A patient with suspected severe preeclampsia is being treated with intravenous magnesium sulfate. Which assessment finding would most likely indicate magnesium toxicity, requiring immediate nursing intervention?

A) Respiratory rate of 10 breaths per minute

C) Blood pressure of 150/90 mmHg

A nurse is caring for a patient with suspected severe preeclampsia who is exhibiting symptoms such as elevated blood pressure, proteinuria, and neurological changes. Intravenous magnesium sulfate is being administered. Which of the following findings would indicate a potential complication from this treatment that requires immediate intervention?

A) Decreased deep tendon reflexes

C) Respiratory rate of 16 breaths per minute

D) Blood pressure remaining at 165/105 mmHg

A pregnant patient at 34 weeks gestation is diagnosed with HELLP syndrome. Her blood pressure remains uncontrolled, and she is experiencing new-onset visual disturbances. Which nursing intervention is the priority to prevent complications in this patient?

C) Initiate magnesium sulfate infusion as ordered.

A) Administer antihypertensive medication as ordered.

B) Prepare the patient for an emergency cesarean delivery.

C) Initiate magnesium sulfate infusion as ordered.

D) Monitor fetal heart rate continuously.

A patient presents with uncontrolled hypertension, fluctuating between 160/100 mmHg and 170/110 mmHg, despite increased dosage of labetalol, and reports new-onset visual disturbances. Laboratory results reveal elevated liver enzymes, a decreased platelet count, and elevated LDH levels. Which of the following is the most appropriate nursing intervention to prioritize at this time?

C) Initiate emergency delivery preparations for the patient.

A) Increase the dosage of antihypertensive medication.

B) Administer magnesium sulfate as ordered to prevent seizures.

C) Initiate emergency delivery preparations for the patient.

D) Monitor the patient's visual symptoms closely for changes.

A nurse is caring for a patient diagnosed with preeclampsia who presents with increased respiratory rate, crackles at the lung bases, and decreased urine output. Which of the following interventions is most appropriate to manage the patient's fluid status and prevent further complications?

B) Administer a diuretic as prescribed to reduce pulmonary congestion.

A) Increase the rate of intravenous fluids to improve renal perfusion.

B) Administer a diuretic as prescribed to reduce pulmonary congestion.

C) Restrict oral fluid intake to minimize the risk of fluid overload.

D) Administer antihypertensive medication to manage blood pressure and improve urine output.

A nurse is caring for a patient with preeclampsia who is preparing for a cesarean delivery. The patient presents with crackles in the lung bases, a respiratory rate of 24 breaths per minute, and decreased urine output. Which of the following interventions should the nurse prioritize to address the patient's respiratory concerns?

C) Position the patient in a semi-Fowler's position to ease breathing.

A) Administer additional intravenous fluids to support renal perfusion.

B) Increase the flow rate of supplemental oxygen via nasal cannula.

C) Position the patient in a semi-Fowler's position to ease breathing.

D) Prepare the patient for immediate diuretic administration to reduce fluid overload.

A nurse is caring for a pregnant patient with severe preeclampsia who is showing signs of confusion and disorientation. After administering magnesium sulfate, which assessment finding should the nurse report immediately to the healthcare provider?

A) Respiratory rate of 10 breaths per minute

D) Blood pressure of 160/100 mmHg

A patient with severe preeclampsia is being monitored for potential complications during pre-operative preparations for a cesarean delivery. The nurse observes that the patient has become confused and disoriented, with a blood pressure of 180/110 mmHg. Magnesium sulfate has been initiated to prevent seizures. Which assessment finding would most likely indicate the need for immediate intervention due to magnesium toxicity?

A) Absence of deep tendon reflexes

B) Presence of brisk deep tendon reflexes

A patient diagnosed with HELLP syndrome requires a cesarean section. Which nursing intervention is most critical to minimize the risk of complications during the procedure?

C) Ensure blood products are readily available due to the patient's altered coagulation profile.

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

B) Monitor magnesium sulfate levels closely to avoid toxicity during the procedure.

C) Ensure blood products are readily available due to the patient's altered coagulation profile.

D) Increase fluid intake to maintain adequate hydration and prevent hypotension.

A nurse is caring for a patient with HELLP syndrome who is scheduled for a cesarean section. The patient's lab results show a platelet count of 85,000/µL and elevated liver enzymes. Which nursing intervention is most important to implement prior to the procedure?

B) Ensure availability of blood products in case of bleeding during surgery.

A) Administer intravenous fluids to prevent dehydration.

B) Ensure availability of blood products in case of bleeding during surgery.

C) Increase the dose of antihypertensive medication to stabilize blood pressure.

D) Educate the patient about the signs of magnesium toxicity.

Preeclampsia - Nursing Case Study

Pathophysiology

• Primary mechanism: Abnormal placentation results in inadequate remodeling of spiral arteries, leading to reduced uteroplacental blood flow and placental ischemia. This triggers the release of antiangiogenic factors into maternal circulation, disrupting normal endothelial function.

• Secondary mechanism: Endothelial dysfunction causes systemic vasoconstriction and increased vascular permeability, contributing to hypertension and proteinuria. This dysfunction also interferes with normal coagulation, increasing the risk of thrombosis.

• Key complication: The altered vascular response and organ perfusion can lead to multi-organ damage, affecting the liver, kidneys, and brain, and may progress to eclampsia if not managed effectively.

Patient Profile

Demographics:

32-year-old female, school teacher

History:

• Key past medical history: Hypertension diagnosed 3 years ago

• Current medications: Labetalol, prenatal vitamins

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Persistent headaches and swelling in the hands and feet

• Key symptoms: Blurred vision, upper abdominal pain, and shortness of breath

• Vital signs: Blood pressure 160/100 mmHg, heart rate 95 bpm, respiratory rate 20 breaths per minute, temperature 37.1°C

Section 1

As the healthcare team continues to monitor the patient, a change in her status becomes increasingly evident. The patient, previously alert, now appears more fatigued and slightly disoriented. She reports an intensification of her headache and describes the upper abdominal pain as more piercing. Upon physical examination, the patient's reflexes are found to be brisk, and there is noticeable clonus in her ankles, indicating potential worsening neurological involvement. Her blood pressure remains elevated at 165/105 mmHg despite adherence to her antihypertensive regimen, and her heart rate has increased to 100 bpm. Urinalysis reveals proteinuria with a protein-to-creatinine ratio of 0.4, suggesting significant renal involvement.

Given these findings, the healthcare team is concerned about the progression towards severe preeclampsia. The patient's blurred vision and escalating upper abdominal pain may suggest hepatic involvement, potentially indicating the onset of HELLP syndrome—a serious complication characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets. Further laboratory tests are ordered to evaluate liver function and platelet count, with particular attention to AST, ALT, and LDH levels, along with a complete blood count.

In response to the patient's deteriorating condition, the clinical team implements more aggressive management strategies. Intravenous magnesium sulfate is initiated to prevent seizure development, and a higher dose of labetalol is considered to better control her hypertension. Continuous fetal monitoring is also set up to assess the well-being of the fetus, given the risks of placental insufficiency. The interdisciplinary team convenes to discuss the potential need for expedited delivery if maternal or fetal status worsens further, underscoring the importance of balancing maternal health with gestational age and fetal maturity in their decision-making process.

Section 2

As the team awaits the results of the additional laboratory tests, the patient's condition continues to present new challenges. Her blood pressure remains uncontrolled, fluctuating between 160/100 mmHg and 170/110 mmHg, despite the increased dosage of labetalol. Her heart rate has stabilized somewhat at 90 bpm, but she reports new-onset visual disturbances, describing flashing lights in her peripheral vision. These symptoms, coupled with her ongoing headache, raise concerns about the risk of eclampsia. The decision to administer magnesium sulfate is proving vital, as the team remains vigilant for any signs of seizure activity.

The laboratory results return, providing a clearer picture of the patient's evolving condition. Her liver enzymes are significantly elevated, with AST at 95 U/L and ALT at 105 U/L, further supporting the suspicion of HELLP syndrome. Platelet count has dropped to 105,000/mm³, indicating a potential for bleeding complications. LDH levels are elevated at 600 U/L, confirming hemolysis. These findings suggest that the patient's hepatic function is deteriorating, and the risk of severe complications increases if delivery is not considered soon.

The team gathers for a critical discussion regarding the management plan moving forward. Given the patient's worsening condition and the diagnostic evidence supporting HELLP syndrome, the consensus leans towards expedited delivery to protect both maternal and fetal health. The interdisciplinary team evaluates the gestational age and fetal maturity, weighing the risks of preterm delivery against the potential for further maternal and fetal compromise. Plans are made to prepare the patient for delivery, with neonatal specialists brought in to provide support for the anticipated preterm infant. The team remains committed to closely monitoring the patient, ready to adjust their approach as necessary to ensure the best possible outcomes.

Section 3

As the team prepares for the expedited delivery, the patient's condition continues to evolve, presenting a new set of challenges. During the pre-operative assessment, the nurse notes that the patient's respiratory rate has increased to 24 breaths per minute, accompanied by mild shortness of breath. Auscultation reveals crackles at the lung bases, raising concerns about potential pulmonary edema, a complication linked to both preeclampsia and fluid overload from the administration of intravenous medications. The patient's oxygen saturation remains stable at 94% on room air, but the team decides to administer supplemental oxygen via nasal cannula to ensure adequate oxygenation.

In light of these respiratory findings, the team re-evaluates the patient's fluid management strategy. They carefully assess her intake and output, noting a decrease in urine output to 25 mL/hour over the past few hours, indicative of renal involvement and possible acute kidney injury. A repeat set of laboratory tests confirms worsening renal function, with creatinine levels rising to 1.8 mg/dL. These findings necessitate a delicate balance in fluid administration to prevent further respiratory compromise while maintaining adequate perfusion and renal support.

The team discusses the immediate need to stabilize the patient's respiratory status while preparing for the cesarean section. Anesthesiology is consulted to determine the safest approach for anesthesia, considering the patient's respiratory and hepatic complications. Concurrently, the neonatology team prepares for the imminent delivery of the preterm infant, ready to address potential respiratory distress syndrome and other complications of prematurity. The patient's care plan is adjusted dynamically, ensuring that all interventions are closely monitored and adapted as her condition demands. This collaborative approach exemplifies the critical role of interdisciplinary teamwork in navigating complex maternal-fetal scenarios.

Section 4

As the team continues to monitor the patient closely, a new complication emerges. Midway through pre-operative preparations, the nurse observes a change in the patient's mental status. The patient begins to exhibit confusion and disorientation, struggling to follow simple commands. Her blood pressure has spiked to 180/110 mmHg, further complicating the clinical picture. Recognizing the signs of possible cerebral involvement, the team becomes concerned about the risk of eclampsia, a severe and life-threatening progression of preeclampsia.

In response to these alarming neurological signs, the team initiates a magnesium sulfate infusion to prevent seizures, closely monitoring the patient for signs of magnesium toxicity. The patient's reflexes are assessed frequently, revealing brisk deep tendon reflexes but no clonus, which reassures the team that toxicity has not yet developed. Concurrently, a stat CT scan of the head is ordered to rule out intracranial hemorrhage or other acute intracranial events.

Given the patient's deteriorating condition, the decision is made to expedite the cesarean delivery. Anesthesiology opts for a spinal anesthesia approach to minimize respiratory compromise, given the patient's pulmonary status. The interdisciplinary team, including obstetrics, anesthesiology, and neonatology, stands ready to manage the complexities of both the mother and the preterm infant. The dynamic and coordinated response highlights the critical need for vigilance and adaptability in managing severe preeclampsia and its complications, ensuring both maternal and fetal safety as the care plan evolves.

Section 5

As the team continues to manage the acute situation, they receive the results of the stat CT scan, which fortunately show no evidence of intracranial hemorrhage or other acute intracranial events. However, her laboratory results reveal worsening proteinuria and elevated liver enzymes, indicative of HELLP syndrome, a severe form of preeclampsia. The patient's platelet count has also dropped to 85,000/µL, raising concerns about coagulation risks during surgery. The team discusses the implications of these findings, recognizing the need for careful monitoring of both bleeding risks and liver function during the cesarean delivery.

Despite the challenging scenario, the magnesium sulfate infusion appears to be stabilizing the patient's neurological symptoms, as her confusion and disorientation slowly improve. Her blood pressure remains elevated but is now more consistently controlled with antihypertensive medications. The team continues to monitor her deep tendon reflexes, which remain brisk but stable, indicating that the magnesium therapy is effective without reaching toxic levels.

With the patient's condition slightly more stable, the interdisciplinary team prepares to proceed with the cesarean section. Anesthesiology remains vigilant given the patient's altered clotting profile, opting to have blood products available should they be necessary during or after the procedure. Throughout, the team maintains open communication lines with neonatology, ready to provide immediate care for the preterm infant. This coordinated effort underscores the importance of interdisciplinary collaboration in navigating the complexities of severe preeclampsia and ensuring the best possible outcomes for both mother and child.