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Virtual Simulation:
Maternity Case 1 Part 2: Olivia Jones
(Complex)
Scenario Overview
Patient name: Olivia Jones
Diagnosis: Severe preeclampsia

Learning Objectives
General:
• Identifies the primary nursing diagnosis
• Identifies relevant patient history information
• Implements patient safety measures
• Identifies physical findings and diagnostics related to patient condition
• Implements provider orders appropriately
• Implements nursing interventions based on patient care needs
• Prioritizes nursing interventions
• Provides patient/family education and teaching
• Recognizes therapeutic and confidential communication techniques
• Reports findings directly and accurately to interprofessional team members
• Utilizes members of the health care team when appropriate
Scenario Specific:
• Recognizes signs and symptoms of severe preeclampsia (hypertensive disorders)
• Performs focused antepartum assessment of patient with severe preeclampsia
• Performs focused antepartum assessment of fetus
• Communicates severe preeclampsia to the interprofessional team
• Administers prescribed antihypertensive medication (magnesium sulfate)
• Implements seizure precautions

Patient Case Introduction to Students
Location: Labor and birthing room
Time: 1500 h

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Maternity Case 2
Olivia Jones (Complex)
Olivia Jones is a 23-year-old African-American female, G1P0 at 36 weeks of gestation. She has been
diagnosed with severe preeclampsia and is admitted to the labor and delivery unit for assessment and
surveillance.
Pregnancy has been unremarkable until routine prenatal visit at 30 weeks with elevated blood pressure
at 146/92 mm Hg, proteinuria, and developing mild preeclampsia. She has been on bed rest at home
until prenatal visit today with increasing symptoms, resulting in admission.
She has gained 3 pounds since prenatal visit 1 week ago. Protein dipstick is +4, negative ketones,
negative glucose, +2 dependent edema, and facial puffiness.
Ms. Jones is complaining of a headache that is not resolved with acetaminophen. She presents with
nausea and fatigue and complaining of epigastric pain, visual changes, and chest tightness. The fetus is
active; however, patient states that it is a bit quieter than normal. There is a possibility of premature
rupture of membranes. An IV with lactated Ringer's is running at 125 mL/hr. Labs were obtained.

Patient Details
Patient Data: Female – Age 23 years. Weight 110 kg (243 lbs). Height 168 cm (66 in).
Gravida: 1 Para: 0
Gestation week: 36
Allergies: No known
Past Medical History: Unremarkable. Nonsmoker. Sedentary lifestyle. Denies history of diabetes,
collagen disease, including Systemic Lupus Erythematosus; denies renal disease or history of
hypertensive disease until development of preeclampsia at 30 weeks gestation.

Provider’s Orders 1
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Nutrition:
o NPO until serum lab results
Activity:
o Bed rest
Assessment:
o BP Q 15 min
o Temp, HR, RR Q 15 min
o Deep tendon reflexes Q 1 hour
o Head-to-toe assessment Q 4 hours
o Breath sounds Q 4 hours
o Continuous pulse ox
o Obtain ultrasound (Indication: biophysical profile, amniotic fluid index)
o One hour FHR/UC monitoring 3 times daily (Q 8 hours)
Precautions:

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Maternity Case 2
Olivia Jones (Complex)
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o Minimize outside stimuli
Labs:
o Comprehensive metabolic panel, STAT
o Hepatic function panel, STAT
Meds:
o Promethazine 25 mg tbl P.O. PRN if she's nauseated
o Lactated Ringer's 500 mL IV bolus x 1 (For nonreassuring fetal heart pattern)
Respiratory:
o Oxygen 10 L/min per non-rebreather mask for nonreassuring (Category II or III) fetal
heart rate. May discontinue oxygen when fetal heart returns to reassuring (Category I)
Call orders:
o Temp < 96.6°F (35.9°C), > 100.4°F (38°C)
o HR < 50, > 100
o RR < 12, > 24
o BP sys < 90, > 140; dia > 90
o SpO2 < 94%
o Nonreassuring fetal HR
o Other: rupture of membranes, vaginal bleeding, abdominal or epigastric pain

Provider’s Orders 2
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Assessment:
o Temp Q 4 hours
o Pulse Q 15 minutes during magnesium sulfate bolus, then Q 1 hour
o Blood pressure Q 15 minutes during magnesium sulfate bolus, then Q 1 hour
o Respiratory rate Q 15 minutes during magnesium sulfate bolus, then Q 1 hour
o Assess respiratory status for cough, shortness of breath and breath sounds Q 2 hours
o Assess hourly for headache and visual changes
o Assess for nausea, vomiting, epigastric pain, upper right quadrant pain Q 2 hours
o Deep tendon reflexes Q 2 hours
Med:
o Give ...