O.B LAb
mscott
Joan18yearoldpt3.pptx
Joan
Prelab
What are some signs/symptoms of preeclampsia?
What are some common treatments that are done for preeclampsia?
What are some side effects of magnesium sulfate?
https://www.youtube.com/watch?v=yta5RRJ-Mg8
Background
Joan Jett is an 18-year-old G1P0 and presents at the antepartum unit after her clinic visit today with a blood pressure 162/93. She has had no prenatal care at this point and is at 36 weeks gestation.
Click on the 5 assessment findings which look like “::” on the patient. When you have finished, continue to the next slide.
Based on the information provided, where should Joan go next?
Please click the hyperlink with your answer
Admitted to the High Risk Antepartum Unit
Sent home with antihypertensive meds
Patient presentation upon admission
Joan was sent to the hospital antepartum unit from her clinic visit today as her blood pressure was elevated. In the clinic, Joan remained asymptomatic. She has now arrived to your floor on the high risk antepartum unit. The admitting nurse has already given her labetolol 10 mg, but her blood pressure continues to rise. She is now becoming lightheaded and has a headache, and said that the whiteboard in her room is becoming blurry. You call the doctor and anticipate that he will order which medication?
Patient Concerns- how would you respond?
Joan is anxious because she is unsure of what is going to happen next. She is supposed to attend prom next weekend and is questioning as to whether or not she will be able to attend. How would you respond to her as her nurse?
I know that this is a scary time. We are doing everything we can to keep you and your baby healthy.
Now is not the time to be worrying about a school dance.
You will absolutely be able to attend your prom next weekend!
Education
Joan is expressing that she is concerned about what will happen to her and her baby. She wants to know whether she can attend her prom next weekend. Answer her concerns on your assignment sheet.
Vital Signs
It has been 30 minutes since labetalol was given.
BP 148/94, HR 100 R 18 T 97.9 O2 98% RA
Reflexes - return to patient
You see responses like this patient’s leg that is assessed first.
Urinalysis - return to patient
Assessment findings show 2+ protein in her urine.
Pain -
The patient states that her head really hurts, and the pain is a 7 out of 10.
Non-stress test - return to patient
Correct! Joan will be admitted to the high risk antepartum unit for further monitoring and testing!
Continue to patient presentation
Correct! You should reassure Joan that staff are doing everything they can to keep her and her baby healthy and safe
New order from MD-
The MD placed an order for Magnesium Sulfate 4 gm IV bolus to help lower her blood pressure, to prevent her from having a seizure from her elevated blood pressure, and to help prevent premature labor. You administer this medication once it is received.
What are the necessary supplies to keep in her room?
Oxygen
Fetal Heart Monitor
Suction
Tongue blade
Blood pressure cuff
Pulse oximetry
Continue to next slide for the answer
All of the mentioned supplies should be kept in Joan’s room as her vital signs will need to be consistently monitored and she is currently on seizure precautions due to her elevated blood pressure.
Click the hyperlink above
You answer the call light...
(It has now been a few hours since Joan received the Magnesium Sulfate)
Joan put her call light on to let you know that her vision is back to normal, but she is now feeling overly fatigued. You check her vital signs and see: HR 80, RR 9, oxygen: 93%, and BP 96/70. You assess several deep tendon reflexes and notice that they are absent.
What would you suspect is happening? What would you do next?
Continue to next slide
Magnesium Toxicity
You look in her chart and see that the MD also ordered Calcium Gluconate 10% IV push, 10 mL over 3 minutes as needed for magnesium toxicity. Joan’s breathing returns to normal and she reports feeling less “foggy”.
Continue to next slide
Reassessment
Before your shift ends, you reassess Joan and her vital signs. BP has lowered to 135/83, HR is now 87, RR is 16, T is 98.0, O2 is 98% on room air. Fetal heart rate is stable at 150 with no contractions present. Joan appears to be alert and is able to answer your questions. She denied no headache, blurred vision, or other signs of distress. She ate 75% of lunch and has had several glasses of water throughout the shift. Joan stated that she isn’t as concerned about prom anymore and that she is solely focused on her and her baby.
One Week Later
The Joan and her healthcare team decide to induce her today because her blood pressure is not well controlled even with magnesium.
Joan states that she is nervous about how she is going to manage the pain.
Educate Joan on her pain management options reference the link below
https://evidencebasedbirth.com/category-pain-management-series/
You are coming on to your night shift at 2300. This is your report on Joan:
The patient is being induced because of uncontrolled pre-eclampsia. She has been on magnesium since she was admitted for bedrest one week ago. She received Cytotec vaginally in the evening and started to become crampy, but her contractions are not regular, and so she slept all night.
The next morning at 0800 the nurse starts the patient on Pitocin and slowly increases it until she is having contractions every 5 minutes. She was at 2 cm at 0800.
When the evening nurse checked the patient at the beginning of the shift, she was only dilated to 4 cm so the RN talked with the provider and turned up the Pitocin. The contractions increased frequency to every 4 minutes apart and lasted 1 minute. The RN checked the patient at 2130 and found that she was 5 cm so the Pitocin was turned up again. FHR has been normal throughout the induction. Mother’s BPs have been in the 130/90 on magnesium. Joan has been coping with the pain with non-pharmacological techniques up to this point.
When you go to assess Joan, she states that the pain is too great, and she wants a pump of remifentanil.
20 minutes After the pump started
Joan says she is more comfortable, but she feels drowsy.
Complete your assessments by clicking on the 4 “::”
Complete your priority nursing intervention based on your assessment and record on your assignment sheet.
Click to the next slide when complete
Call the provider
Give the provider an update on the patient’s condition.
Vital Signs – return to patient
RR: 10
Heart Rate: 78
Blood pressure: 110/70
Oxygen saturation: 92%
Reflexes - return to patient
Reflexes are +2 and symmetrical. No clonus noted.
Fetal Heart Rate
Congrats! You are finished!
Complete all the questions on the assignment sheet and turn it into the assignment box.
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