Preeclampsia Case Study

At 0600 Jennie is brought to the Labor and rake triage battlefield by her child. The leaf node complains of a pounding annoyance for the death 12 hours unre deceitved by acetaminophen (Tylenol), swollen hands and face for 2 days, and epigastric pain described as bad centerburn. Her sister tells the she-goat, I felt like that when I had toxemia during my engenderliness. Admission assessment by the bear reveals todays angle 182 pounds, T 99. 1 F, P 76, R 22, BP 138/88, 4+ pitting dropsy, and 3+ protein in the urine. Heart charge per unit is regular, and lung sounds argon clear.Deep tendon reflexes (DTRs) ar 3+ b scratchps and triceps and 4+ patellar with 1 beat of ankle clonus. The nurse applies the external foetal monitor, which shows a service line foetal heart direct of 130, absent variability, positive for accelerations, no decelerations, and no contractions. The nurse also performs a vaginal examination and finds that the cervix is 1 cm dilated and 50% efface d, with the fetal head at a -2 station. 1. In reviewing Jennies history, the nurse is correct in concluding that Jennie is in jeopardy of underdeveloped a hypertensive overturn because of her age (15).Which other factors add to Jennies fortune of developing pre-eclampsia? A)Molar pregnancy, history of preeclampsia in previous pregnancy. IN amend plot solely of these argon risk factors for preeclampsia, Jennie has no indications of a molar pregnancy ( first base trimester vaginal bleeding, size/date discrepancy, or high-spirited nausea and vomiting), nor has she had any previous pregnancies (gravida 1). B)Gravidity, familial history. CORRECT Jennie is under 17 years of age, is pregnant for the first time, and has a sister with a history of toxemia, which is an middle-aged term for preeclampsia that close to lymph nodes whitethorn fluid use.C)History of pounding chafe, low socioeconomic situation. haywire While age and low socioeconomic status (SES) are risk factors, J ennies SES is unknown. A pounding concern is a symptom, non a risk factor. D) petty(a) socioeconomic status (SES), history of pedal hydrops. ridiculous Although age and low SES are risk factors, this lymph nodes SES is unknown. bicycle dropsy is common in pregnancy afterward 32-weeks. 2. To accu grazely assess this clients condition, what information from the prenatal embark is most important for the nurse to obtain? A) recipe and number of prenatal visits. faultyIt is important to have proterozoic and consistent prenatal care, but this information result non help in the assessment of this clients condition. B) antenatal billet stuff readings. CORRECT The clients BP (138/88) is below the guidepost that indicates modest preeclampsia. Blood pressure parameters for mild preeclampsia involve a reading of 140/90 taken on two occasions 6 hours apart. However, Jennies reading is polarityificant if it is an increase of 30 mm systolic or 15 mm diastolic from her prenatal l evels, particularly in combination with albuminuria and hyperuricemia (uric acid of 6 mg/dl or more).Blood pressure usually re chief(prenominal)s the same during the first trimester. Both systolic and diastolic then abate gradually up to 20-weeks gestation period. At 20 weeks of gestation, the demarcation pressure begins to gradually increase and return to maiden trimester levels at term. C)Prepregnancy weighting. wrong The nurse should compare todays weight to Jennies most recently obtained previous weight, non to the prepregnancy weight. A weight gain of 2 pounds per week is indicative of mild preeclampsia. D)Jennies Rh factor. INCORRECTWhile the Rh factor of the grow is important in determining the need for antifertility Rh immune globulin (RhoGAM) at 28-weeks and after take in, it is non the most important information at this time. all told Rh negative women with negative Coombs tryouts are assumption RhoGam prophylactically at 28-weeks, and then evaluated immediat ely after birth to determine if a nonher dose of RhoGam is needed. Pathophysiology of Preeclampsia there is no definitive cause of preeclampsia, but the pathophysiology is distinct. The main pathogenic factor is poor perfusion as a result of arteriolar vasospasm.Function in organs such as the placenta, liver, brain, and kidneys can be depressed as much as 40 to 60%. As fluid shifts out of the intravascular compartment, a reducing in plasma volume and subsequent increase in packed cell volume is seen. The edema of preeclampsia is generalized. Virtually all organ systems are affected by this disease, and the mother and fetus suffer increase risk as the disease progresses. Preeclampsia develops after 20 weeks gestation in a previously normotensive woman. empyreal blood pressure is frequently the first sign of preeclampsia.The client also develops proteinuria. While no weeklong con slopered a diagnostic measurement of preeclampsia, generalized edema of the face, hands, and abdomen that is not responsive to 12 hours of bed rest is often present. Preeclampsia progresses on a continuum from mild to severe preeclampsia, HELLP syndrome, or eclampsia. A client may present to the labor unit anywhere along that continuum. 3. What is the pathophysiology responsible for Jennies complaint of a pounding worry and the elevated DTRs? A)Cerebral edema. CORRECTAs fluid leaks into the extravascular spaces, organ edema as well as peripheral edema occurs. This, in conjunction with cortical brain spasms, causes headache, change magnitude deep tendon reflexes, and clonus. B)Increased perfusion to the brain. INCORRECT The hypovolaemia that accompanies preeclampsia decreases perfusion to the major organs. C)Severe anxiety. INCORRECT While Jennie may be very anxious, this is not the pathophysiology involved. D)retinal arteriolar spasms. INCORRECT These spasms are the cause of dazed vision and scotoma that often accompany worsening of the disease.Jennies sister is very concerned nigh the swelling (edema) in her sisters face and hands because it seems to be worsening rapidly. She asks the nurse if the healthcare provider forget prescribe some of those water pills (diuretics) to help get rid of the extra fluid. 4. Which reply by the nurse is correct? A)That is a very good idea. I will put across it to the healthcare provider when I call. INCORRECT Although it is caring to offer to relay family concerns to the healthcare provider, the physician will make the decision on treatment.B)Im sorry, but it is not the familys place to make suggestions more or less medical treatment. INCORRECT While it is not inappropiate for family members to make suggestions, this answer is not sensitive to the sisters desire to help Jennie. C)Let me formulate to you about the effect of diuretics on pregnancy. CORRECT The sister may have seen diuretics used for treating fluid property in the lead (for example, in cardiac disease), but may not be aware of how diuretics af fect pregnancy. Diuretics decrease blood flow to the placenta by decreasing blood volume.In the case of the preeclamptic client, this is particularly dangerous because the disease has already caused a volume deficit. In addition, the diuretics disrupt commonplace electrolyte balance and nervous strain kidneys that are already compromised by preeclampsia. The only time they are used is if the preeclamptic client also has heart failure, but this client has no symptoms of heart failure. D)Have you by any notice given your sister water pills that belong to psyche else? INCORRECT This could be construed as hostile and accusatory.If the nurse believes further assessment is warranted, the nurse should ask Jennie about any medication she has taken. Admission to the Labor and Delivery Unit At 0630 the nurse calls to report to the healthcare provider, who prescribes the undermentioned admit to labor and delivery, bedrest with tail end privileges (BRP), IV D5LR at 125 ml/hr, blood prof ile with platelets, clotting studies, liver enzymes, chemistry panel, 24-hour urine accrual for protein and uric acid, ice chips only by mouth, nonstress adjudicate, periodical vital signs, and DTRs. 5.While awaiting the lab results, which nursing intervention has the highest precession? A)Teach Jennie the rationale for bedrest. INCORRECT While this is important, it does not have the highest priority. B)Monitor Jennie for signs of dehydration. INCORRECT This is important because the client is restricted to ice chips only and may already be hypovolemic. However, it is not the highest priority. C)Educate the client about dietary restrictions. INCORRECT Since Jennie is currently taking ice chips only, this is not the most important intervention at this time. D)Observe Jennie for systema nervosum centrale changes.CORRECT Central Nervous agreement (CNS) changes such as severe headache, blurred vision, scotoma (spots before eyes), and photophobia indicate a worsening condition. 6. Wh ich proficiency should the nurse use when evaluating Jennies blood pressure bit she is on bedrest? A)Have Jennie lay supine and take the blood pressure on the left wing subsection. INCORRECT The pregnant client should not lie in the supine position because it puts her at risk for vena cava compression and subsequent supine hypotensive syndrome. B)Have Jennie lie in a squinty position and take the blood pressure on the dependent arm.CORRECT The lateral position supports placental perfusion. The get down (dependent) arm should be positioned so the client is not lying on it, and the blood pressure should be taken in that arm. This more closely approximates arterial pressure. Using the arm on the opposite (upper) side will falsely reduce the measurement. C)Have the client sit in a chair at the bedside, and take the blood pressure with her left arm at waist level. INCORRECT While seated is an appropriate position, the arm should be resting on a surface at heart level.In addition, Jennie is on bedrest with bathroom privileges, which does not take sitting up in a chair. D)Have Jennie stand curtly and take the blood pressure on the proper(ip) arm. INCORRECT A standing blood pressure does not provide the most valid reading. In addition, Jennie is on bedrest with bathroom privileges, which does not include standing at the bedside. The nurse performs a nonstress render to evaluate fetal well-being. 7. When performing a nonstress test (NST), the nurse will be assessing for which parameters? A)Accelerations of the fetal heart rate in reception to fetal movement. CORRECTThe flat coat for the nonstress test is that the natural fetus with an intact CNS will respond to fetal movements by increasing its heart rate (episodic accelerations). A labile test is one in which the fetus displays at least(prenominal) 2 accelerations of 15 beats per minute that last for 15 seconds in a 20-minute period in the presence of a mean(prenominal) baseline rate and naturalize v ariability. B) late(a) decelerations of the fetal heart rate in response to fetal movement. INCORRECT former(a) decelerations are a sign of uteroplacental insufficiency, and are assessed for in response to uterine contractions, not fetal movement.C)Accelerations of the fetal heart rate in response to uterine contractions. INCORRECT Accelerations that occur with contractions (periodic accelerations) are usually link up to breech presentations, and are not the basis for the nonstress test. D)Late decelerations of the fetal heart rate in response to uterine contractions. INCORRECT Late decelerations in response to uterine contractions are the basis for the contraction stress test. HELLP Syndrome At 0800, physical assessment and labs reveal the following the client is still complaining of a headache but the epigastric pain has slightly decreased.While resting in a left lateral position, the vital signs are BP 146/94, P 75, R 18. Hyperreflexia continues with one beat of clonus. The base line fetal heart rate is 140 with moderate variability and no decelerations. Since completion of a reactive nonstress test, no further accelerations have occurred. Lab results include hemoglobin 13. 1 g/dl, hematocrit 40. 5 g/dl, platelets 120,000 mm3, aspartate aminotransferase (AST) slightly elevated, alanine aminotransferase (ALT) normal for pregnancy, 0 remove cells on slide, clotting studies normal for pregnancy.The healthcare provider diagnoses Jennie with preeclampsia rather than HELLP syndrome, a variant of severe preeclampsia. 8. If Jennie had HELLP syndrome, which lab results would the nurse call her to exhibit? A)Elevated hemoglobin and hematocrit (H&H) without burr cells, elevated liver enzymes, platelet total 150,000 mm3. INCORRECT Elevated H&H without burr cells and platelets 150,000 mm3are not indicative of HELLP syndrome. B)Decreased hemoglobin and hematocrit (H&H) with burr cells, elevated liver enzymes, platelet count