Maintain the patient on bedrest in the left lateral position as much as possible. This position assists with venous return and organ perfusion. Maintain a quiet, dim environment for rest, close to the nurse's station. Eliminate extraneous noises, lights, visitors, and interruptions that might precipitate a seizure. Plan assessments and care to ensure optimal rest. Pad the side rails, and keep the bed in the low position with the call light in reach at all times. To be prepared for emergencies, keep a "toxemia kit," which includes an artificial airway, calcium gluconate (antidote for magnesium sulfate), syringes, alcohol pads, and other medications, at the bedside. If the patient is receiving magnesium sulfate, monitor for signs of magnesium toxicity: hyporeflexia, decreased respirations, and oliguria. Expect the patient receiving magnesium sulfate to be lethargic.

If the patient is in labor, closely monitor fetal heart rate patterns and contractions. If the fetal heart rate shows signs of stress, turn the patient to her left side, increase the rate of the IV fluids, administer a humidified oxygen per mask at 10 L/min, and notify the physician. Because abrup-tio placentae is a potential complication of preeclampsia, be alert for any of the following signs of placental detachment: profuse vaginal bleeding, increased abdominal pain, and a rigid abdomen. The fetus also shows signs of distress (late decelerations, bradycardia).

Provide emotional support to the patient and family. The onset and severity of preeclampsia, along with its potential outcomes for the infant, are worrisome. If delivery of a preterm infant is imminent, educate the family on the environment and care given in the neonatal intensive care unit (NICU). Tour the NICU with the father, and explain what can be expected after the birth. This preparation helps alleviate some of the new parents' fears after the delivery.

After delivery, complications of preeclampsia can still manifest over the next 48 hours. Continue ongoing monitoring; be alert for seizures and indications that the patient is going into HELLP syndrome.

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