04.14 Preeclampsia (Pree-)

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Overview

  1. Hypertensive disorder
  2. Proteinuria
  3. After 20 weeks gestation

Nursing Points

General

  1. A woman may or may not be symptomatic but will have elevated blood pressures and proteinuria
  2. Blood pressures
    1. 140/90 or more x 2, 4 hours apart
    2. Or a systolic 160 mmhg or more
    3. Or a diastolic of 90 mmhg or more
      1. So remember 140/90 and 160/90

Assessment

  1. So what does this patient look like?
    1. A sudden increase in edema
      1. Hands and face
    2. Sudden weight gain
      1. Excess fluid retention
    3. Complaints of headache
    4. Complaints of epigastric or RUQ pain
    5. Vision changes
      1. Serious symptom of preeclampsia
      2. From swelling and irritation of the brain and the CNS
    6. Proteinuria
  2. Fetal assessment
    1. Intrauterine growth restriction (IUGR)
      1. Placental blood flow is not at its best

Therapeutic Management

  1. Delivery of the baby is the only cure
  2. Magnesium sulfate is given prophylactically
    1. Seizure prevention
  3. Some antihypertensive drugs might be given to manage BP

Nursing Concepts

  1. Reproduction
  2. Perfusion

Patient Education

  1. Call MD if nausea, vision changes, headaches, epigastric pain or increased swelling occur
  2. Perform daily kick counts
  3. Home BP checks

Reference Links

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Video Transcript

In this lesson I will explain pre-eclampsia and your role in providing safe card to this patient

Preeclampsia is hypertension that occurs in pregnancy after after 20 weeks gestation. The patient will have proteinuria. This is a must have! If there is no protein that it is only gestational hypertension. Preeclampsia is a progression and could progress and worsen. Delivery is the only treatment or cure.

So for preeclampsia we say a patient must be hypertensive. Let’s look at what ranges classify as pre-eclamptic pressures. Blood pressure must be 140/90 or more times 2, 4 hours apart. So they will check it again to see if it has come down and hopefully it has but 140/90 is one option. The other is a systolic of 160 mmhg or more or a diastolic of 90 mmhg or more. So to make this easier just remember 140/90 and 160/90.

So what does this patient look like on assessment? A woman will usually present with a sudden increase in edema especially in hands and face. Why does this happen? Fluid is being retained because the body is not filtering or pumping correctly. There is sudden weight gain. Why? Because of excess fluid retention. The heart is not pumping as effectively so it all backs up. They have complaints of headaches because of the high blood pressure. There is a change in pressure from normotensive to hypertensive. Another assessment finding is complaints of epigastric or right upper quadrant pain. In preeclampsia there is Inflammation is occuring in the body. The liver is inflamed which causes elevated liver enzymes and abdominal pain. Vision changes can also occur, but this is a very dangerous symptom. This occurs from swelling and irritation of the brain and the central nervous symptom.Proteinuria is our must have symptom. So why is that in the urine? The body is sick and inflamed so the kidney filter that keeps protein in the blood is damaged so protein is spilled into the urine

Our management of this patient is really going to revolve around safety. What is the safest treatment for the patient and baby. Delivery of the baby is the only cure for pre-eclampsia. If it is safe to keep the patient pregnant longer and safe for the baby then we will. In this case the patient can be kept in the hospital and receive IV Magnesium sulfate. This is given prophylactically to prevent seizures. Remember how I said preeclampsia is a progressive disease so they can get worse and remember also how we have an inflamed CNS? This can cause seizure. If a seizure occurs the patient is now said to be eclamptic. When seizures occurs the disease process has now advanced and is called eclampsia.. A little side note is that a side effect of Mag sulfate is it lowers blood pressure so that is terrific, right?!! Some antihypertensive drugs might be given to manage blood pressure if magnesium sulfate is not lowering it enough or if they are trying to manage without magnesium. Let’s also talk about the fetus. Fetal assessment needs to be done. This will be looking at blood flow through the placenta to ensure the fetus is getting good blood flow. Also fetal measurements to make sure the baby is growing ok. The fetus can have intrauterine growth restriction known as IUGR. With preeclampsia the fetus doesn’t grow as well hence growth restriction this is because blood flow into the placenta is not at its best. We need good healthy blood flow to come through the placenta to give nutrients to grow the fetus.

The preeclamptic patient needs to receive education on when to call the MD. So if there is nausea, vision changes, headaches, epigastric pain or swelling occur then she should call. They need to be performing daily kick counts. Remember with preeclampsia there is not great blood flow to the placenta which creates an unhealthy environment for that fetus. Kick counts will help us to know if the fetus is still healthy in that environment. The patient should attempt to get 10 kicks in a two hour time frame and notify if they aren’t. She should be taught how to do home blood pressure checks and report readings of 140/90 or a systolic of 160 or more or a diastolic of 90 or more.

Reproduction and perfusion are our nursing concepts. We are worried about the perfusion to the organs and through the placenta.

Ok so our key points. If you remember these you will understand pre-eclampsia. A patient has hypertension. Her blood pressures are 140/90 or systolic over 160 or diastolic over 90. She has proteinuria. This is a MUST! If she has no protein she is not preeclamptic. Remember P & P. Preeclampsia and Protein. The patient is over 20 weeks pregnant. Magnesium sulfate is our drug of choice. This is for seizure prevention but remember a side effect is lowering blood pressure. Our last key point is delivery. This is the only cure.

Make sure you check out the resources attached to this lesson and be sure to review the different hypertensive disorders so you can differentiate between them. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 9

A 34 week pregnant client is seen for a routine prenatal visit. She is asked how she is feeling and tells the nurse “I’ve had a horrible headache for 2 days and my rings suddenly won’t fit on my fingers”. What is the priority nursing action? Select all that apply.

  • Question 2 of 9

A nurse is caring for a pregnant mother who has preeclampsia. Based on the nurse’s knowledge of this condition, the nurse understands that the condition could affect the baby by causing which of the following potential complications?

  • Question 3 of 9

The charge nurse for labor and delivery has one assigned client yourself and is responsible for the entire unit. This nurse has just received report on the unit from the previous charge nurse. Which of the following clients is most concerning?

  • Question 4 of 9

A nurse is assessing a pregnant client for possible preeclampsia. Which symptom would be indicative of this diagnosis?

  • Question 5 of 9

A nurse is caring for a 30 week pregnant client that has proteinuria and blood pressures of 142/92. What order should the nurse expect to receive?

  • Question 6 of 9

The nurse is assessing a client with mild preeclampsia to see if she has progressed to severe preeclampsia. Which of the following would be associated with the progression of this disease process? Select all that apply.

  • Question 7 of 9

A nurse is caring for a newly admitted 32-week pregnant client with a blood pressure of 150/92, proteinuria, and severe right upper quadrant pain. The nurse knows that which of the following is a possible reason for this?

  • Question 8 of 9

The nurse is caring for a client who is 36 weeks pregnant with severe preeclampsia who was started on magnesium sulfate. The client seized, and the nurse addressed the seizure appropriately and notified the provider. The client is no longer exhibiting seizure activity and is stable. What is the next priority?

  • Question 9 of 9

A nurse is caring for a client with preeclampsia that is suffering from some vision changes. What is the best explanation by the nurse of what caused this?

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