Diagnosis, Complications, and Treatment of Preeclampsia (Nursing)

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.