PREGNANCY-INDUCED HYPERTENSION Flashcards
Refers to a spectrum of hypertensive disorders unique to pregnancy. These conditions increase maternal & fetal risks and require careful monitoring and management
Pregnancy-Induced Hypertension
Is a form of high blood pressure in pregnancy
Pregnancy-induced Hypertension
When does PIH develop?
Develops after the 20th week of pregnancy in a woman who has not previously had high blood pressure
What causes increase resistance of blood vessels?
Due to thedecrease in the diameter of the blood vessels which may hinder blood flow.
Classifications of PIH
- Gestational Hypertension
- Preeclampsia
- Eclampsia
- Chronic Hypertension with Superimposed Preeclampsia
- Eclampsia with HELLP Syndrome
High blood pressure that develops after the 20th week of pregnancy in a woman who did not have hypertension before (normotensive woman)
Gestational Hypertension
Characteristics of Gestational Hypertension
- No protein in the urine
- Blood pressure returns to normal w/n 6-12 weeks after delivery
- Mild to moderate in severity
- May resolve after birth
A more severe form of hypertension in pregnancy, characterized by high blood pressure & the presence of proteinuria or signs of organ damage
Pre-eclampsia
Characteristics of Pre-eclampsia
- Proteinuria
- Lead to organ damage, severe swelling, vision changes & other symptoms
- May develop into eclampsia
Results of a Dipstic urinalysis when testing for presence of proteinuria
Greater than or equal to +1
Result when testing for presence of protein in the urine using a 24-hour urine collection
Greater than or equal to 300 mg/24 hours
When does 24-hour urine collection done?
First thing in the morning by **discarding the first morning void **and then collecting all of the urine for the remaining 24 hour period
3 Diagnostic Criteria for Pre-eclampsia
- High blood pressure after 20 weeks of gestation measured on 2 separate occasions, at least 4 hrs apart
- Proteinuria or other signs of kidney/liver dysfunction or thrombocytopenia
- Evidence of organ dysfunction.
- elevated liver enzymes
- kidney problems
- low platelet count
- RUQ
A life-threatening complication of pre-eclampsia, where high blood pressure, proteinuria, and seizure occur
Eclampsia
Characteristics of Eclampsia
- occurs when preeclampsia is not controlled
- seizures - sign of severe complication
- requires emergency medical intervention & often delivery of the baby regardless of gestational age.
Occurs when a woman has pre-existing hypertension (diagnosed before pregnancy or before 20 weeks) & then develops preeclampsia during the pregnancy
Chronic Hypertension with Superimposed Preeclampsia
Characteristics of Chronic Hypertension with Superimposed Preeclampsia
- Hypertension exists before pregnancy, & proteinuria or signs of organ damage appear later
- More complicated to manage due to the combination of pre-existing hypertension & pregnancy-related hypertensio
Is life-threatening conidtion in which a patient experiences seizures along with HELLP syndrome. This condition can lead to severe complications like liver damage, bleeding, kidney failure, and risks to fetal health.
Eclampsia with HELLP syndrome
Characteristics of Eclampsia with HELLP syndrome
- Presence of seizure
- H- hemolysis (destruction of RBCs)
-
EL - Elevated liver enzymes indicating liver damage
*** LP **- Low platelet count, leads to bleeding problems - Requires immedicated medical attention & may necessitate early delivery of the bay
Risk Factors associated with PIH
- History of hypertension
- First Pregnancy
- Maternal Age
- Obesity
- Multiple pregnancy
- Family history
- Pre-existing conditions
- Low socioeconomic status
- History or pre-eclampsia
Why are primigravida at higer risk for PIH compared to women with previous pregnancies?
due to: immune system adaptation, placental development, vascular & hormonal changes.
Key players in the development of pre-eclampsia
- Spiral arteries of the uterus
- Placenta
- Endothelial cells of the blood vessels
Cells lining the inside of all blood vessels & control exchanges between the bloodstream & the surrounding tissues
Endothelial cells
What happens when endothelial cells become damaged?
- Decreases tone - ability to constrict & expand
- Increases permeability - controls what they let through the blood vessel & what they should not.
Nursing Interventions
P- protein monitoring
R- reflexes hyperactive
E- evaluate high blood pressure
E- edema monitoring
C- calcium gluconate
L- left side lying, bed rest & fetal monitoring
A- assess for seizure activity
M-agnesium Sulfate
P-rotein rich diet, watch the salt intake
S-evere complications to watch for
I-ntake & output monitoring
A-ntihypertensive
Protein Monitoring
Lab results reveal the following:
Dipstick Urinalysis : >+1
24 hour urine test: >300 mg
Creatinine-protein ratio test: >0.30 mg/dL
Other lab results to monitor : CBC & Liver function
Reflexes Hyperactive
Since CNS is irritated, nurse should assess the following:
- Nuero status
- Vision Changes
- Headace
- Assess or anticipate for occurence of seizures
Reflexes Hyperactive
Why assess for deep tendon reflex?
Because reflex is hyperactive due to the brain being stressed out or irritated.
Signs of MgSO4 toxicity
Deep tendon reflexes are absent or signifcantly decreased
Edema monitoring
> 2lbs/ week would indicate…
Water weight gain
Antidote for MgSO4 toxicity
Calcium Gluconate
Left-side lying position, bed rest & fetal monitoring
Why have patient in LLD position?
Most favorable position for pregnant women for optimal blood perfusions to the placenta to maintain fetal well-being ; prevents IVC compression.
Left-side lying position, bed rest & fetal monitoring
Why maintain bed rest?
To decrease stimulation
Assess for seizure activity
Why assess for seizure activity?
Risk during and after labor/delivery
Assess for seizure activity
Early or impending signs of seizure.
- Mental status changes
- Facial twitching - the muscles in the face spasm
- Followed by full body tonic - clonic seizure
Assess for seizure activity
Precautions / Responsibilities during a seizure
- Do not leave the patient, stay with her & call for help
- Do not restrain patient
- Place patient in LLD position
- Always have suction machine available
- Administer oxygen inhalation at 8-10 L/min
- Monitor the baby -FHT monitoring
- Raise side rails to prevent patient from falling
- Time the onset, duration & characteristics of the seizure
Admnistered for seizure prevention during labor & after delivery
Magnesium Sulfate
Magnesium sulfate
Early signs of MgSO4 toxicity
- Patient reports of feeling warm
- May observe flushing (redness/warmth)
- Respi rate decreased : <12 breaths/min
- DTRs significantly decreased or absent
- Low urine output - FBC is in place to monitor UO
- EKG changes - slow heart rate, irregular heartbeats, very severe: heart stopping (asystole)
Severe complications to watch for:
- Hemolysis : RBCs are destructed due to obstruction of fibrin clots from DIC
- Elevated Liver enzymes due to liver injury
- Low platelets : due to DIC
- Fetal distress
- Placental abruption : premature separation of the placenta.
- Stroke : due to hypertension
I & O monitoring
Normal urine output
At least 30 cc/hr
Antihypertensive medications
Antihypertensive meds commonly used:
- Labetalol
- Nifedipine
- Methyldopa
- Hydralazine
Antihypertensive meds
Why must antihypertensive meds be used with caution?
Too low BP can cause decreased blood flow to the fetus.
