The nurse is caring for a pregnant client at 34 weeks gestation. The client reports severe itching on her palms and soles, along with dark urine, and scleral jaundice. Lab results show elevated serum bile acids and alanine aminotransferase (ALT). The nurse suspects which of the following?
The nurse is caring for a pregnant client at 34 weeks gestation. The client reports severe itching on her palms and soles, along with dark urine, and scleral jaundice. Lab results show elevated serum bile acids and alanine aminotransferase (ALT). The nurse suspects which of the following?
A. Eclampsia
[5%]
B. Gestational diabetes mellitus
[2%]
C. Cholestasis of pregnancy
[53%]
D. Acute fatty liver of pregnancy
[40%]
Statistics
Subject/Lesson
Subject
Maternal & Newborn Health
Lesson
Antepartum
Client Need
Test Plan
Physiological Adaptation
Related Topic
Alterations in Body Systems
Item Type
Item Type
Analysis
Explanation
Choice C is correct. Cholestasis of pregnancy, also known as intrahepatic cholestasis of pregnancy (ICP), is a liver disorder characterized by impaired bile flow during pregnancy. It typically presents with intense pruritus, especially on the palms and soles, along with jaundice, dark urine, and pale stools. Elevated serum bile acids and liver enzymes, such as alanine aminotransferase (ALT), are commonly observed in laboratory tests of individuals with cholestasis of pregnancy.
Choice A is incorrect. Eclampsia is a hypertensive disorder of pregnancy characterized by hypertension and proteinuria.
Choice B is incorrect. Gestational diabetes mellitus is a condition characterized by high blood sugar levels during pregnancy. It does not present with symptoms such as pruritus, jaundice, or abnormal liver function tests.
Choice D is incorrect. Acute fatty liver of pregnancy is a rare but serious condition characterized by liver dysfunction and fatty infiltration of the liver during pregnancy. While it may present with symptoms similar to cholestasis of pregnancy, such as jaundice and abnormal liver function tests, it does not typically cause intense pruritus or dark urine.
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3 Key Topics
Cholestasis
28.5 Infection & Complication Risks
Additional Info
✓ Cholestasis is a condition characterized by a decrease or interruption in bile flow from the liver to the small intestine. Bile is a digestive fluid produced by the liver that aids in the digestion and absorption of fats and fat-soluble vitamins. When bile flow is impaired, it can lead to the accumulation of bile acids and other substances in the liver and bloodstream, resulting in various signs and symptoms.
✓ It is estimated to affect approximately 0.1% to 2% of pregnancies worldwide.
✓ There is no known prevention, so the focus is always on early recognition and intervention. This may include:
- Regular monitoring of liver function tests, bilirubin levels, and symptoms is crucial for the management of cholestasis.
- Medications such as Ursodiol. Ursodiol, a medication that improves bile flow, may be prescribed to manage cholestasis and alleviate symptoms.
- Induction of labor may be considered if the condition is severe or if the gestational age is near term (37 weeks).
