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Preeclampsia Nursing Guide

The content for this course was created by Kelly LaMonica, DNP, RNC-OB, C-EFM.

Preeclampsia Overview

This course is intended as a Quick Reference for Preeclampsia and will cover an overview and nursing considerations utilizing the nursing process. 

Preeclampsia Etiology and Epidemiology 

Preeclampsia, which is associated with new-onset hypertension, is more frequent after 20 weeks of gestation and often occurs near term. While new-onset proteinuria often occurs as well, hypertension and other signs or preeclampsia symptoms may present without proteinuria. 

Eclampsia is new-onset focal, tonic-clonic, or multifocal seizures without other cause (cerebral arterial ischemia and infarction, epilepsy, intracranial hemorrhage, or drug use). 

Risk factors for preeclampsia include: 

  • Antiphospholipid antibody syndrome 
  • Assisted reproductive technology 
  • Chronic hypertension 
  • Gestational diabetes 
  • Maternal age 35 years or older 
  • Multifetal gestations 
  • Nulliparity 
  • Obstructive sleep apnea 
  • Preeclampsia in a previous pregnancy 
  • Pregestational diabetes 
  • Prepregnancy body mass index greater than 30 
  • Renal disease 
  • Systemic lupus erythematosus 
  • Thrombophilia 

Preeclampsia is attributed to several factors, including: 

  • Chronic uteroplacental ischemia 
  • Exaggerated maternal inflammatory response to deported trophoblasts 
  • Genetic imprinting 
  • Immune maladaptation 
  • Increased trophoblast apoptosis or necrosis 
  • Very low-density lipoprotein toxicity 

Complications of preeclampsia include: 

  • Stroke 
  • Leading cause of maternal morbidity from preeclampsia 
  • Cardiovascular disease 
  • Coma 
  • Eclampsia 
  • Fetal growth restriction 
  • HELLP syndrome 
  • Liver damage 
  • Placental abruption 
  • Postpartum hemorrhage 
  • Preterm birth 
  • Renal damage 
  • Tissue or organ damage 

Preeclampsia Diagnosis 

Preeclampsia is diagnosed with hypertension and proteinuria (≥ 300mg in 24-hour collection OR protein/creatinine ratio ≥ 0.3 mg/dL). If blood pressure is not noted as severe (160/110) and there are no other symptoms, then the individual is diagnosed with preeclampsia without severe features. 

Preeclampsia with severe features is diagnosed with a systolic blood pressure of 160 mm Hg or higher, or diastolic blood pressure of 110 mm Hg or higher. However, women with gestational hypertension without proteinuria should be diagnosed with preeclampsia with severe features if they have any of the following: 

  • Thrombocytopenia 
    • Platelet count below 100,000 
  • Impaired liver function 
    • Abnormally elevated blood concentrations of liver 
  • Severe persistent right upper quadrant or epigastric pain 
    • Without cause by alternative diagnoses 
  • Renal insufficiency 
  • Pulmonary edema 
  • New-onset headache 
    • Not responsive to acetaminophen (Tylenol®) 
  • Visual disturbances 

Blood pressure, urinalysis, and physical exam with lead to a diagnosis. 

Preeclampsia Management 

Once diagnosis is made, the individual and fetus will require close monitoring. Delivery is the only way to cure preeclampsia. 

Treatment is aimed to maintain a blood pressure of 110 to 140/85 mm Hg. 

At gestational age <34 weeks, benefits and risks of pregnancy continuation against maternal disease progression will determine timing of delivery. Any of the following complications can require delivery: 

  • Repeated episodes of severe hypertension despite treatment with three classes of antihypertensive agents 
  • Progressive thrombocytopenia 
  • Progressively abnormal renal or liver tests 
  • Pulmonary edema 
  • Abnormal neurological features (visual scotomata, severe headache, or convulsions) 
  • Nonreassuring fetal status 

Prenatal corticosteroids for fetal lung maturation should be given between 24+0- and 34+0- weeks’ gestation but in cases of elective caesarean section it may be given up until 38+0 weeks. 

Once an individual is admitted to labor and delivery with severe features, they may be treated with magnesium sulfate to prevent seizures. The usual dose is a 4 – 6gm loading dose, followed by 2gm/hr for 24 hours. 

 Treatment for severe range blood pressures include: 

  • Labetalol (Trandate®) IVP 
  • Hydralazine (Apresoline®) IVP 
  • Nifedipine (Adalat®) immediate-release PO 

After delivery, it may take some time for preeclampsia to resolve, and individual will need increased monitoring. 

Preeclampsia Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and education for individuals with preeclampsia are listed below. 

Assessment 

  • History 
    • Altered mental status 
    • Decreased urine output 
    • Diabetes 
    • Dizziness 
    • Dyspnea 
    • Elevated blood pressure prior to pregnancy 
    • Generalized edema, specifically face, hands, and feet 
    • Malaise 
    • Nausea or vomiting 
    • Obstructive sleep apnea 
    • Renal disease 
    • Right upper quadrant pain or epigastric pain 
    • Severe frontal headache and irritability 
    • Sudden weight gain, more than two pounds a week 
    • Systemic lupus erythematosus 
    • Thrombophilia 
    • Visual disturbances 
      • Including blurred vision, temporary vision loss, or light sensitivity 
    • Weakness 
  • Physical Examination 
    • Altered mental status 
    • Decreased vision 
    • Epigastric or right upper quadrant abdominal tenderness 
    • Focal neurologic deficit 
    • Generalized edema with pitting peripheral edema 
    • Hyper-reflexia or clonus 
    • Increased blood pressure 
    • Oliguria 
    • Papilledema 
    • Proteinuria 
    • Seizures 
    • Sudden weight gain 
    • Vascular spasms 
    • Vision changes 

Nursing Diagnosis/Risk For 

  • Anxiety 
  • Alteration in tissue perfusion 
  • Fear 
  • Fluid volume overload 
  • Impaired tissue perfusion 
  • Impaired urinary elimination 
  • Ineffective family coping 
  • Knowledge deficit 
  • Potential for parental role conflict 
  • Risk for injury 

Preeclampsia Interventions 

  • Administer medications, as ordered. 
  • Ensure continuous fetal heart rate monitoring. 
  • Elevate extremities and position in left lateral recumbent position. 
    • Strict bedrest is not prescribed for preeclampsia without severe features or gestational hypertension. 
  • Eliminate constricting clothing or jewelry. 
  • Explain diagnosis, adverse effects, and treatment. 
  • Encourage individual to express feelings. 
  • Help individual develop effective coping strategies. 
  • Insert and maintain the following: 
    • Foley catheter 
    • Large bore IV 
  • Maintain calm environment with quiet and darkened room. 
  • Promote dietary changes. 
  • Provide the following: 
    • Comfort measures and emotional support 
    • Oxygen, if needed 
    • Seizure precautions 
  • Monitor the following: 
    • Complications 
    • Daily weight 
    • Deep tendon reflexes 
    • Edema 
    • Fetal heart rate and fetoplacental assessment 
      • If fetal growth restriction is found 
    • Headache unrelieved by medication 
    • Intake and output 
    • Level of consciousness 
    • Visual changes 
    • Vital signs 

Expected Outcomes 

  • Avoidance of maternal and fetal complications 
  • Delivery of viable fetus 
  • Decrease in maternal blood pressure after delivery 
  • Decreased anxiety, powerlessness, and fear 
  • Effective coping 
  • Exhibit signs of adequate cerebral and peripheral perfusion 
  • Identify strategies to reduce anxiety 
  • Maintain normal fluid volume and elimination 
  • Maintain optimal functioning within confines of visual impairment 
  • Normal sensory perception and tissue perfusion 
  • Perform daily activities of living without excessive fatigue 
  • Prevention of injury 
  • Verbalize fears/concerns 

Individual/Caregiver Education 

  • Individual and fetal diagnosis and treatment 
  • Importance of good prenatal care for mother and baby 
  • Continued adequate nutrition and low sodium diet 
  • Need to control preexisting hypertension
  •  Signs and symptoms of preeclampsia and eclampsia 
  • Early recognition and prompt treatment of preeclampsia 
  • Likelihood of premature birth if blood pressure cannot be controlled 
  • Care of premature infant 
  • What to do if blood pressure elevates and when to call 911 
  • Professional counseling referral if potential for fetal demise exists 
  • Return to obstetrician frequently for follow-up visits, as scheduled 
  • Get assistance when on bedrest and remain off feet, as directed by physician 
  • Maintain well-balanced, low sodium diet 
  • Prevent recurrence: 
    • Control hypertension before becoming pregnant 
    • Strict dietary measures of low sodium, supplemental magnesium, and low-fat meals for high-risk individuals

Maternal HTN/Preeclampsia in the ED

This course provides members of the healthcare team in the emergency department with information to identify and manage hypertensive disorders in pregnancy.

View Course

Additional Information

Content Release Date

4/1/2022

Content Expiration

12/31/2027

Course Contributor 

The content for this course was created by Kelly LaMonica, DNP, RNC-OB, C-EFM. Kelly LaMonica received her Associate’s Degree and RN from Muhlenberg School of Nursing in New Jersey 20 years ago. She began her career in Labor and Delivery 16 years ago. She earned her BSN and MSN from the University of Phoenix and her DNP from Grand Canyon University. She is certified in Inpatient Obstetrics (C-OB) and Electronic Fetal Monitoring (EFM). She is a neonatal resuscitation (NRP) Instructor. She has been a clinical leader for the past 11 years at Penn Medicine Princeton. She is also a Clinical Instructor at Rutgers University and Chamberlain School of Nursing. 

Resources 

References 

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