A 34-week pregnant patient with a history of gestational diabetes and hypertension is diagnosed with preeclampsia with severe features. She is admitted to the labor and delivery unit. Which nursing intervention is the highest priority to prevent complications for this patient?

B) Initiating intravenous magnesium sulfate to prevent seizures

A) Administering corticosteroids to promote fetal lung maturity

B) Initiating intravenous magnesium sulfate to prevent seizures

C) Monitoring the patient's blood pressure every hour

D) Preparing the patient for potential expedited delivery

A 34-week pregnant patient with a history of gestational diabetes and hypertension presents with significant edema, headaches, visual disturbances, and proteinuria. Laboratory results indicate thrombocytopenia and elevated liver enzymes. Which nursing intervention should take priority in managing her condition?

A) Administer intravenous magnesium sulfate to prevent seizures

B) Initiate continuous fetal monitoring to assess for fetal distress

C) Provide corticosteroids to enhance fetal lung maturity

D) Educate the patient about potential dietary changes to manage hypertension

A 32-year-old patient with severe preeclampsia is receiving magnesium sulfate and antihypertensive therapy. She develops shortness of breath, chest discomfort, and crackles are noted in the lung bases, with an oxygen saturation of 92% on room air. What is the most appropriate initial nursing intervention?

A) Administer supplemental oxygen via nasal cannula

B) Increase the rate of intravenous fluids

C) Position the patient in a supine position

D) Administer an additional dose of magnesium sulfate

A pregnant patient with worsening pulmonary edema and persistent shortness of breath shows hypoxemia despite diuretic treatment. Her oxygen saturation is 89% on room air, and her respiratory rate is 28 breaths per minute. Considering these clinical findings, what would be the most appropriate initial nursing intervention to improve the patient's respiratory status?

B) Position the patient in a high Fowler's position

A) Increase the flow rate of oxygen via nasal cannula

B) Position the patient in a high Fowler's position

C) Prepare the patient for immediate endotracheal intubation

D) Administer an additional dose of diuretics as prescribed

A pregnant patient with worsening pulmonary edema and hypoxemia is being monitored. Despite diuretic therapy, her respiratory symptoms persist, and her oxygen saturation has decreased. Which nursing intervention is most appropriate to prioritize at this time?

B) Elevate the head of the bed to improve lung expansion and ease of breathing.

A) Increase the flow rate of the nasal cannula to provide higher oxygen concentration.

B) Elevate the head of the bed to improve lung expansion and ease of breathing.

C) Administer a bronchodilator to open the airways and improve airflow.

D) Prepare for immediate intubation to secure the airway and provide mechanical ventilation.

A postpartum patient with suspected peripartum cardiomyopathy is experiencing increased cardiac workload and pulmonary edema. Which nursing intervention is most appropriate to prioritize in her care plan to prevent further cardiac decompensation?

B) Administer diuretics as prescribed to reduce fluid overload and decrease cardiac workload.

A) Increase the oxygen flow rate to 6 liters per minute to improve oxygen saturation.

B) Administer diuretics as prescribed to reduce fluid overload and decrease cardiac workload.

C) Encourage bed rest to minimize physical exertion and reduce cardiac demand.

D) Initiate intravenous fluids to maintain adequate hydration and support cardiac output.

A postpartum patient with a diagnosis of peripartum cardiomyopathy is on beta-blocker therapy. During your assessment, you note her heart rate is 58 bpm, respiratory rate is 26 breaths per minute, and oxygen saturation is 93% on 4 liters of oxygen via nasal cannula. What is the most appropriate nursing intervention at this time?

B) Hold the beta-blocker and notify the healthcare provider

A) Increase oxygen flow rate to 6 liters per minute

B) Hold the beta-blocker and notify the healthcare provider

C) Encourage the patient to ambulate to improve lung expansion

D) Reassess vital signs in 30 minutes and continue monitoring

A patient with peripartum cardiomyopathy is experiencing mild chest discomfort, fatigue, and hypotension. Her laboratory results show a serum sodium level of 130 mmol/L and a BNP level of 600 pg/mL. Which nursing intervention is most appropriate to prioritize at this time?

A) Administer low-dose diuretics to manage fluid overload

B) Encourage oral fluid intake to correct hyponatremia

C) Prepare for immediate cesarean delivery due to fetal distress

D) Administer a high-sodium diet to rapidly increase sodium levels

A nurse is caring for a pregnant patient diagnosed with peripartum cardiomyopathy who is experiencing increasing fatigue and mild chest discomfort. Her blood pressure is 88/58 mmHg, and her BNP level is elevated. Which intervention should the nurse prioritize to address the patient's condition?

B) Administer the prescribed low-dose diuretic to reduce fluid overload.

A) Encourage the patient to increase oral fluid intake to manage potential dehydration.

B) Administer the prescribed low-dose diuretic to reduce fluid overload.

C) Advise the patient to remain in a supine position to rest and conserve energy.

D) Increase the patient's dietary sodium intake to correct hyponatremia.

Maternity - Nursing Case Study

Pathophysiology

• Primary mechanism: Hormonal regulation in pregnancy involves increased levels of estrogen and progesterone, which are crucial for maintaining the uterine lining and supporting fetal development. These hormones also prepare the body for labor by softening the cervix and promoting uterine contractions.

• Secondary mechanism: Placental function is essential for fetal nourishment and waste removal. It acts as an endocrine organ, producing hormones like human chorionic gonadotropin (hCG), which supports the corpus luteum and early pregnancy maintenance.

• Key complication: Preeclampsia, characterized by hypertension and proteinuria, results from abnormal placental implantation and vascular remodeling, leading to endothelial dysfunction and systemic inflammatory response. Early detection and management are vital to prevent severe maternal and fetal complications.

Patient Profile

Demographics:

28-year-old female, office administrator

History:

• Key past medical history: Gestational diabetes in previous pregnancy, hypertension

• Current medications: Prenatal vitamins, labetalol

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increasing shortness of breath and swelling in legs

• Key symptoms: Persistent headache, visual disturbances, fatigue

• Vital signs: Blood pressure 150/100 mmHg, heart rate 95 bpm, respiratory rate 22 breaths per minute, temperature 37.2°C

Section 1

The medical team initiates a comprehensive assessment of the patient due to her presenting symptoms and history of gestational diabetes and hypertension, which places her at higher risk for developing preeclampsia. During the physical examination, signs of significant edema are noted, particularly in the lower extremities, and the patient's face appears puffy. Auscultation of the lungs reveals mild crackles at the bases, suggesting fluid accumulation. Given her persistent headache and visual disturbances, a neurological assessment is conducted, which shows no focal deficits but raises concerns about cerebral edema.

The attending physician orders a series of laboratory tests and imaging studies to further evaluate the patient's condition. Her complete blood count reveals thrombocytopenia with a platelet count of 95,000/µL, and her liver function tests show elevated liver enzymes, with AST and ALT levels at 80 and 95 IU/L, respectively. A urine dipstick test confirms the presence of significant proteinuria. An ultrasound of the fetus indicates appropriate growth for gestational age, but there is evidence of reduced amniotic fluid, suggesting potential placental insufficiency. These findings are consistent with preeclampsia with severe features, necessitating immediate intervention to prevent progression to eclampsia.

The medical team decides to admit the patient to the labor and delivery unit for close monitoring and management. They initiate intravenous magnesium sulfate to prevent seizures and administer antihypertensive medication to control her blood pressure. The obstetrician discusses the possibility of expedited delivery, given the gestational age of 34 weeks and the risks to both mother and fetus if the pregnancy continues without intervention. The patient is informed of the potential need for corticosteroids to promote fetal lung maturity, should early delivery be deemed necessary. The healthcare team remains vigilant, monitoring the patient’s neurological status and fetal heart rate patterns to ensure timely responses to any changes in condition.

Section 2

Following the initiation of magnesium sulfate therapy and antihypertensive treatment, the patient's blood pressure shows signs of gradual stabilization, with readings now averaging around 145/90 mmHg. However, within a few hours, the patient begins to report increasing shortness of breath and chest discomfort. A repeat physical examination reveals worsening crackles in the lung bases, and her oxygen saturation has decreased to 92% on room air. Concerned about fluid overload and potential pulmonary edema, the medical team orders an arterial blood gas analysis and a chest X-ray. The arterial blood gas results reveal mild hypoxemia with a pH of 7.43, PaCO2 of 37 mmHg, and PaO2 of 65 mmHg. The chest X-ray confirms the presence of bilateral pulmonary infiltrates indicative of pulmonary edema.

In response to these new findings, the medical team decides to cautiously administer diuretics to alleviate fluid overload while maintaining careful monitoring of the patient's electrolyte balance, given the risk of magnesium sulfate toxicity. A repeat neurological assessment shows that the patient's headache has slightly improved, but she reports continued visual disturbances, which prompts ongoing vigilance for signs of central nervous system involvement. Meanwhile, continuous fetal monitoring reveals occasional late decelerations, suggesting intermittent fetal distress. The obstetrician and neonatologist discuss the benefits of administering corticosteroids to enhance fetal lung maturity, considering the possibility of delivery in the next 24-48 hours if maternal or fetal conditions worsen.

As the patient remains in the labor and delivery unit, the healthcare team continues to evaluate her response to interventions closely. They perform frequent assessments of her respiratory status, blood pressure, and urine output to gauge the effectiveness of the diuretic therapy and antihypertensive management. The multidisciplinary team remains prepared to transition to an emergency delivery if there is any indication of further deterioration in maternal or fetal status, ensuring both the mother and baby receive optimal care during this critical period.

Section 3

As the medical team continues to monitor the patient, they notice a change in her status, prompting further evaluation. Despite the administration of diuretics, the patient's shortness of breath persists, and her oxygen saturation has decreased further to 89% on room air, requiring supplemental oxygen via nasal cannula to maintain adequate saturation levels. Her respiratory rate has increased to 28 breaths per minute, and she appears more fatigued and anxious. A repeat auscultation of her lungs reveals more pronounced crackles extending to the mid-lung fields, suggesting that the pulmonary edema may be worsening.

Concerned about the possible progression of her condition, the team orders another set of arterial blood gases. The results show a continuing trend of hypoxemia with a PaO2 of 60 mmHg, while the pH remains stable at 7.41 and PaCO2 at 38 mmHg, indicating a respiratory compromise without significant acidosis. Meanwhile, the patient's blood pressure remains stable at 140/88 mmHg, and her urine output has increased slightly, suggesting some diuretic effect. However, the persistent respiratory symptoms and deteriorating oxygen levels raise concerns about the need for escalating respiratory support and the potential risk to both the mother and the fetus.

In light of these developments, the medical team reevaluates the risk-benefit ratio for potential early delivery. They engage in a thorough discussion with the patient about her condition and the implications for her and her baby's health. The decision to administer corticosteroids is reinforced to accelerate fetal lung maturity, preparing for a possible preterm delivery. Additionally, the team remains vigilant for any further neurological symptoms, as the patient's visual disturbances continue, albeit without worsening. This ongoing assessment underscores the need for a dynamic and responsive management strategy, with the healthcare team ready to adapt to the evolving clinical scenario to ensure the best outcomes for both mother and child.

Section 4

As the medical team continues to monitor the patient, they notice a new complication emerging. The patient begins to exhibit signs of increased cardiac workload, with her heart rate climbing to 115 beats per minute. Despite the administration of supplemental oxygen, her oxygen saturation remains precariously low at 91% on 4 liters per minute via nasal cannula, and her respiratory rate remains elevated at 30 breaths per minute. Concerned about the potential for cardiac involvement due to the persistent pulmonary edema, the team decides to obtain an echocardiogram to assess cardiac function and rule out any underlying heart conditions contributing to her symptoms.

The echocardiogram reveals a mild decrease in left ventricular ejection fraction at 45%, suggesting some degree of systolic dysfunction. This finding raises the suspicion of peripartum cardiomyopathy, a rare but serious condition that can develop during the last month of pregnancy or in the months following delivery. The team discusses these findings with the patient, emphasizing the importance of closely monitoring her cardiac status and adjusting her treatment plan accordingly. They initiate beta-blocker therapy to help manage her heart rate and improve cardiac output, while continuing to monitor her respiratory status and fetal well-being.

In response to these interventions, the patient experiences a slight improvement in her respiratory effort, with her respiratory rate decreasing to 26 breaths per minute and her oxygen saturation stabilizing at 93%. However, the care team remains vigilant, aware of the potential for further complications. They schedule regular follow-up echocardiograms to track her cardiac function and conduct frequent fetal monitoring to ensure that the baby remains stable. This proactive approach highlights the importance of adapting to the evolving clinical picture, balancing the need to manage maternal symptoms while safeguarding fetal health, and preparing for a potential early delivery if the mother's condition does not improve.

Section 5

As the medical team continues their vigilant monitoring, they notice a subtle yet concerning change in the patient's status. Although her respiratory rate remains slightly improved and her oxygen saturation has stabilized modestly, the patient begins to report increasing fatigue and mild chest discomfort. During a routine assessment, the nurse notes that her blood pressure has dropped to 88/58 mmHg, indicating potential hemodynamic instability. Additionally, there is mild jugular venous distension observed upon inspection, suggesting fluid overload and possible worsening of cardiac function.

Concerned about these developments, the team orders a repeat set of laboratory tests, including a complete blood count, electrolytes, and cardiac biomarkers. The results reveal a mild hyponatremia with a serum sodium level of 130 mmol/L and an elevated B-type natriuretic peptide (BNP) level of 600 pg/mL, further supporting the diagnosis of heart failure. These findings prompt the team to adjust her medication regimen, introducing a low-dose diuretic to help manage fluid retention and alleviate cardiac workload. They also decide to increase her beta-blocker dosage cautiously to improve her cardiac function and maintain hemodynamic stability.

The patient's response to these interventions is closely monitored, and her clinical picture continues to evolve. The team remains attentive to her fluid balance, carefully titrating her diuretic therapy to avoid overcorrection of her sodium levels, while maintaining a close watch on fetal heart monitoring to ensure the safety and well-being of the baby. This dynamic situation underscores the complexity of managing peripartum cardiomyopathy and highlights the importance of integrating clinical reasoning with ongoing assessment to optimize both maternal and fetal outcomes. The team prepares for the possibility of an early delivery should the patient's condition not improve, ensuring that all necessary resources are in place for a safe and timely intervention if required.