A 28-year-old patient with gestational hypertension and recent diagnostic results indicating elevated liver enzymes and proteinuria is being monitored for potential progression to preeclampsia. Which nursing intervention is most critical to implement in the immediate care plan to prevent complications?

C) Administer prescribed antihypertensive medication and closely monitor blood pressure.

A) Educate the patient on dietary modifications to reduce sodium intake.

B) Initiate a bedside ultrasound to monitor amniotic fluid levels.

C) Administer prescribed antihypertensive medication and closely monitor blood pressure.

D) Schedule frequent fetal kick counts to assess for potential fetal distress.

A 28-year-old pregnant patient with gestational hypertension now presents with elevated liver enzymes and proteinuria. Which nursing intervention is most appropriate to prioritize in her care plan to reduce the risk of progression to severe preeclampsia?

D) Schedule more frequent prenatal visits to closely monitor maternal and fetal status.

A) Encourage increased fluid intake to promote renal function.

B) Educate the patient on the importance of daily blood pressure monitoring at home.

C) Administer a prescribed dose of magnesium sulfate to prevent seizures.

D) Schedule more frequent prenatal visits to closely monitor maternal and fetal status.

A 32-week pregnant patient is experiencing symptoms suggesting progression towards preeclampsia, including elevated blood pressure, proteinuria, and increased liver enzymes. The healthcare team is considering administering corticosteroids to enhance fetal lung maturity. Which nursing intervention is most appropriate at this time to monitor and address potential complications for both the mother and fetus?

B) Educate the patient on the importance of daily fetal kick counts and schedule daily non-stress tests.

A) Initiate bed rest and monitor maternal vital signs every 4 hours.

B) Educate the patient on the importance of daily fetal kick counts and schedule daily non-stress tests.

C) Administer antihypertensive medication to maintain blood pressure below 140/90 mmHg.

D) Prepare for immediate delivery due to the potential for severe preeclampsia complications.

A 32-week pregnant patient presents with persistent headaches, mild visual disturbances, blood pressure of 158/98 mmHg, mild facial edema, increased liver enzymes, and proteinuria of 2.3 grams per 24 hours. Which nursing intervention is the priority to address the patient's current condition?

B) Administer prescribed corticosteroids to enhance fetal lung maturity.

A) Encourage the patient to maintain a high-protein diet to manage proteinuria.

B) Administer prescribed corticosteroids to enhance fetal lung maturity.

C) Educate the patient on the importance of monitoring fetal kick counts.

D) Prepare the patient for immediate delivery to prevent complications.

A 33-week pregnant patient is experiencing increased blood pressure, severe headaches, upper right quadrant abdominal pain, elevated liver enzymes, and proteinuria. What is the priority nursing intervention in this scenario?

C) Prepare the patient for potential expedited delivery to prevent complications.

A) Encourage the patient to ambulate slowly to improve circulation.

C) Prepare the patient for potential expedited delivery to prevent complications.

D) Provide the patient with a high-protein snack to address proteinuria.

A 33-week pregnant patient with a history of chronic hypertension is admitted for worsening preeclampsia. Despite antihypertensive treatment, her blood pressure is 164/104 mmHg, and she reports severe headaches and right upper quadrant pain. Lab results show elevated liver enzymes and proteinuria. Which of the following nursing interventions is the highest priority at this time?

B) Initiate continuous fetal heart rate monitoring and notify the healthcare provider of the findings.

D) Prepare the patient for possible expedited delivery by obtaining informed consent.

A patient with severe gestational hypertension is experiencing visual disturbances, elevated liver enzymes, and hyperactive reflexes with clonus. Which nursing intervention is most critical to prioritize at this moment?

B) Prepare for potential seizure precautions and administer magnesium sulfate

A) Administer antihypertensive medication immediately

B) Prepare for potential seizure precautions and administer magnesium sulfate

C) Start continuous fetal heart rate monitoring

D) Notify the healthcare provider of the elevated liver enzymes

A pregnant patient at 34 weeks gestation presents with sudden visual disturbances, elevated blood pressure, hyperactive reflexes, and increased liver enzymes. Which of the following is the most appropriate nursing intervention to prioritize at this time?

C) Initiating a magnesium sulfate infusion

A) Administering an antihypertensive medication

B) Preparing the patient for an emergency cesarean section

C) Initiating a magnesium sulfate infusion

D) Obtaining a detailed dietary history to assess for nutritional deficiencies

A nurse is caring for a patient diagnosed with HELLP syndrome who is scheduled for an emergency cesarean section due to fetal distress and maternal complications. Which nursing intervention is the highest priority in preparing the patient for surgery?

B) Administer antihypertensive medication as prescribed.

A) Ensure the patient has signed the surgical consent form.

B) Administer antihypertensive medication as prescribed.

C) Insert an indwelling urinary catheter for accurate output measurement.

D) Notify the neonatal intensive care unit (NICU) team of the impending delivery.

A patient diagnosed with HELLP syndrome is undergoing an emergency cesarean section due to severe maternal and fetal distress. As the nurse, what is the most critical intervention you should prioritize post-delivery to address the maternal condition?

A) Continuously monitor vital signs and adjust antihypertensive medications as needed.

B) Administer a blood transfusion immediately to address thrombocytopenia.

C) Initiate early ambulation to prevent postoperative complications.

D) Encourage immediate breastfeeding to promote maternal-infant bonding.

gestational hypertension - Nursing Case Study

Pathophysiology

• Primary mechanism: Placental ischemia triggers the release of antiangiogenic factors, leading to widespread endothelial dysfunction and increased vascular resistance, causing elevated blood pressure.

• Secondary mechanism: Impaired nitric oxide production and increased oxidative stress contribute to vasoconstriction and reduced blood flow, exacerbating hypertension.

• Key complication: Persistent hypertension can lead to decreased placental perfusion, risking fetal growth restriction and preeclampsia, posing threats to both maternal and fetal health.

Patient Profile

Demographics:

28-year-old female, office manager

History:

• Key past medical history: Mild asthma, no previous pregnancies

• Current medications: Prenatal vitamins, inhaler (albuterol) as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent headache and swelling in hands and feet

• Key symptoms: Elevated blood pressure, visual disturbances, fatigue, mild shortness of breath

• Vital signs: Blood pressure 150/95 mmHg, heart rate 92 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F, oxygen saturation 95% on room air

Section 1

As the clinical team continues to monitor the 28-year-old patient with gestational hypertension, new diagnostic results provide further insight into her condition. Laboratory tests reveal elevated liver enzymes, specifically alanine transaminase (ALT) and aspartate transaminase (AST), indicating potential hepatic involvement. Additionally, urine analysis shows proteinuria with a protein level of 1.2 grams per 24 hours, suggestive of kidney implications. These findings raise concerns about the progression towards preeclampsia, necessitating heightened vigilance and strategic management to mitigate risks.

Upon reviewing the diagnostic results, the healthcare team emphasizes the importance of close monitoring for both maternal and fetal well-being. The patient is counseled on the significance of these findings and the potential implications for her pregnancy. Given the increased risk of preeclampsia, the team considers the initiation of antihypertensive therapy tailored to manage her blood pressure while minimizing potential impacts on the fetus. Further, non-stress tests (NST) and ultrasound assessments are scheduled to evaluate fetal health and placental function, focusing on detecting any signs of fetal growth restriction or distress.

These developments underscore the need for a comprehensive care plan that integrates ongoing surveillance and timely interventions. The patient is advised to maintain regular prenatal appointments and report any exacerbation of symptoms, such as worsening headache, increased visual disturbances, or significant changes in fetal movement. The collaborative approach aims to stabilize the patient's condition, prevent the escalation of complications, and optimize outcomes for both mother and child. As the case unfolds, the healthcare team remains vigilant, ready to adapt the care plan based on evolving clinical indicators.

Section 2

As the patient's pregnancy progresses, the clinical team notes a change in her status during a routine follow-up visit at 32 weeks gestation. The patient reports experiencing persistent headaches and mild visual disturbances, prompting further evaluation. On examination, her blood pressure has risen to 158/98 mmHg, and there is evidence of mild facial edema. These symptoms, combined with her previous laboratory findings, suggest a progression towards preeclampsia. The healthcare team is concerned about the potential for severe complications and decides to conduct a more thorough assessment.

New diagnostic results indicate a further increase in liver enzymes, with ALT at 75 U/L and AST at 85 U/L. Additionally, a repeat urine analysis reveals proteinuria has increased to 2.3 grams per 24 hours. These laboratory findings confirm the suspected progression towards preeclampsia. Fetal monitoring reveals a reassuring but slightly decreased variability in fetal heart rate, raising concerns about potential placental insufficiency. The team discusses the possibility of administering corticosteroids to enhance fetal lung maturity in anticipation of a potential preterm delivery, should the mother's condition worsen.

The healthcare team reevaluates the care plan, emphasizing the need for more frequent monitoring and potential hospitalization to closely observe both maternal and fetal status. The patient is counseled on the importance of recognizing and promptly reporting any new or worsening symptoms, such as severe headaches, epigastric pain, or reduced fetal movements. The comprehensive approach aims to stabilize her condition and prepare for any necessary interventions to ensure the best possible outcomes for both mother and baby. As the situation evolves, the team remains prepared to escalate care, including the possibility of early delivery, to mitigate risks associated with severe preeclampsia.

Section 3

As the patient remains under close observation in the hospital, her clinical status evolves, indicating an escalation of her condition. At 33 weeks gestation, during a routine monitoring session, the nursing staff notes a further increase in her blood pressure, now recorded at 164/104 mmHg, despite the administration of antihypertensive medication. The patient also reports a significant increase in the intensity of her headaches and mentions experiencing upper right quadrant abdominal pain, which she describes as a dull ache radiating towards her back. These symptoms prompt an immediate reassessment by the healthcare team.

New laboratory results reveal a concerning rise in liver enzymes, with ALT now at 110 U/L and AST at 122 U/L, suggesting worsening hepatic involvement. The urine protein level has escalated to 3.1 grams per 24 hours, confirming the progression of proteinuria. A repeat fetal non-stress test shows reduced variability in the fetal heart rate, further indicating potential fetal distress and compromised placental function. Given these findings, the team deliberates the benefits of administering a second dose of corticosteroids to promote fetal lung maturity, while also preparing for the possibility of expedited delivery if maternal or fetal conditions continue to deteriorate.

In light of these developments, the clinical team intensifies monitoring protocols, including continuous fetal heart rate monitoring and frequent blood pressure checks for the mother. The patient is educated on the critical importance of reporting any new symptoms, such as sudden shortness of breath or changes in fetal activity, as these could indicate further complications. The team remains vigilant, ready to implement immediate interventions to safeguard both the mother and the baby, with the understanding that early delivery may be the most prudent course of action to prevent severe preeclampsia-related complications. The focus now shifts towards stabilizing maternal health while ensuring optimal fetal outcomes amid the complexities of this challenging clinical scenario.

Section 4

As the clinical team continues to monitor the patient closely, they note a change in her status that signals further complications. Just a few hours after the intensified monitoring began, the patient experiences a sudden onset of visual disturbances, describing them as "flashing lights" and blurred vision. Concurrently, her blood pressure spikes to 170/110 mmHg, despite the ongoing administration of antihypertensive therapy. These alarming symptoms prompt an immediate escalation in care.

Further assessment reveals that the patient's reflexes have become hyperactive, with a noted increase in deep tendon reflexes and the presence of clonus, indicating a heightened neuromuscular response. Recognizing the risk of eclampsia, the healthcare team administers intravenous magnesium sulfate to prevent seizures and mitigate neurological risks. The decision is made to draw additional laboratory tests, which reveal a further increase in liver enzymes, with ALT rising to 135 U/L and AST reaching 140 U/L, reinforcing concerns of hepatic strain and potential HELLP syndrome development.

In response to the deteriorating maternal condition and the persistent signs of fetal distress, the team convenes an urgent multidisciplinary meeting to reassess the management plan. The consensus is to proceed with expedited delivery to protect both maternal and fetal health. The team prepares for a potential cesarean section, ensuring that neonatal specialists are on standby to provide immediate care for the preterm infant. This proactive approach prioritizes stabilizing the patient's condition while addressing the pressing need for a safe delivery, underscoring the complexity and urgency of managing severe gestational hypertension with emerging complications.

Section 5

As the team proceeds with the plan for expedited delivery, the patient's condition changes suddenly. Despite the administration of magnesium sulfate, the patient begins to experience severe epigastric pain, indicative of further hepatic involvement. Her blood pressure remains elevated at 165/108 mmHg, and she becomes increasingly lethargic, raising concerns about her overall neurological status. The fetal heart rate monitor shows recurrent late decelerations, with a baseline heart rate dropping to 100 beats per minute, highlighting significant fetal distress.

New diagnostic results from the latest laboratory tests reveal a concerning drop in platelet count to 85,000/µL, further supporting the diagnosis of HELLP syndrome. Additionally, her serum creatinine has risen to 1.3 mg/dL, indicating renal impairment. These findings necessitate immediate action to prevent further maternal and fetal compromise. The healthcare team recognizes the urgent need to proceed with delivery, opting for an emergency cesarean section given the progression of symptoms and worsening lab values.

Throughout this critical period, the clinical team maintains a focus on maternal stabilization, closely monitoring vital signs and adjusting antihypertensive therapy as needed. They ensure that the operating room is prepared, and all necessary personnel, including an anesthesiologist, obstetrician, and neonatologist, are present and briefed on the situation. The swift coordination of care exemplifies the importance of timely intervention in the management of severe gestational hypertension and its complications, setting the stage for the next steps in the patient's and infant's care journey.