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PREGNANCY INDUCED HYPERTENSION

PREGNANCY INDUCED HYPERTENSION. A hypertensive disease of pregnancy. Known as pre-eclampsia and eclampsia. Pre-eclampsia = hypertension, proteinuria, edema Eclampsia = other signs plus convulsions

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PREGNANCY INDUCED HYPERTENSION

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  1. PREGNANCY INDUCED HYPERTENSION A hypertensive disease of pregnancy. Known as pre-eclampsia and eclampsia. Pre-eclampsia = hypertension, proteinuria, edema Eclampsia = other signs plus convulsions It develops between the 20th and 24th week of gestation and disappears after the tenth day postpartum

  2. MULTIPLE PREGNANCY PRIMIGRAVIDA UNDER 17 AND OVER 35 HYDATIFORM MOLE PREDISPOSING FACTORS FAMILY HISTORY VASCULAR DISEASE Diabetes, renal LOWER SOCIOECONOMIC STATUS Severe malnutrition, decrease Protein intake Inadequate or late prenatal care

  3. PATHOLOGICAL CHANGES PIH is due to: INCREASED PERIPHERAL RESISTANCE; IMPEDED BLOOD FLOW ( in blood pressure) GENERALIZED ARTERIOLAR CYCLIC VASOSPASMS Endothelial CELL DAMAGE (decrease in diameter of blood vessel) Intravascular Fluid Redistribution Decreased Organ Perfusion Multi-system failure Disease

  4. Clinical ManifestationsClinical Manifestation HYPERTENSION Earliest and The Most Dependable Indicator of PIH

  5. Hypertension B/P = 140 / 90 if have no baseline. 1. 30 mm. Hg. systolic increase or a 15 mm. Hg. diastolic increase (two occasions four to six hours apart)

  6. Rationale for HYPERTENSION The blood pressure rises due to: ARTERIOLAR VASOSPASMS AND VASOCONSTRICTION causing (Narrowing of the blood vessels) an increase in peripheral resistance fluid forced out of vessels HEMOCONCENTRATION Increase blood viscosity = Increased hematocrit

  7. Weight Gain and Edema • Clinical Manifestation: • Edema may appear rapidly • Begins in lower extremities and moves upward • Pitting edema and facial edema are late signs • Weight gain is directly related to accumulation of fluid

  8. WEIGHT GAIN AND EDEMA Rationale: • Decreased blood flow to the kidneys causes a loss of plasma proteins and albumin • This leads to a decreased colloid osmotic pressure. • A  in COP allows fluid to shift from from intravascular to extravascular. • Now there is an accumulation of fluid in the tissues. • Increased angiotensin and aldostersone triggers retention of sodium and water.

  9. The Nurse Must Know The difference between dependent edema and generalized edema is important. The patient with PIH has generalized edema because fluid is in all tissues.

  10. Placenta With Vasospasms and Vasoconstriction of the the vessels in the placenta. Decreased Placental Perfusion and Placental Aging Positive OCT / Late Decelerations With Prolonged decreased Placental Perfusion: Fetal Growth is retarded - IUGR, SGA

  11. Condition is Worsening

  12. Oliguria – 100ml./4 hrs or less than 30 cc. / hour • Edema moves upward and becomes generalized (face, periorbital, sacral) • Excessive weight gain – greater than 2 pounds per week

  13. Central Nervous System Changes • Cerebral edema -- forcing of fluids to extracellular • Headaches -- severe, continuous • Hyperreflexia • Level of Consciousness changes – changes in affect • Convulsions / seizures

  14. Visual Changes Retinal Edema and spasms leads to: • Blurred vision • Double vision • Retinal detachment • Scotoma (areas of absent or depressed vision)

  15. Nausea and Vomiting • Epigastric pain –often sign of impending coma

  16. Pre-Eclampsia Mild Severe B/P 140/90 160/110 Protein 1+ 2+ 3+ 4+ Edema 1+, lower legs 3+ 4+ Weight <1 lb. / week >2lb. / week Reflexes 1+ 2+ brisk 3+ 4+ (Hyperreflexia) Clonus present Retina 0 Blurred vision, Scotoma Retinal detachment GI, Hepatic 0 N & V, Epigastric pain, changes in liver enzymes CNS 0 Headache, LOC changes Fetus 0 Premature aging of placenta IUGR; late decelerations

  17. Interventions and Nursing Care • Home Management • Decrease activities and promote bed rest • Sedative drugs • Lie in left lateral position • Remain quiet and calm – restrict visitors and phone calls • Dietary modifications • increase protein intake to 70 - 80 g/day • maintain sodium intake • Caffeine avoidance • Weigh daily at the same time • Keep record of fetal movement - kick counts • Check urine for Protein

  18. Hospitalization • If symptoms do not get better then the patient needs to be hospitalized in order to further evaluate her condition. • Common lab studies: • CBC, platelets; type and cross match • Renal blood studies -- BUN, creatitine, uric acid • Liver studies -- AST, LDH, Bilirubin • DIC profile -- platelets, fibrinogen, FSP, D-Dimer

  19. Hospital ManagementNursing Care Goal 1. Decrease CNS Irritability 2. Control Blood Pressure 3. Promote Diuresis 4. Monitor Fetal Well-Being 5. Deliver the Infant

  20. Decrease CNS Irritability • Provide for a Quiet Environment and Rest • 1. MONITOR EXTERNAL STIMULI • Explain plans and provide Emotional Support • Administer Medications • 1. Anticonvulsant -- Magnesium Sulfate • 2. Sedative -- Diazepam (Valium) • 3. Apresoline • Assess Reflexes • Assess Subjective Symptoms • Keep Emergency Supplies Available

  21. Magnesium Sulfate • ACTION CNS Depressant, reduces CNS irritability Calcium channel blocker- inhibits cerebral neurotransmitter release • ROUTE IV effect is immediate and lasts 30 min. IM onset in 1 hour and lasts 3-4 hours • Prior to administration: • Insert a foley catheter with urimeter for assessment of hourly output

  22. Test Yourself ! A Woman taking Magnesium Sulfate has a respiratory rate of 10. In addition to discontinuing the medication, the nurse should: a. Vigorously stimulate the woman b. Administer Calcium gluconate c. Instruct her to take deep breaths d. Increase her IV fluids

  23. Nursing CareHospital Management 1. Decrease CNS Irritability 2. Control Blood Pressure 3. Promote Diuresis 4. Monitor Fetal Well-Being 5. Deliver the Infant

  24. Control Blood Pressure • Check B / P frequently. • Give Antihypertensive Drugs • Hydralzine ( apresoline) • Labetalol • Aldomet • Procardia • Check Hemocrit * Do NOT want to decrease the B/P too low or too rapidly. Best to keep diastolic ~90. Need to maintain uteroplacental perfusion!

  25. Nursing CareHospital Management 1. Decrease CNS Irritability 2. Control Blood Pressure 3. Promote Diuresis 4. Monitor Fetal Well-Being 5. Deliver the Infant

  26. Promote Diuresis **Don’t give Diuretic, masks the symptoms of PIH • Bed rest in left or right lateral position • Check hourly output -- foley cath with urimeter • Dipstick for Protein • Weigh daily -- same time, same scale

  27. Nursing CareHospital Management 1. Decrease CNS Irritability 2. Control Blood Pressure 3. Promote Diuresis 4. Monitor Fetal Well-Being 5. Deliver the Infant

  28. Key Point to Remember ! SEVERE COMPLICATIONS OF PIH: • PLACENTAL SEPARATION - ABRUPTIO PLACENTA; DIC • PULMONARY EDEMA • RENAL FAILURE • CARDIOVASCULAR ACCIDENT • IUGR; FETAL DEATH • HELLP SYNDROME

  29. HELLP Syndrome • A multisystem condition that is a form of severe preeclampsia - eclampsia • H = hemolysis of RBC • EL = elevated liver enzymes • LP = low platelets <100,000mm (thrombocytopenia)

  30. HELLP Assessment: 1. Right upper quadrant pain and tenderness 2. Nausea and vomiting 3. Edema • Flu like symptoms • Lab work reveals – a.anemia – low Hemoglobin b.thrombocytopenia – low platelets. < 100,000. c.elevated liver enzymes:

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