A patient in the emergency department with eclampsia experiences a generalized tonic-clonic seizure followed by decreased fetal heart tones. After administering magnesium sulfate, which intervention should the nurse prioritize to address the maternal and fetal condition?

C) Administer supplemental oxygen via non-rebreather mask

A) Initiate non-invasive blood pressure monitoring every 15 minutes

B) Prepare for immediate cesarean delivery

C) Administer supplemental oxygen via non-rebreather mask

D) Increase the rate of magnesium sulfate infusion

A patient in the emergency department has experienced a generalized tonic-clonic seizure due to eclampsia. Despite administration of magnesium sulfate, her blood pressure remains at 180/115 mmHg. Additionally, fetal heart tones are decreased. What is the priority nursing intervention for this patient?

C) Provide supplemental oxygen to improve maternal and fetal oxygenation

A) Administer additional magnesium sulfate to prevent more seizures

B) Initiate immediate delivery due to fetal distress

C) Provide supplemental oxygen to improve maternal and fetal oxygenation

D) Administer an additional dose of hydralazine to lower blood pressure

A pregnant patient diagnosed with HELLP syndrome is being monitored in the intensive care unit. Her laboratory results show elevated liver enzymes and a platelet count of 90,000/mm³. She is also experiencing fetal bradycardia. What is the priority nursing intervention at this time?

B) Prepare the patient for an emergency Cesarean section

A) Administer a platelet transfusion to address thrombocytopenia

B) Prepare the patient for an emergency Cesarean section

C) Administer magnesium sulfate for seizure prophylaxis

D) Monitor the patient's blood pressure every 30 minutes

A nurse is caring for a pregnant patient diagnosed with HELLP syndrome who presents with elevated liver enzymes, low platelet count, and ongoing fetal bradycardia. Which of the following interventions should the nurse prioritize to best address both maternal and fetal well-being?

C) Anticipate and prepare for a possible emergency Cesarean section.

A) Administer a bolus of IV magnesium sulfate to prevent seizures.

B) Prepare for immediate administration of corticosteroids to enhance fetal lung maturity.

C) Anticipate and prepare for a possible emergency Cesarean section.

D) Initiate continuous fetal heart rate monitoring to assess for variability.

A 30-year-old pregnant patient at 38 weeks of gestation presents with severe preeclampsia, evidenced by hypertension, headache, blurred vision, and hyperreflexia. The team is preparing for an emergent Cesarean section due to maternal and fetal compromise. Which nursing intervention is most critical to perform prior to the administration of magnesium sulfate to prevent complications?

A) Ensure the patient has adequate urine output by assessing for at least 30 mL/hour.

B) Verify the presence of deep tendon reflexes before administration.

C) Monitor the fetal heart rate continuously during magnesium sulfate administration.

D) Obtain informed consent for the administration of magnesium sulfate.

A nurse is caring for a patient with worsening eclampsia who presents with severe headache, blurred vision, hyperreflexia, and clonus. The healthcare team has administered magnesium sulfate. What is the most important nursing intervention to implement after the administration of magnesium sulfate to monitor for complications?

B) Assess deep tendon reflexes every hour

A) Monitor blood pressure every 4 hours

B) Assess deep tendon reflexes every hour

C) Check blood glucose levels every 2 hours

D) Monitor urine output every 8 hours

A patient receiving magnesium sulfate during labor presents with respiratory depression and a serum magnesium level of 8.5 mg/dL. What is the nurse's priority intervention?

B) Administer calcium gluconate as ordered to counteract magnesium toxicity.

A) Increase the rate of magnesium sulfate infusion to stabilize the patient.

B) Administer calcium gluconate as ordered to counteract magnesium toxicity.

C) Position the patient in a left lateral position to improve fetal circulation.

D) Prepare for an emergency Cesarean section without further intervention.

A patient in the labor and delivery unit is receiving magnesium sulfate for preeclampsia. The nurse notices that the patient is now exhibiting signs of magnesium toxicity, including a respiratory rate of 10 breaths per minute and lethargy. What is the most immediate nursing intervention to address this complication?

A) Administer calcium gluconate as prescribed

B) Increase the rate of the magnesium sulfate infusion

C) Place the patient in a high Fowler's position

D) Notify the healthcare provider to obtain an order for diuretics

A postpartum patient who underwent a Cesarean section under general anesthesia is now in the intensive care unit. Her recent history includes magnesium toxicity and low platelet count. Which nursing intervention is most critical to prioritize in the immediate postoperative period?

A) Monitor the patient for signs of respiratory depression.

B) Encourage early ambulation to prevent thromboembolism.

C) Administer pain medication as per the scheduled regimen.

D) Educate the patient on breastfeeding techniques.

A postpartum patient who recently underwent a Cesarean section under general anesthesia is being monitored in the intensive care unit. Her oxygen saturation has stabilized at 95% on room air, but she has a history of magnesium toxicity and low platelet count. What is the priority nursing action to ensure her continued recovery and safety?

A) Monitor her for signs of delayed bleeding and reassess her coagulation profile.

B) Increase her oxygen supplementation to maintain saturation at 98%.

C) Encourage early ambulation to prevent thromboembolism.

D) Administer diuretics to prevent fluid overload.

eclampsia - Nursing Case Study

Pathophysiology

• Primary mechanism: Eclampsia primarily arises from endothelial dysfunction in the blood vessels, which leads to increased vascular permeability and subsequent edema, affecting organ perfusion, particularly in the brain.

• Secondary mechanism: Hyperactivation of the renin-angiotensin system contributes to hypertension, exacerbating cerebral edema and increasing the risk of seizures due to altered cerebral blood flow and pressure.

• Key complication: The combination of hypertension and cerebral edema can lead to life-threatening seizures, which are the hallmark of eclampsia and necessitate immediate medical intervention to prevent maternal and fetal morbidity and mortality.

Patient Profile

Demographics:

29-year-old female, elementary school teacher

History:

• Key past medical history: Gestational hypertension diagnosed at 28 weeks of pregnancy

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

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Severe headache and visual disturbances

• Key symptoms: Swelling in the hands and face, upper abdominal pain, nausea, confusion

• Vital signs: Blood pressure 170/110 mmHg, heart rate 98 bpm, respiratory rate 22 breaths per minute, temperature 37.8°C (100°F), oxygen saturation 95% on room air

Section 1

Change in Patient Status:

During the initial assessment in the emergency department, the patient's condition rapidly deteriorates. She experiences a generalized tonic-clonic seizure lasting approximately two minutes. Immediately following the seizure, her oxygen saturation drops to 88% on room air, and she exhibits postictal confusion. The medical team quickly initiates seizure management protocols, administering intravenous magnesium sulfate as a first-line treatment to prevent further seizures. Despite the intervention, her blood pressure remains dangerously elevated at 180/115 mmHg, necessitating the introduction of an intravenous antihypertensive such as hydralazine to achieve more rapid blood pressure control.

As the clinical team stabilizes her immediate symptoms, further assessment reveals decreased fetal heart tones, indicating potential fetal distress. Continuous electronic fetal monitoring is initiated, showing a heart rate of 100 beats per minute with minimal variability. The obstetric team is called for an urgent evaluation. Given the potential for worsening maternal and fetal conditions, the possibility of emergency delivery is discussed with the patient’s family, highlighting the critical balance in managing both maternal safety and fetal well-being.

This sudden change in status prompts a reassessment of the care plan, emphasizing the need for continuous monitoring and prompt intervention to mitigate the risks associated with eclampsia. The healthcare team prioritizes stabilizing the patient’s condition while preparing for potential obstetric intervention. This complex scenario requires careful clinical reasoning to navigate the intertwined challenges of maternal hypertension, seizure prevention, and fetal health, underscoring the importance of a multidisciplinary approach in managing eclampsia and its complications.

Section 2

As the medical team continues to monitor the patient closely, they observe a concerning trend in her laboratory results. New diagnostic tests reveal significantly elevated liver enzymes, with AST and ALT levels more than three times the upper limit of normal, indicating potential hepatic involvement. Additionally, her platelet count has dropped to 90,000/mm³, raising suspicion for HELLP syndrome, a severe form of preeclampsia. These findings necessitate immediate attention, as they suggest worsening maternal status that could further complicate her already critical condition.

In response to these alarming lab results, the healthcare team initiates a more aggressive management approach. The obstetricians consult with a hematologist to discuss the need for possible platelet transfusion, given the risk for bleeding due to thrombocytopenia. Meanwhile, the anesthesiology team evaluates the patient for potential anesthesia needs, should an emergency Cesarean section become necessary. The ongoing fetal bradycardia and minimal heart rate variability further emphasize the urgency of the situation, prompting the team to prepare the patient for potential surgical intervention while continuing to optimize her medical management.

The unfolding scenario requires the team to balance multiple clinical priorities, including controlling maternal blood pressure, managing seizure prophylaxis with magnesium sulfate, and addressing the emerging complications of HELLP syndrome. The interdisciplinary team collaborates closely, considering the timing of delivery as a critical factor in optimizing outcomes for both mother and child. This case exemplifies the complexities of eclampsia management, where vigilant monitoring and timely decision-making are essential to navigate the intertwined challenges of maternal and fetal health.

Section 3

As the healthcare team closely monitors the patient, a sudden change in her clinical status becomes apparent. Her blood pressure, which had been elevated but stable, now spikes to 190/110 mmHg, despite ongoing antihypertensive therapy. The patient begins to complain of a severe headache and blurred vision, symptoms which are consistent with worsening eclampsia and raise immediate concern for potential cerebral involvement. On neurological examination, she demonstrates hyperreflexia and clonus, further indicating the heightened risk of seizure activity. The team swiftly administers an increased dose of magnesium sulfate to prevent seizures, closely monitoring her for signs of magnesium toxicity.

Concurrently, a repeat ultrasound assessment reveals that the fetal heart rate decelerations are becoming more pronounced, with heart rate dropping to 90 beats per minute and minimal variability persisting. These findings suggest increasing fetal distress, potentially necessitating emergent delivery. Given the maternal hemodynamic instability and fetal compromise, the obstetrics team decides to expedite delivery via Cesarean section. As preparations for surgery begin, the anesthesiology team evaluates the potential risks of anesthesia in the context of the patient's thrombocytopenia and elevated liver enzymes, which could complicate both the administration of anesthesia and the surgical procedure itself.

This critical juncture in the patient's care emphasizes the necessity of rapid, coordinated intervention to address the simultaneous maternal and fetal crises. The healthcare team remains vigilant in reassessing the patient's condition, ready to adapt their management plan as new information arises. As they move forward with surgical intervention, the focus shifts to ensuring maternal stabilization while preparing for potential neonatal resuscitation, highlighting the delicate balance required in managing such complex obstetric emergencies.

Section 4

As the healthcare team prepares for the Cesarean section, a new complication arises. The patient, who had been receiving magnesium sulfate to prevent seizures, begins to exhibit signs of magnesium toxicity. Her respiratory rate decreases to 10 breaths per minute, and she appears lethargic, raising concerns about respiratory depression. The nurse promptly alerts the team, and the decision is made to administer calcium gluconate as an antidote to counteract the effects of magnesium. This intervention is critical to stabilize the patient's respiratory status before proceeding with surgery. Concurrently, her latest laboratory results indicate a serum magnesium level of 8.5 mg/dL, confirming the clinical suspicion of toxicity.

Despite the immediate attention to the magnesium toxicity, the team remains focused on the maternal-fetal dyad. The anesthesiology team revisits the patient's coagulation profile and notes that her platelet count has dropped further to 70,000/mm³, elevating the risk of bleeding complications during surgery. Given these challenges, the team evaluates the safest anesthesia approach, opting for general anesthesia to minimize potential complications associated with regional anesthesia in the context of thrombocytopenia. Throughout this period, continuous fetal monitoring reveals persistent bradycardia, underscoring the urgency of the situation.

As the surgical team proceeds to the operating room, the coordination of care remains paramount. The neonatal team is on standby, prepared to provide immediate resuscitation if necessary, given the concerning fetal status. The obstetricians and anesthesiologists work in tandem to ensure maternal stabilization, prioritizing both the safety of the mother and the timely delivery of the baby. This meticulous planning and execution exemplify the critical importance of interdisciplinary collaboration in managing complex obstetric emergencies, setting the stage for the next phase of care following delivery.

Section 5

As the surgical team proceeds with the Cesarean section under general anesthesia, the patient's condition is closely monitored. The initial assessment in the operating room reveals that the patient's vital signs are stable, with a blood pressure of 130/85 mmHg and a heart rate of 88 beats per minute. However, her oxygen saturation remains a concern, hovering around 92% despite supplemental oxygen. The low oxygen saturation prompts the anesthesiology team to adjust the ventilation settings to optimize her respiratory status. Meanwhile, the obstetric team remains vigilant about potential bleeding due to the patient's low platelet count, ready to administer blood products if necessary.

During the operation, the surgical team successfully delivers a baby boy who is immediately assessed by the neonatal team. The newborn exhibits signs of respiratory distress, with an initial Apgar score of 4 at one minute and 6 at five minutes. The neonatal team initiates resuscitation efforts, including positive pressure ventilation, which leads to gradual improvement in the infant's respiratory status. As the baby stabilizes, attention shifts back to the mother, whose intraoperative blood loss is within expected limits, yet her coagulation status necessitates close observation for any delayed bleeding complications.

Postoperatively, the mother is transferred to the intensive care unit for close monitoring, given her recent magnesium toxicity and ongoing risk factors. Her respiratory function continues to improve, with her respiratory rate increasing to 14 breaths per minute and oxygen saturation stabilizing at 95% on room air. The interdisciplinary team plans to reassess her magnesium levels and coagulation profile in the coming hours to guide further management. As the team reflects on the successful delivery and stabilization of both mother and child, they remain alert to any new developments, prepared to adjust the care plan as necessary to ensure continued recovery and safety.