38-Year-Old Female with Preeclampsia
Ms. Johansen, 38, is 26 weeks pregnant with her first child. She was diagnosed with preeclampsia (see p. 1114) three weeks ago. Antihypertensive drugs (p. 724) and daily home care monitoring were initiated. However, her blood pressure is continuing to rise and is now 162/108 mm Hg. She complains of a constant headache, exhibits edema, and her urinalysis is positive for protein.
Her doctor has her admitted and orders further blood tests to assess Ms. Johansen's platelet level and liver function. "We may have to deliver because that’s the only cure for preeclampsia." she says to you during your clinical rotation in obstetrics. “But if we do, then the baby will have problems. It’s a tough decision because we have to balance both the mother's and the baby’s health.”
1. Although blood volume increases during pregnancy, blood pressure normally decreases. You know that blood pressure depends on cardiac output (CO) and total peripheral resistance (TPR) (Figure 19.10, p. 719). How does increased blood volume affect CO, and what factor(s) must change so that blood pressure decreases?
Want to see the full answer?
Check out a sample textbook solutionChapter 28 Solutions
HUMAN ANATOMY & PHYSIOLOGY (LCPO)
- N.H. is a 76-year-old male admitted to the hospital through the emergency department. He fell outside his home. It appears that he may have sustained a fracture to his left hip. He has a history of type 2 diabetes mellitus and has a 40 pack-year smoking history that is now complicated by chronic obstructive pulmonary disease. Data Collected (use only those that apply) Complains of excruciating pain and tenderness in left hip Pain not relieved with morphine BP 166/94 mmHg Diaphoretic and pale skin Respiratory rate 36; crackles, expiratory wheeze X-ray of left hip reveals extracapsular fracture Hematocrit 30%; hemoglobin 15g/dL; WBC 15,000/uL Discussion Questions: Considering the nursing process, list in order the steps in transferring patient from bed to chair post operatively.arrow_forwardMary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. Which of MB’s clinical signs are reflective of the body’s effort to compensate for the decreased oxygen carrying capacity seen with this condition?arrow_forwardMary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. MB is counseled to increase her dietary intake of iron-containing foods. What kinds of food would be recommended?arrow_forward
- Mary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. What type of hematologic disorder would you suspect based on MB’s laboratory values? Why?arrow_forwardMr. Henry is a 50-year-old male who presents to the office for headaches. he has a known history of sinus infections when the seasons change, high blood pressure and depression. his medications include Lopressor 50mg, daily and Claritin 10mg daily. he has a family history significant for aneurysms and depression. His vitals are BP 196/86 right arm seated, HR 87 regular, RR 13, Temp 98 oral. What is a NANDA approved diagnosis you could give her?arrow_forwardJohn Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack-years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00 am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID. Question: Preventing complications of surgery is an important part of all surgical patient care. What preoperative While Mr. Doe is in the Operating Room, what considerations will be taken to ensure Mr. Doe’s safety and positive outcome? Identify 2 IntraOp nursing diagnoses for Mr. Doe teaching does Mr. Doe require in order to prevent complications? Give 3-4 examples)arrow_forward
- A 62-year old, recently widowed male Hispanic patient, KB. was brought in to the emergency department (ED) by his daughter for progressively worsening shortness of breath, fatigue, a lingering non-productive cough, and generalized edema. One month prior, he noticed dyspnea upon exertion, loss of appetite, nausea, vomiting and malaise, which he attributed to the flu. In the emergency department, he appeared anxious and pale, and had a dry yellow tint to the skin. He denied any chest pain, and he could not recall the last time he urinated. He has history of benign prostatic hyperplasia, diabetes mellitus type 2, hypertension, dyslipidemia, and renal insufficiency for the past two years. His ED assessment findings included: 1+ pedal edema, basilar crackles in the lungs bilaterally, and a scant amount of urine according to a bladder scan. His lab results indicated a glomerular filtration rate (GFR) of 12. Based on his subjective and objective symptoms, he was admitted with a diagnosis of…arrow_forwardM. J. is a 76-year-old woman who lives on the side of a very steep mountain. The home health nurse has visited her once a week for the last year. She has running water, electricity, and a coal stove with back-up oil heat for very cold winter nights. She uses the telephone for communication. She has diabetes mellitus, hypertension, hypothyroidism, and is in atrial fibrillation. She has never been in the hospital before. Her current medications include metformin (250 mg twice a day), losartan (50 mg/day), levothyroxine sodium (Synthroid) (50 mcg/day), digoxin (0.125 mg/day), furosemide (Lasix) (10 mg/day), aspirin (81 mg/day), simvastatin (20 mg/day), and warfarin (Coumadin) (4 mg/day, with 6 mg on Sundays). Allergies are to penicillin (hives) and to metoprolol (hypotension and dizziness). M. J. stopped smoking 5 years ago, but until then she smoked one-half pack a day. Last laboratory test results (1 week ago) were: hemoglobin A1C (Hgb A1C) 8.3, international normalized ratio (INR) 1.7,…arrow_forwardM. J. is a 76-year-old woman who lives on the side of a very steep mountain. The home health nurse has visited her once a week for the last year. She has running water, electricity, and a coal stove with back-up oil heat for very cold winter nights. She uses the telephone for communication. She has diabetes mellitus, hypertension, hypothyroidism, and is in atrial fibrillation. She has never been in the hospital before. Her current medications include metformin (250 mg twice a day), losartan (50 mg/day), levothyroxine sodium (Synthroid) (50 mcg/day), digoxin (0.125 mg/day), furosemide (Lasix) (10 mg/day), aspirin (81 mg/day), simvastatin (20 mg/day), and warfarin (Coumadin) (4 mg/day, with 6 mg on Sundays). Allergies are to penicillin (hives) and to metoprolol (hypotension and dizziness). M. J. stopped smoking 5 years ago, but until then she smoked one-half pack a day. Last laboratory test results (1 week ago) were: hemoglobin A1C (Hgb A1C) 8.3, international normalized ratio (INR) 1.7,…arrow_forward
- A 10-year-old boy with known HbSS disease presented to the Paediatric Emergency Department with a oneweek history of fever and severe pain in his right leg, severity 9/10 for the last two days. On examination:Pulse – 100 beats/min, BP – 110/70 mmHg, Capillary refill < 2sec and Respiratory rate – 20 breaths/ min. He has point tenderness anteriorly on proximal tibia. There is no joint swelling.X-ray of the affected limb shows marked periosteal elevation.His complete blood count is: Hb – 6.5 g/dL WBC 30 x 10 /L Plt – 120 x 10 /L with a reticulocyte count of 1%.Of the following the MOST appropriate management in this patient would bea. Ibuprofen, Cefotaxime and top-up transfusionb. Morphine, Ampicillin and hydration therapyc. Morphine, Cefotaxime and hydration therapyd. Morphine, Cefotaxime and top-up transfusionarrow_forwardA 79-year-old woman presents at the Emergency Department with generalized complaints: constantly feeling tired and unwell. Her heart rate was in the range of 110 – 120 beats per minute and her blood pressure was 150/100. She complaints of dry cough and gasping of air. She also states that over the last 2 weeks she has noted that her breathing difficulty has severely limited her activities and has increased to persist even at rest, especially when lying down. She also reports of sudden awakening at night. On enquiry, she reports a recent weight gain along with a general reduction in her state of health. She explains that she has diabetes Type 2 (diet-controlled) from the last 5 years and hypertension since she was 40 years old. Her father died at age 85 due to ‘old age’, her mother died at age 88 after a hip fracture, and a brother age 80 alive with no significant history. She is on Minoxidil 10mg po bid for her hypertension, and has no known drug allergies. She denies any chest pain,…arrow_forwardA 24-year-old male presented with confusion, shortness of breath, and painful calves. It was reported by a friend that he had been lying on the floor for several hours. He was a known intravenous heroin and alcohol abuser. On examination he appeared dehydrated and cold (tem- perature 35°C); his pulse was 75/minute and blood pres- sure 110/70 mmHg. Intravenous injection sites were apparent. His urine was dark coloured. His chest was clear. Arterial blood gases were done in the casualty department and a blood sample was sent to the pathology department and gave the following results (reference ranges are given in brackets): Arterial blood pH PCO₂ PO₂ HCO3- Serum Sodium Potassium Creatinine Calcium Albumin Phosphate Creatine kinase C-reactive protein 7.276 4.82 KPa 12.7 kPa 18.0 mmol/L 138 mmol/L 7.6 mmol/L 236 μmol/L 1.66 mmol/L 32 g/L 2.43 mmol/L >140,000 U/L 73 mg/L (7.35-7.45) (4.7-6.0) (12.0-14.6) (24-29) (135-145) (3.8-5.0) (71-133) (2.10-2.55) (35-50) (0.87-1.45) (55-170) (<10) The…arrow_forward
- Human Anatomy & Physiology (11th Edition)BiologyISBN:9780134580999Author:Elaine N. Marieb, Katja N. HoehnPublisher:PEARSONBiology 2eBiologyISBN:9781947172517Author:Matthew Douglas, Jung Choi, Mary Ann ClarkPublisher:OpenStaxAnatomy & PhysiologyBiologyISBN:9781259398629Author:McKinley, Michael P., O'loughlin, Valerie Dean, Bidle, Theresa StouterPublisher:Mcgraw Hill Education,
- Molecular Biology of the Cell (Sixth Edition)BiologyISBN:9780815344322Author:Bruce Alberts, Alexander D. Johnson, Julian Lewis, David Morgan, Martin Raff, Keith Roberts, Peter WalterPublisher:W. W. Norton & CompanyLaboratory Manual For Human Anatomy & PhysiologyBiologyISBN:9781260159363Author:Martin, Terry R., Prentice-craver, CynthiaPublisher:McGraw-Hill Publishing Co.Inquiry Into Life (16th Edition)BiologyISBN:9781260231700Author:Sylvia S. Mader, Michael WindelspechtPublisher:McGraw Hill Education