Question

It has been a busy day at Great Lakes Medical Center. You have been seeing patients all day and have a pile of paperwork that needs to be completed. As you finish up your last patient, the receptionist calls you to the front desk. When you arrive at the front, you find Samantha Crosby, a 30-year-old pregnant African-American woman, who is complaining of a severe headache that waxes and wanes. She reports that the headache has been present for about a year; however, she is uncertain of the exact onset. She describes the headache as occipital and bifrontal, usually steady but occasionally throbbing and associated with dizziness and nausea when severe. The pain is generally not relieved by analgesics.

When questioned regarding her pregnancy, she reports being 7 months pregnant with a little boy. While she did experience nausea and vomiting in the beginning, that has resolved and she has not had any other issues related to the pregnancy. However, she shares that she has missed some of her prenatal appointments due to the severity of her headaches.
What considerations would the nurse want to think about when caring for a pregnant patient in the last trimester?

Answer 1

When evaluating a pregnant patient like Samantha Crosby with severe headaches in the last trimester, it is crucial to rule out serious conditions like preeclampsia and consider other types of headaches such as tension headaches or migraines. A thorough medical evaluation is immediately required to ensure the safety of both mother and fetus.

Step-by-step explanation:

When caring for a pregnant patient in the last trimester who is complaining of a severe headache, particularly if it is a long-standing issue as described by Samantha Crosby, several considerations should be taken into account. Primarily, it is essential to differentiate between common types of headaches such as tension headaches, which are characterized by tightening of facial and neck muscles and are quite prevalent, and more severe migraine headaches which involve blood vessel swelling and can be associated with nausea and disturbed vision. However, given Samantha's symptoms and pregnancy status, it is crucial to consider pregnancy-related complications such as preeclampsia, which can present with severe headaches, dizziness, and visual disturbances, especially in the third trimester. Immediate medical attention and thorough evaluation are required given the risk to both the mother and the fetus. Other differential diagnoses could include sinus headaches or even more serious conditions such as meningitis, depending on the presence of other symptoms such as fever or stiff neck.