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    PREECLAMPSIA Case Scenario

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    sabao kizuite
    Ms. Alyana Dalisay, a 34-year-old woman with a history of hypertension, presented for her first prenatal visit at 15 weeks gestation. Her ACE inhibitor medication was discontinued due to risks in pregnancy and replaced with methyldopa. She developed preeclampsia at 35 weeks and was induced, delivering a healthy baby boy via vaginal birth. Her blood pressure returned to normal in the first 24 hours postpartum while continuing methyldopa treatment.

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    PREECLAMPSIA Case Scenario

    Uploaded by

    sabao kizuite
    126 views2 pages
    Ms. Alyana Dalisay, a 34-year-old woman with a history of hypertension, presented for her first prenatal visit at 15 weeks gestation. Her ACE inhibitor medication was discontinued due to risks in pregnancy and replaced with methyldopa. She developed preeclampsia at 35 weeks and was induced, delivering a healthy baby boy via vaginal birth. Her blood pressure returned to normal in the first 24 hours postpartum while continuing methyldopa treatment.

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    PREECLAMPSIA Case Scenario(1)

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    Ms. Alyana Dalisay, a 34-year-old woman with a history of hypertension, presented for her first prenatal visit at 15 weeks gestation. Her ACE inhibitor medication was discontinued due to risks in pregnancy and replaced with methyldopa. She developed preeclampsia at 35 weeks and was induced, delivering a healthy baby boy via vaginal birth. Her blood pressure returned to normal in the first 24 hours postpartum while continuing methyldopa treatment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    126 views2 pages

    PREECLAMPSIA Case Scenario

    Uploaded by

    sabao kizuite
    Ms. Alyana Dalisay, a 34-year-old woman with a history of hypertension, presented for her first prenatal visit at 15 weeks gestation. Her ACE inhibitor medication was discontinued due to risks in pregnancy and replaced with methyldopa. She developed preeclampsia at 35 weeks and was induced, delivering a healthy baby boy via vaginal birth. Her blood pressure returned to normal in the first 24 hours postpartum while continuing methyldopa treatment.

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    PREECLAMPSIA

    *Case Notes:

    Ms. Alyana Dalisay, is a 34 y/o, G2 P1001 with a history of previous normal


    spontaneous vaginal delivery 10 years ago. By last menstrual period, the
    patient’s pregnancy is approximately 15 weeks. This is Ms. Dalisay’s first
    prenatal visit; she states that that she knew she was pregnant but did not
    present earlier for care because she had lost her health insurance and wasn’t
    sure when she could go. On review of the patient’s history, she reports a 5-
    year history of hypertension and denies any other medical problems. She
    reports taking lisinopril (an ACE inhibitor) for her hypertension since her initial
    diagnosis. She also says that she has been taking prenatal vitamins since
    taking an at-home pregnancy test.

    On physical examination, she is an obese (BMI of 35) woman who appears to


    be in no distress. Her blood pressure is 140/80 mm Hg, her pulse if 85 bpm,
    and she is afebrile. Her cardiac examination reveals a grade III/VI systolic
    murmur heard best in the left sternal border. Her lungs are clear. She has mild
    pedal edema. Her uterus is 15 weeks in size, and fetal heart tones are
    auscultated with a Doppler at 155 bpm.

    At Ms. Dalisay’s first prenatal visit, her OB-GYN, Dra. Dalubhasa S.


    Pagpapaanak discontinued her current anti-hypertensive medication. As a
    nurse, you explain to Ms. Dalisay that ACE inhibitors are contraindicated
    during pregnancy because they have been associated with neonatal
    hypotension, fetal growth retardation, oligohydramnios, neonatal anuria, renal
    failure, and neonatal death. Dr. Pagpapaanak replaced her medication with
    methyldopa because, as she explained to her, continued BP control during
    pregnancy is very important. You assured her that methyldopa has been
    extensively used in pregnancy and appears to be safe for both her and her
    fetus. In addition, the following prenatal labs were ordered by the doctor,
    namely, CBC, HepBsAg, rubella, gonorrhea/chlamydia, and HIV status as well
    as chemistry panel and 24-hour urine collection.

    As a nurse, you made a diet regimen for Ms. Dalisay and you told her to limit
    foods with added sugars and those that are high in fat and to eat a variety of
    fruits, grains, vegetables, low-fat or fat-free dairy, and proteins, avoiding such
    sources of mercury as shark, swordfish, mackerel, and tilefish, and limiting the
    consumption of another source, tuna, to less than six ounces per week.

    Ms. Dalisay continued her prenatal visits with Dr. Dalubhasa S. Pagpapaanak.
    Her fundal height growth is appropriate and her BP control remains adequate
    on her methyldopa. Her 24-hour urine protein excretion is 147 mg/24 hours,
    and her second trimester serum screen predicts a low risk for fetal Down
    syndrome and trisomy 18. A fetal anatomy survey performed at 20 weeks is
    normal. At her 22-week visit, you notice that her BP has dropped significantly.
    Currently, it is 110/72 mm Hg.
    At the 22-week visit, Ms. Dalisay is taking 250 mg of methyldopa twice daily.
    Given that this is a minimal dose, you elect not to change her medication at
    this time. At 26 weeks fundal growth is appropriate and the fetus is active.
    Ms.Dalisay is working as an office employee and reports that her employer is
    requesting an estimate of the frequency of her prenatal visits, so that they can
    plan her duties.

    Ms. Dalisay continues her care and initiates weekly NST and AFI at 34 weeks
    of gestation. At 35 weeks and three days' gestation, Ms. Dalisay developed a
    persistent headache. Although she knew this was a warning sign of
    preeclampsia, she believes she was in denial. She wanted to hold onto her
    pregnancy as long as possible and thought she could put off telling the
    maternal-fetal medicine specialist until her appointment two days later. At her
    39-week visit, her BP is elevated (155/96 mm HG) and she has 2+ proteinuria.
    She also complains of a headache that is not relieved with acetaminophen
    (Tylenol). Dra. Pagpapaanak send her to labor and delivery for further
    evaluation. Her BPs continue to remain elevated while in triage. A diagnosis
    is made of new-onset superimposed preeclampsia, and the decision is made
    to induce her labor. As she is having uterine contractions every 5 to 8 minutes,
    the decision is made to proceed with oxytocin induction, and there, IV line was
    initiated and started to infuse 1 liter of Lactated Ringer’s solution at 10-11
    gtts/min with a side drip of magnesium sulfate (loading dose: 4g IV infused
    over a period of 20 minutes, followed by a maintenance dose of 2g IV per
    hour) for seizure prophylaxis. After 14 hours of induction (6 hours of active
    labor), Ms. Dalisay delivers a 3,150 g male infant with APGAR scores of 8 and
    9 at one and five minutes. Her elevated blood pressure resolves in the first 24
    hours postpartum on her usual dose of methyldopa. She and the infant are
    discharged on the second day after delivery.

    Given the case scenario above, construct the following:

    1. Charting (SOAPIE)
    2. Case Analysis (with at least 3 NCPs)
    3. Patient Education Form

    Prepared by:

    Anne Myrtle M. Lorenzo, RN, MAN


    Clinical Instructor

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