Beverly Thompson

Preeclampsia
Definition: Preeclampsia is a pregnancy specific hypertensive disease with multisystem involvement. It usually occurs after the 20th week of gestation. It is the most common hypertensive disorder that causes significant complications during pregnancy, occurring at a rate 2% to 7%. It is the occurrence of new-onset hypertension (systolic of 140 + and a diastolic of 90 +) plus new-onset proteinuria. Proteinuria is defined by the excretion of 300 mg or more in a 24 hour urine catch or 1+ on a dipstick. In the absence of proteinuria the following symptoms associated with Preeclampsia can be diagnostic: Thrombocytopenia Impaired liver function new onset renal disease pulmonary disease New onset of cerebral visual disturbances.

Etiology: although there is no known cause for preeclampsia, there are certain risk factors such as: Extremes of age such as younger than 17 and older than 35, Primigravidas Prior history of preeclampsia in earlier pregnancies History of diabetes, renal disease, liver disease Multiple pregnancies Obesity African American

Classifications: Preeclampsia can be categorized as mild or severe. Mild has the following manifestations: 140/90 Proteinuria is 1+ to 2+ on dipstick reading No hyperreflexia noted Liver enzymes may be elevated to soon. Edema may or not be present

Beverly Thompson

Severe has the following manifestations: 160/110 and over twice at least 4 to 6 hours apart Cerebral or visual disturbances (scotomata) Epigastric pain Pulmonary edema Thrombocytopenia (platelet count less than 10,000) Impaired liver function as indicated by abnormally elevated blood concentrations of liver enzymes hyperreflexia

Home care options/Mild Preeclampsia: If a womens preeclampsia is considered mild enough for home care the following are monitored: BP, weight, urine protein is checked daily Weight gains of 3lb in 24 hours or 4 lbs. in a 3 day period is a cause of concern Remote nonstress test are performed on daily or biweekly basis It is extremely important to report to physician if worsening signs of preeclampsia develops

Hospital care of Mild/Preeclamsia: the woman is placed on bedrest (primarily on her left side) she is weighed daily she is assessed for visual disturbances persistent headache epigastric pain worsening edema BP is checked at least 4 times daily

The following tests are performed in hospital: Fetal movement record Nonstress test Ultrasonography every 3 or4 weeks Biophysical profile Amniocentesis to determine fetal lung maturity

Beverly Thompson

Hospital care of severe preeclampsia Complete Bed rest. Seizure inducing stimuli must be reduced High protein , moderate sodium diet is given Anticonvulsants such as Mag Sulf is treatment of choice. Increased levels of mag sulfate include diminished reflexes, decreased respirations, difficulty swallowing, drooling is indicative of toxic levels. Electrolyte and fluid replacement. Iv lines are kept open in case they are needed for drug therapy. Corticosteroids, betamethasone or dexamethasone is administered if the fetus has an immature lung profile. Antihypertensives is given for systolic of 160 to 180 mm hg of higher, and diastolic 105110 mm hg or higher (Hydralazine is most commonly used)Methyldopa is for chronic hypertension in pregnancy

Eclampsia A woman becomes eclamptic in the presence of a seizure (tonic clonic), requires immediate effective treatment When the tonic phase (muscular contractions and rigidity) turn woman to side, turn her head face down to allow saliva to drain from her mouth, side rails should be padded a bolus of 4 to 6 mg of magnesium sulfate is given IV over 5 minutes to control convulsions antihypertensives are given to keep BP between 90 mm to 100, avoiding a decreased ureteroplacental perfusion. Dilantin may be given to prevent seizures Lungs are auscultated for pulmonary edema (furesomide , Lasix) She is checked every 15 for vaginal bleeding, rigidity of the abdomen (which may indicate abruption placenta Birth is the only known cure for preeclampsia /eclampsia Intake and output are measured hourly

Labor induction: Labor may be induced by IV oxytocin when there is evidence of fetal maturity and cervical readiness Severe cases may require c-section The woman may receive mag sulfate and Pitocin simultaneously

Beverly Thompson

If an epidural block is used it should be done by someone skilled in preeclampsiaSpinal or epidural anesthesia is contraindicated if there is coagulopathy or platelet count lower than 50,000/mm Oxygen may be administered to woman during labor according to fetal response Birth should be in the Sims or semisitting position

Postpartum management: Although the woman with preeclampsia usually improves rapidly after giving birth, there is still a risk for seizure during the 48 hrs postpartum. Medical Management: the only cure for preeclampsia is to give birth. Bed rest, must be complete in non-stimulating environment. Diet: a high protein diet with moderate sodium Anticonvulsant medication: magnesium sulfate is the treatment of choice for convulsion, its depressant quality reduces

Nursing Management: Assessment during hospitalization include: Assess BP every 1 to 4 hrs Temperature is taken every 4 hours, if elevated then 2 hrs Fetal heart rate Urinary output, measure every voiding. Output should be 700 ml or greater in 24 hours, or at least 30 ml/hr Urine protein , checked hourly if cath is in place. Readings of +3 or 4+ indicate loss of 5g of protein in 24 hours/ The woman should be weighed daily at the same time everyday, with the same article of clothing. If she is on strict bed rest this might be contraindicated Pulmonary edema, observe for coughing Deep tendon reflex Ask about the presence of headaches Ask about visual disturbances Ask about epigastric pain

Laboratory tests: Daily tests of hematocrit to measure hemoconcentration Bun, creatinine and uric acid levels to assess kidney functioning

Beverly Thompson

Clotting studies for signs of thrombocytopenia or DIC Liver enzymes Magnesium levels

Environment considerations: Maintain a quiet , low stimulating room Should be in a private room Eliminate phone, unless preplanned Limit visitors Woman should maintain the left lateral position with side rails up