44057231 post-partum-preeclampsia-mild

Case PresentationCase PresentationPost Partum PreeclampsiaPost Partum Preeclampsia

Presented to the Clinical Instructors ofPresented to the Clinical Instructors ofNotre Dame of Tacurong CollegeNotre Dame of Tacurong College

Nursing DepartmentNursing Department

Mrs. Xenia A. Diaz, RNMrs. Xenia A. Diaz, RN

In Partial Fulfilment of the In Partial Fulfilment of the Course Requirement inCourse Requirement in

Nursing Care Management 101Nursing Care Management 101

Presented by:Presented by:Arriola, Carlo L.Arriola, Carlo L.

Bonilla, Princess C.Bonilla, Princess C.Cabarlo, Roelyn A.Cabarlo, Roelyn A.

Demitillo, Daylene B.Demitillo, Daylene B.Mangelen, Muamar Samad D.Mangelen, Muamar Samad D.

Pabilona, Sheena Mae S.Pabilona, Sheena Mae S.Perocho, Ivory Joy N.Perocho, Ivory Joy N.Tueres, Margaret G.Tueres, Margaret G.

Vallesfino, Joreyfee C.Vallesfino, Joreyfee C.

August 4,2009August 4,2009

IntroductionIntroduction This is a case of Mrs. I.R, a 21 years old, female a This is a case of Mrs. I.R, a 21 years old, female a

primi gravida, who lives in Polomolok, South Cotabato and primi gravida, who lives in Polomolok, South Cotabato and was admitted last July 6, 2009 in South Cotabato Provincial was admitted last July 6, 2009 in South Cotabato Provincial Hospital w/ the diagnosis of PU, 39 1/7 weeks AOG, CIL, Hospital w/ the diagnosis of PU, 39 1/7 weeks AOG, CIL, G1P1 and after 1 day of delivery she was diagnosed w/ G1P1 and after 1 day of delivery she was diagnosed w/ post partum preeclampsia w/ a BP of 150/100 mmHg under post partum preeclampsia w/ a BP of 150/100 mmHg under the service of Dr. Vencer. Medical Management given.the service of Dr. Vencer. Medical Management given.

Preeclampsia is a disorder of widespread vascular Preeclampsia is a disorder of widespread vascular endothelial malfunction that occurs beyond the 20th week endothelial malfunction that occurs beyond the 20th week of gestation. It is characterized by increased blood of gestation. It is characterized by increased blood pressure (BP) in an individual who was normotensive prior pressure (BP) in an individual who was normotensive prior to the pregnancy, and proteinuria or excessive edema. to the pregnancy, and proteinuria or excessive edema. Although women with preexisting hypertension may also Although women with preexisting hypertension may also develop preeclampsia, hypertension in preeclampsia in the develop preeclampsia, hypertension in preeclampsia in the usually normotensive patient is defined by a systolic BP usually normotensive patient is defined by a systolic BP greater than 140 mm Hg and diastolic BP greater than 90 greater than 140 mm Hg and diastolic BP greater than 90 mm Hg on two successive measurements 4-6 hours apart. mm Hg on two successive measurements 4-6 hours apart.

Diagnostic criteria for severe preeclampsia include at least Diagnostic criteria for severe preeclampsia include at least one of the following: systolic BP greater than 160 mm Hg or diastolic one of the following: systolic BP greater than 160 mm Hg or diastolic BP greater than 110 mm Hg on two occasions 6 hours apart with BP greater than 110 mm Hg on two occasions 6 hours apart with the patient at bed rest; proteinuria, oliguria; cerebral or visual the patient at bed rest; proteinuria, oliguria; cerebral or visual disturbance; pulmonary edema or cyanosis; abdominal pain; disturbance; pulmonary edema or cyanosis; abdominal pain; impaired liver function; thrombocytopenia; or decreased fetal impaired liver function; thrombocytopenia; or decreased fetal growth.growth.

In general population, data are difficult to estimate however In general population, data are difficult to estimate however

Preeclampsia occurs in approximately 5% of all pregnancies Preeclampsia occurs in approximately 5% of all pregnancies internationally. It is the third leading pregnancy-related cause of internationally. It is the third leading pregnancy-related cause of death, after hemorrhage and embolism. Statistically, it is the cause death, after hemorrhage and embolism. Statistically, it is the cause in an estimated 790 maternal deaths per 100,000 live births.in an estimated 790 maternal deaths per 100,000 live births.

This condition is commonly occurs (more frequently) in This condition is commonly occurs (more frequently) in women at the extremes of reproductive age. Younger women (<20 women at the extremes of reproductive age. Younger women (<20 y) have a slightly increased risk. Primigravid patients in particular y) have a slightly increased risk. Primigravid patients in particular seem to be predisposed. Older women (>35 y) have a markedly seem to be predisposed. Older women (>35 y) have a markedly increased risk.increased risk.

Asking the question of how this condition occurs, this case Asking the question of how this condition occurs, this case study will provide information that may help the attendees study will provide information that may help the attendees understand the cause of the condition. This case study will enhance understand the cause of the condition. This case study will enhance the knowledge and skills in dealing with patient who suffer from this the knowledge and skills in dealing with patient who suffer from this preeclampsia. preeclampsia.

Further complications will be prevented if immediate, Further complications will be prevented if immediate, proper action is provided and intervention is rendered. Therefore proper action is provided and intervention is rendered. Therefore it is important the health care provider developed a skills and it is important the health care provider developed a skills and proper management of the client having the condition.proper management of the client having the condition.

We choose this case study because we wanted to have a We choose this case study because we wanted to have a thorough understanding about preeclampsia, why does it occurs thorough understanding about preeclampsia, why does it occurs to the pregnant women and what are the other complications that to the pregnant women and what are the other complications that could possibly lead to death of the mother.could possibly lead to death of the mother.

ObjectivesObjectivesGeneral Objectives:General Objectives:

After 8 hours of discussion, the presenter & After 8 hours of discussion, the presenter & listener will be able to identify the underlying cause of listener will be able to identify the underlying cause of mild preeclampsia, develop skills in discussing it among mild preeclampsia, develop skills in discussing it among the group and a positive attitude in recognizing ways to the group and a positive attitude in recognizing ways to treat the said condition.treat the said condition.

Specific Objectives:Specific Objectives:This case presentation aims to achieve the This case presentation aims to achieve the

following:following:1. Present the vital information of the patient clearly 1. Present the vital information of the patient clearly 2. Identify the present and past history of illness of the patient 2. Identify the present and past history of illness of the patient

accurately.accurately.3. Present the Developmental Data of patient thoroughly3. Present the Developmental Data of patient thoroughly4.. 4.. Enumerate and discuss the signs and symptoms of Post Enumerate and discuss the signs and symptoms of Post

partum Preeclampsia brieflypartum Preeclampsia briefly 5. Present the Anatomy and Physiology of organ involve in 5. Present the Anatomy and Physiology of organ involve in

the condition of patient correctly.the condition of patient correctly.

6. Discuss the Pathophysiology of the said condition of 6. Discuss the Pathophysiology of the said condition of patient accurately.patient accurately.

7. State the importance of Physical Assessment of Patient 7. State the importance of Physical Assessment of Patient Correctly.Correctly.

8. Present the list of problems of patient correctly.8. Present the list of problems of patient correctly.

9. Discuss the Nursing Care Plan of the patient thoroughly.9. Discuss the Nursing Care Plan of the patient thoroughly.

10. Present prognosis of patient accurately.10. Present prognosis of patient accurately.

Patients Vital InformationPatients Vital InformationPatients Name: Mrs. I.RPatients Name: Mrs. I.RAge: 21 yrs. OldAge: 21 yrs. OldSex: FemaleSex: FemaleAddress: Polomolok, South CotabatoAddress: Polomolok, South CotabatoCitizenship: FilipinoCitizenship: FilipinoTribe: CebuanoTribe: CebuanoReligion: Roman CatholicReligion: Roman CatholicEducationalEducationalAttainment: High School GraduateAttainment: High School GraduateOccupation: HousewifeOccupation: HousewifeDate admitted: July 6, 2009Date admitted: July 6, 2009Time admitted: 10:30 p.mTime admitted: 10:30 p.mAdmitting Diagnosis: PU 39 1/7 weeks AOG CIL G1P1, Admitting Diagnosis: PU 39 1/7 weeks AOG CIL G1P1, Post partum PreeclampsiaPost partum Preeclampsia Reason for Admission: For DeliveryReason for Admission: For DeliveryPhysician: Dr. VencerPhysician: Dr. VencerName of the Institution: South Cotabato Provincial HospitalName of the Institution: South Cotabato Provincial HospitalName of Spouse: Mr. EName of Spouse: Mr. EEducational Educational Attainment: High School GraduateAttainment: High School GraduateOccupation: Construction WorkerOccupation: Construction WorkerName of parents: Age Educational AttainmentName of parents: Age Educational AttainmentMr. S 42 High School GraduateMr. S 42 High School GraduateMrs. A 44 High School GraduateMrs. A 44 High School Graduate

History of Present illnessHistory of Present illness

According Mrs. I.R, one day According Mrs. I.R, one day after delivery she was diagnosed of post after delivery she was diagnosed of post partum preeclampsia w/ the BP of 150/100 partum preeclampsia w/ the BP of 150/100 mmHg. MgSO4 was ordered and given by mmHg. MgSO4 was ordered and given by the NOD and strictly monitored her v/s the NOD and strictly monitored her v/s especially the BP for every 15 mins. She especially the BP for every 15 mins. She was not expecting that she had a was not expecting that she had a hypertension and result to preeclampsia. hypertension and result to preeclampsia.

History of Past illnessHistory of Past illness

The patient experienced nausea and vomiting in the past few months The patient experienced nausea and vomiting in the past few months especially during her first trimester. She also stated that she experienced especially during her first trimester. She also stated that she experienced headache occasionally, but usually occur during and after doing household headache occasionally, but usually occur during and after doing household works. According to her she was able to receive complete immunizations. She works. According to her she was able to receive complete immunizations. She did not undergone blood transfusion and surgery nor experienced any accidents did not undergone blood transfusion and surgery nor experienced any accidents and denies of having allergies on foods and any of the drugs. and denies of having allergies on foods and any of the drugs.

Her menarche was when she was 12 years of age with irregular Her menarche was when she was 12 years of age with irregular succeeding menstrual cycle. She also experienced common childhood illnesses succeeding menstrual cycle. She also experienced common childhood illnesses such as colds, cough and fever and was treated only with over the counter drugs such as colds, cough and fever and was treated only with over the counter drugs depending on the illness experienced, such as biogesic, alaxan, mefenafic, depending on the illness experienced, such as biogesic, alaxan, mefenafic, neosep and other more, but also fan of using herbal meds. she fails to admit neosep and other more, but also fan of using herbal meds. she fails to admit herself for medical check-up in relation to inadequate financial sources. It was herself for medical check-up in relation to inadequate financial sources. It was her first pregnancy and her Last menstrual period was October 02, 2008.her first pregnancy and her Last menstrual period was October 02, 2008.

As Mrs. I.R stated her childhood years, she had encountered diseases As Mrs. I.R stated her childhood years, she had encountered diseases such as mumps and chicken pox and other common illness experienced by a such as mumps and chicken pox and other common illness experienced by a normal child. normal child.

During her adulthood she said that her menstrual flow sometimes During her adulthood she said that her menstrual flow sometimes normal and she experienced also progressive dysmenorrhoea. According to her normal and she experienced also progressive dysmenorrhoea. According to her she was fully immunized when she was a child. she was fully immunized when she was a child.

She had undergone pre-natal check-up during her pregnancy. Her first She had undergone pre-natal check-up during her pregnancy. Her first baby was undergone normal delivery. And a day after the delivery her BP raised baby was undergone normal delivery. And a day after the delivery her BP raised up to 150/100 mmHg which is high blood and find out that she is a hypertensive up to 150/100 mmHg which is high blood and find out that she is a hypertensive and was diagnosed of preeclampsia.and was diagnosed of preeclampsia.

Family BackgroundFamily Background Mrs. IR is a 21 y.o. plain housewife and married to a 22 y, o

construction worker. She is the eldest among 3 siblings. She used to belong in a nuclear type of family . after she got married she moved with his husbands family and they were blessed with one child as in the present. As of now, they are still residing at the same place.

Both her parents are still alive, her father is hypertensive but her mother having no known disease. Hypertension is both present to his mother and father’s side as hereditary condition. Mr.E engage in gambling and does it together with his friends on leisure time usually after a long day work in the construction site accompanied with drinking and smoking.

Mr. E considered those habits as a means of relaxation. Mrs. IR diet before was poor due to nausea sensation before and after eating, but get well in next succeeding months. They have their meals three times a day with dried fish and eggs most of the time, but they also serving meat some of the time. The family source of income is from her husbands work only.

In some other unexpected situation such as money matters they depend on the contributions of their parents. The family believes in quack doctors but they seldom use of herbal medicines. According to her when any of the family members get sick they usually use over the counter drugs as management depending on the kind of illness present such as paracetamol for fever.

Mrs. I.R is a practice catholic. But her husband tends not to go the same because he is too busy working in the farm. They have a good and harmonious relationship with their neighbours and family feuds or conflicts are not present as verbalized by his wife.

Effects of illness to Self and FamilyEffects of illness to Self and FamilyMrs. I.R has mixed emotions when she knew Mrs. I.R has mixed emotions when she knew

that she was pregnant for the first that she was pregnant for the first time. But she knew time. But she knew that it is her responsible to take care of her baby. that it is her responsible to take care of her baby.

But when she was diagnosed of having But when she was diagnosed of having preeclampsia she does not expect it but it is in their preeclampsia she does not expect it but it is in their blood line that they are high blood. blood line that they are high blood.

When Mr. E knew that her wife is pregnant he When Mr. E knew that her wife is pregnant he prepares all the necessary things that would be use prepares all the necessary things that would be use for their first baby he was so exited and gives all for their first baby he was so exited and gives all support, love, and care for his wife up to the day of the support, love, and care for his wife up to the day of the delivery of their child and specially when she knew delivery of their child and specially when she knew that his wife is having preeclampsia.that his wife is having preeclampsia.

Expectation to Self and FamilyExpectation to Self and Family

Mrs. I.R did not expect that after she Mrs. I.R did not expect that after she delivered a normal baby she was diagnosed of delivered a normal baby she was diagnosed of having preeclampsia. She wants to be cured as having preeclampsia. She wants to be cured as fast as it can be so that she can take care of fast as it can be so that she can take care of baby. baby.

The family of Mrs. I.R especially her The family of Mrs. I.R especially her husband expected that after she delivers the husband expected that after she delivers the baby and having a preeclampsia, she would baby and having a preeclampsia, she would have a fast recovery and also have a good have a fast recovery and also have a good health to the child.health to the child.

GenogramGenogram

PHYSICAL ASSESSMENT:PHYSICAL ASSESSMENT:Date: July 7, 2009Date: July 7, 2009Time: 5:00 pmTime: 5:00 pmGeneral appearance:General appearance: The patient is female adult, not The patient is female adult, not well groomed, hair is not fixed and well groomed, hair is not fixed and she wear clean and comfortable she wear clean and comfortable clothes. She does have any body clothes. She does have any body odor, she is conscious and well odor, she is conscious and well oriented by the time, place and oriented by the time, place and people around her. She speaks well people around her. She speaks well with clear and audible voice and with clear and audible voice and was able to understand instructions was able to understand instructions and health teachings. The patient is and health teachings. The patient is sitting in bed with IVF of D5LR 1L sitting in bed with IVF of D5LR 1L with 10u of Oxytocin at 200cc with 10u of Oxytocin at 200cc regulated at 20cc/minregulated at 20cc/min. . hooked at hooked at left cephalic veinleft cephalic vein..

Vital signs:Vital signs:

BP- 100/80 mmHgBP- 100/80 mmHg

temp- 36ºCtemp- 36ºC

PR- 82bpmPR- 82bpm

RR- 22rpmRR- 22rpm

Head/Hair/Scalp:Head/Hair/Scalp:Inspection: Inspection: head is proportional to the body and skull is head is proportional to the body and skull is rounded with symmetrical flaccid movement. No dandruff rounded with symmetrical flaccid movement. No dandruff noted, hair is black in color, curly and not properly fixed.noted, hair is black in color, curly and not properly fixed.

Face:Face:Inspection: Inspection: normal muscle movement are performing like normal muscle movement are performing like smiling and yawning, pimples noted with flaccid grimace smiling and yawning, pimples noted with flaccid grimace noted. Also chloasma noted, eyebrows and eyelashes are noted. Also chloasma noted, eyebrows and eyelashes are equally distributed.equally distributed.

Palpation: no tearing of lacrimal sac during palpation, Palpation: no tearing of lacrimal sac during palpation, smooth, uniform.smooth, uniform.

Ears:Ears:Inspection: Inspection: Ears are symmetrical to the head. No lesions Ears are symmetrical to the head. No lesions noted, no deformities noted as well as discharges.noted, no deformities noted as well as discharges.

Nose:Nose:Inspection: Inspection: External nose are symmetrical, uniform in color External nose are symmetrical, uniform in color and no discharges noted. No lesions noted.and no discharges noted. No lesions noted.Palpation: no tenderness and lesions noted upon palpation Palpation: no tenderness and lesions noted upon palpation of maxillary and frontal sinuses.of maxillary and frontal sinuses.

Lips/mouth/ teeth/throat:Lips/mouth/ teeth/throat:Inspection: dry lips noted. Complete set of adult Inspection: dry lips noted. Complete set of adult teeth. Yellow in color with two dental carries noted. teeth. Yellow in color with two dental carries noted. The gums is pink in color, no retraction noted and The gums is pink in color, no retraction noted and no gums bleeding noted, tongue is pink and has no gums bleeding noted, tongue is pink and has white pigment and moves freely.white pigment and moves freely.

Neck:Neck:Inspection: jugular veins are not inflamed and no Inspection: jugular veins are not inflamed and no stiffness noted, neck muscles are equal in size with stiffness noted, neck muscles are equal in size with head centered.head centered.

Respiratory:Respiratory:Inspection: normal chest wall able to breath when Inspection: normal chest wall able to breath when lying in bed. No respiratory distress noted.lying in bed. No respiratory distress noted.Auscultation: no abnormal sound was heard.Auscultation: no abnormal sound was heard.

Cardiovascular:Cardiovascular:Inspection: no irregularities noted.Inspection: no irregularities noted.Auscultation: normal heart beat was heard.Auscultation: normal heart beat was heard.

Breast:Breast:Inspection: nipples are symmetrical to each other, Inspection: nipples are symmetrical to each other, black in color and increase in size. The areolas on black in color and increase in size. The areolas on both breast are black in color and discharges noted.both breast are black in color and discharges noted.Palpation: no tenderness noted.Palpation: no tenderness noted.

Genitalia:Genitalia:Inspection: female genitalia is bleeding, poor in Inspection: female genitalia is bleeding, poor in perineal care.perineal care.

Extremities:Extremities:Inspection: both feet are symmetrical and no Inspection: both feet are symmetrical and no varicose veins noted muscles have moderate varicose veins noted muscles have moderate strength and. Neither onestrength and. Neither one

REVIEW OF SYSTEM REVIEW OF SYSTEM Date: July 7, 2009Date: July 7, 2009Time: 5:00 pmTime: 5:00 pm

General: the patient denies that she does General: the patient denies that she does not experienced fever or any common not experienced fever or any common illnesses before the admission but she illnesses before the admission but she claimed that she experienced weight claimed that she experienced weight changes, body weakness and fatigue but changes, body weakness and fatigue but she denies heat or cold intolerance, she denies heat or cold intolerance, bleeding and radiation.bleeding and radiation.

Integumentary:Integumentary: Skin:Skin: patient denies of having rashes, lumps, patient denies of having rashes, lumps,

sores and itching of the skin.sores and itching of the skin. Hair:Hair: patient claims that she have a dandruff and patient claims that she have a dandruff and

denies of having head lice.denies of having head lice.

Nails:Nails: patient denies of having dirty and long nails; patient denies of having dirty and long nails; nor abnormal growth.nor abnormal growth.

Head:Head: patient denies of having any head injury patient denies of having any head injury and syncope prior to the admission. But the patient and syncope prior to the admission. But the patient claimed of having headache.claimed of having headache.

Eyes:Eyes: patient denies of having blurry vision, patient denies of having blurry vision, trauma, redness, pain, sore, eyes, glaucoma and trauma, redness, pain, sore, eyes, glaucoma and cataracts. She also denies of using eyeglasses.cataracts. She also denies of using eyeglasses.

Ears:Ears: patient denies of hearing loss, pain, infection, patient denies of hearing loss, pain, infection, discharges and used of hearing aid. She also denies discharges and used of hearing aid. She also denies of having impact cerumen and any ear injury before of having impact cerumen and any ear injury before the admission.the admission.

Nose:Nose: patient denies loss of smell, obstruction, patient denies loss of smell, obstruction, injury, epistaxis and discharges but claimed that injury, epistaxis and discharges but claimed that she experienced colds.she experienced colds.

Mouth and throat:Mouth and throat: patient denies of having sore patient denies of having sore throat, sore tongue but claimed of having dental throat, sore tongue but claimed of having dental carries. Denies also of having hoarseness of voice carries. Denies also of having hoarseness of voice and gum problems.and gum problems.

Neck:Neck: patient denies goiter and stiffness of neck. patient denies goiter and stiffness of neck. Respiratory:Respiratory: patient denies cyanosis, having patient denies cyanosis, having

cough and dyspnea. And denies smoking.cough and dyspnea. And denies smoking. Cardiovascular:Cardiovascular: patient denies of having chest patient denies of having chest

pain and palpitations.pain and palpitations.

Muscoskeletal:Muscoskeletal: patient denies joint stiffness but patient denies joint stiffness but claims weakness, back pain, fatigue and leg claims weakness, back pain, fatigue and leg cramps.cramps.

Gastrointestinal:Gastrointestinal: patient denies of having patient denies of having constipation and bowel irregularity.constipation and bowel irregularity.

Endocrine:Endocrine: patient denies of having enlargement patient denies of having enlargement of thyroid glands and denies that she has diabetes.of thyroid glands and denies that she has diabetes.

Female Reproductive:Female Reproductive: patient reported that no patient reported that no deformities about to her vagina, and the patient deformities about to her vagina, and the patient also reported that there was an episiotomy done.also reported that there was an episiotomy done.

Breast:Breast: patient denies of having breast sore and patient denies of having breast sore and lumps.lumps.

Genitourinary:Genitourinary: patient denies of having dysuria, patient denies of having dysuria,

urgency and hematuria.urgency and hematuria. Hematology:Hematology: patient denies of having any patient denies of having any

bruises in both extremities and,bruises in both extremities and, Psychiatric:Psychiatric: patient denies mood changes, patient denies mood changes,

difficulty concentrating and suicidal thought.difficulty concentrating and suicidal thought.

DEVELOPMENTAL DATADEVELOPMENTAL DATA

Name of patient: Name of patient: Mrs. I.R.Mrs. I.R.

Age: Age: 21y.o21y.o

According to Havighurst’s According to Havighurst’s Developmental data Task TheoryDevelopmental data Task Theory

Stage of the patient: Stage of the patient: Early AdulthoodEarly Adulthood

Theory: Theory: Development task TheoryDevelopment task Theory

Description of the theory:Description of the theory:

Robert Havighurst believed that learning is basic Robert Havighurst believed that learning is basic to life that people continue to learn throughout to life that people continue to learn throughout life. He described growth and developmental as life. He described growth and developmental as accruing during six ages, each associated with 6-accruing during six ages, each associated with 6-10 tasks to be learned. Havighurst promoted the 10 tasks to be learned. Havighurst promoted the concept of developmental tasks in the 1950’s. he concept of developmental tasks in the 1950’s. he studied human behavior in terms of studied human behavior in terms of developmental tasks like; skills or approved developmental tasks like; skills or approved behavior pattern, which arise at or about a behavior pattern, which arise at or about a certain period of life. In addition, he noted that certain period of life. In addition, he noted that the successful achievement will lead to happiness the successful achievement will lead to happiness while failure leads to unhappiness and difficulty while failure leads to unhappiness and difficulty with later tasks.with later tasks.

Havighurst’s developmental tasks, provides a Havighurst’s developmental tasks, provides a framework that the nurse to evaluate a person’s framework that the nurse to evaluate a person’s general accomplishments. However, some nurses general accomplishments. However, some nurses find that the broad categories limit its usefulness find that the broad categories limit its usefulness as a tool in assessing specific accomplishments, as a tool in assessing specific accomplishments, particularly those infant and childhood.particularly those infant and childhood.

Age Age periods periods

and and developmdevelopm

ental ental tasktask

Selecting Selecting a matea mate

RemarksRemarks

ACHIEVEDACHIEVED

JustificatioJustificationn

MRS. I.R. MRS. I.R. states that states that

even even though though

they have they have an early an early marriage marriage

of her of her chosen chosen

husband, husband, she does she does

not regret not regret that she that she

selects Mr. selects Mr. E as her E as her

husband is husband is responsiblresponsible enough e enough to start a to start a

familyfamily..

Learning to live Learning to live with partner.with partner.

AchievedAchieved According to According to Mrs. I.R, even Mrs. I.R, even though they though they married early at married early at their age they their age they will live happy will live happy with their family with their family through through sickness and in sickness and in health and at health and at times of crisis.times of crisis.

Starting a family Starting a family

Achieved Achieved Now that Mr. E Now that Mr. E and Mrs. I.R and Mrs. I.R has a baby. has a baby. They said that They said that they will take they will take care of their care of their baby as it baby as it grows and start grows and start a happy family.a happy family.

Managing Managing HomeHome

AchievedAchieved Mrs. I.R is the Mrs. I.R is the one who one who

manages their manages their home if Mr. E is home if Mr. E is at work and she at work and she is also performs is also performs all the all the household household chores but chores but sometimes Mr. sometimes Mr. E is also E is also helping.helping.

Getting started Getting started in an in an

occupation.occupation.

Not achievedNot achieved Mrs. I.R don’t Mrs. I.R don’t have any have any

occupation occupation attended, she attended, she only depends only depends

on her on her husband.husband.

Taking on Civic Taking on Civic ResponsibilityResponsibility

AchievedAchieved Mrs. I.R is Mrs. I.R is aware of her aware of her responsibility as responsibility as an adult and as an adult and as a parent to their a parent to their community in community in terms of terms of participation.participation.

Finding a Finding a congenial social congenial social groupgroup

AchievedAchieved According to According to Mrs. I.R they Mrs. I.R they interact and interact and have bonding have bonding with their with their neighbors and neighbors and helps each helps each other in times of other in times of needs.needs.

Sigmund Freud Psychosexual TheorySigmund Freud Psychosexual Theory

Description of theory: Description of theory: According to Freud’s theory of According to Freud’s theory of psychosexual development, the personality psychosexual development, the personality develops in five overlapping stages of birth to develops in five overlapping stages of birth to adulthood. The libido changes, it’s location of adulthood. The libido changes, it’s location of emphasis within the body from one stage to emphasis within the body from one stage to another. Therefore, a particular stage. The 1another. Therefore, a particular stage. The 1stst three three stages ( oral, anal, phallic) are called pregenital stages ( oral, anal, phallic) are called pregenital stages. The culminating stage is the genital stage. stages. The culminating stage is the genital stage. Ideally an individual progress through the task of Ideally an individual progress through the task of each stage and balance is achieved between the id, each stage and balance is achieved between the id, ego and sub ego. Conflict or stress, however can ego and sub ego. Conflict or stress, however can delay or prolong progression through a stage or delay or prolong progression through a stage or cause a person to regress to a previous stage.cause a person to regress to a previous stage.

TaskTask

Genital Genital (Puberty and (Puberty and

After)After)

RemarksRemarks

AchievedAchieved

JustificationJustification

Mrs. I.RMrs. I.R now is now is having a family; having a family;

achieve in achieve in dependency dependency and maturity.and maturity.

Theory: COGNITIVE THEORYTheorist: JEAN PIAGET (1896-1980)Definition of Theory: Refers to the manner in which people learned to and refuse of language it involves a person’s intelligence, perceptual ability and the ability to process information. It is a progressive of mental ability from illogical to logical thinking from simple to complex problem solving and from understanding ideas to understanding concepts.

TASKTASK

Uses Rational Uses Rational Thinking Thinking

REMARKSREMARKS

AchievedAchieved

JUSTIFICATIONSJUSTIFICATIONSPt is able to Pt is able to

rationalize her own rationalize her own beliefs such as her beliefs such as her

superstitious beliefs.superstitious beliefs.

Reasoning is Reasoning is deductive and deductive and

futuristicfuturistic

AchievedAchieved The pt view life The pt view life as a changing as a changing process, process, addresses the addresses the mistakes done mistakes done and change it and change it for good. for good. Viewing the Viewing the future of her future of her family to be family to be stable someday stable someday as stated by the as stated by the pt.pt.

Textbook DiscussionTextbook DiscussionA. Complete DiagnosisA. Complete Diagnosis

PreeclampsiaPreeclampsiaA disease that only occurs during pregnancy. This disease is A disease that only occurs during pregnancy. This disease is

characterized by swelling, high blood pressure and the presence of characterized by swelling, high blood pressure and the presence of protein in the urine. It occurs in 5 to 10 percent of all pregnancies. It protein in the urine. It occurs in 5 to 10 percent of all pregnancies. It can appear suddenly, without warning, anytime throughout can appear suddenly, without warning, anytime throughout pregnancy, labor or in the early postpartum period. pregnancy, labor or in the early postpartum period.

This disease can also be chronic, gradually becoming worse This disease can also be chronic, gradually becoming worse over a period of time. It may be mild or severe. But no matter how ill over a period of time. It may be mild or severe. But no matter how ill it become with this disease, whether it’s sudden or gradual, the only it become with this disease, whether it’s sudden or gradual, the only cure is delivery of the baby. There are medications and treatments cure is delivery of the baby. There are medications and treatments to keep from becoming more ill with the disease, but no medications to keep from becoming more ill with the disease, but no medications will make the disease go away entirely. After delivery, the disease will make the disease go away entirely. After delivery, the disease eventually goes away, and it is unlikely that it will be suffer any long eventually goes away, and it is unlikely that it will be suffer any long terms effects of the disease. Occasionally, there are complications terms effects of the disease. Occasionally, there are complications that will require medical attention for a time after the delivery. This that will require medical attention for a time after the delivery. This may include taking blood pressure medication and frequent follow-may include taking blood pressure medication and frequent follow-up visits with tour care provider.up visits with tour care provider.http://www.webmd.com/hypertension-highbloodhttp://www.webmd.com/hypertension-highblood

A disorder of widespread vascular endothelial A disorder of widespread vascular endothelial malfunction that occurs beyond the 20th week of gestation. malfunction that occurs beyond the 20th week of gestation. It is characterized by increased blood pressure (BP) in an It is characterized by increased blood pressure (BP) in an individual who was normotensive prior to the pregnancy, individual who was normotensive prior to the pregnancy, and proteinuria or excessive edema. and proteinuria or excessive edema. Dawn C Jung, MD, , Staff Physician, Department of Emergency Medicine, Suny Staff Physician, Department of Emergency Medicine, Suny Downstate Medical Center, Kings County Hospital CenterDownstate Medical Center, Kings County Hospital Center

An abnormal condition of pregnancy characterized by An abnormal condition of pregnancy characterized by the onset of acute hypertension after the twenty-fourth the onset of acute hypertension after the twenty-fourth week of gestation. The classic triad of this complication week of gestation. The classic triad of this complication is hypertension, proteinuria, and edema.is hypertension, proteinuria, and edema.

Mosby’s Pocket Dictionary of Medicine, Nursing, Mosby’s Pocket Dictionary of Medicine, Nursing, and Allied Health (4th Edition)and Allied Health (4th Edition)

This is characterized by the onset of acute This is characterized by the onset of acute hypertension after the 24th week accompanied by hypertension after the 24th week accompanied by proteinuria and edema.proteinuria and edema.

Anatomy and Physiology (G Tribodeau and R. Anatomy and Physiology (G Tribodeau and R.

Patlon 2nd Edition page 834)Patlon 2nd Edition page 834)

Definition of TermsDefinition of Terms Gravida- a woman who been pregnant, without regard to Gravida- a woman who been pregnant, without regard to

pregnancy outcome. pregnancy outcome. Age of Gestation- weeks that the fetus stayed inside of Age of Gestation- weeks that the fetus stayed inside of

the mothers womb.the mothers womb. Pregnancy- a gestational process, comprising the growthPregnancy- a gestational process, comprising the growth

and development with a woman of a newand development with a woman of a new

individual from conception the embryonic individual from conception the embryonic

and fetal periods of birth.and fetal periods of birth. Edema- a build-up of excess serous fluid between tissueEdema- a build-up of excess serous fluid between tissue

cells.cells. Proteinuria- a presence of protein in the urine, which isProteinuria- a presence of protein in the urine, which is

usually an indication of disease.usually an indication of disease. Postpartum- after birth.Postpartum- after birth. Oliguria- small frequent urination.Oliguria- small frequent urination. Thrombocytopenia- reduction in the no. of platelets in the bld.Thrombocytopenia- reduction in the no. of platelets in the bld.

Estrogen- a hormone that controls females secondary sex Estrogen- a hormone that controls females secondary sex characteristics, characteristics,

B. Anatomy and physiologyB. Anatomy and physiology

Internal Reproductive SystemInternal Reproductive SystemThe female gonad associated ducts and glands, and external genitalia that The female gonad associated ducts and glands, and external genitalia that

function in the procreation of offspring. These include (internal) the ovaries, fallopian function in the procreation of offspring. These include (internal) the ovaries, fallopian tubes, uterus, (external) vagina, clitoris, and vulva.tubes, uterus, (external) vagina, clitoris, and vulva.

Function:Function:In the human female reproductive system, ova are produced in the In the human female reproductive system, ova are produced in the ovaries, two , two

small organs set in the pelvic cavity below and to either side of the navel. The ovaries also small organs set in the pelvic cavity below and to either side of the navel. The ovaries also secrete, in cyclic fashion, the hormones secrete, in cyclic fashion, the hormones estrogen and and progesterone (see (see menstruation). ). After an ovum matures, it passes into the uterine tube, or After an ovum matures, it passes into the uterine tube, or fallopian tube. If sperm are . If sperm are present as a result of sexual intercourse or present as a result of sexual intercourse or artificial insemination, fertilization occurs within , fertilization occurs within the tube. The ovum, either fertilized or unfertilized, then passes down the fallopian tube, the tube. The ovum, either fertilized or unfertilized, then passes down the fallopian tube, aided by cilia in the tube, and into the womb, or aided by cilia in the tube, and into the womb, or uterus, a pear-shaped organ specialized , a pear-shaped organ specialized for development of a fertilized egg.for development of a fertilized egg.

An inner uterine layer of tissue, the endometrium, undergoes cyclic changes as An inner uterine layer of tissue, the endometrium, undergoes cyclic changes as a result of the changing levels of the hormones secreted by the ovaries. The endometrium a result of the changing levels of the hormones secreted by the ovaries. The endometrium is thickest during the part of the menstrual cycle in which a fertilized ovum would be is thickest during the part of the menstrual cycle in which a fertilized ovum would be expected to enter the uterus and is thinnest just after menstruation. If no fertilized egg is expected to enter the uterus and is thinnest just after menstruation. If no fertilized egg is present toward the end of the cycle, the thickened endometrium degenerates and sloughs present toward the end of the cycle, the thickened endometrium degenerates and sloughs off and menstruation occurs; if a fertilized egg is present it becomes embedded in the off and menstruation occurs; if a fertilized egg is present it becomes embedded in the endometrium about a week after fertilization. The developing embryo produces endometrium about a week after fertilization. The developing embryo produces trophoblastic cells and these, along with cells from the endometrium, form the placenta, trophoblastic cells and these, along with cells from the endometrium, form the placenta, the organ in which gas, food, and waste exchange between mother and embryo takes the organ in which gas, food, and waste exchange between mother and embryo takes place. The embryo also forms the amniotic sac within which it develops.place. The embryo also forms the amniotic sac within which it develops.

The lower end of the uterus is called the cervix. The vagina, a passage The lower end of the uterus is called the cervix. The vagina, a passage connecting the uterus with the external genitals, receives the penis and the sperm connecting the uterus with the external genitals, receives the penis and the sperm ejaculated from it during sexual intercourse. It also serves as an exit passageway for ejaculated from it during sexual intercourse. It also serves as an exit passageway for menstrual blood and for the baby during menstrual blood and for the baby during birth. The external genitals, or vulva, include the . The external genitals, or vulva, include the clitoris, erectile tissue that responds to sexual stimulation, and the labia, which are clitoris, erectile tissue that responds to sexual stimulation, and the labia, which are composed of elongated folds of skin. After birth the infant is fed with milk from the breasts, composed of elongated folds of skin. After birth the infant is fed with milk from the breasts, or or mammary glands, which are also sometimes considered part of the reproductive , which are also sometimes considered part of the reproductive system.system.

ANATOMY AND PHYSIOLOGY OF THE ANATOMY AND PHYSIOLOGY OF THE HEARTHEART

The human heart is a hollow, pear-shaped organ about the The human heart is a hollow, pear-shaped organ about the size of a fist. The heart is made of muscle that rhythmically size of a fist. The heart is made of muscle that rhythmically contracts, or beats, pumping blood throughout the body. contracts, or beats, pumping blood throughout the body.

Oxygen-poor blood from the body enters the heart from two Oxygen-poor blood from the body enters the heart from two large blood vessels, the inferior vena cava and the superior vena large blood vessels, the inferior vena cava and the superior vena cava, and collects in the right atrium. When the atrium fills, it cava, and collects in the right atrium. When the atrium fills, it contracts, and blood passes through the tricuspid valve into the right contracts, and blood passes through the tricuspid valve into the right ventricle. When the ventricle becomes full, it starts to contract, and ventricle. When the ventricle becomes full, it starts to contract, and the tricuspid valve closes to prevent blood from moving back into the tricuspid valve closes to prevent blood from moving back into the atrium. As the right ventricle contracts, it forces blood into the the atrium. As the right ventricle contracts, it forces blood into the pulmonary artery, which carries blood to the lungs to pick up fresh pulmonary artery, which carries blood to the lungs to pick up fresh oxygen. oxygen.

When blood exits the right ventricle, the ventricle relaxes When blood exits the right ventricle, the ventricle relaxes and the pulmonary valve shuts, preventing blood from passing back and the pulmonary valve shuts, preventing blood from passing back into the ventricle. Blood returning from the lungs to the heart collects into the ventricle. Blood returning from the lungs to the heart collects in the left atrium. When this chamber contracts, blood flows through in the left atrium. When this chamber contracts, blood flows through the mitral valve into the left ventricle. the mitral valve into the left ventricle.

The left ventricle fills and begins to contract, and the mitral The left ventricle fills and begins to contract, and the mitral valve between the two chambers closes. In the final phase of blood valve between the two chambers closes. In the final phase of blood flow through the heart, the left ventricle contracts and forces blood flow through the heart, the left ventricle contracts and forces blood into the aorta. into the aorta.

After the blood in the left ventricle has been forced out, the After the blood in the left ventricle has been forced out, the ventricle begins to relax, and the aortic valve at the opening of the ventricle begins to relax, and the aortic valve at the opening of the aorta closes. aorta closes.

Anatomy and Physiology of the KidneyAnatomy and Physiology of the Kidney

Parts of the kidney:1. Renal pyramid2. Efferent vessel

3. Renal artery4. Renal vein

5. Renal hilum6. Renal pelvis

7. Ureter8. Minor calyx

9. Renal capsule10. Inferior renal capsule

11. Superior renal capsule12. Afferent vessel

13. Nephron14. Minor calyx15. Major calyx

16. Renal papilla17. Renal column

Functions Functions The kidneys filter the blood and eliminate The kidneys filter the blood and eliminate

wastes in the urine through a complex filtration wastes in the urine through a complex filtration network and resorption system comprising more network and resorption system comprising more than 2 million nephrons. The nephrons are than 2 million nephrons. The nephrons are composed of glomeruli and ranal tubules that composed of glomeruli and ranal tubules that filter blood under high pressure, removing urea, filter blood under high pressure, removing urea, salts, and other soluble wastes from blood salts, and other soluble wastes from blood plasma and returning the purified filtrate to the plasma and returning the purified filtrate to the blood. More than 1183 L of blood pass through blood. More than 1183 L of blood pass through the kidneys everyday. The kidneys remove the kidneys everyday. The kidneys remove water as urine and return water that has been water as urine and return water that has been filtered to the blood plasma, thus helping to filtered to the blood plasma, thus helping to maintain the water balance of the body.maintain the water balance of the body.

Anatomy and Physiology of the LiverAnatomy and Physiology of the Liver

(1) right lobe, (2) left lobe,(3) caudate lobe, (4) quadrate lobe, 5) hepatic artery and portal vein, (6) hepatic lymph nodes, (7) gall bladder

Functions Functions The liver produces and excretes The liver produces and excretes bile (a greenish liquid) required for (a greenish liquid) required for

emulsifying fats. Some of the bile drains directly into the emulsifying fats. Some of the bile drains directly into the duodenum, and , and some is stored in the some is stored in the gallbladder. .

The liver performs several roles in The liver performs several roles in carbohydrate and lipid and lipid metabolismThe liver produces The liver produces coagulation factors I (fibrinogen), (fibrinogen), II (prothrombin), (prothrombin), V, , VII, , IX, , X and and XI, as well as , as well as protein C, , protein S and and antithrombin. . The liver breaks down The liver breaks down hemoglobin, creating , creating metabolites that are added to that are added to bile as pigment ( as pigment (bilirubin and and biliverdin). ).

The liver breaks down The liver breaks down toxic substances and most medicinal substances and most medicinal products in a process called products in a process called drug metabolism. This sometimes results in . This sometimes results in toxication, when the metabolite is more toxic than its precursor. , when the metabolite is more toxic than its precursor. The liver converts The liver converts ammonia to to urea. .

The liver stores a multitude of substances, including glucose in the The liver stores a multitude of substances, including glucose in the form of form of glycogen, , vitamin B12, , iron, and , and copper. . In the first trimester In the first trimester fetus, the liver is the main site of , the liver is the main site of red blood cell production. By the 32nd week of gestation, the bone marrow has almost production. By the 32nd week of gestation, the bone marrow has almost completely taken over that task. completely taken over that task.

The liver is responsible for immunological effects- the The liver is responsible for immunological effects- the reticuloendothelial system of the liver contains many immunologically active reticuloendothelial system of the liver contains many immunologically active cells, acting as a 'sieve' for antigens carried to it via the portal system. cells, acting as a 'sieve' for antigens carried to it via the portal system.

Anatomy and Physiology of the PlacentaAnatomy and Physiology of the Placenta

FunctionsFunctionsFiltration and transferFiltration and transfer

The placenta receives nutrients, oxygen, antibodies and hormones The placenta receives nutrients, oxygen, antibodies and hormones from the mother's blood and passes out waste. It forms a barrier, the from the mother's blood and passes out waste. It forms a barrier, the placental barrier, which filters out some substances which could harm the placental barrier, which filters out some substances which could harm the fetus. fetus. The placental barrier does NOT allow the two bloods from the The placental barrier does NOT allow the two bloods from the mother and embryo to mix because if the blood types don't match then the mother and embryo to mix because if the blood types don't match then the baby will be destroyed. Many substances are not filtered out, however, baby will be destroyed. Many substances are not filtered out, however, including alcohol and some chemicals associated with smoking cigarettes. including alcohol and some chemicals associated with smoking cigarettes. Several types of virus, such as Human Cytomegalovirus, may also cross Several types of virus, such as Human Cytomegalovirus, may also cross this barrier; this often leads to various degrees of birth defects in the infant.this barrier; this often leads to various degrees of birth defects in the infant.

Metabolic and endocrine activityMetabolic and endocrine activityIn addition to the transfer of gases and nutrients, the placenta also In addition to the transfer of gases and nutrients, the placenta also

has metabolic and endocrine activity. It produces, amongst other hormoneshas metabolic and endocrine activity. It produces, amongst other hormonesprogesterone, which is important in maintaining the pregnancy; progesterone, which is important in maintaining the pregnancy; somatomammotropin (also known as placental lactogen), which acts to somatomammotropin (also known as placental lactogen), which acts to increase the amount of glucose and lipids in the maternal blood; estrogen; increase the amount of glucose and lipids in the maternal blood; estrogen; relaxin, and human chorionic gonadotrophin HCG. This results in increased relaxin, and human chorionic gonadotrophin HCG. This results in increased transfer of these nutrients to the fetus and is also the main cause of the transfer of these nutrients to the fetus and is also the main cause of the increased blood sugar levels seen in pregnancy. The site of the former increased blood sugar levels seen in pregnancy. The site of the former umbilical cord attachment in the center of the front of the abdomen is known umbilical cord attachment in the center of the front of the abdomen is known as the umbilicus, navel, or belly-button.as the umbilicus, navel, or belly-button.

Anatomy and Physiology of the Anatomy and Physiology of the Nervous systemNervous system

FunctionsFunctionsThe nervous system is the extensive, The nervous system is the extensive,

intricate network of structures that activates, intricate network of structures that activates, coordinates, and controls all the functions of the coordinates, and controls all the functions of the body.body.

The nervous system is broken down into The nervous system is broken down into two major parts: the central nervous system, two major parts: the central nervous system, which includes the brain and spinal cord, and which includes the brain and spinal cord, and the peripheral nervous system, which includes the peripheral nervous system, which includes all nerves, which carry impulses to and from the all nerves, which carry impulses to and from the brain and spinal cord. These include our sense brain and spinal cord. These include our sense organs, the eyes, the ears, our sense of taste, organs, the eyes, the ears, our sense of taste, smell and touch, as well as our ability to feel smell and touch, as well as our ability to feel pain.pain.

Nursing ManagementNursing Management

1.1. Promote bed restPromote bed rest

2.2. Promote good NutritionPromote good Nutrition

3.3. Monitor the blood pressureMonitor the blood pressure

Treatment: If not treated:Treatment: If not treated: Magnesium > seizuresMagnesium > seizures MgSO4 as ordered > comaMgSO4 as ordered > coma

by the physician > deathby the physician > death wellnesswellness

Medical ManagementMedical ManagementBlood Transfusion- the injection if a volume of blood obtained from a Blood Transfusion- the injection if a volume of blood obtained from a healthy person (donor) into the circulation if a patient healthy person (donor) into the circulation if a patient which is the patient recipient whose blood is deficient which is the patient recipient whose blood is deficient in quantity, through accident, diseases or other instances in quantity, through accident, diseases or other instances

that may cause a person to be blood transfuse. that may cause a person to be blood transfuse. -Direct transfusion from one person to the another is rarely -Direct transfusion from one person to the another is rarely

performed; usually packs of carefully stored performed; usually packs of carefully stored blood of blood of different groups are kept in blood banks different groups are kept in blood banks for use as for use as necessary.necessary.

-During transfusion the blood is allowed to drip, under -During transfusion the blood is allowed to drip, under gravity.gravity.

-through a needle inserted into one of the recipient’s -through a needle inserted into one of the recipient’s veins.veins.

-BT is routine during major surgical operation in which -BT is routine during major surgical operation in which blood blood is likely to be lost during operation.is likely to be lost during operation.

In addition; there is another way in blood transfusion so called autotransfusion In addition; there is another way in blood transfusion so called autotransfusion or reintroduction- it is the reintroduction into a patient of her own blood, or reintroduction- it is the reintroduction into a patient of her own blood, this may be blood previously drawn and stored in the blood bank or blood this may be blood previously drawn and stored in the blood bank or blood that has been lost from the pt’s circulation during surgical operation. They that has been lost from the pt’s circulation during surgical operation. They collected blood by suction during the operation , filtered to removed collected blood by suction during the operation , filtered to removed bubbles and small blood clots and to return into one of the pt’s veins bubbles and small blood clots and to return into one of the pt’s veins through a drip.through a drip.

OB ProcedureOB ProcedureEpisiotomy, incision made in the perineum (the tissue bridging the Episiotomy, incision made in the perineum (the tissue bridging the

vagina and rectum) to facilitate childbirth and prevent tearing of the vagina.vagina and rectum) to facilitate childbirth and prevent tearing of the vagina.An episiotomy may be necessary, mainly for women giving birth for the first An episiotomy may be necessary, mainly for women giving birth for the first time, to widen the birth outlet and prevent perineal tearing. The incision is time, to widen the birth outlet and prevent perineal tearing. The incision is made during the second stage of labor, as the largest part of the baby's made during the second stage of labor, as the largest part of the baby's head begins to emerge from the birth canal.head begins to emerge from the birth canal.

An episiotomy is quickly repaired using absorbable stitches under An episiotomy is quickly repaired using absorbable stitches under local anesthetic.An episiotomy is a surgical cut in the muscular area local anesthetic.An episiotomy is a surgical cut in the muscular area between the vagina and the anus (the area called the perineum) made just between the vagina and the anus (the area called the perineum) made just before delivery to enlarge your vaginal opening.before delivery to enlarge your vaginal opening.

RATIONALE: Obstetricians used to do episiotomies routinely to RATIONALE: Obstetricians used to do episiotomies routinely to speed delivery and to prevent the vagina from tearing, particularly during a speed delivery and to prevent the vagina from tearing, particularly during a first vaginal delivery, in the belief that the "clean" incision of an episiotomy first vaginal delivery, in the belief that the "clean" incision of an episiotomy would heal more easily than a spontaneous tear. Many experts also would heal more easily than a spontaneous tear. Many experts also believed that an episiotomy might help prevent later complications, such as believed that an episiotomy might help prevent later complications, such as incontinence.incontinence.

But many studies over the last 20 years have shown that this is not But many studies over the last 20 years have shown that this is not the case. In fact, there is no good evidence showing that episiotomy offers the case. In fact, there is no good evidence showing that episiotomy offers your vaginal tissue and pelvic floor muscles any real protection, and the your vaginal tissue and pelvic floor muscles any real protection, and the procedure may actually cause problems. For this reason, the American procedure may actually cause problems. For this reason, the American College of Obstetricians and Gynecologists as well as a host of other College of Obstetricians and Gynecologists as well as a host of other experts now agree that the procedure shouldn't be done routinely.experts now agree that the procedure shouldn't be done routinely.

EtiologyEtiologyPREDISPOSING FACTORPREDISPOSING FACTOR

First PregnancyFirst Pregnancy

Multiple PregnancyMultiple Pregnancy

Previous history of high Previous history of high blood pressure, kidney blood pressure, kidney

disease or diabetes/heart disease or diabetes/heart diseasedisease

Age Age

SexSex

HeredityHeredity

Race Race

RATIONALERATIONALE

The disease most occurs in Primi mothersThe disease most occurs in Primi mothers

Mrs. I.R delivers a single baby girlMrs. I.R delivers a single baby girl

The patient did not experience any history The patient did not experience any history of high blood pressure and other possible of high blood pressure and other possible disease before that may cause as a factor disease before that may cause as a factor

for Preeclampsia.for Preeclampsia.

The patient is 21 years old.The patient is 21 years old.

Only female bore child in womb.Only female bore child in womb.

There is a member in the patient’s family There is a member in the patient’s family who has hypertension.who has hypertension.

According to studies, most Africans According to studies, most Africans

acquire the disease.acquire the disease.

REMARKSREMARKS

PresentPresent

Not presentNot present



PresentPresent

PresentPresent


PRECIPITATING PRECIPITATING FACTORSFACTORS

SmokingSmoking

ObesityObesity

DietDiet

MalnutritionMalnutrition

PovertyPoverty

RATIONALERATIONALE

Mrs. I.R did not have any Mrs. I.R did not have any vices such as smoking and vices such as smoking and

drinking liquors.but her drinking liquors.but her husband is a chain smoker.husband is a chain smoker.

Mrs. I.R is a mesomorphic Mrs. I.R is a mesomorphic typetype of body of body

The patient loves to eat The patient loves to eat vegetables and but also fan vegetables and but also fan

eating salty foods.eating salty foods.

The patient eats vegetablesThe patient eats vegetables and other foods that is rich and other foods that is rich in nutrients. having a good in nutrients. having a good

appetite.appetite.

The patient belongs to a The patient belongs to a family with low income, not family with low income, not enough to accommodate all enough to accommodate all

their needs.their needs.

Reference:Reference:

REMARKSREMARKS

presentpresent


presentpresent


PresentPresent

SymptomatologySymptomatologySymptomsSymptoms

The patient The patient experience swelling experience swelling of face, hands and of face, hands and

feetfeet

The patient The patient experiences experiences headacheheadache

Patient experiences Patient experiences blurred vision or blurred vision or

seeing spots.seeing spots.

RemarksRemarks

presentpresent




There is swelling of face, There is swelling of face, hands, and feet.hands, and feet.

The patient does not The patient does not experienced headache.experienced headache.

The patient didn’t experience The patient didn’t experience blurred vision at allblurred vision at all

SymptomsSymptoms

The patient The patient experiences experiences

painful heartburnpainful heartburn..

The patient The patient experiences experiences

elevation of blood elevation of blood pressurepressure

The patient The patient experiences experiences nausea and nausea and vomiting.vomiting.

Remarks Remarks


PresentPresent


Reference:Reference:


The patient didn’t The patient didn’t experience experience heartburn.heartburn.

The patient blood The patient blood pressure is pressure is 150/100.150/100.

The patient didn’t The patient didn’t experience nausea experience nausea

and vomiting.and vomiting.

PathophysiologyPathophysiologyPredisposing factor : Precipitating factor:Predisposing factor : Precipitating factor:

1. Age 1. Smoking1. Age 1. Smoking2. Sex 2. Obesity2. Sex 2. Obesity3. Heredity 3. Diet3. Heredity 3. Diet4. Race 4. Malnutrition4. Race 4. Malnutrition 5. Poverty5. Poverty

VasospasmVasospasm

Effects on vascular Effect on renal Effects on Interstitial Effects on vascular Effect on renal Effects on Interstitial

Vasoconstriction decreased glomerular filtration Vasoconstriction decreased glomerular filtration Diffusion fromDiffusion from rate; increased glomerular filtration rate; increased glomerular filtration vascular space intovascular space into Impaired organ perfusion membrane permeability Impaired organ perfusion membrane permeability interstitial spaceinterstitial space Increased BP Increased serum blood EdemaIncreased BP Increased serum blood Edema

PreeclampsiaPreeclampsia

Laboratory and Diagnostic ExaminationLaboratory and Diagnostic ExaminationUrinalysisUrinalysis

Urinalysis can reveal diseases that have gone Urinalysis can reveal diseases that have gone unnoticed because they do not produce striking signs unnoticed because they do not produce striking signs or symptoms. Examples include diabetes mellitus, or symptoms. Examples include diabetes mellitus, various forms of glomerulonephritis, and chronic various forms of glomerulonephritis, and chronic urinary tract infections.urinary tract infections.

The most cost-effective device used to screen The most cost-effective device used to screen urine is a paper or plastic dipstick. This microchemistry urine is a paper or plastic dipstick. This microchemistry system has been available for many years and allows system has been available for many years and allows qualitative and semi-quantitative analysis within one qualitative and semi-quantitative analysis within one minute by simple but careful observation. The color minute by simple but careful observation. The color change occurring on each segment of the strip is change occurring on each segment of the strip is compared to a color chart to obtain results. However, compared to a color chart to obtain results. However, a careless doctor, nurse, or assistant is entirely a careless doctor, nurse, or assistant is entirely capable of misreading or misinterpreting the results. capable of misreading or misinterpreting the results. Microscopic urinalysis requires only a relatively Microscopic urinalysis requires only a relatively inexpensive light microscope.inexpensive light microscope.

Date: July 6, 2009Date: July 6, 2009

Component Component

Color Color

AppearanceAppearance

Specific gravitySpecific gravity

SugarSugar

Albumin Albumin

Reaction Reaction

PUS cells PUS cells

ResultsResults

YellowYellow

1.0051.005

NegativeNegative

NegativeNegative

6.06.0

8-10 8-10

Normal Normal ValueValue

Pale yellowPale yellow

1.010-1.0251.010-1.025

NegativeNegative

NegativeNegative

6.0-7.06.0-7.0

nonenone

InterpretationInterpretation

Normal Normal

A low specific A low specific gravity is a result of gravity is a result of low fluid intake or low fluid intake or

the disease affecting the disease affecting the kidney.the kidney.

Normal Normal

NormalNormal

NormalNormal

The patient has an The patient has an infection as indicated. infection as indicated.

A large number of A large number of pus cells indicated pus cells indicated

infection in the large infection in the large genitourinary tract.genitourinary tract.

NursingNursing

ConsiderationConsiderationEncourage the patient Encourage the patient to increase fluid intaketo increase fluid intake

Encourage patient to Encourage patient to drink fluid in a normal drink fluid in a normal

amount.amount.

Maintain proper Maintain proper nutrition nutrition

Maintain proper Maintain proper nutrition nutrition

Maintain/ Promote Maintain/ Promote good nutritiongood nutrition

ComponentComponent

RBCRBC

Epithelial Epithelial CellsCells

ResultResult

2-32-3

nonenone

NormalNormal

ValueValue

NoneNone

nonenone

InterpretationInterpretation

This maybe This maybe associated to associated to infection. The infection. The patient has an patient has an

infection. A infection. A large number of large number of RBC indicates RBC indicates bleeding from bleeding from some point the some point the genitourinary genitourinary

tract.tract.

NormalNormal

NursingNursing

ConsiderationConsideration

Encourage Encourage patient to eat patient to eat vegetables vegetables such as rich such as rich in iron like in iron like ampalaya.ampalaya.

Maintain Maintain good nutrition good nutrition

and good and good healthy habitshealthy habits

Complete Doctors OrderComplete Doctors OrderDate/TimeDate/Time

07-06-0907-06-09

10:30 PM10:30 PM

Orders of PhysicianOrders of Physician

Please admit to wardPlease admit to ward

TPR every 4 hoursTPR every 4 hours

Low fat, low Salt DietLow fat, low Salt Diet

Lab: UALab: UA

Rationale for the Rationale for the DoctorDoctor

For managementFor management

To have baseline data To have baseline data and to monitor and to monitor

Progress and to prevent Progress and to prevent further complication like further complication like

edemaedema

To determine patients To determine patients condition and disease condition and disease

processprocess

To determine patients To determine patients condition and disease condition and disease

progress.progress.

RemarksRemarks

DoneDone

DoneDone

DoneDone

DoneDone

Date/TimeDate/Time

07-07-0907-07-09

BP:150/100BP:150/100

Order of the PhysicianOrder of the Physician

Lab: HematologyLab: Hematology

Start venoclysis with Start venoclysis with

D5LR 1L @ 30 gtts/min.D5LR 1L @ 30 gtts/min.

IVF with D5LR @ 30 IVF with D5LR @ 30

gtts/min.gtts/min.

M. Maleate 5mg/ 1 tabM. Maleate 5mg/ 1 tab

TID q 5 hrs.TID q 5 hrs.

Mefenamic AcidMefenamic Acid

500mg/1 cap q 6 hrs.500mg/1 cap q 6 hrs.

MgSO4 4-6 g, deep MgSO4 4-6 g, deep

I.M q 4 hrs. PRN I.M q 4 hrs. PRN

Rationale for the OrderRationale for the Order

To determine pt’s condition and To determine pt’s condition and disease progressdisease progress

To provide a medication that To provide a medication that helps lower patients blood helps lower patients blood

pressure.pressure.

To provide route for IVTT To provide route for IVTT medication and to promote medication and to promote additional nutrient through additional nutrient through

dextrose.dextrose.

To prevent and treat postpartum To prevent and treat postpartum hemorrhage caused by uterine hemorrhage caused by uterine

atony or subinvolution.atony or subinvolution.

To relieve painTo relieve pain

To prevent/control seixures in To prevent/control seixures in preeclampsia preeclampsia

RemarksRemarks

Not DoneNot Done

DoneDone

DoneDone

DoneDone

DoneDone

Start BT,Start BT,

Secure 2 Secure 2

units of blood units of blood

Continue Continue medicationmedication

Vital signs Vital signs

every 15 every 15 mins.mins.

to obtain to obtain enough blood enough blood quantity and quantity and quality that quality that

have been in have been in deficiency after deficiency after

the delivery.the delivery.

To continueTo continue

The treatmentThe treatment

To provide To provide baseline data baseline data

of patients of patients condition.condition.

Done Done

DoneDone

DoneDone

List of DrugsList of Drugs

DrugDrugM. MaleateM. Maleate

Mefenamic Mefenamic acidacid

Magnesium Magnesium

sulfatesulfate

Dosage Dosage 5mg/1 tab5mg/1 tab

500mg/1cap500mg/1cap

4-6g4-6g

Route Route P.OP.O

P.OP.O

Deep IMDeep IM

FrequencyFrequency110 q 5 hrs.110 q 5 hrs.

q 6 hrs.q 6 hrs.

q40,prnq40,prn..

Drug StudyDrug Study

Five Nursing DiagnosisFive Nursing Diagnosis

1.1. Pain r/t traumatized tissue secondary to episioraphy as Pain r/t traumatized tissue secondary to episioraphy as evidence by patients verbalization of “medyo na lang evidence by patients verbalization of “medyo na lang man ang sakit sa akong tahi.man ang sakit sa akong tahi.

2.2. Knowledge deficit r/t unfamiliarity with information and Knowledge deficit r/t unfamiliarity with information and resources about breastfeeding as manifested by the resources about breastfeeding as manifested by the patients verbalization “Ano ang makuha sa gatas ng patients verbalization “Ano ang makuha sa gatas ng nanay?”.nanay?”.

3.3. Sleep disturbance r/t noise and changes in environment Sleep disturbance r/t noise and changes in environment as manifested by the patients verbalization “Hindi ako as manifested by the patients verbalization “Hindi ako nakatulog, masyado kasi maingay.”nakatulog, masyado kasi maingay.”

4.4. Self-care deficit r/t inability to perceive body part/ spatial Self-care deficit r/t inability to perceive body part/ spatial relationship [bathing/hygiene].relationship [bathing/hygiene].

5.5. Sedentary lifestyle r/t deficient knowledge of health Sedentary lifestyle r/t deficient knowledge of health benefits of physical exercise.benefits of physical exercise.

Nursing Care PlanNursing Care Plan

PrognosisPrognosisPrognosisPrognosis

Onset of illnessOnset of illness

Duration of illnessDuration of illness

HygieneHygiene

DietDiet

AgeAge

Performance Performance levellevel

GoodGood

==

==

Fair Fair BadBad JustificationJustification

The illness was easily diagnosed right after the The illness was easily diagnosed right after the delivery. delivery.

Illness was diagnosed 4 hours after the delivery Illness was diagnosed 4 hours after the delivery and appropriate nursing management and appropriate nursing management

immediately givenimmediately given

When she was hospitalized, she became When she was hospitalized, she became dependent to her husband in performing some dependent to her husband in performing some

simple task. In terms of ADL the patient simple task. In terms of ADL the patient experience weakness and she cannot perform it experience weakness and she cannot perform it

very well. very well.

When she was admitted to the ward, her When she was admitted to the ward, her physician advised her to have a low fat and low physician advised her to have a low fat and low

salt diet.salt diet.

The age of the client is 21 yrs. Old the age of The age of the client is 21 yrs. Old the age of the client is capable of striving.the client is capable of striving.

On the day of handling the patient, she was On the day of handling the patient, she was experiencing body weakness. And it was then experiencing body weakness. And it was then

manage by medications and some nursing manage by medications and some nursing intervention. After 8 hours of rendering nursing intervention. After 8 hours of rendering nursing

intervention the patient was able to move intervention the patient was able to move properly and perform some simple task. properly and perform some simple task.

Willingness to Willingness to undergo undergo

treatmenttreatment

Family SupportFamily Support

The reason why she was brought to hospital The reason why she was brought to hospital is for proper management. Patient and the is for proper management. Patient and the family are very much willing to let the patient family are very much willing to let the patient undergo the treatment. Although their undergo the treatment. Although their financial status is not that stable they are financial status is not that stable they are supportive for the maintenance of the patient.supportive for the maintenance of the patient.

The husband of the patient is very much The husband of the patient is very much supportive to her hospitalization and supportive to her hospitalization and therapies despite of the expenses. But her therapies despite of the expenses. But her father was not able to visit her because there father was not able to visit her because there is conflict between them.is conflict between them.

Good: 3/8 x 100= 37.5%Fair: 4/8 x 100= 50%Poor: 1/8 x 100= 12.5%

Interpretation:Therefore the patient’s prognosis is good, since the patient

undergone the treatment process completely and religiously followed every treatment regimen, and already managed her situation based on her current status, although sometimes problems that arouses, related to the said condition came.

References:References:..http:// www.webmd.com/ hypertension-high bloodhttp:// www.webmd.com/ hypertension-high blood.Dawn C. Jung, MD, staff physician, Department of Emergency Medicine, Suny .Dawn C. Jung, MD, staff physician, Department of Emergency Medicine, Suny

Downstate Medical Center, Kings Country Hospital CenterDownstate Medical Center, Kings Country Hospital Center.Mosby’s Pocket Dictionary of Medicine, Nursing and Allied Health (4.Mosby’s Pocket Dictionary of Medicine, Nursing and Allied Health (4thth edition) edition).Anatomy and Physiology (G Tribodean and R.Pallon 2.Anatomy and Physiology (G Tribodean and R.Pallon 2ndnd edition page 834 edition page 834.From Wikipedia, the tree encyclopedia.From Wikipedia, the tree encyclopedia.www.wikipedia.com.www.wikipedia.com.http:// www.soulhealer.com / anatomy.ner.htm.http:// www.soulhealer.com / anatomy.ner.htm.Doan-Wiggins L. Hypertension disorders of pregnancy. Emerg Med Clin North .Doan-Wiggins L. Hypertension disorders of pregnancy. Emerg Med Clin North

Am 1987 Aug.5 :495-508 [Medline].Am 1987 Aug.5 :495-508 [Medline]..Lew M. Klonis E: Emergency management of eclampsia and severe pre .Lew M. Klonis E: Emergency management of eclampsia and severe pre

eclampsia. Emerg Med (Fremantle) 2003 Aug; 15 : 361-8 [Medline].eclampsia. Emerg Med (Fremantle) 2003 Aug; 15 : 361-8 [Medline].

.Lipstein H. Lee CC, Crupi RS: A current concept of eclampsia. Am Emerg Med .Lipstein H. Lee CC, Crupi RS: A current concept of eclampsia. Am Emerg Med 2003 May; 21 : 223-6 [Medline].2003 May; 21 : 223-6 [Medline].

.Nurses Pocket Guide with diagnosis, Interventions and Rationales 2007 edition .Nurses Pocket Guide with diagnosis, Interventions and Rationales 2007 edition by: Doenges, Moorhouse and Murrby: Doenges, Moorhouse and Murr

. Maternal and Child Health Nursing (care of the childbearing and childbearing . Maternal and Child Health Nursing (care of the childbearing and childbearing family) by: Adele Pillitenfamily) by: Adele Pilliten

.Nurses Drug Handwork, 2007 edition.Nurses Drug Handwork, 2007 edition

Health & Medicine

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