Gestational Hypertensive Disorders

Pregnancy Induced hypertension or PIH Mom is not hypertensive before pregnancy Hypertension and other symptoms that occur due to pregnancy Disappear with birth of fetus and placenta High risk factors Chronic renal disease Chronic hypertension Family history Primagravidas (a woman who is pregnant for the 1st time) Twins Mom <19 and >40 Diabetes Rh incompatibility Obesity Hydatidiform mole Pathophysiology Can progress from mild to severe Aterial venospasms decrease diameter of blood flow, which results in: Decreased blood flow Increased BP Classifications Transcient Hypertension Preeclampsia Mild severe Eclampsia HELLP syndrome Transcient Hypertension BP > 140/90 Develops during pregnancy No proteinuria No edema (other than “normal” places like ankles) BP returns to normal by 10th day postpartum Mild Preeclampsia BP > 140/90 x 2 at least 4-6 hours apart Weight gain (due to 3rd spacing) +2 pounds/wk in 2nd trimester, or +1 pound/wk in 3rd trimester, or sudden weight gain of 4 pounds/week anytime Norms – 1st trimester: 1 lb/month 2nd and 3rd trimester: 1 lb/week Dependant edema Eyes, face, fingers (above the waist) Proteinuria Urine output > 30ml/hr Nursing care for Mild Preeclampsia Patient at home Bedrest (with BR privileges); side-lying position Mom and family will be taught to monitor: Daily weight Urine dipstick BP Fetal movements Diet: Regular with no salt restrictions If symptoms progress to severe Preeclampsia à Hospital! Severe Preeclampsia Presence of any of the following in a woman diagnosed with Preeclampsia: BP > 160/110 (x2) 4-6 hours apart Proteinuria > 2+ dipstick x2 4 hrs apart Urine output < 500ml/24 hr Pulmonary edema (Crackles heard in lungs) Cerebral changes Headache (Tylenol will not alleviate) visual changes...

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