 BIOGRAPHIC DATA

 NAME : Ruksana khan

 AGE : 23 years
 MRD NO : IP09725213
 MARITAL STATUS : Married
 EDUCATION OF WIFE : 10th class
 EDUCATION OF HUSBAND : 8th class
 OCCUPATION OF WIFE : House wife
 OCCUPATION OF HUSBAND : Barber
 LMP :
 E.D.D :
 INCOME : 12,000/-
 RELIGION : Muslim
 LANGUAGE KNOWN : Hindi and Gujarati
 ADDRESS :
 DIAGNOSIS : G2P2L1A0 WITH POG 37 weeks+6days with pre-eclampsia
 DATE OF ADMISSION :
 DATE OF DISCHARGE : Not yet
 DATE OF CARE STARTED :
 DATE OF CARE ENDED :
 INFORMANT : Self, mother in law

1. INTRODUCTION OF PATIENT
Mrs Ruksana W/O Md. Aslam, 21yrs old female was admitted in HAHC Hospital. Primigravida with
POG 37 weeks +6days with severe pre eclampsia with complaints of abdominal pain she had a
history of pregnancy induced hypertension (PH) in her and having Tab. Eltroxin and udiliv since
11/11/.

On admission BP was 170/110 mm hg conscious oriented , facial puffiness positive. Her general
condition was poor. She looked not adequately hydrated.

On examination- T- 37.2°C

P- 90/ min
BP- 140/88 mm/Hg
R- 22/min
RBS stat- 136mg/ dl

On Fundal examination- Soft

 Cephalic
NTNT O (non-tender, non-tensed)
Liquor adequate
FHS + /R/ 144/min
A series of diagnostic tests were carried out and patient was diagnosed & admitted in Gynae ward
under Unit IV.

MENSTRUAL HISTORY:
She has regular cycles with duration of 4-5 days. She had mild dysmenorrhea.

PAST OBSTETRICAL HISTORY

Mrs. Ruksana is married from last 4 years. Mrs. Ruksana is a multigravida mother. She has a female
baby of 1yr and 7 months of age. She was delivered as Full term normal vaginal delivery in the
hospital with the birth weight of 2.9kgs. She cried immediately after birth. Admitted with the
complains 37wks+6days of amenorrhea. No history of any abortion.

PRESENT OBSTETRICAL HISTORY

Mrs. Ruksana was admitted to HAH Centenary Hospital on 23 Sept 2017 having 37 weeks +6 days of
gestation with complaints of pain abdomen since morning and generalized weakness.

1st Trimester

The mother had bouts of nausea and vomiting and food craving for fried foods and aversion for milk
and milk products. She had increased urination, constipation and fatigue.

2nd Trimester

During the second trimester her nausea subsided but she started feeling pain in the lower abdomen
and groin. She observed changes in her skin and leg cramps and occasional dizziness. She felt
difficulty in lying in supine position and experienced comfort after elevating her head with the help
of pillows. Quickening start at 5th month.

3rd Trimester

During the third trimester she is having increased fatigue, constipation, increased frequency of
mituration and vomiting and increase BP.

Labour Notes:
FTNVD with left mediolateral episiotomy.
Under all aseptic precautions parts painted and draped. Patient given a lithotomy positioned with
good uterine contractions and good bearing efforts. left mediolateral episiotomy given under local
anesthesia A single live male baby with 2.649 kg on 25/07/17 at 9:38 Pm delivered by vertex
presentation no loop of cord around the neck liquor clear cord clamped and cut. placenta delivered
with complete membranes episiotomy stitched back in layers no PPH. Vitals are checked
The client was having pain at suture line. Breast is secretory. Nipples are cracked and painful while
feeding. Baby given expressed milk. Baby is tolerating feeds well. The blood pressure is under
monitoring, edema has reduced considerably.

II. SOCIOECONOMIC BACKGROUND

Mrs Ruksana W/O Md. Aslam lives in a city in her concrete house. Water and electricity facility is
adequate and her house is well ventilated. Her house has toilet constructed. Her husband is the one
of earning member the family she live in a joint family. No pet animals are there in her house.

III. FAMILY HISTORY

a) Family composition

S.NO Name Relationship Age Sex Education Occupation Health

to the status
patient
1. Aslam bhai Husband 25 yrs M 8th Barber Good
2. Ruksana Self 23 yrs F 10th House wife Poor
3. Aliya Daughter 1yr F - - Good

b) Family medical history

There is a history of hypertension in her family, her mother was hypertensive before she died.

And her elder sister has pregnancy induced hypertension during her pregnancy of second baby.

IV. HISTORY OF PRESENT ILLNESS

Present Obstetric History

Mrs. Ruksana was admitted to HAH Centenary Hospital on 23 Sept 2017 having 37 weeks +6 days of
gestation with complaints of pain abdomen since morning and generalized weakness.
1st Trimester
The mother had bouts of nausea and vomiting and food craving for fried foods and aversion for milk
and milk products. She had increased urination, constipation and fatigue.
2nd Trimester
During the second trimester her nausea subsided but she started feeling pain in the lower abdomen
and groin. She observed changes in her skin and leg cramps and occasional dizziness. She felt
difficulty in lying in supine position and experienced comfort after elevating her head with the help
of pillows. Quickening start at 5 month.
3rd Trimester
During the third trimester she is having increased fatigue, constipation, increased frequency of
mituration and vomiting and increase BP.

Labour Notes:
FTNVD with left mediolateral episiotomy .
Under all aseptic precautions parts painted and draped. Patient given a lithotomy positioned with
good uterine contractions and good bearing efforts. left mediolateral episiotomy given under local
anesthesia.A single live male baby with 2.649 kg on 25/07/17 at 9:38 Pm delivered by vertex
presentation no loop of cord around the neck liquor clear cord clamped and cut. placenta delivered
with complete membranes episiotomy stitched back in layers no PPH. Vitals are checked
The client was having pain at suture line. Breast is secretory. Nipples are cracked and painful while
feeding. Baby given expressed milk. Baby is tolerating feeds well. The blood pressure is under
monitoring, edema has reduced considerably.

 PRESENT MEDICAL HISTORY:

Mrs Ruksana Begum developed high blood pressure and abdominal pain with vomiting and
abdominal pain for which she was admitted to the hospital.

 PRESENT SURGICAL HISTORY:

No significant present surgical history

 MENSTRUAL HISTORY:
She has regular cycles with duration of 4-5 days. She had mild dysmenorrhea.

V. HISTORY OF PAST ILLNESS

PAST OBSTETRICAL HISTORY
Mrs. Ruksanais a multigravida mother. Admitted with the complains 37wks +6days of amenorrhea.
No history of any abortion or pregnancy.
HISTORY OF PAST MEDICAL ILLNESS
No any significant history except she had malaria 1 year back and PIH during her previous pregnancy.
HISTORY OF PAST SURGICAL ILLNESS
No past surgical history

VI) PERSONAL HISTORY

1. Personal habit : She is non-alcoholic and non-smoker
2. Diet : She is a non-vegetarian
3. Sleep and rest: bowel habits - once a day: She usually sleeps 8 hours at night. She has no
difficulty falling asleep
4. Activities of daily living : Before the pregnancy she had no difficully in ADL
5. Elimination : Bowel habits-once a day
6. Bladder habits : no problem in bladder habits. She has normal micturition.
7. Hobbies and interest : gossiping with others.
8. Marital status : she is married since 4 years.
9. Sexual history : no history of any sexually transmitted disease
10. Drug history : no history of any drug allergy
11. Obstetric history : G2 P2 AO LI
12. Psychiatric history : no history of any psychiatric illness

VII HEAD TO TOE EXAMINATION

General Appearance
• Nourishment : moderately nourished
• Body Built : moderate
• Hygiene and Grooming : poor hygiene
• Activity : lethargic
• Posture : normal posture
• Movement : normal movements
Mental Status Examination
•Consciousness : conscious
• Look : drowsy
• Attitude : cooperative
• Affect and Mood : appropriate
• Speech : clear and relevant
• Orientation : oriented to time ,place and person
Vital Signs
• Temperature : 98.7F
• Pulse : 86/MINS
• Respiration : 18/MIN
• Blood Pressure : 130/92 mm of hg
Weight and Height
•Height : 150 cm
•Weight : 58kg
•BMI : 23.1
Breast and axilla
•Symmetry : symmetrical
•Areola and nipples : color dark brown and cracked and painful
•Hair distribution : scanty
•Discharge : milk produced
•Axillary nodes : not palpable
•Condition of breast : secretary
Abdomen
•Appetite : normal
•Subjective symptoms : pain present
Skin
•Color : brown
•Texture : dry
•Temperature : warm
•Lesions : absent
•Turgor : normal
•Discoloration : absent
Genitals and rectum
•Hemorrhoids : absent
•Vaginal discharge : bleeding present ( Lochia present)
•Labia majora and minora : normal

ABOUT THE DISEASE

PRE ECLAMPSIA
 Definition :-

Pre-eclampsia is a multi system disorder of unknown characterized by development of hypertension

to the extent of 140/90 mmhg or more with proteinuria and edema or both induced by pregnancy
after the 20" week in a previously normotensive and non proteinuria patient. The pre-eclamptic
features cases of hydatidiform mole and acute polydramnios

CLASSIFICATION

The classifications of hypertension in pregnancy, the two conditions are often incorporated

1)Primary: 70 %
-Pre eclampsia
- Eclampsia (with convulsion)
2)Secondary 30%
-Pre-eclampsia -- Eclampsia superimposed on chronic hypertension (25%)
-Pre-eclampsia-- Eclampsia superimposed on chronic nephritis (5%)
CLINICAL MANIFESTATIONS

These are usually associated with acute onset of the syndrome

1) Head ache

2) Disturbed sleep

3) Diminished urinary output

4) Epigastric pain

5) Eye symptoms

BOOK PICTURE PATIENT PICTURE

Signs & symptoms
 Abnormal weight gain Present
 Raise blood pressure Present
 Edema in legs Present
 Varicosities in legs Present
 Varicosities in vulva Absent
 Proteinuria Present
 Headache Present
 Disturb sleep Present
 Puffiness of face Present
 seizures Absent

RISK FACTORS
Known risk factors for pre-eclampsia include:

•Nulliparity (never given birth)

• Kidney disease
• Chronic hypertension
• Prior history of preeclampsia
• Antiphospholipid antibody syndrome
• Multiple gestation
• Having donated a kidney.
• Having sub-clinical hypothyroidism or thyroid antibodies
• Placental abnormalities such as placental ischemia

PATHOGENESIS
Preeclampsia is thought to result from an abnormal placenta, the removal of which ends the disease
in most cases. During normal pregnancy, the placenta vascularizes to allow for the exchange of water,
gases, and solutes, including nutrients and wastes, between maternal and fetal circulations.
Abnormal development of the placenta leads to poor placental perfusion.
The placenta of women with preeclampsia is abnormal and characterized by poor trophoblastic
invasion. It is thought that this results in oxidative stress, hypoxia, and the release of factors that
promote endothelial dysfunction, inflammation, and other possible reactions.

CAUSES
There is no definitive known cause of preeclampsia, though it is likely related to a number of factors.
Some of these factors include:
• Abnormal placentation (formation and development of the placenta)
• Prior or existing maternal pathology - preeclampsia is seen more at a higher incidence in
individuals with preexisting hypertension, obesity, antiphospholipid antibody syndrome, and those
with history of preeclampsia
• Dietary factors, e.g. calcium supplementation in areas where dietary calcium intake is low has been
shown to reduce the risk of preeclampsia
• Environmental factors, e.g. air pollution

DIAGNOSTIC CRITERIA FOR PRE-ECLAMPSIA

Onset of symptoms after 20 weeks' gestation with remission by 6-12 weeks postpartum*Mild pre-
eclampsia:
• Hypertension (SBP ≥ 140 mmg or DBP ≥ 90 mmHg), may be superimposed on chronic hypertension
• Proteinuria (proteinuria > 300 mg/24 hours, or significant increase from baseline)

SEVERE PRE-ECLAMPSIA IF ONE OR MORE OF THE FOLLOWING:

• Sustained SBP ≥ 160 mmHg or DPB ≥ 110 mmHg (measured twice, at least six hours
• Evidence of other end-organ damage
• Deteriorating renal function including nephrotic range proteinuria ≥ 3 g/24 hours or 3+ on urine
dipstick or sudden oliguria, especially with elevated creatinine*
• CNS disturbance (altered vision, headache)
•Pulmonary edema (3% of patients)
•Epigastric/right upper quadrant pain (stretching of hepatic capsule)
•Thrombocytopenia (15%- 30% of patients)
•HELLP (may occur without proteinuria)
•Evidence of fetal compromise (IUGR, oligohydramnios, nonreassuring fetal testing)

INCIDENCE
The incidence in primigravidae is about 10% and multigravidae 5%

RISK FACTORS FOR PRE-ECLAMPSIA

1) Maternal obstetric factors: nulliparity, history of pre-eclampsia, multiple gestation pregnancy,
gestational hypertension, molar pregnancy
2) Maternal comorbid conditions: chronic hypertension, pregestational vascular/endothelial/renal
disease, pregestational diabetes
3) Maternal genetic factors: antiphospholipid antibody, Factor V Leiden mutation (protein C
resistance), first-degree relative with a pre-eclamptic pregnancy
4) Maternal lifestyle factors: obesity, smoking
5) Other maternal factors: African-American race, age >40 years

ABDOMINAL EXAMINATION
 BOOK PICTURE PATIENT PICTURE
ABDOMINAL EXAMINATION
Inspection :
 may reveal evidences of chronic
placental insufficiency scanty liquor or Absent
growth retardation of the fetus
Palpation :
 Term abdomen.
 Girth of the abdomen round the 37wks 6days 75cm
umbilicus is less than the gestation
period

ETIOLOGY OF PRE - ECLAMPSIA

1) There is an imbalance of different components of prostaglandins- relative or absolute deficiency of

vasodilators prostaglandin (PGI2) synthesized in vascular endothelium and increased synthesis of
thromboxane, a potent vasoconstrictor in platelets.
2) There is increased vascular sensitivity to the pressor agent angiotensin-II.
3) Nitric oxide (NO) :- it is synthesized in the vascular endothelium and syscytiotrophoblast from L-
arginine it significantly relaxes vascular smooth muscle, inhibits platelet aggregation and prevents
intervillous thrombosis. Deficiency of nitric oxide contributes to the development of hypertension.
4) Endothelin- I is synthesized by endothelial cells and it is a potent vasoconstrictor
5) It has been suggested that abnormality is due to a single recessive immune response gene of
homozygous in nature. lupus anticoagulant (LA) and anticardiolipin antibodies (ACAs) also have been
associated with preeclampsia
6) Angiotensinase activity is depressed, more so following proteinuria with elimination of alpha
globulin
INVESTIGATIONS

• Sonography

• Radiography

• Blood investigations

• Fundoscopy

INVESTIGATIONS DONE IN PATIENT

SR.NO TEST NAME RESULT NORMAL RANGE

HAEMATOLOGY
1 HAEMOGLOBIN 11.7GM/DL 13-18GM/DL
2 TOTAL LEUKOCYTE COUNT 11000/CUMM 4000-11000
3 NEUTROPHILS 67% 45-70
4 LYMPHOCYTES 30% 20-45
 5 EOSINOPHILS 01% UPTO 6
6 MONOCYTES 02% 2-10
7 RBC 4.4MILL/CUMM 4.5-5.4
8 HAEMATOCRIT 28.9% 40-54
9 PLATELET COUNT 2.66LACS/CUMM 1.5-4

1) SONOGRAPHY:

MANAGEMENT:

Objectives are

1) To correct /stabilize the altered physiology

2) Prevention of complications

3) Prevention of eclampsia

4) Delivery of a healthy baby,in optimal time with minimum maternal morbidity

GENERAL MANAGEMENT:

• Patient is placed in a bed with side rails. (rest increases the renal blood flow diuresis )
• Detailed history is taken
• BP monitoring hourly
• Quick general, abdominal and vaginal examinations are done
• Catheterization and urine analysis
• Checking vitals half hourly
• Pulse oxymetry (<92%- O 2 administration)
• Fetal Heart Rate (FHR) monitoring
• Maintaining fluid balance
• NBM / NPO
• Continue to care for the woman in a quiet, single room
MANAGEMENT

So long as the etiology of pre-eclampsia remains obscure, the treatment is mostly empirical
and symptomatic .while measures are directed to relieve oedema and hypertension. There is
no specific therapy to proteinuria which automatically subsides with the control of
hypertension

NURSING MANAGEMENT

Nursing Management:
• Moikv EP hourly
• Maintain fluid intake and output chart
• Monitor fetal well being
• Place patient in left lateral position
• Loosen clothes of patient
COMPLICATIONS OF PRE- ECLAMPSIA

Maternal

1) During pregnancy: there is incidence of -

a) Elampsia. (2%)
b) Accidental haemorrhage .
c) Oliguria and anuria
d) Dimness of vision
e) HELLP syndrome
f) Preterm labour either spontaneous labour or induced.
g) Accidental hemorrhage.
2) During labour

a) Elampsia.
b) Increased operative delivery hypertension
c) Retained placenta.
d) PPH due to coagulation failure
e) Shock.
3) Pueperium:

a) Eclampsia.
b) Shock
c) Sepsis
d) Sub involution.
e) Increased puerperal morbidity
Fetal:

a) Intrauterine death

b) IUGR
c) Asphyxia

d) Prematurity

Others:

a) Increased operative delivery.

b) Accidental hemorrhage.

PROGNOSIS
The prognosis of pre eclampia depends of period of gestation, severity of disease and
response to treatment

IMMEDIATE: - if the pre eclampsia is detected early with prompt and effective treatment the
pre eclamptic features subside completely and the prognosis is not unfavorable both mother
and the baby

Maternal mortality: increased with mainly related to eclampia ,accidental

haemorrhage ,acute renal failure pulmonary oedema ,DICand HELLP syndrome

Prenatal mortality: - stillborn is about 20% to 50%

REMOTE:- there is no evidence to suggest that severity of pre-eclampsia or its duration has
got an effect on the development of residual hypertension (50%) or recurrent pre eclampsia
(25%)

PREVENTION
Preventative measures against pre-eclampsia have been heavily studied. Because the
pathogensis of pre-eclampsia is not completely understood, prevention remains a complex
issue. Below are some of the currently accepted recommendations.

• Diet: Protein or calorie supplementation have no effect on pre-eclampsia rates, and dietary
protein restriction does not appear to increase pre-eclampsia rates. Further, there is no
evidence that changing salt intake has an effect.

Supplementation with antioxidants such as vitamin C and E has no effect on pre-eclampsia

incidence,nor does supplementation with vitamin D. Therefore, supplementation with
vitamins C, E, and D is not recommended for reducing the risk of pre-eclampsia.

Calcium supplementation of at least 1 gram per day is recommended during pregnancy as it

prevents preeclampsia where dietary calcium intake is low, especially for those at high risk.

Low selenium status is associated with higher incidence of pre-eclampsia.

• Aspirin: Taking aspirin is associated with a 1% to 5% reduction in pre-eclampsia and a 1%

to 5% reduction in premature births in women at high risk. The World Health Organization
recommends low-dose aspirin for the prevention of pre-eclampsia in women at high risk and
recommend it be started before 20 weeks of pregnancy. The United States Preventive
Services Task Force recommends a low-dose regimen for women at high risk beginning in the
12th week.

• Physical activity: There is insufficient evidence to recommend either exercise or strict

bedrest as preventative measures of pre-eclampsia.

• Smoking cessation

In low-risk pregnancies the association between cigarette smoking and a reduced risk of
preeclampsia has been consistent and reproducible across epidemiologic studies. High-risk
pregnancies (those with pregestational diabetes, chronic hypertension, history of
preeclampsia in a previous pregnancy, or multifetal gestation) showed no significant
protective effect. The reason for this discrepancy is not definitively known; research
supports speculation that the underlying pathology increases the risk of preeclampsia to
such a degree that any measurable reduction of risk due to smoking is masked. However, the
damaging effects of smoking on overall health and pregnancy outcomes outweighs the
benefits in decreasing the incidence of preeclampsia. It is recommended that smoking be
stopped prior to, during and after pregnancy.

TREATMENT
The only known definitive treatment for pre-eclampsia is delivery of the fetus and placenta.

The timing of delivery should balance the desire for optimal perinatal outcomes for the fetus
while reducing maternal risks. The severity of disease and the maturity of the fetus are
primary considerations. These considerations are situation-specific and management will
vary with situation, location, and institution. Treatment can range from expectant
management to expedited delivery of the fetus and placenta by induction of labor or
Caesarian section, in addition to pharmaceutical interventions. Important in management is
the assessment of vulnerable maternal organ systems when possible, management of severe
hypertension, and prevention and treatment of eclamptic seizures.Separate interventions
directed at the fetus may also be necessary.

• Blood pressure

The World Health Organization recommends that women with severe hypertension during
pregnancy should receive treatment with anti-hypertensive agents.Severe hypertension is
generally considered systolic BP of at least 160 or diastolic BP of at least 110.Evidence does
not support the use of one anti-hypertensive over another. The choice of which agent to use
should be based on the prescribing clinician's experience with a particular agent, its cost,
and its availability.Diuretics are not recommended for prevention of preeclampsia and its
complications. Labetolol, Hydralazine and Nifedipine are commonly used antihypertensive
agents for hypertension in pregnancy. ACE inhibitors and angiotensin receptor blockers are
contraindicated as they affect fetal development.
The goal of treatment of severe hypertension in pregnancy is to prevent cardiovascular,
kidney, and cerebrovascular complications. The target blood pressure has been proposed to
be 140-160 mmHg systolic and 90-105 mmHg diastolic, although values are variable.

• Prevention of eclampsia

The intrapartum and postpartum administration of magnesium sulfate is recommended in

severe pre-eclampsia for the prevention of eclampsia. Further, magnesium sulfate is
recommended for the treatment of eclampsia over other anticonvulsants. Magnesium
sulfate acts by interacting with NMDA receptors.

• Epidemiology

Pre-eclampsia affects approximately 2-8% of all pregnancies worldwide, The incidence of

pre-eclampsia has risen since the 1990s, possibly as a result of increased prevalence of
predisposing disorders, such as chronic hypertension, diabetes, and obesity.

Pre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality
worldwide.

Pre-eclampsia is much more common in women who are pregnant for the first time. Women
who have previously been diagnosed with pre-eclampsia are also more likely to experience
preeclampsia in subsequent pregnancies.Pre-eclampsia is also more common in women who
have preexisting hypertension, obesity, diabetes, autoimmune diseases such as lupus,
various inherited thrombophilias such as Factor V Leiden, renal disease, multiple gestation
(twins or multiple birth), and advanced maternal age. Women who live at high altitude are
also more likely to experience pre-eclampsia. Change of paternity in a subsequent pregnancy
has been implicated as affecting risk, except in those with a family history of hypertensive
pregnancy Eclampsia is a major complication of pre-eclampsia. Eclampsia affects 0.56 per
1000 pregnant women in developed countries and almost 10-30 times as many women in
low-income countries as in developed countries.

• Complications

Complications of pre-eclampsia can affect both the mother and the fetus. Acutely,
preeclampsia can be complicated by eclampsia, the development of HELLP syndrome,
hemorrhagic or ischemic stroke, liver damage and dysfunction, acute kidney injury, and
acute respiratory distress syndrome (ARDS).

Pre-eclampsia is also associated with increased frequency of Caesarian section, preterm

delivery, and placental abruption. Furthermore, an elevation in blood pressure can occur in
some individuals in the first week postpartum attributable to volume expansion and fluid
mobilization. Fetal complications include fetal growth restriction and potential fetal or
perinatal death.
Long-term, an individual with preeclampsia is at increased risk for recurrence of
preeclampsia in subsequent pregnancies.

• Eclampsia.

Eclampsia is the development of new convulsions in a pre-eclamptic patient that may not be
attributed to other cause. Eclampsia is a serious complication of pre-eclampsia and results in
high rates of perinatal and maternal morbidity and mortality. Warning symptoms for
eclampsia in an individual with current pre-eclampsia may include headaches, visual
disturbances, and right upper quadrant or epigastric abdominal pain, with headache being
the most consistent symptom. Magnesium sulfate is used to prevent convulsions in cases of
severe pre-eclampsia.

• HELLP Syndrome

HELLP syndrome is defined as hemolysis (microangiopathic), elevated liver enzymes (liver

dysfunction), and low platelets (thrombocytopenia). This condition may occur in 10-20% of
patients with severe pre-eclampsia and eclampsia and is associated with increased maternal
and fetal morbidity and mortality.

 Long term

There is also an increased risk for cardiovascular complications, including hypertension and
ischemic heart disease, and kidney disease. Other risks include stroke and venous
thromboembolism. It seems pre-eclampsia does not increase the risk of cancer.

NURSING CARE PLAN

1. Acute pain due to episiotomy and cracked nipples as evidenced by facial expressions

Interventions

a. Assess the intensity of pain

b. Provide comfortable position to the client
c. Provide hot application over perineal region to reduce pain
d. Administer prescribed medications
e. Provide psychological support.
f. Advice mother for breast care and exposing of breast to air
g. Advice to give expressed breast milk till nipples are cracked
2. Risk for infection due to episiotomy and pre-eclampsia as evidence by disease condition

Interventions:

a. Assess for infection.

b. Assess vital signs.

c. Check temperature accurately because this may indicate infection & immediately inform
the physician.

d. Check orthostatic hypotension, due to release of excess of fluid and blood loss.

e. Provide perineal care and catheter care as in situ.

3. Impaired mobility related to pre- eclampsia evidenced by reduced activity level

Interventions

a. Assess the mobility of the client.

b. Assist client in activities of daily living

c. Encourage patient's relatives in participation of patient care

d. Encourage early ambulation

4. Knowledge deficit related to the disease condition and breastfeeding

Interventions

a. Assess the knowledge level of the patient.

b. Advice client to have nutritious diet like green vegetables, milk, etc and ensure she is
getting enough extra calories and fluids.

c. Advice mother to breastfeed the baby after proper hand washing and breast care.

d. Advice mother to avoid accidental pregnancy by taking family planning measures.

e. Teach mother kegel exercises.

f. Advice client to maintain personal hygiene.

5. Anxiety related to the disease condition as evidence by patient verbal report

Interventions

a. Assess the anxiety level of the client

b. Clear the doubts of the client.

c. Provide psychological support to the client

d. Encourage mother to vent out her feelings.

e. To have a friendly and empathetic approach with the client

SUMMARY
So today we have discuss about the topic pre - eclampsia its definition, sign and symptoms,
management, nursing management medical management complications and nursing care
plan etc.

CONCLUSION
Hypertension is one of the common complications met with in pregnancy and contributes
significantly to maternal and perinatal morbidity and mortality hypertension is a sign of an
underlying pathology and effective management play a significant role in the outcome of
pregnancy. The identification of this clinical entity and effective management play a
significant role in the outcome of pregnancy. Both mother and the baby.

RESEARCH ARTICLE

1) Tessemma A .G.,Tekeste A.,Ayale; The prevalence and factors associated with pre
eclampsia among pregnant women, BMC Pregnancy Childbirth. 2015, 15,(73).

DOI: 10.1186/12884-015-0502-7

A study to assess the prevalence and factors associated with preeclampsia among pregnant
women attending antenatal care in Dessie referral hospital, Northeast Ethiopia. A hospital-
based cross-sectional study was conducted between August and September 2013. A total of
490 pregnant women were enrolled in the study. Pretested and structured questionnaire via
face-to-face interview technique was used for data collection. Results were found that 8.4%.

Women having family history of hypertension, chronic hypertension age ≥35 years, family
history of diabetes mellitus and being unmarried were found to be associated with

2) Michelle Hladunewich,S. Ananth Karumanchi,Richard Lafayette; Pathophysiology of the

Clinical Manifestations of Preeclampsia, 2017.

A meta analysis was performed which claims that five to 7% of all pregnancies are
complicated by preeclampsia. Proteinuria and hypertension dominate the clinical picture,
because the chief target organ is the kidney (glomerular endotheliosis). The pathogenesis of
preeclampsia is complex; numerous genetic, immunologic, and environmental factors
interact. It has been suggested that preeclampsia is a two-stage disease. The first stage is
asymptomatic, characterized by abnormal placental development during the first trimester
resulting in placental insufficiency and the release of excessive amounts of placental
materials into the maternal circulation. This in turn leads to the second, symptomatic stage,
wherein the pregnant woman develops characteristic hypertension, renal impairment, and
proteinuria and is at risk for the HELLP syndrome (hemolysis, elevated liver function

enzymes and low platelets), eclampsia, and other end-organ damage. This review focuses on
the pathophysiology of stages 1 and 2 and then considers the potential that changes in
soluble angiogenic factors may underlie much of the disease process.

3) Jennifer Uzan, Marie Carbonnel, Olivier Piconne, Roland Asmar,and Jean-Marc Ayoubi:
Pre-eclampsia: pathophysiology, diagnosis, and management, 2016; 7: 467-474.

Published online on 2017 Jul 19.

The incidence of pre-eclampsia ranges from 3% to 7% for nulliparas and 1% to 3% for

multiparas. Pre-eclampsia is a major cause of maternal mortality and morbidity, preterm
birth, perinatal death, and intrauterine growth restriction. Unfortunately, the
pathophysiology of this multisystem disorder, characterized by abnormal vascular response
to placentation, is still unclear. Despite great polymorphism of the disease, the criteria for
pre-eclampsia have not changed over the past decade (systolic blood pressure > 140 mmHg
or diastolic blood pressure ≥90 mmHg and 24-hour proteinuria ≥0.3 g). Clinical features and
laboratory abnormalities define and determine the severity of pre-eclampsia. Delivery is the
only curative treatment for pre-eclampsia. Multidisciplinary management, involving an
obstetrician, anesthetist, and pediatrician, is carried out with consideration of the maternal
risks due to continued pregnancy and the fetal risks associated with induced preterm
delivery. Screening women at high risk and preventing recurrences are key issues in the
management of pre-eclampsia.

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