SCENARIO

J.F. is 18-year-old woman, gravida 1 para 2, at 38 weeks gestation. She felt fine until 2 days ago, when
she notices swelling in her hands, feet, and face. She complains of a frontal headache, which started
yesterday and has not been relieved by acetaminophen (Tylenol) or coffee. She says she felt irritable and
doesn’t want the “overhead light on.” Her physician is admitting her for induction of labor. You begin to
assess her.

1. Base on the assessment data you have obtain so far, what do you think is happening to J.F. at
this time?
 Base on the assessment, J.F. has develop pre-eclampsia
2. As you assess J.F in her ankles, you note that she is the closest to letter B the figure below, with
edema at about 4mm. How would you document this edema?
 Slightly indention or 4mm depression
3. What other assessment question should you ask her at this time?
 Have you experience any vision changes?
 Vomits or epigastric pain?
 Changes Fetal movements?
 When is the last time you eat?
4. What information should you obtain from her obstetrics record?
 Hemolysis, urinalysis, platelet count, liver function test, kidney function test
5. What laboratory value should be considered at this time?
 Urine Protein, Bun, Serum Creatinine, ALT, AST, CBC, PTT
6. Name at least 3 possible maternal and 3 possible fetal complication with J.F.’s diagnosis.
 MATERNAL- pulmonary edema, seizure, renal failure
 FETAL- premature birth, fetal growth restriction, placenta abruption
7. What risk factors does J.F. have that cause her to be at risk for this condition? (Select all that
apply)
A. Obesity
B. Nulliparity
C. Single-fetus pregnancy
D. Age less than 20 years
E. Coffee drinker
8. Identify eight measures that would likely be implemented.
 Update the anesthesiologist if epidural desire
 Limit the fluid for prevention of pulmonary edema
 Normal admission labs specially in platelet count
 PO or IV labetalol or hydralazine
 IV magnesium sulfate
 Make seizure prevention
 Hourly measure the intake and urine output
 Limit activity to bathroom

CASE STUDY PROGRESS

The physician orders a magnesium sulfate infusion. As you monitor J.F., you observe for signs of
magnesium sulfate toxicity.

9. What are potential signs of magnesium sulfate toxicity? (Select all that apply.)
A. Absent DTRs
B. Increase respiratory rate
C. Oliguria
D. Muscle rigidity
E. Sever hypotension
10. Four hours later, a serum magnesium level is draw, and the result show 7.8 mEq/L. does this
result need to be reported to the physician? If so, what would you prepare to do?
 Stop infusion
 Assess for magnesium toxicity
 Call the doctor
11. Is there an antidote for magnesium sulfate?
 Calcium gluconate

CASE STUDY PROGRESS

The magnesium sulfate infusion rate is reduced, and an oxytocin infusion has been ordered by the
physician and is being given IV in increments to achieve and adequate contraction pattern. You notice on
the fatal monitor strip that J.F. is experiencing seven uterine contractions in a 10-minute period over a
30-minute window, with a few FHR decelerations noted.

12. What is happening at this time?

 Oxytocin injection are for improving contractions during labor. But it can affect in the
fetal heart
13. What is your priority action?
 Position patient in side lying position
 Administer IV fluid bolus
 Continue monitoring FHR
 Decrease the oxytocin by half if the urine doesn’t come back to normal in 10 min.
 If the urine activity doesn’t come back deflate the oxytocin until the 5 contraction occurs
in 10 min.

CASE STUDY PROGRESS

J.F. progresses in labor, and, at 4-cm dilation, her membrane spontaneously rupture. The small amount
of amniotic fluid is green

14. What does the green amniotic fluid indicate? What is the risk?
 It indicates Meconium Aspiration Syndrome which block the airway of the fetus

CASE STUDY OUTCOME

Five hours later, J.F. delivers a 6-pound, 8-ounce bit, with Apgar score 6 and 7.

15. What is your responsibility at this time?

 First, I will clear the airway of the baby, check the skin color, vital signs, measure the
head and chest circumference,