Pregnancy induced hypertension
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| What two things have to be present for diagnosis of PIH? | High B/P, and Protein in urine
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| What are Risk factors for PIH? | First pregnancy
Age less than 20 and greater than 35
family hx
obesity
diabetes
Multi fetal pregnancy- twins
angiotensin Gene T235
Chronic hypertension or renal disease
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| What are the classic symptoms of PIH? | High B/P >140/90
Protein in urine
Edema above the waist (hands, face)
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| PIH Symptoms that effect Nervous system | headache
seizures
drowsiness
Brisk reflexes
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| PIH Symptoms that effect Ophthalmologic | Visual disturbance- blurring, double vision, see spots
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| PIH Symptoms that effect Dermatologic | Edema
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| PIH Symptoms that effect Cardiopulmonary | Heart attack
stroke
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| PIH Symptoms that effect Renal | kidney disease
decreased urinary output
increased protein
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| PIH symptoms that effect gastrointestinal | N/V
upper right abdominal pain
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| PIH symptoms that effect Musculoskeletal | pain
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| Patho for PIH | Result of Vasospasm
leaky vessels- from damage to cell lining in arterioles
leaky vessels then cause the body to think it has lost fluid
Kidneys then hold fluid - decreasing output which makes blood viscous and start spilling protein
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| Liver during PIH | decrease flow during vasospasm causing damage or necrosis- not enough nutrients to baby
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| Brain during PIH | has decreased flow causing hemorrhage in small capillaries
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| Placenta during PIH | Has decreased flow during vasospasm...IUGR, abruption, hypoxia- cant get O2 to baby, can be emergency situation for baby
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| What lab work is used for diagnosis of PIH | urine test- see if protein present
CBC- looking for platelet
chem with liver profile
uric acid-see if kidneys working properly
type& screen - to see if we need to replace blood
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| How can you tell if PIH is worsening? | If symptoms become severe
B/P 160/110 ect...
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| What is the top priority of Mom and baby with PIH? | safety
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| What is the goal and cure of PIH? | delivery of baby
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| How do you prevent PIH? | Good prenatal care
Medications and supplements have not been proven to prevent it
NO CURE YET
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| What are the top Nursing interventions for PIH | Hourly checks:
Assess B/P , temp, pulse, RR (anything below 12)
Monitor urine out put (want above 30)
monitor weight gain
Assess:
reflexes (absent resp.arrest)
for edema
monitor consciousness
Give mom Mag sulfate
Give baby Steroids
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| When do you give steroids for baby? | Anything before 34 wks gets steroids
Anything after does not
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| Is vaginal delivery or c-section preferred? | vaginal delivery
C-section only for emergency situations
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| What is good and normal for urinary output? | anything above 30cc/ hr
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| What medications are for PIH? | magnesium sulfate
Hydralazine
Labetalol
Nifedipine
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| Magnesium sulfate | Used to prevent seizure
NOT b/p med
High alert- need 2 nurses to start
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| Hydralazine | vasodilator
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| Labetalol | beta blocker
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| Nifedipine | calcium channel blocker
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| Mild PIH | exhibit few if any symptoms
b/p is 140/90 or higher
1+ proteinuria may occur
liver enzymes may be elevated minimally
edema may be present
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| Severe PIH | Develop suddenly
B/P 160/110 or higher on 2 occasions
Proteinuria 5g or higher in 24 hr collection
3+ to 4+ on 2 random samples @ least 4hrs apart
Oliguria is present
Urine output equal or less to 500ml in 24 hrs
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| Other symptoms of severe PIH | N/V
irritability
hyperreflexia
retinal edema
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| HELLP | Hemolysis- broken down RBC
Elevated liver enzymes- very elevated
Low platelets- very low, can have sig. bleed
Serious complication
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| HELLP prominent symptoms | upper right quad pain
severe edema
N/V
mortality is high
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| HELLP sometimes complicated by? | DIC ( Disseminating Intravascular Coagulopathy)- Body not able to coagulate blood w/ potential to hemorrhage -from anywhere , any opening
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| PIH is also known as | Toxemia
Preeclampsia
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