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Diagnosed with gestational diabetes

The patient, SR (she/her), is a 36-year-old who is 34 weeks pregnant with her first child (G1P0000). She was diagnosed with gestational diabetes at 28 weeks of pregnancy and her blood sugars have been controlled with diet and exercise. She initiated prenatal care at 8 weeks gestation, has been attending prenatal visits consistently, and has been taking her prenatal vitamins as directed. SR presents to her routine 34-week obstetric (OB) visit with concerns of severe headache unrelieved by acetaminophen, and swelling in her hands and feet. She also reports feeling dizzy and nauseous.

Answer the following questions

What are some differential diagnoses to include for this patient?
What would be some priority assessments to complete on this patient?
. Vital sign:

. Laboratory tests indicated, specific to the diagnosis

Symptom assessment:

Fetal assessment:

3.What characteristics does this patient have that put her at higher risk for preeclampsia?

Full Answer Section

Migraine headache: While less likely due to the constellation of symptoms, migraines can occur during pregnancy.
Thrombocytopenia (low platelets): This is less common but can cause headaches and even preeclampsia-like symptoms.

Priority Assessments for SR

Vital Signs: Blood pressure (priority), temperature, pulse, oxygen saturation.
Urine Dipstick: This will check for protein in the urine, a key sign of preeclampsia.
Blood Tests:
- Complete Blood Count (CBC) to assess for thrombocytopenia.
- Liver function tests (LFTs) to assess for potential organ dysfunction.
- Blood sugar level (important with gestational diabetes).
Symptom Assessment:
- Character and severity of headache (location, duration, intensity)
- Visual disturbances (blurring, flashing lights)
- Epigastric pain (upper abdominal pain)
- Changes in fetal movement
Fetal Assessment: This may include:
- Non-stress test (NST) or biophysical profile (BPP) to assess fetal well-being.

Characteristics that Increase Risk for Preeclampsia

Primiparity (first pregnancy): SR is a G1P0, increasing her risk.
Gestational diabetes: A pre-existing condition associated with preeclampsia.
Age: While not explicitly stated, some studies suggest a higher risk for preeclampsia in mothers over 35.

Important Note This information is intended for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment.

Sample Answer

Based on SR's symptoms (headache, swelling, nausea, dizziness) at 34 weeks pregnant with gestational diabetes, several differential diagnoses need to be considered:

Preeclampsia: This is a pregnancy complication characterized by high blood pressure (developing after 20 weeks) and signs of organ dysfunction, often including protein in the urine (proteinuria).
Gestational hypertension: High blood pressure without protein in the urine.
Eclampsia: A severe complication of preeclampsia with seizures. It's a medical emergency.