Case Study: Before pregnancy, Mary’s BP was in the range of 110/68 to 120/70. Sh
ID: 238420 • Letter: C
Question
Case Study: Before pregnancy, Mary’s BP was in the range of 110/68 to 120/70. She is 41 and this is her first pregnancy. Her BMI is 24 and she has a history of rheumatoid arthritis. She needed in vitro fertilization to get pregnant and is very excited about this pregnancy. In gestational week 22 her BP was 158/96 and 152/90. Her urine was 2+ for urine. What is the likely diagnosis? _________________________________________________________________
What are Mary’s risk factors for this condition? ______________________________________________________________________
List 4 oral antihypertensive medications to treat this condition?
1.
2.
3.
4.
What other health promotion instructions can the nurse give to the patient?
Mary was started on an oral antihypertensive, but her BP continues to rise to 162/112 and 170/110. Her 24 urine is 2.5 Grams.
Her labs are:
creatinine =2
Hemoglobin = 8.5
ALT = elevated
AST = elevated
Platelets 86,000/mm
What is her diagnosis now? ______________________________________________________________________________
True/False
True or False Mary will have hyperreflexia.
True or False Polyuria will occur.
True or False Mary will most likely feel increased kicking from the fetus.
True or False Mary’s plasma uric acid will drop
True or False Mary will have hyperbilirubinemia.
Mary is admitted to the hospital and started on Magnesium Sulfate. What route is it given? _____________________________________________
What is the purpose of this medication? __________________________________________________
Nursing considerations when administering Magnesium Sulfate:
How will you give the medication?
How will the pt feel when initially receiving Magnesium Sulfate?
What will you monitor while the pt is on Magnesium Sulfate?
What would you do if toxicity of Magnesium Sulfate is suspected?
What other health promotion actions can the nurse take for this patient?
Explanation / Answer
PATIENT DIAGNOSIS
Pre-eclampsia
RISK FACTORS FOR MARY
LIST OF ORAL ANTI HYPERTENSIVES FOR MARY
HEALTH PROMOTION INSTRUCTION
PATIENT DIAGNOSIS IN CASE OF CONTINUOUS RAISE OF BP WITH ELEVATED ALT AND AST AND LOW PLATELET COUNT
Severe preeclampsia
TRUE OR FALSE
Mary will have hypereflexia- False
Polyuria will occur- False
Mary will most likely feel increased kicking from fetus- False
Mary’s plasma uric acid will drop- False
Mary will have hyperbilirubinemia- False
MAGNESIUM SULFATE ADMINISTRATION
To prevent seizure and it can also help prolong a pregnancy for up to two days which allows time for corticosteroid drugs to improve the baby’s lung function.
Loading dose
Inj. Magnesium sulfate 4gm (8ml) with 12 ml distilled water- slow IV
Inj. Magnesium sulfate 4gm (8ml) with 1 ml inj.Lignocaine 2%- Deep IM in each buttocks
Maintenance dose
Inj. Magnesium sulfate 4gm (8ml) with 1 ml inj.Lignocaine 2%- Deep IM in alternative buttocks 4th hourly
Absent of knee jerk
Respiratory rate<16/minute
Urine output <30ml/hour