A patient with preeclampsia is admitted for observation and management. The nurse is monitoring the patient closely. Which of the following assessments would indicate a worsening condition that requires immediate intervention?

C) Presence of clonus during reflex examination

A) Blood pressure reading of 140/90 mmHg

B) Proteinuria level of 300 mg/dL

C) Presence of clonus during reflex examination

D) Mild edema in the lower extremities

A pregnant patient with diagnosed preeclampsia is admitted for observation and management. Her blood pressure is 150/95 mmHg, and she exhibits proteinuria and brisk reflexes. What is the priority nursing intervention to prevent complications?

C) Prepare magnesium sulfate for administration to prevent seizures.

A) Initiate continuous fetal monitoring to assess fetal well-being.

B) Administer antihypertensive medication to lower blood pressure.

C) Prepare magnesium sulfate for administration to prevent seizures.

D) Educate the patient about the importance of bed rest to reduce symptoms.

A nurse is caring for a patient diagnosed with HELLP syndrome. The patient is experiencing increased headache severity, elevated blood pressure, and epigastric pain. What is the nurse's priority action in this situation?

C) Notify the physician of the patient's deteriorating condition.

A) Administer prescribed antihypertensive medication to lower blood pressure.

B) Prepare the patient for an immediate cesarean delivery.

C) Notify the physician of the patient's deteriorating condition.

D) Provide the patient with pain medication for headache relief.

A patient hospitalized with preeclampsia develops signs suggesting HELLP syndrome, including elevated liver enzymes and low platelet count. The healthcare team is considering the next best step in managing her condition. What is the most appropriate nursing intervention to prioritize during this scenario?

B) Prepare the patient for potential immediate delivery to address worsening maternal status.

A) Administer antihypertensive medication to manage elevated blood pressure.

B) Prepare the patient for potential immediate delivery to address worsening maternal status.

C) Monitor the patient closely for signs of seizures and prepare for magnesium sulfate administration.

D) Provide education to the patient about the importance of bed rest and fluid restriction.

A nurse is caring for a patient with worsening HELLP syndrome. The patient's blood pressure is 165/110 mmHg, platelet count is 75,000/µL, hemoglobin is 9.5 g/dL, and liver enzymes are elevated. What is the nurse's priority action to ensure maternal and fetal safety?

C) Notify the healthcare provider about the need for expedited delivery.

A) Administer additional antihypertensive medication as prescribed.

B) Prepare the patient for an immediate blood transfusion.

C) Notify the healthcare provider about the need for expedited delivery.

D) Start magnesium sulfate infusion to prevent seizures.

A patient with worsening HELLP syndrome is being monitored closely. Despite treatment, her blood pressure remains elevated, and she reports severe headaches and epigastric pain. Her platelet count is 75,000 per microliter, hemoglobin is 9.5 g/dL, and liver enzymes are elevated. What is the most critical nursing intervention at this time to address the patient's current condition?

B) Prepare the patient for an urgent cesarean section.

A) Administer prescribed antihypertensive medication immediately.

B) Prepare the patient for an urgent cesarean section.

C) Initiate IV fluid resuscitation to address potential hypovolemia.

D) Monitor the patient’s urine output closely for signs of renal compromise.

A patient with HELLP syndrome is experiencing increased shortness of breath, mild chest discomfort, and pulmonary congestion. Which nursing intervention should be prioritized to address the patient's current symptoms?

A) Administer supplemental oxygen to improve oxygen saturation.

B) Encourage deep breathing exercises to expand lung capacity.

C) Position the patient flat in bed to reduce cardiac workload.

D) Restrict fluid intake to prevent further fluid overload.

A patient with HELLP syndrome is experiencing increased shortness of breath and mild chest discomfort. Upon assessment, the nurse notes bilateral crackles in the lung bases, tachycardia, persistent hypertension, and decreased oxygen saturation. What is the priority nursing intervention to address the patient's current symptoms?

A) Administer supplemental oxygen to maintain adequate oxygenation.

B) Prepare the patient for an emergency cesarean delivery.

C) Initiate intravenous antihypertensive therapy to lower blood pressure.

D) Position the patient in a high Fowler's position to ease breathing.

A patient with HELLP syndrome is being prepared for a cesarean section due to worsening clinical conditions, including elevated blood pressure and decreased platelet count. Which nursing intervention is most critical to monitor in the preoperative period?

B) Initiate seizure precautions and ensure emergency medications are available.

A) Monitor the patient's blood glucose levels closely.

B) Initiate seizure precautions and ensure emergency medications are available.

C) Educate the patient and family about postoperative pain management.

D) Administer a bolus of intravenous fluids to maintain hydration.

A nurse is caring for a patient diagnosed with HELLP syndrome who is scheduled for an emergency cesarean section due to deteriorating maternal and fetal conditions. Considering the current clinical findings, which nursing intervention is the highest priority to perform before the surgery?

B) Notify the blood bank to have blood products ready for possible transfusion.

A) Administer antihypertensive medication to control the patient's blood pressure.

B) Notify the blood bank to have blood products ready for possible transfusion.

C) Educate the patient and family about postoperative care and expectations.

D) Ensure the patient's consent form is signed and documented in the chart.

pregnancy - Nursing Case Study

Pathophysiology

• Primary mechanism: Hormonal changes - The placenta secretes hormones like human chorionic gonadotropin (hCG), progesterone, and estrogen, crucial for maintaining pregnancy. These hormones regulate uterine lining preparation, immune tolerance, and fetal development.

• Secondary mechanism: Cardiovascular adaptation - Blood volume increases by 30-50% to support the growing fetus, leading to increased cardiac output and changes in blood pressure. This adaptation is critical for adequate placental perfusion and fetal oxygenation.

• Key complication: Preeclampsia - A condition characterized by high blood pressure and proteinuria after 20 weeks of gestation. It results from abnormal placental blood vessel development and can lead to serious maternal and fetal complications if untreated.

Patient Profile

Demographics:

29 years old, female, teacher

History:

• Key past medical history: Gestational diabetes in previous pregnancy

• Current medications: Prenatal vitamins, insulin for gestational diabetes

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent headache and swelling in the feet

• Key symptoms: Blurred vision, fatigue, occasional shortness of breath

• Vital signs: Blood pressure 150/95 mmHg, heart rate 96 bpm, temperature 98.6°F, respiratory rate 18 breaths per minute

Section 1

During the initial assessment, the nurse conducts a thorough evaluation of the patient's symptoms and vital signs. The patient's persistent headache, blurred vision, and swelling in the feet raise suspicions of advancing preeclampsia. The nurse notes that the patient's blood pressure remains elevated at 150/95 mmHg, and there is notable edema in the lower extremities. Urinalysis results reveal significant proteinuria, with a protein level of 300 mg/dL, further supporting the diagnosis of preeclampsia. Additionally, the patient's reflexes are brisk, which may indicate neurological involvement, a concerning sign that necessitates close monitoring.

Given these findings, the healthcare team decides to admit the patient for closer observation and management. Laboratory tests, including a complete blood count and liver function tests, are ordered to assess for any further complications such as HELLP syndrome. The team also initiates antihypertensive therapy to manage the patient's blood pressure, while magnesium sulfate is considered to prevent the onset of seizures. The patient's fetal status is continuously monitored via electronic fetal monitoring to ensure there is no compromise.

As the patient is stabilized, the nurse educates her about the signs and symptoms of worsening preeclampsia and the importance of reporting any changes, such as increasing headache or visual disturbances, immediately. The team emphasizes the need for prompt intervention should any signs of eclampsia or other complications arise. This critical period involves vigilant monitoring and coordination among the healthcare team to ensure the safety and well-being of both the mother and the fetus. As the case progresses, the potential for new complications, such as the development of HELLP syndrome or preterm labor, remains a significant concern that requires ongoing assessment and clinical reasoning.

Section 2

As the patient continues her hospital stay, the healthcare team closely monitors her for any signs of progression in her condition. On the second day of admission, the nurse notices a change in the patient's status during the routine assessment. The patient reports an increase in the severity of her headache, describing it as more intense and unrelenting. The nurse also observes that the patient's blood pressure has risen to 160/105 mmHg, despite the initiation of antihypertensive therapy. Additionally, the patient exhibits increased swelling, now extending to her hands and face, and reports new onset epigastric pain, which is concerning for potential liver involvement.

In response to these developments, the physician orders an urgent reevaluation of laboratory tests, including repeat liver function tests, platelet count, and a coagulation profile. The results reveal elevated liver enzymes, with AST and ALT levels rising to 85 U/L and 95 U/L, respectively, and a platelet count that has dropped to 90,000 per microliter. These findings are suggestive of HELLP syndrome, a serious complication of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelet count. The confirmation of HELLP syndrome necessitates swift clinical reasoning to determine the safest and most effective course of action for both mother and fetus.

Given the worsening clinical scenario, the healthcare team discusses the need for potential delivery as the definitive treatment for preeclampsia and its complications. The obstetrician evaluates the fetal status, noting that while the electronic fetal monitoring shows reassuring patterns, the risks to the mother are escalating. The decision is made to proceed with corticosteroid administration to promote fetal lung maturity, in anticipation of possible preterm delivery. The patient is informed of the situation and the rationale for the proposed interventions, ensuring she understands the importance of timely delivery to prevent further complications. The team prepares for the next steps, balancing the urgency of maternal stabilization with the considerations for fetal well-being.

Section 3

As the healthcare team continues to monitor the patient closely, they observe new developments in her clinical status. Despite the administration of corticosteroids and antihypertensive therapy, the patient's blood pressure remains elevated, now at 165/110 mmHg. She continues to experience severe headaches, and her epigastric pain has intensified. During a follow-up assessment, the nurse notes that the patient appears increasingly fatigued and pale. The nurse promptly reports these changes to the obstetrician, who orders additional laboratory tests to further evaluate the patient's condition, suspecting potential worsening of the HELLP syndrome and associated complications.

The latest laboratory results reveal a further decline in the patient’s platelet count, now at 75,000 per microliter, indicating increased risk for bleeding complications. Additionally, the patient's hemoglobin level has dropped to 9.5 g/dL, suggesting possible hemolysis. Liver function tests show continued elevation, with AST and ALT levels rising to 120 U/L and 110 U/L, respectively. These findings confirm the progression of the HELLP syndrome, raising concerns about the patient's coagulation status and the potential for disseminated intravascular coagulation (DIC).

Given the critical nature of the patient's condition and the risk of severe maternal and fetal complications, the healthcare team intensifies their focus on maternal stabilization while preparing for an expedited delivery. Discussions are held with the patient and her family to explain the necessity of urgent delivery to mitigate the escalating risks. The obstetrician outlines the plan for a possible cesarean section if the patient’s condition further deteriorates, emphasizing the need for close monitoring and immediate intervention to protect both maternal and fetal health. With the clinical picture evolving rapidly, the team remains vigilant, ready to adapt their approach as needed to ensure the best possible outcomes.

Section 4

As the healthcare team continues to closely monitor the patient's condition, they observe a change in her status that prompts immediate attention. Overnight, the patient begins to experience increased shortness of breath and mild chest discomfort, symptoms she had not previously reported. The nurse conducts a thorough assessment, noting bilateral crackles in the lung bases upon auscultation, which suggests potential pulmonary edema, a complication that can arise from severe hypertension and fluid shifts associated with HELLP syndrome.

Vital signs reveal a concerning increase in heart rate to 120 beats per minute, alongside persistent hypertension at 170/115 mmHg. Oxygen saturation has dropped to 92% on room air, indicating the need for supplemental oxygen. The nurse collaborates with the obstetrician, who orders a chest X-ray and echocardiogram to evaluate cardiac function and fluid status. Laboratory tests are also repeated to track any further deterioration in organ function.

The chest X-ray confirms the presence of pulmonary congestion, while the echocardiogram shows mild left ventricular hypertrophy, likely secondary to chronic hypertension. These findings suggest that the patient's cardiovascular system is under significant strain, necessitating immediate intervention to prevent further complications. The obstetrician adjusts the treatment plan, introducing diuretics to manage fluid overload and considering the timing for delivery more urgently. The patient and her family are updated on the evolving situation, reinforcing the need for expedited delivery to address both maternal and fetal risks. The team prepares for potential cesarean delivery, ensuring that all necessary precautions are in place to manage the patient's complex condition effectively.

Section 5

As the healthcare team implements the new treatment plan, the patient is closely monitored for any changes in her condition. Within a few hours of initiating diuretic therapy, the nurse observes a slight improvement in the patient’s breathing pattern. Her oxygen saturation increases to 95% with supplemental oxygen, and auscultation reveals a reduction in crackles at the lung bases. Despite these improvements, her blood pressure remains elevated at 165/110 mmHg, and her heart rate is still elevated at 115 beats per minute. The team continues to assess her fluid balance meticulously, ensuring that diuresis is effectively reducing pulmonary congestion without compromising renal function.

Laboratory results return, indicating a marginal improvement in liver enzymes but a concerning further decrease in platelet count to 80,000/mm³, suggesting exacerbation of the HELLP syndrome. The patient's hemoglobin level has dropped slightly, raising concerns about possible hemolysis. These findings prompt the obstetrician to expedite the decision-making process regarding delivery. A cesarean section is deemed necessary to prevent further maternal deterioration and to optimize fetal outcomes, given the potential for worsening placental function as indicated by the patient's clinical trajectory.

As preparations for the cesarean delivery are underway, the clinical team remains vigilant for any signs of additional complications. The anesthesiology team reviews the patient's coagulation status, considering the risk of bleeding due to low platelet count. The obstetrician discusses the plan of care with the patient and her family, emphasizing the critical nature of timely intervention to prevent severe complications such as eclampsia or significant respiratory compromise. With all precautions in place, the team moves forward with the delivery, ensuring that neonatal and maternal support systems are ready to address any immediate needs post-delivery.