Sample Nursing Paper on Preeclampsia

Introduction
Preeclampsia is a hypertensive disorder in pregnancy and is characterized by high blood
pressure more than 140/90mmHg or excess protein in urine after 20 weeks of pregnancy. This
medical condition is among the leading cause of maternal and neonatal mortality and morbidity
in both developed and developing countries. Globally estimated 2-8% of complicated
pregnancies and 10-15% maternal deaths are due to preeclampsia. Developing countries in Asia
and Africa are the most affected for example studies of preeclampsia prevalence in Ethiopia
range from 4-12% and account for 15% maternal deaths (Belay et al, 2020)

Signs and symptoms
The presentation signs and symptoms in women with preeclampsia is associated with
multiple organ systems. These include high blood pressure, protein in urine, weight gain within 2
days because increased body fluids, swelling, pulmonary edema, severe headache, nausea and
severe vomiting, dizziness, chest pain, stomach pain in the upper right part, vision disturbances,
elevated creatinine levels because of impaired kidney function and elevated liver enzymes.
The symptoms occur rarely after 20weeks of gestation and often set in 34 weeks of pregnancy,
some few symptoms may present within 48 hours after delivery and tend to disappear own their
own but can present up to 12 weeks.
Pathogenesis

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Pathogenesis of preeclampsia involves two stages: abnormal development of placenta and
development of maternal syndrome.
Abnormal development of placenta.It is alleged that preeclampsia originates from the
placenta. It is either failure of development or poor functioning of blood vessels that supply
blood to the placenta resulting in low oxygen supply to the placenta and oxidative stress. This is
caused by inadequate flow of blood to uterus, immune system disorder, damage of the blood
vessels and genetic factors (Nephrol, 2019)
Maternal syndrome: The hallmarks of preeclampsia are not limited to the placenta only;
there are extensive effects to the mother. The aetiology of martenal syndrome is believed to be
imbalance of angiogenic factors. Angiogenic factors regulate vascular development and blood
supply to the placenta. Preeclampsia and eclampsia pathologic lesions are indicated by extensive
endothelial lesions in a variety of organs. In a study autopsy of 317 women died of eclampsia, it
was developed that 68.4% of the women had brain lesions with perivascular edema , 36.8%
haemorrhage, 31.6%haemosiderin,10.5% small vessel thrombosis, 15.8% parenchymal necrosis.
72.2% of the women, liver lesions with sinusoidal fibrin, portal and periportal necrosis and in
44.4% hepatic arterial medial necrosis. The renal tissues indicated glomerular endothiliosis
which is bloodless tissue due to hypoxia (Nephrol, 2019)
Risk factors
These are factors that increase the chances of developing of preeclampsia in women.
Age is associated with preeclampsia where maternal age of below 18 and above 40 years has
increased risk.WHO global survey of maternal and newborn health indicated high risk of
preeclampsia to women >35 and < 19 years(Zahra et al,2016).

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Family history of preeclampsia,there is a great possibility of familial pattern in
inheritance of preeclampsia. If a woman experiences a preeclampsia, it is a significant indicator
of her daughter to experience preeclampsia. In a report by Chesley and Cooper the rate of
preeclampsia occurance is sisters (37%), daughters (26%) and grand-daughters (16%) (Zahra et
al, 2016).
History of preeclampsia, there is high risk of developing preeclampsia in a following
pregnancy in women who had preeclampsia in their first pregnancy.
Long inter pregnancy intervals. Interbirth intervals of 4 years or more increases the risk
of developing preeclampsia (Zahra et al, 2016). In a study done on Latin American and
Carribean women indicated that 59 months intervals between pregnancies has higher risk of
preeclampsia than 18-23month interval(Noureen et al,2014).
Multiple pregnancies increases the risk of developing preeclampsia and this is attributed
to the increased placental mass and subsequent increased placenta originated antiangiogenic
markers in circulation (Zahra et al, 2016)
In vitro fertilization is related with increased risk of preeclampsia and gestational
hypertension than in spontenious conceived pregnancies. A cohort study indicated hypertensive
disorder incidence in 5.9% of singleton and 12.6% of twin in assisted reproductive pregnancies
and 4.7% of singleton and 10.4% of twin pregnancies in non assisted reproductive technology
pregnancies (Zahra et al, 2016).
Preexisting medical conditions such diabetes mellitus, kidney diseases, lupus and
rheumatoid arthritis. The risk of developing preeclampsia increases with severity of
pregestational diabetes and also gestational diabetes. There is also increased risk of preeclampsia

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in women with preexisting autoimmune diseases such as lupus and rheumatoid arthritis (Zahra et
al, 2016)
Diagnosis
A diagnostic criterion follows that onset of symptoms 20 weeks of pregnancy with
remission 6-12 weeks after delivery. Preeclampsia can be mild or severe depending on the blood
pressure levels. (i) mild preeclampsia is indicated by high blood pressure with two readings of
more than 140/90mmHg at interval of 4-6 hours and proteinuria with urine dipstic of > 1+ or >
300mg/24hours. (ii) severe preeclampsia is indicated by one or more of the following, sustained
blood pressure of more than 160/110mmHg and sudden oliguria,pulmonary edema, nephritic
range proteinuria, central nervous system symptoms or cyanosis(Nephrol.2019)

Management and prevention
The only treatment of preeclampsia is delivery. Other supportive care prevent progression
to eclampsia include tight monitoring and control of blood pressure by using antihypertensives.
Preconception counseling, blood pressure control, management of complications,
delivery and postnatal monitoring is crucial (Nephrol, 2019).
It is important to focus on the prevention of preeclampsia because of its significant
mortality and morbidity. There is prophylactic use of aspirin. In high risk pregnancies take
Aspirin 81mg daily after 12 weeks of pregnancy control blood pressure for the chronic
hypertensives, avoid smoking, weight loss and control of obesity, regular exercise. Nurses should
advice pregnant women on weight control, obesity and avoiding risk factors.
Nursing care and intervention

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Nursing care for preeclampsia and pregnant induced hypertension entails providing good
prenatal care, sufficient nutrition and control of pregestational hypertension. Early detection and
management of preeclampsia can prevent its progression to eclampsia.
There a several nursing diagnosis and interventions that can help in early recognition and
treatment of preeclampsia (Gil Wayne, 2019).
Deficient fluid volume can be related to plasma protein loss, osmotic pressure and fluid
shift from vascular compartment. The indicators are sudden weight gain, edema, swelling, less
peeing, vomiting. Nurses can intervene by checking weight of the patient regularly, monitor fluid
input and output and regularly monitor blood pressure. Collaborate with other health care
workers like physicians and nutritionist for a better management of the patient condition (Gil
Wayne, 2019).
Decreased cardiac output indicated by change in blood pressure, shortness of breath,
alteration of mental status and edema. Nurses should check vital signs especially pulse and blood
pressure. Control blood pressure using suitable antihypertensives. Collaborate with physician to
determine whether labor induction is possible or surgical procedure (Gil Wayne, 2019).
Maternal injury can be related to tissue hypoxia or edema, abnormal blood profile and
convulsions. Nurses should check for central nervous system involvement indicated by
headache, visual changes and irritability, palpitation of the lower abdomen to check for uterine
tenderness. Collaborate with physician to manage convulsions, magnesium sulphate infusion is
used (Gil Wayne, 2019).
Conclusion
Managing preeclampsia and pregnancy induced hypertension is essentially to ensure
safety of the mother and fetus. Nurses need to be vigilant in empowering women on the

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importance of prenatal clinic visits to check the progression of pregnancy. Patient and family
education is a crucial tool that can be used to eliminate the risks of preeclampsia and other
pregnant induced hypertension. Pregnant women and other home care givers should be trained
on weight measurement, symptom checking and reporting any unusual sign and symptom.
Nurses and obstetricians should be keen in constant monitoring of high risk pregnant women of
preeclampsia because sometimes it fails to demonstrate early symptoms and signs
References
Gil Wayne,BSN,R.N.(2019) 6 Pregnancy Induced Hypertension Nursing Care Plans.
https://nurseslabs.com
Belay Tolu et al, (2019) Maternal and perinatal outcome of preeclampsia without severe feature
among pregnant women managed at a tertiary referral hospital in urban Ethiopia.PLoS
ONE 15(4):e0230638. https//doi.org/10.1371/journal.pone.0230638
Nat Rev Nephrol, (2019) Preeclampsia: pathogenesis, novel diagnostics and therapies.15 (5):
275–289. doi:10.1038/s41581-019-0119-6.
Dr Zahra Hoodbhoy and Beth Payne, (2016) The FIGO Textbook of Pregnancy Hypertension: 1-
195.The Global Library of Women’s Medicine