Pre-eclampsia: Concept Map

what is pre-eclampsia?

- High blood pressure that often occurs in the second trimester of pregnancy.

- New-onset proteinuria and potentially, other major organ dysfunction that could lead to maternal complications or intrauterine fetal morbidity and mortality

Who's at risk?

- History: Personal or family history of preeclampsia

- Pre-existing hypertension

- Have diabetes or an inflammatory disease that affects the immune system (e.g., lupus)

- First pregnancy, or pregnant with twins, triplets

- BMI was > 30 when you became pregnant

what causes pre-eclampsia?

Exact cause isn't known, but several factors are believed to

contribute to the cause:

- Insufficient blood flow to the uterus

- Damage to blood vessels

- Problems with the immune system

- Certain Genes

two key components to diagnosing pre-eclampsia

- Hypertension: (BP > 140/90 mm Hg; 2 measurements taken every 4 hours)

- Proteinuria (new or worsening): (> 0.3 g/24 h after 20 wk gestation)

other diagnostics

In the absence of proteinuria, new-onset hypertension plus new onset of any of the following

- Thrombocytopenia

- Renal insufficiency

- Impaired liver function

- Pulmonary edema

- Cerebral or visual symptoms

nON-SEVERE PRE-ECLAMPSIA

- BP is >140/90 mmHg

- Proteinuria of <0.3 g in 24 hr specimen

- Dipstick: +1 (0.3 g/L)

- Headaches: May be present

- Visual problems: May be present

- Edema: Slight in upper extremities

- Epigastric pain: May be present

- Serum Creatinine: May be elevated

- Thrombocytopenia: Platelets may be low

- AST, ALT: Elevated

SEVERE PRE-ECLAMPSIA

- BP is > 160/110 mmHg

- Proteinuria >0.3 g in 24 hr specimen

- Dipstick: +2 to +3 (1.0-3.0 g/L)

- Headache: Severe

- Edema: Peripheral and pulmonary

- Visual Problems: Blurred, photophobia

- Epigastric pain: Hematoma or rupture may be present

- Serum Creatinine: > 150 mcmol/L

- Thrombocytopenia: Platelets < 50 x 10^9 /L

- AST, ALT: Hepatic dysfunction

fetal complications

These include:

- Oligohydramnios: deficiency of amniotic fluid

- IUGR

- Preterm birth

- Still birth

- Uteroplacental insufficiency: indicates placenta cannot bring enough oxygen and nutrients to growing fetus

maternal complications

These include:

- Seizures

- Blindness

- Stroke

- Myocardial or severe liver dysfunction

- Pulmonary edema

- HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets)

prevention of pre-eclampsia

Preventative measures of pre-eclampsia include:

- Abstention from alcohol

- Smoking cessation

- Multivitamins containing folate (also prevent neural tube defects)

- Calcium supplementation (at least 1 g/day for those with low intake)

- Regular exercise

Tying it all together

Nursing Interventions and Treatments

- Monitoring vitals, FHR for baby

- Assessing lab values: RBCs, platelets, protein levels

- Assessing for edema; face, arms, hands, legs

- Monitor urine output

- Weighing patient

- Assessing for headaches, visual disturbances, epigastric pain, altered LOC

- Minimizing external stress: promoting relaxation and rest

Treatments:

- Early delivery of baby may be possible

- Medications: Anticonvulsants, antihypertensives

- Addressing emotional and psychosocial needs