Management, Surveillance, and Expectant Management of Preeclampsia (Nursing)

00:01 So let's talk about what we can do.

00:03 There are definitely some things we can do to manage preeclampsia, even if we can't make it go away.

00:08 So let's begin with some of the questions that we ask.

00:11 And let's see if some of these sound familiar to you.

00:15 The nurse might ask the client, "Are you experiencing any contractions? Any bleeding? Any leaking of fluid?" Why do we ask those questions? Exactly? We're trying to determine if the client might be in labor.

00:28 But what about these questions? Have you had any headaches? Have you experienced any changes in your vision? Have you had any epic...? Well, we wouldn't say, epigastric pain, we would say, "Have you had heartburn?" Right? How's the baby moving? Have you noticed any swelling? What do you think about those questions? And what they may indicate? Okay, exactly.

00:53 Those are going to go along with preeclampsia.

00:56 So let's think about some of the other things that we do.

00:59 We ask those questions typically during prenatal care.

01:02 Well, one of the reasons why we have prenatal care is so we can detect things like preeclampsia.

01:06 So that's going to be really important.

01:08 So when you think about clients who don't have adequate access to prenatal care, you can see where the chances of having positive outcomes for patients with preeclampsia are going to be affected.

01:20 The next thing is, is that we want to monitor blood pressure.

01:23 And we need baseline.

01:24 We need to see what the trends are in the blood pressure over time.

01:28 So that's going to be done during every visit, every time we see the client, assuming they come to the visits.

01:34 So again, if we have a situation where clients either don't feel welcome or a sense of belonging, or treated poorly, or don't have access to health care, don't have access to prenatal care, we may be missing a very important management diagnostic.

01:50 We want to manage the complications.

01:52 So specifically thinking of poor blood flow, we want to think about damage to the kidney, damage to the liver, any of those things, even the hypertension, we can try to decrease the effects of those complications.

02:05 We can't cure the preeclampsia until we deliver the placenta, but we can manage some of the complications.

02:12 We can think about delivery of the fetus and when we can do it.

02:16 So if the only definitive cure is delivery of the placenta, then we may be able to think about an induction of labor as a way to get the fetus here earlier.

02:26 Now, if we're thinking about a preterm delivery, one of the most important aspects we have to think about is lung maturity.

02:33 Because one of the reasons why preterm babies really struggle is that their lungs are not fully developed.

02:39 We can administer corticosteroids as a way to stimulate production of surfactant and make that transition easier.

02:46 So this may be something that is ordered for the preeclamptic patient in anticipation of delivery.

02:53 We also need to do postpartum monitoring because some clients either don't develop preeclampsia until postpartum, or some clients may continue to have elevations in blood pressure even after that placenta is delivered.

03:07 The American College of Obstetrics and Gynecology has some recommendations on delivery speaking of that, and when it should occur.

03:15 So in clients who are experiencing mild preeclampsia before 37 weeks expectant management is typically what we do.

03:22 We're going to talk about what that is in just a second.

03:26 For mild preeclampsia, after 37 weeks, the recommendation is induction of labor.

03:31 There's no reason to keep the baby inside when that environment is not exactly the best for them.

03:37 So let's talk about severe preeclampsia.

03:40 Pay attention to the change in the gestation cut off.

03:43 So now, we're looking at 34 weeks.

03:45 So if we have a severe preeclamptic, before 34 weeks, and we notice that their symptoms are getting worse, they should be managed by receiving corticosteroids that helps with developing the lungs of the fetus.

03:59 They should also be sent to a facility where there's an NICU or neonatal intensive care unit, and ICU support.

04:06 This could get pretty serious pretty fast, and we want to make sure that the team that's there can manage it.

04:12 If we have a severe preeclamptic, after 34 weeks, there's really no reason to wait.

04:17 Delivery is going to be recommended as soon as the mother stable to do so.

04:22 So let's talk about what that expected management looks like.

04:25 So if we have someone who is stable, they're preeclamptic, and they have mild preeclampsia, and they're stable.

04:32 This is what we recommend.

04:34 We recommend twice weekly blood pressure checks.

04:36 So they're going to have to be able to get to the office at least twice a week.

04:40 They're going to have labs drawn to make sure that the consequences of the preeclampsia is not getting worse and worse.

04:46 So we're going to check platelet counts once a week, liver enzymes and proteinuria, and that usually looks like a 24-hour urine collection.

04:55 Now, sometimes we tell clients to go home and just stay in bed all the time.

05:01 Well, there's really no evidence to support that generalized bed rest at home is going to make any difference in the progression of the disease.

05:08 So we may recommend that they stopped working, and that they rest during the day.

05:11 And they're not overstimulated, but usually staying in bed all day resting.

05:16 If they're safe enough to be on an Expectant Management Protocol, then that's usually not helpful.

05:21 Things like a low salt diet to decrease blood pressure, that usually doesn't work.

05:26 because that's not the physiology of this disease.

05:29 And weight loss at this point, again, is not going to be helpful.

05:33 And there's no evidence to support that as a recommendation.

05:35 And I say all that because clients tend to ask questions about things like that, because they want to be able to fix it.

05:41 There's really not anything they can do to fix it.

05:46 So in terms of other assessments that we might do, so let's see, if we can put these together, and hopefully they begin to make sense as to why we do them? because you understand the physiology and you know where we're going.

05:57 So, McDonald's measurement measures the growth of the fetus.

06:01 Why would we do it? Fetal growth, exactly.

06:04 A nonstress test might be ordered to check for the neurologic stability of the fetus and the oxygenation.

06:11 Why would we do it? Exactly, because we want to make sure that we have good perfusion.

06:17 If there's an ultrasound that's available, a biophysical profile might be done.

06:21 Now remember, that's an ultrasound that looks at fetal tone, movement, the amount of amniotic fluid, and the breathing reflex of the fetus.

06:29 Why would we do that? Exactly, because if the fetus is not well perfused, they won't do any of those things very well.

06:37 And again, we can also check for fetal growth with that same ultrasound.