Preeclampsia
A hypertensive disorder of pregnancy with proteinuria
Definition
Preeclampsia is a pregnancy-specific syndrome of new-onset hypertension (greater than 140/90) and proteinuria (greater than 300 mg/24 hr) occurring after 20 weeks' gestation. Severe features include BP greater than 160/110, visual disturbances, pulmonary edema, renal or liver abnormalities.
Risk Factors
- First pregnancy
- Age less than 20 or greater than 40
- History of preeclampsia
- Chronic hypertension, diabetes, kidney disease
- Obesity
- Multiple gestation
Warning Signs (Severe)
- Severe headache
- Blurred vision, scotomas
- Epigastric or RUQ pain (liver capsule stretching, HELLP)
- Oliguria
- Hyperreflexia with clonus
- Pulmonary edema
Nursing Interventions
Frequent BP monitoring, urine protein checks, hourly reflexes in severe cases, magnesium sulfate infusion for seizure prophylaxis (monitor Mg level 4 to 7 mg/dL, DTRs, respirations, urine output; antidote: calcium gluconate). Antihypertensives (labetalol, hydralazine, nifedipine). Fetal monitoring. Delivery is definitive.
NCLEX Relevance
Mag sulfate therapy: DTRs, RR greater than 12, UO greater than 30 mL/hr.