Case Study: Chronic Hypertension Female Was Admitted To Inpa

Case Study Chronic Hypertensionfemale Was Admittedto 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.) · Lastly, explain which treatment options and diagnostic tests you might recommend

Paper For Above instruction

A comprehensive well-woman exam in a patient diagnosed with chronic hypertension involves a thorough assessment of her medical history, physical health, and social factors that might influence her health and treatment adherence. This exam includes reviewing her obstetric history, understanding previous hypertensive episodes, current medications, lifestyle factors, and screening for other risk factors such as diabetes, renal function, and cardiovascular disease. Physical examination focuses on blood pressure measurement in both arms, assessment of weight, height, BMI, edema, cardiovascular, pulmonary, abdominal, and neurological systems. Pelvic examination may be appropriate to assess general health and exclude other gynecological issues.

The primary diagnosis in this case is chronic hypertension with superimposed preeclampsia or severe features. Chronic hypertension is defined as high blood pressure diagnosed before 20 weeks of gestation or persisting beyond 12 weeks postpartum. The patient’s history of elevated BP prior to pregnancy and its persistence postpartum, along with severity during pregnancy, supports this diagnosis. The fact that her BP was stabilized with medication during pregnancy and subsequently managed postpartum further confirms her primary diagnosis.

Two other differential diagnoses include gestational hypertension and preeclampsia with severe features. Gestational hypertension typically manifests after 20 weeks gestation without proteinuria or organ involvement, which seems less consistent here given her pre-existing hypertension. Preeclampsia with severe features involves hypertension with additional signs such as proteinuria, impaired liver function, renal insufficiency, neurological symptoms, or thrombocytopenia, which need to be ruled out through labs and clinical signs.

Additional questions I would ask the patient include inquiries about her previous hypertensive episodes, medication adherence, lifestyle factors such as diet, physical activity, weight changes, and smoking or substance use. I would also explore her understanding of her condition and her pregnancy’s progress. Sociocultural factors are important; for instance, understanding her access to healthcare, cultural beliefs about medication use during pregnancy and breastfeeding, and support systems can influence adherence and management strategies.

Symptoms to inquire about specifically include headaches, visual disturbances (e.g., blurred vision or seeing spots), epigastric pain, swelling in extremities, dizziness, or neurological symptoms such as weakness or numbness. These symptoms can indicate preeclampsia progression or other organ involvement. Asking about signs of worsening hypertension, such as increased BP readings or symptoms like chest pain or shortness of breath, is critical, especially given her history of severe features.

Regarding treatment options, ongoing antihypertensive therapy needs to be tailored for pregnancy and lactation. Labetalol and nifedipine are appropriate first-line agents for gestational hypertension or chronic hypertension in pregnancy. Regular BP monitoring, both in-clinic and at home, is essential to adjust medication doses accordingly. Additional diagnostic tests should include urine analysis for proteinuria, serum creatinine, liver function tests, complete blood count for thrombocytopenia, and fetal monitoring via ultrasound and non-stress tests. These assessments help evaluate maternal and fetal well-being and detect early signs of preeclampsia or other complications.

Further investigations post-delivery should include renal function tests and long-term cardiovascular risk assessments, as women with hypertensive disorders during pregnancy have an increased risk of future cardiovascular disease. Lifestyle modifications such as dietary counseling, weight management, and physical activity should be emphasized alongside pharmacologic management.

In conclusion, managing a pregnant woman with chronic hypertension requires a multidisciplinary approach, including obstetric, cardiology, and primary care teams. The goal is to maintain optimal maternal blood pressure, ensure fetal health, and prevent complications such as preeclampsia, eclampsia, or long-term cardiovascular issues.

References

• American College of Obstetricians and Gynecologists. (2020). Practice Bulletin No. 222: Gestational Hypertension and Preeclampsia. Obstetrics & Gynecology, 135(6), e237–e260.
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• Mathews, L. K., & Ayoub, A. (2019). Hypertensive Disorders in Pregnancy. In: Williams Obstetrics. McGraw-Hill Education.
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• European Society of Cardiology. (2018). ESC Guidelines on the Management of Cardiovascular Disease During Pregnancy. European Heart Journal, 39(34), 3167–3213.