Hypertension In Pregnancy Flashcards
When does pre-eclampsia usually develop?
Pre-eclampsia usually develops in the 20th week, or even as early as 6-8 weeks
What is the definition of pre-eclampsia?
Hypertension along with proteinuria, or edema, or both
What are risk factors for preeclampsia?
Chronic HTN, Chronic Renal disease, DM, Rh incompatibility, primigravidity, family hx, 40, and multiple gestations
What is the underlying cause of preeclampsia?
Arteriolar insufficiency, due to thick walled vessels which results in vessel wall damage
What is the Patho of preeclampsia?
- Increased BP, leads to decreased placental perfusion
- this results in cell damage
- cell damage causes:
- vasoconstriction
- activation of the coagulation cascade
- intravascular fluid redistribution
- end result is decreased organ perfusion
What does arteriolar spasm cause?
Leads to decreased blood vessel diameter which impedes flow to organs which in turn leads to increased BP
Why might hematocrit be inaccurate due to arteriolar spasm?
Decreased renal perfusion causes Oliguria and proteinuria. This causes a decreased colloid pressure and third spacing of sodium and water. This means that the hematocrit may be increased due to a decreased intravascular water and sodium volume
How does arteriolar spasm cause seizures?
Decreased perfusion to the brain
Severe epigastric pain in preeclampsia is caused by what?
Decreased liver perfusion which causes edema and hemorrhage and causes increased liver enzymes
What are some complications of preeclampsia
Eclampsia which is the development of seizures-which deprives the mother and fetus of vital oxygen
HELLP- hemolysis, elevated liver enzymes, low platelets
DIC- disseminated intravascular coagulation- preceded by a major loss of blood
How is HELLP diagnosed
Lab values
What is the medical management for preeclampsia, and any other hypertensive issue?
The only cure is to deliver the fetus and placenta
Celestone or dexamethasone may be administered between 24-34 weeks to mature lungs
Pain control may be an issue, no epidurals if platelets are below 100,000
What is the nursing care involved in preeclampsia?
Care is focused on deterioration on the condition
- report and contractions or leaking/bleeding
- promote bed rest and quiet environment (frequent bed rest with frequent position changes - milder forms may be allowed some activity
- seizure precautions- suction equipment and O2 at the ready- pad bed rails- if urine output is decreased, catheter may need to be placed
- BP every 15 minutes - best to get patient on their side
