Pre-Eclampsia

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I. INTRODUCTION

Description of the Disease Preeclampsia, also referred to as toxemia, is a condition that pregnant women can get. It is marked by high blood pressure accompanied with a high level of protein in the urine. Women with preeclampsia will often also have swelling in the feet, legs, and hands. Preeclampsia, when present, usually appears during the second half of pregnancy, generally in the latter part of the second or in the third trimesters, although it can occur earlier. In addition symptoms of preeclampsia can include:

apid weight gain caused by a significant increase in bodily fluid !bdominal pain "evere headaches ! change in reflexes educed output of urine or no urine #i$$iness %xcessive vomiting and nausea &he exact causes of preeclampsia are not known, although some researchers

suspect poor nutrition, high body fat, or insufficient blood flow to the uterus as possible causes. &he only real cure for preeclampsia and eclampsia is the birth of the baby. 'ild preeclampsia (blood pressure greater than )*+,-+. that occurs after /+ weeks of gestation in a woman who did not have hypertension before0 and,or having a small amount of protein in the urine can be managed with careful hospital or in1home observation along with activity restriction.

&he group chose the case for the reason that they wanted to show the readers the process on how pre1eclampsia occurs and for them to fully understand and be reminded on one of the complications associated with pregnancy. In developing countries: preeclampsia,eclampsia impact *.*2 of all deliveries (). and may be as high as )32 in some settings in !frica (/. If the rate of life threatening eclamptic convulsions (+.)2 of all deliveries. is applied to all deliveries from countries considered to be the least developed, 4+,+++ cases of women experiencing this serious complication can be expected each year. !ccording to "afe 'otherhood.org of the 434,+++ maternal annually (5., )52, or 67,+4+, are due to eclampsia.

Nurse-Centered Objectives 8pon completion of this case study, the student nurse should be able to: ). Identify the risk factor contributing to the occurrence of the disease. /. 9ormulate significant nursing diagnosis, with the significantly related nursing care plan. 5. Identify the different medications administered for this disease their indications, contraindications, side effect, and specific responsibility . *. Identify the different medications administered for this disease their indications, contraindications, side effect, and specific responsibility . Client-Centered Objectives 8pon completion of this case study, the client should be able to: ). 8nderstand awareness of her disease. /. :now the possible causes of the disease. 5. ;earn and understand why such laboratory examinations are being done.

II. NURSING a.. #emographic #ata

ISTOR!

'rs. <b, a 5- years old housewife and first time mother, who currently resides at =uagua Pampanga with her husband 'r. =yne. "he was born a 9ilipina on November -, )-7- in "ta. ita =uagua Pampanga. &he patient was admitted at a egional >ospital with a chief complaint of abdominal pain, last November )4, /++3 at around 5:++ p.m.

b.. "ocio1%conomic and ?ultural 9actors

'rs. <b is plain housewife and her husband is an extra laborer on a construction site. "he graduated at a Public >igh "chool. !nd she didn@t continue her college level due to financial problem.

'rs. <b was raised as a oman ?atholic, were she learned about religious values but she still believes in super natural forces and superstitious beliefs. When it comes in health matters, she seeks the help of a albularyo and uses herbal medicines to treat any member of the family who has an ailment. Aut when serious matters arise she still refers to medical professionals for help.

c.. %nvironmental factors

's. <b resides at =uagua Pampanga and occupies the ancestry house of her family. &he location of their house is not easily accessible to hospitals, health centers and other government institutions. 'rs. <b did not report any problems regarding her environment which interfered to her pregnancy.

"aternal-child

ealth

istor#

a.. 'aternal B <bstetric record (for <A cases. 'rs. <b was married to 'rs. =yne at the age of 55 years old. "he has a record of &)P+!+;)'+ at her 5-th week of gestation. "he underwent low transverse ceasarian section under a certain obstetrician at the regional hospital last November )3, /++3 at around )+:++ in the evening, she delivered her )st child who is term baby with hyperbilirubinemia.

b.. !ntepartal, Prenatal Preparation

When 'rs. <b was still pregnant, she only consulted once in a district hospital all throughout.

c.. "ignificant &rimestral ?hanges ()st to 5rd trimester.

'rs. <b rxperienced some changes in her pregnancy, such as striae gravidarum, linea nigra, and melasma. "he also experienced nausea and vomiting, di$$iness, and headache.

$a%il#

ealth Illness

istor#

Grandmother

Grandfather

Grandmother

Grandfather

Mother

Father

Patient

Legend:

hypertension died of old age pneumonia asthma deceased

pre eclampsia

*pink border mother side *blue border father side *violet border - patient

Aoth the grandparents from the mother@s side died from old age. 9rom the father@s side, the grandmother died from >ypertension and the father was died from Pneumonia. &he mother is not experiencing any health problems but the father has hypertension and asthma. &he patient, upon admission has elevated blood pressure and is suffering from aggravating factors like anxiety, nervousness and fear.

& !SIC'( 'SS)SS")NT Nove%ber *+, *--.

S/IN

brown skin generally uniform in color except in areas exposed to the sun skin temperature uniform and within the normal range (56C?. when pinched, skin readily springs back to previous state moist skin folds nails with smooth texture nail beds pink prompt capillary refill time (/ seconds. bipedal non1pitting edema

)'D

absence of nodules or masses symmetric facial features and movements symmetric nasolabial folds evenly distributed black hair no infestations

)!)S

eyebrows symmetrically aligned with eDual movement eyelashes eDually distributed and curled slightly outward skin of eyelids intact with no discoloration lids close symmetrically

bilateral blinking exhibited no discharge, edema or tearing white sclera pink palpebral conEunctiva iris black in color pupils eDual in si$e with smooth borders illuminated pupils constricts pupils converge when near obEect is moved toward the nose when looking straight ahead, the client can see obEects in the periphery both eyes coordinated, move in unison with parallel alignment

)'RS

color same as facial skin symmetrically aligned pinna immediately recoils after it is folded pinna is not tender no lesions or discoloration dry cerumen, grayish1tan color normal voice tones audible able to hear ticking of a watch in both ears

NOS)

symmetric and straight no discharge or flaring absence of lesions and tenderness nasal septum intact and in the midline

"OUT

'ND T RO'T

outer lips uniform pink color with symmetric contour, soft and moist buccal mucosa is of uniform pink color gums are pink tongue pink, moist, at central position

N)C/

head centered lymph nodes not palpable

0R)'ST

firm generally symmetric in si$e

C'RDIO1'SCU('R

AP )3+,)++ mm>g P ))* reported palpitations symmetric pulse strength

R)S&IR'TOR!2C )ST

chest symmetric chest wall intact, no tenderness, no masses symmetric chest expansion and excursion : /- breaths per minute

G'STROINT)STIN'(2'0DO")N

striae present at hypogastric and iliac regions linea nigra present no tenderness presence of surgical incision

URIN'R!

absence of nocturia, dysuria, urgency, hesitancy, light yellow urine

R)&RODUCTI1)

regular menstrual cycle =)P)

"USCU(OS/)()T'(2)3TR)"ITI)S

muscle eDual si$e on both sides of the body no bone deformities no tenderness

N)URO(OGIC

can respond to verbal commands oriented conscious displayed anxiety

& !SIC'( 'SS)SS")NT Nove%ber *., *--. S/IN

brown skin generally uniform in color except in areas exposed to the sun skin temperature uniform and within the normal range (56C?. good skin turgor moist skin folds nails with smooth texture nail beds pink prompt capillary refill time bipedal non1pitting edema

)'D

rounded smooth skull contour symmetric facial features symmetric nasolabial folds symmetric facial movements

'IR

thick black hair

evenly distributed no infestations

)!)S

eyebrows symmetrically aligned eyelashes curled slightly outward exhibited bilateral blinking both eyes coordinated, move in unison and with parallel alignment white sclera pink palpebral conEunctiva pupils eDually round and reactive to light and accommodation iris black in color pupils eDual in si$e with smooth borders illuminated pupils constricts no discharge

)'RS

color same as facial skin symmetrically aligned pinna immediately recoils after it is folded pinna is not tender no lesions or discoloration dry cerumen, grayish1tan color normal voice tones audible

NOS) 'ND SINUS)S

symmetric and straight no discharge absence of lesions and tenderness nasal septum intact and in the midline sinuses not tender

"OUT

'ND T RO'T

outer lips uniform pink color symmetric contour buccal mucosa is of uniform pink color no abrasions and ulcerations gums are pink tongue pink, moist, at central position tongue moves freely with no tenderness palate surface intact uvula positioned in midline palatine tonsils pink and smooth and not swollen

N)C/

head centered head movement coordinated and smooth with no discomfort lymph nodes not palpable

0R)'ST 'ND '3I((')

rounded, generally symmetric areola rounded and the same shape nipples round, everted and eDual in si$e milk letdown

C'RDIO1'SCU('R

AP )7+,)++ mm>g P )+7 prompt capillary refill time (less than ) second. symmetric pulse strength

R)S&IR'TOR!2C )ST

chest symmetric chest wall intact, no tenderness, no masses full symmetric chest expansion and excursion respiratory rate of // breaths per minute

G'STROINT)STIN'(2'0DO")N

striae present at hypogastric and iliac regions symmetric movement caused by respiration tender because of suture from cesarean operation

URIN'R!

yellowish urine

R)&RODUCTI1)

regular menstrual cycle =)P) ()1+1+1)1+.

"USCU(OS/)()T'(2)3TR)"ITI)S

muscle eDual si$e on both sides of the body eDual strength no bone deformities no tenderness no tenderness on calf muscle when dorsiflexed

N)URO(OGIC

can respond to verbal commands oriented conscious

& !SIC'( 'SS)SS")NT Nove%ber *4, *--. S/IN

brown skin generally uniform in color except in areas exposed to the sun skin temperature uniform and within the normal range (56./C?. when pinched, skin readily springs back to previous state moist skin folds nails with smooth texture nail beds pink nail plate angle about )7+C prompt capillary refill time bipedal non1pitting edema

)'D

rounded smooth skull contour no masses, tenderness in the scalp

symmetric facial features symmetric nasolabial folds symmetric facial movements

'IR

thick, evenly districbuted black hair no infestations

)!)S

eyebrows symmetrically aligned exhibited bilateral blinking anicteric sclera pink palpebral conEunctiva pupils eDually round and reactive to light and accommodation no discharge

)'RS

symmetrically aligned pinna not tender and immediately recoils after folded no lesions or discoloration dry cerumen, grayish1tan color normal voice tones audible able to hear ticking of a watch in both ears

NOS) 'ND SINUS)S

symmetric and straight no discharge or flaring absence of lesions and tenderness nasal septum intact and in the midline both nares patent

"OUT

'ND T RO'T

outer lips uniform pink color symmetric contour buccal mucosa is of uniform pink color gums are pink tongue pink, moist, at central position palate surface intact uvula positioned in midline palatine tonsils pink and smooth and not swollen gag reflex present 5+ adult teeth, / molars missing, ) with black discoloration of the enamel

N)C/

neck muscles eDual in si$e, head centered head movement coordinated and smooth with no discomfort lymph nodes not palpable

0R)'ST 'ND '3I((')

areola rounded and the same shape nipples round, everted and eDual in si$e milk letdown

C'RDIO1'SCU('R

AP )4+,)++ mm>g P -7 strong, regular rhythm

prompt capillary refill time (less than ) second.

R)S&IR'TOR!2C )ST

chest symmetric right and left shoulders and right and left hips are at the same height chest wall intact, no tenderness, no masses full symmetric chest expansion and excursion respiratory rate is /3 breaths per minute

G'STROINT)STIN'(2'0DO")N

striae present at hypogastric and iliac regions rounded contour symmetric movement caused by respiration tender because of suture form cesarean operation

URIN'R!

yellowish urine

R)&RODUCTI1)

regular menstrual cycle =)P) ()1+1+1)1+.

"USCU(OS/)()T'(2)3TR)"ITI)S

muscle eDual si$e on both sides of the body smooth coordinated movements

eDual strength no tenderness walks aided to maintains balance no tenderness on calf muscle when dorsiflexed

N)URO(OGIC

can respond to verbal commands oriented conscious

DI'GNOSTIC 'ND ('0OR'TOR! &ROC)DUR)S

#iagnostic or ;aboratory Procedure WA? ?ount

Indication or Purpose

#ate <rdered and #ate esults were released November )7, /++3

esults

Normal Falues

!nalysis and Interpretation of esults No infection or inflammation is present.

&o determine infection or inflammation Pre1operation assessment of the patient.

3.+

41)+ x )+-,;

A? ?ount

Pre1operation assessment of the patient.

November )7, /++3

5.5

*./14.* x )+)/ ,;

#ecreased A? count on pregnant is normal because of the increase in plasma volume during

>emoglobin

Pre1operation assessment of the patient.

November )7, /++3

-7

)/+1 )7+g,;

pregnancy. &he result indicates that a )+++ ml sample of blood contains -7 g of hemoglobin. #ecreased

hemoglobin on pregnant is normal because of their increase in plasma >ematocrit (2. Pre1operation assessment of the patient. November )7, /++3 +./+.561+.*6 g,; volume. &he result indicates that a )+++ ml sample of blood contains ./- g of hemoglobin. #ecreased hematocrit on pregnant is normal because of their increase in plasma volume.

Nursin5 Responsibilities Durin5 Different (aborator# &rocedures

6hite 0lood Cell Count

Aefore

%xplain to the patient that the WA? test is used to detect an infection or inflammation.

&ell the patient that the test reDuires a blood sample. %xplain who will perform the venipuncture and when.

%xplain to the patient that he may experience slight discomfort from the needle puncture and the tourniDuet.

Inform the patient that he should avoid strenuous exercise for /* hours before the test. !lso tell him that he should avoid eating a heavy meal before the test.

If the patient is being treated for an infection, advise him that this test will be repeated to monitor his progress.

Notify the laboratory and physician of medications the patient is taking that may affect test results: they may need to be restricted.

#uring

%nsure subdermal bleeding has stopped before removing pressure.

!fter

If a hematoma develops at the venipuncture site, apply warm soaks. If the hematoma is large, monitor pulses distal the venipuncture site.

Inform the patient that he may resume his usual diet, activity and medications discontinued before the test, as ordered.

! patient with severe leucopenia, they have little or no resistance to infection and reDuires protective isolation.

Red 0lood Cell Count Aefore

%xplain to the patient that A? count is used to evaluate the number of A?s and to detect possible blood disorders.

&ell the patient that the test reDuires a blood sample. %xplain who will perform the venipuncture and when.

%xplain to the patient that he may experience slight discomfort from the needle puncture and the tourniDuet.

Inform the patients that he need not restrict foods and fluids

#uring

%nsure subdermal bleeding has stopped before removing pressure.

!fter

If a hematoma develops at the venipuncture site, apply warm soaks.

e%o5lobin Aefore

%xplain to the patient that the hbg test is used to detect anemia or polycythemia or to assess his response to treatment.

&ell the patient that the test reDuires a blood sample. %xplain who will perform the venipuncture and when.

%xplain to the patient that he may experience slight discomfort from the needle puncture and the tourniDuet.

#uring

%nsure subdermal bleeding has stopped before removing pressure.

!fter

If a hematoma develops at the venipuncture site, apply warm soaks.

e%atocrit Aefore

%xplain to the patient that hct is tested to detect anemia and other abnormal conditions

&ell the patient that the test reDuires a blood sample. %xplain who will perform the venipuncture and when.

%xplain to the patient that he may experience slight discomfort from the needle puncture and the tourniDuet.

Inform the patients that he need not restrict foods and fluids

#uring

%nsure subdermal bleeding has stopped before removing pressure.

!fter

If a hematoma develops at the venipuncture site, apply warm soaks.

III. T ) &'TI)NT 'ND

IS I((N)SS

%fforts to unravel the pathogenesis of pre1eclampsia have been hampered by the lack of clear diagnostic criteria for the disease and its subtypes. ?onseDuently, several studies have included a variety of other conditions that do not necessarily reflect an adverse pregnancy outcome.

!bnormal placentation (stage )., particularly lack of dilatation of the uterine spiral arterioles, is the common starting point in the genesis of pre1eclampsia, which compromises blood flow to the maternalBfetal interface. educed placental perfusion

activates placental factors and induces systemic hemodynamic changes. &he maternal syndrome (stage /. is a function of the circulatory disturbance caused by systemic maternal endothelial cell dysfunction resulting in vascular reactivity, activation of coagulation cascade and loss of vascular integrity. Pre1eclampsia has effects on most maternal organ systems, but predominantly on the vasculature of the kidneys, liver and brain.

1. T ) &'TI)NT 'ND 7. "edical "ana5e%ent

IS C'R)

a. I1$s, 0T, NGT feedin5, Nebuli8ation, T&N, O9#5en Therap#

'edical 'anagement I1$ #4; " );

#ate <rdered #ate <rdered November )4, /++3

=eneral #escription 42 dextrose in

Indication G Purpose #4N' is

?lient esponse to &reatment &he patient responded well with no signs of irritation and adverse reactions.

lactated ringers administered by solution intravenous

5+gtts,min (<smolarity of infusion for #ate d,c 4/61hyprtonic, November /+, p> of *.-. /++3 1provides routine daily fluid calories and free and electrolyte water, provides reDuirement with electrolytes. !lso contains sodium lactate minimal carbohydrates calories and to maintenance of parenteral

which is used in correct or replace treating mild to fluid losses due to moderate metabolic acidosis. change in the patient@s diet (NP<. and during the cesarean operation. Nursing esponsibilities:

?heck the doctor@s order

%xplain the procedure to the patient &ell the patient that she might feel a discomfort from the tourniDuet and the IF insertion

?heck and monitor IF9 regulation and level of fluid ?heck if there is a need for removal and replacement of fluid ?heck if the tube is in the vein and signs of edema ?heck if there is a back1flow of blood ?heck if there is bubbles present in the tube !lways 'onitor F,".

b. &har%acotherap#

Arand name and #ate ordered, =eneric name #ate started, #ate changed,

oute of !dministration, #osage and 9reDuency of

=eneral action

?lient response

'efenamic !cid

))1)-1+3

!dministration P.<., 4++mg, &I# for pain

Inhibits prostaglandin synthesis by decreasing the activity of the en$yme, cyclooxygenase, which results in decreased formation of prostaglandin

Patient was relieved from pain.

?ephalosporin

))1)-1+3

I.F., 64+mg, D3

precursors Inhibits bacterial

&he patient did

?efuroxime sodium

cell wall synthesis by

not acDuire infection and

binding to one or did not more of the penicillin1 binding proteins (PAPs. which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Aacteria eventually lyse due to ongoing activity of cell wall autolytic en$ymes (autolysins and murein hydrolases. while cell wall assembly is experience any adverse reaction.

arrested. 9errous "ulfate ))1)-1+3 P.<., <.#. eplaces iron, found in hemoglobin, myoglobin, and other en$ymes0 allows the transportation of oxygen via Nifedipine ))1)-1+3 hemoglobin. P.<., )+mg, AI# Inhibits calcium ion from entering the Hslow channelsH or select &he patient responded well to treatment and did not experience any &he patient responded well to treatment and did not experience any adverse reaction.

voltage1sensitive adverse areas of vascular smooth muscle and myocardium during depolari$ation, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation0 increases reaction.

myocardial oxygen delivery in patients with vasospastic angina

c. Diet

&ype of #iet

#ate <rdered, #ate Performed,

=eneral #escription &he patient is not allowed to take any oral food or liDuid

Indication G Purpose &his is done to prevent alteration of the result of the fasting blood sugar.bcs intake of food can increase

?lient esponse to &reatment &he patient complied with the prescribed diet.

NP<

#ate !dminister ))1)61+3 ))1)-1+3

?lear ;iDuid #iet

))1)-1+3 ))1/+1+3

! diet of clear liDuids maintains vital body fluids, salts, and minerals0 and also gives some energy for patients when

glucose level &his diet reduce stimulation of the digestive system, and leave no residue in the intestinal tract. &his is

&he patient complied with the prescribed diet.

normal food intake why a clear must be liDuid diet is

interrupted. ?lear liDuids are easily absorbed by the body. by mouth (NP<. for a long time. &his diet is also used in preparation for medical tests such as sigmoidoscopy, colonoscopy, or certain x1rays.

often prescribed in preparation for surgery, and is generally the first diet given by mouth after surgery. ?lear liDuids are given when a person has been without food by mouth (NP<. for a long time.

d. )9ercise

!ctivity

=eneral #escription

Purpose

#ate <rder

?lient esponse

?omplete Aed est

Prescribed maternal complication of pregnancy

&o provide adeDuate rest

))1)31+3

&he client adhered to the order without complaints.

1I. NURSING C'R) &('N

?ues "1Isumasakit nga daw ung tahi niya at sumusigaw siyaJ as the "< verbali$ed

Nursing diagnoses !cute pain related to postparum

"cientific %xplanation 8npleasant sensory experience

<bEective !fter /1* hr of nursing intervention, the

Nursing intervention 1 Provide Duite environment

ationale 1to promote pain management.

%xpected outcomes =oal Partially met !%A pt rated the pain

arising from post pt rate the pain surgical incision from cesarean section. from 3 to 5 in a pain scale of )1 )+

1%ncouraged to do deep breathing exercise

1to reduce tension

from 3 to 4 in a pain scale of )1 )+

<1 facial grimaces ated pain as 3 in a pain scale of )1)+, )+ being the highest 1 %ncouraged to 1 %ncouraged adeDuate rest period

1to prevent fatigue

1to reduce pressure on the

=uarding behavior

support the affected area upon movement

affected area

?ues "1Iayoko na muna dapat mabuntis kc papangit ung katawan ko tsaka bat ang itim ng pek1pek koJ as pt verbali$ed

Nursing diagnoses #isturbed body image related to pregnancy !%A changes in appearance

"cientific %xplanation "everity of the abdominal wound due to surgery, a new type of tissues develops that eventually will causes scar formation

<bEective !fter /1* hrs of nursing intervention, the patient will able to understand the change of body image.

Nursing intervention 1%ncouraged client to looked, touch the affected body area

ationale 1to begin to incorporate changes into body image.

%xpected outcomes =oal met the patient recogni$ed and verbali$ed understanding of

1to bring back 1%ncourage the client to have a daily exercise. 1to feel that the the usual physical images.

body changes.

<1presence of melasma 1presence of bipedal edema

1!dvised the "< to give support to the pt (especially emotional feelings.

patient still worthy.

1to aid in recovery.

1!ssist pt to identify positive behavior

?ues ": Ibumibilis nga tibok ng puso koJ verbali$ed by the patient

Nursing diagnoses #ecreased cardiac output

"cientific %xplanation Pregnancy Induced

<bEective !fter * hrs of nursing intervention, the patient will display hemodynamic stability (heart

Nursing intervention 1:eep client on bed and in position of comfort

ationale 1 decreases oxygen consumption

%xpected outcomes =oal 'et !%A within * hrs. of nursing intervention the pt. >

related to altered >ypertension is a heart rate ())) bpm. !%A tachycardia, pt@s condition in which vasospasms occur. It is caused by altered cardiac

1decrease stimuli0 provide

1to promote adeDuate rest

decreased from ))) bpm to )++ bpm, AP from

<: 1with the tenderness of abdominal are 1facial grimaces 1APK )7+,)++ mmhg

report of palpations0 (r,t. decreased venous return !%A edema (ankle., "<A (/3.

rate will decrease Duiet env@t 1to reduce 1%ncouraged deep breathing exercise 1to reduce risk for 1%ncouraged orthostatic anxiety

output that inEures from ))) bpm to endothelial cells of the arteries. Alood vessels become less resistant to )++ bpm, AP from )*+,)++ to )/+,3+.

)*+,)++ to )/+,3+ (Normal AP.

K /3 cycles per min. P K ))) bpm

pressor substances. &his results to vasoconstriction and increases AP dramatically

changing positions slowly

hypotension

1to provide 1give information about positive signs of improvement 1to prevent in changes in cardiac pressures 1Instruct client to or impede blow avoid or limit activities that may stimulate valsalva response (rectal stimulation, flow encouragement

bearing down A.'.

?ues "1

Nursing diagnoses isk for

"cientific %xplanation ?onstipation

<bEective !fter * hrs of

Nursing intervention 1 %ducate

ationale 1 Information

%xpected outcomes =oal 'et !%A

constipation <1 decreased ambulation of the patient bcs of pain and the complete bed rest ordered of the physician. related to post ?" delivery.

may happen due to disturbance of normal bowel movements because intestines were displaced during surgical procedure.

nursing intervention, the patient will verbali$e understanding the etiology and appropriate intervention if constipation may occur.

patient, "< about safe and risky practices for managing constipation.

can help client to the patient make beneficial choices when need arises. verbali$ed understanding about constipation and gained

1 Instruct balance 1 &o improve fiber and bulk in diet and fiber supplements. consistency of stool and facilitate passage through colon. 1 Promote adeDuate fluid intake, also suggest drinking warm fluids. 1 &o promote soft stool and stimulate bowel activity.

knowledge of appropriate intervention.

1 %ncourage activity within limits of individual ability. 1&o stimulate constrictions of the intestines

?ues <1 postpartum surgery

Nursing diagnoses Impaired "kin Integrity related

"cientific %xplanation &he incision from the

<bEective !fter /1* hrs of nursing

Nursing intervention 1stress proper hand hygiene.

ationale 1 to control the spread of

%xpected outcomes =oal 'et !%A the patient was

to surgery

cesarean section altered the skin integrity making it more susceptible to pathogens and even the pt@s normal flora

intervention, the patient will able to know the preventive measures of wound healing 1%ncouraged proper clothing 1%ncouraged to increase foods that are rich in protein

infection.

able to knew the preventive

1 to aid in tissue repair

measures of wound healing

1to maintained the proper skin moisture.

1!pply appropriate dressing 1to help in wound healing

1III. Dischar5e &lan

=eneral ?ondition of client upon discharge #uring nurse1patient interaction upon discharge, the patient was wearing a comfortable pair of white shirt and white paEama and a pair of flat slip1ons while being sealed on a chair cuddling her baby boy. >er hair was untidy and up in a ponytail with visible infestations. "he was oriented enough to follow instructions and answers Duestions asked by the student nurse. "ethods "1 Instructed the patient to take the following home medication as ordered by the physician: 'efenamic !cid 4++mg P N 9errous "ulfate <# Nifedipine )+mg AI# )1 Instructed patient to avoid strenuous activities. !nd practice deep breathing exercise. T1 n,a

1 Instructed patient to take a bath everyday. %mphasi$e the importance of breast feeding. O1 !dvice to visit or have a follow up check1up with her attending physician. D1 ;ow fat, ;ow salt diet.

I3. Conclusion

Nurses can help the nation achieve National >ealth =oals. &hese goals speak directly to both fetus and the mother because pregnancy is a high risk factor for them. ?lose monitoring in pregnant women and health teaching as much as possible about pregnancy could definitely reduce life threatening complications.

"tudies shows that there is no certain facts that will give us the idea where pre1 eclampsia arise. Aut there so many factors that could prevent this complication such as diet modifications, proper compliance with the health care providers, proper exercise. !nd if the complication is already present, proper monitoring, proper diet and drug compliance should be ruled in.

3. Reco%%endations

With this study, the student nurses were able to gain more knowledge and wider view and perspective of the complication of pregnancy which is pre1eclampsia. &hus, the student nurses would like recommend and share some pointers on how to deal with different diseases with pregnancy specifically pre1eclampsia.

&o the government, primarily they should allocate sufficient budget to sustain and provide better facilities. &hey must be responsible enough to create awareness program for care and management for all the 9ilipino people.

&o the health care team, they should righteously implementing basic and ideal procedures regardless of the health care facilities where they belong. &hey must observe and always remember to keep in line with their duties towards both the mother and the child during the pregnancy.

&o the community and the family, that they must be insufficient coordination with the government and the health care team regarding promotion of health before, during, and after the delivery of the baby.