Pregnancy Induced HTN.docx - Pregnancy Induced Hypertension(PIH o Develops after 20 weeks o > 140\/90 o Main characteristic is vasospasm Impedes blood

Pregnancy Induced HTN.docx - Pregnancy Induced...

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Pregnancy Induced Hypertension (PIH)oDevelops after 20 weekso> 140/90oMain characteristic is vasospasmImpedes blood flow to mother’s organs and placentaoPreeclampsiaWhen GH includes proteinuriaoEclampsiaWhen convulsions occuroManifestationsHypertensionSudden weight gainFirst sign of fluid retentionEdema in face and handsProteinuriaoOther symptoms of preeclampsiaSevere headacheHyperactive deep tendon reflexesSeizuresVisual disturbancesBlurred/double visionSeeing spotsDecreased urine outputPulmonary edemaAbnormal blood clotting (HELLP syndrome)Epigastric pain and nausea from liver edemaIncreased liver enzymesoEclampsiaWoman has a seizureThis can result in:Cerebral hemorrhageAbruptio placentaFetal compromiseDeath of mother and babyEffects on the fetus:Decreases oxygenMeconium stoolGrowth retardationDeathoDiagnosing PIHIncreased blood pressuresProtein in the urineElevated liver enzymesIncreased uric acid levelGet concerned with > 6oTreatment for PIHGoal:
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Control hypertensionPrevent seizuresMagnesium sulfateNeuromuscular depressant that blocks acetylcholine at the neuromuscular junctionsIVPrevents seizuresDoes not decrease blood pressureAntihypertensivesHydralazine (Apresoline)IVLabetalolIVDelivery is the only “cure”oNursing InterventionsMagnesium is infused intravenously IVLoading dose of 4 g over 20--30 minutesThen maintenance of 2 g/hr in 100 mLMonitor of magnesium toxicityVital signs every 15 minutes for 2 hours, if stable after 2 hours then every 30 minutesContinuous pulse oximetryFoley is inserted and measured every hour (30 mL/hr)Assess deep tendon reflexes and clonus (pushing on toes, should not wave back) every hourAssess LOC every hourAssess headache and visual disturbance every hourAuscultate lungs every four hoursoSigns of Magnesium ToxicityIf experiencing any of these, STOP immediately and administer calcium gluconate 1--3 g given over 5 minutes IVAbsent deep-tendon reflexesRespiratory depression < 14Urinary output < 30 mL/hrSlurred speech (but might be lethargic)Blurred visionSevere muscle weaknessChest painCall physicianoMiscellaneous Information Related to MagnesiumMust have continuous fetal monitoringNPODepends on how close to delivery mother isMother could lose gag reflexAspiration precautionsStrict bedrestLie on the left lateral side
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Labs will be drawn every 4--6 hours after initiation of treatment, and then either 12--24 hoursMagnesium, bilirubin, AST, ALT, platelets, BUN, creatinine, and uric acidNormal magnesium level = 6--8 mg/dLoHELLP SyndromeHemolysis of RBCsElevatedLiver enzymesLowPlateletsGestational Diabeteso
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