PIH Concept Map Preeclampsia S/Sx Just the facts 1. Hypertensive disease of pregnancy occurring at 20 wks gestation and lasting to 14 wks postpartum 2. Pre-eclampsia- hypertension, proteinuria, and edema 3. Eclampsia- all of the complications of pre-eclampsia plus the presence of convulsions 4. Arteriolar vasospasm and vasoconstriction in the entire body including major organs (multisystem failure disease)
1. Hypertensi Hypertensionon- earlie earliest st and most dependable sign; 30mm Hg systolic increase or 15mm Hg increase diastolic over baseline; MAP increase 2. Prot Proteinur einuriaia- passage passage of of proteins proteins that the tubules cannot reabsorb; excess found in urine; increased serum BUN, creatinine, and uric acid; decrease in urine creatinine clearance 3. Weigh Weightt gain/ gain/Edema Edema-- may appear rapidly beginning in lower extremities and moves upward; accumulation of fluid due to decreased blood flow to kidneys causing increased angiotension and aldosterone which trigger the retention of sodium and water
1. Primi Primigra gravid vida: a: espe especia ciall lly y if <17 or >35 years of age 2. Mul Multip tiple le pre pregna gnanci ncies: es: twi twins, ns, triplets 3. Vas Vascul cular ar dis diseas ease: e: esp especi eciall ally y hypertension, renal disease, or diabetes 4. Hyd Hydati atidif diform orm mol mole: e: man manife ifest sted ed prior to 20 weeks 5. Di Diet etar ary y de defi fici cien enci cies es 6. Dr Drug ug us usee- co coca cain ine e 7. Fa Fami mily ly te tend nden ency cy PIH Tx (home management) 1. Decrease activities and bed rest (side lying position) 2. Dietary modifications- protein intake increase 70-80g/day and maintain sodium intake
PIH Tx (hospital management) 1.
Nursing Diagnosis • Activity intolerance • •
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3. Record fetal activity (kick counts), check urine protein, weigh daily at the same time
1. All All of the cli clinic nical al mani manifes festat tatio ions ns of pre-eclampsia are present (hypertension, proteinuria, and edema) as well as CONVULSIONS 2. Ol Olig igur uria ia,, edema edema,, exces excessi sive ve weight gain, visual changes, CNS lesions, epigastric pain,
Nursing Interventions 1. CNS irritability- provide quite environment and rest, comfort measures, assess reflexes administer MgSO4, assess subjective signs (irritability, HA, blurred vision, epigastric pain) 2. Control BP- monitor VS, give antihypertensive drugs, check hematocrit 3. Promote diuresis- don’t give diuretics; bed rest (left or right lateral position), check output (foley catheter placement), weigh daily, dipstick for protein 4. Monitor fetal well being- check FHTs, fetal assessment test (OCT) 5. Deliver infant
Pregnancy Induced Hypertension (PIH)
Predisposing Factors
Eeclampsia S/Sx
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Anxiety Disturbed sensory perception (visual) Disturbed thought processes Excess fluid volume Fear Impaired urinary elimination Ineffective coping Ineffective tissue perfusion: Cerebral, peripheral Risk for injury
Admini Adm inistr strati ation on of MgSO4 MgSO4-- calciu calcium m channel channel blocker that interferes with the release of ACH decreasing neuromuscular irritability, and decreasing CNS irritabili irritability ty 2. Res Respir pirati ations ons must must be 14-16, 14-16, refl reflexe exes s must be be present and urine output must be 100cc in 4 hours (if above is not present hold med and call Dr) 3. Mon Monit itor or magnes magnesium ium leve levell- normal normal 1.5-2 1.5-2.5; .5; therapeutic 4-8; toxicity =>9 4. Lab Labss- CBC, CBC, plate platelet lets, s, type type and cross cross matc match; h; Renal studies: BUN, creatinine, uric acid; Liver studies: AST, LDH, bilirubin; DIC profile: platelets, fibrinogen, FSP, D-Dimer
