Also, if she has a history of miscarriage, high blood pressure (may or may not be an isolated incident) and complaints of dizziness (the reason for her fall) did you ask about vision disturbances? Did she have any prenatal records in her chart where you could trend her blood pressure from prenatal visits? I'd be wondering about pre-eclampsia/eclampsia.
Edit: Did her blood pressure improve after her anxiety subsided?
no visual disturbances were reported. she did not have any prenatal records- she has not gone to the doctor at all since finding out she was pregnant. i was wondering about blood pressure-- but its not terribly high, -- i was more concerned (later on-- ugh.. i was only with her for 2 hours and could not think about this at all until later) about blood sugar.. since it was early in the morning, she just got up and did not eat anything.. but i looked at her labs and everything was normal, so if they did BS there has nothing wrong there ...
Blood pressure did go down after she calmed down.
A note on, "no visual disturbances were reported..."
While no visual disturbances were reported in the past, that doesn't necessarily mean that she experienced none. It may have been that she was simply never asked about it before or that she didn't think it was a big enough deal to mention. That's where your nursing assessment
comes in. Patients come to us in a variety of states. It isn't uncommon to see a patient who hasn't been to see a doctor in over a decade (especially in the ED). In order to provide appropriate care, we have to develop as clear a snapshot of the patient as we can in the here and now.