A nurse is caring for a pregnant patient with severe preeclampsia who is at 34 weeks of gestation. The latest diagnostic results indicate significant proteinuria, elevated liver enzymes, decreased platelet count, elevated serum creatinine, and signs of fetal distress. What is the most appropriate nursing intervention to prioritize at this time?

B) Prepare the patient for an urgent cesarean delivery.

A) Administer antihypertensive medication to stabilize blood pressure.

B) Prepare the patient for an urgent cesarean delivery.

C) Administer corticosteroids to enhance fetal lung maturity.

D) Increase maternal fluid intake to improve placental perfusion.

A 34-year-old pregnant patient at 32 weeks gestation is diagnosed with severe preeclampsia and exhibits signs of potential HELLP syndrome. The patient’s non-stress test shows variable decelerations, and the biophysical profile score is 6/10. Based on these findings, which nursing intervention should be prioritized to ensure fetal and maternal safety?

B) Prepare the patient for potential emergency cesarean delivery.

A) Increase the patient's oral fluid intake to improve amniotic fluid volume.

B) Prepare the patient for potential emergency cesarean delivery.

C) Administer antihypertensive medication to stabilize blood pressure.

D) Encourage ambulation to promote circulation and reduce the risk of thrombosis.

A nurse is caring for a patient at 34 weeks of gestation with severe preeclampsia. The patient is experiencing worsening headache, visual disturbances, and new onset epigastric pain, and her blood pressure remains above 160/110 mmHg despite treatment. What is the priority nursing intervention to prevent maternal complications?

C) Administer magnesium sulfate as ordered

A) Administer antihypertensive medication as prescribed

B) Initiate continuous fetal monitoring

C) Administer magnesium sulfate as ordered

D) Prepare the patient for immediate cesarean delivery

A patient with severe preeclampsia is experiencing worsening headache, visual disturbances, and new onset epigastric pain. Her blood pressure remains elevated despite antihypertensive therapy. Which nursing intervention is most critical to implement first?

B) Initiate magnesium sulfate therapy

A) Administer an additional dose of antihypertensive medication

B) Initiate magnesium sulfate therapy

C) Prepare the patient for a cesarean section

D) Provide corticosteroids to enhance fetal lung maturity

A patient receiving magnesium sulfate therapy for preeclampsia is being monitored for signs of magnesium toxicity. Which clinical finding should prompt the nurse to immediately notify the healthcare provider?

C) Serum magnesium level of 9.0 mg/dL

A) Respiratory rate of 18 breaths per minute

C) Serum magnesium level of 9.0 mg/dL

D) Blood pressure of 140/90 mmHg

A patient receiving magnesium sulfate therapy for preeclampsia is now showing signs of possible HELLP syndrome with elevated liver enzymes and low platelet count. What is the priority nursing assessment for this patient?

C) Evaluating for signs of bleeding and disseminated intravascular coagulation (DIC).

A) Monitoring for signs of magnesium toxicity, such as decreased deep tendon reflexes.

B) Assessing for signs of respiratory depression, given the magnesium therapy.

C) Evaluating for signs of bleeding and disseminated intravascular coagulation (DIC).

D) Checking for neurological changes, such as headaches or visual disturbances.

A patient undergoing an expedited cesarean section for severe preeclampsia has a blood pressure of 160/110 mmHg despite antihypertensive therapy. She is receiving labetalol intravenously prior to the procedure. Considering her low platelet count, what should the nurse prioritize when preparing the patient for spinal anesthesia?

B) Assessing for signs of bleeding or hematoma formation

A) Monitoring for signs of respiratory depression

B) Assessing for signs of bleeding or hematoma formation

C) Preparing for immediate neonatal resuscitation

D) Ensuring the patient's oxygen saturation remains above 95%

A patient with severe preeclampsia and suspected HELLP syndrome is undergoing an expedited cesarean section. The nurse is preparing for potential complications in the neonate immediately after delivery. Which of the following interventions should the nurse prioritize for the newborn?

B) Preparing for neonatal resuscitation including possible ventilation support

A) Administering IV antibiotics to prevent infection

B) Preparing for neonatal resuscitation including possible ventilation support

C) Initiating glucose monitoring to assess for hypoglycemia

D) Providing phototherapy immediately to prevent jaundice

A patient undergoing a cesarean section for severe preeclampsia with suspected HELLP syndrome is receiving magnesium sulfate for seizure prophylaxis. Which assessment finding would indicate a potential complication from magnesium sulfate therapy that requires immediate intervention?

C) Respiratory rate of 18 breaths per minute

D) Urinary output of 40 mL/hour

A patient undergoing a cesarean section for severe preeclampsia with HELLP syndrome reports a sudden onset of severe headache and visual disturbances. Despite receiving labetalol, her blood pressure remains elevated. The healthcare team has administered magnesium sulfate. Which of the following should the nurse prioritize in the ongoing assessment of this patient?

A) Monitor for signs of magnesium toxicity, such as loss of deep tendon reflexes and respiratory depression.

B) Increase the dose of labetalol to further manage blood pressure and prevent seizure activity.

C) Assess the patient's fluid intake and output to manage potential fluid overload due to magnesium sulfate administration.

D) Evaluate for signs of disseminated intravascular coagulation (DIC) given the drop in platelet count.

preeclampsia - Nursing Case Study

Pathophysiology

• Primary mechanism: Abnormal placentation leads to impaired remodeling of spiral arteries, resulting in high-resistance, low-flow uteroplacental circulation and placental ischemia.

• Secondary mechanism: Placental ischemia triggers the release of anti-angiogenic factors (like sFlt-1 and endoglin) into maternal circulation, causing endothelial dysfunction and systemic vasoconstriction.

• Key complication: Endothelial dysfunction results in hypertension and impaired organ perfusion, contributing to symptoms like proteinuria, edema, and potential multi-organ damage.

Patient Profile

Demographics:

28-year-old female, office manager

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: Persistent headache, blurred vision, upper abdominal pain, swelling in hands and feet

• Vital signs: Blood pressure 160/110 mmHg, heart rate 92 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F

Section 1

New Diagnostic Results:

After the initial assessment, further diagnostic testing was conducted to gain a clearer picture of the patient's condition. Urinalysis revealed significant proteinuria, with a protein level of 4 grams per 24-hour urine collection, indicating severe preeclampsia. Blood tests showed elevated liver enzymes: AST at 95 U/L and ALT at 102 U/L, pointing towards potential liver involvement. Platelet count was slightly decreased at 120,000/mm³, suggesting a risk of HELLP syndrome, a serious complication of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. Serum creatinine was elevated at 1.3 mg/dL, indicating impaired renal function.

A non-stress test and biophysical profile were performed to assess fetal well-being. The non-stress test showed variable decelerations, raising concerns about fetal distress. The biophysical profile scored a 6 out of 10, with decreased fetal movement and reduced amniotic fluid volume, suggesting oligohydramnios. Doppler ultrasound studies of the umbilical artery showed increased resistance, consistent with impaired placental perfusion.

These diagnostic findings suggest an escalation in the severity of the patient's preeclampsia, with potential multi-organ impact and fetal compromise. The healthcare team must now consider the urgency of delivery to prevent further maternal and fetal complications. This decision involves evaluating the gestational age, current maternal-fetal status, and weighing the risks and benefits of continuing the pregnancy versus early delivery. The multidisciplinary team, including obstetrics, neonatology, and maternal-fetal medicine specialists, will collaborate to determine the most appropriate course of action, prioritizing the safety and health of both the mother and the baby.

Section 2

As the healthcare team continues to monitor the patient closely, a change in her status becomes apparent. The patient begins to experience worsening headache and visual disturbances, which are concerning symptoms in the context of severe preeclampsia. Her blood pressure remains elevated despite the administration of antihypertensive medications, with readings consistently above 160/110 mmHg. Additionally, the patient reports new onset epigastric pain, a potential indication of worsening hepatic involvement. These symptoms, coupled with the previous diagnostic findings, suggest an escalation in the severity of her condition and raise the possibility of impending eclampsia or progression to HELLP syndrome.

The interdisciplinary team reviews the patient's status, considering both maternal and fetal indications for intervention. Given the new symptoms and the risk of severe complications, there is a growing consensus towards the need for expedited delivery. The team recognizes that while the patient is at 34 weeks of gestation, the benefits of early delivery now outweigh the risks associated with continued pregnancy. Neonatology is prepared to provide immediate care for the newborn, considering the potential for prematurity-related complications.

In preparation for delivery, the team initiates magnesium sulfate therapy to prevent seizures associated with eclampsia. The patient is also given corticosteroids to enhance fetal lung maturity, optimizing neonatal outcomes. The obstetric team prepares for a possible cesarean section, given the fetal distress indicators and the lack of cervical readiness for labor induction. These interventions reflect a critical response to the evolving clinical picture, prioritizing the stabilization of the patient and optimizing the health prospects for both mother and child.

Section 3

As the patient is stabilized and prepared for delivery, the healthcare team pays close attention to her response to the magnesium sulfate therapy and corticosteroids. While magnesium sulfate is effective in reducing the risk of seizures, it requires careful monitoring due to potential side effects. The patient's deep tendon reflexes are assessed regularly, and serum magnesium levels are measured to ensure they remain within the therapeutic range of 4.8 to 8.4 mg/dL. The patient's respiratory rate is closely observed, remaining steady at 18 breaths per minute, which is within normal limits and indicates no immediate respiratory depression from the magnesium.

However, a new complication arises as the lab results return, revealing a concerning trend in the patient's liver function tests. Her AST and ALT levels have risen significantly, now measuring 150 U/L and 170 U/L respectively, indicating worsening hepatic involvement. Furthermore, her platelet count has dropped to 95,000/mm³, raising suspicions of developing HELLP syndrome. This development necessitates immediate reevaluation of the management plan, as the risk of disseminated intravascular coagulation (DIC) and bleeding increases.

Given these changes, the interdisciplinary team decides to expedite the cesarean section. Anesthesiology is consulted to assess the patient's coagulation status and to plan for anesthesia management, considering the low platelet count. The team remains vigilant, ready to address any unexpected complications during delivery. The evolving situation underscores the importance of timely intervention and the need for a dynamic approach to care, ensuring the best possible outcomes for both mother and child. The focus remains on minimizing maternal morbidity while preparing for neonatal care, given the potential challenges associated with prematurity.

Section 4

As the team prepares for the expedited cesarean section, attention turns to the patient's hemodynamic status. Her blood pressure has remained elevated, with recent readings at 160/110 mmHg, despite antihypertensive therapy. This persistently high blood pressure, coupled with the laboratory abnormalities, heightens concerns about further end-organ damage. The decision is made to administer an additional dose of labetalol intravenously to manage her hypertension more aggressively prior to surgery. Meanwhile, the anesthesiology team continues to evaluate her risk for bleeding due to the low platelet count, and a decision is made to proceed with a spinal anesthesia approach, cautiously balancing the need for effective analgesia with the potential for bleeding complications.

Simultaneously, the neonatology team is alerted and prepares for the premature infant's delivery, considering the possible need for respiratory support and monitoring for complications such as respiratory distress syndrome. Steroid therapy has been initiated earlier to promote fetal lung maturity, and surfactant therapy is on standby. The obstetric team, in collaboration with the neonatologists, ensures that the delivery suite is equipped with neonatal resuscitation equipment, ready for immediate intervention if needed.

As the patient is transferred to the operating room, her condition remains stable but closely monitored. Her oxygen saturation holds steady at 96% on room air, and her heart rate remains within normal limits at 88 beats per minute. The multidisciplinary team's coordinated efforts reflect the critical need for integrated care, with each member poised to act swiftly in response to any changes in the patient or newborn's status. With the evolving situation, the team remains vigilant, understanding that the patient's journey through preeclampsia and potential HELLP syndrome requires continuous assessment and adaptive management strategies to ensure safe delivery and post-operative recovery.

Section 5

As the cesarean section progresses, the patient's condition begins to show signs of new complications. Despite the additional dose of labetalol, her blood pressure remains stubbornly elevated at 158/108 mmHg, raising concern for both neurological and cardiovascular risks. Midway through the procedure, the patient reports a sudden onset of severe headache and visual disturbances, described as "flashing lights" in her field of vision. These symptoms, coupled with her high blood pressure, heighten the suspicion of potential cerebral involvement, such as impending eclampsia or posterior reversible encephalopathy syndrome (PRES).

In response, the team decides to administer magnesium sulfate intravenously, targeting both seizure prophylaxis and potential neuroprotective effects. While the administration of magnesium sulfate aims to stabilize her neurological status, careful monitoring for signs of magnesium toxicity is initiated, with frequent assessments of reflexes and respiratory rate. Concurrently, the team checks the recent laboratory results, which reveal a further drop in platelet count to 75,000/µL and elevated liver enzymes, indicating the progression towards HELLP syndrome. These laboratory findings, in conjunction with her clinical presentation, necessitate a more cautious approach to postoperative management and potential blood product support.

As the neonate is delivered, the multidisciplinary team quickly assesses the newborn's condition. The infant, though preterm, cries spontaneously at birth but exhibits mild respiratory distress, characterized by nasal flaring and intercostal retractions. The neonatology team promptly initiates continuous positive airway pressure (CPAP) to support the infant's breathing, and evaluates the need for surfactant therapy. The combined efforts of the obstetric, anesthesiology, and neonatology teams underscore the complexity of managing severe preeclampsia with HELLP syndrome, requiring continuous vigilance and adaptability to ensure the well-being of both mother and child. With the immediate crisis managed, the focus shifts to the careful monitoring and supportive care needed for recovery and stabilization in the postoperative period.