It is recommended for Nancy to be seen regularly by specialists who know a pregnancy complicated by pre-eclampsia or blood pressure problems. The presence of chronic hypertension is a risk for moderate pre-eclampsia, and the presence of associated edema suggests that the patient already has increased vascular permeability (Beech & Mangos, 2021). On the concentration gradient, the oncotic pressure in the extracellular fluid increases, and there is the protein in the urine. At this point, Nancy is at high risk for pre-eclampsia and needs to have her urine tested for protein. However, controlling the protein in her urine will not wholly avoid a C-section. Nevertheless, it is impossible to say that she is pre-eclampsia because there are no other signs of this pathology.
Calcium channel blockers are drugs that inhibit pregnancy, so they should be kept to avoid pre-eclampsia. The advocated delivery date will be after 37 weeks to prevent the harmful effects of maternal hypertension on the fetus. It is recommended for the patient to discontinue diuretics and switch to other medications because diuretics can lead to micronutrient leaching and increased edema (Lu et al., 2018). The presence of edema is part of chronic hypertension and needs to be controlled during pregnancy. The patient likely requires initiation of alpha-adrenoceptor stimulating medications to lower blood pressure. Vasodilators are also recommended, but they may contribute to increased edema. Hydralazine is thought to be an effective tool for managing blood pressure in pregnant women with diagnosed hypertension (Lu et al., 2018). In addition, calcium intake should be increased to prevent other hypertensive disorders and avoid increased edema (Beech & Mangos, 2021). Aspirin is recommended to dilate blood vessels to reduce blood viscosity and prevent increased thrombosis.
References
Beech, A., & Mangos, G. (2021). Management of hypertension in pregnancy. Australian Prescriber, 44, 148-152. Web.
Lu, Y., Chen, R., Cai, J., Huang, Z., & Yuan, H. (2018). The management of hypertension in women planning for pregnancy. British Medical Bulletin, 128(1), 75–84. Web.