Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Introduction
Preeclampsia is a condition that can occur during pregnancy where there is a sudden rise in blood pressure. It can also lead to clotting issues that may affect organs, such as the liver and kidneys.
Preeclampsia is the most common complication to occur during pregnancy. It generally develops during the third trimester and affects about 1 in 25 pregnancies.
It can progress into eclampsia in some people, where they can experience seizures and enter a coma. It can also be fatal. Prenatal appointments are essential for managing health, preeclampsia, and potential conditions such as eclampsia.
Symptoms of Preeclampsia
Preeclampsia may present no initial symptoms, but common signs include:
Protein in the urine
High blood pressure
Blurry vision, sometimes seeing flashing lights
Headaches, often severe
Feeling ill
Shortness of breath
Pain just below the ribs on the right side
Rapid weight gain, caused by excess fluid
Nausea and vomiting during the second half of pregnancy
Urinating less often
Lower platelet count
Impaired liver function
Pregnant people should seek immediate medical attention if they experience any of these signs or symptoms.
Although some people may develop high blood pressure during pregnancy, it does not necessarily mean they have preeclampsia. The criteria for diagnosing preeclampsia include elevated blood pressure and at least one correlating sign from above.
Causes of preeclampsia
Experts are not sure why preeclampsia occurs. Most say there is a problem with the placenta’s development because the blood vessels that supply it respond differently to hormonal signals and are narrower than normal, limiting blood flow.
Experts also do not fully understand why the blood vessels develop differently, but several factors may play a role. These include:
Damage to the blood vessels
Insufficient blood flow to the uterus
Immune system problems
Genetic factors
Risk Factors of Preeclampsia
Risk factors associated with preeclampsia include:
First pregnancies: The chances of preeclampsia during a first pregnancy are considerably higher than subsequent ones.
Family history: A person whose parent or sibling had preeclampsia has a higher risk of developing it.
Personal history of preeclampsia: A person who had preeclampsia in their first pregnancy can have a much greater risk of having the same condition in subsequent pregnancies.
Certain conditions and illnesses: People with diabetes, chronic high blood pressure, autoimmune disorders, and kidney disease are more likely to develop preeclampsia.
Obesity: Preeclampsia rates are much higher among obese people.
Multiple pregnancies: If a person is expecting two or more babies, the risk is higher.
Diagnosis of Preeclampsia
For a doctor to diagnose preeclampsia, the pregnant person must have a diagnosis of high blood pressure and at least one additional associated sign, such as decreased blood platelets or impaired liver function.
Hypertension
A blood pressure reading of 140/90 mm Hg or higher is abnormal in pregnancy.
The doctor may also order diagnostic tests:
Blood tests: This checks kidney and liver function and whether the blood is clotting properly.
Fetal ultrasound: Doctors will closely monitor the baby’s progress to make sure they are growing correctly.
Non-stress test: The doctor checks how the baby’s heartbeat reacts when they move. If the heartbeat increases 15 beats or more a minute for at least 15 seconds twice every 20 minutes, it is an indication that everything is normal.
Prevention of Preeclampsia
Preeclampsia is not entirely preventable, but there are several steps a pregnant person can take to moderate some factors that contribute to high blood pressure.
These can include:
Drinking between 6 and 8 glasses of water every day
Avoiding fried or highly processed foods
Excluding added salt
Avoiding alcohol and caffeine
Taking regular exercise under their doctor’s guidance
Keeping feet elevated a few times per day
Resting
These steps can help maintain healthy blood pressure and may reduce the risk of preeclampsia. Pregnant people should follow their doctor’s advice on diet and exercise.
Complications of Preeclampsia
There is a risk of severe complications with untreated preeclampsia. Complications may be prevented if the signs of preeclampsia are detected sooner, which is possible by attending routine prenatal visits. However, if the condition is not diagnosed for some reason, the risks are considerably more significant.
The following complications may develop from preeclampsia:
HELLP can very quickly become life-threatening for both the pregnant person and the baby. It stands for hemolysis, elevated liver enzymes, and low platelet count. It is a combined liver and blood clotting disorder that most commonly occurs right after giving birth but can appear at any time after the 20th week of pregnancy. Very rarely, it may occur beforehand. The only way to treat HELLP syndrome effectively is to deliver the baby as soon as possible.
Poor blood flow to the placenta
If blood flow to the placenta is restricted, the baby might not be getting oxygen and nutrients, leading to slower growth, breathing difficulties, and premature birth.
Placental abruption
The placenta separates from the inner wall of the uterus. There may be heavy bleeding in severe cases, which can damage the placenta. Any damage to the placenta may place the baby’s and pregnant person’s life at risk.
Eclampsia
This is a combination of preeclampsia and seizures. The pregnant person may experience pain under the ribs on the right side of their body, intense headache, blurry vision, confusion, and decreased alertness. If left untreated, they are at risk of coma, permanent brain damage, and death. The condition is also life-threatening for the baby.
Preeclampsia can have some long-term consequences for the developing baby. Research shows that high blood pressure in pregnant people may affect the baby’s cognitive skills, which can carry through into later life.
Treatment of Preeclampsia
Preeclampsia is not cured until the baby is delivered.
Until the pregnant person’s blood pressure reduces, they are at a greater risk of stroke, severe bleeding, separation of the placenta from the uterus, and seizures. In some cases, mainly if preeclampsia develops earlier in pregnancy, early delivery may not be the best option for the baby.
People who have had preeclampsia in previous pregnancies are advised to attend prenatal visits more often. The doctor may recommend the following medications:
Antihypertensives
These help to lower blood pressure.
Anticonvulsants
Doctors may use these drugs to prevent a first seizure in severe cases. They may prescribe magnesium sulfate.
Corticosteroids
If the person has preeclampsia or HELLP syndrome – see below – these drugs can help induce fetal lung maturity to prepare for premature delivery. This can prolong the pregnancy.
Rest
If the person is far from the end of their pregnancy and has mild symptoms, the doctor may advise bed rest. Resting helps bring the blood pressure down, increasing blood flow to the placenta and benefiting the baby.
Doctors may advise some people to lie down in bed and only sit up or stand when needed. Others may be allowed to sit in an armchair or on the sofa or bed, but their physical activities will be strictly limited. There will be regular blood pressure and urine tests, and doctors will also monitor the baby closely.
The pregnant person may be hospitalized for continuous bed rest and monitored closely in severe cases.
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Nursing Care Plans for Preeclampsia
Inducing labor
With a diagnosis of preeclampsia close to the end of pregnancy, doctors may advise delivering the baby early.
There may be no choice in very severe cases, and doctors will induce the labor or perform a cesarean delivery as soon as possible. The doctor may give the parent magnesium sulfate to improve uterine blood flow and prevent seizures during childbirth.
Nursing Care Plans for Preeclampsia Based on Diagnosis
Nursing Care Plan 1: Decreased Cardiac Output
Decreased Cardiac Output: Inadequate blood pumped by the heart to meet metabolic demands of the body.
May be related to:
Hypovolemia/decreased venous return
Increased systemic vascular resistance
Possibly evidenced by:
Change in blood pressure/hemodynamic readings
Edema
Shortness of breath
Alteration in mental status
Desired Outcomes
The patient remains normotensive throughout the remainder of the pregnancy.
Patient reports absence and/or decreased episodes of dyspnea.
Patient alters activity level as condition warrants.
Nursing Interventions
Rationale
Record and graph vital signs, especially BP and pulse.
The patient with PIH does not display the normal cardiovascular response to pregnancy (left ventricular hypertrophy, increase in plasma volume, vascular relaxation with decreased peripheral resistance). Hypertension (the second manifestation of PIH after edema) occurs owing to increased sensitization to angiotensin II, which increases BP, promotes aldosterone release to increase sodium/water reabsorption from the renal tubules, and constricts blood vessels.
Assess MAP at 22 weeks gestation. A pressure of 90 mm Hg is considered predictive of PIH. Assess for crackles, wheezes, and dyspnea; note respiratory rate/effort.
Pulmonary edema may transpire with modification in peripheral vascular resistance and a drop in plasma colloid osmotic pressure.
Institute bedrest with a patient in lateral position.
Improves venous return, cardiac output, and renal/placental perfusion.
Check for invasive hemodynamic parameters.
Provides a precise picture of vascular changes and fluid volume. Prolonged vascular constriction, increased hemoconcentration, and fluid shifts decrease cardiac output.
Give antihypertensive drugs such as hydralazine (Apresoline) PO/IV so that diastolic readings are between 90 and 105 mm Hg. Begin maintenance therapy as needed, e.g., methyldopa (Aldomet) or nifedipine (Procardia).
If BP does not respond to conservative measures, short-term medication may be needed in conjunction with other therapies, e.g., fluid replacement and MgSO4. Antihypertensive drugs work directly on arterioles to promote relaxation of cardiovascular smooth muscle and help increase blood supply to the cerebrum, kidneys, uterus, and placenta. Hydralazine is the drug of choice because it does not produce effects on the fetus. Sodium nitroprusside is being used with some success to lower BP (especially in HELLP syndrome).
Check on BP and side effects of antihypertensive drugs. Administer propranolol (Inderal) as appropriate.
Side effects such as tachycardia, headache, nausea, and vomiting, and palpitations may be treated with propranolol.
Prepare for the birth of fetus by cesarean delivery, labor when severe PIH/eclamptic condition is stabilized, but vaginal delivery is not feasible.
If conservative treatment is ineffective and labor induction is ruled out, then surgical procedure is the only means of halting the hypertensive problems.
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Nursing Care Plans for Preeclampsia
Nursing Care Plan 2: Altered Tissue Perfusion (Uteroplacental)
Impaired Tissue Perfusion: Decreased in oxygen resulting in the failure to nourish the tissues at the capillary level.
May be related to:
Maternal hypovolemia
Interruption of blood flow (progressive vasospasm of spiral arteries)
Possibly evidenced by:
Intrauterine growth retardation
Changes in fetal activity/heart rate
Premature delivery
Fetal demise
Desired Outcomes
The patient demonstrates normal CNS reactivity on nonstress test (NST)
The patient is free of late decelerations;
The patient has no decrease in FHR on the contraction stress test/oxytocin challenge test (CST/OCT).
The patient is full-term, AGA.
Nursing Interventions
Rationale
Present information to patient/couple concerning the home assessment or noting daily fetal movements and when to seek immediate medical attention.
Decrease in placental blood flow results in reduced gas exchange and impaired nutritional functioning of the placenta. Potential outcomes of poor placental perfusion include a malnourished, LBW infant and prematurity associated with early delivery, abruptio placentae, and fetal death. Reduced fetal activity means fetal compromise (occurs before detectable alteration in FHR and indicates demand for immediate evaluation/intervention.
Name factors affecting fetal activity.
Cigarette smoking, medication/drug use, serum glucose levels, environmental sounds, time of day, and a sleep-wake cycle of the fetus can increase or decrease fetal movement.
Report signs of abruptio placentae (i.e., vaginal bleeding, uterine tenderness, abdominal pain, and decreased fetal activity).
Immediate attention and intervention increase the likelihood of a positive outcome.
Present contact number for patient to direct questions, address changes in daily fetal movements, and so forth.
Provides a chance to address concerns/misconceptions and intervene in a timely manner, as indicated.
Evaluate fetal growth; measure progressive fundal accompany growth at each office visit or periodically during stress home visits, as appropriate.
Reduced placental functioning may accompany PIH, resulting in IUGR. Chronic intrauterine stress and uteroplacental insufficiency decrease the amount of fetal contribution to the amniotic fluid pool.
Note the fetal response to medications such as MgSO4, phenobarbital, and diazepam.
Depressant effects of medication reduce fetal respiratory and cardiac function and fetal activity level, even though placental circulation may be adequate.
Check FHR manually or electronically, as indicated.
Helps evaluate fetal well-being. An elevated FHR may show a compensatory response to hypoxia, prematurity, or abruptio placentae.
Assess fetal response to BPP criteria or CST, as maternal status indicates.
BPP helps evaluate fetus and fetal environment on five specific parameters to assess CNS function and fetal contribution to the amniotic fluid volume. CST assesses placental functioning and reserves.
Assist with assessing fetal maturity and well-being using L/S ratio, PG, estriol levels, FBM, and sequential sonography beginning at 20–26 weeks’ gestation.
In the event of declining maternal/fetal condition, risks of delivering a preterm infant are weighed against the risks of continuing the pregnancy, using results from evaluative studies of lung and kidney maturity, fetal growth, and placental functioning. IUGR is associated with reduced maternal volume and vascular changes.
Assist with assessment of maternal plasma volume at 24–26 weeks’ gestation using Evans’ blue dye when indicated.
Identifies fetus at risk for IUGR or intrauterine fetal demise associated with reduced plasma volume and reduced placental perfusion.
Utilizing ultrasonography, assist with the assessment of placental size.
Reduced placental function and size are associated with PIH.
Give corticosteroid (dexamethasone, betamethasone) IM for at least 24–48 hr, but not more than 7 days before delivery, when severe PIH necessitates premature delivery between 28 and 34 weeks gestation.
Corticosteroids are thought to induce fetal pulmonary maturity (surfactant production) and prevent respiratory distress syndrome, at least in a fetus delivered prematurely because of condition or inadequate placental functioning. Best results are obtained when the fetus is less than 34 weeks gestation and delivery occurs within a week of corticosteroid administration.
Nursing Care Plan 3: Risk for Maternal Injury
Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.
May be related to:
Tissue edema/hypoxia
Tonic-clonic convulsions
Abnormal blood profile and/or clotting factors
Desired Outcomes
The patient participates in treatment and/or environmental modifications to protect themself and enhance safety.
The patient is free of signs of cerebral ischemia (visual disturbances, headache, changes in mentation).
The patient displays normal levels of clotting factors and liver enzymes.
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Nursing Care Plans for Preeclampsia
Nursing Interventions
Rationale
Check for CNS involvement (i.e., headache, irritability, visual disturbances, or changes on funduscopic examination).
Cerebral edema and vasoconstriction can be evaluated in terms of symptoms, behaviors, or retinal changes.
Emphasize the importance of patient promptly reporting signs/symptoms of CNS involvement.
Delayed treatment or progressive onset of symptoms may result in tonic-clonic convulsions or eclampsia.
Check for alterations in level of consciousness.
In progressive PIH, vasoconstriction and vasospasms of cerebral blood vessels reduce oxygen consumption by 20% and result in cerebral ischemia.
Assess for signs of impending eclampsia: hyperactivity of deep tendon reflexes (3+ to 4+), ankle clonus, decreased pulse and respirations, epigastric pain, and oliguria (less than 50 ml/hr).
Generalized edema/vasoconstriction, manifested by severe CNS, kidney, liver, cardiovascular, and respiratory involvement, precedes the convulsive state.
Establish measures to lessen the likelihood of seizures; i.e., keep room quiet and dimly lit, limit visitors, plan and coordinate care, and promote rest.
Lessens environmental factors that may stimulate irritable cerebrum and cause a convulsive state.
Enforce seizure precautions per protocol.
If a seizure does occur, it reduces the risk of injury.
In the event of a seizure: Position patient on the side; insert airway/bite block only if the mouth is relaxed; suction nasopharynx, as indicated; administer oxygen; avoid restrictive clothing; do not restrict movement. Document motor involvement, duration of seizure, and post-seizure behavior.
Maintains the airway by reducing the risk of aspiration and preventing the tongue from occluding the airway. Maximizes oxygenation. Note: Be cautious with the use of airway/bite block because attempts to insert when jaws are set may result in injury.
Palpate for uterine tenderness or rigidity; check for vaginal bleeding. Review history of other medical problems.
These signs may indicate abruptio placentae, especially if there is a preexisting medical problem, such as diabetes mellitus or a renal or cardiac disorder causing vascular involvement.
Observe for signs and symptoms of labor or uterine contractions.
Convulsions increase uterine irritability; labor may ensue.
Assess fetal well-being, noting FHR.
During seizure activity, fetal bradycardia may occur.
Monitor for signs of DIC easy/spontaneous bruising, prolonged bleeding, epistaxis, GI bleeding.
Abruptio placentae with the release of thromboplastin predisposes the patient to DIC.
Hospitalize if CNS involvement is present.
Immediate introduction of therapy helps to ensure safety and limit complications.
Give MgSO 4 IM or IV using an infusion pump.
MgSO4, a CNS depressant, decreases acetylcholine release, blocks neuromuscular transmission, and prevents seizures. It has a transient effect of lowering BP and increasing urine output by altering vascular response to pressor substances. Although IV administration of MgSO4 is easier to regulate and reduces the risk of a toxic reaction, some facilities may still use the IM route if continuous surveillance is not possible and/or if appropriate infusion apparatus is unavailable. Note: Adding 1 ml of 2% lidocaine to the IM injection may reduce associated discomfort. (Current research suggests that the use of phenytoin infusion may be effective in treating PIH without the adverse side effects, such as respiratory depression and tocolytic effect on uterine smooth muscle, which can impede labor during intrapartum therapy.)
Monitor BP before, during, and after MgSO4 administration. Note serum magnesium levels in conjunction with respiratory rate, patellar/deep tendon reflex (DTRs), and urine output.
A therapeutic level of MgSO4is achieved with serum levels of 4.0–7.5 mEq/L or 6–8 mg/dL. Adverse/toxic reactions develop above 10–12 mg/dL, with loss of DTRs occurring first, respiratory paralysis between 15–17 mg/dL, or heart block occurring at 30–35 mg/dL.
Ready calcium gluconate. Give 10 ml (1 g/10 ml) over 3 min as indicated.
It serves as an antidote to counteract the adverse/toxic effects of MgSO4.
Administer amobarbital (Amytal) or diazepam (Valium), as indicated.
Depresses cerebral activity; has a sedative effect when MgSO4 does not control convulsions. Not recommended as first-line therapy because sedative effect also extends to the fetus.
Perform funduscopic examination regularly.
Helps to evaluate changes or severity of retinal involvement.
Review test results of clotting time, PT, PTT, fibrinogen levels, and FPS/FDP.
Such tests can indicate the depletion of coagulation factors and fibrinolysis, suggesting DIC.
Scan sequential platelet count. Avoid amniocentesis if the platelet count is less than 50,000/mm3. If thrombocytopenia is present during the operative procedure, use general anesthesia. As indicated, transfuse with platelets, packed red blood cells, fresh frozen plasma, or whole blood. Rule out HELLP syndrome.
Thrombocytopenia may arise because of platelet adherence to disrupted endothelium or reduced prostacyclin levels (a potent inhibitor of platelet aggregation). Invasive procedures or anesthesia requiring needle puncture (such as spinal/epidural) could result in excessive bleeding.
Monitor liver enzymes and bilirubin; note hemolysis and presence of Burr cells on peripheral smear.
An elevated liver enzyme (AST, ALT) and bilirubin levels, microangiopathic hemolytic anemia, and thrombocytopenia may indicate the presence of HELLP syndrome, signifying a need for immediate cesarean delivery if the condition of the cervix is unfavorable for induction of labor.
Prepare for cesarean birth if PIH is severe, placental functioning is compromised, and cervix is not ripe or is not responsive to induction.
When fetal oxygenation is severely reduced owing to vasoconstriction within the malfunctioning placenta, immediate delivery may be necessary to save the fetus.
Nursing Care Plan 4: Deficient Fluid Volume
Deficient Fluid Volume: Defined as decreased intravascular, interstitial, and intracellular fluid.
May be related to:
Osmotic pressure plasma protein loss
Decreasing plasma colloid
Allowing fluid shifts out of the vascular compartment
Possibly evidenced by:
Edema formation
Sudden weight gain
Decreased urine output
Hemoconcentration
Nausea/vomiting
Epigastric pain
Headaches
Visual changes
Desired Outcomes
The patient engages in therapeutic regimen and monitoring, as indicated.
The patient verbalizes understanding of the need for close monitoring of weight, BP, urine protein, and edema.
The patient is free of signs of generalized edema (i.e., epigastric pain, cerebral symptoms, dyspnea, nausea/vomiting)
The patient exhibits Hct WNL and physiological edema with no signs of pitting.
Nursing Interventions
Rationale
Weigh patient regularly. Tell patient to record weight at home in-between visits.
Abrupt, notable weight gain (e.g., more than 3.3 lb (1.5 kg)/month in the second trimester or more than 1 lb (0.5 kg)/wk in the third trimester) reflects fluid retention. Fluid moves from the vascular to the interstitial space, resulting in edema.
Differentiate physiological and pathological edema of pregnancy. Locate and determine the degree of pitting.
The presence of pitting edema (mild, 1+ to 2+; severe, 3+ to 4+) of face, hands, legs, sacral area, or abdominal wall, or edema that does not disappear after 12hr of bed rest is vital. Note: Significant edema may actually be present in non-pre-eclamptic patients and absent in patients with mild or moderated PIH.
Note signs of progressive or excessive edema, i.e., epigastric/RUQ pain, cerebral symptoms, nausea, vomiting). Assess for possible eclampsia.
Edema and intravascular fibrin deposition (in HELLP syndrome) within the encapsulated liver are manifested by RUQ pain; dyspnea, indicating pulmonary involvement; cerebral edema, possibly leading to seizures; and nausea, and vomiting, indicating GI edema.
Note alteration in Hct/Hb levels.
Identifies degree of hemoconcentration caused by fluid shift. If Hct is less than 3 times Hb level, hemoconcentration exists.
Check on dietary intake of proteins and calories. Give information as needed.
Proper nutrition decreases the incidence of prenatal hypovolemia and hypoperfusion; insufficient protein/calories increases the risk of edema formation and PIH. Intake of 80–100 g of protein may be required daily to replace losses.
Monitor intake and output. Note urine color, and measure specific gravity as indicated.
Urine output is a sensitive indicator of circulatory blood volume. Oliguria and specific gravity of 1.040 indicate severe hypovolemia and kidney involvement. Note: Administration of magnesium sulfate (MgSO4)may cause a transient increase in output.
Examine clean, voided urine for protein each visit, or daily/hourly as appropriate if hospitalized. Report readings of 2+, or greater.
Aids in identifying the degree of severity/progression of the condition. A 2+ reading implies glomerular edema or spasm. Proteinuria affects fluid shifts from the vascular tree. Note: Urine contaminated by vaginal secretions may test positive for protein, or dilution may result in a false-negative result. In addition, PIH may be present without significant proteinuria.
Assess lung sounds and respiratory rate/effort.
Dyspnea and crackles may mean pulmonary edema, which needs immediate treatment.
Check BP and pulse.
The rise in BP may happen in response to catecholamines, vasopressin, prostaglandins, and, as recent findings suggest, decreased levels of prostacyclin.
Respond to questions and review rationale for avoiding the use of diuretics to treat edema.
Diuretics further increase the chances of dehydration by decreasing intravascular volume and placental perfusion, and they may cause thrombocytopenia, hyperbilirubinemia, or alteration in carbohydrate metabolism in fetus/newborn. Note: It may be useful in treating pulmonary edema.
Schedule prenatal visit every 1–2 wk if PIH is mild; weekly if severe.
Important to monitor changes more closely for the well-being of the patient and fetus.
Review moderate sodium intake of up to 6 g/day. Tell patient to read food labels and avoid foods high in sodium (e.g., bacon, luncheon meats, hot dogs, canned soups, and potato chips).
Some sodium intake is necessary because levels below 2–4 g/day result in more significant dehydration in some patients. However, excess sodium may increase edema formation.
Collaborate with a dietitian as indicated.
The nutritional consult may be beneficial in determining individual needs/dietary plans.
Place patient on a strict regimen of bed rest; encourage lateral position.
Lateral recumbent position decreases pressure on the vena cava, increasing venous return and circulatory volume. This enhances placental and renal perfusion, reduces adrenal activity, and may lower BP as well as account for weight loss through diuresis of up to 4 lb in a 24-hr period.
As appropriate, educate patient and family members or significant others on home monitoring/day-care program.
Some mildly hypertensive patients without proteinuria may be managed on an outpatient basis if adequate surveillance and support is provided and the patient/family actively participates in the treatment regimen.
Substitute fluids either orally or parenterally via an infusion pump, as indicated.
Fluid replacement treats hypovolemia yet must be given cautiously to prevent overload, especially if interstitial fluid is drawn back into circulation when activity is reduced. With renal involvement, fluid intake is restricted; i.e., if the output is reduced (less than 700 ml/24 hr), total fluid intake is restricted to approximate output plus insensible loss. The use of an infusion pump allows more accurate control delivery of IV fluids.
When the fluid deficit is severe, and the patient is hospitalized:
Insert indwelling catheter if kidney output is reduced or is less than 50 ml/hr.
Allows more accurate monitoring of output/renal perfusion.
Help with insertion of lines and/or monitoring of invasive hemodynamic parameters, such as CVP and pulmonary artery wedge pressure (PAWP).
Gives a more precise measurement of fluid volume. In normal pregnancy, plasma volume increases by 30%–50%, yet this increase does not occur in the patient with PIH.
Monitor serum uric acid and creatinine levels and BUN.
Elevated levels, especially of uric acid, indicate impaired kidney function, worsening of the maternal condition, and poor fetal outcome.
Administer platelets as indicated.
Patients with HELLP syndrome awaiting delivery of the fetus may benefit from transfusion of platelets when the count is below 20,000.
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Nursing Care Plans for Preeclampsia
Nursing Care Plan 5: Risk for Imbalanced Nutrition: Less Than Body Requirements
Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet metabolic needs.
It may be related to insufficient intake that can’t meet metabolic demands and replace losses.
Desired Outcomes
The patient verbalizes understanding of individual dietary needs.
Patient demonstrates knowledge of proper diet as evidenced by developing a dietary plan within their own financial resources.
The patient displays appropriate weight gain.
Nursing Interventions
Rationale
Determine patient’s nutritional status, condition of hair and nails, and height and pregravid weight.
Establishes guidelines for determining dietary needs and educating patients. Malnutrition may contribute to the onset of PIH, specifically when the client follows a low-protein diet, has insufficient caloric intake, and is overweight or underweight by 20% or more before conception.
Provide information about normal weight gain in pregnancy, modifying it to meet the client’s needs.
The underweight patient may need a higher-calorie diet; the obese patient should avoid dieting because it places the fetus at risk for ketosis.
Present oral/written information about the action and uses of protein and its role in PIH development.
Regular intake of 80–100 g/day (1.5 g/kg) is sufficient to replace proteins lost in the urine and allow for normal serum oncotic pressure.
Provide information regarding the effect of bed rest and reduced activity on protein requirements.
Decreasing metabolic rate through bed rest and limited activity reduces protein needs.
Collaborate with a dietitian, as indicated.
Helpful in creating individual dietary plans incorporating specific needs/restrictions.
Summary
Preeclampsia is a complication of pregnancy where there is a sudden rise in blood pressure. It usually develops during the third trimester.
Preeclampsia is not entirely preventable, but visiting a doctor for regular prenatal visits may lead to early detection. Limiting highly processed foods and choosing fruits and vegetables — frozen and canned are great options — can also help to keep people and their babies healthier during pregnancy.
It is advisable for pregnant people to speak with a healthcare professional about their risk of developing preeclampsia and its warning signs.
Related FAQs
1. What are some nursing interventions for preeclampsia?
Nursing Management
Monitor blood pressure.
Assess fetal heart rate.
Send blood and urine for testing.
Administer prescribed medications.
Monitor reflexes on patients on magnesium sulfate.
Neurologic checks regularly.
Seizure precautions if ordered.
2. What are some nursing diagnosis for preeclampsia?
Nursing Care Plan for Preeclampsia 4. Nursing Diagnosis: Risk for Injury related to Altered state of mind, hypoxia of the tissues, atypical blood profile and clotting factors, and episodes of tonic-clonic convulsions secondary to Pre-eclampsia.
3. What needs to be included in a plan of care for the woman experiencing preeclampsia?
Plan of Care
A thorough initial assessment of the woman with possible preeclampsia should include a complete history, a complete physical exam with close attention to preeclampsia symptoms including unremitting headaches, edema, visual changes, and epigastric pain, fetal activity, and vaginal bleeding.
4. What are interventions for preeclampsia?
Medications to treat severe preeclampsia usually include:
Antihypertensive drugs to lower blood pressure.
Anticonvulsant medication, such as magnesium sulfate, to prevent seizures.
Corticosteroids to promote development of your baby’s lungs before delivery.
