Home>Homework Answsers>Nursing homework helpnursingMSNa month ago31.05.202510Report issuefiles (1)response1week4.pdfresponse1week4.pdfTable 1: Hypertensive Disorders of PregnancyTable 2: Postpartum Mental Health and Physical DisordersMental Health DisordersClassificat
ion DefinitionGestatio
nal Agein WeeksMaternal
BP ProteinuriaS
ei
z
ur
e
sGestation
al HTNNew-onset HTN without
proteinuria or end-organ
dysfunction>20
weeks≥140/90
on 2
occasion
sNo
N
oMild
Preeclam
psiaHTN with proteinuria or signs of
mild end-organ dysfunction>20
weeks≥140/90
but
<160/110Yes (≥300
mg/24h or
≥1+ dipstick)N
oSevere
Preeclam
psiaPreeclampsia with severe
features (e.g., high BP,
thrombocytopenia, elevated
LFTs)>20
weeks ≥160/110 YesN
oEclampsia
Preeclampsia with seizures not
attributable to other causes>20
weeks≥140/90
(may
vary)Yes
Y
esChronic
HTNHTN diagnosed before 20 weeks
or persists >12 weeks
postpartum<20
weeks or
pre-
existing≥140/90
No (unless
superimpos
ed)N
oSuperimp
osed
Preeclam
psiaChronic HTN with new-onset
proteinuria or worsening BP/
organ dysfunctionAny,
usually
>20
weeks≥140/90
(worseni
ng trend)Yes
N
oConditi
on Definition Signs and Symptoms ManagementPostpar
tum
BluesTransient mood
disturbance in first
few days after
deliveryCrying, mood swings, irritability,
anxiety, sleep disturbance;
resolves <2 weeksReassurance,
support,
monitoringPostpar
tum
Depres
sionMajor depressive
episode within 12
months postpartumSadness, hopelessness, loss of
interest, sleep/appetite
changes, suicidal ideationPsychotherapy,
SSRIs (e.g.,
sertraline),
screeningPostpar
tum
OCDObsessions and/or
compulsions related
to infant safetyIntrusive thoughts (e.g., harm to
infant), compulsive behaviors,
intense distressCBT, SSRIs,
psychiatric referralPostpar
tum
Psycho
sisRare, severe
psychiatric
emergency
postpartumDelusions, hallucinations, mood
swings, confusion, disorganized
thinkingHospitalization,
antipsychotics,
safety precautionsPostpartum Physical ConditionsSOAP Note – Prenatal VisitPatient: Hannah (female)
Age: 38
Gravida/Para: G1P0
Gestational Age: 32 weeks EGASubjectiveChief Complaint:
"I’ve had a headache that won’t go away and I just don’t feel right."Condition Definition Presentation (Signs
and Symptoms) ManagementPuerperal
FeverFever ≥100.4°F on
≥2 days postpartum
(excluding day 1)Uterine tenderness, foul
lochia, chills,
tachycardia, elevated
WBCBroad-spectrum
antibiotics (e.g.,
clindamycin +
gentamicin)Postpartum
HematomaCollection of blood
in vulva/vagina/
pelvis after deliverySevere perineal pain,
swelling, visible mass,
hypotension (if large)Small: Ice, analgesia;
Large: surgical
evacuationSecondary
Postpartum
HemorrhageExcessive bleeding
>24h to 6 weeks
postpartumPersistent bright red
bleeding, passage of
clots, uterine
subinvolutionUterotonics, D&C for
retained products,
antibiotics if infectedSore
NipplesCommon during
early breastfeedingNipple pain, cracking,
bleeding, latch painImprove latch, lanolin,
breast shields,
lactation consultMastitis
Inflammation of
breast tissue (often
due to infection)Unilateral breast pain,
redness, fever, flu-like
symptomsContinue
breastfeeding,
antibiotics (e.g.,
dicloxacillin)Breast
AbscessLocalized pus
collection in breastPainful, fluctuant mass,
erythema, feverDrainage (needle
aspiration or I&D),
antibioticsHPI:
Hannah is a 38-year-old primigravida at 32 weeks gestation presenting for a routine prenatal
visit. She reports experiencing a persistent, dull headache for the past 7 days that has not
responded to acetaminophen. She also describes a general sense of malaise and “not feeling
right.” She denies visual disturbances, nausea, vomiting, epigastric pain, chest pain, shortness of
breath, or recent illness. Fetal movements are present and normal.Obstetric History:• G1P0• No complications reported until this visitMedical History:• No known chronic conditions• No history of chronic hypertension or preeclampsiaMedications:• Prenatal vitamins• Acetaminophen PRN (for headache)Allergies:• NKDASocial History:• Non-smoker, no alcohol or drug use• Supportive home environmentROS:• Neuro: Persistent headache• GU: No dysuria, vaginal bleeding, or leakage• Cardio/Resp: No chest pain, dyspnea• GI: No nausea, vomiting, or RUQ pain• Vision: No changes or disturbances reported• MSK: No swelling noted by patientO – ObjectiveVitals:• BP: 156/96 mmHg (repeated and confirmed)• HR: 86 bpm• RR: 16• Temp: 98.6°F• Weight: [Insert]• Fundal height: 32 cm• Fetal heart rate: 140 bpm (normal)• Fetal movement: Present by maternal reportPhysical Exam:• General: Alert, mildly anxious• HEENT: Normocephalic, no sinus tenderness• CV: Regular rhythm, no murmurs• Lungs: Clear to auscultation bilaterally• Abdomen: Non-tender, fundal height appropriate• Extremities: No significant edema noted• Neuro: No focal deficits, reflexes slightly brisk (3+)• Urine dip: 2+ proteinuriaA – AssessmentPrimary Diagnosis:• Preeclampsia with severe featureso ICD-10: O14.13 – Severe preeclampsia, third trimesterRationale:
BP >140/90 with proteinuria and symptoms (persistent headache, not relieved by medication)
indicates preeclampsia with severe features per ACOG criteria.P – PlanImmediate Management:• Hospital admission for further evaluation and management• Labs ordered:o CBC with plateletso CMP (AST/ALT, creatinine)o LDHo Coagulation profileo 24-hour urine collection or protein/creatinine ratio• Fetal monitoring:o Non-stress test (NST)o Biophysical profile (BPP)o Ultrasound for fetal growth and amniotic fluid indexMedications/Interventions:• Labetalol or hydralazine IV as needed to control BP per hospital protocol• Magnesium sulfate for seizure prophylaxis• Corticosteroids (e.g., betamethasone 12 mg IM q24h × 2) if delivery anticipated <34 weeksEducation:• Explained signs of worsening preeclampsia (severe headache, visual changes, RUQ pain,
reduced fetal movement)• Importance of hospital monitoring for maternal and fetal safety• Possible need for early delivery if condition worsensFollow-up:• Inpatient monitoring and coordination with OB/MFM team• Continued prenatal care per high-risk protocol1. Subjectivea. Relevant HPI Questions:• When did the headache start? Describe its location, intensity, and whether it's continuous or
intermittent.• Does the headache worsen with light, noise, or activity?• Are there any visual symptoms (blurred vision, flashing lights, scotomata)?• Do you have any upper abdominal (RUQ) pain?• Any nausea, vomiting, or swelling in your hands, face, or feet?• Fetal movement – has it changed?• Any recent illness, infections, or trauma?b. Medical History Questions:• Do you have a history of high blood pressure or kidney disease?• Any autoimmune disorders (e.g., lupus, antiphospholipid syndrome)?• Are you currently taking any medications, including over-the-counter or herbal supplements?• Any allergies or history of migraines?c. OB History Questions:• Have you had any complications so far in this pregnancy?• Any prior pregnancies, losses, or fertility treatments?• Results of prior ultrasounds or labs during this pregnancy?• Have you had any bleeding, cramping, or leaking fluid?2. Objectivea. Physical Assessment:• Vitals: Blood pressure (repeat in both arms, after 5 mins of rest), pulse, temperature,
respiratory rate, weight.• General appearance: Distress, alertness, signs of pain or swelling.• Neurological: Mental status, deep tendon reflexes (DTRs), clonus.• Cardiovascular: Heart sounds, edema in extremities.• Pulmonary: Breath sounds (rales/crackles may suggest pulmonary edema).• Abdomen: Fundal height, fetal movement, tenderness, RUQ or epigastric pain.• OB exam: Fetal heart tones (FHT), Leopold's maneuvers.b. Tests to Order and Rationale:• CBC with platelets: Check for thrombocytopenia (part of severe features).• CMP (LFTs, creatinine): Evaluate liver enzymes and renal function.• LDH: Marker of hemolysis.• Urine protein/creatinine ratio or 24-hour urine protein: Quantify proteinuria.• Non-stress test (NST): Assess fetal well-being.• Ultrasound: Assess fetal growth, amniotic fluid, and Dopplers if growth-restriction
suspected.• Magnesium sulfate eligibility screen: For seizure prophylaxis.3. Assessment/Diagnosisa. Primary Diagnosis:• Preeclampsia with severe featureso ICD-10: O14.13 – Severe preeclampsia, third trimesterb. Differential Diagnoses:• Chronic hypertension with proteinuria (unlikely given gestational timing)• Migraine headache (no visual aura or typical features)• Gestational hypertension (but proteinuria and symptoms point beyond this)• HELLP syndrome (if labs show hemolysis, elevated LFTs, low platelets)• 4. Plana. Outpatient Management?• No. This cannot be safely managed outpatient due to:o Severe range BP (≥160 systolic or ≥110 diastolic)o Persistent headache (a severe feature)o Proteinuria + systemic symptomso Risk of rapid decompensation for mother and fetusb. Inpatient Management? Why?• Yes, inpatient is required for:o Close BP and neurological monitoringo Lab surveillance for HELLP or eclampsiao Seizure prophylaxis (magnesium sulfate)o Fetal monitoring for distresso Potential delivery if maternal or fetal conditions worsenc. Outpatient Plan (if symptoms were milder):
N/A in this case due to severe features.d. Inpatient Plan:• Medications:o Magnesium sulfate IV for seizure prophylaxiso Labetalol or hydralazine IV for BP controlo Corticosteroids (betamethasone 12 mg IM x 2 doses) if <34 weeks for fetal lung maturity• Tests:o Serial BP and neuro checks (q4h or more frequent)o Daily labs (CBC, CMP, LDH)o Continuous fetal monitoringo Ultrasound with Dopplers and amniotic fluid index• Discharge Planning:o If stabilized and not delivered: home on oral antihypertensives, twice-weekly NSTs, weekly
labs, and BP checkso If delivered: follow up in 1–2 weeks post-discharge with BP monitoring and depression
screeninge. Patient Education:• Warning signs of worsening: severe headache, vision changes, RUQ pain, decreased fetal
movement• Importance of medication compliance and follow-up visits• Rest and avoid high-sodium foods• Possible need for early delivery• Educate on signs of postpartum preeclampsia and eclampsiaf. Complications if Untreated:• Maternal risks: Eclampsia (seizures), stroke, pulmonary edema, liver rupture, renal failure,
HELLP syndrome, death• Fetal risks: IUGR, placental abruption, hypoxia, preterm delivery, stillbirthPostpartum Physical ConditionsSOAP Note – Prenatal VisitO – ObjectiveA – AssessmentP – Plan1. Subjective2. Objective3. Assessment/Diagnosisresponse1week4.pdfTable 1: Hypertensive Disorders of PregnancyTable 2: Postpartum Mental Health and Physical DisordersMental Health DisordersClassificat
ion DefinitionGestatio
nal Agein WeeksMaternal
BP ProteinuriaS
ei
z
ur
e
sGestation
al HTNNew-onset HTN without
proteinuria or end-organ
dysfunction>20
weeks≥140/90
on 2
occasion
sNo
N
oMild
Preeclam
psiaHTN with proteinuria or signs of
mild end-organ dysfunction>20
weeks≥140/90
but
<160/110Yes (≥300
mg/24h or
≥1+ dipstick)N
oSevere
Preeclam
psiaPreeclampsia with severe
features (e.g., high BP,
thrombocytopenia, elevated
LFTs)>20
weeks ≥160/110 YesN
oEclampsia
Preeclampsia with seizures not
attributable to other causes>20
weeks≥140/90
(may
vary)Yes
Y
esChronic
HTNHTN diagnosed before 20 weeks
or persists >12 weeks
postpartum<20
weeks or
pre-
existing≥140/90
No (unless
superimpos
ed)N
oSuperimp
osed
Preeclam
psiaChronic HTN with new-onset
proteinuria or worsening BP/
organ dysfunctionAny,
usually
>20
weeks≥140/90
(worseni
ng trend)Yes
N
oConditi
on Definition Signs and Symptoms ManagementPostpar
tum
BluesTransient mood
disturbance in first
few days after
deliveryCrying, mood swings, irritability,
anxiety, sleep disturbance;
resolves <2 weeksReassurance,
support,
monitoringPostpar
tum
Depres
sionMajor depressive
episode within 12
months postpartumSadness, hopelessness, loss of
interest, sleep/appetite
changes, suicidal ideationPsychotherapy,
SSRIs (e.g.,
sertraline),
screeningPostpar
tum
OCDObsessions and/or
compulsions related
to infant safetyIntrusive thoughts (e.g., harm to
infant), compulsive behaviors,
intense distressCBT, SSRIs,
psychiatric referralPostpar
tum
Psycho
sisRare, severe
psychiatric
emergency
postpartumDelusions, hallucinations, mood
swings, confusion, disorganized
thinkingHospitalization,
antipsychotics,
safety precautionsPostpartum Physical ConditionsSOAP Note – Prenatal VisitPatient: Hannah (female)
Age: 38
Gravida/Para: G1P0
Gestational Age: 32 weeks EGASubjectiveChief Complaint:
"I’ve had a headache that won’t go away and I just don’t feel right."Condition Definition Presentation (Signs
and Symptoms) ManagementPuerperal
FeverFever ≥100.4°F on
≥2 days postpartum
(excluding day 1)Uterine tenderness, foul
lochia, chills,
tachycardia, elevated
WBCBroad-spectrum
antibiotics (e.g.,
clindamycin +
gentamicin)Postpartum
HematomaCollection of blood
in vulva/vagina/
pelvis after deliverySevere perineal pain,
swelling, visible mass,
hypotension (if large)Small: Ice, analgesia;
Large: surgical
evacuationSecondary
Postpartum
HemorrhageExcessive bleeding
>24h to 6 weeks
postpartumPersistent bright red
bleeding, passage of
clots, uterine
subinvolutionUterotonics, D&C for
retained products,
antibiotics if infectedSore
NipplesCommon during
early breastfeedingNipple pain, cracking,
bleeding, latch painImprove latch, lanolin,
breast shields,
lactation consultMastitis
Inflammation of
breast tissue (often
due to infection)Unilateral breast pain,
redness, fever, flu-like
symptomsContinue
breastfeeding,
antibiotics (e.g.,
dicloxacillin)Breast
AbscessLocalized pus
collection in breastPainful, fluctuant mass,
erythema, feverDrainage (needle
aspiration or I&D),
antibioticsHPI:
Hannah is a 38-year-old primigravida at 32 weeks gestation presenting for a routine prenatal
visit. She reports experiencing a persistent, dull headache for the past 7 days that has not
responded to acetaminophen. She also describes a general sense of malaise and “not feeling
right.” She denies visual disturbances, nausea, vomiting, epigastric pain, chest pain, shortness of
breath, or recent illness. Fetal movements are present and normal.Obstetric History:• G1P0• No complications reported until this visitMedical History:• No known chronic conditions• No history of chronic hypertension or preeclampsiaMedications:• Prenatal vitamins• Acetaminophen PRN (for headache)Allergies:• NKDASocial History:• Non-smoker, no alcohol or drug use• Supportive home environmentROS:• Neuro: Persistent headache• GU: No dysuria, vaginal bleeding, or leakage• Cardio/Resp: No chest pain, dyspnea• GI: No nausea, vomiting, or RUQ pain• Vision: No changes or disturbances reported• MSK: No swelling noted by patientO – ObjectiveVitals:• BP: 156/96 mmHg (repeated and confirmed)• HR: 86 bpm• RR: 16• Temp: 98.6°F• Weight: [Insert]• Fundal height: 32 cm• Fetal heart rate: 140 bpm (normal)• Fetal movement: Present by maternal reportPhysical Exam:• General: Alert, mildly anxious• HEENT: Normocephalic, no sinus tenderness• CV: Regular rhythm, no murmurs• Lungs: Clear to auscultation bilaterally• Abdomen: Non-tender, fundal height appropriate• Extremities: No significant edema noted• Neuro: No focal deficits, reflexes slightly brisk (3+)• Urine dip: 2+ proteinuriaA – AssessmentPrimary Diagnosis:• Preeclampsia with severe featureso ICD-10: O14.13 – Severe preeclampsia, third trimesterRationale:
BP >140/90 with proteinuria and symptoms (persistent headache, not relieved by medication)
indicates preeclampsia with severe features per ACOG criteria.P – PlanImmediate Management:• Hospital admission for further evaluation and management• Labs ordered:o CBC with plateletso CMP (AST/ALT, creatinine)o LDHo Coagulation profileo 24-hour urine collection or protein/creatinine ratio• Fetal monitoring:o Non-stress test (NST)o Biophysical profile (BPP)o Ultrasound for fetal growth and amniotic fluid indexMedications/Interventions:• Labetalol or hydralazine IV as needed to control BP per hospital protocol• Magnesium sulfate for seizure prophylaxis• Corticosteroids (e.g., betamethasone 12 mg IM q24h × 2) if delivery anticipated <34 weeksEducation:• Explained signs of worsening preeclampsia (severe headache, visual changes, RUQ pain,
reduced fetal movement)• Importance of hospital monitoring for maternal and fetal safety• Possible need for early delivery if condition worsensFollow-up:• Inpatient monitoring and coordination with OB/MFM team• Continued prenatal care per high-risk protocol1. Subjectivea. Relevant HPI Questions:• When did the headache start? Describe its location, intensity, and whether it's continuous or
intermittent.• Does the headache worsen with light, noise, or activity?• Are there any visual symptoms (blurred vision, flashing lights, scotomata)?• Do you have any upper abdominal (RUQ) pain?• Any nausea, vomiting, or swelling in your hands, face, or feet?• Fetal movement – has it changed?• Any recent illness, infections, or trauma?b. Medical History Questions:• Do you have a history of high blood pressure or kidney disease?• Any autoimmune disorders (e.g., lupus, antiphospholipid syndrome)?• Are you currently taking any medications, including over-the-counter or herbal supplements?• Any allergies or history of migraines?c. OB History Questions:• Have you had any complications so far in this pregnancy?• Any prior pregnancies, losses, or fertility treatments?• Results of prior ultrasounds or labs during this pregnancy?• Have you had any bleeding, cramping, or leaking fluid?2. Objectivea. Physical Assessment:• Vitals: Blood pressure (repeat in both arms, after 5 mins of rest), pulse, temperature,
respiratory rate, weight.• General appearance: Distress, alertness, signs of pain or swelling.• Neurological: Mental status, deep tendon reflexes (DTRs), clonus.• Cardiovascular: Heart sounds, edema in extremities.• Pulmonary: Breath sounds (rales/crackles may suggest pulmonary edema).• Abdomen: Fundal height, fetal movement, tenderness, RUQ or epigastric pain.• OB exam: Fetal heart tones (FHT), Leopold's maneuvers.b. Tests to Order and Rationale:• CBC with platelets: Check for thrombocytopenia (part of severe features).• CMP (LFTs, creatinine): Evaluate liver enzymes and renal function.• LDH: Marker of hemolysis.• Urine protein/creatinine ratio or 24-hour urine protein: Quantify proteinuria.• Non-stress test (NST): Assess fetal well-being.• Ultrasound: Assess fetal growth, amniotic fluid, and Dopplers if growth-restriction
suspected.• Magnesium sulfate eligibility screen: For seizure prophylaxis.3. Assessment/Diagnosisa. Primary Diagnosis:• Preeclampsia with severe featureso ICD-10: O14.13 – Severe preeclampsia, third trimesterb. Differential Diagnoses:• Chronic hypertension with proteinuria (unlikely given gestational timing)• Migraine headache (no visual aura or typical features)• Gestational hypertension (but proteinuria and symptoms point beyond this)• HELLP syndrome (if labs show hemolysis, elevated LFTs, low platelets)• 4. Plana. Outpatient Management?• No. This cannot be safely managed outpatient due to:o Severe range BP (≥160 systolic or ≥110 diastolic)o Persistent headache (a severe feature)o Proteinuria + systemic symptomso Risk of rapid decompensation for mother and fetusb. Inpatient Management? Why?• Yes, inpatient is required for:o Close BP and neurological monitoringo Lab surveillance for HELLP or eclampsiao Seizure prophylaxis (magnesium sulfate)o Fetal monitoring for distresso Potential delivery if maternal or fetal conditions worsenc. Outpatient Plan (if symptoms were milder):
N/A in this case due to severe features.d. Inpatient Plan:• Medications:o Magnesium sulfate IV for seizure prophylaxiso Labetalol or hydralazine IV for BP controlo Corticosteroids (betamethasone 12 mg IM x 2 doses) if <34 weeks for fetal lung maturity• Tests:o Serial BP and neuro checks (q4h or more frequent)o Daily labs (CBC, CMP, LDH)o Continuous fetal monitoringo Ultrasound with Dopplers and amniotic fluid index• Discharge Planning:o If stabilized and not delivered: home on oral antihypertensives, twice-weekly NSTs, weekly
labs, and BP checkso If delivered: follow up in 1–2 weeks post-discharge with BP monitoring and depression
screeninge. Patient Education:• Warning signs of worsening: severe headache, vision changes, RUQ pain, decreased fetal
movement• Importance of medication compliance and follow-up visits• Rest and avoid high-sodium foods• Possible need for early delivery• Educate on signs of postpartum preeclampsia and eclampsiaf. Complications if Untreated:• Maternal risks: Eclampsia (seizures), stroke, pulmonary edema, liver rupture, renal failure,
HELLP syndrome, death• Fetal risks: IUGR, placental abruption, hypoxia, preterm delivery, stillbirthPostpartum Physical ConditionsSOAP Note – Prenatal VisitO – ObjectiveA – AssessmentP – Plan1. Subjective2. Objective3. Assessment/DiagnosisBids(53)Dr. Ellen RMMISS HILLARY A+Dr. Aylin JMnicohwilliamProf Double Rfirstclass tutorsherry proffMUSYOKIONES A+Dr ClovergrA+de plusSheryl HoganProWritingGuruDr. Everleigh_JKIsabella HarvardBrilliant GeekWIZARD_KIMPROF_ALISTERTeacher A+ WorkAshley ElliePremiumShow All Bidsother Questions(10)16 pages. needed in 7 hourshomework 3AccountingReflection paperI need proficientFor PROFESSOR GEEK onlyPHIBCOM 275 Final ExamINF220Forecasting is an essential tool used by health care administrators to develop objectives and project plans. Develop two objectives for the facility that are consistent with the organizational mission.
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