This biology question covers important biological concepts and processes. The step-by-step explanation below helps you understand the underlying mechanisms and reasoning.
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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.