CHAPTER I

INTRODUCTION
Pre-eclampsia, also referred to as toxemia, is a medical condition where
hypertension arises in pregnancy (pregnancy-induced hypertension) in association with
significant amounts of protein in the urine. Pre- eclampsia refers to a set of symptoms
rather than any causative factor, and there are many different causes for the condition.
Women with preeclampsia will often also have swelling in the feet, legs, and hands. In
addition symptoms of preeclampsia can include:

Rapid weight gain caused by a significant increase in bodily fluid

Abdominal pain
Severe headaches
A change in reflexes
Reduced output of urine or no urine
Dizziness
Excessive vomiting and nausea
Pre-eclampsia may develop from 20 weeks gestation. Its progress differs among

patients. Most cases are diagnosed pre-term. Pre-eclampsia may also occur up to six
weeks post-partum. It is the most common of the dangerous pregnancy complications; it
may affect both the mother and the unborn child.
There are 2 categories of preeclampsia, mild and severe. Severe
preeclampsia is defined as the following:

Blood pressure greater than 160 mm Hg systolic or 110 mmHg diastolic on 2

occasions 6 hours apart

Proteinuria exceeding 2 g in a 24-hour period or 2-4+ on dipstick testing
Increased serum creatinine (> 1.2 mg/dl unless known to be elevated previously)
Oliguria 500 mL/24 h#
Cerebral or visual disturbances
Epigastric pain
Elevated liver enzymes
Thrombocytopenia (platelet count < 100,000/mm3)
Retinal hemorrhages, exudates, or papilledema
Pulmonary edema
Preeclampsia has been described as a disease of theories, because the cause

is unknown. Some theories include:

Endothelial cell injury,

Ejection phenomenon (insufficient production of blocking antibodies),
Compromised placental perfusion,
Altered vascular reactivity,

Imbalance between prostacyclin and thromboxane,

Decreased glomerular filtration rate with retention of salt and water,
Decreased intravascular volume,
Increased central nervous system irritability,
Disseminated intravascular coagulation,
Uterine muscle stretch (ischemia),
Dietary factors, and
Genetic factors.
A database of hospital discharge data from approximately 300,000deliveries in

the United States found the overall incidence of severe preeclampsia was about 1
percent of pregnancies.
Studies of preeclampsia report about 5 percent of nulliparous women develop
preeclampsia and 40 to 50percent of these women develop severe disease. In the
Philippines, according to Department of Health, Maternal Mortality Rate (MMR) is 162
out of 10,000 live births (Family Planning Survey 2006).

Maternal deaths account for 14% of deaths among women. For the past five years all of
the causes of maternal deaths exhibited an upward trend. Preeclampsia showed an
increasing trend of 6.89%; 20%; 40%; and 100%. Ten women die every day in the
Philippines from pregnancy and childbirth related causes but for every mother who dies,
roughly 20 more suffer serious disease and disability. The UNFPA office in the
Philippines declared that family planning can help prevent maternal deaths by 35%.
(http://hb4110.net/wpcontent/uploads/KIT_MATERNAL%20HEALTH_BASIC
%20STATS.doc.)
The only known treatments for eclampsia or advancing pre-eclampsia are
abortion or delivery, either by labor induction or Caesarean section (and therefore
delivery of the placenta). Magnesium sulfate is the first-line treatment of prevention of
primary and recurrent eclamptic seizures (it reduces transmission of nerve impulses
from brain to muscles). The mother and her family deserve careful teaching regarding
the problem, its observation, and its treatment. Regular, adequate prenatal care is the
best insurance for control of the complication.

Importance of the case study

In the part of the client this case will inform the client of what her condition is all about. It
will also lessen the burden of the client increasing her awareness about the whole
course of treatments. And also, the client will be able to familiarize herself about the
importance taking care of her own self through the use of medical regimens.
In the part of the student the student will gain more information and knowledge about the
disease and will lead to a certain new facts about the said condition, such as cause of
disease, pathophysiology, manifestations, related factors as well as the proper nursing
care management and medical regimens to be rendered. This acquired information may
also help the students on how to properly manage and care for patients with the same
state. On the side of the College of Nursing This study could be a used as a guide for
the students and it can bear source of facts and information to students of different
colleges and especially to the students of College of Nursing. On the side of nursing
profession this study will serve as a basis in gathering facts and sets of information with
regards to pre-eclampsia.

OBJECTIVES:
GENERAL OBJECTIVES
Client Centered Objectives

To assess the health of the patient

To develop, implement, and evaluate plans for health promotion
To provide client education and involve patient in implementing therapeutic

regimen to promote understanding and compliance. Nurse Centered

To apply the nursing process in the care of the hospitalized patient
To describe effects of illness on individuals and family members roles and
functions

SPECIFIC OBJECTIVES
Client-Centered Objectives

Discuss indications for and management of a pregnant clients

Discuss nursing implications for medications commonly prescribed for pregnant
Describe nursing care for the client
Use the nursing process to provide individualized care for clients who has

experienced pre- eclampsia.

Support client and family, and encourage them to ask questions so that
information could be clarified and understood

Student-Centered Objectives

Identify major risk factors influencing the said condition.

Identify the risk factor contributing to the occurrence of the disease.
Learn the pathophysiology and manifestations of pre-eclampsia.
Identify common diagnostic tests used for the said condition and their nursing

implications.
Identify and describe nursing measure to promote awareness in the condition.