PREGNANCY INDUCED HYPERTENSION TROLLEY

1. Labor and Delivery Room DJM MUNEESWARI JEYACHANDRAN., MSC

2. Pregnancy Induced Pregnancy Induced Hypertension is Hypertension is high blood pressure happened or high blood pressure happened or Always keep Always keep induced by pregnancy induced by pregnancy which is which is PIH trolley PIH trolley or kit at bedside or kit at bedside otherwise called as preeclampsia. otherwise called as preeclampsia. for for Preeclampsia characterized by high Preeclampsia characterized by high preeclampsia preeclampsia blood pressure, proteinuria, edema or blood pressure, proteinuria, edema or patient. patient. swelling, epigastric pain, decreased swelling, epigastric pain, decreased reflex and urine output. reflex and urine output. DJM

3. S. No Items Nos/ Size Rational or Uses Picture A PIH TROLLEY CONTAINS To keep the airway open to provide unobstructed ventilation and to reduce the risk of aspiration. PIH mother more prone to get Eclampsia (seizure) leads to aspiration or obstructed ventilation. Saves 1/3 of a person’s exhaled air. Allows the patient to rebreathe some of CO2, act as way to stimulate breathing. Flow rate 8-10LPM upto 90% O2 concentration. Use to suction oropharyngeal secretions in order to prevent aspiration during eclamptic seizure. Maintain patent airway. Improve oxygenation by removing mucous secretions and foreign material from the mouth and throat (Oropgarynx). For blood & rapid fluid administration but more painful. Administer blood, pushing fluid rapidly, not painful. Better for all IV Fluid infusion. For small vein, and for temporary short infusion. Easily make the vein come out or visible. Secure the IV cannula and Foley’s catheter in situ. Replacing the fluids and electrolytes. To pick up blood pressure for sudden hypotension. To replace massive fluid exchange or volume expander. 1 Blind insertion Airway Device (BIAD) (or) Oropharyngeal airway Size 2, 3, 4. Each 1 2. Rebreather mask 1 3 Yankeur suction 1 4 IV Cannula G16 (Grey) IV Cannula G18 (Green) IV Cannula G20 (Pink) IV Cannula G22 (Blue) Tourniquet 5 5 5 3 1 5 6 Microbore tape 1 IV RL IV NS IVF. Voluven 7 3 3 1 DJM

4. S. No 8 Items Nos/ Size 2 each Rational or Uses Picture IV Set IV burette For controlled infusion of medications and IVF infusion. To connect the medication to the needle inserted into the patient. Use to deliver a fixed volume of IV fluid at a fixed rate usually added medications. Used for giving test dose. Used to inject fluid into or withdraw fluid from the body. For IM injection administration. Used for dilute antibiotic with NS or Distilled water. Used to withdraw mass blood investigations. Used for Mgso4 and labetalol infusion. Regular walled pointed needles for IM, SC administration. Drawing blood for investigation. Used for ID, IM, IV and aspirate the medication. To send CBC (violet), coagulation profile (blue), LFT RFT (plain), Cross-matching blood samples (one plain tube and Violet tube) for emergency situation. To diagnose HELLP syndrome if LFT high, low platelet, low HB. Eclampsia extends blood clotting times. Collect midstream urine to identify the proteinuria and any infection such as candida, E.coli and so on. Sometimes, physician order 24 hours urine collection to determine the amount of protein lost. If more than 300mg protein in urine indicate preeclampsia. 9 Disposal syringe 1ml. Disposal syringe 2ml Disposal syringe 5ml Disposal syringe 10ml Disposal syringe 20ml Disposal syringe 50ml Needle 20 G Yellow Needle 21 G Green Needle 22 G Black small 3 each 3 each 10 11 Blood collection tubes ETDA tube- violet color Sodium citrate – Blue Plain tube- red or yellow 2 Each 12 Urine collection container (small) or 24 hours urine container or can 1 DJM

5. S. No 13 Items Nos/ Size Each 1 Rational or Uses Picture Foleys catheter Size 12,14,16, To drain and measure continuous urine output if patient under 24hours MgSo4 infusion. Check hourly urine dipstick for protein. Urine output should be 30ml/ hr is normal. Deep tendon reflexes demonstrate homeostasis between cerebral cortex and spinal cord. Increase blood pressure will lead to increasing hyperreflexia or disrupted. PIH affect the blood supply to nervous system cause irritable. Use for all procedure in a sterile way to avoid and prevent infection. PIH is high risk to get infection. Health care professional wear sterile gloves after handwash and make sure dry hand. To check BP regularly Confirm PIH if 3 continuous reading of more than 140/90. (For continuous BP monitoring, use cardiac monitoring to measure BP, Pulse, RR, SPO2 and Show continuous ECG.) The stethoscope has two different heads to receive sound, the bell and the diaphragm. The bell is used to detect low-frequency sounds and The diaphragm to detect high-frequency sounds. Use of the diaphragm side in the measurement of blood pressure, because it is easier to hold and covers a greater area. 14 Reflex hammer 1 15. Sterile gloves Size 6, 6.5, 7, 7.5,8, 8.5 Each 2 16 Manual BP monitor 1 17 Adult Stethoscope 1 DJM

6. S. NoItems Nos/ Size Rational or Uses PIH medications in TROLLEY or TRAY Loading dose 4g MgSO4 in 42ml NS over 15-20minutes. Maintenance Dose 25g MgSO4 in 450ml NS at 20ml/hr for 24hrs. If BP not controlled by Inj. MgSO4. 80ml water for injection +100mg Labetalol (Inj.Trandate) Bolus: 20-80mg IV bolus Q10Min to maximum of 300mg for rapid control of BP. Infusion Dose: 0.5-2mg/min to maximum 2.4gm/day. If severe PIH or BP not controlled by Inj. MgSO4 or labetalol. 5-10 mg IV/IM initially then 5-10mg Q20-30min PRN. If patient in respiratory depression in Overdose of Inj. MgSO4. If Respiration rate: 10 breaths/mint or less is called respiratory depression. Picture 19 INJ. MgSO4 First choice INJ. Labetalol Second choice INJ. Hydralazine Third choice Inj. Calcium Gluconate 10% Antidote 1g / 10ml DJM

7. Cap. Nifedipine (Ca channel blockers) 30-90mg once daily Treat hypertension and chest pain Use to stop preterm delivery (<37Weeks) Local anesthesia used to make numbness on operative site or suturing site. Used to stop seizures Loading dose: - 4-6g (15-20min) Maintenance dose: -1-2g/ hour as continuous IV. Administer after Inj. Mgso4 infusion. Used to reduce the bipedal edema due to hypertension. Use after physician order, because may cause harm to the baby by diminishing placental perfusion. To prevent aspiration during seizure. Mouth gags used to protect the tongues of patients whilst experiencing seizures in eclampsia Inj. Lidocaine 2% 1 ampule Inj. Diazepam (Valium) 1 ampoule 10mg in 2ml Inj. Lasix or Furosemide 3 Nos. 40mg in 4ml 20. Sterile Mouth gag 1 DJM