A client is diagnosed with preeclampsia at 28 weeks. What is the goal of treatment?

The nonstress test (NST) evaluates fetal oxygenation by monitoring the fetal heart rate response to spontaneous fetal movement. A reactive result requires 2 or more accelerations within 20 minutes, indicating a healthy autonomic nervous system. This non-invasive assessment detects potential placental insufficiency or fetal hypoxia.

A. Measure amniotic fluid: Quantifying fluid volume is performed via ultrasound to calculate the amniotic fluid index (AFI). While often paired with an NST to form a biophysical profile, the NST itself uses electronic fetal monitoring to track heart rate patterns only. It does not provide data on fluid pockets.

B. Determine fetal lung maturity: Lung maturity is assessed through an amniocentesis to measure the lecithin-sphingomyelin ratio or the presence of phosphatidylglycerol. The NST is a functional assessment of current oxygenation and neurological status, not a biochemical analysis of surfactant production in fetal lungs.

C. Assess fetal well-being: The primary goal is to confirm that the fetus is adequately oxygenated and has an intact central nervous system. Accelerations in response to movement indicate that the fetal brain is receiving sufficient perfusion. It is the first-line screening tool for high-risk pregnancies.

D. Detect genetic disorders: Screening for chromosomal abnormalities like Trisomy 21 involves maternal serum markers, cell-free DNA testing, or chorionic villus sampling. An NST cannot identify genetic sequences or structural malformations. It only monitors the physiological responses of the fetus at that specific moment.

Hyperemesis gravidarum is a pathological state of intractable vomiting resulting in ketonuria, dehydration, and significant electrolyte depletion. The clinical management aims to restore hemodynamic stability and suppress the overactive emetic reflex. Interventions focus on maintaining metabolic homeostasis and preventing Wernicke’s encephalopathy through thiamine and fluid replacement.

A. Antiemetics: Pharmacological management using pyridoxine, doxylamine, or ondansetron is necessary to interrupt the vomiting cycle. These medications act on the chemoreceptor trigger zone or vestibular system to reduce nausea. Effective suppression of emesis allows for the gradual reintroduction of oral nutrition and hydration.

B. Fluid restriction: Restricting fluids is contraindicated and dangerous for a client already suffering from intravascular dehydration. Adequate hydration is the cornerstone of therapy to prevent renal failure and maintain uteroplacental perfusion. Restricting intake would exacerbate tachycardia and orthostatic hypotension.

C. Avoid triggers: Identifying and eliminating environmental stimuli like strong odors, flickering lights, or specific textures reduces sensory input to the emetic center. Behavioral modification is a non-pharmacological necessity to prevent recurrent episodes of nausea. This helps stabilize the gastric mucosa and CNS.

D. IV fluids: Intravenous rehydration with isotonic crystalloids is the priority intervention for clients unable to tolerate oral intake. This corrects volume deficits and replenishes depleted electrolytes like potassium and chloride. It is essential for reversing metabolic alkalosis caused by loss of gastric acid.

E. Small frequent meals: Once vomiting is controlled, consuming low-fat, high-carbohydrate snacks every 2 to 3 hours prevents an empty stomach. Maintaining stable blood glucose levels minimizes gastric contractions and acid irritation. This dietary strategy supports weight gain and fetal development.