A gravida two, para-one 34-year-old woman presents to the office for prenatal care at 28 weeks of gestation. During her visit, her blood pressure is measured at 160/90, and her weight is recorded as 220 lbs, with a height of 5’1. Four weeks ago, her blood pressure was 122/78, and her weight was 210 lbs. Additionally, she reports a history of gestational diabetes, and her fasting glucose is 108 with an A1C of 6.0.
In this scenario, the practical nurse would need to perform focused assessments to gather additional information and determine the appropriate course of action. These assessments should be based on the given information and the potential complications associated with the patient’s condition.
Firstly, the elevated blood pressure reading of 160/90 is a cause for concern. Hypertension in pregnancy could indicate the development of preeclampsia, a potentially severe condition. The nurse should conduct further assessments to evaluate the patient’s symptoms and identify any signs of preeclampsia, such as severe headache, blurred vision, swelling, or abdominal pain. It would be important for the practical nurse to perform a thorough assessment of the patient’s blood pressure at regular intervals and monitor for any further increase or persistent elevation.
Furthermore, the practical nurse should assess the patient’s blood glucose levels and consider the implications of the fasting glucose reading of 108 and A1C of 6.0. These findings suggest that the patient may have gestational diabetes mellitus (GDM). The nurse should inquire about the patient’s dietary habits, perform a thorough blood glucose monitoring, and assess for any signs or symptoms of uncontrolled hyperglycemia, such as excessive thirst, frequent urination, or fatigue. Additional testing, such as a glucose tolerance test, may be considered to confirm the diagnosis of GDM.
The assessment findings, especially the elevated blood pressure and glucose levels, should be reported to the healthcare team promptly. A significant increase in blood pressure could indicate the development or worsening of preeclampsia and may require immediate medical intervention. Similarly, elevated blood glucose levels in a pregnant woman with a history of gestational diabetes necessitate careful monitoring and potential adjustments to the patient’s management plan. Therefore, the practical nurse should communicate these findings to the healthcare team urgently to ensure prompt evaluation and appropriate management.
Preeclampsia is characterized by the development of high blood pressure and organ dysfunction in pregnancy, typically after 20 weeks of gestation. Common findings of preeclampsia include proteinuria (excess protein in the urine), edema (swelling), and signs of organ damage, such as abnormal liver function tests or low platelet count. Nursing care for preeclampsia focuses on monitoring the patient’s blood pressure, urine output, fetal well-being, and managing any associated complications. Management may involve antihypertensive medications, bed rest, and sometimes early delivery of the baby.
Gestational diabetes mellitus (GDM) is diabetes that develops during pregnancy and typically resolves after delivery. Management of GDM involves close monitoring of blood glucose levels, dietary modifications, and, when necessary, insulin therapy. Common findings of GDM include an elevated fasting blood glucose level, excessive weight gain during pregnancy, and an increased risk of complications such as macrosomia (large birth weight) for the baby and a higher risk of developing type 2 diabetes later in life for the mother. The nurse should educate the patient on appropriate dietary choices, regular exercise, and self-monitoring of blood glucose levels.
In conclusion, based on the case scenario provided, the practical nurse should perform focused assessments related to the patient’s blood pressure and glucose levels. These assessments should include further evaluation for preeclampsia and gestational diabetes. The nurse should communicate the findings promptly to the healthcare team to ensure appropriate evaluation and management. Additionally, the nurse should be familiar with the common findings and nursing care for preeclampsia and gestational diabetes mellitus.