A nurse is caring for a client who has just started having a seizure. Which of the following interventions should the nurse implement?

Rationale for Correct Options:

• Placental abruption: This condition involves the premature detachment of the placenta from the uterine wall, often triggered by hypertensive disorders. The client’s elevated blood pressure (148/94 mm Hg), facial edema, and hyperreflexia point toward preeclampsia, a leading risk factor for placental abruption.
• Hypertension: Hypertension during pregnancy compromises uteroplacental blood flow, potentially causing vascular damage and leading to placental separation. The client’s reading reflects stage 1 hypertension, which, along with other signs, raises concern for placental complications such as abruption.

Rationale for Incorrect Options:

• Spontaneous abortion: Typically occurs before 20 weeks gestation, making it irrelevant for a client at 30 weeks. There are no signs of fetal loss or cervical dilation in this case.
• Placenta previa: Presents with painless vaginal bleeding in the second or third trimester. This client has no vaginal bleeding or placental misplacement.
• Chorioamnionitis: This infection would present with fever, uterine tenderness, and fetal tachycardia. The client is afebrile, has clear lung sounds, and shows no evidence of intrauterine infection.
• Oligohydramnios: Usually detected via ultrasound or significantly low fundal height. The client's fundal measurement (29 cm at 30 weeks) is appropriate, and there’s no mention of decreased amniotic fluid.
• Hyperreflexia: Although suggestive of preeclampsia, it is a secondary symptom that indicates neurologic involvement and seizure risk rather than directly causing placental abruption.
• Vomiting: While it may be associated with preeclampsia, it is non-specific and does not independently increase the risk of placental abruption without supporting findings like hypertension or abdominal pain.

A. Return in two weeks for a follow up MRI: Clients with an implantable cardioverter/defibrillator (ICD) should generally avoid MRI unless the device is specifically labeled MRI-compatible. Magnetic fields can interfere with the ICD’s function and pose serious risks.
B. Wear loose-fitting clothing: Loose clothing prevents friction or pressure over the ICD insertion site, which promotes comfort and reduces the risk of irritation or infection during the healing period after implantation.
C. Expect to have a rapid pulse rate for the first few weeks: A rapid pulse is not an expected finding after ICD placement. If it occurs, it could indicate arrhythmia or improper device function, and should be evaluated promptly.
D. Resume tub baths and swimming after 24 hr: Immersing the incision site in water within 24 hours increases the risk of infection. Clients are typically advised to avoid submerging the area until the incision has fully healed, usually after 2-4 weeks.