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PREGNANCY-INDUCED HYPERTENSION

  • Group of disorders characterized by the presence of hypertension beginning 20 weeks AOG or greater.
  • 2nd cause of maternal mortality in the country.
  • Common in those with age below 17yrs or more than 35 years, protein malnutrition, primiparity, diabetes, little or no prenatal care, low socioeconomic status, previous history of hypertension.
  • Basic manifestations: proteinuria, edema, hypertension.
  • Types:
  1. Toxemia - Pre eclampsia and eclampsia
  2. Chronic Essential Hypertension - present during non-pregnant state and combines with pre-eclampsia.
  • Manifestations to monitor and be corrected:

I. PREECLAMPSIA
1. Mild Preeclampsia
  • Increase in BP 30/15 mmHg above baseline (Roll Over Test)
  • Weight gain of 1 lb or more per week in the last trimester.
  • Mild generalized edema.
  • 1+ proteinuria (<300-500>
2. Severe Preeclampsia
  • Severe hypertension, 30-40 mmHg while on bedrest.
  • Massive anasarca and weight gain.
  • 4+ proteinuria ( 5 grams / 24 hour urine collection)
  • Less than 400 ml urine output in 24 hours.
  • Dizziness, headache, blurring or with spots on vision, nausea and vomiting, epigastric pain and irritability.
II. ECLAMPSIA
  • Changes from preeclampsia.
  • With tonic-clonic seizure attacks to comatose state. Pre-monitoring signs: aura, epigastric pain.
  • Hypertensive crisis.
III. HELLP
  • Characterized by RBC hemolysis, elevated liver enzymes and low platelet count related to severe vasospasm leading to dessiminated intravascular coagulation (DIC).
  • Platelet and RBC transfusion often are administered; coagulation factors are monitored.
  • Labor is induced if AOG is more than 32 weeks; cesarean if less than 32 weeks.
IV. DIC
  • Clinical manifestations include varying degree of bleeding from oozing to generlized hemorrhage, purpura, and petechiae as a result of overstimulation of coagulation factors.
  • Coadgulation factors are closely monitored and replaced.
  • Treatment of underlying cause (i.e. Abruption placenta, fetal death in utero, PIH) resolves its pathology.
* The only cure is to end the pregnancy.
* PIH "must" of Nursing Care includes:
A. Closely monitoring of maternal vital signs (esp. BP) and weight, FHR.
B. Bed rest most of the day; side lying position; 8-12 hours.
C. High protein (60-70 g/day), low sodium diet. Calcium (1200mg), magnesium, 2-6g of zinc; vitamin C and E.
D. Health teachings of mild
E. Administration of Magnesium Sulfate, Corticosteroids and antihypertensives as ordered. HPN drugs are excreted in breast milk.
F. Drug of choice is Magnesium Sulfate (MgSO4).
>Monitor for Magnesium Sulfate toxicity:
B- Blood pressure is decreased.
U- Urine output less than 30 cc/hr.
R- Respiratory rate less than 12 cycles per/min ( 1st to diminish)
P- Patellar reflex
Hydralasine-anti-hypertensive drug of choice.

Normal MgSO4 level is 1.5-3 mEq/L maintenance dose, 4-7 mEq/L loading dose.
> at 8-10 mg/dl, Respiratory rate starts to diminish
> at 10-14 mg/dl , deep tendon reflex is absent.

G. Blood replacements.
H. Monitor for seizure activity and protection from injury.
I. Administer O2 as needed.
J. Prepare mother and her family for early induction of labor. vaginal delivery is preferred over cesarean.
K. Health teachings on contraception.

* SOME NURSING DIAGNOSES AND EXPECTED OUTCOME:

High-Risk for CNS injury
  • BP within acceptable limit
  • Urine output > 30 mL
  • Deep tendon reflexes in normal limits
  • (-) seizures
  • Serum Magnesium within normal level
Altered tissue perfusion: renal
  • I-O balance with output > 30mL
  • Weight gain within normal limtis
  • BUN, Creatinine, uric acid within normal level.
High -risk for impaired fetal well being
  • FHT is within normal limit

Anxiety
  • Verbalizes understanding of the condition and treatment