Introduction
Preeclampsia is a pregnancy-specific multisystem disorder that affects 4% to 9% of pregnancies. The incidence of this condition has surged by 25 percent over the past two decades, and hospitalization for it is linked to a significant risk of fetal and maternal mortality and morbidity. Traditional diagnostic criteria for preeclampsia include proteinuria and hypertension; however, multisystem activation in the lack of proteinuria also meets diagnostic criteria. The clinical course and diagnosis of preeclampsia can result in abrupt worsening, necessitating attentive monitoring for the emergence of severe symptoms. Up to 2/3 of maternal deaths during hospitalisation for childbirth in the U.S.A. result from complications/issues from preeclampsia (Anderson et al., 2017). Numerous of these deaths may have been averted with timely and appropriate interventions, such as screening for clinical symptoms that signal development in the intensity and timing of childbirth.
The goal of the teaching is to provide expectant mothers with preeclampsia education to help provide neonatal care with the aim of preventing this condition. This scholarly paper has the primary purpose of teaching nurses and other associated health practitioners about preeclampsia. It insists on the importance of providing preeclampsia education to expectant mothers that include signs and symptoms of preeclampsia and how vital regular neonatal care is. It discusses preeclampsia, its pathophysiology, and the ethical considerations associated with this medical condition. In addition, it examines the potential ethical issues surrounding preeclampsia, including the informed consent process, the ANA Code of Ethics for Nurses, and nurses’ involvement in the screening, diagnosis, treatment, and management of preeclampsia.
The pathophysiology of preeclampsia
During a healthy/normal pregnancy, the villous cytotrophoblast infiltrates the inner part of the myometrium, and spiral arteries do lose the majority of their muscle fibers and endothelium. These morphological adjustments are accompanied by functional alterations so that spiral arteries turn into low-resistance vessels and, therefore, are less sensitive to vasoconstrictive drugs.
Preeclampsia has a convoluted etiology, with aberrant placentation being the primary culprit. During preeclampsia, abnormal infiltration of the spiral arteries involving cytotrophoblast cells is detected. Invasion of cytotrophoblasts into the uterus is a distinct differentiation route in which fetal cells acquire characteristics of the endothelium they usually replace. This differentiation procedure is incorrect in preeclampsia (Ives et al., 2020). The anomalies may be associated with the nitric oxide route, which plays a significant role in the regulation of vascular tone. Furthermore, the suppression of maternal nitric oxide synthesis hinders embryo implantation. Increased uterine vascular resistance increases placental oxidative and ischemic stress, as well as its vulnerability to vasoconstriction.
This prolonged placental ischemia results in fetal problems, such as intrauterine retardation of growth or mortality. In response, oxidative stress stimulates the release of molecules like oxidized lipids, serum soluble vascular endothelial growth factor 1 cytokines, and free radicals into the maternal circulation. These anomalies cause endothelial dysfunction15, hypertension, thrombophilia, and vascular hyperpermeability in order to account for the decreased blood flow in the umbilical artery caused by peripheral vasoconstriction.
Endothelial dysfunction is accountable for the clinical symptoms detected in the mother, such as degradation of the hepatic endothelium leading to the start of the HELLP syndrome and damage of the cerebral endothelium causing eclampsia. Exhaustion of vascular endothelial growth factor in podocytes increases the ability of endotheliosis to obstruct the slit dampers in the basal lamina, which contributes to impaired glomerular filtration and proteinuria. Lastly, endothelial dysfunction increases microangiopathic hemolytic anemia, and vascular hyperpermeability caused by low serum albumin results in edema, especially in the lungs or lower limbs.
Preeclampsia may be viewed as a dysfunction of the mother’s immune system that hinders it from detecting the fetoplacental unit. The excessive generation of immune cells results in the release of tumor necrosis factor-alpha, which triggers apoptosis of the extravillous cytotrophoblast. Women with preeclampsia had lower levels of HLA-E and HLA-G, which suggests that the leukocyte antigen systems also play a role in the abnormal infiltration of the spiral arteries. During healthy pregnancies, the contact between the trophoblast and these cells is caused by the natural killer cell-secreted vascular placental and endothelial growth factor. Preeclamptic women have been discovered to have elevated levels of soluble fms-like tyrosine kinase 1 (sFlt-1), an antagonist of vascular placental and endothelial growth factor.
Teaching of Preeclampsia
The purpose of teaching preeclampsia is to expand the nurses’ awareness of the condition’s risk factors, symptoms, and indicators and to emphasize the need to educate pregnant mothers about the relevance of routine prenatal care in its management and prevention. I hope that this paper will motivate nurses to encourage expectant moms to become more involved in their prenatal health care (Fox et al., 2019). In addition, it should equip nurses with the skills and information required to offer quality care to preeclampsia patients.
The teaching provides a general overview of preeclampsia and its symptoms. It is essential to discuss the signs and symptoms of preeclampsia with the nurses (edema, proteinuria, and high blood pressure). In addition, it will cover the condition’s risk factors. The teaching will cover the risk factors for preeclampsia, including underlying medical disorders, multiple gestations, preeclampsia, previous history, obesity, and age.
It also emphasizes the importance of prenatal care to nurses. It instructs nurses on how to educate expectant mothers on the necessity of routine prenatal care and the relevance of prenatal care in the management and early diagnosis of preeclampsia. In addition, it addresses treatment and management options. It highlights the numerous preeclampsia treatment and management options, including delivery, medication, and lifestyle modifications.
The effectiveness of the instruction will be evaluated utilizing pre- and post-teaching evaluations, audience feedback, and clinical outcome observation. First, I will analyze the nurses’ pre- and post-lesson understanding of preeclampsia to judge the effectiveness of the lesson. Second, I will solicit input from the nurses regarding the teaching’s efficacy, relevance, and content. Finally, by examining the effect of education on clinical outcomes, such as the nurses’ degree of knowledge and comprehension of the incidence of preeclampsia, I will be able to evaluate the effectiveness of the teaching.
Ethical Issues Surrounding Preeclampsia
Preeclampsia is a common and serious complication of pregnancy. The perceptive obstetrician will commonly identify moral ambiguity and ethical problems during therapeutic care. It is essential to comprehend current difficulties and find solutions to them. Counseling is an integral component of contemporary medicine. In determining which counseling model to employ, nurses must take into account numerous elements, such as the weight of the evidence, the specific clinical context, and the justifiable bounds of autonomy and paternalism in a position of shared responsibility. Partners have a fundamental right to reproduce, even though pregnancy includes substantial dangers (Jørgensen et al., 2014). Informed women are able to negotiate the extremities of these stances while determining whether or not they should risk pregnancy due to their knowledge of both care ethics and rights ethics. The notion of a “fetal patient” is beneficial.
This topic is addressed in Principle 4 of the ANA Code of Ethics for Nurses, which declares that “the nurse has the same obligations to oneself as to others, such as the duty to foster health and safety.” This concept mandates the nurse to emphasize the health and safety of the fetus and expectant mother while simultaneously respecting the autonomy of the expectant mother. A woman with autonomy may choose to deny or grant this status to her previable fetus, while nurses must balance their beneficence and autonomy-based obligations to the pregnant woman with their beneficence-based commitments to the unborn.
As maternal-fetal conflict, we classify maternal behavior that affects the fetus and the future kid. However, pregnant women are morally obligated to protect the fetus if they can do so without jeopardizing their own vital interests. The phrase noncompliance indicates a hierarchical connection between doctor and patient. This diminishes patient autonomy and contradicts informed consent. Although sometimes justifiable, this “label” is typically more harmful than helpful.
The responsibility of the nurse in this ethical dilemma is to present the expectant mothers with pertinent and accurate information regarding the benefits and hazards of various procedures while advocating for the fetus’s well-being. The nurse should engage with the medical team to make sure that the autonomy of the expectant woman is respected while maintaining the fetus’s safety and health. In situations that do not pose an ethical dilemma, it is still the nurse’s responsibility to ensure that ethical concerns are incorporated into the management of preeclamptic. This includes fostering patient autonomy, gaining informed consent, and maintaining patient confidentiality.
Conclusion
This research has examined the pathophysiology, teaching, and ethical considerations associated with preeclampsia. Preeclampsia is one kind of hypertension (high blood pressure) that can develop during pregnancy. The pathophysiology section has emphasized the cellular alterations that develop in the mother and placental blood arteries that lead to preeclampsia. Understanding preeclampsia is essential for guiding the treatment and management of this disorder.
The teaching portion underlines how important it is for nurses to give pregnant women key information about preeclampsia. This section examines the goals and objectives of this instruction and how the program’s efficacy can be measured. The ethics section identifies the ethical dilemma of balancing fetal well-being and maternal autonomy, as well as how nurses might use the ANA Code of Ethics for Nurses to make prudent decisions. This section is intended to assist nurses in navigating the ethical problems of preeclampsia scanning, treatment, and management.
Preeclampsia is a complicated medical condition that requires an effective strategy for treatment and care, as well as a grasp of its pathophysiology, ethical concerns associated with it, and how to deliver and integrate effective teaching (Sharma et al., 2020). The nurses are required to provide proper management and care for patients with preeclampsia and to utilize the ANA Code of Ethics for Nurses as a resource for making ethical decisions.
References
Anderson, C. M., & Schmella, M. J. (2017). Preeclampsia. The American Journal of Nursing, 117(11), 30-38.
Fox, R., Kitt, J., Leeson, P., Aye, C. Y., & Lewandowski, A. J. (2019). Preeclampsia: risk factors, diagnosis, management, and the cardiovascular impact on the offspring. Journal of clinical medicine, 8(10), 1625.
Ives, C. W., Sinkey, R., Rajapreyar, I., Tita, A. T., & Oparil, S. (2020). Preeclampsia—pathophysiology and clinical presentations: JACC state-of-the-art review. Journal of the American College of Cardiology, 76(14), 1690-1702.
Jørgensen, J. M., Hedley, P. L., Gjerris, M., & Christiansen, M. (2014). Ethical issues related to screening for preeclampsia. Bioethics, 28(7), 360–367. https://doi.org/10.1111/j.1467-8519.2012.02005.x
Sharma, G. (2020). CASE REPORT-PREECLAMPSIA: CURRENT APPROACHES TO NURSING MANAGEMENT. Editorial Board, 9(7).
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