What is your differential diagnosis? What interventions would you implement? What further information would you need?.
What is your differential diagnosis? What interventions would you implement? What further information would you need?
Week 8 Case Studies Case Study 1 Case Study: Hypertension in Pregnancy Kita Brown is a 36-year-old G1 P0 black female presenting to her local urgent care with headache and stating her mother took her blood pressure and it was a “little higher than it should be”. Kita has had an unremarkable pregnancy, which was conceived thru IVF. She is currently 30 5/7 weeks pregnant and relates she has had no problem with her pregnancy. She only takes prenatal vitamins, and relates she was on hctz prior to pregnancy for borderline BP but stopped it when she underwent IVF and her BP has remained “pretty normal”. Sher relates she was prescribed po labetalol but did not take it regularly as she didn’t want to take anything that might hurt the baby. Her initial prenatal screening, including initial labs, and third trimester CBC and glucose testing have been normal. She additionally at her 1st prenatal visit had baseline PIH (pregnancy induced hypertension/pre-eclampsia) due to her history of hypertension which were normal including a protein to creatine ratio. Upon intake at the urgent care the notes relate she appears in no apparent distress, and she has reported fetal movement within the past hour. She denies, any other symptoms including epigastric pain, vision changes or nausea. She states fetal movement has been normal, and denies leaking fluid, vaginal bleeding, or contractions. She relates slight swelling and her weight gain date has been 17 lbs. Current BMI is 25.1. BP is 162/90, pulse 82, respirations 16 and unlabored, temperature 98.2 orally. Kita was transferred to the emergency room due to her complaints and her gestational age. Upon arrival to the emergency room 30 minutes later her repeat BP was 166/ 88. It was retaken 15 minutes later and was 162/92. All blood pressures were confirmed with a manual cuff. She had no additional complaints. QUESTIONS: What is your differential diagnosis? What interventions would you implement? What further information would you need? Update: BP stabilized at 140/88 after 2 doses of IV hydralazine and one dose of po nifedipine. Lab results have now returned and are as follows: WBC 10.92 RBC 3.63 Hgb 10.4 Hct 32,5 Plts 238 Glucose 98 Sodium 144 Potassium 3.9 BUN 9 Creatinine 0.64 ALT (SGPT) 96 AST 75 Alk Phos 187 aPTT 26.9 Fibrinogen 650 Uric acid 3 Urine protein/Cretinine ratio 0.11 What is your presumptive diagnosis based on this information? What are your next steps?
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