ST.

MARYS COLLEGE NURSING PROGRAM Tagum City

A CASE STUDY on

Acute Pulmonary edema complicating Severe preeclampsia

Presented to Ms. Lesley Cadua RN,MN Ms. Joan Calzada RN, MN

In Partial Fulfillment of the Requirements In Related Learning Experience (RLE)

By BSN 2-A Pinky rose Marfil Yvonne Obra Axel Mae Abarico Zhendy Solis Holy Eve Pasoquin Ian mizzelDulfina RondelDadula Jose Mari Bernardino John Occeo Niel Sabino

02-03-13

I.

INTRODUCTION

Background Study The group chose Acute Pulmonary edema secondary to severe preeclampsia as our case to be study out of curiosity. This is our first time to encounter this kind of case and because of that, our group was interested in it. We are willing to do this case to challenge our mind in analyzing the problem and to enhance our hidden knowledge, and also to gain new experiences which would bring new learnings for the member of the group. This case study will help the group in understanding the disease process of the patient. This would also help the group in identifying primary needs of the patient with Acute Pulmonary edema with severe preeclampsia. By identifying such needs and health problems arise the group can now formulate an individualized care plan for the patient that would address these needs and problems effectively. Effective management of the problems identified will help the patient to recover faster and maintain a holistic sense of wellness even while in the hospital. This case study would also equip the group with knowledge, skills and attitude on how to manage future patients with the same or similar disease.

GLOBAL

Cohort study - 62,917 consecutive pregnancies from 1989-1999, to describe the incidence, predisposing factors contributing to pulmonary edema in the pregnant patient. Fifty-one women (0.08%) were diagnosed with acute pulmonary edema during ante partum-post partum period. 24 patients (47%) antepartum, 7 patients (14%) intrapartum, 20 patients (39%) post partum. Most common causes: Tocolytics (25.5%) most commonly MgSO4 and SC terbutaline, Cardiac disease(25.5%), Fluid overload (21.5%) and preeclampsia (18%).

A. Aya et al. Patients with Severe Preeclampsia Experience Less Hypotension During Spinal Anesthesia for Elective Cesarean Delivery than Healthy Parturients: A Prospective Cohort Comparison. Anesthesia & Analgesia 2003;97:867-72

Philippine Setting

According to Dept. of Health, Maternal Mortality Rate (MMR) 162 out of 10,000 live births (Family Planning Survey 2006) Maternal deaths account for 14% of deaths among women For the past 5 years, all of the causes of maternal deaths exhibited an upward trend. Pre-Eclampsia showed an increasing trend of 6.89%, 20%, 40%, and 100% 10 women die everyday in the Philippines due to pregnancy and childbirthrelated causes, such as pre-eclampsia http://www.doh.gov.ph/kp/statistics/maternal_deaths.html#2006

OBJECTIVES Define what is acute pulmonary edema secondary to severe preeclampsia. Trace the pathophysiology of acute pulmonary edema secondary to severe preeclampsia. Enumerate the different signs and symptoms of acute pulmonary edema secondary to severe preeclampsia. Formulate and apply nursing care plans utilizing the nursing process . To learn new clinical skills as well as sharpen our current clinical skills required in the management of the patient with acute pulmonary secondary to severe preeclampsia. To develop our sense of unselfish love and empathy in rendering nursing care to our patient so that we may be able to serve future clients with higher level of holistic understanding as well as individualized care.

II.

ASSESSMENT A. BIOGRAPHIC DATA Patients Name: Butron, Lorna T. Address: Prk. 5, Sindahon, Panabo City, Davao del Norte Sex: Female Age: 39 years old Civil Status: Married Birthdate: 03/05/1973 Birthplace: MATI, DAVAO ORIENTAL Nationality: Filipino Religion: Catholic Occupation: House keeper B. CHIEF COMPLAINT Dyspnea C. History of present illness D. Past medical and Nursing History E. Personal, family and socio-economic history F. Patient need assessment

PHYSIOLOGIC NEEDS I. OXYGENATION BP__160/110__ RR 49 cpm____CR___149bpm (CHARACTER) tachypnia___ LUNGS (per auscultation: character, lung sound, symmetry of chest expansion, breathing character and pattern):crackles sounds heard upon auscultation, w/ symmetrical chest expansion, intercostals retraction noted, use of accessory muscles noted. CARDIAC STATUS (per auscultation) sounds, character, chest pain.

__Lub-dubb sound heard with increased intensity per auscultation, chest pain not noted CAPILLARY REFILL bad capillary refill of less than 3 seconds_ SKIN CHARACTER AND COLOR_skin is brown, dry, flaky and

wrinkled.

II. TEMPERATURE MAINTENANCE TEMPERATURE: 36.8oC_ SKIN CHARACTER_Skin is dry, flaky, wrinkled and not warm to touch_ III NUTRITIONAL FLUID HEIGHT/WT 52/45 kg _ AMT. FOOD CONSUMED: w/ good appetite, able to consumed the OF served PRESCRIBED DIET: LSLF EATING PATTERN: 3x a day_ INTAKE (IVF; FLUID/WATER: with IVF of D5LR 1L@30cc/hr, water = 300cc Other OBSERVATION (related)\: Skin is dry, has poor skin turgor IV ELIMINATION Last BOWEL MOVEMENT(frequency, amount, character)__defecated on small amount, NORMAL PATTERN 1- 2x a day, URINATION(Frequency, character, sensation)_able to urinate V REST-SLEEP BED TIME _6-7 pm_WAKING UP__5:30 am_ SLEEP (pattern, amount of sleep)_5-6hrs_ PROBLEM AS VERBALIZED dili ko kaayo makatulog OTHER OBSERVATION (related)_Patient can easily be distracted, thus, having difficulty in sleeping back again VI PAIN AVOIDANCE

 RATE PAIN_-cant able to verbalize- TIME STARTED__7:30 PM_ LOCATION _genital area__BEHAVIOR (restlessness, facial expression, irritable, diaphoretic)frequent change of position noted, grimace face and guarding behavior noted on genital area FREQUENCY_continuos_ CHARACTER cant able to describe, cant able to verbalize OTHER observation (related) Patient has difficulty in sleeping due to pain felt VII SEXUALITY REPRODUCTIVE LMP__N/A__ GRAVIDA/PARITY__G7P5__ MENSTRUAL CYCLE__N/A__ EDC__N/A__ FMILY PLANNING METHOD USE: calendar method CHILDREN (no.) __6__ VIII STIMULATION ACTIVITY WORK: Before: farmer During: needs assistance in performing activities of RECREATION/PAST TIME: daily living, HOBBIES/VICES: sleeping, a moderate smoker and drinker before SAFETY AND SECURITY MENTAL STATUS (Coherent, Responsive, conscious, unconscious) conscious, able to respond by making incomprehensible sounds EMOTIONAL PROBLEM (diaphoretic, trembling, restless)_restlessness: frequent change of position due to pain felt________ LOVE BELONGING NEED CHILDREN (living with?) Patient is loving and supportive Wife (living with) husband. Due respect and care was given to her SELF ESTEEM NEED she is a good person and a loving mother. she has a moderate self esteem, also because she is a friendly type of person and being loved by family members. MENARCHE__N/A__ AOG__N/A__ PRENATAL__N/A__ GYNECOLOGIC PROBLEM__N/A__

G. Physical Assessment January 24, 2013 Skin Head Eyes Ears Color same as facial skin Eyebrows symmetrically aligned with equal movement Eyelashes equally distributed and curled slightly outward Skin of eyelids intact with no discoloration Lids close symmetrically Bilateral blinking exhibited Presence of discharge, Yellowish sclera Pink palpebral conjunctiva Iris black in color Pupils equal in size with smooth borders Illuminated pupils constricts Pupils converge when near object is moved toward the nose When looking straight ahead, the client can see objects in the periphery Both eyes coordinated, move in unison with parallel alignment Eyeballs protruding Present of nodules or masses Symmetric facial features and movements Symmetric nasolabial folds Evenly distributed black hair No infestations Brown skin generally uniform in color except in areas exposed to the sun Skin temperature uniform and within the normal range (37 0C) Dry skin folds Nails with smooth texture Nail beds pink Prompt capillary refill time (4-5 seconds)

 Nose

Symmetrically aligned Pinna immediately recoils after it is folded Pinna is not tender No lesions or discoloration Dry cerumen, grayish-tan color Normal voice tones audible Able to hear ticking of a watch in both ears

Symmetric and straight Nasal septum intact and in the midline

Mouth and Throat Neck Breast Firm Generally symmetric in size Head centered Lymph node palpable Outer lips uniform bluish in color with symmetric contour, Buccal mucosa is of uniform pale in color Gums are pink Tongue slightly pink, not so moist, at central position

Cardiovascular BP 160/110 PR 149 Symmetric pulse strength

Respiratory/Chest Chest symmetric Chest wall intact, no tenderness, no masses Symmetric chest expansion and excursion RR: 49 bpm

Gastrointestinal/Abdomen

Straie present at hypogastric and iliac regions Linea nigra present No tenderness

Urinary Absence of nocturia, dysuria, urgency, hesitancy Light yellow urine

Reproductive Regular menstrual cycle G7p5

Musculoskeletal/Extremities Muscle equal size on both sides of the body No tenderness Presence of edema Smooth coordinated movements

Neurologic Can respond to verbal commands Oriented Conscious

Date shift

H. Course in the ward Nurses Assessment

Nurses Intervention

Medical Management

III. LAB EXAM WBC Count RBC Count Hemoglobin

Laboratory and Diagnostic examinations NORMAL VALUE 3.98-10x109g/L 4.20-6.30 T/L 120-160g/L RESULT 16.8 4.96 107 INTERPRETATION/IMPLICATION Abnormally high due to presence of infection or inflammation Normal Below normal Decreased Hgb count on pregnant

Hematocrit

0.370-0.47g/L

0.345

Platelet count Urine protein collection

140-440 G/L 0

322 +4

is normal because of the increase in plasma volume during pregnancy. Below normal Decreased hematocrit on pregnan is normal because of their increase in plasma volume. normal Abnormally high due to severe preeclampsia

IV.

ANATOMY AND PHYSIOLOGY Anatomy & Physiology of the Respiratory System

The respiratory system is situated in the thorax, and is responsible for gaseous exchange between the circulatory system and the outside world. Air is taken in via the upper airways (the nasal cavity, pharynx and larynx) through the lower airways (trachea, primary bronchi and bronchial tree) and into the small bronchioles and alveoli within the lung tissue. Move the pointer over the coloured regions of the diagram; the names will appear at the bottom of the screen) The lungs are divided into lobes; The left lung is composed of the upper lobe, the lower lobe and the lingula (a small remnant next to the apex of the heart), the right lung is composed of the upper, the middle and the lower lobes. Mechanics of Breathing To take a breath in, the external intercostal muscles contract, moving the ribcage up and out. The diaphragm moves down at the same time, creating negative pressure

within the thorax. The lungs are held to the thoracic wall by thepleural membranes, and so expand outwards as well. This creates negative pressure within the lungs, and so air rushes in through the upper and lower airways. Expiration is mainly due to the natural elasticity of the lungs, which tend to collapse if they are not held against the thoracic wall. This is the mechanism behind lung collapse if there is air in the pleural space (pneumothorax). Physiology of Gas Exchange

Each branch of the bronchial tree eventually subdivides to form very narrow terminal bronchioles, which terminate in the alveoli. There are many millions of alveloi in each lung, and these are the areas responsible for gaseous exchange, presenting a massive surface area for exchange to occur over. Each alveolus is very closely associated with a network of capillaries containing deoxygenated blood from the pulmonary artery. The capillary and alveolar walls are very thin, allowing rapid exchange of gases by passive diffusion along concentration gradients. CO2 moves into the alveolus as the concentration is much lower in the alveolus than in the blood, and O2 moves out of the alveolus as the continuous flow of blood through the capillaries prevents saturation of the blood with O2 and allows maximal transfer across the membrane.

V.

SYMPTOMATOLOGY

SYMPTOMATOLOGY Extreme shortness of breath and difficulty breathing Tightness and pain in the chest Wheezing, coughing Paleness Sweating

ACTUAL SYMPTOMS

IMPLICATION Due to the presence of fluid in the lungs.

PRESENT Due to inadequate blood perfusion.

Bluish nails and lips Pink, frothy mucus coming from nose and mouth Crackles http://www.umm.edu/altmed/articles/pulmonaryedema-000137.htm

Due to inadequate blood perfusion.

VI.

ETIOLOGY OF THE DISEASE

Non-cardiogenic

Hypertensive crisis. The cause of pulmonary edema in the presence of a hypertensive crisis is probably due to a combination of increased pressures in the right ventricle and pulmonary circulation and also increased systemic vascular resistance and left ventricle contractility increasing the hydrostatic pressure within the pulmonary capillaries leading to extravasation of fluid and edema. ^ a b c d Ware LB, Matthay MA. Acute pulmonary edema. N Engl J Med 2005;353:2788-96. doi:10.1056/NEJMcp052699 PMID 163820

VII.

Pathophysiology

Preeclampsia is a result of generalized vasospasm. The underlying cause of the vasospasm remains a mystery, although some of the pathophysiologic processes are known. In normal pregnancy, vascular volume and cardiac output increase significantly. Despite these increases, blood pressure does not rise in normal pregnancy. This is probably because pregnant women develop resistance to the effects of vasoconstrictors, such as angiotensin II. Peripheral vascular resistance decreases because of the effects of certain vasodilators, such as prostacyclin (PGI2), PGE, and endothelium-derived relaxing factor (EDRF). In preeclampsia, however, peripheral vascular resistance increases because some women are sensitive to angiotensin II. They also may have a decrease in vasodilators. For instance, the ratio of thromboxane (TXA2) to PGI2 increases. TXA2, produced by kidney and trophoblastic tissue, causes vasoconstriction and platelet aggregation (clumping). PGI2, produced by placental tissue and endothelial cells, causes vasodilation and inhibits platelet aggregation. Vasospasm decreases the diameter of blood vessels, which results in endothelial cell damage and decreased EDRF. Vasoconstriction also results in impeded blood flow and elevated blood pressure. As a result, circulation to all body organs, including the kidneys, liver, brain, and placenta, is decreased. The following changes are most significant: Decreased renal perfusion reduces the glomerular filtration rate. Blood urea nitrogen, creatinine, and uric acid levels begin to rise. Reduced renal blood flow results in glomerular damage, allowing protein to leak across the glomerular membrane, which is normally impermeable to large protein molecules. Loss of protein reduces colloid osmotic pressure and allows fluid to shift to interstitial spaces. This may result in edema and a reduction in intravascular volume, which causes increased viscosity of the blood and a rise in hematocrit. In response to reduced intravascular volume, additional angiotensin II and aldosterone trigger the retention of both sodium and water. Generalized edema may occur. Decreased circulation to the liver impairs function and leads to hepatic edema and subcapsular hemorrhage, which can result in hemorrhagic necrosis. This is manifested

by elevation of liver enzymes in maternal serum. Vasoconstriction of cerebral vessels leads to pressureinduced rupture of thin-walled capillaries, resulting in small cerebral hemorrhages. Symptoms of arterial vasospasm include headache and visual disturbances, such as blurred vision, spots before the eyes, and hyperactive deep tendon reflexes. Decreased colloid oncotic pressure can lead to pulmonary capillary leak that results in pulmonary edema. Dyspnea is the primary symptom. Decreased placental circulation results in infarctions that increase the risk for abruptio placentae and DIC. Pathologic processes of preeclampsia Cardiovascular system Response to angiotensin II Blood pressure Platelet clumping Cardiac output Thrombocytopenia Systemic vascular resistance Plasma volume Endothelium damage Thromboxane/prost acyclin ratio Endothelium-derived relaxing factor Vascular resistance Small hemorrhages Headache, hyperreflexia convulsions Protinuria Colloid osmotic pressure Fluid shift(edema) Hypovolemia Hematocrit
IUGR

Hematologic system Hemoconcentration Viscosity

Neurologic system Arterial vasospasm Rupture of small capillaries

Renal system Glomerular flow rate Damage to glomeruli

Hepatic system Impaired function Hepatic edema

placenta Placental perfusion

Fetal hypoxemia

Subcaps ular Acidosis hemorrha ge Enzymes Epigastri c pain

Perinatal death

Nutrients

Blood pressure

Angiotensin II and aldosterone Further edema Blood urea, nitrogen, creatinine, and uric acide

Pathology

Blockage of lymphatic vessels

Inability to remove excess fluid from interstitial space

Accumulation of fluid in interstitial space

Pulmonary Edema

Pulmonary edema is excess water in the lung. The normal lung contains very little water or fluid. It is kept dry by lymphatic drainage and a balance among capillary hydrostatic pressure, capillary oncotic pressure, and capillary permeability. Pulmonary edema result from obstruction of the lymphatic system. When lymph drainage is blocked, fluid accumulates in the lungs. Drainage can be blocked by an increase in systemic venous pressure, which elevates the hydrostatic pressure of the large pulmonary veins into which the pulmonary lymphatic system drains. Drainage also can be obstructed by compression of lymphatic vessels by edema, tumors, and fibrotic tissue. VIII Planning Nursing Care Plan

Problem

Nursing Diagnosis

Objective

Nursing Intervention

Rationale

Evaluation

difficulty of breathing

Ineffective breathing pattern r/t

At the end of the nursing shift, the Px will be able to

INDEPENDENT > place Px in a semi to high > this position allow

At the end of the nursing shift, the Px experience adequate respiratory fxn. as evidencedof the ff.: > normal rate, rhythm & depth of respiration > improved

Subjective lung Cues: medyo naglisod ko og ginhawa labi na kung mag ubo ko, as verbalized by the client compliance as a result of

fowler position if increased not contraindicated

diaphragmatic was able to excursion & maximum lung expansion, which

accumulation experience of fluid in the pulmonary interstitium adequate respiratory fxn. > instruct & assist Px to change position, deep breathe, & cough or huff

promotes optimal alveolar ventilation > frequent repositioning

every 1-2 hours Objective Cues: > (+) crackles >rapid, shallow, irregular respiration > use of accessory muscles when coughing > abnormal blood gases > abnormal chest xray result > implement measures to reduce pain splint incision with pillow

helps loosen secretions & promotes a

breath sounds > (-)

more effective crackles cough. It also promotes maximum lung expansion & stimulates surfactant production. Coughing or huffing mobilizes secretions & facilitates removal of these secretions from the > blood gases within normal ranges > Px verbalizes relief from difficulty of breathing

during coughing respiratory & deep breathing tract > a Px with pain often guards respiratory efforts pain reduction DEPENDENT > implement enables the client to

measures to facilitate removal of pulmonary secretions suction as orderes > maintain O2 therapy as ordered

breathe more deeply which enhances alveolar veltilation & O2/CO2 exchange > excessive secretions and inability to clear secretions from the respiratory tract lead to stasis of secretions >

> administer meds that may be ordered to improve Pxs respiratory status

supplemental O2 increases the concentration of oxygen in the alveoli, which increases the diffusion of O2 across the alveolar capillary membrane

> medication therapy is an integral part of treating many respiratory condition

Problem

Nursing Diagnosis

Objective

Nursing Interventions

Rationale

Evaluation

fear Subjective Cues: nahadlok jud ko, kay ingon sa doctor naa daw koy high blood. Unya cge pa jud kog ka lipong. Mao nang paminaw nako laing jud kaayo ako lawas. Dili pa jud ko katulog og tarong

Fear r/t persistent headache

At the end of the nursing shift, the Px will be able to experience a reduction of fear

INDEPENDENT > encourage verbalization of feelings & concerns > verbalization of feelings & concerns helps client identify > assure Px that factors that staff members are nearby; respond to call signal as soon as possible are causing anxiety > close contact & a prompt response to requests provide a sense of security & > reinforce physicians facilitates the

At the end of the nursing shift, the Px will be able to experience a reduction of fear as evidenced by the ff: > verbalization of decreased fear & understanding of the medical procedures

sa cge hunahuna, as verbalized by the client Objective Cues: > disturbed sleep pattern > weak appearance

explanations & clarify misconceptions the Px has about the

development of trust, thus reducing the clients anxiety

diagnostic tests, > factual disease condition, treatment plan & prognosis > implement measures to reduce distress information & an awareness of what to expect help decrease the anxiety that arises from uncertainty

DEPENDENT > administer prescribed antianxiety agents if indicated

> improvement of respiratory status helps relieve anxiety associated with the feeling of not being able to breathe

> helps reduce the Pxs anxiety

Problem

Nursing Diagnosi s

Objective

Nursing Interventio ns

Rationale

Evaluatio n

Ojective cues: Weak and pale in appearance Capillary refill of 3-4 seconds RBC Level=1.49 Hgb level= 34g/L Bp=160/110 mmHg

Ineffective tissue perfusion related to decrease in RBC,

After 4 hours of nursing intervention s, the client will exhibit

Assist client in performing ADL

To promote safety

After 4 hours of nursing interventio n, the

Place the client in

To promote

client will exhibit decrease in oxygen demand

hemoglobi decrease in n and oxygen

trendelenbur venous g position. return

hematocrit demand level and ability to conserve energy.

Maintain adequate ventilation.

and ability To to promote conserve oxygenatio n and energy. good blood circulation

Instruct client to sit and dangle the feet before standing.

To prevent orthostatic hypotensio n

Advise client

to increase intake of food rich in iron and folate such as liver and green leafy vegetables. Iron and folate are necessary for red blood cell production .

Discharge plan Medicines: Diuretics: This medicine is given to remove excess fluid from around your lungs and decrease your blood pressure. You may urinate more often when you take this medicine. Heart medicine: These medicines may be given to make your heartbeat stronger or more regular, or to lower your blood pressure. Vasodilators: Vasodilators may improve blood flow by making the blood vessels in your heart and lungs wider. This may decrease the pressure in your blood vessels and improve your symptoms. Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Follow up with your primary healthcare provider or pulmonologist in 7 to 10 days or as directed. You may need to return for more tests. Write down your questions so you remember to ask them during your visits. Manage pulmonary edema

 Limit your liquids as directed. Follow your primary healthcare provider or pulmonologists directions about how much liquid you should drink each day. Too much liquid can increase your risk for fluid build up. Weigh yourself daily. Weigh yourself at the same time every morning after you urinate, but before you eat. Weight gain can be a sign of extra fluid in your body. Rest as needed. Return to activities slowly, and do more each day. You may have trouble breathing when you are lying down. Use foam wedges or elevate the head of your bed. This may help you breathe easier while you are resting or sleeping. Use a device that will tilt your whole body, or bend your body at the waist. The device should not bend your body at the upper back or neck. Use a device that will tilt your whole body, or bend your body at the waist. The device should not bend your body at the upper back or neck. Limit or avoid alcohol: You will need to limit the alcohol you drink, or avoid alcohol completely. Alcohol can worsen your symptoms and increase your blood pressure. If you have heart failure, alcohol can make it worse. Do not smoke or take drugs: If you smoke, it is never too late to quit. Do not take street drugs, such as cocaine. Smoking and drugs can make your condition and symptoms worse. Ask for information if you need help quitting. limb to high altitudes slowly: Go slowly to allow your body to get used to a higher altitude. Ask your primary healthcare provider about the symptoms of high altitude pulmonary edema (HAPE). Ask what to do if you get these symptoms. Contact your primary healthcare provider or pulmonologist if: you have a fever you gain weight for no known reason you urinate more than usual you have new or increased swelling when you breathe you have questions or concerns about your condition or care.

PHARMACOLOGICAL MANAGEMENT Doctors Order Drug Action Indications Nursing Responsibilities Administer IV loading dose of 4-6 over 30 minutes, continue maintenance infusion of 24g/hour as ordered monitor serum magnesium levels closely assess DTRs and check for ankle clonus have calcium gluconate readily available in case of toxicity monitor for signs and symptoms of toxicity, such as flushing, sweating, hypotension, and cardiac and central nervous system depression Administer 510 mg by slow IV bolus every 20 minutes Use parenteral form immediately after opening ampule Withdraw drug slowly to prevent possible rebound hypertension Monitor for adverse effects such as palpitations, headache, tachycardia,

Magnesium sulfate

Blockage of neuromuscular transmission, vasodilation

Prevention and treatment of eclamptic seizures, reduction in blood pressure in preeclampsia and eclampsia

Hydralazine hydrochloride (Apresoline)

Vascular smooth muscle relaxant, thus improving perfusion to renal, uterine, and ce

Reduction in blood pressure

Labetalol hydrochloride (Normodyne)

Alpha 1 and beta blocker

Reduction in blood pressure

Nifedipine (Procardia)

Calcium channel blocker/dilation of coronary arteries, arterioles, and peripheral arterioles

Reduction in blood pressure, stoppage of preterm labor

Sodium nitroprusside

Rapid vasodilation (arterial and venous)

Severe hypertension requiring rapid reduction in blood pressure Pulmonary

anorexia, nausea, vomiting, and diarrhea Be aware that drug lowers blood pressure without decreasing maternal heart rate or cardiac output Administer IV bolus dose of 1020 mg and then administer IV infusion of 2 mg/minute until desired blood pressure value achieved Monitor for possible adverse effects such as gastric pain, flatulence, constipation, dizziness, vertigo, and fatigue Administer 10 mg orally for three doses and then every 48 hours Monitor for possible adverse effects such as dizziness, peripheral edema, angina, diarrhea, nasal congestions, cough Administer via continuous IV infusion with dose titrated according to blood pressure levels

Furosemide (Lasix)

Diuretic action, inhibiting the reabsorption of sodium and chloride from the ascending loop of Henle

Pulmonary edema

Wrap IV infusion solution in foil or opaque material to protect from light Monitor for possible adverse effects, such as apprehension, restlessness, retrosternal pressure, palpitations, diaphoresis, abdominal pain Administer via slow IV bolus at a dose of 1040 mg over 12 minutes Monitor urine output hourly Assess for possible adverse effects such as dizziness, vertigo, orthostatic hypotension, anorexia, vomiting, electrolyte imbalances, muscle cramps, and muscle spasms

SYNTHESIS OF CLIENTS CONDITION/STATUS FROM ADMISSION TO PRESENT Conclusion We therefore conclude that the study portrayed its importance and helped us know all about Acute pulmonary edema complicating severe preeclampsia. It also helped us understood the causes and effects of the diseases that enabled us to determine the predisposing and precipitating factors and traced the pathophysiology of these disorders. This also had given us the knowledge to identify where and when it had started and how the disease progressed and we had also interpreted the laboratory and diagnostic exam results of the client and recognized the implication of it. We also identified the different pharmacologic treatments indicated to the condition, considering the effects, actions and different nursing considerations with regards to the

administration of the medications. We have also identified and formulated the nursing interventions that we could render to the patient that will help us attain our goal of care to our patient basing from the nursing care plan we have formulated. Patients prognosis After some point in time, as the medical and the nursing management of the patient is constantly done, a development of her present health status is anticipated. Continuous administration of medications will result to termination of the signs and symptoms that was caused by the patients disease such as shortness of breaths, paleness, swelling, high blood pressure, face and hand edema, and dyspnea. Furthermore, vital signs are expected to stabilize. Recommendation On the basis of the findings of this study, the following measures are recommended: 1. Client should take his prescribed medications religiously. He must create a schedule in order for him to be guided as when to take the medicines and for him not to be able to forget in doing so. 2. Follow the prescribed diet. His prescribed diet is a low-salt, low-fat diet, therefore client should avoid salty and fatty foods and client must take note that all canned goods are high in sodium even if it says that it is good for the heart. 3. Have an oral fluid intake with in cardiac tolerance. 4. Lifestyle modification is also important in order to prevent the severity of the condition that will further contribute complications such as cessation of smoking and drinking alcoholic beverages. 5. Visit his doctor regularly for constant check-ups and to continuously monitor his condition. Evaluation of the objectives of the study After few days of conducting study about the case of lorna, we were able to trace the history of her disease locally, nationally and globally. We have come up with a comprehensive assessment of the patients biographical data, cephalo -caudal physical

assessment as well as pertinent medical information with regards to the clients health condition. Apart from that, we were also able to have a clearer view on how the disease affects the patients body by tracing the pathophysiology of the disease process and identifying the different organs involved by reviewing its anatomy and physiology. By understanding fully the mechanism and effects of the disease to the patient, we have interpreted different laboratory results related to her condition. We have also identified and traced some medications and how these drugs affect the patients physiological functioning. Appropriate therapeutic care was well planned and provided to the client. And lastly, we have come up with a discharge plan pertaining to the patients early recovery.

Maternal & Child Health Nursing, 4th Edition by Pillitteri Essentials of maternal and child nursing by Murray