The nurse is caring for a client at 30 weeks gestation who is hospitalized for preeclampsia. After reviewing the client's chart and performing an initial assessment, the nurse notes several abnormal findings. Which finding should the nurse discuss with the health care provider immediately?

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11ecbb05_cbf8_235f_b433_ad6e1e6b4b07_MD0009_00 Placental abruption is a potential complication of preeclampsia related to hypertension that can be life-threatening to the client or fetus. It causes premature detachment of the placenta from the uterine wall, resulting in bleeding from uterine blood vessels. Common manifestations include abdominal pain, dark red vaginal bleeding, a rigid uterus, abnormal fetal heart rate patterns, and uterine tachysystole. Once placental abruption occurs, fetal distress and maternal hypovolemia can develop quickly. Therefore, the nurse should report vaginal bleeding to the health care provider (HCP) immediately because emergency cesarean birth is very common if the client's or fetus' condition deteriorates (Option A). (Option B) Swelling is a common feature of preeclampsia that does not require emergency action, but the nurse should report facial or hand swelling to the HCP. (Option C) Elevated liver enzymes are a severe feature of preeclampsia caused by impaired liver perfusion (end-organ damage) and are part of the diagnostic criteria for HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets). HELLP syndrome requires prompt action because the definitive treatment is giving birth, but the client may be able to have labor induced. (Option D) A urine output of approximately <30 mL/hr may be an early sign of kidney damage (end-organ damage) secondary to preeclampsia; the nurse should report decreasing urine output and strictly monitor intake and output. Educational objective: Placental abruption is a severe complication of preeclampsia that can be life-threatening and requires emergency action. Manifestations include dark red vaginal bleeding, abdominal pain, a rigid uterus, abnormal fetal heart rate patterns, and uterine tachysystole.

The Nurse Is Caring for a Client at 30 Weeks