need help with case study

[sonja77]

Hi everybody,

I'm an LVN student and will graduate in May. I'm on my 2-week OB/GYN rotation right now and have to do a case study. I'm almost done, but I'm not sure about the last question.

Here's the case:

At 36 weeks, Amy is admitted to the L&D unit with severe preeclampsia. Her protein is 4+, BP 160/110, edema is 3+ as well as in the hands and feet, urine putput is 550 ml in the past 24 hours, and fetal heart rate is steady at 140 beats/min. Amy also has gestational diabetes and in the past she had 2 spontaneous abortions and one stillborn baby at 35 weeks.

Question:

What is the immediate medical action the physician would order for Amy?

What I have so far:

• the physician would order Magnesium sulfate to prevent seizures
  
• carefully monitor the Magnesium serum level because of Amy's reduced urine output; have Calcium gluconate on hand for possible toxic levels (>8 mg/dl) of magnesium
  
• Amy would receive antihypertensive drugs because her blood pressure is dangerously high; severe hypertension can cause maternal intracranial bleeding, abruption placentae or placental infarcts
  
• Amy should remain on bed rest on her left side, to promote maximum fetal oxygenation

Here's my question:

Would the physician induce Amy with oxytocin? Or would he just monitor Amy and wait until the fetus shows signs of distress (heart rate out of the normal range)?

Thanks!

[rpbear]

I think that they would induce labor. At 36 weeks the baby will do well. The risks of letting the pregnancy continue are too great. The only cure for PIH is delivery. If the induction doesn't seem like it is going fast enough they may even do a c-section.

This is just my oppinion based on what I have seen done in similar cases, it will be up to the MD as to what is done, but delivery is the only way to make her better. I have seen very preterm baby's delivered because the mom is so sick that it becomes life threatening.

[SmilingBluEyes]

we would induce barring any other reasons NOT to.

[tdr61]

One thing that we would do is order lab work to evaluate how the patients liver is holding up. Those would include a liver panel, platelet count, fibrinigen, clotting studies, and uric acid. If the FHR tracing was reassuring, we would induce...iff the FHR is not reactive and doesn't get reactive most of the MD's I work with would do a c-section if the patients labs were not seriously out of whack.

Ten

[daisybaby, LPN]

In addition to the above mentioned labs, the pt would also go to US for a biophysical profile. And we would most likely induce.

[sonja77]

Thanks for all the input!

I'll make sure to put it all in the case study!

[ragingmomster, BSN, MSN, RN]

Just my two cents,

We would start with 24 hours of Mag before pitting, and use a Cervidil throughout the first 24 hours of Mag if her cervix was not favorable to begin with.

Also a 24 hour urine for Calcium, Creatinine and Uric acid.

Don't forget the basics, SIDE RAIL PADS!!!

[SmilingBluEyes]

Great suggestions/information from everyone. THANKS. And good luck on your project!

[NurseNora, BSN, RN]

The doc might do an amniocentesis for fetal lung maturity. If not mature, see if bedrest, drugs, etc improve the picture so delivery can be postponed until they are mature.

And yes, labs to see if pt is developing HELLP syndrome. BPP for fetal well being. Remember to limit visitors and keep the environment as dim and quiet as possible to reduce stimulation to decrease risk of seizures. Although severe preeclamptics are usually hypovolemic, sometimes Lasix is indicated anyway.