Which conditions does the nurse remain alert for in a pregnant patient with preeclampsia?
OverviewPreeclampsia is development of high blood pressure, swelling or high levels of albumin in the urine between the 20th week of pregnancy and the end of the first week after delivery. Eclampsia is development of convulsive seizures or coma without other causes during that same time frame. Show SymptomsSigns of preeclampsia in a pregnant woman include:
In its milder forms, it may appear as borderline high blood pressure, swelling or water retention that doesn't respond to treatment or albumin in the urine. Pregnant women who have blood pressure of 150/110, marked swelling or water retention and high levels of albumin in their urine may also experience disturbances in their sight or have pain in the abdomen. Their reflexes may be hypersensitive. Causes and Risk Factors It is not known what causes these conditions. Preeclampsia develops in about 5% of pregnant women. These women are usually having their first baby or had high blood pressure or vascular disease before they became pregnant. If preeclampsia isn't treated it may suddenly turn into eclampsia. Eclampsia can be fatal without treatment. One complication of preeclampsia is a condition where the placenta detaches too early from the wall of the uterus (abruptio placentae). DiagnosisIn addition to the symptoms, a doctor may order blood tests, an analysis of the urine and tests of liver function. He or she will also try to rule out unsuspected kidney disease. TreatmentThe goal of treatment is to protect the life and health of the mother. This usually assures that the baby survives, too. When a woman has early, mild preeclampsia, she will need strict bed rest. She should be seen by her doctor every two days. She needs to keep her salt intake at normal levels but drink more water. Staying in bed and lying on her left side will increase her need to urinate. This keeps her from becoming dehydrated and her blood from getting concentrated. If she doesn't immediately improve, she may need to go into the hospital. Once she has been admitted, she will be given a balanced salt solution intravenously. She may be given magnesium sulfate intravenously until her reflexes return to normal. This reduces the risk of seizures. At the same time, blood pressure usually goes down. Swelling should begin to go down, too. If the high blood pressure doesn't respond to the magnesium sulfate, other drugs may be tried to lower blood pressure. Both the mother and baby need constant monitoring. The patient should be observed for complications such as headaches, blurred vision, confusion, abdominal pain, vaginal bleeding or loss of fetal heart sounds. Some doctors may admit the patient directly to the intensive care unit for continuous monitoring of the mother and baby. An obstetrician should be involved in the management of the condition. At this point the goal of treatment becomes delivery of the baby. Any woman who has preeclampsia that doesn't respond to treatment should be stabilized and delivery accomplished, no matter how long the pregnancy has been. Mild preeclampsia may take six to eight hours to stabilize. About four to six weeks after the baby is delivered, the signs of preeclampsia should begin to go away. The patient will need to be watched as closely and as often after delivery as she was during labor. About one out of four cases of eclampsia happen during the first two to four days after delivery. Although she may need to stay in the hospital longer than a normal delivery would require, a woman usually recovers after delivery quickly. She should be seen by her doctor one to two weeks after the delivery. It may be necessary for her to take drugs to manage high blood pressure. © 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. Hypertensive disorders of pregnancy (also known as pregnancy-associated hypertensive disorders, pregnancy induced hypertension) are the most common complications that occur during pregnancy and are a major cause of maternal and fetal morbidity and mortality. These disorders include gestational hypertension, preeclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. If left untreated, preeclampsia can lead to a life-threatening complication called HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. It is estimated that preeclampsia alone complicates 2-8% of pregnancies globally. Hypertensive disorders in pregnancy include five categories of hypertension and are defined as such by the American College of Obstetricians and Gynecologists (ACOG): Nursing care planning and management for pregnant clients with hypertensive disorders or preeclampsia involve early detection, thorough assessment, and prompt treatment of preeclampsia. Another priority is to ensure the mother’s safety and deliver a healthy newborn as close to a full term as possible. Here are six nursing diagnoses for your nursing care plans for pregnant patients with hypertensive disorders, focusing on managing clients with preeclampsia. Decreased Cardiac OutputA decrease in circulating blood volume due to the shifting of fluid from the intravascular to the interstitial spaces occurs in a pregnant client with a hypertensive disorder due to the decrease of the circulating blood volume and the total vascular volume and an increase in the systemic vascular resistance, the heart rate decreases as well as the stroke volume. These mechanisms lead to a decrease in cardiac output seen among clients with hypertensive disorders in pregnancy. Nursing Diagnosis
Related factors may include
Possibly evidenced by
Desired Outcomes
Nursing Assessment and Rationales1. Assess blood pressure and pulse every one (1) hour or as indicated. 2.
Assess the mean arterial pressure (MAP) at 11-13 and 20-24 weeks gestation. A pressure of 90 mm Hg is considered predictive of preeclampsia. 3. Assess for crackles, wheezes, and dyspnea; note respiratory rate/effort. Note client snoring. 4.
Auscultate for the apical pulse and assess the client’s heart rate and rhythm. 5. Assess the client’s neurological status. 6. Assess the client for visual disturbances. 7. Assess the client for indications for an earlier delivery. 8. Monitor and measure the client’s urine output as per protocol. Maintain strict intake and output. 9. Monitor and measure the client’s 24-hour urine for proteinuria. Nursing Interventions and Rationales1. Provide frequent rest periods with bed rest. Restrict activity rather than instituting complete bed rest. 2. Instruct the client to elevate legs when sitting or lying down. 3. Monitor the client’s BP and instruct monitoring of BP at home. 4. Record and graph vital signs, especially BP and pulse. 5. Monitor for invasive hemodynamic parameters such as cardiac output, as indicated. 6. Administer low-dose aspirin as indicated. 7. Administer antihypertensive medications as ordered. Observe for side effects of antihypertensive drugs.
8. Prepare for the birth of fetus by cesarean delivery, labor when severe preeclamptic or eclamptic condition is stabilized, but vaginal delivery is not feasible. Recommended nursing diagnosis and nursing care plan books and resources. Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy. References and sources for this nursing care plan for hypertensive disorders in pregnancy. Updated and reviewed by M. Belleza, R.N. and M. Vera, BSN, R.N. What conditions does the nurse remain alert for in a pregnant patient with preeclampsia?A woman with preeclampsia is at an increased risk of pulmonary edema, thrombocytopenia, hemolysis, coagulopathy, and oliguria. These women are also at an increased risk of stroke (Kennedy, 2019).
What are the conditions in a pregnant client with severe preeclampsia?Severe preeclampsia may include symptoms like:. Hypertensive emergency (blood pressure is 160/110 mmHg or higher).. Decreased kidney or liver function.. Fluid in the lungs.. Low blood platelet levels (thrombocytopenia).. Decreased urine production.. What are the 3 early signs of preeclampsia?Symptoms of pre-eclampsia. severe headache.. vision problems, such as blurring or flashing.. pain just below the ribs.. vomiting.. sudden swelling of the face, hands or feet.. Which hypertensive disorders can occur during pregnancy?The 4 categories of hypertensive disorders of pregnancy are chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. These disorders are among the leading causes of maternal and fetal morbidity and mortality.
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