Question

Read Chapters 11 to 13 from your Text Book

II. Case Study :  Hypertensive Disorder of Pregnancy
Tina is a 42-year-old G1P0 at 35 weeks of gestation who has been sent to labor and delivery for evaluation from her physician’s office. Today at her routine prenatal visit, her blood pressure was 160/95 mm Hg. On chart review, the nurse notes that her first trimester blood pressure readings were 120 systolic over 70 diastolic, and her second trimester readings were 110 systolic over 70 diastolic. The third trimester readings were 130 systolic over 70 to 80 diastolic until today.
1. What questions should the nurse ask Tina as part of her admission interview?
2. What additional physical assessment data should the nurse obtain?
3. What risk factors does Tina have for preeclampsia?
4. Tina’s blood pressure remains elevated and her urine dipstick shows 3+ protein on a clean voided specimen. Which data differentiate preeclampsia from gestational hypertension?
5. Tina’s physician has ordered the induction of labor with an indication of severe preeclampsia. Tina is very worried about having a premature infant and wonders whether the induction could be delayed until 37 or 38 weeks of gestation. How can the nurse explain the situation to Tina?

Answer 1

1. The nurse should ask questions to collect information regarding symptoms of pre-eclampsia

Have you experienced any of the following symtoms recently?

• Headache
• Altered Level of Consciuosness-agitation,restlessness,lehtargy,hallucinations,confusions
• Visual disturbances - blurred vision, floaters, spot, blind spot
• Shortness of Breath
• Complaints of chest pain and cough

These are signs and symptoms of worsening or severe pre-eclampsia

2. During assessment the nurse should include the following parameters:

• Auscultation of heart sounds, lungs and breath sounds
• Presence and degree of edema
• Early signs and symptoms of pulmonary edema such as tachycardia and tachypnea
• Weight checking
• Skin color, temperature and turgor
• Capillary refil, which may indicate decreased perfusion or vasoconstriction if greater than 3 seconds

3. Age > 35 years is one of the risk factors for preeclampsia

4.Gestational Hypertension or transient hypertension is a non-specific term who has blood pressure elevation detected for the first time during pregnancy, without proteinuria. This term used only until a more specific diagnosis can be assigned postpartum. If precelampsis does not occur(if protein does not present in urine) and the woman's blood pressure falls into normal range by 12 weeks postpartum, the diagnosis of transient hypertemsion can be made

5.This patient is at risk of severe eclampsia, which means she has increased risk of perinatal morbidity and mortality, fetal demise.

Educate the client regarding the complications of continuing pregnancy

The clinical course of severe pre-eclampsia may be characterized by a progressive detrioration in both the maternal and fetal conditions. Pregnancies complicated by severe pre-eclampsia have been associated with increased rate of perinatal mortality and significant risk for maternal morbidity and mortality. Because of this fact, there is universal agreement that all patients should be promptly delivered if the disease develops after 34 weeks gestation or before that time if there is evidence of fetal compromise