I.

Introduction

Nursing is a continuous process which involves the relationship

between the nurse and the patient that mutually works together in accomplishing
identified goals in meeting the best care and comfort in the maintenance and
promotion of health prevention of disease and rehabilitation from illness. Nursing
means art and caring, and with this principle in mind we tried to do this case
study not just as a requirement but as a mean of enhancing, gaining and
developing further our knowledge, skills and attitudes in order to give the best
possible and necessary care for our clients condition.

Preeclampsia is a disorder that occurs only during pregnancy and the postpartum
period and affects both the mother and the unborn baby. Affecting at least 5-8%
of all pregnancies, it is a rapidly progressive condition characterized by high
blood pressure and the presence of protein in the urine. Swelling, sudden weight
gain, headaches and changes in vision are important symptoms; however, some
women with rapidly advancing disease report few symptoms.

Preeclampsia and other hypertensive disorders of pregnancy are a leading global

cause of maternal and infant illness and death. By conservative estimates, these
disorders are responsible for 76,000 deaths each year. In developing countries:
preeclampsia/eclampsia impact 4.4% of all deliveries and may be as high as
18% in some settings in Africa If the rate of life threatening eclamptic convulsions
(0.1% of all deliveries) is applied to all deliveries from countries considered to be
the least developed, 50,000 cases of women experiencing this serious
complication can be expected each year. 585,000 maternal annually, 13%, or
76,050, are due to eclampsia. Giving Magnesium Sulfate to all women with
preeclampsia in the world's 143 least developed countries could head off as
many as 35,000 cases of eclampsia per year. (www.preeclampsia.org)
In a systematic review involving six trials (11 444 women) magnesium sulfate
significantly reduced the risk of eclampsia and the risk of maternal death among
patients with pre-eclampsia although the latter was not statistically significant.
Magnesium sulfate was more effective than phenytoin for reducing the risk of
eclampsia among patients with pre-eclampsia. Magnesium sulfate appears to be
substantially more effective than phenytoin or diazepam for the treatment of
eclampsia. Magnesium sulfate is therefore the anticonvulsant of choice for both
prevention and treatment of eclampsia. Implementing magnesium sulfate for the
prevention and treatment of eclampsia in low- and middle-income countries could
potentially benefit hundreds of thousands of women.
(www.who.int)

The reason why we chose this case because we wanted to learn more about the
disease process and gain information on how to properly manage and prevent
complication. Also we researched this case to improve our skills and able to give
the best possible care to patients with the same condition and as a new duty
student nurse we view this case as a very interesting case that would give us
knowledge and skills that can be applied to all patients that we will handle.

II. Nursing Process

A. Assessment

1.Personal Data

a. Demographic Data

Mrs. Pre-eclampsia is a 36 year old, female, a bread winner, who is a

married Roman Catholic And Resides at Bulaklak Village, Sto Nino City of
Sn Fernando Pampanga. She was Born on July 11, 1971. She was
admitted last June 22,2008 in Jose B. Lingad Memorial General Hospital
with a principal diagnosis of “Pregnancy Uterine Delivered Spontaneously
 to a Live Term Baby Boy Cephalic” and a other diagnosis of “Chronic
Hypertension with super imposed Pre-eclampsia.

b. Socio-economic and Cultural factor

The Pre-eclampsia Family has ten members. Mr and Mrs. Pre-eclampsia

have eight children Their eldest is 16 years old and their youngest is just a
week old. Most of Mr and Mrs Pre-eclampsia's children were studying on
public schools in Sn Fernando except for their eldest who have stop going
to school because of financial difficulties of his parents which hinders him
from going to school. Among the eight children only two of them were
delivered in the hospital the eldest and the youngest and the others were
delivered on their house because of financial difficulty. The Pre-eclampsia
family resides near the Sn Fernando Capitol in a Former bar house in
Bulaklak Village, Sto Nino City of Sn Fernando Pampanga. They reside
there for free. The patients family has difficulty paying the hospital bill due
to financial constraints since Mr. Pre-eclampsia is a part time Pedicab
Driver who earns 200 Pesos per day and Mrs. Pre-eclampsia a biscuit re
packer who earns 120 per day which is insufficient to meet the family
needs. Mr. and Mrs. Pre-eclampsia believe on Herbularios and on Herbal
Medicines Because they believe the Herbal Medicines are also effective
with lesser side effects and more affordable. Their Family is a Roman
Catholic. They go to mass every sunday.

c. Environmental Factors

The Pre-eclampsia Family resides near the Sn. Fernando Capitol at

Bulaklak Village, Sto Nino City of Sn. Fernando Pampanga. In a former bar
house wich was lend to them.

The surrounding here is clean because the house is near the Sn. Fernando
Capitol. The place is also prone to flood when it rains hard and also pollution is
very prominent because the house is near the the main road and the existence of
Pasudeco which is a sugar cane refinery that emits a very unpleasant smell
when operates.

2. Personal History

a. Maternal – Obstetrics record

Mrs. Pre-eclampsia was married at the age of 19 to Mr. Pre-

eclampsia with a GPTPAL of G8P8(8008). She has eight children her
eldest son is 16 years old and was born on May 24,1992 at JBLMGH. After
two years she gave birth to a baby girl on April 1,1994. After a year baby
 boy Pre-eclampsia was born on August 12,1995. The next three years
baby boy pre-eclampsia(a) was born on June 19, 1998. After nine months
baby girl pre-eclampsia(a) was born on February 14,1999. The next year
baby boy pre-eclampsia(b) was born on April 18,2000. After five years baby
boy pre-eclampsia(c) was born on June 5,2005. Lastly baby boy pre-
eclampsia(d) was born last June 22,2008 in JBLMGH. Most of Mrs. Pre-
eclampsia's children were born at their house and delivered by a midwife
except for their eldest and the youngest. All of her children were delivered
via Normal Spontaneous Delivery and all of them has full term age of
gestation.

b. Antepartal/Prenatal Preparation

Mrs. Pre-eclampsia only had a check up during her 3 rd trimester of

pregnancy because she is experiencing hypertension. She had a check up
for five times on JBLMGH. She only had a check up during her 3 rd trimester
because of financial constrains which hinders her of consulting.

c. Significant Trimestral Changes

Mrs. Pre-eclampsia didn't experience any discomforts during her 1 st

trimester she did experience discomforts and complication only on her 3 rd
trimester. She experienced hypertension and consulted at JBLMGH at this
hospital she was advised to deliver her baby in the hospital and was given
a medication of aldomet.
 3. Family Health – Illness History

P. Grandmother* P. Grandfather M. Grandmother* M. Grandfather*

Hypertension * Diabetes

P. Uncle P. Uncle* P. Aunt Father* M. Uncle* Mother M. Aunt

Hypertension Hypertension Diabetes

Mrs. Pre-eclampsia Sister Sister Brother

Hypertension Diabetes

* = Dead

The diagram shows that Mrs. Preeclampsia has a history of hypertension on his father side and has a risk for acquiring
diabetes from her mother side. It shows that Mrs. Pre-eclampsia’s sister has already had diabetes.Her paternal
grandmother died from hypertension also her paternal uncle also died from it. Her maternal uncle died from the diabetes.
This shows that her Pregnancy induced hypertension is genetically acquired.
4. History of Present Illness

Mrs. Pre-eclampsia has a history of hypertension and cardio megaly he

was confined at the age of 33 at Jose B. Lingad Memorial General Hospital after her
delivery to her 2nd to the last child. Cardio megaly also known as Enlargement of the
Heart is a medical condition wherein the heart is enlarged. According to her she was
given medications via intravenous injection.

5. History of Present Illness

Mrs. Pre-eclampsia has a Pre-eclampsia according to her her blood

pressure is high when she is on her 3rd trimester according to her she was given a
medication of aldomet and she is checked up for five times in Jose B Lingad
Memorial General Hospital. She was diagnosed of Pre-eclampsia then. Last June
22,2008 she gave birth to a baby boy via Normal Spontaneous Delivery and after he
gave birth he experiences relapsing heightened blood pressure.

6. Physical Examination

Scalp: No flaking noted, no abnormal contour of the skull, no lumps noted, hair is
oily and sticky.

Eyes: Pupils equally round and reactive to light and accomodation

Ears: Presence of cerumen noted, no lumps, no nodules noted

Nose: Symmetrical nosetrils without congestion,

Mouth: Presence of halitosis, no lesion, pink lips, +gag reflex

Neck: No palpable nodes, no lesion

Lymphnodes: No lymph node enlargement

Chest: Symmetrical Chest expansion, no lesion

Heart: Normal rate, regular rhythm upon auscultation

Lungs: Clear breath sounds, Resonance upon auscultation, normal RR

Abdomen: Uterus well contracted, liver and spleen not palpable

Extremities:

Upper: Fracture noted on the right arm, with normal range of motion with equal
pulse, no lesion noted

Lower: Symmetrical, with normal range of motion, no lesio

7. Diagnostic and Laboratory Procedures

Diagnostic/ Date ordered Indication(s) Results Normal Values Analysis and

Laboratory Date Result(s) Or (Units used in interpretation of
Procedures in Purposes Hospital) results
Blood Chemistry

 RBS Date ordered: To determine if the 5.60 RBS is within the

06/22/08 patient is in a 3.83 – 9.0 mmol/L normal range
Date Results in: hypoglycemic indicating that the
06/22/08 state, that may client is not
lead to hypoglycemic.
convulsions.

Date ordered: The result is within

 BUN To measures the normal range
06/22/08
Date Results in: level of urea in the 4.6 1.7 – 8.3 mmol/L indicating that
06/22/08 blood and is used kidneys are
to assess the functioning
glomerular properly.
function or how
well the Kidneys
are working.
 Uric Acid To evaluate the 0.143 – 0.357 The result means
Date ordered: blood levels of 0.574 mmol/L there is Increased
06/22/08 uric acid for gout uric acid levels
Date Results in: and to assess uric due to
06/22/08 acid levels in the overproduction
urine for kidney may also be
stone formation. caused by gout,
by a genetic
disorder of purine
metabolism, or by
metastatic
cancer,
destruction of red
blood cells,
leukemia, or
cancer
chemotherapy.

59.5 10 – 40 U/L The SGOT is

To determine if the higher, so result
 SGOT Date ordered: heart or liver was means kidneys,
06/22/08 being damage, heart, or liver are
Date Results in: this enzyme injured.
06/22/08 released into
blood when the
liver or heart are
damaged.
 16.6 0 – 39 U/L
 SGPT The result means
To determine / is within the
Date ordered: evaluate patient normal range. The
06/22/08 who has SGPT are
Date Results in: symptoms of a normally present
06/22/08 liver disorder. in the liver but not
so sensitive
indicator like
ELECTROLYTES SGOT.

 Sodium This was done to

determine the 142.3
levels of sodium
to detect whether
Date ordered: there’s the right
06/22/08 balance of sodium
Date Results in: and liquid in the
06/22/08 blood to carry out
those functions.
135 – 145 mmol/L
The result is within
the normal range.
There is no
imbalance of
electrolytes within
the client’s body in
relation to sodium.

 Potassium
To help evaluate 3.5 – 5.0 mmol/L The result means
Date ordered: fluid and 3.3 there is imbalance
06/22/08 electrolyte of potassium level
Date Results in: imbalance in in the client, it can
06/22/08 terms of increase the risk
potassium of an abnormal
component. heart beat, it can
also associated
with muscle
 weakness.
 Chloride To determine the
Date ordered: levels of chloride,
06/22/08 can helps 101 – 111 mmol/L The result is within
Date Results in: maintain a 104.5 normal range.
06/22/08 balance of fluids There is no
in the body to imbalance of
prevent certain electrolyte within
chemical client’s body in
reactions from relation to chloride
occurring in the
body that are
necessary it to
keep working
properly.
Nursing Responsibilities:
Prior to:
 Explain to the client and significant others the purpose and indication of the procedure.
 Inform the client that the test requires blood sample.
 Notify the laboratory or the physician about the drugs that client is taking that may affect the test results; it may be necessary to
restrict them.

During:
 Perform venipuncture and collect the sample in a proper container.
 Use aseptic technique when obtaining the sample.
 Handle the sample properly to prevent hemolysis.

After:
 Apply direct pressure on the puncture site until stop bleeding.
 Instruct the significant other to resume the medication that being stop.
 Watch out for edema formation.
 Document the procedure.
 Secure the results and put it in the chart.
 Refer the results to the physicians.
Diagnostic/ Date ordered Indication (s) or Results Normal Values Analysis and
Laboratory Date Result(s) in Purpose (Units used in Interpretation of
Procedures the hospital) results

Date ordered: Color: yellow Color: Straw

For general health
The color,
Urinalysis 6/22/08 screening to Transparency: yellow to amber.
transparency ,
detect renal and
Date Results in: turbid Transparency: sugar, specific
metabolic
gravity, Pus cells,
06/22/08 disease; diagnosis Sugar: negative transparent
RBC, and
of disease or
Albumin: positive Sugar: negative epithelial are all
disorders of the
normal except to
kidney or urinary Reaction: Acidic Albumin: negative
the albumin that
tract; monitoring
Specific Gravity: Specific Gravity: means Protein in
patient’s with
the urine may
diabetes. 1.025 1.015 – 1.025
mean kidney
Pus cells: 5 – 8/ Pus cells: 5- damage, an
infection, cancer,
HPF 10/HPF
high blood
RBC: TNTC/HPF RBC: o-2 HPF pressure,
diabetes, systemic
Epithelial cells: Epithelial cells:
lupus
Moderate. Moderate erythematosus
(SLE), or
glomerulonephritis
is present.

The result is
To determine the
Albumin Date ordered: negative that
presence of
 06/23/08 glomerular Albumin: Negative Albumin: negative indicating the
Date Results in: damage. glomerular
06/23/08 membrane is not
damaged.

Nursing Responsibilities:
Prior to:
 Explain to the significant others the test, it’s purpose and how it done.
 Inform the significant others that the test will require urine specimen.
 Provide a clean container for the specimen.
During:
 Collect the urine in a clean specimen cup.
 Label the specimen properly.
After:
 The specimen should be delivered to the lab within 1 hour.
 Obtain result and secure it to the chart
 Refer result to the physician

Diagnostic/ Date ordered Indication (s) or Results Normal Values Analysis and
Laboratory Date Result(s) Purpose (Units used in Interpretation of
Procedures in the hospital) results
 Blood test

 Blood typing Type A, B, AB, The result means

Date ordered; To determine what
O+ and O the client can
06/22/08 type of blood the
donate blood to
Date Results in: client has.
any kind of blood.
06/22/08
The hemoglobin
Date ordered: test measures the
 Hemoglobin 124 115 – 155 g/L The result is within
06/22/08 amount of
the normal level
Date Results in: hemoglobin in
indicating that the
06/22/08 blood and is a
blood had
good indication of
sufficient oxygen
the blood's ability
that carrying
to carry oxygen
protein.
throughout the
body.

Date ordered: Evaluates anemia

 Hematocrit 38% 38 %– 48 % The result shows
06/22/08 and fluid balance
that the
Date Results in: and measures
percentage of red
 06/22/08 concentration of blood cells in a
RBC within the given volume of
blood volume. the whole blood is
normal.
To evaluate 9.7
Date ordered:
presence of 5‾¹º x 10 ۹ /L The result is within
06/22/08
 White Blood infection/ the normal range
Date Results in:
cells inflammation. that indicating
06/22/08
there is no
presence
infection/
inflammation
because of the
actual number
WBC per volume
of blood.

0.45 – 0.85 The result is within

 Neutrophils Neutrophils are 0.74 normal range that
Date ordered:
phagocytes suggests delayed
06/22/08
engulfing bacteria participation of
 Date Results in: and cellular neutrophils to
06/22/08 products. It presence of
evaluates primary infection.
cell response
during an acute
inflammation
process.
Lymphocytes are
within the normal
Indicates the 0.20 – 0.35 range indicating
 Lymphocyte Date ordered: amount of 0.26 reduced infection
06/22/08 lymphocytes as a result of
Date Results in: participating with continuous
06/22/08 macrophages at a antibiotic
site of local injury. treatment that
does not require
more lymphocytes
to act upon it

The result is
3.45 – 6.35 above the normal
 Total To determine the mmol/L range. So does
Cholesterol Date ordered: amount of 6.58 the possibility of
06/23/08 cholesterol in our plugging the
Date Results in: body that cause arteries due to
06/23/08 risk for heart and cholesterol plaque
blood vessel build-up.
disease.

The result id
 HDL HDL is‘good 0 – 1.70 mmol/L above the normal
Date ordered: cholesterol’ as it 1.80 range. It indicating
06/23/08 protects against High levels seems
Date Results in: heart disease by to be associated
06/23/08 helping remove with low incidence
excess cholesterol of coronary heart
deposited in the disease.
arteries.
The result shows
the normal range
To determine the 1.7 – 4.59 mmol/L of LDL that
 LDL Date Ordered: level of bad 3.09 indicates low risk
 06/23/08 cholesterol in the of acquiring
Date Results in: body that cause coronary or
06/23/08 coronary or vascular disease.
vascular disease.
The result is
above the normal
 Triglycerides Triglyceride is fat 3.72 0.11 – 2.09 level, this may
Date ordered: in the blood mmol/L indicate that High
06/23/08 which, if elevated, triglycerides are
Date Results in: has been also associated
06/23/08 associated with with pancreatitis
heart disease and also
associated with
problems other
than heart disease

Nursing Responsibilities:

Prior to:
 Explain the procedures to the client
  Explain the purpose and indication of the test
 Tell to the significant others or client that the test will not require feeding restriction.

During:
 Use aseptic technique when obtaining the sample
 Label the container properly.
 Bring the collected sample to the laboratory

After:
 Obtain results and secure it to the patients chart
 Refer the results to the physician
Diagnostic/ Date ordered Indication (s) or Results Normal Values Analysis and
Laboratory Date Result(s) Purpose (Units used in Interpretation of
Procedures in the hospital) results

Chest X-Ray Date ordered: To assist in  The lungs are The lungs look It means that the

(CXR – PAV) 06/22/08 diagnosing clear normal in size and result of the CXR

Date Results in: pulmonary and  The cardio shape, and the of the client is all

06/24/08 cardiac disease. thoracic ratio is lung tissue looks normal. There is

Visualizes the borderline in normal. No no abnormality

structure of the diameter (ct growths or other found

lungs and heart. ratio: 14:28) masses can be
 The diaphragm seen within the
and sulci are lungs. The heart
intact looks normal in
size, shape, and
the heart tissue
looks normal. The
blood vessels
leading to and
from the heart
also are normal in
size, shape, and
appearance. The
diaphragm looks
normal in shape
and location. No
abnormal
collection of fluid
or air is seen, and
no foreign objects
are seen.
Nursing Responsibilities:

Prior to:
 Inform the client about the order of CXR.
 Fill-up the request form and give it to the patient.
 Explain the procedure and the purpose of the test

During:
 Tell the patient to relax the body
 Assured to the client that it is a non-invasive procedure
After:
 Secure the result to the clients chart
 Refer the result to the physician.
II. ANATOMY AND PHYSIOLOGY

ANATOMY AND PHYSIOLOGY OF FEMALE

REPRODUCTIVE SYSTEM

I. EXTERNAL PARTS:

1. Mons veneris / mons pubis – a firm, cushion – like elevation of adipose tissue over
the symphysis pubis covered by curly hair or pubic hair forming escutcheon. In female,
pubic hair tends to be triangular distribution, while in male, it tends to be diamond – shaped. It
serves to protect the junction of the pubic bone from trauma.

2. Labia majora – two rounded folds of adipose tissue with overlying skin; they extend from
the mons pubis downward and backward to encircle the vestibule. The outer surface are
covered with hair, where as the inner surface contain sebaceous follicles which are smooth
and moist. Their purpose is mainly to protect the inner delicate parts of the vulva.

The labia majora are homologous of the scrotum in the male organ. At the same time, it is the
frequent site of varicose vein in the vulva. The arterial blood is supplied by the internal and
external pudendal arteries and a portion of the inferior rectus artery. It also shared an
extensive lymphatic supply with the other structure of vulva, which facilitates the spread of
cancer in female reproductive organ, and obstetric or sexual trauma may cause hematoma.
 Immediately under the skin is a sheet of dartos muscle, which is responsible for the
wrinkled appearance as well as for their sensitivity to heat and cold. Ordinarily, these
structures are 7 – 8 cm. in width and 1 – 1.5 cm. in thickness.

3. Labia minora - two thin, flat, reddish folds of tissue lying between the inner surfaces of
the labia majora. Each labium minus consists of a thin fold of connective tissue which when
protected, presents a moist, reddish appearance, similar to that of mucous membrane. The
structure is covered by stratified squamous epithelium. It doesn’t contain hair follicle but it
contains many sebaceous follicles and occasionally a few sweat glands.

 Functions:
a. To lubricate and waterproof the vulvar skin.
b. To provide bactericidal secretion.

The labia minora are classed among erectile structures. This structure is extremely
sensitive and abundantly supplied with several varieties of nerve endings. Anteriorly, each
divide into 2 parts; the upper pair merges into the prepuce and the lower one fuse to form the
frenulum. Posteriorly, the labia minora fuse to form fourchette. The labia minora increase in
size at puberty and decrease after menopause due to estrogen level changes.

4. Clitoris - a small, cylindrical highly sensitive erectile organ corresponding to the male
penis. It is made up of erectile tissue which many large and small venous channels
surrounded by large amount of involuntary muscle tissue, the ischiocarvernosa facilitate
erection of the organ.

 Functions :
a. Stimulate and elevate levels of sexual tension.
b. Serve as a landmark in locating urethral opening during catheterization.
The clitoris measures 5 – 6 mm. long and 6 – 8 mm. across. It has very rich blood and
nerve supplies. It produces smegma, which along with other vulvar secretion has a unique odor
that may be sexually stimulating to the male.
5. Vestibule – an almond – shaped area that is enclosed by the labia minora laterally and
extends from the clitoris to the fourchette antero-posteriorly. The posterior portion of the
vestibule between the fourchette and the vaginal opening is called the fossa navicularis and
is usually observed only in nulliparous women.

The vestibular bulb is located beneath the mucous membrane of the vestibule on either
side which are almond shaped aggregation of vein 3 – 4 cm. long, 1 – 2 cm. wide and 0.5
– 1 cm. thick. These bulbs lie in close opposition to the ischio-pubic rami and partially
covered by the ischiocavernosus and constrictor vaginal muscles. These structures are
liable to injury and rupture which may result in a vulvar hematoma or hemorrhage. It is
perforated usually by 6 openings: urethra, vagina, and bartholin’s gland (2) and
paraurethral gland (2).

5.1. Urethral meatus / urethral orifice – although not a true part, it is

considered as part of the reproductive system because of its closeness and
relationship to the vulva. It is situated in the middle of the vestibule and serves as
an outlet for urine from the urinary bladder.

5.2. Vulvovaginal / bartholin’s gland – pair of small, pea – sized glands located
within the substances of the labia majora. They correspond to the bulbourethral of
Cowper’s gland in male. Often, they are sites of infection, abcess and cyst
formation. Usually, the openings are not visible or palpable. The gland secretes a
small amount of clear, viscid mucus during sexual excitement.

5.3. Paraurethral / skene’s gland – a pair of small glands lying on each side of
the urethra. They produce a small amount of mucus and are especially susceptible
to gonorrheal infection. It is homologous to male prostate.

5.4. Vaginal orifice / introitus – occupies the lower portion of the vestibule and
varies considerably in size and shape. The vagina has an abundantly vascular
supply. Its upper third is supplied by the of the vesicovaginal branches uterine
arteries. Its middle third by the inferior vesical arteries. Its lower third by the
middle hemorrhoidal internal pudendal arteries.

Anteriorly, the vagina is in contact with the bladder and urethra from which is separated
by a connective tissue referred to vesicovaginal septum. Posteriorly between the lower
portion and the rectum is the rectovaginal septum. Approximately, the upper ¼ of the
vagina is separated from the rectum by the rectouterine or cul-de-sac of Douglas.

The vagina varies in length. The anterior and posterior vaginal walls commonly measure
6 – 8 cm. and 7 – 10 cm. in length, respectively. The areas around the cervix at the upper
end of the vagina are called fornicles, right and left, anterior and posterior. The walls are
lined with mucous membrane, which falls into folds, or corrugated formation called
rugae. These are referred to the inner wall of vagina. It is smooth during labor and
parturition. It is not present before menarche and gradually become obliterated after
repeated childbirth and menopause. A healthy vagina has pH of 4.0 – 6.0.

 Functions:
a. serves as excretory duct of the uterus
b. female organ for copulation
 c. part of birth canal

Hymen comprised mainly of connective tissue both elastic and collagen. Both surfaces
are covered by stratified squamous epithelium. The hymen can be broken through
strenous physical activities or masturbation. After childbirth, especially in multipara, the
remnants of the hymen from several cicatrized nodules of varying size called myrtiform
caruncles.

6. Perineum – the area extending from the fourchette to the anus. The pelvic and urogenital
diaphragm provides most of the support of the perineum.

6.1.Pelvic diaphragm – consists of the levator ani muscles which is the principal
muscle that is close to vagina and the coccygeus muscle posteriorly.
The levator ani muscles form a broad muscular sling that originates from the
posterior surface of the superior rami of the pubis, from the inner surface of the
ischial spine and between the 2 sites from the obturator rami.
 3 portion of levator ani muscle:
a. iliococcygeus muscle
b. pubococcygeus muscle
c. puborectalis muscle
The pubococcygeus and puborectalis constrict the vagina and rectum and form an
efficient functional rectal sphincter. Their functions are as follows:
a. play a role in sexual sensory function
b. bladder control
c. Control perineal relaxation during labor and in expulsion of the fetus during birth.

6.2.Urogenital diaphragm – located in the hollow of the pubic arch and consists of
the transverse perineal muscles, constrictor of urethra and internal and external fascial
covering. These muscles originate at the ischial tuberosities and insert into the perineal
body. The strong muscle fibers provide support to the anal canal (sphincter muscle)
during defication and to the lower vagina during delivery.

The perineal body is a wedge – shaped between the vaginal and canal opening which
serves as an anchor point for the muscles, fascia and ligament of the upper and lower
pelvic diaphragm. The perineal body is about 4 cm. wide x 4 cm. deep
and continuous with the septum between the rectum and vagina. This tissue is
flattened and stretched as the fetus moves through the birth canal.

II .INTERNAL ORGAN :
1. Uterus – a hollow pear – shaped organ partialy covered by peritoneum or serosa. The
posterior wall of the uterus is directly covered with peritoneum and the lower portion forms the
anterior portion of the cul-de-sac of Douglas. The cavity of the uterus is lined by the
endometrium. During pregnancy, the uterus serves for reception, implantation, retention and
nutrition of the conceptus which then expels during labor. It undergoes remarkable growth
due to hypertrophy of muscle fibers. Its size increases from 60 g. to about 1,100 g. at term
and a total volume averages about 5 liters. A non – pregnant uterus has an approximately
measurement of 7.5 cm. long x 5 cm. wide x 2.5 cm thick, and during pregnancy, it is
approximately measures 30 cm. x 30 cm. x 20 cm.

 Two Major but unequal parts :

1. body or the corpus – upper triangular portion which constitute the greater
part.
a. Fundus – the upper, rounded prominence above the insertion of the fallopian
tube.
b. Corpus - main portion encircling the intrauterine cavity.
c. Isthmus - known as the lower uterine segment during pregnancy. It is slightly
constricted portion that joins the corpus to the cervix.

2. Cervix – the lowermost portion of the uterus. It is divided by the attachment of

the vagina into vaginal and supravaginal portion. The supravaginal segment on
its posterior surface is covered by peritoneum, laterally, it is attached to the
cardinal ligament and anterior, it is separated from the overlying bladder by loose
connective tissue. The cavity of the cervix is a narrow tube called cervical canal.
a. Internal Os – the narrowed opening between the uterine cavity and the
endocervical canal.
b. External Os – small round opening at the lower end of the cavity and
endocervical canal.
  The corpus of the uterus is made up of 3 layers :
a. Serosal layer or perimetrium – the outermost layer which is composed of
peritoneum.
b. Muscular uterine layer or myometrium – the middle layer. This is continuous
with the muscle layer of the fallopian tube and with that of the vagina. This helps
the organ present a unified reaction to various stimuli – ovulation and orgasm.

 There are 3 distinct layers of uterine ( smooth ) involuntary

muscles :
b.1. The outer layer – found mainly over the fundus, is made up
of longitudinal muscles especially suited to expel the fetus during
birth.

b.2. The middle layers – thick and made up of interlacing muscle fibers in
figure of 8 patterns. These muscles fibers surround large old vessels and their
contraction produces a hemostatic action and control of blood loss after placental
separation.

The vaginal cervix appears pink and ends at the external Os. The cervical canal
appears rosy red and is lined with columnar ciliated epithelium, which contains mucus –
secreting glands. Most cervical cancer begins at this squamocolumnar junction. Elasticity
is the chief characteristics of the cervix. Its ability to stretch is due to the high fibrous and
collagenous content of the supportive tissues and also to the vast number of folds in the
cervical lining.

 The cervical mucosa has 3 functions:

1. provide lubrication for the vaginal canal
2. act as a bacteriostatic agent
3. Provide an alkaline environment to shelter deposited sperm from the acidic
vagina.
At ovulation, cervical mucus is clearer, thinner and more alkaline than at other times.

b.3. The inner layer – made up of circular fibers, which forms

sphincter at the fallopian tube attachment sites and at the internal
Os. The internal Os sphincter inhibits the expulsion of the uterine
contents during pregnancy but stretch in labor as cervical dilatation
occurs. The sphincters at the fallopian tube prevent menstrual
blood from flowing backward into the fallopian tube from the uterus.
 c. Mucosal layer or endometrium – the innermost layer which composed of a single
layer of columnar epithelium, glands and stroma.

 The mucous membrane of endometrium composed of 3 layers :

C.1.compact surface layer
C.2.spongy middle layer of loose connective tissue
C.3. Dense inner layer

From menarche to menopause, the endometrium undergoes monthly degeneration

and renewal in the absence of pregnancy. During menstruation and following
delivery, the compact surface and middle spongy layers slough off. Just after the
menstrual flow ends, the endometrium is 0.5 mm thick; near the end of the
endometrial cycle, just before menstruation begins again, it is about 5 mm thick.
When pregnancy occurs, the endometrium undergoes changes and become
decidua.

 Ligaments of uterus :
1. Broad ligament – comprised of 2 wing like structures that extend from the lateral
margins of the uterus to the pelvic walls and thereby divide the pelvic cavity into
anterior and posterior compartments. Each broad ligament consists of a fold of
peritoneum and these superior, lateral, inferior and medial margins. The inner 2/3 of
the superior margin forms the mesosalphinx to which the fallopian tubes are
attached. The outer third of the superior margin extends from the fimbriated end of
the oviduct to the pelvic wall, forms the infundibulopelvic ligament. The broad
ligament keeps the uterus centrally placed and provides stability within the pelvic
cavity.

2. Round ligament – composed of smooth muscle and connective tissue, and helps the
broad ligament in keeping the uterus in place. It is capable of contraction on time of labor
thereby, it steady the uterus, pulling downward and forward, so that the presenting part of the
fetus is forced into the cervix.

3 3. Cardinal / transverse cervical ligament / Mackenrodt – composed of the dense

connective tissue that medially is united firmly to the supravaginal portion of the cervix. It
serves as the chief uterine support and to upper part of the vagina thus to prevent uterine
prolapsed.
 4.Uterosacral ligament – a cordlike folds of peritoneum extending from the supravaginal
cervical portion of the uterus. It provides support for the uterus at the level of the ischial spine.
They also contain sensory nerve fibers that contribute to dysmenorrhea.

5. Ovarian ligament – anchor the lower pole of the ovary to the cornua of the uterus.
They composed of muscle fibers that allow the ligament to contract.

6. Infundibulopelvic ligament – the suspensory ligament of the ovary. It contains the

ovarian vessels and nerves.

 Position of uterus
The position of the uterus varies depending on a woman’s posture, number of
children borne, bladder and rectal fullness and even normal respiratory pattern.
1. Anteverted – the fundus is tilted forward. It is considered as the normal position.
2. Anteflexed – slightly bend forward.
3. Retroverted – tilted backward
4. Retroflexed – bending backward

 Blood supply is derived from :

1. Uterine artery – which arise from the anterior branch of hypogastric artery passing
towards the uterus through the parametrium. The hypogastric artery provides most of
the blood supply to the pelvic viscera and the pelvic musculature.

It is divided into 2 main branches:

1.1. Cervicovaginal artery – which supplies blood to the lower portion of
the cervix and the upper portion of the vagina.

1.2. Internal iliac artery – a major portion of the blood supply to the
Pelvis. This is commonly referred to as the hypogastric artery.

The internal iliac artery is divided into 2 divisions:

1.2.1. Anterior division – includes the umbilical, middle and inferior
vesicle, middle rectal, obturator, internal pudendal, middle hemorrhoidal,
vaginal and inferior gluteal arteries.
 1.2.2. Posterior division – includes the lateral, sacral, superior
gluteal and iliolumbar arteries.

2. Ovarian artery – a direct branch of the aorta enters the broad ligament through the
infundibulopelvic ligament.

 Nerve Supply :
The nerve supply is derived principally from the sympathetic nervous system but
partly from the cerebrospinal and parasympathetic system.

 Functions of uterus :
1. organ for menstruation
2. organ for gestation

2. Fallopian tube – or oviduct, are 2 trumphet shaped about 8 – 14 cm. in length, 3 – 8 mm

in diameter covered by peritoneum and their lumen lined by mucous membrane.

Parts:
a. Interstitial – the narrow portion contained in the muscular wall of the uterus
approximately 1 cm. in length.
b. Isthmus – proximal to the ampulla. It is the narrow portion of the tube adjoining the
uterus approximately 2 cm. in length.
c. Ampulla – the outer 3rd portion where fertilization occurs and considered as longest
portion with approximately 5 cm. in length.
d. Infundibulum – distal third. Its funnel shaped opening encircles with fimbrae
approximately 2 cm. long. This fimbrae become swollen, almost erectile at ovulation.

 The wall of the fallopian tube is made up of 4 layers :

a. Peritoneal (serous) – covers the tubes.
b. subserous ( adventitial ) – contains the blood and nerve supply
c. Muscular - responsible for the peristaltic movement of the tube.
d. Mucosal – composed of ciliated and unciliated cells with the number of ciliated cells
more abundant at the fimbria.

Any malformation or malfunction of the tubes could result in infertility, ectopic pregnancy
or even sterility. Each fallopian tube is richly supplied with blood by the uterine and
ovarian arteries.

 Functions :
1. site of fertilization
 2. provide transport for the ovum from the ovary to the uterus
3. serve as a warm, moist, nourishing environment for the ovum or zygote

3. Ovaries – 2 almond shaped organ situated in the upper part of the pelvic cavity. The size
varies among women and according to the stage of the menstrual cycle. Each ovary weighs 6 –
10 g with 1.5 – 3 cm wide, 2 – 5 cm long and 1 – 1.5 cm thick. After menopause, ovarian size
diminishes remarkably. The ovary is attached to the broad ligament by the mesovarium. They
also changed in appearance from smooth –surfaced, dull white organs to pitted gray organ.
Scarring due to ovulation causes this pitting.
There is no peritoneal covering for the ovaries. Although this lack of covering assists the mature
ovum to erupt, it also allows easier spread of malignant cells from cancer of the ovaries. A single
layer of cuboidal epithelial cells, called the germinal epithelium covers the ovaries.

 Layers of ovaries :
a. Tunica albuginea - dense and dull white and serves as protective layer.
b. Cortex – main functional part because it contains ova, graafian follicles, corpora
lutea, degenerated corpora lutea (corpora albicantia).
c. Medulla – or central portion of the ovary is composed of loose connective tissue.

Both sympathetic and parasympathetic nerves supply the ovaries. These also
a counterpart to the testes of male organ.

 Functions :
a. ovulation
b. hormone production

CARDIOVASCULAR SYSTEM

The cardiovascular/circulatory system transports food, hormones, metabolic wastes,

and gases (oxygen, carbon dioxide) to and from cells. Components of the circulatory system
include:
  blood: consisting of liquid plasma and cells
 blood vessels (vascular system): the "channels" (arteries, veins, capillaries) which carry
blood to/from all tissues. (Arteries carry blood away from the heart. Veins return blood to
the heart. Capillaries are thin-walled blood vessels in which gas/ nutrient/ waste
exchange occurs.)

 heart: a muscular pump to move the blood

There are two circulatory "circuits": Pulmonary circulation, involving the "right heart," delivers
blood to and from the lungs. The pulmonary artery carries oxygen-poor blood from the "right
heart" to the lungs, where oxygenation and carbon-dioxide removal occur. Pulmonary veins carry
oxygen-rich blood from tbe lungs back to the "left heart." Systemic circulation, driven by the "left
heart," carries blood to the rest of the body. Food products enter the sytem from the digestive
organs into the portal vein. Waste products are removed by the liver and kidneys. All systems
ultimately return to the "right heart" via the inferior and superior vena cavae.

A specialized component of the circulatory system is the lymphatic system, consisting of a moving
fluid (lymph/interstitial fluid); vessels (lymphatics); lymph nodes, and organs (bone marrow, liver,
spleen, thymus). Through the flow of blood in and out of arteries, and into the veins, and through
the lymph nodes and into the lymph, the body is able to eliminate the products of cellular
breakdown and bacterial invasion.

Blood Components

Adults have up to ten pints of blood.

 Forty-five percent (45%) consists of cells - platelets, red blood cells, and white blood cells
(neutrophils, basophils, eosinophils, lymphocytes, monocytes). Of the white blood cells,
neutrophils and lymphocytes are the most important.

Fifty-five percent (55%) consists of plasma, the liquid component of blood

Major Blood Components

Modified from: Joel DeLisa and Walter C. Stolov, "Significant Body Systems," in: Handbook of Severe Disability, edited by
Walter C. Stolov and Michael R. Clowers. US Department of Education,
Rehabilitation Services Administration, 1981, p. 37.

Component Type Source Function

Platelets, cell fragments Bone marrow Blood clotting
life-span: 10
days

Lymphocytes (leukocytes) Bone marrow, Immunity

 spleen, lymph T-cells attack cells containing
nodes viruses. B-cells produce
antibodies.

Red blood cells (erythrocytes), Filled with Bone marrow Oxygen transport
hemoglobin, a compound of iron and protein life-span: 120
days

Neutrophil (leukocyte) Bone marrow Phagocytosis

Plasma, consisting of 90% water and 10% 1. Maintenance of pH

dissolved materials -- nutrients (proteins, salts, level near 7.4
glucose), wastes (urea, creatinine), hormones, 2. Transport of large
enzymes molecules
(e.g. cholesterol)

3. Immunity (globulin)

4. Blood clotting
(fibrinogen)

Vascular System - the Blood Vessels

Arteries, veins, and capillaries comprise the vascular system. Arteries and veins run parallel
throughout the body with a web-like network of capillaries connecting them. Arteries use vessel
size, controlled by the sympathetic nervous system, to move blood by pressure; veins use one-
way valves controlled by muscle contractions.
Arteries
Arteries are strong, elastic vessels adapted for carrying blood away from the heart at relatively
high pumping pressure. Arteries divide into progressively thinner tubes and eventually become
fine branches called arterioles. Blood in arteries is oxygen-rich, with the exception of the
pulmonary artery, which carries blood to the lungs to be oxygenated.

The aorta is the largest artery in the body, the main artery for systemic circulation. The major
branches of the aorta (aortic arch, ascending aorta, descending aorta) supply blood to the head,
abdomen, and extremities. Of special importance are the right and left coronary arteries, that
supply blood to the heart itself.

Major Branches of Systemic Circulation

Source: Joel DeLisa and Walter C. Stolov, "Significant Body Systems," in:
Handbook of Severe Disability, edited by Walter C. Stolov and Michael R.
Clowers. US Department of Education,
Rehabilitation Services Administration, 1981, p. 40.

Name Serves
Head Carotid Brain & skull

Abdomen Mesenteric Intestines

Celiac (Abdominal) Stomach, liver,
spleen

Renal Kidney

Iliac Pelvis

Upper Brachial (axillary) Upper arm

Radial & Ulnar Forearm & hand
Extremity
Dorsal Carpal Fingers

Lower Femoral Thigh

Popliteal Leg
Extremity
Dorsal pedis Foot
Posterior tibial Foot

Capillaries
The arterioles branch into the microscopic capillaries, or capillary
beds, which lie bathed in interstitial fluid, or lymph, produced by
the lymphatic system. Capillaries are the points of exchange
between the blood and surrounding tissues. Materials cross in and
out of the capillaries by passing through or between the cells that
line the capillary. The extensive network of capillaries is estimated at between 50,000 and 60,000
miles long.1

Veins
Blood leaving the capillary beds flows into a series of progressively larger vessels, called venules,
which in turn unite to form veins. Veins are responsible for returning blood to the heart after the
blood and the body cells exchange gases, nutrients, and wastes. Pressure in veins is low, so
veins depend on nearby muscular contractions to move blood along. Veins have valves that
prevent back-flow of blood.

Blood in veins is oxygen-poor, with the exception of the pulmonary veins, which carry oxygenated
blood from the lungs back to the heart. The major veins, like their companion arteries, often take
the name of the organ served. The exceptions are the superior vena cava and the inferior vena
cava, which collect body from all parts of the body (except from the lungs) and channel it back to
the heart.

Artery/Vein Tissues

Arteries and veins have the same three tissue layers, but the proportions
of these layers differ. The innermost is the intima; next comes the media;
and the outermost is the adventitia. Arteries have thick media to absorb
the pressure waves created by the heart's pumping. The smooth-muscle
Blood vessel anatomy media walls expand when pressure surges, then snap back to push the
blood forward when the heart rests. Valves in the arteries prevent back-flow. As blood enters the
capillaries, the pressure falls off. By the time blood reaches the veins, there is little pressure.
Thus, a thick media is no longer needed. Surrounding muscles act to squeeze the blood along
veins. As with arteries, valves are again used to ensure flow in the right direction.

Anatomy of the Heart

The heart is about the size of a man's fist. Located between the lungs, two-thirds of it lies left of
the chest midline The heart, along with the pulmonary (to and from the lungs) and systemic (to
and from the body) circuits, completely separates oxygenated from deoxygenated blood.

Internally, the heart is divided into four hollow chambers, two on the left and two on the right. The
upper chambers of the heart, the atria (singular: atrium), receive blood via veins. Passing through
valves (atrioventricular (AV) valves), blood then enters the lower chambers, the ventricles.
Ventricular contraction forces blood into the arteries.
Oxygen-poor blood empties into the right atrium via the superior and inferior vena cavae. Blood
then passes through the tricuspid valve into the right ventricle which contracts, propelling the
blood into the pulmonary artery. The pulmonary artery is the only artery that carries oxygen-poor
blood. It branches to the right and left lungs. There, gas exchange occurs -- carbon dioxide
diffuses out, oxygen diffuses in.

Pulmonary veins, the only veins that carry oxygen-rich blood, now carry the oxygenated blood
from lungs to the left atrium of the heart. Blood passes through the bicuspid (mitral) valve into the
left ventricle. The ventricle contracts, sending blood under high pressure through the aorta, the
main artery for systemic circulation. The ascending aorta carries blood to the upper body; the
descending aorta, to the lower body.

Blood Pressure and Heart Rate

The heart beats or contracts around 70 times per minute. 1 The human heart will undergo over 3
billion contraction/cardiac cycles during a normal lifetime.

One heartbeat, or cardiac cycle, includes atrial contraction and

relaxation, ventricular contraction and relaxation, and a short
pause. Atria contract while ventricles relax, and vice versa.
Heart valves open and close to limit flow to a single direction.
The sound of the heart contracting and the valves opening and closing produces a characteristic
"lub-dub" sound.
The cardiac cycle consists of two parts: systole (contraction of the heart muscle in the ventricles)
and diastole (relaxation of the ventricular heart muscles). When the ventricles contract, they force
the blood from their chambers into the arteries leaving the heart. The left ventricle empties into
the aorta (systemic circuit) and the right ventricle into the pulmonary artery (pulmonary circuit).
The increased pressure on the arteries due to the contraction of the ventricles (heart pumping)
is called systolic pressure.

When the ventricles relax, blood flows in from the atria. The decreased pressure due to the
relaxation of the ventricles (heart resting) is called diastolic pressure.

Blood pressure is measured in mm of mercury, with the systole in ratio to the diastole. Healthy
young adults should have a ventricular systole of 120mm, and 80mm at ventricular diastole, or
120/80.

Receptors in the arteries and atria sense systemic pressure. Nerve messages from these sensors
communicate conditions to the medulla in the brain. Signals from the medulla regulate blood
pressure.

Electrocardiography (ECG, EKG)

An electrocardiogram measures changes in electrical potential across the heart and detects
contraction pulses that pass over the surface of the heart. There are three slow, negative
changes, known as P, R, and T. Positive deflections are the Q and S waves. The P wave
represents atrial contraction ("the lub"), the T wave the ventricular contraction ("the dub").

EXCRETORY SYSTEM
The excretory system is an organ system that performs the function of excretion, the
bodily process of discharging wastes. It is responsible for the elimination of the waste products of
metabolism as well as other non-useful materials. The main components of the excretory system
are your two kidneys, two tubes that carry urine called ureters, the bladder, and the urethra.

Kidney

The most important organs of the excretory system are the kidneys. The kidneys are placed on
either side of the spinal column near the lower back. The kidneys are bean-shaped and they have
an important job. They are responsible for removing wastes from the blood and they also keep
your blood pressure in check and help with the making of red blood cells. The kidneys filter the
blood and remove any wastes. The Kidney does this via its three lauers which are the Cortex, the
medulla and the pelvis. In the Cortex and Medulla there are Nephrons. These Nephrons comprise
of a Glomerulus (bundle of capilaries), a Bowman's Capsule, a Proximal Convoluted Tubuale, the
decending and ascending Loop of Henle, the Distal Convoluted Tubual and Collecting Ducts. The
collecting ducts come together in the Pelvis. When your body gets ready to pass waste products,
it goes through the kidneys and mixes with water and urine. Then, the waste travels into the
bladder through tubes. These tubes are called Ureters. Now, the bladder holds all of that urine
until it feels so full that you need to get rid of it. That's called urination. When this happens, a tube
called the Urethra takes the urine to the outside of the body.

Ureter
the ureters are muscular ducts that propel urine from the kidneys to the urinary bladder. In the
adult, the ureters are usually 25-30cm (10-12 inches)long.

In humans, the ureters arise from the renal pelvis on the medial aspect of each kidney before
descending towards the bladder on the front of the psoas major muscle. The ureters cross the
pelvic brim near the bifurcation of the iliac arteries (which they run over). This "pelviureteric
junction" is a common site for the impaction of kidney stones (the other being the ureterovesical
valve). The ureters run posteroinferiorly on the lateral walls of the pelvis. They then curve
anteriormedially to enter the bladder through the back, at the vesicoureteric junction, running
within the wall of the bladder for a few centimeters. The backflow of urine is prevented by valves
known as ureterovesical valves, pressure from the filling of the bladder, and the tone of the
muscle in the bladder wall.

In the female, the ureters pass through the mesometrium on the way to the urinary bladder.

Urinary bladder

the urinary bladder is a hollow, muscular, and distensible (or elastic) organ that sits on the pelvic
floor in mammals. It is the organ that collects urine excreted by the kidneys prior to disposal by
urination. Urine enters the bladder via the ureters and exits via the urethra.

In males, the bladder is superior to the prostate, and separated from the rectum by the
rectovesical excavation.

In females, the bladder is separated from the uterus by the vesicouterine excavation.

Urethra

the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the urinary bladder to the
outside of the body. The urethra has an excretory function in both sexes to pass urine to the
outside, and also a reproductive function in the male, as a passage for semen.

The external urethral sphincter is a striated muscle that allows voluntary control over urination.
IV. Patient’s illness

Synthesis of the disease

1. Definition of the disease

Preeclampsia is a pregnancy – specific syndrome that usually

occurs after 20 weeks of gestation and its progress differs among patients,
most cases are diagnosed pre-term. Apart from abortion, Caesarian
section, or induction of labor, and therefore delivery of the placenta, there
is no known cure. It may also occur up to six weeks post-partum. It is the
most common of the dangerous pregnancy complications, it may affect
both the mother and the fetus.It is defined as an elevation in blood
pressure (systolic blood pressure > 14 0mmHg or diastolic pressure > 90
mmHg) and proteinuria (> 300g in 24 hours) developing after 20 weeks of
gestation. Edema, which previously was included in definitions of
eclampsia, was excluded from this most recent definition.

Preeclampsia is a medical condition where hypertension arises in

pregnancy (pregnancy-induced hypertension) in association with
significant amounts of protein in the urine. Because pre-eclampsia refers
to a set of symptoms rather than any causative factor, it is established that
there are many different causes for the syndrome. It also appears likely
that there is a substance or substances from the placenta that may cause
endothelial dysfunction in the maternal blood vessels of susceptible
women. While blood pressure elevation is the most visible sign of the
disease, it involves generalized damage to the maternal endothelium and
kidneys and liver, with the release of vasopressive factors only secondary
to the original damage.

Preeclampsia occurs primarily during first pregnancies subsequent

pregnancies in women with multiple fetuses, diabetes mellitus, or
coexisting renal disease. Pregnancy – induced hypertension is thought to
involve a disease in placental blood flow leading to the release of toxic
mediators that alter the function of endolitheal cells in blood vessels
throughout the body, including those of the kidney, brain, liver and heart.

Etiology

The cause of preeclampsia – eclampsia remains unknown.

Important areas of suspicion in the past have been protein and other
metabolism by the developing placenta, idiosyncratic features of vascular
reactivity, nutritional deficiencies (including protein, calories, sodium,
vitamins and minerals) and smoking.
2. Non - modifiable factors:

 History of preeclampsia. A personal or family history of preeclampsia

increases your risk of developing the condition.
 First pregnancy. The risk of developing preeclampsia is highest during
your first pregnancy or your first pregnancy with a new partner.
 Age. The risk of preeclampsia is higher for pregnant women who are
older than age 35.
 Obesity. The risk of preeclampsia is higher if you're obese.
 Multiple pregnancies. Preeclampsia is more common in women who
are carrying twins, triplets or other multiples.
 Gestational diabetes. Women who develop gestational diabetes have a
higher risk of developing preeclampsia as the pregnancy progresses.
 History of certain conditions. Having certain conditions before you
become pregnant — such as chronic high blood pressure, diabetes,
kidney disease or lupus — increases the risk of preeclampsia.

 Mortality/Morbidity: Preeclampsia is the second leading cause of

maternal mortality, accounting for 12-18% of pregnancy-related maternal
deaths.
 Race: Black women have as much as twice the relative risk of white
women for developing preeclampsia.

Modifiable factors:
Modifiable factors:

 Obesity. The risk of preeclampsia is higher if you're obese.

 Calcium deficiency. Calcium helps maintain vasodilation, so a
deficiency would impair the function of vasodilation.
 Nutritional Problems/Poor Diet. Insufficient protein, excessive protein,
not enough fresh fruit and vegetables (antioxidants), among others
theories.
 High Body Fat. High body fat may actually be the symptom of the
tendency to develop this disorder linked to the genetic tendency towards
high blood pressure, diabetes and insulin resistance.
 Uterine ischemia/ underperfusion. Insufficient blood flow to the uterus.

3. Signs and Symptoms:

Hypertension

 Hypertension is the most significant primary sign of preeclampsia. The

diastolic blood pressure is more reliable than the systolic pressure
because it is less susceptible to extrinsic influences. Any repeated or
constant elevation of the diastolic pressure of 15mm Hg or more above
the pregnancy level must be regarded as hypertension.

Headache and Visual Disturbances

 Severe pounding headache, partial loss of visual acuity, bright/flashing
visual disturbances. Migraines can continue during pregnancy and any
migraine can be excruciating without being life threatening or associated
with signs of pre-eclampsia.

Epigastric Pain
 Epigastric pain, especially if severe or associated with vomiting. The most
sinister epigastric pain is described by the sufferer as severe and is
associated with definite tenderness to deep epigastric palpation.

Sudden excessive weight gain

 Sudden excessive weight gain is a common first sign of impending or

actual preeclampsia. If often develops before the hypertension appears. A
gain of more than 1 kg (2.2 lb) in a week or 3g (6.6 lb) in a month is
generally significant.

Edema

 Edema is first noted in the lower legs, and a small degree of this is normal
in many normal pregnant women. As fluid retention progresses to
imminent or frank preeclampsia, however, the patient is likely to note
puffiness around eyes and tightness of finger rings, particularly on arising
in the morning.

4. Health Promotion and Preventive Aspects

The only known treatments for eclampsia or advancing pre-eclampsia are

abortion or delivery, either by induction or Caesarean section. However, post-
partum pre-eclampsia may occur up to 6 weeks following delivery even if
symptoms were not present during the pregnancy. Post-partum pre-eclampsia is
dangerous to the health of the mother since she may ignore or dismiss
symptoms as simple post-delivery headaches and edema. Hypertension can
sometimes be controlled with anti-hypertensive medication, but any effect this
might have on the progress of the underlying disease is unknown.

There's no known way to prevent preeclampsia. Eating less salt or changing your
activities during pregnancy doesn't reduce the risk. The best way to take care of
yourself and your baby is to seek early and regular prenatal care. If preeclampsia
is detected early, you and your doctor can work together to prevent complications
and make the best choices for you and your baby.

In a preliminary 2006 study, women who took multivitamins and maintained a

healthy weight before conception reduced the risk of developing preeclampsia
during pregnancy by more than 70 percent compared with women of a healthy
weight who didn't take multivitamins or with women who took multivitamins but
were overweight before conception.

Several earlier studies suggested that specific nutritional supplements could

prevent preeclampsia, but these studies haven't stood the test of time. Although a
healthy weight before pregnancy has clear benefits for both mother and baby,
more research is needed to determine the preventive effects of multivitamins and
other nutritional supplements.

Bed rest: Buying time for baby to grow. If you aren't near the end of your
pregnancy and you have a mild case of preeclampsia, your doctor may
recommend bed rest to lower your blood pressure and increase blood flow to
your placenta, giving your baby extra time to mature. You may need to lie in bed,
only sitting and standing when necessary. Or you may be able to sit on the couch
or in bed and strictly limit your activities. Your doctor may want to see you a few
times a week to check your blood pressure, urine protein levels and your baby's
well-being.

If you have more severe preeclampsia, you may need bed rest in the hospital. In
the hospital, you may have regular nonstress tests or biophysical profiles to
monitor your baby's well-being. You may also have ultrasound exams to measure
the volume of amniotic fluid. A lack of amniotic fluid is a sign of poor blood supply
to the baby.
Medications: Helpful for you and your baby. Your doctor may recommend
medication to lower your blood pressure until delivery. If you have severe
preeclampsia or HELLP syndrome, corticosteroid medications can temporarily
improve liver and platelet functioning to help prolong your pregnancy.
Corticosteroids can also help your baby's lungs become more mature in as little
as 48 hours an important step in helping a premature baby prepares for life
outside the womb.

Delivery: The ultimate cure for preeclampsia. If you're diagnosed with

preeclampsia near the end of your pregnancy, you may be treated by inducing
labor right away. The readiness of your cervix whether it's beginning to open
(dilate), thin (efface) and soften (ripen) also may be a factor in determining
whether or when labor will be induced.
V. THE PATIENT AND HIS CARE

A. MEDICAL MANAGEMENT

1. Intravenous Fluid Therapy

Medical Date ordered, General Indication(s)/ Client’s

Management/ Date Description Purposes response to the
Treatment performed, treatment
Date changed.
D5W 1L X 30-31 06/22/08 D5 water is an It is used to Mrs.
gtts./min. 06/22/08 isotonic solution supply water and Preeclampsia
06/22/08 on initial calories to the complied that
administration, it body. It is also she has
provides free used as a fixing regained her
water when solution strength and
dextrose is (diluents) for improved his
metabolized, other IV hydration status
expanding medications. gradually as
intracellular and Dextrose is a evidence by
extracellular fluid natural sugar regulated body
temperature.
volumes. found in the
body and serves
as a major
energy source.
When used as
energy source,
dextrose allows
the body to
preserve its
muscle mass.

D5LRS 1L X 30 06/22/08 It is a sterile, It is indicated as

units oxytocin at 30 06/22/08 nonpyrogenic a source of
– 31 gtts./min. solution for fluid water,
and electrolyte electrolytes and
replenishment calories or as an
and caloric alkalinizing
supply in a agent.
single dose
container for
intravenous
administration.

Nursing Responsibilities:

Prior to:

1. Check the Doctor’s order

2. Check the expiration date of IVF.
3. Inform patient about the IVF to be given.
4. Explain the procedures to the patient or the patient’s significant orders.
 During:

1. Clean the site of administration and observe aseptic technique.

2. Choose vein on the distal arm first.
3. Support patient hand and maintain aseptic technique.
4. Instruct the significant others to support the body of the patient especially
the while inserting the needle.
5. Once in the place regulate the IVF as ordered.
6. Label the IVF bottle properly.

After:

1. Document the IVF properly on the chart.

2. Check for any sign of infection.
3. Monitor the rate flow every hour.
4. Monitor the patency of the tube and the IV site.

B. Drugs

Name of Date ordered, Route of Indication(s) or Specific Client’s

Drugs, Date administration, Purposes foods taken response to
Generic Name, performed, Dosage & the meds w/
Brand Name. Date Frequency of actual S/E
changed. administration.
Magnesium DO: 06/22/08 IV 4 gm It is use to Foods like Mrs.
Sulfate DP: 06/22/08 prevents/controls arozcaldo, Preeclampsia
Seizures by nilaga and feels well
blocking tinolang after taking
neuromuscular manok and the medicine.
transmission and water.
decreasing
amount of
acetylcholine
liberated at end
plate by motor
nerve impulse.

Cephalexin DO: 06/23/08 Oral 500 mg It is used to treat Foods rich in Mrs.
DP: 06/23/08 TID infections by protein, Preeclampsia
bacteria, carbohydrates, felt that the
including upper And calories pain under
respiratory and water. her genital
infections, ear area is
infections, skin lessened.
infections, and
urinary tract
infections.

Mefenamic DO: 06/23/08 Oral 500 mg It is a Foods like Mrs.

Acid DP: 06/23/08 TID nonsteroidal Adobo, Preeclampsia
anti- sinigang, verbalized
inflammatory arrozcaldo and that she feels
drug (NSAID), water. relief.
anti- pyretic,
analgesics. It
may block
certain
substances in
the body that are
linked to
inflammation.
NSAIDs treat the
symptoms of
pain and
inflammation.

Metronidazole DO: 06/23/08 Oral 100 mg It is used to treat Mrs.

DP: 06/23/08 BID or prevent Foods like Preeclampsia
infections that nilagang responded by
are proven or baboy, feeling of
strongly sinigang,water. comfort and
suspected to be relieved.
 caused by
bacteria.

Kalium Durule DO: 06/22/08 Oral 2 tablet Potassium is Foods like, Mrs.
DP: 06/22/08 TID needed to nilagang baka Preeclampsia
maintain good and sinigang regained
health. Although and water. muscle
a balanced diet strength and
usually supplies can move
all the potassium without
a person needs, feeling of
potassium pain in the
supplements muscles and
may be needed bones.
by patients who
do not have
enough
potassium in
their regular diet
or have lost too
much potassium
because of
illness or
treatment with
certain
medicines.

Metoprolol DO: 06/25/08 Oral 100 mg It used to treat Foods like Mrs.
DP: 06/25/08 BID high blood sinigang, Preeclampsia
pressure, alone arrozcaldo and responded by
or with other water. the blood
medicines. pressure of
170/140 to
150/110.

Simvastatin DO: 06/24/08 Oral 40 mg HS It is used in Foods like Mrs.

DP: 0624/08 lowering high Eggcaldo, Preeclampsia
cholesterol and nilaga, water. cholesterol
triglycerides in and
certain patients. triglycerides
It also increases level are
high density lowered down
lipoprotein and the
cholesterol feeling of
levels. It is also dizziness had
used to reduce been
need for medical relieved.
to open blocked
blood vessels.
Amlodipene DO: 06/25/08 Oral mg OD It is used in Foods like Mrs.
DP: 06/25/08 treating high arrozcaldo, Preeclampsia
blood pressure rice, nilagang responded by
and angina baboy and the blood
(chest pain). water. pressure of
170/140 to
150/110.

Ferrous Sulfate DO: 06/23/08 Oral, OD It is used to treat Foods like fish, Mrs.
DP: 06/23/08 iron-deficiency vegetables, Preeclampsia
anemia. Dietary rice, regained the
supplement of arrozcaldo, blood loss
iron. Optimum nilagang baka during her
therapeutic and water. delivery.
responses are
usually noted
within 2-4
weeks.

Nursing Responsibilities:

Prior to:

1. Check the Doctor’s order.

2. Check the medication properly and read labels carefully.
 3. Know the reason for which client is receiving the medication.
4. Check the label 3 times before administering medications.

During:

1. Identify the right client.

2. Administer medication on proper route.
3. Observe for aseptic technique.
4. Administer the medication slowly.

After:

1. Document the given Medication.

2. Assess and document for occurrence of adverse reaction.

C. Diet
 Date ordered Client’s
Date started General Indication/ Specific food response
Type of diet
Date description purpose taken to
changed treatment

NPO DO: 06-22-08 Nothing per This kind of All kinds of Patient
( nothing per DS: 06-22-08 Orem or Nil diet is was foods and verbalized
orem ) DC: 06-23-08 per Os is a ordered for the fluids are hunger but
Latin word for patient for restricted complied
a medical various with the diet
introduction reasons such regimen.
meaning to as for
withhold oral observation,for
foods and aspiration
fluids from a precaution due
patient for to tachypnea,
various vomiting and
reasons. seizure.
OD: 06-23-08
DAT ( diet as DS: 06-23-08 Food rich in The patient
tolerated) The patient protein, complied
can eat rich carbohydrates, with the diet
foods in vitamin C regimen.
carbohydrate, adequate She
protein, intake of regained
vitamin C, fluids. energy as
iron and drink evidenced
fluids as by having
tolerated. slight
increase in
his muscle
strength and
can do
simple
activities of
daily living
with minimal
assistance.

Nursing Responsibilities:
Prior to:

1. Check physician’s order

2. Inform the patient’s SO about the type of diet.
3. Explain the purpose of the diet ordered the consequences of not following
such diet and how it will be implemented.
During:

1. Monitor if the patient complies with the given diet.

2. Monitor intake and output.

After:

1. Document response of the patient.

D. Exercise/ Activity
 Client’s
Date ordered response or
Type of General Indication/
Date started reaction to
exercise description purpose
Date changed the exercise
or activity

Complete DO:06/23/08 Confined in her To promote The patient

bed rest with DS:06/23/08 bed to rest but rest to the had rested
bathroom can do some patient. well and
privilege light activities improved her
like going to condition.
the bathroom
and walking.

Nursing Responsibilities:
Prior to:
1. Check physician’s order
2. Inform the patient’s SO about the type of activity.
3. Explain the purpose of the activity ordered the consequences of not
following such diet and how it will be implemented.
4. Provide proper positioning.

During:

1. Assist the client in doing any activities.

After:

1. Document response of the client.

2. ACTUAL SOAPIE

 June 24, 2008

S > “Hindi ako masyadong nakakatulog kasi nasusuka ako palagi.”
O> Received patient lying on bed, awake, conscious and coherent.
> Appear restless, sleepless and yawning noted.
> Breasts are symmetrical without milk let down
> Urinated once within the shift.
> Defecated once within the shift.
> Lochia Rubra noted, minimal in amount.
> Epysiorraphy not inflamed
> No pain on the calf upon flexion
> No edema on extremeties
> With initial vital signs of: T-37.3 ۫C, PR- 82 bpm, RR-20 bpm, BP-
130/100mmHg
A> Disturbed sleep pattern related to physiological factor (nausea)
P> After 4۫ of NI, the patient will identify individually appropriate interventions to
promote sleep.
I > Established rapport
> Monitored v/s
> Observed physical signs of fatigue
> Identified circumstances that interrupt sleep and frequency.
> Explained necessity of disturbances for monitoring v/s or other care when
client is hospitalized.
> Encouraged to have a warm sponge bath before bed time
> Encouraged to drink milk before bed time
> Encouraged to have adequate food/fluid intake.
> Discouraged taking caffeinated food/beverages before bed time
E > Goal met, patient identified individually appropriate interventions to promote
sleep.

 June 24, 2008

S > “Hindi ako masyadong makatulog kasi nasusuka ako palagi.”

O > Received patient lying on bed, awake, conscious and coherent.
> Appears restless, sleepless, yawning noted
> Breasts are symmetrical without milk let down
> Urinated once within the shift
> defecated once within the shift
> Lochia Rubra noted, minimal in amount
> Epysiorraphy noted not inflamed
> No pain on calf upon flexion
> No edema on extremities
>With initial vital signs of: T- 37.3 °C, P- 82bpm, R-20bpm, and BP-
130/100mmHG.
A > Deficient Fluid Volume related to nausea/vomiting
P > after 4° of NI, the patient will verbalize understanding of causative factors
and purpose of individual therapeutic interventions and medications.
I > Assessed the condition of the patient
> Assessed vital signs: noted strength of peripheral pulses
> Reviewed laboratory data.
> Established 24-hour fluid replacement needs and route to be used.
> Noted client preferences regarding fluid and foods with high fluid content
> Kept fluids within client reach and encourage frequent intake.
> Discussed factors related to occurrence of dehydration.
> Recommended restriction of caffeine, alcohol as indicated.
E > Goal met, the patient verbalized understanding of causative factors and
purpose of individual therapeutic interventions and medications.

 June 24, 2008

S > “Hindi ako masyadong makatulog kasi nasusuka ako palagi.”
O > Received patient lying on bed, awake, conscious and coherent.
> Appears restless, sleepless, yawning noted
> Breasts are symmetrical without milk let down
> Urinated once within the shift
> defecated once within the shift
> Lochia Rubra noted, minimal in amount
> Epysiorraphy noted not inflamed
> No pain on calf upon flexion
> No edema on extremities
>With initial vital signs of: T- 37.3 °C, P- 82bpm, R-20bpm, and BP-
130/100mmHG.
A > Ineffective breastfeeding related to previous history of breastfeeding failure
P > after 4 º of NI, the patient will demonstrate techniques to improve/enhance
breastfeeding.
I > Assessed client knowledge about breastfeeding and extent of instruction that
has been given
> Encouraged discussion of current/ previous breastfeeding experience(s)
> Noted of previous unsatisfactory experiences
> Identified maternal support system; presence and response of significant
other, extended family and friends.
> Determined maternal feeling
> Recommended avoidance or overuse of supplemental feeding and pacifiers
> Encouraged to take warm fluid (soup) to promote milk let down
> Discussed the importance of adequate nutrition/fluid intake, also vitamins and
mineral supplements.
E > Goal met, the patient demonstrated the techniques to improved/enhance
breastfeeding.

 June 25, 2008

S > “Hindi ko nga alam kung may pambayad kami dito.”

O > Received patient lying on bed, awake, conscious and coherent
> Breasts are symmetrical with milk let down
> Urinated once within the shift
> Defecated once within the shift
> Lochia Serosa noted, with minimal in amount
> Epysiorraphy not inflamed
> No pain on calf upon flexion
> No edema noted
> With initial v/s of: T- 37.3 ۫C , P- 79 bpm, R- 18 bpm, BP- 170/140 mmHg
A > Deficient Knowledge related to unfamiliarity with information resources.
P > After 4 hours of NI, the patient will identify relationship of signs and
symptoms to the disease process and correlate symptoms with causative factors.
I > Re-established rapport
> monitored V/S
> Assessed patient’s general condition
> Identified motivating factors for the individual
> Provide information that need to be remembered
> Identified outcome to be achieve
> Identified support persons so requiring information
E > Goal met, patient identified relationship of signs/symptoms to the disease
process and correlate symptoms with causative factors.

 June 25, 2008

S > “Hindi ko nga alam kung may pambayad kami ditto.”

 O > Received patient lying on bed, awake, conscious and coherent
> Breasts are symmetrical with milk let down
> Urinated once within the shift
> Defecated once with the shift
> Lochia Serosa noted with minimal in amount
> Epysiorraphy not inflamed
> No pain on calf upon flexion
> No edema on extremities
> With initial vital signs of: T- 37.3 ºC, P- 79bpm, R-18bpm, BP- 170/140mmHg

A > Anxiety related to situational/maturation crises

P > After 2º of NI, the patient will verbalize awareness of feeling of anxiety
I > Provided health teaching on how to deal with anxiety
> Being available to client for listening and talking
> Acknowledged anxiety/fear. Do not deny or reassure client that everything will
be alright
> Provided accurate information about the situation
> Encouraged client to develop an exercise/activity program

E > Goal met, the patient verbalized awareness of the feeling of anxiety.

VI. CLIENT’S DAILY PROGRESS IN THE HOSPITAL

1. Client’s Daily Progress Chart

DAYS 06/22/08 06/23/08 06/24/08 06/25/08 DISCHARGE
NURSING
PROBLEMS
 Disturbed sleep *
pattern
 Deficient Fluid *
Volume
 Ineffective *
breastfeeding
 Deficient *
Knowledge
 Anxiety *
 Pain *
Vital signs
 Temperature 36.6 37.2 37.2 37.3
 PR 88bpm 81bpm 82bpm 79bpm
 RR 23bpm 26bpm 20bpm 18bpm
 PP 70 60 30 30
 BP 150/80mmHg 160/100mmHg 130/100mmHg 170/140mmHg
Diagnostic/laboratory
procedures
 Blood *
chemistry
 Urinalysis *
 Blood test *
 CBC *
 Chest X-Ray *
Medical
Management
 D5W *
 D5LRS *
Drugs
 Cefalexin * * *
 FeSO4 * * *
 Mefenamic * * *
Acid
 Metronidazol * *
e
 MgSo4 * *
 Kalium * *
Durule
 Metoprolol * *
 Simvastatin * *
 Amlodipene *
Diet
 NPO *
 DAT * * *
Activity Exercise
 CBR * * *

2. DISCHARGE PLANNING
VII. CONCLUSION AND RECOMMENDATIONS

 CONCLUSION
 Upon doing the case study our group gained a lot of information regarding
the Pre-eclampsia (pregnancy-induced hypertension). The group found out that
Pre-eclampsia typically starts after the 20th week of pregnancy and can affects
the placenta that may cause endothelial dysfunction in the maternal blood
vessels of susceptible women. While blood pressure elevation is the most visible
sign of the disease, it involves general damage to the maternal endothelium and
kidneys, liver, and brain. We also learned that pre-eclampsia is also a leading
cause of fetal complication, which include low birth weight, premature birth and
stillbirth. We learned that proper nutrition, monitoring, on time given of medication
and proper management of the health of the client is the best treatment that we
can give to the patient for her to maintain her normal blood pressure and some
other factors concerning her condition.
Finally, after doing the case study, the members of the group
appreciate the Pre-eclampsia than before. As student nurses, we are now
confident in handling a patient with the same illness because they are equipped
with information & enhanced skills through the help of our case study. It is true
that prevention is better than cure.

 RECOMMENDATION

Most of the people now a day are experiencing different symptoms that
they tend to ignore. They don’t even bother to consult doctor to check if there is
something wrong with their health. Until they finally found out that their condition
is already severe.

But experiencing Hypertension should not ignore the symptoms because it

is the most dangerous case. It affects some of the systems and parts of our body
like, the heart, brain, kidney and blood vessels. If it become severe it’s hard to
manage and control. Because we can’t predict the possible things to happen if
Hypertension is occur.

Hypertension can be found out on any ages and gender but the most
dangerous was in pregnant women because they would die or the baby and also
put in critical situation. They need frequent consultation to monitor their situation.
Especially when they reach the second trimester (20 weeks pregnancy) because
it’s the start of what we call “Pregnancy –Induced Hypertension” or Pre-clampsia.
Pre – clampsia is also the leading cause of fetal complications, which include low
birth weight, premature baby and stillbirth.

But not all are aware of this condition because most of the Filipino are
poor and not bother to visit the doctor for consultation because of the kind of
status they have. We are aware uneducated is one of the factors why some
become ignorant .They don’t take any interest on something that they will not
benefit or can cause a lot of money. Because we are aware that the economy
status now is low and all the price of the product in the market is too high.

For example our client, she is pregnant and working even though her
husband is working because they have seven children that need to feed and
provides things and need to send to school. But their salary is not enough for
them to support their big family. She focused on earning some money for their
living and when her pregnancy reaches the second trimester she experienced
increased in blood pressure. She only went to the Barangay health center and
not in a doctor because of having low income. Time past, without even knowing
that her condition become severe and make them spend a lot of money when
she gave birth because of not taking initiative to visit a doctor for consultation and
also the health of her baby become affected.

That’s the most reason of the people who don’t initiative to consult a
doctor of having low income and saying it’s not that really serious. They don’t
know that Hypertension is dangerous condition to pregnant that needs to monitor
by the specialist and need to manage properly.

For the patient:

 They (mothers) should consult a doctor if they fee something wrong with
their health. If they hesitated to consult because of knowing they need to spend a
lot of money for that. That’s not true because there are some hospitals who take
low charge on that consultation like some government hospitals and they can
even buy they medicine in government pharmacy for a low price. They should
think that it’s an investment in maintaining their health in good condition because
having a good health you can work properly and you don’t need to be absent
because you are sick,. You can earn more because you are in good condition. If
you ignore it you tend to become weak, you can’t concentrate on something, you
can’t do you job properly. Especially the pregnant woman, It’s good to secure
your health and the baby than lost it without knowing it.

For the Significant others:

Encourage them to consult a doctor, especially if you are the person who
has more knowledge about it. If you need to explain the possible things to
happen and what are the benefits they can get on that do it. What the pregnant
women needs to do if she is in that situation (Increased BP). You never know on
that thing do is you save not only one’s life but two.

For the Health Care Provider:

Nurses and Doctors are the one who is really responsible in taking care of
the health of the patient. They should give the best service they can give.
Especially those women who are pregnant are need more care and need to take
care because they caring a new life that need support. Teach them on how to
manage their condition, the things that they need and not need to do, the things
that they should aware. Health care providers are the one who have knowledge
on that situation. Explain the possible things that might happen, their condition for
them to be aware. Explain in a way that they understand it, like explain the result
in their level of their understanding for them to know to gain their cooperation.

For the Department of Health:

 For the people to be aware of pregnancy-induced Hypertension, why not
make an advertisement and free consultation for the pregnant in rural areas,
because most of the pregnant women there didn’t know that disease. And also
make it one of their priorities like the TB control program etc… Because those
pregnant women are the one holding the lives of their baby that need proper care
and maintenance in terms of medical treatment. The management of the DOH
can also conduct an seminar (health teaching) in teaching the mother the proper
nutrition and healthy life style to prevent on acquiring some diseases that can
affect their baby inside their womb.

E2 ung pathophy nun gamin…. Hndi to pang pre ec ah!!!!

5. Pathophysiology

Book-Centered

Altered lifestyle Stress Altered Uterine Factors Altered

Uterine Contractions
Altered nutrition emotional Decrease blood flow over distention from

trauma,
Smoking long car commute preeclampsia uterine anomalies,
uterine
Illicit drug use heavy work uncontrolled diabetes infection
Heart dse, abruptio placentae,
Placenta previa

Cathecholamine
Release

others

Abdominal
surgery,
Uterine irritability Decreased placental
gastroenteritis,
Friction pyelonephritis

prostaglandin synthesis

cervical changes

preterm labor
Patient-Centered

Altered lifestyle Stress Altered Uterine Factors Altered

Uterine Contractions
Altered nutrition emotional Decrease blood flow over distention from
heavy work
trauma,
Uterine infection

Cathecholamine
Release

,
Uterine irritability Decreased placental
Friction

prostaglandin synthesis

cervical changes

preterm labor