Case Study: 19-year-old G2P1 Woman and 34-year old G3P2 Woman (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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      Slides Hypertensive Disorders of Pregnancy Nursing.pdf
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    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.

    About the Lecture

    The lecture Case Study: 19-year-old G2P1 Woman and 34-year old G3P2 Woman (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Hypertensive Disorders of Pregnancy: Preeclampsia (Nursing).

    Included Quiz Questions

    1. Immediate induction of labor
    2. ICU monitoring until 40 weeks
    3. Expectant management until 40 weeks
    4. Administration of corticosteroids
    1. Heart rate of 45 bpm
    2. Somnolence
    3. Heart rate of 180 bpm
    4. Client complaining of a metallic taste
    5. Deep tendon reflexes 0
    1. Presence of clonus
    2. Generalized petechiae
    3. Creatinine of 2.01 mg/dL
    4. Left-upper quadrant pain
    5. Platelet count of 160,000/mm3

    Author of lecture Case Study: 19-year-old G2P1 Woman and 34-year old G3P2 Woman (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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