A nurse is assessing a pregnant woman with gestational hypertension. The nurse understands that a major risk of untreated preeclampsia includes:

1. A

   Placental abruption

2. B

   Hyperglycemia

3. C

   Preterm labor

4. D

   Urinary tract infection

Appeared in: NORCET 7 Prelims -2024

Explanation

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• Preeclampsia, a hypertensive disorder of pregnancy, is one of the most frequent conditions associated with placental abruption.
• The underlying pathophysiology of preeclampsia involves systemic vasospasm and endothelial (blood vessel lining) damage.
• This vascular damage can affect the spiral arteries that supply the placenta, leading to hemorrhage in the decidua basalis and causing the placenta to prematurely separate from the uterine wall.
• Untreated or severe hypertension significantly increases the risk of this separation, which is a life-threatening emergency for both the mother and fetus due to the risk of hemorrhage and fetal hypoxia.

Why Other Options Were Wrong

• Option B: Hyperglycemia (high blood sugar) is a defining characteristic of gestational diabetes mellitus, which is a metabolic disorder, not a direct complication of the vascular pathology seen in preeclampsia.
• Option C: While severe preeclampsia is a common reason for medically indicated preterm delivery, and it can be associated with spontaneous preterm labor, placental abruption is a more direct and severe pathological complication resulting from the disease's vascular effects.
• Option D: Urinary tract infections (UTIs) are common during pregnancy due to anatomical and physiological changes (e.g., urinary stasis), but their cause is bacterial and unrelated to the hypertensive and vascular pathophysiology of preeclampsia.

Related Visual

• Visual 1: Diagram - An illustration showing the premature separation of the placenta from the uterine wall with a visible retroplacental hematoma, defining placental abruption.
• Visual 2: Flowchart - A flowchart depicting the pathophysiology of preeclampsia leading to placental abruption, starting from vasospasm and endothelial injury to vascular damage and placental separation.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Complications of Preeclampsia to guide bedside assessment, documentation, and the next nursing action.
• Nurses must vigilantly monitor blood pressure and assess for signs of abruption (e.g., vaginal bleeding, abdominal pain, uterine tenderness/rigidity) in any patient with a hypertensive disorder of pregnancy.
• Early detection and rapid intervention are critical to prevent severe maternal hemorrhage, Disseminated Intravascular Coagulation (DIC), and fetal compromise or death.
• What if? - If the patient with preeclampsia suddenly reports severe, constant abdominal pain and a hard, rigid uterus (even without visible bleeding), the nurse must suspect a concealed placental abruption and initiate emergency protocols immediately. This is a life-threatening emergency requiring urgent delivery.

How to Approach the Question

• Identify the core clinical concept: The question asks for a major risk associated with untreated preeclampsia, which is a hypertensive disorder of pregnancy.
• Analyze the pathophysiology of preeclampsia: Recall that preeclampsia involves widespread vasospasm and endothelial cell damage, affecting blood vessels throughout the body, including those supplying the placenta.
• Evaluate each option based on this pathophysiology:
• A) Placental abruption: This is a premature separation of the placenta. The vascular damage from hypertension makes this a direct and severe consequence.
• B) Hyperglycemia: This relates to glucose metabolism and is linked to diabetes, not primarily to hypertension.
• C) Preterm labor: This can be a consequence, but it is often a necessary medical intervention due to the severity of preeclampsia, whereas abruption is a direct pathological event caused by the disease.

Concept Tested & Keywords

• Concept Tested: Complications of Preeclampsia
• Stem keywords: pregnant woman, gestational hypertension, preeclampsia, major risk
• Lead-in keywords: includes
• Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

Question ID

QDJ85N2aZHIvLR9NNGQOs8

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