A pregnant patient is diagnosed with oligohydramnios and suspected preeclampsia. Which nursing intervention should be prioritized to ensure fetal well-being?

C) Schedule frequent non-stress tests to monitor fetal heart rate patterns

A) Encourage increased oral fluid intake to improve amniotic fluid volume

B) Administer antihypertensive medication as prescribed to control maternal blood pressure

C) Schedule frequent non-stress tests to monitor fetal heart rate patterns

D) Provide dietary counseling to ensure adequate maternal nutrition

A pregnant patient at 32 weeks gestation is diagnosed with oligohydramnios and signs of intrauterine growth restriction (IUGR). The nurse notes elevated liver enzymes and the patient reports persistent headaches and visual disturbances. Which nursing intervention is most critical at this time?

C) Administer antihypertensive medication as ordered

A) Initiate bed rest to improve placental blood flow

B) Prepare the patient for an immediate cesarean section

C) Administer antihypertensive medication as ordered

D) Educate the patient on signs of preterm labor

A 32-year-old pregnant patient is admitted for monitoring due to suspected preeclampsia. Her blood pressure is 150/95 mmHg, she reports a persistent headache, and her urine dipstick shows +1 proteinuria. A non-stress test reveals occasional variable decelerations. What is the nurse’s priority intervention to address the potential fetal risk?

B) Reposition the patient to her left side.

A) Encourage the patient to increase her fluid intake.

B) Reposition the patient to her left side.

C) Administer an antihypertensive medication as prescribed.

D) Prepare the patient for an immediate cesarean section.

A nurse is caring for a pregnant patient with suspected preeclampsia. The patient's blood pressure is 150/95 mmHg, she reports persistent headache and visual disturbances, and her urine dipstick test shows +1 proteinuria. Which nursing intervention should be prioritized to address the current clinical findings?

C) Prepare for the administration of magnesium sulfate to prevent seizures.

A) Administer antihypertensive medication to lower blood pressure immediately.

B) Educate the patient about reducing salt intake to manage blood pressure.

C) Prepare for the administration of magnesium sulfate to prevent seizures.

D) Collect a 24-hour urine sample to monitor protein levels more accurately.

A patient diagnosed with HELLP syndrome is receiving magnesium sulfate therapy to prevent seizures. Which of the following nursing assessments is the most critical to perform to ensure the safe administration of magnesium sulfate?

A) Monitoring deep tendon reflexes

B) Measuring blood glucose levels

C) Assessing for signs of hypocalcemia

D) Checking for peripheral edema

A patient with HELLP syndrome is receiving magnesium sulfate therapy. Which nursing assessment is a priority to prevent potential complications associated with this treatment?

A) Monitor deep tendon reflexes every hour.

B) Assess fetal heart rate variability continuously.

C) Check maternal blood glucose levels every two hours.

D) Measure urine output every four hours.

A patient receiving magnesium sulfate therapy for severe preeclampsia begins to show signs of magnesium toxicity, including lethargy, reduced deep tendon reflexes, and a decreased respiratory rate. Which nursing intervention should be prioritized to address the magnesium toxicity?

B) Administer calcium gluconate as ordered by the healthcare provider.

A) Continue monitoring the patient's vital signs and document findings.

B) Administer calcium gluconate as ordered by the healthcare provider.

C) Increase the rate of magnesium sulfate infusion to manage hypertension.

D) Instruct the patient to perform deep breathing exercises to improve respiratory rate.

A patient receiving magnesium sulfate therapy for severe preeclampsia begins to show signs of magnesium toxicity. Which of the following is the most appropriate initial nursing action?

D) Discontinue the magnesium sulfate infusion and monitor the patient closely.

A) Increase the rate of the magnesium sulfate infusion.

B) Prepare for immediate cesarean delivery.

C) Administer calcium gluconate as an antidote.

D) Discontinue the magnesium sulfate infusion and monitor the patient closely.

A pregnant patient at 34 weeks gestation presents with increased resistance in the umbilical artery, elevated liver enzymes, and a slight decrease in platelet count. Given these findings, what is the priority nursing intervention?

D) Monitor fetal heart rate continuously

A) Administer magnesium sulfate to prevent seizures

B) Increase maternal hydration to improve placental perfusion

C) Prepare for an immediate cesarean section

D) Monitor fetal heart rate continuously

A pregnant patient at 34 weeks gestation presents with a biophysical profile score of 6/10, increased resistance in the umbilical artery on Doppler ultrasound, and laboratory findings suggestive of HELLP syndrome. What is the priority nursing intervention?

B) Prepare the patient for an immediate cesarean section as per the team's decision.

A) Continue monitoring fetal heart rate and maternal blood pressure every hour.

B) Prepare the patient for an immediate cesarean section as per the team's decision.

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

D) Provide bed rest and encourage oral hydration to improve placental blood flow.

prenatal assessment - Nursing Case Study

Pathophysiology

• Primary mechanism: Placental insufficiency - This condition occurs when the placenta fails to deliver adequate oxygen and nutrients to the fetus, potentially leading to intrauterine growth restriction and hypoxia. It can result from maternal hypertension, diabetes, or placental abnormalities.

• Secondary mechanism: Amniotic fluid abnormalities - Polyhydramnios or oligohydramnios can disrupt fetal development. Polyhydramnios may be linked to gestational diabetes, while oligohydramnios could indicate fetal renal issues or placental dysfunction, affecting fetal movement and lung development.

• Key complication: Preterm labor - This can arise from infections, cervical insufficiency, or placental abruption. It poses risks such as respiratory distress syndrome or neurodevelopmental delays in the neonate due to incomplete organ maturation.

Patient Profile

Demographics:

28 years old, female, elementary school teacher

History:

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

• Current medications: Prenatal vitamins, labetalol

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increased swelling and headaches

• Key symptoms: Persistent headache, visual disturbances, increased swelling in hands and feet

• Vital signs: Blood pressure 150/95 mmHg, heart rate 92 bpm, temperature 98.6°F, respiratory rate 18 breaths per minute

Section 1

As the prenatal assessment progresses, new diagnostic results reveal concerning developments. An ultrasound is performed to evaluate the status of the fetus and the placenta. The ultrasound findings indicate oligohydramnios, with an amniotic fluid index (AFI) of 4 cm, significantly below the normal range of 8-18 cm. This suggests decreased amniotic fluid, which may be linked to placental insufficiency and could adversely affect fetal lung development and movement. Additionally, the ultrasound shows signs of intrauterine growth restriction (IUGR), with the estimated fetal weight below the 10th percentile for gestational age, raising concerns about adequate fetal nutrition and oxygenation.

Concurrent laboratory tests provide further insight into the patient's condition. Blood tests reveal elevated liver enzymes (AST and ALT), with AST at 45 U/L and ALT at 50 U/L, indicating potential liver involvement. Platelet counts, however, remain within normal limits at 190,000/µL, suggesting that the patient is not yet experiencing significant thrombocytopenia, a common feature in conditions like preeclampsia with severe features. These findings, combined with the patient's persistent headache and visual disturbances, strengthen the suspicion of preeclampsia, necessitating close monitoring and potential intervention to prevent progression to more severe complications.

Given these developments, the healthcare team discusses the possibility of hospitalization to closely monitor both maternal and fetal well-being. The focus will be on managing blood pressure, monitoring fetal growth, and assessing the need for potential early delivery if the maternal condition worsens or fetal distress is detected. The interdisciplinary team, including obstetricians, nurses, and neonatologists, prepares to implement a comprehensive care plan aimed at optimizing outcomes for both the mother and her unborn child.

Section 2

As the healthcare team prepares to implement the care plan, they decide to admit the patient for closer monitoring and management of her condition. Upon admission, a comprehensive initial assessment is conducted. The patient's blood pressure is recorded at 150/95 mmHg, higher than her baseline but not yet at a critical level. Her heart rate is 88 beats per minute, and respiratory rate is 18 breaths per minute, both within normal limits. However, her persistent headache and intermittent visual disturbances, described as seeing flashing lights, remain concerning. A urine dipstick test reveals +1 proteinuria, which, while not severe, adds to the growing suspicion of preeclampsia.

The team orders additional diagnostic tests to further evaluate both maternal and fetal status. A non-stress test (NST) is performed to assess fetal well-being, revealing occasional variable decelerations, which suggest possible umbilical cord compression in the context of oligohydramnios. Fetal heart rate remains reactive overall, but the decelerations prompt the team to consider more frequent monitoring. Continuous electronic fetal monitoring is initiated to track any changes in fetal heart patterns, providing real-time data to inform potential interventions.

As the patient's condition is closely monitored, the healthcare team engages in frequent discussions about the balance between prolonging the pregnancy to allow for further fetal development and the risks associated with worsening maternal and fetal status. The team considers administering antenatal corticosteroids to accelerate fetal lung maturity in anticipation of possible preterm delivery. The plan includes continued monitoring of maternal liver function and blood pressure, as well as fetal growth assessments, to determine the optimal timing for delivery should the patient's condition deteriorate. This careful evaluation and dynamic decision-making underscore the interdisciplinary team's commitment to achieving the best possible outcomes for both mother and child.

Section 3

As the healthcare team continues to monitor the patient, new diagnostic results provide further insight into her condition. Blood tests reveal elevated liver enzymes and a platelet count that has begun to drop, suggestive of HELLP syndrome, a severe form of preeclampsia. Laboratory findings show AST at 85 IU/L (normal range 10-40 IU/L), ALT at 95 IU/L (normal range 7-56 IU/L), and platelets at 110,000/µL (normal range 150,000-450,000/µL). These findings escalate the urgency of the situation, as HELLP syndrome can lead to serious complications for both mother and fetus.

In response to these new developments, the healthcare team decides to initiate magnesium sulfate therapy to prevent seizures, a common complication associated with severe preeclampsia. The patient's blood pressure remains elevated at 155/98 mmHg, prompting the administration of antihypertensive medication to maintain maternal stability. The decision is made to continue antenatal corticosteroids to enhance fetal lung maturity, as the possibility of preterm delivery becomes more likely. Continuous fetal monitoring shows persistent variable decelerations, reinforcing the need for close surveillance.

The team convenes to reassess the care plan, considering the potential need for delivery if maternal or fetal conditions deteriorate further. The maternal-fetal medicine specialist emphasizes the importance of balancing maternal safety with fetal development, advocating for a multidisciplinary approach to manage this high-risk pregnancy. The collaborative decision-making and proactive interventions highlight the complexity of the case, as the team strives to optimize outcomes in a challenging clinical scenario. This situation necessitates ongoing vigilance and adaptability, as new complications could arise at any moment.

Section 4

As the healthcare team continues to monitor the patient, a change in her status becomes apparent. Despite the initiation of magnesium sulfate therapy, the patient begins to exhibit signs of magnesium toxicity. She reports feeling increasingly lethargic and experiences a reduction in deep tendon reflexes, which are now rated at 1+ compared to the previous 2+. Her respiratory rate has decreased to 10 breaths per minute, raising concerns among the team about her respiratory function. In response to these findings, the magnesium sulfate infusion is temporarily halted, and calcium gluconate is prepared as an antidote to counteract the effects of toxicity.

Alongside these developments, the patient's blood pressure remains difficult to control, fluctuating between 150/95 mmHg and 160/100 mmHg despite the administration of antihypertensive medication. The fetal monitoring shows intermittent late decelerations, indicating potential uteroplacental insufficiency. This suggests that the fetus may not be receiving adequate oxygenation, necessitating immediate reassessment of both maternal and fetal conditions. The healthcare team, led by the maternal-fetal medicine specialist, decides to perform a biophysical profile and Doppler ultrasound to further evaluate fetal well-being and placental function.

These findings prompt a critical discussion within the multidisciplinary team regarding the timing of delivery. While the goal is to prolong the pregnancy to allow further fetal development, the emerging complications and the mother's deteriorating condition heighten the risk of adverse outcomes. The team must weigh the benefits and risks of continuing the pregnancy against the potential need for an expedited delivery. The decision-making process underscores the necessity of ongoing clinical vigilance and the ability to swiftly adapt the care plan to ensure the best possible outcomes for both mother and child.

Section 5

New diagnostic results reveal concerning developments in both maternal and fetal health. The biophysical profile, which evaluates fetal breathing, movement, muscle tone, heart rate, and amniotic fluid volume, scores a 6 out of 10, indicating moderate risk. The Doppler ultrasound shows increased resistance in the umbilical artery, suggesting compromised blood flow between the placenta and fetus, further supporting the diagnosis of uteroplacental insufficiency. These findings correlate with the intermittent late decelerations seen on fetal monitoring, reinforcing the concern that the fetus is experiencing episodic hypoxia.

Laboratory results return with elevated liver enzymes and a slight decrease in platelet count, hinting at the development of HELLP syndrome, a serious complication of preeclampsia. The patient's creatinine levels have also risen, indicating potential renal impairment. With these results, the team acknowledges the escalating severity of the maternal condition, which, combined with the compromised fetal status, intensifies the need for a timely and strategic plan of care.

The multidisciplinary team reconvenes to discuss the implications of these findings. Given the worsening maternal lab values and fetal assessment scores, the decision leans towards expediting delivery to prevent further deterioration. The team prioritizes stabilizing the mother's condition, adjusting her antihypertensive regimen, and preparing for a possible cesarean section. This pivotal moment underscores the importance of balancing maternal and fetal risks, where swift, informed clinical reasoning is critical to safeguarding both lives.