PREGNANCY-INDUCED HYPERTENSION (PIH; PREECLAMPSIA AND ECLAMPSIA)

Description: 1. Originally called TOXEMIA. Because researchers pictured a toxin of some kind being introduced bye the woman in response to the foreign protein of the growing fetus, the toxin leading to the typical symptoms. No such toxin has ever been identified.

Description: 2. Preeclampsia is a hypersensitive disorder of pregnancy developing after 20 weeks’ gestation and characterized by EDEMA, HYPERTENSION, and PROTEINURIA. 3. Eclampsia is an extension of preeclampsia and is characterized by the client experiencing siezures.

Etiology: 1. The cause of preeclampsia is unknown. 2. Possible contributing factors include: a. Genetic or immunologic b. Primigravida status c. Conditions that create excess trophoblastic tissue, such as multiple gestation, diabetes or hyaditiform mole. d. Age younger than 18 or older than 35 years.

Pathophysiology: Pathophysiologic basis is VASCULAR SPASM leading to Hypertension (vascualr effect), Edema( interstitial effect), and Proteinuria (kidney effect).

ASSESSMENT FINDINGS Clinical manifestations of mild preeclampsia Blood pressure exceeding 140/90 mmHg; or increase above baseline of 30 mmHg in systolic pressure and 15 mmHg in diastolic pressure on two readings taken 6 hours apart. Generalized EDEMA in the face, hands, and ankles (a classic sign) Weight gain of about 1.5kg (3.3lbs) per month in the second trimester or more than 1.3 to 2.3 kg (3 to 5lbs) per week in the third trimester Proteinuria 1+ to 2+, or 300mg/dL, in a 24 hour sample.

ASSESSMENT FINDINGS 2. WARNING SIGNS OF WORSENING PREECLAMPSIA Rapid rise in blood pressure Rapid weight gain Generalized EDEMA Increased PROTEINURIA Epigastric pain, marked hyperreflexia, and severe headache, which usually precede convulsions in eclampsia Visual disturbances Oliguria (<120 ml in 4 hours) Irritabilitiy Severe nausea and vomiting Maybe managed at home

ASSESSMENT FINDINGS 3. Clinical manifestation of severe preeclampsia Blood pressure exceeding 160/110mmHg noted on two readings taken 6 hours apart with the client on bed rest. Proteinuria exceeding 5g/24 hours Oliguria (less than 400ml/24 hours) Headache Blurred vision, spots before eyes, retinal edema Pitting edema of the sacrum, face and upper extremeties Dyspnea Epigastric pain Nausea and Vomiting Hyperreflexia Managed in the hospital

ASSESSMENT FINDINGS 4. Eclampsia exists once the patient has experienced a grand mal seizure. The patient may progress to more serious complications such as cerebral hemorrhage, liver rupture and coma. Hypertension, Proteinuria, CONVULSIONS, and COMA OBSTETRICAL EMERGENCY!!!

NURSING MANAGEMENT FOR PREECLAMPSIA FOR ECLAMPSIA Asssess BP in sitting and left lateral position, protein level in urine, changes in level of consciousness, WEIGHT, FHT, VAGINAL BLEEDING Maintian IV line BEDREST (aids in sodium excretion) Keep Oxygen and airway equipment available at bedside, also padded tongue depressor Left lateral recumbent position (to avoid uterine pressure on vena cava) Minimize stimuli High protein diet Medication as ordered ( Magnesium Sulfate, Valium, Apresoline) Seizure precautions (note headaches, visual changes, dizziness and epigastric pain Side rails up and padded Aspiration precaution post ictal phase

Magnesium Sulfate Drug of choice for the prevention and treatment of convulsions decreasing muscular irritability and CNS depression Therapeutic level is 4-7 mg/100ml Given slow piggy back IV but may be irritating to vein or IM given Z-tract method Monitor RR closely as respirations may be depressed Poor urinary excretion may lead to toxicity!!!Accurate I and O (catheterization) Monitor Deep Tendon reflex (DTR), absence means increase in magnesium level Monitoring of maternal and fetal vital signs Antidote is CALCIUM GLUCONATE

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