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    Case Simulation 118

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    Rica Avendaño
    - J.F. is a 18-year-old pregnant woman admitted for induction of labor at 38 weeks due to symptoms of preeclampsia including high blood pressure, headaches, and edema. On assessment she is found to have 2+ pitting edema and protein in her urine. - She is started on a magnesium sulfate infusion to prevent seizures from preeclampsia. Four hours later her magnesium level is found to be too high at 7.8 mEq/L, requiring the infusion rate to be reduced. - During labor she experiences tachysystole with more than 5 contractions in 10 minutes. Her membranes then rupture with meconium-stained fluid, increasing risk of infection for the

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    Case Simulation 118

    Uploaded by

    Rica Avendaño
    248 views4 pages
    - J.F. is a 18-year-old pregnant woman admitted for induction of labor at 38 weeks due to symptoms of preeclampsia including high blood pressure, headaches, and edema. On assessment she is found to have 2+ pitting edema and protein in her urine. - She is started on a magnesium sulfate infusion to prevent seizures from preeclampsia. Four hours later her magnesium level is found to be too high at 7.8 mEq/L, requiring the infusion rate to be reduced. - During labor she experiences tachysystole with more than 5 contractions in 10 minutes. Her membranes then rupture with meconium-stained fluid, increasing risk of infection for the

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    CASE SIMULATION 118

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    - J.F. is a 18-year-old pregnant woman admitted for induction of labor at 38 weeks due to symptoms of preeclampsia including high blood pressure, headaches, and edema. On assessment she is found to have 2+ pitting edema and protein in her urine. - She is started on a magnesium sulfate infusion to prevent seizures from preeclampsia. Four hours later her magnesium level is found to be too high at 7.8 mEq/L, requiring the infusion rate to be reduced. - During labor she experiences tachysystole with more than 5 contractions in 10 minutes. Her membranes then rupture with meconium-stained fluid, increasing risk of infection for the

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    248 views4 pages

    Case Simulation 118

    Uploaded by

    Rica Avendaño
    - J.F. is a 18-year-old pregnant woman admitted for induction of labor at 38 weeks due to symptoms of preeclampsia including high blood pressure, headaches, and edema. On assessment she is found to have 2+ pitting edema and protein in her urine. - She is started on a magnesium sulfate infusion to prevent seizures from preeclampsia. Four hours later her magnesium level is found to be too high at 7.8 mEq/L, requiring the infusion rate to be reduced. - During labor she experiences tachysystole with more than 5 contractions in 10 minutes. Her membranes then rupture with meconium-stained fluid, increasing risk of infection for the

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    J.F. is experiencing preeclampsia which is evident by her high blood pressure, edema, and protein in her urine.

    Based on the assessment I think J.F is having Preeclampsia, evident with high BP, edema and protein in urine.

    Tachysystole - Tachysystole is marked by more than five contractions per ten minutes over the course of 30 minutes.

    AVENDAÑO, Rica Marie A.

    BSN 2C - Group 9 September 7, 2021

    CASE STUDY 118

    INSTRUCTION. All questions apply to this case study. Your responses should be brief and to
    the point. When asked to provide several answers, list them in order of priority of significance.
    Do not assume information that is not provided. Please print or write clearly. If your response is
    not legible, it will be marked as?, and you will need to rewrite it.

    Scenario:
    J.F. is an 18-year-old woman, gravida 1 para 0, at 38 weeks' gestation. She felt fine until 2 days
    ago, when she noticed swelling in her hands, feet, and face. She complains of a frontal
    headache, which started yesterday and has not been relieved by acetaminophen (Tylenol) or
    coffee. She says she feels irritable and doesn't want the “overhead lights on.” Her physician is
    admitting her for induction of labor. You begin to assess her.

    Assessment:
    Vital Signs: BP 152/84 mm Hg; HR 88 beats/min
    Oral Temperature: 98.8F (37.1 C)
    Weight: 131.4kg (289lb); height: 5ft, 4in
    Edema: noted in hands, feet and face
    Deep Tendon Reflexes (DTR) +2, no clonus
    Urine dipstick reveals proteinuria +3

    1. Based on the assessment date you have obtained so far, what do you think is happening to
    J.F. at this time?
    - Based on the assessment I think J.F is having Preeclampsia, evident with high BP,
    edema and protein in urine.

    2. As you assess J.F. for the edema in her ankles, you note that she is closest to letter B in the
    figure. How would you document this edema?
    - I will document this as 2+ pitting edema.
    3. What other assessment questions should you ask her at this time?
    - The assessment questions that I should ask her this time are:
    ● Does she feel the baby move?
    ● Pain in the abdomen area?
    ● Any vaginal bleeding?
    ● Weight gained in the past week?
    ● Do you smoke, do alcohol and drugs?

    4. What information should you obtain from her obstetric record?


    - The information that i should obtain from her record are:
    ● Due Date
    ● Recent blood work
    ● Fundal height record
    ● Medical history
    ● Family history
    ● Weight
    ● BP measurements in the past

    5. What laboratory values should be considered at this time?


    ● Blood work (CBC with PT,PTT)
    ● Urinalysis
    Complete blood count (CBC) - measures and counts your blood cells.
    Prothrombin Time (PT) - measures the integrity of the extrinsic system as well as factors
    common to both systems.
    Partial Thromboplastin Time (PTT) - measures the integrity of the intrinsic system and
    the common components.
    Urinalysis - A urinalysis is a urine test that can test for drugs, pregnancy, or diseases and
    conditions such as urinary tract and kidney infection or kidney problems.

    6. Name at least three possible maternal and three possible fetal complications with J.F.?
    - Maternal
    a. Abruptio placenta - is an uncommon yet serious complication of pregnancy. The
    placenta develops in the uterus during pregnancy. It attaches to the wall of the uterus
    and supplies the baby with nutrients and oxygen.
    b. Stroke - preeclampsia can cause seizures (eclampsia) and lead to stroke.
    c. Renal damage - Acute renal failure (ARF) is regarded as relatively uncommon in
    preeclampsia-eclampsia (PE-E) and, in any event, of moderate degree or reversible.
    Cortical necrosis is reported as rare, even in fatal cases.
    - Fetal
    a. Still birth - Stillbirths are much more likely to occur with severe preeclampsia.
    b. Low birth weight - Preeclampsia is associated with low birth weight, both because of
    increased risks of preterm and of small-for-gestational-age (SGA) births.
    c. Brain damage - it can cause brain damage and/or cerebral palsy in the baby.
    7. What risk factors does J.f. have that cause her to be at risk for this condition?
    a. Obesity - Insulin resistance that results from pre-pregnancy obesity or by an excessive
    weight gain during gestation is associated with a reduced cytotrophoblast migration and
    uterine spiral artery remodeling, which in turn conducive to placental hypoxia and
    ischemia.
    b. Nulliparity - Nulliparity is the largest population attributable risk factor for preeclampsia.
    c. Single-fetus pregnancy
    d. Age younger than 20 years - Risk of adverse outcome remained increased in
    adolescent compared to young adult mothers (20–24 years)
    e. Coffee drinker

    8. Identify eight measures that would likely be implemented.


    1. Inform patient that condition will get cured after birth
    2. Monitor I&O
    3. Monitor fetal status
    4. Low stimulus environment to promote rest
    5. NPO
    6. Monitor for headaches
    7. Have O2 equipment in bedside
    8. Evaluate edema

    CASE STUDY PROGRESS


    The physician orders a magnesium sulfate infusion. As you monitor, J.F., you observe for signs
    of magnesium sulfate toxicity.

    9. As you monitor J.F., you observe for signs of magnesium sulfate toxicity. What are
    the potential signs of magnesium sulfate toxicity? SATA.
    a. Absent DTRs - As the plasma levels increase by the magnesium sulfate, the muscle
    weakness becomes more pronounced and there is a marked reduction and then loss of
    deep tendon reflexes
    b. Increased respiratory rate
    c. Oliguria - Oliguria is when you pee less than usual.
    d. Muscle rigidity
    e. Severe hypotension - Magnesium sulfate may attenuate blood pressure by decreasing
    the vascular response to pressor substances.

    10. Four hours later, a serum magnesium level is drawn, and the result shows 7.8 mEq/L. Does
    this result need to be reported to the physician? If so, what would you prefer to do?
    - 7.8 mag level is too high and should be reported
    - Normal range of magnesium: 1.7 to 2.2 mg/dL (0.85 to 1.10 mmol/L)
    CASE STUDY PROGRESS
    The magnesium sulfate infusion rate is reduced, and an oxytocin infusion has been ordered by
    the physician and is being given IV in increments to achieve an adequate contraction pattern.
    You notice on the fetal monitor strip that J.F. is experiencing seven uterine contractions in a
    10-minute period over a 30-minute window, with a few FHR decelerations noted.

    11. Is there an antidote for magnesium sulfate?


    - Yes, Calcium gluconate - Calcium Gluconate is the gluconate salt of calcium. An
    element or mineral necessary for normal nerve, muscle, and cardiac function, calcium as
    the gluconate salt helps to maintain calcium balance and prevent bone loss when taken
    orally.

    12. What is happening at this time?


    - Tachysystole - Tachysystole is marked by more than five contractions per ten minutes
    over the course of 30 minutes.

    CASE STUDY PROGRESS


    J.F. progresses in labor, and, at 4-cm dilation, her membranes spontaneously rupture. The small
    amount of amniotic fluid is green.

    13. What are the priority actions?


    ● Stop oxytocin
    ● Call PCP - Primary Care Physician
    ● Position patient on her side
    ● Administer O2 at 10L by non-rebreather mask
    ● Monitor FHR - normal fetal heart rate

    CASE STUDY PROGRESS


    Five hours later, J.F. delivers a 6-pound, 8-ounce boy, with Apgar scores of 6 and 7.

    14. What does the green amniotic fluid indicate? What are the risks?
    - Meconium.
    The risks are:
    ● If swallowed by the baby, it may lead to respiratory infections.
    ● CS delivery

    15. What are your responsibilities at this time?


    ● Monitor I&O
    ● Closely monitor VS, DTRs, LOC, uterine tone and lochia

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