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1 page paper Nursing intervention, pharmacologic intervention and plan of care for a patient with preeclampsia Documents e W Leadership Journal R. W Leadership journal 2... W Leadership activities

Answer 1

Preeclampsia is the disease condition in pregnancy wher there is increased blood pressure may or may not accompanied by damage to other organs like kidneys and liver. It usualy occurs after 20 weeks of pregnancy. Preeclampsia can lead to several complications both to mother and fetus.
pharmacologic management in preeclampsia

• to control high blood pressure

Nifedipine
Mode of action
• Peripherally acting calcium antagonist.
Administration
• Use orally or sublingually.
• Give 10mg nifedipine, repeating dose after 30 minutes if required.
• Maintenance dose is given 8 hourly, with a maximum dose of 20mg.
Adverse effects
• Sublingual use may cause a rapid profound BP drop and impair uteroplacental perfusion if other agents are also in use.
• Use cautiously with MgSO4 (both antagonise calcium).
Labetalol
Mode of action
Combined α- and β-adrenergic blocker.

Administration
• Give 5-20mg boluses slowly IV at 10 minute intervals to a maximum of 50mg.
• Alternatively, start IV infusion at 20 mg/hour. Double infusion rate every 30 minutes as needed to a maximum of 160 mg/hour.
• May be given orally (dose: 100-200mg PO hourly, until BP controlled - maintenance dose is given 12 hourly). Absorption may be reduced in labour.
Contraindications
• Asthma and cardiac failure.
Intravenous hydralazine infusion
Mode of action
Direct acting arterial vasodilator.
Administration
• Never infuse hydralazine via the same cannula as magnesium sulphate – preferably avoid using the same arm.
• Dilute 80mg (4 vials) of hydralazine in 500ml
of 0.9% saline or Hartmann’s solution (not in 5% glucose).
Infuse hydralazine at 2mg/hour (= 12.5ml/hour). The correct number of drops per minute can be calculated from information on the packets of the IV giving set.
• If you have a syringe-driver pump, use 40mg hydralazine in 40ml and start at 2 ml/hour
(= 2mg/hour)
• If diastolic blood pressure (DBP) is still over 100, increase rate by 1mg/hour and check BP in next 30 min (maximum of 5 mg/hour).
• If DBP is between 90-100 keep same rate and continue to monitor BP every 30 min.
• If DBP is less then 90, reduce hydralazine infusion by 1mg/hour.
Monitoring
• Record BP results and rate of infusion on a monitoring sheet.
Adverse effects
• Hypotension. If DBP decreases suddenly below 90mmHg stop the infusion and administer a 250ml fluid bolus over 1 hour.
• Maternal tachycardia is often a limiting side effect of hydralazine.

• to prevent convulsions

If severe BP ≥160/110 and/or symptoms of CNS irritability, suggesting risk of progression to eclampsia (headache, blurred vision), start magnesium sulphate (MgSO4).

nursing interventions

• Intense maternal monitoring
• MgSO4 administration if prescribed. Nursing responsibilities in administering MgSo4 are:

1. Always use an infusion pump
2. Always document in grams per hour
3. Calcium gluconate immediately available
4. Assess for signs of toxicity
5. Assess DTR’s
6. Assess urine output hourly
7. Assess heart rate and rhytum
8. Auscultate lungs – listen for signs of pulmonary congestion  Assess respiratory rate and quality

• administer  Antihypertensive medications checking 10 Rs
• Depending on the condition of mother and fetus, delivery might be indicated
• Electronic fetal monitoring
• Assess vital signs based on status to determine worsening of the disease and response to therapy.
• Obtain BP with consistent methods
• Record hourly intake and output using a Foley catheter with a urometer.
• Reduce stimulation from noise and light.
• Maintain patient on strict bedrest
• Maintain IV access (D5W or LR at nor more than 150 mL/hr)
• Lab work as ordered including: type and crossmatch and platelets
• Test urine for protein
• Assess deep tendon reflexes
• Ask patient to tell you if she develops a headache, blurred vision, dizziness, or epigastric pain, or if she feels uncomfortable or different.
• Observe the patient for restlessness or apprehension

plan of action in preeclampsia

Initial assessment and management
Use ‘ABC’

Usually no problems in airway. Assess for breathing difficulties like increased respiratory rate, auscultate to rule out the presence of pulmonary edema.
Circulation:
Measure BP, pulse, oxygen saturation.
Left lateral tilt.
Perform blood analysis for Hb, platelets, clotting, blood group.
If platelets low (<100x109/l) check liver function tests.
Insert urinary catheter, dip for protein, monitor urine output hourly.
Record strict fluid balance and administer maintenance fluids (Hartmann’s or 0.9% saline), initially at 1000ml per 12 hours. There is a delicate balance between two potential complications; renal failure exacerbated by hypovolaemia and fluid overload causing cerebral and/or pulmonary oedema. Awareness of this balance is crucial to successful treatment of patients with pre-eclampsia and eclampsia.
If oliguric (urine output < 30ml/h average over 4 hours) consider a modest fluid challenge (250ml 0.9% saline).
Look for oedema.
Disability: ask specifically about headache, blurring of vision or fits
assess reflexes, looking for clonus and perform fundoscopy

Record vital signs on a flow sheet or critical care chart

Administer medications to prevent convulsions, to control blood pressure and other related commorbidities.