Diagnosis, Complications, and Treatment of Preeclampsia (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    Learning Material 5
    • PDF
      Slides Hypertensive Disorders of Pregnancy Nursing.pdf
    • PDF
      Slides Hypertensive Disorders Diagnosis Complications and Treatment of Preeclampsia.pdf
    • PDF
      Review Sheet Preeclampsia Nursing.pdf
    • PDF
      Reference List Maternity Nursing Care of the Childbearing Family.pdf
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    00:01 So now let's talk about that full diagnosis.

    00:03 We understand the physiology a little bit better.

    00:06 Let's see if we can move along the cascade and apply it.

    00:09 So the diagnosis of preeclampsia occurs when there's an elevated blood pressure.

    00:15 And by elevated, again, the criteria we use in pregnancy is 140/90 on two separate occasions that are at least 4 hours apart.

    00:24 So when we think about taking the blood pressure, you always want to make sure that you use proper technique.

    00:29 Some people have what we call white coat syndrome, where they come into the office, and just the idea of seeing a provider makes their blood pressure go through the roof.

    00:37 If that's the case, that's not the blood pressure that you should use.

    00:40 Or if they're running late for an appointment, or they've had a really distressing conversation with someone else, or depending on some of the things that they may have just eaten, that's not a good time to get a baseline.

    00:51 So make sure that blood pressure is representative of a normal blood pressure for them.

    00:56 We can also look for signs of proteinuria.

    00:59 So hopefully those physiology bells are ringing in your head right now.

    01:03 We can get a dipped urine sample, which is one of the reasons why we check urine often throughout pregnancy.

    01:09 We can get a 24 hour urine sample.

    01:10 And if we find more than 300 mg of protein in that 24 hour urine sample, then we can make this diagnosis.

    01:18 And a protein/creatine ratio is one of the newer tests that we've started using in the last few years, and it is very accurate.

    01:25 So we can measure both the protein and the creatinine.

    01:29 Those are two different tests, and we can look at the ratio.

    01:32 And if that ratio is greater than 0.3 grams, then that's indicative of preeclampsia.

    01:37 And then finally, kidney function. We can look at the serum creatinine.

    01:41 And if that levels increased above 1.1, then we absolutely along with the hypertensive diagnosis can diagnose preeclampsia.

    01:51 So those are the features of mild preeclampsia.

    01:53 Now let's talk about the features of severe preeclampsia.

    01:56 There's no moderate preeclampsia. Just these two.

    02:00 So the features include a blood pressure greater than 160/110.

    02:05 Thrombocytopenia, which means that the platelet counts are going to be below 100,000.

    02:12 Because of the damage to the liver, the patient's going to experience impaired liver function, and you might see that on the labs.

    02:19 The serum creatinine levels are going to be continue to increase above 1.1.

    02:26 The leaky vessels.

    02:27 Think about leaky vessels in the lungs and that pulmonary edema.

    02:30 This would be something you would notice that's associated with severe preeclampsia.

    02:34 And new-onset visual disturbances. Do you remember what those are? So, the scotoma and the blurry vision.

    02:44 Now, we're going to talk about another variant of severe preeclampsia.

    02:48 So these are kind of in a category together.

    02:50 So, eclampsia versus preeclampsia.

    02:54 They're really only important part to remember about this in terms of differentiating the two, is that a eclampsia means that a seizure has occurred.

    03:03 So a new-onset tonic clonic seizure for a person who's never experienced seizures before, and they have preeclampsia.

    03:12 Now, sometimes we haven't diagnosed the preeclampsia yet.

    03:15 So, sometimes, the seizure is where we first say, "Oh, wow, I think this client has preeclampsia." Well, actually, now they have eclampsia because they've seized.

    03:24 So the only difference is the seizure.

    03:26 Everything else is the same.

    03:28 So you can have mild preeclampsia, but the minute you have a seizure, then you've moved to eclampsia or you could have severe preeclampsia, and the minute you have a seizure, you move to eclampsia.

    03:40 So thinking about complications that can occur.

    03:43 So, further complications of having preeclampsia.

    03:46 About 10 to 20% of those clients will go on to develop DIC or HELLP syndrome.

    03:51 And we'll talk about HELLP in just a second.

    03:53 So hold on to that one.

    03:55 About 1% to 5% will develop pulmonary edema.

    03:59 About 1% to 5% will develop eclampsia.

    04:03 1% to 4% will develop an abruptio placenta.

    04:06 So abruptio placenta really occurs when the placenta pulls away from the uterine wall, before the baby comes out, which is definitely not good.

    04:15 And rarely, although it does happen, clients with preeclampsia can move into complete, complete liver failure.

    04:23 So we've been talking about the mother and a little bit about the baby.

    04:26 So let's shift our focus to talking about the fetus because [inaudible] is definitely important.

    04:31 So with preeclampsia, and we have this abnormal placental development, we're going to have a restriction of blood flow, and that's going to cause a restriction of fetal growth.

    04:41 So these things are just going to sort of happen in a circle.

    04:44 So we have hypoperfusion to the placenta.

    04:47 We get IUGR.

    04:48 And if we have IUGR, then we're likely to really require an early birth.

    04:53 And if we require an early birth, then the baby's ability to survive and an extrautero environment is going to be impaired.

    05:00 So they may end up with low Apgar, which indicates a poor transition to extrauterine life.

    05:07 Going back to the mother and thinking about long term effects.

    05:11 So, cardiovascular disease, and hypertension, heart disease and stroke, definitely is going to be a potential.

    05:18 That could happen both short term.

    05:20 And we've also of late found that there's some long-term risks of having preeclampsia.

    05:26 Metabolic syndrome may also occur in clients who've experienced preeclampsia.

    05:30 Postpartum cardiomyopathies, or end-stage renal disease depending on how severe that preeclampsia might have been.

    05:37 Now, here's the hard part.

    05:38 That we can't really do anything about someone who has preeclampsia, in terms of making it go away.

    05:45 There's no definitive cure for preeclampsia during pregnancy.

    05:48 There's not a magic medication or anything like that.

    05:52 The definitive treatment for preeclampsia is delivery of the placenta, which creates a problem considering some preeclampsia develops very early on in the pregnancy.

    06:02 So if you've got a 20, 22, 23 week client with preeclampsia, delivering the placenta is really not going to be very effective in terms of having a baby that's able to survive outside the uterus.

    06:14 But remember this, the only definitive treatment is delivery of that placenta.

    About the Lecture

    The lecture Diagnosis, Complications, and Treatment of Preeclampsia (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Hypertensive Disorders of Pregnancy: Preeclampsia (Nursing).

    Included Quiz Questions

    1. Elevated liver enzymes
    2. Auscultated lung crackles
    3. Visual disturbances
    4. Increasing platelet count
    5. Decreased serum creatinine
    1. Poor fetal growth
    2. Maternal post-partum hypertension
    3. Maternal postpartum end-stage-renal disease
    4. High fetal APGAR score
    5. Vaginal delivery of fetus
    1. Delivery of the placenta
    2. Strict bed rest
    3. Antihypertensive medication
    4. Blood transfusion

    Author of lecture Diagnosis, Complications, and Treatment of Preeclampsia (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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