CASE STUDY OF SEVERE PRE-ECLAMPSIA Patient JB 40 year old G1P0 at… CASE STUDY OF SEVERE PRE-ECLAMPSIAPatient JB 40 year old G1P0 at 36 weeks gestation accompanied by her husband was seen and examined in the Emergency Room with a chief complaint of severe headache, facial swelling, ankle edema and blurring of vision .Initial vital signs as follows: Temperature- 36.4 degrees Celsius Heart Rate- 85 beats per minute Respiratory rate- 17 BP- 200/110. Weight-81 kgLeopold’s maneuver done reveals fundic height of 32cm, longitudinal lie, fetal back felt at the right side, on cephalic presentation, head engaged ?.Patient was also attached to an electronic fetal monitor. FHT: 135 bpm, reassuring variability, No deceleration and acceleration noted.Patient felt no contractions at the time of examination. Routine urinalysis reveals ++ ProteinLABS DONE Results Normal Range for PregnancyHemoglobin 11.1 g/dL 11-14 g/dLWhite Blood Cell Count 18.9 x 109/L 6-16 x 109/LNeutrophils 16.2 x 109/L 2-7.5 x 109/LPlatelets 346 x 109/L 150-400 x 109/LSodium 139 mmol/L 130-140 mmol/LPotassium 4.2 mmol/L 3.3-4.1 mmol/LUrea 8.1 mmol/L 2.4-4.3 mmol/LCreatinine 68 umol/L 34-82 umol/LC-reactive protein 127 mg/L <5 mg/L In the ER, JB was given Nifedipine 10 mg sublingual STAT. Repeat BP after 30 minutes was 190/110. Few minutes upon checking the BP, the patient had a seizure of less than 30 seconds. She was hooked immediately to oxygen via a mask at 10 LPM and was put on the left lateral position.The patient was immediately assessed by the OB resident and Magnesium Sulfate 4g SIVP and Hydralazine 50 mg SIVP STAT. Repeat vital signs as follows: BP-170/100 HR-88 bpm RR-20 SPO2-99% Patient was advised to be admitted for further observation and management.FAMILY HISTORYFather- hypertensive, diagnosed with liver cirrhosis, Mother- diagnosed with DM type 2 and bronchial asthma.PAST MEDICAL HISTORY+ Seasonal allergies to dust and pollen, long standing asthma- uses Salbutamol inhaler to relieve symptoms. Patient cannot recall when the last attack occurred.+ wrist fracture during high school volleyball varsity days- ORIF with plating was done at Phil Orthopedic Center.OB HISTORYLMP June 5, 2021 Menarche- 14 years old claims to have a regular cycle, period lasting up to 5 days consuming 4-5 pads fully soaked on Day 2 and 3 with associated dysmenorrhea on those days.PERSONAL HISTORYMarried for 10 years, works as medical secretary, smoker and occasional alcoholic beverage drinker but claims she stopped after finding out she's pregnant.Educational attainment: College undergraduate- Nursing.COURSE IN THE WARD In the ward, Patient JB was carefully monitored with continuous BP monitoring and she was also attached to a CTG machine to monitor her baby as well. The following morning, she claims that she is starting to feel well, her latest BP was 130/80. Her OB ordered to transfer her to the labor room for induction of labor and the plan is to deliver the baby via NSD. She was given Primrose oil 1gm cap q4 po and 1 cap intravaginally at HS and Dexamethasone 6mg IV q 12 hours X4 doses. After 3 days, the patient was hooked to an IV of D5LR 1L with incorporation of oxytocin at 12-13 gtts/min. Due to poor cervical dilatation, patient was scheduled for CS on that day.POST OPERATIVE STAY IN THE WARDPatient JB gave birth to alive baby girl 2.8 kg with APGAR score of 7 at 1 minute, 9 at 5 minute. Post op orders as follows: FOB X 8, monitor vital signs q2 and refer for increased BP, Pain meds of Paracetamol 900 mg q6 X 6 doses then Tramadol +Paracetamol tab q8 PRN once on diet for pain Ketorolac 30 mg IV q8 PRN for breakthrough pain, NPO then clear liquids if positive flatus, Continue Methyldopa 250 mg 1 tab O, Hydralazine 5mg IV for BP above 150/100 mmHg, Cefuroxime 500mg q8 X 7days, Methergine 1 tab TID and Malunggay cap TIDonce on diet.COURSE IN THE WARD- FIRST DAY POST OPWith stable vital signs the whole day.Patient's diet was shifted to Soft low salt low fatIVF consumed, Foley catheter removed, patient able to ambulate around the room and to the NICU to visit he baby.Her AP ordered Dulcolax supp and be able to have bowel movement, patient's diet was shifted to regular low salt, low fat diet.SECOND DAY POST OPPatient was discharged in good condition with the following home medications:Cefuroxome 500 mg TID X 5 days moreMethergine 1 tab TID X 5 days moreMalunggay 1 cap TIDIron + folic 1 tab ODMethyldopa 250 mg tab ODFollow up check up after 1 week at AP's clinicWHAT IS THE ACTUAL FINDINGS?Body PartActual FindingsSKIN HAIR NAILS HEAD FACE & NECK EYES EARS MOUTH & PHARYNX NOSE THORAX & LUNGS HEART BREAST ABDOMEN MUSKULOSKELETAL GENITAL RECTUM & ANUS Health Science Science NursingBSN 122
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