Pre-eclampsia

Description of the Disease

Preeclampsia, also referred to as toxemia, is a condition that pregnant women can get. It is marked by high blood pressure accompanied with a high level of protein in the urine. Women with preeclampsia will often also have swelling in the feet, legs, and hands. Preeclampsia, when present, usually appears during the second half of pregnancy, generally in the latter part of the second or in the third trimesters, although it can occur earlier.

Symptoms of Preeclampsia can include:

Rapid weight gain caused by a significant increase in bodily fluid Abdominal pain Severe headaches A change in reflexes Reduced output of urine or no urine Dizziness

Excessive vomiting and nausea Pre-eclampsia may develop from 20 weeks gestation. Its progress differs among patients. Most cases are diagnosed pre-term. Pre-eclampsia may also occur up to six weeks post-partum. It is the most common of the dangerous pregnancy complications; it may affect both the mother and the unborn child. T h e r e a r e 2 c a t e g o r i e s o f pre-eclampsia, m i l d a n d s e v e r e . Severe preeclampsia is defined as the following:

blood pressure greater than 160 mm Hg systolic or 110 mm Hg diastolic on 2 occasions 6 hours apart Proteinuria exceeding 2 g in a 24-hour period or 2-4+ on dipstick testing Increased serum creatinine (> 1.2 mg/dL unless known to be elevated previously) Oliguria 500 mL/24 h cerebral or visual disturbances epigastria pain elevated liver enzymes thrombocytopenia (platelet count < 100,000/mm) retinal hemorrhages, exudates, or papilledema pulmonary edema

Diagnostic Test:
Urinalysis Blood tests. Prolonged urine collection test. Fetal ultrasound.

Fetal Cardiotocography Fetal Biometry Non stress test or biophysical profile. Amniotic fluid assessment.

Treatment:
Bed rest and medication such as calcium channel blockers can be used to lower blood pressure. This will reduce the likelihood of complications caused by high blood pressure, such as stroke (when the blood supply to the brain is disturbed). You may also be prescribed anticonvulsant medication to prevent the convulsions (fits) of eclampsia. Injections of magnesium sulphate can halve the risk of pregnant women developing eclampsia. They can also be used to treat convulsions if they occur.

Causes:
The exact causes of preeclampsia are not known, although some researchers suspect poor nutrition, high body fat, or insufficient blood flow to the uterus as possible causes.

DRUGS

ACTION

INDICATION

CONTRAINDICATIONS

SIDE EFFECTS

NURSING RESPONSIBILITIES

Generic Name: Hydralazine Brand Name: Apresoline

Classification: Antihypertensive, Vasodilator

-Hydralazine is a vasodilator that works by relaxing the muscles in the blood vessels to help them dilate (widen). This lowers blood pressure and allows blood to flow more easily through the veins and arteries.

Moderate 1. to severe hyperte 2. nsion (with a diuretic). Lowering high 3. blood pressure helps prevent strokes, heart 4. attacks, and kidney problems. 5. CHF unresponsive to conventional therapy with Digoxin and 6. diuretics

Hypersensitivity Severe tachycardia

Dizziness 1. Drowsiness 2. Headache

Dissecting aortic aneurysm Heart failure with high cardiac output Myocardial insufficiency due to mechanical obstruction Coronary artery disease

3. Tachycardia 4. Angina 5. Arrhythmias 6. Edema 7. Orthostatic hypotension 8. Diarrhea 9. Nausea and vomiting 10. Rashes 11. Sodium retention 12. Arthralgias

-Monitor the clients blood pressure and pulse frequently during initial dosage adjustment and periodically throughout therapy. Report significant changes to the physician. 1. -Monitor frequency of prescription ref ills to determine adherence. -The nurse must be aware that Hydralazine may cause a positive direct Combos test result. 2. IM or IV route should be used only when the drug cannot be given orally.

7. Patients with recent MI 1. , rheumatic heart disease affecting the mitral valve 2. Severe renal and hepatic

disease 3. Pregnancy 4. Lactation 5. Children

13. Arthritis 14. Peripheral neuropathy 15. Drug induced lupus syndrome

3. Hydralazine may be administered concurrently with diuretics or beta blockers to permit lower doses and minimize side effects. 4. Instruct the patient not to let anyone else take his or her medication.