PATHOPHYSIOLOGY

Modifiable Pregnancy Lifestyle Non-modifiable Age Gender - Female

Reduced responsiveness to pressor substances appears to be lost

Vascular effects Vasoconstriction

Vomiting

Vasospasm Kidney effect

Poor organ perfusion Blood pressure Poor placental perfusion

blood flow resistance Back pressure

Pressure to brain

Degenerative changes occur

Ischemia in pancreas

Permeability of the glumerular membrane

Glumerular filtration rate

Epigastric pain

Reduced the fetal nutrient and O2 supply

Heart is forced to pump against rising peripheral resistance

Allowing serum protein albumin & globulin to escape into urine

Lowered urine output and creatinine clearance

protenuria Interstitial effect Albumin holds oncotic pressure Weight gain Protein loss

Endometial damage

Platelet clusters in the site of endometrial damage thrombocytophenia gum bleeding

Imbalance between oncotic pressure and hydrostatic pressure

edema

Conclusion Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity not only here in the Philippines but also worldwide. Proper prenatal care is essential to be able to monitor the condition of the mother and the baby, especially if there is a problem scene in patient. This allows the health care provider to find and treat conditions such us preeclampsia. As with any pregnancy, a good prenatal diet full of vitamins and basic food group is important. Pregnant women should not be self centered with regards to their condition; they must always consider the baby inside their body to be free from any abnormality that might happen due to complications. One factor of having this kind of disease during pregnancy is the age of the woman, 35 years of age like Mrs. X she must know the outcome of it since her last pregnancy she had also eclampsia. We, therefore conclude that if a woman has a plan to have a baby, it is necessary to prepare her not only financial, emotional, the most important of all is physical. Because it has plenty of changes will occur inside and outside of the body. The importance of prenatal care is very vital, as mentioned above it can be helpful for the mother and the baby as well to have a healthy delivery and free from any complications.

Recommendation Preeclampsia is a serious condition in a pregnant woman that needs a lot of precautions to be able to avoid it next time that she gets pregnant. The student nurses give recommendations to our patient to help her to cope up and avoid this situation next time she wanted to have a baby: 1. According to a study woman who do not receive prenatal care are seven times more likely to die from complication related to preeclampsia than women who receive prenatal care, it means that it is vital to have a prenatal care for further monitoring of the patient. 2. Early detection, careful monitoring, and treatment of eclampsia are crucial in preventing mortality related to this disorder. 3. Bed rest and taking high blood pressure medication can lower the blood pressure but will not stop preeclampsia from worsening or reduce the risk of its complications. 4. The most effective treatment for preeclampsia at or near term (after 37 weeks of pregnancy) is to deliver the baby. This helps to minimize the risk of harm to the woman or her baby from worsening preeclampsia. Babies at or near term are not at high risk of complications from prematurity and usually will not need to spend time in a special care nursery. 5. Mrs. X is 35 years of age and already had 5 children as student nurses advised her to have ligation. 6. Always bring the prescribed medication after discharge in the hospital. 7. Instruct the patient of proper hygiene. Emphasize the importance of breast feeding. 8. Advise to visit or have a follow up check-up with her attending physician. 9. Instruct patient to avoid strenuous activities. And practice deep breathing exercise. 10. Monitor food intake it must be low in fat, low in salt.

Gordon College
College of Nursing

Pre-eclampsia (Delivery Room)

Submitted by: Eliza S. Boncodin Mikka Mae Capus Mary Ann Casaul Nina Rica Ealdama Rachel Ebuenga Eclarinal Alfred BSN- IVB1

Submitted to: Eloisa Rosapapan, RN Clinical Instructor

Laboratory test Preeclampsia usually shows up during a routine prenatal blood pressure check followed by a urine test. The diagnosis depends on the presence of high blood pressure and protein in your urine after 20 weeks of pregnancy. Substances called biochemical markers in your blood and urine may be warning signs of preeclampsia. That's one of the reasons it's essential to seek early and regular prenatal care throughout your pregnancy. The following laboratory tests were recommended:

Blood tests. These can determine how well your liver and kidneys are functioning and whether your blood has a normal number of platelets the cells that help blood clot.

Prolonged urine collection test. Urine samples taken over at least 12 hours and up to 24 hours can quantify how much protein is being lost in the urine, an indication of the severity of preeclampsia. 24 Hour Urine for Protein and Creatinine Creatinine is a product of muscle metabolism. It is produced at a nearly constant rate and is excreted in the urine.

Because of it's constant rate of production, the amount of creatinine in the urine is an indirect measurement of kidney function (glomerular filtration rate). If kidney function is significantly reduced, the urine creatinine will fall. With more severe degrees of kidney failure, the serum creatinine will eventually rise. A 24-hour collection of urine is the most accurate way to assess renal function with creatinine. A blood (serum) creatinine is also measured during this time and used to calculated the volume of urine needed to "clear" the measured amount of creatinine from the blood and into the urine. This is called the "creatinine clearance." Vigorous exercise or muscular trauma occurring during the collection will cause an increased amount of creatinine in the blood and may lead to false creatinine clearance results. Serum proteins are normally extracted from urine prior to it being released from the kidney.

Because the renal glomeruli are imperfect, normal individuals may occasionally have "trace" amounts of protein in their urine. Larger amounts (1+ or more) are considered abnormal and may reflect an underlying kidney problem. Urine protein can be measured on any urine sample (a "spot urine"), but the most accurate measure is with a 24-hour collection of urine. During pregnancy, due to the increased renal blood flow, some additional protein may be lost in the urine. This increased protein loss should not normally be in quantities exceeding 300 mg in 24 hours. If more than 300 mg in 24 hours is found, this may signal the development of pre-eclampsia.

Fetal ultrasound. Your doctor may also recommend close monitoring of your baby's growth, typically through ultrasound. This test directs high-frequency sound waves at the tissues in your abdominal area. These sound waves bounce off the curves and variations in your body, including your baby. The sound waves are translated into a pattern of light and dark areas creating images of

your baby on a monitor that can be recorded electronically or on film for a look at the inside of your uterus.

Nonstress test or biophysical profile. These make sure your baby is getting enough oxygen and nourishment. A nonstress test is a simple procedure that checks how your baby's heart rate reacts when your baby moves. Your baby is doing fine if the heart rate increases at least 15 beats a minute for at least 15 seconds twice in a 20-minute period. A biophysical profile combines an ultrasound with a nonstress test to provide more information about your baby's breathing, tone, movement and the volume of amniotic fluid in your uterus.

Reference: http://www.brooksidepress.org/Products/OBGYN_101/MyDocuments4/Lab/24hour_Urine_for_Protein_and_Creatinine.htm http://www.mayoclinic.com/health/preeclampsia/DS00583/DSECTION=tests-anddiagnosis