A pregnant patient at 12 weeks of gestation presents with severe morning sickness, leading to a 5% weight loss from her pre-pregnancy weight, mild dehydration, and hypokalemia. The healthcare team has initiated intravenous fluids and potassium supplementation. Which intervention should the nurse prioritize to further address the patient's nutritional needs?

B) Recommend small, frequent meals to manage nausea and improve nutrient intake.

A) Initiate a high-protein, low-fat diet to prevent further weight loss.

B) Recommend small, frequent meals to manage nausea and improve nutrient intake.

C) Encourage the patient to increase fluid intake orally to address dehydration.

D) Schedule a consultation with a dietitian for specialized nutritional support.

A pregnant patient at 10 weeks gestation presents with persistent morning sickness, significant weight loss, mild dehydration, and hypokalemia. After initiating intravenous fluid therapy with normal saline and potassium supplements, and administering ondansetron, the clinical team plans to reassess her condition. Which assessment finding would indicate an improvement in the patient's status?

B) Potassium level of 3.5 mEq/L

A) Blood pressure of 145/92 mmHg

B) Potassium level of 3.5 mEq/L

C) Decreased urine output of 20 mL/hr

D) Persistent dry mucous membranes

A pregnant patient at 22 weeks of gestation presents with persistent nausea, vomiting, and fatigue. Her potassium level is 3.2 mEq/L, and her blood pressure is 142/92 mmHg. The clinical team is considering various management strategies. Which of the following interventions should be prioritized to address the most immediate concern?

D) Administer potassium supplements to correct hypokalemia.

A) Initiate enteral nutrition to improve caloric and nutrient intake.

B) Administer a low-dose antihypertensive to manage blood pressure.

C) Increase the frequency of maternal and fetal monitoring for early detection of complications.

D) Administer potassium supplements to correct hypokalemia.

A pregnant patient with gestational hypertension and hypokalemia is experiencing persistent nausea and vomiting despite treatment with ondansetron. Her potassium level remains low, and her blood pressure is elevated. The clinical team has initiated more frequent maternal and fetal monitoring and is considering a nutritional consult and low-dose antihypertensive therapy. What is the nurse's priority intervention to improve this patient's condition?

B) Collaborate with the dietitian to initiate enteral nutrition to improve nutritional intake.

A) Increase the dose of ondansetron to better control nausea and vomiting.

B) Collaborate with the dietitian to initiate enteral nutrition to improve nutritional intake.

C) Administer oral potassium supplements to correct hypokalemia more rapidly.

D) Monitor blood pressure closely and prepare to administer an antihypertensive if prescribed.

A pregnant patient at 28 weeks gestation is being monitored for gestational hypertension and at risk for preeclampsia. She is on low-dose labetalol therapy and has been educated to recognize warning signs of preeclampsia. Given her current condition and treatment plan, which intervention should the nurse prioritize to ensure optimal maternal and fetal outcomes?

D) Encourage the patient to maintain a daily log of her blood pressure and symptoms.

A) Increase dietary potassium intake to correct electrolyte imbalance.

B) Educate the patient on the importance of weekly prenatal visits for close monitoring.

C) Advise the patient to rest frequently to manage her fatigue levels.

D) Encourage the patient to maintain a daily log of her blood pressure and symptoms.

A pregnant patient at 30 weeks gestation is diagnosed with gestational hypertension and shows increased resistance in the uterine artery Doppler studies, suggesting compromised placental perfusion. The healthcare team has initiated low-dose labetalol and increased prenatal visit frequency. Which nursing intervention is most critical in the ongoing management of this patient?

B) Monitoring the fetal heart rate and movement during each prenatal visit.

A) Educating the patient on the importance of bed rest to reduce blood pressure.

B) Monitoring the fetal heart rate and movement during each prenatal visit.

C) Instructing the patient to increase her dietary sodium intake to manage fatigue.

D) Scheduling regular ultrasounds to assess fetal growth and amniotic fluid levels.

A pregnant patient at 32 weeks gestation has been admitted with severe preeclampsia. Her laboratory tests show proteinuria, elevated liver enzymes, and thrombocytopenia. Which intervention should the nurse prioritize to prevent complications for both the mother and the fetus?

A) Administer magnesium sulfate to prevent seizures.

B) Initiate an immediate induction of labor.

C) Increase the dose of antihypertensive medication to lower blood pressure rapidly.

D) Prepare the patient for an immediate cesarean delivery.

A pregnant patient at 34 weeks gestation presents with persistent headaches, blurred vision, elevated blood pressure of 152/98 mmHg, proteinuria, mild elevation of liver enzymes, and a decreased platelet count. Which of the following actions should the nurse prioritize to address the risk of complications for both the mother and fetus?

B) Administer intravenous magnesium sulfate to prevent seizures associated with severe preeclampsia.

A) Encourage the patient to rest in a left lateral position to improve placental perfusion.

B) Administer intravenous magnesium sulfate to prevent seizures associated with severe preeclampsia.

C) Increase the oral intake of fluids to manage potential dehydration from diuretics.

D) Prepare the patient for immediate delivery to prevent HELLP syndrome.

A pregnant patient with suspected HELLP syndrome is admitted with elevated blood pressure and is receiving magnesium sulfate for seizure prophylaxis. Which nursing intervention is most critical to ensure maternal safety during magnesium sulfate therapy?

B) Observe for signs of magnesium toxicity, such as decreased deep tendon reflexes

A) Monitor fetal heart rate continuously

B) Observe for signs of magnesium toxicity, such as decreased deep tendon reflexes

C) Administer antihypertensive medication as prescribed

D) Encourage the patient to increase fluid intake

A patient with preeclampsia is admitted to the hospital with elevated blood pressure and a decreasing platelet count. Magnesium sulfate is administered for seizure prophylaxis. Which of the following nursing interventions is most critical when monitoring for magnesium sulfate toxicity in this patient?

A) Monitor the patient's urinary output hourly.

B) Assess the patient's deep tendon reflexes every 4 hours.

C) Check the patient's blood pressure every 2 hours.

D) Monitor fetal heart rate every 4 hours.

pregnancy morning sickness - Nursing Case Study

Pathophysiology

• Primary mechanism: Elevated levels of human chorionic gonadotropin (hCG), produced by the placenta, are strongly associated with morning sickness. The peak of hCG levels during the first trimester correlates with the timing and severity of symptoms, suggesting a direct role in nausea and vomiting.

• Secondary mechanism: Increased estrogen levels during pregnancy can also contribute to morning sickness. Estrogen may enhance the sensitivity of the chemoreceptor trigger zone (CTZ) in the brain, which plays a crucial role in the vomiting reflex.

• Key complication: Persistent vomiting can lead to dehydration and electrolyte imbalances, potentially progressing to hyperemesis gravidarum, which requires medical intervention to prevent adverse outcomes for both the mother and fetus.

Patient Profile

Demographics:

29-year-old female, office manager

History:

• Key past medical history: Mild asthma, managed with inhaler

• Current medications: Prenatal vitamins, albuterol inhaler as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent morning sickness with increased frequency and intensity

• Key symptoms: Nausea and vomiting, fatigue, mild dehydration, dizziness

• Vital signs: Blood pressure 140/90 mmHg, heart rate 110 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F, oxygen saturation 97%

Section 1

As the clinical team continues to monitor the patient's condition, her persistent morning sickness has intensified, raising concerns about potential complications. During the initial assessment, the patient presented with a significant weight loss of 5% of her pre-pregnancy body weight over the past two weeks, indicating that the vomiting episodes are impacting her nutritional status. The clinical team noted her increased fatigue and mild dehydration, as evidenced by dry mucous membranes and decreased skin turgor. Laboratory results revealed hypokalemia with a potassium level of 3.0 mEq/L, suggesting that her electrolyte imbalance could be worsening. The elevated blood pressure of 140/90 mmHg is also concerning, possibly indicating the onset of gestational hypertension, which requires close monitoring to prevent further complications.

Considering the clinical findings, the team decided to initiate intravenous fluid therapy to correct dehydration and electrolyte imbalances. The patient was started on normal saline with potassium supplements to address the hypokalemia. Additionally, antiemetic medication such as ondansetron was administered to help manage the nausea and vomiting. The patient's response to these interventions will be closely monitored, with particular attention to her vital signs, hydration status, and electrolyte levels. The team is aware that if the current measures do not provide sufficient relief, further interventions such as nutritional support and potential admission for more intensive management may be necessary.

The evolving situation requires careful clinical reasoning to determine the most effective strategies for managing the patient's symptoms while minimizing risks to her and the developing fetus. The team is preparing for a follow-up assessment to evaluate the effectiveness of the interventions and to make any necessary adjustments to the care plan. The patient's journey will continue to unfold, with a focus on ensuring maternal and fetal well-being through proactive and responsive clinical care.

Section 2

As the clinical team conducted a follow-up assessment, they noted a mixed response to the initial interventions. The patient's nausea and vomiting had slightly decreased with the administration of ondansetron, but she still experienced significant episodes, particularly in the morning. Despite ongoing intravenous fluid therapy, her laboratory results indicated that the hypokalemia had only marginally improved, with her potassium level now at 3.2 mEq/L. Moreover, her blood pressure readings remained elevated, with a recent measurement showing 142/92 mmHg, raising concerns about the progression of gestational hypertension.

Clinically, her weight remained stable, with no further significant loss, but her fatigue persisted, suggesting that her nutritional intake was still insufficient. The team recognized that her current condition necessitated a broader approach to management. A nutritional consult was requested to explore options for enteral nutrition to ensure adequate caloric and nutrient intake. Additionally, the team considered the introduction of low-dose antihypertensive therapy to manage her blood pressure, weighing the benefits against potential risks to the fetus.

Recognizing the potential for new complications, such as preeclampsia, the clinical team decided to increase the frequency of maternal and fetal monitoring. This included more regular assessments of fetal growth and well-being using ultrasound and Doppler studies to evaluate placental blood flow. The team understood that ongoing vigilance was essential to address any emerging issues promptly. Their aim was to maintain a delicate balance between aggressive intervention and the safety of both the mother and the developing fetus, ensuring that any changes in her condition would be swiftly and effectively managed.

Section 3

As the clinical team continued to monitor the patient, new diagnostic results revealed additional concerns that warranted a change in management strategy. A recent ultrasound indicated that while fetal growth was within normal limits, there was increased resistance in the uterine artery Doppler studies, suggesting compromised placental perfusion. This finding elevated the risk for potential development of preeclampsia and warranted more stringent monitoring. Additionally, repeat laboratory tests showed a slight improvement in her potassium levels, now at 3.4 mEq/L, but still below the normal range, indicating the need for ongoing electrolyte management. Her blood pressure remained elevated, with readings consistently around 140/90 mmHg, reinforcing the necessity for antihypertensive therapy.

In response to these findings, the team decided to initiate low-dose labetalol to manage the patient's gestational hypertension, carefully monitoring for any adverse effects on both mother and fetus. The nutritional consult led to the implementation of a tailored enteral feeding plan, aiming to improve her caloric and nutrient intake and addressing her persistent fatigue. These interventions were complemented by increasing the frequency of prenatal visits to weekly, allowing for closer observation of both maternal and fetal health.

The patient was educated on recognizing warning signs of preeclampsia, such as severe headaches and visual disturbances, and was encouraged to maintain a daily log of her blood pressure and symptoms. As the team implemented these changes, they remained vigilant, understanding that the evolving clinical picture required a flexible, yet cautious approach. This stage of management focused on preemptively addressing potential complications while striving to optimize outcomes for both the mother and the fetus, setting the stage for ongoing assessment and potential adjustments in care.

Section 4

As the weeks progressed, the clinical team noted a change in the patient's status that warranted immediate attention. During a routine weekly prenatal visit, the patient reported experiencing persistent headaches and episodes of blurred vision, symptoms that aligned with the early warning signs of preeclampsia she had been educated to monitor. Upon examination, her blood pressure had risen further to 152/98 mmHg, despite adherence to the antihypertensive regimen. These developments prompted the team to perform additional diagnostic tests to assess for the presence of preeclampsia.

The results of the laboratory tests were concerning, revealing proteinuria with a urine protein-to-creatinine ratio of 0.35, indicative of renal involvement. Liver function tests showed mildly elevated liver enzymes, with AST at 55 U/L and ALT at 62 U/L, suggesting hepatic stress. Meanwhile, the patient's platelet count had decreased to 120,000/mm³, raising suspicion for a more severe form of hypertensive disorder. Given these findings, the team recognized the need to escalate care to prevent progression to severe preeclampsia or HELLP syndrome.

In response to these new complications, the healthcare team decided to admit the patient for closer monitoring and more aggressive management. Intravenous magnesium sulfate was initiated to prevent seizures, and the decision was made to increase the dose of labetalol to better control her blood pressure. The patient was also started on corticosteroids to promote fetal lung maturity in anticipation of a potential early delivery. This change in management strategy was crucial to stabilize the mother's condition while preparing for possible preterm birth, highlighting the dynamic nature of managing hypertensive disorders in pregnancy and the importance of vigilant monitoring and timely intervention.

Section 5

As the patient settled into the hospital setting, the team conducted an initial assessment to establish a baseline for ongoing evaluation. Upon admission, the patient's blood pressure remained elevated at 150/95 mmHg despite the increased labetalol dosage. Her reflexes were brisk, with a 3+ deep tendon reflex noted, underscoring the need for close monitoring for magnesium toxicity once magnesium sulfate infusion began. Fetal heart monitoring was initiated to ensure fetal well-being, and the tracings showed a reassuring pattern with a baseline of 140 beats per minute and moderate variability.

Throughout the first 24 hours of admission, the patient was closely observed for any signs of worsening condition or magnesium sulfate side effects. Her neurological status remained stable, with no reports of dizziness or further visual disturbances, suggesting a favorable initial response to the seizure prophylaxis. Repeat laboratory tests were ordered to track the progression of her condition. The urine protein-to-creatinine ratio showed a slight increase to 0.45, and liver enzymes remained elevated but stable. However, the platelet count decreased further to 110,000/mm³, intensifying the clinical concern for impending HELLP syndrome.

These developments prompted the clinical team to discuss the potential need for early delivery with the patient and her family, weighing the risks of preterm birth against the escalating maternal complications. The decision was made to continue monitoring closely while maximizing maternal stabilization efforts. This approach aimed to prolong the pregnancy as safely as possible, allowing corticosteroids additional time to enhance fetal lung maturity, while preparing for an expedited delivery should the maternal or fetal condition deteriorate. This stage of the patient's care highlighted the critical balance required in managing complex pregnancies, emphasizing the need for ongoing reassessment and readiness to act swiftly in response to any changes.