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CASE STUDY
Pregnancy Induced Hypertension
Introduction ,[object Object],[object Object],[object Object],[object Object]
Demographic Data
Eclampsia was found to be more common among young and adolescent women . Age Distribution Age group [ years  ] 22 [46.80%] 19 [40.42%] 3 [6.38% ] 3 [ 6.38%] 19 or less 20-24 25-29 30 or more
Significance of the Study ,[object Object],[object Object],[object Object]
Study of the Subject Matter
What is Pregnancy-induced Hypertension? ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy  and Physiology
Reproductive System
[object Object],[object Object],[object Object],[object Object],[object Object]
Baby and Placenta
[object Object]
Blood Vessel
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Structure and Functions of Blood Vessels Structure Functions Arteries  - The walls (outer structure) of arteries contain smooth muscle fiber that contract and relax under the instructions of the sympathetic nervous system. Transport blood away from the heart; Transport oxygenated blood only (except in the case of the pulmonary artery). Arterioles  - Arterioles are tiny branches of arteries that lead to capillaries. These are also under the control of the sympathetic nervous system, and constrict and dilate, to regulate blood flow. Transport blood from arteries to capillaries; Arterioles are the main regulators of blood flow and pressure. Venules  - Venules are minute vessels that drain blood from capillaries and into veins. Many venules unite to form a vein. Drains blood from capillaries into veins, for return to the heart
Structure Functions Capillaries  - Capillaries are tiny (extremely narrow) blood vessels, of approximately 5-20 micro-metres  (one micro-metre = 0.000001metre) diameter. There are networks of capillaries in most of the organs and tissues of the body. These capillaries are supplied with blood by arterioles and drained by venules. Capillary walls are only one cell thick (see diagram), which permits exchanges of material between the contents of the capillary and the surrounding tissue.  Function is to supply tissues with components of, and carried by, the blood, and also to remove waste from the surrounding cells ... as opposed to simply moving the blood around the body (in the case of other blood vessels); Exchange of oxygen, carbon dioxide, water, salts, etc., between the blood and the surrounding body tissues. Veins  - The walls (outer structure) of veins consist of three layers of tissues that are thinner and less elastic than the corresponding layers of arteries. Veins include valves that aid the return of blood to the heart by preventing blood from flowing in the reverse direction. Transport blood towards the heart; Transport deoxygenated blood only (except in the case of the pulmonary vein).
Comparison between Arteries and Veins Arteries Veins Transport blood away  from  the heart; Transport blood  towards  the heart; Carry  Oxygenated  Blood  (except in the case of the Pulmonary Artery); Carry  De-oxygenated  Blood (except in the case of the Pulmonary Vein); Have relatively  narrow  lumens Have relatively  wide  lumens (see diagram above);  Have relatively  more  muscle/elastic tissue; Have relatively  less  muscle/elastic tissue; Transports blood under  higher  pressure (than veins); Transports blood under  lower  pressure (than arteries); Do not have valves  (except for the semi-lunar valves of the pulmonary artery and the aorta). Have valves  throughout the main veins of the body. These are to prevent blood flowing in the wrong direction, as this could (in theory) return waste materials to the tissues.
 
Narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. When blood vessels constrict, the flow of blood is restricted or slowed, thus, retaining body heat and increasing vascular resistance. Cutaneously, this makes the skin turn paler because less blood reaches the surface. This helps to prevent the radiation of heat. Blood Vessel are tubes which carry blood. Veins are blood vessels which carry blood from the body back to the heart. Arteries are blood vessels which carry blood from the heart to the body. There are a few main blood vessels which connect to different chambers of the heart. The aorta is the largest artery in our body. The left ventricle pumps blood into the aorta which then carries it to the rest of the body through smaller arteries. The pulmonary trunk is the large artery which the right ventricle pumps into. It splits into pulmonary arteries which take the blood to the lungs. The pulmonary veins take blood from the lungs to the left atrium. All the other veins in our body drain into the inferior vena cava (IVC) or the superior vena cava (SVC). These two large veins then take the blood from the rest of the body into the right atrium.   Abnormal Normal
Heart
[object Object],[object Object],[object Object],[object Object],[object Object]
Blood flow through the Heart
Brain Controls the central nervous system (CNS), by way of the cranial nerves and spinal cord, the peripheral nervous system (PNS) and regulates virtually all human activity. Involuntary, or "lower," actions, such as heart rate, respiration, and digestion, are unconsciously governed by the brain, specifically through the autonomic nervous system. Complex, or "higher," mental activity, such as thought, reason, and abstraction, is consciously controlled.
Neurons
Generalized seizures are caused by abnormal electrical activity at multiple locations in the brain and/or over a large area of the brain. This results in loss of consciousness and body stiffening, which is followed by shaking of the arms and legs. Abnormal electrical activity may start in one part of the brain and cause isolated symptoms. Sometimes this abnormal electrical activity spreads through the brain, resulting in a generalized seizure. Seizures can be caused by a specific area of the brain that is injured or inflamed, or they can be due to stress on the brain from a more widespread systemic process, such as severely low blood sugar.
Name:  Ms. M.T Age:  19 Sex:  Female Address:  69 Pooc Maligaya, San Vicente, San Pedro Laguna Civil Status:  Single Occupation:  None Name of Spouse:  Mr. Benigno Carpellar Date of Admission:  August 07, 2008 PATIENT’S PROFILE
Chief Complaint:  Seizures History of present Illness:  Patient delivered at San Pedro Municipal Hospital. After hours she had 2 episodes of tonic clonic seizures hence referral to our institution and then subsequently admitted. Physical Examination:  Li open, uterus oblique, no abnormal masses  Admitting Diagnosis:  NSD Day 0 Post Partum Eclampsia G1P1(1001) BRIEF HISTORY
LABORATORY RESULTS
HEMATOLOGY: Diagnostic Exam Result Normal Range Findings Hemoglobin 136 M:140-170 / F:120-140 gml/dl Increased Hematocrit .41 M:0.44-0.54 – F:0.37-.47 Normal WBC 9.0 5.0-10.0 Normal Platelet 280 150-400cc/mL Normal ABO Typing “ A”
DIFFERENTIAL COUNT : Diagnostic Exam Result Normal Range Findings Segmenter 69 40-60 Increased Lymphocytes 31 20-40 Normal
URINALYSIS: Diagnostic Exam Result Normal Range Findings Color Yellow Yellow/Amber Normal Transparency Clear Clear Normal Reaction 5.0 4.8-7.8 Normal SP Gravity 1.030 1.015-1.025 Increased Sugar Negative Negative Normal Protein Negative Negative Normal Pus Cells 2-3 HPF 0-4 HPF Increased RBC 1.5-2.0 HPF 0-3 HPF Normal Epithelial Cells Few Few Present Normal
BLOOD CHEMISTRY: Diagnostic Exam Result Normal Range Findings BUN 12.3 mg/dl 10-50 mg/dl Normal Creatinine 1.1 mg/dl F:0.5-1.0 mg/dl M:0.6-1.2 mg Increased SGOT 26.8 1u/L 10-40 IU/L Normal SGPT 13.9 1u/L 5-35 IU/L Normal
PATHOPHYSIOLOGY
MEDICAL MANAGEMENT   DOCTOR’S ORDER RATIONALE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DOCTOR’S ORDER RATIONALE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Drug Study
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Contraindicated in patients hypersensitive to drug or other cephalosporins. Infections of the urinary and lower respiratory tracts. Cefuroxime is a second-generation Cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal. Generic Name Cefuroxime Classification:   Cephalosporin, second generation Dosage:   1.5 g IV LD Nursing Responsibilities Side or Adverse Effects Contraindication Indication Mechanism of Action Drug Name
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Vasospastic angina, classic chronic stable angina pectoris. Unknown. Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arterioles . Generic Name: Nifedipine Classification:   Calcium channel blocker Dosage:   10 mg 1 tab. BID  Nursing Responsibilities Side and Adverse Effects  Contraindication Indication Mechanism of Action Drug Name
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Contraindicated in patient hypertensive to drug and in those with coronary artery disease or mitral valvular rheumatic heart disease. Essential hypertension (orally, alone, or with other anti-hypertensives), severe essential hypertension (parenterally, to lower blood pressure quickly) Unknown. A direct-acting vasodilator that mainly relaxes anteriolar smooth muscle. Generic Name Hydralazine Classification:  Antihypertension Nursing Responsibilities Adverse  Effects  Contraindication Indication Mechanism of Action Drug Name
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],To prevent or control seizures in preeclampsia or eclampsia. May decrease acetylcholine released by nerve impulses, but its anticonvulsant mechanism is unknown. Generic Name : Magnesium sulfate Classification:   Anticonvulsant Dosage:  4gm SIVP and; 5g IM on each buttocks Nursing Responsibilities Adverse Effects  Contraindication Indication Mechanism of Action Drug Name
Nursing care Plan
Patient’s Name: M.T Age: 19 Medical Diagnosis: Pregnancy Induced Hypertension  Nursing Diagnosis:  Decreased Cardiac Output related to decreased venous return . Short Term Goal: At the end of my shift, patient will have a decreased blood pressure and will be able to have an adequate    rest and sleep. Long Term Goal: At the end of  hospitalization, patient will be able to maintain vital signs within acceptable range. CUES PROBLEM SCIENTIFIC RATIONALE INTERVENTIONS RATIONALE EVALUATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hypertension -Inadequate blood pumped by the heart to meet the metabolic demands of the body.  [note: In a Hyper Metabolic state although cardiac output and tissue perfusion are interrelated, altough there are differences. When cardiac output is decreased tissue perfusion problems will develop however, tissue perfusion problems can exixt without decreased cardiac output. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],-Provides baseline for comparison to follow trends and evaluate response to interventions. -Decreases oxygen consumption and risk for de-compensation and for  maximum comfort. -To provide Encouragement. -To minimize dehydration. -To promote adequate rest. Goal Met. The patient will be able to have an adequate rest and sleep, and the patient’s blood pressure will decreased. The patient will be able to respond well to interventions and performed actions.
Patient’s Name: M.T Age: 19 Medical Diagnosis: Pregnancy Induced Hypertension Nursing Diagnosis: Impaired physical mobility related to decrease muscle strength  Short Term Goal: After rendering my nursing intervention, patient will be able to verbalize understanding of situation and individual treatment regimen and safety measures. Long Term Goal: Upon discharge,  the patient will be able to maintain or increase strength and function of the  affected and compensatory body part.  CUES PROBLEM SCIENTIFIC RATIONALE INTERVENTIONS RATIONALE EVALUATION ,[object Object],[object Object],[object Object],Impaired Physical Mobility Limitation in independent, purposeful physical movement of the body or of one or more extremities ,[object Object],[object Object],[object Object],[object Object],[object Object],- It may restrict movement -to note any incongruencies with reports of abilities -to maintain position of function and reduce risk of pressure ulcers  -promotes well being and maximizes energy production. -enhances commitment to plan optimizing outcomes  Goal Met: The patient will be able to  verbalize understanding of situation and individual treatment regimen and safety measures. The patient will be able to maintain proper function of the part  being affected.
Presented by: Dave Jay S. Manriquez RN.

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Eclampsia

  • 3.
  • 5. Eclampsia was found to be more common among young and adolescent women . Age Distribution Age group [ years ] 22 [46.80%] 19 [40.42%] 3 [6.38% ] 3 [ 6.38%] 19 or less 20-24 25-29 30 or more
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  • 7. Study of the Subject Matter
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  • 12. Anatomy and Physiology
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  • 19. Structure and Functions of Blood Vessels Structure Functions Arteries - The walls (outer structure) of arteries contain smooth muscle fiber that contract and relax under the instructions of the sympathetic nervous system. Transport blood away from the heart; Transport oxygenated blood only (except in the case of the pulmonary artery). Arterioles - Arterioles are tiny branches of arteries that lead to capillaries. These are also under the control of the sympathetic nervous system, and constrict and dilate, to regulate blood flow. Transport blood from arteries to capillaries; Arterioles are the main regulators of blood flow and pressure. Venules - Venules are minute vessels that drain blood from capillaries and into veins. Many venules unite to form a vein. Drains blood from capillaries into veins, for return to the heart
  • 20. Structure Functions Capillaries - Capillaries are tiny (extremely narrow) blood vessels, of approximately 5-20 micro-metres (one micro-metre = 0.000001metre) diameter. There are networks of capillaries in most of the organs and tissues of the body. These capillaries are supplied with blood by arterioles and drained by venules. Capillary walls are only one cell thick (see diagram), which permits exchanges of material between the contents of the capillary and the surrounding tissue. Function is to supply tissues with components of, and carried by, the blood, and also to remove waste from the surrounding cells ... as opposed to simply moving the blood around the body (in the case of other blood vessels); Exchange of oxygen, carbon dioxide, water, salts, etc., between the blood and the surrounding body tissues. Veins - The walls (outer structure) of veins consist of three layers of tissues that are thinner and less elastic than the corresponding layers of arteries. Veins include valves that aid the return of blood to the heart by preventing blood from flowing in the reverse direction. Transport blood towards the heart; Transport deoxygenated blood only (except in the case of the pulmonary vein).
  • 21. Comparison between Arteries and Veins Arteries Veins Transport blood away from the heart; Transport blood towards the heart; Carry Oxygenated Blood (except in the case of the Pulmonary Artery); Carry De-oxygenated Blood (except in the case of the Pulmonary Vein); Have relatively narrow lumens Have relatively wide lumens (see diagram above); Have relatively more muscle/elastic tissue; Have relatively less muscle/elastic tissue; Transports blood under higher pressure (than veins); Transports blood under lower pressure (than arteries); Do not have valves (except for the semi-lunar valves of the pulmonary artery and the aorta). Have valves throughout the main veins of the body. These are to prevent blood flowing in the wrong direction, as this could (in theory) return waste materials to the tissues.
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  • 23. Narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, particularly the large arteries, arterioles and veins. The process is the opposite of vasodilation, the widening of blood vessels. When blood vessels constrict, the flow of blood is restricted or slowed, thus, retaining body heat and increasing vascular resistance. Cutaneously, this makes the skin turn paler because less blood reaches the surface. This helps to prevent the radiation of heat. Blood Vessel are tubes which carry blood. Veins are blood vessels which carry blood from the body back to the heart. Arteries are blood vessels which carry blood from the heart to the body. There are a few main blood vessels which connect to different chambers of the heart. The aorta is the largest artery in our body. The left ventricle pumps blood into the aorta which then carries it to the rest of the body through smaller arteries. The pulmonary trunk is the large artery which the right ventricle pumps into. It splits into pulmonary arteries which take the blood to the lungs. The pulmonary veins take blood from the lungs to the left atrium. All the other veins in our body drain into the inferior vena cava (IVC) or the superior vena cava (SVC). These two large veins then take the blood from the rest of the body into the right atrium. Abnormal Normal
  • 24. Heart
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  • 26. Blood flow through the Heart
  • 27. Brain Controls the central nervous system (CNS), by way of the cranial nerves and spinal cord, the peripheral nervous system (PNS) and regulates virtually all human activity. Involuntary, or "lower," actions, such as heart rate, respiration, and digestion, are unconsciously governed by the brain, specifically through the autonomic nervous system. Complex, or "higher," mental activity, such as thought, reason, and abstraction, is consciously controlled.
  • 29. Generalized seizures are caused by abnormal electrical activity at multiple locations in the brain and/or over a large area of the brain. This results in loss of consciousness and body stiffening, which is followed by shaking of the arms and legs. Abnormal electrical activity may start in one part of the brain and cause isolated symptoms. Sometimes this abnormal electrical activity spreads through the brain, resulting in a generalized seizure. Seizures can be caused by a specific area of the brain that is injured or inflamed, or they can be due to stress on the brain from a more widespread systemic process, such as severely low blood sugar.
  • 30. Name: Ms. M.T Age: 19 Sex: Female Address: 69 Pooc Maligaya, San Vicente, San Pedro Laguna Civil Status: Single Occupation: None Name of Spouse: Mr. Benigno Carpellar Date of Admission: August 07, 2008 PATIENT’S PROFILE
  • 31. Chief Complaint: Seizures History of present Illness: Patient delivered at San Pedro Municipal Hospital. After hours she had 2 episodes of tonic clonic seizures hence referral to our institution and then subsequently admitted. Physical Examination: Li open, uterus oblique, no abnormal masses Admitting Diagnosis: NSD Day 0 Post Partum Eclampsia G1P1(1001) BRIEF HISTORY
  • 33. HEMATOLOGY: Diagnostic Exam Result Normal Range Findings Hemoglobin 136 M:140-170 / F:120-140 gml/dl Increased Hematocrit .41 M:0.44-0.54 – F:0.37-.47 Normal WBC 9.0 5.0-10.0 Normal Platelet 280 150-400cc/mL Normal ABO Typing “ A”
  • 34. DIFFERENTIAL COUNT : Diagnostic Exam Result Normal Range Findings Segmenter 69 40-60 Increased Lymphocytes 31 20-40 Normal
  • 35. URINALYSIS: Diagnostic Exam Result Normal Range Findings Color Yellow Yellow/Amber Normal Transparency Clear Clear Normal Reaction 5.0 4.8-7.8 Normal SP Gravity 1.030 1.015-1.025 Increased Sugar Negative Negative Normal Protein Negative Negative Normal Pus Cells 2-3 HPF 0-4 HPF Increased RBC 1.5-2.0 HPF 0-3 HPF Normal Epithelial Cells Few Few Present Normal
  • 36. BLOOD CHEMISTRY: Diagnostic Exam Result Normal Range Findings BUN 12.3 mg/dl 10-50 mg/dl Normal Creatinine 1.1 mg/dl F:0.5-1.0 mg/dl M:0.6-1.2 mg Increased SGOT 26.8 1u/L 10-40 IU/L Normal SGPT 13.9 1u/L 5-35 IU/L Normal
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  • 48. Presented by: Dave Jay S. Manriquez RN.