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Outline
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.
What else should the nurse ask?
- Do you have any blurred vision?
- Do you have any abdominal pain?
- Have you seen any floaters?
- Have you had any sudden swelling?
- Have you had any sudden weight gain?
- With preeclampsia there can be vision changes, sudden edema (especially in the hands and face), sudden weight gain from fluid retention, and epigastric pain.
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.
What do you expect the Dr. to order?
- Urine check for protein -Urine needs to be checked for protein. In preeclampsia there will be protein spilled into the urine.
Why did the doctor not order IV fluids?
- IV fluids- We do not want to add fluid volume at this time. This puts more pressure on to the heart and this patient is overloaded with fluid at this time.
The nurse tells Maria to give a urine sample and when Maria returns from the bathroom she gets in the bed and begins to seize.
[faq lesson="true" question="What does the nurse need to do?"]
- Call for help- the nurse needs to call and get help in the room.
- lower the bed for patient safety
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.
What is happening with this patient?
- The patient has become eclamptic – When a patient has preeclampsia and seizes they now have eclampsia
What do you expect the provider to order?
- Magnesium sulfate- this is the drug of choice to prevent seizures and as a side effect it will also lower the blood pressure
- Lebetolol- this is the drug of choice to treat high blood pressure
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