Hello we have tried to answer everything on this case

Hello we have tried to answer everything on this case study however we could use help with any aditional information that is lacking and could use some help organizing the material. I would appreciate it. OB Case Study #1 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 1. Based on Monica’s symptoms and the nurse’s assessment data (above), what do you think is happening to Monica? Based on the assessment we have made for Monica we are concerned with the following data. Blood pressure 168/94, Significant Proteinuria 3+, swelling in hands and feet (fluid retention), severe persistent headache, and vision changes (Diplopia). These findings we believe are consistent with Pre-eclampsia and furthur investigation would be needed immediately given the current data and her history. What additional subjective data questions should the nurse ask the patient? Did you have any complications during your first pregnancy? -Have you noticed any changes in fetal movement? -Have you had any recent nausea or vomiting? -Have you had any other vision changes aside from diplopia such as blurry vision or seeing spots? -Have you noticed any changes in your urine, are you going more or less than usual? – Have you had any epigastric pain? – Have you had any shortness of breath ? Are you exercising? What is your activity level? How long have you been having headaches for? Are you taking any medications prescribed or over the counter ? Do you have a history of diabetes? When lying flat do you have any pain under your left or right ribs? What risk factors predispose Monica to this condition? -Older age Monica is 42 years olds old putting her at greater risk. -Previous use of Labetalol for 9 weeks in her history during her first pregnancy could suggest a history of hypertension and preeclampsia -Race: Monica is African Canadian which puts her at increased risk for preeclampsia. -Multiple gestation /2 marks 2. What lab values would be important to obtain and why? Close Blood pressure monitoring: Very crucial to monitor blood pressure while not a lab value consistently elevated blood pressure 140/90 can give insight into a patient developing preeclampsia and to investigate further Complete blood count (CBC) HELLP- Hemolysis (indicated by elevated bilirubin and decreased hgb) Liver enzymes (elevated ALT and AST indicate liver damage or dysfunction seen severe preeclampsia) Platelet count: thrombocytopenia can indicate severe preeclampsia and lead to increased bleeding PT, PTT, INR: with thrombocytopenia can suggest other coagulation disorders Renal Function Tests BUN, Creatinine: Elevated levels can indicate impaired kidney function. Uric Acid: Elevated levels can be associated with Preeclampsia however is not diagnostic on its own. LDH (Lactate Dehydrogenase)- Increased levels can indicate hemolysis which is a component of preeclampsia. 24 urine collection- assess for proteinuria Fetal Ultrasound- To assess fetal growth and amniotic fluid levels. Possible CT HEAD??? /2 marks GOOD SOURCE IF YOU ALL WANNA HAVE A LOOK https://www.ontariofetalcentre.ca/conditions/placenta/pre-eclampsia/ 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? This client showed clinical manifestations preeclampsia therefore, magnesium sulfate is the drug of choice for the prevention of seizures. The client’s respiratory rate is clinically significant as it may be associated with pulmonary edema which reduces gaseous exchange and tissue perfusion. Additionally, /2 marks 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) ??mol/L AST: 70 H (0-35) U/L ALT: 62 H (3-36) U/L HELP syndrome Total bilirubin: 29 H (<26) ??mol/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 ( HGB IS A RED FLAG) 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 (RED FLAG) 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. HELP syndrome: ? usually occurs with preeclampsia ; high blood pressure, elevated liver enzymes, low platelet count , hemolysis . Common to have abdominal pain on the right upper side. -Placenta abruption (concealed) ? Assessment data that is relevant include: decrease in hemoglobin and platelets related to blood loss Abdomenal pain and tenderness related to internal bleeding /3 marks Based on Monica's suspected condition, what interventions exist for this patient? Hellp syndrome interventions: -Bed rest - Medication to lower your blood pressure. - Blood transfusion to treat low platelet levels. - Corticosteroids to help the lungs of the fetus develop. -Blood tests to monitor liver function and platelet count. Placenta abruption interventions: - Monitor for hemorrhage to prevent hypovolemic shock -Monitor changes in vitals -monitor for light headedness, rapid heartbeat and low blood pressure - Monitor oxygen and skin colour - monitor for anxiety and changes of LOC - Monitor I &O - Monitor for vaginal bleeding - Position on left side laying position (prevents pressure on vena cava) - Monitor for signs of DIC :bruising or bleeding from IV site , mouth, nose, - Monitor FHR - Administer blood products as ordered -Administer oxygen as ordered - Administer fluid volume replacement as ordered /1 mark 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? Suspect infection? Hemorrhage? Wound dehiscence? Bowel obstruction? Lack of support at home? Uncontrolled BP?..... teach S&S of infection (red,swollen,warm etc)... high fiber diet to avoid straining while pooping... /2 marks 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])? We believe that Monica would benefit most from the following supports to ensure optimal recovery. 1.Obstetrician/Gynecologist (OB/GYN) (JOSH-let me know what you guys think) To follow up on Monica's postpartum recovery and manage any complications from preeclampsia, and provide guidance on postpartum care. Reason: We believe that this will ensure Monica's health is stable, and any effects of preeclampsia are addressed. Optimizing postpartum care. ACOG. (n.d.). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care /1 mark 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. Home care supports (wound care, psw) Lactation consultant Pharmacy

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."