A Case Study of Patient with Pre-Eclampsia

A Case Study of Patient with Pre-Eclampsia

 CHAPTER ONE

INTRODUCTION

Overview of the study

This is a client case study carried out on Mrs. L.O. a 30 years old primigravida with pre-eclampsia who was admitted in the labour ward of mile 4 hospital Abakaliki on 5th February 2017. She was referred from antenatal clinic to the labour ward on account of raised BP(180/120 mmHg), proteinuria of 2+ on dipstick and paedal oedema that is pitting. A diagnosis of pre-eclampsia was made by the doctor in charge and the following treatment prescribed: magnesium sulphate (4mg in IV infusion for hours and 5mg on each buttock) and 10mg IV hydralazine slowly for 15 minutes. Mrs. L.O. now called the husband on phone and intimated him on the situation at hand. The husband now reported immediately with Mrs. L.O.’s mother-in-law and sister-in-law; all looking perplexed not knowing the reason for admitting somebody looking healthy and mobile. Also, the mother-in-law was crying aloud that her enemy is after the daughter-in-law to take away her life and have buried charm for her that makes the leg swollen. It is at this point that I approached them and allayed their anxiety, explained to them that Mrs. L.O. is suffering from severe pre-eclampsia. I further counseled them on the need for immediate intervention and close observation to avoid fitting which may endanger her life and that of her baby which they did not object.

Pre-eclampsia is a disorder of pregnancy characterized by high blood pressure and a large amount of protein in the urine (Philip, 2010). Hypertensive disorders of pregnancy represent the most significant complication of pregnancy affecting approximately 5% of all pregnancies and 11% of all first pregnancies. They continue to be a major cause of maternal, foetal and neonatal morbidity and mortality (Fraser and Cooper, 2009). There are four different levels of hypertensive disorders in pregnancy: chronic Hypertension (Discovered prior to 20 weeks gestation), gestational hypertension, pregnancy induced hypertension also known as toxemia or preeclampsia, preeclampsia/Eclampsia superimposed by chronic hypertension (Zamorski and Green, 2008). According to Zamorski and Green (2008), Pregnancy induced hypertension (PIH), are high blood pressure disorders of pregnancy. It has long been one of the major problems for mothers in pregnancy, along with infection and postpartum hemorrhage. Pre-eclampsia affects 5-8% of all pregnancies but 10-20% of mothers will have a hypertensive disorder during pregnancy.

Case Study Background

The family composition: The family is a nuclear family.  Mrs L.O is living with her husband, mother-in-law and sister-in-law at Umuoghara village in Ezza North LGA, Ebonyi State. The family is living in their country home in a cement house with corrugate zinc. The house has four rooms which is spacious enough to accommodate them. The home is located in a village setting and its environment is very conducive to health as it is surrounded with trees that enhance adequate ventilation.

Demographic Information

Name:          Mrs. L.O.

Ad                          Address:      Umuoghara village in Ezza North LGA, Ebonyi  State.

Sex:                  Female

Age:                  30 years

Parity:                                 G1PO

Gestational age:        24 weeks

Occupation:             Petty trader

Nationality:              Nigerian

Religion:                  Christianity (RMC)

Family Member

Name Age Sex Relationship Occupation
Mr. J.O. 35 years Male Husband Vulcanizer
Mrs. L.O. 30 years Female client Petty trader
Mrs. M.O. 64 years Female Mother-in-law Farmer
Miss. C.O. 25 years Female Sister-in-law Apprentice

 Household Description

The family is living in their country home in a cement house with corrugate zinc. The house has four rooms which is spacious enough to accommodate them. The home is located in a village setting and its environment is very conducive to health as it is surrounded with trees that enhance adequate ventilation.

Ventilation

The home being located in a village setting has one window in each room and it is surrounded with trees that enhance adequate ventilation.

Kitchen Accommodation

The kitchen is located outside the main building and is moderate in size, not covered so they only cook there and take the food inside the main building.

 Distribution of the Rooms

Mrs. L.O. and the husband use one room as their bedroom room, the middle one as sitting room, the third room for the mother-in-law and sister-in-law and the extreme one for keeping their foods, utensils and other related items.

Toilet Facility/Bathroom

The family use bush method for toileting and have a small secluded house covered with palm fronds as their bathroom. Inside the bathroom, there were two slabs of stones – one for keeping the bucket and the other for standing while bathing. The public health nurse advised them to always sweep, weed the bathroom and wash the stone regularly to avoid fall.

Water supply

Their source of water supply is stream and they were advised to always boil the water, filter and allow it to cool before drinking it. This is to avoid water borne diseases.

Lightening/electricity supply

There is electricity supply which is not always constant and they make use of locally made lamps.

Refuse Disposal

The family discards decomposable refuse into their farms and burn the inorganic ones.

Environmental sanitation:

The compound is clean and is occasionally swept and grasses weeded out on every first Saturday of each month

Drainage system:

 The premises are always dry with no stagnant water around the building.

Socio economic status

The family income is enough to carter for the major need of the family. The man being a vulcanizer and the wife as a petty trader generate enough income for the house up keep.

Role of the family members 

Each of the family members play an important role to ensure the family is waxing strong.

Mode of interaction within the family

The family maintains a quiet and peaceful home where there is love, unity understanding and cooperation among each member.

Pattern of family activities

The day to day family living in cooperates a family prayer which is usually said together most morning and night, after morning routine the man heads to his workshop while the woman attends to her petty business, and return home after each day activity to eat, relax, discuss and retire to their room.

Family cohesiveness and solidarity

There is strong emotional bonding and family tie within the family, despite slight misunderstanding, they still try to hold on to their belief and trust in God.

Environmental hazard

Mrs L.O is majorly exposed to noise in the market place where she does her petty trading.

Social history

Mr. and Mrs. J.O have always lived in their home town Umuoghara village in Ezza North LGA, Ebonyi  State.

Health Information

Mrs. L.O. is a healthy looking pregnant woman, not pale, not in obvious distress, have paedal oedema. She is G1PO. In the past, she has not been admitted in the hospital and have always sought healthcare from patent medicine dealers and occasionally uses herbs for minor ailment.

Past medical mistory

Mrs. L.O. has not been admitted into the hospital, but has been treated by patent medicine dealers for some ailment that present with fever, chills and weakness and occasionally she uses herbs. Usually she recovers after treatment.

Past surgical history

She had appendicectomy when she was 25 years.

Past nutritional history

She tolerates all food except in some occasions when she had loss of appetite due to pregnancy condition.

Past social history

She associate easily with people, takes alcohol sparingly and does not smoke cigarette.

Vital signs

Temperature: 36.80C

Pulse: 86b/m

Respiratory rate: 20 c/m

General Physical Assessment

Hair     –Brown colour, neatly packed and densely distributed.

Head   The size of her head is appropriate for her stature

Eyes –The eyes were sharp, not swollen, no discharge in the eyes and conjunctiva richly vascularized.

Face           Was swollen.

Mouth  The mucous membrane of the mouth is richly vascularised.

Limbs      The limbs were oedematous, no extra digit

Chest         The chest is clinically clear, no cough or catarrh. It moves normally with respiration.

 History of present condition

My client Mrs. L.O. who was admitted in the labour ward of mile 4 hospital Abakaliki on 5th February 2017, was referred from antenatal clinic to the labour ward on account of raised BP(180/120 mmhg), proteinuria of 2+ on dipstick and paedal oedema that is pitting. A diagnosis of pre-eclampsia was made by the doctor in charge. Mrs. L.O. now called the husband on phone and intimated him on the situation at hand. The husband now reported immediately with Mrs. L.O.’s mother-in-law and sister-in-law; all looking perplexed not knowing the reason for admitting somebody looking healthy and mobile. It is at this point that I approached them and allayed their anxiety, explained to them that Mrs. L.O. is suffering from severe pre-eclampsia. I further counseled them on the need for immediate intervention and close observation to avoid fitting which may endanger her life and that of her baby which they did not object.

 Management

  • Loading dose of MgSO4 (4g) given over 5 – 10 min iv (or 4g of MgSO4 in 500mls normal saline for 3 hours) and 5g of MgSO4 im each on the buttock followed by maintenance dose of 5g MgSO4 4hourly for 24 hours.
  • 10mg of hydralazine iv given slowly for 15 minutes only when diastolic is greater than 110mmHg.
  • Tab 250mg Aldomet i tds x 5/7
  • Tab 20mg nifedipine i daily x 5/7
  • Tab Paracetamol 250mg prn
  • Tab fesolate x 1 tds daily 1/12
  • Tab folic acid x 1 daily 1/12

Objectives of the case study

  1. To enlighten the client on the causes, clinical manifestations, complications and management of the disease condition.
  2. To ensure optimal wellbeing of the mother and the foetus during gestational period
  3. To render wholistic care to my client so as to have safe delivery and child survival.

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