001hypertensive disorders in pregnancy.pdf

7/27/2019 001Hypertensive Disorders in Pregnancy.pdf

1/23

Hypertensive Disorders

in

Pregnancy


2/23

Pregnancy Induced Hypertension

Terms :

PIH development of HPN ( BP> 140 /90 duringsecond half of pregnancy, occurs in previouslynormotensive woman.

Pre-eclampsia renal involvement leads toproteinuria

Eclampsia CNS involvement leads to seizures

HELLP clinical picture dominated by

hematologic and hepatic signs and symptoms. Chronic HPN elevation of BP occurs before 20

weeks gestation.


3/23

Hypertensive Disorders of Pregnancy

a potentially life-threatening disorder

that usually develops after 20 week

of pregnancy

most common in nulliparous women cause is unknown.

systemic vasospasm occur, affecting

every organ system


4/23

Two categories ofPIH

1 .Preeclampsia Mild / Severe

- non convulsive form of disorder

- maybe mild or severe

- occurs after 20 weeks gestation

- higher incidence in the low

socioeconomic group


5/23

Factors that increases the risk for developing

Pre-eclampsia

1- Primigravidas age 40 yrs and above

2- Women with chronic hypertension /

Renal disease

3- Low socioeconomic status

4- Young maternal age > less than 17 yrs.

5- Women with DM or Multiple pregnancies

6- Dietary deficiencies


6/23

2. Eclampsia -

- convulsive form of the disorder

- occurs between 24 weeks gestation and

the end of the first post partum week

- higher incidence with first pregnancies,

multiple gestations and history of vascular

disease


7/23

Assessment Findings:

1. BP over 140/90 mmHg or an increaseof 30 mmHg systolic and 15mmHgdiastolic over baseline taken on 2

occasions 4-6 hrs. apart. 2. Increase in generalized edema

associated with a sudden weight gain ofmore than 5lbs.( 2.3 Kg) per week

3. Proteinuria

4. Convulsion and or coma


8/23

SIGNIFICANT CHANGES IN PIH

Decreased renal perfusion reducesGFR( Glomerular Filtration Rate)

Reduced blood flow to kidneys

causing glomerular damage Loss of PRO from kidneys reduces

colloid osmotic pressure and allowsfluid to shift from vascular to interstitial

spaces Hypovolemia additional angiotensin II

and aldosterone (retention of Na andwater)


9/23

Decreased circulation to the liver impaired liver function (hepatic edema

and subscapular hemorrhage) Vasoconstriction of cerebral vessels -

small cerebral hemorrhages ( spotsbefore eyes, blurred vision)

Decreased colloid oncotic pressure pulmonary capillary leak ( pulmonaryedema)

Decreased placental circulation infarctions (abruptio placenta)


10/23

Changes Associated with PIH

Effects on the

Interstitial

History of Systematic Vasospasm

Effects on the

Vascular system

Vasoconstriction

Impaired organ

Perfusion

Hypertension

Effects on the

renal system

Reduced glomerularFiltraction rate: Increased

Glomercular membrance

permeability

Increased serum bloodUrea nitrogen and

creatinine

Oliguria and protelnuria

Fluid diffusion from

Vascular space into

Interstitial space

Effects on the

Interstitial


11/23

Preventive Measures for PIH:

1. Adequate prenatal care close attentionto weight gain, monitoring BP and urinary

protein.

2. Low dose aspirin (6080 mg /day) per

doctors order suppresses synthesis of

thromboxane that causes vasoconstrictionand platelet aggregation.


12/23

3. Calcium supplementation for less

sensitivity to the pressor effects of

angiotensin II and have a lower incidence ofHPN.

4. Sedatives ( Diazepam or Phenobarbital)given if MgSO4 fails in Eclampsia to bring

seizures under control.

5. Environment modification


13/23

Manifestations / Classic Signs :

1. Generalized edema rapid weight gaindue to fluid retention , present in lower

legs, hands and face ( tightening ofwedding ring )

2. Hypertension BP 140/90;30 mmHgsystolic and 15mmHg diastolic

3. Proteinuria


14/23

Symptoms :

Continuous headache, drowsiness, mentalconfusion ( poor cerebral perfusion )

Visual disturbances ( blurring of vision )

arterial spasms, edema of retina Numbness or tingling of hands and feet

compression of nerves by retained fluid

Epigastric pain or upset stomach distention of hepatic capsule

Decreased urinary output poor perfusion

of the kidneys > acute renal failure


15/23

Nursing Considerations for Pre-eclampsia

1. Sedentary activity for most of the day or bedrest.

2. Keep record of fetal movements or kick

count 3. Check BP 2-4x a day ( same arm, same

position)

4. Weigh daily( same time, same scale)

5. Advice on dietary regulation - low or no salt,

protein rich foods


16/23

6. Administration of anti-hypertensives and diureticsper doctors order Hydralazine, Nifedipine orLabetalol

7. Anticonvulsant Meds MgSO4 ( to preventconvulsions), Phenytoin , Nifedifine

- Check DTR before administration

- Keep CA Gluconate on standby ( antidote ) -Monitor urine output ( shd. be 30 ml/hr)

RR ( 12 BPM )

Side Effects: CNS depression, depression of

Respiratory Center 8. Environment should be kept quiet with dim lights

9. Seizure precautions and prevent injury foreclampsia


17/23

General Nursing Measures:

1. High protein, low salt diet

2. Adequate fluid intake

3. Bed rest in lateral position

4. Antihypertensive methyldopa,hydralazine


18/23

5. Magnesium sulfate have

antidote ready at bedside (Cagluconate)

6. Monitor VS, level of consciousness

and DTR

7. Maintain seizure precautions


19/23

Symptoms of Magnesium Sulfate Toxicity

1. Decreased deep tendon reflexes or

absent

2. Muscle flaccidity

3. Central Nervous System depression /altered sensorium ( confusion, lethargy,

slurring speech, drowsiness, disorientation )

4. Decreased respiratory rate - < than 12

breaths per minute

5. Decreased renal function

6. Sweating and flushing sensations


20/23

Severe Complications of Eclampsia:

1. Seizures ( eclampsia)

2. Cerebral edema

3. Stroke

4. Abruptio placenta

5. Fetal death


21/23

Assessment of Edema

Characteristics

Minimal edema of lower extremities

Marked edema of lower extremities

Edema of lower extremities,face

hands and sacral area

Generalized massive edema that

include ascites

Grade

+ 1

+ 2

+ 3

+ 4


22/23

Chronic Hypertensive Vascular Disease

(CHVD )

Persistent hypertension before pregnancybefore 20th week of gestation or beyond

42nd wk. postpartum.

Seen in older women who are obese and

those with DM.

Can be attributed to heredity, race

Can lead to pre-eclampsia , and seen onthe basis of rise in BP, sustained

proteinuria and generalized edema

Management :


23/23

Management :

High protein diet with adequate salt

Advise woman to weigh herselfevery 3 days to detect abnormal

weight gain

Anti hypertensive drugs if diastolicis consistently higher than 90

mmHg. Anti-hypertensive drugsshould not be teratogenic.(methyldopa )

001hypertensive disorders in pregnancy.pdf

Documents