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Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 2
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Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Jan 02, 2016

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Page 1: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Complication during pregnancy and its nursing management:

- Pregnancy induces hypertension.

Clinical Aspect of Maternal and Child NursingNUR 363Lecture 2

Page 2: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

OBJECTIVES

List criteria for the diagnosis of preeclampsia

List criteria for the diagnosis of severe preeclampsia/HELLP syndrome

Discuss current management considerations

Page 3: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Hypertension

Sustained BP elevation of 140/90 or greater

Proper cuff size Measurement taken while seated

Page 4: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

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.

Page 5: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Forms of HTN in Pregnancy

-Eclampsia is an extension of preeclampsia and is characterized by the client experiencing seizures.

Page 6: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Risk Factors

Risk Factors

Renal disease Family history of PIH

Age > 40 Diabetes mellitus

African American Twin gestation

Chronic hypertension

Page 7: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Cardiovascular Effects Increased cardiac output Increased systemic vascular resistance Hypovolemia

Page 8: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Neurologic Effects

Headache Cerebral edema Hyper-reflexia

Page 9: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Hematologic Effects Volume contraction Elevated hematocrit Low platelets Anemia due to hemolysis

Page 10: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Renal Effects

Decreased glomerular filtration rate Increased BUN/creatinine Proteinuria Oliguria Acute tubular necrosis

Page 11: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Fetal Effects

Increased prenatal morbidity Placental abruption Fetal growth restriction Fetal distress

Page 12: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

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.

Page 13: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Management

The ultimate cure is delivery Assess gestational age Assess cervix Fetal well-being Laboratory assessment Rule out severe disease!!

Page 14: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

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

Page 15: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Indications for Delivery Worsening BP Nonreassuring fetal condition Fetal lung maturity Favorable cervix

Page 16: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Hypertensive Emergencies Fetal monitoring IV access IV hydration The reason to treat is maternal, not fetal May require ICU

Page 17: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

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

Page 18: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

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

Page 19: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Acute Medical Therapy

Hydralazine Labetalol Nifedipine Nitroprusside Diazoxide Clonidine

Page 20: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Key Steps Using Vasodilators 250-500 cc of fluid, IV Allow time for drug to work Avoid over treatment

Page 21: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Hydralazine

Dose: 5-10 mg every 20 minutes Onset: 10-20 minutes Duration: 3-8 hours Side effects: headache, flushing,

tachycardia. Mechanism: peripheral vasodilator

Page 22: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

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

Page 23: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

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

Page 24: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Clonidine

Dose: 1 mg po Onset: 10-20 minutes Duration: 4-6 hours Side effects: unpredictable, avoid rapid

withdrawal Mechanism: Alpha agonist, works centrally

Page 25: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

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

Page 26: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Seizure Prophylaxis

Magnesium sulfate 4-6 g bolus 1-2 g/hour Monitor urine output With renal dysfunction, may require a

lower dose

Page 27: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Magnesium Sulfate

Is not a hypotensive agent Works as a centrally acting anticonvulsant Also blocks neuromuscular conduction Serum levels: 6-8 mg/dL

Page 28: Complication during pregnancy and its nursing management: - Pregnancy induces hypertension. Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture.

Toxicity (for Magnesium Sulfate)

Respiratory rate < 12 Altered sensorium Urine output < 25-30 cc/hour