A 34-year-old woman at 34 weeks gestation presents with severe headache, blurred vision, RUQ pain, and a blood pressure of 168/110. What is the most likely diagnosis and the immediate nursing priority?

A 34-year-old woman at 34 weeks gestation presents with severe headache, blurred vision, RUQ pain, and a blood pressure of 168/110. What is the most likely diagnosis and the immediate nursing priority?

• A. Preeclampsia with severe features; initiate seizure prophylaxis with magnesium sulfate and BP control per orders, and prepare for delivery as indicated.
• B. Eclampsia; administer antihypertensives and magnesium sulfate; deliver immediately.
• C. Gestational hypertension; monitor and plan delivery at 37 weeks.
• D. Acute fatty liver of pregnancy; initiate liver support and expedite delivery.

Answer: (A)

Preeclampsia with severe features is the scenario here: after 20 weeks of gestation, a pregnant person has high blood pressure plus signs of end-organ involvement. Severe features are suggested by headache, visual disturbances, and RUQ pain, which reflect cerebral and hepatic involvement. When these signs appear, the priority is to stabilize the mother to prevent progression to seizures (eclampsia) and other complications, and to manage blood pressure promptly. The best approach is to start seizure prophylaxis with magnesium sulfate and control the blood pressure according to the orders, while preparing for delivery if indicated. Magnesium sulfate helps prevent seizures by stabilizing neuronal activity, which is crucial given the severe-range BP and neurologic symptoms. Monitoring is essential during administration: watch for magnesium toxicity—loss of deep tendon reflexes, slowed respiration, and reduced urine output—so you can respond quickly if needed. Blood pressure management aims to reduce risk of stroke or placental at-rescission while maintaining adequate perfusion to both mother and fetus. Delivery is the definitive treatment for preeclampsia with severe features, and at 34 weeks, after maternal stabilization, delivery is typically pursued unless there are compelling maternal-fetal reasons to defer. Why the other scenarios don’t fit as well: eclampsia would involve actual seizures already occurring, which isn’t stated here. gestational hypertension lacks the end-organ signs like severe headache, vision changes, and RUQ pain. acute fatty liver of pregnancy presents with liver dysfunction and coagulopathy symptoms that aren’t clearly indicated in this picture. In summary, the priority is to prevent progression to seizures and control BP with magnesium sulfate and antihypertensives, while planning for delivery once the mother is stabilized.

Preeclampsia with severe features is the scenario here: after 20 weeks of gestation, a pregnant person has high blood pressure plus signs of end-organ involvement. Severe features are suggested by headache, visual disturbances, and RUQ pain, which reflect cerebral and hepatic involvement. When these signs appear, the priority is to stabilize the mother to prevent progression to seizures (eclampsia) and other complications, and to manage blood pressure promptly.

The best approach is to start seizure prophylaxis with magnesium sulfate and control the blood pressure according to the orders, while preparing for delivery if indicated. Magnesium sulfate helps prevent seizures by stabilizing neuronal activity, which is crucial given the severe-range BP and neurologic symptoms. Monitoring is essential during administration: watch for magnesium toxicity—loss of deep tendon reflexes, slowed respiration, and reduced urine output—so you can respond quickly if needed. Blood pressure management aims to reduce risk of stroke or placental at-rescission while maintaining adequate perfusion to both mother and fetus.

Delivery is the definitive treatment for preeclampsia with severe features, and at 34 weeks, after maternal stabilization, delivery is typically pursued unless there are compelling maternal-fetal reasons to defer.

Why the other scenarios don’t fit as well: eclampsia would involve actual seizures already occurring, which isn’t stated here. gestational hypertension lacks the end-organ signs like severe headache, vision changes, and RUQ pain. acute fatty liver of pregnancy presents with liver dysfunction and coagulopathy symptoms that aren’t clearly indicated in this picture.

In summary, the priority is to prevent progression to seizures and control BP with magnesium sulfate and antihypertensives, while planning for delivery once the mother is stabilized.