Posted: May 24th, 2022

Recoding a pregnant mother-Based case study

recoding a pregnant mother-Based case study. thai primegravida multpara.

This essay is about a process recording for a pregnant mother. Process recording is a written record of an interaction with a client. Pregnant mothers are in danger of any disease but there most alarming gestational diseases; these include hypertension, cardiac disease, anemia, diabetes, hyperemis gravidarum and many more. In this essay am only going to dwell in gestational hypertension.

This is a process recording of a case study of a pregnant mother. Mrs. B is a 16 years old primigravida at 30 weeks gestation and has attended the antenatal clinic three times. All finding were within the normal range until her last visit 1 week ago when her blood pressure was 130/90mmHg.On urinalysis there was no proteinuria. The fetal heart sounds were normal, the fetus was active and uterine size was consistent with dates. She has come to clinic today, as requested, for follow up. (www.reproline.jhu.edu/../05-CS-5.2.htm)

According to above case study a diagnosis of hypertension in pregnancy was made. Hypertension in pregnancy is defined as rise in the blood pressure above 130/90mmHg.It is also associated with increased level of protein in urine with or without oedema. Hypertension is mostly called disease of primigravida although it can also occur in multiparous or reoccur in cases where it was present in the 1st pregnancy. Risk factors of hypertension include family history of pre-eclampsia, long standing high blood pressure or kidney disease, pregnancy induced diabetes, auto-immune disease. Hypertension in pregnancy is divided into pre-eclampsia and eclampsia. In pre-eclampsia blood pressure is more than 130/90mmHg, proteinuria with or without oedema while eclampsia is high blood pressure of 130/90mmHg and above, convulsions, with or without proteinuria and oedema. Other signs and symptoms of hypertension includes; hyperreflexion, right upper quadrant pain (tense liver capsule), headache, blurring of vision. (Benson M.D)

The management of hypertension is basically focused towards lowering blood pressure. Mild preeclampsia (BP less than 160/100,no proteinuria, mild oedema),strict bed rest and encourage lying in the left side, check blood pressure 4 hourly if in hospital, daily weight and fetal heart tones check, urine protein measurement after 2 days. Induce labour if no improvement and fetus is term. May sedate with Phenobarbital 30mg 2 times per day. Severe pre-eclampsia (more than 160/100mmHg,proteinuria, oedema), admit, no added salt diet, convulsions precautions, examine eye grounds, daily weights check, BP check after 1-4hr,fetal heart tone recording at least daily. Place Foley catheter and monitor urine input-output chart. Do laboratory testing to evaluate severe hypertension. This includes testing for target organ damage, possible causes of hypertension, and other risk factors. Do urinalysis, full blood count and serum sodium, potassium, creatinine, and glucose levels. Other optional tests include uric acid, creatinine clearance, microalbuminuria, glycosylated hemoglobin, 24-hour urinary protein, serum calcium, thyroid-stimulating hormone, and an electrocardiogram. (Pritchard J.A, P.C MacDonald, and N.F Gant)

Routine tests for eclampsia include: full blood count, urine dip for protein, electrolytes, creatinine, liver enzymes and bilirubin, In full blood count, where platelet count is less than 150,000/L, 75% are because of dilutional thrombocytopenia of pregnancy, 24% are due to preeclampsia, and about 1% of cases are due to other platelet disorders not linked to pregnancy. Platelets counts less than 100,000/L suggest preeclampsia. Haemoconcentration is suspected when hemoglobin levels are greater than 13 g/dL while low levels may be as a result of microangiopathic hemolysis or iron deficiency. Urinalysis is used as a screen for proteinuria. Trace levels to +1 proteinuria are acceptable, but levels of +2 are alarming and should be quantified with a 24-hour urine collection or spot urine protein: creatinine ratio. Serum creatinine generally is less than 0.8 mg/dL during pregnancy; higher levels indicate intravascular volume contraction or renal involvement in preeclampsia. A serum uric acid level greater than 5 mg/dL is unusual, but unclear marker of tubular dysfunction in preeclampsia. (http://www.guideline.gov/summary/summary.aspx?doc_id=9338.)

High levels of hepatic trans aminases may be a sign of liver involvement in preeclampsia and may take place in the absence of epigastric pain. Higher levels of urine, more than 300mg/d are abnormal and may be a sign of renal involvement in preeclampsia. Creatinine levels less than 100 mL/min may be because of renal dysfunction that is either chronic or due to preeclampsia.

Imaging studies should not be done in an unstable patient and should not delay rapid facilitated delivery in a pregnant woman. A new convulsion in pregnancy is a sign of hypertension but primary neurological disorders must be excluded. Obtain chest x-ray to evaluate for pulmonary oedema if there is dyspnoea or hypoxia taking place in a woman with preeclampsia. The x-ray shows a diffuse increase in lung markings with no cephalization or vascular redistribution seen in patients with pulmonary oedema from systolic dysfunction. Computer topography scan of the brain is performed to rule out cerebral hemorrhage in case of convulsions, severe headache, or altered level of consciousness. Computer topography scan will show hypo dense areas involving white matter of occipital lobes and high frontal/parietal lobes in eclampsia. They signify focal and reversible areas of oedema that are the result of capillary leak or focal areas of impaired venous flow. (http://www.guideline.gov/summary/summary.aspx?doc_id=9338)

Magnetic resonance imaging of the brain may be done to assess for defects in the cerebral cortex such as hemorrhage, oedema, and infarction in preeclamptic women with convulsions, severe visual disturbance, or altered mental status. The result of preeclampsia is bilateral occipital bright spots that signify focal oedema (posterior reversible leukoencephalopathy syndrome). Result is the same as the changes observed when a non-pregnant patient has hypertensive encephalopathy. Computer topography scan or ultrasonography of the liver may be used to assess for sub-capsular hemorrhage or infarction in constant severe epigastric pain or distinctly elevated hepatic trans aminases. Echocardiography may be necessary to rule out left ventricle hypertrophy in chronic hypertension and cardiomyopathy or occult valvular disease in pregnant women with pulmonary oedema.

Other tests performed include; Electroencephalogram to assess recurrent convulsions activity, constant altered level of consciousness, or changed mental status. Fetal monitoring with the assistance of an obstetrician is necessary in pregnant women with preeclampsia.

Preeclampsia is a disease of the placenta, hence if the placenta is severely affected, subtle hypoperfusion of the fetus can occur, which may at first manifest as a reduced levels of the amniotic fluid, intrauterine fetal death, and fetal growth restriction as an effect of placental insufficiency. In sever hypertension; consider advising the obstetrician to obtain a fetal ultrasound at 18 weeks’ gestation to document growth. Sequential ultrasounds may be essential to document fetal growth velocity and to monitor amniotic fluid volume. Histological findings indicate that incomplete decidualization of the spiral arterioles, which may be part of the pathogenesis of preeclampsia. The kidneys may show glomerular endotheliosis or, rarely acute tubular necrosis or cortical necrosis. (Chobanian AV, Bakris GL, Black HR,).

For treatment, give magnesium sulphate Intramuscular (load with 4-6g IV over 20 minutes and 4-5g IM, then 4g IM after 4 hours) or Intravenous (4-6g IV stat over 20 minutes, then constant infusion of 1-3g per hour in 100cc 5%dextrose). Hydralazine 5-10mg IV or IM after 2-4hours for blood pressure control. Complications include acute renal failure, malignant hypertension, disseminated intravascular coagulation, pulmonary oedema, cerebrovascular accident (Catherine Wolf, Dennis Palmer D.O)

In conclusion, all pregnant mothers should be closely monitored especially primigravidas because she might not be aware of the danger signs of pregnancy. Hypertension being among the most dangerous diseases in pregnancy so pregnant mothers are advised to visit clinics frequently in case they notice anything unusual. If possible, a pregnant mother should have weekly recording of blood pressure and for pregnant mothers already diagnosed with gestational hypertension should have daily recording of blood pressure. Gestational hypertension in most cases subsides after delivery but in some cases it extends after delivery. In such cases the mother should be thoroughly investigated to know the cause of hypertension because it can progress to be malignant hypertension.

Work cited

American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of hypertension. National Guideline Clearinghouse. Available at http://www.guideline.gov/summary/summary.aspx?doc_id=9338. Retrieved on 11/02/2011

Benson M.D.( 1989) Obstetrician Pearls,.Philadelphia:F.A Davis.

[Best Evidence] Hedderson MM, Ferrara A (.2008) High blood pressure before and during early pregnancy is associated with an increased risk of gestational diabetes mellitus. Diabetes Care. Dec 31(12)

Chobanian AV, Bakris GL, Black HR, et al. (.2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 289(19):2560-72.

Managing Complications in Pregnancy and Childbirth. (pg s-35 to s-43) Retrieved on 11/02/2011 from; www.reproline.jhu.edu/../05-CS-5.2.htm

Magee LA, Helewa M, Moutquin J-M et al.( 2008) Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy. Journal of Obstetrics and Gynaecology Canada [serial online]:S1-S48. Retrieved on 11/02/2011

Mulrow CD, Chiquette E, Ferrer RL.( 2000) Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment No.14 AHRQ Publication.

Niswander K.R.,( 1991) Manual of Obstetrics 4th edition. Boston: Little, Brown

Pritchard J.A, P.C MacDonald, and N.F Gant.( 1985) Williams Obstetrics.Conneticut:Appleton-Century-crofts

---

Get Professional Assignment Help Cheaply

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Why Choose Our Academic Writing Service?

• Plagiarism free papers
• Timely delivery
• Any deadline
• Skilled, Experienced Native English Writers
• Subject-relevant academic writer
• Adherence to paper instructions
• Ability to tackle bulk assignments
• Reasonable prices
• 24/7 Customer Support
• Get superb grades consistently

 

Online Academic Help With Different Subjects

Literature

Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.

Finance

Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!

Psychology

While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.

Engineering

Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.

Nursing

In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.

Sociology

Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.

Business

We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!

Statistics

We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.

Law

Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

• When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
• We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

• The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
• We will have a different writer write the paper from scratch.
• Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment  Help Service Works

1.      Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2.      Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3.      Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4.      Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!

---