Preeclampsia
RN Case Study
At 0600 a 42 year old primigravida client is brought to the Labor and Delivery triage area by
her sister. The client reports having a pounding headache for the last 12 hours unrelieved by
acetaminophen, swollen hands and face for 2 days, blurry vision, and epigastric ...
preeclampsia rn case study at 0600 a 42 year old primigravida client is brought to the labor and delivery triage area by her sister the client reports having a pounding headache for the last 12 hours
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Preeclampsia
RN Case Study
At 0600 a 42 year old primigravida client is brought to the Labor and Delivery triage area by
her sister. The client reports having a pounding headache for the last 12 hours unrelieved by
acetaminophen, swollen hands and face for 2 days, blurry vision, and epigastric pain
described as bad heartburn. The client expresses concern because her due date is not for
four more weeks. Her sister tells the nurse, "I felt like that when I had toxemia during my
pregnancy."
1. In reviewing Ashley's history, the RN is correct in concluding that Jennie is in jeopardy of developing a
hypertensive disorder because of her age (15). Which other factor(s) add to Ashelys risk of developing
preeclampsia? (Select all)
-Molar pregnancy and history of preeclampsia in previous pregnancy.
-Familial history.
History of pounding headache, low socioeconomic status.
Preexisting medical or genetic condition, such as Factor V Leiden.
-Nulliparity.
-Familial history
Ashley is older than 40 years of age and has a sister with a history of toxemia, which is an old term for
preeclampsia that some clients may still use.
-Preexisting medical or genetic condition, such as Factor V Leiden.
Reasons for preeclampsia are unknown, but research shows that preexisting medical conditions and
genetic conditions put the client at higher risk for preeclampsia.
-Nulliparity.
First pregnancy places a client at higher risk for preeclampsia than multiparity with the same partner.
2. To accurately assess this client's condition, what information from the prenatal record is most
important for the RN to obtain?
Pattern and number of prenatal visits.
Prenatal blood pressure readings.
,Prepregnancy weight.
Ashley's Rh factor.
Prenatal blood pressure reading
The client's blood pressure (BP) (138/88) is below the guideline that indicates mild preeclampsia. Blood
pressure parameters for mild preeclampsia include a reading of 140/90 taken on two occasions 6 hours
apart. However, Ashley's reading is significant if it is an increase of 30 mm systolic or 15 mm diastolic
from her prenatal levels, particularly in combination with proteinuria, blurry vision, epigastric pain and
hyperuricemia (uric acid of 6 mg/dl or more). Blood pressure usually remains the same during the first
trimester. Both systolic and diastolic then decrease gradually up to 20-weeks' gestation. At 20 weeks'
gestation, the blood pressure begins to gradually increase and return to 1st trimester levels at term.
Pathophysiology of Normal Pregnancy vs Preeclampsia
Normal pregnancy is a vasodilated state. Peripheral vascular resistance decreases by 25%. Diastolic BP
drops 10mm Hg at mid pregnancy and returns to prepregnancy levels at term. There is a 50% rise in
blood volume and cardiac output increases 30% and 50%. Increased renal flow results in increased
glomerular filtration rate. In preeclampsia, the main pathology is poor organ perfusion as a result of
arteriolar vasospasm and endothelial activation. There is an increase in peripheral resistance when the
blood pressure rises. It is more than just hypertension. It is a systemic disorder. Function in the placenta,
liver, brain, and kidneys can be depressed as much as 40% to 60%. As fluid shifts out of the intravascular
compartment, a decrease in plasma volume and subsequent increase in hematocrit is seen. The edema
of preeclampsia is generalized. This disease affects virtually all organ systems, and the mother and fetus
suffer increasing risk as the disease progresses.
Preeclampsia develops after 20 weeks' gestation in a previously normotensive woman. Elevated blood
pressure is frequently the first sign of preeclampsia. The client has a headache and blurred vision and
also develops proteinuria. While no longer considered a diagnostic measurement of preeclampsia,
generalized edema of the face, hands, and abdomen that is not responsive to 12 hours of bed rest is
often present. Preeclampsia progresses along a continuum from mild to severe preeclampsia, eclampsia,
or hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. A client may present to
the labor unit anywhere along that continuum. Hepatic involvement can lead to periportal hemorrhagic
necrosis in the liver, which causes right upper quadrant or epigastric pain.
...
3. What is the pathophysiology responsible for Ashely's complaint of a pounding headache and the
elevated DTRs?
Cerebral edema.
, Increased perfusion to the brain.
Severe anxiety.
Retinal arteriolar spasms.
cerebral edema
As fluid leaks into the extravascular spaces, organ edema as well as peripheral edema occurs. This, in
conjunction with cortical brain spasms, causes headache, increased deep tendon reflexes, and clonus.
4. Ashely's sister is concerned about the edema in her sister's face and hands. She asks the RN if the
(HCP) will prescribe some of "those water pills" (diuretics) to help get rid of the excess fluid.
Which response by the RN is correct?
"That is a very good idea. I will relay it to the healthcare provider when I call."
"I'm sorry, but it is not the family's place to make suggestions about medical treatment."
"Let me explain to you about the effect of diuretics on pregnancy."
"Have you by any chance given your sister water pills that belong to someone else?"
"Let me explain to you about the effect of diuretics on pregnancy.
The sister may have seen diuretics used for treating fluid retention before (for example, in cardiac
disease), but may not be aware of how diuretics affect pregnancy. Diuretics decrease blood flow to the
placenta by decreasing blood volume. In the case of the preeclamptic client, this is particularly
dangerous because the disease has already caused a volume deficit. In addition, the diuretics disrupt
normal electrolyte balance and stress kidneys that are already compromised by preeclampsia. The only
time they are used is if the preeclamptic client also has heart failure, but this client has no symptoms of
heart failure.
5. After the RN establishes IV placement, she collects a bag of D5LR for the oxytocin, which is available
as 20 units in 1000mL D5LR. The order from the HCP is oxytocin 2mU/min to augment labor. Calculate
the drip rate for the oxytocin. (Whole number)
6
1/1000 x 2mu/1hr=
2000/20000=
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