HELLP Syndrome (Case Protocol)

3P’S: Bueza
Brief Description: Carpio
Anatomy and Physiology:
Ramos
Pathophysiology: Ramos
Laboratory: Cabanilla
PERSON: Carpio
Course in the Ward:
Duenes
Drug Study: Bueza
NCP: Cabanilla
GROUP 2
CASE PROTOCOL
References >>
G4P4(4004) Pregnancy Uterine 32 1/7
weeks AOG 2000g Premature baby boy
delivered via LTCS; HELLP Syndrome
secondary to Pre eclampsia

3PS
HELLP SYNDROME
JHULIEN HANNE BUEZA
PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Name: Aling Nena
Age: 41 years old
Sex: Female
Address: Brgy. Quezon, Solano, Nueva
Vizcaya
Birthdate: January 12, 1978
Birthplace: Brgy. Quezon, Solano, Nueva
Vizcaya

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Civil Status: Married
Nationality: Filipino
Primary Language: Ilocano
Religion: Roman Catholic
Educational Attainment: High School
Graduate
Occupation: Restaurant Cashier

SO
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Name: Manong Lando
Address: Brgy. Quezon, Solano, Nueva
Vizcaya
Educational Attainment: High School
Undergraduate
Occupation: Butcher
Relationship to the Patient: Husband

HOSPITA
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO Date/Time of Admission: January 20, 2019/
9:30 AM
Attending Physician: Dr. HB
Admitting Diagnosis: G4P3 (3003) Pregnancy
Uterine 32 weeks AOG,Pre eclampsia
Principal Diagnosis: G4P4(4004) Pregnancy
Uterine 32 1/7 weeks AOG 2000g Premature
baby boy delivered via LTCS; HELLP Syndrome
secondary to Pre eclampsia

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Minor illnesses such as cough,
colds and fever over the years
She buys over the counter
medications like Paracetamol
and Decolgen.
No history of surgeries nor
accidents was noted.

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
10 years gap from her last pregnancy.
LMP: May 30, 2018.
Pre pregnant weight: 52kg
Eight weeks delayed so she took a pregnancy
test which yielded a positive result. Sought for
a prenatal checkup at RHU Quezon where
she was confirmed to be pregnant and was
given ferrous sulphate and folic acid.
Wt: 54kg
After that, no succeeding check-ups were
done.

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
BP was retaken and remained at a high
rate of 150/100 mmHg then Methyldopa
and paracetamol were ordered.
Aling Nena was arranged for laboratory
tests such as CBC with APC, urinalysis,
BUN, creatinine, and STAT orders for
PPT, LDH, AST and ALT.
BP was then rechecked and 140/90
mmHg was recorded.

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Two days prior to admission
• Dizziness
• Body malaise
• Relieved by rest, and sleep so did not
bother seek medical consultation
40yr; 32wk AOG; CC:
 Severe nape pain (7/10)
 Blurring of vision
 Pain RUQ (8/10)
 VS: T-37, P-95, R-24, BP-150/100,
O2Sat: 99%, FHT: 135

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
The physician who assessed and
examined Aling Nena initially diagnosed
her with G4P3 (3003) Pregnancy Uterine
32 weeks AOG, Pre eclampsia thereby
admitting the patient in the OB Ward.

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Thelarche at 10 years old and Menarche
at 11. Her menstrual period usually lasts
5 to 7 days and she consumes about 2 to
3 pads per day. Menstrual cycle is 28
days as noted.
In 2005, Aling Nena was a 27 year-old
woman carrying her first child. Two years
after, she got pregnant with her second
baby. Third baby came after 2 years

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
All three pregnancies had complete
prenatal check-ups (RHU), had no
complications, all were full term, BP hx
were normal ranged 120/80 and delivered
via normal spontaneous delivery. She also
stated that she was administered with TT1
- TT4 vaccines from her first to third
pregnancy.

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Usual diet consists of fish, pork,
chicken, and vegetables from their
backyard garden.
She is also fond of drinking coffee
consuming about 2 to 3 cups but
avoided it during her pregnancy and
replaced it with milk (Bear Brand).
Water intake is approximated as 7- 8
glasses per day.

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Aling Nena does not smoke nor have
smoking history. Alcohol
consumption was mentioned but
only on special occasions.
She stated no time for exercise and
that the only physical activity she
has is her usual routine at the store.
No known allergies to medications,
food and environment was reported.

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Aling Nena’s mother had pre-
eclampsia
when she delivered her fifth child
(youngest).
No other incidence was noted
until Aling Nena’s case.
Hypertension is present in her
father’s
side and 7 family members has it.

PROFILE
PASTHX
PRESENT
OB
LIFESTYL
E
FAMILIAL&
SOCIO
Aling Nena earns about
P6,000.00 monthly and her
husband brings home P400.00 a
day.

BRIEF
DESCRIPTION
HELLP SYNDROME
ROSEMARIE CARPIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT

PIH
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT

G-HPN
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Source:
stanfordchildrens.org
Babycenter.com

G-HPN
NEPHRON
S
ETIOLOGY
S/Sx
Dx
MANAGEMENT
• 140/90
• (-) Proteinuria
• (-) Edema
• No drug necessary
Source: Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of the
Child Caring and Childrearing Family 6th Edition. Philadelphia: Lippincott
Williams & Wilkins

PRE-
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
• 20th week of pregnancy
• new-onset hypertension plus
new-onset proteinuria.
Source: Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of the
Child Caring and Childrearing Family 6th Edition. Philadelphia: Lippincott
Williams & Wilkins
8.6/10,000
Source: Ajog.org

ANATOM
NEPHRON
S
ETIOLOGY
S/Sx
Dx
MANAGEMENT
1.MILD PRE-ECLAMPSIA
• BP: 140/90mmHg
• Positive Proteinuria (1+, or
2+)
• Weight gain of more than
2lb/wk in the second
trimester, or 1lb/wk in third
trimester Source: Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of
the Child Caring and Childrearing Family 6th Edition. Philadelphia:
Lippincott Williams & Wilkins
• Damage can occur without
proteinuria
• Does not predict how
severely the disease will
progress
Source: Pre-eclampsia.org
No longer included as
diagnostic criterion.
source: Disease and Disorder: A Nursing
Therapeutics Manual

ANATOM
NEPHRON
S
ETIOLOGY
S/Sx
Dx
MANAGEMENT
2. SEVERE PRE-ECLAMPSIA
• BP: 160/110 mmHg or above
• Proteinuria (3+, or 4+)
• Extreme edema
• Cerebral edema: visual disturbance,
severe headache, ankle clonus
Source: Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of

Source: Pillitteri, A. (2010).
Maternal and Child Health
Nursing: Care of the Child
Caring and Childrearing
Family 6th Edition.
Philadelphia: Lippincott
Williams & Wilkins

PRE-
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
• Most severe classification of
PIH.
• Grand-mal seizure (tonic-clonic),
or coma occurs.
3.3%
Source: Ajog.org
Source: Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of

HELLP
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
emolysis
levated
ow
iver enzyme
latelets
Source: American Journal of Roentgenology

DEFINITIO
CLASSIFICATI
ON
ETILOGY
S/Sx
Dx
MANAGEMENT
• Louis Weinstein
• Rare manifestation of hypertensive
diseases of pregnancy
• 4-12% (americanpregnancy.org)
• 28-36 week gestation (The Journal of
Obstetrics and Gynecology of India, 2009)
• Affects about 0.2-0.6% of all
pregnancies (americanpregnancy.org)
• Mortality rate: 7.7-60%
(preeclampsia.org)

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
1. Partial HELLP –one, or two abnormalities
2. Complete/Full HELLP –all three abnormalities
-high risk for complication

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
The Mississippi classification.
• Class I (severe thrombocytopenia): platelets
under 50,000/mm3
• Class II (moderate thrombocytopenia):
platelets between 50,000 and 100,000/mm3
• Class III (mild thrombocytopenia): platelets
between 100,000 and 150,000/mm3
Source: The Journal of Obstetrics and
Gynecology of India, 2009

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
ABNORMAL VESSEL IN
THE PLACENTA

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Source: The Role Of Ethnicity In The Development Of Pre-Eclampsia, 1998 and Pre-eclampsia.org, 2018
Source: pre-eclampsia.org, 2019
Source: BMC Pregnancy and
Child Birth 2008
Women who have had preeclampsia in a prior pregnancy should receive counseling
and assessments before their next pregnancy. -ACOG

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
• General Malaise
• Headache
• Dizziness
• Nausea and vomiting
• RUQ pain
80-85%
Source: American Journal of Roentgenology
Not all s/sx are present
-Dr. Valdez

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
• Changes in vision (local vasospasm)
• most serious symptoms of pre-
eclampsia
• flashing lights, auras, light sensitivity, or
blurry vision or spots.
• High blood pressure
• Proteinuria
• Bleeding

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Complete Blood Count
RBC: 4.2–5.4 mil/mm3
Hgb: 11–16 g/dL
Hct: 33%–36%

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Peripheral Blood
Smear
WNL values

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Liver Function
Test
AST: 5-40 IU/L
ALT: 5-35 IU/L
LDH: 115-225 IU/L
BILIRUBIN: 0.1-1.0 mg/dL

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Kidney Function
Test
Creatinine: 79.56 – 114.92umol/L
BUN: 10–20 mg/dL

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Urinalysis
Protein: Negative (<10mg/dL)

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Non-stress test or
biophysical profile

A total score of 10 out of 10 or 8 out of 10 with normal fluid is considered normal. A score of 6 is considered
equivocal, and a score of 4 or less is abnormal. A score of less than 8 indicates the fetus may not be. However,
decreased biophysical activities may also be seen for a brief time in the preterm fetus after treatment with ether
betamethasone or dexamethasone given to enhance fetal lung maturity, receiving enough oxygen.

DEFINITIO
CLASSIFICATI
ON
ETIOLOGY
S/Sx
Dx
MANAGEMENT
Ultrasound, MRI,
CT scan

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
1. Magnesium Sulfate (anti-
convulsant)
2. Anti-hypertensive
4. Corticosteroid
CALCIUM GLUCONATE:
Antidote (5mL/min)

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
• Strict Bed Rest
-due to potential for sudden deterioration of
maternal, or fetal condition.
• Delivery
-best treatment, but not cure.

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
• Cesarean Delivery
-HELLP syndrome is not an indication for cesarean
delivery.
-Vaginal delivery is attempted in patients in
gestations beyond 32 weeks, or in the
presence of active labor or membrane rupture.
-CS is performed if the pregnancy is less than
30 weeks with an unfavorable cervix, and absence of
active labor.
For women with preeclampsia, it is suggested that
the mode of delivery does not need to be cesarean
delivery. The mode of delivery should be deter-
mined by fetal gestational age, fetal presentation,
cervical status, and maternal–fetal condition.
-ACOG
For women with HELLP syndrome and before the
gestational age of fetal viability, it is
recommended that delivery be undertaken shortly
after initial maternal stabilization.

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
Mild Pre-eclampsia
• Promoting bed rest
• Promote good nutrition
• Provide emotional support
• Monitoring and managing
potential complications

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
Severe Pre-Eclampsia
• Support bed rest
• Monitor Maternal, and
fetal well-being
• Support a nutritious diet

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
Eclampsia
• Promote safety
• Maintain patent airway
**Priority

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
After delivery:
• Monitoring for Complication
• Maintaining fluid and electrolyte
balance
• Relieving pain • NPO: 8hrs
• Liquid – soft diet
• Early ambulation
• Proper wound
care
• Encourage use of
binder
DISCHARGE
it is suggested that discharge instructions
include information about the signs and
symptoms of preeclampsia as well as the
importance of prompt reporting of this
information to their health care providers.
-ACOG

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
• varies from woman to woman, but HELLP
syndrome is rarely fatal.
• is thought to largely depend on the
gestational age at delivery and birth
weight.
Stabilize until 37 weeks –Dr. Valdez
If the disease has remained stable without evidence
of progression or severe features, delivery at 37
weeks of gestation is suggested. -ACOG

DEFINITIO
CLASSIFICATI
ON
ETIOLOG
Y
S/Sx
Dx
MANAGEMENT
• DIC
• Abruptio Placenta
• Pulmonary Edema
• Pleural Effusions
• Acute Renal Failure
• Stroke

ANATOMY AND
PHYSIOLOGY
HELLP SYNDROME
MARVIN RAMOS
FEMALER.
INTERNAL
S.A.R
FETAL
C.
IN
RELATION
PATHO

FEMALER.
EXTERNAL
S.A.R
FETAL
C.
IN
RELATION
PATHO
For reproduction
Divided into two
1. EXTERNAL ( Labia minora and majora,
clitoris, mons pubis )
2. INTERNAL ( Vagina, Cervix, Uterus,
Fallopian tube and ovaries )
Source: Regan, J., Russo, A, & VanPutte, C. (2013). Seeley’s Essentials of
Anatomy and Physiology Eighth Edition. New York, NY: McGraw-Hill
Companies, Inc.

DEFINITIO
EXTERNAL
S.A.R
FETAL
C.
IN
RELATION
PATHO
Source:
https://www.youtube.com/channel/UCNI0q
OojpkhsUtaQ4_2NUhQ

DEFINITIO
INTERNAL
S.A.R
FETAL
C.
IN
RELATION
PATHO
Source:
https://www.youtube.com/channel/UCNI0q
OojpkhsUtaQ4_2NUhQ

FEMALE
EXT.&
INT.
S.A.R
FETAL
C.
IN
RELATION
PATHO
Source: Regan, J., Russo, A, & VanPutte, C. (2013). Seeley’s Essentials of Anatomy
and Physiology Eighth Edition. New York, NY: McGraw-Hill Companies, Inc.

FEMALER.
EXT.&
INT.
S.A.R
FETAL
C.
IN
RELATION
PATHO
Source: Regan, J., Russo, A, & VanPutte, C. (2013). Seeley’s Essentials of Anatomy
and Physiology Eighth Edition. New York, NY: McGraw-Hill Companies, Inc.

FEMALE
EXT.&
INT.
S.A.R
FETAL
C.
IN
RELATION
PATHO
(source: Pillitteri, A. (2010). Maternal and Child Health
Nursing: Care of the Child Caring and Childrearing Family 6th
Edition. Philadelphia: Lippincott Williams & Wilkins)

FEMALER.
EXT.&INT.
S.A.R
FETAL
C.
IN
RELATION
PATHO
IN RELATION

FEMALER.
EXT.&INT.
S.A.R
FETAL
C.
IN
RELATION
PATHO
>>>

P.E.R.S.O.N
HELLP SYNDROME
ROSEMARIE CARPIO
PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Source: Kelley, J. & Weber, J. (2010). Health
Assessment in Nursing Fifth Addition. New York, NY:
Lippincott Williams & Wilkins.

PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Pre-Assessment
January 20, 2019
A pregnant woman on her 40’s arrived
at OB-ER ambulatory. She seems upset
as evidence by eye lack luster, and
facial grimace and a guarding behavior
on her right abdominal upper quadrant.
Her hair was tied into bun but quite
messy because of loose strands her
face, and was wearing appropriate
clothes for the weather.

PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Pre-Assessment
January 20, 2019
PAIN ASSESSMENT:
Character:
Squeezing pain
Onset:
January 20, 2019; sudden
Location:
RUQ

PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Pre-Assessment
January 20, 2019
Duration:
Continuous pain and getting worse when moving,
or doing physical activities such as walking.
Severity:
Using the Universal Pain Assessment Tool, the
scale is 8/10-Severe; The pain is quite intense
and is causing the patient to avoid, or limit physical
activity, also, cannot concentrate on anything
except pain.

PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Pre-Assessment
January 20, 2019
Pattern:
“Kapag gagalaw ako sumasakit, pero kapag
nagpapahinga ako nababawasan yung sakit.”
Associated factors:
The pain affects the activities of the patient at
home, “Ang sakit po, hindi nga ako nakapagluto ng
baon para sa maga anak kong papasok ng school
kasi pumunta na agad ako dito.”

PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Post-Assessment
January 22, 2019
Patient was seen lying on bed, on Moderate
High Back Rest, with an ongoing IVF of D5LR 1L
to run for 8hours regulated at 30-31gtts/min at
500ml level inserted aseptically on her left
dorsum or dorsal hand using gauge 20 IV
cannula, patent and infusing well. She has a
facial grimace and with presenting guarding
behavior on her abdomen. Her hair was tied into
bun, and wearing appropriate clothes for the
weather (t-shirt, pajama, socks)

PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Post-Assessment
January 22, 2019
PAIN ASSESSMENT:
Character:
Sharp pain
Onset:
Post-Operation (January 21, 2019)
Location:
Pain from incision

PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Post-Assessment
January 22, 2019
Duration:
Continuous pain and getting worse when
moving, or doing physical activities such as
walking.
Severity:
Using the Universal Pain Assessment Tool, the
scale is 6/10-Moderate; Interferes her
concentration, and felt uncomfortable

PSYCHOSOCIA
L
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
02
NUTRITION
Post-Assessment
January 22, 2019
Pattern:
Moving makes it worse, and relieved, when lying
on bed and controlled when given pain
medication.
Associated factors:
The pain affects:
“Hindi kasi ako masyadong makatulog dito sa
hospital at nararamdaman ko pa rin yung sakit
dito sa tyan ko kapag gabi lalo kapag gagalaw
ako, hindi ako komportable.”
20-25min sleep disturbance
Total: 4hrs with interruption

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
PRE ASSESSMENT (1/20/19) POST ASSESSMENT (1/22/19)
FAMILY
Type: Nuclear Family
Rank: Mother
Religion: Roman Catholic
SIGNIFICANT OTHER
Age: 40y/o
Relationship: Husband
FINANCIAL RESOURCES
Educational Attainment: HS
Occupation: Restaurant Cashier
Primary Source of Health: RHU
Quezon
Patients are more compliant with
physicians' orders and more satisfied
with the care they receive from those
physicians when their family and
friends are effectively involved in
their care management. (source:
sk.sagepub.com)

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
MOOD and AFFECT:
Patient was able to express a wide
variety of affects to display sadness,
excitement, happiness, fear,
embarrassment, etc, and
appropriately responds to any type of
stimuli.
SPEECH:
Dialect: Tagalog/Ilocano
Observations: She speaks in a
modulated voice
COPING MECHANISM:
Problem Focused
Patient complies to all instructions of
the doctor.

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
ORIENTATION:
Patient was well-oriented as evidence
by awareness of the date, time, and
place asked by the student nurse.
Memory was intact as evidence by
accurate answers such as:
Immediate: “Anong oras po kayo
dinala rito?”
Recent: “Kelan po kayo unang
nakaramdam ng pananakit sa may
tiyan?”
Remote: “Saan po kayo unang
nagkakilala ng asawa ninyo?”
Immediate: “Nagb-breastfeed po
kayo?”
Recent: “Sino po yung nasa tabi niyo
nung nagising po kayo?”
Remote: “Naaalala niyo pa po ba kung
kailan namatay ang lolo ninyo?
Depression, and anxiety both
affects immediate, and recent
memory but not the remote
memory. (source: researchgate.net)

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONEMNT
O2
NUTRITION
ABDOMEN:
Contour: Protruding
Fundal height: 32 cm
Contour: Protruding
Fundal height: Umbilicus level
Firm fundus
Incision: 13cm (horizontally/low
transverse cs)
STOOL
Not assessed
Consistency: Formed
Color: Brown
Frequency: 1x

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONEMNT
O2
NUTRITION
URINE:
Second-void sample
Color: Dark Yellow
Clarity: Cloudy/Foamy
Amount: 60ml
Protein 1+
Hooked to IFC
Color: Amber
Clarity: Slightly foamy
Amount: 100ml
Trace
Due to decreased blood flow to the
Kidney, which caused temporary
glomerular damage, will resulted to
spilling of protein to the urine. (source:
preeclampsia.org and YY: Osmosis)
Any amount of protein in your urine over 300
mg in one day may indicate preeclampsia.
However, the amount of protein doesn't
define how severe the preeclampsia is or may
get.
(source: preeclampsia.org)

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
SLEEP
Not assessed
Characteristics: Interrupted sleep
Total hours of sleep: 4 hours
Presence of eye bags
Lack of concentration
ACTIVITY
Current Activity:
ADL’s:
Bathing – 2
Dressing – 2
Toileting – 2
Transferring – 3
Feeding – 0
Bathing – 0
Dressing – 0
Toileting – 0
Transferring – 0
Feeding – 0
“Hindi kasi ako masyadong makatulog
dito sa hospital at nararamdaman ko pa
rin yung sakit kapag gabi lalo kapag
gagalaw ako, hindi ako komportable.”
Due to patient’s uncomfortable
environment, and pain from incision.
Walking, taking the stairs, and
even lifting or moving supplies
will all cause the blood pressure
to increase.
It is highly recommended that bed rest or the restriction of other physical activity not be
used for the primary prevention of preeclampsia and its complications. (source:
Hypertensioninpregnancy)
Bed rest, therefore, is the best method of aiding increased evacuation of sodium and
encouraging diuresis. Rest should always be in a lateral recumbent position to avoid
uterine pressure on the vena cava and prevent supine hypotension syndrome. (source:
Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of the Child Caring and Childrearing
Family 6th Edition. Philadelphia: Lippincott Williams & Wilkins)
In most cases, bed rest is used to give the body it's best chance to normalize. Bed rest will
be used with women who have conditions related to high blood pressure in order to
decrease stress and lower blood pressure. It may also be necessary to help increase
blood flow to the placenta. (source: americanpregnancy.org)

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
BODY FRAME:
POSTURE: Not assessed
GAIT: Not assessed
POSTURE: Fair
Head forward, abdomen prominent,
exaggerated curve in upper back, and
slight hallow back.
GAIT: Normal gait
Patient was able to do a heel strike
and toe off in one gait cycle, stance
and swing were properly observed.
(source: iBody academy)
MUSCLE
Strength and Tone:
Right Arm – 5
Right Leg – 5
Left Arm – 5
Left Leg – 5
Patient scored 5 in each extremity
which means that she can respond
against full resistance, while the
muscle tone was firm.
Tremor: None

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
ROM’s:
Patient participated in all of the ROM
exercises instructed by the student
nurse.
Arms: Patient can extend both arms
Elbows: Full resistance
Wrist: Can flex, extend, and deviate
Hands and Fingers: Can adduct and
abduct, thumb can flex, and extend and
oppose
Knee: Patient can extend, or flex both
knees
MOTOR FUNCTION:
Fine: Patient can type, and send
messages through cellular phone. She
can also use pen to write her name
when the student nurse asked her to.

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
Gross: Not assessed Gross: Patient was able to walk from
bed to the bathroom.

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONTMENT
O2
NUTRITION
ALLERGIES
Food: None
Medication: None
Environment: None
Eyes:
PERRLA not assessed due to patient’s
visual disturbance (blurred vision)
Patient doesn’t use any eye glasses.
Nose:
There were no lesions, and unusual
secretion noted.
PRE-ASSESSMENT:
Due to high blood pressure of the
patient, the retina’s vessels were
affected that caused visual
disturbance (blurred vision).
(source: webmd.com and YT: Osmosis)
POST-ASSESSMENT:
Since patient is still monitored for any residual
hypertension, and pregnant who has PIH during
pregnancy and will eventually subside after 6 weeks, it
is suggested that sudden stimulation such as shining a
beam of flashlight for assessment is to be avoided to
prevent seizure.
(source: Pillitteri, A. (2010). Maternal and Child Health Nursing:
Care of the Child Caring and Childrearing Family 6th Edition.
Philadelphia: Lippincott Williams & Wilkins)

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONTMENT
O2
NUTRITION
Mouth:
There were no lesions, and unusual
secretion noted. Lips were chapped,
and no sign of cyanosis.
Ear:
There were no lesions, or unusual
secretion noted on both ears. Patient
doesn’t wear hearing aid.
Patient was able to answer in a low
tone questions.

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
RESPIRATION
Rate: 24
Rhythm: Regular
oscillating cycle of inspiration and
expiration
Depth: Normal
Rate: 20
NAIL:
Color: Pink
Capillary Refill: Rapid; less 2sec
PERIPHERAL PULSE:
Rate: 95 Rate: 76

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
SKIN INTEGRITY:
Patient has a brown skin and a few
scars on her arm like oil burn scar. She
also has minimal pimple scar on both
cheeks.
• Pale, cool, and clammy skin
Patient has a 13cm incision on the
abdomen from C-Section delivery.
Temperature: 37 C
Route: Axilla
Temperature: 36.2 C
EDEMA:
Patient has a non-pitting edema on
both lower extremities
Edema:
This extra retention of fluid is needed to soften the body, which enables it
to expand as the baby develops. Extra fluid also helps prepare the pelvic
joints and tissues to open for delivery. The extra fluids account for
approximately 25% of the weight women gain during pregnancy.
(source: americanpregnancy.org)
Edema is no longer included as a diagnostic criterion for preeclampsia,
although it is often present, as it is an expected occurrence in pregnancy
and has not shown to be discriminatory.
(source: Disease and Disorder: A Nursing Therapeutics Manual)

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
HOSPITAL DIET:
NPO Clear liquid to Soft Diet
FLUID I and O:
–within shift
I: 850ml
O: 480ml (approximately)
–within shift
I: 1L
O: 600ml (approximately)
Lochia:
Rubra
From 7-3hrs duty:
3 maternity pads
It is suggested that weight loss, and extremely
low sodium diets (less than 100 mEq/d) not be
used for managing chronic hypertension in
pregnancy.
(source: Hypertensioninpregnancy)

PSYCHOSOCIA
ELIMINATIO
N
RESTAND
ACTIVITY
SAFETYAND
ENVIRONMENT
O2
NUTRITION
SKIN TURGOR:
Skin goes back immediately after 1-2
second.
IVF: D5LR x 8hrs
Site: Left Dorsal
IVF: D5LR x 8hrs
HEIGHT: 5’5
WEIGHT: 61
BMI: 22.43
Mesomorph
WEIGHT: 57.1
BMI: 21
Next: COURSE IN THE WARD
Forward: DRUG STUDY // NCP
For fluid and electrolyte replenishment
and caloric supply in a single dose
container for intravenous administration.

LABORATORY
RESULTHELLP SYNDROME
REXEL CABANILLA
Leeuwen, A., Poelhuis-Leth, D., Bladh, M. (2013)
Davis's Comprehensive Handbook of Laboratory
Diagnostic Tests with Nursing Implication. (5th ed).
Philadelphia: F.A Davis Company.>>>

DRUG STUDY
HELLP SYNDROME
JHULIEN HANNE BUEZA
Wolters Kluwer (2017). Nursing Drug Handbook 37th
Edition. Aptara, Inc.>>>

DATE DRUGS
January
20, 2019
 Methyldopa
9:30am 250 mg 2 tabs now then TID
 Paracetamol
500mg every 6 hours RTC
 Magnesium Sulfate
9:30am 4g slow IV then 5g IM in each
buttock
 Dexamethasone
9:30 am 12mg IM every 12 hours x 2 doses

January 21,
2019
 Cefuroxime Sodium
8:00am 1.5g IV before OR ANST
 Bupivacaine Hydrochloride
10:10am 50mg (as 0.25% solution)
 Midozalam Hydrochloride
10:15am 2.5mg IV Given slowly
 Nalpubhine Hydrochloride
10:20am 50mg/ml IV
 Cefuroxime Sodium
11:00am 1.5g IV every 8 hours

DATE DRUGS
January 20,
2019
• Oxytocin
11:00am IVF D5LRS 1L + 20u oxytocinx8hours
TF: D5LRS 1L + 10u oxytocinx 8 hours
D5LRS 1L x 8hours
• Tramadol Hydrochloride
11:00am 50mg IV every 8 hours x 3 doses
• Tranexamic Acid
11:00am 2g IV every 8 hours x 3 doses
• Ranitidine Hydrochloride
11:00am 50mg IV every 8 hours x while on NPO
• Diclofenac Sodium
11:00am 75mg IV every 6 hours x 3 doses ANST

January 22,
2019
 Amlodipine Besylate
8:00am 10 mg 1 tab OD Take home
medication
 Co-Amoxiclav
8:00am 625mg 1 tab BID x 7 days
 Celecoxib
8:00 am 200mg 1 tab BID
 Ferrous Sulfate
8:00am 325mg 1 tab OD
Take home medication- 1 tab OD
 Ascorbic Acid
8:00am 80mg 1 tab OD
Take home medication- 80mg 1 tab OD

COURSE IN THE
WARDHELLP SYNDROME
EDEN DUENES
>>>

NURSING CARE
PLANHELLP SYNDROME
REXEL CABANILLA
>>>

Deglin, J., Sanoski, C. & Vallerand, A. (2011). Davis’s Drug Guide for Nurses Twelfth Edition. Philadelphia, PA: iGroup
Press. Co., Ltd.
Doenges, M., Moorhouse, & M., Murr, A. (2006). Nurse’s Pocket Guide Tenth Edition. Philadelphia, PA: iGroup Press.
Co., Ltd.
Jaypee Brothers (2005). Jaypee’s Nurses Dictionary Second Edition. New Delhi, Daryaganj: Jaypee Brothers Medical
Publisher (P) Ltd.
Kelley, J. & Weber, J. (2010). Health Assessment in Nursing Fifth Addition. New York, NY: Lippincott Williams &
Wilkins.
Leeuwen, A., Poelhuis-Leth, D., Bladh, M. (2013) Davis's Comprehensive Handbook of Laboratory Diagnostic Tests
with Nursing Implication. (5th ed). Philadelphia: F.A Davis Company.
Giddens, Jean., & Langford, R. (2007). Mosby’s PDQ for RN Second Edition. Singapore: Elsevier Pte., Ltd.
Pillitteri, A. (2010). Maternal and Child Health Nursing: Care of the Child Caring and Childrearing Family 6th Edition.
Philadelphia: Lippincott Williams & Wilkins

Regan, J., Russo, A, & VanPutte, C. (2013). Seeley’s Essentials of Anatomy and Physiology Eighth Edition. New York,
NY: McGraw-Hill Companies, Inc.
Wolters Kluwer (2017). Nursing Drug Handbook 37th Edition. Aptara, Inc.
Wolters Kluwer (2009). Pathophysiology Made Incredibly Easy! Fourth Edition. New York, NY: Lippincott Williams &
Wilkins.
JOURNAL:
Hellp Syndrome: A Case Report with Guidelines For Diagnosis And Management by K. W. Patterson And D. P.
O'toole
HELLP Syndrome case study by Falah Abdul-Hadi Muhi
The HELLP syndrome: Clinical issues and management. A Review by BMC Pregnancy and Childbirth
Hypertension in Pregnancy by The American College of Obstetrician and Gynecology (Given by Dr. Porto)
The Role of Ethnicity in the Development of Pre-Eclampsia by Keith Williams, MB BS, FRCSC, MBA,l France
Galerneau, MD, FRCSC,2

DATABASE:
https://www.aafp.org/afp/1999/0901/p829.html
https://online.epocrates.com/diseases/100034/HELLP-syndrome/Diagnostic-Tests
https://www.preeclampsia.org/health-information/faqs
https://www.preeclampsia.org/health-information/hellp-syndrome
https://www.webmd.com/baby/how-often-do-i-need-prenatal-visits
https://www.babycentre.co.uk/x542273/should-i-worry-if-i-have-low-platelets-gestational-thrombocytopenia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399052/pdf/prenatal-5-90-92.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1885765/pdf/2449.pdf
ACOG.org
VIDEOS:
https://www.youtube.com/watch?v=80ddMfvgb6g&t=21s
https://www.youtube.com/watch?v=jSz_ZSFr4pY&t=31s
https://www.youtube.com/watch?v=LykToowL2PU&t=36s
https://www.youtube.com/watch?v=RB5s85xDshA&t=1s
https://www.youtube.com/watch?v=pDo9NuibkwY
https://www.youtube.com/watch?v=X7mX8mG3NrE
Front Page >>

HELLP Syndrome (Case Protocol)

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to HELLP Syndrome (Case Protocol)

Similar to HELLP Syndrome (Case Protocol) (20)

More from Saint Mary's University Philippines

More from Saint Mary's University Philippines (7)

Recently uploaded

Recently uploaded (20)

HELLP Syndrome (Case Protocol)

Editor's Notes