Preeclampsia FINAL

PRE - ECLAMPSIA
Blood pressure
Blood pressure 140/90 mmHg

Blood pressure Blood pressure
Week 0 Week 20 Delivery
Gestational hypertension
Maternal organ damage and/or fetal distress

(proteins in urine, increased swelling)
Preeclampsia
Blood pressure
Week 0 Delivery
signs of preeclampsia
Chronic hypertension with superimposed

preeclampsia
Preeclampsia
brain dysfunction
(seizures, coma)
Eclampsia
Blood pressure Blood pressure
Week 0 Week 20 Delivery
Postpartum preeclampsia / eclampsia

(rare but dangerous)
GENERAL OBJECTIVES
 To perform physical assessment of a woman with obstetrical
problems.
 To provide advices, health teaching to patient and family for

management of the disease, medication and complications.
 To identify minor and major discomfort and advice the woman

relieving measures.
 To apply nursing process to care the client with obstetric

problems as per need.
SPECIFIC OBJECTIVES
 Early identification of worsening pre-eclampsia.
 Develop a management for obstetric care which includes a

plan of delivery.
Leading cause of
MORTALITY RATE
morbidity long term disability
death
Maternal deaths in Asia
WOLDWIDE
63,000
Maternal deaths annually Second leading cause of Maternal deaths in the Phil
maternal mortality
RISK FACTOR
First Chronic
Pregnancy hypertension
Obesity
Diabetes, kidney disease,

Multiple pregnancy
lupus
RISK FACTOR
Previous
Pregnancy In vitro
complications fertilization
< 20 or > 35 Age
Family history African, Hispanic

Race
more at risk
ANATOMY AND
PHYSIOLOGY
ANATOMY AND
PHYSIOLOGY
PATHOPHYSIOLOGY
SIGNS AND SYMPTOMS
High blood pressure Protein in urine Change in vision Swelling in the hands
(140/90 or greater) or seeing spots and face
Headache Nausea and vomiting Upper abdominal pain Decrease in urine output
COURSE OF
TREATMENT AND
MEDICATIONS
LABETALOL
300mg labetalol in 100 ml of 5% Dextrose start with 120mgh
(40mls/hr) then increase by 20 ml every 30 minutes till diastolic
BP is less 90mmhg or to maximum infusion rate.
COURSE OF
TREATMENT AND
MEDICATIONS
HYDRALAZINE INFUSION
Add 50 mg hydralazine to 500ml, 0.5 normal saline commencing
at rate of to 10ml/hr. start infusion at 40 ml/hr and increase every
10 minutes until BP is controlled.
COURSE OF
TREATMENT AND
MEDICATIONS
MAGNESIUM SULFATE INFUSION
Give Mgs04 4grams IV push slowly over 10 to 20 minutes or in
50 ml minibag over 10 to 20 minutes.
CASE STUDY
PATIENT PROFILE
Name of the patient: Miss Oh
Age: 29 years old
Sex: Female
Address: San Pedro, Puerto Princesa City
Civil Status: Married
Religion: Roman Catholic
Occupation: Housewife
Date and Time Admitted: October 3, 2021
PATIENT PROFILE
Chief complaints: Mild lower abdominal pain and edema
on face, upper and lower extremities
Impressions / Admitting G2 P1 at 37 weeks elevated B/p with
Impressions: proteinuria
Pre-op diagnosis: Gravida 2 para 1 at 37 weeks previous 1
Caesarian section
Post-op diagnosis: Para 2 post secondary Caesarian section
due preeclampsia + failed IOL+ 1x
previous Caesarian section.
PATIENT PROFILE
Surgical operation Emergency caesarian section due to failed
performed: IOL
Final diagnosis: Para 2 Post Secondary Caesarian section
due to Preeclampsia + failed
induction of labor + 1x previous
Caesarian section
Discharge date: October 10, 2021
Attending physician: Dr. Buena
Miss Oh, is a 38-year-old, gravida 2, para 1 female who presented in
emergency at 37 weeks plus 5 days gestation with sudden development of
edema on the face and upper and lower extremities along with a mild
lower abdominal pain.
On examination her blood pressure (BP) was elevated at 140/98 mmHg.

Her pulse 81 beats per minute (bpm), respiratory rate 15 breaths per
minutes, and temperature was 36.4 °C. Her urine sample showed ++ 2
proteinuria. There was evidence of edema on her face, upper and lower
extremities and her lower deep tendon reflexes were brisk but without
any clonus.
Miss O denied any visual disturbances and epigastric pain. On palpitation
of the abdomen, the symphysio-fundal height was 38cm. The fetal lie was
longitudinal and the back appeared to be on the right. The presentation
appeared to be cephalic and the head was 3/5 engaged.
Cardiotocograph showed fetal heart rate at 135 bpm, with reassuring

variability. There was no deceleration and acceleration was normal. It was
also noted that contractions were absent.
Her past medical history, no allergy on food and medications. With
regards on her family history, both parents suffer from hypertension with
maintenance
With regards to her social history, Miss Oh is a housewife and lives with
her husband. She never smoked and not taken alcohol since she was
pregnant. She had 1x previous caesarian section due to pre eclampsia at
34 weeks. Her baby was admitted to NICU due to small gestational age
(weighing 1.3 kgs ) but discharged after 5 days.
Her initial investigations showed a normal full blood count, liver
enzymes and creatinine. However urate (0.37 mmol/l) and the protein:
creatinine ratio (44 mg/mmol) levels were elevated. Miss O is
demonstrating symptoms of pre-eclampsia including hypertension,
proteinuria, edema.
A diagnosis of Moderate pre-eclamptic toxaemia was made, Miss Oh was

admitted in OB ward Isolation for strict monitoring. treatment
immediately given, She was hooked to nifedipine 10 mg IV titration
according to protocol. Bolos dose of magnesium sulfate was given to her
to prevent any occurrence of seizure. Maintenance dose followed after 2
minutes as per protocol. Strictly monitoring of intake, output and BP and
fetal monitoring using cardiotocography (CTG).
The next morning Miss Oh's BP stabilised to 128/74 mm Hg and she
reported feeling better. With the BP stable and a reassuring CTG a
decision to induce delivery was made and she was given Prostaglandin E2
(PGE2) over two days. However there was poor response and the cervix
remained obstinately unchanged and so it was decided the baby would
need to be delivered via caesarean section.
Post caesarian section, delivered to health baby Girl, wt of 2.5kgs. Her
vitals signs remain normal Bp- 110/ 78mmgh, Pulse 65, T-36.0, Rr- 24
urine dipstick negative. Incision site dry and intact without any signs of
post partum hemorrhage. after 2 days of post partum delivery she was
discharge, with no home medication but given only appointment for
follow up check up after 3 days in the clinic.
DRUG STUDY
Drug Action Contraindication
cardiac failure
inhibits both alpha and severe bradycardia

Labetalol beta adrenergic severe hypotension
receptors
anyone with history of
obstructive airway
disease including
asthma.
DRUG STUDY
relaxes the blood vessels low blood pressure

so that blood can flow
Hydralazine more easily through the
coronary artery disease
body stroke
DRUG STUDY
anticonvulsant
a cardiovascular drug severe renal failure
Magnesium calcium blocker
cardiac ischemia
tocolytic agent
Sulfate anti-arrhythmia drug heat block
analgesia and fertilizer pulmonary edema
reduces the risk of

eclampsia by half
EXPECTED
ASSESSMENT INTERVENTION EVALUATION
OUTCOME
SUBJECTED DATA: After nursing intervention  Administer prescribed After nursing
 Severe headache patient will: medications and follow per intervention patient:
and visual blurring hospital protocol.
 Decrease blood pressure  Blood pressure was
 Frequency urination with in 3 hours  Health teaching such as: improved with in 1
 Encourage patient to hour.
 Dizziness, slight  Decrease fluid volume with decrease fluid intake from  After 4 days the
headache and in 7 days. 1.5l to 750ml. volume was
abdominal pains.  Bed rest, give analgesia reduced.
 Maintain normal sleep of prescribed  Body activities was
 Patient complained the patient during  Provide good ventilation, maintained. During
she had irregular hospitalization. quite and comfortable hospitalization
sleep environment and minimize  Sleep pattern was
 Reduce fear due to environmental activity and improved and
 Increased systolic hospitalization. noise. maintained with in a
blood pressure  Monitor VS esp Bp, Urine day.
140/98. output and check for  Re-assessment fear
presence of proteinuria. was reduced during
hospitalization.
CONCLUSION
a global problem and challenge
prevention of the disease is difficult
only option treatment is delivery of the baby

Preeclampsia FINAL

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PRE - ECLAMPSIA

Blood pressure 140/90 mmHg

Week 0 Week 20 Delivery

Maternal organ damage and/or fetal distress

Chronic hypertension with superimposed

Week 0 Week 20 Delivery

Postpartum preeclampsia / eclampsia

 To provide advices, health teaching to patient and family for

 To identify minor and major discomfort and advice the woman

 To apply nursing process to care the client with obstetric

 Develop a management for obstetric care which includes a

Diabetes, kidney disease,

< 20 or > 35 Age

Family history African, Hispanic

On examination her blood pressure (BP) was elevated at 140/98 mmHg.

Cardiotocograph showed fetal heart rate at 135 bpm, with reassuring

A diagnosis of Moderate pre-eclamptic toxaemia was made, Miss Oh was

inhibits both alpha and severe bradycardia

relaxes the blood vessels low blood pressure

reduces the risk of

prevention of the disease is difficult

only option treatment is delivery of the baby

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