Primary Nursing Diagnosis

Altered tissue perfusion (cardiopulmonary, cerebral, peripheral, renal) related to arterial vasospasm and obstruction to flow

OUTCOMES. Vital signs status; Urinary elimination; Fluid balance; Neurological status; Coagulation status; Tissue perfusion: Abdominal organs; Fetal status: Intrapartum

INTERVENTIONS. Fluid monitoring; Fluid/electrolyte management; Seizure precautions; Medication administration; Vital signs monitoring; Fluid management; Bedside laboratory testing; Electronic fetal monitoring

H PLANNING AND IMPLEMENTATION Collaborative

Often, preeclampsia occurs before the fetus is term. The goals of treatment are to prevent seizures, intracranial hemorrhage, and serious organ damage in the mother and to deliver a healthy term infant. The only cure for preeclampsia is delivery of the infant; however, if the infant is preterm, care is balanced between preventing maternal complications and allowing the fetus more time in utero. If the symptoms in preeclampsia are mild, often the patient is treated at home on bedrest, with careful instructions and education on the danger signs and frequent prenatal visits to monitor progression of the disorder. Antihypertensives are usually not prescribed for mild preeclamptics; no differences in gestational age or birthweight have been noted, and growth-restricted infants were twice as frequent in mothers who took labetalol than those treated with bedrest/hospitalization alone. Mild preeclampsia is really a misnomer, because it can become severe very rapidly. Frequent tests of fetal well-being are done throughout the pregnancy, including an NST and biophysical profile, to detect the effects of preeclampsia on the fetus.

If symptoms of preeclampsia worsen, hospitalization is mandatory. Maintain the patient on complete bedrest. If the urine output is below 30 mL/hr, suspect renal failure and notify the physician. Readings of 2+ to 4+ protein in the urine and urine-specific gravities of greater than 1.040 are associated with proteinuria and oliguria. Hemodynamic monitoring with a central venous pressure catheter or a pulmonary artery catheter may be initiated to regulate fluid balance. Magnesium sulfate is given via intravenous (IV) infusion to prevent seizures. Serum magnesium levels are done to determine if the level has reached the therapeutic level; serum levels also alert the caregiver of a move toward toxicity. If the magnesium sulfate infusion does not prevent seizure, the physician may order phenobarbital or benzodiazepines. Using either low doses of aspirin or dietary calcium supplementation is being explored as means to prevent preeclampsia.

If the patient is alert and is not nauseated, a high-protein, moderate-sodium diet is appropriate. Low-salt diets are not indicated. Glucocorticoids may be given to the mother intramuscularly at least 48 hours before delivery to assist in maturing fetal lungs to decrease the severity of respiratory difficulties in the preterm neonate. A cesarean section is indicated if the fetus is showing signs of distress or if preeclampsia is severe and the patient is not responding to aggressive treatment. All efforts are made to stabilize the patient's condition before surgery.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description Rationale

Magnesium sulfate

6 g IV piggyback (PB)

Anticonvulsant Pregnancy-induced hypertension

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