1. What are Rosa’s risk factors for developing pre-eclampsia?2. Why did the nurse ask Rosa about headaches, blurred vision, and RUQ pain?3. What signs and symptoms prompted Rosa’s physician to consult with the maternal-fetal specialist and arrange for a transfer to a tertiary care center? Using this information:Rosa Garcia is a 25-year-old married Mexican immigrant who is pregnant with her first child. Rosa’s family practice physician has been caring for her since her first prenatal visit at 114/7 weeks’ gestation. During the initial prenatal visit, the following data were obtained:Vital signs: temperature: 98.6°F (37.0°C); pulse: 78 beats/min; respirations: 20 breaths/min; blood pressure: 110/70; weight: 146 lb (66.4 kg)A complete physical examination was performed with normal findings, and prenatal labs including a thyroid-stimulating hormone level (TSH; because of a positive family history for hypothyroidism) were drawn. During the interview, the nurse inquired about any other family medical problems. Rosa reported that both her sister and her mother had experienced pre-eclampsia during pregnancy.An ultrasound was ordered for pregnancy dating because Rosa had experienced irregular menstrual periods since discontinuing oral contraceptives.Rosa kept her regular prenatal appointments every 4 weeks and the pregnancy progressed uneventfully until 4 months later, when she presented to the office with increased blood pressure and swollen legs. Rosa had noticed an increased swelling that extended up to the knees of both legs. She denied hand or facial swelling, headaches, visual problems, or RUQ pain. Her sister, a chiropractor, had been checking her blood pressure and noted it to be as high as 160 to 170/100 to 110 mm Hg. At this prenatal visit, the following data were obtained:Blood pressure: 144/96 (sitting). Repeat on left side: 140/90. Weight: 172.5 lb (78.4 kg)Urine dipstick reading: 1 +Physical examination: Generalin no acute distress; abdomen: nontender fundus at 28-11.8 in. (30 cm) above the symphysis pubis; FHR 150 bpm; cardiovascular: 1 + pedal edema; neurological: reflexes 3 + with no clonus.Assessment: Pre-eclampsia without severe features.The following laboratory tests were ordered: CBC with platelet count, liver enzyme determination (AST, ALT, LDH), alkaline phosphatase (ALP), prothrombin time (PT), a chemistry panel (electrolytes: Na+, K+, Cl-, HCO3-, Ca2+, Mg2+), blood urea nitrogen (BUN), creatinine (Cr), uric acid, and a 24-hour urine collection for protein and creatinine clearance. A sonogram (ultrasound) was also ordered to monitor the status of the fetus.Rosa was instructed to go home, rest on her left side as much as possible, and call the nurse if she experienced increased edema, headaches, visual disturbances, or RUQ pain. She was told to continue with fetal kick counts and twice daily blood pressure monitoring, record all findings and symptoms, and return to the office in 1 week.On her next office visit 8 days later, Rosa reported that she had been adhering to frequent rest periods at home and had noticed that her leg edema was improved. She exclaimed: “I can see my ankle bones again!” Her sister had continued to monitor the blood pressure. According to the blood pressure log, Rosa’s systolic blood pressure measurements had been in the 160s and the diastolic measurements were in the 80 to 90 range. Rosa denied headaches, visual disturbances, or abdominal pain and remarked that the fetus had been active. At this visit, the following data were obtained:Blood pressure: 160/98 (sitting); 162/100 (left side); weight: 160 lb (72.7 kg); fundal height: 27 cm; FHR: 150 to 170 bpm; reflexes: 3 to 4 + with no clonus; urinary protein: 4 + (2,000 + mg/dL) on dipstickAssessment: Pre-eclampsia with severe features at 294/7 weeks’ gestational ageAt this point, Rosa’s physician consulted with a maternal fetal medicine specialist, who advised transferring Rosa to a tertiary care center 50 miles away. Rosa was promptly transferred to the tertiary care center and admitted to the obstetric service. Health Science Science Nursing NURS 4131 Share QuestionEmailCopy link Comments (0)
solved: 1. What are Rosa’s risk factors for developing pre-eclampsia
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