was tested, and results were negative

INTERVENTIONS GIVEN DURING THE VISIT

 The mother was given a health talk on preventing infection, balancing rest and
activity.
 Corticosteroids were given to enhance the lung maturation to since there a high
chance of preterm birth.
 The mother was advised of adequate hydration.
 The mother was admitted in order to manage the blood pressures as well as the fetus.
 The mother was assisted in developing the birth plan.

DEVELOPMENT OF AN INDIVIDUAL BIRTH PLAN (IBP)

Among the interventions, the mother was advised and assisted in making an
individual birth plan focusing on several elements;

 Expected date of delivery: The client’s expected date of delivery was on December
28, 2023and advised to be ready two weeks before that time. The mother should be
aware of the danger signs of pregnancy and should visit a health center on seeing
them.

 Transport plan: Advised on having a transport plan to the health facility that will
enable her to a health facility.
  Emergency plan: I also advise their clients to have a financial plan that is savings that
will gather for any emergencies.
 Accompaniment: I also discussed the accompaniment to the health facility where she
decided to be accompanied by the mother and the sister.

 Place of delivery: The client was advised to have a place of delivery in mind and told
the importance of delivery in a health facility..

HEALTH PROMOTION AND SCHEDULING NEXT APPOINTMENT

 We educate the patient about lifestyle modification that she should avoid fatty food .
 We emphasized the importance of a well-balanced diet and also discussed the need of
folic acid and other vitamins during pregnancy.
 We encouraged adequate fluid intake, especially water to stay hydrated which is vital
for her and the baby's health.

 We also stressed the significance of regular prenatal check-up or visits with healthcare
providers to monitor the progress of pregnancy.

 We recommend safe and appropriate exercise during pregnancy to maintain physical

fitness reduces discomfort and prepare for labor.

 We also emphasized the importance of adequate rest and sleep to help the body
recover and cope with the physical and emotional demand of pregnancy.

 We educated her on potential environment of environmental hazards that should avoid

such as harmful chemicals radiation and certain medication.

The mother was advised to come to the hospital if she experiences any of the signs of
labor or any other alarming issue. Her next ANC visit on 20 of November 2023.
 NURSING CARE PLAN

A.I.C LITEIN MISSION HOSPITAL

NAME: JOLLY CHEPKEMOI. AGE: 35 YEARS.
ASSESSM NURSIN GOAL/ NURSING SCIENTIF IMPLEMENT EVALUA
ENT G EXPECTED INTERVEN IC ATION TION
DATA DIAGN OUTCOME TION RATION
OSIS ALE
On Headach 1. To alleviate 1. 1: Nurse Mercy The mother
assessment es can be pain within 1 Administer Paracetam administered reported
, the one of hour. paracetamol, ol is a Paracetamol ease of
mother the 2. To ease the 1g TDS per commonly tablets, 1g, per pain in her
reports symptom headache after oral. used pain oral. frontal part
headache s of 1 hour. 2. relieve it 2. Nurse Mercy of the
on the preeclam Encourage helps to also ensured head.
frontal part psia, a the mother reduce that the mother
of the head serious to drink a lot headache had taken
in the past pregnanc of water, and enough water.
week. y-related about eight provide 4. Nurse
condition glasses per relief. Emmah gave
character day. 2: the mother a
ized by 3. To proper health talk on
high encourage hydration spending some
blood the patient to and relieve time for a rest
pressure rest and have headaches and some time
and some time of for a small
damage activity. physical
to organs activity.
like the
liver and
kidneys..

On Impaired Reduction in 1: Elevation 1: Nurse Dennis |The edema

assessment Tissue edema, with a of the Legs. Elevation provided the is reduced
, the Perfusio decrease in 2:Compressi of the patient with a
mother had n swelling in on therapy Legs health talk on
edema on This the lower such as promotes the importance
the lower diagnosis extremities. stocking venous of elevation of
extremities reflects improved 3: Ensuring return and the legs and
the circulation in the patient reduces assisted in
impaired the affected maintains edema. elevating.
blood extremities, adequate 2: 2. Nurse Judy
flow and reducing the fluid intake. Compressi gave a health
oxygen risk of on therapy talk
delivery complications helps compression
to the like skin improve therapy
 lower breakdown circulation 3. Nurse Judy
extremiti and venous and reduce ensured that
es due to insufficiency swelling in there is
the the lower adequate fluid
edema extremities intake
.
3:
Ensuring
the patient
maintains
adequate
fluid
intake, as
dehydratio
n can
worsen
edema.
On 1: To controlled 1;Educate 1: To 1. Nurse Judy The blood
assessing Hyperten blood the patient assess the performed pressure
the sion pressure about effectivene Administered was
patient's 2: Risk within target lifestyle ss of the controlled
had for ranges. modification treatment medications. at 123/78
elevated Complic 2: Reduced 2: Monitor and ensure mm/hg
blood ations cardiovascular blood blood 2;Nurse Judy
pressures related to risk factors. pressure pressure is monitored the
0f 163/87 Hyperten 3: Rest, regularly within a blood pressure
mm/hg sion counseling safe range. 3; Nurse Judy
3: and support. 2: Promote gave the health
Anxiety a healthy talk to the
related to diet; patient on
Elevated exercise health diet and
Blood this help exercise.
Pressure lower
blood
pressure.
 REFFERENCE
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Prevention of chronic disease by means of diet and lifestyle changes. Disease Control Priorities in
Developing Countries. 2nd edition.

Artinian, N. T., Fletcher, G. F., Mozaffarian, D., Kris-Etherton, P., Van Horn, L., Lichtenstein, A. H., ...
& Burke, L. E. (2010). Interventions to promote physical activity and dietary lifestyle changes for
cardiovascular risk factor reduction in adults: a scientific statement from the American Heart
Association. Circulation, 122(4), 406-441.