PIH Concept Map

Preeclampsia S/Sx 1. Hypertension- earliest and most dependable sign; 30mm Hg systolic increase or 15mm Hg increase diastolic over baseline; MAP increase 2. Proteinuria- passage of proteins that the tubules cannot reabsorb; excess found in urine; increased serum BUN, creatinine, and uric acid; decrease in urine creatinine clearance 3. Weight gain/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 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) Eeclampsia S/Sx 1. All of the clinical manifestations of pre-eclampsia are present (hypertension, proteinuria, and edema) as well as CONVULSIONS 2. Oliguria, edema, excessive weight gain, visual changes, CNS lesions, epigastric pain, visual changes (blurred vision)

Predisposing Factors 1. Primigravida: especially if <17 or >35 years of age 2. Multiple pregnancies: twins, triplets 3. Vascular disease: especially hypertension, renal disease, or diabetes 4. Hydatidiform mole: manifested prior to 20 weeks 5. Dietary deficiencies 6. Drug use- cocaine 7. Family tendency 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 3. Record fetal activity (kick counts), check urine protein, weigh daily at the same time

Pregnancy Induced Hypertension (PIH)

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- dont 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

PIH Tx (hospital management) 1. Administration of MgSO4- calcium channel blocker that interferes with the release of ACH decreasing neuromuscular irritability, and decreasing CNS irritability 2. Respirations must be 14-16, reflexes must be present and urine output must be 100cc in 4 hours (if above is not present hold med and call Dr) 3. Monitor magnesium level- normal 1.5-2.5; therapeutic 4-8; toxicity =>9 4. Labs- CBC, platelets, type and cross match; Renal studies: BUN, creatinine, uric acid; Liver studies: AST, LDH, bilirubin; DIC profile: platelets, fibrinogen, FSP, D-Dimer

Nursing Diagnosis Activity intolerance 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