A pregnant lady 38 weeks gestation diagnosed with eclampsia. On duty nursing officers should assess which par… - NORCET 2 -2021 (Shift-2)

NORCET 2 -2021 (Shift-2)

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

Temperature is a general vital sign and not a specific indicator for monitoring the progression of eclampsia or the side effects of its primary treatment, magnesium sulfate.
While fever can occur post-seizure or indicate a separate infectious process, it is not a primary assessment parameter for preventing seizures or magnesium toxicity.
The other three options—knee jerk movements, deep tendon reflexes, and urine output—are all critical for assessing neurological status and monitoring for life-threatening magnesium sulfate toxicity.

Option A: Knee jerk movements are a specific type of deep tendon reflex (DTR). Assessing DTRs is essential for monitoring the patient's neurological status and detecting magnesium sulfate toxicity.
Option B: Assessing deep tendon reflexes is a critical priority. Hyperreflexia can signal impending seizures, while hyporeflexia or absence of reflexes is a classic sign of magnesium sulfate toxicity.
Option C: Urine output is a vital parameter to monitor because magnesium sulfate is cleared by the kidneys. Oliguria (urine output less than 30 mL/hr) indicates impaired renal function and a high risk of magnesium accumulation and toxicity.

Visual 1: Table: Signs and symptoms of magnesium sulfate toxicity correlated with serum levels.
Visual 2: Diagram: Illustration of how to perform a patellar reflex (knee-jerk) assessment on a patient.
Visual 3: Flowchart: Nursing actions for suspected magnesium sulfate toxicity, starting with stopping the infusion and administering calcium gluconate.

Clinical Relevance

Nursing practice connection: Knowing Nursing assessment and management of a patient with eclampsia helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Vigilant nursing assessment is crucial in managing eclampsia to prevent maternal and fetal mortality. Failure to recognize signs of magnesium toxicity can lead to respiratory arrest and death.
The therapeutic window for magnesium sulfate is narrow (4-7 mEq/L). Nurses must be able to quickly identify signs of toxicity (loss of DTRs, respiratory depression, oliguria) and intervene immediately.
The antidote for magnesium sulfate toxicity, calcium gluconate, should always be readily available at the bedside of any patient receiving a magnesium infusion.

How to Approach the Question

First, identify the question type. This is a negative question using the keyword 'except', asking you to find the option that is NOT a priority.
Recall the core pathophysiology of eclampsia (seizures due to severe preeclampsia) and its standard treatment (magnesium sulfate).
Think about the primary nursing responsibilities when administering magnesium sulfate. The main concern is preventing and detecting toxicity.
Evaluate each option based on its relevance to monitoring for eclampsia complications and magnesium toxicity.
Option A (Knee jerk) and B (Deep tendon reflexes) are directly related to CNS assessment and are the first sign of magnesium toxicity.
Option C (Urine output) is directly related to the excretion of magnesium sulfate; poor output leads to toxicity.

Concept Tested & Keywords

Concept Tested: Nursing assessment and management of a patient with eclampsia.
Stem keywords: pregnant lady, 38 weeks gestation, eclampsia, nursing officers, assess parameters
Lead-in keywords: except
Clinical cues: Diagnosis of eclampsia at 38 weeks gestation implies an acute, high-risk situation requiring immediate and specific monitoring.
Negative lead-in flag: Question asks for the parameter that is NOT a priority.

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