Pregnancy Induced Hypertension

2. Pregnancy Induced Hypertension Benita Beard 2012

3. Objectives: Examine implications of Pregnancy Induced Hypertension(PIH) on a pregnancy. Discuss assessments for a patient with PIH. Describe care of a patient with PIH.

4. Shana is a 26 year old with 2 children (ages 4 and 7). She is currently expecting her third child. Shana’s boyfriend of 2 years, left Shana after finding out she was pregnant. She is currently living with her sister, Kyana. Kyana is a single parent of 2 children, ages 3 and 5. Shana and her sister, Kyana, are very close and have combined resources to make their lives easier. Shana cares for the children and maintains things at home while Kyana works.

5. Shana’s First Prenatal Visit • Assessment Data: • 26 year old African American • G3P2 • Upon exam was found to be 12 weeks pregnant. • 107/84, 98.9, 82, 18 • Weight: 180 lbs

6. Shana is now 20 weeks gestation at her Prenatal Visit • Assessments: • Weight 192 lbs • BP 118/88, HR 88 • Hgb 11.5, Hct 33. • Urine negative for sugar and trace for protein

7. Shana is now 29 weeks gestation. Two weeks ago she was experiencing back pain and discomfort that went away after two hours. • She felt the same symptoms the next day and went to the see her health care provider. • Shana had no cervical changes. She was found to have a urinary tract infection(UTI). • Shana has had no further symptoms since treatment of her UTI.

8. Today Shana has come to the office with complaints of a headache that won’t go away. • Assessments: • 32 weeks gestation • 162/110 • Gained 7 lbs in last 2 weeks • Legs, feet and hands are puffy • Denies seeing spots or stars, but does admit to having blurred vision from time to time. • Reflexes are 3+ • Protein in urine is 3+

9. Figure 20.5 Clinical manifestations and pathophysiology of preeclampsia-eclampsia

10. Shana is placed in a dark room for 30 minutes and isinstructed to lay on her left side. Her blood pressure decreases to 158/94. She refuses to go to the hospital. She is sent home on bedrest and is to do a 24 hour urine collection. She is to call if she has any further symptoms She is to return to the office in the AM.

11. Shana brings the 24 hour urine collection to the office. Her pressure remains at 158/94. She denies headache or visual disturbances. She has all four children with her and is in a hurry to return home. She promises to rest and to call if she has any further symptoms.

12. Shana’s sister comes home from work and finds Shana passed out on the floor. She is taken by EMS directly to the labor and delivery unit. • EMS Assessment: • BP 192/112, HR 102, RR 24 • FHR – 140s • Shana is awake but is confused as to what happened.

13. Shana needs to be assigned a room. Three patients have arrived on the Labor and Delivery unit at the same time. • 1-Shana • 2-Multigravida with twins in early labor • 3-Primagravida in early labor • Rooms available are a small room directly across form the nurses station usually used for testing. • A large room at the end of the hall • A swing room used for overflow adjacent to the Labor and Delivery Unit.

14. Shana is placed in a room and assessed. • Assessments: • BP 192/112, T 98.6, HR 102, RR 24 • Denies pain or contractions • FHTs are 130’s to 140’s • 3+ Reflexes with Negative clonus • Urine 3+ ketones and 3+ protein • Vaginal exam revealed 2 cm dilated, 50% effaced with membranes intact.

15. Shana’s healthcare provider has written the following orders. • Bedrest • Stat labs • Magnesium sulfate 4 gm bolus now and continue per protocol at 2 gms per hour. • IV of LR at 125cc per hour • Continuous fetal monitoring

16. Shana is placed on magnesium sulfate. She will be given a 4 gm loading dose and then be maintained on 2 gms an hour. Once stabilized the order is to have Pitocin started IV, per protocol, for labor induction.

17. 6 hours later Shana’s assessment findings are: • BP 188/98, T 98.6, HR 102, R 16 pain (6) • Vaginal exam reveals 4 cm and 90% effaced at zero station. Contractions are firm every 3-4 minutes lasting 40-90 seconds. • Membranes were ruptured by healthcare provider with clear fluid noted. • Reflexes 3+ with negative clonus • Shana is now asking for something for pain

18. Shana was given an epidural for pain management and complained of an urge to push during insertion. Vaginal examination reveals 10 cm 0/+1 station 100% effaced

19. Shana is now pushing with contractions • What’s next? • What is needed for mom, for baby? • What do nurses need to have prepared for delivery? • What outcomes, for Shana and the baby, does the nurse need to anticipate based on Shana’s prenatal and labor history?

20. How might Shana’s postpartum “course” differ from the “normal” postpartum course?

21. Sources • www.emedicine.medscape.com/article/1476919-overview • www.mayoclinic.com/health/preeclampsia/DS00583 • www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001900 • www.preeclampsia.org/signs&symptoms • London, M., Ladewig, P., Ball, J., Bindler, R., & Cowen, K. (2011). Maternal & Child Nursing Care. (3rd Ed.). New Jersey: Pearson Education, Inc. • Ward, Susan L. and Hisley, S. M. (2009). Maternal-Child Nursing Care: Optimizing Outcomes for Mathers, Children, & Families. Philadelphia: F. A. Davis Company.