Eclampsia Flashcards
What is gestational HTN
Onset of HTN after 20 weeks
If left untreated or even if treated, gestational HTN may progress to __
Preeclampsia
how is Preeclampsia-eclampsia diagnosed?
- Systolic greater than 140 and/or a diastolic of 90 or higher on two occasions at least 4 hours apart and after 20 weeks
- With or without proteinuria
- Or severe HTN after 20 weeks ( sys at or above 160 and/or a dia at or above 110)
What are the qualifications for proteinuria?
300mg or more in a 24 hours collection or a random urine dipstick test of 1+ or higher)
-Protein to creatinine ratio of 0.3mg
What is eclampsia?
WHen preeclampsia progresses into a generalized seizure
What is defined as chronic HTN for a pregnant woman?
HTN before pregnancy, DX before 20 weeks, or continuing beyond 12 weeks PP
How is superimposed (over chronic HTN) preeclampsia determined?
- Onset of proteinuria after 20 weeks
- Increase in pre-existing proteinuria
- sudden exacerbation of controlled HTN
- Change in labs (Plate less than 100K, Elevated LFT, decreased renal function)
- Development of HA, Epigastric pain, or visual changes
What is the only known cure for preeclampsia?
Birth
What is the Initial patho of preeclampsia?
- Generalized VC
- Vasospasms
What is the current theory as to why preeclampsia happens?
- Begins during placental formation
- Abnormal development in maternal spiral ateries leads to decreased perfusion and oxygenation
- Diminished perfusion leads to a release of placental micro-particles that cause a systemic inflammatory response
A woman may have HELLP syndrome and be absent of ___. if she does she still is considered to have ____
HTN
Preeclampsia
Normotensive woman should be considered to have preeclampsia if she has___
Other signs of reduced organ perfusion
During treatment of preeclampsia, why is fluid replacement monitored and managed
To avoid worsening the womans’ reduced intravascular volume without giving her too much that would cause pulmonary edema or ascites
What type of birth is prefered for a preeclamptic mother? Why?
Induced vaginal
-To avoid bleeding and clotting that comes with c-sections
What are the three main effects of preeclampsia on the CV/pulmonary system?
- Increased vascular resistance
- Increased Cardiac output and stroke volume
- Decreased colloid osmotic pressure
Describe how preeclampsia affects the CV and Pulmonary system
- Increased sensitivity to angiotensin causes an increase in BP via vasoconstriction.
- As BP rises, so does CO and SV creating increased vascular resistance
- This raise in Vascular resistance causes excess permeability of capillaries and in turn, will decrease plasma volume and edema will occur (especially in the lungs)
What are the three main effects of preeclampsia on the hematologic system?
- Thrombocytopenia (deficiency of platelets)
- Altered platelet function
- Hemolysis
Describe how preeclampsia affects the hematologic system
- hemoconcentration occurs d/t loss of plasma volume, this increased the viscosity of the blood.
- The increased viscosity causes hemolysis in the microvasculature and platelet clumping
- The clumping damages the platelets as well as endothelial cells leading to reduced platelets and an increased in thromboxane A (TXA) (altered Thromboxane: Prostacyclin ratio)
- Thromboxane A causes vasoconstriction and platelet aggregation this continuing the process when it is elevated
What are the 3 main effects of preeclampsia on the neurological system?
- Hyperreflexia
- Headache
- Seizure (eclampsia)
Describe how preeclampsia affects the neurological system
- The vasoconstriction and vasospasms cause ruptures in the small capillaries in the cerebral vasculature
- These ruptures cause small hemorrhages that eventually cause cerebral edema
- This cerebral edema causes headaches and hyperreflexia
- If it continues, seizures will occur
What are the two major effects of preeclampsia on the renal system?
- proteinuria
2. Altered function
Describe how preeclampsia affects the renal system
- Decreased glomerular blood flow from the HTN causes damage to the glomeruli
- This damage alters the function of the filtration and allows for protein to be lost through the urine (proteinuria) as well as causing an increased BUN, creatinine and uric acid
- When the protein leaves colloid osmotic pressure decreases causing edema
- When the edema occurs, hypovolemia occurs as well. This increases the viscosity of the blood and triggers angiotensin/aldosterone thus furthering the pathology
What are the two main effects of preeclampsia on the hepatic system?
- Hepatic dysfunction
2. Hepatic rupture
Describe how preeclampsia affects the hepatic system
-Hepatic function is altered as vascular resistance and inflammation occurs and hepatic edema occurs
-This eventually leads to a subcapsular hematoma
-This causes increased liver enzymes and epigastric pain
(HELLP SYNDROME)
What are the 6 main effects of preeclampsia on the fetus?
- Fetal intolerance to labor
- Preterm birth
- Oligohydramnios
- Intrauterine growth restriction
- Intrauterine fetal death
- Abruptio placentae
Describe how preeclampsia affects the fetus
- Decreased placental perfusion leads to reduced O2 and nutrients
- This decreased in O2 causes hypoxia which can lead to late decelerations and decreased/absent variability
- The decreased nutrients can lead to intrauterine growth restriction and intrauterine fetal death
- This can also lead to placental abruption as the spiral arteries have less circulation
What does HELLP syndrome stand for?
Hemolysis, elevated liver enzymes, low platelets
What labs are checked for preeclampsia?
- CBC
- Urine dipstick to detect protein and maybe glucose
- Liver enzymes and bilirubin
- GFR
- BUN, Creatinine, Uric acid
- AFI
What is the main medication given to prevent preeclampsia from progressing to eclampsia? What is it preventing specifically?
Magnesium Sulfate to prevent seizures
What is the loading dose for Mag sulfate? Maintainance dose?
4g over 20 minutes
2g/hr after
What are some common SE’s of mag sulfate during the loading dose?
N/V and flushing heat
What is the duration of magnesium sulfate administration?
for 24 hours after delivery (the orders will tell you)
Why is Mag toxicity a serious likelihood for preeclamptic women?
Because it is excreted renally
What are the Signs/Symptoms of Magnesium citrate toxicity?
- Decreased RR
- Decreased DTR
- Altered LOC and mental status
What is the safe serum magnesium level?
4-8
What is the antidote to magnesium sulfate?
A 10ml push of 10% calcium gluconate over 3-5 minutes
How will mag sulfate affect FHT?
decreased variability
A urine output of ____ is an indicator of elevated magnesium levels
under 30ml/hr
Preeclamptic BP needs to be treated if the systolic is above ___ and/or the diastolic is above ___
160
110
What consideration needs to be taken when decreasing BP?
If it is done too fast it can affect Cerebral blood flow
What are the three main BP meds for preeclamptic mothers?
- Labetalol
- Hydralazine
- Nifedipine
When treating maternal HTN in a preeclamptic mom, when should you notify the MD? 3
- Diastolic below 80 or above 150
- Cat II or III tracing
- HR below 50 or above 120 after med administration
What are some considerations for Labetalol?
Beta blocker
decreases PVR but not CO or HR
What are some considerations for Hydralazine?
It is a vasodilator and the higher the does the lower the BP or watch for dizziness
What are some considerations for Nifedipine?
-It is synergistic with Mag sulfate and can drastically lower BP, DTRs, and HR
If seizures occur, what medication is given?
Lorazepam
What are some considerations for Lorazepam?
- It is a benzo with anti seizure properties
- Skeletal muscle relaxant
- anti-emetic
What are the nursing interventions/care for an eclamptic patient
- Seizure precautions
- Cluster care
- SaO2 above 95
- Stop Labor
What medication (that controls bleeding) should not be given if the woman has preeclampsia/eclampsia
Methylergonovine (Methergine)
Because it will increase BP and stroke them out
