A patient with severe preeclampsia and developing HELLP syndrome is being prepared for delivery. Which nursing intervention is most critical to ensure patient safety during the administration of magnesium sulfate?

A) Monitor deep tendon reflexes every hour

B) Encourage ambulation to prevent thromboembolism

C) Administer diuretics to reduce edema

D) Increase fluid intake to ensure adequate hydration

A patient with severe preeclampsia is being monitored in a high-dependency unit. Which of the following nursing interventions is the highest priority to prevent complications in this patient?

C) Administering magnesium sulfate for seizure prophylaxis

A) Administering antihypertensive medications as prescribed

B) Initiating continuous fetal monitoring

C) Administering magnesium sulfate for seizure prophylaxis

D) Preparing the patient for expedited delivery

A patient in the third trimester of pregnancy presents with severe preeclampsia, evidenced by elevated blood pressure, neurological symptoms, and laboratory findings consistent with HELLP syndrome. Despite treatment with magnesium sulfate, her condition is deteriorating. Which of the following nursing actions is the highest priority 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 seizures.

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

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

D) Initiate continuous fetal monitoring and document findings every 30 minutes.

A patient with HELLP syndrome is being transferred to the ICU for closer monitoring. Her blood pressure remains elevated, and she exhibits signs of neurological irritation despite magnesium sulfate administration. What is the priority nursing action to address the patient's current condition?

C) Prepare the patient for an emergent cesarean section to prevent further complications.

A) Increase the dose of magnesium sulfate to control the neurological symptoms.

B) Administer a bolus of intravenous fluids to improve renal perfusion.

C) Prepare the patient for an emergent cesarean section to prevent further complications.

D) Initiate continuous fetal monitoring to assess fetal well-being.

A patient with severe preeclampsia is showing signs of neurological deterioration, including confusion and intensified headache, despite receiving magnesium sulfate therapy. Which nursing intervention should be prioritized to address the patient's current condition?

C) Prepare the patient for an immediate cesarean section to prevent further maternal and fetal compromise.

A) Increase the rate of magnesium sulfate infusion to enhance seizure prophylaxis.

B) Administer oxygen via nasal cannula to improve maternal oxygenation.

C) Prepare the patient for an immediate cesarean section to prevent further maternal and fetal compromise.

D) Administer an additional dose of labetalol to lower blood pressure further.

A patient with preeclampsia in the ICU is receiving magnesium sulfate and labetalol for blood pressure management. She exhibits a severe headache, confusion, and 2 beats of clonus at the ankles. What is the nurse's priority action to prevent further complications?

C) Reassess the patient's neurological status and notify the healthcare provider.

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

B) Prepare the patient for an immediate cesarean section.

C) Reassess the patient's neurological status and notify the healthcare provider.

D) Administer oxygen at 2 L/min via nasal cannula to improve oxygenation.

A nurse is caring for a pregnant patient diagnosed with HELLP syndrome who is being prepared for an emergent cesarean section. Given the patient's current clinical status, which nursing intervention is most critical to prioritize to ensure both maternal and fetal safety during this procedure?

C) Preparing for potential airway management and intubation

A) Administering magnesium sulfate to prevent seizures

B) Continuing to titrate labetalol to manage blood pressure

C) Preparing for potential airway management and intubation

D) Monitoring urine output to assess renal function

A patient with HELLP syndrome is being prepared for an emergent cesarean section. Her platelet count is 85,000/mm³, AST and ALT levels are elevated, and urine output is less than 20 mL per hour. Her blood pressure remains elevated despite labetalol administration, and oxygen saturation is at 90% on room air. What is the priority nursing intervention to optimize maternal and fetal outcomes during the preparation for surgery?

B) Administer supplemental oxygen via face mask to improve oxygen saturation.

A) Increase the labetalol dosage to further control blood pressure.

B) Administer supplemental oxygen via face mask to improve oxygen saturation.

C) Insert an indwelling urinary catheter to monitor renal function more accurately.

D) Notify the neonatal team to prepare for potential resuscitation of the newborn.

A patient with severe preeclampsia and suspected HELLP syndrome is undergoing an emergent cesarean section. Given her current clinical presentation, which nursing intervention should be prioritized to prevent further complications?

B) Prepare for possible blood transfusion to manage coagulopathy during surgery.

A) Administer additional antihypertensive medication to further lower blood pressure.

B) Prepare for possible blood transfusion to manage coagulopathy during surgery.

C) Increase the oxygen flow rate to improve oxygen saturation levels.

D) Administer diuretics to manage fluid overload and reduce edema.

A patient with preeclampsia and HELLP syndrome is scheduled for an emergent cesarean section. Given the patient's current condition, which nursing intervention is the highest priority to ensure maternal stability prior to surgery?

B) Prepare to administer blood products for potential hemorrhagic complications

A) Administer a diuretic to manage fluid overload

B) Prepare to administer blood products for potential hemorrhagic complications

C) Increase the oxygen flow rate to improve saturation levels

D) Reassess the patient's Glasgow Coma Scale score every 4 hours

preeclampsia - Nursing Case Study

Pathophysiology

• Primary mechanism: Preeclampsia is initiated by abnormal placentation, leading to poor remodeling of spiral arteries. This results in reduced blood flow to the placenta, causing ischemia and releasing factors that damage endothelial cells.

• Secondary mechanism: The endothelial dysfunction triggers systemic vasoconstriction and increased vascular permeability. This leads to hypertension and proteinuria, hallmark signs of preeclampsia, as well as potential organ damage.

• Key complication: If unmanaged, preeclampsia can progress to eclampsia, characterized by seizures, or lead to HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets), posing severe risks to both the 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 200 mg twice daily

• 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 160/110 mmHg, heart rate 92 bpm, respiratory rate 20 breaths per minute, temperature 98.6°F

Section 1

As the healthcare team conducts an initial assessment, further findings underscore the gravity of the patient's condition. Upon physical examination, the patient's edema is pronounced, particularly in the lower extremities, and she exhibits pitting edema upon palpation. Auscultation of the lungs reveals mild bilateral crackles at the bases, suggesting potential pulmonary involvement. The presence of right upper quadrant tenderness is noted, raising concerns for liver involvement, a common complication of severe preeclampsia.

Laboratory results reveal significant proteinuria with a 24-hour urine protein of 5 grams, indicating severe renal involvement. Liver function tests show elevated liver enzymes, with AST and ALT levels both over three times the upper limit of normal, and a platelet count of 95,000/μL, suggesting the development of HELLP syndrome. Serum creatinine is slightly elevated, indicating compromised renal function. These findings, combined with the patient's symptoms of severe headache and visual disturbances, suggest escalating preeclampsia severity.

Given these findings, the healthcare team must consider the urgent need for stabilization and potential delivery. The patient's condition necessitates close monitoring in a high-dependency unit, with continuous fetal monitoring to assess for fetal distress. The priority is to manage the severe hypertension and prevent progression to eclampsia or exacerbation of HELLP syndrome. Magnesium sulfate is initiated for seizure prophylaxis, and the obstetric team is consulted for an expedited delivery plan, weighing the risks and benefits for both maternal and fetal outcomes.

Section 2

As the healthcare team continues to monitor the patient, they note a change in her status that requires immediate attention. Over the next few hours, the patient's blood pressure remains persistently elevated despite initial antihypertensive therapy, with readings consistently around 170/110 mmHg. Despite the administration of magnesium sulfate, the patient begins to exhibit signs of neurological irritation, including increased reflexes and clonus, raising concerns for the imminent risk of eclampsia. Her severe headache persists, and she reports worsening visual disturbances, described as seeing spots and experiencing flashes of light, which could indicate cerebrovascular involvement.

New laboratory results arrive, indicating further deterioration in her condition. Her platelet count has dropped to 80,000/μL, and her liver enzymes have increased further, with AST now at 250 U/L and ALT at 300 U/L, confirming the progression of HELLP syndrome. Her serum creatinine has risen to 1.8 mg/dL, reflecting worsening renal impairment. Fetal monitoring reveals variable decelerations in the fetal heart rate, suggesting potential fetal distress.

In response to these developments, the healthcare team escalates the patient's care. A decision is made to transfer her to the intensive care unit for closer monitoring and management, with an anesthesiology consult requested to prepare for potential emergent delivery. The obstetric team discusses the risks and benefits with the patient and her family, emphasizing the need for urgent delivery to prevent further maternal and fetal complications. The plan includes optimizing maternal stability through aggressive blood pressure control and continuous seizure prophylaxis while preparing for a possible cesarean section, given the deteriorating maternal and fetal conditions.

Section 3

As the patient is transferred to the intensive care unit, the healthcare team conducts a thorough initial assessment to establish a baseline for her current status. Upon arrival, her vital signs reveal a blood pressure of 175/115 mmHg, heart rate of 95 beats per minute, respiratory rate of 24 breaths per minute, and an oxygen saturation of 93% on room air, indicating mild hypoxemia. Neurological assessment confirms the presence of 3+ reflexes in the patellar tendons and the presence of 2 beats of clonus at the ankles, further heightening the concern for impending eclampsia. The patient's persistent severe headache and visual disturbances remain unrelieved, despite the ongoing administration of magnesium sulfate.

In light of these findings, the healthcare team prioritizes stabilizing the patient's cardiovascular and neurological status. An IV infusion of labetalol is initiated, titrated to achieve a target blood pressure of less than 160/110 mmHg, while magnesium sulfate infusion is continued to maintain therapeutic levels of seizure prophylaxis. The fetal heart rate monitoring continues to show variable decelerations, prompting continuous assessment by the obstetric team. The anesthesiology team prepares for potential emergent delivery, with a focus on ensuring adequate maternal oxygenation and hemodynamic stability to support both mother and fetus.

Despite these interventions, the patient's condition remains precarious. Her headache intensifies, and she begins to exhibit slight confusion, which raises concerns about possible cerebral edema or an impending seizure. The healthcare team is faced with the critical decision of proceeding with a cesarean section to prevent further maternal and fetal compromise. The situation demands swift clinical reasoning and coordinated action to optimize outcomes, underscoring the urgency of the evolving scenario.

Section 4

As the healthcare team continues to monitor the patient closely, new diagnostic results reveal a concerning trend. Laboratory tests show that the patient's platelet count has dropped to 85,000/mm³, indicating thrombocytopenia, and her liver function tests reveal elevated AST and ALT levels, suggesting hepatic involvement consistent with HELLP syndrome. Additionally, her urine output has decreased to less than 20 mL per hour over the past two hours, raising the alarm for worsening renal function. These findings necessitate a reevaluation of the management plan, as they indicate a progression of the disease process and increased risk for both maternal and fetal complications.

The team reconvenes to discuss these developments, recognizing the imperative need for immediate action. The obstetrician, in collaboration with the intensivist and anesthesiologist, decides that urgent delivery is necessary to prevent further deterioration. They prepare for an emergent cesarean section, ensuring that all critical care measures are in place to manage the anticipated challenges. The patient's worsening neurological symptoms, combined with the laboratory findings, underscore the urgency of the situation. The team emphasizes maintaining maternal hemodynamic stability and optimizing fetal oxygenation during the procedure, highlighting the importance of coordinated care and swift clinical decision-making.

As preparations for the cesarean section proceed, the patient's blood pressure remains elevated despite the titration of labetalol, and her oxygen saturation has further decreased to 90% on room air. The anesthesiology team plans for potential airway management challenges due to her respiratory status and prepares for the possibility of intubation. The healthcare team is acutely aware of the delicate balance required to manage the complex interplay of preeclampsia complications, ensuring that both mother and baby receive the best possible care in this critical moment.

Section 5

As the healthcare team prepares for the emergent cesarean section, they conduct a thorough initial assessment to prioritize immediate interventions and ensure readiness for potential complications. The patient is observed to be increasingly lethargic, with a Glasgow Coma Scale score of 13, indicating mild confusion and reduced alertness. Her blood pressure remains significantly elevated at 175/110 mmHg despite ongoing labetalol administration, and her heart rate is tachycardic at 112 beats per minute. Respiratory assessment reveals shallow breathing, with a noted respiratory rate of 24 breaths per minute and diminished breath sounds, prompting concerns about compromised respiratory function. Her oxygen saturation has stabilized slightly at 92% with supplemental oxygen via a non-rebreather mask, but the team remains vigilant given her recent desaturations.

New diagnostic results further compound the urgency of the situation. A repeat complete blood count shows a further decline in platelet levels to 75,000/mm³, intensifying the risk of bleeding during surgery. Coagulation studies reveal prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), suggesting coagulation abnormalities. The patient’s serum creatinine has risen to 1.8 mg/dL, corroborating the earlier concern about deteriorating renal function. Given these findings, the anesthesiology team discusses the possibility of requiring blood products intraoperatively to manage potential hemorrhagic complications. They assess the availability of platelets and fresh frozen plasma to address any coagulopathy that may arise during the procedure.

The healthcare team reviews the situation collectively, understanding that the patient's condition is precarious and necessitates expedited action. They prioritize maintaining maternal stability through careful monitoring of fluid balance, blood pressure, and respiratory status while preparing for the cesarean section. Emphasis is placed on minimizing time to delivery to reduce risks for both mother and fetus, and ensuring that neonatal care specialists are on standby for immediate assessment and intervention post-delivery. As the team executes their plan, they remain acutely aware of the need for swift, coordinated efforts to navigate the complexities of preeclampsia with HELLP syndrome, demonstrating the critical role of clinical reasoning in managing this high-risk obstetric emergency.