Click to highlight the findings that require immediate follow-up: • Respiratory rate 12/min (decreasing trend: 18 → 14 → 12) — Immediate follow-up ✓ • DTR decreased to 1+ (was 3+ on admission) — Immediate follow-up ✓ • Hourly urine output 20 mL (oliguria) — Immediate follow-up ✓ • Client reporting seeing spots (visual disturbance) — Immediate follow-up ✓ • Platelet count 90,000/mm³ (thrombocytopenia) — Immediate follow-up ✓ • Elevated ALT 72 and AST 69 (liver involvement) — Immediate follow-up ✓ • Facial edema present — Immediate follow-up ✓ • Uterine contractions every 3–4 min — Expected in active labor • FHR 140/min with minimal variability — Concerning but attributed to magnesium

This client is showing signs of magnesium sulfate toxicity AND worsening preeclampsia progressing toward HELLP syndrome. Magnesium toxicity: respiratory rate decreasing to 12/min (danger threshold is below 12/min), loss of deep tendon reflexes (1+ from 3+), and oliguria (20 mL/hr — below minimum 25–30 mL/hr) indicate magnesium accumulation requiring immediate withholding of infusion and administration of calcium gluconate (antidote). HELLP syndrome: thrombocytopenia (platelet count 90,000), elevated liver enzymes (ALT, AST), and visual disturbances (seeing spots) indicate progression to HELLP — a life-threatening obstetric emergency requiring immediate provider notification, possible delivery, and blood product administration.