Preeclampsia and Gestational Hypertension

Overview

Preeclampsia is a multisystem hypertensive disorder of pregnancy that occurs after 20 weeks of gestation. It is characterized by vasospasm and reduced perfusion to vital organs, including the placenta. If left untreated, it can progress to eclampsia, which involves maternal seizures and potential fetal death.

Key nursing concepts

• Preeclampsia is defined by hypertension and proteinuria occurring after 20 weeks of pregnancy.
• Eclampsia is the onset of seizure activity or coma in a woman with preeclampsia.
• Severe features include a blood pressure over 160/110 mmHg and visual disturbances.
• Magnesium sulfate is used for seizure prevention, not primarily for blood pressure control.
• The HELLP syndrome is a life-threatening variant of severe preeclampsia.
• Nursing priority is maintaining maternal safety and preventing progression to eclampsia.

Important nursing considerations

• Monitor fetal heart rate patterns for late decelerations indicating distress.
• Assess blood pressure frequently to detect worsening hypertension.
• Monitor deep tendon reflexes and check for clonus to assess neurotoxicity.
• Keep calcium gluconate at the bedside as an antidote for magnesium toxicity.
• Maintain a quiet environment with low lighting to prevent seizure activity.
• Ensure a Foley catheter is in place to monitor strict hourly urinary output.

Patient teaching

• Report any persistent headaches, blurred vision, or spots in the eyes immediately.
• Notify the provider of sudden swelling in the face or hands.
• Explain the importance of daily fetal kick counts to monitor baby wellbeing.

Related practice questions

Real questions from the NursGuru bank, each with the answer and rationale.

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