Case Study: Chronic Hypertension Female Admitted To Inpatien

Case Study Chronic Hypertensionfemale Was Admitted To Inpatient Care

Case Study: Chronic Hypertension Female was admitted to inpatient care with a diagnosis of chronic hypertension with severe features and started on Labetalol 200 mg po q 8 hours. She was monitored for 3 days and her BP stabilized at 130/78. Fetal testing was reassuring. She was discharged home on hospital day 3 on Labetalol and was to be seen twice weekly for BP checks, and was instructed to take her BP at home twice daily. Safety of medications was discussed in-depth with her.

Signs/symptoms of PIH were reviewed with her. Two weeks later she had po nifedipine added. She subsequently delivered a healthy baby girl at 39 weeks gestation. She was discharged home on above medications (as she was breastfeeding) and continued meds for hypertension past her 6-week postpartum appointment. She was referred to her primary care provider for continuing care.

Purpose of this case study is to address the significantly different standards of labs and vital signs for pregnant patients. Based on the case study above, complete a comprehensive well-woman exam. What is your primary diagnosis? Explain. What are two other differential diagnoses? Explain. What additional questions you would ask the patient? Explain your reasons for asking the additional questions. Then, what types of symptoms you would ask for? Be specific and provide examples. (Note: When asking questions, consider sociocultural factors that might influence your question decisions.) Then, explain which treatment options and diagnostic tests you might recommend.

Paper For Above instruction

Introduction

The management of hypertension during pregnancy presents unique challenges given the physiological changes associated with pregnancy and the potential risks to both mother and fetus. Accurate diagnosis, careful monitoring, and appropriate interventions are critical to prevent adverse outcomes. This case study offers an illustrative example of a woman with chronic hypertension who successfully delivered a healthy baby following a tailored treatment plan. This paper provides a comprehensive approach to her care, including diagnosis, differential considerations, additional questioning, symptom assessment, and recommended interventions.

Primary Diagnosis

The primary diagnosis for this patient is chronic hypertension with severe features during pregnancy. Chronic hypertension is characterized by elevated blood pressure predating pregnancy or diagnosed before 20 weeks of gestation, persisting postpartum. In this case, the patient was diagnosed with chronic hypertension prior to pregnancy and exhibited severe features—such as markedly elevated blood pressure—indicating the need for intensive management. The initial BP readings of 130/78 following treatment, and the stability achieved with Labetalol, support this diagnosis. Managing her hypertension was critical to reducing risks such as placental abruption, fetal growth restriction, and preeclampsia, while ensuring fetal safety.

Differential Diagnoses

Two other potential differential diagnoses include gestational hypertension and preeclampsia without severe features. Gestational hypertension refers to new-onset hypertension diagnosed after 20 weeks of gestation in women without prior hypertension. It can progress to preeclampsia but is distinguished by the absence of proteinuria or severe features initially. Preeclampsia, particularly with severe features, involves not only high blood pressure but also signs of end-organ dysfunction such as elevated liver enzymes, thrombocytopenia, or renal impairment. Although her prenatal course included normal fetal testing and no overt signs of preeclampsia, ongoing assessment of symptoms and lab tests was essential for differentiation, especially given her history of chronic hypertension.

Additional Questions for the Patient

Key questions to ask include prior history of hypertensive episodes, medication adherence, family history of hypertension or preeclampsia, and lifestyle factors such as diet, physical activity, stress levels, and substance use. Assessing medication adherence helps determine the effectiveness of control measures. Family history can identify genetic predisposition. Questions about diet and activity levels can inform lifestyle modifications, while inquiries about substance use—including alcohol or recreational drugs—are vital because these can influence blood pressure and fetal health.

Additional questions should also explore sociocultural factors, such as language barriers or cultural beliefs influencing healthcare-seeking behavior and medication acceptance. Understanding her support system and access to healthcare resources is essential, especially for continuity of care postpartum.

Symptoms to inquire about

Specific symptoms to assess include headaches, visual disturbances, epigastric pain, sudden weight gain, swelling, and decreased fetal movement. For example, frequent headaches or visual changes may indicate worsening hypertensive severity or early signs of preeclampsia. Sudden swelling or edema, especially in hands and face, could also signal preeclampsia. Asking about decreased fetal movement, such as reduced kicks, helps monitor fetal well-being. Cultural considerations include respecting her perceptions and beliefs about symptoms, ensuring explanations are understandable and culturally sensitive.

Treatment Options and Diagnostic Tests

Effective management involves pharmacologic and non-pharmacologic approaches. First-line medications include antihypertensives safe for pregnancy, such as labetalol, nifedipine, and methyldopa. In her case, adding oral nifedipine was appropriate for blood pressure control. Continuation postpartum includes medications compatible with breastfeeding, as implemented here. Non-pharmacologic strategies include dietary modifications (reducing sodium intake), stress reduction, and promoting physical activity within tolerance.

Diagnostic testing focuses on regular BP monitoring, urine analysis for proteinuria, and lab tests including renal function (creatinine, BUN), liver enzymes, complete blood count (CBC), and fetal surveillance via ultrasound to monitor fetal growth and well-being. Biophysical profiles and non-stress tests are vital in detecting fetal compromise. Serial assessments allow early detection of worsening preeclampsia or other complications, enabling timely interventions.

In cases of severe hypertension or preeclampsia, inpatient management with IV antihypertensives and close monitoring may be necessary. Postpartum, continued antihypertensive management is advised, with ongoing assessment of blood pressure control and screening for chronic hypertension development.

Conclusion

The comprehensive management of this pregnant woman with chronic hypertension underscores the importance of individualized care that takes into account her medical history, sociocultural context, and fetal health. Appropriate diagnosis, vigilant monitoring, and tailored therapeutic strategies contributed to her successful delivery. Future care involves continued blood pressure control, postpartum follow-up, and lifestyle interventions to reduce long-term cardiovascular risks.

References

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