Preeclampsia and the Nurses Role
Clinical Reflection and Research Paper
Briana Terrill
The University of New Hampshire
NURS 620
April 20th, 2011
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Description
In clinical I took care of an African American 33 year old G2 P1 woman who was
admitted to be induced. Her baby was past her due date with the gestational age of 40 weeks and
2 days. She had preeclampsia, which was diagnosed by having increased blood pressure as well
as having one gram of protein in her urine.
Issue of concern
Preeclampsia is classified as blood pressure between 140 and 160 systolic, and 90 and
110 diastolic with proteinuria present (Perry, Hockenberry, Lowdermilk, & Wilson, 2010). The
pathophysiology of preeclampsia is arteriolar vasospasm, which decreases blood flow to the
organs and raises blood pressure (Perry et al., 2010). The issue is that preeclampsia can progress
to severe preeclampsia, HELP syndrome and then eclampsia which can potentially harm the
mother and baby (Perry et al., 2010). Therefore, to prevent the progression to more
compromising conditions, constant assessment was required.
Action Taken by myself, the nurse and the client
Throughout the patients labor the nurse and I assessed her reflexes for hyperreflexivity.
We also asked the patient if she was experiencing headaches, or epigastric pain. I monitored her
blood pressure every hour, and I assessed for edema in the patient’s extremities. The nurse
constantly monitored the fetal heart monitor for late decelerations in the fetal heart rate. When
late decelerations occurred, this meant that the baby was not getting an adequate blood supply.
The nurse asked the mother to turn to a different side, and the patient would do so. Therefore the
action the patient took was to comply with flipping suggestions, and alert myself or the nurse if
she was experiencing a headache, or epigastric pain.
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Evidence-Based Research
Standards of Care
The standards of care for pregnant women with preeclampsia were taken from UpToDate
which provides constantly updated evidenced based medical information. The standards of care
include continuous maternal-fetal monitoring (Norwitz & Repke, 2011). This includes for
example monitoring blood pressure, heart rate, respiratory rate, urine output, and patellar reflexes
every hour (Norwitz & Repke, 2011). This evidence strengthened my decision to constantly
monitor the mother and baby for signs of distress or worsening conditions.
Also, the recommendations suggest that magnesium sulfate be used for women with
severe preeclampsia, but that it does not need to be used in women with mild preeclampsia
because of the side effects and a reduction in neonatal mortality (Norwitz & Repke, 2011). The
nurse explained that she was not using magnesium sulfate in this patient’s case because the risks
outweighed the benefits which correlate with the standards of care.
Nursing Research and Evidence Based Practice
The standards of care are beneficial to know from a medical standpoint, but it is also
important to know the nurses role in preeclampsia. Nursing research provides this knowledge
and expands current standards with patient centered care.
One study looked at the correlation of stress and preeclampsia. The study compared mild
preeclampsia and worsening or severe preeclampsia in relation to stress, well being, perceived
social support and symptoms (Black, 2007). The study concluded that social support and wellbeing were the same in both mild and severe preeclampsia; however stress was often present in
severe preeclampsia (Black, 2007). The nursing implications of this study were to not only
evaluate the physiologic symptoms of worsening preeclampsia such as headaches, epigatric pain
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and hyper reflexes but to also include perception of stress in nursing assessment (Black, 2007).
In the clinical setting, the nurse and I did not assess for stress in this patient even though, the
evidence suggests that stress could signal the progression from mild to severe preeclampsia. In
the future this could be a helpful tool in nursing assessment.
A second study examined the benefits of stretching on preeclampsia. The experimental
group routinely practiced stretching exercises and the control group practiced routine walking
exercises (Yeo, 2010). Heart rate and blood pressure were taken weekly, and compared between
the two groups (Yeo, 2010). The results were that although blood pressure between groups
showed no significant difference, heart rates in the stretching group were significantly lower than
those in the walking group (Yeo, 2010). The author suggests that regular stretching changes the
vagal tone and thus improves preeclampsia (Yeo, 2010). It is important to note that 85% of
participants in this study were Caucasian, which hinders the generalizability of the study
especially to the patient who I took care of because she was a different race. In clinical I was not
involved in the patient’s prenatal care, however she explained that all she did was take prenatal
vitamins. If I was involved in this patient’s prenatal care, I would make the decision to suggest
stretching exercises. If nurses knew of this evidence, they could suggest stretching exercises to
patients in order to improve their preeclamptic condition during pregnancy and labor.
A third study examined maternal heart rate variability and fetal behavior in normotensive
and hypertensive pregnant women. The results were that in the normotensive group there was no
correlation between maternal heart rate variability and fetal heart rate, body or breathing
movements (Brown, Lee, Hains, & Kisilevsky, 2008). However, in the hypertensive group the
maternal heart rate variability and fetal spontaneous heart rate (Brown et al., 2008). The study
concluded that maternal heart rate changes in hypertensive women impact the heart rate in the
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fetus (Brown et al., 2008). The implications of this study are that fetal heart monitoring is
needed, due to the constantly changing fetal heart rate in mothers with preeclampsia. Also,
nurses can attempt maintain the mother’s heart rate by reducing stress. In this clinical case the
nurse constantly monitored the fetal heart monitor and intervened as needed. Also, the nurse
advocated for adequate pain control to reduce stress in the patient, which correlates with the
evidenced based research because reducing stress will reduce the heart rate in the mother and
consequently in the baby as well.
Outcome of the clinical situation
The outcome of this clinical situation was that the patient delivered a healthy baby boy
with no complications of labor or birth. The baby was born with a nuchal cord, and the nurse
explained to me that this could have been why we were seeing late decelerations on the fetal
monitor late in her labor. The mother did not exhibit any progression to severe preeclampsia, and
experienced a positive birth experience.
Evaluation
The constant assessments contributed to a successful outcome. These assessments
assured the patient and the healthcare team that the condition was not progressing. In addition,
lowering the lights and speaking in a calm tone contributed to lowering the patient’s stress. The
only aspect that was less then optimum was the time it took the anesthesiologist to arrive to place
the epidural. This led to unnecessary pain and stress; however when it was in the patient was
calm and relaxed.
Learning Experience
Through this experience I learned about all of the nursing interventions and assessments
required for a woman with preeclampsia. In addition, I gained experience with a fetal heart
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monitor. I learned that evidence based research is the foundation of clinical decision making. I
learned that prenatal stretching can improve the preeclamptic condition. I learned that stress is an
important assessment piece in the preeclamptic woman because it can signal progression from
mild to severe preeclampsia. Last, I learned that anything that effects the mother’s heart rate can
affect the fetus’s heart rate and that nurses can implement stress reduction to decrease the heart
rate.
Future Implications
In the future, I would begin nursing management of preeclampsia as soon as the patient is
diagnosed prenatally. The nursing research showed that prenatal stretching exercises can
improve the preeclamptic condition, and therefore would benefit the patient. In the future I
would assess stress in the preeclamptic woman during labor because nursing research has shown
that stress can signal a progression from mild to severe preeclampsia. Last, I would in addition to
constantly monitoring the mother and infants heart rate, reduce stress in the mother. This has
been shown in nursing research to affect the heart rate in the fetus. To accomplish this I would
turn off lights, provide adequate pain relief, reduce stimuli, and facilitate a therapeutic
relationship. In changing practice in accordance to evidence based practice, I can positively
impact the future of my patients’ care.
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References
Black, K. D. (2007). Stress, symptoms, self-monitoring confidence, well-being, and social support in the
progression of preeclampsia/gestational hypertension.JOGNN: Journal of Obstetric, Gynecologic &
Neonatal Nursing, 36(5), 419-429. Retrieved
from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009683566&site=ehost-live
Brown, C. A., Lee, C. T., Hains, S., & Kisilevsky, B. S. (2008). Maternal heart rate variability and fetal
behavior in hypertensive and normotensive pregnancies.Biological Research for Nursing, 10(2), 134144. Retrieved
from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010064945&site=ehost-live
Norwitz, E., & Repke, J. (2011, February 14). Management of Preeclampsia. Retrieved April 20, 2011,
from UpToDate: http://www.uptodate.com/contents/management-ofpreeclampsia?source=search_result&selectedTitle=2~150
Perry, S., Hockenberry, M., Lowdermilk, D., & Wilson, D. (2010). Maternal Child Nursing Care (4th
Edition ed.). Maryland Heights, MI: MOSBY Elsevier.
Yeo, S. (2010). Prenatal stretching exercise and autonomic responses: Preliminary data and a model for
reducing preeclampsia. Journal of Nursing Scholarship,42(2), 113-121. doi:10.1111/j.15475069.2010.01344.x