ABRUPTIO PLACENTA

Definition:
- Premature separation of the placenta from the uterine wall.
- Common cause of bleeding during the second half of pregnancy
- Usually occurs after 20 to 24 weeks of pregnancy but may occur as late as during first or
second stage of labor.

Placental abruption (also known as abruptio placentae) is an obstetric catastrophe

(complication of pregnancy), wherein the placental lining has separated from the uterus of
the mother. It is the most common cause of late pregnancy bleeding. In humans, it refers to
the abnormal separation after 20 weeks of gestation and prior to birth. It occurs in 1% of
pregnancies worldwide with a fetal mortality rate of 20-40% depending on the degree of
separation. Placental abruption is also a significant contributor to maternal mortality.

The heart rate of the fetus can be associated with the severity.

Risk factors:
- women with parity of 5 or more
- women over 30 years of age
- women with pre-eclampsia - eclampsia and renal or vascular disease.

Factors contributing to ABRUPTIO PLACENTA

- multiple gestations
- hydramnios
- cocaine use
- dec. blood flow to the placenta
- trauma to the abdomen
- dec. serum folic acid levels
- PIH

Cause: Unknown
Theories proposed relating it’s occurrence to dec. blood flow to the placenta through the
sinuses during the last trimester; Excessive intrauterine pressure caused by hydramnios or multiple
pregnancy may also be contributing factors.

Clinical manifestations:
 ℜ Covert (severe)/ Mild separation/ Mild Abruptio Placenta
The placenta separates centrally and the blood is trapped between the placenta and the
uterine wall.
Signs and Symptoms:
1. no overt bleeding from vagina
2. rigid abdomen
3. acute abdominal pain
4. dec. BP
5. inc. pulse
6. uteroplacental insufficiency

ℜ Overt (partial)/ Moderate separation/ Moderate Abruptio Placenta

The blood passes between the fetal membranes and the uterine wall and escapes vaginally.
May develop abruptly or progress from mild to extensive separation with external hemorrhage.
Signs and Symptoms:
1. vaginal bleeding
2. rigid abdomen
3. acute abdominal pain
4. dec. BP
5. inc. pulse
6. uteroplacental insufficiency

ℜ Placental Prolapse/ Severe separation/ Severe Abruptio Placenta

Massive vaginal bleeding is seen in the presence of almost total separation with possible
fetal cardiac distress.
Signs and Symptoms:
1. massive vaginal bleeding
2. rigid abdomen
3. acute abdominal pain
4. shock
5. marked uteroplacental insufficiency

Management:
- monitoring of maternal vital signs, fetal heart rate (FHR), uterine contractions and vaginal
bleeding
- likelihood of vaginal delivery depends on the degree and timing of separation in labor
- cesarean delivery indicated for moderate to severe placental separation
- evaluation of maternal laboratory values
- F & E replacement therapy; blood transfusion
- Emotional support
Nursing Interventions:
- Assess the patient’s extent of bleeding and monitor fundal height q 30 mins.
- Draw line at the level of the fundus and check it every 30 mins (if the level of the fundus
increases, suspect abruptio placentae)
- Count the number of pads that the patient uses, weighing them as necessary to determine
the amount of blood loss
- Monitor maternal blood pressure, pulse rate, respirations, central venous pressure, intake
and output and amount of vaginal bleeding q 10 – 15 mins
- Begin electronic fetal monitoring to continuously assess FHR
- Have equipment for emergency cesarean delivery readily available:
-prepare the patient and family members for the possibility of an emergency CS
delivery, the delivery of a premature neonate and the changes to expect in the
postpartum period
-offer emotional support and an honest assessment of the situation
- if vaginal delivery is elected, provide emotional support during labor
-because of the neonate’s prematurity , the mother may not receive an analgesic
during labor and may experience intense pain
-reassure the patient of her progress through labor and keep her informed of the
fetus’ condition
- tactfully discuss the possibility of neonatal death
-tell the mother that the neonate’s survival depends primarily on gestational age, the
amount of blood lost, and associated hypertensive disorders
-assure her that frequent monitoring and prompt management greatly reduce the
risk of death.
- encourage the patient and her family to verbalize their feelings
- help them to develop effective coping strategies, referring them for counseling if necessary.

Goals of Care:
1. blood loss is minimized, and lost blood is replaced to prevent ischemic necrosis of distal
organs, including kidneys
2. DIC is prevented or successfully treated.
3. normal reproductive functioning is retained
4. the fetus is safely delivered
5. the woman retains a positive sense of self-esteem and self-worth.

Additional lab results:

Hgb- ↓
Platelet - ↓
Fibrinogen - ↓
Fibrin degradation products - ↑

Other possible nursing diagnosis:

• Impaired gas exchange: fetal related to insufficient oxygen supply secondary to premature
separation of the placenta.

• Pain related to bleeding between the uterine wall and the placenta secondary to premature
separation of the placenta.

• Fear related to perceived or actual grave threat to body integrity secondary to excessive
bleeding and threat to fetal survival.

• Grieving related to actual or threatened loss of infant.

• Powerlessness related to maternal condition and hospitalization.

• Risk for deficient fluid volume related to excessive losses secondary to premature placental
separation.

Pathophysiology
Trauma, hypertension, or coagulopathy, contributes to the avulsion of the anchoring placental villi
from the expanding lower uterine segment, which in turn, leads to bleeding into the decidua
basalis. This can push the placenta away from the uterus and cause further bleeding. Bleeding
through the vagina, called overt or external bleeding, occurs 80% of the time, though sometimes
the blood will pool behind the placenta, known as concealed or internal placental abruption.

Women may present with vaginal bleeding, abdominal or back pain, abnormal or premature
contractions, fetal distress or death.

Abruptions are classified according to severity in the following manner:

• Grade 0: Asymptomatic and only diagnosed through post partum examination of the
placenta.
• Grade 1: The mother may have vaginal bleeding with mild uterine tenderness or tetany,
but there is no distress of mother or fetus.
 • Grade 2: The mother is symptomatic but not in shock. There is some evidence of fetal
distress can be found with fetal heart rate monitoring.
• Grade 3: Severe bleeding (which may be occult) leads to maternal shock and fetal death.
There may be maternal disseminated intravascular coagulation. Blood may force its way
through the uterine wall into the serosa, a condition known as Couvelaire uterus.

Intervention
Placental abruption is suspected when a pregnant mother has sudden localized abdominal pain with
or without bleeding. The fundus may be monitored because a rising fundus can indicate bleeding.
An ultrasound may be used to rule out placenta praevia but is not diagnostic for abruption. The
mother may be given Rhogam if she is Rh negative.

Treatment depends on the amount of blood loss and the status of the fetus. If the fetus is less than
36 weeks and neither mother or fetus are in any distress, then they may simply be monitored in
hospital until a change in condition or fetal maturity whichever comes first.

Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are
in distress. Blood volume replacement and to maintain blood pressure and blood plasma
replacement to maintain fibrinogen levels may be needed. Vaginal birth is usually preferred over
caesarean section unless there is fetal distress. Caesarean section is contraindicated in cases of
disseminated intravascular coagulation. Patient should be monitored for 7 days for PPH. Excessive
bleeding from uterus may necessitate hysterectomy if family size is completed.
 ANATOMY & PHYSIOLOGY OF FEMALE REPRODUCTIVE ORGAN

 FEMALE EXTERNAL STUCTURES

a. Mons Veneris

• A pad of adipose tissue located over the symphisis pubis, the pubic bone
joint.

• It protects the junction of pelvic bone from trauma.

b. Labia Minora

• Just posterior to the mons veneris spread two hairless folds of

connective tissue.
c. Labia Majora

• Two halves of adipose tissue covered by loose connective tissue and

epithelium.
d. Vestibule

• Flattened smooth surface inside the labia.

• The space wherein we can see the vaginal and uretral opening.

e. Clitoris

• Small rounded erectile tissue at the forward junction of the labia minora.

• Sensitive to touch and temperature center of sexual arousal and orgasm.

f. Skene’s Gland
PARAURETRAL GLANDS
• Located just lateral to urinary meatus.

• It produces lubricating fluid that helps to maintain the moistness of the

vestibule.
Bartholin’s Gland (vulvovaginal)
• Located just lateral to vaginal opening.

• It secretes mucus to provide vaginal lubrications.

g. Fourchette

• Ridge of tissues formed by the posterior joining the two labias.

 INTERNAL STRUCTURES

1. Ovaries
• Almond shaped
• Produce, mature and discharge ova
• Initiate and regulate menstrual cycle
• 4 cm long, 2 cm in diameter, 1.5 cm thick
• Produce estrogen and progesterone

- Estrogen: promotes breast development & pubic hair distribution prevents

osteoporosis and keeps cholesterol levels reduced & so limits effects of
atherosclerosis Fallopian tubes.

2. Fallopian tubes
• Approximately 10 cm in length
• Arises from each corner of the uterine body
• Conveys ova from ovaries to the uterus
• Site of fertilization
• Parts: interstitial
isthmus – cut/sealed in BTL
ampulla – site of fertilization
infundibulum – most distal segment; covered with fimbria

3. Uterus
• Hollow muscular pear shaped organ
- uterine wall layers: endometrium(inner); myometrium(middle);
perimetrium(outer)
• Organ of menstruation
• Receives the ova
• Provide place for implantation & nourishment during fetal growth
• Protects growing fetus
• Expels fetus at maturity
• Has 3 divisions: corpus – fundus , isthmus (most commonly cut during CS
delivery) and cervix.

4. Uterine Wall
• Endometrial layer: formed by 2 layers of cells which are as follows:
• basal layer- closest to the uterine wall.
• glandular layer – inner layer influenced by estrogen and progesterone; thickens
and shed off as menstrual flow.
 • Myometrium – composed of 3 interwoven layers of smooth muscle; fibers are
arranged in longitudinal; transverse and oblique directions giving it extreme
strength.

5. Vagina
• Acts as organ of copulation
• Conveys sperm to the cervix
• Expands to serve as birth canal
• Wall contains many folds or rugae making it very elastic
Fornices – uterine end of the vagina; serve as a place for pooling of semen following
coitus.
• Bulbocavernosus – circular muscle act as a voluntary sphincter at the external
opening to the vagina (target of Kegel’s exercise).
 PLACENTA

• It serve s as the fetal lungs, kidneys and gastrointestinal tract and as a separate
endocrine organ throughout pregnancy.

 CIRCULATION

• The fetus is connected by the umbilical cord to the placenta, the organ that develops
and implants in the mother's uterus during pregnancy.
• As early as the 12th day of pregnancy, maternal blood circulation begins to collect
in the intervillus spaces of the uterine endometrium surrounding the chronic villi.
• By the 3rd week of pregnancy, through the blood vessels in the umbilical cord, the
fetus receives all the necessary nutrition, oxygen, and life support from the mother
through the placenta..
• From there, the nutrients are being transported back to the growing embryo.
• Waste products and carbon dioxide from the fetus are sent back through the
umbilical cord and placenta to the mother's circulation to be eliminated.
• The blood from the mother enters the fetus through the vein in the umbilical cord. It
goes to the liver and splits into three branches. The blood then reaches the inferior
vena cava, a major vein connected to the heart.

 Inside the fetal heart

- Blood enters the right atrium, the chamber on the upper right side of the
heart. Most of the blood flows to the left side through a special fetal
opening between the left and right atria, called the foramen ovale.
- Blood then passes into the left ventricle (lower chamber of the heart) and
then to the aorta, (the large artery coming from the heart).
- From the aorta, blood is sent to the head and upper extremities. After
circulating there, the blood returns to the right atrium of the heart through
the superior vena cava.
- About one-third of the blood entering the right atrium does not flow through
the foramen ovale, but, instead, stays in the right side of the heart,
eventually flowing into the pulmonary artery.

• Because the placenta does the work of exchanging oxygen (O2) and carbon dioxide
(CO2) through the mother's circulation, the fetal lungs are not used for breathing.
Instead of blood flowing to the lungs to pick up oxygen and then flowing to the rest
of the body, the fetal circulation shunts (bypasses) most of the blood away from the
lungs. In the fetus, blood is shunted from the pulmonary artery to the aorta through
a connecting blood vessel called the ductus arteriosus.
Pathophysiology of Abruptio Placentae
 Preeclampsia
Preeclampsia, also referred to as toxemia, is a condition that pregnant women can get. It is

marked by high blood pressure accompanied with a high level of protein in the urine. Women with

preeclampsia will often also have swelling in the feet, legs, and hands. Preeclampsia, when present,

usually appears during the second half of pregnancy, generally in the latter part of the second or in

the third trimesters, although it can occur earlier.

In addition symptoms of preeclampsia can include:

• Rapid weight gain caused by a significant increase in bodily fluid

• Abdominal pain

• Severe headaches

• A change in reflexes

• Reduced output of urine or no urine

• Dizziness

• Excessive vomiting and nausea

The exact causes of preeclampsia are not known, although some researchers suspect poor

nutrition, high body fat, or insufficient blood flow to the uterus as possible causes.

The only real cure for preeclampsia and eclampsia is the birth of the baby. Mild

preeclampsia (blood pressure greater than 140/90) that occurs after 20 weeks of gestation in a

woman who did not have hypertension before; and/or having a small amount of protein in the urine

can be managed with careful hospital or in-home observation along with activity restriction.
Pathophysiology:
Efforts to unravel the pathogenesis of pre-eclampsia have been hampered by the lack of clear

diagnostic criteria for the disease and its subtypes. Consequently, several studies have included a

variety of other conditions that do not necessarily reflect an adverse pregnancy outcome.
 Abnormal placentation (stage 1), particularly lack of dilatation of the uterine spiral

arterioles, is the common starting point in the genesis of pre-eclampsia, which compromises blood

flow to the maternal–fetal interface. Reduced placental perfusion activates placental factors and

induces systemic hemodynamic changes. The maternal syndrome (stage 2) is a function of the

circulatory disturbance caused by systemic maternal endothelial cell dysfunction resulting in

vascular reactivity, activation of coagulation cascade and loss of vascular integrity. Pre-eclampsia

has effects on most maternal organ systems, but predominantly on the vasculature of the kidneys,

liver and brain.

Summary

What Is Preeclampsia?

Also referred to as toxemia, preeclampsia is a condition that pregnant women can get. It is marked
by high blood pressure accompanied with a high level of protein in the urine. Women with
preeclampsia will often also have swelling in the feet, legs, and hands. Preeclampsia, when present,
usually appears during the second half of pregnancy, generally in the latter part of the second or in
the third trimesters, although it can occur earlier.

What Is Eclampsia?

Eclampsia is the final and most severe phase of preeclampsia and occurs when preeclampsia is left
untreated. In addition to the previously mentioned signs of preeclampsia, women with eclampsia
often have seizures. Eclampsia can cause coma and even death of the mother and baby and can
occur before, during, or after childbirth.

What Causes Preeclampsia and Eclampsia?

The exact causes of preeclampsia and eclampsia are not known, although some researchers suspect
poor nutrition, high body fat, or insufficient blood flow to the uterus as possible causes.

Who Is at Risk for Preeclampsia?

Preeclampsia is most often seen in first-time pregnancies and in pregnant teens and women over
40. Other risk factors include:

• A history of high blood pressure prior to pregnancy.

 • Previous history of preeclampsia.
• A history of preeclampsia in mother or sisters.
• Obesity prior to pregnancy.
• Carrying more than one baby.
• History of diabetes, kidney disease, lupus, or rheumatoid arthritis.

What are the Signs of Preeclampsia?

In addition to swelling, protein in the urine, and high blood pressure, symptoms of preeclampsia
can include:

• Rapid weight gain caused by a significant increase in bodily fluid

• Abdominal pain
• Severe headaches
• A change in reflexes
• Reduced output of urine or no urine
• Dizziness
• Excessive vomiting and nausea

Does Swelling Mean I Have Preeclampsia During Pregnancy?

Some swelling is normal during pregnancy. However, if the swelling doesn't go away with rest and
is accompanied by some of the above symptoms, be sure to see your doctor right away.

How Can Preeclampsia Affect My Baby?

Preeclampsia can prevent the placenta from receiving enough blood, which can cause your baby to
be born very small. It is also one of the leading causes of premature births and the difficulties that
can accompany them, including learning disabilities, epilepsy, cerebral palsy, and hearing and
vision problems.

What Is the Treatment for Preeclampsia and Eclampsia?

The only real cure for preeclampsia and eclampsia is the birth of the baby.

Mild preeclampsia (blood pressure greater than 140/90 that occurs after 20 weeks of gestation in a
woman who did not have hypertension before; and/or having a small amount of protein in the urine
can be managed with careful hospital or in-home observation along with activity restriction.

If the baby is pre-term, the condition can be managed until your baby can be safely delivered. Your
health care provider may prescribe bed rest, hospitalization, or medication to prolong the
pregnancy and increase your unborn baby's chances of survival. If your baby is close to term, labor
may be induced.
The treatment for more severe preeclampsia (having vision problems, lung problems, abdominal
pain, fetal distress, or other signs and symptoms) may require more emergent treatment -- delivery
of the baby -- irrespective of the baby's age.

Other treatments include:

• Magnesium can be injected into the veins to prevent eclampsia-related seizures.

• Hydralazine or another antihypertensive drug to manage severe elevations of blood
pressure.
• Monitoring fluid intake.
 CARDIOVASCULAR SYSTEM

INTRODUCTION

The cardiovascular/circulatory
system transports food, hormones, metabolic
wastes, and gases (oxygen, carbon dioxide) to
and from cells. Components of the circulatory
system include:

• blood: consisting of liquid plasma

and cells
• Blood vessels (vascular system): the
"channels" (arteries, veins,
capillaries) which carry blood to/from
all tissues. (Arteries carry blood
away from the heart. Veins return
blood to the heart. Capillaries are
thin-walled blood vessels in which
gas/ nutrient/ waste exchange occurs.)
• heart: a muscular pump to move the blood

There are two circulatory "circuits": Pulmonary circulation, involving the "right heart," delivers
blood to and from the lungs. The pulmonary artery carries oxygen-poor blood from the "right heart" to
the lungs, where oxygenation and carbon-dioxide removal occur. Pulmonary veins carry oxygen-rich
blood from tbe lungs back to the "left heart." Systemic circulation, driven by the "left heart," carries blood
to the rest of the body. Food products enter the sytem from the digestive organs into the portal vein.
Waste products are removed by the liver and kidneys. All systems ultimately return to the "right heart"
via the inferior and superior vena cavae.

A specialized component of the circulatory system is the lymphatic system, consisting of a

moving fluid (lymph/interstitial fluid); vessels (lymphatics); lymph nodes, and organs (bone marrow,
liver, spleen, thymus). Through the flow of blood in and out of arteries, and into the veins, and through
the lymph nodes and into the lymph, the body is able to eliminate the products of cellular breakdown and
bacterial invasion.

BLOOD COMPONENTS

Adults have up to ten pints of blood.

• Forty-five percent (45%) consists of cells - platelets, red

blood cells, and white blood cells (neutrophils, basophils,
eosinophils, lymphocytes, monocytes). Of the white blood
cells, neutrophils and lymphocytes are the most important.

1. Fifty-five percent (55%) consists of plasma, the liquid

component of blood.

MAJOR BLOOD COMPONENTS

Component Type Source Function
Platelets, cell fragments Bone marrow Blood clotting
life-span: 10
days
Lymphocytes (leukocytes) Bone marrow, Immunity
spleen, lymph T-cells attack cells containing
nodes viruses. B-cells produce antibodies.
Red blood cells (erythrocytes), Filled with Bone marrow Oxygen transport
hemoglobin, a compound of iron and protein life-span: 120
days
Neutrophil (leukocyte) Bone marrow Phagocytosis
Plasma, consisting of 90% water and 10% 1. Maintenance of pH level
dissolved materials -- nutrients (proteins, salts, near 7.4
glucose), wastes (urea, creatinine), hormones, 2. Transport of large
enzymes molecules
(e.g. cholesterol)
3. Immunity (globulin)

4. Blood clotting (fibrinogen)

VASCULAR SYSTEM - THE BLOOD VESSELS

Arteries, veins, and capillaries comprise the vascular system. Arteries and veins run parallel throughout
the body with a web-like network of capillaries connecting them. Arteries use vessel size, controlled by the
sympathetic nervous system, to move blood by pressure; veins use one-way valves controlled by muscle
contractions.

Arteries

Arteries are
strong, elastic vessels adapted
for carrying blood away from the heart at relatively high pumping pressure. Arteries divide into progressively
thinner tubes and eventually become fine branches called arterioles. Blood in arteries is oxygen-rich, with the
exception of the pulmonary artery, which carries blood to the lungs to be oxygenated.

The aorta is the largest artery in the body, the main artery for systemic circulation. The major branches of
the aorta (aortic arch, ascending aorta, descending aorta) supply blood to the head, abdomen, and extremities. Of
special importance are the right and left coronary arteries that supply blood to the heart itself.

MAJOR BRANCHES OF SYSTEMIC CIRCULATION

Name Serves
Head Carotid Brain & skull
Abdomen Mesenteric Intestines
Celiac (Abdominal) Stomach, liver, spleen
Renal Kidney
Iliac Pelvis
Upper Extremity Brachial (axillary) Upper arm
Radial & Ulnar Forearm & hand
Dorsal Carpal Fingers
Lower Extremity Femoral Thigh
Popliteal Leg
Dorsal pedis Foot
Posterior tibial Foot
Capillaries

The arterioles branch into the microscopic capillaries, or capillary beds, which lie bathed in
interstitial fluid, or lymph, produced by the lymphatic system. Capillaries are the points of exchange
between the blood and surrounding tissues. Materials cross in and out of
the capillaries by passing through or between the cells that line the
capillary. The extensive network of capillaries is estimated at between
50,000 and 60,000 miles long.

Three types of capillaries can be distinguished based on features of

ethe endothelium.

1. Continuous capillaries -- are formed by "continuous" endothelial cells and basal lamina. The
endothelial cell and the basal lamina do not form openings, which would allow substances to
pass the capillary wall without passing through both the endothelial cell and the basal lamina.
Both endothelial cells and the basal lamina can act as selective filters in continuous
capillaries.

2. Fenestrated capillaries -- The endothelial cell body forms small openings called
fenestrations, which allow components of the blood and interstitial fluid to bypass the
endothelial cells on their way to or from the tissue surrounding the capillary. The
fenestrations may represent or arise from pinocytotic vesicles which open onto both the
luminal and basal surfaces of the cell. The extent of the fenestration may depend on the
physiological state of the surrounding tissue, i.e. fenestration may increase or decrease as a
function of the need to absorb or secrete. The endothelial cells are surrounded by a
continuous basal lamina, which can act as a selective filter.

3. Discontinuous capillaries -- are formed by fenestrated endothelial cells, which may not even
form a complete layer of cells. The basal lamina is also incomplete. Discontinuous capillaries
form large irregularly shaped vessels, sinusoids or sinusoid capillaries. They are found where
a very free exchange of substances or even cells between bloodstream and organ is
advantageous (e.g. in the liver, spleen, and red bone marrow).

Veins

Blood leaving the capillary beds flows into a series of progressively larger vessels, called venules,
which in turn unite to form veins. Veins are responsible for returning blood to the heart after the blood
and the body cells exchange gases, nutrients, and wastes. Pressure in veins is low, so veins depend on
nearby muscular contractions to move blood along. Veins have valves that prevent back-flow of blood.

Blood in veins is oxygen-poor, with the exception of the pulmonary veins, which carry
oxygenated blood from the lungs back to the heart. The major veins, like their companion arteries, often
take the name of the organ served. The exceptions are the superior vena cava and the inferior vena cava,
which collect body from all parts of the body (except from the lungs) and channel it back to the heart.

Artery/Vein Tissues

Arteries and veins have the same three tissue layers, but the proportions of
these layers differ. The innermost is the intima; next comes the media; and the
outermost is the adventitia. Arteries have thick media to absorb the pressure waves
created by the heart's pumping. The smooth-muscle media walls expand when pressure surges, then snap
back to push the blood forward when the heart rests. Valves in the arteries prevent back-flow. As blood
enters the capillaries, the pressure falls off. By the time blood reaches the veins, there is little pressure.
Thus, a thick media is no longer needed. Surrounding muscles act to squeeze the blood along veins. As
with arteries, valves are again used to ensure flow in the right direction.

ANATOMY OF THE HEART

The heart is about the size of a man's fist. Located between the lungs, two-thirds of it lies left of
the chest midline the heart, along with the pulmonary (to and from the lungs) and systemic (to and from
the body) circuits, completely separates oxygenated from deoxygenated blood.

Internally, the heart is divided into four hollow chambers, two on the left and two on the right.
The upper chambers of the heart, the atria (singular: atrium), receive blood via veins. Passing through
valves (atrioventricular (AV) valves), Blood then enters the lower chambers, the ventricles. Ventricular
contraction forces blood into the arteries.

Oxygen-poor blood empties into the right atrium via the superior and inferior vena cavae. Blood
then passes through the tricuspid valve into the right ventricle which contracts, propelling the blood into
the pulmonary artery. The pulmonary artery is the only artery that carries oxygen-poor blood. It branches
to the right and left lungs. There, gas exchange occurs -- carbon dioxide diffuses out, oxygen diffuses in.
 Pulmonary veins, the only veins that carry oxygen-rich blood, now carry the oxygenated blood
from lungs to the left atrium of the heart. Blood passes through the bicuspid (mitral) valve into the left
ventricle. The ventricle contracts, sending blood under high pressure through the aorta, the main artery for
systemic circulation. The ascending aorta carries blood to the upper body; the descending aorta, to the
lower body.
℘ Basic Parts and their functions
o Coronary Arteries

Because the heart is composed primarily of cardiac muscle tissue that continuously contracts and
relaxes, it must have a constant supply of oxygen and nutrients. The coronary arteries are the network of
blood vessels that carry oxygen- and nutrient-rich blood to the cardiac muscle tissue.

The blood leaving the left ventricle exits through the aorta, the body’s main artery. Two coronary
arteries, referred to as the "left" and "right" coronary arteries, emerge from the beginning of the aorta, near
the top of the heart.

The initial segment of the left coronary artery is called the left main coronary. This blood vessel is
approximately the width of a soda straw and is less than an inch long. It branches into two slightly smaller
arteries: the left anterior descending coronary artery and the left circumflex coronary artery. The left
anterior descending coronary artery is embedded in the surface of the front side of the heart. The left
circumflex coronary artery circles around the left side of the heart and is embedded in the surface of the
back of the heart.

Just like branches on a tree, the coronary arteries branch into progressively smaller vessels. The
larger vessels travel along the surface of the heart; however, the smaller branches penetrate the heart
muscle. The smallest branches, called capillaries, are so narrow that the red blood cells must travel in single
file. In the capillaries, the red blood cells provide oxygen and nutrients to the cardiac muscle tissue and
bond with carbon dioxide and other metabolic waste products, taking them away from the heart for disposal
through the lungs, kidneys and liver.

When cholesterol plaque accumulates to the point of blocking the flow of blood through a
coronary artery, the cardiac muscle tissue fed by the coronary artery beyond the point of the blockage is
deprived of oxygen and nutrients. This area of cardiac muscle tissue ceases to function properly. The
condition when a coronary artery becomes blocked causing damage to the cardiac muscle tissue it serves is
called a myocardial infarction or heart attack.

o Superior Vena Cava

The superior vena cava is one of the two main veins bringing de-oxygenated blood from the body
to the heart. Veins from the head and upper body feed into the superior vena cava, which empties into the
right atrium of the heart.
 o Inferior Vena Cava

The inferior vena cava is one of the two main veins bringing de-oxygenated blood from the body
to the heart. Veins from the legs and lower torso feed into the inferior vena cava, which empties into the
right atrium of the heart.

o Aorta

The aorta is the largest single blood vessel in the body. It is approximately the diameter of your
thumb. This vessel carries oxygen-rich blood from the left ventricle to the various parts of the body.

o Pulmonary Artery

The pulmonary artery is the vessel transporting de-oxygenated blood from the right ventricle to
the lungs. A common misconception is that all arteries carry oxygen-rich blood. It is more appropriate to
classify arteries as vessels carrying blood away from the heart.

o Pulmonary Vein

The pulmonary vein is the vessel transporting oxygen-rich blood from the lungs to the left atrium.
A common misconception is that all veins carry de-oxygenated blood. It is more appropriate to classify
veins as vessels carrying blood to the heart.

o Right Atrium

The right atrium receives de-oxygenated blood from the body through the superior vena cava
(head and upper body) and inferior vena cava (legs and lower torso). The sinoatrial node sends an impulse
that causes the cardiac muscle tissue of the atrium to contract in a coordinated, wave-like manner. The
tricuspid valve, which separates the right atrium from the right ventricle, opens to allow the de-oxygenated
blood collected in the right atrium to flow into the right ventricle.

o Right Ventricle

The right ventricle receives de-oxygenated blood as the right atrium contracts. The pulmonary
valve leading into the pulmonary artery is closed, allowing the ventricle to fill with blood. Once the
ventricles are full, they contract. As the right ventricle contracts, the tricuspid valve closes and the
pulmonary valve opens. The closure of the tricuspid valve prevents blood from backing into the right
atrium and the opening of the pulmonary valve allows the blood to flow into the pulmonary artery toward
the lungs.

o Left Atrium

The left atrium receives oxygenated blood from the lungs through the pulmonary vein. As the
contraction triggered by the sinoatrial node progresses through the atria, the blood passes through the mitral
valve into the left ventricle.

o Left Ventricle

The left ventricle receives oxygenated blood as the left atrium contracts. The blood passes through
the mitral valve into the left ventricle. The aortic valve leading into the aorta is closed, allowing the
ventricle to fill with blood. Once the ventricles are full, they contract. As the left ventricle contracts, the
mitral valve closes and the aortic valve opens. The closure of the mitral valve prevents blood from backing
into the left atrium and the opening of the aortic valve allows the blood to flow into the aorta and flow
throughout the body.

o Papillary Muscles

The papillary muscles attach to the lower portion of the interior wall of the ventricles. They
connect to the chordae tendineae, which attach to the tricuspid valve in the right ventricle and the mitral
valve in the left ventricle. The contraction of the papillary muscles opens these valves. When the papillary
muscles relax, the valves close.

o Chordae Tendineae

The chordae tendineae are tendons linking the papillary muscles to the tricuspid valve in the right
ventricle and the mitral valve in the left ventricle. As the papillary muscles contract and relax, the chordae
tendineae transmit the resulting increase and decrease in tension to the respective valves, causing them to
open and close. The chordae tendineae are string-like in appearance and are sometimes referred to as "heart
strings."

o Tricuspid Valve

The tricuspid valve separates the right atrium from the right ventricle. It opens to allow the de-
oxygenated blood collected in the right atrium to flow into the right ventricle. It closes as the right ventricle
contracts, preventing blood from returning to the right atrium; thereby, forcing it to exit through the
pulmonary valve into the pulmonary artery.
 o Mitral Value

The mitral valve separates the left atrium from the left ventricle. It opens to allow the oxygenated
blood collected in the left atrium to flow into the left ventricle. It closes as the left ventricle contracts,
preventing blood from returning to the left atrium; thereby, forcing it to exit through the aortic valve into
the aorta.

o Pulmonary Valve
o The pulmonary valve separates the right ventricle from the pulmonary artery. As the ventricles
contract, it opens to allow the de-oxygenated blood collected in the right ventricle to flow to the
lungs. It closes as the ventricles relax, preventing blood from returning to the heart.
o Aortic Valve

The aortic valve separates the left ventricle from the aorta. As the ventricles contract, it opens to
allow the oxygenated blood collected in the left ventricle to flow throughout the body. It closes as the
ventricles relax, preventing blood from returning to the heart.

BLOOD PRESSURE AND HEART RATE

The heart beats or contracts around 70 times per minute. The human
heart will undergo over 3 billion contraction/cardiac cycles during a normal
lifetime.

One heartbeat, or cardiac cycle, includes atrial contraction and

relaxation, ventricular contraction and relaxation, and a short pause. Atria
contract while ventricles relax, and vice versa. Heart valves open and close to limit flow to a single
direction. The sound of the heart contracting and the valves opening and closing produces a characteristic
"lub-dub" sound.

The cardiac cycle consists of two parts: systole (contraction of the heart muscle in the ventricles)
and diastole (relaxation of the ventricular heart muscles). When the ventricles contract, they force the
blood from their chambers into the arteries leaving the heart. The left ventricle empties into the aorta
(systemic circuit) and the right ventricle into the pulmonary artery (pulmonary circuit). The increased
pressure on the arteries due to the contraction of the ventricles (heart pumping) is called systolic
pressure.

When the ventricles relax, blood flows in from the atria. The decreased pressure due to the
relaxation of the ventricles (heart resting) is called diastolic pressure.

Blood pressure is measured in mm of mercury, with the systole in ratio to the diastole. Healthy
young adults should have a ventricular systole of 120mm, and 80mm at ventricular diastole, or 120/80.

Receptors in the arteries and atria sense systemic pressure. Nerve messages from these sensors
communicate conditions to the medulla in the brain. Signals from the medulla regulate blood pressure.

THE LYMPHATIC SYSTEM

The lymphatic system functions 1) to absorb excess fluid, thus preventing tissues from swelling;
2) to defend the body against microorganisms and harmful foreign particles; and 3) to facilitate the
absorption of fat (in the villi of the small intestine).

Capillaries release excess water and plasma into intracellular spaces, where they mix with lymph,
or interstitial fluid. "Lymph" is a milky body fluid that also contains proteins, fats, and a type of white
blood cells, called "lymphocytes," which are the body's first-line defense in the immune system.

Lymph flows from small lymph capillaries into lymph vessels that are similar to veins in having
valves that prevent backflow. Contraction of skeletal muscle causes movement of the lymph fluid through
valves. Lymph vessels connect to lymph nodes, lymph organs (bone marrow, liver, spleen, thymus), or to
the cardiovascular system.

• Lymph nodes are small irregularly shaped masses through which lymph vessels flow. Clusters of
nodes occur in the armpits, groin, and neck. All lymph nodes have the primary function (along
with bone marrow) of producing lymphocytes.
• The spleen filters, or purifies, the blood and lymph flowing through it.
• The thymus secretes a hormone, thymosin that produces T-cells, a form of lymphocyte.
PATHOPHYSIOLOGY OF HYPERTENSION
 Hypertension (high blood pressure) is a disease of vascular regulation resulting from malfunction
of arterial pressure control mechanisms (central nervous system, rennin-angiotensinaldosterone system,
extracellular fluid volume.) the cause is unknown, and there is no cure. The basic explanation is that
blood pressure is elevated when there is increased cardiac output plus increased peripheral vascular
resistance.

The two major types of hypertension are primary (essential) hypertension, in which diastrolic
pressure is 90 mm Hg or higher and systolic pressure is 140 mm Hg or higher in absence of other causes
of hypertension (approximately 95 % of patients); and Secondary hypertension, which results primarily
from renal disease, endocrine disorders, and coarctation of the aorta. Either of these conditions may give
rise to accelerated hypertension – a medical emergency – in which blood pressure elevates very rapidly to
threaten one or more of the target organs: the brain, kidney, or the heart.

Hypertension is one of the most prevalent chronic diseases for which treatment is available;
however, most patients with hypertension are unaware, untreated, or inadequately treated. Risk factors for
hypertension are age between 30 and 70; black; overweight; sleep apnea; family history; cigarette
smoking; sedentary lifestyle; and diabetes mellitus. Because hypertension presents no over symptoms, it
is termed the “silent killer.” The untreated disease may progress to retinopathy, renal failure, coronary
artery disease, heart failure, and stroke.

Hypertension in children is defined as the average systolic or diastolic blood pressure greater than
or equal to the 95th percentile for age and sex with measurement on at lease three occasions. The
incidence of hypertension in children is low, but it is increasingly being recognized in adolescents; and it
may occur in neonates, infants, and young children with secondary causes.
 Anatomy and Physiology

• Vagina: A muscular passageway that leads from the vulva (external genitalia) to the
cervix.

• Cervix: A small hole at the end of the vagina through which sperm passes into the
uterus. Also serves as a protective barrier for the uterus. During childbirth, the cervix
dilates (widens) to permit the baby to descend from the uterus into the vagina for
birth.

• Uterus: A hollow organ that houses the baby during pregnancy. During childbirth, the
uterine muscles contract to push out the baby. Each month, unless a fetus has been
conceived, the uterine wall sheds its lining (see The Menstrual Cycle and Ovulation
below).

• Ovaries: Two organs that produce hormones and store eggs. Each ovary releases one
egg per month.

• Fallopian tubes: Muscular tubes that eggs released from the ovaries must traverse to
reach the uterus.
The Menstrual Cycle and Ovulation

Each month a woman’s body goes through a menstrual cycle. A woman can become
pregnant only during ovulation, a several-day phase in the middle of the menstrual cycle when one
of the ovaries releases an egg.

If the ovulated egg is fertilized by a man’s sperm following sexual intercourse, it will
implant in the endometrium, the lining of the uterus that becomes the placenta during
pregnancy. The placenta nurtures the fertilized egg as it develops and grows into a baby.

Female Anatomy
Events Weeks of Pregnancy
1st Trimester
The woman's last period before 0
fertilization occurs.

Fertilization occurs. 2
The fertilized egg (zygote) begins to
develop into a hollow ball of cells
called the blastocyst.

The blastocyst implants in the wall 3

of uterus.The amniotic sac begins to
form.

The area that will become the brain 5

and spinal cord (neural tube) begins
to develop.

The heart and major blood vessels 6

are developing. The beating heart
can be seen during ultrasonography.

The beginnings of arms and legs 7

appear.

Bones and muscles form. The face 9

and neck develop.
Brain waves can be detected.
The skeleton is formed. Fingers and
toes are fully defined.

The kidneys begin to function. 10

Almost all organs are completely
formed.
The fetus can move and respond to
touch (when prodded through the
woman's abdomen).
The woman has gained some weight,
and her abdomen may be slightly
enlarged.

2nd Trimester
The fetus's sex can be identified. 14
The fetus can hear.

The fetus's fingers can grasp. The 16

fetus moves more vigorously, so that
the mother can feel it.
The fetus's body begins to fill out as
fat is deposited beneath the skin.
Hair appears on the head and skin.
Eyebrows and eyelashes are present.

The placenta is fully formed. 20

The fetus has a chance of survival 24

outside the uterus.
The woman begins to gain weight
more rapidly.

3rd Trimester

The fetus is active, changing 25

positions often.
The lungs continue to mature.
The fetus's head moves into position
for delivery.
On average, the fetus is about 20
inches long and weighs about 7
pounds. The woman's enlarged
abdomen causes the navel to bulge.

Delivery 37-42
 MEDICAL MANAGEMENT AND NURSING INTERVENTION

℘ Medical management

1. The pharmacological therapy includes the following:

• Amoxicillin (antibiotic) 500 mg cap BID x 7 days
• Mefenamic Acid 500 mg cap BID as needed
• Ferrous Sulfate 1 cap OD x 30 days
• Methyllergometrine 1 tab BID
• Magnesium Sulfate (anticonvulsant) 4g slow IV
2. The pharmacological therapy for inducing diuresis is:
• 5% Dextrose in Lactated Ringer's
3. Recommended for low fat low salt diet because of high blood pressure.
4. Advise to massage her uterus.
5. Advise to remain on drug therapy to control blood pressure.

℘ Nursing consideration

1. Monitor vital signs q4h

2. Administer medications as prescribed
3. Record urine output
4. Provide health education:
• Advised patient to massage uterus
• Advised patient to massage and apply warm compress on the breast
• Decrease fluid intake
• Advised patient to elevate lower extremities and apply warm compress on edema
• Encouraged to decrease sodium intake
• Advised patient to complete immunization on time
Predisposing Factors Etiologic Factor Precipitating Factors
• Age (<20, >35 years old) • Unknown • Sedentary Lifestyle
• Race • Poor Diet
• Family History of Hypertension

↑ BP – vasospasm

Decreased placental perfusion

Endothelial cell activation

Vasoconstriction Activation of coagulation Intravascular fluid

of cascade redistribution

Decreased organ perfusion

A
 Generalized vasoconstriction Hypertension

IUGR
Decreased placental perfusion
A Uteroplacental arteriole lesions Abruptio placenta
Increased uterine contractility

Placental production of Proteinuria

endothelin Glomerular damaged Increased plasma uric acid and creatinine
Oliguria
Increased sodium retention
Endothelial cell
damage Visual edema of face, hands, and
Generalized Edema abdomen
Vasospasms Fixing edema alter 12 hours of bed rest

Headache
Cortical brain spasms Hyperreflexia
Seizure activity
Increased thromboxane to prostacyclin
Increased sensitivity to angiotensin II Pulmonary edema Dyspnea
Decreased nitric oxide

Fluid shifts from Intravascular to Blurred vision

Retinal arteriolar spasms Scotoma
intracellular space
(Decreased plasma volume)
(Increased hematocrit)
Decreased Hemoglobin
Hemolysis of RBC Maternal hyperbilirubinemia
Increased endothelin

Intravascular coagulation
Elevated liver enzymes (AST and LDH)
Nausea and vomiting
Hepatic microemboli; Epigastric pain
Liver damage Right upper quadrant pain
Decreased blood glucose
Liver rupture

Platelet aggregation Low platelet count

and fibrin deposition (Thrombocytopenia)-DIC
DRUG USES DOSAGE SIDE-EFFECTS PRECAUTIONS

 It is a penicillin-type  Take this medication by  Nausea, vomiting or  Before taking

antibiotic used to treat a mouth with or without diarrhea may occur. If amoxicillin, tell your
wide variety of food, usually every 8 or any of these effects doctor or pharmacist if
bacterial infections. It 12 hours, or as directed persist or worsen, you are allergic to it; or
works by stopping the by your doctor. The notify your doctor or to penicillin or
growth of bacteria. dosage is based on your pharmacist promptly cephalosporin
 This antibiotic treats medical condition and  It can commonly cause antibiotics; or if you
only bacterial response to therapy. a mild rash that is have any other
infections. It will not usually not serious. allergies.
work for viral However, you may not  Before using this
infections (e.g., be able to tell it apart medication, tell your
common cold, flu). from a rare rash that doctor or pharmacist
could be a sign of a your medical history,
severe allergic reaction. especially of: kidney
Therefore, seek disease, a certain type
immediate medical of viral infection
Amoxicillin
attention if you develop (infectious
any rash. mononucleosis).
 Tell your doctor  This medication should
immediately if any of be used only when
these highly unlikely clearly needed during
but very serious side pregnancy. Discuss the
effects occur: dark risks and benefits with
urine, persistent nausea your doctor.
or vomiting,
stomach/abdominal
pain, yellowing eyes or
skin, easy bruising or
bleeding, persistent sore
throat or fever.
Ferrous Sulfate  It is an iron supplement  Follow all directions on  Constipation, diarrhea,  Before taking this
used to treat or prevent the product package, or stomach cramps, or medication, tell your
low blood levels of iron take as directed by your upset stomach may doctor or pharmacist if
(e.g., for anemia or doctor. Do not take occur. These effects are you are allergic to it; or
during pregnancy). Iron more than the usually temporary and to tartrazine; or if you
is an important mineral recommended dosage. may disappear as your have any other
that the body needs to If you are uncertain body adjusts to this allergies.
produce red blood cells about any of the medication. If any of  This medication should
and keep you in good information, consult these effects persist or not be used if you have
health. your doctor or worsen, contact your certain medical
pharmacist. doctor or pharmacist conditions. Before
 This medication is best promptly. taking this medication,
taken on an empty consult your doctor or
stomach 1 hour before pharmacist if you have:
or 2 hours after meals. iron overload disorder
Take with a full glass of (e.g., hemochromatosis,
water (8 ounces or 240 hemosiderosis).
milliliters) unless your  During pregnancy, this
doctor directs you medication should be
otherwise. If stomach used only when clearly
upset occurs, you may needed. Discuss the
take this medication risks and benefits with
with food. Avoid taking your doctor.
antacids, dairy
products, tea, or coffee
within 2 hours before or
after this medication
because they will
decrease its
effectiveness. Do not
lie down for 30 minutes
after taking this
medication.
 If you are taking a time-
release tablet or
capsule, it must be
swallowed whole. Do
 not crush, chew, or
break the tablet or
capsule. Doing so can
destroy the long action
of the drug and may
increase side effects.

 Mefenamic acid is  Dosage is based on  Upset stomach, nausea,  Before taking

Mefenamic Acid used for the short- your medical condition heartburn, dizziness, mefenamic acid, tell
term treatment of and response to drowsiness, diarrhea, your doctor or
mild to moderate pain therapy. To reduce and headache may pharmacist if you are
from various your risk of stomach occur. If any of these allergic to it; or to
conditions. It is also bleeding and other side effects persist or aspirin or other
used to decrease pain effects, take this worsen, notify your NSAIDs (e.g.,
and blood loss from medication at the doctor or pharmacist ibuprofen, naproxen,
menstrual periods. lowest effective dose promptly. celecoxib); or if you
 Mefenamic acid is for the shortest  Tell your doctor have any other
known as a possible time. Do not immediately if any of allergies.
nonsteroidal anti- increase your dose, these unlikely but  Before using this
inflammatory drug take it more frequently, serious side effects medicine, consult your
(NSAID). or take it for a longer occur: fainting, doctor or pharmacist if
time than prescribed. persistent/severe you have: aspirin-
This medication headache, hearing sensitive asthma (a
usually should not be changes (e.g., ringing history of worsening
taken for more than 7 in the ears), breathing with
days at a time. fast/pounding runny/stuffy nose after
 If you are taking this heartbeat, taking aspirin or other
drug on an "as needed" mental/mood changes, NSAIDs, severe kidney
basis (not on a regular stomach pain, difficult/ disease, recent heart
schedule), remember painful swallowing, bypass surgery
that pain medications swelling of the (CABG), active
work best if they are ankles/feet/hands, bleeding/sores in
used as the first signs sudden/unexplained stomach/intestines
of pain occur. If you weight gain, vision (ulcer, gastrointestinal
wait until the changes. bleeding).
symptoms have  Stop taking mefenamic  This drug may make
worsened, the acid and tell your you dizzy or drowsy
medicine may not doctor immediately if  This medicine may
 work as well. any of these rare but cause stomach
 If you are using this very serious side bleeding. Daily use of
medication for painful effects occur: easy alcohol and tobacco,
periods, take your first bruising/bleeding, especially when
dose as soon as your signs of infection (e.g., combined with this
period starts or pain fever, persistent sore medicine, may increase
begins. Usually, you throat), unexplained your risk for stomach
will only need to take stiff neck, change in bleeding. Limit alcohol
it for the first 2 to 3 the amount/color of and stop smoking.
days of your period. urine.  During the first 6
 This drug may rarely months of pregnancy,
cause serious, possibly this medication should
fatal liver disease. If be used only when
you notice any of the clearly needed. It is not
following rare but very recommended for use
serious side effects, during the last 3
stop taking mefenamic months of pregnancy
acid and consult your due to possible harm to
doctor or pharmacist the unborn baby and
immediately: persistent interference with
nausea/vomiting, normal labor/delivery.
severe Discuss the risks and
stomach/abdominal benefits with your
pain, extreme/unusual doctor.
tiredness, weakness,  This drug may pass
dark urine, yellowing into breast milk and
eyes/skin. could have undesirable
 A very serious allergic effects on a nursing
reaction to this drug is infant. Therefore,
rare. However, stop breast-feeding is not
taking mefenamic acid recommended while
and immediately seek using this drug.
medical attention if Consult your doctor
you notice any of the before breast-feeding.
following symptoms of
a serious allergic
reaction: rash/blisters,
itching/swelling
 (especially of the
face/tongue/throat),
severe dizziness,
trouble breathing.

 This medication is used  Take this medication  Headache, nausea,  Before taking
to help stop bleeding by mouth without dizziness, or vomiting methylergometrine, tell
Methylergometrine after delivery of the food, usually 3-4 times may occur. If any of your doctor or
placenta in childbirth. daily for a maximum these effects persist or pharmacist if you are
Methylergonovine of 1 week or as worsen, tell your allergic to it; or to
maleate belongs to a directed by your doctor or pharmacist similar ergot alkaloids
class of drugs known as doctor. promptly. (e.g., ergonovine); or if
ergot alkaloids. It  Dosage is based on  Tell your doctor you have any other
works by increasing the your medical condition immediately if any of allergies.
stiffness of the uterus and response to these unlikely but  Before using this
muscles after the last therapy. serious side effects medication, tell your
stage of labor. This occur: leg cramps, doctor or pharmacist
effect decreases ringing in the ears, your medical history,
bleeding. stuffy nose, diarrhea, especially of: heart
bad taste in the mouth. disease (e.g., venoatrial
 Tell your doctor shunt, mitral valve
immediately if any of stenosis), other
these rare but very complications during
serious side effects pregnancy (e.g., pre-
occur: sweating, eclampsia, eclampsia),
fast/irregular heartbeat, a serious blood
breathing problems, infection (sepsis),
hallucinations. blood vessel problems
 Seek immediate (e.g., Raynaud's
medical attention if phenomenon,
this rare but very obliterative vascular
serious side effect disease), kidney
occurs: chest pain. problems, liver
problems.
 This medication must
not be used during
pregnancy. It may
harm an unborn baby.
 This drug passes into
breast milk
 Disseminated intravascular coagulopathy
Disseminated intravascular coagulation (DIC) is a complex systemic thrombohemorrhagic disorder
involving the generation of intravascular fibrin and the consumption of procoagulants and
platelets.

Definition:

The subcommittee on DIC of the International Society on Thrombosis and Hemostasis has
suggested the following definition for DIC: "An acquired syndrome characterized by the
intravascular activation of coagulation with loss of localization arising from different causes. It can
originate from and cause damage to the microvasculature, which if sufficiently severe, can produce
organ dysfunction"

Acute and chronic forms

DIC is a pathophysiologic term describing a continuum of events that occur in the coagulation
pathway in association with a variety of disease states. DIC occurs in acute and chronic forms.

Pathophysiology:

The pathophysiology of DIC involves the initiation of coagulation via endothelial injury or tissue
injury and the subsequent release of procoagulant material in the form of cytokines and tissue
factors. Interleukin-6 and tumor necrosis factor may be the most influential cytokines involved in
coagulation activation (via tissue factor) and may be responsible for the end-organ damage that
occurs. Further, in the setting of sepsis, neutrophils and their secretory products may promote
platelet-mediated fibrin formation.

Signs and symptoms

The affected person is often acutely ill and shocked with widespread haemorrhage (common
bleeding sites are mouth, nose and venipuncture sites), extensive bruising, renal failure and
gangrene. The onset of DIC can be fulminant, as in endotoxic shock or amnioitic fluid embolism,
or it may be insidious and chronic, as in cases of carcinomatosis or retention of dead fetus.
The mechanism of disseminated intravascular coagulation:

Systemic activation
Of coagulation

Intravascular deposition Depletion of platelets

Of fibrin And coagulation factors

Thrombosis of small
Midsize vessels Bleeding
And organ failure

Causes
DIC can occur in the following conditions:

• Cancers of lung, pancreas, prostate and stomach

• Obstetric: abruptio placentae, retained dead fetus, pre-eclampsia, amniotic fluid embolism
• Massive tissue injury: Trauma, burns, extensive surgery
• Infections: Gram-negative sepsis, Neisseria meningitidis, Streptococcus pneumoniae,
malaria, histoplasmosis, aspergillosis, Rocky mountain spotted fever
• Miscellaneous: Liver disease, snake bite, acute intravascular hemolysis, giant hemangioma,
shock, heat stroke, vasculitis, aortic aneurysm, Serotonin syndrome

Treatment
The only effective treatment is the reversal of the underlying cause. Anticoagulants are given
exceedingly rarely when thrombus formation is likely to lead to imminent death (such as in
coronary artery thrombosis or cerebrovascular thrombosis). Platelets may be transfused if counts
are less than 5,000-10,000/mm3 and massive hemorrhage is occurring, and fresh frozen plasma
may be administered in an attempt to replenish coagulation factors and anti-thrombotic factors,
although these are only temporizing measures and may result in the increased development of
thrombosis.

DIC results in lower fibrinogen levels (as it has all been converted to fibrin), and this can be tested
for in the hospital lab. A more specific test is for "fibrin split products" (FSPs) or "fibrin
degradation products" (FDPs) which are produced when fibrin undergoes degradation when blood
clots are dissolved by fibrinolysis.

In some situations, infusion with antithrombin may be necessary.

 DIC
Consumption of coagulation factors Microvascular coagulation and fibrin deposition

Deficiency of coagulation factors Secondary fibrinolysis with FDP production Microvascular obtruction

Haemorrhagic diathesis Organ ischaemia

 Hydatidiform Mole
WHAT IS GESTATIONAL TROPHOBLASTIC DISEASE?

Gestational Trophoblastic Disease, existing in many terms like Hydatidiform Mole, is a

condition associated with second-trimester bleeding. It is an abnormal proliferation and
degeneration of the trophoblastic villi. As the cells degenerate, they become filled with fluid and
appear as clear fluid-filled, grape-sized vesicles. With this condition, the embryo fails to develop
beyond a primitive start. Such structures must be identified because they are associated with
choriocarcinoma, a rapidly metastasizing malignancy. The incidence of gestational trophoblastic
disease is approximately 1 in every 1,500 pregnancies.

Two types of molar growth can be identified by chromosomal analysis:

Complete Mole: All trophoblastic villi swell and become cystic. If an embryo forms, it dies early at
only 1 to 2 mm in size, with no fetal blood present in the villi. On chromosomal analysis, although
the karyotype is a normal 46XX or 46XY, this chromosome component was contributed only by a
father or an “empty ovum” was fertilized and the chromosome material was duplicated (Fig. 1).

Sperm Ovum
2 4
+ + Duplication =

Fig. 1.Complete mole.

Partial Mole: With a partial mole, some of the villi form normally. The syncytiotrophoblastic
layer of the villi, however, is swollen and misshapen. A macerated embryo of approximately 9
weeks; gestation may be present in the villi. A partial mole has 69 chromosomes (a triploid
formation in which there is three chromosomes instead of two for every pair, one set supplied by
Sperm Ovum
an ovum that apparently was fertilized by two sperm or an ovum fertilized by one sperm in which
meiosis or reduction division
4 did not occur). 2This could also occur if one set 6of 23 chromosomes
+ =
was supplied by one sperm and an ovum did not undergo reduction division supplied 46 (see Fig.
or
2). In contrast to complete moles, partial moles rarely lead to choriocarcinoma.
2

+ + 2 = 6

2
 Fig. 2. Partial mole.
III. PREDISPOSING FACTORS

A. Diet: Low CHON and low Vitamin A (carotene) intake.

B. Age: Women older than 35 years. GTD is higher toward the beginning and toward the end of
child bearing period. It is ten times more in women who are 45 years old and beyond.
C. Race: Asian heritage. Molar pregnancy has no racial or ethnic predilection, although Asian
countries show a rate 15 times higher than the US rate.

IV. SIGNS AND SYMPTOMS

A. Symptoms:
1. amenorrhea
2. exaggerated symptoms of pregnancy especially vomiting
3. symptoms of preeclampsia that may be present as headache and edema
4. vaginal bleeding as the main complaint; due to the separation of vesicles from the uterine
wall and there may be blood-stained, watery discharge (the watery part is from the ruptured
vesicles)
• Prune juice-like discharge may occur brownish because it is retained for sometime
inside the uterine cavity.
• Blood may be concealed in the uterus, thereby causing enlargement.
 5. abdominal pain: may be dull-aching due to rapid distension of uterine by mole or by
concealed hemorrhage; colicky due to start of expulsion
6. ovarian pain due to stretching of ovarian capsule or complication in the cystic ovary as
torsion

B. Signs:
1. preeclampsia develops in 20 – 30 % cases, usually before 20 weeks’ AOG
2. pallor indicating anemia may be present
3. hyperthyroidism develops in 3-10% of cases manifested by enlarged thyroid gland and
tachycardia (due to chorionic thyrotropin secreted by the trophoblast and hCG also has a
thyroid-stimulating effect)

Nursing Management:

Nursing Considerations:

• A gynecologic oncologist should be consulted if the patient is believed to be at risk for or

has developed malignant disease.
• No special diet is required.
• Patients may resume activity as tolerated.
• Pelvic rest is recommended for 4-6 weeks after evacuation of the uterus, and the patient is
instructed not to become pregnant for 12 months. Adequate contraception is recommended
during this period.
• Monitor serial beta-HCG values to identify the rare patient who develops malignant
disease. If a pregnancy does occur, the elevation in beta-HCG would be confused with
development of malignant disease.
 V. PATHOPHYSIOLOGY

Low intake of proteins and vitamin A, Asian heritage, Women older than 35 years

Partial mole
or
Complete mole

Chronic villi degenerates and become filled with fluid

No vasculature in chorionic villi

Early death & absorption of embryo Absence of FHT

Uterus
expands faster Abdominal
Trophoblastic proliferation than normal pain

High secretion of hCG High progesterone low estrogen High chorionic

thyrotropin

Decreased contraction Amenorrhea

Marked nausea &
vomiting Hyperthyroidism

Separation of vesicles from

uterine wall
Multiple theca lutein cysts Enlarged thyroid
in the ovaries gland; tachycardia
Vaginal bleeding &
discharge of vesicles

Ovarian
pain

Pallor Preeclampsia
Note: Those inside the boxes end up as the signs & symptoms of H mole.

SCHIZOPHRENIA

Schizophrenia is an extremely complex mental disorder: in fact it is probably many illnesses

masquerading as one. A biochemical imbalance in the brain is believed to cause symptoms. Recent
research reveals that schizophrenia may be a result of faulty neuronal development in the fetal
brain, which develops into full-blown illness in late adolescence or early adulthood.

Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions, movement, and
behavior. It cannot be defined as a single illness; rather thought as a syndrome or disease process
with many different varieties and symptoms. It is usually diagnosed in late adolescence or early
adulthood. Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25 years of
age for men and 25 to 35 years of age for women.

TYPES OF SCHIZOPHRENIA:

The diagnosis is made according to the client’s predominant symptoms:

• Schizophrenia, paranoid type is characterized by persecutory (feeling victimized or spied

on) or grandiose delusions, hallucinations, and occasionally, excessively religiosity
(delusional focus) or hostile and aggressive behavior.
• Schizophrenia, disorganized type is characterized by grossly inappropriate or flat affect,
incoherence, loose associations, and extremely disorganized behavior.
• Schizophrenia, catatonic type is characterized by marked psychomotor disturbance, either
motionless or excessive motor activity. Motor immobility may be manifested by catalepsy
(waxy flexibility) or stupor.
• Schizophrenia, undifferentiated type is characterized by mixed schizophrenic symptoms
(of other types) along with disturbances of thought, affect, and behavior.
• Schizophrenia, residual type is characterized by at least one previous, though not a current,
episode, social withdrawal, flat affect and looseness of associations.

ANATOMY AND PHYSIOLOGY:

Structure and function of the nervous system

I. Structures

A. The neurologic system consists of two main divisions, the central nervous system (CNS) and the
peripheral nervous system (PNS). The autonomic nervous system (ANS) is composed of both
central and peripheral elements.

1. The CNS is composed of the brain and spinal cord.

 2. The PNS is composed of the 12 pairs of the cranial nerves and the 31 pairs of the spinal
nerves.

3. The ANS is comprised of visceral efferent (motor) and the visceral afferent (sensory)
nuclei in the brain and spinal cord. Its peripheral division is made up of visceral efferent
and afferent nerve fibers as well as autonomic and sensory ganglia.

B. The brain is covered by three membranes.

1. The dura matter is a fibrous,

connective tissue structure containing
several blood vessels.

2. The arachnoid membrane is a delicate

serous membrane.

3. The pia matter is a vascular membrane.

C. The spinal cord extends from the medulla

oblongata to the lower border of the first
lumbar vertebrae. It contains millions of
nerve fibers, and it consists of 31 nerves – 8 cervical, 12 thoracic, 5 lumbar, and 5 sacral.

D. Cerebrospinal fluid (CSF) forms in the lateral ventricles in the choroid plexus of the pia
matter. It flows through the foramen of Monro into to the third ventricle, then through the
aqueduct of Sylvius to the fourth ventricle. CSF exits the fourth ventricle by the foramen of
Magendie and the two foramens of Luska. It then flows into the cistema magna, and finally
it circulates to the subarachnoid space of the spinal cord, bathing both the brain and the
spinal cord. Fluid is absorbed by the arachnoid membrane.

II. Function
A. CNS

1. Brain

a The cerebrum is the center for consciousness, thought, memory, sensory input, and
motor activity; it consists of two hemispheres (left and right) and four lobes, each
with specific functions.

i The frontal lobe controls voluntary muscle movements and contains motor areas,
including the area for speech; it also contains the centers for personality,
behavioral, autonomic and intellectual functions and those for emotional and
cardiac responses.

ii The temporal lobe is the center for taste, hearing and smell, and in the brain’s
dominant hemisphere, the center for interpreting spoken language.
 iii The parietal lobe coordinates and interprets sensory information from the
opposite side of the body.

iv The occipital lobe interprets visual stimuli.

b The thalamus further organizes cerebral function by transmitting impulses to and

from the cerebrum. It also is responsible for primitive emotional responses, such as
fear, and for distinguishing between pleasant and unpleasant stimuli.

c Lying beneath the thalamus, the hypothalamus is an automatic center that regulates
blood pressure, temperature, libido, appetite, breathing, sleeping patterns, and
peripheral nerve discharges associated with certain behavior and emotional
expression. It also helps control pituitary secretion and stress reactions.

d The cerebellum or hindbrain, controls smooth

muscle movements, coordinates sensory
impulses with muscle activity, and maintains
muscle tone and equilibrium.

e The
brain stem, which includes the mesencephalon, pons, and medulla oblongata,
relays nerve impulses between the brain and spinal cord.

2. The spinal cord forms a two-way conductor pathway between the brain stem and the
PNS. It is also the reflex center for motor activities that do not involve brain control.

B. The PNS connects the CNS to remote body regions and conducts signals to and from these
areas and the spinal cord.

C. The ANS regulates body functions such as digestion, respiration, and cardiovascular
function. Supervised chiefly by the hypothalamus, the ANS contains two divisions.

1. The sympathetic nervous system serves as an emergency preparedness system, the

“flight-for-fight” response. Sympathetic impulses increase greatly when the body is
under physical or emotional stress causing bronchiole dilation, dilation of the heart and
voluntary muscle blood vessels, stronger and faster heart contractions, peripheral blood
 vessel constriction, decreased peristalsis, and increased perspiration. Sympathetic
stimuli are mediated by norepinephrine.

2. The parasympathetic nervous system is the dominant controller for most visceral
effectors for most of the time. Parasympathetic impulses are mediated by acetylcholine.

TREATMENTS AND MEDICATIONS:

Currently, there is no method for preventing schizophrenia and there is no cure. Minimizing the
impact of disease depends mainly on early diagnosis and, appropriate pharmacological and psycho-
social treatments. Hospitalization may be required to stabilize ill persons during an acute episode.
The need for hospitalization will depend on the severity of the episode. Mild or moderate episodes
may be appropriately addressed by intense outpatient treatment. A person with schizophrenia
should leave the hospital or outpatient facility with a treatment plan that will minimize symptoms
and maximize quality of life.

A comprehensive treatment program can include:

• Antipsychotic medication
• Education & support, for both ill individuals and families
• Social skills training
• Rehabilitation to improve activities of daily living
• Vocational and recreational support
• Cognitive therapy

Medication is one of the cornerstones of treatment.

Once the acute stage of a psychotic episode has passed, most people with schizophrenia will need
to take medicine indefinitely. This is because vulnerability to psychosis doesn’t go away, even
though some or all of the symptoms do. In North America, atypical or second generation
antipsychotic medications are the most widely used. However, there are many first-generation
antipsychotic medications available that may still be prescribed. A doctor will prescribe the
medication that is the most effective for the ill individual

Another important part of treatment is psychosocial programs and initiatives. Combined with
medication, they can help ill individuals effectively manage their disorder. Talking with your
treatment team will ensure you are aware of all available programs and medications.

In addition, persons living with schizophrenia may have access to or qualify for income support
programs/initiatives, supportive housing, and/or skills development programs, designed to promote
integration and recovery.

NURSING INTERVENTIONS:
Strengthening differentiation

• Provide patient with honest and consistent feedback in a non threatening manner.
• Avoid challenging the content of patient’s behavior
• Focus interactions on patient’s behavior.
• Administer drugs as prescribed while monitoring and documenting patient’s
response to drug regimen.
• Use simple and clear language when speaking with the patient.
• Explain all procedures, test and activities to patient before starting them

Promoting socialization

• Encourage patient to talk about feelings in the context of a trusting, supportive

relationship.
• Allow patient to reveal delusions to you without engaging in power struggle over
the content or the entire reality of the delusions.
• Use supportive, emphatic approach to focus on patient’s feelings about troubling
events or conflicts.
• Provide opportunities for socialization and encourage participation in group
activities.
• Be aware of personal space and use touch judiciously.
• Help patient to identify behaviors that alienate significant others and family
members.

Ensuring safety:

• Monitor patient for behaviors that indicate increased anxiety and agitation.
• Collaborate patient to identify anxious behaviors as well as causes.
• Establish consistent limits on patients behavior and clearly communicate these
limits to patients, family member, and health care providers.
• Secure all potential weapons and articles from patients room and the unit
environment that could be used to inflict injury.
• Determine the need for external control, including seclusion or restraints.
Communicate the decision to patient and put plan into action.
• Frequently monitor the patient within guidelines of facility’s policy on restrictive
devices and assess the patients level of agitation.
• When patient’s level of agitation begins to decrease and self control regained,
establish a behavioral agreement that identifies specific behaviors that indicate self
control against are escalation agitation.
 Phases of COPAR
Definitions of COPAR:

D A social development approach that aims to transform the apathetic, individualistic

and voiceless poor into dynamic, participatory and politically responsive community.

a A collective, participatory, transformative, liberative, sustained and systematic

process of building people’s organizations by mobilizing and enhancing the capabilities
and resources of the people for the resolution of their issues and concerns towards
effecting change in their existing oppressive and exploitative conditions (1994 National
Rural Conference)

R A process by which a community identifies its needs and objectives, develops

confidence to take action in respect to them and in doing so, extends and develops
cooperative and collaborative attitudes and practices in the community (Ross 1967)
  A continuous and sustained process of educating the people to understand and develop
their critical awareness of their existing condition, working with the people collectively
and efficiently on their immediate and long-term problems, and mobilizing the people
to develop their capability and readiness to respond and take action on their immediate
needs towards solving their long-term problems

Importance of COPAR:

1. COPAR is an important tool for community development and people empowerment

as this helps the community workers to generate community participation in
development activities.

2. COPAR prepares people/clients to eventually take over the management of a

development programs in the future.

3. COPAR maximizes community participation and involvement; community resources

are mobilized for community services.

Principles of COPAR:

1. People, especially the most oppressed, exploited and deprived sectors are open to
change, have the capacity to change and are able to bring about change.

2. COPAR should be based on the interest of the poorest sectors of society

3. COPAR should lead to a self-reliant community and society.

COPAR Process:

C A progressive cycle of action-reflection action which begins with small, local and
concrete issues identified by the people and the evaluation and the reflection of and on
the action taken by them.

t Consciousness through experimental learning central to the COPAR process because

it places emphasis on learning that emerges from concrete action and which enriches
succeeding action.
 COPAR is participatory and mass-based because it is primarily directed towards and
biased in favor of the poor, the powerless and oppressed.

b COPAR is group-centered and not leader-oriented. Leaders are identified, emerge

and are tested through action rather than appointed or selected by some external force
or entity.

Phases of the COPAR Process

I. Pre-entry Phase

A. Is the initial phase of the organizing process where the community/organizer looks for
communities to serve/help.

B. It is considered the simplest phase in terms of actual outputs, activities and strategies and
time spent for it.

Activities include:

1. Designing a plan for community development including all its activities and
strategies for care development.

2. Designing criteria for the selection of site

3. Actually selecting the site for community care

Preparation of the Institution

o Train faculty and students in COPAR.

o Formulate plans for institutionalizing COPAR.
o Revise/enrich curriculum and immersion program.
o Coordinate participants of other departments.

Site Selection

o Initial networking with local government.

o Conduct preliminary special investigation.
o Make long/short list of potential communities.
o Do ocular survey of listed communities.
Criteria for Initial Site Selection

o Must have a population of 100-200 families.

o Economically depressed.
o No strong resistance from the community.
o No serious peace and order problem.
o No similar group or organization holding the same program.

Identifying Potential Municipalities

o Make long/short list.

Identifying Potential Barangay

o Do the same process as in selecting municipality.

o Consult key informants and residents.
o Coordinate with local government and NGOs for future activities.

Choosing Final Barangay

o Conduct informal interviews with community residents and key informants.

o Determine the need of the program in the community.
o Take note of political development.
o Develop community profiles for secondary data.
o Develop survey tools.
o Pay courtesy call to community leaders.
o Choose foster families based on guidelines.

Identifying Host Family

o House is strategically located in the community.

o Should not belong to the rich segment.
o Respected by both formal and informal leaders.
o Neighbors are not hesitant to enter the house.
o No member of the host family should be moving out in the community.

II. Entry Phase

A. Sometimes called the social preparation phase as to the activities done here includes the
sensitization of the people on the critical events in their life, innovating them to share their
dreams and ideas on how to manage their concerns and eventually mobilizing them to take
collective action on these.

B. This phase signals the actual entry of the community worker/organizer into the
community. She must be guided by the following guidelines however.
 1. Recognizes the role of local authorities by paying them visits to inform them of their
presence and activities.

2. The appearance, speech, behavior and lifestyle should be in keeping with those of the
community residents without disregard of their being role models.

3. Avoid raising the consciousness of the community residents; adopt a low-key profile.

Guidelines for Entry

o Recognize the role of local authorities by paying them visits to inform their presence and
activities.
o Her appearance, speech, behavior and lifestyle should be in keeping with those of the
community residents without disregard of their being role model.
o Avoid raising the consciousness of the community residents; adopt a low-key profile.

Activities in the Entry Phase

o Integration - establishing rapport with the people in continuing effort to imbibe

community life.
 living with the community
 seek out to converse with people where they usually congregate
 lend a hand in household chores
 avoid gambling and drinking

o Deepening social investigation/community study

 verification and enrichment of data collected from initial survey
 conduct baseline survey by students, results relayed through community
assembly

Leader Spotting Through Sociogram.

Key persons - approached by most people

Opinion leader - approach by key persons
Isolates - never or hardly consulted

III. Organization Building Phase

 A. Entails the formation of more formal structures and the inclusion of more formal
procedures of planning, implementation, and evaluating community-wide activities. It is at
this phase where the organized leaders or groups are being given trainings (formal,
informal, OJT) to develop their skills and in managing their own concerns/programs.

Key Activities

o Community Health Organization (CHO)

 preparation of legal requirements
 guidelines in the organization of the CHO by the core group
 election of officers
o Research Team Committee
o Planning Committee
o Health Committee Organization
o Others
o Formation of by-laws by the CHO

IV. Sustenance and Strengthening Phase

A. Occurs when the community organization has already been established and the
community members are already actively participating in community-wide undertakings.
At this point, the different communities setup in the organization building phase are already
expected to be functioning by way of planning, implementing and evaluating their own
programs with the overall guidance from the community-wide organization.

1. Strategies used may include:

a. Education and training

b. Networking and linkaging

c. Conduct of mobilization on health and development concerns

d. Implementing of livelihood projects

 e. Developing secondary leaders

Key Activities

o Training of CHO for monitoring and implementing of community health program.

o Identification of secondary leaders.
o Linkaging and networking.
o Conduct of mobilization on health and development concerns.
o Implementation of livelihood projects.
 Ten (10) Herbal Medicines in the Philippines
Approved by the Department of Health (DOH)

These are the list of the ten (10) medicinal plants that the Philippine Department of Health
(DOH) through its "Traditional Health Program" has endorsed. All ten (10) herbs have been
thoroughly tested and have been clinically proven to have medicinal value in the relief and
treatment of various aliments:

LAGUNDI (Vitex Negundo)

A shrub known in English as the “5-leaved chase tree” which grows wild in vacant lots and waste
land. The flowers are blue and bell-shaped and small fruits turn black when ripe. It is better to
collect the leaves where are in bloom. Matured branches are planted.

Parts utilized: leaves, flower.

Uses and Preparation:

Asthma, cough and fever- boil the chopped raw fruits or leaves in 2 glasses of water left for 15
minutes until the water left in only one glass. Strain. The following dosages of the decoction are
given to age group.

Dysentery, colds and pain in any part of the body as influenza – boil a handful of leaves and
flowers in water to produce a glass full of decoction 3 times a day.

Skin Diseases (dermatitis, scabies, ulcer, eczema) and wounds – prepare a decoction of the
leaves. Wash and clean the skin/ wound with the decoction.

Headache- crushed leaves may be applied on the forehead.

Rheumatism, sprain, contusion insect bites- pound the leaves and apply on affected part.

Aromatic bath for sick patients - prepare leaf decoction for use in sick and newly delivered
patients.

Yerba Buena (Clinopodium douglasii)

A small multi- branching aromatic herb commonly known as Peppermint. The leaves are small,
elliptical ands with soothed margin. The stem creeps to ground, and develops roots. May also be
propagated through cuttings.
Parts utilized: leaves, sap of plant

Uses:

For pain in different parts of the body as headache, stomach ache – boil chopped leaves in two
glasses of water for 15 minutes. Cool and strain.

Preparation: Divide decoction into two parts and drink one part every three hours.

Rheumatism, arthritis and headache – crush the fresh leaves squeeze sap. Massage sap on
painful parts with eucalyptus.

Cough and colds – get about 10 fresh leaves and soak in a glass of hot water. Drink as tea. Acts as
an expectorant.

Swollen Gums – steep 6 grams of fresh plant in a glass of boiling water for 30 minutes. Use
solution as gargle.

Toothache – cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in
aching tooth cavity. Mouth should be rinsed by gargling salt solution before inserting the cotton.
To prepare salt solution add 5 grams of table salt to one glass of water.

Menstrual and gas pain – soak a handful of leaves in a glass of boiling water. Drink infusion. It
induces menstrual flow and sweating.

Nausea and fainting – crush leaves and apply at nostrils of patients.

Insect bites – crush leaves and apply juice on affected part or pound leaves until paste-like. Then
rub this on affected part.

Pruritis- boil plant alone or with eucalyptus in water. Use decoction as wash on affected area.

Sambong ( Blumea Balsamifera)

English name: Blumea camphora
A plant that reaches 1.5 to 3 meters high with rough hairy leaves. Young plants around mother
plant may be separated when they have three or more leaves.

Parts utilized: leaves

Uses: Anti- edema, diuretic, anti- urolithiasis -boil chopped leaves in water for 15 minutes until
one glassful remains. Cool and strain.

Preparation: Divide decoction into 3 parts. Drink one part 3 times a day.
Remember that sambong is not a medicine for kidney infection.

Tsaang Gubat (Carmona retusa)

A shrub with small, shiny nice- looking leaves that grows in wild uncultivated areas and forests.
Mature stems are used for planting.

Parts utilized: leaves

Uses:

Diarrhea – boil the following amount of chopped leaves in 2 glasses of water for 15 minutes or
until amount of water goes down to 1 glass. Cool and strain.

Preparation: Divide decoction into 4 parts. Let patient drink 1 part every 3 hours.

Stomachache- wash leaves and chop. Boil chopped leaves in 1 glass of water for 15 minutes. Cool
and filter, strain and drink.

Niyug- Niyugan (Quisqualis Indica L.)

A vine known as “Chinese honey suckle” which bears tiny fruits and grows wild in backyards. It is
effective for the elimination of intestinal worms. The seeds must come from mature. Dried but
newly opened fruits. Propagated through stem cuttings about 20cm in height.

Parts utilized: seeds

Uses: An anti- helmintic- used to expel round worms ascariasis.

Preparation: The seeds are taken 2 hours after supper. If no worms are expelled, the dose may be
repeated after one week.

This is not to be given to children below four years old.

Special precautions: Follow recommended dosage. Overdose causes hiccups.

Bayabas / Guava (Psidium Guajava L.)

A tree about 4- 5 meters high with tiny flowers with round or oval fruits that are eaten raw.
Propagated through seeds.

Parts utilized: leaves

Uses: For washing wounds- may be used twice a day.

For diarrhea- may be taken 3-4 twice a day.
Preparation: As gargle and to relieve toothache. Warm decoction is used for gargle. Freshly
pounded leaves are used for toothache. Guava leaves are to be washed well and chopped. Boil for
15 minutes at low fire. Do not cover pot. Cool and strain before use.

Akapulko (Cassie, alata L.)

It is also known as "bayabas-bayabasan" and "ringworm bush" in English, this herbal medicine is
used to treat ringworms and skin fungal infections.

Parts utilized: leaves

Use: anti-fungal: Tinea Flava, ringworm, athlete’s foot and scabies.

Preparation: Fresh, matured leaves pounded. Apply as soap to the affected part 1-2 times a day.

Ulasimang- bato (Peperonia Pellucida)

A weed, with heart-shaped leaves also known as "pansit-pansitan", grows in shady parts of the
garden and yard. It is effective in fighting arthritis and gout. The leaves can be eaten fresh (about a
cupful) as salad or like tea.

Parts utilized: leaves

Use: Lowers uric acid. (rheumatism and gout)

Preparation: Wash leaves well. One and a half cup leaves are boiled in two glassfuls of water over
lower fire. Do not cover pot. Cool and strain. Divide into three parts and drink each part three
times a day after meals.

May also be eaten as salad. Wash the leaves well. Prepare one and a half cups of leaves. Divide
into 3 parts and take as salad three times s day.

Bawang (Allium sativum)

popularly known as "garlic", it mainly reduces cholesterol in the blood and hence, helps control
blood pressure. Also a remedy for toothache

Parts utilized: Garlic Bulb

Uses: For hypertension: Toothache; to lower cholesterol levels in blood.

Preparation:

May be fried, roasted, soaked in vinegar for 30 minutes or blanched in boiled water for 5 minutes.
Take 2 pieces three times a day after meals.

For toothache: Pound a small piece and apply to affected part.

Ampalaya (Mamordica Charantia)

known as "bitter gourd" or "bitter melon" in English, it most known as a treatment of diabetes
(diabetes mellitus), for the non-insulin dependent patients.

Parts utilized: leaves

Use: Lower blood sugar levels

Preparation: Gather and wash young leaves very well. Chop. Boil 6 tablespoons in two glassfuls
of water for 15 minutes under low fire. Do not cover pot. Cool and strain. Take one third cup 3
times a day after meals.

Remember that young leaves may be blanched/ steamed and eaten ½ glassful 2 times a day.

Reminders on the Use of Herbal Medicine.

1. Avoid the use of insecticide as these may leave poison on plants.

2. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low
heat.
3. Use only part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of symptoms or sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a
doctor.