Preeclampsia Case Study

At 0600 Jennie is brought to the Labor and Delivery triage territory by her sister. The customer gripes of a beating migraine throughout the previous 12 hours unrelieved by acetaminophen (Tylenol), swollen hands and face for 2 days, and epigastric agony portrayed as awful acid reflux. Her sister tells the attendant, â€Å"I felt like that when I had toxemia during my pregnancy. † Admission appraisal by the medical attendant uncovers: the present weight 182 pounds, T 99. 1â ° F, P 76, R 22, BP 138/88, 4+ pitting edema, and 3+ protein in the pee. Pulse is standard, and lung sounds are clear.Deep ligament reflexes (DTRs) are 3+ biceps and triceps and 4+ patellar with 1 beat of lower leg clonus. The attendant applies the outside fetal screen, which shows a gauge fetal pulse of 130, missing inconstancy, positive for increasing velocities, no decelerations, and no withdrawals. The medical caretaker likewise plays out a vaginal assessment and finds that the cervix is 1 cm expanded a nd half destroyed, with the fetal head at a - 2 station. 1. In checking on Jennie's history, the medical attendant is right in reasoning that Jennie is in peril of building up a hypertensive issue as a result of her age (15).Which different components add to Jennie's danger of creating preeclampsia? A) Molar pregnancy, history of preeclampsia in past pregnancy. Inaccurate While these are chance variables for preeclampsia, Jennie has no signs of a molar pregnancy (first trimester vaginal dying, size/date error, or unreasonable sickness and regurgitating), nor has she had any past pregnancies (gravida 1). B) Gravidity, familial history. Right Jennie is under 17 years old, is pregnant for the first run through, and has a sister with a background marked by toxemia, which is an old term for preeclampsia that a few customers may in any case use.C) History of beating cerebral pain, low financial status. Erroneous While age and low financial status (SES) are hazard factors, Jennie's S ES is obscure. A beating migraine is a side effect, not a hazard factor. D) Low financial status (SES), history of pedal edema. Mistaken Although age and low SES are chance factors, this present customer's SES is obscure. Pedal edema is regular in pregnancy following 32-weeks. 2. To precisely evaluate this present customer's condition, what data from the pre-birth record is generally significant for the medical caretaker to acquire? A) Pattern and number of pre-birth visits. INCORRECTIt is essential to have early and reliable pre-birth care, yet this data won't help in the evaluation of this current customer's condition. B) Prenatal pulse readings. Right The customer's BP (138/88) is underneath the rule that shows gentle preeclampsia. Circulatory strain parameters for mellow preeclampsia incorporate a perusing of 140/90 taken on two events 6 hours separated. Notwithstanding, Jennie's perusing is critical on the off chance that it is an expansion of 30 mm systolic or 15 mm dias tolic from her pre-birth levels, especially in mix with proteinuria and hyperuricemia (uric corrosive of 6 mg/dl or more).Blood pressure generally continues as before during the primary trimester. Both systolic and diastolic at that point decline continuously as long as 20-weeks incubation. At 20 weeks of incubation, the pulse starts to step by step increment and come back to first trimester levels at term. C) Prepregnancy weight. Erroneous The medical caretaker should contrast the present load with Jennie's most as of late got past weight, not to the prepregnancy weight. A weight increase of ;2 pounds for every week is characteristic of gentle preeclampsia. D) Jennie's Rh factor. INCORRECTWhile the Rh factor of the mother is significant in deciding the requirement for prophylactic Rh invulnerable globulin (RhoGAM) at 28-weeks and after birth, it isn't the most significant data right now. All Rh negative ladies with negative Coomb's tests are given RhoGam prophylactically at 28- weeks, and afterward assessed following birth to decide whether another portion of RhoGam is required. Pathophysiology of Preeclampsia There is no complete reason for preeclampsia, yet the pathophysiology is unmistakable. The primary pathogenic factor is poor perfusion because of arteriolar vasospasm.Function in organs, for example, the placenta, liver, mind, and kidneys can be discouraged as much as 40 to 60%. As liquid moves out of the intravascular compartment, a lessening in plasma volume and resulting increment in hematocrit is seen. The edema of preeclampsia is summed up. For all intents and purposes all organ frameworks are influenced by this ailment, and the mother and hatchling endure expanding hazard as the sickness advances. Preeclampsia creates following 20 weeks incubation in a formerly normotensive lady. Raised circulatory strain is much of the time the principal indication of preeclampsia.The customer additionally creates proteinuria. While not, at this point thought about an analytic estimation of preeclampsia, summed up edema of the face, hands, and midsection that isn't receptive to 12 hours of bedrest is regularly present. Preeclampsia advances along a continuum from gentle to serious preeclampsia, HELLP condition, or eclampsia. A customer may present to the work unit anyplace along that continuum. 3. What is the pathophysiology answerable for Jennie's objection of a beating cerebral pain and the raised DTRs? A) Cerebral edema. CORRECTAs liquid breaks into the extravascular spaces, organ edema just as fringe edema happens. This, related to cortical mind fits, causes cerebral pain, expanded profound ligament reflexes, and clonus. B) Increased perfusion to the mind. Erroneous The hypovolemia that goes with preeclampsia diminishes perfusion to the significant organs. C) Severe nervousness. Off base While Jennie might be exceptionally on edge, this isn't the pathophysiology included. D) Retinal arteriolar fits. Off base These fits are th e reason for obscured vision and scotoma that regularly go with declining of the disease.Jennie's sister is worried about the expanding (edema) in her sister's face and hands since it is by all accounts intensifying quickly. She inquires as to whether the human services supplier will endorse some of â€Å"those water pills† (diuretics) to help dispose of the abundance liquid. 4. Which reaction by the medical caretaker is right? A) â€Å"That is an excellent thought. I will transfer it to the human services supplier when I call. † INCORRECT Although it is minding to offer to hand-off family worries to the human services supplier, the doctor will settle on the choice on treatment.B) â€Å"I'm sorry, yet it isn't the family's place to make proposals about clinical treatment. † INCORRECT While it isn't inappropiate for relatives to make proposals, this answer isn't touchy to the sister's longing to help Jennie. C) â€Å"Let me disclose to you about the impact of diuretics on pregnancy. † CORRECT The sister may have seen diuretics utilized for treating liquid maintenance previously (for instance, in heart illness), yet may not know about how diuretics influence pregnancy. Diuretics decline blood stream to the placenta by diminishing blood volume.In the instance of the preeclamptic customer, this is especially risky in light of the fact that the sickness has just caused a volume deficiency. What's more, the diuretics disturb typical electrolyte parity and stress kidneys that are as of now undermined by preeclampsia. The main time they are utilized is if the preeclamptic customer additionally has cardiovascular breakdown, yet this customer has no manifestations of cardiovascular breakdown. D) â€Å"Have you by any possibility given your sister water pills that have a place with another person? † INCORRECT This could be understood as antagonistic and accusatory.If the attendant accepts further appraisal is justified, the medi cal attendant ought to get some information about any prescription she has taken. Admission to the Labor and Delivery Unit At 0630 the medical caretaker calls to answer to the human services supplier, who endorses the accompanying: confess to work and conveyance, bedrest with restroom benefits (BRP), IV D5LR at 125 ml/hr, CBC with platelets, coagulating contemplates, liver chemicals, science board, 24-hour pee assortment for protein and uric corrosive, ice chips just by mouth, nonstress test, hourly indispensable signs, and DTRs. 5.While anticipating the lab results, which nursing intercession has the most elevated need? A) Teach Jennie the basis for bedrest. Erroneous While this is significant, it doesn't have the most noteworthy need. B) Monitor Jennie for indications of lack of hydration. Erroneous This is significant on the grounds that the customer is limited to ice chips just and may as of now be hypovolemic. Be that as it may, it isn't the most elevated need. C) Educate the customer about dietary limitations. Off base Since Jennie is as of now taking ice chips just, this isn't the most significant mediation right now. D) Observe Jennie for CNS changes.CORRECT Central Nervous System (CNS) changes, for example, serious cerebral pain, obscured vision, scotoma (spots before eyes), and photophobia demonstrate an exacerbating condition. 6. Which method should the medical attendant use while assessing Jennie's pulse while she is on bedrest? A) Have Jennie lay prostrate and take the pulse on the left arm. Inaccurate The pregnant customer ought not lie in the recumbent position since it puts her in danger for vena cava pressure and resulting prostrate hypotensive condition. B) Have Jennie lie in a horizontal position and take the circulatory strain on the ward arm.CORRECT The sidelong position bolsters placental perfusion. The lower (subordinate) arm ought to be situated so the customer isn't lying on it, and the pulse ought to be taken in that arm. This all the more intently approximates blood vessel pressure. Utilizing the arm on the inverse (upper) side will erroneously lessen the estimation. C) Have the customer sit in a seat at the bedside, and take the circulatory strain with her left arm at abdomen level. Erroneous While sitting is a suitable position, the arm ought to lay on a surface on the most fundamental level level.In expansion, Jennie is on bedrest with restroom benefits, which does exclude sitting up in a seat. D) Have Jennie stand quickly and take the circulatory strain on the correct arm. Inaccurate A standing bloo