CASE STUDY CASE STUDY IIII

A 17y/o G1P0 woman, at 36 wks gestation comes to your office c/o HA and epigastric pain. On assessment, the nurse finds that she has gained 8 lbs in the past month.1. What is the significance (if any) of her presentation?2. What other assessments should you make at this time?3. What is the required treatment for this client?

VS: BP:159/60, P-88, R-VS: BP:159/60, P-88, R-18, T-afebrile18, T-afebrile

What is your What is your differential differential

dx?dx?

Renal failureRenal failure PreeclampsiaPreeclampsia pheochromocytomapheochromocytoma

UA= +3 proteinUA= +3 protein Pt denies N/V, blurred vision, Pt denies N/V, blurred vision,

contractions, leaking, bleeding. contractions, leaking, bleeding. +FM. Pt states she has routine +FM. Pt states she has routine prenatal care since 8wks with no prenatal care since 8wks with no complications during this complications during this pregnancy. pregnancy.

What do you do What do you do next?next?

Transfer to L&D to R/O diagnosisTransfer to L&D to R/O diagnosis Repeat BP, UARepeat BP, UA IVF and labsIVF and labs Perform sonogramPerform sonogram Place her on external fetal Place her on external fetal

monitoringmonitoring

Repeat BP after 6hrs from office Repeat BP after 6hrs from office BP 150/90. UA- +3proteinBP 150/90. UA- +3protein

Sonogram: AFI-13cm, BBP-8, Sonogram: AFI-13cm, BBP-8, +FM+FM

Tracing: no contractions, FHR-Tracing: no contractions, FHR-120’s reactive tracing. 120’s reactive tracing.

VE: closed/80/-2VE: closed/80/-2

Lab:Lab: Cbc- HG/Hct: 7/27, plt: 90,000 no Cbc- HG/Hct: 7/27, plt: 90,000 no

WBCWBC BMP: 140/3/101/24/30/1.2BMP: 140/3/101/24/30/1.2 LFT: AST: 299 ALT: 385 Bili: normalLFT: AST: 299 ALT: 385 Bili: normal LDH: elevatedLDH: elevated Uric acid 8Uric acid 8 UA: +3 protein no other abnlUA: +3 protein no other abnl Fibrinogen: 180Fibrinogen: 180

What is the What is the patient’s patient’s

treatment?treatment?

TreatmentTreatment Pt is admitted to L&D for inductionPt is admitted to L&D for induction Pt is observed very carefully and start Pt is observed very carefully and start

pitocinpitocin MgSo4 placedMgSo4 placed Rpt labs Q4Rpt labs Q4 IF failed induction or labs/symtoms IF failed induction or labs/symtoms

worsen proceed with C/Sworsen proceed with C/S PostpartumPostpartum

Repeat labs daily until normalRepeat labs daily until normal Rhogam within 48-72hrsRhogam within 48-72hrs Rubella vaccineRubella vaccine Continue MgSo4 for 24hrsContinue MgSo4 for 24hrs