e Study #1 ( need help answering for studying and

e Study #1 ( need help answering for studying and 2 current references max) Subjective: Monica Porter is a 42-year-old African Canadian woman, G2 P1, at 35 weeks gestation. During her first pregnancy, Monica was on labetalol for 9 weeks (33 weeks gestation until 3 weeks post-partum). Monica felt fine until two days ago, when she started experiencing a persistent, severe headache with complaints of diplopia. She has tried acetaminophen and coffee, but neither have given her relief. Yesterday she noticed swelling in her hands, feet, and face. Her physician has decided to admit her for observation. Social: Monica lives at home with her 14-month-old son and elderly mother, whom she is the primary care provider. Monica wants to prolong delivery for another two weeks to maximize her income before going on maternity leave. Objective: Chart View: Assessment BP: 168/94 mmHg HR: 80 beats/min RR: 19 breaths/min T: 37.2 oC Weight: 90 kg (198lb) Height: 5 ft. 6 in Edema: hands, feet, face Deep tendon reflexes: +2, no clonus Urine dipstick: +3 proteinuria Based on Monica’s symptoms and the nurse’s assessment data (above), what do you think is happening to Monica? What additional subjective data questions should the nurse ask the patient? What risk factors predispose Monica to this condition? What lab values would be important to obtain and why? After the nurse notified the physician of Monica’s condition, the physician orders magnesium sulfate. The nurse administers magnesium sulfate and walks into Monica’s room to discontinue her IV and reassess her vital signs. Monica’s vital signs are as follows: T 37.1 oC, P 109 beats/min, RR 7 breaths/min, BP 100/60 mm/Hg, 02 94% on room air. Why is magnesium sulfate the drug of choice in this situation? What vital sign data is relevant that must be recognized as clinically significant to the nurse? The physician discontinues the infusion and orders calcium gluconate. One hour after the calcium gluconate is administered the nurse reassesses Monica and obtains a new set of lab values. Chart View: Assessment BP: 189/91 mmHg HR: 90 BPM, 2+; S1, S2, S3 RR: 18 breaths/min; clear entry bilaterally T: 37.2 oC 02 Sat: 97% RA Severe headache RUQ pain, abdomen guarded and tender on palpation in the mid epigastric area Edema: hands, feet, face Urine dipstick: +3 proteinuria Skin intact, no rashes, normal colour Chart View: Laboratory Values Potassium: 4.6 (3.5-5.0 ) mmol/L Sodium: 136 (135-145) mmol/L BUN 8.5 H (2.5-8.0) mmol/L Creatinine 155 H (50-90) µmol/L AST: 70 H (0-35) U/L ALT: 62 H (3-36) U/L Total bilirubin: 29 H (<26) µmol/L WBC 8.7 (3.6-11.0) x 109/L RBC 4.79 (3.70-5.00) x1012/L HBG 60 (115-150) g/L HCT 0.44 (0.345-0.450) L/L MCV 86.0 (80.0-99.0) fL MCH 28.6 (27.0-33.0) pg MCHC 333 (320-360) g/L RDW 13.2 (12.0-15.0) % Platelet Count 90 L (140-400) x109/L MPV 15.5 (9.0-14.0) fL Urine: ++ Proteinuria What assessment data is relevant that must be recognized as clinically significant to the nurse? Based on the clinical symptoms and lab values, what does the nurse suspect is happening to Monica? Please provide rationale based on the lab values. / Based on Monica's suspected condition, what interventions exist for this patient? After considering the trend in Monica's condition and the health of her baby, the care team decides that delivery is the safest choice. Monica delivers a healthy baby via cesarian section and is discharged home after 72-hours. Identify one potential barrier to a successful discharge and one strategy you will teach Monica to ensure successful self-management/treatment adherence prior to discharge? What interdisciplinary team members should be involved in Monica's case to ensure optimal recovery and why (e.g., does your patient require a home assessment [OT])? Identify 2 key local community services or resources that should be coordinated for Monica to ensure optimal recovery. Explain the rationale for your chosen resources.

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