PREE ECLAMPSIA

Presented By Abdulla Khamis Ngwali

ZU/FHS/4674/13

INTRODUCTION

• Some women experience significant problems during the months of gestation that can greatly affect pregnancy outcome.

• The syndrome of pre-eclampsia can affect all maternal organ systems, but it is usually detected by the presence of new hypertension, proteinuria, and edema in pregnancy (Douglas & Redman, 1994).

THE STATUS OF THE PATIENT

Demographic dataPatient’s particulars

• Name: M. M. A.• Permanent address: Chumbuni, Unguja.• Age: 27years • Sex: Female• Occupation: House Wife• Marital Status: Married• Husband’s name: Mohd Hassan• Date of admission: 02/03/2016 • Time: 10:35am

MEDICAL HISTORY

Patient’s Present History/ chief complain• A 27-years old primigravida patient was admitted at

Maternity Ward at Mnazi Mmoja Hospital on 2nd of March, 2016 with 35 Weeks and 3 days of gestation age with a diagnosis of severe pre-eclampsia.

• She complained that, she feels pain in the epigastric region and feel dizziness. She was pale and fairly looking and had a BP of 180/110mmHg measured, a dipstick Proteinuria of 2+, oedema +++, a severe headache and visual blurring.

Patient’s Present History/ chief complain cont’• Subsequently she undergo delivery by cesarean section

under general anesthesia and twins’ baby boys’ one with weighing 1.8kgs and 1.6kgs was delivered with APGAR scores of 7 and 9 respectively.

Previous Medical history

• No previous hospitalization history, family background shows a history of hypertension.

• During Her first and second prenatal visits had been normal in all parameters including BP, which was recorded as 120/80 to 110/70mmHg.

• From her third visit showed a slight risen of her Blood Pressure which reads 140/90 mmHg, slight proteinuria of 2+ with slight edema of the lower limb.

Previous Medical history Cont’

• The woman was seen on the next week with slight decrease of vital signs and laboratory investigation.

CURRENT DIAGNOSIS AND TREATMENTDiagnosis

• Severe Pre-eclampsia.

Treatment:

• Medication such as antihypertensive and MgSO4 infusion was started with a loading dose 4g in 250mL N/SIV, run over 15minutes (slowly), 5g + 1 Ml Lignocaine IM in R or L buttock.

• Followed by a maintenance dose of Magnesium Sulfate 2g/h as a continuous intravenous infusion for 24h.

• Tablet Aldoment 800mg t.d.s 2/7

• Syrup Haemovit 15ml t.d.s 2/5.

NURSING ASSESSMENT OF THE PATIENT

• Subjective data

• Objective data

VITAL SIGNS AND TEST RESULTS

Vital signThe vital signs were done, where by the results shows that:-

Date Time Vital Signs

02/03/2016

10: 50am

BP: 180/110mmHg, Temp: 37.5ºC, Resp rate: 21b/min, Pulse rate: 75b/min, SP02: 97%

03/03/2016 10:55am

BP: 165/85mhhmHg, Temp: 37.7ºC, Resp rate: 22b/min

Pulse rate: 73b/min, SP02: 98%

Test ResultsThe doctor was suspect pre- eclampsia to the patient, the

certain tests were needed and the result shows that:-

• Blood tests :- Full blood picture was done and the results shows:-

Hemoglobin/hematocrit: - 12 g/dl, Platelets:- < 100,000/mm3 and Bilirubin 3mg/dl

• Urine analysis:- A single urine sample that was used to measure the ratio of; Creatinine >1.2 mg/dl, and Protein 2+

• Ultrasound: - The ultrasound shows that; the Fetal heart rate was 132b/min, fetal weight first twin is 1.8kg and second twin is 1.6kg, and the amount of fluid in the uterus (amniotic fluid) was adequate.

NURSING OBSERVATION

• General state of health Patient was well groomed with cleanness of the body,

conscious and aware of one’s self and environment and she can move by herself.

• Mental Status The patient is alert, conscious, and aware of the

environment.

NURSING DIAGNOSIS

1. Risk of developing eclampsia related to severe pre-eclampsia as evidence by BP of 180/110mmHg measured, a dipstick Proteinuria of 2+, oedema +++, a severe headache and visual blurring.

2. Excess fluid volume related to increase fluid intake as evidence by edema and frequency urination.

3. Activity intolerance related to hypertension as evidence by feels dizziness, slight headache and abdominal pains.

NURSING DIAGNOSIS

4. Sleep pattern disturbance related to feeling of birth process as evidence by patient complained that she having irregular sleep.

5. Fear related to hospitalization as evidence by increased tension, increased systolic blood pressure 183/100mmHg

NURSING CARE PLAN

DATE ASSESSMENTS EXPECTED

OUTCOME

INTERVENTION EVALUATION

Subjective DataSevere headache and visual blurring Objective Data BP of 180/110mmHg measured, a dipstick Proteinuria of 2+, oedema +++

To decrease blood pressure within 3hrs

-Provide the patient with prescribed analgesic medication such as tablets Paracetamol 500mg tds x 3/7-Provide the patient with MgSO4 infusion with a loading dose 4g in 250mL N/SIV, run over 15minutes (slowly)

Blood Pressure was improved within 1hrs

NURSING CARE PLAN

DATE ASSESSMENTS EXPECTED

OUTCOME

INTERVENTION EVALUATION

Subjective DataFrequency urination. Objective DataEdema

To decrease fluid volume within 7days

-Encourage the patient to decrease fluid intake from 1.5L to 750ml

After 3 days the fluid volume was reduce.

NURSING CARE PLAN

DATE ASSESSMENTS EXPECTED

OUTCOME

INTERVENTION EVALUATION

Subjective Data

Dizziness, slight headache and abdominal pains.

To maintain normal activity to the patient during hospitalization with 2 days

-Encourage patient to have bed rest-Provide the patient with prescribed anti pyretic medication such as tablets Paracetamol 500mg tds x 3/7

Body activities was maintained during hospitalization

NURSING CARE PLAN

DATE ASSESSMENTS EXPECTED

OUTCOME

INTERVENTION EVALUATION

Subjective Data

Patient

complained that

she having

irregular sleep

To maintain normal sleep of the patient during hospitalization within a day.

-Counsel the patient and Health education due to her condition.

-Encourage patient to decrease stress.

-Provide good ventilation in the room, minimize environmental activity or noise

Sleep pattern

was maintained

within a day

NURSING CARE PLAN

DATE ASSESSMENTS EXPECTED

OUTCOME

INTERVENTION EVALUATION

Subjective DataIncreased tension

Objective DataIncreased systolic blood pressure 183/100mmHg

To reduce fear of the patient due to hospitalization within a day

Monitor blood pressure of the patient so as not to continuing increasing.

-Administer antihypertensive drugs.

-Counsel the patient from free of hospitalized fear.

During assessment, Fear was reduce during hospitalization within a day

CARE PROVIDED OF THE PATIENT WITH SEVERE PRE-ECLAMPSIA

(Nursing care and management)

• Nursing care was done to the patient to prevent serious consequence to the mother’s and fetus’s health, including eclampsia, stillbirth, and liver and kidney failure.

• The patient was carefully monitored on high blood pressure and convulsions, and was treated with medication such as with antihypertensive and MgSO4 infusion.

• A woman will be advised to follow a prescribed medication regularly.

• She should take enough rest, small exercises, eat balanced diet and proper hygiene.

• Continue with post partum care schedule visit to evaluate her condition and should send her children for immunization, continue with breast feeding.

HEALTH EDUCATION TO THE PATIENT ACCORDING TO HER CONDITION

• Should as well be counseling for informed choice of

post partum family planning.

• Next pregnancy should attend ANC services early to prevent and identify and appropriate management of pre-eclampsia.

RECOMMENDATIONS FOR CHANGES OF THE CURRENT CARE PLAN

1. In the attempt to improve care of women with severe pre- eclampsia efforts should be made by hospital administrators to ensure that there are adequate equipment and supplies for assessing and managing patients (example cardio pulmonary monitor, oxygen, suction and BP machine) with severe pre-eclampsia.

RECOMMENDATIONS FOR CHANGES OF THE CURRENT CARE PLAN

2. Hospital administration should formulate operational team that will assess and ensure the adherence of checklist/Guideline use in managing women with severe pre-eclampsia.

This will help in improving quality of care in the management of severe pre-eclampsia.

RECOMMENDATIONS FOR CHANGES OF THE CURRENT CARE PLAN

3. Hospital administrators should make sure improvement of Nurse-midwives knowledge and practice should be parallel with the improvement of resuscitative equipment and essential drugs for managing severe pre-eclampsia.

This should be done through continuing education, seminars and in service training.