preeclampsia

Preeclampsia and Eclampsia Nursing Diagnosis Care Plan

Preeclampsia and Eclampsia Nursing Diagnosis Care Plan NCLEX Review

Preeclampsia and Eclampsia:

Pre-eclampsia is a medical condition that arises from persistent high blood pressure at around 20 weeks of pregnancy, causing damage to organs such as kidneys and liver.

Kidney damage is characterized by the presence of protein in the urine, known as proteinuria.

If left untreated, pre-eclampsia can lead to eclampsia, a serious complication where in the high blood pressure results to the occurrence of seizures.

This is life-threatening for both the mother and her baby. One in every 200 pregnant women with pre-eclampsia develops eclampsia in the United States. The most effective treatment for pre-eclampsia or eclampsia is the delivery of the baby.

Signs and Symptoms

Pre-eclampsia

It can be asymptomatic at first, and blood pressure may start creeping up slowly

  • Persistently high blood pressure (above 140/90 mmHg) – checked for at least 2 occasions, 4 hours apart
  • Proteinuria
  • Severe headaches
  • Visual disturbances (blurry vision, light sensitivity, temporary loss of vision)
  • Upper abdominal pain
  • Nausea / vomiting
  • Decreased urine output
  • Swelling /edema – usually seen on the face and hands and can also be in the lower limbs
  • Shortness of breath (if fluid starts to fill the lungs)
  • Sudden weight gain

Eclampsia

In addition to the signs and symptoms of pre-eclampsia, a patient with eclampsia may have seizure symptoms such as:

  • Staring
  • Decreased level of alertness
  • Convulsions or violent shaking

Causes

During pregnancy, new blood vessels are formed to deliver blood efficiently to the placenta in order to nourish the fetus.

These blood vessels may be narrower or dysfunctional in women with pre-eclampsia, limiting the blood flow to the placenta. Damage to the blood vessels, immune system disorders, genetics, or other hypertension-related disorders can cause this damage of the blood vessels.

Pregnancy-induced hypertension, if poorly managed or left untreated, can result to the development of pre-eclampsia and subsequent eclampsia.

The risk factors for pre-eclampsia include a personal history of pre-eclampsia in previous pregnancies, a family history of pre-eclampsia, first pregnancy, multiple pregnancy, chronic hypertension (patient is hypertensive even before pregnancy), age (very young women and women above 35 years of age), obesity, in vitro fertilization, history of diabetes or kidney disease, and race (black women are at higher risk than other races).

Complications

  1. Preterm birth. Severe pre-eclampsia requires prompt delivery of the baby to prevent the development of eclampsia or seizures in order to save the life of both the mother and the baby. Preterm babies may suffer from lung or other organ problems or low birth weight.
  2. Fetal growth restriction. Pre-eclampsia involves the low oxygen and blood supply to the placenta. The baby may suffer from growth retardation due to this.
  3. Abruptio placentae. The placenta may separate from the inner uterine wall before the delivery of the baby, due to pre-eclampsia. This can cause life-threatening heavy bleeding.
  4. HELLP syndrome. The name of this syndrome stands for Hemolysis (wherein red blood cells are destroyed), Elevated Liver enzymes and Low platelet count..

Diagnosis

  • Blood pressure checks
  • Urinaysis –  to find any protein in the urine (proteinuria)
  • Blood tests – full blood count and biochemistry –to check for low platelet count and signs of kidney problems and/or impaired liver function
  • Imaging – find fluid in the lungs (pulmonary edema)
  • Physical assessment –new onset of headaches or visual disturbances
  • Fetal ultrasound – to closely monitor for the growth of the baby
  •  Non-stress test or biophysical profile -to check for the baby’s heart rate reacts when the baby moves

Treatment

  1. Delivery. The most important and effective treatment is to deliver the baby. Induced labor or C-section may be done to facilitate the delivery of the baby.
  2. Antihypertensives. To lower blood pressure levels, antihypertensives that are safe for pregnancy should be prescribed.
  3. Corticosteroids. Severe pre-eclampsia may require corticosteroids to help boost platelets and liver function, as well as to speed up the maturity of the baby’s lungs.
  4. Anticonvulsants. To prevent seizures, magnesium sulfate may be prescribed.
  5. More frequent prenatal visits. This is necessary to closely monitor maternal health and fetal well being.
  6. Diet and supplements. Low salt, low caloric diet is advised to prevent the development of pre-eclampsia. Garlic or fish oil as well as calcium supplements may also be recommended by the physician.

Nursing Care Plans for Preeclampsia and Eclampsia

  1. Nursing Diagnosis: Decreased cardiac output related to increased systemic vascular resistance secondary to preeclampsia, as evidenced by an average blood pressure level of 180/90, shortness of breath, and edema of the palms

Desired Outcome: The patient will have an improved cardiac output through well-controlled blood pressure levels throughout the remainder of her pregnancy.

InterventionRationale
Assess vital signs, conduct physical examination, and commence daily weight monitoring.Edema, headaches, visual disturbances, and epigastric pain are associated with the patient’s high blood pressure level. Weight gain is an important symptom of preeclampsia. Fluid retention may be evident if the mother has a weight gain of more than 1.5kg/month during the 2nd trimester, or more than 0.5 kg/week during the 3rd trimester.
Instruct the patient to have bedrest and avoid environmental stressors.To lower blood pressure levels, improve cardiac rate, and enhance renal-placental perfusion.
Administer hypertensives as prescribed.To lower blood pressure levels. Common antihypertensives for preeclampsia include hydralazine, MgSO4, and nifedipine.
Prepare to deliver the baby either by labor induction or Cesarean section.The baby may be delivered earlier than expected if the risks for the mother and the baby become higher. Pregnancy induced-hypertension, which is related to pre-eclampsia, usually goes away 6 months post partum
Preeclampsia and Eclampsia
  1. Nursing Diagnosis: Altered Uteroplacental Tissue Perfusion related to maternal hypovolemia secondary to pre-eclampsia as evidenced by intrauterine fetal growth retardation viewed in the scans, and changes in fetal heart rate

       Desired Outcome: Patient’s baby will have a stable fetal heat rate when subjected to contraction stress test.

InterventionsRationales
Teach the patient and her partner or next of kin on how to perform home assessment which includes noting daily fetal movements and identifying signs of fetal distress and how to get help immediately.Decrease in fetal activity may mean fetal compromise or distress, which requires immediate medical attention.  
Encourage the pregnant patient to follow a healthy lifestyle, such as smoking cessation and avoidance of illegal drug use, proper hydration, enough sleep, and appropriate diet.Fetal movement and activity can be affected by cigarette smoking, drug abuse, dehydration, sleep deprivation, and poor dietary choices.
Educate the patient on the signs of abruptio placenta and instruct to get help immediately if any of these occur.To give the patient enough information on the warning signs of abruptio placentae, which include uterine tenderness, vaginal bleeding, decreased fetal activity, and abdominal pain.  
Monitor fetal growth by measuring the fundus, and check fetal heart rate at each clinic visit.To determine if the baby is experiencing intrauterine growth retardation related to preeclampsia.  
If the baby needs to be delivered prematurely, give IM corticosteroids as prescribed, not more than 7 days prior to expected date of delivery.To enhance the production of surfactants which are necessary to speed up the pulmonary maturity of the fetus and avoid respiratory distress syndrome.
Preeclampsia and Eclampsia

References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.     

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.

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