Benita Beard 2012 Objectives Examine implications of Pregnancy Induced HypertensionPIH on a pregnancy Discuss assessments for a patient with PIH Describe care of a patient with PIH Shana is a 26 year old with 2 children ages 4 and 7 She is currently expecting her third child Sh ID: 473587
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Slide1Slide2
Pregnancy Induced Hypertension
Benita Beard 2012Slide3
Objectives:
Examine implications of
Pregnancy Induced Hypertension(PIH)
on a pregnancy.
Discuss assessments for a patient with PIH.
Describe care of a patient with PIH.Slide4
Shana is a 26 year old with 2 children (ages 4 and 7). She is currently expecting her third child. Shana’s
boyfriend
of 2 years, left Shana after finding out she was pregnant.
She is currently living with her
sister,
Kyana
.
Kyana
is a single parent of 2 children, ages 3 and 5.
Shana and her sister,
Kyana
,
are very
close and have combined resources to make their lives easier. Shana cares for the children and maintains things at home while
Kyana
works.Slide5
Assessment Data:
26 year old African American
G3P2
Upon
exam
was found to be 12 weeks pregnant.
107/84, 98.9, 82, 18Weight: 180 lbs
Shana’s
First Prenatal VisitSlide6
Assessments:
Weight 192
lbs
BP 118/88, HR 88
Hgb
11.5,
Hct 33. Urine negative for sugar and trace for
protein
Shana
is now 20 weeks
gestation at her Prenatal VisitSlide7
Shana is now 29 weeks gestation. Two weeks ago she was experiencing back pain and discomfort that went away after two hours.
She felt the same symptoms the next day and went to the see her health care provider.
Shana had no cervical changes. She was found to have a urinary
tract
infection(UTI).
Shana has had no further symptoms since treatment of her UTI. Slide8
Assessments:
32 weeks gestation
162/110
Gained 7 lbs in last 2 weeks
Legs, feet and hands are puffy
Denies seeing spots or stars, but does admit to having blurred vision from time to time.
Reflexes are 3+Protein in urine is 3+
Today Shana has come to the office with complaints
of a
headache that won’t go away. Slide9
Figure 20.5
Clinical manifestations and pathophysiology of preeclampsia-eclampsiaSlide10
Shana is placed in a dark room for 30 minutes and
is
instructed to lay on her left side. Her blood pressure decreases to 158/94.
She refuses to go to the hospital.
She is sent home on
bedrest
and is to do a 24 hour urine collection. She is to call if she has any further symptoms
She is to return to the office in the AM.Slide11
Shana brings the 24 hour urine collection to the office. Her pressure remains at 158/94
. She denies headache or visual disturbances.
She has all four children with her and is in a hurry to return home. She promises to rest and to call if she has any further symptoms.Slide12
EMS Assessment:
BP 192/112, HR 102, RR 24
FHR – 140s
Shana is awake but is confused as to what happened.
Shana’s
sister comes home from
work and finds Shana passed
out
on the floor. She is taken by EMS directly
to the labor and delivery unit.Slide13
1-Shana
2-Multigravida with twins in early labor
3-Primagravida in early labor
Rooms available are a small room directly across form the nurses station usually used for testing.
A large room at the end of the hall
A swing room used for overflow adjacent to the Labor and Delivery Unit.
Shana
needs to be assigned a room. Three patients have arrived
on the Labor and Delivery unit at
the same time
.Slide14
Assessments:
BP 192/112, T 98.6, HR 102, RR 24
Denies pain or contractions
FHTs are 130’s to 140’s
3+ Reflexes with Negative
clonus
Urine 3+
ketones
and 3+ protein
Vaginal exam revealed 2 cm dilated, 50% effaced with membranes intact.
Shana is placed in a room and assessed.Slide15
Bedrest
Stat labs
Magnesium sulfate 4
gm
bolus now and continue per protocol at 2
gms
per hour.IV of LR at 125cc per hourContinuous fetal monitoring
Shana’s healthcare provider has written the following orders.Slide16
Shana is placed on magnesium sulfate. She will be given a 4
gm
loading dose and then be maintained on 2
gms
an hour.
Once stabilized the order is to have Pitocin started IV, per protocol, for labor induction.Slide17
BP 188/98, T 98.6, HR 102, R 16 pain (6)
Vaginal exam reveals 4 cm and 90% effaced at zero station. Contractions are firm every 3-4 minutes lasting 40-90 seconds.
Membranes were ruptured by healthcare provider with clear fluid noted.
Reflexes 3+ with negative clonus
Shana is now asking for something for pain
6
hours later Shana’s assessment findings are:Slide18
Shana was given an epidural for pain management and complained of an urge to push during insertion.
Vaginal examination reveals
10 cm
0/+1 station
100% effacedSlide19
What’s next?
What is needed for mom, for baby?
What do nurses need to have prepared for delivery?
What outcomes, for Shana and the baby, does the nurse need to anticipate based on Shana’s prenatal and labor history?
Shana
is now pushing with contractionsSlide20
How
might
Shana’s
postpartum
“course”
differ from the “normal” postpartum course?Slide21
www.emedicine.medscape.com/article/1476919-overview
www.mayoclinic.com/health/
preeclampsia
/DS00583
www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001900
www.preeclampsia.org/signs&symptoms
London, M.,
Ladewig
, P., Ball, J.,
Bindler
, R., & Cowen, K. (2011).
Maternal & Child Nursing Care
. (3
rd
Ed.). New Jersey: Pearson Education, Inc.Ward, Susan L. and Hisley, S. M. (2009). Maternal-Child Nursing Care: Optimizing Outcomes for Mathers, Children, & Families. Philadelphia: F. A. Davis Company.
Sources