DAVAO MEDICAL SCHOOL FOUNDATION, INC.

MEDICAL SCHOOL DRIVE, BAJADA, DAVAO CITY

COLLEGE OF NURSING

IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS
IN NCM 102 RLE

CASE STUDY
ECLAMPSIA

SUBMITTED TO:
GREMMA W. BARATAS, RN, MN
CLINICAL INSTRUCTOR

SUBMITTED BY:
JAN FRANCIS D. ALBERO, ST. N
EPHRAIM FRITZ Z. BAWA-AN, ST. N
MA. TRICIA JOY CONSOL B. FANO, ST. N
FRANCIS JOHN GANDEZA, ST. N
FARDEJAH MAISA L. KASUYO, ST. N
ALICIA MAY T. MEDIDA, ST. N
DIRK LOWELL G. REBOSURA, ST. N
KYLES YFTACH F. TEOROSEO, ST. N

DATE SUBMITTED:
MARCH 3, 2016

TABLE OF CONTENTS

I. INTRODUCTION....................................................................................................1-2
A. Background of the study.........................................................................................1
B. Significance of the study.........................................................................................2
C. Relevance of the study...........................................................................................2
II. OBJECTIVES(General and Specific objectives) .................................................3-4
III. HEALTH HISTORY.................................................................................................5
IV. PATIENT PROFILE.................................................................................................5
V. DEVELOPMENTAL TASK....................................................................................6-7
VI. GENERAL ASSESSMENT..................................................................................8-9
VII. ANATOMY AND PHYSIOLOGY....................................................................10-12
VIII. DEFINITION OF TERMS...............................................................................13-14
IX. ETIOLOGY............................................................................................................15
X. PATHOPHYSIOLOGY......................................................................................16-18
XI. PROGNOSIS........................................................................................................19
XII. SYMPTOMATOLOGY....................................................................................20-22
XIII. MEDICAL AND SURGICAL TREATMENT...................................................23-26
XIV. DIAGNOSTIC TEST (LABORATORY TEST)...............................................26-32
XV. NCP................................................................................................................33-35
XVI. DISCHARGE PLANNING (METHOD)..........................................................36-37
A. Medication............................................................................................................36
B. Exercise................................................................................................................37
C. Treatment..............................................................................................................37
D. Health Teaching....................................................................................................37
E. Out-patient order...................................................................................................37
F. Diet........................................................................................................................37

XVII. RECOMMENDATIONS.....................................................................................38
XVIII. BIBLIOGRAPHY/REFERENCES....................................................................39

INTRODUCTION
A. BACKGROUND OF THE STUDY
Hypertensive disorders are the most common medical complication of pregnancy,
affecting 6% to 8% of all pregnancies.1 Approximately 30% of hypertensive disorders in
pregnancy are caused by chronic hypertension, and 70% are caused by gestational
hypertension. The spectrum of disease ranges from mildly elevated blood pressures
(BP) with minimal clinical significance to severe hypertension and multiorgan
dysfunction. The incidence of disease is dependent on many different demographic
parameters, including maternal age, race, and associated underlying medical
conditions. Although geographic and racial differences in incidence have been reported,
several risk factors have been identified as predisposing to the development of
preeclampsia in different populations. For patients with a twin gestation, the incidence
and severity are higher than in those with singleton pregnancy.2 In addition, the
incidence is significantly higher in patients with previous preeclampsia and in those with
previous preeclampsia remote from term.3 Patients older than age 35 years also have
an increased incidence of preeclampsia, mainly because of increased undiagnosed
chronic hypertension in this group of patients. Understanding the disease process and
the impact of hypertensive disorders on pregnancy is of the utmost importance,
because these disorders remain a major cause of maternal and perinatal morbidity and
mortality worldwide.

SIGNIFICANCE OF THE STUDY

As a health care provider, life modification and improvement of patients wellbeing in regardless of race, gender and age is our primary goal. In fact, giving
unfathomable care to the sick is not only our sole responsibility but promoting health,
preventing illness, and alleviating suffering are some of our various obligations we need
to carry out in order to meet clients needs. Basically, catering ones need is a fulfillment
and creates satisfaction that will be inculcated to our minds forever.

RELEVANCE OF THE STUDY

We had interest and choose the attention-grabbing case for its atypical trait. We
appreciate this case since it is rare and challenging to our part as a student nurse. We
apprehend that this case study requires critical thinking and scientific method which will
probably enable us relate our knowledge gained from our instructors and studying.

OBJECTIVES
GENERAL OBJECTIVE:
At the end of our two-week exposure in the Southern Philippines Medical Center
Gynecology ward, we will be able to come up with a case study regarding a patient who
has eclampsia. This covers learning additional knowledge on what eclampsia is all
about, what are the different types and causes of it, how the disease progresses and
manifests its signs and symptoms, how does it affect the patient and the significant
others. In return, we, as health care personnel, may impart health teaching regarding
maintenance of current health status, prevention of potential problems and promotion
family support and emotional support for the patients wellbeing.
SPECIFIC OBJECTIVES:
This case study is made to achieve the following reasons:
1. Establish rapport with our patient as well as her significant others to gain trust
and cooperation.
2. Collect significant information regarding our patients conditions as well as the
family history, past and present health history.
3. Thoroughly assess our patient in cephalocaudal manner .
4. Evaluate clients data according to the nursing and developmental theory.
5. Present the anatomy and physiology of the organs involved.
6. Trace the Pathophysiology of the disease process and its enduring
symptomatology
7. Review and interpret medical order and results of possible laboratory
examination that the client has undergone.
3

8. Identify the different signs and symptoms, as well as the presentation of its
etiology and contributing factors in the development of pyelonephritis for future
purpose.
9. Make effective nursing care plans that address the present and possible needs.
10. Present Drug study on the clients medication.
11. Present discharge plan for clients condition.

HEALTH HISTORY
Patient had headache for 1 week, after CS, BTL for fetal distress.

PATIENT PROFILE

Name: Barney
Sex: Female
Age: 35 years old
Status: Married
Address: Agdao, Davao City
Nationality: Filipino
Religion: Roman Catholic
Occupation: None
Birthdate: August 8, 1980
Mother: Edna
Father: Jaunito
Spouse: Marlot
Birth Place: Davao City
Chief Complaint: Seizures

GENOGRAM
Fathers side

Mothers Side

Grandfath
er
64, alive

Youngest
22, alive

Grandmother
50, alive

Patient
35
eclampsia

Youngest
2 weeks

Second
eldest
36, alive

2nd youngest
10 years

Grandfath
er
70, dead

Eldest
38, alive

2nd eldest
11 years

Grandmother
60, alive

Daughter
28, alive

Son
(husband
of the
patient)
35, alive

Eldest
14 years

Male
Female
Patient

DEVELOPMENTAL TASK
Ericksons Stage Theory
Conflict
Resolution or virtue

Age
Adulthood
26-64 years

Generativity vs
Stagnation

Care

Culmination in old
age
Caritas, Caring for
others and agape
empathy and concern

Generativity vs. Stagnation

During middle adulthood (ages 40 to 65 yrs), this stage establish our careers, settle down within
a relationship, begin own families and develop a sense of being a part of the bigger picture.
This stage give back to society through raising children, being productive at work, and becoming
involved in community activities and organizations.
By failing to achieve these objectives, this become stagnant and feel unproductive. Success in
this stage will lead to the virtue of care.
Generativity is the concern of guiding the next generation. Socially-valued work and disciplines
are expressions of generativity.
The adult stage of generativity has broad application to family, relationships, work, and society.
Generativity, then is primarily the concern in establishing and guiding the next generation... the
concept is meant to include... productivity and creativity."
During middle age the primary developmental task is one of contributing to society and helping
to guide future generations. When a person makes a contribution during this period, perhaps by
raising a family or working toward the betterment of society, a sense of generativity- a sense of
productivity and accomplishment- results. In contrast, a person who is self-centered and unable
or unwilling to help society move forward develops a feeling of stagnation- a dissatisfaction with
the relative lack of productivity.
Central tasks of middle adulthood

Express love through more than sexual contacts.

Maintain healthy life patterns.

Develop a sense of unity with mate.

Help growing and grown children to be responsible adults.

Relinquish central role in lives of grown children.

Accept children's mates and friends.

Create a comfortable home.

Be proud of accomplishments of self and mate/spouse.

Reverse roles with aging parents.

Achieve mature, civic and social responsibility.

Adjust to physical changes of middle age.

Use leisure time creatively.

ASSESSMENT

Skin
She has an even skin tone to the rest of her body. Good skin turgor noted and warm to
touch.
Head
She has a normocephalic head ,she has a symmetrical facial features and her facial
movements are well coordinated. She has dark thick hair which are evenly distributed to
her clean scalp.
Eyes
Her pupils are symmetrically equal, has a brisk reaction to light and a uniform
accommodation.
Ears
Mild tenderness was noted upon palpation on both ears, hearing is present on both
ears.
Mouth
She has symmetrical lips. Moist and fair pinkish in color. Tongue is at midline able to
move accordingly.

Chest & Lungs

Symmetrical expansion upon breathing. Clear breath sounds noted upon auscultation
she is not in any form of respiratory distress.
Heart and Central Vessels
Her heart sounds is regular upon auscultation. No abnormal pulsation and tenderness
noted on pulsation areas and carotid arteries.
Abdomen
She has a good skin integrity and symmetrically fair and round.
Extremities
Both her hands are normal with regular peripheral pulses on her extremities. She is able
to move her extremities accordingly. She has no spinal deformities with good skin
turgor. Skin discoloration not noted.

ANATOMY AND PHYSIOLOGY

The Circulatory (Cardiovascular) System

The Circulatory system is designed to deliver oxygen and nutrients to all parts of
the body and pick up waste materials and toxins for elimination. This system is
made up of the heart, the veins, the arteries, and the capillaries.
Circulation is achieved by a continuous one way movement of blood throughout the
body. The network of blood vessels that flow through the body is so extensive that
blood flows within close proximity to almost every cell.
Heart The heart is a muscular pump that propels blood throughout the body. The
heart is located between the lungs, slightly to the left of center in the chest. The
heart is broken down into four chambers including:
RIGHT ATRIUM which is a chamber which receives oxygen poor blood
from the veins.
RIGHT VENTRICLE which pumps the oxygen poor blood from the right
atrium to the lungs.
LEFT ATRIUM which receives the now oxygen rich blood that is returning
from the lungs.
LEFT VENTRICLE which pumps the oxygenated blood through the arteries
to the rest of the body.
Blood Vessels
Blood vessels are broken down into three groups: the arteries which carry blood out
of the heart to the capillaries, the veins which transports oxygen poor blood back to
the heart, and the capillaries which transfer oxygen and other nutrients into the
cells and removes carbon dioxide and other metabolic wastes from these body
tissues.
Blood Pressure
Blood pressure is the force exerted by the blood against the walls of the blood
vessels. The ooutput or direct pumping of the heart and the resistance to blood flow
in the vessels determines blood pressure. Resistance is determined by blood
viscosity and by friction.

10

Renal System
The urinary system, also known as the renal system, consists of the kidneys,
ureters, bladder, and the urethra. Each kidney consists of millions of functional units
called nephrons.
Renin Angiotensin Aldosterone system.
When blood volume falls or blood flow to the kidneys decreases, juxtaglomerular cells in the
kidneys secrete renin into the bloodstream. In sequence, renin and angiotensin converting
enzyme (ACE) act on their substrates to produce the active hormone angiotensin II, which
raises blood pressure in two ways. First, angiotensin II is a potent vasoconstrictor; it raises
blood pressure by increasing systemic vascular resistance. Second, it stimulates secretion of
aldosterone, which increases reabsorption of sodium ions and water by the kidneys. The water
reabsorption increases total blood volume, which increases blood pressure.
Antidiuretic hormone. ADH is produced by the hypothalamus and released from the posterior
pituitary in response to dehydration or decreased blood volume. Among other actions, ADH
causes vasoconstriction, which increases blood pressure.
Atrial Natriuretic Peptide. Released by cells in the atria of the heart, ANP lowers blood
pressure by causing vasodilation and by promoting the loss of salt and water in the urine, which
reduces blood volume.

11

DEFINITION OF TERMS

1. Kidney -The kidneys are bean-shaped organs that serve several essential
regulatory roles in vertebrates.
2. Ureters- the duct by which urine passes from the kidney to the bladder or
cloaca.
3. Bladder - a membranous sac in humans and other animals, in which urine is
collected for excretion.
4. Urethra - the duct by which urine is conveyed out of the body from the bladder,
and which in male vertebrates also conveys semen
5. Nephrons - each of the functional units in the kidney, consisting of a glomerulus
and its associated tubule, through which the glomerular filtrate passes before
emerging as urine.
6. juxtaglomerular cells- (JG cells, or granular cells) are cells in the kidney that
synthesize, store, and secrete the enzyme renin.
7. Renin (angiotensinogenase) an enzyme that participates in the body's reninangiotensin aldosterone system (RAAS)also known as the renin-angiotensinaldosterone axisthat mediates extracellular volume (i.e., that of the blood
plasma, lymph and interstitial fluid), and arterial vasoconstriction. Thus, it
regulates the body's mean arterial blood pressure.
8. Angiotensin - is a peptide hormone that causes vasoconstriction and a
subsequent increase in blood pressure. It is part of the renin-angiotensin system,
which is a major target for drugs that lower blood pressure.
9. Aldosterone - a steroid hormone, "the main mineralocorticoid hormone
produced by the outer section (zona glomerulosa) of the adrenal cortex in the
adrenal gland.
10. Beta human chorionic gonadotrophin (beta-hCG) - Human chorionic
gonadotropin (hCG) is a hormone produced by the embryo following
implantation.
11. Circulation - The movement of blood through the body that is caused by the
pumping action of the heart.
12. Blood vessels- a tubular structure carrying blood through the tissues and organs;
a vein, artery, or capillary.

12

13. Blood - a bodily fluid in humans and other animals that delivers necessary
substances such as nutrients and oxygen to the cells and transports metabolic
waste products away from those same cells
14. Oxygen poor blood- deoxygenated blood
15. Oxygen rich blood- oxygenated blood
16. Arteries- any of the muscular-walled tubes forming part of the circulation system
by which blood (mainly that which has been oxygenated) is conveyed from the
heart to all parts of the body.
17. Capillaries - A capillary is an extremely small blood vessel located within the
tissues of the body, that transports blood from arteries to veins. Capillaries are
most abundant in tissues and organs that are metabolically active.
18. Blood viscosity - is the thickness and stickiness of blood. It is a direct measure of
the ability of blood to flow through the vessels.

13

19. ETIOLOGY

Eclampsia often follows preeclampsia, which is characterized by high blood pressure

after the 20th week of pregnancy. If your preeclampsia worsens and affects your brain,
causing seizures or a coma, you have developed eclampsia.

Doctors dont know what causes preeclampsia. The following explains how the
symptoms of preeclampsia can lead to eclampsia.

High Blood Pressure

Preeclampsia can cause your blood pressure (the force of blood against the walls of
your arteries) to become high enough to damage your arteries and other blood vessels.
Damage to your arteries may restrict blood flow and produce swelling in the blood
vessels of your brain. If this swelling interferes with your brains ability to function,
seizures may occur

Proteinuria

Preeclampsia commonly affects kidney function. Protein in your urine, also known as
proteinuria, is a key sign of the condition. Your kidneys filter waste from your blood but
retain beneficial nutrients, such as protein, in the blood for redistribution to your body. If
the kidneys filters (glomeruli) sustain damage, protein can leak through these filters and
excrete into your urine.
14

PATHOPHYSIOLOGY

Predisposing
Nulliparity
Family History
Poor outcome of
previous pregnancy
Hydatid mole
Teen pregnancy
Age (>35 years old)
Gestational diabetes

Pre-eclampsia
S/S
Convulsions
BP(160/110)
Proteinuria
Oliguria
Elevated Serum
creatinine
(>1.2mg/dL)

Etiology
(UNKNOWN)

Precipitating
Lower socio-economic
status
Obesity
Nutrition
Dietary deficiency or
excess

Woman who had

developed high blood
pressure who had no
history of high blood
pressure, usually after
the 20th week

Trophoblast did not

infiltrate well in the
decidua
Spinal artery did not
allow large amount of
blood to flow

Leads to poor oxygen in the

placenta

Agitates the placenta, there

stimulates the release of
harmful agents in the mothers
baby

15

Damage the cells specifically

the endothelial cells

Damage the blood vessels

make them harder to relax
resulting to hypertension

Makes the blood vessel full of

leaks that would let loose
protein, that can cause
excretion of protein in the urine

Water follows protein in the

tissues that can cause to edema
Headaches,
seizures, visual
symptoms

Epigastric pain

Malfunction of liver d/t increase

liver enzymes

Fetal growth

When endothelial cells are

damaged it would result to
clottings

Contracted labor

16

eclampsia

If treated

If not treated

Good prognosis

Complications
placenta
abruption, liver
hematoma, DIC,
Stroke

death

17

PROGNOSIS
Most women will have good outcomes for their pregnancies complicated by
preeclampsia or eclampsia. Some women will continue to have problems with their
blood pressure and will need to be followed closely after delivery. About 25% of women
who have had eclampsia will have elevated blood pressure in a subsequent pregnancy,
and about 2% will also have eclampsia in subsequent pregnancies.
Most babies will do well. Babies born prematurely will usually stay in the hospital longer.
A rule of thumb is to expect the baby to stay in the hospital until their due date.
Unfortunately, a few women and babies experience life-threatening complications from
preeclampsia or eclampsia. Complications in babies are generally related to premature
delivery, and outcomes for both mothers and babies are significantly worse in
developing countries. The maternal mortality (death) rate from eclampsia in developed
counties ranges from 0% to 1.8% of cases. Most of the cases of maternal death are
complicated by a condition known as HELLP syndrome, which is characterized by
preeclampsia along with hemolytic anemia, elevated liver function tests (LFTs), and low
platelet count.

18

SYMPTOMATOLOGY
SIGNS AND

IF PRESENT

RATIONALE

SYMPTOMS
Convulsions

BP (160/110)

Eclampsia is characterized by generalized

convulsions in pregnant women with
hypertension and proteinuria. Little is known
about what triggers the convulsions in this
syndrome. The prevailing view is that
convulsions are caused by cerebral
vasospasm and cerebral edema. However,
many important clinical findings argue
against cerebral edema or hypertensive
encephalopathy as the sole causes of
convulsions in eclampsia. The uteroplacental ischemia causes the release of
certain molecules such as neurokinin B,
inflammatory cytokines, endothelins, and
tissue plasminogen activator. These
molecules stimulate excitatory neuronal
receptors and alter neuronal excitability,
synaptic transmission, and neuronal survival
independent of any vascular effects.
Highlighting the neuromodulatory and the
convulsive effects of each of these
molecules which are elevated in preeclampsia, offers a new perspective on the
mechanisms of convulsions in eclampsia.
Readings between 160/110 and 180/110
usually indicate STAGE 2 HYPERTENSION,
which puts you at high risk for lifethreatening problems such as heart attack
and stroke.
High blood pressure in this range can cause
symptoms such as headache, nausea and
vomiting, mental confusion, vision changes,
chest pain, or shortness of breath. If you
notice any of these symptoms, your high
blood pressure is considered a hypertensive
emergency and you need to call 911. During
a hypertensive emergency, a medical team
will work to bring your blood pressure down
quickly. If you don't have these symptoms
but your blood pressure remains high,
19

Oliguria

Proteinuria

doctors call this "hypertensive urgency." It's

important to seek medical attention for
hypertensive urgency, so that doctors can
help bring your blood pressure down over a
period of hours to days.
is the low output of urine. In humans, it is
clinically classified as an output more than
80 ml/day but less than 400ml/day] The
decreased output of urine may be a sign of
dehydration, kidney failure, hypovolemic
shock, HHNS hyperosmolar Hyperglycemic
Nonketotic Syndrome, multiple organ
dysfunction syndrome, urinary
obstruction/urinary retention, DKA, preeclampsia, and urinary tract infections,
among other conditions.
Declining kidney function predicts increasing
cardiovascular risk in people with
hypertension. Microalbuminuria is a marker
for cardiovascular risk and declining kidney
function. Agents that block the reninangiotensin-aldosterone system (RAAS),
notably angiotensin-converting enzyme
(ACE) inhibitors and angiotensin receptor
blockers (ARBs), reduce proteinuria and
microalbuminuria, lower blood pressure and
slow the progression of proteinuric kidney
disease. Evidence is accumulating that the
combination of an ACE inhibitor and an ARB
is the optimal means of RAAS blockade in
this setting, slowing the progression of
nephropathy independently of blood
pressure lowering to a greater degree than
can be achieved using maximum approved
doses of either agent alone. However, the
emerging therapeutic potential of ACE
inhibitor/ARB combination therapy in
hypertensive kidney disease requires further
characterization. The Irbesartan in the
Management of PROteinuric patients at high
risk for Vascular Events trial aims to
determine definitively whether the
combination therapy of an ARB, irbesartan
and an ACE inhibitor, ramipril, is more
effective than ramipril alone in reducing the
urinary albumin excretion rate in patients at
20

Elevated serum
creatinine
(>1.2mg/dL)

high cardiovascular risk with hypertension

and proteinuria or microalbuminuria.
Creatinine is a chemical waste molecule that
is generated from muscle metabolism.
Creatinine is produced from creatine, a
molecule of major importance for energy
production in muscles. Approximately 2% of
the body's creatine is converted to creatinine
every day. Creatinine is transported through
the bloodstream to the kidneys. The kidneys
filter out most of the creatinine and dispose
of it in the urine.

21

MEDICAL TREATMENT

Generic name:

Metoprolol

Brand name:

Lopressor

Classification:

Beta-adrenergic blocking agents

Dosage:

100mg

Route:

PO

Frequency:

TID

22

MECAHNISM OF ACTION
Unknown. A selective beta blocker that selectively blocks beta1 receptors; decreases
cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses
rennin secretion.

INDICATIONS

Hypertension

Acute MI

Angina Pectoris

CONTRAINDICATIONS

Hypersensitive to drug.

Pt. with sinus bradycardia, cardiogenic shock and heart failure

ADVERSE EFFECTS OF THE DRUG

CV: Bradycardia, Heart failure

NURSING RESPONSIBILITIES

Always check patients apical pulse

Monitor BP

Store drug at room temperature.

Inform patient about the side effects and adverse effects of the medication.
23

Advise patient to take it with meals.

Tell patient to report if he/she feels shortness of breath.

Tell patient that metoprolol is not advisable to breastfeeding mothers.

Advise not to withdrawn drug abruptly.

Generic Name:

MgSO4

Route
PO
Dosage
6 doses
Frequency
q4
Classification: Therapeutic: mineral and electrolyte replacements/supplements.
Pharmacologic: minerals/electrolytes
Indications
Treatment/prevention of hypomagnesemia. Treatment of hypertension. Anticonvulsant
associated with severe eclampsia, pre-eclampsia, or acute nephritis. Unlabeled uses:
Preterm labor. Treatment of Torsade de pointes. Adjunctive treatment for
bronchodilation in moderate to severe acute asthma.
Mechanism of Action
Essential for the activity of many enzymes. Plays an important role in neurotransmission
and muscular excitability. Therapeutic Effects: Replacement in deficiency states.
Resolution of eclampsia.

Contraindications/Precautions
24

Contraindicated in: Hypermagnesemia; Hypocalcemia; Anuria; Heart block; Active labor

or within 2 hr of delivery (unless used for preterm labor). Use Cautiously in: Any degree
of renal insufficiency; Digitalized patients.
Adverse Reactions/Side Effects
CNS: drowsiness. Resp: decreased respiratory rate. CV: arrhythmias, bradycardia,
hypotension. GI: diarrhea.MS:muscle weakness. Derm: flushing, sweating. Metab:
hypothermia.

Nursing Management
Before
- Assess for contraindicatedconditions.
- Monitor knee-jerk reflex beforerepeated parenteral administration.
- Give as laxative as temporarymeasure.
- Reserve IV use in eclampsia forlife-threatening situations.
- Observe the 15 rights in drugadministration.
During
- Give IM route by deep IM injection.
- Monitor serum magnesium levels.
- Do not give oral MgSO4 with abdominal pain, nausea, or vomiting.- Do not administer
if knee-jerk reflexes are suppressed- Monitor bowel function.
After
- Arrange to discontinue administration as soon as levels are within normal limits and
desired clinical response is obtained.
- Discontinue if diarrhea or cramping occurs.
- Arrange for dietary measures, exercise and environmental control to return to normal
bowel activity.
- Report sweating, flushing, muscle tremors or twitching, inability to move extremities.
- Maintain urine output at a level of 100 mL every 4 hr during parenteral administration.

25

DIAGNOSTIC TEST
HEMATOLOGY
Hemoglobin

Result
L 63.0

Range
115.0 155.0 g/L

Hematocrit

L 0.23

0.36 0.48

RBC

L 3.86

4.20 6.10 x10^6/uL

WBC

H 10.42

5.0 10.0 x10^3/uL

MCV

L 58.80

79.40 94.80 fl

Interpretation
A low hemoglobin count is a
commonly seen blood test result.
Hemoglobin (Hb or Hgb) is a
protein in red blood cells that
carries oxygen throughout the
body.
In many cases, a low
hemoglobin count is only slightly
lower than normal and doesn't
affect how you feel. If it gets
more severe and causes
symptoms, your low hemoglobin
count may indicate you have
anemia.
Causes of low hematocrit, or
anemia, include: Bleeding
(ulcers, trauma, colon cancer,
internal bleeding) Destruction of
red blood cells (sickle cell
anemia, enlarged spleen)
Decreased production of red
blood cells (bone marrow
supression, cancer, drugs)
When the hemoglobin count is
low, the body is not able to get
as much oxygen to go
throughout the body.
An increased production of white
blood cells to fight an infection
Mean corpuscular volume (MCV)
is the average volume of red
cells in a specimen. MCV is
elevated or decreased in
accordance with average red cell
size; ie, low MCV indicates
microcytic (small average RBC
size), normal MCV indicates
normocytic (normal average
RBC size), and high MCV
26

MCHC

L 27.8

32.20 35.50 g/dL

Neutrophil

H 79

55.00 75.00 %

Lymphocyte

L 16

20 35%

Monocyte

2 10 %

Eosinophil

1.000

18%

Differential
count

indicates macrocytic (large

average RBC size).
The mean corpuscular
hemoglobin concentration, a
measure of the concentration of
hemoglobin in a given volume of
packed red blood cells. It is
reported as part of a standard
complete blood count.
The blood differential test
measures the percentage of
each type of white blood cell
(WBC) that you have in your
blood. It also reveals if there are
any abnormal or immature cells.
It is important to realize that an
abnormal increase in one type of
white blood cell can cause a
decrease in the percentage of
other types of white blood cells.
An increased percentage of
neutrophils may be due to: Acute
infection. Acute stress.
Lymphocytopenia is an
abnormally low number of
lymphocytes (a type of white
blood cell) in the blood. Many
disorders can decrease the
number of lymphocytes in the
blood, but viral infections
(including AIDS) and
undernutrition are the most
common.
A blood differential test, also
called a white blood cell count
differential, measures the
number of each of the five types
of white blood cells present in
your blood: neutrophils.
lymphocytes. monocytes.
Eosinophils have two distinct
functions in your immune
system. They destroy invading
germs like viruses, bacteria, or
parasites such as Giardia and
pinworm. Eosinophils also create
27

Basophil

Platelet Count

Urinalysis
Chemical Analysis
pH

319

150 400 x10^3/uL

Result
6.5

Range

an inflammatory response,
especially if an allergy is
involved.
Basophils are produced in your
bone marrow, circulate in the
blood and are the least abundant
of all leukocytes. They are
classified as immune cells and
categorized a granulocytes.
Therefore, the basic function of
this white blood cell is release of
its substances in response to a
foreign invasion.
A platelet count is a lab test to
measure how many platelets you
have in your blood. Platelets are
parts of the blood that help the
blood clot. They are smaller than
red or white blood cells.

Interpretation
A urine pH test can tell
your doctor how acidic
or basic (alkaline) your
urine is using a simple,
painless urine test.
Many diseases, your
diet, and the medicines
you take can affect
how acidic or basic
your urine is. For
instance, results that
are either too high or
low can indicate the
likelihood that your
body will form kidney
stones. If your urine is
at an extreme on either
the low or high end of
pH levels, you can
adjust your diet to
reduce the likelihood
painful kidney stones
28

Glucose

Negative

Protein

Negative

Urine
Flowcytometry
WBC

8.0

will form. In short, your

urine pH is an indicator
of your overall health
and gives your doctor
important clues as to
what is going on in
your body.
The glucose urine test
measures the amount
of sugar (glucose) in a
urine sample. The
presence of glucose in
the urine is called
glycosuria or
glucosuria.
Urine protein testing is
used to detect protein
in the urine, to help
evaluate and monitor
kidney function, and to
help detect and
diagnose early kidney
damage and disease.
0 27 /uL

Leukocyte esterase is
an enzyme present in
most white blood cells
(WBCs). Normally, a
few white blood cells
(see microscopic
examination) are
present in urine and
this test is negative.
When the number of
WBCs in urine
increases significantly,
this screening test will
become positive.
When the WBC count
in urine is high, it
means that there is
inflammation in the
urinary tract or kidneys.
The most common
29

RBC

H 40

0 28 /uL

Epithelial Cells

H 14

0 7/uL

cause for WBCs in

urine (leukocyturia) is a
bacterial urinary tract
infection (UTI), such as
a bladder or kidney
infection.
This test is used to
detect hemoglobin in
the urine
(hemoglobinuria).
Hemoglobin is an
oxygen-transporting
protein found inside
red blood cells (RBCs).
Its presence in the
urine indicates blood in
the urine (known as
hematuria). The small
number of RBCs
normally present in
urine usually result in a
"negative" test.
However, when the
number of RBCs
increases, they are
detected as a "positive"
test result.
Epithelial cells in urine
may be a cause for
concern if the numbers
are higher than normal.
The sloughing of
epithelia is quite a
normal process of the
body sheddingdead
cells and creating new
ones. If epithelial cells
are high in your urine it
could signal a problem
with your kidneys or an
infection in your urinary
system. This article will
examine some
possible causes of
epithelial cells in urine
and what urinalysis
30

Cast

Bacteria

means.
Urinary casts are
formed only in the
distal convoluted
tubule (DCT) or the
collecting duct (distal
nephron). The proximal
convoluted tubule
(PCT) and loop of
Henle are not locations
for cast formation.
Hyaline casts are
composed primarily of
a mucoprotein (TammHorsfall protein)
secreted by tubule
cells.
Urine is normally
sterile, which means
that it contains no
bacteria. A small
number of bacteria
may be found in the
urine of many healthy
people. This is usually
considered to be
harmless. However, a
certain level of bacteria
can mean that the
bladder, urethra, or
kidneys are infected.

31

NCP
Assessment
Objective:
Hemoglobin :
68

Diagnosis
Activity
intolerance
related to
weakness

Planning
After 8 hours
of nursing
intervention
the patient will
be able to:
Report that
she is able to
ambulate
within the
room
Demonstrate a
decrease in
physiologic
signs of
intolerance

Intervention
Assess
patients ability
to do normal
tasks
To know
if the
patient
needs
assistan
ce

Evaluation
Patient reveals
an increase in
activity
tolerance
Demonstrating
a reduction on
physiologic
signs of
activity
intolerance

Note changes
in muscle
weakness
Recommend
bed rest and
quiet
atmosphere
Provide
assistance on
activities and
ambulation
when
necessary

Assessment
Objective:
Hemoglobin:
68

Diagnosis
Risk for
infection
related to
inadequate
secondary
defenses
(decreased
hemoglobin)

Planning
After 8 hours
of nursing
intervention
the patient will
be able to:
Identify
interventions
to prevent/
reduce risk for
infection

Intervention
Monitor VS
Obtain
appropriate
fluid
specimens for
observation
and culture
testing.

Evaluation
Verbalize
understanding
of instructions.

Observe for
localized signs
of infection
Instruct
patient to
wash hands
before eating.
32

33

DISCHARGE PLANNING
Medication

Exercise

Instruct the patient to comply with

the treatment regimen faithfully.
Rationale:
this would promote
faster recovery and prevention of
relapse.
Intruct to take medication with exact
dosge as ordered
Rationale: correct dosage hinders
from possible adverse effects due
to overdosing of a certain drug
Explain the side effects of
medication
Rationale: to orient or to have
knowledge of what possible side
effects to expectg upon taking the
drugs.
Refer
for
further
reassessment.
Intruct patient to avoid taking
medication that are not prescribed
by the physicians.
Rationale:over the counter drugs
might cause side effects or even
adverse effects that may worsen
status.
Remind the patients significant
others
for
the
scheduled
consultsation with the physician
Rationale: in order to determine the
effectiveness of the drug.
Take full course of medication
Rationale: to kill microorganisms
resistance.
Instruct significant others to refere
immediately if there is an adverse
reaction of the drug
Rationale: to discontinue theraphy
and to lessen complications.
Discuss to the client importance or
help client develop a program of
34

exercise and relaxation techniques

as tolerated.
Health Teaching

Moreover, a teaching plan that

affect clients holistic wellness
should be done in order to maintain
an environment that is conducive

Out-patient Order

for health promotion.

Proper referral is best for the health
care provider to evaluate condition
of the client, whether it is improving
or not. Also, for early diagnosis of

Diet

any other underlying conditions

Proper execution of clients diet is
very important so informing and
instructing client or clients watcher
about proper meals to be given to
the client and increasing oral fluid
intake is important. ( Dietary Salt:
moderate intake, and high in
cholesterol foods)

Encouraged to increase fluid intake

to at least 8-10glasses per day as
tolerated to maintain hydration.

Advised to eat as fruits and green

leafy vegetables.

35

RECOMMENDATIONS
As nurses, our vital role is to provide health care and deliver services in the
hospital to improve the health status of each individual. This nursing care study is
important for us because it in enables to give the proper health teaching to our chosen
client.
We recommended this case to the following persons and institution for the further
improvement of the study.
TO THE FAMILY:
This study for the family of our patient to follow the treatment prescribed such as
to take the medications as on time and right dosage and other recommended measures
by the physicians, encourage having adequate rest to hasten the recovery of the
patient. Through the adherence of fulfillment of the suitable medical management, for
the fast recovery of the patient.
TO THE STUDENT:
We recommended this study for the students as a reference for the future cases,
in order to have some based line datas to refer.
TO THE COLLEGE OF NURSING
We recommended this study to our department for giving us a precise details and
an access of further study of this case. We advocate also for giving us an abundance
time to research in order to prevent typographical and grammatical errors.
TO THE SOUTHERN PHILIPPINES MEDICAL CENTER
We recommended this study to Southern Philippines Medical Center for them to
able to evaluate and appreciate the said case and share this as a reference and
information having those patients who has certain condition.

36

BIBLIOGRAPHY/REFERENCES
1. Blackwells Nursing Dictionary Second Edition (2005), Blackwells Publishing Ltd.
2. Sibai, B.M. (2004) Pre-eclampsia: An inflammatory syndrome? American Journal
of Obstetrics and Gynecology, 191, 1061-1062. doi:10.1016/j.ajog.2004.03.042
3. Williams, K., Bianco Lim, K., Wilson, S., et al. (2004) Can clinical symptomology
predict maternal cerebral perfusion pressure in pre-eclampsia? Revista Chilena
de Obstetrica y Ginecologia, 69, 361-367..
4. Urassa, D.P., Carlstedt, A., Nystrom, L., Massawe, S.N. and Lindmark, G. (2006)
Eclampsia in Dar es Salaam, TanzaniaIncidence, outcome, and the role of
antenatal care. Acta Obstetrica et Gynecologica Scandinavica, 85, 571-578.
doi:10.1080/00016340600604880
5. Fundamentals of Nursing Eight Edition, Kozier&Erbs, Pearson, Prentice Hall
6. Nurses Pocket Guide, Diagnoses Prioritized Interventions, and
rationales,MarilynnE.Doenges,Mary Frances Moorhoouse,Alice C. Murr, 13 th
edition.
7. Lippincotts Nursing Drug Handbook, Lippincott, 2014

37