Treatment for Hypertension in Women

Case Study: KB

Patient Information: KB, 36, Female, Black

S.

CC (chief complaint): \\\\\\\"My mother took my blood pressure and it was a little higher than it should be\\\\\\\"

HPI: KB is a 36-year-old black female, who is 30 5/7 weeks pregnant. She presents with a complaint of high blood pressure noted by her mother. She also reports recent headaches but no other symptoms such as epigastric pain, vision changes, or nausea. She has noticed slight swelling and weight gain of 17 lbs to date. Fetal movement has been normal and she denies any leaking fluid, vaginal bleeding, or contractions. Prior to her pregnancy, she was on hctz for borderline BP but stopped it when she underwent IVF. Her blood pressure has since remained \\\\\\\"pretty normal\\\\\\\". Her current BP is 162/90 with a pulse of 82, respirations 16, and temperature 98.2 orally.

Current Medications: Prenatal vitamins

Allergies: None reported

PMHx: Borderline hypertension. No history of major illnesses. Currently in her first pregnancy, conceived through IVF.

Soc & Substance Hx: Non-smoker, non-drinker, no recreational drug use. Works as a teacher.

Fam Hx: Mother living with hypertension. No known genetic disorders.

Surgical Hx: None reported.

Mental Hx: None reported.

Violence Hx: No current or historical concerns about personal, home, community, or sexual safety.

Reproductive Hx: Currently 30 5/7 weeks pregnant (G1 P0), conceived via IVF. No complications reported.

ROS: GENERAL: Slight swelling noted, 17lbs weight gain since the start of pregnancy. CARDIOVASCULAR: High blood pressure readings at home. RESPIRATORY: Breathing is unlabored, respirations 16. NEUROLOGICAL: Complains of headache. GENITOURINARY/REPRODUCTIVE: Normal fetal movement, no vaginal bleeding or fluid leakage.

O.

Physical exam: KB is alert, oriented, and in no apparent distress. Fetal heart rate and movement are within normal limits. Peripheral edema noted in the lower extremities.

Diagnostic results: Lab work for CBC and glucose are within normal limits. BP is 162/90, pulse 82, respirations 16, temperature 98.2 orally.

A.

1. Gestational Hypertension: Given the elevated BP readings and absence of proteinuria (Mruma et al., 2020).

2. Preeclampsia: High BP and headaches could be early signs despite absence of proteinuria (Tanner et al., 2022).

3. Chronic Hypertension: KB has a history of borderline hypertension (Thomas et al., 2020).

Most important diagnosis: Gestational Hypertension, as her hypertension started after 20 weeks of pregnancy without the presence of significant proteinuria.

P.

Further diagnostics including urine protein/creatinine ratio and liver function tests are recommended to rule out preeclampsia. She should be counseled to continue monitoring blood pressure at home, monitor for symptoms of preeclampsia, and maintain regular prenatal visits. Labetalol could be considered for BP control given her previous prescription and it\\\\\\\'s generally safe use in pregnancy. A referral to a high-risk obstetrician might be necessary given her elevated BP.

Reflection

I agree with the care provided. Regular monitoring and appropriate referral is crucial in this case. I would advise KB about the importance of medication adherence. Labetalol is generally safe in pregnancy and could help maintain her BP within a safer range, reducing risk to both her and the baby. It is important to address concerns about medication safety in pregnancy to improve adherence.

Health promotion and disease prevention should also be discussed with KB, focusing on the importance of a balanced diet, regular physical activity, and stress management techniques, as well as the importance of routine prenatal care visits. It is also important to ensure she knows the warning signs of severe preeclampsia, such as severe headache, vision changes, severe upper abdominal pain, and to seek immediate medical care if these occur.

Reflecting on this case, I would also say that I recognize areas for improvement. One major area is patient education. Kita\\\\\\\'s reluctance to take her medication shows the need to have more detailed discussions about the benefits and risks of prescribed medications. Also, I see the need for better screening practices for hypertension in pregnant women, especially those with a history of high blood pressure.