Olivia Jones Preeclampsia Case Study
|Patient’s initial: OJ Age:23 M/F: Female
|Diagnosis: Severe preeclampsia Length of stay: 2 hours Allergies: None
|HCP: Yes Consults: Recommended
|Fall Risk: Moderate Isolation: No Transfer: Bed rest
|IV Type: Lactated Ringer Location: Labor and Delivery Unit Fluid Rate: continuous 125 mL per hour or 500 mL bolus for non-reassuring fetal heart rate pattern
|Critical Labs: LDH, Creatinine, BUN, Triglyceride
|Other Services Hypoxemia consults needed: Yes
|1. Olivia’s course of stay. Admission day/post-op day Olivia was admitted on 10/21/2020 with severe preeclampsia related complaints. Preeclampsia is high blood pressure after 20 weeks of gestation. The condition can be classified into two; mild preeclampsia (>140/90mm Hg blood pressure) and severe preeclampsia (>160/110 mm Hg) (Saito 12).
|2. Preeclampsia Pathophysiology Preeclampsia pathophysiology is an enigma yet devastating to both the mother and the fetus. Sharma (29) argues that it is related to vasospasm and hypoperfusion.
|3. Olivia Jones case relevant vital signs/nursing assessments/lab-diagnostic test results Alerts (Signs and symptoms) Elevated BPLow platelet countPersistent epigastric painHigh levels of serum creatinine andHyperreflexia Nursing Assessments Lab results using the urine dipstickBUN result and serum CreatinineVital signs assessment (persistent headache, altered level of consciousness and visual disturbances)
|4.Body systems to be assessed Lung’s fluid (pulmonary edema) New-onset headaches Visual disturbances (Saito 22). Protein in the urine (proteinuria) Low platelet amount (Sharma 7) Impaired liver function
|5.Current Nursing priority Today, what needs to be done today is baby delivery if the patient experiences uncontrollable hypertension, eclampsia, and compromised renal function.Maintaining the patient’s fluid balanceEnhancing adequate tissue perfusionPreventing injuryIncreasing patient’s knowledge while decreasing anxietyMaintenance of the cardiac output
|6.Independent Nursing Interventions Administer LR 500 ml (150Ml/hrAdminister Magnesium Sulfate, 5g/250mL, 100 mL/hMinimize patient’s stimulationOffer emesis basisStabilize BP, HR and FHR levelsEducate the patient about preeclampsia andInstall a pad side rail of the bed
|7.Worst most likely outcome As argued earlier, severe preeclampsia poses a risk to both the mother and the baby. If the nursing goal of stabilizing the mother by controlling hypertension is unsuccessful, it can lead to perinatal mortality and placental abruption.Other complications include DIC, seizures and HELLP Syndrome
|8.Preventing the worst from happening Severe preeclampsia is treated aggressively since high BP poses a threat to the mother and the fetus. As Saito (2) argues in his work, nursing management of a patient with preeclampsia involvesa closer monitoring of BP and ongoing assessment to prevent disease progression. To prevent perinatal mortality and placental abruption, stabilizing the mother-fetus dyad is imperative and prepare for birth. BP can be stabilized through Magnesium Sulfate IV infusion or IM injection.Apart from bed rest, the nurse should ensure that the fluid balance is maintained.
|9.Nursing assessments that will identify the complication 24-hour urine test-this diagnostic test blood proteins. For 0.3 g, then the condition is mild, while a 2.0g and above indicate a severe case.Serum BUN– assesses serum creatinine and serum uric acid. The test is used in evaluating the renal function and glomerular filtration capacity. It also evaluates uric acid and urea clearance. Liver Function Test– The two tests used, in this case, include the AST and ALT (Sharma 8).
|10.Nursing Interventions For women with mild preeclampsia, nurses frequently monitor her to detect any changes since the condition progresses rapidly. For them with severe preeclampsia, the blood pressure should be closely monitored, and antihypertensives applied as directed by the physician. These drugs reduce blood pressure. Other interventions include assessing the patient’s vision and the level of consciousness (Okpomeshine 5). Any changes in regards to the two should be reported to the physician. The woman should be assessed for pulmonary edema and advised to rest and increase liquids’ update.
|While Providing Care
|Clinical assessment data to be trended The patient’s BP is still high, and modifications should be made to avoid exposing the fetus to placental abruption.
|Does the nursing priority need modification after assessing the patient Yes. Since the BP level is still high, the baby should be birthed.
|3. After reviewing the primary care provider’s note, the new orders’ rationale is uncontrollable preeclampsia.
|4.Building rapport and trust with the patient Building rapport with the patient will occur in various ways, including introducing oneself before offering any care, validating fears and desires, and listening effectively.
|5.Patient’s educational, emotional, psychosocial, spiritual and crucial care priorities Firstly, the patient will be educated on the importance of rest, call light use for assistance, diversional activities she can participate in bed rest, and NPO until the serum results are out. Emotionally, the family will be encouraged to offer support while at bed rest.
|After Patient Care
|1.Delegated nursing interventions Installing the side rail of the bedMinimizing stimulationAssisting the patient in the bathroom
|2.Specific decisions based on recognition and interpretation of relevant clinical data Delivery of baby if hypertension is uncontrolled, uncontrolled eclampsia, pulmonary edema and a compromised renal function
|3. What could have been done differently? Throughout the client’s stay, the labor signs and symptoms were closely monitored. Electronic fetal monitoring to access its well-being should have been conducted throughout the stay.
|4.Lessons learned Severe preeclampsia risks both the mother’s and the fetus’s life and should be controlled aggressively.
|5.What will be applied in the future In the future, various preeclampsia management learned in this exercise will be applied. Apart from medication, encouraging the patients to rest and take many fluids will also be applied in the future.
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Okpomeshine, Christine. Top of Form
Knowledge, Attitudes, and Perceptions of Preeclampsia among First-Generation Nigerian Women in the United States. Trafford on Demand Pub. 2014. Print.
Saito, Shigeru. Preeclampsia: Basic, Genomic, and Clinical. 2018. Internet resource.
Top of Form
Sharma, Nidhi. Prediction of Maternal and Fetal Syndrome of Preeclampsia. London: IntechOpen, 2019. Print.