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Preeclampsia (45 min)

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A 38-year-old female is 36 weeks pregnant and arrives to labor and delivery for a headache that won’t go away with acetaminophen. The nurse gets the patient’s vitals.

Critical Thinking Check

What else should the nurse ask?

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The nurse notes that the patient’s blood pressure is 156/98 mm hg and asks the patient “have you had any blurred vision, floaters or changes to that? Any sudden swelling, sudden weight gain? ”
The patient responds, “yes, I keep seeing floaters and have even thrown up from it. I do have some swelling and my upper abdomen has really been hurting. My head is really hurting.” The nurse goes to call the doctor. Nurse to Dr. “Hey Dr. Smith your patient, Maria Evans is here with some symptoms of preeclampsia. She has a BP of 156/98 mm hg, epigastric pain, bad headache, and some vision changes.

Critical Thinking Check

What do you expect the Dr. to order?

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Critical Thinking Check

Why did the doctor not order IV fluids?

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The nurse calls for help and nurses enter the room. They call the patient’s name, get fetal heart tones, apply oxygen, protect the patient. A nurse calls the doctor again and explains the patient is having seizure.

Critical Thinking Check

What is happening with this patient?

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Critical Thinking Check

What do you expect the provider to order?

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Debrief: This patient came in with symptoms of preeclampsia. Preeclampsia is elevated blood pressure about 140/90 (more than once), vision changes, edema, and epigastric pain. Preeclampsia always has protein in the urine, which was in the process of being checked. Eclampsia occurred when the seizure started. Magnesium sulfate is given to stop and prevent seizures. A side effect is lower BP. Labetalol is given to lower the blood pressure.
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