A nurse is providing teaching to a client who is at 6 weeks of gestation about manifestations of potential complications during pregnancy. For which of the following manifestations should the nurse instruct the client to notify the provider?

Hemoglobin 18.0 g/dL

Preeclampsia: Mild hemoconcentration can occur due to third spacing and fluid shift.

HELLP Syndrome: HELLP is more characterized by low hemoglobin due to hemolysis rather than high hemoglobin.

Alanine aminotransferase (ALT) 40 units/L

Preeclampsia: Liver enzymes can be mildly elevated in severe preeclampsia, but not as prominent as in HELLP.

HELLP Syndrome: Consistent finding. Elevated ALT reflects liver dysfunction, one of the hallmark components of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets).

Platelet count 98,000/mm³

Preeclampsia: Thrombocytopenia can occur in severe preeclampsia. Platelets <100,000/mm³ is concerning for progression to severe disease.

HELLP Syndrome: Consistent finding. Low platelets are a key diagnostic criterion of HELLP syndrome.

Blood Pressure 162/112 mm Hg

Preeclampsia: Consistent finding. Hypertension (≥140/90 mm Hg) is the primary diagnostic criterion for preeclampsia.

HELLP Syndrome: Often present with elevated blood pressure as well. HELLP is a variant of severe preeclampsia so elevated BP is common.

A. Obtain a 24 hr urine specimen: This is the gold standard for quantifying proteinuria and diagnosing preeclampsia, but a rapid 3+ protein dipstick and severe symptoms/lab findings have already established the diagnosis of severe preeclampsia/HELLP. Treatment (magnesium sulfate, blood pressure control, and preparation for delivery) should not be delayed to wait for a 24-hour collection.

B. Monitor intake and output hourly: Clients with preeclampsia are at risk for renal impairment and fluid overload due to vasospasm and endothelial injury. Hourly monitoring ensures adequate renal perfusion (goal urine output ≥30 mL/hr) and prevents complications like pulmonary edema.

C. Administer betamethasone: At 31 weeks’ gestation, preterm delivery is likely if maternal or fetal status deteriorates. Betamethasone promotes fetal lung maturity, reducing the risk of respiratory distress syndrome in the newborn.

D. Provide a low-stimulation environment: A quiet, dimly lit room minimizes external triggers that can increase CNS irritability and lower the seizure threshold in severe preeclampsia. This is essential for preventing eclampsia.

E. Give antihypertensive medication: Severe BP readings (≥160/110 mm Hg) require prompt pharmacologic intervention (e.g., labetalol, hydralazine) to reduce the risk of stroke or placental abruption while maintaining uteroplacental perfusion.

F. Maintain bedrest: Activity restriction (preferably left lateral position) enhances uteroplacental blood flow and decreases BP. It also helps prevent falls or injury if the client becomes symptomatic or experiences a seizure.

G. Perform a vaginal examination every 12 hr: This is contraindicatedin clients with preeclampsia who are not in active labor.Vaginal examinations may induceuterine contractionsandincrease infection riskwithout clinical benefit. Cervical assessment should only be done if delivery is imminent or indicated by the provider.