Question

write a case study on a patient suffering from pre eclampsia

Answer 1

Name : Mrs. X

Age : 24

Marital status : Married

Obsteritrical score : G2IUD1

GESTATION: 27+4Weeks

Chief complaints

• Epigastric pain, vomiting, head ache

Past history

History of IUD due to PIH.

Menstrual history

Menarche at 14 years with 6-7 furation. Regulary and 30cycle interval. No history of dysmenorrhea and intermenstral bleeding.

No history of contraceptive use.

No relevant past medical and surgical history

No allergies and childhood disease.

She immunized up to age.

No history of smoking and alcoholism.

Regular bowel and bladder habits.

No family history of major disease.

On summary of physical examination

BP :140/110mm of hg

Bilateral pedal edema and periorbital edema present.

Pre eclampsia

It is pregnancy induced hyperyension associated with significant proteinuria.

Criteria

Pre eclampsia is diagnosed when BP is >140 systolic and >90diastolic and 300 mg of protein in a 24 hour urine.

Risk factors

• Family history : hypertension
• Genetic disorder
• Obstetric factors: primi young or elderly
• Rh incompatibility
• Placental abnormalities
• New paternity
• Obesity: BMI >35Kg/M2
• Pre existing vascular disease.
• Chronic hypertension
• Diabetes
• Hyperhomocystenemia
• ETIOPATHOLOGICAL FACTORS

Failure of trophoblastic invasion

Vascular endothelial damage

Inflammatory mediayors

Coagulation abnormalities

Increased oxygen free radicals

Genetic predisposition

Dietary deficiency of excess

Pathophysiology

In preeclampsia , primary wave of trophoblastic invasion partly impaired and the second wave fails to occur.This result uteroplacental insufficiency which worses gestation.

Placental abnormalities causes endothelial cell dysfunction .

Endothelial dysfunction leads to activation of platelets and coagulation system. This result in wide spread DIC and hence platelets and clotting factors used up.These result in consumption of clotting factors and platelets manifest thrombocytopenia.

Metabolic factors such as obesity and insulin resistance causes pre eclampsia.

Clinical types

Mild : It include >140/90 mm of hg but less than 160 mm of hg systolic BP.

Severe preeclampsia

It includes

>160/100 mm of hg

Proteinuria>5gm/24hr

Oliguria <400ml/hr

Platelet count<100,000/mm3

HELLP syndrome

Cerebral or visual disturbances

Severe epigastric pain

Retinal hemorrhage.

IUGR

pulmonary edema.

Management

Bed rest with left lateral position.

Drug: methyldopa(1000-2000mg/day) , nifidepine(20-40mg/day) and labetalol(200-400mg /day)

To ptevent eclampsiam magnesium sulphate 4 g Intravenously and 4gm IM and 4gm IV infusion for 24 hrs

Nursing management

Asess the BP, signs and symptoms and physical examination

Nursing diagnosis

1. Impaired cerebrovascular tissue perfusion related to decreased cardiac output.

2. Impaired gas exchange related to accumulation of fluid in the lumgs pulmonary edema.

3. Activity intolerance related to edema