TRINITY UNIVERSITY OF ASIA

St. Luke’s College of Nursing

E. Rodriguez Sr. Ave., Cathedral Heights

Quezon City, Philippines

CASE ANALYSIS ON PREECLAMPSIA

Submitted by:

Robles, Khristine Gabrielle U.

2NU04
I. History of Present Admission

A 29-year-old female from Marikina City, went to OPD obstetric clinic for her checkup last October 16, 2019 at 4:30PM.

Upon arrival, the patient verbalized that she is already experiencing nape pain. The OPD nurse took her blood pressure

and the reading was 170/100. She was then referred to the Emergency Room at 5:00PM. She has done several tests

like complete blood count, urinalysis, etc, and she was admitted at 7:30PM in the same day.

Admitting diagnosis: 𝐆𝟐 𝐏𝟏 (1000) pregnancy uterine 30 1/7 weeks AOG cephalic not in labor; preeclampsia.

II. Past Medical History

The patient denies any sickness aside from cough and common colds.

III. Family Health History

The patient stated that her father is hypertensive and her mother has asthma.

IV. Obstetric History

The patient’s last menstrual period was March 19, 2019 and the expected date of delivery is December 27, 2019. Patient

stated that she has pregnant before but her child died three days after birth.CAUSE OF DEATH???
 V. Pathophysiology

VI. Diagnostic Examinations

VII. Medications

Name of Dosage Indication Contraindication Side effects Nursing consideration

Drug
MgSO4 4 amps ID Treatment/prevention of
TIV hypomagnesemia.
Treatment of
hypertension. Prevention
of seizures associated
with severe eclampsia,
preeclampsia, or acute
nephritis.
Unlabeled Use: Preterm
labor. Treatment of torsade
de pointes. Adjunctive
treatment for
bronchodilation in moderate
to severe acute asthma
Contraindicated CNS:  Hypomagnesemia/Anticonvulsa
in: drowsiness. nt: Monitor pulse, BP,
Hypermagnesemia; Resp: low respirations, and ECG
Hypocalcemia; respiratory frequently throughout
Anuria; Heart block;rate. administration of parenteral
CV: magnesium sulfate.
OB: Avoid using for arrhythmias, Respirations should be at least
more than 5–7 days bradycardia, 16/min before each dose.
for preterm labor hypotension.  Monitor neurologic status before
(may risk of GI: diarrhea. and throughout therapy.
hypocalcemia and MS: muscle Institute seizure pre-cautions.
bone changes in weakness. Patellar reflex (knee jerk) should
newborn); avoid Derm: be tested before each
continuous use flushing, parenteral dose of magnesium
during active labor sweating. sulfate. If response is absent,
or within 2hr of Metab: no additional doses should be
delivery due to hypothermia administered until positive
potential for response is obtained.
magnesium toxicity  Monitor intake and output ratios.
in newborn. Urine output should be
maintained at a level ofa tleast
Use Cautiously in: 100 mL/4 hr.
Any degree of renal  Lab Test Considerations:
insufficiency Monitor serum magnesium
levels and renal function
 periodically throughout
administration of parenteral
magnesium sulfate.
Hydralazine 5mg TIV Moderate to severe Use Cautiously in: CNS:  Monitor BP and pulse
hypertension (with a Cardiovascular or dizziness, frequently during initial dose
diuretic). cerebrovascular drowsiness, adjustment and periodically
disease; Severe headache. during therapy.
renal and hepatic CV:  Lab Test Considerations:
disease (dose tachycardia, Monitor CBC, electrolytes,
modification may angina, LE cell prep, and ANA titer
be necessary); arrhythmias, prior to and periodically
edema, during prolonged therapy.
OB, Lactation: orthostatic  May cause a positive direct
Has been used hypotension. Coombs’ test result.
safely during GI: diarrhea,
pregnancy. nausea,
vomiting.
Derm: rash.
F and E:
sodium
retention.
MS:
arthralgias,
arthritis.
Neuro:
peripheral
neuropathy.
Misc: drug-
induced lupus
syndrome.
KCL tab 2 tab TID x Treatment/prevention of Contraindicated CNS:  Assess for signs and
750mg/tablet 2 days potassium depletion. in: Hyperkalemia; confusion, symptoms of hypokalemia
Severe renal restlessness, (weakness, fatigue, U wave
impairment; weakness. on ECG, arrhythmias,
Untreated CV: polyuria, polydipsia) and
Addison’s disease; arrhythmias, hyperkalemia (see Toxicity
Some products ECG and Over-dose).
may contain changes. GI:  Lab Test Considerations:
tartrazine (FDC abdominal Monitor serum potassium
yellow dye #5) or pain, before and periodically
alcohol; avoid using diarrhea, during therapy. Monitor renal
in patients with flatulence, function, serum bicarbonate,
known nausea, and pH. Determine serum
hypersensitivity or vomiting magnesium level if patient
intolerance; tablets, has refractory hypokalemia;
Hyperkalemic capsules hypomagnesemia should be
familial periodic only, GI corrected to facilitate
paralysis. ulceration, effectiveness of potassium
stenotic replacement. Monitor serum
Use Cautiously in: lesions. chloride because
Cardiac disease; Neuro: hypochloremia may occur if
Renal impairment; paralysis, replacing potassium without
Diabetes mellitus paresthesia. concurrent chloride
(liquids may contain  Toxicity and Overdose:
sugar); Symptoms of toxicity are
Hypomagnesemia those of hyperkalemia(slow,
(may make irregular heartbeat; fatigue;
correction of muscle weakness;
hypokalemia more paresthesia; con-fusion;
difficult); GI dyspnea; peaked T waves;
hypomotility depressed ST segments;
including dysphagia prolonged QT segments;
or esophageal widened QRS complexes;
compression from loss of P waves; and cardiac
left atrial arrhythmias).
enlargement
 (tablets, capsules);
Patients receiving
potassium-sparing
drugs.
Methyldopa 2 tablets Management of moderate Contraindicated CNS:  Monitor BP and pulse
250mg/tablet PO every 8 to severe hypertension in: Hypersensitivity; sedation, frequently during initial dose
hours (with other agents). Active liver disease. depression. adjustment and periodically
EENT: nasal during therapy. Report
Use Cautiously in: stuffiness. significant changes.
Previous history of CV:  Monitor intake and output
liver disease; OB: myocarditis, ratios and weight and
Has been used bradycardia, assess for edema daily,
safely (may be edema, especially at beginning of
used for treatment orthostatic therapy. Report weight gain
of hypertension in hypotension. or edema; sodium and water
pregnancy); GI: drug- retention may be treated
induced with diuretics.
Lactation: Usually hepatitis,  Assess patient for
com-patible with diarrhea, dry depression or other
breast feeding; mouth. GU: alterations in mental status.
erectile Notify healthcare
Geri: high risk of dysfunction. professional promptly if
adverse reactions; Hemat: these symptoms develop.
consider age- eosinophilia,  Monitor temperature during
related impairment hemolytic therapy. Drug fever may
of hepatic, renal anemia. occur shortly after initiation
and cardiovascular Misc: fever. of therapy and may be
function as well as accompanied by eosinophilia
other chronic ill- and hepatic function
nesses. Appears on changes. Monitor hepatic
Beers list. May function test if unexplained
cause bradycardia fever occurs.

Dexamethaso 6mg TIV Used systemically and
ne q12 x 4 locally in a wide variety of
doses chronic diseases including:
Inflammatory, Allergic,
Hematologic, Endocrine,
Neoplastic, Dermatologic,
Autoimmune disorders,
and exacerbate  Lab Test Considerations:
depression. Monitor renal and hepatic
function and CBC before
and periodically during
therapy.
 Monitor direct Coombs’ test
before and after 6 and 12
months of therapy. May
cause apositive direct
Coombs’ test, rarely
associated with hemolytic
anemia.
 May cause higher BUN,
serum creatinine, potassium,
sodium, prolactin, uric acid,
AST, ALT, alkaline
phosphatase, and bilirubin
concentrations
 May cause prolonged
prothrombin times.
 May interfere with serum
creatinine and AST
measurements.
Contraindicated Adverse  Indicated for many
in: reactions/side conditions. Assess involved
Active untreated effects are systems before and
infections (may be much more periodically during therapy.
used in patients common with  Assess for signs of adrenal
being treated for high- insufficiency (hypotension,
tuberculous dose/long- weight loss, weakness,
meningitis); Known term therapy nausea, vomiting, anorexia,
alcohol or bisulfite CNS: lethargy, confusion,
hypersensitivity or depression,
Management of cerebral intolerance (some euphoria, restlessness) before and
edema, Diagnostic agent in products contain hallucinations periodically during therapy.
adrenal disorders. these and should , headache,  Monitor intake and output
be avoided in high ratios and daily weights.
Unlabeled Use: Short-term susceptible intracranial Observe patient for
administration to high-risk patients); pressure peripheral edema, steady
mothers before delivery to Lactation: Avoid (children weight gain, rales/crackles,
prevent respiratory chronic use. only), or dyspnea. Notify physician
distress syndrome in the Use Cautiously in: insomnia, or other health care
newborn. Adjunctive Chronic treatment personality professional should these
management of nausea and (will lead to adrenal changes, occur.
vomiting from suppression; use psychoses,  Cerebral Edema: Assess for
chemotherapy. Treatment of lowest possible restlessness. changes in level of
airway edema prior to dose for shortest EENT: consciousness and
extubation. Used in period of time); cataracts, headache throughout
neonates with Stress (surgery, high therapy.
bronchopulmonary infections); supple- intraocular  Lab Test Considerations:
dysplasia to facilitate mental doses may pressure. CV: Monitor serum electrolytes
ventilator weaning. be needed; hypertension, and glucose. May cause
Potential infections edema. GI: hyperglycemia, especially in
(may mask signs); peptic patients with diabetes.
OB: Safety not ulceration, Monitor hematologic values,
established; Pedi: anorexia, serum electrolytes, and
Early postnatal nausea, serum and urine glucose in
administration of increased patients on prolonged
high doses can appetite, therapy. May cause low
cause significant vomiting. WBC counts. May cause low
and persistent Derm: acne, serum potassium and
reductions in lower wound calcium and high serum
neuromotor and healing, ec- sodium concentrations.
cognitive chymoses,  Guaiac tests tools. Promptly
functioning; results hirsutism, report presence of guaiac-
in low growth; use petechiae. positive stools
 lowest possible Endo:  Suppresses reactions to
dose for shortest adrenal allergy skin tests.
period of time. suppression,  Dexamethasone
hyperglycemi Suppression Test: To
a. F and E: diagnose Cushing’s
amenorrhea, syndrome, obtain baseline
hypokalemia, cortisol level; administer
alkalosis. dexamethasone at 11PMand
Hemat: obtain cortisol levels at 8AM
thromboembo the next day. Normal
lism, response is a decreased
thrombophleb cortisol level.
itis. Metab:
weight gain.
MS: muscle
wasting,
osteoporosis,
avascular
necrosis of
joints, muscle
pain. Misc:
cushingoid
appearance
(moon face,
buffalo
hump), higher
susceptibility
to infection.

VIII. Nursing Care Plan