Health promotion intervention

 

• Did you face any challenges, any success? If so, what were they? Treating pregnant patients and their needed follow up.
• Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales. Patient pregnant of 32 weeks came in having high BP and edema to the legs 
• Mention the health promotion intervention for this patient.
• What did you learn from this week's clinical experience that can beneficial for you as an advanced practice nurse? Learned how to manage preclampsia and edema with 3rd trimester pregnant women 
• Support your plan of care with the current peer-reviewed research guideline.
 

Sample Answer

 

 

 

 

 

 

 

Clinical Case Reflection: Preeclampsia Management

 

 

1. Challenges and Successes

 

CategoryDetails
ChallengeTreating pregnant patients and their needed follow-up. The primary challenge was the delicate balance required in managing a high-risk condition (Preeclampsia) while safeguarding two patients (mother and fetus). Specifically, ensuring patient compliance with frequent, structured follow-up (twice-weekly BP checks, weekly lab work, fetal non-stress tests/BPPs) was difficult due to transportation and work schedules.
SuccessEarly diagnosis and stabilization. Successfully identifying the classic triad of symptoms (hypertension, edema, and later confirmed proteinuria), initiating appropriate stabilization (IV access, lab draws), and effectively communicating the seriousness of the condition to the patient and family, which led to immediate inpatient admission and subsequent positive maternal/fetal outcomes.

Detailed Patient Assessment and Plan of Care

 

 

A. Patient Presentation

 

Chief Complaint: "My legs are swollen, and I've been getting headaches."

History: 32-year-old female, G2P1, currently 32 weeks gestation by last menstrual period (LMP) and dating ultrasound. No history of chronic hypertension. Reports a new, persistent occipital headache for the past 24 hours, blurred vision intermittently, and significant swelling in bilateral lower extremities that does not resolve overnight.

Vital Signs (S&S):

BP: $158/102$ mmHg (confirmed after 15 minutes rest).

Heart Rate: 92 bpm.

Respiratory Rate: 18 bpm.

Temperature: $98.6^{\circ}$F ($37^{\circ}$C).

Fetal Heart Rate (FHR): 145 bpm, reactive.

Physical Assessment (S&S):

Head/Eyes: Reports mild photophobia. Fundoscopic exam may reveal retinal arteriolar spasm (if performed).

Cardiovascular: Tachycardia, clear lung sounds.

Abdominal: Soft, fundal height appropriate for gestational age (32 cm).

Extremities: $3+$ pitting edema extending up to the knees bilaterally (significant finding). Patellar reflexes hyperactive ($3+$).

Labs (Initial): CBC, CMP, Uric acid, LDH, Coagulation panel. Crucially: 24-Hour Urine Protein or Urine Protein/Creatinine Ratio (UPCR).

 

B. Differential Diagnoses (DDx) and Rationales

 

DDxRationales
1. PreeclampsiaHighest likelihood. Presence of new-onset hypertension ($\ge 140/90$ mmHg) after 20 weeks gestation plus signs of end-organ damage (headache, visual changes, severe edema, hyperreflexia). Confirmed by proteinuria (UPCR $\ge 0.3$).
2. Gestational HypertensionCommon DDx. Presents with new-onset hypertension after 20 weeks but lacks proteinuria or signs of end-organ damage. If initial labs (liver/kidney function) and proteinuria screens are negative, the diagnosis shifts here (but close monitoring is essential as it can progress).