Page 687 - Saunders Comprehensive Review For NCLEX-RN

10. The need for preterm delivery or cesarean delivery
11. Maternal and/or fetal death

J. Interventions for hypertension and preeclampsia

1. Close blood pressure and weight monitoring
throughout the pregnancy; the client may need to be
taught how to take her blood pressure at home.
2. Weekly or twice weekly health care visits may be
necessary; delivery may be recommended at 37 weeks
of gestation (earlier if there is evidence of fetal
distress).
3. Monitor fetal activity (teach the client how to perform
Kick counts) and fetal growth (ultrasounds will be
prescribed).
4. Encourage frequent rest periods, instructing the client
to lie in the lateral position; for preeclampsia with
severe features, the client may be hospitalized and
bed rest may be prescribed (client should be placed in
the lateral position).
5. Administer medications as prescribed to reduce blood
pressure; blood pressure should not be reduced
rapidly, because placental perfusion can be
compromised.
6. Provide adequate fluids.
7. Monitor intake and output; a urinary output of
30 mL/hr indicates adequate renal perfusion.
8. Monitor neurological status, because changes can
indicate cerebral hypoxia or impending seizure.
9. Monitor deep tendon reflexes and for the presence of
hyperreflexia or clonus, because hyperreflexia
indicates increased central nervous system irritability
(Box 22-5).
10. Monitor for HELLP syndrome.
11. Evaluate renal function through prescribed studies
such as blood urea nitrogen, serum creatinine, and 24-
hour urine levels for creatinine clearance and protein.
12. Magnesium sulfate (use a controlled infusion device)
may be prescribed to prevent seizures; magnesium
sulfate may be continued for 24 to 48 hours
postpartum.
13. Monitor for signs of magnesium toxicity with the
administration of magnesium sulfate, including
flushing, sweating, hypotension, depressed deep
tendon reflexes, decreased urine output, and central
nervous system depression including respiratory
depression; keep antidote (calcium gluconate)
available for immediate use, if necessary.
14. Corticosteroids may be prescribed to promote fetal

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