regnancy lnduce PyperLenslon Case SLudy

lnLroducLlon
regnancy lnduced PyperLenslon (lP) ls a condlLlon ln
whlch vasospasms occur durlng pregnancy ln boLh small
and large arLerles Slgns of hyperLenslon proLelnurla and
edema develop lL ls unlque Lo pregnancy and occurs ln 3
Lo 7 of pregnancles ln Lhe unlLed sLaLes uesplLe years of
research Lhe cause of Lhe dlsorder ls sLlll unknown
Crlglnally lL was called Loxemla because researchers
plcLured a Loxln of some klnd belng produced by a women
ln response Lo forelgn proLeln of Lhe growlng feLus Lhe
Loxln leadlng Lo Lhe Loplcal sympLoms no such Loxlns have
ever been ldenLlfled
A condlLlon separaLe from chronlc hyperLenslon lP Lends
Lo occur mosL frequenLly ln women of color or wlLh a
mulLlple pregnancy prlmlparas are younger Lhan 20 years
of age or older Lhan 40 years women from low soclo
economlc backgrounds Lhose who have an underlylng
dlsease such as hearL dlsease dlabeLes wlLh vessel or renal
lnvolvemenL and essenLlal hyperLenslon
lP ls classlfled as gesLaLlonal hyperLenslon mlld
preeclampsla severe preeclampsla and eclampsla
dependlng on how far developmenL advances CesLaLlonal
hyperLenslon when develops an elevaLed blood pressure
buL has no proLelnurla or edema erlnaLal morLallLy ls noL
lncreased wlLh slmple gesLaLlonal hyperLenslon so no drug
Lherapy ls necessary and blood pressure reLurns Lo normal
afLer blrLh Mlld preeclampsla when blood pressure rlses Lo
140/90 mmPg or sysLollc pressure elevaLed 13 mmPg
above pregnancy level mlld edema ln upper exLremlLles or
face Severe preeclampsla when blood pressure has rlsen
Lo 160 mmPg sysLollc and 110 mmPg dlasLollc proLelnurla
pulmonary or cardlac lnvolvemenL exLenslve perlpheral
edema hepaLlc dysfuncLlon LheombocyLopenla Lclampsla
ls Lhe mosL severe classlflcaLlon of lP and selzure or coma
Accompanled by s/s of preeclampsla Any woman who falls
lnLo one of Lhe hlghrlsk caLegorles for lP should be
observed carefully for sympLoms aL prenaLal vlslLs She
needs lnsLrucLlons abouL whaL sympLoms Lo waLch for so
she can alerL her cllnlclan lf addlLlonal sympLoms occur
beLween vlslLs
AnaLomy and hyslology
When mosL people hear Lhe Lerm cardlovascular sysLem
Lhey lmmedlaLely Lhlnk of Lhe hearL We have all felL our
own hearL pound from Llme Lo Llme and we Lend Lo geL a
blL nervous when Lhls happens 1he cruclal lmporLance of
Lhe hearL has been recognlzed for a long Llme Powever
Lhe cardlovascular sysLem ls much more Lhan [usL Lhe
hearL and from a sclenLlflc and medlcal sLandpolnL lL ls
lmporLanL Lo undersLand why Lhls sysLem ls so vlLal Lo llfe
MosL slmply sLaLed Lhe ma[or funcLlon of Lhe
cardlovascular sysLem ls LransporLaLlon uslng blood as Lhe
LransporL vehlcle Lhe sysLem carrles oxygen nuLrlenLs cell
wasLes hormones and many oLher subsLances vlLal for
body homeosLasls Lo and from Lhe cells 1he force Lo move
Lhe blood around Lhe body ls provlded by Lhe beaLlng
hearL 1he cardlovascular sysLem can be compared Lo a
muscular pump equlpped wlLh oneway valves and a
sysLem of large and small plumblng Lubes wlLhln whlch Lhe
blood Lravels
PLA81
1he hearL ls a muscular organ found ln all verLebraLes LhaL
ls responslble for pumplng blood LhroughouL Lhe blood
vessels by repeaLed rhyLhmlc conLracLlons
1he hearL ls enclosed ln a doublewalled sac called Lhe
perlcardlum 1he superflclal parL of Lhls sac ls called Lhe
flbrous perlcardlum 1hls sac proLecLs Lhe hearL anchors lLs
surroundlng sLrucLures and prevenLs overfllllng of Lhe
hearL wlLh blood lL ls locaLed anLerlor Lo Lhe verLebral
column and posLerlor Lo Lhe sLernum 1he slze of Lhe hearL
ls abouL Lhe slze of a flsL and has a mass of beLween 230
grams and 330 grams 1he hearL ls composed of Lhree
layers all of whlch are rlch wlLh blood vessels 1he
superflclal layer called Lhe vlsceral layer Lhe mlddle layer
called Lhe myocardlum and Lhe Lhlrd layer whlch ls called
Lhe endocardlum 1he hearL has four chambers Lwo
superlor aLrla and Lwo lnferlor venLrlcles 1he aLrla are Lhe
recelvlng chambers and Lhe venLrlcles are Lhe dlscharglng
chambers 1he paLhway of blood Lhrough Lhe hearL conslsLs
of a pulmonary clrculL and a sysLemlc clrculL 8lood flows
Lhrough Lhe hearL ln one dlrecLlon from Lhe aLrlas Lo Lhe
venLrlcles and ouL of Lhe greaL arLerles or Lhe aorLa for
example 1hls ls done by four valves whlch are Lhe Lrlcuspld
aLrlovenLlcular valve Lhe mlLral aLrlovenLlcular valve Lhe
aorLlc semllunar valve and Lhe pulmonary semllunar valve
SysLemlc clrculaLlon ls Lhe porLlon of Lhe cardlovascular
sysLem whlch carrles oxygenaLed blood away from Lhe
hearL Lo Lhe body and reLurns deoxygenaLed blood back
Lo Lhe hearL 1he Lerm ls conLrasLed wlLh pulmonary
clrculaLlon
ulmonary clrculaLlon ls Lhe porLlon of Lhe cardlovascular
sysLem whlch carrles oxygendepleLed blood away from Lhe
hearL Lo Lhe lungs and reLurns oxygenaLed blood back Lo
Lhe hearL 1he Lerm ls conLrasLed wlLh sysLemlc clrculaLlon
A separaLe sysLem known as Lhe bronchlal clrculaLlon
supplles blood Lo Lhe Llssue of Lhe larger alrways of Lhe
lung
ArLerles are blood vessels LhaL carry blood away from Lhe
hearL All arLerles wlLh Lhe excepLlon of Lhe pulmonary and
umblllcal arLerles carry oxygenaLed blood
ulmonary arLerles
1he pulmonary arLerles carry deoxygenaLed blood LhaL has
[usL reLurned from Lhe body Lo Lhe hearL Lowards Lhe lungs
where carbon dloxlde ls exchanged for oxygen
SysLemlc arLerles
SysLemlc arLerles can be subdlvlded lnLo Lwo Lypes
muscular and elasLlc accordlng Lo Lhe relaLlve
composlLlons of elasLlc and muscle Llssue ln Lhelr Lunlca
medla as well as Lhelr slze and Lhe makeup of Lhe lnLernal
and exLernal elasLlc lamlna 1he larger arLerles (10mm
dlameLer) are generally elasLlc and Lhe smaller ones (01
10mm) Lend Lo be muscular SysLemlc arLerles dellver blood
Lo Lhe arLerloles and Lhen Lo Lhe caplllarles where
nuLrlenLs and gasses are exchanged
1he AorLa
1he aorLa ls Lhe rooL sysLemlc arLery lL recelves blood
dlrecLly from Lhe lefL venLrlcle of Lhe hearL vla Lhe aorLlc
valve As Lhe aorLa branches and Lhese arLerles branch ln
Lurn Lhey become successlvely smaller ln dlameLer down
Lo Lhe arLerlole 1he arLerloles supply caplllarles whlch ln
Lurn empLy lnLo venules 1he very flrsL branches off of Lhe
aorLa are Lhe coronary arLerles whlch supply blood Lo Lhe
hearL muscle lLself 1hese are followed by Lhe branches off
Lhe aorLlc arch namely Lhe brachlocephallc arLery Lhe lefL
common caroLld and Lhe lefL subclavlan arLerles
AorLa Lhe largesL arLery ln Lhe body orlglnaLlng from Lhe
lefL venLrlcle of Lhe hearL and exLends down Lo Lhe
abdomen where lL branches off lnLo Lwo smaller arLerles
(Lhe common lllacs) 1he aorLa brlngs oxygenaLed blood Lo
all parLs of Lhe body ln Lhe sysLemlc clrculaLlon
1he aorLa ls usually dlvlded lnLo flve segmenLs/secLlons
Ascendlng aorLaLhe secLlon beLween Lhe hearL and Lhe
arch of aorLa
Arch of aorLaLhe peak parL LhaL looks somewhaL llke an
lnverLed u
uescendlng aorLaLhe secLlon from Lhe arch of aorLa Lo
Lhe polnL where lL dlvldes lnLo Lhe common lllac arLerles
o 1horaclc aorLaLhe half of Lhe descendlng aorLa above
Lhe dlaphragm
o Abdomlnal aorLaLhe half of Lhe descendlng aorLa
below Lhe dlaphragm
ArLerloles
ArLerloles Lhe smallesL of Lhe Lrue arLerles help regulaLe
blood pressure by Lhe varlable conLracLlon of Lhe smooLh
muscle of Lhelr walls and dellver blood Lo Lhe caplllarles
velns are blood vessels LhaL carry blood Lowards Lhe hearL
MosL velns carry deoxygenaLed blood from Lhe Llssues back
Lo Lhe lungs excepLlons are Lhe pulmonary and umblllcal
velns boLh of whlch carry oxygenaLed blood velns dlffer
from arLerles ln sLrucLure and funcLlon for example
arLerles are more muscular Lhan velns and Lhey carry blood
away from Lhe hearL
velns are classlfled ln a number of ways lncludlng
superflclal vs deep pulmonary vs sysLemlc and large vs
small
Superflclal velns
Superflclal velns are Lhose whose course ls close Lo Lhe
surface of Lhe body and have no correspondlng arLerles
ueep velns
ueep velns are deeper ln Lhe body and have correspondlng
arLerles
ulmonary velns
1he pulmonary velns are a seL of velns LhaL dellver
oxygenaLed blood from Lhe lungs Lo Lhe hearL
SysLemlc velns
SysLemlc velns draln Lhe Llssues of Lhe body and dellver
deoxygenaLed blood Lo Lhe hearL
ALrlum someLlmes called aurlcle refers Lo a chamber or
space lL may be Lhe aLrlum of Lhe laLeral venLrlcle ln Lhe
braln or Lhe blood collecLlon chamber of a hearL lL has a
Lhlnwalled sLrucLure LhaL allows blood Lo reLurn Lo Lhe
hearL 1here ls aL leasL one aLrlum ln anlmals wlLh a closed
clrculaLory sysLem
8lghL aLrlum ls one of four chambers (Lwo aLrla and Lwo
venLrlcles) ln Lhe human hearL lL recelves deoxygenaLed
blood from Lhe superlor and lnferlor vena cava and Lhe
coronary slnus and pumps lL lnLo Lhe rlghL venLrlcle
Lhrough Lhe Lrlcuspld valve ALLached Lo Lhe rlghL aLrlum ls
Lhe rlghL aurlcular appendlx
LefL aLrlum ls one of Lhe four chambers ln Lhe human hearL
lL recelves oxygenaLed blood from Lhe pulmonary velns
and pumps lL lnLo Lhe lefL venLrlcle vla Lhe aLrlovenLrlcular
valve
venLrlcle ls a chamber whlch collecLs blood from an aLrlum
(anoLher hearL chamber LhaL ls smaller Lhan a venLrlcle)
and pumps lL ouL of Lhe hearL
8lghL venLrlcle ls one of four chambers (Lwo aLrla and Lwo
venLrlcles) ln Lhe human hearL lL recelves deoxygenaLed
blood from Lhe rlghL aLrlum vla Lhe Lrlcuspld valve and
pumps lL lnLo Lhe pulmonary arLery vla Lhe pulmonary valve
and pulmonary Lrunk
LefL venLrlcle ls one of four chambers (Lwo aLrla and Lwo
venLrlcles) ln Lhe human hearL lL recelves oxygenaLed
blood from Lhe lefL aLrlum vla Lhe mlLral valve and pumps
lL lnLo Lhe aorLa vla Lhe aorLlc valve
aLhophyslology of regnancy lnduced PyperLenslon (lP)
Cllnlcal ManlfesLaLlons
A Mlld reeclampsla
8 of 140/90
1+ Lo 2+ proLelnurla on random
welghL galn of 2 lbs per week on Lhe 2nd LrlmesLer and 1 lb
per week on Lhe 3rd LrlmesLer
SllghL edema ln upper exLremlLles and face
8 Severe reeclampsla
8 of 160/110
34+ proLenurla on random
Cllgurla (less Lhan 300 ml/24 hrs)
Cerebral or vlsual dlsLurbances
LplgasLrlc paln
ulmonary edema
erlpheral edema
PepaLlc dysfuncLlon
C Lclampsla ls an exLenslon of preeclampsla and ls
characLerlzed by Lhe cllenL experlenclng selzures

ulagnosLlc LvaluaLlon
8ased on Lhe presenLlng sympLoms CfLen Lhe dlsease
process has been developlng and affecLlng Lhe renal and
vascular sysLem
lrequenLly a sudden welghL galn wlll occur of 2 lb or more
ln 1 week or 6 lb or more wlLhln 1 monLh 1hls ofLen
occurs before Lhe edema ls presenL
Medlcal 1reaLmenL and LvaluaLlon
Magneslum SulfaLe (regnancy rlsk caLegory 8)
muscle relaxanL prevenL selzures
loadlng dose 46g malnLenance dose 12g/h lv
lnfuse lv dose slowly over 1330 mln
-Always admlnlsLer as a plggy back lnfuslon
-Assess 8 urlne ouLpuL u18 and clonus every hour
-Cbserve for CnS depresslon and hypoLonla ln lnfanL aL
blrLh
Pydrazallne (Apresollne) regnancy rlsk caLegory C
anLl hyperLenslve (perlpheral vasodllaLor) use Lo decrease
hyperLenslon
310mg/lv
AdmlnlsLer slowly Lo avold sudden fall of 8
-MalnLaln dlasLollc pressure over 90 mmPg Lo ensure
adequaLe placenLal fllllng
ulazepam (vallum) regnancy rlsk caLegory u
halL selzures
310mg/lv
admlnlsLer slowly uose may be repeaLed every 1013
mln (up Lo 30mg/hr)
-Cbserve for resplraLory depresslon for boLh moLher and
lnfanL aL blrLh
Calclum CluconaLe (regnancy rlsk caLegory C)
anLldoLe for Magneslum SulfaLe
1g/lv (10 mL of a 10 soluLlon)
have prepared aL bed slde when admlnlsLerlng
Magneslum SulfaLe
admlnlsLer aL 3mL/mln
CompllcaLlons of lP
lnLrauLerlne growLh resLrlcLlon (luC8) an abnormally
resLrlcLed symmeLrlc or asymmeLrlc growLh of feLus
Cllgohydramnlos abnormally low volume of amnloLlc fluld
8lsk of placenLal abrupLlon premaLure separaLlon of a
normally slLuaLed placenLa from Lhe wall of uLerus
8lsk of preLerm dellvery (ofLen laLrogenlc) dellvery before
37 weeks of gesLaLlon
CoagulopaLhy
SLlllblrLh
Selzures
Coma
8enal fallure
MaLernal hepaLlc damage
Pemolysls
LlevaLed llver enzymes levels
Low plaLeleL counL (PLLL syndrome)
nurslng lnLervenLlons
lnLervenLlon for mlld lP
8aLlonale
1 Assess maLernal vS and feLal hearL raLe
Lo deLecL any lncrease whlch ls warnlng LhaL a women's
condlLlon ls worsenlng
2 Lncourage elevaLlon of edemaLous arms and legs
Lo lncrease venous blood reLurn
3 Lncourage compllance wlLh bed resL ln a laLeral
recumbenL poslLlon
Lo lncrease evacuaLlon of sodlum and encouraglng dluresls
and laLeral recumbenL poslLlon can avold uLerlne pressure
on Lhe vena cava and prevenL suplne hypoLenslon
syndrome
4 rovlde emoLlonal supporL
Lhls can make a women underesLlmaLe Lhe severlLy of Lhe
slLuaLlon
3 SupporL paLlenL wlLh bed resL and darken Lhe room lf
posslble
because a brlghL llghL can Lrlgger selzures
6 CbLaln dally hemaLocrlL levels as ordered
Lo monlLor blood concenLraLlon and help Lo Lhe exLenL of
plasma loss Lo lnLersLlLlal space or exLenL of Lhe edema
7 CbLaln blood sLudles (C8C plaLeleLs counL llver funcLlon
8un and creaLlnlne and flbrln degregaLlon)
Lo assess for renal and llver funcLlon and Lhe developmenL
of dlssemlnaLed lnLravascular coagulaLlon whlch ofLen
accompanles severe vasospasms
8 CbLaln dally welghLs aL Lhe same Llme each day
Lo evaluaLe Llssue fluld reLenLlon
9 8alse slde ralls
Lo help prevenL ln[ury lf selzure should occur
10 SupporL nuLrlLlous dleL of moderaLe Lo hlgh ln proLeln
and moderaLe ln sodlum
Lo compensaLe for proLeln she ls loslng ln her urlne
11 An lndwelllng caLheLer may be lnserLed as ordered
Lo allow accuraLe recordlng of ouLpuL and comparlson wlLh
lnLake
12 Cxygen admlnlsLraLlon Lo Lhe moLher may be glven as
ordered
Lo malnLaln adequaLe feLal oxygenaLlon and prevenL feLal
bradycardla
13 AdmlnlsLer medlcaLlon for selzures and hyperLenslon
eplsodes as ordered
Lo prevenL selzures and hyperLenslon

lnLervenLlon for severe lP
8aLlonale
1 MalnLaln paLlenL's alrway by noL puLLlng a Longue blade
beLween a women's LeeLh durlng selzures
Lo prevenL broken of LeeLh whlch could Lhen be asplraLed
2 1urn a woman on her slde
Lo allow secreLlons Lo draln from her mouLh

ulscharge lan
Lxerclse
encourage paLlenL's on deep breaLhlng exerclses
move exLremlLles when lylng
elevaLe Lhe head parL when sleeplng Lo promoLe lncrease
perlpheral clrculaLlon
encourage overall passlve and acLlve exerclses program
durlng pregnancy Lo prevenL need for cesarean blrLh
exerclses llke Lallor slLLlng squaLLlng kegel exerclse pelvlc
rocklng and abdomlnal muscle conLracLlon wlll promoLe
easy dellvery
1reaLmenL
use of drugs
caLheLerlzaLlon
obLalnlng labs (C8C plaLeleLs counL llver funcLlon 8un
and creaLlnlne and flbrln degregaLlon)
PealLh 1eachlng
Lncourage paLlenL foe sodlum resLrlcLlon
Lncourage Lo avold foods rlch ln oll and faLs
Lncourage paLlenL Lo llmlL her dally acLlvlLles and exerclses
Cngolng AssessmenL
Cbserve carefully for sympLoms aL prenaLal vlslL
Clve lnsLrucLlon abouL whaL sympLoms Lo waLch for so she
can alerL her cllnlclan lf addlLlonal sympLoms occur
beLween vlslLs
uleL
low faLs and sodlum dleL resLrlcLlon lf posslble
hlgh ln proLeln calclum and lron
AdequaLe fluld lnLake
Sex
llmlL sexual acLlvlLy
sexual lnLercourse aL 2nd LrlmesLer should be avolded