Question

The nurse is assessing a multigravida, 36 weeks gestation for symptoms of pregnancy-induced hypertension and preeclampsia. The nurse should give priority to assessing the client for: A. Facial swelling B. Pulse deficits C. Ankle edema D. Diminished reflexes

Short answer

Answer: Facial swelling

Step-by-step solution

Understanding the terms

Before beginning the comparison of symptoms, it is essential to understand the key terms: 1. Pregnancy-induced hypertension (PIH) - Also known as gestational hypertension, PIH is high blood pressure that develops during pregnancy and usually resolves after childbirth. 2. Preeclampsia - A more severe form of PIH, preeclampsia is characterized by high blood pressure, protein in the urine, and often swelling in the hands, face, and feet. In severe cases, preeclampsia can lead to life-threatening complications for both the mother and baby.

Analyzing the symptoms

Now, we will analyze each symptom provided in the exercise. A. Facial swelling: Facial swelling, particularly around the eyes, can be an indicator of preeclampsia. It's because of fluid retention, which is a common feature of preeclampsia. B. Pulse deficits: Pulse deficits are not typically associated with PIH or preeclampsia. They can indicate other cardiovascular issues. C. Ankle edema: Ankle edema (swelling) can be a common symptom of pregnancy, especially in the third trimester. While it can be present in PIH or preeclampsia cases, it is not exclusive to these conditions. D. Diminished reflexes: Diminished reflexes can indicate neuromuscular issues but are not directly related to PIH or preeclampsia.

Determine the priority symptom

Considering the analysis of each symptom, facial swelling (A) is the most specific and concerning symptom among the options provided related to pregnancy-induced hypertension and preeclampsia. The nurse should prioritize assessing the client for facial swelling.

Key concepts

Preeclampsia

Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys. It usually occurs after 20 weeks of pregnancy in women whose blood pressure had been normal. Recognizing preeclampsia early is crucial because it can lead to serious, even fatal, complications for both the mother and the baby. Some key symptoms to look out for include:

• Severe headaches
• Changes in vision, including temporary loss of vision, blurred vision, or light sensitivity
• Upper abdominal pain
• Nausea or vomiting
• Decreased urine output or shortness of breath
• Facial swelling (especially around the eyes)

Precise diagnosis involves monitoring blood pressure and testing urine for protein. Effective management and treatment depend on the severity of the condition and how far along the pregnancy is.

Gestational Hypertension

Gestational hypertension is another type of pregnancy-induced hypertension that differs from preeclampsia as it does not include the presence of protein in urine. This condition is identified by the development of high blood pressure in a pregnant woman who previously had normal blood pressure. It is important to closely monitor gestational hypertension as it can progress to preeclampsia. Key facts about gestational hypertension include:

• High blood pressure detected after 20 weeks of gestation
• Typically resolves after childbirth
• Does not initially include other systemic effects like proteinuria

Women with gestational hypertension usually undergo regular prenatal check-ups to assess their blood pressure and any associated risks to both the mother and the baby.

Nursing Assessment

Nursing assessments in cases of pregnancy-induced hypertension and preeclampsia involve a thorough investigation into various symptoms and physical signs to ensure the well-being of both mother and fetus. Nurses focus on identifying typical symptoms and performing routine checks to detect any early signs of complications. Critical components of nursing assessments may include:

• Taking regular blood pressure measurements
• Checking for protein in urine samples
• Observing for any unusual swelling, particularly in the face and hands
• Evaluating reflexes for any neurological changes

The prioritization of certain symptoms, such as significant facial swelling, can often provide a clue to the severity of the condition requiring immediate attention.

Third Trimester Pregnancy Symptoms

The third trimester of pregnancy is often when many women experience a variety of physical changes and symptoms as they prepare for childbirth. Understanding these symptoms is crucial for differentiating between normal pregnancy discomforts and signs of potential complications such as pregnancy-induced hypertension or preeclampsia. Common symptoms in the third trimester may include:

• Increased swelling in ankles and feet
• Shortness of breath as the baby presses upwards against the diaphragm
• Back pain and pelvic discomfort as the body prepares for labor
• Increased fatigue as the body supports the growing baby

While many of these symptoms are expected during the third trimester, new or unexpected symptoms, like facial swelling or severe headaches, should be evaluated by a healthcare provider to rule out conditions like preeclampsia.