SAN PABLO COLLEGE

COLLEGE OF NURSING

CASE STUDY

I. CLINICAL SCENARIO/ACTUAL CASE(f2f) with Patient’s Profile

Patient X, a 39-year-old-female with a status of G3P2 from San Cristobal San Pablo City,
Laguna was admitted on February 12, 2024, at exactly 7:38 am because of Abdominal Pain
(especially on the upper right side), high blood pressure and convulsions.

The Patient’s initial vital signs were taken and noted. Patient X weight 60 kilograms, has a
body mass index of 22.9, a temperature 36.7 degree cel, a blood pressure of 175/80 mmHg,
a respiratory rate of 25 beats per minute, a heart rate of 115 beats per minute, and an
O2SAT of 88%.

Patient’s Demographic Profile:

Name: Patient X
Age: 39 years old
Address: San Cristobal San Pablo City, Laguna
Gender: Female
Weight: 60kg
Marital Status: Married
Date of Admission: February 12, 2024
Time of Admission: 7:38 am

II. DEFINITION OF DISEASE/CLINICAL SITUATION

ECLAMPSIA

Eclampsia is a rare but serious complication of preeclampsia. Preeclampsia is a disorder of

pregnancy in which of person who’s pregnant has high blood pressure and protein in their
urine. Eclampsia is when a person with preeclampsia develops seizures (convulsions) during
pregnancy. Seizures are episodes of shaking, confusion and disorientation or put the
pregnant person in a coma caused by abnormal brain activity. In some cases, it can lead to
stroke or death.
Eclampsia typically occurs after the 20th week of pregnancy. It’s rare and affects less than 3%
of people with preeclampsia. Eclampsia can cause complications during pregnancy and
requires emergency medical care.

RISK FACTORS

The biggest risk factor for eclampsia is preeclampsia. Most people with preeclampsia don’t
develop eclampsia. You may also be at higher risk for eclampsia if:

 You’re pregnant with multiples.

 You have an autoimmune condition.
 You consume a poor diet or have obesity (a BMI greater than 30).
 You have diabetes, hypertension or kidney disease.
 You’re younger than 17 or older than 35.
 This is your first pregnancy.
 Family or personal history of preeclampsia or eclampsia.

WARNING SIGNS

What are the warning signs of eclampsia?

Many people will have warning signs before having seizure caused by eclampsia. Some
of these signs are:

 Severe headaches.
 Difficulty Breathing.
 Nausea or vomiting.
 Trouble urinating or not urinating often.
 Abdominal pain
 Blurred vision, seeing double or loss of vision.
 Swelling of the hands, face or ankles.

SIGNS AND SYMPTOMS

What are the symptoms of eclampsia?

1. Increase HPN precedes SEIZURE

- Impending signs of seizure are headache, visual disturbances and epigastric
pain) followed by circulatory hypertension and collapse
Stages:
a. Tonic Phase – all body contracts, arching of back, arms and legs are stiff
b. Clonic Phase – all of the muscle of body will contract and relax
 c. Post-Ictal Phase – semi comatose/ patient cannot be arouse except for painful
stimuli
2. May lead to coma
3. Labor may begin because of premature separation of placenta secondary to
vasospam which might lead to preterm delivery

III. PATHOPHYSIOLOGY/PHYSIOLOGY
(Note: Pathophysiology for Diseases with Disease process e.g. MI, CVA. Physiology for cases
like fracture, fall and the likes)

IV. ASSESSMENT
a. Physical Assessment (Head to Toe)
 NORMAL VALUE RESULT CLINICAL
SIGNIFICANCE
Weight 46kg-62kg 60 kg Normal
Height 5 ft, 2 inches Normal
BMI 18.5 – 24.9 22.9 Normal

b. Systems Assessment

RESULT NORMAL VALUE INDICATION

BP 175/80 mmHg 120/80 mmHg Elevated

RR 22.9 bpm 12-20 bpm Tachypnea

PR 115 bpm 60-100 bpm Tachycardia

Temperature 36.7 degree c 36.5-37.5 degree c Normal

O2 Sat 88% 95-100% Low

c. Laboratories

CBC Parameter Result Reference Clinical Significance

Range
Hemoglobin 9.8 g/dL 12.0 - 15.5 g/dL Low hemoglobin indicates
anemia, common in
eclampsia due to
hemodilution and increased
red blood cell destruction.
May contribute to tissue
hypoxia.
Hematocrit 30% 36% - 46%
Low hematocrit confirms
anemia. This decrease is
 often attributed to
hemodilution and increased
plasma volume associated
with eclampsia.
White Blood Cell 14,000/μL 4,000 - Elevated white blood cell
Count (WBC) 11,000/μL count suggests inflammation
or infection, which can
complicate eclampsia
management.
Platelet Count 160,000/μL 150,000 - Normal platelet count is
450,000/μL reassuring as
Red Blood Cell 3.6 x 10^6/μL 4.2 - 5.4 x Decreased red blood cell
Count (RBC) 10^6/μL count indicates anemia,
consistent with
eclampsiarelated
hemodilution and
increased RBC
destruction. May lead to
tissue hypoxia.
Mean Corpuscular 83 fL 80 - 100 fL MCV within normal range
Volume (MCV) suggests normocytic
anemia, typical in
eclampsia.

Mean Corpuscular 27.8 pg 27 - 31 pg MCH within normal range

Hemoglobin indicates normochromic
(MCH) anemia, common in
eclampsia.
Mean 33.5 g/dL 32 - 36 g/dL MCHC within normal
Corpuscular range confirms
Hemoglobin normochromic anemia,
Concentration characteristic of
(MCHC) eclampsia.

d. Diagnostic Procedures

DIAGNOSTIC PROCEDURE DESCRIPTION OF PROCEDURE CLINICAL FINDINGS

BLOOD TESTS Blood test are common tests
healthcare providers use to
measure or examine
substances in your blood such
as blood cells, chemicals,
proteins and more.
URINE TESTS A urinalysis is a common test
that can assess many different
Blood tests show
abnormal factors.
(Platelet, RBC, and
Hemoglobin)
Proteinuria is typically
one of the presenting
 aspects of your health with a
urine sample. Healthcare
providers often urinalysis tests
to screen for or monitor certain
health conditions and to
diagnose urinary tract
infections.
CREATININE TESTS Creatinine test is a measure of
how well your kidneys are
performing their job of filtering
waste from your blood.
Creatinine is a chemical
compound left over from
energy-producing processes in
your muscles. Healthy kidneys
filter creatinine out of the
blood. Creatinine exists your
body as a waste product in
urine.
V. Treatment (use the format provided)
Patient Name: Patient X
Treatment Indication Rationale
Medical/Surgical
Magnesium Sulfate Used for Magnesium sulfate may act
immediate as a vasodilator, with
Brand Name: control of life- actions in the peripheral
Concept Ob threatening vasculature or the
convulsions in cerebrovasculature, to
the treatment of decrease peripheral
severe toxemias vascular resistance and/or
(pre-eclampsia relieve vasoconstriction.
and eclampsia)
of pregnancy. Magnesium sulfate may
also protect the blood-brain
barrier and limit cerebral
edema formation, or it may
act through a central
symptoms in patients
with eclampsia. A timed
collection has been the
criterion standard for
urinalysis to detect
proteinuria (>300 mg/24
h or >1 g/L).
In a 24-hour urine
collection, the reference
range for protein
excretion in pregnancy is
up to 300 mg/d.
Creatinine clearance
increases approximately
50% during pregnancy,
and levels less than 100
mL/min suggest renal
dysfunction that is either
chronic or due to
preeclampsia.
Nursing Considerations
 Use caution with
Renal insufficiency.
 Monitor EKG and
Respiratory status.
 Monitor Mg levels.
 Ensure dosage.
 Monitor signs and
symptoms of
Magnesium Sulfate
toxicity.
 anticonvulsant action.

VI. Drug Study (use the format provided)

Patient Name: Patient X

Generic – Classification/ Side effects/ Nursing Consideration Patient teaching

Brand Indication Adverse Reaction
name (Common/Life- threatening)

Phenytoin Phenytoin is  Headache  Careful cardiac  Take

indicated to monitoring is phenytoin
Brand treat grand  Constipation needed during exactly as
Name: mal seizures, and after directed.
Dilantin complex  Slurred speech administering
partial intravenous  Do not
seizures, and  Decreased phenytoin take more
to prevent coordination or less of it
and treat  Monitor serum or take it
seizures  Nausea drug levels more
during or often than
following  Swollen gums  Contraindicated prescribed
neurosurgery. for clients with by your
 Restlessness heart block doctor.

 Confusion  Use cautiously  Your

in clients with doctor will
 Allergic reaction hepatic or renal start you
impairment on a low
dose of
 Taper dose; do phenytoin
not stop and
abruptly gradually
increase
your dose,
not more
often than
 once every
7 to 10
days.

Generic – Classification/ Side effects/ Nursing Consideration Patient teaching

Brand Indication Adverse Reaction
name (Common/Life-
threatening)

Diazepam Diazepam, one  Confusion  Assess blood  Do not take

of the pressure, pulse a larger
Brand benzodiazepines,  Constipation and respiration dose, take it
Name: was first if IV more often,
Valium suggested for  Irritability administration. or for a
women with longer time
eclampsia. It is  Sleepiness  Provide than your
commonly used frequent sips doctor tells
for treating a  Agitation of water for you to.
wide range of dry mouth.
conditions,  Dizziness  Tell your
including  Provide fluids doctor if you
anxiety,  Dry mouth and fibre for have ever
insomnia, constipation. drunk large
seizures, and  Feeling sad amounts of
muscle spasms. or empty  Evaluate alcohol, if
therapeutic you use or
 Blurred response, have ever
vision mental state used street
and physical drugs, or
dependency have
after long-term overused
use. prescription
medications.

 Diazepam
may make
you feel
dizzy,
increasing
your risk of
falls. Be
careful
when sitting
or standing
up after
lying down.
 VII. NCP (use the format provided)

Nursing Diagnosis: Decreased Cardiac Output r/t decreased venous return evidence by eclampsia,
altered BP and edema.

ASSESSMENT PLANNING/GOAL IMPLEMENTATION RATIONALE EVALUATION GOAL

Desired Outcome Independent/dependent Reason for the Expected MET
Nursing intervention intervention Outcome
Pertinent Data: Patient will: Nurse will: Why: Positive result Yes No
Subjective: Short Term: 1. Establish rapport 1. To gain Short Term: /
patient’s
“Pagod na After 3 hrs of trust and The patient
pagod na ako at nursing cooperation. shall have
nahihirapan na interventions, 2. Monitor and assess displayed
ako huminga” as the patient will VS 2. To obtaion hemodynamic
verbalized by display blood baseline. stability
the patient. pressure within 3. Assess patient’s (blood
her normal general physical 3. To determine pressure
range. condition. presence of within closer
abnormality. range).
Long Term:
4. Determine baseline 4. Provides Long Term
After 3 days of vital opportunities
nursing signs/hemodynamic to track The patient
Objective: interventions, Parameters changes. shall have
the patient will including demonstrated
Edema demonstrate peripheral pulses. activities that
activities that reduce the
Variations in BP reduce workload 5. Review signs of 5. To prevent workload of
reading of the heart. impending hypovolemic the heart
Restlessness failure/shock. shock. (stress
management,
V/S 6. Position with flat or 6. To increase therapeutic
BP: 175/80 keep trunk venous medication
mmHg horizontal while return. regimen
Temp: 36.7 C raising legs 20 to 30 program,
RR: 22 degrees balanced
PR: 115 bpm (contraindicated in activity/rest
congestive state in plan.
which semi-fowler’s
position is
preferred).

7. Promote adequate 7. To maximize

rest by decreasing sleep
 stimuli. periods.

 If the client goal was not met, briefly describe why and what step would be taken next:

VIII. Sample Charting (utilizing FDAR)

Sample Charting

Patient Name: Patient X

Date/Time Focus D>Data A>Action R>Response

2/12/24 Elevated Blood Pressure D: BP: 175/80 mmHg PR: 115 bpm
12:00 PM A: Monitored BP, Administered
medication as per doctor’s order,
provided comfort measures (back and
neck massage, elevation of head).
Educatued patient on stress
management, deep breathing exercises,
and relaxation technique. Monitored
response to medications to control
blood pressure.
R: Decreased blood pressure from
175/80 mmHg to 145/80 mmHg.
---------------------------------------------------

IX. Recommendation for Research

Level 2 New Researches on a Particular Disease
Level 3 and 4 Use the format provided

Eclampsia: Causes, Symptoms, Diagnosis & Treatment (clevelandclinic.org)