Hypertensive disorders of pregnancy-Nursing III-Test 2

Pregnancy induced HTN (gestation HTN) is classified as a BP higher than _______, without the presence of _______. It is diagnosed after ________

1-140/90

2-protein in urine

3-20 weeks

Preeclampsia is classified as a BP 1__________, plus the presence of 2_______

1-higher than 140/90

2→300 mg of protein in urine

Eclampsia

tonic-clonic seizures in relation with increased BP and proteinuria

Interventions for eclampsia

-position airway and administer O2

-position on left side and prevent injury

-suction secretions from mouth when seizure is over

-delivery of infant

risk factors for HTN disorders

-first pregnancy

-diabetes

-lupus

-age 40 or older

-obesity

-chronic HTN

-kidney disease

-twins

complications from HTN disorders

-abruptio placentae

-placental insufficiency

-intrauterine growth restriction

-intrauterine fetal death

-maternal death

clinical manifestations of preeclampsia-NEED TO KNOW

-blurred or altered vision

-light sensitivity

-epigastric/RUQ pain (due to liver inflammation)

headache (especially when unrelieved by tylenol)

edema

proteinuria

hyperreflexia

hypertension

rapid weight gain

management of preeclampsia is based on:

severity of symptoms

mild preeclampsia is:

monitored at home with

-bed rest and lying on side to improve uteroplacental blood flow and reduce blood pressure

-daily BP checks, weights, urine dipstick for proteinuria and record

-fetal kick counts

preeclampsia patient is taught to notify HCP immediately of these complications:

-edema of hands, face, eyes

-persistent headache

-N/V

-visual changes-blurred vision

-RUQ/Epigastric pain

-sudden rapid weight gain

-decreased urine output

-decreased fetal activity 

-seizures

nausea and vomiting should be over

after the 1st trimester

nursing care for preeclamptic hospital patients

-assess for worsening signs and symptoms

-fetal nonstress test

-assess reflexes

-daily weight

-strict I&O

urine dipstick

24 hour urine protein

labs: liver enzymes and platelet counts

medications for preclampsia

magnesium sulfate, betamethasone, antihypertensives (hydralazine or labetalol)

severe preeclampsia is classified as

BP over 160/110

-proteinuria of more than 5gm/24 hours

-oliguria if less than 400 ml/24 hours

cerebral and visual disturbances

-rapid weight gain

monitor very closely and deliver infant when symptoms remain and cannot be managed

HELLP Syndrome is a dangerous combination of three medical conditions:

hemolytic anemia, elevated liver enzymes, and low platelet (less than 100,000)

-this is life threatening for the mother and infant

signs and symptoms of HELLP syndrome

-RUQ/epigastric pain

-N/V

-doesn’t feel well for several days

-persistent headache

-blurred vision

-hyperreflexia'

-seizure

-overall, worsening symptoms of preeclampsia

diagnostic labs for HELLP syndrome

-low H&h

elevated LDH, AST, ALT (liver impairment)

low platelets (less than 100,000)

elevated BUN

treatment for HELLP syndrome is based upon 3 things:

severity of disease

gestational age of fetus

condition of mother and fetus

common medications used for HELLP syndrome

mag sulfate, hydralazine or labetalol, betamethasone

nursing care for HELLP syndrome is similar to that of a woman with severe preeclampsia

assess for signs and symptoms:  N/V, malaise, increased or severe epigastric/RUQ pain, increased edema, severe headache, blurred vision, fluid retention, weight gain, tender abdomen

-must assess frequently as status can change quickly

seizure and bleeding precautions