Preeclampsia Case Study
At 0600 Jennie is brought to the Labor and Delivery triage area by her sister. The client complains of a pounding headache for the last 12 hours unrelieved by acetaminophen (Tylenol), swollen hands and face for 2 days, and epigastric pain described as bad heartburn. Her sister tells the nurse, "I felt like that when I had toxemia during my pregnancy."
Admission assessment by the nurse reveals: today's weight 182 pounds, T 99.1° F, P 76, R 22, BP 138/88, 4+ pitting edema, and 3+ protein in the urine. Heart rate is regular, and lung sounds are clear. Deep tendon reflexes (DTRs) are 3+ biceps and triceps and 4+ patellar with 1 beat of ankle clonus.
The nurse applies the external fetal monitor, which shows a baseline fetal heart rate of 130, absent variability, positive for accelerations, no decelerations, and no contractions. The nurse also performs a vaginal examination and finds that the cervix is 1 cm dilated and 50% effaced, with the fetal head at a -2 station.
1.
In reviewing Jennie's history, the nurse is correct in concluding that Jennie is in jeopardy of developing a hypertensive disorder because of her age (15). Which other factors add to Jennie's risk of developing preeclampsia?
A) Molar pregnancy, history of preeclampsia in previous pregnancy.
INCORRECT
While all of these are risk factors for preeclampsia, Jennie has no indications of a molar pregnancy (first trimester vaginal bleeding, size/date discrepancy, or excessive nausea and vomiting), nor has she had any previous pregnancies (gravida 1).
B) Gravidity, familial history.
CORRECT
Jennie is under 17 years of age, is pregnant for the 1st time, and has a sister with a history of toxemia, which is an old term for preeclampsia that some clients may still use.
C) History of pounding headache, low socioeconomic status.
INCORRECT
While age and low socioeconomic status (SES) are risk factors, Jennie's SES is unknown. A pounding headache is a symptom, not a risk factor.
D) Low
Admission assessment by the nurse reveals: today's weight 182 pounds, T 99.1° F, P 76, R 22, BP 138/88, 4+ pitting edema, and 3+ protein in the urine. Heart rate is regular, and lung sounds are clear. Deep tendon reflexes (DTRs) are 3+ biceps and triceps and 4+ patellar with 1 beat of ankle clonus.
The nurse applies the external fetal monitor, which shows a baseline fetal heart rate of 130, absent variability, positive for accelerations, no decelerations, and no contractions. The nurse also performs a vaginal examination and finds that the cervix is 1 cm dilated and 50% effaced, with the fetal head at a -2 station.
1.
In reviewing Jennie's history, the nurse is correct in concluding that Jennie is in jeopardy of developing a hypertensive disorder because of her age (15). Which other factors add to Jennie's risk of developing preeclampsia?
A) Molar pregnancy, history of preeclampsia in previous pregnancy.
INCORRECT
While all of these are risk factors for preeclampsia, Jennie has no indications of a molar pregnancy (first trimester vaginal bleeding, size/date discrepancy, or excessive nausea and vomiting), nor has she had any previous pregnancies (gravida 1).
B) Gravidity, familial history.
CORRECT
Jennie is under 17 years of age, is pregnant for the 1st time, and has a sister with a history of toxemia, which is an old term for preeclampsia that some clients may still use.
C) History of pounding headache, low socioeconomic status.
INCORRECT
While age and low socioeconomic status (SES) are risk factors, Jennie's SES is unknown. A pounding headache is a symptom, not a risk factor.
D) Low