Answer the questions related to Case Scenario 1 about Mrs. Kila, a 33-year-old primigravida, and Case Scenario 2 about Mary, a 24-year-old woman who delivered a baby girl.

a) Mrs. Kila's diagnosis is Severe Preeclampsia. This is indicated by her gestational age (34 weeks), new-onset hypertension (BP 160/100 mmHg), significant proteinuria (+3 on dipstick), and symptoms like persistent headache and generalized edema (face, hands, pitting edema on legs).

b) The primary risk factor for preeclampsia present in this case is that Mrs. Kila is a primigravida (first pregnancy).

c) The signs and symptoms of the condition shown by Mrs. Kila are:

• Persistent headache
• Swelling of her feet and face (generalized edema, pitting edema on legs, swelling of hands)
• Blood Pressure of 160/100 mmHg (hypertension)
• +3 proteinuria on urine dipstick

d) Additional assessments or investigations that should be done include:

• Blood tests: Complete Blood Count (CBC) with platelet count, Liver Function Tests (AST, ALT), Renal Function Tests (Creatinine, BUN, Uric Acid), Lactate Dehydrogenase (LDH).
• Urine tests: 24-hour urine collection for total protein.
• Fetal assessment: Ultrasound for fetal growth and amniotic fluid volume, Doppler velocimetry of the umbilical artery, Non-stress Test (NST) or Biophysical Profile (BPP) to assess fetal well-being.
• Neurological assessment: Deep Tendon Reflexes (DTRs) to check for hyperreflexia.

e) The possible complications of untreated preeclampsia are:

• For the mother:
  • Eclampsia (seizures)
  • HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)
  • Placental abruption
  • Acute kidney injury
  • Cerebral hemorrhage/stroke
  • Pulmonary edema
• For the fetus:
  • Intrauterine Growth Restriction (IUGR)
  • Preterm birth
  • Oligohydramnios
  • Fetal distress
  • Stillbirth

f) Immediate nursing or midwifery management for Mrs. Kila includes:

• Hospitalization for close monitoring.
• Continuous monitoring of maternal vital signs (BP, pulse, respiratory rate, temperature), urine output (hourly), Deep Tendon Reflexes (DTRs), and signs of worsening preeclampsia (headache, visual changes, epigastric pain).
• Continuous Fetal Heart Rate (FHR) monitoring or frequent Non-stress Tests (NSTs).
• Administration of antihypertensive medications (e.g., Labetalol, Hydralazine) to control severe hypertension.
• Administration of Magnesium Sulfate for seizure prophylaxis.
• Bed rest in a left lateral position to optimize placental perfusion.
• Fluid restriction to prevent pulmonary edema.
• Preparation for delivery, as it is the definitive treatment for preeclampsia, especially at 34 weeks gestation.

g) Health education for Mrs. Kila should include:

• An explanation of preeclampsia, its severity, and the importance of treatment.
• Instruction on warning signs of worsening preeclampsia (severe headache, visual disturbances, epigastric pain, decreased fetal movement, sudden weight gain, increased swelling) and when to seek immediate medical attention.
• The importance of adherence to bed rest and prescribed medications.
• Guidance on daily fetal kick counts to monitor fetal well-being.
• Information about the need for continued monitoring postpartum as preeclampsia can persist or develop after delivery.