How to Answer Nancy Year Chronic Questions (Complete Guide)

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Original Question

Nancy is a 40-year-old chronic hypertensive patient who has been seen at your clinic for 5 years. She is happy today when she reports that she is 2 months pregnant and would like a referral to a nurse midwife for prenatal care. She has never had issues with her blood pressure after she quickly adapted to a calcium channel blocker and diuretic for her treatment. She does get a bit of dependent edema at the end of the day that remains less than 1+ and says it typically “gives me an excuse to put my feet up!” She comes with a sheaf of printouts about pre-eclampsia from the internet. She is asking for a urine sample to check for protein because she “does not want a Csection.” Would Nancy fit the mold for referral to a midwife for routine pregnancy care? (Consider your nurse practice act for degree of complexity handled by certified nurse midwives in your state.) Is she correct in her assumption that she has pre-eclampsia? Is she currently on any medications that must be stopped today before she sees an obstetrician/gynecologist? What are the categories of HTN medications typically given to women with preexisting HTN who become pregnant?

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