Nursing Care Plan

Preeclampsia - 4 Nursing Diagnosis

Nursing Diagnoses 2015-17:
Definitions and Classification
(NANDA Nursing Diagnoses)

Preeclampsia is a serious health disorder that affects the minority of pregnant women. It is a condition where a pregnant woman has high blood pressure and high levels of protein in her urine. Preeclampsia is usually pronounced during second trimester and third trimester in pregnancy.

The main and first symptom of preeclampsia is hypertension, usually a reading of 140/90 mm Hg or an increase of 30 mm Hg systolic (top number) and 15 mm Hg diastolic (bottom number) in your normal blood pressure reading. High increase in the blood pressure imposes is the first symptom of Preeclampsia in pregnant women. Preeclampsia can develop into eclampsia, a condition where the mother would have seizures. While rare, other complications for the mother include stroke, rupture of the liver, bleeding problems, and premature separation of the placenta from the uterus prior to birth. Preeclampsia is more common with first pregnancies, teenage mothers, women over 40 and carrying multiple fetuses, but any pregnant woman can develop it. It usually develops late in the pregnancy (after 37 weeks) but can occur any time from 20 weeks to two weeks after delivery.

Mild preeclampsia usually has no noticeable symptoms and is only found when a pregnant woman goes in for her normal prenatal visit and her doctor discovers elevated protein in the urine and high blood pressure. The difference between mild and severe preeclampsia is only 20 mm Hg systolic and 10 mm Hg diastolic.

The only cure for preeclampsia is to give birth.

It is common that women who are diagnosed with preeclampsia do not feel like anything is wrong. Some preeclampsia symptoms include:
  •     Pains in the abdominal area
  •     Urinating less than normal
  •     Weight gain more than two pounds per week
  •     Rapid weight gain over a few days
  •     Persistent dull, throbbing headaches
  •     Nausea and vomiting
  •     Vision problems
Women with a history of preeclampsia are more at risk for more severe versions of the condition for later pregnancies.

Changes in reflex and nervous system are another factor. The nervous system coordinated the body system and its functionality. The nervous system controls and coordinates all our actions as humans as all the body systems are connected to each other. Preeclampsia affects the central nervous system which results to severe headache, impaired vision, partial and sometimes total blindness.

Abdominal Pains as a result of liver malfunction. The liver being a vital organ in the body plays important role in digestion. This is specifically connected to protein and amino acids stability. Through deamination and detoxication of protein, the liver gets rid of nitrogenous waste products that are not excreted by the kidney from the blood stream.

After the data is collected and then analyzed so that the diagnosis may be found in severe preeclampsia clients are:
1. Fluid Volume Deficit related to plasma protein loss, decreased colloid osmotic pressure. (Marilyn Doenges, 2000)
2. Impaired tissue perfusion related to the occurrence of vasospasm arterioles (prene M Bobak, 1995:835)
3. Risk for Injury: the fetus related to inadequate placental blood perfusion (Prene M Bobak 1989:718)
4. Imbalanced Nutrition, Less Than Body Requirements related to inadequate food intake manifested by nausea and anorexia (Sharon J Reeder, 1987:747)
5. Anxiety: moderate: fear of pregnancy failure related to lack of knowledge (Marilyn Doenges, 2000)

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