Question

Develop a plan of care for the woman experiencing preeclampsia, eclampsia, and HELLP syndrome.

Answer 1

Ans) Plan of care:

1) Preeclampsia:

-Monitor vital signs (patient and fetus) -monitor urinary output - Deep tendon reflexes -medication administration (magnesium sulfate/antihypertensive agents) and monitor for side effects -magnesium levels every four hours -creatinine levels to monitor kidney function -patient on fluid restriction due to possibility of fluid overload

2) Eclampsia:

- Provide support to the patient during this difficult time and answer questions that she may have.
- Provide information regarding the current disease state as well as the treatment plan.
-:Maintain an intake and output record, restricting fluid to prevent further edema.
- Assist the patient with range-of-motion exercises and frequent position changes when the patient is on bed rest.
- Frequently assess the patient's vital signs as well as her present skin condition and report abnormal findings immediately.
- Reposition the patient frequently to prevent skin breakdown.
- Protect the patient from injury during times of seizure activity by padding the side rails. Institute seizure precautions.
- Keep the couple informed of the status of the fetus. Institute continuous fetal heart rate monitoring as indicated.
- Administer anticonvulsive agents, as ordered; initiate I.V. access and maintain I.V. patency.

3) HELLP syndrome:

- Stabilise mother
- Observe BP , P, T RESPS, 02 SATS (BP every 15 mins)
- Treat as high dependency
- Observe lochia carefully if postnatal as increased risk of DIC
- If antenatal decided optimum time for delivery - vaginal is not contraindicated
- If premature will require steroids
- Control maternal BP - labetalol or nifedipine
- Control seizures - magnesium sulphate - a respiratory depressor so observe resps and refexes carefully

- If antenatal - CTG
- Some evidene that corticosteroids can be helpful in treatment of help syndrome but more research is required
- May need fresh frozen plasma, platelets and RBCs to correct any coagulation issues.
- Catheter indwelling and careful fluid balance (85mls/hour)
- IV access - CBC, LIVER FUNCTION TESTS, CREATININE, CLOTTING STUDIES and UREA AND ELECTROLYTES