Discussion Post - Edited
Discussion Post - Edited
Discussion Post - Edited
student’s name
course title
instructor’s name
institution
date
Summary of your chosen case study
Gloria is a 55years old American female who wishes to get pregnant for her fiancé. she got a
cardiac stent at the age of 50 years and hypertension, taking zocor, Plavix, and lisinopril. Her
surgical history is significant, with a successful minor tonsillectomy. Her routine medical and
gynecological tests are standard. She denies alcohol and substance use. Due to her advanced age,
she successfully got pregnant through IVF on her second cycle and started taking folic acid
400mcg daily, baby aspirin, and Procardia. a while later, she presented to the emergency
department with complaints of pain in the right chest and facial swelling. On examination, she
has high blood pressure at 160/92mmHg and lower limb 2+ pitting edema. Diagnostic tests done
are liver function tests which are four times the average value, and the platelets are above
50,000. she was initiated on magnesium sulfate and labetalol and delivered a male infant who
survived 20 minutes.
What is your differential diagnosis?
According to the patient's symptoms, my differential diagnoses are HELLP syndrome,
preeclampsia, and hypertension in pregnancy. HELLP is an acronym for hemolysis, elevated
liver enzymes, and low platelet count. It is a potentially life-threatening syndrome in pregnancy
that results from microvascular endothelial activation and cell injury. The presenting symptoms
are blurring of vision, chest pain on the right part, headache, body swelling, nausea, and fatigue.
The risk factors for HELLP syndrome are advancing age of above 34 years, multiparity, history
of poor pregnancy outcome, and European descent. The complications are pulmonary edema,
acute renal failure, placenta abruption, and disseminated intravascular coagulation. This is the
patient's primary diagnosis because she presents with similar symptoms of chest pain, facial
swelling, high blood pressure, and pitting edema. She is a 55years old American patient and had
a late abruption and signs of acute kidney injury.
Preeclampsia is a pregnancy-related disorder characterized by endothelial dysfunction after 20
weeks. It is characterized by elevated blood pressure above 140/90mmHg, impaired hepatic
function, thrombocytopenia, pulmonary edema, renal insufficiency, and cerebral and visual
symptoms. It is common in nulliparity, chronic hypertension, and maternal age 35 years and
above. The patient presents with similar symptoms of edema, right-sided chest pain, and lower
limb pitting edema. Preeclampsia is not the patient's diagnosis because she was not yet 20 weeks
gestation, and there was no proteinuria.
Why did you make this diagnosis decision?
the primary diagnosis
What is your treatment plan?
What evidence-based research can you provide to support your decision (choice for differential
diagnosis and plan/intervention)?
What resources did you use to meet your best practice guidelines?
Address the ethical dilemmas and other issues for your case study:
The ethical dilemma in this case study is beneficence versus autonomy. Beneficence is providing
good quality care to the best of their ability to prevent harmful conditions or consequences to the
patient. Autonomy is the moral principle of following the patient's influence or desires. The
patient is 55 years old with a cardiac stent and hypertension. she wants to get pregnant through
IVF because of reduced fertility with advancing age. A patient above 50 years has a higher risk
of pregnancy complications than other women. the common complications are placenta previa,
gestational diabetes mellitus, hypertension, preeclampsia, and cesarean delivery.
Ethical issues
the patient has an abrupt placenta and delivered a male infant who only lived for 20 minutes, and
she still desires to have another trial. The ethical issues in this scenario are beneficence, non-
maleficence, and autonomy. as the advanced nurse practitioner, I would provide post-abortion
care services to meet the emotional and physical needs of the patient, such as healing and
preparing for the next delivery. I would explain to the patient the risks of IVF and pregnancy in
advancing age, such as placenta previa, gestational diabetes mellitus, hypertension, and
preeclampsia. I would recommend safer options for child delivery, such as using a surrogate or
adoption.
Psychological issues
loss of pregnancy and infertility presents psychological problems such as depression and low
self-esteem. Infertile women have less or no confidence in themselves compared to fertile
women despite several trials of seeking treatment. Parenthood is a significant transition in life,
especially for women. Unfulfilled wish for a child is associated with depression, anxiety, anger,
and social isolation due to stigma. The outcome of infertility treatment depends on psychological
interventions such as cognitive behavioral therapy to reduce the symptoms of anxiety and
depression.
Physical issues
the patient has medical problems such as hypertension and cardiovascular disease that increases
the risk of unsuccessful pregnancy. IVF increases the risk f irregular heart rate, placenta
abruption, and kidney diseases during pregnancy. Additionally, children born through IVF tend
to develop hypertension and arterial diseases early in life.
Financial issues
the cost of IVF and treating the associated complications is high. Couples struggling with
infertility spend more money on therapy sessions and intense fertility treatment options. The
team should be prepared financially because most fertility treatment options are not 100%
successful. The financial burden and low socioeconomic status