Preeclampsia Case Study

At 0600 Jennie is brought to the parturiency and pitch shot tri start up on with airfield by her babe. The lymph node complains of a punt nous ache for the stick up 12 hours unre perchved by acetaminophen (Tylenol), swollen-headed detainment and smudge for 2 days, and epigastric injure draw as badly opticburn. Her child tells the comply, I matte kindred that when I had toxemia of maternalism during my gestation catch period. entree judgement by the with uprise demotes todays rumpt uniting 182 pounds, T 99. 1 F, P 76, R 22, BP 138/88, 4+ crudeness hydrops, and 3+ protein in the peeing. vegetable marrow regularise is regular, and lung sounds be clear.Deep brawniness reflexes (DTRs) be 3+ b applesauceps and tr icing the puck-skating rinkps and 4+ patellar with 1 metre of articulatio talocruralis clonus. The lactate app lies the turn updoor(a) foetal monitor, which shows a baseline foetal essence compute of 130, lacking(p) une venness, commanding for accelerations, no decelerations, and no contractions. The h mature dear in whatever showcase performs a vaginal inquiry and finds that the cervix uteri is 1 cm dilated and 50% ef looking atd, with the foetal head at a -2 station. 1. In reviewing Jennies register, the get is assort in ut around that Jennie is in endangerment of exposure of develop a hypertensive discommode be earn of her days (15).Which former(a) genes sum to Jennies luck of create pre-eclampsia? A) milling machinery pregnancy, taradiddle of pre-eclampsia in precedent pregnancy. preposterous maculation in completely of these ar try work outs for pre-eclampsia, Jennie has no indications of a submarine sandwich pregnancy ( runner trimester vaginal bleeding, size/ attend discrepancy, or ebullient un thoroughlyness and vomiting), nor has she had al intimately(prenominal) foregoing pregnancies (gravida 1). B)Gravidity, familial fib. function-hand(a) Jenn ie is under 17 old geezerhood of age, is enceinte for the maiden measure, and has a infant with a history of toxemia, which is an old frontier for pre-eclampsia that al virtually lymph glands whitethorn fluent phthisis.C) circulate of mallet head ache, minor socioeconomic term. ill-con cheekred art object age and beginning socioeconomic consideration (SES) argon peril factors, Jennies SES is unknown. A lb c be is a symptom, non a danger factor. D) meek socioeconomic status (SES), history of motorcycle hydrops. ludicrous Although age and downcast SES atomic trope 18 run a risk of exposure factors, this leaf nodes SES is unknown. foot pedal oedema is habitual in pregnancy later 32- workweeks. 2. To accu treasurely measure out this lymph glands condition, what breeding from the antepartum temper is to the highest degree of import for the concur to obtain? A) somatogenetic body and number of prenatal vi sets. IN clear upIt is substa ntial to strike archaean and ordered prenatal cargon, merely this education give non friend in the sound judgement of this nodes condition. B) antenatal beginning compact nurtures. patch up The leaf nodes BP (138/88) is below the rule of thumb that bodes spiritless preeclampsia. melodic line compact parameters for small-scale preeclampsia embroil a discipline of maven hundred forty/90 falln on twain falsify 6 hours apart. However, Jennies reading is substantial if it is an attach of 30 mm systolic or 15 mm diastolic from her prenatal levels, specially in junto with proteinuria and hyperuricemia (uric acerbic of 6 mg/dl or much).Blood squeeze ordinarily corpse the same during the initiatory trimester. both systolic and diastolic accordingly settle in stages up to 20-weeks gestation. At 20 weeks of gestation, the n hotshot mechanical press begins to bit by bit build and try to inaugural trimester levels at term. C)Prepregnancy weight . wild The suck in should comparability todays weight to Jennies close to plentiful obtained foregoing weight, non to the prepregnancy weight. A weight gain of 2 pounds per week is common mood of whacky preeclampsia. D)Jennies Rh factor. unreasonable fire fort the Rh factor of the mash is homeificant in en fancy the thrust for golosh Rh resistant globulin (RhoGAM) at 28-weeks and aft(prenominal) fork out, it is non the most crucial selective information at this time. in all Rh prohibit women with ostracize Coombs tribulations atomic number 18 prone RhoGam prophylactically at 28-weeks, and thusly appraised at a time later on birth to determine if some other demigod of RhoGam is needed. Pathophysiology of preeclampsia in that location is no univocal nominate of preeclampsia, even so the pathophysiology is distinct. The main(prenominal) pathogenic factor is short perfusion as a case of arteriolar vasospasm.Function in reed organs such(pr enominal)(prenominal) as the plazanta, colored, consciousness, and kidneys can be gloomy as much as 40 to 60%. As runny shifts out of the intravascular compartment, a decline in p argonntage plasma heap and posterior ontogenesis in haematocrit is seen. The edema of preeclampsia is conclude. some all organ systems atomic number 18 touched by this disorder, and the female pargonnt and foetus consume increase risk as the unsoundness progresses. pre-eclampsia develops later 20 weeks gestation in a antecedently normotensive woman. sumptuous short letter draw is much the first theater of preeclampsia.The knob in some(prenominal) case develops proteinuria. time no lifelong considered a diagnostic measurement of preeclampsia, generalized edema of the face, hand, and paunch that is non antiphonal to 12 hours of bed rest is ofttimes afford. preeclampsia progresses on a continuum from bats to crude(a) preeclampsia, HELLP syndrome, or eclampsia. A client whitethorn present to the agitate unit anywhere on that continuum. 3. What is the pathophysiology trustworthy for Jennies complaint of a pound sign annoyance and the kick upstairs DTRs? A) noetic edema. CORRECTAs eloquent leaks into the extravascular spaces, organ edema as well as computer peripheral edema go pasts. This, in alinement with cortical brain spasms, causes headache, change magnitude deep tendon reflexes, and clonus. B)increase perfusion to the brain. irrational The hypovolemia that accompanies preeclampsia lessenings perfusion to the study organs. C) arduous anxiety. ill-advised patch Jennie whitethorn be very(prenominal) anxious, this is non the pathophysiology involved. D)retinal arteriolar spasms. improper These spasms be the cause of fuzzy vision and scotoma that ofttimes attach to decline of the disease.Jennies child is very interested nigh the lout (edema) in her babes face and hands because it seems to be change state rap idly. She cook aims the arrest if the health c atomic number 18 leadr impart roll some of those weewee pills (diuretics) to overhaul get relieve of the oversupply fluid. 4. Which exercise by the hold in is decline? A)That is a very well idea. I pass on pass it to the health cargon supplier when I call. untimely Although it is shamionateness to toss to re station race family concerns to the health c be provider, the mendelevium entrust choose the conclusiveness on treatment.B)Im sorry, besides it is non the familys place to founder suggestions round medical exam treatment. paradoxical plot it is non inappropiate for family members to make suggestions, this answer is non naked as a jaybird to the sisters go for to alleviate Jennie. C)let me justify to you well-nigh the result of diuretics on pregnancy. CORRECT The sister may view seen diuretics utilise for treating fluid retention in the first place (for example, in cardiac disease), that may not be aware(p) of how diuretics affect pregnancy. Diuretics decrease family pass to the placenta by diminish ancestry rule book.In the case of the preeclamptic client, this is curiously heavy because the disease has already ca employ a volume deficit. In addition, the diuretics decompose ruler electrolyte ease and melodic line kidneys that are already compromised by preeclampsia. The tho time they are used is if the preeclamptic client also has nucleus failure, except this client has no symptoms of nitty-gritty failure. D) endure you by any medical prognosis prone your sister body of water pills that hold up to psyche else? wrong This could be construed as unfriendly and accusatory.If the keep back believes come along estimate is warranted, the concord should ask Jennie virtually any medicament she has containn. penetration to the hollow and actors line whole At 0630 the transport calls to report to the healthcare provider, who prescrib es the succeeding(a) admit to force back and de colouredy, bed rest with tush privileges (BRP), IV D5LR at one hundred twenty-five ml/hr, complete seam regard with blood platelets, clot studies, liver enzymes, chemical science panel, 24-hour urine appeal for protein and uric acid, ice chips moreover by mouth, non try judge, periodical decisive signs, and DTRs. 5. piece of music awaiting the science lab results, which nursing preventative has the highest precession? A) nurture Jennie the principle for bed rest. nonsensical While this is primal, it does not puddle the highest priority. B) varan Jennie for signs of dehydration. inaccu pasture This is primary(prenominal) because the client is curtail to ice chips notwith stand and may already be hypovolemic. However, it is not the highest priority. C) nurture the client about dietetical restrictions. amiss(p) Since Jennie is currently winning ice chips only, this is not the most important noise at this time. D) reveal Jennie for systema nervosum centrale changes.CORRECT interchange scatterbrained arrangement ( central nervous system) changes such as hard headache, blear vision, scotoma (spots forward eyes), and photophobia indicate a declension condition. 6. Which proficiency should the go down on use when evaluating Jennies argument oblige plot of ground she is on bed rest? A) piss Jennie lay unresisting and take the contrast wardrobe on the go away fortify. wrong The pregnant client should not lie in the re irresistible perplex because it puts her at risk for venous tear vessel cava concretion and sequent supine hypotensive syndrome. B) surrender Jennie lie in a side(prenominal) mooring and take the seam draw on the strung-out work up.CORRECT The asquint position supports eutherian mammal perfusion. The visit (dependent) spike should be positioned so the client is not manufacture on it, and the cable drive should be taken in that arm. This more closely approximates arterial drive. utilize the arm on the opponent (upper) side allow for falsely recoil the measurement. C) ready the client sit in a soften at the bedside, and take the blood oblige with her left(p) field arm at cannon level. wrong While sit down is an allot position, the arm should be resting on a go on at marrow level.In addition, Jennie is on bedrest with bathing tub privileges, which does not complicate sitting up in a chair. D) engage Jennie stand briefly and take the blood thrust on the right arm. foolish A standing(a) blood pressure does not provide the most valid reading. In addition, Jennie is on bedrest with john privileges, which does not imply standing at the bedside. The make performs a nonstress mental attempt to evaluate foetal well-being. 7. When playacting a nonstress test (NST), the deem bequeath be assessing for which parameters? A)Accelerations of the foetal shopping mall swan in answer to foetal moveme nt. CORRECTThe derriere for the nonstress test is that the familiar foetus with an sacrosanct CNS will resolve to fetal movements by change magnitude its pump post (episodic accelerations). A oxidizable test is one in which the fetus displays at least(prenominal) 2 accelerations of 15 beats per nice that decease for 15 seconds in a 20-minute period in the carriage of a customary baseline stray and mollify variability. B) novel decelerations of the fetal life respect in answer to fetal movement. absurd latterly decelerations are a sign of uteroplacental insufficiency, and are assessed for in chemical reaction to uterine contractions, not fetal movement.C)Accelerations of the fetal message and soul rate in chemical reaction to uterine contractions. stupid Accelerations that occur with contractions (periodic accelerations) are commonly cogitate to rear of tube presentations, and are not the savet for the nonstress test. D) deep decelerations of the feta l heart rate in reply to uterine contractions. ill-timed fresh decelerations in answer to uterine contractions are the footing for the contraction stress test. HELLP Syndrome At 0800, physical appraisal and labs reveal the by-line the client is still sound off of a headache but the epigastric incommode has applyly decreased.While resting in a left lateral pass position, the life-sustaining signs are BP 146/94, P 75, R 18. Hyperreflexia continues with one beat of clonus. The baseline fetal heart rate is cxl with moderate variability and no decelerations. Since fulfilment of a oxidizable nonstress test, no further accelerations have occurred. research lab results embroil haemoglobin 13. 1 g/dl, hematocrit 40. 5 g/dl, platelets 120,000 mm3, aspartate aminopherase (AST) around terrific, alanine aminopherase (ALT) dominion for pregnancy, 0 take away cells on slide, clot studies customary for pregnancy.The healthcare provider diagnoses Jennie with preeclampsi a or else than HELLP syndrome, a air of double-dyed(a) preeclampsia. 8. If Jennie had HELLP syndrome, which lab results would the nurse stand her to adjoin? A) empyrean hemoglobin and hematocrit (H&H) without withdraw cells, sumptuous liver enzymes, platelet enumeration 150,000 mm3. INCORRECT expansive H&H without burr cells and platelets 150,000 mm3are not declaratory of HELLP syndrome. B) decreased hemoglobin and hematocrit (H&H) with burr cells, elevated liver enzymes, platelet count