Treatment and Nursing
(1) Home care is suitable for mild cases, involving outpatient treatment combined with home rest. The goal is to control the condition through enhanced monitoring and prevent progression to severe stages.
a. Ensure rest. Reduce workload appropriately or rest at home. In addition to ensuring 8–10 hours of nighttime sleep, daytime naps of 2 hours are recommended. Advocating left-side lying helps increase urine output and improves uteroplacental circulation.
b. Dietary guidance. Choose high-protein, vitamin-rich, low-fat foods; ensure adequate iron and calcium supplementation. Unless there is generalized edema, salt restriction is not strictly enforced, but excessive consumption of salted foods should be avoided.
c. Medication therapy. Appropriate sedatives such as diazepam can inhibit the thalamus and hypothalamus, reducing stimulation. Inform pregnant women about medication effects to alleviate concerns and encourage cooperation.
d. Prenatal check-ups. Strengthen maternal and fetal monitoring by increasing visits to high-risk clinics. Educate pregnant women and their families to recognize persistent headache, upper abdominal pain, blurred vision, nausea, vomiting, or facial and hand swelling. Immediate medical consultation is required upon symptom onset.
(2) Hospital care: For patients whose condition cannot be controlled through home observation or those with moderate to severe cases, hospitalization is generally necessary.
① Psychological care. Actively care for the pregnant woman, patiently answer questions, help her become familiar with the hospital environment, and relieve anxiety.
② Rest. Except under special circumstances, patients should remain in bed (preferably left-side lying). Provide a clean, quiet environment with dim lighting to ensure rest and sufficient sleep.
③ Diet. Provide high-protein, vitamin-rich, low-fat, low-salt food. Once improvement occurs, gradually resume normal salt intake. If sudden headache, chest tightness, or blurred vision appears, contact the physician immediately for emergency measures.
④ Increase monitoring, closely observe changes in condition, record input and output, regularly monitor fetal heart rate and blood pressure, and pay attention to subjective symptoms. If sudden headache, chest tightness, or blurred vision occurs, contact the physician immediately for emergency intervention.
⑤ Regularly test urine routine, specific gravity, protein quantification, accurately weigh body weight, and repeat fundus examination to assess treatment efficacy.
⑥ Ward management. Keep the ward tidy with minimal items, dim lighting, quiet, and comfortable. Position beds away from walkways, equip with bed rails, emergency carts, and suction devices.
⑦ Medication therapy. Administer sedatives, antihypertensives, antispasmodics, and diuretics as prescribed. Know drug forms, dosages, actions, side effects, and routes of administration; adjust dosage timely according to condition changes as directed.
⑧ Termination of pregnancy. If the condition continues to deteriorate despite active treatment or shows no significant improvement, carefully weigh pros and cons and consider inducing labor.
(3) Management of eclampsia: Eclampsia is the most severe stage of pregnancy-induced hypertensive syndrome. Principles include controlling convulsions, preventing injury, minimizing stimuli, and timely termination of pregnancy.
① Assign dedicated personnel for continuous nursing care.
② For unconscious patients, use head-low lateral position, elevate one shoulder. Promptly clear oral secretions to maintain airway patency. Temporarily withhold food. Provide oxygen inhalation. Place a gauze-wrapped tongue depressor between teeth. Install bed rails around the bed to prevent falls.
③ Hang dark curtains to block light; keep room quiet and well-ventilated. Perform all procedures centrally to minimize disturbance and external stimuli that could trigger convulsions.
④ Use magnesium sulfate and other drugs as prescribed to control convulsions.
⑤ Closely monitor condition, track labor signs, measure blood pressure, pulse, respiration, and temperature every hour. Record input/output, send blood and urine samples for testing promptly, repeat fundus examination and bedside ECG. Early detection and management of complications such as cerebral edema, pulmonary edema, acute renal failure, and placental abruption.
⑥ Timely termination of pregnancy. Eclampsia often leads to spontaneous labor. If no labor signs, decide delivery method within 24–48 hours after convulsion control based on gestational age, pelvic conditions, cervical status, and fetal maturity. Since symptoms improve after pregnancy termination, timely delivery is an effective treatment.
⑦ Eclampsia may still occur within 24 hours postpartum to 5 hours post-delivery; continue close monitoring and care.
(4) Nursing Care for Magnesium Sulfate Use: Magnesium sulfate has antispasmodic, antihypertensive, and diuretic effects. Intravenous infusion or intramuscular injection effectively prevents and controls eclampsia in moderate to severe pregnancy-induced hypertensive syndrome. Magnesium sulfate is also a central nervous system depressant; overdose may lead to respiratory and cardiac inhibition, even death. Therapeutic doses have no significant effect on uterine contractions or fetus. Normal serum magnesium levels in pregnant women range from 0.75–1 mmol/L; therapeutic levels are 2–3 mmol/L; levels above 3–3.5 mmol/L indicate toxicity, initially manifesting as absent knee reflexes, followed by generalized muscle weakness and respiratory suppression. Levels exceeding 7.5 mmol/L may cause cardiac arrest. Thus, emphasis is placed on:
① Check knee reflex, breathing rate (≥16 breaths/min), and hourly urine output (≥25ml) before each dose and during continuous IV infusion.
② Keep calcium gluconate (10% solution, 10ml ampoule) at bedside for immediate IV injection in case of magnesium toxicity.
③ Intramuscular magnesium sulfate is irritating to local tissues; therefore, add 2ml of 2% procaine, use a long 8.33cm needle for deep gluteal injection. If redness, swelling, or pain occurs locally, apply hot compresses.
④ During IV administration, monitor fetal heart rate and movements, increase surveillance to prevent extravasation. Strictly control infusion speed (ideally 1g/hour, maximum 2g/hour) to maintain therapeutic blood magnesium levels.
Magnesium sulfate usage: Initial loading dose is 10ml of 25% magnesium sulfate dissolved in 10ml of 25% glucose, slowly injected IV (no less than 5 minutes). Then, 60ml of 25% magnesium sulfate is dissolved in 1000ml of 5% glucose for IV drip (1g/hour, max 2g/hour). Stop IV drip at bedtime, switch to 10ml of 25% magnesium sulfate plus 2ml of 2% procaine for deep gluteal IM injection. Starting the next day, skip the loading dose, only use IV drip and nightly IM injection for several days. Alternatively, use only IM injection: 20ml of 25% magnesium sulfate plus 2ml of 2% procaine, administered every 6 hours. The disadvantage of IM injection is local pain, which may be poorly tolerated. IV drip achieves peak blood magnesium concentration within 1 hour, then rapidly declines; IM injection peaks at 2 hours, then declines slowly. Therefore, using IV drip during the day and IM injection at night maintains sustained effective blood magnesium levels. Clinical choice depends on condition, adjusting route and dosage as needed.<Pregnancy-induced Hypertensive Syndrome>