Question

Case Study: Before pregnancy, Mary’s BP was in the range of 110/68 to 120/70. She is 41 and this is her first pregnancy. Her BMI is 24 and she has a history of rheumatoid arthritis. She needed in vitro fertilization to get pregnant and is very excited about this pregnancy. In gestational week 22 her BP was 158/96 and 152/90. Her urine was 2+ for urine. What is the likely diagnosis?   _________________________________________________________________

What are Mary’s risk factors for this condition? ______________________________________________________________________

List 4 oral antihypertensive medications to treat this condition?

1.

2.

3.

4.

What other health promotion instructions can the nurse give to the patient?

Mary was started on an oral antihypertensive, but her BP continues to rise to 162/112 and 170/110. Her 24 urine is 2.5 Grams.

Her labs are:

creatinine =2

Hemoglobin = 8.5

ALT = elevated

AST = elevated

Platelets 86,000/mm

What is her diagnosis now? ______________________________________________________________________________

True/False

True or False                                                     Mary will have hyperreflexia.

True or False                                                     Polyuria will occur.

True or False                                                     Mary will most likely feel increased kicking from the fetus.

True or False                                                     Mary’s plasma uric acid will drop

True or False                                                     Mary will have hyperbilirubinemia.

Mary is admitted to the hospital and started on Magnesium Sulfate. What route is it given? _____________________________________________

What is the purpose of this medication? __________________________________________________

Nursing considerations when administering Magnesium Sulfate:

How will you give the medication?

How will the pt feel when initially receiving Magnesium Sulfate?

What will you monitor while the pt is on Magnesium Sulfate?

What would you do if toxicity of Magnesium Sulfate is suspected?

What other health promotion actions can the nurse take for this patient?

Answer 1

PATIENT DIAGNOSIS

Pre-eclampsia

RISK FACTORS FOR MARY

• Age more than 40 years
• Pregnant for the first time
• Invitro fertilization

LIST OF ORAL ANTI HYPERTENSIVES FOR MARY

• Labetalol- dual role of alpha and beta adrenergic antagonist
• Doxazosine- selective alpha blocker
• Methyldopa- alpha 2 adrenergic receptors antagonist
• Hydralazine- Vasodilator       
• Nifedepine- Calcium channel blocker

HEALTH PROMOTION INSTRUCTION

• Advice to take rest as much as possible
• Advice to take high protein, fibre and vitamin diet
• Prophylactic fish oil
• Calcium supplementation
• Advice to check weight regularly
• Blood pressure to be monitored daily at home or every 4 hours in hospital
• Abdominal examination should be carried out daily

PATIENT DIAGNOSIS IN CASE OF CONTINUOUS RAISE OF BP WITH ELEVATED ALT AND AST AND LOW PLATELET COUNT

Severe preeclampsia

TRUE OR FALSE

Mary will have hypereflexia- False

Polyuria will occur- False

Mary will most likely feel increased kicking from fetus- False

Mary’s plasma uric acid will drop- False

Mary will have hyperbilirubinemia- False

MAGNESIUM SULFATE ADMINISTRATION

• Purpose of the medicine

To prevent seizure and it can also help prolong a pregnancy for up to two days which allows time for corticosteroid drugs to improve the baby’s lung function.

• Route of administration

Loading dose

Inj. Magnesium sulfate 4gm (8ml) with 12 ml distilled water- slow IV

Inj. Magnesium sulfate 4gm (8ml) with 1 ml inj.Lignocaine 2%- Deep IM in each buttocks

Maintenance dose

Inj. Magnesium sulfate 4gm (8ml) with 1 ml inj.Lignocaine 2%- Deep IM in alternative buttocks 4^th hourly

• How the patient feel initially when administering drug
  • Flushing
  • sweating

• Nursing consideration while administering drug
  • Deep tendon reflexes (knee jerk should be normal)
  • Respiratory rate (should not less than 16)
  • Urine output (should not less than 30ml per hour)
  • Serum concentration of the drug

• How will you monitor the patient when on magnesium sulfate?
  • Connect the patient with cardiac monitor to monitor vitals
  • Maintain I/O chart
  • Take blood series of blood samples to know serum concentration of the drug
  • Continuous fetal monitoring
  • Observe signs of magnesium sulfate toxicity

Absent of knee jerk

Respiratory rate<16/minute

Urine output <30ml/hour

• In case of magnesium sulfate toxicity
  • Give antidote- Inj.Calcium gluconate 10ml through IV

• Health promotion action
  • Explain rationale to the patient and support persons with the use of tocolytics to prevent preterm birth
  • Explain all procedures
  • Allow for expression of anxiety
  • Adequate hydration
  • Importance of bed rest in lateral recumbent position
  • Educate to immediately report the subtle signs and symptoms of preterm labor.