Professional Documents
Culture Documents
Pre Eclampsia
Pre Eclampsia
CLASSIFICATION OF PREECLAMPSIA
PREECLAMPSIA COMPLICATIONS
PATHOPHYSIOLOGY OF PREECLAMPSIA
NURSING INTERVENTIONS
EVALUATION
CONCLUSION
REFERENCES
1
OBJECTIVES
At the end of the course the students will be able to demonstrate good knowledge
of the following:
1. What Is Preeclampsia
2. Classification of Preeclampsia PE
7. Preeclampsia Complications
What Is Preeclampsia?
Preeclampsia, formerly called toxaemia, is when pregnant women have high blood
pressure, protein in their urine, and swelling in their legs, feet, and hands. It can range
from mild to severe. It usually happens late in pregnancy, though it can come earlier
Preeclampsia can lead to eclampsia, a serious condition that can have health risks for
mom and baby and, in rare cases, cause death. If your preeclampsia leads to seizures,
The only cure for preeclampsia is to give birth. Even after delivery, symptoms of
2
preeclampsia can last 6 weeks or more.
Classification of Preeclampsia PE
Mild Preeclampsia PE
late-onset form of the disease until 32 to 34 weeks gestation (2) This often happens
with high-risk pregnancies, such as those that are multiples or have had one or both of
The first signs of mild preeclampsia are a discernable increase in blood pressure and a
develop, and delivery by inducing labour or C-section when it reaches severe forms.
Moderate Preeclampsia PE
Moderate preeclampsia is diagnosed when the systolic blood pressure exceeds 151
It is sometimes also used as an umbrella term for mild and severe forms of
3
women whose mildness is categorized as early-onset and occurs antepartum.
symptoms such as headache and visual disturbances are present. Preeclampsia may be
preeclampsia has reached average levels of severity, and if a pregnant woman’s blood
pressure goes above 160/110, she may develop seizures or myocardial infarction. If
blood pressure does not improve within a few days to weeks, delivery by inducing
The mild form often improves without treatment, but severe conditions need to be
poorly controlled and liver or kidney dysfunction if the placenta separates from the
uterine wall (placental abruption). In such cases, an emergency cesarean section may
be necessary.
Preeclampsia is dangerous in that the mother may have a stroke due to uncontrolled
blood pressure. However, women with severe preeclampsia are not in danger of dying
Severe Preeclampsia
4
physician would look at these features: headaches, visual disturbances, seizures, and
pulmonary oedema.
(systolic BP > 140 or diastolic BP > 90 mm Hg) damaged endothelial cells lose their
tone, therefore, vasospasm (contraction of the vessel) starts to occur and this leads to
Proteinuria: (> 300 mg in 24 hours) this is due to kidney injury…the kidneys are
being deprived of proper blood flow and endothelial cells that line the glomerulus
(this structure filters the blood and it normally does NOT filter large molecules like
protein) are damaged. The damaged cells of the glomerulus start to leak protein from
the blood into the urine causing proteinuria. Note: this also drops protein levels in the
Also due to kidney compromise: uric acid and creatinine levels INCREASE and
Oedema: (eyes, face, extremities, pulmonary oedema, increase weight gain, cerebral
oedema): the increase in permeability of the endothelial cells causes the protein to
escape the vessel. Remember protein helps regulate oncotic pressure…so where
protein goes, so does water. Therefore, water will leave the intravascular area and
shift to the interstitial tissue and cause swelling. This further complicates things
5
because it decreases blood volume. So, there is less blood volume being used to
Lungs: fluid can start to accumulate in the lungs leading to difficulty breathing
Brain: due to brain swelling and decreased perfusion the woman may experience
headache, vision changes, hyperreflexia, clonus (if this is present there is a HIGH risk
Upper abdominal pain and increase in liver enzymes (AST and ALT): the liver is
Decreased platelets (leading the DIC), hemolysis (rupture of red blood cells)…
leading to HELLP Syndrome: the damaged endothelial cells cause red blood cells to
rupture and it causes the body to want to repair the cells…so platelets start to
congregate at these cells (note in severe cases there are many damaged endothelial
cells in the body so that requires a lot of platelets)…this depletes the platelet stores
and cause micro-clot development with the vessels, which decreases perfusion even
more.
Preeclampsia can happen as early as 20 weeks into pregnancy, but that’s rare.
Symptoms often begin after 34 weeks. In a few cases, symptoms develop after birth,
tolerance. The exact cause remains unknown, but risk factors include: being over 35
6
years old, having previous preeclampsia/eclampsia, abnormal placentation, multiple
gestations (twins and triplets), Black race, preterm labour, intrauterine growth
blood supply to tissue in the body. This causes hypertension, elevated pulse rate, and
factor for preeclampsia and gestational diabetes. Overweight mothers are exposed to
this condition because of an increase in circulating estrogen in the body. This causes a
The exact mechanisms behind this are unknown, but it has been suggested that
elevated levels of factor VIII and von Willebrand factor may lead to increased risk for
preeclampsia.
who have experienced any of the above are at greater risk to develop the condition
again during subsequent pregnancies than those with no prior histories. This could be
due to genetic factors, but the mechanism behind this has not yet been determined.
-Viral diseases during pregnancy: It is known that viruses can trigger preeclampsia
7
in some women, but the exact mechanism through which they do so remains to be
discovered. A recent study has suggested that viral infection of the placenta may
increase levels of interleukin-6 (IL-6), a cytokine that plays an essential role in the
development of preeclampsia. It has also been suggested that virus particles can be
transferred from the mother to her child and lead to infection, which may trigger
preeclampsia.
Preeclampsia Complications
Preeclampsia is a severe complication that can affect fetal growth and survival. This
(RDS) and intrauterine growth restriction. Pre-eclampsia also increases the risk of
HELLP SYNDROME
Hemolysis. This is when the red blood cells that carry oxygen through your body
break down.
Elevated liver enzymes. High levels of these chemicals in your blood mean liver
problems.
Low platelet counts. This is when you don’t have enough platelets, so your blood
8
doesn’t clot the way it should.
Preeclampsia can also cause your placenta to suddenly separate from your uterus,
Preeclampsia can last for weeks or even months in some cases. Eventually, a woman
with the condition will go into labour and give birth. After delivery, symptoms usually
disappear. However, sometimes they do not fade right away, and a woman may have
high blood pressure for weeks or even months after giving birth. If this is the case, she
may need to take blood pressure medication or other drugs such as corticosteroids
If a woman’s blood pressure becomes dangerously high, she will be hospitalized and
placed on medications that lower the pressure (diuretics or other drugs) and deliver
blockers.
Magnesium sulfate helps prevent seizures, which may develop in severe cases of
preeclampsia. Women with milder signs and symptoms who are not at risk for
After delivery, magnesium sulfate treatment is continued until 24 hours after the
9
PATHOPHYSIOLOGY OF PREECLAMPSIA
in fetal-placental perfusion. The role of maternal factors (e.g., age, excess weight
gain) and fetal factors (e.g., sex and elevated unconjugated bilirubin concentration)
has recently been reevaluated to determine those factors that may predispose women
to the condition.
the woman with possible preeclampsia should include a complete history, a complete
headaches, oedema, visual changes, and epigastric pain, fetal activity, and vaginal
bleeding.
The patient’s history about their maternal age, gestational age, previous gestational
which may have been associated with preeclampsia such as oedema or hypertension,
Preeclampsia has been diagnosed by the criteria of systolic blood pressure (SBP) ≥
4 h apart in a previously normotensive patient with positive urine protein (at least 1+
The gestational age was calculated by using the date of the last menstrual period and
10
then confirmed by ultrasonography of the fetus before the consideration for pregnancy
termination.
need vital signs, including pulse ox every 30 minutes (should be done every 5 minutes
during loading dose of magnesium sulfate). These women need lung sounds assessed
every 2 hours. Level of consciousness, oedema and assessment for headache, visual
disturbances, epigastric pain should occur every 8 hours. Strict (hourly) intake and
output should be monitored, and intake should be ≤ 125 mL/hour. Fetal monitoring
-Rest, reassurance, frequent monitoring of vital signs and fluid intake, administration
– Monitor BP daily
The only way to prevent preeclampsia is by early diagnosis and management. A good
history and physical exam are essential for accurate diagnosis. If signs and symptoms
of preeclampsia are present, the patient should be seen every 4 hours until delivery.
According to the AACN Synergy Model for Critical Analysis and Resolution of
Clinical Problems, six interrelated diagnoses may be applicable in planning care for a
-Deficient Knowledge
11
-Impaired Physical Mobility
OBJECTIVES:
ACTIVITY GOALS:
Remember that normal urine output is generally defined as 1.5 litres per day;
however, the amount of fluid these patients drink does not correlate with their urine
output.
ACTIONS:
because this reduces the risk of renal failure. Encourage to drink 1/2 cup fluid with
each meal and at least 64 oz. daily unless contraindicated by her symptoms or lab
Assess the client’s condition regularly to ensure that her health has not worsened.
If any changes are noticed or significant sudden weight gain, then medication may
12
need adjusting accordingly.
Educate on dietary measures should be given as appropriate, for example, low salt,
low fat intake, and regular consumption of fresh fruit and vegetables
PATIENT GOALS:
bath or shower, listening to music, watching TV, etc. [comfort measures can help
Deficient Knowledge:
with the patient on a day to day basis, they should provide the patient with written
instructions on what behaviours to avoid or take precautions for the condition. The
nurse should also warn her about when to seek medical attention and emphasize the
Interventions:
Instructing the pregnant women on what actions to take based on her diagnosis.
Outcome Criteria: The patient will demonstrate positive knowledge of the condition,
its symptoms, and how to care for herself prior to discharge from the hospital.
It is vital that the patient does not strain during labor or while carrying out any
13
activities at night or in the day. The patient should be made aware of when she
requires help with her daily activities. She also needs to be educated on how to handle
Outcome Criteria: The patient will not strain during labor or while participating in
daily activities, and she will not need extra assistance from family members for this
purpose. She will follow all instructions provided by the nurse on how to use her
Risk for Injury: The patient is at risk of physical damage while in labor because of
the high BP and blood volume loss. She may also sustain injuries that interfere with
history from the patient on how she perceives her physical mobility.
Outcome Criteria: The patient will not sustain any injuries while in labor or
Impaired Physical Mobility and Risk for Injury diagnoses will be evaluated through
clinical observations and by obtaining a history from the patient on how she perceives
Imbalanced Nutrition:
Less than body requirements: The patient’s nutritional intake will be evaluated at the
start of her hospital stay regarding eating habits and food preferences.
Outcome Criteria:
The patient will have a good appetite for healthy foods high in vitamins, minerals,
protein, and low-fat content. She will follow all recommendations from dieticians
14
regarding sugar levels and protein content under her care plan.
through clinical observations and patient interviews. Based on the findings, the
complications for the mother and baby during the postpartum period.
The patient may become dehydrated because of decreased fluid intake, and therefore
Outcome Criteria: The patient will follow all instructions given to her by the nurses
on how much fluids she requires each day (8 glasses) and will access the taste of
different foods that are high in liquid content. She will carry out her daily activities
Balanced Fluid Volume: The client requires sufficient fluids throughout her hospital
stay and during labor to help maintain her blood volume and avoid dehydration.
Outcome Criteria: The pregnant woman will follow all instructions given by the
nurses and dieticians on how much fluids she requires each day (8 glasses). She will
assess the taste of different foods that are high in liquid content. She will carry out her
daily activities while using urine dipsticks to check for proper hydration levels.
from the patient on how she perceives her physical mobility, nutritional intake, and
hydration levels. The findings will then be used to develop strategies to meet the
15
patient’s needs and ensure she is in good condition after labor.
The patient has been informed about the pain experienced during childbirth before her
Outcome Criteria: The patient will not have an increased heart rate or respiratory
rate during delivery under the supervision of nurses to prevent any problems. To
further address her fear and anxiety, she will be taught relaxation techniques that
breathing.
The Ineffective Protection from Pain diagnosis will be investigated through clinical
observations and patient interviews. Based on the findings, relevant nursing care
interventions will be implemented to reduce pain before, during, and after delivery
assessed based on her educational level and whether she has given birth before.
Outcome Criteria: The patient will be taught how to cope with labor contractions
through relaxation exercises and breathing techniques by nurses. She may then use
her skills at home after she has been discharged from the hospital. She will be taught
about the different pain-relieving methods available during labor, such as gas and air,
and patient interviews. Based on the findings, relevant nursing care interventions will
16
be implemented to provide the patient with information regarding labor, pain
NURSING EVALUATION
If any changes are noticed or significant sudden weight gain, then medication may
Educate on dietary measures should be given as appropriate, for example, low salt,
low fat intake, and regular consumption of fresh fruit and vegetables
CONCLUSION
The study enabled the synthesis of specific nursing care to women with pre-
eclampsia, which can reduce complications and mortality rates. Nursing care
described in this review covers mainly thorough physical examination, early detection
circumference, slow speed deflation of the mercury column (mmHg ≤2), the need for
Creating and following care protocols guided by scientific evidence in daily clinical
17
nursing practise can be helpful to guide the decision-making process and ensure the
We highlight the need for studies on the thematic subject of this review with
methodological rigour, seeking to provide the nurse subsidies for nursing care.
REFERENCES
2015.
preeclampsia in nulliparous women at low risk,” Obstetrics & Gynecology, vol. 119,
in pregnancy,” Women's Health Journal, vol. 10, no. 4, pp. 385–404, 2014.
6.L. Say, D. Chou, A. Gemmill et al., “Global causes of maternal death: a WHO
systematic analysis,” The Lancet Global Health, vol. 2, no. 6, pp. e323–e333, 2014.
Obstetrics & Gynecology and Reproductive Biology, vol. 170, no. 1, pp. 1–7, 2013.
18
Brazil,” PLoS ONE, vol. 9, no. 5, Article ID e97401, 2014.
10.E. Zanette, M. A. Parpinelli, F. G. Surita et al., “Maternal near miss and death
for monitoring quality of maternal health care,” Best Practice & Research Clinical
approach,” Journal of Human Hypertension, vol. 24, no. 2, pp. 104–110, 2010.
risks model in screening for pre-eclampsia by maternal factors and biomarkers at 35-
37 weeks' gestation,” Ultrasound in Obstetrics & Gynecology, vol. 48, no. 1, pp. 72–
79, 2016.
19