Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 2
Complication during pregnancy and its nursing management:
- Pregnancy induces hypertension.
Clinical Aspect of Maternal and Child NursingNUR 363Lecture 2
OBJECTIVES
List criteria for the diagnosis of preeclampsia
List criteria for the diagnosis of severe preeclampsia/HELLP syndrome
Discuss current management considerations
Hypertension
Sustained BP elevation of 140/90 or greater
Proper cuff size Measurement taken while seated
Forms of HTN in PregnancyGestational hypertension is also known as
pregnancy induced hypertension (PIH), or preeclampsia.
-Preeclampsia is a hypertensive disorder of pregnancy developing after 20 weeks gestation and characterized by edema, vasospasms of the arteries and proteinuria.
Forms of HTN in Pregnancy
-Eclampsia is an extension of preeclampsia and is characterized by the client experiencing seizures.
Risk Factors
Risk Factors
Renal disease Family history of PIH
Age > 40 Diabetes mellitus
African American Twin gestation
Chronic hypertension
Cardiovascular Effects Increased cardiac output Increased systemic vascular resistance Hypovolemia
Neurologic Effects
Headache Cerebral edema Hyper-reflexia
Hematologic Effects Volume contraction Elevated hematocrit Low platelets Anemia due to hemolysis
Renal Effects
Decreased glomerular filtration rate Increased BUN/creatinine Proteinuria Oliguria Acute tubular necrosis
Fetal Effects
Increased prenatal morbidity Placental abruption Fetal growth restriction Fetal distress
Severe Preeclampsia
BP > 180 systolic or 110 diastolic
Proteinuria > 5 g per day
Oliguria Elevated liver
enzymes
Low platelets Growth restriction Headache Epigastric pain Pitting edema.
Management
The ultimate cure is delivery Assess gestational age Assess cervix Fetal well-being Laboratory assessment Rule out severe disease!!
Gestational HTN at Term
Delivery is always a reasonable option if term
If cervix is unfavorable and maternal disease is mild, expectant management with close observation is possible
Indications for Delivery Worsening BP Nonreassuring fetal condition Fetal lung maturity Favorable cervix
Hypertensive Emergencies Fetal monitoring IV access IV hydration The reason to treat is maternal, not fetal May require ICU
Criteria for Treatment Diastolic BP > 105-110 Systolic BP > 200 Avoid rapid reduction in BP Do not attempt to normalize BP Goal is DBP < 105 not < 90
Nursing Care Focus
Assisting the woman in obtaining prenatal care Helping her cope with therapy Caring for acutely ill woman
Know what signs/symptoms to monitor for and when to intervene
Administering medications as prescribed
Acute Medical Therapy
Hydralazine Labetalol Nifedipine Nitroprusside Diazoxide Clonidine
Key Steps Using Vasodilators 250-500 cc of fluid, IV Allow time for drug to work Avoid over treatment
Hydralazine
Dose: 5-10 mg every 20 minutes Onset: 10-20 minutes Duration: 3-8 hours Side effects: headache, flushing,
tachycardia. Mechanism: peripheral vasodilator
Labetalol
Dose: 20mg, then 40, then 80 every 20 minutes, for a total of 220mg
Onset: 1-2 minutes Duration: 6-16 hours Side effects: hypotension Mechanism: Alpha and Beta block
Nifedipine
Dose: 10 mg po, not sublingual Onset: 5-10 minutes Duration: 4-8 hours Side effects: chest pain, headache,
tachycardia Mechanism: CA channel block
Clonidine
Dose: 1 mg po Onset: 10-20 minutes Duration: 4-6 hours Side effects: unpredictable, avoid rapid
withdrawal Mechanism: Alpha agonist, works centrally
Nitroprusside
Dose: 0.2 – 0.8 mg/min IV Onset: 1-2 minutes Duration: 3-5 minutes Side effects: cyanide accumulation,
hypotension Mechanism: direct vasodilator
Seizure Prophylaxis
Magnesium sulfate 4-6 g bolus 1-2 g/hour Monitor urine output With renal dysfunction, may require a
lower dose
Magnesium Sulfate
Is not a hypotensive agent Works as a centrally acting anticonvulsant Also blocks neuromuscular conduction Serum levels: 6-8 mg/dL
Toxicity (for Magnesium Sulfate)
Respiratory rate < 12 Altered sensorium Urine output < 25-30 cc/hour