Sample Case Study

Case Study

INTRODUCTION Edema is the accumulation of fluid in the intestinal cell. A person with edema manifested swelling in different parts of the body. In pregnant woman, edema usually occurs between the second and third trimester. Clinically, it is divided into three degrees namely: a. Mild Case → obvious edema appears on the legs and feet but can disappear after rest. b. Moderate Case → edema extends to thighs and vulva or even in the abdomen. c. General Edema → accumulation of fluids in the abdomen Swelling or normal edema during pregnancy is not really dangerous, however, if a pregnant woman suddenly swell in the hands and face, there is a possibility that she might be developing pre -eclampsia. This is a serious condition that can be life threatening for the mother and baby. Pre-eclampsia typically results in high blood pressure during pregnancy, putting the life of both the mother and the baby at stake. This is the reason why even a simple normal edema should still be monitored.

OBJECTIVES General: This study aims to deepen our knowledge and understanding about edema. Specific: After this, we should be able to: 1. Define what edema is. 2. Identify its cause. 3. Discuss it’s effect in the mother and baby. 4. Determine the appropriate interventions to be done. 5. Know what is/are the possible complication.

THEORETICAL FRAMEWORK Mommy X just like any mother- to be have experienced pregnancy discomfort like morning sickness, dizziness and tiredness. Among all those discomfort, edema in her lower extremities is what Edema in Pregnancy

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Case Study bothers her the most. Even though people around her keep on telling her that it is fine and need not to worry about she still can’t help but think if it was really alright. Edema on her first and her second pregnancy disappeared on their own. What she was worried about was if it can possibly have any effect on her baby’s health.

COMPONENT OF NURSING HEALTH HISTORY I.BIOGRAPHICAL DATA Name: Mommy X Address: 426 Barangka Ibaba, Mandaluyong City Age: 33 years old Gender: Female Religious Affiliation: Roman Catholic Marital Status: Married Occupation: Plain Housewife Place: Mauway, Lying-in Chief Complaint: 37 weeks, AOG G2 p1 (T1P0A0L1) Midwives: Marieta Reyes and Milagros Naïve

Edema in Pregnancy

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Case Study

II. NURSING HISTORY A. History of Present Illness The baby was planned together with the place of delivery, the Mauway-Lying-In Clinic. The baby according to the mother will be breastfeed just like their first born baby. B. Past Health History Mommy X has also experienced edema during her first pregnancy. Aside from it, she had no other complaint regarding her pregnancy. She also hasn’t experienced any serious illnesses like hypertension, diabetes and the like.

C. Family History There are no history of diabetes, allergies and mental disorder in the family. The only one that they identify was hypertension in her husband’s family. D. Maternal and Obstetrical History Mommy X have 2 beautiful daughters including the newborn, both were born normally. She has no multiple pregnancies and no history of abortion. August 19, 2008 / 11:04 am Mommy X gives birth to a healthy baby girl with the following measurements: Weight: 2.4 kg Height: 31 cm Head Circumference: 33 cm Chest Circumference: 32 cm

III. PATTERN OF FUNCTIONING 1. Coping Patterns:

Psychological Health

Edema in Pregnancy

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Case Study Whenever she has a problem she always pray to God to give her strength to be able to cope up and solve no matter what problem it was. 2. Interaction Patterns: Mommy X is the type of person one can easily get along with for she was very friendly and approachable. 3. Cognitive Patterns: There are no sign of mental disturbances in Mommy X. She seems to cope up well with the hardship of pregnancy and pain of labor. 4. Self Concept: She views herself as a woman, a wife to her husband and a mother to her two beautiful daughters. 5. Emotional Pattern: She is a positive type of person. She deals effectively with her emotions. 6. Sexuality: For Mommy X, being a woman is being responsible enough to take good care of your family and keeping it intact no matter what happen.

7. Family Coping Pattern: If there is /are problems in the family they discuss it together (she and her husband) and solve it together.

Socio-Cultural Health 1. Cultural Pattern: They celebrate fiesta, Christmas and New Year and other significant event or occasions. 2. Significant Relationship: She does not have any complain with regards to her relationship with her husband. She cited her husband as a responsible and loving one.

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Case Study 3. Recreational Pattern: The Family goes to church every Sunday and their favorite past time is watching television specifically the noon time show, Wowawee… 4. Environment: According to Mommy X, Their place was a very quiet place to live in although sometimes, there are quarrellings in the neighborhood which is inevitable of course, all in all, their place was ideal for her. 5. Economic In the family, all finances are shouldered by her husband who is a bodyguard with a salary of P 33 per day.

Spiritual Health 1. Religious Belief They are Roman Catholic who believed in God and the only savior, His son Jesus Christ. 2. Values and Valuing They practice kissing the hands of elders and value respect and good attitude at all times.

IV. ACTIVITIES OF DAILY LIVING

Activities

Before Hospitalizatio n

Edema in Pregnancy

After Hospitalizatio n

Analysis

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Case Study 1. Nutrition Mostly vegetables and soups

Vegetables and soups also

The mother prefers nutritious and soupy foods for the sake of her baby that was breastfeeding on her.

Every morning

Every morning

The mother still has her normal elimination pattern even after delivery.

No exercise

Do some walking in the morning together with the baby

Because of the new born baby, the mother now lends time to do little exercises together with her baby.

Practice good grooming

The same

The mother still maintains good grooming.

8 hours of sleep 1 hour nap

3-4 hours 30 minutes nap

The mother usually lack in sleep at night due to the supervision she was doing on her newborn baby

3x a week

No sex

Sexual intercourse was not practice after delivery because the wound was still new and not yet completely

2. Elimination

3. Exercise

4. Hygiene

5. Rest and Sleep

6. Sexual activities

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Case Study healed.

V. PHYSICAL ASSESSMENT Day: Wednesday 19.4(normal)

A. Measurement s

Date: August 20, 2008

Findings

Weight

Normal M= 78.5 7.7†,

43 kilograms

F=58.8 4.1†

BMI:

Interpretation/ Analysis Normal

5 ft. tall

M=163.5 cm (5' 4.4") F=151.8 cm (4' 11.8")

Normal

Findings

Normal

Interpretation/ Analysis

37◦

36.5◦C-37.2◦C

normal

69bpm

60-100bpm

Normal

24bpm

6-20bpm

normal

110/80mmgh

120/90mmgh

H hypotensive

Height

B. Vital signs

Time: 10:43 am

Temperature Pulse Rate Respiratory Rate Blood pressure

HEAD TO TOE PHYSICAL ASSESSMENT Body Parts / Technique

Actual Findings

Edema in Pregnancy

Normal Findings

Interpretat ion

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Case Study Head 1.Skull Palpation Size, shape or contour, symmetry and curvature.

2.Scalp

Normal

Normal

Inspection Carefully separate the hair at various locations. Inspect for color, appearance, and presence of masses, lice nits, and dandruff. Palpation Areas for tenderness

Proportion to the size of the body, round, with prominences in the frontal area interior and the occipital are posterior, symmetrical in all planes, gently curved.

Normal

Normal White, clean, free from masses, lumps, scars, lice, nits, dandruff, and lesions.

Normal

Normal

Normal

No areas of tenderness.

Normal

3.Hair Inspection Inspect for the color, distribution,

Normal

Edema in Pregnancy

Black evenly distributed and covers the whole scalp,

Normal

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Case Study thickness, and lubrication or appearance.

thick, shiny and free from split ends. Normal

Palpation Palpate for texture

Coarse of fine

4.Face Inspection Observe for the symmetry, shape, facial expression, movement and appearance.

Normal

Normal

Normal

Oblong or oval or round or square or heartshape, symmetrical, facial expression that is dependent on the mood or true feelings, smooth and free from wrinkles and no involuntary muscle movements.

Normal

Normal

5.Eyes Inspection Observe for placement, symmetry, protrusion, clarity, and lacrimations. *Eyebrows Inspection Observe for color, symmetry, and quantity of hair,

Normal

Normal

Edema in Pregnancy

Parallel and evenly placed, symmetrical, non protruding, with scant amount of secretions, both eyes bright and clear. Black, symmetrical, thick, raise and

Normal

Normal

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Case Study distribution and placement unparallel. *Eyelashes Inspection Observe for the color, distribution

lower symmetrically, evenly distributed and parallel with each other. Tenderness and pain Black evenly distributed and tuned outward.

and direction *Eyelids Inspection Ask the client to close eyes. Observe for position and symmetry and then ask him to open eyes again. Palpation Using the tip of the index finger, palpate the lacrimal gland.

Abnormal

Pale

Upper lid covers a small portion of the iris and the cornea and sclera when the eyes are open. When the eyes are closed---the symmetrical

Abnormal

Normal Normal Non-palpable, non tender. Normal Normal

Normal Normal *Lower palpebral conjunctiva Inspection Edema in Pregnancy

Salmon pink, shiny, moist. Page 10

Case Study Ask the client to look up and pull the lower lid down, Observe for color and appearance.

Normal Normal White and clear, no visible blood vessels.

*Sclera Inspection Color and clarity

Normal Normal

*Cornea Inspection Clarity and texture *Pupils Inspection Size, shape, symmetry, reaction to light and accommodati on.

Iris Inspection Size, color, shape

*Testing for eye movement Inspection Stand

Normal

Normal

Normal

Edema in Pregnancy

Transparent, shiny, smooth. Round, equal constrict when light is pointed to the eyes and dilated when light is removed, constrict when object is close to the eyes and dilated when object is removed away.

Normal

Proportional to the size of the eyes, round, black brown, symmetrical.

Normal

Able to move eyes in full

Normal

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Case Study directly in front of the client and hold the finger at about one foot in front of the client’s eyes. Ask the client to refrain from moving his head and follow the direction of the examiner’s fingers with his eyes only. Move the finger in a slow manner though the cardinal fields of gaze. *Testing for visual fields Inspection Stand 2-3 ft. from the client. Ask (one ear at a time and then at the back of the client for both ears).

ranges of motion or able to move in all direction.

Normal Normal Able to see 60 degrees superiority. Normal Normal

Normal

Midline, symmetrical and patent.

Normal

Normal Normal Able to repeat the words Normal Normal

Instruct the client not to move his Edema in Pregnancy

In the correct placement, Patent and Page 12

Case Study head and to repeat the words that you will say.

6.Nose

symmetrical

Normal

Clean, pinkish, with few cilia.

Normal

Straight.

Normal

Normal

Normal

Inspection Placement, symmetry and patency. *Internal nares Inspection Appearance, color of mucus membrane, presence of cilia.

*Septum Inspection Appearance

Normal

Normal Normal Pinkish, symmetrical with lip margin well defined, smooth and moist. Normal

7.Mouth *Lips Inspection Observe for color, shape, symmetry, lip margin and appearance *Gums Inspection

Normal

Normal

Normal

Normal

Edema in Pregnancy

Pinkish, smooth, moist, no reseeding, no swelling and no discharge

32 permanent teeth, wellaligned, free from caries or filling and no halitosis.

Normal

Normal

Normal

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Case Study Observe for color, appearance, discharge and swelling or contraction. *Teeth Inspection Number, color, alignment, general condition, breath *Tongue Inspection Inspect for size, color, surface,

Normal

Normal

Midline, straight end thin

Normal

Normal

Pinkish, moist and smooth

Normal

Pinkish, moist, smooth

Normal

Slightly pinkish

Normal

At the center Symmetrical and freely movable

Normal

Normal

appearance and movement *Frenulum Inspection Position and appearance

Large, medium, red or pink, slightly rough in top, smooth along the lateral margins, moist shiny and freely movable.

Normal

*Checks (buccal mucosa) Inspection Color and appearance

Normal

8.Palate

Normal

*Soft palate Inspection Color and appearance Edema in Pregnancy

Pinkish, noninflamed Page 14

Case Study

*Hard palate Inspection Color and appearance.

Normal Normal Proportional to the size of the body and head, symmetrical and straight.

*Uvula Inspection Position, color, size, symmetry, And mobility

No palpable lumps, masses or areas of tenderness

*Tonsils Inspection Detect if there is hoarseness of voice

9.*Neck

Normal

Palpable

Inspection Size, symmetry, position

*Palpation Palpate for lumps, masses or areas of tenderness

Normal

Palpates the Adam’s apple (for male)

Freely movable without difficulty

Normal

Symmetrical and able to resist applied force(both muscle)

Able to resist applied force Edema in Pregnancy

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Case Study symmetrical in structure of size and muscular strength

Range of motion Chin to chest Ear to shoulder Muscular strength Inspection Symmetry and strength of the sternocleidomas toid muscle

Normal

Force/strength of the trapezius muscle

10. Thorax (Anterior and posterior) Inspection Have the client all comfortably. Inspect for the shape, position of the spine, slope of the ribs, retraction of the intercostals spaces (ICS) on the inspiration, and bulging of the ICS on experimentation .

Edema in Pregnancy

The chest contour is symmetrical and the chest is twice as wide as deep (anteriposterior diameter in a 1:2 ratio) the spine is straight posteriorly, the ribs tend to slope across and down the ribs are prominent in a thin person there is no bulging or retraction of breathing.

Normal

The chest wall moves symmetrically during respiration

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Case Study Observe for symmetry of the chest wall during respiration

Palpation Palpate for lumps, masses, areas of tenderness.

Normal Normal

No lumps, masses, areas of tenderness sides of the thorax expand symmetrically. the examiners thumb separate approximately 2 inches during breathing Normal

Normal

Normal Normal

Measure chest excursion (to determine the depth of breathing). Place hands on the lower portion of the rib cage with the thumbs 2 inches apart pointing toward the spine so a small fold of the skin appears between the thumbs.

The vibrations are feeling most strongly between the first and second ribs along the sternum interiorly and between the scapulae posteriorly.

Normal

Normal

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Case Study Ask the client to take a few deep breaths. Elicit lacille fromitus (a thrill felt by the hand on the chest wall while the client is speaking). Place the palms of the hands bilaterally symmetrical on the chest. Start from the top of the chest wall going down .each time the hands move down, ask the client to say ninety-nine or one-one –one with the same intensity of voice.

Normal Normal

Normal Normal

Percussion: Anterior thorax. The client is preferably in a lying position.

Normal

Posterior thorax. The client is sitting position with the arms folded forward Edema in Pregnancy

Vesicular sounds are heard over lung periphery particularly at the base of the lungs, they are soft intensity, low pitched gentle sighing sounds created by hair moving through smaller airways bronchovessicul ar so this are heard at the 1st and 2nd IC at the sternum

Normal

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Case Study across the chest. This position will separate scapulae further to expose more lung to assessment.

interiorly and between the scapulae posteriorly

No pulsations.

Normal

Normal Using the direct percussion, percuss in the ICS over symmetrical areas of the chest starting from the supraclavicular area. Compare one side of the chest with the other.

Normal Normal

Pulsations visible and palpable Auscultation: Use the flat-disc diaphragm. Use the systematic zigzag procedure used in percussion. Ask the client to take slow deep breaths through the mouth. Listen at each Edema in Pregnancy

Abdominal aortic pulsation visible and Page 19

Case Study point to the breath sounds during a complete respiration. Compare findings at each point on the opposite side of the chest.

palpable.

The 2 heart sounds are audible in all areas but loudest at apical area..

Normal

CR ranges from 60-100 beats per minute.

Normal

Normal

*Heart Inspection and palpation: Place the client in supine position. Stand in the client’s right side. Ask client not to talk. Inspect and palpate the valve areas of the heart.

Normal

Females: variable in size depending on body build, rounded shape, symmetrical

*Aortic areas Around at the 2nd ICS on the right angle of Louis as a dominance on the Sternum *Pulmonic Areaat the 2nd ICS on the left of Louis. Note: Observe these areas at an angle to the side to improve

Males: Flat, symmytrical, if obese, may be slightly rounded.

Normal

Normal

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Case Study the chance of seeing pulsations.

Normal Normal

*Tricusspid Area – move the fingers along the client’s left sternal border to the 5th ICS.

*Apical Area – moves the fingers laterally to the left midclavicular line (LMCL), which is slightly below the nipple. This point where the apex touches the anterior chest wall is known as the point of maximal impulse (PMA)

*Epigastric Area – at the tip of the sternum. Auscultation: Auscultate the hearth in all 4 anatomic sites: aortic, Edema in Pregnancy

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Case Study pulmonic, tricuspid and apical (mitral) Eliminate all sources of room noise. Heart sounds are of low intensity and other noise hinders the nurse’s ability to hear them. Identify the first sounds described and “lub”. Then, identify the 2nd sound. This is higher – pitched that SI, described as “dub” Use the bellshaped diaphragm. Once SI and S2 are identified, count the heart rate for one minute. Each combination of S1 and S2 counts as one heart beat.

Skin is the same in color in the abdomen, no retractional dimpling.

Normal

No masses or lumps, tenderness, breast tissues are firm and elastic.

Normal

Normal

11.Breast Inspection Ask the client to remove the top gown or drape to allow simultaneous Edema in Pregnancy

Round or oval, color darker that surrounding skin, symmetrical

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Case Study visualization of the breast. Have the client sit comfortably with arms at the sides. Inspect the breast for size, symmetry and contour or shape.

No masses and tenderness.

Inspect the skin of breast for color, retraction, or dimpling.

Palpation Assist the client in supine position. This position allows the breast tissues to flatten evenly against the chest wall facilitating palpation. Ask client to false his/her hand and place it under the head palpate the breast for lumps or masses, tenderness, and consistency of breast tissues. The palmar surface of the first three

Round, averted, equal in size, similar in color. Both nipple points in one direction, no discharge, no lesion No masses, tenderness and discharge. Normal Normal

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Case Study fingers is used to compress breast tissues against the chest wall. Perform palpation in a clockwise rotary motion from the borders going inward.

Normal Normal

*Areola Inspection Inspect for size, shape, color and summetry.

Palpation Palpate for masses and tenderness

Normal

Normal

*Nipples Inspection Inspect for size, shape, position, discharge and lesions. Normal Palpation Use thumb and index finger to compress the Edema in Pregnancy

Skin is unblemished, no scars, color is uniform, flat, rounded or scapoid, symmetrical movement caused by respiration, nortic pulsation at epigastric are visible thin persons, umbilicus is flat or concave positioned midway between the xipoid process and the symphisisd pubis, color is the same as the surrounding skin.

Normal

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Case Study nipple to determine any discharge. Normal Rough

12.Abdomen Divide the abdomen into 4 imaginary quadrants. Draw a vertical line from the xipoid process to the symphysis pubis and a horizontal line across the umbilicus. These quadrants are labeled right upper quadrants (RUQ).left lower quadrants (LLQ), and right lower quadrant (RLQ) Ask the client if he/she needs to void. Drape the upper chest and legs. Explore the abdomen from the xipoid process to the symphisis pubis. The client lies in supine position with arms down at the sides. A small pillow may be placed under the head.

Normal

Abnormal Has edema

Abnormal Has edema

Abnormal Has edema

Abnormal Has edema

Edema in Pregnancy

Liver’s edge feels firm and Page 25

Case Study non-tender

Inspection Inspect the abdomen for skin integrity, color, contour, symmetry, movement or pulsations and color and placement of umbilicus.

Auscultation Warm the diaphragm of the sytethoscope. Cold stethoscope may cause the client to contact the abdominal muscles and the contractions may be heard during auscultation. Diaphram is used because intestinal sounds are Edema in Pregnancy

Tympanic ground predominated because of the air in the stomach and int4estines. Percussion sound is dull at the liver’s lower portion.

Perform with ease

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Case Study highpitched sounds. Place the diaphragm in each of the 4 quadrants over all auscultation sites. It may take minute to hear bowel sounds. Palpation Perform light palpation first to detect areas of tenderness, muscle guarding (voluntary tightening of muscles), lumps or masses, constancy, and organomegaly. Depress the abdominal wall lightly, about 1 cm with the pads of your fingers. Move the finger pads in a sight circular motion. Palpate all 4 quadrants. Palpate the liver using deep palpation. Stand on the client’s right side. Place your left hand on the posterior thorax at about Edema in Pregnancy

Perform with ease

Symmetrical in size and length, no abnormalities, fine hair equally distributed, no visible varicose vein

Warm and smooth

Clean no lesions, 5 toes on each foot.

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Case Study the 11th and 12th rib and then apply upward pressure. This maneur makes it easier to feel the liver anteriorly. With the fingers of the right hand pointing upward, place the hand on the RUQ well below the liver’s lower border, then press gently until you reach a depth of 1 ½ 2 inches. Ask the client to take a deep breath using the abdominal muscles. As he inhales, try to palpate the liver’s edge as it descends.

Performs with ease

Performs with ease

Performs with ease

Performs with ease

Percussion Percuss each of the 4 quadrants starting from the RUQ going clockwise.

*Wrist Ask the client to flex and extend Edema in Pregnancy

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Case Study hands at the wrist and then perform radial and ulnar flexion. *Hands and fingers Ask the client to do flexion, extension, abduction of fingers,

13.Lower Extremities Inspection Inspect for symmetry of size and length and the presence of abnormalities. Note the pattern of hair distribution, color and presence of varicose veins. Palpation Palpate from thighs to logs for temperature, and texture. *Feet and Toes Inspection Inspect for cleanliness, skin lesion and Edema in Pregnancy

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Case Study number of toes

*Hips *Range of Motion Ask the client to do flexion, extension, abduction, adduction, and internal external rotation of the legs *Knees Ask the client to flex and extend each leg *Ankle Ask the client to do flexion, extension, aversion, and inversion of each foot. *Foot and Toes Ask the client to flex, extend, abduct and adduct toes

VI. ANATOMY AND PYSIOLOGY Edema in Pregnancy

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Case Study

The Human Circulatory System

Edema in Pregnancy

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Case Study

BLOOD • •

•

•

Blood contains the fluid part called Plasma, and many blood cells Plasma is a yellowish, slightly alkaline liquid that comprises 55% of blood, and is a mixture of nutrients (amino acids, sugars, fatty acids, glycerol, salts), hormones, antibodies, enzymes and some dissolved gases in water Red Blood Cells (Erythrocytes) are made in the bone marrow in the centre of certain long bones. Red blood cells have nuclei when first formed, but lose their nuclei when mature. They live only about 4 months before being destroyed by the spleen and the liver. Red blood cells contain red chemical called haemoglobin that attaches either to oxygen or carbon dioxide molecules to transport them around the body. White Blood Cells (Leukocytes) are made in bone marrow and the spleen. They live only 2 to 4 days, because their purpose is to fight infection. They either surround or ingest foreign particles or bacteria (macrophages that perform phagocytosis), or produce chemicals such as antibodies and antitoxins to neutralise the invading particles or bacteria.

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Case Study •

Platelets are small disc-shaped blood cells without a nucleus. They are formed in bone marrow, and play an important role in the clotting of blood.

BLOOD VESSELS •

•

•

Arteries take blood away from the heart. They usually contain blood rich in oxygen. Arteries have elastic muscular walls that can dilate and constrict as each pulse of blood goes through. Veins take blood back to the heart. They contain valves that allow a one-way flow of blood. Veins are less muscular than arteries. Capillaries are the smallest and most numerous of blood vessels. The capillary diameter is only the width of one red blood cell, so blood travels slowly through capillaries. The capillary wall is only one cell thick to allow exchange of nutrients and oxygen into, and wastes such as carbon dioxide out of the body cells.

STRUCTURE OF THE HEART

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Case Study • • • • •

The heart is a strong muscular organ used to pump blood. It has 4 blood-collecting chambers - 2 atria and 2 ventricles. Valves between the chambers allow one-way blood flow. The wall of the left ventricle is the thickest and strongest because blood from here is pumped all around the body. The heart has its own blood supply via the coronary artery. If this is blocked, a 'heart attack' may occur.

BLOOD FLOW THROUGH THE HEART • • •

Oxygenated Blood - contains a lot of oxygen but very little carbon dioxide Deoxygenated blood - contains very little oxygen bit a lot of carbon dioxide Direction of Blood Flow - Blood from body - Vena Cava - Right Atrium - Right Ventricle - Pulmonary Artery - Lungs - Pulmonary Veins - Left Atrium - Left Ventricle - Aorta - All body cells

VII. PATHOPYSIOLOGY Growing uterus puts pressure on pelvic and vena cava. (Pressure slows down circulation and causes blood to pool in legs and forcing fluid from veins into the tissues of feet and ankles)

Uterus enlarges, it presses down on main veins to the legs. ( the reduces the flow of blood returning to heart which pushes water into the tissues into the legs and feet)

Mild Case

Swelling or puffiness of tissue on skin

Edema in Pregnancy

Stretch skin or shiny

Paleness

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Case Study

SUBCUTANEOUS EDEMA → commonly occurs in the legs and ankles due to the influence of gravity in woman.

EDEMA →excessive accumulation of fluid in body tissues popularly known as dropsy. The resultant swelling may be local or with an injuring or inflammation.

VIII. DIAGNOSIS, LABORATORY RESULTS AND PROCEDURE Date: May 19, 2008 HEMATOLOGY

Examination

Results

Reference Value

Hemoglobin (mass concentration)

128

(M) 130 – 180 (F) 120 -160

Erythrocytes (volume fraction)

0.39

(M) 0.40 – 0.54 (F) 0.37 – 0.47

Leucocytes (no. concentration)

8.7

5-10x10 9/l

Erythrocytes(no. concentration)

4.2

(M) 4.5 – 6.0 (F) 4.0 -5.5x10 12/l

Thrombocytes Edema in Pregnancy

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Case Study

Neutrophil

0.75

(F) 0.51 – 0.67

Lymphocytes

0.20

(N) 0.21 – 0.35

Monocytes

0.03

0.02 – 0.08

Eosinophil

0.02

0.01 – 0.04

URINALYSIS

Result

Analysis

Nursing Care

Light Yellow Hazy

Normal Normal

Health Teaching Health Teaching

Negative Negative

Normal Normal

Health Teaching Health Teaching

Microscopic Examination: 1.Epithelial Cells

Few

Normal

Health Teaching

Few

Normal

Health Teaching

2.Mucus Threads

Few

Normal

Health Teaching

1-2/hpf

Compromised

Hygiene

Physical Examination: 1.Color 2.Character / Transparency Chemical Examination: 1.Albumin 2.Sugar

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Case Study 3.Amorphous Urates

for infection 0-1hpf

Teaching

Normal

4.Pus Cells

Health Teaching 7.1

Normal Health Teaching

5.RBC

1.015

Normal Health Teaching

6.PH 7.Specific Gravity

Diagnostic X-Ray / Ultrasound Report Name :

Libot, Nemia

Age :

33 years old

Sex :

Female

Civil Status :

Married

O.R Number :

99661

Physician :

Luz Uy

Date :

May 19, 2008

Case Number :

08-2563 Fetal and Obstetrical Report

Number of Fetus :

Single

Presentation :

Cephalic

Biparietal Diameter :

6.21 cm 25 weeks, 2d

Edema in Pregnancy

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Case Study Femoral Length :

4.82 cm 25 weeks, 6d

Abdominal Circumference :

20.4 cm 24 weeks, 6d

FHR :

139 beats/min.

Placental Location :

Anterior highying

Amniotic Fluid :

11.7cm AFI

Gender :

Female

Maturity grade :

1

Average Gestational Age :

25 weeks, 2d

Estimated Fetal Body Weight :

815 grams

Impression: Single, Live, Intrauterine Pregnancy in Cephalic presentation of about 25 weeks and 2 days based on bpd, FL and Ac. GR. 1, Anterior Placenta Normohydraminios EDC : August 30, 2008 M.J.M. Alba MD, DPBR Radiologist / Sonologist

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