SIMULATION 1 PREWORK
Maternity Nursing Care
Ricci, S. (2017). Essentials of Maternity, Newborn, and Women’s Health Nursing, 4th Edition.
Hypertensive Disorders of Pregnancy, Chapter 19, pp. 671-680
Preeclampsia and Eclampsia, Chapter 19, pp. 672-680
1. What is Preeclampsia? Pathophysiology
Preeclampsia is a disorder that commonly occurs during first pregnancy, causing vasospasms and
hypoperfusion. The exact pathophysiology is unknown, however, it has a direct effect on the
cardiovascular, hepatic, renal and central nervous system. (Ricci, 2016, pg. 672)
2. What are the symptoms of Preeclampsia?
There are two stages of Preeclampsia that are considered to be mild or severe. In the mild stages
the symptoms include blood pressure greater than 140/90mmHg, proteinuria of 324mg/24 or
greater than plus 1 in a random dipstick urine sample, mild weight gain and edema. For severe
Preeclampsia the symptoms include blood pressure greater than 160/110mmHg, proteinuria of
500mg/24hr or greater than plus 3 on a random dipstick urine sample, hyperreflexia, headaches,
oliguria, blurred vision, scotomata, pulmonary edema, thrombocytopenia, cerebral disturbances,
HELLP, RUQ and gastric pain. (Ricci, 2016, pg. 673)
3. How might Preeclampsia affect my baby?
Preeclampsia can affect the baby because the symptoms can lead to potential preterm birth,
placental abruption, fetal distress during pregnancy and childbirth, and intrauterine growth
restriction. These babies are at risk for receiving low amounts of nutrients and oxygenated blood
leading to fetal distress and further complications. (Ricci, 2016, pg. 675)
4. Is there a test for Preeclampsia?
There is not one specific test for Preeclampsia but there are several labs and diagnostics that are
considered. This includes blood pressure reading of 140/90mmHg or greater on two different
occasions at least 4-6 hours apart. Proteinuria of greater than 324mm/24hr period, CBC, serum
electrolytes, BUN, creatinine, and liver enzyme levels. (Ricci, 2016, pg. 675)
5. How is Preeclampsia treated?
Preeclampsia is treated based on severity and is managed on a case by case scenario. For more
mild cases the treatment may include bed rest, frequent blood pressure monitoring at home q46h, nutritional diet with sodium restriction, and regular lab testing. The goal is to prevent
progression of the disease and to manage the blood pressure and fluid volume status and keep it
under control. For more severe cases the treatment is more aggressive and includes
hospitalization in order to stabilize the mother and baby. The ultimate goal would be delivering
the fetus if it is viable. With severe Preeclampsia the mother can experience cerebral functioning
issues, seizure activity and ultimately it can lead to long term morbidities for both mother and
baby or death. (Ricci, 2016, pg. 673)
6. What medications are given for Preeclampsia?
Medications given for Preeclampsia are Magnesium sulfate which helps with vasodilation and
seizure prevention, Hydralazine hydrochloride (Apresoline) for relaxing vascular smooth
muscles and reducing blood pressure, Labetalol hydrochloride (Normodyne) which is a beta
blocker to reduce blood pressure, Nifedipine (Procardia) which is calcium channel blocker to
dilate the coronary arteries and help stop preterm labor, Sodium nitroprusside which is a fast
acting vasodilator for severe hypertension, and Furosemide (Lasix) which is a loop diuretic to
help with pulmonary edema and promote diuresis. (Ricci, 2016, pg. 678)
7. What are the nursing interventions for Preeclampsia?
Interventions for Preeclampsia include frequent monitoring. Women should be educate on signs
and symptoms of Preeclampsia and when they should contact their provider or go in to be seen.
In more stable patients they can be managed at home with stable vitals, labs, and normal fetal
movement. They should receive periodic assessments to monitor their condition, including nonstress test to monitor the condition of the fetus. For more severe cases hospitalization will be
needed and the patient should be kept on bed rest in the left lateral lying position, with reduced
stimulation in a calm, quiet, dark room. They will need to be on seizure precautions and have
oxygen and suctioning equipment available at the bedside. (Ricci, 2016, pg. 675)
8. What assessments are performed on a Mom with Preeclampsia
For a Mom with Preeclampsia a thorough assessment should be conducted. This includes, their
blood pressure and vital signs, any subjective data that may indicate progression of the disease.
Subjective data could be visual changes, headaches, migraines, unusual bleeding, and abdominal
pain. They should also have regular assessment of their urine to monitor for protein. (Ricci,
2016, pg. 674)
References
Ricci, S. (2016). Essentials of Maternity, Newborn, and Women's Health Nursing. [VitalSource
Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9781496367037/