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A Nurse's Guide to Spotting Preeclampsia in Patients

Nurses are an integral part of patient care, especially for pregnant patients. Many nurses have the opportunity to form strong bonds with patients during the many monthly checkups, labor and delivery, and the postpartum period. They're the most consistent and attentive caregivers in medical settings and are often the first ones patients go to when they have questions about their care. Nurses can play a large role in patient advocacy as well, and in emergency situations, they may have to be the voice for the patient. In patients with preeclampsia, this is especially important. Nurses who work in obstetrics can make a huge difference by recognizing symptoms that the patient might write off as "not a big deal." Preeclampsia is a serious problem that can go undetected, and having someone who can help with diagnosis or hold a patient's hand while they deal with the complications it can cause can make a huge difference.

Educating Your Patients

Education is empowering, and nurses are one of the biggest providers of that education. Preeclampsia can strike quickly and progress rapidly, with the symptoms becoming severe in the time between regular monthly prenatal appointments. Educating patients on the symptoms of preeclampsia can give them a greater understanding of the seriousness of the condition so they can monitor themselves between appointments.

When pregnant patients recognize the signs and symptoms of preeclampsia because they were given a detailed understanding by their nurse, they are more likely to report symptoms as well as comply with treatment plans. This can help to minimize the adverse outcomes of preeclampsia and cause much less stress overall for the patient.

Symptoms of Preeclampsia

  • Abdominal pain in the right side
  • Blurry vision
  • Dark spots appearing in your vision
  • Headaches
  • High blood pressure
  • Light sensitivity
  • Protein in the urine
  • Retaining water (causing weight gain and swelling)
  • Shortness of breath
  • Swelling in your hands and face

Patient Care During Preeclampsia

photo of pregnant woman and doctor doing exam

Nurses and medical centers are expected to follow a standard set of practices for every pregnant person dealing with preeclampsia.

  • Blood pressure must be measured accurately. To do so, the patient should be positioned sitting or in a semi-reclining position, feet flat on the floor, legs uncrossed, and arms at heart level for 5 minutes while their blood pressure is measured.
  • Severe high blood pressure must be treated quickly. If the patient has two blood pressure readings in 15 minutes or less of 160/110 or higher, they must be treated with medication within an hour to avoid a stroke or a brain bleed. They must then be monitored to make sure the medication is working, and alternate support must be provided if it isn't.
  • Nurses should help prevent seizures. If the patient has already had a seizure, the staff must help prevent it from happening again by intravenously giving medication immediately. Medication may need to be given for longer than 24 hours after delivery if symptoms persist, but there must always be a stock of medication so there's no delay in treatment.
  • The care staff must be knowledgeable about how to handle preeclampsia and when to escalate care. Nurses must be prompt when it comes to evaluating the patient by looking at blood pressure, heart rate, and urine production and watching for confusion, agitation, loss of vision, persistent headaches, shortness of breath, or unresponsiveness.
  • Patients must be fully briefed on everything they need to know and given the support they need. Keeping patients informed every step of the way is important to ensuring that they understand what is happening. It's important in a life-or-death situation like preeclampsia for symptoms to be taken seriously by patients and care staff alike to keep everybody healthy.

Immediate Postpartum Support

Patients with high blood pressure during pregnancy should be closely monitored after birth. Even during the postpartum period, preeclampsia can occur and even worsen. In the United States, the standard of care suggests that patients have a six-week checkup, but those who experienced preeclampsia during their pregnancy should be seen between 48 and 72 hours after hospital discharge to check on their blood pressure. This is also a great time to let them know about preeclampsia symptoms that might arise during the postpartum period and fill out a symptoms sheet so you can get a better idea of how they're doing, even if they may be brushing things off as fine.

During the postpartum period, nurses should also check in on the patient's mental health. Those who survive preeclampsia are up to four times more likely to have post-traumatic stress disorder (PTSD) compared to those who had a healthy pregnancy. A nurse is a trusted advocate for emotional and mental health needs as well as physical needs, so having somebody there during a time of stress and emotional burden can do wonders in reducing trauma, both in the short term and the long term. These mental check-ins can be done in that initial appointment after discharge as well as at the six-week checkup.

Caring for Preeclampsia Patients Beyond Pregnancy

picture of woman in hospital bed with baby and nurse

Preeclampsia doesn't end when the baby is born: It puts the patient's health at risk for years to come. Those who have had preeclampsia can be at increased risk of heart disease, stroke, and high blood pressure for as long as 15 years postpartum. Having had preeclampsia one time may also increase the risk of having it again in future pregnancies.

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