A nurse is caring for a patient with severe preeclampsia who is receiving intravenous magnesium sulfate. Which assessment finding should prompt the nurse to take immediate action?

B) Respiratory rate is 10 breaths per minute.

A) Deep tendon reflexes are 2+ and equal bilaterally.

B) Respiratory rate is 10 breaths per minute.

C) Blood pressure is 150/90 mmHg.

D) Urine output is 40 mL per hour.

A nurse is caring for a patient with preeclampsia who is experiencing significant pitting edema, brisk deep tendon reflexes, and proteinuria. The patient is receiving intravenous magnesium sulfate. Which laboratory value is most critical for the nurse to monitor to prevent complications from the treatment?

C) Liver function tests (AST, ALT)

A nurse is caring for a patient with severe preeclampsia and emerging HELLP syndrome. The patient's platelet count has decreased, and mild hepatomegaly is observed. Given the patient's condition and the current management plan, which of the following nursing interventions is most critical to prioritize?

D) Increase the frequency of neurological checks to promptly identify any signs of seizure activity.

A) Administer antihypertensive medication as ordered to control elevated blood pressure.

B) Continuously monitor fetal heart rate patterns for signs of fetal distress.

C) Prepare the patient for emergency cesarean delivery should signs of further deterioration occur.

D) Increase the frequency of neurological checks to promptly identify any signs of seizure activity.

A patient with severe preeclampsia and emerging HELLP syndrome is being closely monitored. The nurse observes a decreasing platelet count, mild hepatomegaly, and elevated blood pressure despite medication adjustments. Which priority nursing intervention should the nurse implement to address these complications?

A) Increase the frequency of monitoring neurological status to detect early signs of complications.

B) Administer additional antihypertensive medications to further lower blood pressure.

C) Prepare the patient for immediate cesarean delivery due to the risk of maternal deterioration.

D) Educate the patient on the importance of bed rest to manage blood pressure levels.

A patient with HELLP syndrome is experiencing a further decrease in platelet count, elevated liver enzymes, and persistent hypertension. Which nursing intervention is most critical to prioritize at this time?

B) Prepare the patient for potential emergency delivery

A) Administer antihypertensive medication as prescribed

B) Prepare the patient for potential emergency delivery

C) Educate the patient about signs of impending labor

D) Encourage oral fluid intake to improve hydration

A patient with HELLP syndrome is experiencing decreasing platelet count and elevated liver enzymes. The healthcare team is closely monitoring the patient's blood pressure and fetal heart rate. Which nursing intervention is most critical to prioritize at this time?

B) Prepare for potential emergency cesarean delivery.

A) Administer antihypertensive medication as ordered.

B) Prepare for potential emergency cesarean delivery.

C) Monitor for signs of placental abruption.

D) Educate the patient about lifestyle modifications to manage blood pressure.

A patient with severe preeclampsia and HELLP syndrome is being treated with magnesium sulfate. Which clinical assessment finding should prompt the nurse to withhold the next dose of magnesium sulfate and notify the healthcare provider immediately?

B) Urine output of 20 mL per hour

A) Respiratory rate of 14 breaths per minute

B) Urine output of 20 mL per hour

D) Blood pressure of 150/90 mmHg

A nurse is caring for a patient with severe preeclampsia and suspected HELLP syndrome who is experiencing a sudden spike in blood pressure and altered mental status. Which of the following interventions should the nurse prioritize to prevent complications?

B) Increase the rate of the magnesium sulfate infusion.

A) Administer an antihypertensive medication as ordered.

B) Increase the rate of the magnesium sulfate infusion.

C) Prepare the patient for an emergency cesarean section.

D) Initiate continuous fetal heart rate monitoring.

A nurse is caring for a postpartum patient diagnosed with HELLP syndrome who has undergone a cesarean section. The patient's blood pressure remains elevated at 165/105 mmHg, and her platelet count has decreased to 80,000/mm³. What is the most appropriate immediate nursing action to prevent further complications?

A) Administer magnesium sulfate as ordered to prevent seizures

B) Increase the rate of IV fluids to manage hypotension

C) Encourage early ambulation to promote circulation

D) Apply ice packs to the abdomen to reduce liver pain

A patient with severe preeclampsia is undergoing a cesarean section. Post-operatively, the nurse notes that the patient's blood pressure remains at 165/105 mmHg despite antihypertensive treatment, and her platelet count is 80,000/mm³ with elevated liver enzymes. What is the nurse's priority intervention at this time?

B) Prepare to administer magnesium sulfate to prevent seizures

A) Administer additional antihypertensive medication as prescribed

B) Prepare to administer magnesium sulfate to prevent seizures

C) Increase oxygen delivery to improve oxygen saturation

D) Notify the healthcare provider about the low platelet count

preeclampsia - Nursing Case Study

Pathophysiology

• Primary mechanism: Abnormal placentation leads to poor remodeling of uterine spiral arteries, resulting in reduced placental perfusion and ischemia. This triggers the release of antiangiogenic factors into the maternal circulation, disrupting endothelial function.

• Secondary mechanism: Endothelial dysfunction causes systemic vasoconstriction and increased vascular permeability, contributing to hypertension and proteinuria, hallmark signs of preeclampsia.

• Key complication: The combination of hypertension and endothelial damage can lead to multi-organ dysfunction, including renal impairment, liver injury, and increased risk of placental abruption, posing significant risks to both mother and fetus.

Patient Profile

Demographics:

28-year-old female, school teacher

History:

• Key past medical history: Gestational hypertension in previous pregnancy

• Current medications: Prenatal vitamins, Labetalol

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe headache and visual disturbances

• Key symptoms: Swelling in hands and feet, upper abdominal pain, nausea

• Vital signs: Blood pressure 160/100 mmHg, heart rate 92 bpm, respiratory rate 20 breaths/min, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

As the case progresses, the patient undergoes a comprehensive initial assessment to evaluate the severity of her condition and to guide further management. Upon physical examination, the nurse notes significant pitting edema in the hands and feet, consistent with the patient's report of swelling. The upper abdominal pain, coupled with the severe headache and visual disturbances, raises concerns about potential liver involvement and central nervous system effects. The patient's deep tendon reflexes are brisk, indicating heightened neuromuscular irritability, which can be a precursor to eclamptic seizures.

The laboratory results reveal proteinuria with a 24-hour urine collection showing 3.5 grams of protein, confirming significant renal involvement. Liver function tests show elevated transaminases, with AST at 85 U/L and ALT at 110 U/L, suggesting hepatic stress, possibly indicating the onset of HELLP syndrome. Platelet count is slightly reduced at 130,000/µL, warranting close monitoring for further decline. These findings highlight the systemic impact of preeclampsia and underscore the need for vigilant monitoring and swift intervention to prevent progression to severe complications.

Given the patient's worsening condition, the healthcare team decides to intensify monitoring and treatment. Intravenous magnesium sulfate is initiated to prevent seizures, and the Labetalol dosage is adjusted to better control her blood pressure. Fetal monitoring shows reassuring patterns for now, but the team remains on high alert for any signs of fetal distress. The patient's care plan is promptly adjusted to include a multidisciplinary approach, involving obstetricians, nephrologists, and anesthesiologists, to prepare for potential emergent delivery if maternal or fetal status deteriorates further.

Section 2

As the healthcare team continues to closely monitor the patient's condition, new diagnostic results reveal further complications. A repeat complete blood count shows that the patient's platelet count has decreased to 110,000/µL, indicating a worsening trend that raises concerns about the progression of HELLP syndrome. In addition, a follow-up liver ultrasound is performed to assess hepatic function and structure, revealing mild hepatomegaly, which suggests increasing hepatic stress. The nurse notes that the patient's blood pressure remains elevated at 165/105 mmHg despite the adjustment in Labetalol dosage, necessitating further evaluation by the medical team.

In response to these findings, the healthcare team intensifies the patient's management plan. The frequency of neurological checks is increased to every 30 minutes to quickly identify any signs of seizure activity or other complications. The patient's magnesium sulfate levels are closely monitored to ensure therapeutic levels, with adjustments made as necessary to maintain optimal seizure prophylaxis. Given the potential for rapid deterioration, the team discusses the likelihood of needing to expedite delivery if maternal or fetal conditions worsen. The patient's care plan is updated to include continuous fetal monitoring, and an anesthesiologist is consulted to evaluate the safest options for potential delivery under these complex circumstances.

These developments prompt the team to reassess the patient's overall stability and readiness for potential delivery. Multidisciplinary discussions focus on balancing the risks of preterm delivery against the mother's declining condition, with an emphasis on proactive decision-making to safeguard both maternal and fetal health. The team remains vigilant, prepared to act swiftly should any new complications arise, reflecting the dynamic nature of managing severe preeclampsia with emerging HELLP syndrome.

Section 3

As the healthcare team continues monitoring the patient, new diagnostic results indicate further complications. The latest laboratory tests show a further decrease in platelet count to 95,000/µL, confirming the progression of HELLP syndrome. Liver function tests reveal elevated AST and ALT levels, rising to 280 U/L and 310 U/L, respectively, suggesting worsening hepatic involvement. These findings prompt the team to reassess the patient's condition, as the risk of maternal and fetal complications increases.

In response to these developments, the patient's management plan is adjusted. The obstetrician, concerned about the potential for worsening maternal and fetal outcomes, emphasizes the need for close monitoring and swift decision-making. The team increases the frequency of blood pressure monitoring to every 15 minutes, as the patient's blood pressure remains persistently high despite medication adjustments. Continuous fetal heart rate monitoring shows variable decelerations, raising concerns about fetal distress. The anesthesiologist evaluates the patient's candidacy for epidural anesthesia, considering both maternal and fetal stability.

With the patient's condition deteriorating, the healthcare team convenes a multidisciplinary meeting to discuss the timing and mode of delivery. The primary focus remains on balancing the risks of preterm birth with the worsening maternal health. The neonatology team is involved in planning for potential preterm delivery, preparing for immediate neonatal care. This collaborative approach ensures readiness to act should the patient's status further decline, underscoring the critical nature of managing severe preeclampsia with evolving HELLP syndrome.

Section 4

As the healthcare team continues to monitor the patient, a change in her status becomes evident. The patient's blood pressure, despite intensified medication efforts, spikes to 170/110 mmHg. She begins to exhibit signs of altered mental status, appearing increasingly confused and lethargic. These neurological changes prompt immediate concern for possible cerebral involvement, a complication associated with severe preeclampsia and HELLP syndrome. Her deep tendon reflexes are brisk, with clonus noted, raising the alarm for the potential onset of eclampsia. The nursing team promptly initiates a magnesium sulfate infusion to prevent seizures, closely observing for signs of magnesium toxicity.

Simultaneously, the fetal heart rate monitor reveals more pronounced variable decelerations with a concerning decrease in baseline variability, indicating possible fetal hypoxia. The persistent fetal distress, combined with the mother's unstable condition, pressures the team to expedite delivery. In consultation with the obstetrician, the decision is made to proceed with an emergency cesarean section. This decision is driven by the need to mitigate risks to both the mother and the fetus, as prolonging the pregnancy further could lead to catastrophic outcomes.

In preparation for surgery, the anesthesiologist evaluates the patient's respiratory status, noting a slight decrease in oxygen saturation at 93% on room air, necessitating supplemental oxygen to maintain adequate levels. The team ensures all resources are available for immediate neonatal resuscitation, given the likelihood of prematurity complications. As the patient is prepped for the operating room, the urgency and coordination among the multidisciplinary team illustrate the critical nature of timely intervention in managing severe preeclampsia with HELLP syndrome.

Section 5

As the patient is transferred to the operating room, the surgical team quickly but carefully initiates the cesarean section. Throughout the procedure, the anesthesiologist closely monitors the patient’s cardiovascular and respiratory status, noting any significant changes. The patient’s blood pressure remains elevated despite the administration of antihypertensive medications, maintaining a concerning level of 165/105 mmHg. Her oxygen saturation stabilizes at 95% with supplemental oxygen, but her respiratory rate is slightly elevated at 24 breaths per minute, indicating a degree of respiratory compensation for the systemic stress her body is undergoing.

Meanwhile, the lab results return, providing a clearer picture of her rapidly evolving condition. Her platelet count has dropped further to 80,000/mm³, confirming the progression toward HELLP syndrome. Liver function tests reveal an increase in AST and ALT levels, now measuring 150 U/L and 120 U/L, respectively, further substantiating liver involvement. These findings underscore the urgency of the situation, as both maternal and fetal well-being continue to be at significant risk.

As the newborn is delivered, the neonatal team swiftly assesses the infant, who is smaller than expected for gestational age, with an Apgar score of 5 at one minute due to poor muscle tone and low heart rate. Immediate resuscitation efforts are initiated, including positive pressure ventilation and gentle stimulation. The mother, although relieved at the safe delivery of her child, remains in a critical state. The team’s focus shifts to stabilizing her post-operatively, ensuring careful monitoring for any signs of eclampsia, managing her hypertension, and addressing her altered laboratory findings. This meticulous attention is crucial to prevent further complications such as hemorrhage or seizure, illustrating the complex balance needed in managing severe preeclampsia and HELLP syndrome.