A 32-year-old pregnant patient with a history of asthma is diagnosed with preeclampsia. She presents with elevated blood pressure, proteinuria, and respiratory distress due to fluid overload. Which nursing intervention is the priority to address her symptoms and prevent complications?

B) Position the patient in high Fowler's position to improve respiratory function.

A) Administer magnesium sulfate to prevent seizures.

B) Position the patient in high Fowler's position to improve respiratory function.

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

D) Administer antihypertensive medication to control blood pressure.

A pregnant patient with preeclampsia and a history of asthma presents with elevated blood pressure, mild anemia, and proteinuria. She is being treated with magnesium sulfate for seizure prevention and antihypertensive therapy. Which nursing intervention is most critical to prioritize in this scenario?

A) Regularly monitor deep tendon reflexes and respiratory status.

B) Encourage increased oral fluid intake to manage edema.

C) Position the patient in a supine position to improve blood flow.

D) Administer an additional dose of antihypertensive medication if BP exceeds 150/100 mmHg.

A patient with worsening preeclampsia is being closely monitored. Which of the following nursing interventions is the priority to address both maternal and fetal well-being?

C) Increasing the frequency of fetal heart rate monitoring

A) Administering oxygen via nasal cannula to improve maternal oxygenation

B) Preparing the patient for an immediate cesarean delivery

C) Increasing the frequency of fetal heart rate monitoring

D) Administering additional antihypertensive medication

A pregnant patient with preeclampsia is experiencing high blood pressure, headache, blurred vision, anemia, and worsening proteinuria. Fetal monitoring indicates occasional decelerations in the fetal heart rate. Which action should the nurse prioritize to address the current situation?

B) Prepare for the possibility of expedited delivery.

A) Increase the dosage of magnesium sulfate.

B) Prepare for the possibility of expedited delivery.

C) Administer additional antihypertensive medication.

D) Provide oxygen therapy to the patient.

A patient diagnosed with HELLP syndrome is being managed conservatively due to her preterm pregnancy. Which nursing intervention is most critical in monitoring for worsening maternal condition?

A) Regularly assess deep tendon reflexes and clonus

B) Monitor blood glucose levels every 4 hours

C) Encourage increased oral fluid intake to prevent dehydration

D) Position the patient in a supine position to promote circulation

A pregnant patient with preeclampsia is suspected to have developed HELLP syndrome based on laboratory findings of elevated liver enzymes and a decreased platelet count. What is the priority nursing intervention to address the potential complications associated with this condition?

C) Initiate seizure precautions and administer magnesium sulfate as prescribed.

A) Administer antihypertensives to manage increased blood pressure.

B) Prepare the patient for an immediate cesarean delivery to prevent further liver damage.

C) Initiate seizure precautions and administer magnesium sulfate as prescribed.

D) Perform a non-stress test to continuously monitor fetal well-being.

A patient with severe preeclampsia is receiving a magnesium sulfate infusion. Which clinical sign should alert the nurse to possible magnesium toxicity?

B) Respiratory rate of 8 breaths per minute

A) Hyperactive deep tendon reflexes

B) Respiratory rate of 8 breaths per minute

C) Blood pressure reading of 140/90 mmHg

D) Presence of headache and blurred vision

A patient with worsening preeclampsia is being treated with magnesium sulfate. Which clinical finding should the nurse prioritize to report to the healthcare provider as a possible sign of magnesium toxicity?

A) Respiratory rate of 10 breaths per minute

C) Blood pressure of 150/90 mmHg

A patient with severe HELLP syndrome is undergoing a cesarean section. The nurse is responsible for monitoring the patient for signs of magnesium toxicity. Which of the following assessment findings should the nurse report immediately to the healthcare provider?

B) Respiratory rate of 12 breaths per minute

A) Diminished deep tendon reflexes

B) Respiratory rate of 12 breaths per minute

D) Blood pressure of 150/90 mmHg

A patient with severe HELLP syndrome is being prepared for an urgent cesarean section. The nursing team is monitoring for signs of magnesium toxicity while the patient receives magnesium sulfate infusion. Which clinical finding would require immediate intervention by the nurse?

B) Respiratory rate decreases to 10 breaths per minute.

A) Deep tendon reflexes are diminished but present.

B) Respiratory rate decreases to 10 breaths per minute.

D) Blood pressure fluctuates between 160/100 mmHg and 170/110 mmHg.

Maternity - Nursing Case Study

Pathophysiology

• Primary mechanism: Hormonal changes - During pregnancy, significant hormonal shifts occur, primarily involving estrogen and progesterone, which facilitate uterine growth, maintain the uterine lining, and prepare the body for labor and lactation.

• Secondary mechanism: Placental function - The placenta acts as a critical interface between mother and fetus, delivering oxygen and nutrients while removing waste. It also produces hormones that support fetal development and maternal adaptations to pregnancy.

• Key complication: Preeclampsia - A condition characterized by high blood pressure and potential organ damage, often linked to impaired placental blood flow and endothelial dysfunction. It can lead to serious health risks for both mother and fetus, necessitating careful monitoring and management.

Patient Profile

Demographics:

28-year-old female, teacher

History:

• Key past medical history: Asthma, gestational diabetes during current pregnancy

• Current medications: Prenatal vitamins, albuterol inhaler as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Shortness of breath and abdominal pain

• Key symptoms: Fatigue, elevated blood pressure, mild swelling in hands and feet

• Vital signs: Blood pressure 145/92 mmHg, heart rate 98 bpm, respiratory rate 22 breaths per minute, temperature 98.7°F, oxygen saturation 94% on room air

Section 1

As the healthcare team conducts an initial assessment, the patient's symptoms and vital signs raise concerns about the progression of her condition. Her blood pressure remains elevated at 148/94 mmHg, and she reports persistent shortness of breath despite resting in a semi-Fowler's position. Physical examination reveals 2+ pitting edema in the lower extremities and increased swelling in her hands and face. Auscultation of the lungs indicates bilateral crackles at the bases, suggestive of fluid accumulation. The fundal height measurement is consistent with gestational age, but fetal heart rate monitoring shows mild tachycardia at 165 bpm, raising concerns about fetal stress.

Laboratory results reveal important diagnostic changes: a complete blood count shows hemoglobin at 10.5 g/dL and hematocrit at 32%, indicating mild anemia. Liver function tests are elevated, with AST at 55 U/L and ALT at 60 U/L. Urinalysis reveals proteinuria, with a protein-creatinine ratio of 0.35, confirming the suspicion of preeclampsia. These findings, combined with her symptoms and elevated blood pressure, suggest a moderate risk for complications. Clinical reasoning must now focus on managing the preeclampsia to prevent further maternal and fetal complications, such as eclampsia or preterm delivery.

Given the patient's asthma, the team must also consider the respiratory implications of fluid overload and prioritize interventions that stabilize her hemodynamic status. The healthcare team decides to initiate magnesium sulfate to prevent seizures, along with antihypertensive therapy to control her blood pressure. Continuous fetal monitoring is established to assess fetal well-being closely. The patient is educated about the importance of reporting any new symptoms, such as severe headaches or visual disturbances, which could indicate worsening preeclampsia. This approach aims to mitigate risks and prepare for potential escalation of care, including possible delivery planning if maternal or fetal conditions deteriorate.

Section 2

As the healthcare team monitors the patient's response to the initial interventions, there is a notable change in her status. Despite the administration of magnesium sulfate and antihypertensive therapy, her blood pressure remains stubbornly high at 152/96 mmHg. The patient reports a new onset of a dull, constant headache and experiences intermittent blurred vision, both of which are concerning for worsening preeclampsia. Her respiratory status is stable, but she continues to experience mild dyspnea, and auscultation still reveals crackles at the lung bases.

Laboratory results from a follow-up analysis reveal a further decrease in hemoglobin to 10.2 g/dL, with hematocrit dropping to 31%, suggesting progression of anemia. Her liver function tests show a slight increase, with AST now at 62 U/L and ALT at 65 U/L, indicating ongoing hepatic involvement. Additionally, her proteinuria has worsened, with the protein-creatinine ratio increasing to 0.45. These findings corroborate the clinical suspicion of advancing preeclampsia, necessitating a reassessment of her current management plan.

Given these developments, the healthcare team intensifies fetal monitoring, which now shows occasional decelerations in the fetal heart rate, raising concerns about fetal compromise. The team discusses the potential need for expedited delivery, emphasizing the importance of balancing maternal stabilization against the risks of preterm delivery. The patient is counseled on the current situation, and preparations are made for a potential transfer to a higher level of care should her condition require more intensive interventions. This careful monitoring and planning are crucial in navigating the complexities of her evolving clinical picture, ensuring both maternal and fetal safety.

Section 3

As the healthcare team continues to manage the patient's condition, a new complication arises. Within hours, the patient begins to experience increased epigastric pain, which she describes as a sharp, persistent discomfort radiating towards her back. Concerned about potential worsening liver involvement or the development of HELLP syndrome, the team orders an urgent set of laboratory tests. The results reveal a further elevation in liver enzymes, with AST now at 85 U/L and ALT at 78 U/L, along with a significant drop in platelet count to 95,000/mm³. These findings strongly suggest the onset of HELLP syndrome, a serious complication of preeclampsia, which necessitates immediate attention.

In light of these developments, the patient's management plan is reassessed with a multidisciplinary team. The obstetrician emphasizes the need for stabilization and preparation for possible delivery, given the risks to both maternal and fetal health. The decision is made to administer corticosteroids to enhance fetal lung maturity, anticipating the potential need for early delivery. Continuous fetal monitoring remains a priority, and the team keeps a close watch for any further signs of fetal distress.

The patient's condition underscores the importance of timely and coordinated care in managing complex obstetric cases. The healthcare team is keenly aware of the delicate balance between prolonging the pregnancy for fetal benefit and addressing the escalating maternal risks. As the situation evolves, they remain vigilant in their assessments and prepared to escalate care, ensuring that both the mother and her unborn child receive the best possible outcomes. This approach highlights the critical role of clinical reasoning and swift decision-making in navigating the complexities of high-risk pregnancies.

Section 4

As the healthcare team continues to monitor the patient closely, a change in her status becomes evident. Within a few hours, the patient's blood pressure begins to rise significantly, measuring 165/110 mmHg, despite the administration of antihypertensive medication. Her reflexes become hyperactive, and she reports a new onset of headache and blurred vision, both concerning signs of worsening preeclampsia. The nursing team, vigilant in their observations, promptly reports these changes to the obstetrician, who recognizes the potential for seizures and the need for immediate intervention.

In response, the medical team initiates a magnesium sulfate infusion to prevent eclamptic seizures, adjusting the dosage carefully while monitoring for signs of magnesium toxicity, such as respiratory depression or diminished reflexes. Alongside this, fetal heart rate monitoring reveals intermittent decelerations, raising concerns about compromised fetal oxygenation. The obstetrician and neonatologist confer to reassess the risks and benefits, emphasizing the need for possible expedited delivery to mitigate both maternal and fetal risks.

As the team works collaboratively, they reassess the patient's laboratory results, noting a further drop in platelet count to 80,000/mm³ and a slight increase in bilirubin levels, indicating progression of HELLP syndrome. This development necessitates a discussion regarding the timing and method of delivery. With the patient's condition deteriorating and fetal well-being at risk, the consensus leans towards an urgent cesarean section. The healthcare team prepares for this critical intervention, ensuring all necessary resources and personnel are available to support both maternal and neonatal care during and after the procedure.

Section 5

As preparations for the urgent cesarean section are underway, the healthcare team remains vigilant in monitoring the patient's response to the ongoing magnesium sulfate infusion and antihypertensive therapy. Despite these interventions, the patient's condition continues to evolve. Her blood pressure remains elevated, fluctuating between 160/100 mmHg and 170/110 mmHg, and her headache persists, although slightly alleviated by analgesics. However, the patient's urine output begins to decrease to less than 30 mL/hour, raising concerns about potential renal involvement and the worsening of HELLP syndrome. Laboratory results reveal a further decline in platelet count to 70,000/mm³ and an increase in liver enzyme levels, with AST reaching 85 IU/L and ALT rising to 78 IU/L, reinforcing the diagnosis of severe HELLP syndrome.

The fetal heart rate monitoring continues to present challenges, with persistent late decelerations and minimal variability, indicating potential fetal distress. The neonatologist and obstetrician discuss the implications of these findings, emphasizing the need for swift delivery to prevent further compromise. Meanwhile, the nursing team meticulously assesses the patient for signs of magnesium toxicity, noting that her deep tendon reflexes remain present but are now diminished, and her respiratory rate is stable at 14 breaths per minute, suggesting that the magnesium levels are within a therapeutic range.

Given the complexity of the situation, the healthcare team engages in a focused discussion on the timing of the cesarean section, weighing the risks of continuing the pregnancy against the potential neonatal outcomes associated with preterm delivery. The obstetrician decides to proceed with the cesarean section within the next hour, aiming to optimize both maternal and fetal outcomes. As the team prepares for surgery, they ensure that all necessary equipment and personnel, including a neonatal resuscitation team, are in place to address any immediate post-delivery complications. This coordinated approach reflects the critical balance between timely intervention and comprehensive care, setting the stage for the next phase of the patient's journey.