QLexNursing

Blood Pressure 164/112 mmHg

🔷 Severe-range hypertension is defined as a systolic blood pressure ≥160 mmHg or diastolic ≥110 mmHg on two occasions at least 4 hours apart in a woman ≥20 weeks’ gestation.

🔷 Olivia’s blood pressure of 164/112 mmHg on admission exceeds this threshold, confirming severe hypertension, a hallmark feature of severe preeclampsia.

🔷 Elevated blood pressure causes endothelial dysfunction and vasospasm, compromising perfusion to maternal organs and placenta.

🔷 This level of hypertension increases the risk of cerebral hemorrhage, stroke, and placental abruption.

🔷 Immediate antihypertensive therapy and seizure prophylaxis (e.g., magnesium sulfate) are warranted to reduce morbidity.

Proteinuria (2+ on Dipstick)

🔷 Proteinuria is a diagnostic criterion for preeclampsia and indicates renal involvement.

🔷 A dipstick reading of 2+ or more (especially with concurrent hypertension) supports the diagnosis of preeclampsia.

🔷 This finding results from glomerular endotheliosis, a classic lesion in preeclampsia that leads to increased glomerular permeability.

🔷 Proteinuria in combination with elevated BP confirms multi-organ dysfunction is present.

🔷 In severe cases, 24-hour urine protein or urine protein/creatinine ratio may be obtained for quantification, but dipstick is a key initial finding.

Platelets 120,000/mm³

🔷 A platelet count below 150,000/mm³ is considered thrombocytopenia, which is a severe feature in preeclampsia.

🔷 Platelets of 120,000/mm³ suggest consumption coagulopathy associated with endothelial damage.

🔷 Decreased platelets increase risk for bleeding complications, especially during labor or cesarean delivery.

🔷 This finding may also suggest progression to HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), a life-threatening variant.

🔷 Monitoring platelet trends is critical to determine disease severity and guide delivery timing.

AST 76 U/L and ALT 68 U/L

🔷 Both AST and ALT are elevated above normal ranges, indicating hepatic involvement, which qualifies as a severe feature.

🔷 Liver dysfunction results from hepatic vasospasm and microvascular injury, common in severe preeclampsia.

🔷 These elevations may be accompanied by epigastric or RUQ pain, which were not reported here but are associated warning signs.

🔷 Hepatic involvement raises the risk of subcapsular hematoma or liver rupture, particularly if unmanaged.

🔷 These lab abnormalities necessitate close monitoring and consideration for delivery to prevent maternal harm.

3+ Reflexes and Ankle Clonus

🔷 Hyperreflexia (3+ reflexes) and the presence of ankle clonus indicate neuromuscular irritability, a hallmark of CNS involvement in severe preeclampsia.

🔷 This reflects cerebral edema or vasospasm, and signals an increased risk for seizures (eclampsia).

🔷 Magnesium sulfate is used for seizure prophylaxis, and reflexes must be monitored for toxicity.

🔷 These neurological signs often precede headaches, visual changes, and altered mental status.

🔷 The findings justify initiation of seizure precautions and magnesium therapy as ordered.

Persistent Headache and Blurry Vision

🔷 Neurological symptoms like persistent headache and visual disturbances are severe features of preeclampsia.

🔷 These result from cerebral vasospasm or edema, which can lead to seizures or stroke.

🔷 A frontal headache unrelieved by usual methods, especially with visual changes, is alarming.

🔷 These symptoms suggest impending eclampsia and must be urgently addressed.

🔷 Prompt recognition and management with magnesium sulfate is crucial to prevent maternal morbidity.

Facial Swelling (Edema)

🔷 Sudden facial or periorbital swelling is a classic sign of fluid retention and capillary leak syndrome in preeclampsia.

🔷 Generalized edema is more concerning when accompanied by hypertension and proteinuria.

🔷 Edema in the face or hands typically precedes organ dysfunction and disease progression.

🔷 This symptom reflects increased vascular permeability, a result of endothelial injury.

🔷 While not diagnostic alone, facial edema supports the diagnosis in combination with other features.