Preeclampsia Case Study

At 0600 Jennie is brought to the Labor and Delivery triage region by her sister. The customer whines of a beating migraine throughout the previous 12 hours unrelieved by acetaminophen (Tylenol), swollen hands and face for 2 days, and epigastric torment portrayed as awful acid reflux. Her sister tells the medical attendant, â€Å"I felt like that when I had toxemia during my pregnancy. † Admission evaluation by the medical attendant uncovers: the present weight 182 pounds, T 99. 1â ° F, P 76, R 22, BP 138/88, 4+ pitting edema, and 3+ protein in the pee. Pulse is standard, and lung sounds are clear.Deep ligament reflexes (DTRs) are 3+ biceps and triceps and 4+ patellar with 1 beat of lower leg clonus. The medical caretaker applies the outer fetal screen, which shows a standard fetal pulse of 130, missing changeability, positive for increasing velocities, no decelerations, and no constrictions. The medical caretaker additionally plays out a vaginal assessment and finds that the cervix is 1 cm enlarged and half destroyed, with the fetal head at a - 2 station. 1. In assessing Jennie's history, the medical attendant is right in reasoning that Jennie is in danger of building up a hypertensive issue as a result of her age (15).Which different components add to Jennie's danger of creating preeclampsia? A) Molar pregnancy, history of preeclampsia in past pregnancy. Off base While these are hazard factors for preeclampsia, Jennie has no signs of a molar pregnancy (first trimester vaginal dying, size/date inconsistency, or unnecessary queasiness and retching), nor has she had any past pregnancies (gravida 1). B) Gravidity, familial history. Right Jennie is under 17 years old, is pregnant for the first run through, and has a sister with a background marked by toxemia, which is an old term for preeclampsia that a few customers may in any case use.C) History of beating cerebral pain, low financial status. Off base While age and low financial status (SES) are haz ard factors, Jennie's SES is obscure. A beating migraine is a manifestation, not a hazard factor. D) Low financial status (SES), history of pedal edema. Mistaken Although age and low SES are hazard factors, this current customer's SES is obscure. Pedal edema is regular in pregnancy following 32-weeks. 2. To precisely evaluate this current customer's condition, what data from the pre-birth record is generally significant for the medical caretaker to get? A) Pattern and number of pre-birth visits. INCORRECTIt is imperative to have early and predictable pre-birth care, yet this data won't help in the evaluation of this present customer's condition. B) Prenatal circulatory strain readings. Right The customer's BP (138/88) is underneath the rule that demonstrates gentle preeclampsia. Pulse parameters for mellow preeclampsia incorporate a perusing of 140/90 taken on two events 6 hours separated. Be that as it may, Jennie's perusing is huge on the off chance that it is an expansion o f 30 mm systolic or 15 mm diastolic from her pre-birth levels, especially in blend with proteinuria and hyperuricemia (uric corrosive of 6 mg/dl or more).Blood pressure typically continues as before during the main trimester. Both systolic and diastolic at that point decline steadily as long as 20-weeks growth. At 20 weeks of incubation, the circulatory strain starts to bit by bit increment and come back to first trimester levels at term. C) Prepregnancy weight. Erroneous The attendant should contrast the present load with Jennie's most as of late got past weight, not to the prepregnancy weight. A weight increase of ;2 pounds for every week is demonstrative of mellow preeclampsia. D) Jennie's Rh factor. INCORRECTWhile the Rh factor of the mother is significant in deciding the requirement for prophylactic Rh resistant globulin (RhoGAM) at 28-weeks and after birth, it isn't the most significant data right now. All Rh negative ladies with negative Coomb's tests are given RhoGam pro phylactically at 28-weeks, and afterward assessed following birth to decide whether another portion of RhoGam is required. Pathophysiology of Preeclampsia There is no complete reason for preeclampsia, however the pathophysiology is particular. The primary pathogenic factor is poor perfusion because of arteriolar vasospasm.Function in organs, for example, the placenta, liver, mind, and kidneys can be discouraged as much as 40 to 60%. As liquid moves out of the intravascular compartment, a reduction in plasma volume and ensuing increment in hematocrit is seen. The edema of preeclampsia is summed up. For all intents and purposes all organ frameworks are influenced by this infection, and the mother and embryo endure expanding hazard as the malady advances. Preeclampsia creates following 20 weeks growth in a formerly normotensive lady. Raised circulatory strain is much of the time the main indication of preeclampsia.The customer likewise creates proteinuria. While not, at this point thou ght about an indicative estimation of preeclampsia, summed up edema of the face, hands, and midsection that isn't receptive to 12 hours of bedrest is frequently present. Preeclampsia advances along a continuum from gentle to extreme preeclampsia, HELLP condition, or eclampsia. A customer may present to the work unit anyplace along that continuum. 3. What is the pathophysiology answerable for Jennie's protest of a beating cerebral pain and the raised DTRs? A) Cerebral edema. CORRECTAs liquid holes into the extravascular spaces, organ edema just as fringe edema happens. This, related to cortical cerebrum fits, causes migraine, expanded profound ligament reflexes, and clonus. B) Increased perfusion to the cerebrum. Inaccurate The hypovolemia that goes with preeclampsia diminishes perfusion to the significant organs. C) Severe tension. Off base While Jennie might be extremely restless, this isn't the pathophysiology included. D) Retinal arteriolar fits. Wrong These fits are the reason for obscured vision and scotoma that regularly go with intensifying of the disease.Jennie's sister is worried about the expanding (edema) in her sister's face and hands since it is by all accounts compounding quickly. She inquires as to whether the social insurance supplier will recommend some of â€Å"those water pills† (diuretics) to help dispose of the abundance liquid. 4. Which reaction by the medical caretaker is right? A) â€Å"That is a generally excellent thought. I will hand-off it to the social insurance supplier when I call. † INCORRECT Although it is minding to offer to hand-off family worries to the social insurance supplier, the doctor will settle on the choice on treatment.B) â€Å"I'm sorry, however it isn't the family's place to make recommendations about clinical treatment. † INCORRECT While it isn't inappropiate for relatives to make recommendations, this answer isn't delicate to the sister's craving to help Jennie. C) â€Å"Let me disclose to you about the impact of diuretics on pregnancy. † CORRECT The sister may have seen diuretics utilized for treating liquid maintenance previously (for instance, in heart illness), yet may not know about how diuretics influence pregnancy. Diuretics decline blood stream to the placenta by diminishing blood volume.In the instance of the preeclamptic customer, this is especially hazardous on the grounds that the sickness has just caused a volume shortage. Also, the diuretics upset typical electrolyte equalization and stress kidneys that are as of now undermined by preeclampsia. The main time they are utilized is if the preeclamptic customer likewise has cardiovascular breakdown, however this customer has no manifestations of cardiovascular breakdown. D) â€Å"Have you by any possibility given your sister water pills that have a place with another person? † INCORRECT This could be interpreted as antagonistic and accusatory.If the attendant accepts further app raisal is justified, the attendant ought to get some information about any prescription she has taken. Admission to the Labor and Delivery Unit At 0630 the medical caretaker calls to answer to the human services supplier, who recommends the accompanying: confess to work and conveyance, bedrest with washroom benefits (BRP), IV D5LR at 125 ml/hr, CBC with platelets, coagulating examines, liver compounds, science board, 24-hour pee assortment for protein and uric corrosive, ice chips just by mouth, nonstress test, hourly crucial signs, and DTRs. 5.While anticipating the lab results, which nursing mediation has the most noteworthy need? A) Teach Jennie the method of reasoning for bedrest. Mistaken While this is significant, it doesn't have the most noteworthy need. B) Monitor Jennie for indications of lack of hydration. Off base This is significant in light of the fact that the customer is limited to ice chips just and may as of now be hypovolemic. In any case, it isn't the most ele vated need. C) Educate the customer about dietary limitations. Off base Since Jennie is at present taking ice chips just, this isn't the most significant mediation as of now. D) Observe Jennie for CNS changes.CORRECT Central Nervous System (CNS) changes, for example, serious cerebral pain, obscured vision, scotoma (spots before eyes), and photophobia demonstrate an exacerbating condition. 6. Which strategy should the medical attendant use while assessing Jennie's circulatory strain while she is on bedrest? A) Have Jennie lay prostrate and take the pulse on the left arm. Erroneous The pregnant customer ought not lie in the recumbent position since it puts her in danger for vena cava pressure and ensuing prostrate hypotensive disorder. B) Have Jennie lie in a horizontal position and take the circulatory strain on the ward arm.CORRECT The sidelong position bolsters placental perfusion. The lower (subordinate) arm ought to be situated so the customer isn't lying on it, and the p ulse ought to be taken in that arm. This all the more intently approximates blood vessel pressure. Utilizing the arm on the inverse (upper) side will erroneously lessen the estimation. C) Have the customer sit in a seat at the bedside, and take the circulatory strain with her left arm at abdomen level. Wrong While sitting is a proper position, the arm ought to lay on a surface on the most fundamental level level.In expansion, Jennie is on bedrest with restroom benefits, which does exclude sitting up in a seat. D) Have Jennie stand quickly and take the circulatory strain on the correct arm. Wrong A standing bloo