This week, you will explore the FNP\’s role in family-centered maternal health. Readings for this week include Chapters 19 – 22 in your Schadewald textbook.
Due this week:
Episodic Case Write-Up
Assignment
Episodic Case Write-Up
Utilizing a patient you have seen in the clinic, complete an episodic case write-up. You will also be graded on the ability to select an appropriate patient encounter or visit in completing this assignment.
Please make sure to consult the attached rubric prior to starting.
Episodic Case Write Up
Name
Institution
Date
Episodic Case Write up
Chief Complaint
The patient a 40-year old African-American presents to the clinic complaining of severe, persistent headaches and blurred vision.
Pertinent History
The patient has had a history of chronic hypertension for the last 5 years. The patient’s mother is alive but suffers from hypothyroidism and hypertension.
Review of Systems:
GENERAL: Weight gain, has severe headaches, fatigue, and general body weakness
HEENT: Blurred vision, no hearing loss, no sneezing, nasal congestion, runny nose, or sore throat
SKIN: No itching or rash
CARDIOVASCULAR: Has chest pressure, chest pain, and chest discomfort. Has palpations
RESPIRATORY: Dyspnea
GASTROINTESTINAL: No anorexia, has nausea. No vomiting. Has right upper abdominal pain.
GENITOURINARY: No burning on urination. No significant changes in bladder or bowel control
NEUROLOGICAL: Severe headaches and dizziness. No syncope, paralysis, numbness, or tingling.
MUSCULOSKELETAL: No muscle pain, back pain, joint pain, or stiffness.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating or cold or heat intolerance. No polyuria or polydipsia.
REPRODUCTIVE: Pregnant. No reports of vaginal discharge. Sexually active.
ALLERGIES: No history of asthma, hives, eczema, or rhinitis.
Physical Examination
Vitals: BP 140/90, P 66, Weight 174, Height 5’6′
Neurological: Dizziness and severe headaches (Peres et al., 2018).
HEENT: Blurred vision
Cardiovascular: Palpations, chest pressure
Diagnosis
The primary diagnosis for the patient is based on her clinical manifestation and history of preeclampsia. Preeclampsia is a condition in pregnancy that is characterized by hypertension as well as proteinuria. Hypertension of above 160/110 mm Hg shows severity of the condition and could expose the patient to stroke, seizure, liver abnormalities and pulmonary edema. The condition can however occur in the absence of proteinuria. According to Stevens et al. (2017), preeclampsia is among the top six leading causes of maternal deaths, adverse neonatal outcomes as well as maternal morbidity. The rising trends in the condition are linked to high rates of obesity among women in the US and delayed pregnancies. The signs and symptoms of the mother include persistent and severe headaches, blurred vision, pain in the right abdomen, shortness of breath (Schadewald et al., n.d). Fetal signs and symptoms include slowed growth, a decreased amount of amniotic fluid, and decreased blood flow through the placenta.
Interventions
The recommended laboratory tests for a patient presenting with similar signs and symptoms include a Complete Blood Count test, a test on serum alanine aminotransferase, and aspartate aminotransferase (AST) levels, serum creatinine tests, uric acid test as well as a urine dipstick analysis. Test results indicating a progressive renal insufficiency of a serum creatinine concentration of > 1.1 mg/DI, platelet count of <100, 000/Ul, and liver transaminase levels of twice normal concentrations would be an indication of preeclampsia.
Some of the non-pharmacological interventions that can be recommended include rest which may take different forms like sitting down or having continuous bed rest either at home or hospital for mother and fetal surveillance. A pharmacological agent recommended as a first-line treatment for the management of preeclampsia is Nifedipine per os in slow-release forms. The medication should be administered in the dosage of between 30 and 60 mg once a day during breakfast and a maximum of 120 mg/day. Second-line treatments are Methyldopa per os, 250-500 mg, 2-3 times per day, and a maximum of 2-3 g/day. The other second-line treatment is Atenolol per os, 50-100 mg/day (Peres et al., 2018).
Besides the antihypertensive medications, corticotherapy is recommended for women whose pregnancy is between 24 and 36 weeks of gestation with a probable delivery within the next seven days. The therapy lowers respiratory discomfort and improves fetal outcomes. The most common used corticosteroids are intravenous Betamethasone 12 g IM, 2 doses with a 24 h interval and intravenous Dexamethasone, 10 mg IV, and 2 doses with a 24 h interval.
Client education should be done especially to sensitize patients about the disease manifestation, risk factors, and preventive and management strategies. With adequate information at hand, the patients are likely to make healthy lifestyle choices alleviating their danger to disease and complications.
References
Peres, G. M., Mariana, M., & Cairrão, E. (2018). Pre-Eclampsia and Eclampsia: An Update on the Pharmacological Treatment Applied in Portugal. Journal of cardiovascular development and disease, 5(1), 3.
Schadewald, D. M., Pritham, U. A., Youngkin, E. Q., Davis, M. S., & Juve, C. (5th ed.). Women’s health: A primary care clinical guide
Stevens, W., Shih, T., Incerti, D., Ton, T. G., Lee, H. C., Peneva, D., … & Jena, A. B. (2017). Short-term costs of preeclampsia to the United States health care system. American journal of obstetrics and gynecology, 217(3), 237-248.