38-Year-Old Female with Preeclampsia
Ms. Johansen, 38, is 26 weeks pregnant with her first child. She was diagnosed with preeclampsia (see p. 1114) three weeks ago. Antihypertensive drugs (p. 724) and daily home care monitoring were initiated. However, her blood pressure is continuing to rise and is now 162/108 mm Hg. She complains of a constant headache, exhibits edema, and her urinalysis is positive for protein.
Her doctor has her admitted and orders further blood tests to assess Ms. Johansen's platelet level and liver function. "We may have to deliver because that’s the only cure for preeclampsia." she says to you during your clinical rotation in obstetrics. “But if we do, then the baby will have problems. It’s a tough decision because we have to balance both the mother's and the baby’s health.”
4. What roles does cortisol play in a developing fetus and how would an injection of cortisol help a premature infant?
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HUMAN ANATOMY+PHYSIOLOGY-ACCESS(IAC)
- M.H. is an 80-year-old Caucasian female who is married and lives with her spouse. She presents to your office today with her spouse, feeling “coocoo, I just don’t feel right.” Currently she is taking rosuvastatin prescribed by her cardiologist for hyperlipidemia and a daily 325 mg aspirin. She drinks 3–6 hard liquor drinks a day, 3–4 times a week in the evening, and has a 65-year smoking habit, currently smoking two packs per day (ppd). She has no known allergies. Past surgical history includes hysterectomy for a benign fibroid. Family history of breast cancer in three sisters, Type 2 diabetes and CVA in one sister, cancer of unknown origin in one brother. All siblings and parents are deceased. Her husband reports that she is hard of hearing. He feels that it is due to cerumen build-up in her ears. She refuses to have the buildup removed. Her husband is also worried about her memory—states that she “just does not remember things like she used to. She keeps asking me the same questions…arrow_forwardMary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. Which of MB’s clinical signs are reflective of the body’s effort to compensate for the decreased oxygen carrying capacity seen with this condition?arrow_forwardMary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. MB is counseled to increase her dietary intake of iron-containing foods. What kinds of food would be recommended?arrow_forward
- Mary Brown [MB] is a healthy 36-year-old woman with complaints of persistent generalized fatigue. At her annual checkup, her vital signs: heart rate (HR), 118 beats/min; blood pressure (BP), 110/60 mm Hg; oral temperature, 37°C; and respiratory rate (RR), 26 breaths/min. Her skin, conjunctiva and nail beds are pale. Laboratory results: hematocrit (Hct), 27%; hemoglobin (Hb), 9 g/dL and hypochromatic red blood cells (RBCs) are present. What other history data would be helpful in determining the cause of this disorder?arrow_forwardDescription A-45-year-old woman presents complaining of fatigue, 30 pounds of weight gain despite dieting, constipation, and menorrhagia. On physical examination, the thyroid is not palpable: the skin is cool, dry, and rough: the heart sounds are quiet; and the pulse rate is 50 bpm. The rectal and pelvic examinations show no abnormalities, and the stool is negative for occult blood. The clinical findings suggest hypothyroidism. Questions A. What other features of the history should be elicited? What other findings should be sought on physical examination? B. What is the pathogenesis of this patient's symptoms? C. What laboratory tests should be ordered, and what results should be anticipated? D. What are the possible causes of this patient's condition? Which is most likely? E. What other conditions may be associated with this disorder?arrow_forwardRalph , is 5 months post congestive heart failure (CHF), he is... Ralph , is 5 months post congestive heart failure (CHF), he is confined to a wheel chair due to advanced peripheral neuropathy and foot drop. His care is managed at home by a family nurse practitioner (FNP) who visits once a week and as necessary. On one of her visits, the FNP notes that Ralph has developed a Grade 3 sacral decubitus ulcer, lower extremity edema, and dyspnea while sitting. He is also confused and not oriented to person, place or time. Questions 1. 2. What risk factors for tissue break down are present? Explain in detail, the cellular changes that led to the sacral decubitus, now with necrotic dermal tissue. (Hint: the etiology and pathogenesis of the ulcer from injury to cellular death)arrow_forward
- A 62-year old, recently widowed male Hispanic patient, KB. was brought in to the emergency department (ED) by his daughter for progressively worsening shortness of breath, fatigue, a lingering non-productive cough, and generalized edema. One month prior, he noticed dyspnea upon exertion, loss of appetite, nausea, vomiting and malaise, which he attributed to the flu. In the emergency department, he appeared anxious and pale, and had a dry yellow tint to the skin. He denied any chest pain, and he could not recall the last time he urinated. He has history of benign prostatic hyperplasia, diabetes mellitus type 2, hypertension, dyslipidemia, and renal insufficiency for the past two years. His ED assessment findings included: 1+ pedal edema, basilar crackles in the lungs bilaterally, and a scant amount of urine according to a bladder scan. His lab results indicated a glomerular filtration rate (GFR) of 12. Based on his subjective and objective symptoms, he was admitted with a diagnosis of…arrow_forwardM. J. is a 76-year-old woman who lives on the side of a very steep mountain. The home health nurse has visited her once a week for the last year. She has running water, electricity, and a coal stove with back-up oil heat for very cold winter nights. She uses the telephone for communication. She has diabetes mellitus, hypertension, hypothyroidism, and is in atrial fibrillation. She has never been in the hospital before. Her current medications include metformin (250 mg twice a day), losartan (50 mg/day), levothyroxine sodium (Synthroid) (50 mcg/day), digoxin (0.125 mg/day), furosemide (Lasix) (10 mg/day), aspirin (81 mg/day), simvastatin (20 mg/day), and warfarin (Coumadin) (4 mg/day, with 6 mg on Sundays). Allergies are to penicillin (hives) and to metoprolol (hypotension and dizziness). M. J. stopped smoking 5 years ago, but until then she smoked one-half pack a day. Last laboratory test results (1 week ago) were: hemoglobin A1C (Hgb A1C) 8.3, international normalized ratio (INR) 1.7,…arrow_forwardM. J. is a 76-year-old woman who lives on the side of a very steep mountain. The home health nurse has visited her once a week for the last year. She has running water, electricity, and a coal stove with back-up oil heat for very cold winter nights. She uses the telephone for communication. She has diabetes mellitus, hypertension, hypothyroidism, and is in atrial fibrillation. She has never been in the hospital before. Her current medications include metformin (250 mg twice a day), losartan (50 mg/day), levothyroxine sodium (Synthroid) (50 mcg/day), digoxin (0.125 mg/day), furosemide (Lasix) (10 mg/day), aspirin (81 mg/day), simvastatin (20 mg/day), and warfarin (Coumadin) (4 mg/day, with 6 mg on Sundays). Allergies are to penicillin (hives) and to metoprolol (hypotension and dizziness). M. J. stopped smoking 5 years ago, but until then she smoked one-half pack a day. Last laboratory test results (1 week ago) were: hemoglobin A1C (Hgb A1C) 8.3, international normalized ratio (INR) 1.7,…arrow_forward
- A 10-year-old boy with known HbSS disease presented to the Paediatric Emergency Department with a oneweek history of fever and severe pain in his right leg, severity 9/10 for the last two days. On examination:Pulse – 100 beats/min, BP – 110/70 mmHg, Capillary refill < 2sec and Respiratory rate – 20 breaths/ min. He has point tenderness anteriorly on proximal tibia. There is no joint swelling.X-ray of the affected limb shows marked periosteal elevation.His complete blood count is: Hb – 6.5 g/dL WBC 30 x 10 /L Plt – 120 x 10 /L with a reticulocyte count of 1%.Of the following the MOST appropriate management in this patient would bea. Ibuprofen, Cefotaxime and top-up transfusionb. Morphine, Ampicillin and hydration therapyc. Morphine, Cefotaxime and hydration therapyd. Morphine, Cefotaxime and top-up transfusionarrow_forwardA 79-year-old woman presents at the Emergency Department with generalized complaints: constantly feeling tired and unwell. Her heart rate was in the range of 110 – 120 beats per minute and her blood pressure was 150/100. She complaints of dry cough and gasping of air. She also states that over the last 2 weeks she has noted that her breathing difficulty has severely limited her activities and has increased to persist even at rest, especially when lying down. She also reports of sudden awakening at night. On enquiry, she reports a recent weight gain along with a general reduction in her state of health. She explains that she has diabetes Type 2 (diet-controlled) from the last 5 years and hypertension since she was 40 years old. Her father died at age 85 due to ‘old age’, her mother died at age 88 after a hip fracture, and a brother age 80 alive with no significant history. She is on Minoxidil 10mg po bid for her hypertension, and has no known drug allergies. She denies any chest pain,…arrow_forwardA 24-year-old male presented with confusion, shortness of breath, and painful calves. It was reported by a friend that he had been lying on the floor for several hours. He was a known intravenous heroin and alcohol abuser. On examination he appeared dehydrated and cold (tem- perature 35°C); his pulse was 75/minute and blood pres- sure 110/70 mmHg. Intravenous injection sites were apparent. His urine was dark coloured. His chest was clear. Arterial blood gases were done in the casualty department and a blood sample was sent to the pathology department and gave the following results (reference ranges are given in brackets): Arterial blood pH PCO₂ PO₂ HCO3- Serum Sodium Potassium Creatinine Calcium Albumin Phosphate Creatine kinase C-reactive protein 7.276 4.82 KPa 12.7 kPa 18.0 mmol/L 138 mmol/L 7.6 mmol/L 236 μmol/L 1.66 mmol/L 32 g/L 2.43 mmol/L >140,000 U/L 73 mg/L (7.35-7.45) (4.7-6.0) (12.0-14.6) (24-29) (135-145) (3.8-5.0) (71-133) (2.10-2.55) (35-50) (0.87-1.45) (55-170) (<10) The…arrow_forward
- Basic Clinical Lab Competencies for Respiratory C...NursingISBN:9781285244662Author:WhitePublisher:Cengage