Pathophysiology of Preeclampsia essay paper
Pathophysiology of Preeclampsia essay paper
Presenting Complaint
Use a real patient or V simulation scenario of your choice to write this case study. Am uploading the criteria and grading rubric.
Use a real patient or V simulation scenario of your choice to write this case study. Am uploading the criteria and grading rubric. Pathophysiology of Preeclampsia essay paper
Rosette is a 38-year-old African American female. She is para 2+3 gravida 6 at 37 weeks gestation. She came to the hospital accompanied by her husband. She presents with lower limb swelling and severe headache that was of acute onset, visual disturbances, and epigastric pain associated with nausea and vomiting. She denies having had confusion, oliguria, convulsions, and stroke.
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Past Medical and Surgical History
Rosette has been attending her antenatal clinic and high-risk clinic due to hypertension and bad obstetrics history. On her past medical history, she reports having sinusitis has been taking antihistamines to relieve her symptoms. She is also asthmatic and she has been using a Ventolin inhaler. She has hypertension and she has been taking methyldopa 500mg once daily. She has never been through a major and minor surgical procedure.
Family Social-Economic History
In her family history, her mother is suffering from hypertension, type two diabetes mellitus, and fatty liver disease. Her father suffers from hypertension, asthma, and eczema. Rosette works as a banker and she is married and she lives with her husband and two children. She reports having not indulged in drinking alcohol and smoking tobacco.
Obstetrics and Gynecology History
In her obstetrics and gynecological history, she has two living children and had had three consecutive miscarriages at a gestational age of 10, 14, and 16 weeks respectively. Before pregnancy, she did not have any gynecological illness. Pathophysiology of Preeclampsia essay paper
Examination Findings
On examination her blood pressure was 181/101 mmHg, pulse rate of 88 beats per minute, respiratory rate of 14 cycles per minute, the temperature of 36.7 degrees celsius, oxygen circulation is at 98% off oxygen. On general examination, she is sick-looking. She has a puffy face and hands with bilateral pitting edema up to the knee joint. She did not have jaundice, pallor, dehydration or lymphadenopathy. On abdominal examination, fundal height was 38cm, fetal lie was longitudinal, the fetal presentation was cephalic, fetal heart rate was at 138 bpm of regular rhythm. The engagement was at 3/5 and the mother reports to perceive fetal movement. She had epigastric tenderness upon palpation. Other body systems had unremarkable findings.
Diagnostic Test
Her urine sample shows proteinuria + + +. Full hemogram had normal white blood cell count, normal platelets, and normal red blood cells. Renal function test had normal electrolytes and creatinine. Urea was elevated at 13g/dl. Liver enzymes are within the normal range upon doing a liver function test. Random blood sugar was at 6.7mmol/dl.
Diagnosis and Treatment
A diagnosis of pre-eclampsia was made. Rossette was admitted to the antenatal ward. Treatment was started immediately; nifedipine 10mg stat and 4-hourly blood pressure monitoring. The second reading was 158/91 mmHg. After stabilizing the blood pressure induction of labor started by used prostaglandin E2 (PGE2) that has dinoprostone. The mechanism of action was to ripen the cervix and induce contractions (Suvakov, et al, 2020). Rossette had a spontaneous vertex delivery. She stayed in the hospital for 3 days for observation and was discharged on the 4th day. She was advised to continue with her anti-hypertension medicine and start a follow-up clinic two weeks after delivery. The definitive management for preeclampsia is delivery. The main aim is to prevent the progression of preeclampsia to eclampsia and HELLP syndrome. Drugs used in the management of hypertension in pregnancy are methyldopa and labetalol. In rosette’s situation, it is not advisable to use labetalol due to the underlying condition of asthma. The patient has been on methyldopa despite the persistently elevated high blood pressure. The recommended medicine was nifedipine 10 mg twice daily (Suvakov, et al, 2020). Magnesium sulfate is recommended as a prophylactic dose. It should be given to avoid a patient from having eclampsia and the dose should be given 24 hours after delivery
Pathophysiology of Preeclampsia
Preeclampsia is defined as hypertension and proteinuria with or without pathologic edema. It occurs due to vascular endothelial malfunction and vasospasm after 20 weeks gestation. It is characterized by a blood pressure greater than 140/90 mmHg and proteinuria above 20 weeks gestation (Gyamfi-Bannerman, et al, 2020). Preeclampsia had two stages; stage one and stage two. The first stage involves a reduction in placental perfusion due to abnormal implantation and poor placental vasculature during development. Poor placental perfusion leads to deficient oxygen supply from the maternal side causing prolonged fetal hypoxia. Poor perfusion causes failure in the occurrence of endothelialization which leads to endothelial damage, atherosclerosis, and placenta infarction. Vascular endothelial growth factor and placenta growth factor are important in maintaining and regulating placental vasculogenesis. The imbalance between these two factors leads to an antiangiogenic state and endothelial dysfunction (Rana, et al, 2019). The second stage of preeclampsia involves intense inflammation and maternal endothelial cell dysfunction, insulin resistance, dyslipidemia, and reduced immune function due to the imbalances of the vascular endothelial growth factor and placenta growth factor. Clinically it is manifested with elevated blood pressure, proteinuria, and multiple organ dysfunctions. Edema in preeclampsia is usually decreased by 20%. This causes an abnormal shift of extracellular fluids into the intravascular space hence a low plasma volume that causes weight gain and edema (Rana, et al, 2019). Preeclampsia is a global challenge with a significant cause of maternal and perinatal morbidity and mortality. The treatment option is delivery to save the mother from complications like eclampsia and HELLP syndrome. Pathophysiology of Preeclampsia essay paper
NURS 378 Clinical Case Study GRADING CRITERIA
Fall 2020
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NAME:_________________________________________ DATE:______________________
| Grading Criteria | Possible Points | Points Earned/Comments |
| SUBMISSION ON DUE DATE | 10 POINTS |
|
| NEAT, GRAMMAR, SPELLING, APA style, REFERENCES (AT LEAST 3
PEER REVIEWED JOURNALS) |
10 POINTS |
|
| DESCPRITION OF SCENORIO:
Include the Understanding of the scenario. (Either choose a patient from your clinical experience from working on the unit or create your own based on a topic chosen. A real patient or simulation scenario is preferred) |
10 POINTS |
|
| Treatment
(Including diagnostic testing and medical management for your disorder.) |
20 Points | |
| PATHOPHYSIOLOGY OF DISEASE PROCESS:
INCLUDING SIGNS AND SYMPTOMS |
20 POINTS |
|
| NURSING DIAGNOSIS
(INCLUDE 2 DIAGNOSIS, 2 GOALS FOR EACH, 3 NURSING INTERVENTIONS WITH RATIONALES, AT LEAST 1 OUTCOME) |
30 POINTS | |
| TOTAL POINTS | 100 POINTS |
References
Gyamfi-Bannerman, Pandita, Miller& Friedman, (2020) Preeclampsia and in existing hypertension The Journal of Maternal-Fetal & Neonatal Medicine, 33(21), 3619-3626.
Rana, Lemoine, & Karumanchi,(2019) pathophysiology of Preeclampsia Circulation research, 124(7), 1094-1112.
Suvakov, Obradovic, & Gojnic-Dugalic, (2020) Treatment of hypertension and preeclampsia with other comorbidities The Journal of Clinical Endocrinology & Metabolism Pathophysiology of Preeclampsia essay paper
