Preeclampsia and Eclampsia Nursing Care Plan: Diagnosis, Interventions, and Management

Preeclampsia, a significant complication during pregnancy, affects 5-7% of pregnancies globally. It’s defined by the new onset of elevated blood pressure (above 140/90 mmHg) and protein in the urine (proteinuria) after the 20th week of gestation. Research indicates that preeclampsia can stem from issues in placental development, genetic predispositions, environmental factors, and changes in the mother’s cardiovascular and inflammatory systems.

If preeclampsia is not managed, it can impede fetal growth, elevate the risk of placental abruption, cause organ damage in the mother, and progress to eclampsia. Eclampsia is a severe form of preeclampsia distinguished by the occurrence of seizures, posing significant risks to both mother and child.

Delivery of the baby is currently the only definitive treatment for preeclampsia and eclampsia. Typically, after childbirth, preeclampsia resolves within a few days to several weeks. Nurses play a crucial role in identifying high-risk pregnancies, preventing preeclampsia and managing eclampsia through diligent assessment, patient education, and comprehensive antenatal care. Many cases can be avoided or effectively managed with timely interventions. These include consistent monitoring of blood pressure and symptoms, stress management, weight management, proper nutrition, fetal heart rate monitoring, and regular prenatal check-ups.

Nursing Assessment for Preeclampsia and Eclampsia

The initial phase of nursing care is a thorough nursing assessment, which involves gathering physical, psychosocial, emotional, and diagnostic data. This section will explore the subjective and objective data pertinent to preeclampsia and eclampsia, guiding nurses in accurate diagnosis and care planning.

Reviewing Health History for Risk Factors

1. Recognizing General Preeclampsia Symptoms: The classic triad of preeclampsia symptoms includes hypertension, proteinuria, and edema. However, nurses should also be vigilant for other signs such as:

• Persistent, severe headaches
• Visual disturbances (blurred vision, seeing spots)
• Shortness of breath or dyspnea
• Epigastric pain or right upper quadrant pain

2. Identifying Preeclampsia Risk Factors: Assessing a patient’s risk profile is crucial. Factors that increase the likelihood of developing preeclampsia include:

• Multiple pregnancies (twins, triplets, etc.)
• Pre-existing obesity
• Gestational diabetes or pre-existing diabetes
• Family history or personal history of preeclampsia
• Nulliparity (first pregnancy)
• Maternal age under 20 or over 40 years
• Polyhydramnios (excessive amniotic fluid)
• Pre-existing hypertension, diabetes, renal disease, or autoimmune disorders
• African American ethnicity
• Use of assisted reproductive technology like in vitro fertilization

3. Medication History and Preeclampsia Risk: Certain medications used during pregnancy may elevate the risk of preeclampsia. It’s important to review the patient’s medication list, noting use of:

• Antidepressants
• Benzodiazepines
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Antiretrovirals for HIV treatment
• Triptans for migraine management
• Asthma medications like montelukast
• Methamphetamine

4. Assessing Patient Knowledge about Preeclampsia and Eclampsia: Evaluate the patient’s current understanding of preeclampsia and eclampsia. Misconceptions due to prior knowledge, cultural beliefs, or familial influences can affect patient compliance and early symptom recognition. Understanding their baseline knowledge is key to effective patient education.

Physical Examination in Preeclampsia and Eclampsia

1. Vigilant Monitoring of Maternal Vital Signs: Elevated systolic or diastolic blood pressure should raise suspicion for preeclampsia. Diagnosis requires blood pressure readings of 140/90 mmHg or higher on two occasions, at least four hours apart, after 20 weeks of gestation, alongside diagnostic tests.

2. Respiratory Assessment: Auscultate lung sounds if the patient reports shortness of breath. Crackles or wheezing may indicate pulmonary edema, a serious complication of preeclampsia.

3. Abdominal Palpation: Palpate the right upper quadrant and epigastric area for tenderness. Liver involvement occurs in about 10% of severe preeclampsia cases, presenting as pain in these regions.

4. Edema Evaluation: Assess for edema, noting location, extent, and severity. While mild swelling in pregnancy is common, rapid onset or worsening edema, particularly in the face, hands, or significant dependent edema, is concerning.

5. Fetal Growth Monitoring: Preeclampsia can impair blood flow to the placenta, potentially leading to fetal growth restriction. Monitor fundal height and fetal movements, and anticipate the need for fetal growth ultrasounds.

6. Regular Weight Monitoring: Rapid weight gain (more than 3-5 pounds per week) can indicate fluid retention associated with preeclampsia. Monitor weight trends at each prenatal visit.

7. Intake and Output Tracking: Decreased urine output may signal compromised kidney function secondary to reduced circulating blood volume. Monitor and document intake and output to assess fluid balance.

8. Seizure Precautions and Monitoring: Be alert for signs of eclampsia, which is marked by seizure activity in a preeclamptic patient without other identifiable causes. Implement seizure precautions for patients with severe preeclampsia or those exhibiting neurological symptoms.

Diagnostic Procedures for Preeclampsia and Eclampsia

1. Urine Tests: Urine analysis is crucial for diagnosing preeclampsia:

• Urine dipstick: Positive result of 1+ protein or greater.
• 24-hour urine collection: Protein excretion of 300 mg or more.
• Urine protein to creatinine ratio: Ratio greater than 0.3.

2. Blood Tests: Blood tests help assess the severity and impact of preeclampsia:

• Complete blood count (CBC): Check for thrombocytopenia (platelet count < 100,000/mm³), indicating HELLP syndrome or severe preeclampsia.
• Complete metabolic panel (CMP): Evaluate liver function (elevated liver enzymes like AST, ALT) and renal function (elevated creatinine > 1.1 mg/dL).
• Renal function tests: Assess creatinine and BUN levels to evaluate kidney function.

3. Fetal Status Assessment: Evaluate fetal well-being using:

• Non-stress test (NST) and biophysical profile (BPP): Assess fetal heart rate patterns and overall fetal condition.
• Ultrasound: Measure amniotic fluid index (AFI) and estimated fetal weight to assess fetal well-being and growth.
• Doppler velocimetry: Assess blood flow in the umbilical artery and middle cerebral artery to evaluate placental function and fetal response.

4. Advanced Imaging: In cases of severe headaches, neurological deficits, or seizures, CT scans or MRI of the brain may be necessary to rule out intracranial abnormalities associated with eclampsia or other conditions.

Alt Text: A nurse is checking the blood pressure of a pregnant woman during a prenatal visit, illustrating routine monitoring for preeclampsia risk factors.

Nursing Interventions for Preeclampsia and Eclampsia

Nursing interventions are vital for managing preeclampsia and preventing progression to eclampsia, aimed at ensuring the well-being of both mother and baby.

Managing Pregnancy-Induced Hypertension

1. Early Diagnosis and Prompt Intervention: Early detection and immediate action are paramount in managing preeclampsia. Emphasize consistent blood pressure control and seizure prophylaxis as primary goals.

2. Pharmacological Management of Hypertension: Administer antihypertensive medications as prescribed to stabilize blood pressure. Common medications include:

• Intravenous (IV) labetalol
• IV hydralazine
• Oral nifedipine
• Methyldopa (for less acute management)

3. Aspirin Therapy for High-Risk Patients: For women at high risk of preeclampsia, low-dose aspirin therapy (81mg daily) is often initiated in the late first trimester and continued through the third trimester to reduce the risk of developing preeclampsia.

4. Activity Modification: While strict bed rest is no longer routinely recommended, reducing strenuous physical activity can help lower blood pressure. Advise patients to avoid overexertion and ensure adequate rest periods.

5. Expectant Management and Monitoring: For stable patients with gestational hypertension or preeclampsia without severe features, expectant management may be appropriate. This involves educating the patient on the necessity of:

• Regular serial ultrasonography to monitor fetal growth and well-being.
• Weekly antepartum testing (NST, BPP).
• Close monitoring of symptoms and blood pressure at home.
• Routine laboratory tests to assess maternal condition.

6. Timely Delivery of the Fetus: Delivery remains the only definitive cure for preeclampsia. Decisions regarding timing of delivery are based on gestational age, disease severity, and maternal and fetal status:

• For gestational hypertension or preeclampsia without severe features, delivery is typically recommended at 37 weeks of gestation.
• In cases of severe preeclampsia, delivery may be necessary as early as 34 weeks, or even earlier depending on the clinical situation.

7. Betamethasone Administration: If preterm delivery is anticipated before 34 weeks, administer corticosteroids like betamethasone to promote fetal lung maturity and reduce the risk of neonatal complications.

8. Seizure Prevention in Eclampsia Risk: Intravenous magnesium sulfate is the primary agent for seizure prophylaxis in patients with preeclampsia, particularly those with severe features. It is crucial to monitor for magnesium toxicity (respiratory depression, hyporeflexia) when administering this medication.

Preventing Preeclampsia and Eclampsia Complications

1. Postpartum Monitoring: Preeclampsia and eclampsia risks do not immediately cease after delivery. Hypertension and seizures can occur up to six weeks postpartum. Continue vigilant monitoring of blood pressure and symptoms in the postpartum period.

2. Dietary Recommendations: Educate patients on dietary modifications that can help manage blood pressure and fluid balance. Recommendations include:

• Reducing sodium intake to help manage hypertension and edema.
• Ensuring adequate calcium, magnesium, and potassium intake through diet or supplements.
• Limiting processed foods, fried foods, salty snacks, and sugary drinks.
• Emphasizing a balanced diet rich in fruits, vegetables, and whole grains.

3. Patient Education on Warning Signs: Instruct patients to immediately contact their healthcare provider if they experience any of the following symptoms:

• Seizures
• Difficulty breathing or worsening shortness of breath
• Severe or persistent headaches
• Visual disturbances (blurred vision, spots, flashing lights)
• Epigastric or right upper quadrant pain
• Decreased fetal movement
• Vaginal bleeding

4. Promoting Treatment Adherence: Stress the importance of adhering to prescribed medications, dietary recommendations, lifestyle modifications, and scheduled prenatal and postpartum appointments.

5. Stress Management Techniques: High stress levels can exacerbate hypertension. Encourage stress-reducing practices such as:

• Deep breathing exercises
• Relaxation techniques and mindfulness
• Light aerobic exercise, as approved by the healthcare provider
• Adequate sleep and rest

6. Counseling on Future Pregnancy Risks: Inform women with a history of preeclampsia about the increased risk of recurrence in subsequent pregnancies. The recurrence risk is higher with a history of severe preeclampsia.

7. Long-Term Cardiovascular Health Education: Preeclampsia is linked to an increased lifetime risk of cardiovascular disease (CVD). Educate patients on the importance of:

• Regular blood pressure monitoring throughout life.
• Maintaining a healthy lifestyle, including regular exercise, weight management, a heart-healthy diet, and avoiding smoking and excessive alcohol intake.

Nursing Care Plans for Preeclampsia and Eclampsia

Nursing care plans provide a structured approach to prioritizing assessments and interventions for patients with preeclampsia and eclampsia, focusing on both immediate and long-term care goals. Examples of nursing care plans include addressing decreased cardiac output, deficient knowledge, impaired skin integrity, risk for imbalanced fluid volume, and risk for unstable blood pressure.

Nursing Care Plan: Decreased Cardiac Output

Nursing Diagnosis: Decreased Cardiac Output related to increased cardiac demands and decreased blood supply secondary to preeclampsia.

Related Factors:

• Hypovolemia
• Decreased venous return due to vasospasm
• Increased systemic vascular resistance

Evidenced By:

• Elevated blood pressure
• Hemodynamic changes
• Edema
• Dyspnea
• Changes in mental status (anxiety, restlessness)

Expected Outcomes:

• Patient will maintain blood pressure within acceptable parameters for pregnancy.
• Patient will demonstrate stable hemodynamic readings.
• Patient will exhibit reduced edema and improved respiratory status.

Nursing Assessments:

1. Blood Pressure Monitoring: Rationale: Hypertension is a hallmark of preeclampsia and directly impacts cardiac workload.
2. Assess for Heart Failure Signs: Rationale: Preeclampsia can lead to heart failure due to increased afterload and fluid overload. (Symptoms: fatigue, exertion intolerance, rapid weight gain, edema, dyspnea).
3. Platelet Count Assessment: Rationale: Thrombocytopenia can indicate severity of preeclampsia and is associated with coagulation issues and reduced cardiac function.
4. Fetal Growth Assessment: Rationale: Reduced cardiac output can compromise placental blood flow and fetal oxygenation, leading to growth restriction.

Nursing Interventions:

1. Left Lateral Position: Rationale: Enhances venous return and placental perfusion.
2. Oxygen Administration: Rationale: Increases oxygen availability for maternal and fetal tissues.
3. Antihypertensive Medications: Rationale: Reduces afterload and stabilizes blood pressure, decreasing cardiac workload.
4. Fluid Restriction (if indicated): Rationale: Prevents fluid overload in patients with edema or pulmonary congestion.
5. Activity Restriction: Rationale: Reduces cardiac demand and promotes placental blood flow.
6. Prepare for Cesarean Delivery (if necessary): Rationale: In severe cases, delivery may be required to prevent maternal and fetal compromise.

Nursing Care Plan: Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to preeclampsia and eclampsia, their management, and potential complications.

Related Factors:

• Lack of exposure to information
• Misinformation or misconceptions
• Unfamiliarity with resources

Evidenced By:

• Expressed concerns and questions about preeclampsia
• Misunderstanding of management strategies
• Development of preventable complications
• Inaccurate follow-through with recommendations

Expected Outcomes:

• Patient will verbalize understanding of preeclampsia, eclampsia, and their management plan.
• Patient will identify potential complications and know when to seek medical attention.
• Patient will demonstrate adherence to recommended lifestyle and self-care modifications.

Nursing Assessments:

1. Assess Knowledge Level: Rationale: Determines baseline understanding and educational needs.
2. Identify Misconceptions: Rationale: Addresses and corrects inaccurate beliefs that may hinder compliance.
3. Assess Readiness to Learn: Rationale: Ensures teaching is effective and patient is receptive to information.

Nursing Interventions:

1. Educate on Reportable Symptoms: Rationale: Empowers patient to recognize and respond to worsening condition. (Provide written and verbal instructions on symptoms like blurred vision, headaches, epigastric pain, dyspnea).
2. Involve Support System: Rationale: Enhances patient support and reinforces education.
3. Positive Reinforcement: Rationale: Encourages learning and behavior change.
4. Instructions on Appointments and Tests: Rationale: Ensures adherence to monitoring and follow-up care.

Nursing Care Plan: Impaired Skin Integrity

Nursing Diagnosis: Impaired Skin Integrity related to edema, hypertension, and potential thrombocytopenia associated with preeclampsia.

Related Factors:

• Disease process
• Edema
• Hypertension
• Decreased platelets

Evidenced By:

• Pitting edema
• Petechiae
• Skin fragility

Expected Outcomes:

• Patient will maintain intact skin without breakdown.
• Patient will verbalize understanding of skin care measures to promote skin health.

Nursing Assessments:

1. Assess Skin Impairment Extent: Rationale: Determines severity of edema and petechiae to guide interventions. (Note grade of pitting edema, presence of petechiae or bruising).
2. Assess Skin Care Practices: Rationale: Identifies practices that may exacerbate skin issues and need for correction.

Nursing Interventions:

1. Antihypertensive Administration: Rationale: Reduces edema and pressure on blood vessels, promoting skin integrity.
2. Educate on Normal vs. Abnormal Swelling: Rationale: Helps patient differentiate normal pregnancy swelling from concerning edema.
3. Leg Elevation: Rationale: Reduces dependent edema and promotes venous return.
4. Comfortable Clothing and Shoes: Rationale: Prevents pressure points and skin irritation.
5. Compression Stockings: Rationale: Supports venous return and reduces edema in lower extremities.
6. Avoid Straining: Rationale: Minimizes pressure on fragile capillaries, reducing petechiae formation.

Nursing Care Plan: Risk for Imbalanced Fluid Volume

Nursing Diagnosis: Risk for Imbalanced Fluid Volume related to fluid shifts, sodium retention, and decreased kidney filtration in preeclampsia.

Related Factors:

• Plasma protein loss
• Decreased osmotic pressure
• Fluid shifts from vascular space
• Sodium and water retention
• Decreased kidney filtration

Evidenced By:

Risk diagnoses are identified by risk factors, not by evidence of the problem itself.

Expected Outcomes:

• Patient will maintain adequate fluid balance, as evidenced by stable blood pressure.
• Patient will demonstrate balanced fluid intake and output.
• Patient will remain free from pulmonary edema and generalized edema.

Nursing Assessments:

1. Blood Pressure Monitoring: Rationale: Elevated BP is a key indicator of fluid volume excess in preeclampsia.
2. Assess for Edema, Proteinuria, Weight Gain: Rationale: These are cardinal signs of fluid imbalance and preeclampsia. (Note proteinuria levels, edema severity, weekly weight gain).
3. Fetal Well-being Assessment: Rationale: Fluid imbalance can impact placental perfusion and fetal oxygenation.

Nursing Interventions:

1. Preeclampsia Management: Rationale: Addresses the underlying cause of fluid imbalance. (Collaborate with medical team).
2. Fluid Administration (cautiously): Rationale: May be needed to expand intravascular volume, but must be carefully managed to avoid overload.
3. Dietary Instructions: Rationale: Sodium restriction and electrolyte balance can aid in fluid management.
4. Intake and Output Monitoring: Rationale: Tracks fluid balance and kidney function.

Nursing Care Plan: Risk for Unstable Blood Pressure

Nursing Diagnosis: Risk for Unstable Blood Pressure related to uteroplacental insufficiency, hormonal changes, and fluid retention in preeclampsia.

Related Factors:

• Disease process of preeclampsia
• Uteroplacental perfusion issues
• Hormonal fluctuations
• Fluid retention

Evidenced By:

Risk diagnoses are identified by risk factors, not by evidence of the problem itself.

Expected Outcomes:

• Patient will maintain blood pressure at or below 140/90 mmHg.
• Patient will demonstrate understanding of interventions to manage blood pressure.
• Patient will not experience symptoms of severe hypertension (headache, dizziness, visual changes).

Nursing Assessments:

1. Blood Pressure Monitoring: Rationale: Early detection of blood pressure changes is crucial.
2. Blood and Urine Tests Review: Rationale: Assesses impact on kidney function and overall severity of preeclampsia. (Review protein levels, creatinine, platelets).
3. Fetal Health Ultrasound: Rationale: Unstable BP can affect fetal well-being and growth.

Nursing Interventions:

1. Medication Administration: Rationale: Antihypertensives are essential for blood pressure control.
2. Salt Intake Limitation: Rationale: Reduces sodium and water retention, lowering BP.
3. Lifestyle Modifications Education: Rationale: Stress reduction, relaxation, and activity modification can stabilize BP.
4. Post-Delivery Monitoring: Rationale: Hypertension can persist or develop postpartum. (Educate on postpartum warning signs).

References

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