A pregnant patient at 35 weeks gestation is admitted with worsening pre-eclampsia. She presents with right upper quadrant pain, headaches, and brisk reflexes. Lab results indicate proteinuria, elevated liver enzymes, and a low platelet count. Which nursing intervention is the priority to address the potential complication of eclampsia?

A) Administer intravenous magnesium sulfate as ordered.

B) Prepare the patient for an immediate C-section.

C) Provide continuous fetal monitoring and document findings.

D) Encourage the patient to ambulate to reduce edema.

A patient with worsening pre-eclampsia presents with elevated liver enzymes, proteinuria, and a low platelet count. Which nursing intervention is the priority to prevent further maternal complications?

C) Initiate seizure precautions and administer magnesium sulfate as ordered.

A) Administer antihypertensive medication as prescribed to control blood pressure.

B) Prepare the patient for immediate cesarean delivery to prevent fetal compromise.

C) Initiate seizure precautions and administer magnesium sulfate as ordered.

D) Encourage the patient to rest in a lateral position to improve placental blood flow.

A 34-week pregnant patient is experiencing severe pre-eclampsia with elevated blood pressure, visual disturbances, and right upper quadrant pain. Intravenous magnesium sulfate has been administered. What is the most critical nursing intervention to prioritize immediately after initiating magnesium sulfate therapy?

B) Assess deep tendon reflexes regularly

A) Monitor fetal heart rate continuously

B) Assess deep tendon reflexes regularly

C) Measure maternal blood glucose levels

D) Obtain a complete blood count (CBC)

A 34-week gestation patient with severe pre-eclampsia is being treated with intravenous magnesium sulfate for seizure prophylaxis and antihypertensive medications. She reports right upper quadrant pain, and an ultrasound shows mild hepatic enlargement. Considering these findings, what is the most appropriate nursing intervention?

A) Monitor the patient's urine output hourly.

B) Increase the rate of magnesium sulfate infusion.

C) Position the patient in a supine position.

D) Encourage the patient to ambulate frequently.

A patient with severe pre-eclampsia is being prepared for a cesarean section due to signs of HELLP syndrome. Which nursing intervention is most crucial before the procedure to ensure maternal and fetal safety?

A) Administer intravenous magnesium sulfate to prevent seizures

B) Increase the rate of IV fluids to manage potential hypotension

C) Initiate continuous fetal heart rate monitoring to assess fetal well-being

D) Provide the patient with a high-protein meal to support liver function

A patient with suspected HELLP syndrome is undergoing a cesarean section. Which nursing intervention is most critical to prioritize during the immediate postoperative period?

B) Monitoring for signs of bleeding and ensuring availability of blood products

A) Administering antihypertensive medication to maintain stable blood pressure

B) Monitoring for signs of bleeding and ensuring availability of blood products

C) Assessing for changes in neurological status every 4 hours

D) Encouraging early ambulation to prevent thromboembolic events

A patient undergoing a cesarean section due to HELLP syndrome exhibits an elevated blood pressure and a declining platelet count. As a nurse, which intraoperative intervention is most critical to prevent complications during surgery?

C) Prepare and have blood products readily available for potential transfusion

A) Administer antihypertensive medication to manage elevated blood pressure

B) Monitor fetal heart rate continuously to detect any signs of fetal distress

C) Prepare and have blood products readily available for potential transfusion

D) Increase intravenous fluid rate to maintain adequate hydration

During the postoperative period following a cesarean section complicated by HELLP syndrome, which assessment finding would most likely indicate the need for immediate intervention by the nursing team?

C) Increasing abdominal pain and distension

B) Blood pressure of 110/70 mmHg

C) Increasing abdominal pain and distension

D) Heart rate of 90 beats per minute

A patient undergoing a cesarean section exhibits a sudden drop in blood pressure to 90/60 mmHg and an increased heart rate of 125 beats per minute. The patient also demonstrates decreased urine output and laboratory findings consistent with HELLP syndrome. What is the most appropriate immediate nursing intervention to address the patient's hemodynamic instability?

A) Administer a bolus of isotonic intravenous fluids.

B) Initiate a continuous infusion of magnesium sulfate.

C) Prepare the patient for immediate surgical intervention.

D) Increase the rate of oxygen delivery via nasal cannula.

Pre-eclampsia - Nursing Case Study

Pathophysiology

• Primary mechanism: Abnormal placentation leads to poor remodeling of the uterine spiral arteries, resulting in high-resistance, low-flow blood supply to the placenta. This causes placental ischemia and the release of factors that trigger systemic endothelial dysfunction.

• Secondary mechanism: Endothelial dysfunction causes widespread vasoconstriction, increased vascular permeability, and activation of the coagulation cascade. This contributes to hypertension, proteinuria, and generalized edema.

• Key complication: Systemic vasculature changes can lead to multi-organ damage, including renal impairment, hepatic dysfunction, and cerebral edema, increasing the risk of severe complications such as eclampsia, stroke, or HELLP syndrome.

Patient Profile

Demographics:

32-year-old female, school teacher

History:

• Key past medical history: Gestational hypertension in previous pregnancy

• Current medications: Prenatal vitamins, Labetalol 200 mg twice daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe headaches and visual disturbances

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

• Vital signs: Blood pressure 160/110 mmHg, heart rate 95 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

As the clinical team conducts an initial assessment, the patient's condition suggests worsening pre-eclampsia with the potential for further complications. A physical examination reveals pronounced pitting edema in the lower extremities and hands, with the patient reporting increasing discomfort and persistent headaches. Her abdominal pain localizes to the right upper quadrant, indicating possible hepatic involvement. The team notes that her reflexes are brisk and there is mild clonus present, raising concerns about potential neurological involvement.

Laboratory results return with significant findings: proteinuria is confirmed with a 24-hour urine protein level of 350 mg, suggesting renal involvement. Liver function tests show elevated liver enzymes, with alanine aminotransferase (ALT) at 95 U/L and aspartate aminotransferase (AST) at 100 U/L, indicating hepatic strain. Additionally, a complete blood count reveals a platelet count of 110,000/mm³, which is lower than normal and suggests the early stages of HELLP syndrome. These findings prompt the team to consider rapid intervention to prevent further deterioration.

Given these concerning developments, the clinical team prioritizes stabilizing the patient's condition. They discuss the potential need for expedited delivery to mitigate risks to both the mother and the fetus. Continuous fetal monitoring is initiated to assess fetal well-being, and the patient is closely observed for signs of progression to eclampsia, such as seizures or further neurological compromise. The healthcare team must now evaluate the benefits and risks of continuing the pregnancy versus early delivery, weighing the progression of symptoms and lab results against gestational age and fetal development.

Section 2

As the clinical team continues to monitor the patient, her condition evolves, necessitating a reassessment of her status and care plan. Within a few hours, the patient begins to exhibit more pronounced symptoms of neurological involvement. She reports experiencing visual disturbances, including blurred vision and seeing spots, which further raises concern for potential progression to eclampsia. The team notes an increase in her blood pressure readings, now consistently elevated at 165/110 mmHg. This hypertensive urgency underscores the need for immediate intervention to prevent further complications.

In response to these developments, the team decides to administer intravenous magnesium sulfate to address the risk of seizures, a critical step in managing severe pre-eclampsia. Additionally, antihypertensive medications are initiated to control her elevated blood pressure. Despite these interventions, the patient's discomfort with her right upper quadrant pain intensifies, prompting the clinical team to perform an ultrasound to evaluate for potential liver complications such as subcapsular hematoma or hepatic rupture. The ultrasound reveals mild hepatic enlargement but no immediate signs of rupture, providing some reassurance but maintaining a high level of vigilance.

Considering the gestational age of 34 weeks and the increasing risks to both mother and fetus, the team prepares for the possibility of an expedited delivery. A multidisciplinary discussion involving obstetricians, neonatologists, and anesthesiologists is convened to plan the safest approach for delivery, balancing the risks of prematurity against the likelihood of maternal and fetal deterioration if the pregnancy continues. Continuous fetal monitoring indicates variable decelerations, suggesting some fetal distress, and reinforces the urgency of the situation. The team remains alert to any further changes in the patient's condition, ready to pivot their approach as necessary to ensure the best possible outcome for both mother and child.

Section 3

As the team implements the care plan, the patient is closely monitored for any response to the interventions. Within a few hours, her neurological symptoms show slight improvement; she reports that the visual disturbances have lessened, though she still experiences occasional blurring. Her blood pressure stabilizes somewhat, fluctuating between 150/100 mmHg and 155/105 mmHg, indicating a partial response to the antihypertensive treatment. However, her right upper quadrant pain persists, warranting continued observation and management.

Despite these interventions, new laboratory results reveal concerning changes in her liver function tests, with elevated liver enzymes: AST at 98 U/L and ALT at 105 U/L, indicating hepatic stress. Additionally, her platelet count has decreased to 110,000/μL, raising suspicion for HELLP syndrome, a serious condition that can complicate severe pre-eclampsia. These findings necessitate an urgent reassessment of her condition and reinforce the significance of early delivery to prevent further maternal and fetal complications.

The team discusses the results and decides to proceed with delivery, given the increasing maternal risks and the potential for fetal distress. Steroid therapy for fetal lung maturation has been completed, and the patient is prepared for a cesarean section, given the unfavorable cervical status and urgency of the situation. While maintaining continuous monitoring, the team communicates the plan to the patient and family, ensuring understanding and support throughout the process. The goal is to proceed swiftly and safely, prioritizing the health and safety of both mother and baby.

Section 4

As the patient is prepared for the cesarean section, the team conducts a final pre-operative assessment to ensure readiness and identify any new developments. The patient's vital signs are closely monitored, revealing a slight increase in heart rate to 110 beats per minute, which could be attributed to anxiety or the body's stress response. Her blood pressure remains elevated, fluctuating between 148/98 mmHg and 154/102 mmHg. The assessment also notes mild peripheral edema, particularly in the lower extremities, but no new neurological symptoms are observed. Fetal monitoring shows a stable heart rate with no signs of distress, providing some reassurance as the team moves forward with delivery.

In the hours leading up to the procedure, the patient's laboratory values are re-evaluated to confirm the diagnosis and guide perioperative management. The new results show a further decline in platelet count to 98,000/μL, reinforcing the urgency to address potential complications from HELLP syndrome. Liver enzymes continue to rise, with AST now at 105 U/L and ALT at 110 U/L, signifying ongoing hepatic involvement. These findings prompt the multidisciplinary team to discuss the need for vigilant intraoperative and postoperative monitoring for any signs of bleeding or worsening liver function, emphasizing the importance of prompt intervention should these complications arise.

The team implements a comprehensive plan, including the availability of blood products and collaboration with anesthesiology to manage potential bleeding risks during the cesarean section. The patient's care plan is adjusted to increase the frequency of monitoring after delivery, with particular attention to her hemodynamic status and any further changes in neurological or hepatic function. This proactive approach aims to mitigate complications and ensure a safe outcome for both mother and baby, highlighting the critical role of continuous clinical reasoning and adaptation in managing complex obstetric cases.

Section 5

As the cesarean section progresses, the surgical team remains vigilant, closely monitoring the patient for any signs of developing complications. Approximately halfway through the procedure, the anesthesiologist notes a sudden drop in the patient's blood pressure to 90/60 mmHg, accompanied by a further increase in heart rate to 125 beats per minute. These changes prompt immediate clinical reasoning to differentiate between potential causes such as intraoperative bleeding, anesthetic effects, or an acute stress response. The surgeon quickly evaluates the surgical field for any evidence of excessive bleeding, while the anesthesiology team adjusts the patient's fluid management and considers the need for vasopressors to stabilize her hemodynamic status.

Concurrently, the nursing team observes that the patient's urine output has decreased to less than 20 mL/hour, raising concerns about renal perfusion and potential acute kidney injury. This finding, coupled with the patient's declining platelet count and rising liver enzymes, suggests a worsening of the HELLP syndrome, highlighting the complexity of the patient's condition. The multidisciplinary team promptly initiates a transfusion of platelets and considers the administration of fresh frozen plasma to mitigate the risk of coagulopathy.

Despite these challenges, the cesarean section is completed successfully, and the newborn is delivered with a strong cry, reassuring the team of the baby's immediate well-being. Postoperatively, the focus shifts to the mother's recovery, with a heightened emphasis on monitoring her vital signs, urine output, and laboratory values. The team plans for frequent assessments in the intensive care unit to detect any further complications early, such as worsening hepatic function or the development of disseminated intravascular coagulation (DIC). This proactive approach underscores the importance of continuous clinical reasoning and adaptation in managing the dynamic nature of pre-eclampsia with HELLP syndrome, ensuring optimal care for both mother and child.