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Introduction
Preeclampsia is a disorder that occurs only during pregnancy and the postpartum
period and affects both the mother and the unborn baby. Affecting at least 5-8% of
all pregnancies, it is a rapidly progressive condition characterized by high blood
pressure and the presence of protein in the urine. Swelling, sudden weight gain,
headaches and changes in vision are important symptoms; however, some women
with rapidly advancing disease report few symptoms.
The reason why we chose this case because we wanted to learn more about the
disease process and gain information on how to properly manage and prevent
complication. Also we researched this case to improve our skills and able to give
the best possible care to patients with the same condition and as a new duty
student nurse we view this case as a very interesting case that would give us
knowledge and skills that can be applied to all patients that we will handle.
A. Assessment
1.Personal Data
a. Demographic Data
c. Environmental Factors
The surrounding here is clean because the house is near the Sn. Fernando
Capitol. The place is also prone to flood when it rains hard and also pollution is
very prominent because the house is near the the main road and the existence of
Pasudeco which is a sugar cane refinery that emits a very unpleasant smell when
operates.
2. Personal History
b. Antepartal/Prenatal Preparation
Mrs. Pre-eclampsia only had a check up during her 3rd trimester of pregnancy
because she is experiencing hypertension. She had a check up for five times
on JBLMGH. She only had a check up during her 3 rd trimester because of
financial constrains which hinders her of consulting.
* = Dead
The diagram shows that Mrs. Preeclampsia has a history of hypertension on his father side and has a risk for acquiring
diabetes from her mother side. It shows that Mrs. Pre-eclampsias sister has already had diabetes.Her paternal
grandmother died from hypertension also her paternal uncle also died from it. Her maternal uncle died from the diabetes.
This shows that her Pregnancy induced hypertension is genetically acquired.
4. History of Present Illness
6. Physical Examination
Scalp: No flaking noted, no abnormal contour of the skull, no lumps noted, hair is
oily and sticky.
Extremities:
Upper: Fracture noted on the right arm, with normal range of motion with equal
pulse, no lesion noted
Potassium
To help evaluate 3.5 5.0 mmol/L The result means
Date ordered: fluid and 3.3 there is imbalance
06/22/08 electrolyte of potassium level
Date Results in: imbalance in in the client, it can
06/22/08 terms of increase the risk of
potassium an abnormal heart
component. beat, it can also
associated with
muscle weakness.
Chloride To determine the
Date ordered: levels of chloride, The result is within
06/22/08 can helps maintain 101 111 mmol/L normal range.
Date Results in: a balance of fluids 104.5 There is no
06/22/08 in the body to imbalance of
prevent certain electrolyte within
chemical reactions clients body in
from occurring relation to chloride
in the body that
are necessary it
to keep working
properly.
Nursing Responsibilities:
Prior to:
Explain to the client and significant others the purpose and indication of the procedure.
Inform the client that the test requires blood sample.
Notify the laboratory or the physician about the drugs that client is taking that may affect the test results; it may be necessary to
restrict them.
During:
Perform venipuncture and collect the sample in a proper container.
Use aseptic technique when obtaining the sample.
Handle the sample properly to prevent hemolysis.
After:
Apply direct pressure on the puncture site until stop bleeding.
Instruct the significant other to resume the medication that being stop.
Watch out for edema formation.
Document the procedure.
Secure the results and put it in the chart.
Refer the results to the physicians.
Diagnostic/ Date ordered Indication (s) or Results Normal Values Analysis and
Laboratory Date Result(s) in Purpose (Units used in Interpretation of
Procedures the hospital) results
Nursing Responsibilities:
Prior to:
Explain to the significant others the test, its purpose and how it done.
Inform the significant others that the test will require urine specimen.
Provide a clean container for the specimen.
During:
Collect the urine in a clean specimen cup.
Label the specimen properly.
After:
The specimen should be delivered to the lab within 1 hour.
Obtain result and secure it to the chart
Refer result to the physician
Diagnostic/ Date ordered Indication (s) or Results Normal Values Analysis and
Laboratory Date Result(s) Purpose (Units used in Interpretation of
Procedures in the hospital) results
Blood test
Lymphocytes are
Date ordered: Indicates the within the normal
Lymphocyte 06/22/08 amount of 0.20 0.35 range indicating
Date Results in: lymphocytes 0.26 reduced infection
06/22/08 participating with as a result of
macrophages at a continuous
site of local injury. antibiotic
treatment that
does not require
more lymphocytes
to act upon it
The result is
Triglycerides Date ordered: Triglyceride is fat above the normal
06/23/08 in the blood which, 3.72 0.11 2.09 level, this may
Date Results in: if elevated, has mmol/L indicate that High
06/23/08 been associated triglycerides are
with heart disease also associated
with pancreatitis
and also
associated with
problems other
than heart disease
Nursing Responsibilities:
Prior to:
Explain the procedures to the client
Explain the purpose and indication of the test
Tell to the significant others or client that the test will not require feeding restriction.
During:
Use aseptic technique when obtaining the sample
Label the container properly.
Bring the collected sample to the laboratory
After:
Obtain results and secure it to the patients chart
Refer the results to the physician
Diagnostic/ Date ordered Indication (s) or Results Normal Values Analysis and
Laboratory Date Result(s) Purpose (Units used in Interpretation of
Procedures in the hospital) results
Chest X-Ray Date ordered: To assist in The lungs are The lungs look It means that the
(CXR PAV) 06/22/08 diagnosing clear normal in size and result of the CXR
Date Results in: pulmonary and The cardio shape, and the of the client is all
06/24/08 cardiac disease. thoracic ratio is lung tissue looks normal. There is
Visualizes the borderline in normal. No no abnormality
structure of the diameter (ct growths or other found
lungs and heart. ratio: 14:28) masses can be
The diaphragm seen within the
and sulci are lungs. The heart
intact looks normal in
size, shape, and
the heart tissue
looks normal. The
blood vessels
leading to and
from the heart also
are normal in size,
shape, and
appearance. The
diaphragm looks
normal in shape
and location. No
abnormal
collection of fluid
or air is seen, and
no foreign objects
are seen.
Nursing Responsibilities:
Prior to:
Inform the client about the order of CXR.
Fill-up the request form and give it to the patient.
Explain the procedure and the purpose of the test
During:
Tell the patient to relax the body
Assured to the client that it is a non-invasive procedure
After:
Secure the result to the clients chart
Refer the result to the physician.
II. ANATOMY AND PHYSIOLOGY
I. EXTERNAL PARTS:
1. Mons veneris / mons pubis a firm, cushion like elevation of adipose tissue over
the symphysis pubis covered by curly hair or pubic hair forming escutcheon. In female, pubic
hair tends to be triangular distribution, while in male, it tends to be diamond shaped. It serves
to protect the junction of the pubic bone from trauma.
2. Labia majora two rounded folds of adipose tissue with overlying skin; they extend from
the mons pubis downward and backward to encircle the vestibule. The outer surface are
covered with hair, where as the inner surface contain sebaceous follicles which are smooth
and moist. Their purpose is mainly to protect the inner delicate parts of the vulva.
The labia majora are homologous of the scrotum in the male organ. At the same time, it is the
frequent site of varicose vein in the vulva. The arterial blood is supplied by the internal and
external pudendal arteries and a portion of the inferior rectus artery. It also shared an extensive
lymphatic supply with the other structure of vulva, which facilitates the spread of cancer in
female reproductive organ, and obstetric or sexual trauma may cause hematoma.
Immediately under the skin is a sheet of dartos muscle, which is responsible for the
wrinkled appearance as well as for their sensitivity to heat and cold. Ordinarily, these
structures are 7 8 cm. in width and 1 1.5 cm. in thickness.
3. Labia minora - two thin, flat, reddish folds of tissue lying between the inner surfaces of the
labia majora. Each labium minus consists of a thin fold of connective tissue which when
protected, presents a moist, reddish appearance, similar to that of mucous membrane. The
structure is covered by stratified squamous epithelium. It doesnt contain hair follicle but it
contains many sebaceous follicles and occasionally a few sweat glands.
Functions:
a. To lubricate and waterproof the vulvar skin.
b. To provide bactericidal secretion.
The labia minora are classed among erectile structures. This structure is extremely
sensitive and abundantly supplied with several varieties of nerve endings. Anteriorly, each
divide into 2 parts; the upper pair merges into the prepuce and the lower one fuse to form the
frenulum. Posteriorly, the labia minora fuse to form fourchette. The labia minora increase in
size at puberty and decrease after menopause due to estrogen level changes.
4. Clitoris - a small, cylindrical highly sensitive erectile organ corresponding to the male penis.
It is made up of erectile tissue which many large and small venous channels surrounded by
large amount of involuntary muscle tissue, the ischiocarvernosa facilitate erection of the organ.
Functions :
a. Stimulate and elevate levels of sexual tension.
b. Serve as a landmark in locating urethral opening during catheterization.
The clitoris measures 5 6 mm. long and 6 8 mm. across. It has very rich blood and
nerve supplies. It produces smegma, which along with other vulvar secretion has a unique odor
that may be sexually stimulating to the male.
5. Vestibule an almond shaped area that is enclosed by the labia minora laterally and
extends from the clitoris to the fourchette antero-posteriorly. The posterior portion of the
vestibule between the fourchette and the vaginal opening is called the fossa navicularis and is
usually observed only in nulliparous women.
The vestibular bulb is located beneath the mucous membrane of the vestibule on either
side which are almond shaped aggregation of vein 3 4 cm. long, 1 2 cm. wide and 0.5
1 cm. thick. These bulbs lie in close opposition to the ischio-pubic rami and partially
covered by the ischiocavernosus and constrictor vaginal muscles. These structures are
liable to injury and rupture which may result in a vulvar hematoma or hemorrhage. It is
perforated usually by 6 openings: urethra, vagina, and bartholins gland (2) and
paraurethral gland (2).
5.1. Urethral meatus / urethral orifice although not a true part, it is considered
as part of the reproductive system because of its closeness and relationship to the
vulva. It is situated in the middle of the vestibule and serves as an outlet for urine
from the urinary bladder.
5.2. Vulvovaginal / bartholins gland pair of small, pea sized glands located
within the substances of the labia majora. They correspond to the bulbourethral of
Cowpers gland in male. Often, they are sites of infection, abcess and cyst formation.
Usually, the openings are not visible or palpable. The gland secretes a small amount
of clear, viscid mucus during sexual excitement.
5.3. Paraurethral / skenes gland a pair of small glands lying on each side of the
urethra. They produce a small amount of mucus and are especially susceptible to
gonorrheal infection. It is homologous to male prostate.
5.4. Vaginal orifice / introitus occupies the lower portion of the vestibule and
varies considerably in size and shape. The vagina has an abundantly vascular supply.
Its upper third is supplied by the of the vesicovaginal branches uterine arteries. Its
middle third by the inferior vesical arteries. Its lower third by the middle
hemorrhoidal internal pudendal arteries.
Anteriorly, the vagina is in contact with the bladder and urethra from which is separated
by a connective tissue referred to vesicovaginal septum. Posteriorly between the lower
portion and the rectum is the rectovaginal septum. Approximately, the upper of the
vagina is separated from the rectum by the rectouterine or cul-de-sac of Douglas.
The vagina varies in length. The anterior and posterior vaginal walls commonly measure 6
8 cm. and 7 10 cm. in length, respectively. The areas around the cervix at the upper
end of the vagina are called fornicles, right and left, anterior and posterior. The walls are
lined with mucous membrane, which falls into folds, or corrugated formation called rugae.
These are referred to the inner wall of vagina. It is smooth during labor and parturition. It is
not present before menarche and gradually become obliterated after repeated childbirth
and menopause. A healthy vagina has pH of 4.0 6.0.
Functions:
a. serves as excretory duct of the uterus
b. female organ for copulation
c. part of birth canal
Hymen comprised mainly of connective tissue both elastic and collagen. Both surfaces are
covered by stratified squamous epithelium. The hymen can be broken through strenous
physical activities or masturbation. After childbirth, especially in multipara, the remnants of
the hymen from several cicatrized nodules of varying size called myrtiform caruncles.
6. Perineum the area extending from the fourchette to the anus. The pelvic and urogenital
diaphragm provides most of the support of the perineum.
6.1.Pelvic diaphragm consists of the levator ani muscles which is the principal
muscle that is close to vagina and the coccygeus muscle posteriorly.
The levator ani muscles form a broad muscular sling that originates from the
posterior surface of the superior rami of the pubis, from the inner surface of the ischial
spine and between the 2 sites from the obturator rami.
3 portion of levator ani muscle:
a. iliococcygeus muscle
b. pubococcygeus muscle
c. puborectalis muscle
The pubococcygeus and puborectalis constrict the vagina and rectum and form an
efficient functional rectal sphincter. Their functions are as follows:
a. play a role in sexual sensory function
b. bladder control
c. Control perineal relaxation during labor and in expulsion of the fetus during birth.
6.2.Urogenital diaphragm located in the hollow of the pubic arch and consists of
the transverse perineal muscles, constrictor of urethra and internal and external fascial
covering. These muscles originate at the ischial tuberosities and insert into the perineal
body. The strong muscle fibers provide support to the anal canal (sphincter muscle) during
defication and to the lower vagina during delivery.
The perineal body is a wedge shaped between the vaginal and canal opening which
serves as an anchor point for the muscles, fascia and ligament of the upper and lower
pelvic diaphragm. The perineal body is about 4 cm. wide x 4 cm. deep
and continuous with the septum between the rectum and vagina. This tissue is
flattened and stretched as the fetus moves through the birth canal.
II .INTERNAL ORGAN :
1. Uterus a hollow pear shaped organ partialy covered by peritoneum or serosa. The
posterior wall of the uterus is directly covered with peritoneum and the lower portion forms the
anterior portion of the cul-de-sac of Douglas. The cavity of the uterus is lined by the
endometrium. During pregnancy, the uterus serves for reception, implantation, retention and
nutrition of the conceptus which then expels during labor. It undergoes remarkable growth due
to hypertrophy of muscle fibers. Its size increases from 60 g. to about 1,100 g. at term and a
total volume averages about 5 liters. A non pregnant uterus has an approximately
measurement of 7.5 cm. long x 5 cm. wide x 2.5 cm thick, and during pregnancy, it is
approximately measures 30 cm. x 30 cm. x 20 cm.
b.2. The middle layers thick and made up of interlacing muscle fibers in figure
of 8 patterns. These muscles fibers surround large old vessels and their
contraction produces a hemostatic action and control of blood loss after placental
separation.
The vaginal cervix appears pink and ends at the external Os. The cervical canal
appears rosy red and is lined with columnar ciliated epithelium, which contains mucus
secreting glands. Most cervical cancer begins at this squamocolumnar junction. Elasticity
is the chief characteristics of the cervix. Its ability to stretch is due to the high fibrous and
collagenous content of the supportive tissues and also to the vast number of folds in the
cervical lining.
Ligaments of uterus :
1. Broad ligament comprised of 2 wing like structures that extend from the lateral
margins of the uterus to the pelvic walls and thereby divide the pelvic cavity into
anterior and posterior compartments. Each broad ligament consists of a fold of
peritoneum and these superior, lateral, inferior and medial margins. The inner 2/3 of
the superior margin forms the mesosalphinx to which the fallopian tubes are attached.
The outer third of the superior margin extends from the fimbriated end of the oviduct to
the pelvic wall, forms the infundibulopelvic ligament. The broad ligament keeps the
uterus centrally placed and provides stability within the pelvic cavity.
2. Round ligament composed of smooth muscle and connective tissue, and helps the
broad ligament in keeping the uterus in place. It is capable of contraction on time of labor thereby,
it steady the uterus, pulling downward and forward, so that the presenting part of the fetus is forced
into the cervix.
5. Ovarian ligament anchor the lower pole of the ovary to the cornua of the uterus. They
composed of muscle fibers that allow the ligament to contract.
Position of uterus
The position of the uterus varies depending on a womans posture, number of
children borne, bladder and rectal fullness and even normal respiratory pattern.
1. Anteverted the fundus is tilted forward. It is considered as the normal position.
2. Anteflexed slightly bend forward.
3. Retroverted tilted backward
4. Retroflexed bending backward
1.2. Internal iliac artery a major portion of the blood supply to the
Pelvis. This is commonly referred to as the hypogastric artery.
2. Ovarian artery a direct branch of the aorta enters the broad ligament through the
infundibulopelvic ligament.
Nerve Supply :
The nerve supply is derived principally from the sympathetic nervous system but
partly from the cerebrospinal and parasympathetic system.
Functions of uterus :
1. organ for menstruation
2. organ for gestation
Parts:
a. Interstitial the narrow portion contained in the muscular wall of the uterus
approximately 1 cm. in length.
b. Isthmus proximal to the ampulla. It is the narrow portion of the tube adjoining the
uterus approximately 2 cm. in length.
c. Ampulla the outer 3rd portion where fertilization occurs and considered as longest
portion with approximately 5 cm. in length.
d. Infundibulum distal third. Its funnel shaped opening encircles with fimbrae
approximately 2 cm. long. This fimbrae become swollen, almost erectile at ovulation.
Any malformation or malfunction of the tubes could result in infertility, ectopic pregnancy
or even sterility. Each fallopian tube is richly supplied with blood by the uterine and ovarian
arteries.
Functions :
1. site of fertilization
2. provide transport for the ovum from the ovary to the uterus
3. serve as a warm, moist, nourishing environment for the ovum or zygote
3. Ovaries 2 almond shaped organ situated in the upper part of the pelvic cavity. The size
varies among women and according to the stage of the menstrual cycle. Each ovary weighs 6 10
g with 1.5 3 cm wide, 2 5 cm long and 1 1.5 cm thick. After menopause, ovarian size
diminishes remarkably. The ovary is attached to the broad ligament by the mesovarium. They also
changed in appearance from smooth surfaced, dull white organs to pitted gray organ. Scarring
due to ovulation causes this pitting.
There is no peritoneal covering for the ovaries. Although this lack of covering assists the mature
ovum to erupt, it also allows easier spread of malignant cells from cancer of the ovaries. A single
layer of cuboidal epithelial cells, called the germinal epithelium covers the ovaries.
Layers of ovaries :
a. Tunica albuginea - dense and dull white and serves as protective layer.
b. Cortex main functional part because it contains ova, graafian follicles, corpora lutea,
degenerated corpora lutea (corpora albicantia).
c. Medulla or central portion of the ovary is composed of loose connective tissue.
Both sympathetic and parasympathetic nerves supply the ovaries. These also
a counterpart to the testes of male organ.
Functions :
a. ovulation
b. hormone production
CARDIOVASCULAR SYSTEM
The cardiovascular/circulatory system transports food, hormones, metabolic wastes,
and gases (oxygen, carbon dioxide) to and from cells. Components of the circulatory system
include:
There are two circulatory "circuits": Pulmonary circulation, involving the "right heart," delivers blood
to and from the lungs. The pulmonary artery carries oxygen-poor blood from the "right heart" to
the lungs, where oxygenation and carbon-dioxide removal occur. Pulmonary veins carry oxygen-
rich blood from tbe lungs back to the "left heart." Systemic circulation, driven by the "left heart,"
carries blood to the rest of the body. Food products enter the sytem from the digestive organs into
the portal vein. Waste products are removed by the liver and kidneys. All systems ultimately return
to the "right heart" via the inferior and superior vena cavae.
A specialized component of the circulatory system is the lymphatic system, consisting of a moving
fluid (lymph/interstitial fluid); vessels (lymphatics); lymph nodes, and organs (bone marrow, liver,
spleen, thymus). Through the flow of blood in and out of arteries, and into the veins, and through
the lymph nodes and into the lymph, the body is able to eliminate the products of cellular breakdown
and bacterial invasion.
Blood Components
Forty-five percent (45%) consists of cells - platelets, red blood cells, and white blood cells
(neutrophils, basophils, eosinophils, lymphocytes, monocytes). Of the white blood cells,
neutrophils and lymphocytes are the most important.
Red blood cells (erythrocytes), Filled with Bone marrow Oxygen transport
hemoglobin, a compound of iron and protein life-span:
120 days
Arteries
Arteries are strong, elastic vessels adapted for carrying blood away from the heart at relatively
high pumping pressure. Arteries divide into progressively thinner tubes and eventually become
fine branches called arterioles. Blood in arteries is oxygen-rich, with the exception of the pulmonary
artery, which carries blood to the lungs to be oxygenated.
The aorta is the largest artery in the body, the main artery for systemic circulation. The major
branches of the aorta (aortic arch, ascending aorta, descending aorta) supply blood to the head,
abdomen, and extremities. Of special importance are the right and left coronary arteries, that supply
blood to the heart itself.
Name Serves
Veins
Blood leaving the capillary beds flows into a series of progressively larger vessels, called venules,
which in turn unite to form veins. Veins are responsible for returning blood to the heart after the
blood and the body cells exchange gases, nutrients, and wastes. Pressure in veins is low, so veins
depend on nearby muscular contractions to move blood along. Veins have valves that prevent
back-flow of blood.
Blood in veins is oxygen-poor, with the exception of the pulmonary veins, which carry oxygenated
blood from the lungs back to the heart. The major veins, like their companion arteries, often take
the name of the organ served. The exceptions are the superior vena cava and the inferior vena
cava, which collect body from all parts of the body (except from the lungs) and channel it back to
the heart.
Artery/Vein Tissues
Arteries and veins have the same three tissue layers, but the proportions
of these layers differ. The innermost is the intima; next comes the media;
and the outermost is the adventitia. Arteries have thick media to absorb the
pressure waves created by the heart's pumping. The smooth-muscle
media walls expand when pressure surges, then snap back to push the
Blood vessel anatomy
blood forward when the heart rests. Valves in the arteries prevent back-
flow. As blood enters the capillaries, the pressure falls off. By the time blood reaches the veins,
there is little pressure. Thus, a thick media is no longer needed. Surrounding muscles act to
squeeze the blood along veins. As with arteries, valves are again used to ensure flow in the right
direction.
Oxygen-poor blood empties into the right atrium via the superior and inferior vena cavae. Blood
then passes through the tricuspid valve into the right ventricle which contracts, propelling the blood
into the pulmonary artery. The pulmonary artery is the only artery that carries oxygen-poor blood. It
branches to the right and left lungs. There, gas exchange occurs -- carbon dioxide diffuses out,
oxygen diffuses in.
Pulmonary veins, the only veins that carry oxygen-rich blood, now carry the oxygenated blood from
lungs to the left atrium of the heart. Blood passes through the bicuspid (mitral) valve into the left
ventricle. The ventricle contracts, sending blood under high pressure through the aorta, the main
artery for systemic circulation. The ascending aorta carries blood to the upper body; the descending
aorta, to the lower body.
The cardiac cycle consists of two parts: systole (contraction of the heart muscle in the ventricles)
and diastole (relaxation of the ventricular heart muscles). When the ventricles contract, they force
the blood from their chambers into the arteries leaving the heart. The left ventricle empties into the
aorta (systemic circuit) and the right ventricle into the pulmonary artery (pulmonary circuit). The
increased pressure on the arteries due to the contraction of the ventricles (heart pumping) is called
systolic pressure.
When the ventricles relax, blood flows in from the atria. The decreased pressure due to the
relaxation of the ventricles (heart resting) is called diastolic pressure.
Blood pressure is measured in mm of mercury, with the systole in ratio to the diastole. Healthy
young adults should have a ventricular systole of 120mm, and 80mm at ventricular diastole, or
120/80.
Receptors in the arteries and atria sense systemic pressure. Nerve messages from these sensors
communicate conditions to the medulla in the brain. Signals from the medulla regulate blood
pressure.
EXCRETORY SYSTEM
The excretory system is an organ system that performs the function of excretion, the
bodily process of discharging wastes. It is responsible for the elimination of the waste products of
metabolism as well as other non-useful materials. The main components of the excretory system
are your two kidneys, two tubes that carry urine called ureters, the bladder, and the urethra.
Kidney
The most important organs of the excretory system are the kidneys. The kidneys are placed on
either side of the spinal column near the lower back. The kidneys are bean-shaped and they have
an important job. They are responsible for removing wastes from the blood and they also keep
your blood pressure in check and help with the making of red blood cells. The kidneys filter the
blood and remove any wastes. The Kidney does this via its three lauers which are the Cortex, the
medulla and the pelvis. In the Cortex and Medulla there are Nephrons. These Nephrons comprise
of a Glomerulus (bundle of capilaries), a Bowman's Capsule, a Proximal Convoluted Tubuale, the
decending and ascending Loop of Henle, the Distal Convoluted Tubual and Collecting Ducts. The
collecting ducts come together in the Pelvis. When your body gets ready to pass waste products,
it goes through the kidneys and mixes with water and urine. Then, the waste travels into the
bladder through tubes. These tubes are called Ureters. Now, the bladder holds all of that urine
until it feels so full that you need to get rid of it. That's called urination. When this happens, a tube
called the Urethra takes the urine to the outside of the body.
Ureter
the ureters are muscular ducts that propel urine from the kidneys to the urinary bladder. In the
adult, the ureters are usually 25-30cm (10-12 inches)long.
In humans, the ureters arise from the renal pelvis on the medial aspect of each kidney before
descending towards the bladder on the front of the psoas major muscle. The ureters cross the
pelvic brim near the bifurcation of the iliac arteries (which they run over). This "pelviureteric
junction" is a common site for the impaction of kidney stones (the other being the ureterovesical
valve). The ureters run posteroinferiorly on the lateral walls of the pelvis. They then curve
anteriormedially to enter the bladder through the back, at the vesicoureteric junction, running
within the wall of the bladder for a few centimeters. The backflow of urine is prevented by valves
known as ureterovesical valves, pressure from the filling of the bladder, and the tone of the
muscle in the bladder wall.
In the female, the ureters pass through the mesometrium on the way to the urinary bladder.
Urinary bladder
the urinary bladder is a hollow, muscular, and distensible (or elastic) organ that sits on the pelvic
floor in mammals. It is the organ that collects urine excreted by the kidneys prior to disposal by
urination. Urine enters the bladder via the ureters and exits via the urethra.
In males, the bladder is superior to the prostate, and separated from the rectum by the
rectovesical excavation.
In females, the bladder is separated from the uterus by the vesicouterine excavation.
Urethra
the urethra (from Greek - ourethra) is a tube which connects the urinary bladder to the
outside of the body. The urethra has an excretory function in both sexes to pass urine to the
outside, and also a reproductive function in the male, as a passage for semen.
The external urethral sphincter is a striated muscle that allows voluntary control over urination.
IV. Patients illness
Etiology
Modifiable factors:
Modifiable factors:
Hypertension
Epigastric Pain
Edema
Edema is first noted in the lower legs, and a small degree of this is normal
in many normal pregnant women. As fluid retention progresses to imminent
or frank preeclampsia, however, the patient is likely to note puffiness around
eyes and tightness of finger rings, particularly on arising in the morning.
There's no known way to prevent preeclampsia. Eating less salt or changing your
activities during pregnancy doesn't reduce the risk. The best way to take care of
yourself and your baby is to seek early and regular prenatal care. If preeclampsia
is detected early, you and your doctor can work together to prevent complications
and make the best choices for you and your baby.
Bed rest: Buying time for baby to grow. If you aren't near the end of your
pregnancy and you have a mild case of preeclampsia, your doctor may
recommend bed rest to lower your blood pressure and increase blood flow to your
placenta, giving your baby extra time to mature. You may need to lie in bed, only
sitting and standing when necessary. Or you may be able to sit on the couch or in
bed and strictly limit your activities. Your doctor may want to see you a few times
a week to check your blood pressure, urine protein levels and your baby's well-
being.
If you have more severe preeclampsia, you may need bed rest in the hospital. In
the hospital, you may have regular nonstress tests or biophysical profiles to
monitor your baby's well-being. You may also have ultrasound exams to measure
the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply
to the baby.
Medications: Helpful for you and your baby. Your doctor may recommend
medication to lower your blood pressure until delivery. If you have severe
preeclampsia or HELLP syndrome, corticosteroid medications can temporarily
improve liver and platelet functioning to help prolong your pregnancy.
Corticosteroids can also help your baby's lungs become more mature in as little as
48 hours an important step in helping a premature baby prepares for life outside
the womb.
A. MEDICAL MANAGEMENT
Nursing Responsibilities:
Prior to:
After:
B. Drugs
Cephalexin DO: 06/23/08 Oral 500 mg It is used to treat Foods rich in Mrs.
DP: 06/23/08 TID infections by protein, Preeclampsia
bacteria, carbohydrates, felt that the
including upper And calories pain under
respiratory and water. her genital
infections, ear area is
infections, skin lessened.
infections, and
urinary tract
infections.
Kalium Durule DO: 06/22/08 Oral 2 tablet Potassium is Foods like, Mrs.
DP: 06/22/08 TID needed to nilagang baka Preeclampsia
maintain good and sinigang regained
health. Although and water. muscle
a balanced diet strength and
usually supplies can move
all the potassium without
a person needs, feeling of
potassium pain in the
supplements muscles and
may be needed bones.
by patients who
do not have
enough
potassium in
their regular diet
or have lost too
much potassium
because of
illness or
treatment with
certain
medicines.
Metoprolol DO: 06/25/08 Oral 100 mg It used to treat Foods like Mrs.
DP: 06/25/08 BID high blood sinigang, Preeclampsia
pressure, alone arrozcaldo and responded by
or with other water. the blood
medicines. pressure of
170/140 to
150/110.
Ferrous Sulfate DO: 06/23/08 Oral, OD It is used to treat Foods like fish, Mrs.
DP: 06/23/08 iron-deficiency vegetables, Preeclampsia
anemia. Dietary rice, regained the
supplement of arrozcaldo, blood loss
iron. Optimum nilagang baka during her
therapeutic and water. delivery.
responses are
usually noted
within 2-4
weeks.
Nursing Responsibilities:
Prior to:
During:
After:
C. Diet
Date ordered Clients
Date started General Indication/ Specific food response
Type of diet
Date description purpose taken to
changed treatment
NPO ( DO: 06-22-08 Nothing per This kind of All kinds of Patient
nothing per DS: 06-22-08 Orem or Nil diet is was foods and verbalized
orem ) DC: 06-23-08 per Os is a ordered for the fluids are hunger but
Latin word for patient for restricted complied
a medical various with the diet
introduction reasons such regimen.
meaning to as for
withhold oral observation,for
foods and aspiration
fluids from a precaution due
patient for to tachypnea,
various vomiting and
reasons. seizure.
OD: 06-23-08
DAT ( diet as DS: 06-23-08 Food rich in The patient
tolerated) The patient protein, complied
can eat rich carbohydrates, with the diet
foods in vitamin C regimen.
carbohydrate, adequate She
protein, intake of regained
vitamin C, fluids. energy as
iron and drink evidenced
fluids as by having
tolerated. slight
increase in
his muscle
strength and
can do
simple
activities of
daily living
with minimal
assistance.
Nursing Responsibilities:
Prior to:
After:
D. Exercise/ Activity
Clients
Date ordered response or
Type of General Indication/
Date started reaction to
exercise description purpose
Date changed the exercise
or activity
Nursing Responsibilities:
Prior to:
1. Check physicians order
2. Inform the patients SO about the type of activity.
3. Explain the purpose of the activity ordered the consequences of not
following such diet and how it will be implemented.
4. Provide proper positioning.
During:
After:
2. ACTUAL SOAPIE
June 24, 2008
S > Hindi ako masyadong nakakatulog kasi nasusuka ako palagi.
O> Received patient lying on bed, awake, conscious and coherent.
> Appear restless, sleepless and yawning noted.
> Breasts are symmetrical without milk let down
> Urinated once within the shift.
> Defecated once within the shift.
> Lochia Rubra noted, minimal in amount.
> Epysiorraphy not inflamed
> No pain on the calf upon flexion
> No edema on extremeties
> With initial vital signs of: T-37.3 C, PR- 82 bpm, RR-20 bpm, BP-
130/100mmHg
A> Disturbed sleep pattern related to physiological factor (nausea)
P> After 4 of NI, the patient will identify individually appropriate interventions to
promote sleep.
I > Established rapport
> Monitored v/s
> Observed physical signs of fatigue
> Identified circumstances that interrupt sleep and frequency.
> Explained necessity of disturbances for monitoring v/s or other care when
client is hospitalized.
> Encouraged to have a warm sponge bath before bed time
> Encouraged to drink milk before bed time
> Encouraged to have adequate food/fluid intake.
> Discouraged taking caffeinated food/beverages before bed time
E > Goal met, patient identified individually appropriate interventions to promote
sleep.
E > Goal met, the patient verbalized awareness of the feeling of anxiety.
2. DISCHARGE PLANNING
VII. CONCLUSION AND RECOMMENDATIONS
CONCLUSION
Upon doing the case study our group gained a lot of information regarding
the Pre-eclampsia (pregnancy-induced hypertension). The group found out that
Pre-eclampsia typically starts after the 20th week of pregnancy and can affects
the placenta that may cause endothelial dysfunction in the maternal blood
vessels of susceptible women. While blood pressure elevation is the most visible
sign of the disease, it involves general damage to the maternal endothelium and
kidneys, liver, and brain. We also learned that pre-eclampsia is also a leading
cause of fetal complication, which include low birth weight, premature birth and
stillbirth. We learned that proper nutrition, monitoring, on time given of medication
and proper management of the health of the client is the best treatment that we
can give to the patient for her to maintain her normal blood pressure and some
other factors concerning her condition.
Finally, after doing the case study, the members of the group
appreciate the Pre-eclampsia than before. As student nurses, we are now
confident in handling a patient with the same illness because they are equipped
with information & enhanced skills through the help of our case study. It is true that
prevention is better than cure.
RECOMMENDATION
Most of the people now a day are experiencing different symptoms that
they tend to ignore. They dont even bother to consult doctor to check if there is
something wrong with their health. Until they finally found out that their condition
is already severe.
Hypertension can be found out on any ages and gender but the most
dangerous was in pregnant women because they would die or the baby and also
put in critical situation. They need frequent consultation to monitor their situation.
Especially when they reach the second trimester (20 weeks pregnancy) because
its the start of what we call Pregnancy Induced Hypertension or Pre-clampsia.
Pre clampsia is also the leading cause of fetal complications, which include low
birth weight, premature baby and stillbirth.
But not all are aware of this condition because most of the Filipino are
poor and not bother to visit the doctor for consultation because of the kind of
status they have. We are aware uneducated is one of the factors why some
become ignorant .They dont take any interest on something that they will not
benefit or can cause a lot of money. Because we are aware that the economy
status now is low and all the price of the product in the market is too high.
For example our client, she is pregnant and working even though her
husband is working because they have seven children that need to feed and
provides things and need to send to school. But their salary is not enough for
them to support their big family. She focused on earning some money for their
living and when her pregnancy reaches the second trimester she experienced
increased in blood pressure. She only went to the Barangay health center and
not in a doctor because of having low income. Time past, without even knowing
that her condition become severe and make them spend a lot of money when
she gave birth because of not taking initiative to visit a doctor for consultation and
also the health of her baby become affected.
Thats the most reason of the people who dont initiative to consult a
doctor of having low income and saying its not that really serious. They dont
know that Hypertension is dangerous condition to pregnant that needs to monitor
by the specialist and need to manage properly.
Encourage them to consult a doctor, especially if you are the person who
has more knowledge about it. If you need to explain the possible things to
happen and what are the benefits they can get on that do it. What the pregnant
women needs to do if she is in that situation (Increased BP). You never know on
that thing do is you save not only ones life but two.
Nurses and Doctors are the one who is really responsible in taking care of
the health of the patient. They should give the best service they can give.
Especially those women who are pregnant are need more care and need to take
care because they caring a new life that need support. Teach them on how to
manage their condition, the things that they need and not need to do, the things
that they should aware. Health care providers are the one who have knowledge
on that situation. Explain the possible things that might happen, their condition for
them to be aware. Explain in a way that they understand it, like explain the result
in their level of their understanding for them to know to gain their cooperation.
5. Pathophysiology
Book-Centered
Cathecholamine
Release
others
Abdominal
surgery,
Uterine irritability Decreased placental gastroenteritis,
Friction pyelonephritis
prostaglandin synthesis
cervical changes
preterm labor
Patient-Centered
Cathecholamine
Release
,
Uterine irritability Decreased placental
Friction
prostaglandin synthesis
cervical changes
preterm labor