The nurse knows that a diagnosis for gestational diabetes can be determined with which lab values?

Rationale for correct condition: The client presents with a history of chronic hypertension, headache, visual disturbances, upper abdominal discomfort, and elevated blood pressure. Diagnostic results show elevated uric acid, proteinuria, and decreased platelet count. Physical examination reveals facial swelling, trace pitting edema, and hyperreflexia with clonus. These findings indicate preeclampsia, a condition of elevated blood pressure and proteinuria after 20 weeks of gestation. Preeclampsia may lead to severe complications if untreated.

Rationale for actions:

• Administering magnesium sulfate helps prevent seizures associated with severe preeclampsia.
• Preparing for immediate delivery is necessary if preeclampsia poses a severe risk to the mother or fetus.

Rationale for parameters:

• Monitoring blood pressure trends is crucial to manage and prevent severe hypertensive complications.
• Checking platelet count helps detect worsening coagulopathy, which is common in preeclampsia.

Rationale for incorrect conditions:

• Gestational hypertension: It lacks proteinuria and does not fully account for symptoms like severe headache and visual disturbances.
• HELLP syndrome: Although it shares similarities, HELLP would present with more severe hemolysis and liver involvement.
• Placental abruption: This condition would present with vaginal bleeding and abdominal pain, which are not reported in this case.

Rationale for correct condition: The client is likely experiencing PPROM, as evidenced by the sudden gush of clear fluid and continued light leakage, confirmed by fluid pooling in the vaginal vault that tested positive for ferning. PPROM can lead to preterm labor and increased risk of infection. The absence of contractions or bleeding, and the mild lower abdominal discomfort, further supports this diagnosis.

Rationale for actions: Administering prophylactic antibiotics helps prevent infection, which is a significant risk with PPROM. Educating the client on kick counts ensures monitoring of fetal well-being. Preparing for an emergent C-section is not immediately necessary as the cervix is closed. Providing IV fluids for hypotension is not applicable here as blood pressure is elevated. Discharging the client with follow-up in one week is inappropriate given the risk of infection and preterm labor.

Rationale for parameters: Monitoring signs of infection is crucial, as PPROM increases infection risk. Maternal blood pressure trends must be watched due to elevated readings, suggesting possible complications. Meconium-stained amniotic fluid, while concerning, is not present. Maternal platelet levels and fundal height measurements do not directly address the current risks associated with PPROM.

Rationale for incorrect conditions: Placental abruption typically involves abdominal pain and bleeding, which are absent. Preeclampsia involves hypertension and proteinuria, but no significant proteinuria is present. Oligohydramnios involves decreased amniotic fluid, but the client reports clear fluid leakage indicating rupture of membranes.