Preeclampsia & Eclampsia Nursing Care

Preeclampsia is new-onset hypertension after 20 weeks of gestation (commonly ≥140/90 on two occasions) plus proteinuria — or, even without proteinuria, plus signs of organ involvement. The underlying problem is widespread endothelial dysfunction: vessels leak and spasm everywhere, which is why the disease shows up in the brain (headache, seizures), liver (epigastric pain, rising enzymes), kidneys (proteinuria, rising creatinine), lungs (edema), and platelets (falling counts).

Eclampsia is preeclampsia plus seizures. HELLP syndrome — hemolysis, elevated liver enzymes, low platelets — is a severe variant that can present with deceptively mild blood pressure. The only cure for any of them is delivery; everything else buys time and prevents catastrophe.

Track the disease by system: blood pressure trend (not single readings), deep tendon reflexes and clonus (hyperreflexia signals CNS irritability — the pre-seizure state), headache and vision (scotomata, blurring, light sensitivity), epigastric or RUQ pain (a liver capsule under tension — never dismiss it as heartburn), urine output and protein, edema pattern (face and hands, sudden weight gain), and lung sounds for pulmonary edema.

Fetal surveillance runs in parallel — the same diseased placenta that endangers the mother restricts the fetus, so continuous monitoring during magnesium therapy and severe-range pressures is standard. Decreased variability is expected with magnesium; late decelerations are not.

Seizure-safe environment from admission: low stimulation (quiet, dim, limited visitors), side rails padded per policy, suction and oxygen set up and checked, calcium gluconate available, IV access patent.

During an eclamptic seizure: stay, protect from injury, turn to the side as soon as possible (aspiration is the killer), do not force anything into the mouth, note time and character, support breathing after the tonic-clonic phase ends, and anticipate magnesium bolus orders and urgent delivery planning. Fetal bradycardia during the seizure is common — maternal stabilization comes first, because the fetus recovers when the mother does.

Severe-range BP is its own emergency: sustained ≥160/110 gets rapid-acting antihypertensives (labetalol, hydralazine, or nifedipine per protocol) — the goal is preventing maternal stroke, not normalizing the number.

Strict intake and output. Oliguria below ~30 mL/hr changes magnesium safety and signals worsening disease — it is a call, not a note.

This diagnosis hijacks a pregnancy story. The patient planned a birth; she got an infusion pump, hourly checks, and talk of early delivery. Name it: “This isn’t the experience you planned, and it’s okay to be upset about that while we keep you both safe.” Magnesium itself makes patients feel flushed, weak, and foggy — warn her before the load: “This medicine will make you feel hot and heavy. That’s expected. Tell me about anything else.”

Explain the checks so vigilance reads as care, not alarm: “I’ll be checking your reflexes and breathing every hour — that’s how we keep the medication at the right level.” Include the support person; they are your extra observer for headache, confusion, or twitching.

• Warning signs that mean call or come in now: severe headache, visual changes, right-upper-belly pain, sudden swelling of face/hands, decreased fetal movement

• Why blood pressure checks continue after the baby comes — the disease can appear or worsen up to six weeks postpartum

• Home BP monitoring technique and the numbers that trigger a call, per discharge plan

• Preeclampsia raises lifetime cardiovascular risk — this history belongs in every future medical visit

• In future pregnancies, early prenatal care and possibly low-dose aspirin per provider — recurrence risk is real and manageable