power point preeclampsia

PREECLAMPSIA

INTRODUCTION

Preeclampsia, also referred to as toxemia, is a condition that pregnant women can get.

3 Cardinal Signs: 1.) Hypertension 2.) Proteinuria 3.) Edema

In addition, symptoms of preeclampsia can include:

• Rapid weight gain caused by a significant increase in bodily fluid

• Abdominal pain• Severe headaches• A change in reflexes• Reduced output of urine or no urine• Dizziness• Excessive vomiting and nausea

Classifications:

1. Mild Preeclampsia - blood pressure greater than 140/90

2. Severe Preeclampsia – blood pressure greater than 160/110

NURSING HEALTH HISTORY

PATIENTS NAME: Ms. XYZADDRESS: Brgy. Buao Gandara, SamarSEX: FemaleSTATUS: SingleBIRTHDATE: November 11,2009BIRTHPLACE: Gandara, Samar AGE: 20 years oldNATIONALITY: FilipinoRELIGION: Roman CatholicDATE OF ADMISSION: September 21, 2009TIME OF ADMISSION: 8:20amTYPE OF ADMISSION: NewADMITTING PHYSICIAN: Dr. RamosCHIEF COMPLAINT: “High Blood Pressure”

HISTORY OF PRESENT ILLNESS

Patient was admitted at Gandara District Hospital last September 11, 2009 due to UTI. She had a normal blood pressure last September 17, 2009. When she had labored, her blood pressure in Gandara District Hospital was 200/130 mmHg. She was given Captropil 25g tab ½ tab OD, and Digoxin 0.25mg tab ½ tab OD. Persistence of increase blood pressure was referred at Samar Provincial Hospital for further evaluation and management hence admitted.

TENTATIVE DIAGNOSIS: Pre-eclampsia (pre and post-partum)

PAST HEALTH HISTORYMs. XYZ had complete immunizations during childhood.

FAMILY HEALTH HISTORYMs. XYZ’s MOTHER had a history of hypertension while she was pregnant.

PHYSICALASSESSMENT

GENERAL APPEARANCE

Ms. XYZ is 20-year old primigravida. She is conscious and coherent upon assessment. She has edema on her face and has difficulty upon ambulation.

VITAL SIGNSBP: 170/120 RR: 22 cpmPR: 105 bpm Temp.: 37⁰C

BODY PARTS NORMAL FINDINGS ACTUAL FINDINGS INTERPRETATION

Hair Evenly distributed, thick, silky, resilient hair

Shiny, evenly distributed

Normal

Head Rounded, absence of nodules or masses

Rounded, no injuries, absence of nodules

Normal

Face Round and brown in color, symmetrical with no masses and involuntary movements

Symmetrical with no masses and involuntary movements, edematous

Edema is due to increased tubular

reabsorption of sodium

Eyes Eyebrows evenly distributed, eyelashes equally distributed, no discoloration of eyelids, pupil black in color and equal in size

Eyebrows evenly distributed, pupil black in color and equal in size

Normal

Ears No discharge, auricles symmetrical, able to hear clearly and sounds can be heard on both ears

No discharge, auricles symmetrical, able to hear clearly

Normal

Nose No discharge, color uniform to skin, not tender, no lesion

No discharge, not tender, no lesions

Normal

Mouth Lips are pink in color, white, shiny tooth enamel, gum and surface of the tongue are pink

No bad odor, teeth is clean and white, gums pink in color

Normal

Skin Varies from light to deep brown, no edema, skin temp. is in normal range

Light brown , dry skin Decreased fluid intake

Nails Smooth fingernails and toenails texture

Smooth fingernails and toenails texture, short nails without nail polish

Normal

Neck Head centered, coordinated head movement, no discomfort

Head centered, coordinated head movement, no discomfort

Normal

Upper extremities No deformities No deformities Normal

Lungs No adventitious breath sounds

No adventitious breath sounds

Normal

Heart Full pulsation, thrusting quality upon auscultation

Full pulsation, thrusting quality upon auscultation

Normal

Breast Rounded shape, slightly unequal in size, areola is round, nipples are not inverted, no discharge except in pregnant or breastfeeding women

Rounded shape, slightly unequal in size, areola is round, nipples are not inverted, presence of milk coming out from the breast

Normal

Abdomen Unblemished skin, no evidence of enlargement of liver or spleen, symmetric movement caused by respiration

Presence of linea negra, presence of striae gravidarum, fundus is firm and below the umbilicus

Normal

Genitals Wide variation of pubic hair, no lesions, no inflammation

Presence of episiotomy, presence of vaginal discharge

Normal

Lower extremities No deformities No deformities Normal

ANATOMY &

PHYSIOLOGY

CARDIOVASCULAR SYSTEM

CARDIOVASCULAR SYSTEMThe cardiovascular/circulatory system

transports food, hormones, metabolic wastes, and gases (oxygen, carbon dioxide) to and from cells. Components of the circulatory system include:

• Blood: consisting of liquid plasma and cells • Blood vessels (vascular system): the "channels"

(arteries, veins, capillaries) which carry blood to/from all tissues. (Arteries carry blood away from the heart. Veins return blood to the heart. Capillaries are thin-walled blood vessels in which gas/ nutrient/ waste exchange occurs.)

• Heart: a muscular pump to move the blood

ANATOMY OF THE HEART

http://www.cardioconsult.com/Anatomy/

The heart is about the size of a man's fist. Located between the lungs, two-thirds of it lies left of the chest midline the heart, along with the pulmonary (to and from the lungs) and systemic (to and from the body) circuits, completely separates oxygenated from deoxygenated blood.

Internally, the heart is divided into four hollow chambers, two on the left and two on the right. The upper chambers of the heart, the atria receive blood via veins. Passing through valves (atrioventricular valves), Blood then enters the lower chambers, the ventricles. Ventricular contraction forces blood into the arteries.

BLOOD PRESSURE AND HEART RATE

One heartbeat, or cardiac cycle, includes atrial contraction and relaxation, ventricular contraction and relaxation, and a short pause.

The cardiac cycle consists of two parts: systole (contraction of the heart muscle in the ventricles) and diastole (relaxation of the ventricular heart muscles).

PATHOPHYSIOLOGY

DRUG ANALYSIS

NAME OF DRUG INDICATION MECHANISM OF ACTION

ADVERSE REACTION

CONTRAINDICATION & CAUTION

NURSING CONSIDERATION

PATIENT’S TEACHINGS

Captopril 25mgOr 1tab 30minX 2 doses BID

Hypertension Inhibits ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Less angiotensin II decreases peripheral arterial resistance, decreasing aldosterone secretion, which reduces sodium and water retention and lowers blood pressure.

Leukopenia, Agranulocytosis, Pancytopenia, thrombocytopenia

•Patients with hypersensitivity to drug and other ACE inhibitors•Patients with impaired renal function or serious autoimmune disease and those who have been expose to other drugs that affect WBC counts or immune response.

•Monitor patient’s blood pressure and pulse rate frequently.•Drug causes the most frequent occurrence of cough, compared with other ACE inhibitors.

•Instruct patient to take drug 1hr before meals; food in the GI tract may reduce absorption.•Inform patient that lightheadedness is possible especially during the first few days of therapy. Tell her to rise slowly to minimize this effect and to report occurrence to prescriber. If fainting occurs, she should stop drug and call prescriber immediately.•Advise patient to report signs of infection such as fever and sore throat.•Inform client that taste of food maybe diminished during first month of therapy


ADVERSE REACTION


NURSING CONSIDERATIO

N


Methyldopa 250mg BID

Hypertension Stimulates the central alpha-adrenergic receptors that results in a decreased sympathetic outflow to the heart, kidneys, and peripheral vasculature.

Peripheral edema, anxiety, nightmares, drowsiness, headache, dry mouth, drug fever and mental depression.

•Patients who are hypersensitive to drug or any component of the formulation. Active hepatic disease, liver disorders.•Use cautiously in patients with history of impaired hepatic function or sulfite sensitivity and in breastfeeding women.

•Monitor patient’s BP regularly.•Monitor CBC with differential counts before therapy and periodically after.•Observe for and report involuntary choreoathetoid movements. Drug may have to be stopped.

•Tell patient not to suddenly stop taking drug, but to notify prescriber if unpleasant adverse reactions occur.•Instruct patient to report signs and symptoms of infection.•Tell patient to check his weight daily and notify the prescriber if she gains more than 5lbs. Sodium and water retention may occur but can be relieved with diuretics.•Warn the patient that drug may impair ability to perform tasks that require mental alertness, particularly at start of therapy. A once-daily dose at bedtime minimizes daytime drowsiness.•Inform patient that low BP and dizziness on standing can be minimized by rising slowly and avoiding sudden position changes.


ADVERSE REACTION




Amlodipine 5mg OD

Mild and moderate hypertension

Decreases peripheral vascular resistance thus promoting a decrease in blood pressure

•Reflex tachycardia•Marked hypotension

•Patients with severe hypotension•Patients with liver disease, CHF, aortic stenosis, and lactation

•Monitor liver function test results before therapy starts, after 12weeks, whenever the dosage increases and periodically during therapy.•Reduce dose or stop drug if AST or ALT levels increase to more than 3 times the upper limit of normal and stay elevated.•Assess the patient for myalgias, muscle tenderness or weakness, and marked elevation of CPK level. Stop drug if CPK level exceeds 10 times the upper limit of normal.•Stop drug if patient has evidence of myopathy or has a condition that increases the risk of renal failure

•Advice patient to promptly report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever.•Urge patient to continue appropriate diet, exercise and weight loss regimens.


ADVERSE REACTION




Hydralazine 5mg IVTT

Essential hypertension, preeclamsia and eclampsia

Unknown. A direct-acting peripheral vasodilator that relaxes arteriolar smooth muscles.

Headache, dizziness, orthostatic hypotension, tachycardia, edema, nausea, vomiting, diarrhea

•Patients hypersensitive to drug•With coronary artery disease or mitral valvular rheumatic heart disease•Use cautiously in patients with suspected cardiac disease

•Monitor patient’s BP, pulse rate and body weight frequently. Drug may be given with diuretics and beta blockers to decrease sodium retention and tachycardia and to prevent angina attacks.•Monitor patient closely for signs and symptoms of lupuslike syndrome and notify prescriber immediately if they develop.•Improve patient compliance by giving drug b.i.d. Check with prescriber.

•Instruct patient to take oral form with meals to increase absorption.•Inform patient that low BP and dizziness upon standing can be minimized by standing slowly and avoiding sudden position changes.•Tell woman of childbearing age to notify prescriber if she suspects pregnancy. Drug will need to be stopped.•Tell patient to notify prescriber of unexplained prolonged general tiredness or fever, muscle or joint aching or chest pain.


ADVERSE REACTION




Furosemide 1amp IV

Edema and hypertension

A potent loop diuretic that inhibits sodium and chloride reabsorption at the proximal and distal tubules and the ascending loop of Henle

•Headache•Dizziness•Paresthesia•Weakness•Restlessness•Fever•Orthostatic hypotension•Nausea and vomiting•Diarrhea•Constipation

•Patients hypersensitive to drug and with anuria.•Use cautiously in patients with hepatic cirrhosis and in those allergic to sulfonamides. Use during pregnancy only if potential benefits to mother clearly outweigh risks to fetus.

•To prevent nocturia, P.O. and I.M. preparations in the morning. Give second dose in early afternoon.•Monitor weight, BP, and Pulse rate routinely with long-term use and during rapid diuresis. •Monitor fluid intake and output and electrolyte, BUN, and carbon dioxide levels frequently.•Watch for signs of hypokalemia such as muscle weakness and cramps.•Drug may not be well absorbed orally in patients with severe heart failure.•Monitor uric acid level especially in patients with a history of gout.

•Advice patient to take drug with food to prevent GI upset, and to take drug in morning to prevent need to urinate at night. If patient needs second dose, tell her to take it early in the afternoon, 6 to 8 hours after morning dose.•Inform patient of possible potassium and magnesium supplements.•Instruct patient to stand slowly to prevent dizziness.


ADVERSE REACTION




Digoxin Heart failure, paroxysmal supra-ventricular tachycardia, atrial fibrillation and flutter

Inhibits sodium- potassium- activated adenosine triphosphatase, promoting movement of calcium from from extracellular to intracellular cytoplasm and strenghthening myocardial contraction.

•Fatigue•Generalizedmuscle weakness•Headache•Malaise•Dizziness•Nausea and vomiting•Stupor•Paresthesia

•Patients hypersensitive to drug and in those with digitalis-induced toxicity, ventricular fibrillation, or ventricular tachycardia unless caused by heart failure.

•Before giving loading dose, obtain baseline data and ask patient about use of cardiac glycosides within the previous 2 to 3 weeks.•Before giving drug, take apical-radial pulse for 1 minute. Record and notify prescriber of significant changes.•Excessive slowing of pulse rate maybe a sign of digitalis toxicity. Withhold drug and notify prescriber.

•Tell patient to report pulse less than 60 bpm or more than 110 bpm or skipped beats or other rhythm changes.•Instruct patient to report adverse reactions promptly. Nausea and vomiting, diarrhea, appetite loss, and visual disturbances may be early indicators of toxicity.•Encourage patient to eat potassium-rich foods.•Tell patient not to substitute one brand for another.

LABORATORYRESULTS

NORMAL FINDINGS ACTUAL FINDINGS

Hemoglobin 120-160 gms/L 115.8gms/L

Hematocrit 0.36-0.46 0.35

WBC 5-10X10/L 7.2X10/L

Segmenter 0.40-0.60 0.68

Lymphocytes 0.20-0.35 0.32

Blood uric acid 200-320 mmol/L 490.5 mmol/L

Creatinine 44-80 mmol/L 127 mmol/L

Triglycerides 1.71-2.28 mmol/L 2.02 mmol/L

HDL 0.77-1.66 mmol/L 1.16 mmol/L

LDL Up to 3.9 mmol/L 4.88 mmol/L

Fasting Blood Sugar 4.2-6.4 mmol/L 5.07 mmol/L

Cholesterol Up to 6.7 mmol/L 6.95 mmol/L

Baseline laboratory test information is useful in the early diagnosis of preeclampsia because it can be compared with later results to evaluate progression and severity of the disease.

Hematocrit, hemoglobin and platelets levels are monitored closely for changes indicating worsening of the patient’s status. Because hepatic involvement is a possible complication, serum glucose level are monitored if liver function tests indicate elevated liver enzymes.

Renal laboratory assessments include monitoring trends in serum creatinine and BUN levels. As renal function becomes compromised, renal excretion of creatinine and other waste products decreases. As renal excretion decreases, serum creatinine levels, BUN, and uric acid increases.

NURSINGCAREPLAN

CUES NURSING DIAGNOSIS

GOAL NURSING INTERVENTIONS

RATIONALE EVALUATION

Subjective:DyspneaFatigueObjective:Variation in blood pressure readingsEdemaRestlessnessPostural hypotension

Decreased cardiac output related to decreased venous return

At the end of the shift, the patient will participate in activities that reduce blood pressure or cardiac workload.

1. Monitor blood pressure of the patient.

2. Observe skin color, moisture, and temperature.

3. Encourage changing positions slowly, dangling legs before standing.

4. Give skin care and assist with frequent position changes.

5. Provide calm, restful surroundings, minimize unnecessary noise.

Comparison of pressures provides a more complete picture of vascular involvement.Presence of pallor, cool, moist skin maybe due to peripheral vasoconstriction.To reduce risk for orthostatic hypotension.

To prevent development of pressure sores.

Help reduce sympathetic stimulation and promotes relaxation.

Goal met as evidenced by patient is able to participate in activities that reduce blood pressure or cardiac work load.




Subjective:ThirstWeaknessObjective:Dry skinDecreased urine outputPostural hypotension

Deficient fluid volume related to decreased fluid intake

At the end of the shift, the patient will be able to maintain fluid volume at functional level as evidenced by normal urine output, stable vital signs and good skin turgor.

1. Weigh patient routinely.

2. Monitor intake and output.

3. Reassess dietary intake of proteins and calories.

4. Provide frequent oral care as well as eye care.

Sudden significant weight gain reflects fluid retention.

Urine output is a sensitive indicator of circulatory blood volume.

Adequate nutrition reduces incidence of hypovolemia and hypoperfusion.

To prevent injury from dryness.

Goal met as evidenced by patient has normal urine output, stable vital signs, and good skin turgor.




Subjective:“Diri ako ginaganahan pagkaon” as verbalized by the patient.•Lack of interest in food

Objective:•Weakness •Insufficient food intake

Risk for imbalance nutrition less than body requirements related to insufficient intake to meet the metabolic demands

At the end of the shift (3-11pm), the patient will be able to demonstrate behaviors, lifestyle changes to regain or maintain appropriate weight.

1. Note total daily intake including calorie intake, patterns and times of eating.

2. Use flavoring agents such as lemon or herbs if salt is restricted.

3. Encourage client to choose foods that are appealing.

4. Promote adequate timely fluid intake.

5. Promote pleasant, relaxing environment including socialization when possible.

To reveal changes that should be made in patient’s dietary intake. (NANDA 10th edition, p. 371)To enhance food satisfaction and stimulate appetite. (NANDA 10th edition, p. 372)To stimulate appetite. (NANDA 10th edition, p.372)Limiting fluids 1hour prior to meal decreases possibility of early satiety. (NANDA 10th edition, p.373) To enhance intake. (NANDA 10th edition, p.372)

Goal met as evidenced by patient was able to eat food sufficient enough to meet her metabolic needs.




Subjective:“Madali la ak kapuyon” as verbalized by the patient.Objective:Observed difficulty in ambulationGrimaced face during ambulationRespiratory rate of 22 cpm

Activity intolerance related to bed rest secondary to preeclampsia

Within the 8-hour shift, the patient will be able to perform at least one activity of daily living.

1. Monitor current potential for desired activities.

2. Assist patient with self-care activities as needed. Let the patient determine how much assistance is needed.

3. Monitor vital signs before and after activity.

4. Encourage rest as needed in between activities.

5. Provide for a quiet, non-stimulating environment.

Provide baseline for planning activities and increased in activities.

Allows the patient to have some control and choice in plan.

Vital signs increase with activity and should return to baseline within 5-7 minutes after activity.

Planned rests assist in maintaining and increasing activity tolerance.

Allows proper resting period for the patient’s body to recuperate.

Goal met as evidenced by patient was able to comb her hair and eat her food on her own.




Subjective:•“Kinukurian ako paglalakat.” as verbalized by the patient.

Objective:•Inability to walk independently •Grimaced face during ambulation

Self-care deficit related to decreased strength and endurance as evidenced by inability to ambulate independently

At the end of a 2-hour nursing intervention, the patient will to demonstrate techniques to meet self-care needs and identify or use available resources.

1. Assess patient’s psychological status.

2. Offer assistance as needed with hygiene such as mouth care, back rubs, and perineal care.

3. Offer choices when possible such as selection of juices, destination during ambulation.

Physical pain experience may be compounded by mental pain that interferes with client’s desire and motivation to assume autonomy.

Improves self-esteem; increases feelings of well-being.

Allows some autonomy, even though patient depends on professional assistance.

Goal met as evidenced by patient was able to meet self-care needs such as mouth care without assistance.

power point preeclampsia

Documents

normal blood pressure

normal nose

blood anatomy

blood tofrom

walled blood vessels

distributed rounded

presence of vaginal

color uniform