A nurse is caring for a patient diagnosed with severe pre-eclampsia. The patient is receiving magnesium sulfate for seizure prophylaxis. Which of the following signs should prompt the nurse to immediately notify the healthcare provider?

B) The patient's deep tendon reflexes are absent.

A) The patient reports feeling flushed and warm.

B) The patient's deep tendon reflexes are absent.

C) The patient experiences mild nausea and vomiting.

D) The patient has a blood pressure reading of 150/90 mmHg.

A patient with HELLP syndrome is experiencing worsening neurological symptoms and uncontrolled hypertension despite treatment. Which nursing intervention is the priority to prevent further maternal complications?

C) Administer antihypertensive medication as ordered and monitor blood pressure closely.

A) Increase the dose of magnesium sulfate as per protocol.

B) Prepare the patient for an immediate Cesarean section.

C) Administer antihypertensive medication as ordered and monitor blood pressure closely.

D) Initiate bed rest and closely monitor maternal and fetal status.

A patient diagnosed with HELLP syndrome is showing signs of worsening neurological status and uncontrolled hypertension despite treatment. Which of the following nursing interventions is the priority to prevent further complications?

D) Initiate intravenous antihypertensive therapy to achieve rapid blood pressure control.

A) Increase the dosage of magnesium sulfate to manage the patient's neurological symptoms.

B) Prepare the patient for immediate delivery to address the progression of HELLP syndrome.

C) Monitor the patient's neurological status and blood pressure closely while continuing current treatments.

D) Initiate intravenous antihypertensive therapy to achieve rapid blood pressure control.

A patient experiencing eclampsia is receiving magnesium sulfate to prevent seizures and Labetalol for hypertension. After an eclamptic seizure with a subsequent spike in blood pressure, the healthcare team decides to administer hydralazine. What is the primary rationale for choosing hydralazine in this situation?

A) Hydralazine acts quickly to lower blood pressure, reducing the risk of further seizures.

B) Hydralazine provides long-term control of blood pressure, preventing future hypertensive episodes.

C) Hydralazine reduces the risk of fetal bradycardia by stabilizing maternal hemodynamics.

D) Hydralazine enhances the effectiveness of magnesium sulfate by promoting renal excretion.

A pregnant patient experiencing eclampsia is being treated with magnesium sulfate and Labetalol. After an eclamptic seizure, her blood pressure rises to 190/115 mmHg. Despite the ongoing treatments, the patient further deteriorates, and fetal distress is noted. Which of the following is the most appropriate nursing action to prioritize at this time?

B) Prepare the patient for an immediate cesarean section to address fetal distress.

A) Increase the rate of magnesium sulfate infusion to prevent further seizures.

B) Prepare the patient for an immediate cesarean section to address fetal distress.

C) Administer an additional dose of Labetalol to achieve better blood pressure control.

D) Reassess the patient's neurological status for any changes in the Glasgow Coma Scale.

A nurse is caring for a patient with severe preeclampsia undergoing an urgent cesarean section. The patient's blood pressure remains elevated despite treatment, and fetal monitoring indicates late decelerations. Which nursing intervention is the priority to improve fetal oxygenation?

B) Repositioning the patient to the left lateral position

A) Administering additional hydralazine to lower blood pressure

B) Repositioning the patient to the left lateral position

C) Increasing the rate of intravenous fluids

D) Preparing for immediate neonatal resuscitation

A nurse is caring for a patient with severe preeclampsia scheduled for an urgent cesarean section. Considering the patient's unstable blood pressure and neurological status, which nursing intervention is the highest priority to prevent complications during the perioperative period?

A) Administering a magnesium sulfate bolus to prevent seizures.

B) Monitoring fetal heart rate continuously to detect any further distress.

C) Preparing for immediate intubation to manage potential respiratory depression.

D) Ensuring the patient is positioned on her left side to improve placental perfusion.

A patient undergoing a cesarean section for severe preeclampsia develops acute respiratory distress with a drop in oxygen saturation to 90% and bilateral crackles on auscultation. What is the most appropriate initial nursing intervention to address the suspected pulmonary edema?

B) Initiate high-flow oxygen therapy using a non-rebreather mask.

A) Position the patient in a semi-Fowler's position to facilitate breathing.

B) Initiate high-flow oxygen therapy using a non-rebreather mask.

C) Administer intravenous morphine to reduce anxiety and respiratory workload.

D) Prepare for immediate endotracheal intubation and mechanical ventilation.

A 32-year-old patient undergoing a cesarean section for preeclampsia develops acute pulmonary edema intraoperatively. The anesthesiology team has transitioned her to a non-rebreather mask and initiated intravenous furosemide. Which additional nursing intervention is most appropriate to support the patient's respiratory status in this scenario?

B) Position the patient in a semi-Fowler's position to enhance lung expansion

A) Perform chest physiotherapy to mobilize secretions

B) Position the patient in a semi-Fowler's position to enhance lung expansion

C) Reduce intravenous fluid administration to prevent further fluid overload

D) Administer bronchodilators to alleviate respiratory distress

pre eclampsia - Nursing Case Study

Pathophysiology

• Primary mechanism: Abnormal placentation leads to inadequate remodeling of uterine spiral arteries, causing high-resistance, low-flow circulation and placental ischemia. This ischemic placenta releases antiangiogenic factors into maternal circulation, disrupting endothelial function.

• Secondary mechanism: Endothelial dysfunction results in widespread vasoconstriction and increased vascular permeability. This causes hypertension and fluid leakage into interstitial spaces, leading to edema and proteinuria.

• Key complication: These mechanisms can progress to multi-organ dysfunction, including liver impairment, renal damage, and potential progression to eclampsia, characterized by seizures, posing significant risks to both mother and fetus.

Patient Profile

Demographics:

32-year-old female, school teacher

History:

• Key past medical history: Gestational hypertension in previous pregnancy

• Current medications: Prenatal vitamins, Labetalol 100 mg twice daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent headache and visual disturbances

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

• Vital signs: Blood pressure 160/110 mmHg, heart rate 92 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F

Section 1

During the initial assessment, the patient's condition was evaluated in light of her persistent headache, visual disturbances, and significant hypertension. A focused physical examination revealed 3+ pitting edema in the lower extremities and marked periorbital swelling. The patient reported increasing discomfort due to upper abdominal pain, which she rated as 6 out of 10 on the pain scale, and ongoing nausea that had led to reduced oral intake. A fundoscopic examination indicated mild retinal changes consistent with hypertensive retinopathy. These findings, along with her elevated blood pressure, raised concerns about severe pre-eclampsia and potential end-organ damage.

Laboratory tests were promptly ordered to further assess the extent of the patient's condition. The results showed proteinuria with a urine protein-to-creatinine ratio of 0.5, indicating significant protein loss. Liver function tests revealed elevated liver enzymes, with AST and ALT levels at 85 IU/L and 92 IU/L, respectively, suggesting hepatic involvement. Renal function tests showed a mildly elevated serum creatinine level of 1.3 mg/dL, pointing to potential renal impairment. These lab values, in conjunction with the patient's clinical presentation, underscored the need for immediate intervention to prevent progression to eclampsia or other severe complications.

In response to these findings, the healthcare team initiated a more aggressive treatment plan. The patient's dosage of Labetalol was increased to better control her blood pressure, and magnesium sulfate was administered intravenously for seizure prophylaxis. Continuous fetal monitoring was implemented to assess the baby's well-being, given the maternal hemodynamic instability. The obstetrician discussed the potential need for expedited delivery, weighing the risks and benefits to both mother and fetus, as the team closely monitored the patient's response to the interventions. This comprehensive approach aimed to stabilize the patient's condition while preparing for any necessary escalation in care, highlighting the critical balance between maternal and fetal health in the management of pre-eclampsia.

Section 2

As the healthcare team continued to closely monitor the patient's condition, new complications emerged that required immediate attention. Despite the administration of magnesium sulfate, the patient began to exhibit signs of worsening neurological status. She reported increased confusion and her speech became slightly slurred, prompting further neurological assessment. A repeat blood pressure measurement showed a reading of 185/110 mmHg, indicating that her hypertension was not yet adequately controlled despite the increased Labetalol dosage. The patient's reflexes were brisk, and there was a notable increase in clonus, raising concerns about the potential for an impending eclamptic seizure.

Laboratory results returned with further concerning findings. The platelet count had dropped to 95,000/µL, suggesting the onset of thrombocytopenia. Additionally, the patient's LDH levels were markedly elevated at 600 IU/L, indicative of hemolysis and further supporting the development of HELLP syndrome. The patient's renal function also showed further compromise, with a serum creatinine level now at 1.5 mg/dL, signaling an increasing risk of acute kidney injury.

In light of these developments, the healthcare team recognized the need for escalation of care. The decision was made to initiate corticosteroid therapy to enhance fetal lung maturity in anticipation of a potential preterm delivery. The obstetrician consulted with the neonatology team to prepare for the possible delivery of a premature infant. Continuous assessment of both maternal and fetal status remained paramount, as the team balanced the urgency of addressing the mother's deteriorating condition with the goal of prolonging the pregnancy to optimize neonatal outcomes. This situation required careful clinical reasoning to evaluate the timing and mode of delivery, considering the progression of maternal complications and the fetal gestational age.

Section 3

As the healthcare team continued to monitor the patient, her condition evolved, presenting new challenges that required immediate attention. Despite the ongoing administration of magnesium sulfate to prevent seizures, the patient experienced an eclamptic seizure. The team quickly intervened, securing the patient's airway and administering an additional bolus of magnesium sulfate to stabilize her neurological status. Post-seizure assessment revealed further deterioration, including a Glasgow Coma Scale score of 11, indicating moderate impairment of consciousness. This acute neurological event reinforced the urgency of potentially delivering the baby to prioritize maternal safety.

In response to the seizure, the patient's blood pressure surged to 190/115 mmHg, despite the ongoing Labetalol treatment. This prompted the healthcare team to initiate an intravenous infusion of hydralazine to achieve more immediate blood pressure control. Concurrently, continuous fetal monitoring indicated concerning decelerations, with a fetal heart rate dropping to 100 beats per minute, suggesting fetal distress. This reinforced the decision to expedite delivery as a means to improve both maternal and fetal outcomes.

The obstetrician, in collaboration with the neonatology team, determined that the risks associated with continuing the pregnancy outweighed the benefits. Consequently, plans for an urgent cesarean section were made, balancing the need for maternal stabilization with the potential for neonatal resuscitation. This development necessitated close coordination across the multidisciplinary team, ensuring that both the mother and newborn received comprehensive and immediate care. The impending delivery marked a critical juncture, underscoring the importance of clinical reasoning in managing complex, rapidly evolving obstetric emergencies.

Section 4

As the team prepared for the urgent cesarean section, they conducted a comprehensive initial assessment to gather critical information for the procedure. The patient's vital signs remained unstable, with blood pressure fluctuating between 185/110 mmHg and 195/120 mmHg, despite the hydralazine infusion. The heart rate stabilized at 110 beats per minute, while respiratory rate was noted at 22 breaths per minute, indicating mild tachypnea likely related to anxiety and physiological stress. Oxygen saturation hovered around 94% on room air, prompting the administration of supplemental oxygen to optimize maternal oxygenation before surgery. Laboratory results revealed worsening proteinuria, with a urine protein-to-creatinine ratio of 5.5, highlighting severe renal involvement. Serum creatinine levels increased to 1.6 mg/dL from a baseline of 0.9 mg/dL, confirming acute kidney injury secondary to preeclampsia.

Neurologically, the patient's condition showed slight improvement post-intervention, with a Glasgow Coma Scale score rising to 13. However, she remained drowsy and disoriented, necessitating continuous monitoring to prevent further complications. Fetal heart monitoring continued to show persistent late decelerations, reinforcing the urgency of delivery. The obstetrician conducted a bedside ultrasound to assess fetal well-being, which revealed reduced amniotic fluid volume and absent end-diastolic flow in the umbilical artery, indicating significant placental insufficiency. These findings underscored the critical need to proceed with delivery to prevent adverse outcomes for both mother and baby.

In response to these developments, the multidisciplinary team carefully coordinated the logistics of the cesarean section. Anesthesia was consulted to discuss the safest approach, considering the patient's fluctuating blood pressure and neurological status. Neonatology prepared for the possibility of neonatal resuscitation, given the signs of fetal distress and potential for premature delivery complications. The team remained vigilant, anticipating potential intraoperative challenges and ensuring all necessary resources and expertise were available. This collaborative effort highlighted the importance of clinical reasoning and adaptability in managing the intricate dynamics of preeclampsia with severe features, as they worked to achieve the best possible outcomes for the patient and her child.

Section 5

As the surgical team commenced the cesarean section, an unexpected complication emerged. Despite the administration of supplemental oxygen, the patient's oxygen saturation dropped further to 90%, and she began exhibiting signs of respiratory distress. Her respiratory rate increased to 28 breaths per minute, and auscultation of the lungs revealed bilateral crackles, indicating potential pulmonary edema. Given the existing preeclampsia and the fluid shifts associated with it, the team suspected acute pulmonary edema as a complication. This necessitated immediate intervention to stabilize her respiratory status and maintain adequate oxygenation during the surgical procedure.

The anesthesiology team quickly adjusted the patient's oxygen delivery, transitioning from nasal cannula to a non-rebreather mask to provide a higher concentration of oxygen. Concurrently, they initiated diuretic therapy with intravenous furosemide to manage the fluid overload contributing to her pulmonary symptoms. The obstetric team, aware of the potential for further deterioration, expedited the surgical process, ensuring minimal delay in delivering the baby to reduce maternal and fetal stress. Throughout these interventions, the importance of clinical reasoning was paramount as the team balanced the need to manage the acute respiratory complication while maintaining focus on the primary goal of a safe delivery.

Despite these challenges, the collaborative approach and swift actions of the multidisciplinary team resulted in a successful delivery. The neonate, though requiring initial resuscitation efforts due to respiratory distress, responded well to the interventions and was quickly stabilized by the neonatology team. The mother's respiratory status improved with the diuretic therapy, and her oxygen saturation returned to 95% on the non-rebreather mask. As the surgical team completed the cesarean section, they remained vigilant for any further complications. This scenario underscored the critical importance of adaptability and comprehensive clinical reasoning in managing complex obstetric emergencies, ensuring both maternal and neonatal safety in the face of evolving challenges.