Question

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. Have you expeienced any of the following symptoms during the past few weeks?

• Blurred vision
• Headache
• Right upper Quadrant pain

Do you have any family history of hypertension/thyroid abnormalities  during pregnancy?

2. When caring for a patient with pre-eclampsia a nurse should remember the nemonic

S-significant blood pressure changes may occur without warning

P-proteinuria is a serious sign of renal involvement

A-arterioles are affected by vasospasms that results in endothelial damage and leakage of fluid into interstitial spaces. Edema results

S- significant laboratory changes(most notably, liver function tests and platelet count) signal worsening of the disease

M- multiorgan system can be involved: cardiovascular, hematologic,hepatic, renal and central nervous system)

S- symptoms appear after 20 weeks of gestation

During assessment the nurse should include the following parameters:

• Auscultation of heart,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, texture and turgor
• Capillary refil , which may increased decreased perfusion or vasoconstriction if >3seconds

3.Primigravida(6-7 times increased risk)

Age extremes (> 35 years), these two are the risk factors of preeclampsia for Ms.Tina

4. Pre-eclampsia is a pregnancy-specific sytemic syndrome clinically defined as an increase in BP (140/90) after 20 weeks gestation accompanied by proteinuria. This increase in BP measurement represents a change from the usual BP findings throughout the pregnancy

Gestational or transient hypertension is a non-specific term used to describe the woman who has a blood pressure elevation detected for the first time during pregnancy, without proteinuria. If preeclampsia does not develop(e.g: protein does not become present in the urine) and the woman's BP falls into a normal range by 12 weeks postpartum, the diagnosis of transient /gestational hypertension can be made

5.Educate Tina regarding the effects of sevre preeclampsia which may be characterized by a progressive deterioration in both maternal and fetal conditions Tina is an at risk patient for severe preclampsia(160/110 mm Hg)

Pregnancies complicated with severe preeclampsia have been associated with increased rate of perinatal mortality and significant risk for maternal mortality and morbidity. Because of this fact, there is universl 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 maternal or fetal compromise