{ "name": "Preeclampsia & Gestational Hypertension", "slug": "preeclampsia", "url": "https://nursingplex.com/care-plans/preeclampsia", "category": "Maternal & Newborn (OB)", "summary": "Hypertensive pregnancy disorder; BP control, magnesium sulfate safety and seizure precautions.", "nursing_diagnoses": [ "Risk for injury", "Excess fluid volume", "Risk for fetal injury" ], "overview": [ "Preeclampsia is a pregnancy-specific hypertensive disorder appearing after 20 weeks of gestation, defined by new-onset hypertension of 140/90 mmHg or higher on two occasions at least four hours apart, plus proteinuria or evidence of end-organ dysfunction. Gestational hypertension is elevated pressure without those additional findings. The underlying problem is abnormal placental implantation with shallow trophoblast invasion, producing placental ischemia, release of vasoactive factors, widespread endothelial injury, vasospasm and capillary leak.", "Because vasospasm affects every organ, the picture is multi-system rather than merely a blood pressure number. Renal involvement produces proteinuria and oliguria; hepatic involvement produces right upper quadrant or epigastric pain and elevated transaminases; cerebral involvement produces headache, hyperreflexia, visual changes and, if untreated, eclamptic seizures. HELLP syndrome — hemolysis, elevated liver enzymes and low platelets — is a severe variant that can occur even without markedly high pressures. Uteroplacental insufficiency causes fetal growth restriction, oligohydramnios and abruption.", "The only definitive cure is delivery of the placenta. Management balances fetal maturity against maternal risk. Magnesium sulfate is given for seizure prophylaxis, antihypertensives for severe-range pressures, and corticosteroids for fetal lung maturity in preterm gestations. Risk persists after birth: eclampsia can occur up to several weeks postpartum, so discharge teaching is a safety intervention, not a formality." ], "key_facts": [ { "label": "Severe features", "text": "Systolic 160 mmHg or higher or diastolic 110 mmHg or higher, platelets under 100,000, doubled transaminases, creatinine above 1.1 mg/dL, pulmonary edema, or new cerebral or visual symptoms." }, { "label": "Magnesium sulfate", "text": "Prevents seizures, not hypertension. Therapeutic range roughly 4–7 mEq/L. Monitor deep tendon reflexes, respiratory rate above 12, and urine output at least 30 mL/hr." }, { "label": "Magnesium toxicity antidote", "text": "Calcium gluconate must be immediately available at the bedside; first sign of toxicity is loss of deep tendon reflexes, followed by respiratory depression and cardiac arrest." }, { "label": "Warning symptoms", "text": "Severe headache unrelieved by acetaminophen, visual changes, epigastric or right upper quadrant pain, and sudden facial or hand swelling — all signal worsening disease." }, { "label": "Postpartum risk", "text": "Eclampsia can occur up to six weeks after delivery, most often within 48 hours; continue monitoring and teach warning signs before discharge." } ], "nursing_priorities": [ "Prevent eclamptic seizures and manage them safely if they occur.", "Control severe-range blood pressure without compromising placental perfusion.", "Monitor maternal end-organ function and fetal well-being continuously.", "Recognize HELLP syndrome, abruption and pulmonary edema early.", "Prepare for delivery — the only cure — at the safest possible time.", "Continue surveillance and teaching through the postpartum period." ], "assessment": { "subjective": [ "Severe or persistent headache not relieved by usual analgesics", "Blurred vision, photophobia, scotomata or seeing spots", "Epigastric or right upper quadrant pain — an ominous sign of liver involvement", "Nausea and vomiting appearing in late pregnancy", "Sudden swelling of the face and hands, or rings and shoes no longer fitting", "Decreased fetal movement", "Anxiety about the pregnancy, hospitalization and preterm birth" ], "objective": [ "Blood pressure 140/90 mmHg or higher, or 160/110 mmHg or higher in severe disease", "Proteinuria on dipstick or elevated protein-to-creatinine ratio", "Rapid weight gain and generalized, non-dependent edema of face and hands", "Hyperreflexia with clonus — a strong predictor of impending seizure", "Oliguria under 30 mL/hr, rising creatinine and uric acid", "Elevated AST and ALT, low platelets and hemolysis on smear in HELLP", "Crackles, dyspnea or falling oxygen saturation from pulmonary edema", "Fetal heart rate abnormalities, late decelerations, minimal variability or growth restriction on ultrasound", "Uterine tenderness, rigidity or vaginal bleeding suggesting abruption" ], "related_factors": [ "Abnormal placentation with placental ischemia and endothelial dysfunction", "Generalized arteriolar vasospasm reducing organ and placental perfusion", "Increased capillary permeability with intravascular volume depletion despite edema", "Cerebral irritability and edema increasing seizure threshold sensitivity", "First pregnancy, multiple gestation, chronic hypertension, diabetes, obesity, prior preeclampsia, extremes of maternal age", "Anxiety and knowledge deficit about a sudden high-risk diagnosis" ] }, "goals": [ "The patient remains free of seizures throughout the antepartum, intrapartum and postpartum periods.", "Blood pressure stays below the severe range with the ordered therapy.", "Urine output remains at or above 30 mL/hr and deep tendon reflexes stay present during magnesium therapy.", "The fetal heart rate tracing remains reassuring until delivery.", "The patient states the danger signs requiring immediate care before discharge.", "No maternal injury, pulmonary edema or magnesium toxicity occurs." ], "interventions": [ { "title": "Monitor maternal and fetal status", "points": [ "Take blood pressure with the patient in a consistent position and correct cuff size at the ordered frequency, and report severe-range values immediately.", "Assess deep tendon reflexes and clonus each shift and before each magnesium adjustment; hyperreflexia signals rising cerebral irritability.", "Measure hourly urine output with an indwelling catheter during magnesium therapy and report output below 30 mL/hr.", "Weigh daily and assess for facial, hand and pulmonary edema; auscultate lungs at least every four hours.", "Follow platelets, liver enzymes, creatinine, uric acid and hemoglobin for HELLP and worsening organ function.", "Maintain continuous or scheduled fetal monitoring per order, review for late decelerations and reduced variability, and teach daily fetal movement counts." ] }, { "title": "Administer magnesium sulfate safely", "points": [ "Give the loading and maintenance doses by infusion pump on a dedicated line, never as a bolus push.", "Keep calcium gluconate and resuscitation equipment at the bedside for the entire infusion.", "Before and during therapy check respiratory rate above 12, present deep tendon reflexes, urine output at or above 30 mL/hr, and level of consciousness.", "Hold the infusion and notify the provider immediately for absent reflexes, respiratory depression, oliguria, slurred speech or chest heaviness.", "Explain expected effects — warmth, flushing, sedation, a heavy feeling — so the patient is not alarmed.", "Continue magnesium for the ordered period after delivery, usually 24 hours, because seizure risk persists." ] }, { "title": "Control blood pressure and protect perfusion", "points": [ "Give antihypertensives such as labetalol, hydralazine or nifedipine as ordered for severe-range readings and recheck pressure at the specified intervals.", "Avoid overly rapid pressure reduction, which drops placental perfusion and can cause fetal distress.", "Position the patient in a left lateral tilt to maximize uteroplacental blood flow and venous return.", "Monitor for maternal tachycardia, headache and hypotension after antihypertensive dosing.", "Avoid ACE inhibitors and ARBs in pregnancy; they are teratogenic." ] }, { "title": "Prevent and manage seizures", "points": [ "Keep the room quiet and dimly lit, cluster care, and limit visitors and stimulation.", "Pad the side rails, keep the bed low, and have suction and oxygen set up and tested at the bedside.", "During a seizure do not restrain the patient or insert anything in the mouth; turn her to the side, protect the head, note the time and duration, and call for help.", "After the seizure administer oxygen by non-rebreather, suction as needed, assess the fetus, and anticipate additional magnesium and rapid delivery planning.", "Document the event fully, including precipitating symptoms and fetal response." ] }, { "title": "Prepare for delivery and monitor fluid balance", "points": [ "Give corticosteroids as ordered for fetal lung maturity in preterm gestations and explain the reason to the family.", "Maintain strict intake and output; these patients are intravascularly depleted yet exquisitely prone to pulmonary edema, so fluids are restricted and pump-controlled.", "Prepare for induction or cesarean birth as the plan dictates, with type and screen, IV access and neonatal team notification.", "Anticipate postpartum hemorrhage risk; note that magnesium relaxes the uterus and increases atony risk, so assess fundal tone frequently after birth." ] }, { "title": "Support and educate the patient and family", "points": [ "Explain the diagnosis, monitoring and the reasoning behind bed rest, restrictions and possible early delivery.", "Encourage the patient to report headache, visual change or epigastric pain immediately rather than waiting for rounds.", "Involve the partner and family in warning-sign teaching, since the patient may be sedated on magnesium.", "Address grief and anxiety about preterm birth and NICU care, and offer social work or chaplaincy support.", "Discuss future risk: prior preeclampsia raises the risk of recurrence and of later cardiovascular disease, and low-dose aspirin may be recommended in a future pregnancy." ] } ], "patient_teaching": [ "Call your provider immediately for a severe headache that does not go away, blurred vision or spots, pain under your ribs on the right, or sudden swelling of the face and hands.", "Keep every prenatal appointment; blood pressure and urine checks catch worsening disease before you feel it.", "Rest on your left side to improve blood flow to the baby.", "Count fetal movements daily and report any decrease.", "Take only medications your provider approves — avoid NSAIDs unless told otherwise.", "Preeclampsia can still occur after delivery, so watch for these same warning signs for six weeks postpartum.", "Attend your postpartum blood pressure check, usually within a week of discharge.", "Tell future providers about this pregnancy; it affects your long-term heart health and future pregnancy planning." ] }