Preeclampsia is a common problem during pregnancy.

The condition sometimes referred to as pregnancyinduced hypertension is defined by high blood pressure and excess protein in the urine after 20 weeks of pregnancy. Often, preeclampsia causes only modest increases in blood pressure. Left untreated, however, preeclampsia can lead to serious even fatal complications for both mother and baby. A. Mild Preeclampsia  BP of 140/90  1+ to 2+ proteinuria on random  weight gain of 2 lbs per week on the 2nd trimester and 1 lb per week on the 3rd trimester  Slight edema in upper extremities and face B. Severe Preeclampsia  BP of 160/110  3-4+ protenuria on random  Oliguria (less than 500 ml/24 hrs)  Cerebral or visual disturbances  Epigastric pain  Pulmonary edema  Peripheral edema  Hepatic dysfunction Eclampsia is an extension of preeclampsia and is characterized by the client experiencing seizures. NURSING MANAGEMENT 1. Monitor for, and promote the resolution of, complications.  Monitor vital signs and FHR.  Minimize external stimuli; promote rest and relaxation  Measure and record urine output, protein level, and specific gravity.  Assess for edema of face, arms, hands, legs, ankles, and feet. Also assess for pulmonary edema.  Weigh the client daily.  Assess deep tendon reflexes every 4 hours.  Assess for placental separation, headache and visual disturbance, epigastric pain, and altered level of consciousness.
Test
Blood Hematocrit Renal Function Serum uric acid Creatinine Creatinine clearance BUN Coagulation Platelets Fibrin degradation products

Findings
>40% ?5.5 mg/dL >6.0 mg/dL (severe PIH) ?1.0 mg/dL 2.0-3.0 md/dL (severe PIH) <150 mL/min 8-10 mg/dL (severe PIH) 10-16 mg/dL (severe PIH) <100,000 mL (severe PIH) ?16 g/mL (severe PIH)

2. Provide treatment as prescribed.  Mild preeclampsia treatment consists of bed rest in left lateral recumbent position,balanced diet with moderate to high protein and low to moderate sodium, and administration of magnesium sulfate  Severe preeclampsia treatment consists of complete bed rest, balanced diet with high protein and low to moderate sodium, administration of sulfate, fluid and electrolyte replacements and sedative hypertensives such as diazepam or phenobarbital or an anticonvulsant such as phenytoin  Eclampsia treatment consists of administration of magnesium sulfate intravenously 3. Institute seizure precautions. Seizures may occur up to 72 hours after delivery. 4. Address emotional and psychosocial needs.

Nursing Care Plans for Preeclampsia

y y y y y y y y A patient with mild preeclampsia typically reports a sudden weight gain, The patient's history reveals hypertension Inspection reveals generalized edema, especially of the face. Palpation may reveal pitting edema of the legs and feet. Deep tendon reflexes may indicate hyperreflexia. Oliguria Blurred vision caused by retinal arteriolar spasms, Epigastric pain or heartburn, irritability, and emotional tension. Patient may complain of a severe frontal headache.

In a patient with severe preeclampsia: Blood pressure readings increase to 160/110 mm Hg or higher on two occasions, 6 hours apart, during bed rest. Also, Ophthalmoscopic examination may reveal vascular spasm, papilledema, retinal edema or detachment, and arteriovenous nicking or hemorrhage. Diagnostic Highlights Nursing Care Plan For Preeclampsia Hemolysis, elevated liver enzyme levels, and a low platelet count (HELLP syndrome) characterize severe eclampsia. A unique form of coagulopathy is also associated with this disorder. y y y y y y y y y Urine for protein and creatinine Uric acid Blood urea nitrogen (BUN) Liver enzymes: AST, ALT, LDH,Bilirubin Platelets Coagulation studies RBC (red blood cell) Hgb (hemoglobin) Hct (hematocrit)

Preeclampsia Treatment Therapy for patients with preeclampsia is intended to halt the progress of the disorder specifically, the early effects of eclampsia, such as seizures, residual hypertension, and renal shutdown and to ensure fetal survival. Some physicians advocate the prompt inducement of labor, especially if the patient is near term; others follow a more conservative approach. Therapy may include: y y y complete bed rest in the preferred left lateral lying position to enhance venous return an antihypertensive, such as methyldopa or hydralazine magnesium sulfate to promote diuresis, reduce blood pressure, and prevent seizures if the patient's blood pressure fails to respond to bed rest and the antihypertensive and persistently rises above 160/100 mm Hg, or if central nervous system irritability increases. If fetal life is endangered cesarean section or oxytocin inducement may be required to terminate the pregnancy.