Preeclampsia

With: Jack Arnold, Leora Bain, Maria Licari, Tracy Demaeyer, Maria
Hall, & Aubry Hire
Background
Etiology
Abnormal placental development
Predisposing maternal factors
Oxidative stress
Immune Maladaptation
Genetic susceptibility
(Ahmed, February, 2011)
Background
Frequency
5-10% of all pregnancies develop
preeclampsia. (Murray & McKinney)
Significance
Major cause of perinatal death (Murray &
McKinney, p. 519).
Associated with intrauterine fetal growth
restriction (IFGR).


Risk factors associated with preeclampsia
The most significant risk factors for preeclampsia are:
Previous history of preeclampsia.
Multiple gestation (i.e., pregnant with more than one
baby)
History of chronic high blood pressure, diabetes, kidney
disease or organ transplant.
First pregnancy.
Obesity, particularly with Body Mass Index (BMI) of 30
or greater
Over 40 or under 18 years of age
Risk Factors (cont.)
Most significant risk factors (cont.)
Family history of preeclampsia (i.e., a mother, sister,
grandmother or aunt had the disorder)
Polycystic ovarian syndrome
Lupus or other autoimmune disorders, including
rheumatoid arthritis, sarcoidosis and multiple sclerosis
In-vitro fertilization
Sickle cell disease
All retrieved from Preeclampsia Foundation.
Current Treatments: Home Care
Therapeutic Treatments
Teach mom to monitor:
blood pressure
Urine
Weight
Fetus
Proper Diet
Reduced activity
Follow up visits every 3-4 days
Know S&S of worsening condition
Current Treatments: Inpatient Care
Medical:
The only cure for preeclampsia is to deliver the
baby, (Murray & McKinney, 2014, p. 521).
Pharmacological:
Steroids
Antihypertensives
Anticonvulsants
Therapeutic
Bed rest
Continuous fetal monitoring
Nursing Diagnosis #1
Powerlessness r/t complication threatening
pregnancy
Nursing Interventions
Establish a therapeutic relationship with the client
by spending one-on-one time.
Assign the same caregiver as often as possible
Provide support and be empathetic
Encourage the client in goal-directed activities that
promote a sense of accomplishment.

Nursing Diagnosis #2
Anxiety r/t threat to self and infant
Nursing Interventions
Educate client about how to manage the disease
process such as diet, bed rest, pharmacological
management
Use of therapeutic touch to help calm and comfort
the client
Nursing Diagnosis #3
Situational low Self-Esteem r/t loss of
idealized pregnancy
Interventions:
Assess the client for s/s of depression and potential
for suicide and/or violence
Accept clients own pace in working through grief
Provide information about support groups
preeclampsia.org

Duration
after 20 weeks
rarely before 20 weeks
commonly diagnosed in late 2nd or 3rd trimester
resolves after birth
up to 6 weeks after birth
rare
Varies greatly
onset individualized
Outcomes
Resolution
Three signs that the woman is recovering
Follow-up
Seizures
Continuing assessment
HELLP
Residual Effects
Increased risk factor for hypertension

References
Ahmed, A. (2011, February). New insights into the etiology of preeclampsia: identification of key elusive factors for the vascular
complications. Thrombosis Research, 127(3), s72-s75. http://dx.doi.org/10.1016/S0049-3848(11)70020-2
American Heart Association (2014) Types of blood pressure medications.
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/Types-of-
Blood-Pressure-Medications_UCM_303247_Article.jsp http://www.preeclampsia.org/health-information/about-
preeclampsia
Buley, K. (2010). Puzzling out preeclampsia. Nursing Made Incredibly Easy, 8(2), 20. doi: 10.1097/01.NME.0000368747.44795.7a
Dekker, G. A., & Sibai, B. M. (1998, November). Etiology and pathogenesis of preeclampsia: Current concepts. American Journal
of Obstetrics and Gynecology, 179(5), 1359-1375.
http://dx.doi.org/10.1016/S0002-9378(98)70160-7


References
Ladwig, G. B., & Ackley, B. J. (2014). Mosby's guide to nursing diagnosis.
Mayo Clinic (2014). Prednisone and other corticosteroids. http://www.mayoclinic.org/steroids/art-20045692 MedicineNet.com.
(September 4, 2014). http://www.medicinenet.com/pregnancy_preeclampsia_and_eclampsia/article.htm
Murray, S. S., & McKinney, E. S. (2014). Complications of pregnancy. In Foundations of maternal-newborn and womens health
nursing (6th ed., pp. 504-535). St. Louis, MO: Elsevier Saunders.
Peach State Health Plan (2011) Anticonvulsants quick reference drug list.
http://www.pshpgeorgia.com/files/2011/08/Anticonvulsants-quick-reference-drug-list-111811.pdf
Preeclampsia Foundation (2014) FAQs. http://www.preeclampsia.org/health-information/faqs