高血压英文ppt精品课件complications of pregnancy nonbleeding

Complications of Pregnancy Non-bleeding Complications Pre-term labor 28 37 weeks (after the age of viability and before term) Causes: Hypertensive disease Placenta disorders STDs Congenital anomalies Smoking Unknown Treatment Goals of treatment Stop the contractions of labor Slow the process and prepare for birth Medications used: Yutopar Magnesium Sulfate These may be effective if cervix is 140/90, or of 30/15) on 2 occasions at least 6 hours apart Weight gain with edema in lower extremities Proteinuria (mild) 1+ on 2 successive days Course of the Disease Severe Preeclampsia B/P 160/100 (at rest) on 2 occasions at least 6 hours apart. Oliguria-400 ml/24 hours or less Proteinuria ore pronounced (3+) or 5 grams in 24 hours. Eclampsia if vasospasms worsens and B/P damage to cerebral vessels and cerebral edema = seizure activity Multi-systems affects CNS leading to seizure activity Headaches Visual disturbances Hyperreflexia/clonus Altered LOC Eclampsia Hematologic effects Platelet aggregation/intravascular clotting, damage to RBCs, consumption of clotting factors Abnormal shaped and/or damaged RBCs Increased fibrin split products (FSP) Thrombocytopenia DIC Hepatic effects Congestion from fibrin deposits, ischemia, increased hepatic pressure (portal hypertension) Nausea/vomiting Epigastric pain Liver enzymes Liver rupture (very rare) Renal effects: SCOT Thrombocytopenia HELLP Syndrome Severe form of preeclampsia Hemolysis Elevated liver enzymes Low platelets H E L L P Symptoms are: Severe epigastric pain (RUQ) Nausea / vomiting Goals of Nursing Care are twofold Protecting the Fetus Instruct mother to lie in the side-lying position (left) Avoid the supine position Assess fetal status Non-stress test Contractions Ultrasound Nursing Care for mother Diastolic B/P 90 and no fetal ditsress=bedrest at home Diastolic B/P 100 hospitalized until delivery Nursing care for MOM Minimize eternal stimuli Maintain bedrest preferably the side-lying position Organize work and disturb as little as possible Provide quiet/privacy for visits with family Provide patient teaching Observe for worsening of condition B/P proteinuria Reflex irritability Epigastric pain Medical Treatment Drug of Choice: Magnesium sulfate anticonvulsant, CNS depressant, reduces muscle excitability and B/P Nursing care Monitor vital signs until stable, LOC Assess for signs of toxicity Urinary output, respiratory rates DTRs( deep tendon reflex) Have calcium gluconate on hand Medical Treatment If seizures occur even with MgSO4 1. Phenobarbital 2. Diazepam (Valium) 3. Phenytoin (Dilantin) Other medications if no seizures, but B/P remains elevated Hydralzine (apresoline) with Side effects of tachycardia in mom and thrombocytopenia in baby Successful & safe delivery If symptoms continue with bed rest and treatment delivery seems to bring about relief of symptoms Tests to determine fetal lung maturity Post-par