Question

Part 1

Tina is a 42-year-old G1 P0 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. On chart review, the nurse notes that her first trimester blood pressures were 120s/70s and her second trimester readings were 110s/70s. The third trimester readings were 130s/70s-80s until today.

What questions should the nurse ask Tina as part of her admission interview?

What additional physical assessment data should the nurse obtain?

What risk factors does Tina have for preeclampsia?

Part 2

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?

Part 3

Tina's physician has ordered induction of labor with an indication of severe preeclampsia. Tina is very worried about having a premature infant and wonders if the induction could be delayed until 37 or 38 weeks of gestation. How can the nurse explain the situation to Tina?

Answer 1

PRE-ECLAMPSIA

Multisystem disorder of unknown aetiology characterised by the development of hypertension to the extent of 140/90 mm Hg or more with proteinuria after the 20 th week in previously normotensive and non -proteinuric woman.

PART 1

Question for admission interview

• any discomfort comparing to early trimester
• presence of fatigue
• movement of baby( identify /not)
• difficulty in breathing
• sleep pattern during a day

additional physical assessment data

• History of hypertension in family
• headache - yes/no if yes : location
• Disturbed sleep pattern
• urinary output- frequency of voiding and quantity
• pain in the abdomen, if yes: location
• if epigastric pain -check for vomiting
• the colour of the vomitus
• vision problem : blurring / scotomata/ dimness of vision/ blindness (sometimes)
• weight gain
• presence of edema - face/ abdominal wall/ vulva/ whole body

risk factors

• Primi gravida :young /elderly(first time exposure to chorionic villi)(10 %)
• family history

PART 2

Gestational hypertension

blood pressure above 140/90 mm Hg for the first time in pregnancy after 20 weeks, without proteinuria.

however, preeclampsia is gestational hypertension with proteinuria.

other factors which differentiate preeclampsia from gestational hypertension

oedema: demonstration of pitting oedema over the ankles after 12 hours bed rest or rapid gain in weight of more than 1lb a week or more than 5 lb a month in the later months of pregnancy may be the earliest evidence of pre-eclampsia.

proteinuria: the presence of total protein in 24 hours urine of more than 0.3 gm or greater than or equal to 2+ (1.0 gm/L) on at least two random clean catch urine samples tested greater than or equal to 4 hours apart in the absence of urinary tract infection is considered significant.

test for protein by multiple reagent strips (dipstick)

Trace= 0.1gm/L

1+=0.3gm/L

2+= 1 gm/L

3+= 3.0 gm/L

4+= 10.0 gm/L

Tina has the blood pressure of 160/95 and in her third trimester of pregnancy which was normal in the first and second trimester.moreover, she has proteinuria and shows 3+ in the protein test which is 3.0gm/ L, more than moderate. these two factors prove the case of tina is pre-eclampsia nit gestational hypertension.