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The GTPAL

CASE STUDY # 2

1.      The GTPAL of Susie Martinez is 52023.  Based on the vital signs of the patient, it shows that Susie is experiencing eclampsia, as indicated by her blood pressure of 176/94.  In addition, the patient complains of headaches and blurry vision.  Additional diagnostic tests should be conducted in order to fully determine the extent of her eclampsia.  Urinalysis should be performed in order to determine the amount of proteins in the urine.  In addition, it would also be essential to perform a complete blood count (CBC), as well as platelet count.  Liver functions tests should also be conducted to determine the condition of the patient’s liver.  It is also important to perform tests that would determine the level of serum electrolytes, as well as that of creatinine.  It is anticipated that the protein concentration in the urine sample of a patient with possible eclampsia to be above 5 grams within a 24 hour collection.

It is important to immediately provide treatment to the patient.  As Susie is currently on her 37th week of pregnancy, it is best that the patient deliver the baby as soon as possible, before any other complications would ensue.  If the patient’s condition were

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less severe, wherein the diastolic blood pressure would be somewhere between 140 and 160, then the patient could be administered with an intravenous line to provide supplemental fluid to her body.  The patient would also be confined to bed rest until her blood pressure normalizes.

2.      The interventions that could be implemented when the patient’s condition worsens would include transferring her to the intensive care unit so that immediate medical support and attention could be given.  In addition, the intravenous line of Ringer’s solution, which contains 0.9% saline solution, should be increased in terms of drip rate.  The increase in the drip rate of the intravenous line would increase the patient’s rate of urine production, which in turn can facilitate in the release of excretory wastes from the body.  It would also be helpful to administer magnesium sulfate through the intravenous line as this would prevent the development of seizures in the patient.  Magnesium sulfate can also decrease the blood pressure and the reactivity of the patient’s reflexes.  The optimal concentration of magnesium sulfate should be 4 grams every 20 minutes, which is equivalent to 4 to 7 milliequivalents per liter.  Extreme caution should be taken with regards to magnesium sulfate as significant amount of this reagent may result in lethargy, as well as hypotonia.  It is also possible to induce a depression in the respiratory rate of the patient if markedly high concentrations of magnesium sulfate are administered to the patient.  In the case that magnesium sulfate is not effective to achieve the desired physical outcome in the patient, it is possible to administer phenytoin.  This reagent also results in the prevention of seizures

3.                  If bleeding occurs after delivery of the baby through Caesarian section, the patient should be brought back to the hospital as it is possible that the patient is suffering from vaginal bleeding (Jain et al., 2009).  It is also probable that another surgical procedure should be performed on the patient.  The main causative factor responsible for bleeding after Caesarian section is atony of the uterus, which is the abnormal non-contraction of the uterus thus encouraging the attachment of placental fragments to the uterine lining.  Bleeding can be caused by the late release of the remaining fragments of the placenta after the delivery of the baby (Wang et al., 2009).  The prevalence of vaginal bleeding in patients who have undergone Caesarian section is higher when the patient has experienced previous deliveries through the same method (Kiley and Shulman, 2009).

It is also possible to administer medications that would prevent the contraction of the uterus of the patient.  This is the opposite reaction needed during delivery, wherein drugs that would induce contraction of the uterus would facilitate in the delivery of the baby.  Vaginal bleeding after Caesarian section, on the other hand, can be treated with drugs that would inhibit uterine contractions, in order to suppress vaginal bleeding.  It is also possible that there is a need to perform as hysterectomy to prevent further vaginal bleeding.  To prevent extreme blood loss in the patient, blood transfusion can be performed on the patient (Padmanabhan et al., 2009).

The patient should be checked every hour for any improvement in her condition.  When the bleeding eventually subsides, the patient can be checked every 2 to 4 hours.  The patient can be moved from the intensive care unit to the recovery room after 48 hours of absence of any episode of vaginal bleeding.

4.      The patient most possibly is still experiencing spotting every now and then, especially if she is still being administered with anti-contraction drugs of the uterus.  Her blood count should be normal as blood transfusion has been performed.  Her blood pressure is also assumed to be normal and there will be no need to provide her with supplemental magnesium sulfate.

5.  Upon discharge from the hospital, the patient should be instructed to refrain from performing any strenuous physical activities in order to prevent any induction of uterine contraction.  In addition, the patient should be asked to rest as much as possible so that her strength should return.  She should also be advised to continue taking supplemental ferrous sulfate to replace the lost blood from her episode of vaginal bleeding.  The patient should also be asked to provide good care of her newborn child, as well as to provide breastfeeding, if possible.

Reference

Jain, N.J., Kruse, L.K., Demissie, K. and Khandelwal, M.  (2009).  Impact of mode of delivery on neonatal complications: Trends between 1997 and 2005.  Journal of Maternal and Fetal Neonatal Medicine, 22, 491-500.

Kiley, J. and Shulman, L.P.  (2009). Cesarean scar ectopic pregnancy in a patient with multiple prior cesarean sections: A case report.  Journal of Reproductive Medicine, 54, 251-254.

Padmanabhan, A., Schwartz, J. and Spitalnik, S.L.  (2009).  Transfusion therapy in postpartum hemorrhage.  Seminars in Perinatology, 33, 124-127.

Wang, L.M., Wang, P.H., Chen, C.L., Au, H.K., Yen, Y.K. and Liu, W.M.  (2009).  Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: A case report.  Journal of Obstetric and Gynaecologic Research, 35, 379-384.

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