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Pre-clampsia
Eclampsia
Chronic HTN
Fistr pregnancy
Age > 35
Family history
Renal disease
Obesity
DM
Mutifetal pregnancy
Preclampsia
What is it?
Effect of fetus
Preventive Measures
Prenatal monitoring
meds
Renal perfusion
Proteins
Vascular volume
Liver circulation
Cerebral vessels
Placental circulation
Manifestations
Classic signs
Additional signs
CV system
Increased
Reponses to angiotensin II
BP
SVR
Decreased
CO
Plasma volume
Hematologic
Increased
Hemoconcentration
Viscosity
Platelet clumping
Thrombocytopenia
Endothelium damage
Neurologic
Arterial vasospasm
Small hemorrhages
Headache **
Hyperreflexia **
Convulsions (eclampsia)
Renal
Decreased
GFR
Damage to glomeruli
Proteinuria
Hypovolemia
Increase
HCT
Hepatic
Impaired
Hepatic edema
Epigastric pain
Placenta
Decreased
Perfusion
Fetal hypoxemia
Acidosis
Perinatal death
Nutrients
IUGR
Mild Preclampsia
Activity restrictions
UA
Fetal assessment
Diet
Mild
Severe
BP > 160
Cr (serum) normal
Platelets normal
DBP >110
Decreased <100,000
Elevated
UO normal
Headache (severe)
IUGR
Oliguria
Present often
>1.2
Common
May be present
Maternal goals
Fetal goals
Bedrest
Antihypertensive
Anticonvulsants
Intrapartum management
Antihypertensives
Hydralazine
Calcium channel
Beta blocker
Anticonvulsants
Reduces vasoconstriction
IV
Safe
Nursing Process
Assessment
Head to toe
Weight
Fetal monitoring
Reflexes
Interventions
Epidural??
EFM
Prevent seizures
Magnesium Protocol
Need primary IV
BP every 2 hrs.
UO every 2 hrs.
sensorium
Discontinue
Eclampsia
Generalized seizures
Temporarily in coma
Complications of Seizure
Fluid shifts
Oliguria
Cerebral hemorrhage
Ruptured placenta
Early labor
HE::P Syndrome
Management of Eclampsia
O2 and suction
Intubation equipment
Meds
Actual Seizure
Administer O2
Notify provider
Admin MgSo4
Weight
Activity restrictions
Reduce stimuli
Vital signs
Fetal assessment
Antihypertenives
Monitor reflexes
IV sites checked
Lasix
Digitalis
Edema
Breathe sounds
Emotional support
HELLP
EL
Hemolysis of RBCs
LP
Low platelets
Incidence
Manifestations
Hallmark symptom
Or lower R chest
Or midepigastric
Generalized malaise
Abd. tenderness
N/V
Severe edema
Headache
Diagnostics
Liver enzymes
Decreased haptoglobin
Treatment
ICU
MgSO4
Hydralazine
Fluid replacement
Complications
Bleeding
include:
Placental Abruption
Blood transfusion
Chronic HTN
Tx
Diet
Prevent preeclampsia
Meds
Aldomet (Methydopa)
Calcium channel
Beta blockers