NCM 109 - Pregnancy Induced Hypertension

Systolic

represents the pressure produced when the heart contracts

Diastolic

represents the pressure when the heart relaxes.

PIH

a condition in which vasospasm affects both small and large arteries during pregnancy

toxemia

was previously called this because it was once believed that toxins were produced by the mother in response to the foreign proteins of the growing fetus. This explanation was later abandoned because no toxins were identified

20th week

The increase in blood pressure usually develops after

Gestational Hypertension

occurs when the mother develops a blood pressure of approximately 140/90 mmHg without edema or proteinuria.

vasoconstriction, kidney damage, edema

effects of vasospasm

protenuria, decreased urine output

kidney damage leads to

Preeclampsia

occurs when elevated blood pressure is accompanied by edema and proteinuria after the 20th week of pregnancy

Primiparas, High Parity, Low socioconomic status, obesity/multiple pregnancy, HTN/DM,Kidney Disease, ESRD, DM

Pre-eclampsia risk factors (PHLOWED)

HTN, Edema, Proteinuria

Pre-eclampsia triad

Severe Preeclampsia

Severe preeclampsia may be present when the blood pressure reaches 160 mmHg systolic and 110 mmHg diastolic on at least two occasions, six hours apart, while the woman is resting in bed

0

Reflex is absent

+1

Reflex is present but hypoactive

+2

Reflex is normal

+3

Reflex is brisker than average

+4

Reflex is hyperactive, and clonus may be present

Ankle Clonus

assessed by quickly dorsiflexing the woman's foot several times and observing for repetitive movement after the foot is released

Mild Clonus

2 movements

Moderate Clonus

3 to 5 movements

Severe Clonus

More than 6 movements

Magnesium Sulfate

administered to prevent or limit seizures.

Calcium gluconate

used as the antidote for magnesium sulfate toxicity

Eclampsia

most severe form of pregnancy-induced hypertension and it involves deterioration of the woman's condition and the development of a generalized tonic-clonic seizure, usually because of severe cerebral edema

Tonic Phase

tonic phase involves stiffening or rigidity of the muscles of the arms and legs and it usually lasts approximately 20 seconds and may be followed by loss of consciousness

Clonic Phase

involves hyperventilation and jerking movements of the extremities and it usually lasts approximately 30 seconds, although recovery following the seizure may require several hours

Hypertension, Elevated Liver Enzymes, Low Platelets

HELLP syndrome

Transitional Hypertension

described in the presentation as hypertension occurring between 20 and 24 weeks of pregnancy

Chronic Hypertension

hypertension that is present before the 20th week of pregnancy and remains unresolved six weeks after delivery

250 mg/mL in 10- to 20-mL vials

Magsul srock

3

Magsul dosage count

Hydralazine (apresoline)

antihypertensive and peripheral vasodilator and dose is 5 to 10 mg intravenously as ordered

Diazepam (Valium)

antiseizure medication and dose is 5 to 10 mg intravenously

+1

Approximately 2 mm edema depth

+2

Approximately 4 mm edema depth

+3

Approximately 6 mm edema depth

+4

Approximately 8 mm edema depth

Grade +1

Minimal edema is present in the lower extremities

Grade +2

MArked edema is present in the lower extremities

Grade +3

Edema affects the lower extremities, face, hands, and sacral area.

Grade +4

Generalized massive edema is present and may include ascites, or accumulation of fluid within the peritoneal cavity