Ru Final Preeclampsia DR

8/6/2019 Ru Final Preeclampsia DR

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UNIVERSITY OF CEBU LAPU-LAPU AND MANDUE

A.C Cortes Avenue, Looc, Mandue, City

COLLEGE OF NURSING

RESOURCE UNIT

PREECLAMPSIA

SUBMITTED BY:

Alcantara, Alfeony

Apa, Rachelle Ann

Bardon, Gevirna

Bering, Marian MaeDel Rosario, Keeshia

Dungog, Kristine

Escabas, Kimberly Joyce

Fegarido, Ariz

Inoc, Crisilda

Lao, Brenda

SUBMITTED TO:

Edna Estandarte, RN

-clinical instructor-

DATE SUBMITTED:

February 19, 2010


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A.C Cortes, Avenue, Looc, Mandaue, City

COLLEGE OF NURSING

Area: DELIVERY ROOM CHONG HUA HOSPITAL

Concept: PREECLAMPSIA

General Objective: After 1 hour and 11 minutes of interactive lecture discussion, the BSN 2-A group 1 students will be able to gainbasic knowledge

positive attitude about Preeclampsia.

SPECIFIC OBJECTIVES CONTENT METHODOL-

OGY

TIME

ALLOTMENT

RESOURCES

Specifically the Level IIstudents will be able to:

1. discuss the overview of

preeclampsia: Every year, 536, 000 women die from pregnancy-related causes.More than 80 % of maternal deaths worldwide are due to five

direct causes; hemorrhage, sepsis, unsafe abortion, obstructedlabor and hypertensive disease of pregnancy.

The latest report from the Confidential Inquiries into MaternalDeaths (UK) List, eclampsia and preeclampsia as the second most

common cause and showed an increase from the previous report.The latest statistics from the Philippine Obstetrical and

Gynecological Society (2006), listed hypertension as causing143/545 (26-28%) maternal deaths. Further broken down,

hypertension deaths were eclampsia (50), preeclampsia (66),preexisting hypertension (8), chronic hypertension with

Openingprayer

Preconditioning

Activity

Lecturediscussion

3 minutes

A. Human resource

B. Materials visual aids

C. Books

Maternal andChild Health

Nursing: Carof the Child

BearingFamily 5

th

Edition;Adele

Pillitteri Intoductory

Maternity anPediatric


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2. define related terms:

Pregnancy-inducedHypertension

GestationalHypertension

Preeclampsia

Mild Preeclampsia

Severe Preeclampsia

preeclampsia (8) and the HELLP syndrome (11).

Clearly, therefore, any attempt to curb maternal and perinatalmortality and morbidity due to hypertensive states will result notonly in less loss of lives but also in less deprivation of financial

and maternal resources.

is a condition in which vasospasm occurs duringpregnancy in both small and large arteries.

develops an elevated blood pressure (140/90mmHg) buthas no proteinuria or edema: blood pressure returns tonormal after birth

abnormal condition of pregnancy characterized by theonset of acute hypertension (140/90mmHg) after the 24

th

week of gestation; +1 pitting edema; sudden excessiveweight gain, swelling of the feet, hands and feet and

proteinuria

blood pressure rises to 140/90 mmHg or systolic pressureelevated 30 mmHg or diastolic pressure elevated 15mmHg above pregnancy level; proteinuria of 1-2+ on arandom sample; weight gain over 2 lbs./week in second

trimester; mild edema in upper extremities or face

blood pressure rises to 160/110 mmHg; proteinuria 3-4+on a random sample and 5 g on a 24-hour sample;

extensive edema; cerebral or visual disturbances; nausea

5 minutes

Nursing: N.

Jayne and

NancyHatfield

Straight,Barbara R.;Maternal-

Newborn;PIH,

Preeclampsia

andEclampsia,Edition 4 by

LippincotWilliams and

Wilkins, 530Walnut Stree

Philadelphia,PA 19106;page 193

Diseases 4thedition; Ray

A. Hargrove-Huttel

Essentials ofPathophysiolgy Conceptsof Altered

Health Status2

ndEdition;

Carl MattsonPorth RN,

MSN, PHD


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Eclampsia

Hypertension

Edema

Proteinuria

Coma

Seizure

3. discuss the anatomy and

physiology of the systems

and vomiting; headache; epigastric pain; increased

hematocrit and proteinuria

most severe classification of PIH, seizure and comaaccompanied by the signs and symptoms preeclampsia.

a common disorder characterized by elevated bloodpressure persistently exceeding 140/90 mmHg

the abnormal accumulation of fluid in interstitial spaces ofthe tissues such as in the pericardial sac, intrapleural space,peritoneal cavity or joint capsules

the presence in the urine of abnormally large quantities ofproteins

a state of profound unconsciousness, characterized by theabsence of spontaneous eye openings, response to painfulstimuli and vocalization

a hyper citation of neurons in the brain leading to sudden,violent, involuntary series of contractions of a group of

muscles

BLOOD VESSELS AND CIRCULATIONFunctions of the peripheral circulation:

CARRY BLOOD

AndersonsPathology

volume 2 9th

edition ; JohnM. Kissane

D. Electronic

sources:www.preeclampsia.

org / about. asp


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involve. -blood vessels carry blood from the heart to and back to all

tissues of the body and back to the heart

EXCHANGE NUTRIENTS, WASTE PRODUCTS ANDGASES-nutrients and oxygen diffuse from blood vessels to cells in

essentially all areas of the body TRANSPORT

-hormones, components of the immune system, moleculesrequired for coagulation, enzymes, nutrients, gases, waste

products and other substances are transported in the blood

to all areas of the body REGULATE BLOOD PRESSURE

-the peripheral circulatory system and the heart work

together to regulate blood pressure within a normal rangeof values

DIRECT BLOOD FLOW-the peripheral circulatory system directs blood to tissues

when increased blood flow is required to maintainhomeostasis

GENERAL FEATURES OF BLOOD VESSEL STRUCTURE1. Blood is pumped from the heart through elastic arteries,

muscular arteries, and arterioles to the capillaries.2. Blood returns to the heart from the capillaries through

venules, small veins and large veins.3. Except for capillaries and venules, blood vessels have

three layers:

y The tunica intima consists of endothelium,basement membrane, and connective tissue.

y The tunica media, the middle layer, containscircular smooth muscle and elastic fibers.

y The outer tunica adventitia is connective tissue.

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ARTERIES

1. Large elastic arteries have many elastic fibers but littlesmooth muscle in the air walls and carry blood from theheart to smaller arteries with little decrease in pressure.

2. Muscular arteries have much smooth muscle & someelastic fibers and undergo vasodilation and

vasoconstriction to control blood flow to different regionsof the body.

3. Arterioles are the smaller arteries and have smooth musclecells and a few elastic fibers and undergo vasodilation andvasoconstriction to control blood flow to local areas.

CAPILLARIES

1. Capillaries consist of only endothelium and are surroundedby a basement membrane and loose connective tissue.

2. Nutrient and waste product exchange in the principalfunction of capillaries.

3. Blood is supplied to capillaries by arterioles. Precapillarysphincters regulate blood flow through capillary networks.

VEINS

1. Venules are endothelium surrounded by a basement

membrane.2.Small veins are venules covered with a smooth muscle and a

layer of connective tissue.3. Medium-sized and large veins contains smooth muscle and

elastic fibers than arteries of the same size.4. Valves prevent the black flow of blood in the veins.


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THE PHYSIOLOGY OF THE CIRCULATION

Blood Pressure

1.Blood pressure is the measure of the force exerted by blood

against the blood vessels wall. Blood pressure moves bloodthrough vessels.

2. Blood pressure can be measured by listening for Korotkoffsounds produced as blood flows through arteries partially

constricted by a blood pressure cuff.

Pressure and Resistance

Blood pressure fluctuates between 120 mmHg (systolic) and 80

mmHg (diastolic) in the aorta. If constriction of blood vesselsoccurs, resistance to blood flow increases, and blood flow

decreases.

Pulse Pressure

1. Pulse pressure is the difference between systolic anddiastolic pressure. Pulse pressure increases when strokevolume increases.

2. A pulse can be detected when large arteries are near thesurface of the body.

Capillary Exchange

1. Most exchange across the wall of the capillary is bydiffusion.

2. Blood pressure, capillary permeability, and osmosis affectmovement of fluid across the wall of the capillaries. Thereis a net movement of fluid from the blood into the


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4. explain the

pathophysiology ofpreeclampsia

tissues,the fluid gained by the tissues is removed by the

lymphatic sytem.

Schematic Diagram (see APPENDIX A)

EXPLANATION:

Preeclampsia is the result of generalized vasospasm. Theunderlying cause of the vasospasm remains a mystery but some of

the physiologic processes are known. In normal pregnancy,vascular volume is significantly increased and cardiac output is

increased. Despite these factors, blood pressure does not rise innormal pregnancy, probably because pregnant women develop

resistance to the effects of vasoconstrictors such as angiotensin II.Moreover, a disease in peripheral vascular resistance occurs from

the effects of certain vasodilators, such as prostacyclin(PGI),prostaglandin E(PGE) and endothelium-derived relaxing

factor(FDRF).In preeclampsia, however, peripheral vascular resistance

increases because of the sensitivity of some women to angiotensinII and a decrease in vasodilators. For instance, there is an increase

in the ratio of thromboxane A to prostaxyclin. Thromboxane,produced by placental tissue and endothelial cells, causes

vasodilation and inhibits platelet aggregation.Vasoconstriction decreases the diameter of blood vessels ,

which results in endothelial cell damage and decreased EDRF.Vasoconstriction also results in impeded blood flow and elevated

blood pressure. As a result circulation to all body organs,including the kidneys, liver, brain and placenta is decreased. The

following changes are most significant:

y Decreased renal perfusion reduces the glomerular

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filtration rate. Consequently, blood urea nitrogen,

creatinine, and uric acid level rise.

y Glomerular damage secondary to reduced renalblood flow allows protein to leak across theglomerular membrane.

y Loss protein from the kidneys reduces colloidosmotic pressure and allows fluid to shift to

interstitial spaces. This fluid shift may result inrelative hypovolemia, which causes increased

viscosity of the blood and a rise in hematocrit.

Generalized edema often occurs.y In response to hypovolemia, additional angiotensin

II and aldosterone are secreted to trigger theretention of both sodium and water. The pathologic

processes spiral: additional angiotensin II results infurther vasospasm and hypertension; aldosterone

increases fluid retention, and edema is worsened.

y Decreased circulation to the liver impairs liverfunction and leads to hepatic edema and

subcapsular hemorrhage, which can result inhemorrhagic necrosis. This process is manifested

by elevated liver enzyme levels in maternal serum.Epigastric pain is a common symptom.

y Vasoconstriction of cerebral vessels leads topressure induced rupture of thin-walled capillaries,

resulting in small cerebral hemorrhages. Signs andsymptoms of arterial vasospasm include headacheand visual disturbances, such as well as

hyperretlexia.

y Decreased colloid oncotic pressure can lead topulmonary capillary leaks that result in pulmonary

edema. Dyspnea is the primary symptom.

y Decreased placental circulation results in


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5. enumerate the risk factorsof preeclampsia

6. identify the causes of

preeclampsia

infractions that increase the risk for abruption

placentae and DIC. In addition, the fetus may

experience IUGR and persistent fetal hypoxemia.

Risk Factors

y Overweighty Prepregnacy diabetesy Older than 35 years oldy Chronic hypertensiony Renal diseasey Multifetal gestationy Presence of immunologic disorders (e.g. Lupus or

antiphospholipid antibody syndrome

The causes of preeclampsia is unknown but there are possible

contributing factors include:

y genetic or immunologic factorsy low socioeconomic backgrounds (because of poor

nutrition)

y multiple pregnancyy primigravid statusy age younger than 18 or older than 35 years oldy diabetes with vessel or renal involvementy heart diseasey essential hypertension

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7. know the different signs

and symptoms ofpreeclampsia:

8. distinguish the

complications of

preeclampsia:

o elevated blood pressureo abnormal weight gaino edema on the face, fingers, lower extremities and abdomenafter bed resto proteinuriao sever headacheo bluured or double visiono epigastric paino nausea and vomitingo irritabilityo cyanosiso shortness of breatho coma and seizure (eclampsia)

Maternal and fetal death Disseminated intravascular coagulation Eclampsia Pulmonary edema Cerebral hemorrhage Congestive heart failure Arrhythmias Myocardial infarction Intravascular endothelial damage HELLP syndrome

H- hemolysis

E- elevatedL- liver enzymes

L- lowP- platelets

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9. recognize the treatment of

preeclampsia.

The primary goals of treatment are to deliver a healthy baby

and restore the woman to a healthy state. The most important

decision regarding management of preeclampsia involves thetiming of delivery because the only cure for preeclampsia is to endthe pregnancy.

COMPLETE BED REST in the preferred left lateral lyingposition to enhance venous return.

AN ANTIHYPERTENSIVE such as methyldopa orhydralazine. This treatment is controversial because it is

only given to treat severely elevated blood pressure (more

than 160/110 mmHg) because a rapid drop in the bloodpressure can lead to decreased placental perfusion resultingin fetal distress.

PREVENTING MATERNAL SEIZURE is anotherimportant goal of the therapy. Magnesium sulfate is the

most effective medication to prevent and treat eclampticseizures. It promotes dieresis, reduce blood pressure,

prevents seizures, relaxes skeletal muscles, raises the

seizure threshold through direct action on the centralnervous system and reduces edema by causing a shift in

fluid from the extracellular spaces into the intestine. Themost evident symptoms of overdose includes decreased

urine output, depressed respirations, reducedconsciousness and decreased deep tendon reflexes. A

solution of 10 ml of a 10% calcium gluconate solution (1g) should be kept ready nearby for immediate intravenous

administrations as a specific antidote for magnesiumtoxicity.

If these measures fail to improve the patientscondition or if fetal life is endangered, cesarean section or

oxytocin inducement may be required to terminate thepregnancy.

Adequate nutrition, good prenatal care and control of

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10. determine the prognosis

of pre eclampsia

11. apply and appreciate the

nursing interventions given:

preexisting hypertension during pregnancy decrease the

incidence and severity of preeclampsia. Early recognition

and prompt treatment of this cab prevent progression toeclampsia.

The prognosis for women with preeclampsia depends onthe maternal effects of hypertension on the body systems

(e.g. cardiovascular, central nervous systems, renal) andthe ability to prevent or control the disease before

eclampsia develops. The combination of proteinuria and

hypertension dramatically increases the risk of perinatalmortality. The only definitive cure for preeclampsia isdelivery.

y Observe the patient for signs of fetal distress by closelymonitoring the result of stress and non-stress tests.

y Keep emergency resuscitative equipment and anti-convulsant available in case of seizures and cardiac orrespiratory arrest. Carefully monitor the administration of

magnesium sulfate.

y Keep calcium gluconate at the bedside to counteract thetoxic effects of magnesium sulfate.

y Protect the patient from injury, maintain seizureprecautions. Dont leave a patient whose condition isunstable unattended.

y Keep an airway open and oxygen available at bedside.y Monitor the patient regularly for changes in blood

pressure, pulse rate, respiratory rate, vision, level ofconsciousness, deep tendon reflexes and for headache

unrelieved by medication. Immediately report for changes.

y Monitor extent and location of edema. Elevate affected

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extremities to promote venous return.

y Assess fluid balance by measuring intake and output andby checking daily weight.

y Insert an indwelling urinary catheter, if necessary.y Provide a quite, darkened room until the patients

condition stabilizes and enforce strict bed rest.

y Provide emotional support for the patient and family.Encourage them to verbalize their feelings. If the patientscondition necessitates premature delivery, point out that

the infants of mother with this condition is usually small

for gestational but sometimes are better than otherpremature neonates of the same weight, possibly becausethey have developed adaptive responses to stress in utero.

y Help the patient and her family develops effective copingstrategies.

y Prepare for emergency cesarean delivery if indicated.y Alert the anesthesiologist and pediatrician.


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APPENDIX A


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BIBLIOGRAPHY:

. Books

Maternal and Child Health Nursing: Care of the Child Bearing Family 5th Edition; Adele Pillitteri Intoductory Maternity and Pediatric Nursing: N. Jayne and Nancy Hatfield Straight, Barbara R.; Maternal-Newborn; PIH, Preeclampsia and Eclampsia, Edition 4 by Lippincot Williams and Wilkins, 530 Walnut Street Phila

19106; page 193

Diseases 4th edition; Ray A. Hargrove-Huttel Essentials of Pathophysiology Concepts of Altered Health Status 2nd Edition; Carl Mattson Porth RN, MSN, PHD Andersons Pathology volume 2 9th edition ; John M. Kissane Reeder, Martin, Koniak-griffin; Maternity Nursing (Family, Newborn, and Womens Health Care), 18th edition, Philadelphia, California Emily Slone McKinny, et.al. Matrnal-child Nursing.2nd edition. Pp.631-635

Electronic sources:www.preeclampsia. org / about.Asp

http://nursingdepartment.blogspot.com/2010/01/pathophysiology-of-pre-eclampsia.html


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A.C Cortes Avenue, Looc, Mandue, City

COLLEGE OF NURSING

RESOURCE UNIT

PREECLAMPSIA

SUBMITTED BY:

Alcantara, Alfeony

Apa, Rachelle Ann

Bardon, Gevirna

Bering, Marian Mae

Del Rosario, Keeshia

Dungog, Kristine

Escabas, Kimberly Joyce

Fegarido, Ariz

Inoc, Crisilda

Lao, Brenda

SUBMITTED TO:

Hazel Faith M. Genabe, RN

-clinical instructor-

DATE SUBMITTED:

February 19, 2010


19/19

Documents

Ru Final Preeclampsia DR