ST. MARYS COLLEGENURSING PROGRAMTagum City

A CASE STUDYon

Acute Pulmonary edema complicating Severe preeclampsia

Presented to

Ms. Lesley Cadua RN,MNMs. Joan Calzada RN, MN

In Partial Fulfillment of the Requirements

In

Related Learning Experience(RLE)

By

BSN 2-A

Pinky rose MarfilYvonne ObraAxel Mae AbaricoZhendy SolisHoly Eve PasoquinIan mizzelDulfinaRondelDadulaJose Mari BernardinoJohn OcceoNiel Sabino

02-03-13

I. INTRODUCTION

Background StudyThe 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 childbirth-related causes, such as pre-eclampsiahttp://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 NorteSex: FemaleAge: 39 years oldCivil Status: MarriedBirthdate: 03/05/1973Birthplace: MATI, DAVAO ORIENTALNationality: FilipinoReligion: CatholicOccupation: House keeper

B. CHIEF COMPLAINT

Dyspnea

C. History of present illness

D. Past medical and Nursing HistoryE. Personal, family and socio-economic historyF. Patient need assessment

PHYSIOLOGIC NEEDSI. 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 turgorIV 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 againVI 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 feltVII SEXUALITY REPRODUCTIVE LMP__N/A__ AOG__N/A__ GRAVIDA/PARITY__G7P5__ PRENATAL__N/A__ MENSTRUAL CYCLE__N/A__ GYNECOLOGIC PROBLEM__N/A__ EDC__N/A__ FMILY PLANNING METHOD USE: calendar method CHILDREN (no.) __6__MENARCHE__N/A__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 beforeSAFETY 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 herSELF ESTEEM NEEDshe 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.edeH

G. Physical AssessmentJanuary 24, 2013Skin Brown skin generally uniform in color except in areas exposed to the sun Skin temperature uniform and within the normal range (370C) Dry skin folds Nails with smooth texture Nail beds pink Prompt capillary refill time (4-5 seconds)Head Present of nodules or masses Symmetric facial features and movements Symmetric nasolabial folds Evenly distributed black hair No infestationsEyes 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 Ears Color same as facial skin 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 earsNose Symmetric and straight Nasal septum intact and in the midlineMouth and Throat 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 positionNeck Head centered Lymph node palpableBreast Firm Generally symmetric in sizeCardiovascular BP 160/110 PR 149 Symmetric pulse strengthRespiratory/Chest Chest symmetric Chest wall intact, no tenderness, no masses Symmetric chest expansion and excursion RR: 49 bpmGastrointestinal/Abdomen Straie present at hypogastric and iliac regions Linea nigra present No tendernessUrinary Absence of nocturia, dysuria, urgency, hesitancy Light yellow urineReproductive Regular menstrual cycle G7p5Musculoskeletal/Extremities Muscle equal size on both sides of the body No tenderness Presence of edema Smooth coordinated movementsNeurologic Can respond to verbal commands Oriented Conscious

H. Course in the wardDate shiftNurses AssessmentNurses InterventionMedical Management

III. Laboratory and Diagnostic examinations

LAB EXAMNORMAL VALUERESULTINTERPRETATION/IMPLICATION

WBC Count3.98-10x109g/L16.8Abnormally high due to presence of infection or inflammation

RBC Count4.20-6.30 T/L4.96Normal

Hemoglobin120-160g/L107Below normal Decreased Hgb count on pregnant is normal because of the increase in plasma volume during pregnancy.

Hematocrit0.370-0.47g/L0.345Below normalDecreased hematocrit on pregnan is normal because of their increase in plasma volume.

Platelet count140-440 G/L322normal

Urine protein collection0+4Abnormally high due to severe preeclampsia

IV. ANATOMY AND PHYSIOLOGYAnatomy & 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 intolobes; The left lung is composed of theupper lobe, thelower lobeand thelingula(a small remnant next to the apex of the heart), the right lung is composed of theupper, themiddleand thelowerlobes.Mechanics of BreathingTo take a breath in, theexternal intercostal musclescontract, moving the ribcage up and out. Thediaphragmmoves 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 sub-divides to form very narrow terminal bronchioles, which terminate in thealveoli. 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 bypassive diffusion along concentration gradients.CO2movesintothe alveolus as the concentration is much lower in the alveolus than in the blood, and O2movesout ofthe alveolus as the continuous flow of blood through the capillaries prevents saturation of the blood with O2and allows maximal transfer across the membrane.

V. SYMPTOMATOLOGY

SYMPTOMATOLOGYACTUAL SYMPTOMSIMPLICATION

Extreme shortness of breath and difficulty breathingPRESENTDue to the presence of fluid in the lungs.

Tightness and pain in the chest

Wheezing, coughing

PalenessDue to inadequate blood perfusion.

Sweating

Bluish nails and lipsDue to inadequate blood perfusion.

Pink, frothy mucus coming from nose and mouth

Crackles

http://www.umm.edu/altmed/articles/pulmonary-edema-000137.htm

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 underlyingcause of the vasospasm remains a mystery, althoughsome of the pathophysiologic processes are known. In normalpregnancy, vascular volume and cardiac output increasesignificantly. Despite these increases, blood pressure doesnot rise in normal pregnancy. This is probably because pregnantwomen develop resistance to the effects of vasoconstrictors,such as angiotensin II. Peripheral vascular resistancedecreases because of the effects of certain vasodilators, suchas prostacyclin (PGI2), PGE, and endothelium-derived relaxingfactor (EDRF).In preeclampsia, however, peripheral vascular resistanceincreases because some women are sensitive to angiotensinII. 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, causesvasoconstriction and platelet aggregation (clumping). PGI2,produced by placental tissue and endothelial cells, causesvasodilation and inhibits platelet aggregation.Vasospasm decreases the diameter of blood vessels, whichresults in endothelial cell damage and decreased EDRF.Vasoconstriction also results in impeded blood flow and elevatedblood 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 filtrationrate. Blood urea nitrogen, creatinine, and uricacid levels begin to rise. Reduced renal blood flow results in glomerular damage,allowing protein to leak across the glomerularmembrane, which is normally impermeable to largeprotein molecules. Loss of protein reduces colloid osmotic pressure andallows fluid to shift to interstitial spaces. This may resultin edema and a reduction in intravascular volume,which causes increased viscosity of the blood and arise in hematocrit. In response to reduced intravascularvolume, additional angiotensin II and aldosteronetrigger the retention of both sodium and water. Generalizededema may occur. Decreased circulation to the liver impairs function andleads to hepatic edema and subcapsular hemorrhage,which can result in hemorrhagic necrosis. This is manifestedby elevation of liver enzymes in maternal serum. Vasoconstriction of cerebral vessels leads to pressureinducedrupture of thin-walled capillaries, resulting insmall cerebral hemorrhages. Symptoms of arterial vasospasminclude headache and visual disturbances,such as blurred vision, spots before the eyes, and hyperactivedeep tendon reflexes. Decreased colloid oncotic pressure can lead to pulmonarycapillary leak that results in pulmonaryedema. Dyspnea is the primary symptom. Decreased placental circulation results in infarctionsthat increase the risk for abruptio placentae and DIC.Pathologic processes of preeclampsiaCardiovascular systemHematologic systemNeurologic systemRenal systemHepatic systemplacenta

Response to angiotensin II

Blood pressure

Cardiac output

Systemic vascular resistance

Plasma volume

Hemoconcentration

Viscosity

Platelet clumping

Thrombocytopenia

Endothelium damage

Thromboxane/prostacyclin ratio

Endothelium-derived relaxing factor

Vascular resistance

Blood pressure

PathologyArterial vasospasm

Rupture of small capillaries

Small hemorrhages

Headache, hyperreflexia

convulsionsGlomerular flow rate

Damage to glomeruli

Protinuria

Colloid osmotic pressure

Fluid shift(edema)

Hypovolemia

Hematocrit

Angiotensin II and aldosterone

Further edema

Blood urea, nitrogen, creatinine, and uric acideImpaired function

Hepatic edema

Subcapsular hemorrhage

Enzymes

Epigastric painPlacental perfusion

Fetal hypoxemia

Acidosis

Perinatal death

Nutrients IUGR

Pulmonary EdemaAccumulation of fluid in interstitial spaceInability to remove excess fluid from interstitial spaceBlockage of lymphatic vessels

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

ProblemNursing DiagnosisObjectiveNursing InterventionRationaleEvaluation

difficulty of breathingSubjective Cues:medyo naglisod ko og ginhawa labi na kung mag ubo ko, as verbalized by the client

Objective Cues: > (+) crackles>rapid, shallow, irregular respiration> use of accessory muscles when coughing> abnormal blood gases> abnormal chest x-ray resultIneffective breathing pattern r/t lung compliance as a result of accumulation of fluid in the pulmonary interstitiumAt the end of the nursing shift, the Px will be able to experience adequate respiratory fxn.INDEPENDENT> place Px in a semi to high fowler position if not contraindicated

> instruct & assist Px to change position, deep breathe, & cough or huff every 1-2 hours

> implement measures to reduce pain splint incision with pillow during coughing & deep breathing

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

> administer meds that may be ordered to improve Pxs respiratory status> this position allow increased diaphragmatic excursion & maximum lung expansion, which promotes optimal alveolar ventilation> frequent repositioning helps loosen secretions & promotes a more effective cough. It also promotes maximum lung expansion & stimulates surfactant production. Coughing or huffing mobilizes secretions & facilitates removal of these secretions from the respiratory tract> a Px with pain often guards respiratory efforts pain reduction enables the client to 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> 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 conditionAt the end of the nursing shift, the Px was able to experience adequate respiratory fxn. as evidencedof the ff.:> normal rate, rhythm & depth of respiration> improved breath sounds> (-) crackles> blood gases within normal ranges> Px verbalizes relief from difficulty of breathing

ProblemNursing DiagnosisObjectiveNursing InterventionsRationaleEvaluation

fearSubjective 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 sa cge huna-huna, as verbalized by the clientObjective Cues:> disturbed sleep pattern> weak appearanceFear r/t persistent headacheAt the end of the nursing shift, the Px will be able to experience a reduction of fearINDEPENDENT> encourage verbalization of feelings & concerns

> assure Px that staff members are nearby; respond to call signal as soon as possible

> reinforce physicians explanations & clarify misconceptions the Px has about the diagnostic tests, disease condition, treatment plan & prognosis> implement measures to reduce distress

DEPENDENT> administer prescribed antianxiety agents if indicated> verbalization of feelings & concerns helps client identify factors that are causing anxiety> close contact & a prompt response to requests provide a sense of security & facilitates the development of trust, thus reducing the clients anxiety> factual information & an awareness of what to expect help decrease the anxiety that arises from uncertainty

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

> helps reduce the Pxs anxietyAt 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

ProblemNursing DiagnosisObjectiveNursing InterventionsRationaleEvaluation

Ojective cues:Weak and pale in appearance Capillary refill of 3-4 seconds RBC Level=1.49 Hgb level= 34g/L Bp=160/110 mmHgIneffective tissue perfusion related to decrease in RBC, hemoglobin and hematocrit levelAfter 4 hours of nursing interventions, the client will exhibit decrease in oxygen demand and ability to conserve energy.Assist client in performing ADL

Place the client in trendelenburg position.

Maintain adequate ventilation.

Instruct client to sit and dangle the feet before standing.

Advise client to increase intake of food rich in iron and folate such as liver and green leafy vegetables.

To promote safety

To promote venous return

To promote oxygenation and good blood circulation

To prevent orthostatic hypotension

Iron and folate are necessary for red blood cell production.After 4 hours of nursing intervention, the client will exhibit decrease in oxygen demand and ability to conserve energy.

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 MANAGEMENTDoctors OrderDrugActionIndicationsNursing Responsibilities

Magnesium sulfateBlockage of neuromuscular transmission, vasodilationPrevention and treatment of eclamptic seizures, reduction in blood pressure in preeclampsia and eclampsiaAdminister IV loading dose of 4-6 over 30 minutes, continue maintenance infusion of 2-4g/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

Hydralazinehydrochloride(Apresoline)Vascular smoothmuscle relaxant,thus improvingperfusion torenal, uterine,and ceReduction in bloodpressureAdminister 510 mg by slow IV bolus every20 minutesUse parenteral form immediately after openingampuleWithdraw drug slowly to prevent possiblerebound hypertensionMonitor for adverse effects such aspalpitations, headache, tachycardia,anorexia, nausea, vomiting, and diarrhea

Labetalolhydrochloride(Normodyne)Alpha 1 and betablockerReduction in bloodpressureBe aware that drug lowers blood pressurewithout decreasing maternal heart rate orcardiac outputAdminister IV bolus dose of 1020 mg and thenadminister IV infusion of 2 mg/minute untildesired blood pressure value achievedMonitor for possible adverse effects such asgastric pain, flatulence, constipation,dizziness, vertigo, and fatigue

Nifedipine(Procardia)Calcium channelblocker/dilationof coronaryarteries,arterioles, andperipheralarteriolesReduction in bloodpressure,stoppage ofpreterm laborAdminister 10 mg orally for three doses andthen every 48 hoursMonitor for possible adverse effects such asdizziness, peripheral edema, angina,diarrhea, nasal congestions, cough

SodiumnitroprussideRapid vasodilation(arterial andvenous)Severe hypertensionrequiring rapidreduction in bloodpressurePulmonaryAdminister via continuous IV infusion with dosetitrated according to blood pressure levelsWrap IV infusion solution in foil or opaquematerial to protect from lightMonitor for possible adverse effects, such asapprehension, restlessness, retrosternalpressure, palpitations, diaphoresis,abdominal pain

Furosemide(Lasix)Diuretic action,inhibiting thereabsorption ofsodium andchloride fromthe ascendingloop of HenlePulmonary edemaAdminister via slow IV bolus at a dose of1040 mg over 12 minutesMonitor urine output hourlyAssess for possible adverse effects such asdizziness, vertigo, orthostatic hypotension,anorexia, vomiting, electrolyte imbalances,muscle cramps, and muscle spasms

SYNTHESIS OF CLIENTS CONDITION/STATUS FROM ADMISSION TO PRESENTConclusionWe 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 prognosisAfter 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. RecommendationOn 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 studyAfter 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 PillitteriEssentials of maternal and child nursing by Murray