L1 - Pregnancy Induced Hypertension

Pregnancy Induced Hypertension

Is a condition in which vasospasm occurs during pregnancy in both small and large arteries.

Toxemia

Pregnancy Induced Hypertension is originally called

Toxemia

researchers pictured a toxin of some kind being produced by a woman in response to the foreign protein of the growing fetu

the growing fetus is considered as a foreign body which leads to the production of proteins

How does Vasospasms occur in Primipara

When they release it narrows the blood vessels

How does Proteins affect the body

To work 2x to supply the growing fetus

When a woman is pregnant, she is required to increase her cardiac workload, which requires her body to __

After 20 weeks of AOG (5months)

When does PIH usually develops

Toxins and Proteins

Fetus might release _ and _that could lead to the vasoconstriction of the blood vessel

Hyperreflexia

There is cerebral edema in the patient

Magnesium Sulfate

Medication that prevents seizures; it is also used for preterm labor because it is a muscle relaxant

Retina

Vasospams causes decreased amount of blood flow in the __ which causes visual image disruptions

Hypertension, Edema, Proteinuria

What are the TRIAD symptoms

Women with Multiple Pregnancies

RISK FACTORS

More placenta equals more anti-angiogenic factors which damage and constrict the mother’s blood vessels

Reduces blood flow

A stretched uterus ___; the body raises blood pressure to "force" oxygen to the babies

Younger than 20

RISK FACTORS

Body may not be fully developed to handle the massive cardiovascular demands of pregnancy, resulting in poor placental vessel formation

Older than 40

RISK FACTOR

"Vascular aging." blood vessels are less elastic and may have undiagnosed wear (stiffness), making them more likely to fail under the stress of increased blood volume

Primipara

RISK FACTOR

The immune system often overreacts to the first exposure to placental tissue, causing vessel inflammation because of the release of toxins = Nagkakaroon ng vasospasm or narrowing (lumiliit ang daloy ng dugo)

Vitamins

RISK FACTOR

Limited access to __ (like Calcium) impairs blood vessel and placental health

Stress

Chronic environmental stress triggers hormones that damage the cardiovascular system over time

Inadequate Monitoring

Barriers to regular prenatal care prevent early detection and the use of preventative treatments (like low-dose aspirin).

Hydramnios

Excess Fluid

• uterine stretching

• reduced oxygen

• pressure spike

Effects of Hydramnios

Uterine Stretching

Too much fluid over- distends the uterus, physically compressing the surrounding blood vessels.

Restricts blood flow

Blood vessels compression __to the placenta (ischemia).

Pressure spike

The placenta releases stress signals, forcing the mother's blood pressure to rise to "push" oxygen through the squeezed vessels

Vessel Damage

High blood sugar scars and stiffens blood vessels. They cannot expand to handle the 50% increase in blood volume during pregnancy, causing pressure to spike

Kidney Strain

A __ can’t process extra fluid. They release hormones (like Renin) that aggressively raise blood pressure to maintain filtration.

Release even more toxic proteins

inflammation, triggering the placenta to __

Renin Angiotensin Aldosterone

the Kdiney releases hormones like __ : these hormones control the blood pressure

increase in that is responsible by maintaining blood pressure

lowRenin Angiotensin

Vasospams

Common denominator of PIGH

Vasospams

The one responsible for every cause of risk factor

small arteries

There is an increased wall tension → it squeezes even the __ → lead to placental ischemia → which triggers placental proteins

placental ischemia

There is an increased wall tension → it squeezes even the small arteries → lead to ___ → which triggers placental proteins

Ischemia

Nawawalan ng oxygen ang blood, due to the proteins being released it now leads to a constriction of the mother's blood pressure

Blurry of vision “floaters”

there is retina constriction because of the protein released → Reduced oxygen supply

Deccrease

In PIH there is a __ urine output due to decrease blood supply going to the kidneys

Creatinine

waste product of the body (hindi siya na eexcrete sa katawan it stays at the system)

Hypertension

Blood vessels "squeeze" shut (vasospasm), forcing the heart to pump against higher pressure

Proteinuria

The "leaky" vessels in the kidneys allow protein to slip out of the blood and into the urine

Edema

Damaged vessel walls leak fluid into the body's tissues (swelling of face/hands)

Vision Changes

High pressure causes swelling in the brain and eyes, irritating the visual nerves

• Hypertension

• Proteinuria

• Edema

• Visual changes

Signs and Symptoms of PIH

Gestational Hypertension

BP - 140/90 for the 1st and after 20 weeks
No proteinuria, BP returns to normal by 12 weeks postpartum

Peripheral arterial spasms are starting, but the “pipes” aren’t leaky enough to damage the kidneys

Mild Preeclampsia

BP - 140/90 (2 READINGS - 6 hours apart)
Proteinuria 1+ to 2+ and UPPER BODY EDEMA

Endothelial damage allows protein and fluid to leak into tissues/urine

Severe Preeclampsia

BP - 160/110 while bed rest
Proteinuria 3+ to 4+, Severe Headaches, VISUAL CHANGES

Extreme vasospasms is starving the brain, liver, and kidneys of oxygen

Eclampsia

Any PIH related blood pressure
Tonic-clonic seizures or coma

Cerebral edema (brain swelling) reaches a breaking point

Gestational Hypertension

No need for medication after manganak kasi mareregulate na, yung baby itself lang naman nakakapag cause

Mild Preeclampsia

Facial edema and hindi na kasya ang ring

Severe Preeclampsia

mataas ang BP kahit nakahiga at walang ginagawa
- There is already cerebral edema & accumulation of fluids in the brain

Eclampsia

Tonic-clonic: grad mal and petit mal

Grad mal

gumagaling; parang lasing lang

Petit mal

hyperreflexia or coma

Diastolic Key

The __ is the most important for you to document because it directly reflects the severity of the arterial spasms (how tightly the vessels are squeezing)

+30 Systolic or +15 Diastolic

The Baseline Rule: If a woman’s pre-pregnancy BP is known, an increase of __ Diastolic counts as hypertension, even if she hasn't hit 140/90 yet

140/90 taken twice 6 hours apart; 1+ to 2+

BP and Protein of Mild Pre-eclampsia

Yes >2lb/wk in 2nd trimester; >1lb/wk in 3rd trimester

Is there upper body weight gain in Mild Pre-eclampsia

• monitor antiplatelet therapy

• Promote bed rest

• Promote Good nutrition
  Provide emotional support

Nursing intervention for a woman with Mild PIH

Monitor Antiplatelet Therapy

administer low-dose aspirin (50–150 mg); Avoid excessive levels to prevent maternal bleeding

Bedrest

Aids sodium evacuation and diuresis.

Lateral recumbent position

What position to avoid vena cava pressure

• Pag na compress ang vena cava – hypotension and there will be a problem of uteroplacental formation (it may stop)

Salt

What food is restricted for edema, but prper intake is necessary to avoid activating the renin-angiotensin-aldosterone system

6g (one teaspoon) 2.4g of sodium

What is the daily intake of salt

160/110 (twice 6hrs apart at bed rest) or Diastollic is +30

What is the BP of Severe Pre-eclampsia

+3 - +4 in 24 hour urine collection

Protein in Severe Pre-eclampsia

(decreased) Oliguria 400-600mL in 24 hours

In sevre pre-eclampsia renal/output is __

Severe headache, Blurred vision, Hyperreflexia, Clonus, Cerebral edema

What is the Neurologic finding in Severe Pre-eclampsia

30mL/hr

urine output normal

CONFINEMENT

BP=/>160/110mmHg (on bed rest) + extensive edema + marked proteinuria [3 to 4] + cerebral or visual disturbances + marked hyperreflexia + oliguria [500 mL per 24 hours or less]

Induce Labor & CS operations

36 weeks AOG / (+) fetal lung maturity (amniocentesis)

Lecithin–Sphingomyelin

Amniocentesis we look at

interventions will be instituted to attempt to alleviate the severe symptoms.

<36 weeks AOG / (-) fetal lung maturity (amniocentesis

Betametasone

– medication to promote lung maturity

seizure- triggering stimuli

Enforce complete bed rest and close monitoring. Restrict visitors to prevent

output recording

Insert an indwelling catheter for accurate__

Infectiono

Measure urinary proteins and specific gravity - check if there is __

Kidney function

Collect a 24-hour urine sample to determine protein and creatinine clearance.

placental separation

Blood Prep: Cross-match blood type in case of ___

Fluid Status

Track daily hematocrit levels for blood concentration and obtain daily weights at the same time in consistent clothing

High protein, moderate sodium

Dietary Intake: Provide a diet moderate to high in __ and moderate in _

hydralazine, labetalol, or nifedipine

Medication for PIH to lower BP

Hydralazine

Check pulse and BP pre- and post- administration; watch for maternal tachycardia with __

80–90 mmHg

BP Goal: Maintain diastolic pressure at __ to ensure placental perfusion

Placental perfusion

amount of blood in the placental going to the fetus is enough

Magnesium Sulfate

Drug of choice (DOC) for eclampsia prevention

Magnesium Sulfate

Acts as a CNS depressant to prevent seizures and a "cathartic" to shift fluid and reduce edema

IV loading dose (bolus)

Magnesium Sulfate is administered via __ followed by continuous infusion as effects last only 30–60 minutes

5 to 8 mg/100 mL

Maintain MagSul levels at __ to prevent seizures while avoiding toxicity.

respiratory depression, cardiac arrhythmias (magsulfate toxicity), or cardiac arrest.

Levels above the MagSul therapeutic range can cause

Calcium Gluconate

Acts as the specific antagonist for magnesium sulfate toxicity.

Calcium Gluconate

Reverses neuromuscular blockade by displacing magnesium at the cellular leve

10 Kicks in an hour

MagSul observe fetal movement if decreased, KICKS must be

Floppy baby

MagSul: Watch the neonate for respiratory depression or __ syndrome (hypotonia) due to magnesium crossing the placenta