Situation: Priya, a 28-year-old woman at 34 weeks gestation, is seen in the outpatient clinic for a routine prenatal visit. Background: She has a history of seasonal allergies and a BMI of 26 prior to pregnancy. She reports mild ankle swelling that started this week and denies headache or visual changes. BP is 128/82 mmHg, HR 88 bpm, and urine dipstick shows 1+ protein. Assessment: Fundal height measures 33 cm. Fetal heart rate is 148 bpm. Deep tendon reflexes are 2+ bilaterally. She states, 'I noticed my rings are getting tight but I figured that was normal.' Recommendation: The nurse is reviewing findings before the primary health care provider enters the room. Which finding requires the nurse to escalate to the primary health care provider most urgently?
- Bilateral ankle edema with tight-fitting rings
- Blood pressure of 128/82 mmHg with 1+ proteinuria
- Fetal heart rate of 148 bpm
- Fundal height of 33 cm at 34 weeks gestation