Question

GROUP 2 CASE STUDY: Preeclampsia

#1. M.M. is a 19-year-old woman, gravida 1 para 0, at 38 weeks' gestation. She felt fine until 2 days ago, when she noticed swelling in her hands, feet, and face. She complains of a headache, which started yesterday and has not been relieved by acetaminophen or coffee. She says she must be having a lot of heartburn as “it hurts a lot here” gesturing to the area above her umbilicus. She appears irritable, doesn't want the overhead lights on and says her vision is “acting funny.” Her physician is admitting her for induction of labor and administration of magnesium sulfate. She remarks to the nurse, “My cousin had high blood pressure when she had her baby and I don’t remember her getting that magnesium.”

Assessment

Vital signs: BP 152/84 mm Hg; HR 88 beats/min

Oral temperature: 98.8 ° F (37.1 ° C)

Weight: 131.4 kg (289 lb); height: 5 ft, 4 in

Edema: noted in hands, feet, and face

Deep tendon reflexes (DTRs) + 2, no clonus

Urine dipstick reveals proteinuria + 3

Initial Lab Results

Hemoglobin (Ref 12-16 g/dl )	16g/dl
Hematocrit (Ref 37-47% )	47%
White blood cell (Ref 4,500-10,000/mcL)	11,000/mcL
Platelets (Ref 150,000-400,000/mm³)	105,000 /mm³
BUN (Ref 10-20 mg/dl)	22 mg/dl
Creatinine (Ref 0.5-1.1 mg/dl)	1.2 mg/dl
LDH (Ref 45-90units/L)	120 units/L
AST (Ref 4-20 units/L )	61 units/L
ALT (Ref 3-21 units/L )	56 units/L
Bilirubin (Ref 0.1-1 mg/dl)	1.2 mg/dl

INITIAL RESPONSE

#1.         How is preeclampsia diagnosed? How is this different from gestational hypertension, eclampsia, and chronic hypertension? What risk factors does M.M. have that cause her to be at risk for this condition? What would be an explanation for three of M.M. signs/symptoms? What are some of the nursing actions that would be implemented in her care related to preeclampsia?   What are possible complications of which the nurse needs to be aware?

Answer 1

1- preeclampsia is defined as bp >140/90 after period of 20 week pregnany present sign of end organ damage and proteinuria

In gestational hypertension no sign of end organ damage and proteinuria only bp increase >140/90 after 20 week of pregnancy

In eclampsia patient present severe gernalized tonic clanic seizers with sign and symptoms of severe preeclampsia,bp> 160/110

Chronic hypertension is defined by hypertension present before pregnany and persist after child birth ,in gestational hypertension present after 20week of pregnancy and subside till 12 week after child birth