Preeclampsia Case Study

At 0600 Jennie is brought to the Labor and Delivery triage territory by her sister. The customer whines of a beating cerebral pain throughout the previous 12 hours unrelieved by acetaminophen (Tylenol), swollen hands and face for 2 days, and epigastric agony depicted as awful acid reflux. Her sister tells the medical attendant, â€Å"I felt like that when I had toxemia during my pregnancy. † Admission evaluation by the 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 normal, 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 medical attendant applies the outside fetal screen, which shows a benchmark fetal pulse of 130, missing inconstancy, positive for increasing speeds, no decelerations, and no withdrawals. The medical attendant additionally plays out a vaginal assessment and finds that the cervix is 1 cm expanded and half destroyed, with the fetal head at a - 2 station. 1. In looking into Jennie's history, the medical caretaker is right in inferring that Jennie is in danger of building up a hypertensive issue as a result of her age (15).Which different elements add to Jennie's danger of creating preeclampsia? A) Molar pregnancy, history of preeclampsia in past pregnancy. Erroneous While these are hazard factors for preeclampsia, Jennie has no signs of a molar pregnancy (first trimester vaginal dying, size/date inconsistency, or unnecessary sickness and heaving), 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 past filled with 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. Off base While age and low financial status (SES) are chance factors, Je nnie's SES is obscure. A beating cerebral pain is a manifestation, not a hazard factor. D) Low financial status (SES), history of pedal edema. Wrong Although age and low SES are chance factors, this present customer's SES is obscure. Pedal edema is basic in pregnancy following 32-weeks. 2. To precisely survey this present customer's condition, what data from the pre-birth record is generally significant for the medical attendant to acquire? A) Pattern and number of pre-birth visits. INCORRECTIt is imperative to have early and steady pre-birth care, yet this data won't help in the evaluation of this current customer's condition. B) Prenatal circulatory strain readings. Right The customer's BP (138/88) is beneath the rule that demonstrates mellow preeclampsia. Circulatory strain parameters for mellow preeclampsia incorporate a perusing of 140/90 taken on two events 6 hours separated. Nonetheless, Jennie's perusing is critical in the event that it is an expansion of 30 mm systoli c or 15 mm diastolic 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 main trimester. Both systolic and diastolic at that point decline slowly as long as 20-weeks incubation. At 20 weeks of incubation, the pulse starts to continuously increment and come back to first trimester levels at term. C) Prepregnancy weight. Off base The attendant should contrast the present load with Jennie's most as of late got past weight, not to the prepregnancy weight. A weight addition of ;2 pounds for every week is demonstrative of mellow 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-week s, and afterward assessed following birth to decide whether another portion of RhoGam is required. Pathophysiology of Preeclampsia There is no authoritative 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, cerebrum, and kidneys can be discouraged as much as 40 to 60%. As liquid moves out of the intravascular compartment, an abatement 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 sickness, and the mother and hatchling endure expanding hazard as the illness advances. Preeclampsia creates following 20 weeks growth in a formerly normotensive lady. Raised circulatory strain is regularly the primary indication of preeclampsia.The customer likewise creates proteinuria. While not, at this point thought about an an alytic estimation of preeclampsia, summed up edema of the face, hands, and mid-region that isn't receptive to 12 hours of bedrest is regularly present. Preeclampsia advances along a continuum from mellow to extreme preeclampsia, HELLP disorder, or eclampsia. A customer may present to the work unit anyplace along that continuum. 3. What is the pathophysiology liable for Jennie's grievance of a beating cerebral pain and the raised DTRs? A) Cerebral edema. CORRECTAs liquid holes into the extravascular spaces, organ edema just as fringe edema happens. This, related to cortical mind fits, causes migraine, expanded profound ligament reflexes, and clonus. B) Increased perfusion to the mind. Off base The hypovolemia that goes with preeclampsia diminishes perfusion to the significant organs. C) Severe uneasiness. Wrong While Jennie might be on edge, this isn't the pathophysiology included. D) Retinal arteriolar fits. Off base These fits are the reason for obscured vision and scotoma that regularly go with exacerbating of the disease.Jennie's sister is extremely 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 social insurance supplier will recommend 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 recommendations about clinical treatment. † INCORRECT While it isn't inappropiate for relatives to make recommendations, 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 diuretic s on pregnancy. † CORRECT The sister may have seen diuretics utilized for treating liquid maintenance previously (for instance, in cardiovascular ailment), however 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 perilous in light of the fact that the illness has just caused a volume shortage. What's more, the diuretics upset typical electrolyte equalization 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, however this customer has no side effects 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 translated as antagonistic and accusatory.If the attendant accepts further evaluation is justified, the attendant ought to get some information about any prescription she has taken. Admission to the Labor and Delivery Unit At 0630 the attendant calls to answer to the social insurance 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 compounds, science board, 24-hour pee assortment for protein and uric corrosive, ice chips just by mouth, nonstress test, hourly essential signs, and DTRs. 5.While anticipating the lab results, which nursing mediation has the most noteworthy need? A) Teach Jennie the method of reasoning for bedrest. Erroneous While this is significant, it doesn't have the most noteworthy need. B) Monitor Jennie for indications of drying out. 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 noteworthy need. C) Educate t he customer about dietary limitations. Off base Since Jennie is right now taking ice chips just, this isn't the most significant mediation as of 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 a declining condition. 6. Which procedure should the attendant use while assessing Jennie's circulatory strain while she is on bedrest? A) Have Jennie lay prostrate and take the circulatory strain on the left arm. Wrong The pregnant customer ought not lie in the recumbent position since it puts her in danger for vena cava pressure and ensuing prostrate hypotensive condition. B) Have Jennie lie in a horizontal position and take the circulatory strain on the ward arm.CORRECT The sidelong position underpins placental perfusion. The lower (subordinate) arm ought to be situated so the customer isn't lying on it, and the circulatory strain 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 decrease 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. Off base 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. Wrong A standing bloo

Search Techniques

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