Pathophysiology Case Study Preeclampsia
Uploaded by sls465 on Apr 18, 2007
Pathophysiology Case Study: Preeclampsia
Caring for women in pregnancy presents a unique challenge to the healthcare team. Obstetrical nursing requires an in-depth knowledge of the physiological, psychological, and social processes of the high-risk childbearing woman and her fetus during pregnancy. In a community hospital setting, care challenges can be further complicated by the possible limitations of available resources. The following case study will explore the necessary insights and their implications in caring for the high-risk pregnant client in a community hospital setting.
J.B. is a 24-year-old, gravida 1, para 0, at 25.2 weeks gestation per early ultrasound. She presented to the Labor and Delivery unit at 09:26 a.m. with complaints of feeling a gush of fluid and vaginal bleeding. Upon arrival, her blood pressure was elevated at 174/109. Her pulse was 98, respirations 24, and temperature 97.6 F (36.4 C). Her weight was 230 lbs. (103.5 Kg) with a reported prepregnant weight of 217 pounds.
The fetal heart rate (FHR) was auscultated at 125-130 beats per minute (bpm) with audible decreases heard down to 60-90 bpm lasting 30-40 seconds. Uterine activity was palpated and confirmed J.B.’s complaint of abdominal tightening and cramping. However, due to her obesity and left lateral positioning, it was difficult to obtain a readable tracing on the electronic fetal monitor (EFM). Additionally, her reflexes were +1, clonus absent, 2+ pedal edema, and +1 urine albumin. The tocodynamometer and ultrasound transducers of the EFM were readjusted, but the FHR could not be verified despite several attempts. Labs were drawn for CBC, type and screen, drugs of abuse, and Chem 20 analysis. An IV of lactated ringers was started, oxygen 10L/snug facemask was administered, and the obstetrician was notified to report to the bedside.
Other assessment data revealed her abdomen to be tender but soft per palpation, but again due to obesity, it was very difficult to assess timing, duration, and intensity of uterine contractions. The frequency was documented as every three to five minutes. She was leaking small amounts of pink fluid from her vagina and ferning was noted to be positive.
Key indicators of the admission assessment data, such as the elevated blood pressure, proteinuria, and edema, pointed to the cardinal symptoms of preeclampsia. Preeclampsia is one of the classifications that falls under the umbrella term of pregnancy induced...