Question

You admitted a patient to Labor unit. He blood pressure is 190/100. She has no history of high BP before pregnancy. The fetal HR is decelerating to 120 during contractions.

What is the problem. Define it and talk about what signs and symptoms cause you to make an assumption and provide nursing intervention in the appropriate order/standards of care. Discuss this do not just write words out of the book.

Answer 1

ANSWER: The problem in this pregnant lady is Pre-eclampsia.

PRE-ECLAMPSIA:

Preeclampsia is defined as the presence of (1) a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient,

OR

(2) an SBP greater than or equal to 160 mm Hg or a DBP greater than or equal to 110 mm Hg or higher (In this case, hypertension can be confirmed within minutes to facilitate timely antihypertensive therapy).

SIGNS AND SYMPTOMS IN PRE-ECLAMPSIA. ARE AS FOLOWS:

1. Headache.

2. Dyspnea (Difficulty in breathing).

3. Edema.

4. Epigastric or right upper quadrant abdominal pain.

5. Blurred vision.

6. Altered mental status.

7. Weakness or malaise.

NURSING INTERVENTION IN APPROPRIATE ORDER OF CARE IS GIVEN BELOW:

Immediate delivery is the only cure for pre-eclampsia.

1. Inform patient about her labor progression.

2. Inform her about high blood pressure and to relax and don't overstress.

3. To monitor patients blood pressure and fetal heart rate after every 30 minutes continually and keep doctor informed about the changes.

4. To deliver baby using forceps and ventouse or Caesarean section.