Case Study: Hypertension in Pregnancy

Week 8: Common Health Conditions with Implications for Women

Medical science continues to make progress in better understanding the differences between specific health issues of women and health issues of men. Though some differences continue to confound healthcare professionals, significant progress continues to be made.
Technologies also continue to emerge to better support the treatment of women’s health issues. This includes devices to assist in the screening and diagnosis of women’s health conditions.
For this week, you will use a case study to analyze diagnoses presented in a case study. You also will consider and propose treatment plans for those diagnoses.

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Learning Objectives
Students will:
• Analyze differential diagnoses for patients
• Determine prioritized patient assessments
• Recommend diagnostic tests and treatment options
• Evaluate general guidelines for health screenings
• Identify key terms, concepts, and principles related to the primary care of individuals, families, and communities

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:
Based on your assigned case study, post the following:
1. What is your differential diagnosis? Provide a differential diagnosis (dx) with a minimum of 3 possible conditions or diseases.
2. Define what you believe is the most important diagnosis. Be sure to include the first priority in conducting your assessment.
3. What interventions would you implement? Explain which diagnostic tests and treatment options you would recommend for your patient and explain your reasoning.

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