SEVERE PRE-ECLAMPSIA

Group 4

Introduction
Pre-eclampsia refers to a set of symptoms

rather than any causative factor, and there are many different causes for the condition. It appears likely that there are substances from the placenta that can 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, kidneys, and liver, with the release of vasoconstrictive factors being secondary to the original damage.

 Pre-eclampsia

may develop from 20 weeks gestation (it is considered early onset before 32 weeks, which is associated with increased morbidity). Its progress differs among patients; most cases are diagnosed pre-term. Preeclampsia may also occur up to six weeks postpartum. Apart from Caesarean section or induction of labor (and therefore delivery of the placenta), there is no known cure. It is the most common of the dangerous pregnancy complications; it may affect both the mother and the unborn child.

 There is no proven way to prevent preeclampsia.

Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. The way to "cure" preeclampsia is to deliver the baby. Pre-eclampsia is diagnosed when a pregnant woman develops high blood pressure (two separate readings taken at least six hours apart of 140 or more in systolic blood pressure and/or 90 or more in diastolic blood pressure) and 300 mg of protein in a 24-hour urine sample (proteinuria). A rise in baseline blood pressure (BP) of 30 mmHg systolic or 15 mmHg diastolic, while not meeting the absolute criteria of 140/90, is still considered important to note, but is not

 Pre-eclampsia is also more common in women

who have preexisting hypertension, diabetes, autoimmune diseases, women with a family history of pre-eclampsia, obese women, and women with a multiple gestation (twins or multiple birth). The single most significant risk for developing pre-eclampsia is having had preeclampsia in a previous pregnancy

 All over the world, pre-eclampsia is seen in 5 to

14% of all pregnancies. It is the second most common cause of premature delivery and infant deaths in developing countries. It is also the third cause of death in pregnant women with an estimated 790 dead mothers for every 100,000 live babies. African Americans have the worst mortality rate compared to Caucasians. Young women (less than 20 years old) and older women (35 years old and older) are inclined to develop this condition during the course of pregnancy.

 Extrapolated statistics in Southeastern Asia show

that the Philippines is second to Indonesia with 46,400 incidence based on a population of 86.2 million. This is using the 0.05% incidence rate of pre-eclampsia without considering countryspecific data resources. Filipinas have their share of pre-eclampsia; experiencing manas" (edema), blood in the urine, and hypertension. It is a common belief in the country that sleeveless clothing, afternoon naps, and late showers must be avoided as well as salty, fatty and oily food to prevent pre-eclampsia from happening.

Chief Complaint/Clinical Syndrome

ELEVATED BLOOD PRESSURE

CLIENTS PROFILE
The clients initial is O.E.C, female, 31 y/o, who currently

resides with her husband and siblings at 3108 Kamalig St. Brgy. CAA, Las Pias City. She was born on May 02, 1980 in Loon, Bohol. She is married for eight years. She is a Filipino and was raised as a Roman Catholic. She is a BS Education college undergraduate and she didnt continue her college level due to financial problem. Her occupation is a store keeper. Her usual source of medical care is at the health center. Her usual source of information is the health center and media. She was admitted at University of Perpetual Help Medical Center, last March 06, 2012 about around 12:03 am with chief complaint of elevated blood pressure. She was on a Soft Diet (SD). Her admitting diagnosis was PU 36 4/7 weeks AOG Preeclampsia severe G4P3. Her final diagnosis was PU 36 4/7 weeks AOG Preeclampsia severe G4P4. She underwent Cesarean Section with Bilateral Tubal Ligation;

GORDONS FUNCTIONAL ASSESSMENT HISTORY

Health Perception/Health Management Pattern

A. History of present illness: Mrs. O.E.C verbalized her

overall health as Maayos naman pero ung previous IV injection site ko medyo masakit. When it comes to serious health matters, she seeks the help of a medical care and uses herbal medicines to treat any member of the family who has an ailment. She described that her family always follow the instructions given by a health care professional whenever an illness occurs. She described to keep healthy and to prevent any diseases in her family practices and healthy lifestyle by maintaining good hygiene, eating vegetables, balanced diet, exercising, and monitoring the nutritional health of each member. She visited her dentist twice a year for dental care. She visited her Ob-gyne once a year for pap-smear. She took Tramadol 100mg SIVP, Adalat 20mg/tab 1 tab OD, Ferrous Sulfate 1 tab BID, Mefenamic acid 500mg 1 cap q6, Cefuroxime 500mg 1 tab OD, Dulcolax 1 suppository, 1 Amp Phenegram + 1 Amp Nubain IM, Hydralazine 5mg IV for BP,

 Her initial reason to seek for health care was

amenorrheic for 6 weeks when she self conducted pregnancy test which revealed positive result. She had a total of 6 prenatal checkups, 2 prenatal checkups was due at Health Center. First check up was due at 31 weeks AOG where laboratory work up were requested but not done. At 33 weeks AOG, patient was diagnosed to have bacterial vaginosis, given metronidazole 500 mg BID. Few hours prior to admission (PTA) patient experienced abdominal pain accompanied with 5 episodes of soft stools. No vomiting noted. Sought consult at ER and BP was noted to be elevated and subsequently admitted.

 B. Medical History of Past Health: Mrs. O.E.C

had experienced colds, flu, fever and measles from her childhood till her adulthood. She had an accidental skin burn from plastic on her right lower feet. She never had any operations but she had to be hospitalized because of pregnancy reasons. She is a G3P2 patient. Her mother, present at the interview, said she completed all her immunizations. She said that she has no allergies to foods, drugs, chemicals or environment allergies but she had allergies on her left chest stated during 3rd trimester of her pregnancy until giving birth maybe due to

C. Family History

Nutritional/Metabolic Pattern
Gordons Functional Assessment History

Nutritional/Metabolic Pattern
Mrs. O.E.C eats rice, oatmeal and bread with any kind

of meal for breakfast. Her lunch is frequently vegetables or fishmeal with rice. She said that whatever meal was served at lunch, its the same at dinner. She eats breads as snacks. She drinks water a lot and she drink 1-3 glasses of juices once a week. She drinks coffee 1-3 glasses a day but she stop drinking when she is pregnant. She doesnt have any problems associated with her appetite. Never had any special diet prescribed by the doctor and doesnt have any food preference. She takes iron supplements. She doesnt have any allergies with food and has never experienced any difficulty in consuming food. She said that she observed gaining weight but is not

Elimination Pattern
Gordons Functional Assessment History

Elimination Pattern
Mrs. O.E.C urinates frequently, especially if she

drinks cold water. Her urine color is light yellow and doesnt have any problems on urination. She had an indwelling Foley catheter when she was admitted. She said her bowel movements happen once a day and her stool is yellow brown formed and doesnt have any assistive device for defecating.

Activity/Exercise Pattern
Gordons Functional Assessment History

Activity/Exercise Pattern
Mrs. O.E.C describe that she is ready to go home

after a few days of rest after birth. She exercises frequently (walking). Her leisure activities are usually listening to music and going out with family or friends. She had experienced shortness of breath and colds and doesnt experience any weakness, cough, chest pain, palpitations, leg pain, and muscle joints. She could do full self care with the following activities; feeding, bathing, toileting, bed mobility, dressing, grooming, general mobility, cooking, home maintenance, and shopping.

Sleep/Rest Pattern
Gordons Functional Assessment History

Sleep/Rest Pattern
She said that her sleeping pattern is usually

less than 6 hours because of frequent urination. She goes to bed at around 10 in the evening and wakes up around 8 to 10 in the morning if her sleep is not disrupted. She feels rested after sleep. Her usual rituals before sleep are prayer. She never experienced difficulty staying asleep.

Cognitive/Perceptual Pattern
Gordons Functional Assessment History

Cognitive/Perceptual Pattern
Patient is able to speak and write. She speaks

Tagalog, English, Bicol language and learns best when someone is teaching her. She never experienced any problems with hearing. She has poor vision and needs glasses to see far areas. She never had a visual examination but doesnt experience any dizziness when shes not wearing glasses.

Self-Perception/Self-Concept Pattern
Gordons Functional Assessment History

Self-Perception/Self-Concept Pattern
Mrs. O.E.C described herself as strong but easily

gets upset and tensed. She hasnt experienced anything yet that could make her feel so different. She is now currently happy because she is still alive despite of what complication she has had during pregnancy and she is concern in her baby a lot.

Role/Relationship Pattern
Gordons Functional Assessment History

Role/Relationship Pattern
Mrs. O.E.C lives with her family. She said that her

significant people and their relationship with them are satisfying. Describe her relationship with her family as close. Talk to each other in order to make decisions in their family. She said that they dont have any problems right now. She described that their family income is enough for their daily needs. She has her neighbors as friends. There are 6 members in their family and her husband is the breadwinner and every time there is sick in the family they feels uneasy.

Sexuality/Reproductive Pattern
Gordons Functional Assessment History

Sexuality/Reproductive Pattern
Mrs. O.E.C has now 4 children and no history of

abortion. She doesnt have any sexual problems in her relationship and she said specifically taking pills for 6 months prior to her current baby. The patient is sexually active and has only 1 partner. She said that she is comfortable with her sexual functioning and doesnt have any difficulties. She is unsure of her last date of menstruation and she had her menarche at 12 years old.

Coping/Stress-Tolerance Pattern
Gordons Functional Assessment History

Coping/Stress-Tolerance Pattern
Mrs. O.E.C said that she doesnt have any

changes in her life these past few years. And solve any family problem with talking to each other. Her husband is usually the person she talks to if they have a problem. And she is usually tense if there is a problem.

Value/Belief Pattern
Gordons Functional Assessment History

Value/Belief Pattern
Mrs. O.E.C plans to have her children complete

their education. She also had personal and values beliefs that she believed in and consider religion as big part of her life. She makes decisions with the help of others. She said that what she like most of herself is her kindness. If she is tense she doesnt do anything. She also said that a nurse could provide her comfort with care, providing answer in question and advised.

PHYSICAL EXAMINATION

Skin
Inspection
Fair complexion Warm to touch No presence of lesions except

for striae and moles (+) scar on left foot

Palpation
Skin dry, on both upper and

lower extremities (+) non pitting edema on lower extremities

Scalp and Hair

Inspection Black hair Scalp is clean and dry Evenly distributed (-) Dandruff (-) Lesions (-) Presence of any parasites Fine and thick hair Palpation Scalp is symmetrical upon palpation Scalp is smooth.

Nails
Inspection (+) pale nail beds (+) nail clubbing Palpation Nail is round, hard,

immobile Poor capillary refill of <4 seconds Smooth and firm

Head
Inspection
Head symmetrical, round,

erect and midline No deformities seen Held still and upright

Palpation
Head is hard and smooth (-) Lumps

(-) Depression
(-) Lesions

Eyes
Inspection and

palpation
Eye lashes evenly

distributed Sclera appears white (+) Pale conjunctiva Iris and pupil round Constriction on pupillary response (+) PERRLA

Ears
Inspection
Same color as face Ears are equal in size bilaterally No redness and swelling seen on

both ears has no lesions, enlargement or tenderness no unusual discharges free from obstruction with few cerumen
Palpation
(-) Nodules (-) Lesions (-) tenderness upon palpation of

Nose
Inspection
nose symmetrical in

appearance Same color as face (+) dry nasal mucosa (-) colds no presence of lesions, masses able to sniff through nostrils (-) epistaxis
Palpation
no nodules (-) tenderness

Mouth and Throat

Inspection
Gums have pale-red stippled

surface (-) lesions, inflammation, bleeding Lips symmetrical Lips are moist and smooth Tongue slightly pink with no lesions. Tongue in midline and moves freely

Neck
Inspection
Symmetrical with head in

central position Able to move head without discomfort (-) lesions (-) enlargement of the thyroid gland (+) Full ROM

Palpation
(-) palpable cervical lymph

node Trachea in midline No pain felt upon palpation

Chest
Inspection
Without lesions Quiet rhythmic

and effortless breathing

Palpation
No masses or tendern

ess

Abdomen
Inspection
Abdominal contour

rounded Symmetrical No rashes or lesions (+) striae

Auscultation
Gurgling sounds in

abdomen
Palpation
No swelling

Upper Extremities
Inspection (+) ROM No lesions

Lower Extremities
Inspection Scar is present on right foot (+) Edema on left and right foot (+) ROM

PATHOPHYSIOLOGY

Vasospasm
Vascular effects Kidney effects Interstitial effects
Diffusion of fluid from blood stream into interstitial tissue

Vasoconstriction occurs

Increased permeability of the glomerular membrane

decreased glomerular filtration

Increased kidney tubular

Blood pressure increases

reduces the blood supply to organs

Proteinuria

Lowered urine output and clearance of creatinine

Edema

Poor placental perfusion

ischemia in the panceras

reduce the fetal nutrient and oxygen supply

epigastric pain and elevated amylase creatinine

DIAGNOSTIC TESTS

Complete Blood Count (CBC)

It is one of the most important laboratory tests. Most of the hematologic disease can be diagnosed from the CBC findings. It is frequently part of the routine laboratory work included when a patient is admitted.

Hemoglobin

It is a protein used by red blood cells to distribute oxygen to other tissues and cells in the body. It is traditionally defined as the percentage of RBCs per volume of whole blood. It is a count of the actual number of red blood cells per volume of blood. Cells that deliver oxygen throughout the body and make blood look red. These immune cells form in the bone marrow to help fight infection. High levels may indicate infection. Low levels may result from treatment or disease.

133

110.00 150.00g/L

Within normal range

Hematocrit

0.40

0.37-0.47 L

Within normal range

RBC

4.42

4.50-5.50x1012 L

Massive RBC loss, such as acute hemorrhage

WBC

9.9

4.50 10.00 x 109 /L

Within normal range

Lymphocytes

Include T-cells, B-cells, and NK cells. Viral infections may increase their number. Monocytes are a type of phagocyte. These mature into macrophages, important germ eating cells. A type of phagocyte that produces the anti-inflammatory protein histamine. A high number indicates allergies or parasitic infections. Platelets are cells produced by the bone marrow to help your blood clot in order to stop bleeding from injury.

0.15

0.20 0.40

Indicates viral or bacterial infection Within normal

Monocytes

0.06

0.00 0.07

range

Eosinophil

0.01

0.00 0.05

Within normal range

Platelet Count

174

150.00 400.00

Within normal range

Partial Thromboplastin Time (PTT)

Blood test that measures the time it takes your blood to clot. A PTT test can be used to check for bleeding problems.

Partial Thromboplastin Time

Actual Findings Normal Range Implication

Test

31.4 secs

23-36 secs

Within normal range

Control

29 secs

Prothrombin Time (PT)

It is done to evaluate the blood for its ability to clot. It is often done before surgery to evaluate how likely the patient is to have a bleeding or clotting problem during or after surgery.

Prothrombin Time
Actual Findings Control 12.8 secs Normal Range 10-13 Implication Within normal range

Test INR INR is used to make sure the results from a PT test is the same at one lab as it is at another lab, in order to standardize the results between labs

11.4 secs 0.86 Lesser than or equal to 1.2 Within normal range

Activity %

132%

70-130%

Clinical Chemistry Section: Body Fluids

BUN

It is done to measure kidney function. It is also done to check if the person is suffering from severe dehydration.

3.4

2.5-6.1 mmol/L Within normal range

Creatinine Lactate Dehydrogenase General indicator of the existence and severity of acute or chronic tiss ue damage Potassium testing is frequently ordered, along with other electrolytes, as part of a routine physical.

62 1073

46-92 umol/L 313-616 u/L

Within normal range Indicative of tissue damage

Potassium

2.9 (2x done)

3.5-5.1 mmol/L

Indicative of electrolyte imbalance and dehydration

SGOT

Serum Glutamic Oxaloacetic transaminase

It is also called aspartate transaminase. An enzyme that is normally present in liver and heart cells. SGPT is released into blood when the liver or heart is damaged. It is used to measure liver function. It is also called alanine aminotransferase. An enzyme that is normally present in liver and heart cells. SGPT is released into blood when the liver or heart is damaged. It is used to measure liver function.

107

14-36 u/L

Indicative of liver damage

SGPT Serum Glutamic Pyruvic transaminase

74

9-52 u/L

Indicative of liver damage

Sodium

To identify an electrolyte imbalance. is also used to see if a person with high blood pressure is eating too much salt.

139

137-145 mmol/L

Within normal range

Uric Acid

It is done to see if you have high levels of uric acid in your blood. High levels of uric acid can cause gout or kidney disease.

520

149-369 umol/L

An overproduction of uric acid occurs when there is excessive breakdown of cells, or a kidney problem with the inability of the kidneys to excrete uric acid. An increase in the serum uric acid could be a sign of a worsening preeclampsia.

Urinalysis
The urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or cellular material in the urine associated with different metabolic and kidney disorders. It is ordered widely and routinely to detect any abnormalities that require follow up.

Color

Light Yellow Hazy

Amber Yellow Clear

Normal

Transparency

It indicates bacterial infection, but can also be caused by crystallization of salts Within normal range

Reaction (pH)

Urine pH is used to classify urine as either a dilute acid or base solution It measures the amount of proteins, such as albumin, found in a urine sample. It measures the concentration of all chemical particles in the urine. It measures the number of red blood cells in a urine sample

6.5

4.5-7.5

Protein

+2

It is an indication that the client has pre-eclampsia Within normal range

Specific Gravity RBC

1.025

1.0031.035 4/HPF

1-3/HPF

Pus Cells

10-15/ HPF

0-5/ HPF

It may indicate urinary tract infection

CLINICAL FINDINGS, SIGNIFICANT SIGNS AND SYMPTOMS

CLINICAL FINDINGS
Blood pressure 180/120: It is probably in response to a

gradual loss of resistance to angiotensin II. This response has been linked to the ratio between the prostaglandins prostacyclin and thromboxane. Prostacyclin is a potent vasodilator. It is decreased in preeclampsia. This changes the ratio between the prostaglandins, allowing the potent vasoconstriction and platelet- aggregating effect of thromboxane to dominate. Proteinuria 2+: means the presence of an excess of serum proteins in the urine due to increased permeability of the glomerular membrane Decreased lymphocytes due to surgery. Increased Lactate dehydrogenase due to tissue damage. LDH elevated in a wide variety of conditions reflecting its widespread tissue distribution. Decreased potassium indicates electrolyte imbalance Elevated liver enzymes

PROBLEM LIST (PRIORITIZATION AND JUSTIFICATION OF PROBLEMS)

Actual or Active
PROBLEM NO. PROBLEM JUSTIFICATION

Acute pain

Client verbalized pain

Increased Cardiac Output

Elevated BP

Disturbed body image Client expressed her concerns about her figure

Potential or High Risk

PROBLEM NO. PROBLEM JUSTIFICATION

Risk for deficient fluid volume

Clients fluid intake is decreased

Risk for electrolyte imbalance

Clients Potassium level: 2.9 mmol/L (NV: 3.5-5)

NURSING DIAGNOSIS

Nursing Diagnosis
1. Acute pain related to post operative procedure

as evidenced by the patient report of demonstrate discomfort 2. Increased Cardiac Output related to severe preeclampsia as evidence by elevated blood pressure 3. Disturbed body image related to edema as evidence by self pity 4. Risk for deficient fluid volume related to edema as evidence by decrease fluid intake 5. Risk for electrolyte imbalance related to decrease fluid intake as evidence by lowered potassium level

NURSING CARE PLAN

Assessment
Subjective: Masakit yung tahi ko sa tiyan Pain scale: 7 /10 Objective: Facial grimace showing pain With abdominal incision; dry and intact With abdominal binder (-) serosanguino us secretions on the incision site

Diagnosis
Acute pain related to post operative procedure as evidenced by the patient report of demonstrate discomfort

Planning
After 3 days, the client will: Relieved from pain Able to participate in health maintenance to prevent infection Will be able to display improvement in wound healing

Intervention
Assess for referred pain, as an appropriate

Rationale
To determine possibility of underlying condition requiring treatment Pain is a subjective experience and cannot be felt by others To maintain acceptable level of pain. Notify physician if regimen is inadequate to meet pain control goal To prevent fatigue

Evaluation
Goal was met, client was relieved from pain and showed an improvement in wound healing.

Accept clients description of pain

Administer analgesics, as indicated, to maximum dosage, as needed

Encourage adequate rest periods Discuss with SO(s) ways in which they can assist client and reduce precipitating factors that may cause or increase pain

Assessment Diagnosis
Subjective: Hindi naman ako nahihilo Objective: Blood Pressure of 180/120 upon admission No presence of dizziness Pt. is ambulatory Increased Cardiac Output related to severe preeclampsia as evidence by elevated blood pressure

Planning
After 2 days, the client: Will obtain stable and normal blood pressure. Will be free from risk of further complications .

Intervention
Reminded to maintain on SD diet.

Rationale
Soft Diet could help to lessen cardiac output because of the decrease effort in chewing the food. This decrease in mechanical digestion could also help to decrease cardiac output Adequate bed rest could decrease cardiac workload and lowers BP. To prevent further complications and to monitor if BP was still elevated Antihypertensive drugs decrease cardiac workload, excitability of the heart and lowers BP.

Evaluation
Goal was met, there is no further elevation of Blood Pressure and risk of complications.

Emphasized importance of adequate rest

Monitored v/s q 4H

Give antihypertensive medications as ordered by the physician

Assessment
Subjective: May namamaga parin pala sa paa ko, akala ko nga mawawala na yan pagka panganak ko Nakakahiya nga minsan kasi parang ang panget tingnan Objective: Presence of edema in both feet. Disturbed facial expression

Diagnosis
Disturbed body image related to Edema as evidence by self pity

Planning
After 3 days, the client will: Be relieved from edema Not be disturbed with her physical appearance again.

Intervention
Advised client to lessen fluid and sodium.

Rationale
Lessening sodium and fluid intake may help to lessen edema and prevent further fluid retention. Knowing the causative factor could help in preparing for a better intervention and preventing further complications. To know if the patient could easily cope and recover with certain emotional or physical disturbances, so that further interventions could be done.

Evaluation
Goal was met, the edema was getting smaller and patient was able to cope and understand the situation.

Assess for causative factor

To determine coping abilities and skills

Assessment
Subjective: Objective: Dry lips Decreased fluid intake.

Diagnosis
Risk for deficient fluid volume related to edema as evidence by decrease fluid intake

Planning
While there is a restriction of fluid, patient should not be dehydrated.

Intervention
Assess factors that may contribute to dehydration.

Rationale
Noting factors that may contribute to dehydration may prevent further risk or deficit. Assessing this could help to determine if there is already a presence of dehydration Monitoring Input and Output could ensure accurate fluid status, such as loss and intake. Teach the patient on proper fluid control like drinking on sips rather than gulps.

Evaluation
Clients responses to treatment, teachings and actions performed.

Assess skin turgor and oral mucous membranes

Monitor Input and Output

To promote wellness by doing a health teaching

Assessment
Subjective: Objective: Diagnostic result of decreased potassium level (2.9 mmol/L)

Diagnosis
Risk for electrolyte imbalance related to decrease fluid intake as evidence by lowered potassium level

Planning
In further diagnosis patient will display laboratory results within normal range for an individual and will be free of complications resulting from electrolyte imbalance.

Intervention
Monitor heart rate and rhythm by palpation and auscultation.

Rationale
Tachycardia, bradycardia, and other dysrrhythmias are associated with potassium, calcium and magnesium imbalances. Factors such as inability to drink, large diuresis or kidney failure, trauma and surgery affect individuals fluid imbalance. This is to determine what proper food or nutrients should be given to the pt. To monitor if there is further decrease of electrolytes

Evaluation
Clients responses to treatment and actions performed.

Monitor fluid intake and output

Identify potential electrolyte deficit

Laboratory testing

DRUG STUDY

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION Dizziness Drowsiness Depression Hypotension Palpitations Bradycardia

NURSING RESPONSIBILITIES Monitor for signs and symptoms of adverse cardiovascular reactions. Frequently assess vital signs, especially BP and pulse. Monitor for drug tolerance and efficacy Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light headedness caused by sudden decrease of BP Dont stop medication abruptly

Stimulates alphaadrenergic BRAND NAME receptors in CNS, Clonidine decreasing sympathetic DOSAGE outflow, inhibiting 75 mg/day vasoconstriction, and ultimately FREQUENCY reducing blood PRN for BP pressure. Also prevents ROUTE transmission of oral pain impulses by inhibiting paon pathway signals in brain. CLASSIFICATION antihypertensive

Catapres

Hypertension, alone or with other drugs, especially diuretics

Hypersensitivity to drug Concurrent anticoagulant therapy Renal insufficiency, serious cardiac or cerebrovascular disease Elderly patients Pregnancy and lactation

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES Monitor urine output Monitor electrolyte levels and liver function tests

Magnesium Sulfate Increases osmotic gradient in small BRAND NAME intestine, which draws MgSO4 water into intestines and causes distention. These DOSAGE effects stimulate 4g or 5g peristalsis and bowel evacuation. In antacid FREQUENCY action, reacts with HCL Q6 in stomach to form water and increase ROUTE gastric pH. In IM anticonvulsant action, depresses CNS & blocks transmission of peripheral neuromuscular impulses. CLASSIFICATION Electrolyte replacement, laxative, antacid, anticonvulsant

Mild magnesium deficiency

Hypermagnese mia Heart block Myocardial damage Active labor or within 2 hours of delivery Renal impairment Pregnancy

Hypermagn esemia Hypocalce mia

Advise patient to consult physician in taking magnesium if hes taking other medications.
Ensure pregnancy before taking the drug

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES Assess patients response todrug 30 min. after administration Tell patient drug works best when taken before pain becomes severe Instruct patient to consult physician before use of other OTC drugs Inform patient that drug can cause physical & psychological dependence

Tramadol BRAND NAME Tramadol hydrochoride DOSAGE 100 mg/day FREQUENCY QID ROUTE oral

Inhibits reuptake of serotonin and norepinephrine in CNS CLASSIFICATION Analgesic

Moderately severe acute pain

Hypersensitivi ty to drug Renal and hepatic impairment Pregnancy Breastfeeding

Dizziness Headache Drowsiness Vasodilation

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION Hypersensitivi ty to drug, aspirin and other NSAIDs Concurrent use of aspirin and other NSAIDs Renal impairment Labor and delivery Breastfeeding Pregnancy

ADVERSE REACTION

NURSING RESPONSIBILITIES Monitor for adverse reactions Inform patient that drug is meant for short term pain management Instruct patient to avoid aspirin Caution female patient to avoid drug if breastfeeding

Ketorolac BRAND NAME Ketorolac tromethamine DOSAGE 30 mg/day FREQUENCY Q8 x 3 doses ROUTE Oral

Interferes with prostaglandin biosynthesis by inhibiting cyclooxygenase pathway of arachidonic acid metabolism; also acts as potent inhibitor of platelet aggregation CLASSIFICATION Analgesic, Antipyretic, antiinflammatory

Moderately severe acute pain

Dizziness Headache Drowsiness Hypertension Constipation Excessive thirst Edema

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION Hypersensitivi ty to cephalosporin s or penicillins Renal and hepatic impairment Pregnancy Breastfeeding

ADVERSE REACTION Hyperactivity Seizures Headache Renal dysfunction Hepatic dsyfunction Hemolytic anemia

NURSING RESPONSIBILITIES Monitor for adverse reactions Monitor neurologic status Monitor kidney & liver function test results. Intake and output. Monitor temperature Instruct patient to take drug with food 12 hours as prescribed Advise patient to report CNS changes

Interferes with bacterial cell wall BRAND NAME synthesis and Cefuroxime sodium division by binding to cell wall, causing DOSAGE cell to die. Active 100 mg/day against gramnegative and gramFREQUENCY positive bacteria, OD with expanded activity against ROUTE gram-negative Oral bacteria. Exhibits minimal immunosuppresant activity. Cefuroxime CLASSIFICATION Anti-infective

Moderate to severe infections, including those of skin, bone, joints, urinary or respiratory, gynecologic infections

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES Monitor for vital signs and cardiovascular status. Tell patient that medication can be given with or without meals. Tell patient to swallow drug whole, on empty stomach and not with grape fruit juice

Adalat BRAND NAME Nifedipine DOSAGE 20 mg/day FREQUENCY OD ROUTE oral

Inhibits calcium transport into mycardial and vascular smooth muscles cells, suppressing contractions. Dilates main coronary arteries and arterioles and inhibits coronary artery spasm, increasing oxygen delivery to heart and decreasing frequency and severity of angina attacks CLASSIFICATION Antihypertensive

Hypertension

Hypersensitivi ty to drug Chronic renal impairment Pregnancy Breastfeeding patients

Headache Dizziness Fatigue Hypotension Constipation

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES give drugs with meals(to avoid GI upset, n&v), warn patient that stool may be dark and tarry, constipation or diarrhea mayb occur, advice patient to drink FeSO4 with orange juice or any drinks rich in vit. C

Ferrous Sulfate BRAND NAME Feosol DOSAGE 1 tab FREQUENCY OD ROUTE oral

elevates serum iron concentration, which then helps to form hgb or trapped in the reticuloendothelial cells for storage and eventual conversion to a usable form of iron. CLASSIFICATION iron preparation, anti-anemics

prevention and treatment of iron deficiency anemia. Dietary supplemental for iron

allergyto any ingredients, sulfate allergy, hemochromato sis, hemosiderosis, hemolytic anemias.

GI irritation, anorexia, nausea and vomiting, diarrhea, constipation, dark stool

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION Contraindicated in patients hypersensitive to drug or other cephalosporins. Use cautiously in breastfeeding in women and in patients in history of colitis or renal insufficiency.

ADVERSE REACTION

NURSING RESPONSIBILITIES Before administering, ask patient if he is allergic to penicillins or cephalosporins. Obtain specimen for culture and sensitivity tests before giving first dose. After constitution, drug may be stored for 24 hours at room temperature or 1 week under refrigeration. If large doses are given, therapy is prolonged, or patient is at high risk, monitor for sign and symptoms.

Cefoxitin sodium BRAND NAME Mefoxin DOSAGE 2g FREQUENCY ROUTE IV

Second-generation cephalosporins that inhibits cellwall synthesis, promoting osmotic instability; usually bactericidal CLASSIFICATION Cephalosporins

Serious infections of the respiratory and GU tracts; skin, softtissue, bone and joint infections; bloodstream and intra-abdominal infections caused by susceptible organisms (such as Escherichia coli and other coliform bacteria, penicilinase, and non penicilinase producing staphylococcus aureus, S. Epiderdimis, streprococci, klebsiella, haemophilus influenza, and bacteroides, including B. Fragilis)

Fever,hypotension, phlebitis, thrombophlebitis, nausea, vomiting, dypnea, urticaria.

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION Contraindicated in patients hypersensitivity to drug. Certain commercial preparations contain sodium metabisulfate.

ADVERSE REACTION

NURSING RESPONSIBILITIES

Nalbuphine hydrochloride BRAND NAME Nubain DOSAGE 1 ampule ROUTE IM

Unknown. Binds with opiate receptor in the CNS, altering perception of and emotional response to pain. CLASSIFICATION Central nervous system drugs

Moderate to severe pain.

Reassess patients Cramps, dyspepsia, level of pain at least 15 to 30 min. bitter taste, after parenteral administration. nausea, vomiting Monitor circulatory constipation, and respiratory status and bladder biliary tract and bowel function. spasms. Constipation is often severe with maintenance therapy. Make sure stool softener or other laxative is ordered.

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE REACTION

NURSING RESPONSIBILITIES Accept and acknowledge client description of pain. Advised patient to eat foods rich in fiber like apple, pineapple, banana and drink orange juices. Determine fluid intake Observe nonverbal cues like facial grimace, how clients walk and holds body sits. Provide comfort measures.

Mefenamic Acid BRAND NAME PONSTEL DOSAGE 250 mg 500 mg FREQUENCY PRN ROUTE ORAL

Produces antiinflammatory, analgesic, antipyretic effects, possibly by inhibiting prostaglandin synthesis. CLASSIFICATION ANALGESIC, ANTIPYRETIC

Contraindicated Mild to patients moderate pain, hypersensitivity to dysmenorrhea drugs; history of aspirin or NSAID induced bronchospasm, allergic rhinitis or urticarial; GI ulceration or inflammation; renal disease.

GI: Nausea, diarrhea, peptic ulceration, GI bleeding, anorexia, flatulence and constipation

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION Contraindicated with hypersensitivity to anti histamine or phenothiazine. Use cautiously with lower respiratory tract.

ADVERSE REACTION GI: Epigastric distress, nausea, vomiting, diarrhea, constipation.

NURSING RESPONSIBILITIES Monitor neurologic status. Stay alert for sign and symptoms of neuroleptic malignant syndrome (high fever, sweating, unstable blood pressure, muscle riginity, and autonomic dysfunction. Monitor CBC anfd liver function tests. In long-term therapy, assess for other adverse CNS effects, including extra pyramidal reactions.

Promethazine hydrochloride BRAND NAME Phenergan DOSAGE 1ampule ROUTE IM

Diminishing the effect of histamine on cells of the upper respiratory tract and eyes and decreasing sneezing, mucus production, itching and tearing that accompanied allergic reaction. CLASSIFICATION Antiemetic

Symptomatic relief of perennial and seasonal allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis. Preoperative, Postoperative or obstetric sedation

DISCHARGE PLANNING

Medications

Cefuroxime
Administer 100 mg/day once a day

Report to the physician any adverse reactions

(Hyperactivity, Seizures, Headache) Instruct to take drug with food 12 hours as prescribed

Adalat
Administer 20 mg/day once a day

Medication can be given with or without meals.

Swallow the whole drug, on empty stomach and

not with grape fruit juice

Mefenamic Acid
Administer 500 mg as necessary.

Accept and acknowledge client description of

pain. Advised patient to eat foods rich in fiber like apple, pineapple, banana and drink orange juices.

Ferrous Sulfate
Administer 1 tab once a day

Take drugs with meals(to avoid GI upset, n&v)

Stool may be dark and tarry Constipation or diarrhea may occur Drink FeSO4 with orange juice or any drinks rich

in vit. C

Exercise
Generally, it is recommended that women wait about eight

weeks if they have had a cesarean. However, some women can start exercising before this. Instruct the patient that if she feels her body is ready, she should decide to start an exercise program, discuss it with her health care provider first.
She should also continue with her Kegel exercises to

strengthen her pelvic floor muscles. If she underwent cesarean, it is best to wait until her bleeding stopped and her health care provider has given her the green light before she starts doing any form of postnatal exercises.
Postnatal fitness can help ease a host of discomforts simply

by increasing her circulation. Exercise can also help with any postpartum depression she might be experiencing. Plus, if she maintained her exercise, she will be providing her children with an excellent example of how to stay healthy. To maximize the benefits of the exercise, she should try to stick to a well-balanced, healthy diet. And instruct her that

Treatment
Advise the client not to engage in any house

chores that might jeopardize her health.

Health teaching
Mother

Breastfeeding
Motivate the mother by informing her of breast

feeding benefits Wash hands before handing the breast Do not use soap, alcohol, antiseptic agents in cleaning the breast especially the nipples Express a small amount of milk before feeding time Breastfeed when the baby demands Empty the breast with each feeding Expose breast to air Advise mother to wear nursing bra Manage pain from engorgement by feeding the baby or by the use breast pump Use a bra lined with clean cotton gauze to absorb moisture

Sex
Traditionally, midwives and doctors have advised

that a woman shouldn't consider having full sex (i.e. intercourse) until after her postnatal checkup. This examination usually takes place about six weeks after the birth.
She should consult with her doctor who does her

postnatal examination for advice on when to resume intercourse with her partner particularly about using additional lubrication.

Work
If she needs to return to work soon after

the baby is born, instruct her to start planning during her pregnancy. Adjusting to dual roles as mother or father and working parent takes time.

Health Teaching
Baby

Cord Care
Use cotton balls with alcohol on cleaning the cord

Clean the cord from the base up to the tip

Never try to pull the cord off. The cord will fall on its

own. Keep the cord on the outside of the baby's diaper. Call the baby's physician if there is: Bleeding from the end of the cord or the area near the skin. Pus (a yellow or white discharge). Swelling or redness around the navel. Signs that the navel area is painful to the baby.

Bathing the baby

Prepare all the equipment needed: soap, towel,

wash cloth, water, basin. Be sure to place these items where she can easily reach them so that her baby is never unattended. The water should be on the right temperature (not hot, and not cold) To prevent chilling, slowly undress the baby and wrap in a towel and uncover the part shes currently washing. Do not use soap on babys face. Remember to start with the face and the neck and do the diaper area last.

Newborn Screening (NBS)

Ideally, the baby undergoes Newborn Screening

(NBS) within three days after birth. NBS will be able to tell if the baby was born with any metabolic disorders that will affect the body's normal processes and functions.

Immunization
Immunization protects against several dangerous

diseases. A child who is not immunized is more likely to become undernourished, to become disabled, and to die. Immunization protects children against some of the most dangerous diseases of childhood. A child is immunized by vaccines, which are injected or given by mouth. The vaccines work by building up the child's defenses. If the diseases strike before a child is immunized, immunization is too late. A child who is not immunized is very likely to get measles, chicken pox, mumps, rubella, and polio. These diseases can kill. But even children who

Out Patient (follow-up)

The patients doctor or midwife will want

to see her four to six weeks after giving birth to check on her physical recovery from pregnancy and delivery, see how shes doing emotionally, and address her needs going forward. The practitioner will need to check the womans incision a week or two after delivery to make sure it's healing properly.

Diet
Advise

client to eat proper diet. Encourage her to eat more vegetable and frequent intake of liquids. Advise her to eat food, which are rich in proteins such as meat, milk, cheese, fish, beans, nuts, grains, etc. Iron like soy beans, tofu, spinach, shrimp, etc. And vitamin C, like orange, papaya, kiwi, strawberry and green leafy vegetables. Protein helps to repair body tissue; iron provides formation of RBC and ascorbic acid for helping absorption of iron.

References/Bibliography
NCM Book

NANDA
Drug handbook

Thank You!!!