SURIGAO EDUCATION CENTER

College of Allied Medical Sciences

Nursing Department
Surigao City

A CASE PRESENTATION
OF
PREECLAMPSIA

Presented by:
Jomari Jones Q. Zapanta
Jokko Jane M. Espinol
Asian Star B. Lago
Diaden M. Morite

December 15, 2016

Presented to:
Mrs. Vivian C. Morales,RN
Mrs. Lydia Litang,RN, MAN
Mrs. Rocelyn S. Dawsan,RN
 TABLE OF CONTENTS

 Dedication
 Acknowledgement
 Introduction… … … … … … … … … … … … … … … … … … ...
 Review of Related Literature… … … … … …
 Nursing Health History
 Biographic Data
 Admission Data
 History of Present Illness
 Past Health History
 Childhood Illness
 Childhood Immunization
 History of Hospitalization
 Medical History
 Surgical History
 Accidents and Injuries
 Obstetrical History
 Sexual History
 Allergies

 Family Health History
 Personal Habits
 Diet
 Sleep/Rest pattern
 Elimination Pattern
 Social Data
 Family Relationship/Friendship
 Educational History
 Occupational History
 Economic Status
 Patterns of Health Care
 Review of System
 Integumentary System
 Respiratory System
 Cardiovascular System
 Genitourinary System
 Gastrointestinal System
 Reproductive System
 Musculoskeletal System
 Endocrine System
 Circulatory System
 Neurologic System
 Physical Examination
 Skin
 Hair
 Nails
 Skull and Face
 Eyes
 Ears
 Nose
 Mouth and Throat
 Clinical Laboratory
 Hematology
 Urinalysis
 Anatomy and Physiology
 Ovary
 Fallopian Tube
 Uterus
 Vagina
 Vulva
 Breast and Mammary Gland
 Reproductive Cycle
 Oogenesis and Ovulation
 Fertilization
 Menstruation
 Pregnancy
 Lactation
 Pathophysiology
 Drug Study
 Nursing Care Plan
 Discharge Plan
 Definition of Terms
 References
 DEDICATION

We heartily dedicate this case study to:

Our parents and families, who fully supported us in

making this case study, encouraging us in order for us to make
this case study a possibility.
To our class adviser for her powerful urge in
motivating us to complete this study.
To our classmates and friends for giving us
inspiration and encourage them with this case study.
And most of all to our Almighty Heavenly Father and
to His son Jesus Christ for never ending guidance and support.
And we the son and daughters of Christ, return the entire honour
in His name.
 ACKNOWLEDGMENT

We acknowledge these following persons that aid our compilation:

To God almighty that bestowed wisdom upon us

To our loving family

To our most respected dean of nursing department

To our clinical instructors that patiently thought us to learn

Our dear classmates whom became our closest friends

 INTRODUCTION
Pre-eclampsia is a disorder of pregnancy characterized by high
blood pressure and often a large amount of protein in the urine.
The disorder usually occurs in the third trimester of pregnancy
and worsens over time. In severe disease there may be red blood
cell breakdown, a low blood platelet count, impaired liver
function, kidney dysfunction, swelling, shortness of breath due
to fluid in the lungs, or visual disturbances. Pre-eclampsia
increases the risk of poor outcomes for both the mother and the
baby. If left untreated, it may result in seizures at which
point it is known as eclampsia.

Within our duty in Caraga Regional Hospital, we receive patient

C delivered a preterm baby boy and yellowish pigment complexion
last November 12,2016 of 10:45pm. She’s 17 yrs old, single, a
student, and Roman Catholic born in Claver, Surigao City. Having
an irritable mood, resistant to answer questions and constantly
avoiding interview, still we pursued this case. Relating the
stated documentation from the chart, patient C is suitable case
to be studied, she is lacerated due to fetal distress and
meconium stained amniotic fluids in the uterus. In relation to
her laboratory results there was an increased leukocytes, +1
protein on urine analysis and elevated blood pressure diagnosed
with preeclampsia. Gravidity1 parity1 with 32 weeks and 6 days
gestation delivered spontaneous with vaginal laceration under
repair as ordered by the physician last November 15, 2016.

Preeclampsia is a serious condition of pregnancy, and can be

particularly dangerous because many of the signs are silent
while some symptoms resemble “normal” effects of pregnancy on
our body. Many women suffering from preeclampsia don’t feel
sick, and may be surprised or become frustrated when they are
admitted to the hospital or prescribed bed rest since they still
feel well. High blood pressure is an important sign of
preeclampsia. The disease is sometimes referred to as a silent
killer because most people can’t “feel” their blood pressure
going up. As a result, patient awareness of the warning signs
is one of the most important tools we have to successfully help
women receive the care they need.
 REVIEW OF RELATED LITERATURE

Formerly called toxemia, preeclampsia is a condition that

pregnant women develop. It is marked by high blood pressure in
women who have previously not experienced high blood pressure
before. Preeclamptic women will have a high level of protein in
their urine and often also have swelling in the feet, legs, and
hands. This condition usually appears late in pregnancy, generally
after the 20 week mark, although it can occur earlier.
If undiagnosed, preeclampsia can lead to eclampsia, a serious
condition that can put you and your baby at risk, and in rare
cases, cause death. Women with preeclampsia who have seizures are
considered to have eclampsia.
There's no way to cure preeclampsia, and that can be a scary
prospect for moms-to-be. But you can help protect yourself by
learning the symptoms of preeclampsia and by seeing your doctor
for regular prenatal care. When preeclampsia is caught early, it's
easier to manage.
The exact causes of preeclampsia and eclampsia -- a result of a
placenta that doesn't function properly -- are not known, although
some researchers suspect poor nutrition or high body fat are
possible causes. Insufficient blood flow to the uterus could be
associated. Genetics plays a role, as well.
Preeclampsia is most often seen in first-time pregnancies, in
pregnant teens, and in women over 40. While it is defined as
occurring in women have never had high blood pressure before,
other risk factors include:

 A history of high blood pressure prior to pregnancy

 A history of preeclampsia
 Having a mother or sister who had preeclampsia
 A history of obesity
 Carrying more than one baby
 History of diabetes, kidney disease, lupus, or rheumatoid
arthritis

In addition to swelling, protein in the urine, and high blood

pressure, preeclampsia symptoms can include:

 Rapid weight gain caused by a significant increase in bodily

fluid
 Abdominal pain
 Severe headaches
 Change in reflexes
  Reduced urine or no urine output
 Dizziness
 Excessive vomiting and nausea
 Vision changes

You should seek care right away if you have:

 Sudden and new swelling in your face, hands, and eyes(some

feet and ankle swelling is normal during pregnancy.)
 Blood pressure greater than 140/90.
 Sudden weight gain over 1 or 2 days
 Abdominal pain, especially in the upper right side
 Severe headaches
 A decrease in urine
 Blurry vision, flashing lights, and floaters

You can also have preeclampsia and not have any symptoms. That's
why it's so important to see your doctor for regular blood
pressure checks and urine tests.
Preeclampsia can prevent the placenta from receiving enough blood,
which can cause your baby to be born very small. It is also one of
the leading causes of premature births, and the complications that
can follow, including learning disabilities, epilepsy, cerebral
palsy, hearing and vision problems.
In moms-to-be, preeclampsia can cause rare but serious
complications that include:

 Stroke
 Seizure
 Water in the lungs
 Heart failure
 Reversible blindness
 Bleeding from the liver
 Bleeding after you've given birth

Preeclampsia can also cause the placenta to suddenly separate from

the uterus, which is called placental abruption. This can cause
stillbirth.
The only cure for preeclampsia and eclampsia is to deliver your
baby. Your doctor will talk with you about when to deliver based
on how far along your baby is, how well your baby is doing in your
womb, and the severity of your preeclampsia.
 If your baby has developed enough, usually by 37 weeks or later,
your doctor may want to induce labor or perform a cesarean
section. This is will keep preeclampsia from getting worse.
If your baby is not close to term, you and your doctor may be able
to treat preeclampsia until your baby has developed enough to be
safely delivered. The closer the birth is to your due date, the
better for your baby.
If you have mild preeclampsia - also known as preclampsia with and
without severe features, your doctor may prescribe:

 Bed rest either at home or in the hospital; you'll be asked

to rest mostly on your left side.
 Careful observation with a fetal heart rate monitor and
frequent ultrasounds
 Medicines to lower your blood pressure
 Blood and urine tests

Your doctor also may recommend that you stay in the hospital for
closer monitoring. In the hospital you may be given:

 Medicine to help prevent seizures, lower your blood pressure,

and prevent other problems
 Steroid injections to help your baby's lungs develop more
quickly

Other treatments include:

 Magnesium can be injected into the veins to prevent

eclampsia-related seizures
 Hydralazine or another antihypertensive drug to manage severe
blood pressure elevations
 Monitoring fluid intake and urine output
 For severe preeclampsia, your doctor may need to deliver your
baby right away, even if you're not close to term.
 After delivery, signs and symptoms of preeclampsia should go
away within 1 to 6 weeks.
 NURSING HEALTH HISTORY

Biographic Data:
Hospital : Caraga Regional Hospital
Case No. : 155073
Ward : OB Ward
Name of Patient : Patient C
Age : 17 yrs old
Sex : Female
Civil Status : Single
Address : Daywan, Claver Surigao del
Norte
Occupation : High School Graduate
Date of Birth : November 12, 2016
Religion : Catholic
Height : 4"5
Weight : 52.6 kg
Fathers name : Mr. Robert Canda
Mother’s name : Mrs. Tessie Canda

Admission Data:
Mode of Transmission : Ambulation
Date and Time of Admission : November 12, 2015
11:21 AM
Vital Signs upon admission
 Heart Rate : 66 bpm
 Respiratory Rate : 23cpm
 Blood Pressure : 160/110 mmHg
 Body Temperature : 37 °C

Admitting Physician : DR.AMANEO MA.RICAR GODINEZ

Attending Physician : DR.AMANEO MA.RICAR GODINEZ
Chief Compliant : Labor pains with watery discharges
Final Diagnosis : Pregnancy Uterine, Term, Cephalic,
Delivered spontaneously a live baby boy; as 0.3 BW
2320gm, preeclampsia, thickly meconeum stained
amniotic tfluid; repair of laceration under local
anesthesia block; G1P1 (1001).
 HISTORY OF PRESENT ILLNESS

Present condition started about few hours in the

evening 3 days prior to admission. Patient claimed that she had
experienced onset of labor pain with watery vaginal discharged.
Patient was conscious and afebrile.
PAST HEALTH HISTORY
I- Childhood Illness
Patient did experience chickenpox at age four, mumps
at age 10 and measles at age 4. Her parents did not bring her to
the hospital or health center but they gave antibiotic such as
cefalexcin syrup 250mg/5ml at home.

II – Childhood Immunization
Patient was already immunized with DPT and OPV but was
not able to recall the dates when it was given. Her parents told
her that she had received her vaccines.

HISTORY OF HOSPITALIZATION
III- Medical History

No known previous hospitalization as stated by the

patient.

IV – Surgical History

Patient stated that she did not undergo any surgical

procedures.

V- Accidents and Injuries

Patient verbalized that she had no history of any

type of accidents, But minimal injuries like wound from a knife
was experienced by her that do not took a longer period of time
for healing, when she was a child.

VI- Obstetrical History

At 13 years of age, patient had already her first

menstruation (menarche). She claimed that her usual menstruation
last about 3 days with a color of red blood. She could consume 4
pc of pad/day. She did experienced menstrual discomfort like
dysmenorrhea.
Her LMP was on September 19 ,2016 with an EDC of November 12, 16
She had no history of miscarriage and delivered her first child
through Caesarean section. PrimiGravida-1 Term-1 Preterm-0
Abortion-0 Living-1, did not used any contraceptive.

VII-Sexual History

The patient cannot verbalize about her sexual experiences

related to lack of proper knowledge about sexual intercourse and
age inappropriate to understand sex.

VIII-Allergies

Patient has no known allergies to food and drugs as she

claimed.

XI- Family Health History

Patient stated that she has family history of

hypertension; her father is always under the influenced of
alcohol and her mother is hypertensive.

X- Personal Habits

Patients usual habits is eating and watching television,

sometimes fund of listening to music and taking long walk in
their municipality in Claver.

XI – Diet

Patient eats three meals in a day. Her usual meal

consists of 2 cup of rice, fish, meat with fats and vegetables.
She also eats bread and fruits like orange and banana. Also
likes junk foods for snacks.

XII- Sleep/Rest pattern

She has no problem in sleeping. She usually sleeps at 8-

9pm and wakes up at 8am. Her means of relaxation is through
watching T.V, having nap time during afternoon.

XIII-Elimination Pattern
 Before hospitalization, patient usually defecates once a
day and urinates 4 times a day with no difficulties eliminating.
Stool is soft to touch and color brown as stated by the patient
and urine is cloudy and yellowish color.

SOCIAL DATA

XIV-Family Relationship/Friendship

Patient’s support system in times of stress and problems

is her parents and friends.

XVI- Educational History

Patient’s educational attainment is High school graduate.

She had difficulties in learning in subject such as mathematics
and English.

XVII- Occupational History

According to Patient C she is supported by her parents

because she is high school graduated only.

XIX- Economic Status

Patient’s illness presents financial concerns. Her

parents are the one’s assisting and paying for her medical care.
Her mother claimed that they are a member of 4P'S program.

Patterns of Health Care

 Patient’s means of health care is through visitation to
her OBIGYNE.
 Patient visit her OB monthly as scheduled to have prenatal
check-up on her pregnancy period.
 Adequate care is being provided by health care team
members of the hospital institution.
 Patient’s family believed in “HILOT” and Herbal doctors.
Psychological Data

According to Patient C the major stressors she

experienced is being pregnant. Her usual coping pattern is to
comfort her baby because she accepts mother’s responsibilities.

REVIEW OF SYSTEM

INTEGUMENTARY SYSTEM
 No history of skin infection as claimed
 With history of dandruff
 Brown skin complexion
 Patient has intact skin with good skin turgor
 Slightly swelling on her lower extremities and part of her
faces
 Skin is warm to touch
 Patient has no lesion

RESPIRATORY SYSTEM
 No complaints of weaknesses on simple activity.
 No appearance of difficulty in breathing
 Has no history of pneumonia, asthma or emphysema.
 No abnormality sounds upon auscultation

CARDIOVASCULAR SYSTEM

 No complaints of weaknesses on simple activity.

 No complaints of palpitations.
 No history of chest pain.
 Has no history of hypertension, as claimed
 Patient’s blood pressure is 160/110
 Patient’s pulse rate is 66 beat per minute

GENITOURINARY SYSTEM
 Urinates 4 times a day as claimed by the patient.
 No pain upon voiding.
  Color of the urine yellow and the transparency of it is
cloudy as a result of urinalysis
 No history of UTI.

GASTROINTESTINAL SYSTEM
 With no complaints of constipation as stated by the
patient.
 Patient has no abnormality in defecating
 No abnormal bowel sounds, as claimed
 Patient With no history of hemorrhoids and rectal bleeding.

REPRODUCTIVE SYSTEM
 Satisfaction to sex life was experienced as claimed by
her.
 With no history of abortion

MUSCULOSKELETAL SYSTEM
 With complaints of weakness
 With complaints of fatigue
 With complaints of lower back pain
 No history of fracture or any injury

ENDOCRINE SYSTEM
 Patient has no history of thyroid trouble

CIRCULATORY SYSTEM
 With no history of painful tonsils during patients early
age
 With no history of having nodules on the neck
 No history of bleeding problems
 No history of hypertension

NEUROLOGIC SYSTEM
 Patient is conscious to time, place and people
 Has no history of seizure
 PHYSICAL EXAMINATION

Skin

Inspection
 Has a brown complexion
 Has closed intact skin
 No lesions
 Slightly swelling in the lower extremities and past of her
face
Palpation
 Skin is warm to touch
 Has a good skin turgor

Hair
Inspection
 Color of hair is black
 No infestation of parasites
 With dandruff
 Has a long and straight hair

Nails
Inspection
 Pink nail bed
 Nails are completely distributed in her fingers
 Patient has no cracked or nail injuries

Skull and face

Inspection
 Facial skin uniform in color
 Normal facial movement
 No lesions
 Skull shape is round and symmetric

Eyes
Inspection
 Both eyes were symmetrical
 Eyelashes equally distributed, curled slightly outward
 Pupils are equally rounded
 The pupil was brown in color with white conjunctiva
 Blinking reflex was normal and functional
 Peripheral reflexes are normal and functional
 Vision acuity is in normal range and can read the Snellen
chart
  Patient is not using any glasses and contact lenses as
visional aid

Ears
Inspection
 Auricles same color as facial skin, symmetrical and are
aligned with outer canthus of eye
 Pinna recoils after it is folded
 No cerumen
 Able to hear spoken words clearly
 No discharges

Nose
Inspection
 Has the same color as facial skin
 Not tender, no lesion
 No discharges
 Straight and symmetrical
 Able to identify odors like alcohol, cologne and coffee

Mouth and throat

Inspection
 Lips are smooth not pale
 Lips are symmetrical
 Tongue moves freely
 Gums is pinkish in color
CLINICAL LABORATORY

HEMATOLOGY SECTION

NAME : CANDA, ROSEMALLY SPECIMEN ID : 2482

AGE / SEX : 17/ FEMALE MEMBERSHIP : NON MEMBER
REQUESTED BY : DR. AMANEO ROOM / WARD : / OB
CASE # : 155073 RESULT DATE : 11/12/2016
10:28 PM

TEST RESULT REFERENCE UNIT SIGNIFICANCE

HGB : 12.8 11.0-15.0 g/ Dl NORMAL

HCT : 40.0 37.0-47.0 * NORMAL
WBC Count: 26.96 4.0 - 10.00 10^9 /L INFECTION
Lymphocyte : 5.6 20.0 – 40.0 * LYMPHOCYTOPENIA
Monocyte : 1.8 3.0 – 12.0 * MONOCYTOPENIA
Neutrophils: 92.5 50.0 – 70.0 * ACUTE INFECTION
Platelet Count: 203 150 - 400 10^3/uL NORMAL
RBC : 4.32 3.50 – 5.00 10^6/uL NORMAL
MCV : 92.6 80.0 – 100.0 fL NORMAL
MCH : 29.6 27.0 –34.0 pg NORMAL
MCHC : 31.9 32.0 – 36.0 g/dL NORMAL
RDW-CV: 12.7 11.0 – 16.0 * NORMAL
 URINALYSIS

November 12, 2016

During labor

Laboratory Laboratory Normal Value Marks Significance

Test Result

Color Yellow Light yellow Normal ------------

Transparency Cloudy Clear Abnormal Proteinuria

Protein 30 0-10 1+ Proteinuria

Ph 7.5 5-9 Normal -----------

Leukocytes >=Ca13 <Ca15 Normal -----------

Glucose Negative Negative Normal -----------

Blood >=Ca200 <Ca10 3+ Hematuria

Creatinine 100 34-147 normal -----------

November 18, 2016

After delivery

Laboratory Laboratory Normal Marks Significance

Test Result Value

Color Yellow Light Normal -----------

yellow
Transparency Yellowish Clear Abnormal -----------

Protein Negative 0-10 Negative -----------

Ph 7.5 5-9 Normal -----------

Leukocytes Ca12 <Ca15 Normal ----------

Glucose Negative Negative Normal -----------

Blood >=Ca200 <Ca10 3+ Hematuria

Creatinine 50 34-147 Normal -----------

Anatomy and Physiology
Pregnancy, also known as gravidity or gestation, is the time
during which one or more offspring develops inside
a woman. A multiple pregnancy involves more than one offspring,
such as with twins. Pregnancy can occur by sexual
intercourse or assisted reproductive technology. It usually
lasts around 40 weeks from the last menstrual period (LMP) and
ends in childbirth. This is just over nine lunar months, where
each month is about 29½ days. When measured from conception it
is about 38 weeks. An embryo is the developing offspring during
the first eight weeks following conception, after which, the
term fetus is used until birth. Symptoms of early pregnancy may
include missed periods, tender breasts, nausea and vomiting,
hunger, and frequent urination. Pregnancy may be confirmed with
a pregnancy test.
CARDIOVASCULAR SYSTEM:
When most people hear the term
cardiovascular system, they
immediately think of the heart. We
have all felt our own heart "pound"
from time to time, and we tend to get
a bit nervous when this happens. The
crucial importance of the heart has
been recognized for a long time.
However, the cardiovascular system is
much more than just the heart, and
from a scientific and medical
standpoint, it is important to
understand why this system is so vital
to life.
Most simply stated, the major function
of the cardiovascular system is
transportation. Using blood as the transport vehicle, the system
carries oxygen, nutrients, cell wastes, hormones, and many other
substances vital for body homeostasis to and from the cells. The
force to move the blood around the body is provided by the
beating heart. The cardiovascular system can be compared to a
muscular pump equipped with one-way valves and a system of large
and small plumbing tubes within which the blood travels.

HEART:
The heart is a muscular organ found in all vertebrates that is
responsible for pumping blood throughout the blood vessels by
repeated, rhythmic contractions.
The heart is enclosed in a double-walled sac called the
pericardium. The superficial part of this sac is called the
fibrous pericardium. This sac protects the heart, anchors its
surrounding structures, and prevents overfilling of the heart
with blood. It is located anterior to the vertebral column and
posterior to the sternum. The size of the heart is about the
size of a fist and has a mass of between 250 grams and 350
grams. The heart is composed of three layers, all of which are
rich with blood vessels. The superficial layer, called the
visceral layer, the middle layer, called the myocardium, and the
third layer which is called the endocardium. The heart has four
chambers, two superior atria and two inferior ventricles. The
atria are the receiving chambers and the ventricles are the
discharging chambers. The pathway of blood through the heart
consists of a pulmonary circuit and a systemic circuit. Blood
flows through the heart in one direction, from the atrias to the
ventricles, and out of the great arteries, or the aorta for
example. This is done by four valves which are the tricuspid
atrioventicular valve, the mitral atrioventicular valve, the
aortic semilunar valve, and the pulmonary semilunar valve.
Systemic circulation is the portion of the cardiovascular system
which carries oxygenated blood away from the heart, to the body,
and returns deoxygenated blood back to the heart. The term is
contrasted with pulmonary circulation.

Pulmonary circulation is the portion of the cardiovascular

system which carries oxygen-depleted blood away from the heart,
to the lungs, and returns oxygenated blood back to the heart.
The term is contrasted with systemic circulation. A separate
system known as the bronchial circulation supplies blood to the
tissue of the larger airways of the lung.
Arteries are blood vessels that carry blood away from the heart.
All arteries, with the exception of the pulmonary and umbilical
arteries, carry oxygenated blood.
Pulmonary arteries
The pulmonary arteries carry deoxygenated blood that has just
returned from the body to the heart towards the lungs, where
carbon dioxide is exchanged for oxygen.
Systemic arteries
Systemic arteries can be subdivided into two types – muscular
and elastic – according to the relative compositions of elastic
and muscle tissue in their tunica media as well as their size
and the makeup of the internal and external elastic lamina. The
larger arteries (>10mm diameter) are generally elastic and the
smaller ones (0.1-10mm) tend to be muscular. Systemic arteries
deliver blood to the arterioles, and then to the capillaries,
where nutrients and gasses are exchanged.
The Aorta
The aorta is the root systemic artery. It receives blood
directly from the left ventricle of the heart via the aortic
valve. As the aorta branches, and these arteries branch in turn,
they become successively smaller in diameter, down to the
arteriole. The arterioles supply capillaries which in turn empty
into venules. The very first branches off of the aorta are the
coronary arteries, which supply blood to the heart muscle
itself. These are followed by the branches off the aortic arch,
namely the brachiocephalic artery, the left common carotid and
the left subclavian arteries.
Aorta the largest artery in the body, originating from the left
ventricle of the heart and extends down to the abdomen, where
it branches off into two smaller arteries (the common iliacs).
The aorta brings oxygenated blood to all parts of the body in
the systemic circulation.

The aorta is usually divided into five segments/sections:

 Ascending aorta—the section between the heart and the

arch of aorta
 Arch of aorta—the peak part that looks somewhat like an
inverted "U"
 Descending aorta—the section from the arch of aorta to
the point where it divides into the common iliac
arteries
o Thoracic aorta—the half of the descending aorta
above the diaphragm
o Abdominal aorta—the half of the descending aorta
below the diaphragm
Arterioles
Arterioles, the smallest of the true arteries, help regulate
blood pressure by the variable contraction of the smooth muscle
of their walls, and deliver blood to the capillaries.
Veins are blood vessels that carry blood towards the heart. Most
veins carry deoxygenated blood from the tissues back to the
lungs; exceptions are the pulmonary and umbilical veins, both of
which carry oxygenated blood. Veins differ from arteries in
structure and function; for example, arteries are more muscular
than veins and they carry blood away from the heart.
Veins are classified in a number of ways, including superficial
vs. deep, pulmonary vs. systemic, and large vs. small.
Superficial veins
Superficial veins are those whose course is close to the surface
of the body, and have no corresponding arteries.
Deep veins
Deep veins are deeper in the body and have corresponding
arteries.
Pulmonary veins
The pulmonary veins are a set of veins that deliver oxygenated
blood from the lungs to the heart.
Systemic veins
Systemic veins drain the tissues of the body and deliver
deoxygenated blood to the heart.
Atrium sometimes called auricle, refers to a chamber or space.
It may be the atrium of the lateral ventricle in the brain or
the blood collection chamber of a heart. It has a thin-walled
structure that allows blood to return to the heart. There is at
least one atrium in animals with a closed circulatory system.
Right atrium is one of four chambers (two atria and two
ventricles) in the human heart. It receives deoxygenated blood
from the superior and inferior vena cava and the coronary sinus,
and pumps it into the right ventricle through the tricuspid
valve. Attached to the right atrium is the right auricular
appendix.

Left atrium is one of the four chambers in the human heart. It

receives oxygenated blood from the pulmonary veins, and pumps it
into the left ventricle, via the atrioventricular valve.
Ventricle is a chamber which collects blood from an atrium
(another heart chamber that is smaller than a ventricle) and
pumps it out of the heart.
Right ventricle is one of four chambers (two atria and two
ventricles) in the human heart. It receives deoxygenated blood
from the right atrium via the tricuspid valve, and pumps it into
the pulmonary artery via the pulmonary valve and pulmonary
trunk.

Left ventricle is one of four chambers (two atria and two

ventricles) in the human heart. It receives oxygenated blood
from the left atrium via the mitral valve, and pumps it into the
aorta via the aortic valve.

Placental Blood Circulation

The placenta (also known as afterbirth) is an organ that
connects the developing fetus to the uterine wall to allow
nutrient uptake, provide thermo-regulation to the fetus, waste
elimination, and gas exchange via the mother's blood supply,
fight against internal infection and produce hormones to support
pregnancy. The placenta provides oxygen and nutrients to growing
babies and removes waste products from the baby's blood. The
placenta attaches to the wall of the uterus, and the baby's
umbilical cord develops from the placenta. The umbilical cord is
what connects the mother and the baby. Placentas are a defining
characteristic of placental mammals, but are also found in some
non-mammals with varying levels of
development.[1] The homology of such structures in
various viviparous organisms is debatable and, in invertebrates
such as Arthropoda, is analogous at best.
The word placenta comes from the Latin word for cake,
from Greek πλακόεντα/πλακοῦντα plakóenta/plakoúnta, accusative
of πλακόεις/πλακούς plakóeis/plakoús, "flat, slab-like",[2][3] in
reference to its round, flat appearance in humans. The classical
plural is placentae, but the form placenta is common in modern
English and probably has the wider currency at present.
Prototherial (egg-laying) and metatherial (marsupial) mammals
produce a choriovitelline placenta that, while connected to the
uterine wall, provides nutrients mainly derived from the egg
sac.
The placenta functions as a fetomaternal organ with two
components: the fetal placenta (Chorion frondosum), which
develops from the same blastocyst that forms the fetus, and
the maternal placenta (Decidua basalis), which develops from the
maternal uterine tissue.[4] In humans, the placenta averages 22 cm
(9 inch) in length and 2–2.5 cm (0.8–1 inch) in thickness, with
the center being the thickest, and the edges being the thinnest.
It typically weighs approximately 500 grams (just over 1 lb). It
has a dark reddish-blue or crimson color. It connects to the
fetus by an umbilical cord of approximately 55–60 cm (22–
24 inch) in length, which contains two umbilical arteries and
one umbilical vein.[5] The umbilical cord inserts into
the chorionic plate (has an eccentric attachment). Vessels
branch out over the surface of the placenta and further divide
to form a network covered by a thin layer of cells. This results
in the formation of villous tree structures. On the maternal
side, these villous tree structures are grouped into lobules
called cotyledons. In humans, the placenta usually has a disc
shape, but size varies vastly between different mammalian
species.[6]
The placenta begins to develop upon implantation of
the blastocyst into the maternal endometrium. The outer layer of
the blastocyst becomes the trophoblast, which forms the outer
layer of the placenta. This outer layer is divided into two
further layers: the underlying cytotrophoblast layer and the
overlying syncytiotrophoblast layer. The syncytiotrophoblast is
a multinucleated continuous cell layer that covers the surface
of the placenta. It forms as a result of differentiation and
fusion of the underlying cytotrophoblast cells, a process that
continues throughout placental development. The
syncytiotrophoblast (otherwise known as syncytium), thereby
contributes to the barrier function of the placenta.
The placenta grows throughout pregnancy. Development of the
maternal blood supply to the placenta is complete by the end of
the first trimester of pregnancy (approximately 12–13 weeks).
Placental circulation
Maternal placental circulation
In preparation for implantation of the blastocyst, the uterine
endometrium undergoes "decidualisation". Spiral arteries in
decidua are remodeled so that they become less convoluted and
their diameter is increased. The increased diameter and
straighter flow path both act to increase maternal blood flow to
the placenta. The relatively high pressure as the maternal blood
fills intervillous space through these spiral arteries bathes
the fetal villi in blood, allowing an exchange of gases to take
place. In humans and other hemochorial placentals, the maternal
blood comes into direct contact with the fetal chorion, though
no fluid is exchanged. As the pressure decreases between pulses,
the deoxygenated blood flows back through the endometrial veins.
Maternal blood flow is approximately 600–700 ml/min at term
Fetoplacental circulation
Deoxygenated fetal blood passes through umbilical arteries to
the placenta. At the junction of umbilical cord and placenta,
the umbilical arteries branch radially to form chorionic
arteries. Chorionic arteries, in turn, branch into cotyledon
arteries. In the villi, these vessels eventually branch to form
an extensive arterio-capillary-venous system, bringing the fetal
blood extremely close to the maternal blood; but no
intermingling of fetal and maternal blood occurs ("placental
barrier").
Endothelin and prostanoids cause vasoconstriction in placental
arteries, while nitric oxide causes vasodilation. On the other
hand, there is no neural vascular regulation, and catecholamines
have only little effect.
The fetoplacental circulation is vulnerable to persistent
hypoxia or intermittent hypoxia and reoxygenation, which can
lead to generation of excessive free radicals. This may
contribute to pre-eclampsia and other pregnancy
complications. It is proposed that melatonin plays a role as
an antioxidant in the placenta

Functions

Nutrition

Maternal side of a placenta shortly after birth.

The perfusion of the intervillous spaces of the placenta with
maternal blood allows the transfer of nutrients and oxygen from
the mother to the fetus and the transfer of waste products
and carbon dioxide back from the fetus to the maternal blood
supply. Nutrient transfer to the fetus occurs via
both active and passive transport. Active transport systems
allow significantly different plasma concentrations of various
large molecules to be maintained on the maternal and fetal sides
of the placental barrier.[14]Adverse pregnancy situations, such as
those involving maternal diabetes or obesity, can increase or
decrease levels of nutrient transporters in the placenta
resulting in overgrowth or restricted growth of the fetus.
Excretion
Waste products excreted from the fetus such as urea, uric acid,
and creatinine are transferred to the maternal blood
by diffusion across the placenta.
Immunity
IgG antibodies can pass through the human placenta, thereby
providing protection to the fetus in uter. This transfer of
antibodies begins as early as the 20th week of gestational age,
and certainly by the 24th week. This passive immunity lingers
for several months after birth, thus providing the newborn with
a carbon copy of the mother's long-term humoral immunity to see
the infant through the crucial first months of extrauterine
life. IgM, however, cannot cross the placenta, which is why some
infections acquired during pregnancy can be hazardous for the
fetus.
Furthermore, the placenta functions as a selective maternal-
fetal barrier against transmission of microbes. However,
insufficiency in this function may still cause mother-to-child
transmission of infectious diseases.
Endocrine function

 The first hormone released by the placenta is called the human

chorionic gonadotropin hormone. This is responsible for
stopping the process at the end of menses when the Corpus
luteum ceases activity and atrophies. If hCG did not interrupt
this process, it would lead to spontaneous abortion of the
fetus. The corpus luteum also produces and
releases progesterone and estrogen, and hCG stimulates it to
increase the amount that it releases. hCG is also what is the
indicator of pregnancy, and the hormone that pregnancy tests
look for. These tests will work when menses has not occurred
or after implantation has happened on days seven to ten. hCG
may also have an anti-antibody effect, protecting it from
being rejected by the mother’s body. hCG also assists the male
fetus by stimulating the testes to produce testosterone, which
is the hormone needed to allow the sex organs of the male to
grow.
 Progesterone helps the embryo implant by assisting passage
through the fallopian tubes. It also affects
the fallopian tubes and the uterus by stimulating an increase
in secretions necessary for fetal nutrition. Progesterone,
like hCG, is necessary to prevent spontaneous abortion because
it prevents contractions of the uterus, and is necessary for
implantation.
 Estrogen is a crucial hormone in the process of proliferation.
This involves the enlargement of the breasts and uterus,
allowing for growth of the fetus and production of milk.
Estrogen is also responsible for increased blood supply
towards the end of pregnancy through vasodilation. The levels
of estrogen during pregnancy can increase so that they are
thirty times what a non-pregnant woman mid-cycles estrogen
level would be.
 Human placental lactogen is a hormone used in pregnancy to
develop fetal metabolism and general growth and development.
Human placental lactogen works with Growth hormone to
stimulate Insulin-like growth factor production and regulating
intermediary metabolism. In the fetus, hPL acts on lactogenic
receptors to modulate embryonic development, metabolism and
stimulate production of IGF, insulin, surfactant
and adrenocortical hormones. hPL values increase with multiple
pregnancies, intact molar pregnancy, diabetes and Rh
incompatibility. They are decreased
with toxemia, choriocarcinoma, and Placental insufficiency.
 PATHOPHYSIOLOGY

Pathophysiology
of Preeclampsia
Predisposing Factor: Precipitating Factor:

Age: 17 Lifestyle: love to eat

fatty foods, salty
Sex: Female foods.
Family Hx: Hypertension Unknown Etiology

Decrease cardiac output

Endothelial cell damage

Vasospasm

Kidney effect
Interstitial effect
Vascular effect
Decreased glomeruli filtration rate
and increased permeability of
glomeruli membranes.
Vasoconstriction
Diffusion of fluid from
blood stream into
Increased blood scrum urea, nitrogen,
interstitial tissue
uric, acid, and creatinine
Poor organ perfusion

Decreased urine output and

edema
proteinuria
Increased blood pressure

PRE-ECLAMPSIA
 Drug Study

Brand Name: Cefuroxine

Generic Name: Ceftin

Dosage: 500mg bid

Timing: 3x a day

Classification: Antibiotic

Indication: Treatment of lyme disease, treatment of acute

bacterial maxillary sinusitis in pateint

Mechanism of Actions: Bacterial inhibits synthesis of bacterial

cell wall causing cell death.

Adverse effect:

CNS: Headache, dizziness, lethargy, paresthesias,.

GI: Nausea, vomiting, diarrhea,anorexia, abdominal pain.

Contraindication:

 Contraindicated with allergy to cephalosporins

or penicillins
 Use cautiously with renal failure, lactation,
pregnancy.
 Nursing consideration: -Culture infection site
and arrange for sensitivity tests before and
during therapy if expected response is not
seen.
 Give oral drug with food to decrease GI upset
and enhance absorption.
 This drug is specific for this infection and
should not be used to self-treat other
problems.
 Drug Study

Generic Name: Apo-mefenamic

Brand Name: Mefenamic Acid

Dosage: 500mg

Timing: 3 times a day

Classification: NSAID

Indication: Relief of moderate pain when therapy will not exceed

1 week.

Mechanism of Actions: Anti-inflamatory, analgestic, an

antipyretic activities related to inhibition of proglaglandin
synthesis; exact in mechanism of action not known.

Adverse effect:

 CNS: Headache, dizziness, somnolence, insomnia, fatigue,

tiredness, ophthalmic effecs.
 Respiratory: Dyspnea, hemoplysis, pharyngitis, bronchospasm,
rhinitis.

Contraindication: Contain dicated with hypersensitivity to

mefinamic acid action or NSAID allergy, and as treatment of
perioperative pain with coronary artery by pass grafting.

Nursing consideration:

Be aware that patient may be at increased for CV events, GI

bleeding, monitor accordingly.

 Give with milk or food to decrease GI upset.

 Arrange for periodic ophthalmologic examinations during
long-term therapy
 Take drug with food take only the prescribed dosage do not
take the drug longer than 1 week.
 Drug Study

Brand Name: Ferrous Sulfate

Generic Name: Apo-ferrous sulfate

Dosage: None
Timing: Once a day

Classification: Iron preparation

Indication:

 Prevents and treatment of iron deficiency anemias.

 Dietary supplement for iron.

Mechanism of Actions:

Elevates the serum iron concentration, and is then converted to

Hgb or trapped in the reticuloendothelial cells for storage and
eventual conversion to a usable form of iron.

Adverse effect:

 CNS: CNS toxicity, acidosis, coma and death with overdose.

 GI: GI upset, anorexia, nausea, vomiting, constipation,
diarrhea, dark stools

Contraindication:

 Contraindicated with allergy to any ingredient; sulfate

allergy; hemochromatosis, hemosiderosis, hemolytic, anemias.
 Use cautiously with normal iron balance, peptic ulcer
regional enteritis, ulcerative colitis.

Nursing consideration:

 Confirm the patient does have iron deficiency anemia before

treatment.
 The the drug on an empty stomach with water. Take after
meals if Gi upset is sever (avoid milk, eggs, coffee, and
tea
 NURSING CARE PLAN 1

Assessment:

Subjective Cues:

- “Sakit ang ako tahi” as verbalized by the patient.

Objective Cues:

- Holding of her breath upon sitting

- Guarded behavior and facial grimace when sitting, standing
and walking.
- Patient is having discomfortable feeling in her vagina.

Nursing Diagnosis:

- Acute pain related to surgical incision of vaginal repair.

Planning, Objectives and Goals:

- After 2 hours of nursing interventions, the patient pain

will be relieve pain and discomfort.

Interventions:
- Assess the patients pain (location, severity of pain,
characteristics, onset and duration, frequency and
precipitating factors)
- Provide/ teach patient in pin management, such as listening
to music or other entertainment media.
-

Evaluation:
- After 3 hrs of nursing interventions the patient will be
relieved from pain and discomfort.
 NURSING CARE PLAN 2

Assessment:

Subjective Cues:
“Satisfy ako nagpasuso sa ako baby.” As verbalized by the
patient.

Objective Cues:
- The patient is able to do right position during
breastfeeding.
- The baby is able to suck/swallow the nipple correctly.
- The patient talks to her baby during breastfeeding.

Nursing Diagnosis

Effective breastfeeding related to breastfeeding knowledge.

Planning, Objectives and Goals:

- After 4 hour of nursing intervention, the patient will be

able to gain more knowledge about the breastfeeding and
it’s benefits.

Interventions:
- Assess the patients knowledge and previous experience with
breastfeeding.
- Teach the patient about the benefits of breastfeeding.
- Demonstrate how to support and position the infant.
- Encourage the patient skin to skin contact.
- Discuss/demonstrate breastfeeding aids.
- Instruct SO to encourage patient to breastfeed infant.

Evaluation:

After 4 hours of nursing interventions, the patient is able

to gain knowledge assess about breastfeeding and benefits.
 NURSING CARE PLAN 3

Assessment:

Objective Cues:
- Patient’s age is 17 years old
- High school undergraduate
- Patient’s lacks interest to express and convey role as a
mother.

Nursing Diagnosis:

Deficient knowledge related to immaturity age.

Planning, Objectives and Goals:

- After 2 hours of parenting class patient will be able to

identify and accept role as a mother.

Independent Nursing Interventions:

Independent:

- Inform patient regarding the program.

- Encourage patient to participate and present willingness to
involve.
- Notify specific role assumption in essential to parenting
child.
- Use languages/ words that patient will understand.
- Instruct significant others to help patient understand in
raising a child.
- Teach patient about sexual intercourse and how to perform
responsibly.
- Teach family planning and use of contraceptives.

Evaluation:

- After 2 hours of parenting class patient can now identify

and accept role responsibly.
- Goal met.
 NURSING CARE PLAN 4

Assessment:

Objective Cues:
- Vaginal laceration
- Postpartum for 2 days
- Meconium stained uterus

Nursing Diagnosis:

- Infection related to vaginal laceration and meconium

stained uterus.

Planning, Objectives and Goals:

After 8 hours of duty patient will be able to minimize/control

infection.

Interventions:

- Inform patient the importance of maintaining body hygiene.

- Inform the importance of perennial care.
- Instruct patient the proper performance of perennial care
and flushing
- Advice patient to eat fruits and vegetables, fiber in rich
nutritional intake.
- Inform patient the importance of taking medications as
prescribed by physician.

Collaborative:
- Administer 500mg cefuroxime capsules 3x a day
- Plain NSS 1000ml.

Evaluation: After 8 hours of duty, patient will be able to

control/minimize infection.
 DISCHARGE PLAN
Upon discharge from the hospital, the patient and her
significant others will be given home care instructions
containing in the following:

MEDICATIONS  Continue taking the medicines

prescribed by the physician such as:
 Cefuroxime 500 mg 3x a day for 7
days.
 Mefenamic acid 500mg; cap 3x a
day for 5 days
 MV+ Fe; cap once a day for 1
month
ENVIRONMENTAL  Advised patient or SO to have
CONSIDERATION psychological and by providing
quiet environment, and avoiding
stressful
Situation
TREATMENT  Avoid sexual intercourse until
perineal wound is completely healed
 Instructed patient to follow proper
instructions medications prescribed
by the physician
 Drink at least 8-10 glasses a day
 Eat more fruits and vegetables to
facilitate easy bowel movement
HEALTH TEACHING  Encourage patient to continue
breastfeeding
 Encourage personal hygiene regularly
OUT-PATIENT CHECK-  Instructed patient to follow scheduled
UP check up
 Instructed patient to seek medical
attention when adverse reactions and
sign and symptom occur
DIET  Advised the patient’s SO to let the
patient eat nutritious food like
fruits, vegetables and green leafy
 Instructed SO to control or limit the
food of the patient which contain
sodium
 SPIRITUAL  Encourage patient to be more faithful
and have trust in God
 Encourage SO to pray for the patients
early recovery

IVF SHEET

SUMMARY OF INTRAVENOUS FLUIDS

BOTTLE DATE TIME STARTED IV(1000cc) Drop Rate

(gtts/min)

1 11/12/2016 6:18 (L) arm D5LR 20gtts/min

2 11/13/2016 D5LR 20gtts/min

DEFINATION OF TERMS

Anti inflammatories - substances that reduce or suppress

inflammation.

Analgesics - compounds capable of relieving Pain without the

Loss of Consciousness.

Antipyretics – Drugs that are used to reduced Body Temperature

in Fever.

Acidosis – a pathologic condition of acid accumulation or

depletion of base in the body. The two main types are
Respiratory Acidosis and Metabolic Acidosis, due to metabolic
acid fluid up.

Bronchospasm – Spasmodic contraction of the Smooth Muscle of the

Bronchi.

Caesarean Section – Extraction of the Fetus by means of

abdominal Hysterctomy

Fertilization – The fusion of a Spermatozoon (Spermatozoa) with

an Ovum thus resulting in the formation of a Zygote.

Hypertension – Persistently high systemic Arterial Blood

Pressure. Based on multiple on readings (Blood Pressure
Determination ). Hypertension is currently defined as when
SYSTOLIC Pressure is consistently greater than 140 mmHg or when
DIASTOLIC Pressure is consistently 90 mmHg or more.
APPENDICIES

VITAL SIGNS

November 12, 2016

BLOOD PULSE RESPIRATORY TEMPERATURE SPO

TIME PRESSURE RATE RATE (°C) (%)
(mm/hg) (bpm) (cpm)
11:40 120/90 --- --- --- ---
pm
12:00 120/80 --- --- --- ---
am
12:15 110/80 --- --- --- ---
am
12:30 110/80 --- --- --- ---
am
12:45 110/80 --- --- --- ---
am
1:00 110/80 --- --- --- ---
am
1:15 120/80 --- --- --- ---
am
1:30 120/80 --- --- --- ---
am
1:45 120/90 --- --- --- ---
am
2:00 120/90 --- --- --- ---
am
3:00 110/90 --- --- --- ---
am
4:00 110/90 --- --- --- ---
am
November 17, 2016

BLOOD PULSE RESPIRATORY TEMPERATURE SPO

TIME PRESSURE RATE RATE (°C) (%)
(mm/hg) (bpm) (cpm)

8:05 am 160/110 66 23 36.2 ---

9:05 am 140/90 64 20 36 ---
10:05 am 160/110 78 22 36.4 ---
11:05 am 150/110 72 21 37.6 ---
2:00 pm 150/100 70 22 36.2 ---
4:00 pm 160/90 78 23 37 ---
REFERENCES

http://www.mdedge.com/clinicianreviews/article/79478/cardiology/
pregnancy-induced-hypertension

https://www.scribd.com/doc/66170616/Pregnancy-Induced-
Hypertension

http://www.webmd.com/baby/guide/preeclampsia-eclampsia#1