Report severe headache, visual disturbances, or epigastric/right upper quadrant pain as these signal impending eclampsia.
Before you read
Test yourself first: 1 question
Question 1 of 1
A client receiving IV magnesium sulfate for preeclampsia has absent deep tendon reflexes, a respiratory rate of 10, and decreased urine output. What is the nurse's FIRST action?
Answer: B. These findings indicate magnesium sulfate toxicity. The nurse should first stop the infusion to prevent further accumulation, then notify the provider and prepare to administer calcium gluconate, the antidote that antagonizes magnesium's effects. Continuing the infusion would worsen the respiratory depression.
Keep the streak going with more questions like these, each with a full rationale.
What is preeclampsia?
It is caused by abnormal placental development leading to vasospasm, endothelial damage, and reduced organ perfusion. It matters because untreated it can progress to eclampsia (seizures), HELLP syndrome, and fetal compromise. Classic triad memory aid: hypertension, proteinuria, edema.
Key points to remember
- New-onset BP at or above 140/90 on two readings after 20 weeks gestation defines the hypertension component.
- Proteinuria (300 mg or more in 24 hours, or protein/creatinine ratio elevation) reflects glomerular damage.
- Generalized vasospasm reduces perfusion to the brain, liver, kidneys, and placenta.
- Severe-feature signs include headache, visual changes (blurring, spots, scotomata), and epigastric or right upper quadrant pain from hepatic capsule stretch.
- Hyperreflexia and clonus indicate central nervous system irritability and rising seizure risk.
- Sudden facial and hand edema with rapid weight gain reflects third-spacing of fluid.
Signs & symptoms
- BP ≥ 140/90 after 20 wks
- Proteinuria, edema (face/hands)
Nursing priorities
- Monitor blood pressure frequently and assess deep tendon reflexes and clonus each shift.
- Place the patient on the left lateral side to maximize uteroplacental perfusion.
- Administer prescribed antihypertensives (labetalol, hydralazine, nifedipine) to keep BP controlled but not hypotensive.
- Initiate magnesium sulfate as ordered for seizure prophylaxis in severe features and keep the environment quiet and low-stimulus.
- Maintain seizure precautions and have oxygen, suction, and emergency medications at the bedside.
Labs & values
Patient teaching
- Report headaches, visual changes, or upper abdominal pain immediately rather than waiting for an appointment.
- Keep all prenatal visits for blood pressure, weight, and urine monitoring.
- Rest on the left side and follow activity restrictions prescribed by the provider.
Red flags: report now
- Report severe headache, visual disturbances, or epigastric/right upper quadrant pain as these signal impending eclampsia.
- Report oliguria (urine output under 30 mL/hr), which indicates worsening renal perfusion.
- Report a sudden drop in platelets, rising liver enzymes, or hemolysis, which suggest HELLP syndrome.
- Definitive cure is delivery of the placenta; escalate immediately if seizures, severe BP, or fetal distress occur.
References
Clinical references for this topic
