Implementing Screening Guidelines for Preeclampsia Prevention in a Birth Center: A Quality Improvement Project.

The aim of the project was to identify women at risk for developing preeclampsia who present for birth center care in order to initiate preventative treatment and retain them within the birth center practice. Birth center patients with preeclampsia disqualify for birth center care requiring hospital transfer. The target population consisted of pregnant women choosing birth center care with certified nurse midwives. Quality improvement method was utilized. Over 5-weeks, patients with 12 to 28 weeks' gestation were screened for preeclampsia risk factors; patients with high risk for preeclampsia initiated low-dose aspirin (LDA). All patients were evaluated for preeclampsia diagnosis up to 2 weeks postpartum. Outcomes were evaluated through chart audits. Screening for preeclampsia risk significantly increased LDA use. Preeclampsia screening did not statistically reduce incidences of preeclampsia but did show a moderate reduction. Use of LDA did not statistically reduce preeclampsia diagnoses but had a large reduction effect. Screening for preeclampsia in birth center patients results in increased use of LDA and potentially decreased rates of hospital transfer. Implementing preeclampsia screening is cost-effective and allows for increased patient retention.

Husband's knowledge related to their role in caring wives with preeclampsia risk

OBJECTIVE: Around the world, preeclampsia still become a problem. It is affected nearly eight percent of total pregnancies and resulted in women's morbidity and mortality. Pregnant women who are at risk for preeclampsia certainly need support from the family, especially their husband. Some studies suggest that the expecting fathers was less involved in pregnancy. Other studies also suggested that men have less knowledge about pregnancy complication. The purpose of this study was to analyze the correlation between husband's knowledge and their role in caring wives with preeclampsia risk. METHOD: The design in this study was cross-sectional with purposive sampling. There were 93 husbands involved in the study. Data collection used questionnaires and analyzed by Spearman's rho test (α≤0.01). The independent variable was husband's knowledge and the dependent variable was their role in caring wives with preeclampsia risk. RESULT: More than 60% participant had less knowledge about preeclampsia especially the signs and the risk factors. The majority of husband performed moderate role in caring their wives. Their role included attends antenatal visit, motivates their wives to reduce salt intake and limit tiring activity. Only less than 20% always avoid smoking while at home, helps with house chores, and seeking information related preeclampsia. The results showed that there was a correlation between husband's knowledge and their role in caring wife with preeclampsia risk (p = 0.000; r=0.440). CONCLUSION: Husbands with more knowledge about preeclampsia performed better role in caring wives with preeclampsia risk

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From pregnancy to renal disease: Understanding preeclampsia.

Preeclampsia is a hypertensive disorder of pregnancy defined as new-onset hypertension that develops during pregnancy and resolves after delivery. Using a case history as an illustration, this article discusses hypertensive disorders of pregnancy with a focus on preeclampsia and its renal implications.

Simulation-enhanced nurse mentoring to improve preeclampsia and eclampsia care: an education intervention study in Bihar, India.

BACKGROUND: Inadequately treated, preeclampsia and eclampsia (PE/E) may rapidly lead to severe complications in both mothers and neonates, and are estimated to cause 60,000 global maternal deaths annually. Simulation-based training on obstetric and neonatal emergency management has demonstrated promising results in low- and middle-income countries. However, the impact of simulation training on use of evidence-based practices for PE/E diagnosis and management in low-resource settings remains unknown. METHODS: This study was based on a statewide, high fidelity in-situ simulation training program developed by PRONTO International and implemented in collaboration with CARE India on PE/E management in Bihar, India. Using a mixed methods approach, we evaluated changes over time in nurse mentees' use of evidence-based practices during simulated births at primary health clinics. We compared the proportion and efficiency of evidence-based practices completed during nurse mentees' first and last participation in simulated PE/E cases. Twelve semi-structured interviews with nurse mentors explored barriers and enablers to high quality PE/E care in Bihar. RESULTS: A total of 39 matched first and last simulation videos, paired by facility, were analyzed. Videos occurred a median of 62 days apart and included 94 nurses from 33 primary health centers. Results showed significant increases in the median number of 'key history questions asked,' (1.0 to 2.0, p = 0.03) and 'key management steps completed,' (2.0 to 3.0, p = 0.03). The time from BP measured to magnesium sulfate given trended downwards by 3.2 min, though not significantly (p = 0.06). Key barriers to high quality PE/E care included knowledge gaps, resource shortages, staff hierarchy between physicians and nurses, and poor relationships with patients. Enablers included case-based and simulation learning, promotion of teamwork and communication, and effective leadership. CONCLUSION: Simulation training improved the use of evidence-based practices in PE/E simulated cases and has the potential to increase nurse competency in diagnosing and managing complex maternal complications such as PE/E. However, knowledge gaps, resource limitations, and interpersonal barriers must be addressed in order to improve care. Teamwork, communication, and leadership are key mechanisms to facilitate high quality PE/E care in Bihar.

Significado del cuidado de enfermería en la gestante con preeclampsia en la Unidad de Cuidado Intensivo Obstétrico / Meaning of nursing care in pregnant women with preeclampsia in the Obstetric Intensive Care Unit

Introducción. La preeclampsia sigue siendo la segunda causa de morbilidad materna en el Huila, por tal motivo, la gestante con preeclampsia debe ingresar a una unidad de cuidados intensivos con el ánimo de mitigar complicaciones. De estas unidades intensivas obstétricas se conoce que existen cuatro en Colombia; una de ellas en Neiva-Huila. Por tratarse de un sitio relativamente novedoso, aún se desconocen las características de cuidado que allí se ofrecen desde la vivencia de la gestante gravemente enferma. Objetivo. Describir el significado del cuidado de enfermería para las gestantes con preeclampsia, a partir de una vivencia de hospitalización en la Unidad de Cuidado Intensivo Obstétrico del Hospital Universitario de Neiva, durante el segundo semestre de 2017 Metodología. Estudio de tipo cualitativo, fenomenología interpretativa según la visión heideggeriana, en el que participaron voluntariamente 11 mujeres, seleccionadas según criterios de muestro teórico. La muestra se definió por saturación teórica y la recolección de datos mediante entrevistas a profundidad; el análisis y reducción siguió la técnica hermenéutica propuesta por Diekelman, Allen y Tanner. Resultados. Para las participantes del estudio, el significado del cuidado de enfermería en la Unidad Intensiva Obstétrica se encuentra sustentado bajo cuatro temas: intercambiando saberes y satisfacciones, una mujer invisible, relación transpersonal de cuidado, necesidades. Conclusiones: las gestantes que vivieron la experiencia de ser cuidadas en la unidad intensiva obstétrica, agradecen el cuidado que brinda la enfermera y lo reconocen como un aspecto fundamental para sobrellevar la dura situación de estar aisladas de su familia e hijos mientras atraviesan una situación que pone en riesgo su vida, esta hospitalización representa el cambio absoluto de su rol, en este entorno alejado y frio el significado que las mujeres dan al cuidado de enfermería, prioriza en un intercambio constante de emociones donde emerge una relación de dos seres humanos que no siempre es positiva.

Introduction. Preeclampsia continues to be the second cause of maternal morbidity in Huila, for this reason, the pregnant woman with preeclampsia must enter an intensive care unit with the intention of mitigating complications. Of these intensive obstetric units it is known that there are four in Colombia; one of them in Neiva-Huila. Because it is a relatively new site, the characteristics of care that are offered there from the experience of the seriously ill pregnant woman are still unknown. Objective. Describe the meaning of nursing care for pregnant women with preeclampsia, from a hospitalization experience in the Obstetrics Intensive Care Unit of the University Hospital of Neiva, during the second semester of 2017 Methodology. Qualitative, hermeneutic, interpretive study, in which 11 women voluntarily participated, selected according to criteria of theoretical sampling. The sample was defined by theoretical saturation and data collection through in-depth interviews; the analysis followed the hermeneutical technique proposed by Diekelman, Allen and Tanner. Results For the study participants, the meaning of nursing care in the Intensive Obstetric Unit is based on four themes: exchanging knowledge and satisfaction, an invisible woman, transpersonal relationship of care, needs. Conclusions: pregnant women who lived the experience of being cared for in the intensive obstetric unit, appreciate the care provided by the nurse and recognize it as a fundamental aspect to cope with the harsh situation of being isolated from their family and children while going through a situation that puts At risk your life, this hospitalization represents the absolute change of your role, in this remote and cold environment the meaning that women give to nursing care, prioritizes in a constant exchange of emotions where a relationship of two human beings emerges that is not always It is positive.

Preeclampsia: Acute Complications and Management Priorities.

Acute complications of preeclampsia contribute substantially to maternal and fetal morbidity and mortality. The considerable variation in onset, clinical presentation, and severity of this hypertensive disease that is unique to pregnancy creates challenges in identifying risk factors for clinical deterioration. Delivery of the fetus remains the only definitive treatment for preeclampsia. Surveillance of signs and symptoms and laboratory parameters consistent with progression in severity requires an appreciation of the dynamic and progressive nature of the disease. This article provides a comprehensive overview of the pathophysiology of preeclampsia, setting the foundation for discussion of management priorities for acute complications that pose the greatest risks to maternal health.

CE: Preeclampsia: Current Approaches to Nursing Management.

: Preeclampsia, one of four hypertensive disorders of pregnancy, has traditionally been characterized as new-onset hypertension and proteinuria developing after 20 weeks' gestation. It is, however, now understood to be a complex, progressive, multisystem disorder with a highly variable presentation and a number of potentially life-threatening complications. The American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy has refined preeclampsia diagnostic criteria accordingly, and as the disorder's pathogenesis has been more clearly defined, new targets for screening, diagnosis, prevention, and treatment have emerged. This clinical update provides a review of current practice related to preeclampsia risk assessment, prediction, and management. It discusses preeclampsia pathophysiology and points readers to valuable health care resources on the topic.

Nursing care for women with pre-eclampsia and/or eclampsia: integrative review.

OBJECTIVE: To analyze the available evidence in the literature on nursing care for women with pre-eclampsia and/or eclampsia. METHODS: Integrative review searching for primary studies in the databases PubMed, CINAHL, LILACS and SciELO. RESULTS: The sample size consisted of 17 primary studies published between January 2000 and December 2014, grouped into four categories: standardizing blood pressure measurement technique; training with simulation; instruments for standardization of care and quality of care The main nursing actions were: physical examination, early detection of signs of pre-eclampsia/eclampsia, monitoring of laboratory tests, fetal assessment, qualification and training of professionals. We identified the need for standardization of care from instruments, protocols and blood pressure measurement technique, early identification and treatment of hypertensive crisis through institutional protocols and review of cases and work processes. CONCLUSION: Women with pre-eclampsia and/or eclampsia require specific nursing care, which must be guided by care protocols based on scientific evidence. OBJETIVO: Analisar as evidências disponíveis na literatura sobre assistência de enfermagem às mulheres com pré-eclâmpsia e/ou eclâmpsia. MÉTODO: Revisão integrativa cuja busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL, LILACS e SciELO. RESULTADOS: Amostra foi composta por 17 estudos primários, publicados entre janeiro de 2000 e dezembro de 2014, agrupados em quatro categorias: padronização da técnica de mensuração da pressão arterial; treinamentos com simulação; instrumentos para padronização da assistência e qualidade da assistência As principais ações de enfermagem foram: exame físico, identificação precoce de sinais de pré-eclâmpsia/eclâmpsia, acompanhamento de exames laboratoriais, avaliação fetal, capacitação e treinamento dos profissionais. Identificou-se a necessidade de padronização do atendimento a partir de instrumentos e protocolos e da técnica de aferição da pressão arterial, identificação e tratamento precoces da crise hipertensiva mediante protocolos institucionais e revisão de casos e processos de trabalho. CONCLUSÃO: Mulheres com pré-eclâmpsia e/ou eclâmpsia exigem cuidados de enfermagem específicos, os quais devem ser pautados em protocolos de cuidados baseados em evidências científicas.

Assistência de enfermagem a parturientes acometidas por pré- eclâmpsia / Nursing assistance to parturients affected by pre-eclampsia / Cuidados de enfermería a las parturientas afectadas por la preeclampsia

Objetivo: avaliar a assistência de enfermagem prestada à mulher acometida por pré-eclampsia e investigar junto aos enfermeiros, queixas, conflitos e medos da mulher no decurso da gestação. Método: estudo exploratório, com abordagem qualitativa, realizado entre agosto e setembro de 2011, com 16 enfermeiros, em duas maternidades para gestação de alto risco de João Pessoa/PB. Os dados foram analisados a partir da técnica do Discurso do Sujeito Coletivo. Resultados: as ideias centrais foram: Cuidado voltado a préeclampsia; Sentimentos quanto à hospitalização; Orientações dietéticas e de controle da pressão arterial; e Atendimento das necessidades individuais e avaliação dos resultados. Conclusão: a Sistematização da Assistência de Enfermagem proporciona benefícios à paciente e à equipe da saúde, facilitando o processo de trabalho.(AU)

Objective: to evaluate the nursing assistance provided to women affected by pre eclampsia and investigate with the nurses; complains; conflicts and women's fear during the pregnancy time. Method: an exploratory study with qualitative approach which took place between August and September 2011, with 16 nurses, in two maternities to high risk pregnancy in Joao Pessoa/PB. Data were analyzed trough the Collective Subject Discourse technique. Results: the main ideas were: Care turned to pre-eclampsia; feelings about hospitalization; dietary and pressure arterial control guidelines; necessity individual cares and results evaluation. Conclusion: the nursing assistance systematization provides benefits to the patient and to the Health team, making easier the work process.(AU)

Objetivo: evaluar la atención de enfermería prestada a las mujeres afectadas por la preeclampsia y investigar con las enfermeras, quejas, conflictos y temores de las mujeres durante el embarazo. Método: estudio exploratorio con enfoque cualitativo, llevado a cabo entre agosto y septiembre de 2011, con 16 enfermeras en dos hospitales para los embarazos de alto riesgo de João Pessoa/PB. Los datos fueron analizados a partir de la técnica del Discurso del Sujeto Colectivo. Resultados: las ideas centrales fueron: Precaución volvida a preeclampsia; Sentimientos sobre la hospitalización; directrices sobre la dieta y el control de la presión arterial; la satisfacción de las necesidades individuales y la evaluación de resultados. Conclusion: la sistematización de la asistencia de enfermería proporciona beneficios para la paciente y el equipo de enfermería, lo que facilita el proceso de trabajo.(AU)

Nursing care for women with pre-eclampsia and/or eclampsia: integrative review / Asistencia de enfermería a mujeres con preeclampsia y/o eclampsia: revisión integradora / Assistência de enfermagem a mulheres com pré-eclâmpsia e/ou eclâmpsia: revisão integrativa

Abstract OBJECTIVE: To analyze the available evidence in the literature on nursing care for women with pre-eclampsia and/or eclampsia. METHODS: Integrative review searching for primary studies in the databases PubMed, CINAHL, LILACS and SciELO. RESULTS: The sample size consisted of 17 primary studies published between January 2000 and December 2014, grouped into four categories: standardizing blood pressure measurement technique; training with simulation; instruments for standardization of care and quality of care The main nursing actions were: physical examination, early detection of signs of pre-eclampsia/eclampsia, monitoring of laboratory tests, fetal assessment, qualification and training of professionals. We identified the need for standardization of care from instruments, protocols and blood pressure measurement technique, early identification and treatment of hypertensive crisis through institutional protocols and review of cases and work processes. CONCLUSION: Women with pre-eclampsia and/or eclampsia require specific nursing care, which must be guided by care protocols based on scientific evidence.

Resumen OBJETIVO: Analizar las evidencias disponibles en la literatura acerca de la asistencia de enfermería a las mujeres con preeclampsia y/o eclampsia. MÉTODO: Revisión integradora, cuya búsqueda de los estudios primarios se llevó a cabo en las bases de datos PubMed, CINAHL, LILACS y SciELO. RESULTADOS: La muestra estuvo compuesta de 17 estudios primarios, publicados entre enero de 2000 y diciembre de 2014, agrupados en cuatro categorías: estandarización de la técnica de mensuración de la presión arterial; entrenamientos con simulación; instrumentos para la estandarización de la asistencia y calidad de la asistencia. Las principales acciones de enfermería fueron: examen físico, identificación precoz de señales de preeclampsia/eclampsia, seguimiento de exámenes de laboratorio, evaluación fetal, capacitación y entrenamiento de los profesionales. Se identificó la necesidad de estandarización de la atención mediante instrumentos y protocolos y la técnica de verificación de la presión arterial, identificación y tratamiento precoces de la crisis hipertensiva mediante protocolos institucionales y revisión de casos y procesos laborales. CONCLUSIÓN: Mujeres con preeclampsia e/o eclampsia demandan cuidados de enfermería específicos, los que deben pautarse en protocolos de cuidados basados en evidencias científicas.

Resumo OBJETIVO: Analisar as evidências disponíveis na literatura sobre assistência de enfermagem às mulheres com pré-eclâmpsia e/ou eclâmpsia. MÉTODO: Revisão integrativa cuja busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL, LILACS e SciELO. RESULTADOS: Amostra foi composta por 17 estudos primários, publicados entre janeiro de 2000 e dezembro de 2014, agrupados em quatro categorias: padronização da técnica de mensuração da pressão arterial; treinamentos com simulação; instrumentos para padronização da assistência e qualidade da assistência As principais ações de enfermagem foram: exame físico, identificação precoce de sinais de pré-eclâmpsia/eclâmpsia, acompanhamento de exames laboratoriais, avaliação fetal, capacitação e treinamento dos profissionais. Identificou-se a necessidade de padronização do atendimento a partir de instrumentos e protocolos e da técnica de aferição da pressão arterial, identificação e tratamento precoces da crise hipertensiva mediante protocolos institucionais e revisão de casos e processos de trabalho. CONCLUSÃO: Mulheres com pré-eclâmpsia e/ou eclâmpsia exigem cuidados de enfermagem específicos, os quais devem ser pautados em protocolos de cuidados baseados em evidências científicas.

NURSES -- ARE WE EVER OFF DUTY?

Halfway home from a family holiday to Fiji I had just put down my book and closed my eyes, when my husband nudged me and pointed out a man in the opposite row calling for help. Without thinking I jumped up and assessed the situation.

Cardiovascular Implications of Preeclampsia.

Cardiovascular disease (CVD) is the leading cause of death of women in the United States. Many healthcare providers are unaware of sex-specific factors that affect the development of CVD. Nursing care for women with a history of preeclampsia and their children is presented. Preeclampsia affects 4% to 8% of all pregnancies. Rates have increased by 25% over the past 2 decades. Research supports the link between preeclampsia and risk of future CVD in women and the children of affected pregnancies. Appropriate preconception, prenatal and postpartum education, and surveillance are necessary to improve the long-term health of both mother and infant. Currently, there are no evidence-based interventions specific to the prevention of CVD for women and their children who have been affected by preeclampsia. However, women who have had preeclampsia may require yearly risk factor assessment and education regarding cardiovascular prevention strategies such as smoking cessation, increased physical activity, importance of a healthy diet, and maintenance of a healthy weight. Preeclampsia should be acknowledged by healthcare providers as a CVD risk factor. Appropriate monitoring, education, and CVD preventive strategies need to be implemented with this population and their children.

Hipertensión y embarazo / Hypertension and pregnancy

La preeclampsia ­ eclampsia es una de las principales causas de morbimortalidad materna y perinatal a nivel mundial

Metodología enfermera aplicada a mujeres primigestas con preeclampsia grave / Nurse methodology applied to primigravid women with severe pre-eclampsia

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Reflexiones metodológicas aplicadas al caso clínico de la gestante intervenida de cesárea con preeclampsia / Methodological reflections applied to clinical case of a caesarean section performed on a pregnant woman with pre-eclampsia

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Práctica enfermera en Unidades de Cuidados Intensivos Maternales. Preeclampsia grave en primigesta / Nursing practice in maternity intensive care units. Severe pre-eclampsia in a primigravida

Mujer de 39 años, gestante de 31 + 5 semanas, que llegó a nuestra Unidad de Cuidados Intensivos (UCI) derivada del Servicio de Urgencias del hospital, presentando tobillos hinchados, dolor de cabeza y cansancio al esfuerzo moderado. Se procedió a una toma de presión arterial (158/96 mmHg) y una valoración de edemas de miembros inferiores. La monitorización cardio-fetal era normal. Conocedora y usuaria de pautas saludables en el embarazo, no seguía ningún tratamiento. Madre soltera, se mostró preocupada por su feto (conseguido a través de fecundación in vitro) y supimos de la ayuda de su madre ante cualquier contratiempo. Elaboramos un Plan de Cuidados Individualizado. Utilizamos para recogida de datos: valoración 14 necesidades de Virginia Henderson y taxonomía diagnóstica NANDA, NOC, NIC. Detectamos como diagnóstico de enfermero «Exceso de volumen de líquidos» y «Riesgo de alteración de la diada materno-fetal» y como complicaciones potenciales, la eclampsia y la prematuridad del feto. Nuestros objetivos generales (NOC) fueron integrar a la mujer en el proceso al que se enfrentaba y que supiera reconocer los factores de riesgo propios de su enfermedad. Las intervenciones enfermeras (NIC) contemplaban la enseñanza de su enfermedad y tratamiento y la instauración de nuevos hábitos de vida saludables. El rol de la enfermera en una UCI Maternal permitió ayudar a la mujer a mantener un máximo bienestar materno-fetal, facilitándole para ello la suplencia requerida en la satisfacción de sus necesidades. Un mal manejo de la situación nos adentra en un marco de morbimortalidad alto en nuestras unidades

39 year old woman, pregnant for 31+5 weeks, who came to our intensive care unit (ICU) referred from the emergency department of the hospital, having swollen ankles, headache and fatigue at moderate effort. We proceeded to take blood pressure (158/96 mmHg) and assess lower limb edema. The fetal heart rate monitoring was normal. Knowledgeable and user of healthy guidelines during her pregnancy, she did not follow any treatment. Single mother, she worried about her fetus (achieved through in vitro fertilization), her mother offered to help for any mishap. We developed an Individualized Care Plan. For data collection we used: Rating 14 Virginia Henderson Needs and diagnostic taxonomy NANDA, NOC, NIC. Nursing diagnoses of "fluid volume excess" and "risk of impaired maternal-fetal dyad" were detected, as well as potential complications such as eclampsia and fetal prematurity. Our overall objectives (NOC) were to integrate the woman in the process she faced and that she knew how to recognize the risk factors inherent in her illness. Nursing interventions (NIC) contemplated the awareness and treatment of her illness and the creation of new healthy habits. The work of nursing Maternal ICU allowed women to help maintain maximum maternal and fetal well-being by satisfying any of her needs. Mishandling of the situation leads into a framework of high morbidity and mortality in our units

Plan de cuidados a paciente intervenida de cesárea con preeclampsia / Care plan for women with cesarean section and pre-eclampsia

Las afecciones del embarazo en general, y la preeclampsia en particular, son problemas que habitualmente se tratan en las unidades de recuperación postanestesia y de hospitalización. La preeclampsia es la forma más frecuente de hipertensión arterial asociada al embarazo (50%), que afecta del 7% al 10% de las mujeres gestantes. Se define como un síndrome multisistémico del embarazo y puerperio, en el que se presenta una reducción de la perfusión sistémica generada por vasoespasmo y activación de los sistemas de coagulación. Se presenta un caso clínico del postoperatorio inmediato de una paciente intervenida de cesárea urgente tras ser diagnosticada de preeclampsia, elaborando un plan de cuidados enfermeros basado en los patrones funcionales de M. Gordon y guiado por la taxonomía NANDA-NOC-NIC, donde se identifican 6 diagnósticos de Enfermería, que serán la base de la realización de este proceso enfermero: riesgo de infección, exceso de volumen de líquidos, riesgo de sangrado, conocimientos deficientes sobre su proceso patológico, dolor agudo y ansiedad. La aplicación de este plan de cuidados supone una mejora en la atención al paciente y en la organización del trabajo

Pregnancy pathologies in general, and pre-eclampsia in particular, are problems usually treated in post-anesthesia recovery and hospitalization units. Pre-eclampsia is the most frequent form of hypertension associated with pregnancy (50%). It affects from 7% to 10% of pregnant women. It is known as pregnancy and puerperium multisystem syndrome. It is due to a reduction of the systemic perfusion generated by the vasospasms and the activation of the coagulation systems. A clinical case is presented of the immediate post-surgery period of a patient, who has been operated on cesarean section after having been diagnosed with pre-eclampsia. A nursing care plan was prepared, based on Marjory Gordon functional patterns and guided by NANDA-NOC-NIC taxonomy, where 6 nursing diagnoses, which are the basis for the fulfillment of this nursing process, are identified: Risk of infection, excess fluid volume, risk of bleeding, insufficient knowledge about its pathological process, severe pain, and anxiety. The application of this care plan leads to an improvement in the patient care and in the work organization

[Nursing practice in maternity intensive care units. Severe pre-eclampsia in a primigravida]. / Práctica enfermera en Unidades de Cuidados Intensivos Maternales. Preeclampsia grave en primigesta.

39 year old woman, pregnant for 31+5 weeks, who came to our intensive care unit (ICU) referred from the emergency department of the hospital, having swollen ankles, headache and fatigue at moderate effort. We proceeded to take blood pressure (158/96 mmHg) and assess lower limb edema. The fetal heart rate monitoring was normal. Knowledgeable and user of healthy guidelines during her pregnancy, she did not follow any treatment. Single mother, she worried about her fetus (achieved through in vitro fertilization), her mother offered to help for any mishap. We developed an Individualized Care Plan. For data collection we used: Rating 14 Virginia Henderson Needs and diagnostic taxonomy NANDA, NOC, NIC. Nursing diagnoses of "fluid volume excess" and "risk of impaired maternal-fetal dyad" were detected, as well as potential complications such as eclampsia and fetal prematurity. Our overall objectives (NOC) were to integrate the woman in the process she faced and that she knew how to recognize the risk factors inherent in her illness. Nursing interventions (NIC) contemplated the awareness and treatment of her illness and the creation of new healthy habits. The work of nursing Maternal ICU allowed women to help maintain maximum maternal and fetal well-being by satisfying any of her needs. Mishandling of the situation leads into a framework of high morbidity and mortality in our units.