Nursing Priorities for Preeclampsia – Inpatient (Nursing)

00:01 So thinking about our priorities, once the client comes to the hospital.

00:05 So, if they're in the hospital, they're being admitted, because they have preeclampsia.

00:09 Then one of the things that the nurse is going to absolutely have to do is make sure they're doing intensive monitoring of all the subjective and objective symptoms that might be there.

00:19 What we're trying to make sure is that preeclampsia is not moving towards severe preeclampsia.

00:25 Medication might be ordered, which we'll talk about in just a second.

00:28 We want to make sure that we don't wait around.

00:30 The medication that's ordered for this preeclamptic likely needs to be given as soon as possible.

00:36 Continuous fetal monitoring to make sure that oxygenation for the fetus stays at a normal level, we want to monitor intake and output.

00:44 So thinking about the fact that we have leaky vessels, and we could develop pulmonary edema, eye and nose are going to give us a really good indication of where things are going.

00:53 We also want to be really careful with the amount of IV fluid that we're giving.

00:57 We don't want to fluid overload a client.

00:59 Their vessels are leaky.

01:01 We want to reduce stimulation.

01:03 So this is not the time for lots of text messages, or watching something that's really flashy on Netflix.

01:10 We're going to go for a dimly lit room, we're not going to have Grand Central Station in their room where there lots of people coming in and out that needs to be stabilized as well.

01:18 Maintaining strict bed rest.

01:20 Now in the hospital, that's very different than being home.

01:23 If they're home and they're stable enough to be home, then strict bed rest is typically not what we're going to do.

01:29 In the hospital, however, if they're sick enough to be there, then strict bed rest is going to be important.

01:34 And that includes going to the restroom.

01:36 And that may need to be done via bed pan.

01:38 IV access.

01:40 Definitely going to be there in case our situation gets worse.

01:44 And then lab work is going to be ordered.

01:45 Again, likely this is going to need to be done step.

01:49 We're going to test the urine for protein.

01:51 It may be that the client ends up with an indwelling catheter which will make this much easier to do.

01:56 But it definitely will have to be done periodically to look for worsening preeclampsia.

02:01 So, I realized that I told you that the definitive cure for preeclampsia is delivery of the placenta.

02:07 So, why are we talking about things that are going on postpartum? Well, because patients can have continuing symptoms really even after the placenta comes out.

02:17 And some clients are actually going to really first be diagnosed during the postpartum with preeclampsia.

02:23 So, the first thing we want to make sure we're doing is monitoring the blood pressure.

02:27 So, that needs to happen at least the first 72 hours after delivery, that we're checking the blood pressure at least every eight hours to make sure that it's stabilizing.

02:35 Likely, it's going to be q4 hours for those first few hours to make sure we're doing okay.

02:41 When the patient goes home, they may need to come back sooner than two weeks or six weeks so that we can again see that the blood pressure is trending down.

02:50 And then finally, getting to our last point about clients who first are diagnosed with preeclampsia.

02:56 For the clients that have preeclampsia, anywhere from 0.3% to 27.5% of those clients who have preeclampsia, might be diagnosed during the postpartum period.

03:06 And it's likely that they were beginning to preeclampsia while they were in labor.

03:10 We just missed it for some reason.

03:12 So that's what that looks like during the postpartum period.