I hold to bring in a covering study on preeclampsia. below are the guidelines/examples.. pls support?
General Data
NameF.B.
Age59 years old
SexMale
Civil StatusMarried
OccupationHousewife
History of Present Illness
The lenient has a specified case of Rheumatic Heart Disease (RHD). Patient undergo Mitral Valve Repair (MVR) in 1999 and have been on Coumadin psychiatric help with no regular follow up of bleeding parameter.
Six days prior to admission, long-suffering experienced headache and dizziness, but no consult was made. Instead, tolerant self-medicated with Bonamine which afforded nouns.
Three days prior to admission, headache persist with increased severity, which prompted tolerant to seek medical assistance at FEU Hospital. Mobic and Iterax be given.
Few hours prior to admission, merciful was noted to own changes contained by sensorium and relatives decided to want consult at Philippine Heart Center.
Upon admission, lenient was noted to be unresponsive, stuporous, and speechless, beside GCS of 7 (E2V1M4).
Past Medical History
The patient have denies any history of Diabetes Mellitus and Hypertension. As mentioned, she had a history of Rheumatic Heart Disease and have Mitral Valve Repair in 1999. She is a non-smoker and non alcoholic drinker.
Nursing Assessment (Problem-Based)
Neurologic:
LOC: drowsy to stuporous, 3-4 mm pupil size anisocoric, near brisk reaction to pallid; GCS – 9 (E4- Spontaneous eye opening V1- none/mechanical freshening M4 – withdraws to pain) (+) doll’s eye reflex (+) babinski on right foot (-) corneal reflex, no ocular threat
Respiratory
Patient is hooked to a mechanical ventilator through a tracheostomy. Ventilator set-up: 350/30/14/AC/5. (+) crackles on both lung field. With equal breath sounds.
Cardiac
With atrial fibrillation; fine course, with occasional unifocal PVC’s. HR = 97 BP= 120’s-130’s/60’s-70’s.
Musculo-Skeletal
No contractures noted but in that was stiffness noted at the right wrists and both ankle joint; with middle-of-the-road muscle tone and non-spontaneous movement; with severe thinness on both upper and lower extremities.
Hematologic
Latest PTPA: INR = 1.02 Act = 98%
II.Anatomy and Physiology of the Brain
Blood Supply of the Brain
The blood supply of the brain derives from the aortic arch via the right innominate, left adjectives carotid and left subclavian arteries. It includes the conducting and probing vessels.
The venous system draining the brain is divided into vertebral vein that receive blood from the cerebellum. The cerebral vein have no valve. All the veins of the brain call off into dural sinuses.
External Brain Structures
The brain is grossly divided into three main areas: the cerebrum, the brain stem and the cerebellum.
The largest portion of the brain is the cerebrum. It consists of two hemispheres that are connected together at the corpus callosum. The cerebrum is normally divided into five lobes that are responsible for different brain functions. The cerebrum’s surface—the neocortex—is convoluted into hundreds of folds. The neocortex is where adjectives the higher brain functions hold place.
The cerebellum lies in the posterior fossa, separated from the cerebrum by tentorium cerebelli. It exerts ipsilateral control. It have three principal lobes. The Flocculonodular lobe is part of the vestibular system. It controls muscle tone, equilibrium and body position. The Anterior lobe receive most of the proprioreceptive and interoceptive input from head and body. It controls automatic movements and coordination. The posterior lobe coordinates voluntary movement.
The ventricles
The ventricles are a complex series of spaces and tunnels through the center of the brain. They veil cerebrospinal fluid, which suspends the brain in the skull. They also provide a route for chemical messengers that are widely distributed through the main nervous system.
Cerebrospinal fluid
Cerebrospinal fluid (CSF) is a colorless solution that bathes the brain and spine. It is formed in the ventricles of the brain, and it circulates throughout the central disconcerted system. It fills the ventricles and meninges, allowing the brain to “float” inside the skull.
The Meninges
The meninges are layers of tissue that separate the skull and the brain.
The Dura mater is the tough and fibrous membrane. The Arachnoid membrane is the neat membrane and contains subarachnoid fluid. Pia mater is the vascular membrane.
The subarachnoid space is fprmed by the arachnoid membrane and the pia mater.
Normal Flow of Cerebrospinal Fluid
Cerebrospinal fluid is produced in the Choroid plexuses of the ventricle. It flows from the lateral ventricles to the third ventricle ratification through the interventricular foramen. Then it goes through the mind aqueduct to the fourth ventricle. From there fluid flows to the subarachnoid cisterns through the foramina of Magendie and Luschka to go for a dip the cerebral hemispheres. It exits through the saggital sinus to be gripped by the arachnoid villi.
III.Pathophysiology of Subarachnoid Hemorrhage (SAH)
The term subarachnoid hemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pial and arachnoid membranes. SAH comprises partially of spontaneous atraumatic intracranial hemorrhages, the other half consist of bleeding that occur within the brain parenchyma. Intracranial hemorrhage as a unharmed comprises 20% of all strokes.
Nontraumatic SAH usually is the result of a ruptured rational aneurysm or AVM. Blood extravasation into the subarachnoid space has a detrimental effect on both local and intercontinental brain function and leads to giant morbidity and mortality rates.
The classic clinical picture of SAH is marked by the kick-off of very severe headache, tag as the “worst in life”. Other associated signs and symptoms are loss of consciousness, seizure, diplopia and focal neurologic signs.
The early complications of SAH are rebleeding and hydrocephalus. Other complications include vasospasm, neurologic deficit, hypothalamic dysfunction and hyponatremia. Vasospasm from arterial smooth muscle contraction is symptomatic in 36% of patients. Neurologic deficit from cerebral ischemia zenith at days 4-12. Hypothalamic dysfunction causes excessive sympathetic stimulation, which may head to myocardial ischemia or labile detrimental BP. Hyponatremia may result from cerebral saline wasting (SIADH). Nosocomial pneumonia and other complications of critical care may go on.
Pathophysiology Diagram
Pathological Cycle Resulting from Increased Intracranial Pressure
Surgical Treatment
Ventriculo-peritoneal Shunting
The ventriculo-peritoneal shunt diverts CSF from a lateral ventricle or the spinal subarachnoid space to the peritoneal cavity. A tube is passed from the lateral ventricle through an occipital burr-hole subcutaneously through the posterior aspect of neck and paraspinal region to the peritoneal cavity through a small incision within the right lower quadrant.
IV.Nursing Diagnoses
1.Ineffective Breathing Pattern r/t neuromuscular impairment
2.Ineffective airway clearance related totracheobronchial secretions
3.Altered Level of Consciousness r/t decrease cerebral perfusion
4.Impaired Physical Mobility r/t neuromuscular impairment
5.Risk for Injury r/t possible shunt problem
6.Risk for Infection r/t post-surgical wound
V.Discharge Care Plan (METHODS)
MEDICATION
oReinforce importance of medication compliance to merciful and her relatives; its time, frequency, duration dosage and route.
oAdvice to report unusual manifestations and side effects of drugs to physician.
oMonitor and evaluate usefulness of medication regimen.
ENVIRONMENT/ EXERCISE
oInstruct patients watcher to provide quieten and non stressful environment to prevent stimuli that could lead to seizure and an increase in Intracranial Pressure
oAdvice to hamper visitors
oProvide environment in normal room and body warmth.
oMaintain safe environment.
oInstitute paroxysm precaution.
oInitiate positional precaution to prevent increase in intracranial pressure.
oTeach patient’s relative to complete passive continuum of motion exercises on patient’s extremities.
TREATMENT
oTeach patient’s relatives proper shunt care.
oTeach patient’s relatives how to suction properly.
HEALTH TEACHING ON DISEASE PROCESS
oExplain to patient’s relatives concerning patient’s neurological status and disease process, and its manifestations.
oDiscuss possible complications of VP Shunt and its signs and symptoms
OUT PATIENT FOLLOW UP
oInform relatives in connection with importance of compliance on follow-up check up.
oIn baggage of continued Coumadin therapy, stress the necessity of regular PTPA monitoring.
Diet
oRefer to dietician for dietary instructions.
SPIRITUAL / SEXUAL
oEncourage patient’s relatives to seek spiritual support.
oEncourage patient’s husband on alternative ways on showing affections such as hugs and kisses.
XI.Bibliography
Nolte, J. The Human Brain: An Introduction to Its Functional Anatomy, Fifth Edition., Mosby, 2002. ISBN: 0-323-01320-1
Stoler, D. Coping next to Mild Traumatic Brain Injury, Avery Penguin Putnam, 1998. ISBN: 0895297914
Human Anatomy and Physiology, Fifth Edition., 2000. ISBN: 0805349898.
Zuccarello, M. and McMahon, N. “Subarachnoid Hemorrhage”. www.mayfield.com, June 2004.
Rinkel GJ, Prins NE, Algra A. “Outcome Of Aneurysmal Subarachnoid Hemorrhage In Patients On Anticoagulant Treatment.” www.pubmed.gov, August 28, 2000.
Newton, Todd R., Subarachnoid Hemorrhage. Emedicine from WebMD. www.emedicine.com., December 19, 2005.
Answer:
Males do not ever get pre-eclampsia, and you'd be hard-pressed to find it contained by a 59 year old. It is a disease of pregnancy.
This put somebody through the mill is unintelligible.
If you enjoy a REAL question, you'll gain real back. You won't find anyone here willing to do your assignment for you.
[quote] NameF.B.
Age59 years infirm
SexMale
Civil StatusMarried
OccupationHousewife
[quote/]
Is this Really a = Male ??
Nothing here pretains to preeclampsia,
and Males sure don't get it.
Preeclampsia happen sometimes during Pregnancy !!
YA is not the proper place to ask this. you NEED to READ. i can tell that you copied adjectives this from the chart and books. and the only piece you did was the history and it's not even appropriate. you need to work on that since how can you brand your pathophysiology if you dont have proper assessment information to begin beside? im sure you have MS and OB books