A patient diagnosed with preeclampsia presents with bilateral pitting edema, mild basilar crackles, and retinal changes. Laboratory results show proteinuria, elevated liver enzymes, and a reduced platelet count. Which nursing intervention is most critical in preventing potential complications in this patient?

C) Monitoring the patient’s reflexes for signs of magnesium toxicity

A) Administering prescribed labetalol to control blood pressure

B) Encouraging the patient to increase fluid intake to manage edema

C) Monitoring the patient’s reflexes for signs of magnesium toxicity

D) Advising the patient to remain on bed rest to reduce stress

A 32-year-old pregnant woman at 34 weeks gestation presents with bilateral pitting edema, facial puffiness, and mild basilar crackles. Her laboratory results reveal proteinuria, elevated liver transaminases, and a slightly reduced platelet count. Which of the following nursing actions is a priority to prevent further complications in this patient?

C) Initiate seizure precautions and administer magnesium sulfate as prescribed

A) Administer a diuretic to reduce edema

B) Prepare the patient for an emergency cesarean section

C) Initiate seizure precautions and administer magnesium sulfate as prescribed

D) Encourage the patient to increase fluid intake to improve renal function

A patient with severe preeclampsia is experiencing a rise in blood pressure and symptoms suggestive of worsening condition, including epigastric pain and headaches. Laboratory findings indicate a decline in platelet count and elevated liver enzymes. What is the priority nursing action to address the potential development of HELLP syndrome?

C) Continue the magnesium sulfate infusion and notify the healthcare provider

A) Administer an additional dose of labetalol to control blood pressure

B) Prepare the patient for an immediate cesarean section

C) Continue the magnesium sulfate infusion and notify the healthcare provider

D) Initiate continuous fetal monitoring and observe for signs of fetal distress

A patient with severe preeclampsia is being monitored closely. Her blood pressure has increased to 165/110 mmHg despite antihypertensive therapy, and she reports epigastric pain and persistent headaches. Laboratory findings show a platelet count of 105,000/mm³ and elevated liver enzymes (AST 110 U/L, ALT 125 U/L). What is the most appropriate nursing action to prioritize in this situation?

B) Prepare the patient for immediate delivery as per the obstetric team's decision.

A) Increase the labetalol dosage and continue monitoring.

B) Prepare the patient for immediate delivery as per the obstetric team's decision.

C) Administer an additional antihypertensive medication to better control blood pressure.

D) Provide education on the signs of impending eclampsia to the patient.

A patient in the labor and delivery unit is exhibiting signs of severe preeclampsia with a progression towards HELLP syndrome. Despite treatment with labetalol and magnesium sulfate, her blood pressure remains elevated, and she reports severe headaches and epigastric pain. The team is considering a cesarean delivery due to her deteriorating condition and fetal distress. What is the primary nursing intervention to prioritize at this stage to ensure maternal and fetal safety?

D) Closely monitor and document fetal heart rate patterns continuously

A) Administer additional antihypertensive medication to further lower blood pressure

B) Prepare the patient for an immediate cesarean delivery

C) Increase the dosage of magnesium sulfate to prevent seizures

D) Closely monitor and document fetal heart rate patterns continuously

A patient at 36 weeks of gestation is diagnosed with severe preeclampsia and is showing signs of HELLP syndrome. Her blood pressure remains elevated despite treatment with labetalol and magnesium sulfate. She continues to report severe headaches and epigastric pain, and her platelet count is decreasing. What is the most appropriate nursing action to prioritize at this time?

B) Prepare the patient for a possible cesarean delivery.

A) Increase the dosage of labetalol to better control blood pressure.

B) Prepare the patient for a possible cesarean delivery.

C) Administer additional magnesium sulfate to prevent seizures.

D) Encourage the patient to ambulate to promote natural labor progression.

A patient with severe preeclampsia is experiencing increased respiratory distress and pulmonary edema. What is the priority nursing intervention to address the patient's current respiratory status?

C) Place the patient in a semi-Fowler's position to facilitate lung expansion.

A) Administer a diuretic to reduce fluid overload.

B) Increase the magnesium sulfate infusion rate to prevent seizures.

C) Place the patient in a semi-Fowler's position to facilitate lung expansion.

D) Discontinue the magnesium sulfate infusion immediately to prevent toxicity.

A patient with severe preeclampsia on magnesium sulfate therapy is experiencing increased respiratory distress, pulmonary edema, and fetal distress. What should be the nurse's priority intervention to address the patient's respiratory status?

C) Position the patient in a semi-Fowler's position and provide supplemental oxygen.

A) Increase the rate of magnesium sulfate infusion to decrease the risk of seizures.

B) Administer diuretics immediately to reduce pulmonary edema.

C) Position the patient in a semi-Fowler's position and provide supplemental oxygen.

D) Contact the obstetrician to prepare for an emergent cesarean delivery.

A patient with severe preeclampsia is exhibiting signs of magnesium toxicity, including hyperreflexia and clonus. Given her diminished urine output and elevated blood pressure, which nursing action is the highest priority?

C) Administer calcium gluconate to counteract magnesium toxicity.

A) Administer diuretics to increase urine output.

B) Prepare for immediate delivery to address fetal distress.

C) Administer calcium gluconate to counteract magnesium toxicity.

D) Monitor blood pressure closely and adjust antihypertensive medication.

A patient with severe preeclampsia is showing signs of magnesium toxicity, including hyperreflexia and clonus. Her serum magnesium level is 4.8 mg/dL, and she has diminished urine output. What is the priority nursing intervention to address this situation?

B) Prepare and administer a bolus of calcium gluconate

A) Increase the rate of magnesium sulfate infusion to control blood pressure

B) Prepare and administer a bolus of calcium gluconate

C) Administer additional antihypertensive medication

D) Restrict fluid intake to prevent further renal compromise

preclampsia - Nursing Case Study

Pathophysiology

• Primary mechanism: Abnormal placentation leads to defective remodeling of spiral arteries, causing them to remain narrow and high-resistance, which reduces placental blood flow and triggers systemic endothelial dysfunction.

• Secondary mechanism: Endothelial dysfunction results in widespread vasoconstriction and increased vascular permeability, contributing to hypertension and proteinuria.

• Key complication: This cascade can progress to multi-organ damage, notably affecting the liver, kidneys, and central nervous system, posing significant risks to both maternal and fetal health if not managed promptly.

Patient Profile

Demographics:

28-year-old female, teacher

History:

• Key past medical history: Gestational hypertension in previous pregnancy, hypothyroidism

• Current medications: Levothyroxine 100 mcg daily, prenatal vitamins

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent headache and visual disturbances

• Key symptoms: Swelling in hands and face, increased fatigue, upper abdominal pain

• Vital signs: Blood pressure 150/100 mmHg, heart rate 92 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F

Section 1

As the clinical team conducts an initial assessment, the patient's condition is further evaluated with a thorough physical examination and additional diagnostics. On examination, she exhibits bilateral pitting edema in her lower extremities and facial puffiness, consistent with her reported swelling. Auscultation of the lungs reveals mild basilar crackles, suggesting possible fluid overload. A fundoscopic exam of the eyes identifies retinal changes, including arteriolar narrowing and hemorrhages, correlating with her complaint of visual disturbances.

Laboratory tests are promptly ordered to assess the extent of organ involvement. Results reveal proteinuria with a urine protein-to-creatinine ratio of 0.4, indicating significant renal involvement. Liver function tests show elevated transaminases, with AST and ALT levels at 85 U/L and 92 U/L, respectively, hinting at hepatic stress or damage. Platelet count is slightly reduced at 120,000/mm³, raising concerns about potential progression to HELLP syndrome. Creatinine levels are within the upper normal range at 1.1 mg/dL, warranting close monitoring for potential renal impairment.

These findings prompt the healthcare team to consider escalation in management. The elevated blood pressure, proteinuria, and lab abnormalities suggest the progression of preeclampsia with potential for more severe complications. Management strategies are adjusted to include antihypertensive therapy with labetalol and magnesium sulfate for seizure prophylaxis. The obstetric team discusses the possibility of expedited delivery, weighing the risks and benefits due to the potential for rapid deterioration of both maternal and fetal status. Ongoing monitoring of maternal and fetal wellbeing is prioritized to swiftly identify any further changes in the patient's condition. This evolving scenario necessitates vigilant clinical reasoning to anticipate and mitigate further complications.

Section 2

As the clinical team continues to monitor the patient closely, they observe a change in her status that necessitates immediate attention. The patient's blood pressure, previously managed at 150/95 mmHg with labetalol, has risen to 165/110 mmHg despite the antihypertensive therapy, indicating a potential escalation in the severity of her preeclampsia. In addition to the rising blood pressure, the patient begins to report new symptoms of epigastric pain and persistent headaches, which are concerning for worsening preeclampsia or impending eclampsia.

In response to these changes, the clinical team decides to increase the dosage of labetalol and continues the magnesium sulfate infusion for seizure prophylaxis. Blood tests are repeated to evaluate any progression in organ dysfunction. The results reveal a further decline in platelet count to 105,000/mm³, and the liver enzyme levels have risen to AST of 110 U/L and ALT of 125 U/L. These findings suggest an increased risk of developing HELLP syndrome, a severe form of preeclampsia with hemolysis, elevated liver enzymes, and low platelet count, requiring the team to consider more aggressive management strategies.

Given the patient's deteriorating condition and the potential risks to both mother and fetus, the obstetric team decides to expedite delivery. The decision is made to proceed with induction of labor, considering the gestational age and fetal status. Continuous fetal monitoring is implemented to assess for any signs of fetal distress, and the patient is moved to labor and delivery for closer observation and intervention. This approach aims to prevent further complications and optimize outcomes for both the patient and her unborn child, highlighting the critical importance of timely decision-making in the management of severe preeclampsia.

Section 3

As the patient is moved to the labor and delivery unit, the clinical team performs an initial assessment to establish her current status and baseline. The patient's vital signs show a sustained elevated blood pressure at 170/115 mmHg, and she continues to report severe frontal headaches and worsening epigastric pain. On physical examination, the patient appears visibly anxious and uncomfortable, with mild facial edema and hyperreflexia noted. The fetal heart rate monitor indicates a baseline fetal heart rate of 150 beats per minute, with occasional decelerations suggestive of intermittent fetal distress.

In light of these findings, the team reviews the results of the latest laboratory tests, which provide further insight into the patient's deteriorating condition. The platelet count has decreased further to 95,000/mm³, confirming the progression toward HELLP syndrome. Additionally, the patient's renal function tests reveal an elevated creatinine level of 1.4 mg/dL, indicating possible kidney involvement. These diagnostic results underscore the urgency of the situation, prompting the team to reevaluate the current plan and consider further interventions to stabilize the patient while proceeding with labor induction.

The response to the increased dosage of labetalol and magnesium sulfate infusion is closely monitored. Despite these interventions, the patient's blood pressure remains high, with minimal improvement in her headache and epigastric pain. Given the lack of response and the concerning lab results, the obstetric team discusses the possibility of transitioning to a cesarean delivery if labor induction does not progress promptly or if fetal distress worsens. This decision reflects the need to balance the risks to the mother with the imperative to ensure a safe delivery for the baby, emphasizing the critical role of continuous assessment and adaptability in managing severe preeclampsia.

Section 4

As the team continues to monitor the patient's condition, a noticeable change in her status emerges. The patient begins experiencing increased respiratory distress, characterized by a respiratory rate that has escalated to 28 breaths per minute, with shallow breaths and audible wheezing. Auscultation reveals crackles at the lung bases, suggesting the development of pulmonary edema, a complication associated with severe preeclampsia and fluid overload from magnesium sulfate therapy. This respiratory compromise adds a new layer of urgency to the clinical picture, necessitating immediate intervention to prevent further deterioration.

The decision is made to administer supplemental oxygen via a non-rebreather mask to improve oxygenation, with continuous pulse oximetry monitoring revealing an initial saturation level of 88%. The team adjusts the patient's position to semi-Fowler's to facilitate lung expansion and enhance respiratory function. Concurrently, the obstetrician consults with the anesthesiology and neonatology teams to prepare for a potential emergent cesarean delivery, as the fetal heart rate monitor shows increased variability and more frequent decelerations, indicating worsening fetal distress. This multifaceted approach underscores the critical need for comprehensive care coordination and swift clinical decision-making to optimize outcomes for both mother and baby.

The patient's symptoms and lab results prompt a reassessment of her fluid balance and medication regimen. Diuretics are cautiously considered to manage the pulmonary edema, while the magnesium sulfate infusion is carefully titrated to mitigate the risk of magnesium toxicity. Throughout this process, the nursing team plays a pivotal role in conducting frequent assessments, ensuring effective communication among the multidisciplinary team, and providing essential support to the patient and her family during this intensely challenging time. As the situation evolves, the healthcare team remains vigilant, ready to adapt to the dynamic clinical scenario to ensure the safety and well-being of the patient and her unborn child.

Section 5

As the clinical team continues to manage the patient's condition, new diagnostic results provide additional insight into her complex clinical picture. Laboratory tests reveal a serum magnesium level of 4.8 mg/dL, approaching the upper therapeutic range, raising concerns about potential magnesium toxicity. Concurrently, the patient's urine output has diminished to 20 mL/hr, indicating possible renal compromise and necessitating careful reevaluation of her fluid and electrolyte balance. Blood pressure remains elevated at 165/110 mmHg, despite the administration of antihypertensive medications, highlighting the persistent severity of her preeclampsia.

The fetal non-stress test shows persistent late decelerations, with the baseline fetal heart rate dropping to 100 beats per minute, suggesting ongoing fetal distress. These findings prompt the obstetrician to expedite the decision for an emergency cesarean delivery, prioritizing the safety of both mother and child. Meanwhile, the nursing team focuses on meticulous monitoring of the patient's neurological status, as she begins to exhibit hyperreflexia and clonus, further signs of magnesium toxicity.

In response to these developments, the team acts swiftly to adjust the patient's medication regimen. A bolus of calcium gluconate is prepared as a precautionary measure to counteract potential magnesium toxicity, while diuretics are administered judiciously to address fluid overload and support renal function. Throughout these interventions, the nursing team maintains vigilant assessment, ensuring the patient receives optimal care as she is prepared for the operating room. This thorough coordination underscores the critical nature of timely and informed decision-making in managing severe preeclampsia and its complications.