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I.

INTRODUCTION
Pre-eclampsia Although women pressure have many healthy pregnant blood babies

with high

without serious problems, high blood pressure can be dangerous for both the mother and the fetus. Women with pre-existing, or chronic, high blood pressure are more likely to have certain complications during pregnancy than those with normal blood pressure. However, some women develop high blood pressure while they are pregnant (often called gestational hypertension). The effects of high blood pressure range from mild to severe. High blood pressure can harm the mother's kidneys and other organs, and it can cause low birth weight and early delivery. In the most serious cases, the mother develops preeclampsia-or "toxemia of pregnancy"-which can threaten the lives of both the mother and the fetus. What is preeclampsia? Preeclampsia is a condition that typically starts after the 20th week ofpregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia affects the placenta, and it can affect the mother's kidney, liver, and brain. When preeclampsia causes seizures, the condition is known as eclampsia-the second leading cause of

maternal death in the U.S. Preeclampsia is also a leading cause of fetal complications, which include low birth weight, premature birth, and stillbirth. There is no proven way to prevent preeclampsia. Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. The way to "cure" preeclampsia is to deliver the baby. What Are the Symptoms of Preeclampsia and How Is It Detected? Unfortunately, there is no single test to predict or diagnose preeclampsia. Key signs are increased blood pressure, edema and protein in the urine (proteinuria). Other symptoms that seem to occur with preeclampsia include persistent headaches, blurred vision or sensitivity to light, and abdominal pain. All of these sensations can be caused by other disorders; they can also occur in healthy pregnancies. Regular visits with your doctor help him or her to track your blood pressure and level of protein in your urine, to order and analyze blood tests that detect signs of preeclampsia, and to monitor fetal development more closely. Who Is More Likely to Develop Preeclampsia?

Women with chronic hypertension (high blood pressure

before becoming pregnant).

Women who developed high blood pressure or preeclampsia

during a previous pregnancy, especially if these conditions occurred early in the pregnancy.

Women who are obese prior to pregnancy. Pregnant women under the age of 20 or over the age of 40. Women who are pregnant with more than one baby.

Women with diabetes, kidney disease, rheumatoid

arthritis, lupus, orscleroderma.

II.

OBJECTIVES

General objective: At the end of our case study, we, the group 3 presenters and also the audience will be able to gain knowledge about preeclampsia with pulmonary congestion and develop a good attitude towards each member of the group. Specific Objectives: At the end of our case study, we, the group 3 presenters, will be able to:

have a broader knowledge about the said disease, review the anatomy and physiology of the cardiovascular system,

use critical thinking to identify areas of care that could benefit from additional research,

discuss the predisposing factors, precipitating factors, signs and symptoms and pathophysiology of pre-eclampsia with pulmonary congestion,

develop a comprehensive Nursing Care Plans, make appropriate Drug Study,

do physical examination and review of systems,

have a good attitude towards the group, and

expose ourselves on various diseases, thus, the experience would help us overcome our doubts and boost our confidence towards handling patients.

III. BASELINE DATA

Patient Name: Address: Age: Place of Birth: Gender: Marital Status: Religion: Educational Attainment: Occupation: Nationality:

Mrs. JL HPC 28 years old LCBC Female Married Roman Catholic College underaduate none Filipino

Date of Admission: Ward of Admission: Attending Physician: Chief Complaint:

November 10, 2011 OB ward Dr. G and Dr. B elevated BP, edema on both legs x 1 month, PTC

Admission Diagnosis: IUP, 33 4/7 weeks AOG, N/L, Severe Pre- eclampsia Principal Diagnosis: Source: G1P0, Pulmonary Congestion

Primary: Patient Secondary: Husband, Mother-in-law, and Patients chart.

IV. HEALTH HISTORY


Present Health History 3 months prior to admission, Mrs JL and her husband lived at MP. It was Sunday noon, Mrs JL was busy cooking and preparing for their lunch when suddenly she felt dizzy. She sat down to a chair nearby thinking that she was just tired, since she was 5 months pregnant. Moments later, she felt pain in her chest. She called her husband who was watching television that time. Mr GB came hurriedly into the kitchen and was shocked by the sight of his wife who was almost unconscious. He immediately brought her to the nearest hospital. The doctor told her that she was hypertensive and was prescribed with antihypertensive drugs and she has to limit her strenuous activities that might trigger her blood pressure to rise. She was also told that the baby was just fine.

October 21, 2011, the couple went home at HPC to visit the family of Mr GB. During that time, she was complaining about her cough but she had never sought any medical attention thinking it was just a common cold. November 10, 2011 at around 2 pm, while she was walking outside the yard, she felt difficulty of breathing and headache. They immediately went to the health center. Her blood pressure was 200/140 mmHg and respiratory rate of 27cpm. There was no doctor during that time so she was referred to BDH and was admitted under the service of Dr. U. At around 3:30, the doctor thought that it would be better if she will be transferred to RMPH. At 4:40, she was admitted to RMPH OB ward under the service of Dr B and Dr G. She was given O2 inhalation at 4 LPM, furosemide 20 mg IVTT, nifedipine 5 mg, catapres 75 mcg, and methyldopa 500 mg. Past Health History During her childhood, she received complete immunizations of BCG, DPT, OPV, measles and Hep B. She had her menarche at the age of 11. She experienced having mumps, diarrhea fever, cough, cold and self-medicates with over the counter medications such as paracetamol, neozep, and cough medicines. She received 2 shots of tetanus toxoid during her prenatal visits. She has no known allergies. She said that she was hypertensive when she was at the age of 21 but never been hospitalized before. It was her first time to be admitted in the hospital and it was also her first pregnancy. Family History According to the patient, her mother was diabetic and hypertensive her father is also hypertensive. Two of her 6 siblings are also hypertensive. Psychosocial Profile

- Health Practice Mrs JL uses herbal medicines such as banaba, lapunaya, sambong, yerba Buena, tawa-tawa, etc. as remedies for cough, colds and other illnesses. She also uses over the counter medicines such as paracetamol, neozep and cough medications. Whenever she gets sick, she doesnt go to a hospital to have a check-up.
-

Nutritional Pattern Mrs JL is fond of eating salty foods such as dried fish, and dayok. She also eats vegetables, meats and seldom eats fruits.

Sleep and Rest Patterns She usually sleeps 5 to 10 hours a day. She sleeps at 10pm and wakes up at 6am. She takes afternoon naps whenever shes tired of doing household chores.

- Activity and Exercise Pattern In day time, the patient is busy cleaning the house, cooking and taking care of her husband while her husband goes to work. She usually watches television in the afternoon and at night time. She doesnt exercise regularly because she is busy doing household chores.

VII. PHYSICAL ASSESSMENT


Area of Assessment Initial Assessment (November 16, 2011) Final Assessment (November

18,2011)

Integumentary System

Skin is warm and dry to touch. Pitting edema is present the lower extremeties Head is symmetrical and round. Hair is black, evenly distributed and texture is coarse. No presence of parasites. Lid margins are moist and pink: lashes are short, evenly spaced and curled outward. Bulbar conjunctiva is clear with tiny vessels visible; palpebral conjunctiva is pink with no discharges; sclera is white. Cornea is transparent, smooth and moist. Pupil is equally round with approximately 3 mm reactive to light and accommodation. Ears of equal in size and similar in appearance. The alignment of pinna is within the corner of the eye. It is non tender upon palpation. Small amounts of cerumen noted. Nose is symmetrical in appearance, it is smooth with no changes in nares during respiration and septum is in the midline.

No significant changes.

Head

No significant changes.

Eyes

No significant changes.

Ears

No significant changes.

Nose

No significant changes.

Sinuses are non tender upon palpation. Lips and surrounding tissue are relatively symmetrical in position with no lesions. Buccal mucosa is pink, moist smooth with no lesions. Gums are pink, moist and clearly defined margins. Teeth are stable in fixation, a bit yellowish and shiny with 30 teeth. Tongue is moist, papillae are present; symmetrical in appearance and midline fissures are present. Oropharynx is pink, tonsillar pillars are symmetrical; tonsils are present and without exudates; uvula at the midline and rises on phonation. Neck is smooth, controlled range of motion from up right position: flexion, extension, lateral abduction and rotation. Trachea is in the midline position. Thyroid gland is smooth, firm and non tender. Cervical lymph nodes are non palpable and non tender. Chest symmetry is equal with respiratory rate of 24 cpm. Tactile fremitus was decreased in vibration. Thoracic expansion is 2-3 inches and symmetrical. During

Mouth and Throat

No significant changes.

Neck

No significant changes.

Lungs and Thorax

Respiratory rate of 22 cpm, no other significant changes noted.

auscultation presence of crackles were heard on both lungs. The clients pulse rate Pulse rate: 87 bpm, was 88 bpm, blood blood pressure: pressure is 180/110 180/100 mmHg, no mmHg, presence of other significant pitting edema was noted changes noted. on both legs. Skin is pale, globular at 28 cm fundal height. With surgical incision site at the lower abdomen (caesarean section) Patient is NPO.

Cardiovascular System

Abdomen

Nutrition

Patient is DAT

She is on a complete bed rest and is weak. With Musculoskeletal limited range of motion system on upper and lower extremities. Cannot able do her ADL such as combing her hair, change her clothes. She alert and awake and answers to questions appropriately. She is oriented to self, place, and time. And she can able to follow directions accurately.

No significant changes.

Neurolgic Function

No significant changes.

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