Preeclampsia-Eclampsia
RAPID Reasoning
Dana Myers, 40 years old
RAPID Reasoning Case Study: Lee Arthur
Preeclampsia-Eclampsia
History of Present Problem:
Dana Myers is a 40-year-old woman, G-3 P-2 who is 34 weeks gestation. Her health care provider has been monitoring
her weekly because her blood pressure has been increasing the past month and is currently 146/88. Last week she had 1+
non-pitting edema of both lower extremities (BLE) and her urine was negative for protein. Today during her clinic visit,
Dana’s BP was 168/90. She had 2+ proteinuria and 3+ pitting edema BLE. She also complained of a mild headache in
the center of her forehead, and seeing “spots.” Fetal heart tones via Doppler are 136/minute in the lower left quadrant.
Abdominal measurement from pubic bone to top of fundus is 31 cm.
The primary care provider was concerned and Dana has been admitted to the community hospital labor and delivery
unit to be evaluated for severe preeclampsia. You are the admitting nurse responsible for her care.
Personal/Social History:
Dana has two children, ages two and four. She is married and both she and her husband are excited to have another
baby, but have been concerned about this pregnancy. Dana’s previous two pregnancies were healthy, without incident,
resulting in the vaginal births of a boy, then a girl. Dana’s parents live in the same town and are supportive.
Dana works part-time teaching English at the local community college. Her husband is an engineer who works full
time and is occasionally out of town for work. Dana is generally healthy, without any chronic illnesses. She does not
smoke or use recreational drugs. She reports drinking socially but refrains while pregnant.
What data from the histories are RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
• 40 years old • Mother is of advanced maternal age, which could lead to possible
, • 34 weeks gestation complications during delivery or genetic defects
• Blood pressure has been increasing • The fetus is preterm because it is less than 37 weeks gestation
over the past month and is currently • Dana’s blood pressure has continuously increased over the last
164/98 month to the point where she is now experiencing hypertension. If
• 3+ pitting edema in BLE her blood pressure has continued to increase, it is likely that efforts
• 2+ proteinuria have been made to bring her blood pressure down but have not had
• Mild headache in the center of her any effect.
forehead and is “seeing spots” • 3+ pitting edema indicates that Dana has a lot of excess fluid
• FHR 136bpm in LLQ collecting in her lower extremities
• Fundal height 31cm • The presence of protein in urine is indicative of preeclampsia
• Headache combined with other signs and symptoms of
preeclampsia can indicate increased likelihood of seizures.
Headache may be caused by increased pressure in the vessels
within the skull and can be impairing her vision due to the high
pressure in these vessels
• The fetus’s heartrate is within normal limits and the fetus is in the
left side of the uterus
• Fundal height is lower than expected, which may indicate that the
infant is going to be small for gestational age
RELEVANT Data from Social History: Clinical Significance:
• Two young children • Because the patient has two other young children at home, her
• Married, husband is excited about new attention will be divided among them and she may find herself
child more stressed to care for all of them. This will also mean that she
• No complications with previous has some experiencing caring for children and may not need as
pregnancies much patient education as a first-time mother
• Parents live in the same town • Because the patient is married and the husband is excited about the
• Husband travels for work new baby, it is likely that he will help support her and help with
• She works part-time and husband caring for her children and the new infant
works full-time • Complications in previous pregnancies can lead to increase risk of
• No chronic illnesses, no smoking, no complications in future pregnancies. Because she has not had any
use of recreational drugs complications with previous pregnancies, she is less likely to
• Did not drink alcohol while pregnant experience complications with her current one.
• The patients’ parents live in the same town as her, so they will may
be able to help support her or help with caring for the children,
such as babysitting
• Because the husband travels for work, he may not be available or
around as much to help the patient with caring for their children
• Because both the patient and her husband work, they may need a
babysitter or family members to watch their kids if they work
similar shifts. This also ensures that they have more income and a
better ability to provide for their family.
• Because the patient does not have any chronic illnesses and has not
used alcohol, drugs, or smoked during her pregnancy, her baby will
not have fetal alcohol syndrome and other complications
associated with substance abuse or chronic conditions.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment (5th VS):
T: 98.4 F/36.9 C (oral) Provoking/Palliative: None
P: 84 (regular) Quality: Stabbing/throbbing
R: 20 (regular) Region/Radiation: Eyes, forehead
BP: 164/98 Severity: 5/10
RAPID Reasoning
Dana Myers, 40 years old
RAPID Reasoning Case Study: Lee Arthur
Preeclampsia-Eclampsia
History of Present Problem:
Dana Myers is a 40-year-old woman, G-3 P-2 who is 34 weeks gestation. Her health care provider has been monitoring
her weekly because her blood pressure has been increasing the past month and is currently 146/88. Last week she had 1+
non-pitting edema of both lower extremities (BLE) and her urine was negative for protein. Today during her clinic visit,
Dana’s BP was 168/90. She had 2+ proteinuria and 3+ pitting edema BLE. She also complained of a mild headache in
the center of her forehead, and seeing “spots.” Fetal heart tones via Doppler are 136/minute in the lower left quadrant.
Abdominal measurement from pubic bone to top of fundus is 31 cm.
The primary care provider was concerned and Dana has been admitted to the community hospital labor and delivery
unit to be evaluated for severe preeclampsia. You are the admitting nurse responsible for her care.
Personal/Social History:
Dana has two children, ages two and four. She is married and both she and her husband are excited to have another
baby, but have been concerned about this pregnancy. Dana’s previous two pregnancies were healthy, without incident,
resulting in the vaginal births of a boy, then a girl. Dana’s parents live in the same town and are supportive.
Dana works part-time teaching English at the local community college. Her husband is an engineer who works full
time and is occasionally out of town for work. Dana is generally healthy, without any chronic illnesses. She does not
smoke or use recreational drugs. She reports drinking socially but refrains while pregnant.
What data from the histories are RELEVANT and has clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
• 40 years old • Mother is of advanced maternal age, which could lead to possible
, • 34 weeks gestation complications during delivery or genetic defects
• Blood pressure has been increasing • The fetus is preterm because it is less than 37 weeks gestation
over the past month and is currently • Dana’s blood pressure has continuously increased over the last
164/98 month to the point where she is now experiencing hypertension. If
• 3+ pitting edema in BLE her blood pressure has continued to increase, it is likely that efforts
• 2+ proteinuria have been made to bring her blood pressure down but have not had
• Mild headache in the center of her any effect.
forehead and is “seeing spots” • 3+ pitting edema indicates that Dana has a lot of excess fluid
• FHR 136bpm in LLQ collecting in her lower extremities
• Fundal height 31cm • The presence of protein in urine is indicative of preeclampsia
• Headache combined with other signs and symptoms of
preeclampsia can indicate increased likelihood of seizures.
Headache may be caused by increased pressure in the vessels
within the skull and can be impairing her vision due to the high
pressure in these vessels
• The fetus’s heartrate is within normal limits and the fetus is in the
left side of the uterus
• Fundal height is lower than expected, which may indicate that the
infant is going to be small for gestational age
RELEVANT Data from Social History: Clinical Significance:
• Two young children • Because the patient has two other young children at home, her
• Married, husband is excited about new attention will be divided among them and she may find herself
child more stressed to care for all of them. This will also mean that she
• No complications with previous has some experiencing caring for children and may not need as
pregnancies much patient education as a first-time mother
• Parents live in the same town • Because the patient is married and the husband is excited about the
• Husband travels for work new baby, it is likely that he will help support her and help with
• She works part-time and husband caring for her children and the new infant
works full-time • Complications in previous pregnancies can lead to increase risk of
• No chronic illnesses, no smoking, no complications in future pregnancies. Because she has not had any
use of recreational drugs complications with previous pregnancies, she is less likely to
• Did not drink alcohol while pregnant experience complications with her current one.
• The patients’ parents live in the same town as her, so they will may
be able to help support her or help with caring for the children,
such as babysitting
• Because the husband travels for work, he may not be available or
around as much to help the patient with caring for their children
• Because both the patient and her husband work, they may need a
babysitter or family members to watch their kids if they work
similar shifts. This also ensures that they have more income and a
better ability to provide for their family.
• Because the patient does not have any chronic illnesses and has not
used alcohol, drugs, or smoked during her pregnancy, her baby will
not have fetal alcohol syndrome and other complications
associated with substance abuse or chronic conditions.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment (5th VS):
T: 98.4 F/36.9 C (oral) Provoking/Palliative: None
P: 84 (regular) Quality: Stabbing/throbbing
R: 20 (regular) Region/Radiation: Eyes, forehead
BP: 164/98 Severity: 5/10
