00:01
So let's try some cases
and see if we can put
all of this information together.
00:05
So let's meet these two clients
and figure out if we can determine
what their risk
factors might be?
And how they're presenting
for preeclampsia?
So let's talk about Celina first.
00:15
So, Celina is a 19-year-old
G2P1 at 35 weeks
by a reliable
last menstrual period,
and she presents to the clinic
with a complaint of a headache
since Monday evening.
00:26
Her prenatal course has been
uneventful to this point.
00:29
And she denies
contractions bleeding,
and reports that the baby
has been active per usual.
00:35
So is there anything about her
history that causes you any concern?
Exactly.
This headache.
00:43
So we definitely are going to need
to dig a little bit deeper
into her history.
00:47
We definitely need to know
what her blood pressure is,
and maybe check for proteinuria
to see if there's anything else
that might indicate
that she might have
preeclampsia.
00:56
Very good.
00:58
So let's take a look
at Samantha.
01:00
Samantha is a 34-year-old
G3P2 at 34 weeks,
and she presents to the hospital
after referral from the clinic
for an elevated blood pressure and
2+ proteinuria on a dip specimen.
01:12
She had two blood pressure's.
01:14
The first one was
168/114.
01:16
And the second one was
152/110.
01:20
So what do you think
about her risk factors?
What about her case makes you think
something might be going on?
First, we can think about her age,
34 getting close to the 35.
01:33
She's also 34 weeks
and is experiencing really two
pretty high blood pressures
that are really in the
severe range of preeclampsia,
are almost there.
01:41
And she also has proteinuria
from a dip sample.
01:45
So all those things together
definitely point to the fact
that she likely
has preeclampsia.
01:52
Now, let's try some questions
and see how we do.
01:55
This question asks about,
which of the following symptoms
are consistent
with magnesium sulfate
toxicity?
So which one of these
would make you think that
this client may need to have an
adjusted magnesium sulfate infusion?
Exactly,
a heart rate of 40.
02:18
So, DTR is being 3+
that's hyperreflexia.
02:21
So, that doesn't go along
with being toxic to mag sulfate.
02:25
Flushing is an expected
side effect.
02:27
So we kind of expect
that that's going to happen.
02:30
And a urine output
that's 20 mLs.
02:32
And it's 20 mLs this hour,
and 20 mLs the next hour,
that's also not indicative
of magnesium sulfate toxicity.
02:40
Heart rate of 40, however,
is very low.
02:42
And we want to definitely
get on top of that
because this client is trending
in the wrong direction.
02:49
Let's try the next question.
02:51
Which of the following are symptoms
consistent with HELLP syndrome?
HELLP syndrome.
02:57
Hemolysis, elevated liver enzymes,
and low platelets.
03:06
Exactly,
right upper quadrant pain.
03:09
So we're thinking about the liver,
and the damage there.
03:11
Now, a blood pressure of
160/110
definitely goes
with severe preeclamptic
would certainly set someone at risk
for HELLP syndrome,
but it doesn't confirm that.
03:21
Our urine output of
20 mLs per hour,
again, not consistent
with HELLP syndrome,
and a headache.
03:27
Although, it does go along
with severe preeclampsia
it doesn't necessarily link itself
to HELLP syndrome,
but right upper quadrant pain,
absolutely does.
03:38
Alright, let's try another one.
03:39
Which of the following assessments
are consistent with preeclampsia
with severe feature?
So, we're thinking about
severe preeclampsia.
03:46
Which one?
And it's select that all that apply.
03:48
So there's going to be
more than one answer.
03:50
Take a look.
03:56
Yes,
right upper quadrant pain.
03:58
That should be sort of a remembrance
from last question
and a platelet count
that's less than 100,000.
04:05
And remember, that's called
thrombocytopenia.
04:08
Let's look at the other options
and go through those.
04:11
DTRs of 2+
that's normal.
04:14
A blood pressure of 158/88.
04:18
That's high,
definitely hypertension.
04:20
But it doesn't meet the criteria
of severe preeclampsia.
04:23
And a PCR of 0.34,
definitely
diagnostic of preeclampsia,
but not severe preeclampsia.
04:32
Next question.
04:33
Which of the following
subjective complaints?
So this is going to be something
the clients going to tell us
may indicate preeclampsia.
04:44
Great, B.
04:45
New-onset 3rd-trimester
nausea and vomiting.
04:48
So, although nausea and vomiting
may happen throughout the pregnancy,
if a client pops
in the 3rd trimester,
that's after 28 weeks
with nausea and vomiting,
your preeclampsia, your radar,
should be just going off like crazy.
05:02
So an increase in urination
doesn't have anything to do
with preeclampsia.
05:05
In fact, it may actually
be less urination.
05:09
Heartburn at 16 weeks...
05:11
pretty typical.
05:12
And preeclampsia
won't have started
at 16 weeks anyway,
so that doesn't work.
05:16
And lightning, then anything to do
with this question
because lightning has to do
with the baby dropping in the pelvis
in preparation for labor.