Preeclampsia Nursing Care Plan

Patient Information
Name: Jane Smith Age: 32

Medical History: Type 2 Diabetes Mellitus

Pregnancy Details (Gestational Age, etc.):

34 weeks gestation, first pregnancy

Current Medications:
Prenatal vitamins, Insulin

Assessment
Blood Pressure Readings:
160/100 mmHg

Presence of Proteinuria:
2+ on dipstick test

Symptoms (e.g., headache, blurred vision, abdominal pain):

Occasional headaches, episodes of blurred vision

Fetal Assessment (if applicable):

Normal fetal heart rate, no signs of distress

Edema Assessment:
Mild edema in feet and ankles

Reflexes (e.g., deep tendon reflexes):

Hyperreflexia noted

Nursing Diagnosis

Risk for Decreased Cardiac Output related to: Hypertension and preeclampsia
Risk for Fetal Injury related to: Preeclampsia and high blood pressure

Anxiety related to:

Health of unborn baby and self, potential complications

Planning

Goals

Short-term Goal: Maintain blood pressure within safe limits, prevent seizures
Long-term Goal: Safe delivery of baby, resolution of preeclampsia post-delivery
 Specific Objectives
Regular blood pressure monitoring, education on signs of eclampsia, and dietary advice

Interventions

Monitoring

Blood Pressure Monitoring:

Every 4 hours

Urine Protein Monitoring:

Daily

Fetal Monitoring:
Twice daily fetal heart rate checks

Positioning

Left Lateral Position:

Encourage left lateral position to optimize blood flow

Seizure Precautions

Magnesium Sulfate Administration:

As prescribed

Observation for Signs of Eclampsia:

Continuous monitoring for headaches, visual changes, or upper abdominal pain

Fluid Management

IV Fluids: As prescribed, monitor for fluid overload

Oral Fluids: Encourage adequate hydration

Patient Education

Disease Process:
Explanation of preeclampsia and its implications
 Signs of Worsening Condition:
Educate about signs of severe preeclampsia and eclampsia

Dietary Recommendations:
Low sodium diet, adequate protein intake

Evaluation

Response to Interventions:
Blood pressure stabilized, no further headaches or visual disturbances

Blood Pressure Control:

Managed within target range

Fetal Well-being:
Stable fetal heart rate, no signs of fetal distress

Additional Notes
Plan for close monitoring and possible early delivery if condition worsens
Regular antenatal appointments to monitor maternal and fetal health