Chapter 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Case 1 Teresa is a 36-year-old primigravida who is expecting twins. She is 26 weeks pregnant. She stays after your “What to Expect with Twins” class to talk to you. Although Teresa is a nurse, she has many questions and concerns. Her twins are a result of years of trying to get pregnant and in vitro fertilization. She is nervous about whether she will have a vaginal delivery or a cesarean section. She is worried about having the babies prematurely. She wants you to tell her everything that could go wrong so she can be prepared 1. Why is Teresa’s pregnancy considered a high-risk pregnancy Incorrect answer. Teresa’s pregnancy is considered high risk pregnancy because most of IVF pregnancies require induced labor or caesarean section.  Also, most babies conceived through IVF are born prematurely or with a low birth weight. Incorrect.. there is a higher incidence of preterm birth due to multiple gestation, IVF itself does not increase the risk factor IVF increases the risk of Down syndrome as well. Incorrect as IVF allows for early genetic testing. 2.    Discuss potential pregnancy-related complications for Teresa. What else? Some of the potential pregnancy –related complications for Teresa are late miscarriage,  She is 26 weeks pregnant.. this is no longer a complication. ovarian hyper stimulation syndrome, She is 26 weeks pregnant.. this is no longer a complication.     This is for IVF not the pregnancy high blood pressure, pre-eclampsia, premature delivery, low birth weight,  birth defects,  Fetal not maternal and stress.  3.    Discuss the potential risks to the babies. You only discuss problems of prematurity.. what else? The babies are at a higher risk of being born with breathing problems because mostly twins who are conceived through in vitro fertilization are born prematurely and therefore it means that their respiratory system and organs like lungs are not fully developed. They are also at risk of jaundice or sepsis.  Case 2  Sarah is 19-year-old G1P0 at 36 weeks' gestation. Sarah has been followed weekly in the clinic for mild–moderate preeclampsia. At her clinic appointment today, Sarah’s blood pressure reading was 188/104. She is admitted to the antepartum unit for management of her worsening preeclampsia. You perform her admission assessment and note that her reflexes are brisk, her heart rate is 94, she complains of having an intense headache, and is seeing spots before her eyes. You perform an abdominal assessment and note that she has significant epigastric tenderness. (Learning Objective 5) 1.    Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome. this is a definition not a care plan The best way to treat Sarah for preeclampsia is to deliver the baby because at 36 weeks’ gestation, the baby is full grown and it will be safer to deliver the baby and avoid further complications. In some cases, this c.

1. Chapter 19: Nursing Management of Pregnancy at Risk:
Pregnancy-Related Complications
Case 1
Teresa is a 36-year-old primigravida who is expecting twins.
She is 26 weeks pregnant. She stays after your “What to Expect
with Twins” class to talk to you. Although Teresa is a nurse,
she has many questions and concerns. Her twins are a result of
years of trying to get pregnant and in vitro fertilization. She is
nervous about whether she will have a vaginal delivery or a
cesarean section. She is worried about having the babies
prematurely. She wants you to tell her everything that could go
wrong so she can be prepared
1. Why is Teresa’s pregnancy considered a high-risk pregnancy
Incorrect answer.
Teresa’s pregnancy is considered high risk pregnancy because
most of IVF pregnancies require induced labor or caesarean
section.
Also, most babies conceived through IVF are born prematurely
or with a low birth weight. Incorrect.. there is a higher
incidence of preterm birth due to multiple gestation, IVF itself
does not increase the risk factor
IVF increases the risk of Down syndrome as well. Incorrect as
IVF allows for early genetic testing.
2. Discuss potential pregnancy-related complications for
Teresa.
What else?
Some of the potential pregnancy –related complications for
Teresa are late miscarriage, She is 26 weeks pregnant.. this is
no longer a complication.

2. ovarian hyper stimulation syndrome, She is 26 weeks pregnant..
this is no longer a complication.
This is for IVF not the pregnancy
high blood pressure, pre-eclampsia, premature delivery, low
birth weight,
birth defects, Fetal not maternal
and stress.
3. Discuss the potential risks to the babies.
You only discuss problems of prematurity.. what else?
The babies are at a higher risk of being born with breathing
problems because mostly twins who are conceived through in
vitro fertilization are born prematurely and therefore it means
that their respiratory system and organs like lungs are not fully
developed. They are also at risk of jaundice or sepsis.
Case 2
Sarah is 19-year-old G1P0 at 36 weeks' gestation. Sarah has
been followed weekly in the clinic for mild–moderate
preeclampsia. At her clinic appointment today, Sarah’s blood
pressure reading was 188/104. She is admitted to the antepartum
unit for management of her worsening preeclampsia. You
perform her admission assessment and note that her reflexes are
brisk, her heart rate is 94, she complains of having an intense
headache, and is seeing spots before her eyes. You perform an
abdominal assessment and note that she has significant
epigastric tenderness. (Learning Objective 5)
1. Develop a plan of care for the woman experiencing
preeclampsia, eclampsia, and HELLP syndrome.
this is a definition not a care plan
The best way to treat Sarah for preeclampsia is to deliver the
baby because at 36 weeks’ gestation, the baby is full grown and
it will be safer to deliver the baby and avoid further
complications. In some cases, this condition may continue after
delivery. So if this happens with Sarah, then she will be given
intravenous medication to prevent seizures and control blood

3. pressure. Eclampsia can also be managed by delivering the
baby. However, before the process of delivering the baby,
immediate medical attention is required to treat the blood
pressure levels, and stop the seizures. She will be given
magnesium sulfate to stop the seizures and also prevent seizures
in the future. Also, she will be given antihypertensive
medications to stabilize the blood pressure (Plante & Ryan,
2020). HELLP syndrome will also be managed by delivering the
baby.
References
Vlasyuk, V. (2019). What is the Cause of the Caput
Succedaneum and the Region of Periosteal Blood Congestion of
the Blood of the Skull?.
Plante, L. A., & Ryan, J. G. (2020). Preeclampsia, Eclampsia,
HELLP Syndrome. In Evidence-Based Critical Care (pp. 749-
757). Springer, Cham.
For the Disease Summary for this case study, see the CD-ROM.
PATIENT CASE
Ms. K.Z., a 22-year-old university coed, was rushed to the
emergency room 35 minutes after sustaining multiple stab
wounds to the chest and abdomen by an unidentified assailant.
A witness had telephoned 911. Paramedics arriving at the scene
found the victim in severe acute distress. Vital signs were
obtained: HR 128 (baseline 80), BP 80/55 (baseline 115/80), RR
37 and labored. Chest auscultation revealed decreased breath
sounds in the right lung consistent with basilar atelectasis (i.e.,
collapsed lung). Pupils were equal, round, and reactive to light
and accommodation. Her level of consciousness was reported as
“awake, slightly confused, and complaining of severe chest and
abdominal pain.” Pedal pulses were absent, radial pulses were
weak, and carotid pulses were palpable. The patient was
immediately started on intravenous lactated Ringer’s solution at
a rate of 150 mL/hr. Patient Case Question 1. With two words,

4. identify the specific type of hypovolemic shock in this patient.
An electrocardiogram monitor placed at the scene of the attack
revealed that the patient had developed sinus tachycardia. She
was tachypneic, became short of breath with conversation, and
reported that her heart was “pounding in her chest.” She
appeared to be very anxious and continued to complain of pain.
Her skin and nail beds were pale but not cyanotic. Skin turgor
was poor. Peripheral pulses were absent with the exception of a
thready brachial pulse. Capillary refill time was approximately
7–8 seconds. Doppler ultrasound had been required to obtain an
accurate BP reading. The patient’s skin was cool and clammy.
There was a significant amount of blood on her dress and on the
pavement near where she was lying. Patient Case Question 2.
Based on the patient’s clinical manifestations, approximately
how much of her total blood volume has been lost?
During transport to the hospital, vital signs were reassessed: HR
138, BP 75/50, RR 38 with confusion. She was diagnosed with
hypovolemic shock and IV fluids were doubled. Blood samples
were sent for typing and cross-matching and for both chemical
and hematologic analysis. Laboratory test results are shown in
Patient Case Table 6.1 Patient Case Question 3. How many units
of whole blood are minimally required? Patient Case Question
4. Is it necessary that sodium bicarbonate be administered to the
patient at this time? Oxygen was started at 3 L/min by nasal
cannula. Repeat arterial blood gases were: PaO2 82 mm Hg,
PaCO2 38 mm Hg, pH 7.36, SaO2 95%. Patient Case Question
5. Are arterial blood gas results improving or deteriorating? ER
physicians chose not to start a central venous line. An
indwelling Foley catheter was inserted with return of 180 mL of
amber-colored urine. Urine output measured over the next hour
was 14 mL. Ms. Z’s condition improved after resuscitation with
1 L lactated Ringer’s solution and two units packed red blood
cells over the next hour.
Patient Case Question 6. Based on urine output rate, in which
class of hypovolemic shock can the patient be categorized at
this time? Laboratory blood test results are shown in Patient

5. Case Table 6.2
Patient Case Question 7. Explain the pathophysiology of the
abnormal BUN and Cr. Patient Case Question 8. Does the
patient have a blood clotting problem? Patient Case Question 9.
Explain the pathophysiology of the abnormal serum glucose
concentration. The patient was taken to the operating room for
surgical correction of lacerations to the right lung, liver, and
pancreas. There, she received an additional six units of type B+
blood. Surgery was successful and the patient was admitted to
the ICU for recovery with the following vital signs: HR 104, BP
106/70, RR 21, urinary output 29 mL/hr. A repeat BUN and Cr
revealed that these renal function parameters had returned to
near-normal values (23 mg/dL and 1.4 mg/dL, respectively).
Patient Case Question 10. Based on clinical signs after surgery,
in which class of hypovolemic shock can the patient be
categorized at this time?
Bruyere, Harold J.. 100 Case Studies in Pathophysiology
(Kindle Locations 824-828). Wolters Kluwer Health. Kindle
Edition.