Comprehensive Assessment of Preeclampsia Patient
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Comprehensive Assessment of Preeclampsia Patient
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Labs, tests, and other diagnostics
Comprehensive Assessment of Preeclampsia Patient.. Urinalysis helps to determine protein content in the urine. A dispstick treated with chemical could be used. Any change in color shows the presence of protein. Nonetheless, ultrasound can also be done to determine developmental restrictions on the part of the fetus. Blood tests could also be conducted to measure protein also known as placental growth factor (PIGF). In most cases, high PIGF indicates the absence of preeclampsia (Chaiworapongsa et al., 2016).
Differential diagnoses
A differential diagnosis was the surest way to distinguish the condition as the most probable cause of the patient sickness by elimination process (Cozzolino et al., 2015). During assessment APNs are often unsure of the exact ailment, hence the need to undertake various assessment that then points to a life-threatening condition.
Management plan
a. Diagnosis
The diagnosis of preeclampsia..
Comprehensive Assessment of Preeclampsia Patient
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involves protein urine and high blood pressure after the twentieth week of pregnancy. The diagnosis of preeclampsia is also determined by low platelet count; impairment of the liver; pulmonary edema and visual disturbances (Odigboegwu, Pan & Chatterjee, 2018). During pregnancy, a blood pressure of more than 140/90mm Hg is not normal. Nonetheless, one reading is not enough to establish that a patient has preeclampsia. A second abnormal reading four hours after the first reading can help in establishing the present of the disease (Brown & Garovic, 2014).
Comprehensive Assessment of Preeclampsia Patient
b. Treatment
Preeclampsia can be cured by delivering fetus and placenta. Additionally, antihypertensive are prescribed to lower the blood pressure (Brown & Garovic, 2014). Similarly, if the condition is severe corticosteroid can be used to temporarily improve the functioning of liver and platelet counts. Anticonvulsant particularly magnesium sulphate can be prescribed to prevent seizure.
Even though medication can reduce blood pressure and decrease the risk of stroke in the mother, such treatments cannot improve the underlying issue in the placenta. As a result, they do not prevent the progress of the disease. Treatment of pregnancy with preeclampsia relies on the severity of the disease and gestational age (Brown & Garovic, 2014). Delivery method is determined by position of the fetus, dilation and thinning of cervix and condition of the fetus. In most cases, oxytocin is given intravenously to induce labor. However, if labor fails to progress or there are complications, a caesarian section can be performed.
c. Patient education
Research shows that inadequate knowledge about the severity of disease during pregnancy contributes to more than a half of maternal deaths (Main et al., 2015). The potential challenge to accessing care is a threat to women; hence patient education can help in early detection while preventing negative outcomes.
Essentially patient education should explain preeclampsia, risks associated with disease, signs and symptoms. Education should also use to use easy to understand education content to ensure that women can recognize the signs as well as symptoms of the disease.
d. Follow-up care
Protein in the urine and high blood pressure resolve after delivery, but there is need for follow-up care so as to check chances of cardiovascular diseases. Evidence shows that after preeclampsia, there is a higher risk of developing cardiovascular diseases (da Silva et al., 2014). Follow-up care also required to monitor blood pressure and determine if there is need for medication.
Assessment
Diagnosis Positives Negatives Rationale & Reference
Preeclampsia Presence of protein un urine,
BP above or equals to 140 mmHg systolic and/or greater than 90
mmHg diastolic, low platelets, headache, liver malfunction Absence of proteinuria While preeclampsia was determined by the presence of high blood pressure and proteinuria, research shows the likelihood for the patient to have preeclampsia without necessarily presenting with proteinuria.
In the same vein, it would be unusual to have BP that goes way above 140/90mm Hg; however, several readings would be performed after 4 hours to determine the presence of preeclampsia (Carter et al., 2017). Nonetheless, the presence of proteinuria and high blood pressure above 140/90mm Hg, would point towards preeclampsia.
Chronic Hypertension Presence of protein in urine, BP greater than 140 mmHg systolic and/or greater than 90 mmHg diastolic Absence of proteinuria Although chronic hypertension is simply high blood pressure that an expectant woman experience before pregnancy, it may be hard to determine when it commences because it does not present symptoms (Dunietz et al., 2017).
Gestational Hypertension Increased BP, blurred vision Absence of proteinuria An expectant woman who had normal BP in the first 20 weeks can show signs of Gestational hypertension 20 weeks onwards particularly, with BP reading above 140/90 mm Hg with traces of protein in the urine.
Essentially, with gestational hypertension and proteinuria, a woman could present with Preeclampsia (Garg et al., 2015).
Lab/Imaging (Results) Patient results Rationale
Urinalysis Too much protein in the urine after urinalysis Urinalysis is vital when it comes to ruling out the likelihood of Preeclampsia. In this case, urine can be collected for 24 hours, to allow determine the level of proteinuria.
Comprehensive Assessment of Preeclampsia Patient
Lab/Imaging (Results) Patient results Rationale
Ultrasound Patient had ultrasound done before doctor visit. The ultrasound is necessary to establish how the fetus is growing. Ultrasound images enable the physicians to approximate the fetal weight and the amount of fluid in the uterus. By and large, ultrasound will allow the doctor to detect any fetal developmental restriction (Chaiworapongsa et al., 2016).
Plan:
Condition Pharmacological Nonpharmacological
Alternative Treatments Test Follow up
Referral Rationale
Preeclampsia Antihypertensive and anticonvulsant. In this case, 10mg of amlodipine and
4mg of doxazosin would be administered. Bed rest, low-salt diet and reduced anti-oxidants consumption Urinalysis and Ultrasound In the event that symptoms persist, patient should be screened on a weekly basis. Early intervention methods, through urinalysis and ultrasound can help to preclude preeclampsia and
intra-uterine fetal mortality, especially when BP goes undetected (Chaiworapongsa et al., 2016).
Health promotion
According Anderson and Schmella (2017), screening of preeclampsia is important among pregnant women to identify high-risk pregnancies. Moreover, this helps in reducing complication as well as deaths. During screening, nurses focus on identifying the risk factors while creating awareness about the time of exposure between paternal semen and pregnancy. In addition, nurses should educate women about birth control techniques so as to reduce preeclampsia.
Disease prevention
Comprehensive Assessment of Preeclampsia Patient
Evidence shows that preeclampsia can be prevented through primary and secondary strategies that concentrate on antenatal surveillance, lifestyle changes, and pharmacological intervention (Bezerra et al., 2012). Moreover, prevention of preeclampsia focus on primary interventions including bed rest, reduced intake of salt, and antioxidants such as garlic, marine oil, Vitamin E and C. Secondary strategies to prevent involve use of drugs including progesterone, nitricoxide, asprin, calcium supplements and diuretics (Maia e Holanda Moura, et al., 2012).
Reflection
The practicum was a platform to use my acquired knowledge. Moreover, the practicum presented me the opportunity to use critical thinking skills in different clinical scenarios. Furthermore, I learned how several factors can complicate the prevention of preeclampsia. These factors include low predictive value of screening tests, etiology and disease presentation.
Another thing I learned is that prompt interventions can lower the risks that come with preeclampsia. This is also an indication that many women should be treated to prevent one case. Additionally, I realized that preeclampsia is a global health issue with significant rates of maternal and neonatal mortality. Regardless, there are numerous diagnostics that could present as preeclampsia, I would always undertake a differential analysis to be able to distinguish the signs and narrow down to the real problem. As such, I used critical skills, evidence-based practice and acquired knowledge to engage with the patient and make the right diagnosis.
Comprehensive Assessment of Preeclampsia Patient
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b. Treatment
Preeclampsia can be cured by delivering fetus and placenta. Additionally, antihypertensive are prescribed to lower the blood pressure (Brown & Garovic, 2014). Similarly, if the condition is severe corticosteroid can be used to temporarily improve the functioning of liver and platelet counts. Anticonvulsant particularly magnesium sulphate can be prescribed to prevent seizure.
Comprehensive Assessment of Preeclampsia Patient
Comprehensive Assessment of Preeclampsia Patient
Even though medication can reduce blood pressure and decrease the risk of stroke in the mother, such treatments cannot improve the underlying issue in the placenta. As a result, they do not prevent the progress of the disease. Treatment of pregnancy with preeclampsia relies on the severity of the disease and gestational age (Brown & Garovic, 2014). Delivery method is determined by position of the fetus, dilation and thinning of cervix and condition of the fetus. In most cases, oxytocin is given intravenously to induce labor. However, if labor fails to progress or there are complications, a caesarian section can be performed.
Comprehensive Assessment of Preeclampsia Patient
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c. Patient education
Research shows that inadequate knowledge about the severity of disease during pregnancy contributes to more than a half of maternal deaths (Main et al., 2015). The potential challenge to accessing care is a threat to women; hence patient education can help in early detection while preventing negative outcomes.
Essentially patient education should explain preeclampsia, risks associated with disease, signs and symptoms. Education should also use to use easy to understand education content to ensure that women can recognize the signs as well as symptoms of the disease.
d. Follow-up care
Protein in the urine and high blood pressure resolve after delivery, but there is need for follow-up care so as to check chances of cardiovascular diseases. Evidence shows that after preeclampsia, there is a higher risk of developing cardiovascular diseases (da Silva et al., 2014). Follow-up care also required to monitor blood pressure and determine if there is need for medication.
Assessment
Diagnosis Positives Negatives Rationale & Reference
Preeclampsia Presence of protein un urine,
BP above or equals to 140 mmHg systolic and/or greater than 90
mmHg diastolic, low platelets, headache, liver malfunction Absence of proteinuria While preeclampsia was determined by the presence of high blood pressure and proteinuria, research shows the likelihood for the patient to have preeclampsia without necessarily presenting with proteinuria.
In the same vein, it would be unusual to have BP that goes way above 140/90mm Hg; however, several readings would be performed after 4 hours to determine the presence of preeclampsia (Carter et al., 2017). Nonetheless, the presence of proteinuria and high blood pressure above 140/90mm Hg, would point towards preeclampsia.
Chronic Hypertension Presence of protein in urine, BP greater than 140 mmHg systolic and/or greater than 90 mmHg diastolic Absence of proteinuria Although chronic hypertension is simply high blood pressure that an expectant woman experience before pregnancy, it may be hard to determine when it commences because it does not present symptoms (Dunietz et al., 2017).
Gestational Hypertension Increased BP, blurred vision Absence of proteinuria An expectant woman who had normal BP in the first 20 weeks can show signs of Gestational hypertension 20 weeks onwards particularly, with BP reading above 140/90 mm Hg with traces of protein in the urine.
Essentially, with gestational hypertension and proteinuria, a woman could present with Preeclampsia (Garg et al., 2015).
Lab/Imaging (Results) Patient results Rationale
Urinalysis Too much protein in the urine after urinalysis Urinalysis is vital when it comes to ruling out the likelihood of Preeclampsia. In this case, urine can be collected for 24 hours, to allow determine the level of proteinuria.
Comprehensive Assessment of Preeclampsia Patient
Lab/Imaging (Results) Patient results Rationale
Ultrasound Patient had ultrasound done before doctor visit. The ultrasound is necessary to establish how the fetus is growing. Ultrasound images enable the physicians to approximate the fetal weight and the amount of fluid in the uterus. By and large, ultrasound will allow the doctor to detect any fetal developmental restriction (Chaiworapongsa et al., 2016).
Plan:
Condition Pharmacological Nonpharmacological
Alternative Treatments Test Follow up
Referral Rationale
Preeclampsia Antihypertensive and anticonvulsant. In this case, 10mg of amlodipine and
4mg of doxazosin would be administered. Bed rest, low-salt diet and reduced anti-oxidants consumption Urinalysis and Ultrasound In the event that symptoms persist, patient should be screened on a weekly basis. Early intervention methods, through urinalysis and ultrasound can help to preclude preeclampsia and
intra-uterine fetal mortality, especially when BP goes undetected (Chaiworapongsa et al., 2016).
Health promotion
According Anderson and Schmella (2017), screening of preeclampsia is important among pregnant women to identify high-risk pregnancies. Moreover, this helps in reducing complication as well as deaths. During screening, nurses focus on identifying the risk factors while creating awareness about the time of exposure between paternal semen and pregnancy. In addition, nurses should educate women about birth control techniques so as to reduce preeclampsia.
Disease prevention
Comprehensive Assessment of Preeclampsia Patient
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Evidence shows that preeclampsia can be prevented through primary and secondary strategies that concentrate on antenatal surveillance, lifestyle changes, and pharmacological intervention (Bezerra et al., 2012). Moreover, prevention of preeclampsia focus on primary interventions including bed rest, reduced intake of salt, and antioxidants such as garlic, marine oil, Vitamin E and C. Secondary strategies to prevent involve use of drugs including progesterone, nitricoxide, asprin, calcium supplements and diuretics (Maia e Holanda Moura, et al., 2012).
Reflection
The practicum was a platform to use my acquired knowledge. Moreover, the practicum presented me the opportunity to use critical thinking skills in different clinical scenarios. Furthermore, I learned how several factors can complicate the prevention of preeclampsia. These factors include low predictive value of screening tests, etiology and disease presentation.
Another thing I learned is that prompt interventions can lower the risks that come with preeclampsia. This is also an indication that many women should be treated to prevent one case. Additionally, I realized that preeclampsia is a global health issue with significant rates of maternal and neonatal mortality. Regardless, there are numerous diagnostics that could present as preeclampsia, I would always undertake a differential analysis to be able to distinguish the signs and narrow down to the real problem. As such, I used critical skills, evidence-based practice and acquired knowledge to engage with the patient and make the right diagnosis.
Comprehensive Assessment of Preeclampsia Patient
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References
Anderson, C. M., & Schmella, M. J. (2017). CE: Preeclampsia current approaches to nursing management. AJN The American Journal of Nursing, 117(11), 30-38. doi: 10.1097/01.NAJ.0000526722.26893.b5
Bezerra Maia e Holanda Moura, S., Marques Lopes, L., Murthi, P., & da Silva Costa, F. (2012). Prevention of preeclampsia. Journal of pregnancy, 2012. doi: 10.1155/2012/435090
Brown, C. M., & Garovic, V. D. (2014). Drug treatment of hypertension in pregnancy. Drugs, 74(3), 283-296. doi: 10.1007/s40265-014-0187-7
Carter, W., Bick, D., Mackintosh, N., & Sandall, J. (2017). A narrative synthesis of factors that affect women speaking up about early warning signs and symptoms of pre-eclampsia and responses of healthcare staff. BMC pregnancy and childbirth, 17(1), 63.
Chaiworapongsa, T., Romero, R., Whitten, A. E., Korzeniewski, S. J., Chaemsaithong, P., Hernandez-Andrade, E., … & Hassan, S. S. (2016). The use of angiogenic biomarkers in maternal blood to identify which SGA fetuses will require a preterm delivery and mothers who will develop pre-eclampsia. The Journal of Maternal-Fetal & Neonatal Medicine, 29(8), 1214-1228.
Cozzolino, M., Bianchi, C., Mariani, G., Marchi, L., Fambrini, M., & Mecacci, F. (2015). Therapy and differential diagnosis of posterior reversible encephalopathy syndrome (PRES) during pregnancy and postpartum. Archives of gynecology and obstetrics, 292(6), 1217-1223.
da Silva, M. D. L. C., de Andrade Galvão, A. C. A., de Souza, N. L., de Azevedo, G. D., Jerônimo, S. M. B., & de Araújo, A. C. P. F. (2014). Women with cardiovascular risk after preeclampsia: is there follow-up within the Unified Health System in Brazil?. Revista Latino-Americana de Enfermagem, 22(1), 93. doi: 10.1590/0104- 1169.3197.2389
Dunietz, G. L., Strutz, K. L., Holzman, C., Tian, Y., Todem, D., Bullen, B. L., & Catov, J. M. (2017). Moderately elevated blood pressure during pregnancy and odds of hypertension later in life: the POUCHmoms longitudinal study. BJOG: An International Journal of Obstetrics & Gynaecology, 124(10), 1606-1613.
Garg, A. X., Nevis, I. F., McArthur, E., Sontrop, J. M., Koval, J. J., Lam, N. N., … & Segev, D. L. (2015). Gestational hypertension and preeclampsia in living kidney donors. New England Journal of Medicine, 372(2), 124-133.
Main, E. K., McCain, C. L., Morton, C. H., Holtby, S., & Lawton, E. S. (2015). Pregnancy related mortality in California: causes, characteristics, and improvement opportunities. Obstetrics & Gynecology, 125(4), 938-947.10.1097/AOG.0000000000000746
Odigboegwu, O., Pan, L. J., & Chatterjee, P. (2018). Use of antihypertensive drugs during preeclampsia. Frontiers in cardiovascular medicine, 5. doi: 10.3389/fcvm.2018.00050
Comprehensive Assessment of Preeclampsia Patient
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