What is preeclampsia and eclampsia?Eclampsia is a serious, and often fatal condition in pregnancy where uncontrolled hypertension causes seizures. Preeclampsia refers to a hypertensive state during pregnancy or the postpartum period that precedes eclampsia. This is a very serious complication of pregnancy, so let’s discuss some preeclampsia nursing basics together, shall we? Show
How is preeclampsia diagnosed?While traditional guidelines state that the hallmark signs of preeclampsia are hypertension with proteinuria, the new guidelines from ACOG (American College of Obstetricians and Gynecologists) no longer require proteinuria as part of the diagnostic criteria. According to ACOG, the data shows that organ damage to the liver and kidneys can be present even without seeing protein in the urine. With that said, be aware that your exams and the NCLEX will likely include proteinuria as a key symptom along with hypertension. The new ACOG guidelines indicate that preeclampsia is present with the following criteria:
 How do you conduct a preeclampsia nursing assessment?Knowing how to conduct a preeclampsia nursing assessment can help alert you to possible complications that could, if left untreated, be fatal for both mom and baby. Women with preeclampsia may report having a headache that doesn’t resolve, dizziness or even visiual disturbances like blurred vision and seeing spots. She may also complain of nausea and/or vomiting. Another common symptom is sudden weight gain of 2-5 pounds in one week or swelling in the face, hands or legs. Fluid building up in the lungs can caues mom to feel short of breath as well. As for protein in the urine, it can sometimes be noticed due to its foamy nature, but don’t take the absence of foamy urine as proof the patient doesn’t possibly have this condition. However, on exams, proteinuria is almost always described as “foamy urine.” How is preeclampsia treated?Preeclampsia nursing interventions and medical treatment will vary based on the severity of the condition, but please note that it is considered a progressive disease that needs careful monitoring and frequent reevaluation. Your patient with mild preeclampsia (defined by ACOG as 140-159 systolic or 90-109 diastolic) requires very close monitoring. Higher blood pressures (above 160 systolic or 110 diastolic) are considered to be in the “severe preeclampsia” category and guidelines indicate treatment is necessary at this point to prevent seizure (eclampsia). The treatment for preeclampsia is magnesium sulfate for those who fall into that higher blood pressure category or who have symptoms that typically precede seizures such as headache, visual disturbances or other neurological changes. Note that the magnesium is used to prevent and treat seizure. We still need to decrease blood pressure and this is typically done using IV labetalol and/or hydralazine, though studies show that one antihypertensive is not necessarily more effective than another. Many times clinicians will use medications they are most familiar with, and the group I work with tends to use nicardipine as a continuous infusion or labetalol and hydralazine as IV push medications. If IV access is not available, PO nifedipine, a calcium-channel blocker, is often used. What about delivery?Preeclampsia resolves after delivery, though it’s important to note that it can developing the postpartum period as well. In some cases, immediate delivery of the baby may be necessary to alleviate the hypertensive condition. Be aware that once the baby is born, the magnesium infusion will likely continue for a period of time and the mom will need to be monitored for several weeks after giving birth. What are some risk factors for preeclampsia?
What are the complications of preeclampsia?Left untreated, preeclampsia can cause serious problems for mom and baby:
What is ACOG?You may be saying, “Yeah, all this is great…but what the heck is ACOG?” ACOG is an excellent resource for you guys, so I’m glad you asked! It is the American College of Obstetricians and Gynecologists, a group dedicated to the development and promotion of best practice guidelines in women’s health. You can learn all about them at their website at www.acog.org. Get this on audio in Episode 68 of the Straight A Nursing Podcast!References ACOG. (2017, September). Emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Retrieved from The American College of Obstetricians and Gynecologists website: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Emergent-Therapy-for-Acute-Onset-Severe-Hypertension-During-Pregnancy-and-the-Postpartum-Period?IsMobileSet=false Lew, M., & Klonis, E. (2003). Emergency management of eclampsia and severe pre-eclampsia. Emergency Medicine (Fremantle, W.A.), 15(4), 361–368. March of Dimes. (n.d.). Preeclampsia. Retrieved from http://www.marchofdimes.org/complications/preeclampsia.aspx Mayo Clinic. (n.d.). Preeclampsia Symptoms and causes – Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745 What assessments need to be frequently conducted for the patient with preeclampsia?Heart health
The American College of Obstetricians and Gynecologists advises that women with a history of preeclampsia (who gave birth before 37 weeks of gestation) or who have a history of recurrent preeclampsia get a yearly assessment of blood pressure, lipids, fasting blood glucose, and body mass index.
What are the nursing responsibilities in monitoring preeclampsia?Nursing care planning and management for pregnant clients with hypertensive disorders or preeclampsia involve early detection, thorough assessment, and prompt treatment of preeclampsia. Another priority is to ensure the mother's safety and deliver a healthy newborn as close to a full term as possible.
How do you assess the risk of preeclampsia?ACOG guidelines in predicting the development of preeclampsia include, systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm HG or more on at least 2 occasions at least 4 hours apart. 300 mg or more of protein per 24 hour urine collection. Protein/creatinine ration of 0.3 mg/dL or more.
What is the nursing management for a patient with preeclampsia?The overall management of preeclampsia includes supportive treatment with antihypertensives and anti-epileptics until definitive treatment - delivery. In preeclampsia without severe features, patients are often induced after 37 weeks gestation after with or without corticosteroids to accelerate lung maturity.
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What give some assessment need to be frequently conducted for the client with preeclampsia?
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