Assessment Nursing Diagnosis Objectives Intervention Rationale Evaluation

Subjective Data: Risk for Complications - Stabilize the - Initiate MgSO4 - Medications like - The patient's
Related to Severe blood pressure infusion as per MgSO4, vital signs are
Objective Data: Preeclampsia: Due to of the mother the provided labetolol, monitored,
- Patients' main the patient's elevated within the protocol to nifedipine, and including blood
complaints: blood pressure, normal range prevent seizures hydralazine are pressure,
pelvic cramps, proteinuria, and (systolic 140 associated with essential to neurological
lower back neurological symptoms, mmHg, severe manage severe status, pain
discomfort, there is a risk of diastolic 90 preeclampsia. preeclampsia and levels,
headache, complications such as mmHg). - Provide pain hypertension, emotional state,
impaired vision. eclampsia, stroke, and - If feasible, relief measures, preventing fetal heart rate,
organ dysfunction. delay the such as complications. and treatment
- Obstetric history: progression of acetaminophen - Pain management response.
G1P0, estimated preterm labor. or other improves the - Pain relief
30 weeks, no - Ensure the prescribed patient's comfort measures are
prenatal care. health of the medications, to and reduces assessed, and
fetus and watch alleviate the stress, potentially emotional
- Low medical for indicators of pelvic cramping lowering blood support is
history, no meds. distress. and headache. pressure. provided. The
- Inform the - Offer emotional - Continuous fetal patient's well-
- High blood patient about support and monitoring being is
pressure 175/115, preeclampsia, education to the ensures the well- monitored, and
heart rate 95, preterm labor, patient being of the adjustments to
respiration rate and the regarding her fetus, guiding the care plan are
17, temperature significance of medical clinical decisions. made based on
36.5. prenatal care. condition, - Emotional the patient's
treatment, and support and response to
- Tender lower the importance education treatment.
abdomen, 2 cm of prenatal care. empower the
dilated cervix, - Involve a social patient to
greenish worker or participate in her
discharge per os. counselor if care, reducing
necessary to anxiety and
- Urinalysis: 3+ address anxiety promoting
protein, 2+ blood. and stress overall well-
related to the being.
- Assessment: If unplanned
available, fetal pregnancy and
heart rate health concerns.
monitoring.
Drug Study: Magnesium Sulfate (MgSO4):
Classification: Anticonvulsant
Indication: Prevention of eclampsia and as a neuroprotective agent for the fetus.
Action: Reduces neuromuscular irritability and blocks peripheral neuromuscular transmission.
Dosage and Administration: Loading dose of 4g IV over 20-30 minutes, followed by a maintenance dose of 1g/hour IV.
Nursing Considerations: Monitor vital signs, reflexes, respiratory rate, and urine output regularly. Assess for signs of magnesium toxicity (depressed reflexes,
respiratory depression). Administer via a volumetric infusion pump.