Help me, help me please

NightNurseRN13 · Mar 22, 2014

Prophylactic treatment r/t history of gestational HTN is my guess

klone, MSN, RN · Mar 22, 2014

First, It's not called PIH anymore. It's either gestational hypertension or pre-eclampsia. gHTN is high pressures. Pre-e is all the labs that accompany it. It's old school to treat Pre-e with MGSO4. Now, it's used as maternal of fetal neuroprotection only (maternal, if there is concern about seizures and fetal, to prevent CP if the infant may be born early).

akulahawkRN, ADN, RN, EMT-P · Mar 22, 2014

Why did the patient get Cytotec and Pitocin? What do those agents do, specifically to the uterus?

Now what does Magnesium sulfate do to the uterus?

Why else might a pregnant or recently pregnant female be given Mag sulfate in the setting of PIH? Here's a hint, it's not just for pre-eclampsia...

Because there's not a whole lot of info, I can only guess that it's not because of it's uterine effects that the Mag was given...

rosemary_petals · Mar 22, 2014

The Mag was given after delivery-postpartum. I know it can lower blood pressure, but I'm not sure if it was given to do this or prevent seizure. I was confused as to why it would be given in a patient with gestational HTN. I would have thought they would give something else in the place of mag. I've always learned that it is usually given to just prevent seizure but one of it's side effects is lowering BP, but it is no given to treat bp.

j0yegan · Mar 22, 2014

Patient is receiving mag for hypertension (pre-eclampsia) that could possibly lead to seizures (eclampsia). It is prophylactic.

William2 · Mar 22, 2014

Mag was given to act two ways as i see it: it acts as a sedative therefore reducing bp and increasing seizure threshold as those with pre-ecamplsia are at risk for developing seizures as you know(ecamplsia after it happens).

However the values you state indicate she did not have proteinuria however i question that because this is one lap report. Did you review a history of lab reports to assess whether this problem sort of controlled therefore protein absent? Did you assess the pt for hypertension, and edema, headache, abdominal/epigastric pain?

Low platelets are commonly seen with PIH. Low CBC values could be dilutional or from FVO, or again from the pregnancy process. But again i do not know the patient therefore so this is speculative.

Care plan/s: Whats the pertinent medical dx for this client?

What are your priorities of the day with this client? (includes treatments, meds)

What assesments are you going to make based of these?

What complications could occur and what are interventions that could prevent these?

This is part of the paperwork my school used frequently. Answering these made care planning easier. I.e

PIH

priority:respiratory status- assessment: respiratory rate

kidney function: assessment: output (ml/hr) [mag excreted by kidneys therefore bad kidneys/less perfused kidneys= toxic buildup=respiratory depression/arrhythmias]

Complication: arrythmias, resp depression.

Intervention: monitoring labs, dtrs, output, cardiac output, fetal monitoring- stop infusion if toxic state identified.

Interventions and assessments somewhat mirror each other at times, but the point is this is how i would go about it.

Just tie a couple nursing dx to the above and your good to go. Risk for seizures? Risk for respiratory depression? bleeding tendency r/t disease process AEB lab values. I'm not sure of ob nursing diagnosis because i particularly dislike this field but im sure she is at risk for pronlonged labor or difficulty if she has decreased CBC values. Mimics a activity intolerance type to me.

Then again there is the meds she was on during labor and then any psychosocial considerations. The point here is there are many ways to go with this care plan depending on how many nursing diagnoses you need.

Esme12, ASN, BSN, RN · Mar 22, 2014

I think this will help...http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768605/.

.http://sigo.it/pdf/management_postpartum_hyperten_preeclampsia.pdf

Esme12, ASN, BSN, RN · Mar 22, 2014

duplicate threads merged

jadelpn, LPN, EMT-B · Mar 22, 2014

I am just throwing this out there--Mag given as a seizure precaution, general precaution r/t increased BP.

You have a patient with HTN to begin with. Pitocin increases the demand on the body--even if a patient is receiving pain control, I have seen pitocin increase a patient's BP. Which then lowers a seizure threshold, and increases a whole lot of other complications, including a stroke in the patient. Which is magnified if the patient then is laboring.

So your care plans need to reflect what risks are there--activity intolerance, alteration in health care, and another favorite--spiritual distress r/t IF the patient was set on a natural birth, and no interventions (if applicable), r/o fluid imbalance, r/o alteration in mental status (due to seizure precautions).

There is a great deal of medical stuff going on, but remember, your nursing diagnosis and plan of care may be r/t a medical diagnosis, but it is different than a medical diagnosis. If that makes sense. Some schools will not allow a "r/t medical diagnosis" to be on a care plan. So you need to think outside the box and NOT get caught up in the detailed medical parts for the purpose of nursing care plans. (and of course you need to be quite caught up if you are caring for this patient, this is thoughts that are strictly care plan based).

There are some facilities that require a fall and skin risk care plan for every patient. A discharge care plan is also a good habit to get into. Also, educational care plans.

Good luck, and let us know what you went with. Interesting questions!