The nurse is continuing to care for the client.
Nurses’ Notes.
Day 1, 0900:. Day 1, 0930:. Client is at 31 weeks of gestation and presents with a severe.
headache unrelieved by acetaminophen.
Client also reports.
urinary frequency and decreased fetal movement.
Client is a G3. P2 with one preterm birth.
Client reports a constant and throbbing headache and rates it. as a 6 on a scale of 0 to 10. Denies visual disturbances.
+3. pitting edema in bilateral lower extremities.
Patellar reflex 4+. without the presence of clonus.
Client reports occasional.
nighttime leg cramps.
Reports three fetal movements within the.
last 30 min.
External fetal monitor applied with a baseline FHR.
140/min with occasional accelerations and moderate variability.
No uterine contractions noted.
Vital Signs.
Day 1, 0900:. Temperature (oral) 36.9° C (98.4° ). Heart rate 72/min.
Respiratory rate 16/min.
BP 162/112 mm Hg. Oxygen saturation 979% on room air.
Day 1, 0930:. Temperature (oral) 37.1° C (98.8° ). Heart rate 84/min.
Respiratory rate 18/min.
BP 166/110 mm Hg. Oxygen saturation 999% on room air.
Color yelow yelow). pH 5.9 (4.6 to 8). Protein 3+ (negative). Specific gravity 1.013 (1.005 to 1.03). Leukocyte esterase negative (negative). Nitrites negative (negative). Ketones negative (negative). Crystals negative (negative). Casts negative (negative). Glucose trace (negative). WBC 5 (0 to 4). WBC casts none (none). RBC 1 (less than or equal to 2). RBC casts none (none). Day 1, 1030:. CBC:. Hemoglobin 18.0 g/dL (12 to 16 g/dL). Hematocrit 35% (37 to 479%). Platelets 98,000/mm³ (150,000 to 400,000/mm³). BUN 19 mg/dL (10 to 20 mg/dL). Creatinine 0.8 mg/dL (0.5 to 1 mg/d). WBC 8,000/mm³ (5,000 to 10,000/mm³). Glucose 85 mg/dL (74 to 106 mg/dL). Liver Enzymes:. Alanine aminotransferase (ALT) 40 units/L (4 to 36 units/L). Aspartate aminotransferase (AST) 42 units/L (0 to 35 units/L). Total bilirubin 1.2 mg/dL (0.3 to 1 mg/dL). The nurse is reviewing the assessment findings.
For each assessment finding, click to specify if the finding is consistent with.
preeclampsia or HELLP syndrome.
Each finding may support more than one.
disease process.
A.
Platelet count
B.
Hemoglobin
C.
Alanine aminotransferase (ALT)
D.
Blood pressure
The correct answer and Explanation is :
Based on the provided assessment findings, we can evaluate whether they are consistent with preeclampsia or HELLP syndrome:
A. Platelet Count
Finding: 98,000/mm³
Condition: HELLP Syndrome
Explanation: A platelet count below 100,000/mm³ is a critical indicator of HELLP syndrome, which is characterized by hemolysis, elevated liver enzymes, and low platelet count. In preeclampsia, thrombocytopenia is also observed but is more pronounced in HELLP syndrome.
B. Hemoglobin
Finding: 18.0 g/dL
Condition: Preeclampsia and HELLP Syndrome
Explanation: Elevated hemoglobin levels can indicate hemoconcentration due to dehydration or plasma volume contraction, often seen in preeclampsia. In HELLP syndrome, hemolysis can also lead to increased hemoglobin but is typically accompanied by a drop in platelet counts and elevated liver enzymes.
C. Alanine Aminotransferase (ALT)
Finding: 40 units/L
Condition: HELLP Syndrome
Explanation: Elevated ALT levels indicate liver involvement and are consistent with HELLP syndrome. While liver enzymes can be elevated in severe preeclampsia, the significant elevation seen in HELLP (usually more than double the normal range) is more pronounced and indicative of liver dysfunction.
D. Blood Pressure
Finding: 162/112 mm Hg
Condition: Preeclampsia
Explanation: Elevated blood pressure (≥140/90 mm Hg) is a defining criterion for preeclampsia. While it can also occur in HELLP syndrome, high blood pressure is a hallmark of preeclampsia and is used for its diagnosis.
Summary
In this case, the low platelet count and elevated liver enzymes point more towards HELLP syndrome, while the elevated blood pressure is indicative of preeclampsia. The elevated hemoglobin can relate to both conditions, making it essential for the nurse to monitor these findings closely to guide treatment and management strategies effectively.