Nursing Diagnosis, Interventions, and Care Plan for Preeclampsia-Student’s Guide
Introduction
Preeclampsia is a condition that occurs in approximately 4% of all pregnancies. It can develop any time after 20 weeks gestation and typically presents with high blood pressure, proteinuria (excess protein in the urine), edema (swelling), weight gain, headaches, blurred vision, and painless bleeding from vaginal tissues or other sites on the body. A pregnant woman who has preeclampsia requires prompt medical attention as it is a life-threatening disease. It can lead to eclampsia which increases the risk for stroke and seizure.
This post will discuss the nursing diagnosis for preeclampsia along with interventions and care plans to manage this condition. The post should be helpful to medical practitioners who work with pregnant women on an everyday basis. However, in case you are a nursing student and are stuck with your assignment, our top writers are ready to help as well. All you have to do is place an order with us.
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
What is Preeclampsia?
Preeclampsia is pregnancy-induced hypertension (PIH) disease. It is characterized by new-onset hypertension (BP>140/90 mm Hg) and proteinuria occurring after the 20th week of gestation. It is essential to distinguish preeclampsia from eclampsia because the former can be treated and resolve with delivery while the latter may be fatal.
Preeclampsia is a dangerous disease and should be treated as an emergency condition. It can lead to eclampsia which increases the risk for stroke and seizure.
What is Eclampsia?
Eclampsia is a severe form of preeclampsia. It develops when the blood pressure becomes dangerously high (160/110 mm Hg), with significant proteinuria and seizures. Eclampsia can lead to maternal death, hepatic coma, cerebral edema, and stroke.
Signs and Symptoms of Eclampsia
The signs and symptoms vary from woman to woman. The most common ones are:
-Severe headache (throbbing or pulsating)
-Blurred vision and double vision
-Persistent abdominal pain, nausea, vomiting & indigestion
-Excessive sweating even though she feels cold all over her body.
-Shortness of breath (with or without breathing difficulty)
-Seizures (convulsions, spasms)
–Fainting spells or feeling lightheaded/dizzy
Preeclampsia can occur at any time during the pregnancy, but it usually develops after 20 weeks of gestation. The severity of the disease also varies widely from one woman to another.
Preeclampsia Risk Factors (in no particular order)
-Smoking: Smoking triggers constriction of peripheral blood vessels, which reduces blood supply to tissue in the body. This causes hypertension, elevated pulse rate, and increased respiratory rate. These increase the chances of preeclampsia occurring in a woman; when it does happen, it usually develops earlier than normal
-Being overweight or obese before conception: Being overweight or obese is a risk 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 shift in blood volume, which leads to hypertension.
-Having a personal or family history of thrombophilia (blood clotting disorders): 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.
-Prior history of preeclampsia, eclampsia, or gestational hypertension: Women 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 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.
Classification of Preeclampsia PE
There are two types of preeclampsia, which have different pathogenesis:
Preeclampsia without proteinuria or other evidence of kidney disease is “isolated preeclampsia.” It usually develops after 20 weeks of gestation.
Preeclampsia with superimposed pre-existing chronic renal disease is termed “pre-existing preeclampsia.” It can occur at any time during pregnancy.
Mild Preeclampsia PE
Mild preeclampsia may be diagnosed before 20 weeks of gestation. However, it is a 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 their parents develop preeclampsia in a past pregnancy.
The first signs of mild preeclampsia are a discernable increase in blood pressure and a small amount of protein in the urine.
Preeclampsia can be treated with bed rest, anticonvulsant medications if seizures develop, and delivery by inducing labor or C-section when it reaches severe forms.
Moderate Preeclampsia PE
Moderate preeclampsia is diagnosed when the systolic blood pressure exceeds 151 mmHg, or the diastolic blood pressure exceeds 100 mm Hg in a female who previously has been normotensive.
It is sometimes also used as an umbrella term for mild and severe forms of preeclampsia. It is also used to define women with milder forms of preeclampsia, women whose mildness is categorized as early-onset and occurs antepartum.
Proteinuria is always present in the moderate form of preeclampsia, but other symptoms such as headache and visual disturbances are present. Preeclampsia may be accompanied by other medical complications, including renal disease, hepatic disease, thrombocytopenia, and HELLP syndrome.
Preeclampsia is not dangerous to the mother until it is moderate in severity. Once 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 there is no improvement of preeclampsia’s symptoms with bed rest or the control of blood pressure does not improve within a few days to weeks, delivery by inducing labor or C-section must occur.
The mild form often improves without treatment, but severe conditions need to be treated. Complications of severe preeclampsia include seizures if blood pressure is 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 from the disease.
Severe Preeclampsia
Severe Preeclampsia Pregnancy Induced Hypertension (PIH) occurs in severe preeclampsia and HELLP syndrome. To identify the severity of preeclampsia, a physician would look at these features: headaches, visual disturbances, seizures, and pulmonary edema.
What Causes Preeclampsia (PE)?
Preeclampsia is an autoimmune disease that results from a failure of maternal-fetal tolerance. The exact cause remains unknown, but risk factors include: being over 35 years old, having previous preeclampsia/eclampsia, abnormal placentation, multiple gestations (twins and triplets), Black race, preterm labor, intrauterine growth restriction, and abnormal maternal liver function.
What Are the Risk Factors for Preeclampsia?
Preeclampsia affects females more than males and non-Hispanic African American women at a higher rate. Other risk factors are family history of preeclampsia, previous early pregnancy loss or fetal death, chronic hypertension, renal disease, autoimmune disease, thyroiditis, lupus, primiparity, and increased parity.
The pathophysiology of preeclampsia is due to the resistance of the hypertrophied placenta to general vasodilation. This causes placental hypoperfusion with alterations 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 possible etiologic role of maternal coagulation defects, genetic disorders, tissue hypoxia, alterations in immunoregulatory functions, and microangiopathy in the pathogenesis of preeclampsia is not yet elucidated. Multiple pregnancies, such as twins and triplets.
What Are the Signs & Symptoms of Preeclampsia?
Preeclampsia can be defined as the onset of new-onset hypertension and proteinuria after the 20th week of gestation. Most women with preeclampsia present with new-onset hypertension (systolic BP > 140 or diastolic BP > 90 mm Hg) and proteinuria (> 300 mg in 24 hours). Other symptoms include headache, visual disturbances (dim vision, color blindness), epigastric pain, and nausea.
Preeclampsia also causes significant maternal symptoms during pregnancy: pre-eclamptic headache, vision problems (dim vision, colorblindness), abdominal pain, high blood pressure, and protein in the urine. Most women have these signs and symptoms of preeclampsia late in their pregnancy. The earlier the disease is found, the better because it becomes less likely that complications will occur.
How to Prevent Preeclampsia
Currently, there is no known way to prevent preeclampsia. Avoiding tobacco, alcohol, and excessive caffeine are thought to be the most important of many possible ways of preventing it. In addition, not having too much weight gain (25-35 pounds) during pregnancy seems to reduce the risk of developing preeclampsia, as does eating a healthy diet.
What Are the Nursing Diagnoses for Preeclampsia?
The only way to prevent preeclampsia is by early diagnosis and management. A good history and physical exam are essential for an accurate diagnosis. If signs and symptoms of preeclampsia are present, the patient should be seen every 4 hours until delivery. Any progress in signs or symptoms that would suggest changes in the condition should lead to more frequent assessments.
-Rest, reassurance, frequent monitoring of vital signs and fluid intake, administration of antihypertensive medications, prevention or management of seizures, and preparation for delivery.
– Monitor BP daily
-Provide IV fluids if needed
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 patient suffering from preeclampsia. They include:
-Deficient Knowledge
-Impaired Physical Mobility
–Imbalanced Nutrition: Less than body requirements
-Disturbed Energy Field
These diagnoses are organized into a nursing care plan.
Ps: We also have articles on diagnoses of C diff
Preeclampsia: Nursing Interventions and Care Plan
Deficient Knowledge:
As preeclampsia is a disease that affects the mother’s cardiovascular system, it should be managed by obstetricians or midwives. However, since these professionals are not with the patient on a day-to-day basis, they should provide the patient with written instructions on what behaviors to avoid or take precautions for the condition. The nurse should also warn her about when to seek medical attention and emphasize the importance of doing so.
Interventions:
Instructing the pregnant woman 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.
Impaired Physical Mobility:
It is vital that the patient does not strain during labour or while carrying out any 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 her medical equipment, i.e., BP cuff, continuous fetal monitor, etc.
Outcome Criteria: The patient will not strain during labour 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 medical equipment properly.
Risk for Injury: The patient is at risk of physical damage while in labour because of the high BP and blood volume loss. She may also sustain injuries that interfere with her maternal-fetal attachment if she has frequent seizures.
Impaired Physical Mobility will be assessed through observations and by obtaining a history from the patient on how she perceives her physical mobility.
Outcome Criteria: The patient will not sustain any injuries while in labour or throughout her hospital stay.
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 her physical mobility.
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 regarding sugar levels and protein content under her care plan.
Imbalanced Nutrition: Less Than Body Requirements diagnosis will be investigated through clinical observations and patient interviews. Based on the findings, the nutrition status of the mother will be evaluated by dieticians to prevent any complications for the mother and baby during the postpartum period.
Deficient Fluid Volume:
The patient may become dehydrated because of decreased fluid intake, and therefore she should be supplied with a sufficient volume of fluids.
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 while using a urine dipstick to check for proper hydration levels.
Balanced Fluid Volume: The client requires sufficient fluids throughout her hospital stay and during labour 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.
Impaired Physical Mobility, Imbalanced Nutrition, and Deficient Fluid Volume diagnoses will be evaluated through clinical observations and by obtaining a history 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 patient’s needs and ensure she is in good condition after labour.
Effective Protection from Pain:
The patient has been informed about the pain experienced during childbirth before her hospitalization to cope with the pain emotionally.
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 involve breathing exercises such as alternate nostril breathing and diaphragmatic 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 under the supervision of nurses.
Deficient Knowledge: The patient’s knowledge of preparing for labour will be assessed based on her educational level and whether she has given birth before.
Outcome Criteria: The patient will be taught how to cope with labour 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 labour, such as gas and air, water therapy (immersion), injection, etc.
The Deficient Knowledge diagnosis will be investigated through clinical observations and patient interviews. Based on the findings, relevant nursing care interventions will be implemented to provide the patient with information regarding labour, pain management methods, and her postpartum recovery period.
Sample Nursing Care Plan for Preeclampsia PE
Nursing Care Plan for Preeclampsia (can be used with modifications for preeclampsia and gestational hypertension):
OBJECTIVES:
Prevent maternal renal failure. Minimize fetal distress
ACTIVITY GOALS:
Remain in a semi-Fowler’s position as much as possible. Maintain normal fluid intake, minimum 64 oz. daily, unless contraindicated by symptoms or lab values. 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:
Encourage the patient to remain in semi-Fowler’s position as much as possible 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 values [e.g., increased thirst; decreased output].
Assess the client’s condition regularly to ensure that her health has not worsened.
Monitor the client’s blood pressure regularly using an appropriate device.
If any changes are noticed or significant sudden weight gain, then medication may need adjusting accordingly.
Manage to vomit using anti-emetics to reduce nausea and vomiting
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:
Remain as comfortable as possible during the disease and delivery.
Encourage to use comfort measures such as changing position, relaxing in a warm bath or shower, listening to music, watching TV, etc. [comfort measures can help reduce nausea and fatigue].
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Preeclampsia and Maternal Health
Harmful effects of preeclampsia on mothers include: – Growth restriction, particularly growth of the head circumference; – Fetal death; – Epileptic seizures in both mother and fetus; – Possibly, eclampsia; – Mild-to-severe maternal hypertension that can cause organ damage.
Preeclampsia and Fetus/Infant Risks
Fetal risks include growth restriction, intrauterine death, hyperbilirubinemia leading to kernicterus (a form of brain damage) if the child is born alive, and preeclampsia in subsequent pregnancies.
Management of Preeclampsia
If you suspect preeclampsia or are caring for someone who has it, be sure to refer to your regional guidelines on managing this condition. In addition:
– Monitor blood pressure at least once per day
– Record weight gain and note any sudden weight gain
– Check for edema, and
– Assess for changes in mental status/level of consciousness.
Preeclampsia Complications
Preeclampsia is a severe complication that can affect fetal growth and survival. This condition may cause abruptio placenta, abruption placentae, placental infarction, preterm labour (before 37 weeks), fetal distress, uterine rupture, or perforation. Premature infants are at a high risk of developing respiratory distress syndrome (RDS) and intrauterine growth restriction. Pre-eclampsia also increases the risk of maternal complications, including renal failure, disseminated intravascular coagulation, hepatic coma, stroke, myocardial infarction, and death.
Hellp syndrome
HELLP syndrome is a complication of preeclampsia. It occurs in about 5% of cases, and the symptoms include:
– Hemolytic anemia (high levels of bilirubin, low Hct, and low Hb)
-Abdominal pain can radiate to the back
-Liver dysfunction may occur
– Low platelet count (usually lower than 150,000 cells/ul)
-The triad of HELLP may also manifest as:
* Elevated Liver enzymes (ALT, AST, ALP) -these enzymes are elevated to greater than twice the normal range.
Abnormal levels of liver function tests can occur with preeclampsia.
How Long Does Preeclampsia Last?
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 regularly (e.g., until her blood pressure returns to normal).
How to Treat Preeclampsia
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 delivered her baby as soon as possible.
Newer treatments include magnesium sulphate given intravenously or calcium channel blockers.
Magnesium sulphate helps prevent seizures, which may develop in severe cases of preeclampsia. Women with milder signs and symptoms who are not at risk for seizures may be treated with calcium channel blockers or antihypertensive drug therapy such as labetalol.
After delivery, magnesium sulphate treatment is continued until 24 hours after the blood pressure has returned to normal.
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Summary
Preeclampsia is a condition that can cause high blood pressure and other problems in pregnancy. It can affect the mother’s organs, including the liver and kidneys. This condition may make delivery very difficult or even impossible.
In severe cases, it may be necessary to deliver the baby early by cesarean section. If preeclampsia is diagnosed early and the woman receives prompt appropriate treatment, the pregnancy should proceed smoothly.
Preeclampsia is a severe condition that can be life-threatening to both the mother and baby. If you have problems during your pregnancy or are at risk for preeclampsia, see your doctor right away.
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