HIMALAYAN COLLEGE OF NURSING

HIHT SWAI RAM NAGAR, DEHRADUN

Care Study Format For Postnatal Mother

Obstetrics And Gynaecological Nursing

M.Sc (N) 2nd year

Student’s data:

Name of the student: Priyanka Joshi

Class: M.Sc (Nursing) 2nd Year

Date of care started: 18.01.2014

Date of care ended: 24.01.2014

Diagnosis: G3 A2 L0 with POG 28 weeks by USG with IUD, Bell’s palsy with severe pre-eclampsia.

Area of care study: Gynae A

1. Demographic data:
Name of the patient: Mrs. Shabnam
Name of husband: Mr. Mohd. Shakir
Age: 34 years
IPD no.:1588932
Address: VPO- Mirdgan, Dehradun

2. Socio-economic status: Mrs. Shabnam belongs to a middle class family and stays in pukka house with
all the facilities like water, electricity, sanitation etc. Her husband is the only member in the family and
his income is enough to meet the daily needs.

3. Family history:
No. of family members: 2
Monthly income- 8000 per month.
S.NO. NAME RELATIONSHIP AGE, SEX OCCUPATION ANY DISEASE
WITH THE CONDITION
PATIENT
1. Mr. Mohd. Shakir Husband 40 years, M Taylor -
2. Mrs. Shabnam Patient 34 years, F housewife Increased B.P

4. Personal history:
a. Personal health history: Mrs. Shabnam is moderately built person and she is non-vegetarian. She prefers
three meals per day. She takes chapatti, vegetables with tea in the breakfast, rice and daal in the lunch, chapatti
and daal in dinner. Monthly two times take non-vegetarian food. Her bowel and bladder pattern is normal. She
does not have any bad habits or any type of addiction like smoking, drinking or chewing tobacco.
b. Menstrual history: 4-5 days average flow, regular 28 days cycle. Menarche started at around 14
years.
 c. Marital history: 3 years married life.
5. Medical & surgical history:
a. Past: hypertension but no medication was taken for HTN. No past surgical history.
b. Present: Mrs. Shabnam came to the HIHT hospital with the complaints of amenorrhea since 6 months, absent
fetal movement form 1 day, difficulty in speaking from 1 day. Patient was apparently well 6 month back when
she developed amenorrhea. Pregnancy was confirmed by UP. She was un-booked case & was not under follow
up of any doctor.
6. Obstetric history:
a. Past obstetric history:
A1: 2 year back, IUD at 6th month of pregnancy, induction of labour done & dead baby was
delivered.
A2: 1 year back, IUD at 6th month of pregnancy, induction of labour done & dead baby was
delivered.
b. Present obstetric history:
T1: no H/o vomiting, frequency of micturation, no H/o fever with rash, LPV/BPV. No USG done.
T2: H/o quickening present, 1st dose of T.T 1st covered, no H/o LPV/BPV, no H/o folic, iron acid
intake.
7. Details of delivery:
a. Onset of labour (date & time): 19.01.14 at 6:30 pm
b. Rupture of membrane (spontaneous/artificial): not present
c. Mode of onset of labour (spontaneous/artificial): artificial
d. Type of delivery: normal vaginal delivery
e. Date & time of delivery: 19.01.14 at 6: pm
f. Sex of baby: female
g. APGAR score: IUD
h. Birth weight:557 gms
i. Vital signs of mother:
Pulse: 68/min
B.P.: 170/100 mmhg
Temperature: afebrile
j. Blood loss: approx. 200ml
k. Delivery of placenta:
Spontaneous: after 10 min of delivery
Weight: 89 gms
Cord length: 40cm
Completeness: complete placenta delivered
l. Perineum: normal
m. Immediate post partum period:
Vital signs:
Pulse: 68/min
B.P.: 170/100 mmhg
Temperature: afebrile
Uterus: contracted
Vaginal bleeding: normal amount
Breast feeding initiated: baby not alive
Medication used during intrapartal period: oxcitocin 4 unit 30 drops/min, merthrgin 1amp (IM)
 8. Postnatal assessment:
a. General findings: stable
b. Obstetric findings:
9. Theory application: -
Henderson’s theory:-
Introduction
 “The Nightingale of Modern Nursing”
 “Modern-Day Mother of Nursing.”
 "The 20th century Florence Nightingale."
 The unique function of the nurse is to assist the individual, sick or well, in the performance of those
activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he
had the necessary strength, will or knowledge. And to do this in such a way as to help him gain
independence as rapidly as possible" (Henderson, 1966).

The 14 components:-

i. Breathing pattern:- normal

ii. Eat & drink adequately: - not able to eat at adequately due to bell’s palsy.
iii. Elimination body waste: - normal eliminate the waste
iv. Move & maintain desirable: - able to move & maintain desirable position.
v. Sleep & rest: - not taking adequate rest due to tension as their baby is not alive.
vi. Select suitable clothes dress & undress: - able to select suitable clothes.
vii. Maintain body temperature within normal range by adjusting clothing & modifying environment:
- able to maintain.
viii. Keep the body clean & well groomed & protect the integument: - not able to maintain her personal
hygiene by herself due to lack of knowledge regarding hygiene.
ix. Avoid danger in the environment & avoid injuring other: - able to avoid danger in the environment
& avoid injuring other.
x. Communicate with other & expressing emotion, needs, fears, opinions: - not able to communicate to
anyone & not expressing their emotion about their baby & their feeling due to difficulty in speaking
(bell’s palsy).
xi. Worship according to one’s faith: - not able to worship due to hospitalization.
xii. Work in such a way that there is a sense of accomplishment: - not able to do any work as she is
hospitalized only doing their daily life activity.
xiii. Play or participate in various form of recreation: - not able to participate in any play or recreation.
xiv. Learn, discover or satisfy the curiosity that lead to normal development & health & uses the
available health facilities: - not able to learn or discover.

10. Investigations:
Sno. Investigation Patient values Normal values
1. Haematology:
Hb 13.49 g/dl 12-16 g/dl
TLC 11.20 thou/cumm 4-11 thou/cumm
MCH 31.40 pg 27-31 pg
Platelet 12.49 thou/cumm 150-400 thou/cumm
RDW 19.18 % 11.6-14.8 %
DLC:-
 Neutrophil 60% 55-70%
Lymphocyte 24% 20-40%
Eosinophil 01% 00-06%
Monocyte 07% 02-05%
2. Biochemistry investigation
Glucose 93 mg/dl
Urine: proteinuria 2 grams in 24 hr
3. USG:- Single dead foetus, placenta appears post amniotic fluid is adequate, FL-33mm, GA-20wks

11. Medications:
a. Inj. Labetalol: - it is a unique among adrenergic anotagonists in blocking both a & b receptors.
Labetalol is orally affected & undergone considerable first pass metabolism.
Indication: - all grades of hypertension. Specially used in phenochromocytoma & clonidine
withdrawal hypertension.
Doses: - start with 50mg twice daily, increase at fort night interval to 100-200 mg twice daily. Usual
dose 200-400 mg daily. For my patient 20 mg iv stat 4-6 hrly.
Contraindication: - children, allergy, right ventricular failure, secondary pulmonary hypertension,
A.V. block, sinus bradycardia shock, CHF, pregnancy, lactation.
Special precaution: - abrupt withdrawal, diabetes, cardiac failure, anaesthesia, hyperthyroidism,
postural hypotension, eye & skin reaction, liver dysfunction.
b. Inj. Ractac:- it is a potent long acting histamine H2 receptor antagonist for the treatment of duodenal
& gastric ulcer. It inhibits basal & stimulating secretions of gastric acid, reducing both the volume &
acid & pepsin content of the secretion. It has long duration of action.
Indication:- duodenal ulcer, benign gastric ulcer, to reduce acidity.
Dosage:- maintaining dose is 150 mg at night, for my patient 150 mg iv BD.
Contraindication:- hypersensitivity
Side-effects:- skin rashes, headache, dizziness, mental confusion, hallucination, blurred vision,
leucopoenia, arthalgia.
c. Inj. Taxim: - broad spectrum cephalosporin for parenteral administration, is bactericidal and effective
against gram negative proteus spp both indole negative & positive.
Indication: - respiratory, urinary, bone, soft tissue infection, gonorrhoea, meningitis.
Doses: - adult: 2-6 gms daily in 2-3 divided dose. Max. 12 gm daily.
Contraindication:- hypersensitivity, severe renal failure.
Side effect: - urticaria, drug fever, anaphylaxis, nausea, vomiting, diarrhoea, leukopenia.
d. Tab Misoprostol:- Prostaglandins are derivatives of protanoic acid from which they derive their
names. Prostaglandins, PGE2 and PGF2α are exclusively used in clinical practice.
Indications:- Induction of abortion, termination of molar pregnancy, cervical ripening prior to induction
of abortion or labour, acceleration of labour, management of atonic postpartum haemorrhage, medical
management of tubal ectopic pregnancy.
Contraindications:- Absolute:- Hypersensitivity of the compound, Asthma, Acute PID. Relative:-
Hypertension, cardiovascular disease, renal disease, peptic ulcer, jaundice, uterine scar.
Mechanism of action:- PGs sensitise the myometrium to oxytocin. PGF2α acts mainly on the cervix due
to its collagenolytic property.
Dosage and forms:- PGE1 misoprostol 50 mg,given four hourly by oral ,vaginal or rectal route for
induction of labour, Injectable or vials:- PGE2- prostin E2 containing 1mg/ml, PGF2 α( Dinoprost
tromethamine), containing 5mg/ml, Methyl analauge of PGF2 α (corboprost) containing 2.5 mg /10ml
 vial, PGE1 misoprostol 50 mg,given four hourly by oral ,vaginal or rectal route for induction of
labour.(Misoprostol ) 50µg 4 hourly schedule by oral , vaginal or rectal route is used . It is rapidly
absorbed and is more effective than oxytocin or dinoprostone for induction of labour.
Adverse reactions:- Headache, dizziness, hypotension, leg cramps, joint swelling, blurred vision.
e. MgSo4:- Action:- Decrease acetylcholine in motor nerve terminals, which is responsible for anti
convulsant properties, there by decreases neuro muscular irritability . it also decrease intra cranial
oedema and helps in diuresis. Its peripheral vasodilatation effect improves the uterine blood supply
Use:- It is a valuable drug lowering seizer’s threshold in women with pregnancy induced hypertension.
The drug is used in preterm labour to decrease uterine activity.
Doses:- prophylactic MgSo4 2.5 gm iv 4 hrly.
Side effect:- Maternal: Severe CNS depression( respiratory depression and circulatory collapse),
evidence of muscular paresis( diminished knee jerks). Foetal: Tachycardia, hypoglycaemia.

12. Anatomy & physiology:

Uterus:-
The uterus is a hollow pear-shaped muscular organ located in the true pelvis between the bladder &
rectum. The function of the uterus is to nourish the developing fetus prior to birth.
Blood supply:-
The uterine artery arrives at the level of the cervix and is a branch of the internal iliac artery. It sends a
small branch to the upper vagina & then runs upward in a twisted fashion to meet the ovarian artery &
form an anastomosis with it near the cornu. The ovarian artery is a branch of the abdominal aorta,
leaving near the renal artery. It supplies the ovary and uterine tube before joining the uterine artery. The
blood drain through corresponding veins.
Lymphatic drainage:-
Lymph is drained from the uterine body to the internal iliac glands and from the cervical area to many
other pelvic lymph glands. This provides an effective defence against uterine infection.
Nerve supply:-
The nerve supply is mainly from the autonomic nervous system, sympathetic & parasympathetic via
inferior hypo gastric or pelvic plexus.
Placenta:-
The placenta is completely formed and functioning 10 weeks after fertilization. Functions of placenta is
respiration, nutrition, storage, excretion, protection, endocrine & placental circulation.
Placental circulation: - maternal blood is discharged in a pulsatile fashion into the intervillous space by
80-100 spiral arteries in the deciduas basalis. It spurts towards the chorionic plate & flows slowly around
the villi, eventually returning to the endometrial veins and the maternal circulation. There are about 150
ml of maternal blood in the intrevillous spaces, which is exchanged 3-4 times/min.
Fetal blood, low in oxygen, is pumped by the fetal heart towards the placenta along the umbilical arteries
and transported along their branches to the capillaries of the chorinic villi where exchange of nutrient
takes place between the mother & fetus. Having yielding up carbon dioxide and waste products and
absorbed oxygen & nutrient, the blood is returned to the fetus via the umbilical vein.

In normal pregnancy:

(1) Angiotensin-II (part of a2 globulin) is destroyed by angiotensinase which is liberated from the placenta.
Thus, the blood pressure is stabilised.
(2) The vascular system becomes refractory, selectively to pressor agent angiotensin-II. This is probably
brought out by vascular synthesis of prostaglandin I2 and nitric oxide (NO) which have got vasodilator
effect. The interaction between the two systems stabilises the blood pressure in normal pregnancy.

OEDEMA: The cause of excessive accumulation of fluids in the extracellular tissue spaces is not clear.
Excessive retention of sodium in the oedematous state is probably due to increased aldosterone out of
activation of corticosterone by angiotensin-II. But paradoxically in severe pre-eclampsia, aldosterone level
falls. Diminished renal blood flow, decreased glomerular filtration rate and increased tubular reabsorption
are also responsible for retention of sodium.

PROTEINURIA : The probable chain of events is as follows. Spasm of the afferent glomerular arte-rioles
—> anoxic damage to the endothelium of the glomerular tuft —> increased capillary permeability —>
increased leakage of proteins. Tubular reabsorption is simultaneously depressed. Albumin constitutes 50-
60% and alpha globulin constitutes 10-15% of the total proteins excreted in the urine.

Pathophysiology

While the question as to why the syndrome occurs still remains unsolved, the pathological changes are well
documented, specially in severe pre-eclampsia or in eclampsia.
13. Disease condition (comparison of book picture with patient):
My patient having three disease conditions that is IUD baby, pre-eclampsia & bell’s plasy:
A. IUD: (intra uterine fetal death):-
Definition: - IUD embraces all the fetal death weighing 500 gm or more occurring both during
pregnancy (ante partum death) and during labour (intrapartum).
OR
Ante partum death occurring beyond the period of viability is termed as IUD.
Etiology:-
a. Maternal (5-10%):-
 Hypertensive disorder in pregnancy (in my  Antiphospholipid syndrome
patient)  Thrombophilias
 Diabetes  Abnormal labour
 Maternal infection  Post term pregnancy
 Hyperpyrexia  Systemic lupus erythematosus
b. Fetal (25-40%)
 Chromosomal abnormalities  Rh- incompatibility
 Major structural anomalies  Non immune hydrops
 Infection  IUGR
c. Placental (20-35%)
 APH  Placental insufficiency(may be the reason
 Cord accident for my patient)
 TTTS
d. Iatrogenic:-
 External cephalic version  Drugs (quinine beyond therapeutic doses)
e. Unknown (25-35%)
Diagnosis:-
Book picture Patient picture
 Absence of fetal movements  Absence of fetal movements
 Retrogression of positive breast changes  Fundal height & it becomes smaller
 Fundal height & it becomes smaller  Uterus feels flaccid
 Uterus feels flaccid  Fetal heart sound absent
 Fetal heart sound absent
 Egg-shell crackling (late feature)

Treatment:-
Book picture Patient picture
 Oxytocin infusion (if cervix favourable) 5-10  Misoprostol 200 µg vaginally repeat after every
unit in 500 ml RL (IV) 4 hr.
 Prostaglandin vaginally repeat after 6-8 hr
 Misoprostol 25-50 µg vaginally or orally repeat
after every 4 hr.
 Caesarean section (abnormal case)
 B. PRE-ECLAMPSIA:-
Definition: - pre-eclampsia is a multi system disorder of unknown aetiology characterised by
development of hypertension to the extent of 140/90 mmhg or more with proteinuria after 20 weeks in
a previously nor-motensive & non proteinuria women.
The pre-eclampsia feature may appear even before the 20th week as in case hydatidiform mole & acute
Polyhydramnios.

Risk factors:-
Book picture Patient picture
a. Primigravida (young or elderly) a. Primigravida (elderly).
b. Family history of hypertension, pre eclampsia b. Other not significant
c. Placental abnormalities
d. Obesity (BMI > 35 kg/M2, insulin resistance)
e. Pre-existing vascular disease
f. New paternity
g. Thrombophilias

Etiopathologic factors for pre-eclampsia:-

Book picture Patient picture

 Failure to trophoblast invasion (abnormal placentation)  Not significant
 Vascular endothelial damage
 Inflammatory mediator (cytokines)
 Immunological intolerance between maternal and fetal
tissues
 Coagulation abnormalities
 Increased oxygen free radicals
 Genetic predisposition (polygenic disorders)
 Dietary deficiency or excess

Diagnosis:-
Book picture Patient picture
 BP > 160 systolic or >110 diastolic  BP > 160 systolic or >110 diastolic
 5grams of protein in 24 hour urine  2grams of protein in 24 hour urine
 Oliguria  Oliguria
 Disturbed sleep  Disturbed sleep
 Diminished urine output  Diminished urine output
 Headache  Headache
 Abnormal weight gain (more than 5lb in a month)  Visible oedema over the ankles.
 Visible oedema over the ankles.
 Cerebral of visual disturbances
 Pulmonary edema or cyanosis
 Epigastric or RUQ pain
 Impaired liver function
 Thrombocytopenia
 IUGR
 Investigation:-

1. Urine
2. Ophthalmic examination
3. Blood values (serum uric acid level>4.5 mg/dl)
4. Antenatal fetal monitoring

Treatment:-

Book picture Patient picture

 Rest  Rest
 Diet (daily protein 100 gm. Total calories  Diet (daily protein 100 gm. Total calories
approx 1600 cal/day) approx 1600 cal/day)
 Diuretics (e.g Lasix 40 mg)  Antihypertensive (labetalol)
 Antihypertensive (methyldopa, labetalol,
nifedipine, hydralazine)
PREDICTION AND PREVENTION

Pre-eclampsia is not a totally preventable disease. Somewhat, it is found more related to chains of social ills
such as poor maternal nutrition, limited or no antenatal care and poor reproductive education. However,
some specific "high risk" factors leading to pre-eclampsia may be identified in an individual. These are —

1. primigravida specially with young and elderly,

2. poor nutrition,
3. low level of education,
4. presence of complicating factors like pre-existing hypertension, antiphospholipid syndrome twins,
polyhydramnios, clinical or latent diabetes, nephritis, etc.,
5. history of pre-eclampsia or hypertension in the family or in previous pregnancy
6. abnormal weight gain and
7. Rising serum uric acid level.
The following regime should be enforced in such a group of patients in an attempt to prevent or to
detect early manifestations of pre-eclampsia.

 Regular antenatal check up at frequent interval from the beginning of pregnancy to detect at the earliest,
the rapid gain in weight or a tendency of rising blood pressure specially the diastolic one.
 The patient is advised to take adequate rest in bed on her left side at least extra 2 hours at noon from the
20th week of pregnancy onwards.
 Low dose aspirin 60 mg daily beginning early in pregnancy in potentially high risk patients seems
promising. It selectively reduces platelet thromboxane production. Aspirin in low doses is known to
inhibit cyclo-oxygenase in platelets thereby preventing the formation of thromboxane A2 without
interfering with prostacyclin generation,
 Calcium supplementation (2 gm per day) reduces the risk of pre-eclampsia,
 Antioxidants, vitamins E and C, taking from 16-22 weeks onwards reduce the risk of pre-eclampsia.
She should be on a well balanced diet rich in protein.

C. BELL’S PALSY:-
Definition: - It is a disorder characterised by paralysis of facial nerve.
Aetiology:-
 Viral infection  Hereditary factor
 Inflammation of nerve  Diabetes mellitus
  Hypertension  Pregnancy
 Multiple sclerosis

Anatomy:-
Facial nerve originals in pons and branches into moto and sensory fibres. Motor fibres supply muscles of
the face and are responsible for facial expression. Sensory fibre supply anterior two third of the tongue
and are responsible for taste.
Pathophysiology:-
Presence of the aetiology factors causes inflammation of the facial nerve. Complete paralysis of the
nerve result in lon of motor sensory and parasympathetic function ipsilater to the lesions.
Causes & symptoms:-
Book picture Patient picture
 Pain behind the ear or face or few hr or day  Pain face or few hr or day before the onset of
before the onset of paralysis. paralysis.
 Displacement of the lip towards unaffected  Displacement of the lip towards unaffected
side. side.
 Flattening of nasolabial folds.  Impaired communication
 Corneal blink reflex is absent  Impaired taste sensation.
 Collection of tears in lower lid.  Eating & drinking impaired
 Impaired communication  Patient can’t smile grimace or whistle.
 Impaired taste sensation.
 Eating & drinking impaired
 Patient can’t smile grimace or whistle.
Treatment:-
Book picture Patient picture
 Electrotherapy  No treatment was given
 Physiotherapy to strengthen the affected muscles
 Massage exercise
 Warm & most heat application to soothen painful
facial muscles.
 Antiviral drugs
 Steroids, prednisolone
 Analgesics
14. Identification & Prioritization of health needs & health problems of mother & baby:
a. Reduce the B.P.
b. Maintain the nutritional pattern
c. Prevent from hospital infection
d. Provide psychological support
e. Maintain the body comfort
f. Provide adequate knowledge regarding disease condition.
15. Formulation of nursing care plan:
S. Assessment Nursing Goal Implementation Evaluation
n diagnosis
o.
1. Subjective Increased B.P The client  Provided antihypertensive drugs as B.P.
data: - patient related to will prescribed by physician that is maintained.
said that she disease maintain Labetalol.
feels condition as the blood  B.P. 4 hourly taken.
palpitation. evidenced by pressure.  Low salt diet Provided
 Objective measuring B.p  Advised for Deep breathing exercises.
data:-  Advised for more fluids.
increased B.P
2. Subjective Impaired  I.V fluids administered. Nutritional
The client
data: - patient nutritional  Increased the fluid volume intake. level
will
says that pattern less maintained.
maintain  Assessed the general condition of
feeling of than body the patient as to determine the wt of
dizziness & requirement nutrition client.
fatigue. related to level in
Objective inadequate  Prepared a proper menu planning for
body.
data:- intake & bell’s the client.
inadequate palsy as  Encouraged the client to do mild
nutrition. evidence by exercise.
visualization
 Encouraged the client to intake blunt
diet.
 Adviced the client to avoid the intake
of fat-rich and higher calorie food.
 Provided the client environment to
sleep and rest.
 Encouraged the client to verbalize
fears.
 Eliminating excess noise in the client
environment.
 Provided dimensional therapy to the
client.
Subjective
3. Impaired body The client  Assess the general condition of Relived
data:- patient comfort related will relive patient as to determines the level of from
said that she headache.
to headache from pain
is feeling due to headache
pain in head.  Provide the client silent and noise free
hypertension
Objective environment.
data:-
headache
4. Objective Anxiety
Anxiety and The client  Assess the general condition of client.
data:- patient level
fear related to will able
asking  Determine the vital sign of client. reduced.
generalized to remove
questions  Provide a schedule that alternates
lack of all its fear
related to long resting periods with period of
knowledge & anxiety.
disease again activity.
related to
& again. hypertension.  Plan for emotional as well as physical
rest.
 Discuss with client to reduce stress
and decrease tension.
 Answer all the question of client
regarding disease condition.
5. Objective Psychological The client  Psychological support provided. Patient is
data:- patient now in
 is depressed imbalance will  Health education given to control stable
related to fetal achieve hypertension and for regular check condition.
loss as the up.
evidenced by psychologi
visualization. cal
balance.
6. Objective Risk of To reduce  Aseptic techniques were used. Level of
data: patient risk of
infection the risk of
not  Hand washing was done before & infection
related to infection.
maintaining after each procedure. reduced.
hospitalization
personal  Cannula changed after every 3 days.
as evidenced
hygiene. by  Personal hygiene maintained.
cannulization.
7. Objective Knowledge To provide  Health education given related to Patient gain
data:- Knowledge.
deficit related knowledge disease condition.
questioning to disease regarding 
of patient Follow-up advises given.
condition as disease
shows lack of evidenced by condition.
knowledge. questioning of
patient related
to disease.

8. Risk of injury related to increase B.P. as evidenced by B.P. monitoring.

9. Eating & drinking impaired related to Bell’s palsy as evidenced by visualization.
10. Impaired communication related to IUD baby & Bell’s palsy as evidenced by visualization.
11. Activity intolerance related to generalized weakness, dizziness due to hypertension
16. HEALTH EDUCATION
a. Aware the client about the cause of hypertension.
b. Advice for regular antenatal check-ups.
c. Advice to take regular medicine for hypertension.
d. Advice the patient to control the obesity as obese person are more prone to hypertension.
e. Advices the client that increase triglycerides or cholesterol Ted risk of hypertension so advise the
patients to control cholesterol level in body.
f. Advice the client to have salt free diet.
g. Advice the client to avoid high fat and calorie diet.
h. Advice the client that diabetes mellitus give risk to hypertension so advice to control glucose level.
17. Summary: Mrs. Shabnam is 34 year old female admitted to the hospital HIHT on 18.01.14 with the
complaints of amenorrhea since 6th month & absent fetal movement. She was delivered IUD baby on
19.01.14. After that she treated for Bell’s palsy & pre-eclampsia.
18. Patient evaluation:- Mrs. Shabnam’s condition was critical. He was suffering from pre-eclampsia,
Bell’s palsy with absent fetal movment that was treated by artificial induction of labour and expulsion of
IUD fetus on 19.01.14. Prognosis was good. Patient was discharged on 24.01.14 follow up on 31.1.14.
19. Student self evaluation:- I provided the complete care to Mrs. Shabnam suffering from pre-eclampsia,
Bell’s palsy with IUD baby. I provided care during the treatment. I learned about meningomyocele pre-
 eclampsia, Bell’s palsy with IUD, its causing factors, care provide to patient with pre-eclampsia, Bell’s
palsy with IUD, its management and drug provided to the patient with pre-eclampsia, Bell’s palsy with
IUD. To assess investigation & assessment of postnatal mother with IUD baby.

20. Bibliography:-
 DC Dutta; textbook of obstetrics, new central book agency (P) Ltd; 7th edition, page no. 219-230 &
322-326.
 Myles; textbook for midwives, 5th edition, page no.117-119 & 149-150.
 Drugs today vol no.1; 206, 693.

 Lewis, Heitkemper dirisen; medical surgical nsg. 6th edition; mosby, 2004, usa; 652-654.
 Joycee m. black, Jawf hokanson hawks; medical surgical nsg; 7th edition; elsevir, 2005: 1112.
 Hypertension and Pregnancy, http://www.emedicine.medscape.com
 Case presentation
On
Pre-eclampsia, Bell’s
palsy & IUD

Submitted to: - Submitted by:-

Mrs. Sylvia Devi Priyanka Joshi

Lecturer M.Sc (N) 1st Year

HCN HCN

Submitted on:-

03/08/2014