0830: A 37-year-old nulliparous woman at 36 weeks gestation presents to the emergency department with complaints of severe headache, blurred vision, and upper abdominal pain. She reports feeling generally unwell and fatigued for the past 24 hours. Her pregnancy has been uncomplicated until now, with consistent prenatal care. On arrival, her vital signs are: blood pressure 160/100 mmHg, heart rate 88 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F (37°C), and oxygen saturation 98% on room air. Physical exam reveals mild lower extremity edema and no signs of trauma. Fetal monitoring shows a baseline heart rate of 150 bpm with moderate variability, no accelerations, and no decelerations. The client has no uterine contractions.

0830

• Complete Blood Count (CBC)
• Comprehensive Metabolic Panel (CMP)
• Urinalysis (UA)
• Continuous Fetal Monitoring

0900: Client evaluated following complaints of severe headache, blurred vision, and upper abdominal discomfort. BP remains elevated compared to baseline. Physical exam reveals mild lower extremity edema. Laboratory results reviewed and show elevated liver enzymes, decreased platelet count, and positive proteinuria. Fetal monitoring remains reassuring at this time. Based on clinical presentation and lab findings, the client is diagnosed with preeclampsia.

1000

• Magnesium Sulfate infusion: Loading dose 4 gm over 15 minutes, maintenance dose 2 grams/hour
• Labetalol 20 mg IV bolus followed by 40 mg IV bolus if not effective within 10 minutes; then 80 mg every 10 minutes (maximum total dose of 300 mg/60 ml)
• Vital signs every 15 minutes
• Magnesium level every 4 hours