NSG 6005 Advanced Pharmacology FL02 Week 1 completed A

NSG 6005 Advanced Pharmacology FL02 Week 1 Ms. BD who has been pregnant before and is now pregnant with a history of chronic hypertension has to be evaluated. Hypertension is the most common medical problem encountered in pregnancy and remains an important cause of maternal, and fetal, morbidity and mortality. It complicates up to 15% of pregnancies and accounts for approximately a quarter of all antenatal admissions. The hypertensive disorders of pregnancy cover a spectrum of conditions, of which pre-eclampsia poses the greatest potential risk and remains one of the most common causes of maternal death (Kattah, & Garovic, 2013). As healthcare professionals applying subjective or objective information to assess Ms. BD's condition is very important. However, the healthcare professional should be careful how they apply subjective data to create an outcome. To get a subjective view, the nurse would ask Ms. BD additional information in regards to her previous pregnancy and her experience with hypertension as well as diet. Objective data would include additional blood and urine test to evaluate her hypertension. This would give the nurse a better understanding. Prinzide which are considered ACE inhibitors can bring harm to a growing fetus. Taking Prinzide during pregnancy can increase the risk of serious health and can cause injury or death to the unborn baby. The U.S. Food and Drug Administration (FDA) now categorizes Prinzide as a pregnancy Category D medicine for all trimesters which can cause serious problems in the fetus or newborn. Therefore, the healthcare provider should immediately discontinue Ms. BD from taking Prinzide (Kattah, & Garovic, 2013). There is increased risk to the fetus if it is exposed to Prinzide during the first trimester. Some of the complications seen with fetuses or newborns exposed to Prinzide during pregnancy include hypotension, kidney failure, loss of life, jaundice, developmental problems with the nervous system, developmental problems with the cardiovascular system which includes the heart and/or blood vessels, deformities of the head and face and developmental problems with the lungs (Kattah, & Garovic, 2013). Maternal outcomes for pregnancy complicated by hypertension range from uneventful pregnancy in women with chronic, controlled hypertension to death in cases of preeclampsia-eclampsia. The major adverse outcomes include central nervous system (CNS) injuries such as seizures (eclampsia), hemorrhagic and ischemic strokes. Additionally, the effects of chronic, controlled hypertension in pregnancy on the fetus are minimal. However, preeclampsia-eclampsia can lead to higher frequency of induced labor, fetal growth restriction, neonatal respiratory difficulties, and increased frequency admission to neonatal intensive care unit. Therefore, laboratory assessment is necessary. Some of the assessment would include hemolysis, elevated liver enzymes, thrombocytopenia, and elevated creatinine or multiple abnormalities, also measurements of creatinine clearance, blood urea nitrogen, albumin, 24-hour urinary protein, serum calcium, uric acid, glycosylated hemoglobin, thyroid-stimulating hormone (TSH), liver enzymes and bilirubin, and a urine dip for protein. These tests are imperative to evaluate the progress of hypertension and also the growing fetus (Townsend, O’Brien, & Khalil, 2016). Methyldopa is an antihypertensive agent thought to act by stimulating α2-adrenergic receptors. Methyldopa is used to treat hypertension and is safe for pregnant mothers. Methyldopa exhibits variable absorption from the gastrointestinal tract. It is metabolized in the liver and intestines and is excreted in urine. Additionally, it is a competitive inhibitor of the enzyme DOPA decarboxylase, also known as aromatic L-amino acid decarboxylase, which converts L-DOPA into dopamine and It is converted to α-methylnorepinephrine by dopamine beta-hydroxylase (DBH). Some side effects include dizziness, lightheadedness, drowsiness, headache, stuffy nose, and weakness may occur as the body adjusts to the medication. However, if this persists Ms. BD should speak with her healthcare provider (Kattah, & Garovic, 2013). The doctor would ensure that Ms. BD is taking the right medications along with other prenatal vitamins. The doctor would also advise on frequent tests and monitoring of the fetus as well as provide educational material on methyldopa which would include side effects and other necessary information. Along with the medication MS. BD would also need to create a holistic lifestyle plan to care for herself and the growing fetus which includes diet and nutrition. Therefore the doctor would ensure that Ms. BD is also provided with this information. As a nurse, I would treat this physician. I would ensure that she has done all the required tests, make my evaluations. I would also prescribe her the relevant medications along her prenatal care. Additionally, I would make sure there are following tests and monitoring of the fetus. Reference Kattah, A. G., & Garovic, V. D. (2013). The Management of Hypertension in Pregnancy. Advances in Chronic Kidney Disease, 20(3), 229–239. Townsend, R., O’Brien, P., & Khalil, A. (2016). Current best practice in the management of hypertensive disorders in pregnancy. Integrated Blood Pressure Control, 9, 79–94.