A 38-year-old female is 36 weeks pregnant and arrives to labor and delivery for a headache that won’t go away with acetaminophen. The nurse gets the patient’s vitals.
With preeclampsia there can be vision changes, sudden edema (especially in the hands and face), sudden weight gain from fluid retention, and epigastric pain.
The nurse notes that the patient’s blood pressure is 156/98 mm hg and asks the patient “have you had any blurred vision, floaters or changes to that? Any sudden swelling, sudden weight gain? ”
The patient responds, “yes, I keep seeing floaters and have even thrown up from it. I do have some swelling and my upper abdomen has really been hurting. My head is really hurting.” The nurse goes to call the doctor. Nurse to Dr. “Hey Dr. Smith your patient, Maria Evans is here with some symptoms of preeclampsia. She has a BP of 156/98 mm hg, epigastric pain, bad headache, and some vision changes.
IV fluids- We do not want to add fluid volume at this time. This puts more pressure on to the heart and this patient is overloaded with fluid at this time.
The nurse tells Maria to give a urine sample and when Maria returns from the bathroom she gets in the bed and begins to seize.
[faq lesson="true" question="What does the nurse need to do?"]
Call for help- the nurse needs to call and get help in the room.
lower the bed for patient safety
The nurse calls for help and nurses enter the room. They call the patient’s name, get fetal heart tones, apply oxygen, protect the patient. A nurse calls the doctor again and explains the patient is having seizure.
Magnesium sulfate- this is the drug of choice to prevent seizures and as a side effect it will also lower the blood pressure
Lebetolol- this is the drug of choice to treat high blood pressure
Debrief: This patient came in with symptoms of preeclampsia. Preeclampsia is elevated blood pressure about 140/90 (more than once), vision changes, edema, and epigastric pain. Preeclampsia always has protein in the urine, which was in the process of being checked. Eclampsia occurred when the seizure started. Magnesium sulfate is given to stop and prevent seizures. A side effect is lower BP. Labetalol is given to lower the blood pressure.
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.
Miriam Wahrman, MSN/Ed, RNC-MNN 
Chance Reaves, MSN-Ed, RN 