Need help with Nursing Diagnoses: Preeclampsia

[samiam4]

I can't seem to come up with nursing diagnoses to save my life!

I'm doing a case study and this is what it says:

S.D. is a 41 yr old woman, gravida 1 para 0, at 36 weeks gestation. This morning in clinic she had a BP of 143/93, Pulse of 78 beats/min, edema +2, headache, DTRs +2, proteinuria +3. She weighs 198 pounds and is 5'1". SHe is an insulin dependent diabetic. Her diabetes has been well controlled throughout the pregnancy. Her physician admits her for induction of labor.

Question:

List two priority nursing diagnoses from all information and develop a care plan for one of these.

What I came up with for diagnoses:

1. 1. Fluid Volume Deficit r/t plasma protein loss a/e/b edema +2, urine protein of +3, headache
2. 2. Decreased Cardiac Output r/t hypertension a/e/b blood pressure of 143/94
3. 3. Ineffective tissue perfusion (peripheral) r/t peripheral edema and hypertension a/e/b +2 edema and B/P of 143/93
4. 4. Deficient Knowledge, regarding induction of labor and delivery r/t gravida 1 para 0

I know I'm only supposed to come up with 2 priority nursing diagnoses but I'm just not happy with any of my choices because I feel that they are wrong and don't make any sense..... Can someone help me revise my current nursing diagnoses so that they are correct? Thanks!!

[nurseprnRN, BSN, RN]

You're right; other than the knowledge deficit (and this lady may have a much bigger problem than being a g1p1), they don't make sense .

"1. Fluid volume deficit r/t plasma protein loss a/e/b edema +2, urine protein of +3, headache

Do you have any evidence that she has a fluid volume deficit? It is true that plasma protein loss could cause one, but deficits are not necessarily caused by edema, urine protein, or headache (which is what you're saying which is why it doesn't make sense).

2. Decreased cardiac output r/t hypertension a/e/b blood pressure of 143/94

High blood pressure doesn't cause decreased cardiac output. Generally speaking, high cardiac output is the result of strong cardiac function; low cardiac output is the result of something wrong with the heart (except for really bad hypovolemic shock, where your heart can be fine but just not have anything to pump).

3. Ineffective tissue perfusion (peripheral) r/t peripheral edema and hypertension a/e/b +2 edema and b/p of 143/93"

What's your evidence for ineffective perfusion, which is usually used to refer to inadequate arterial flow and low tissue oxygenation? See, that isn't caused by edema or high blood pressure either.

So, let's look at what you know about preeclampsia, a medical indication for early induction that has to do with high blood pressure and ....? -- what are its symptoms, and why should we care? What's a common complication of diabetes (what body system is affected early?), and what you would have to observe and intervene for? What are you finding in your ob book about preeclampsia?

See what you find there, and then come back. I'll bet you'll get some great ideas in your text.

[samiam4]

Hey, thanks for the reply!

After researching and going through my book...I found a nursing diagnosis:

Book says:

Deficient fluid volume r/t fluid shift from intravascular space secondary to vasopasm.

Goal: client is restored to normal fluid volume levels

This one I came up with myself after reading the text:

Ineffective tissue perfusion r/t vasospasm a/e/b elevated blood pressure (143/94)

Goal: Blood pressure will be within acceptible limits, below 140/90mm Hg within in 48 hours

Unfortunately i have no idea what the book diagnosis means?! Can someone please explain?

What do you think of my new diagnosis I came up with?

This nursing diagnoses thing is still giving me a huge headache and anxiety....

Preeclampsia- hypertension, proteinuria, edema, elevated liver funtion tests. Generalized vasospasm and endothelial cell damage decrease perfusion and oxygenation throughout the body causing widespread organ dysfunction.

[KimN]

Okay okay let's see if I can make any sense here from student to student. It seems that maybe prioritizion is the issue here? I know when I started nursing school I would be so stressed about these things that I would find myself pulling for amy diagnosis that would fit, that I didn't think about the actual components of the problem and what is the most pressing issue that I need to be aware of as a nurse.

The goal for preeclampsia is to get momma as far along or as close to term as we can get her and prevent her from developing eclampsia (seizures). Eclampsia can cause significant fetal harm and possibly death because of insufficient oxygenation. So that is a safety issue that takes priority in this case. Yes, she has high blood pressure but are you sure that her problem is related to fluid deficit .. and if so what makes you think that? Are there medications and non-pharmacological treatments that can help reduce the risk of this woman having a seizure? And what about the fetus ... you've got two patients here so we need to be monitoring them both. So I think if you decided to bring the baby in and the risk for hypoxia related to (vasospasms/seizure/whatever) as evidenced by (signs of more severe preeclampsia .. headache, BP, DTRs, etc). Also, what if she has a seizure - what would have to happen then? ... hmm premature delivery ... C-section complications ... ??

And lets think about diabetes here too and how that can complicate preeclampsia as well as the baby when it's born. What signs will the baby have from having a diabetic mother .. what are the S/S of hypoglycemia in baby and momma.

I know it's a ramble but I hope it helps. This stuff can be very fun and fulfilling if done thoroughly and thoughtfully. You'll be thankful one day when you see it in real life and think "I know about this!" :)