Pregnancy Induced Hypertension Case Study

H O L Y A N G E L U N I V E R S I T Y
College of Nursing
In Partial Fulfilment of Requirements for RLE 104
P R E G N A N C Y I N D U C E D H Y P E R T E N S I O N
A Boo!B"se# C"se S$u#%
Presen$e# To&
Teachers Full Name MAN, RN
Su'(i$$e# B%&
Gueco, Daryl C.
GROUP ) of N!*+,
Pregnancy-Induced Hypertension: A ase !tudy 2
September 29, 2010
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TABLE O- CONTENTS
INTRODUCTION
BRIEF DESCRIPTI! F T"E DISE#SE 3
RE#S!S FR C"SI!G T"E C#SE $
ST#TISTICS %
ST&DE!T !&RSE'CE!TRED B(ECTI)ES *
DIAGNOSTIC . LABRATORY PROCEDURES +
PHYSICAL ASSESS/ENT 01
ANATO/Y . PHYSIOLOGY 29
PATHOPHYSIOLOGY
S,!T"ESIS F T"E DISE#SE --
DEFI!ITI! F T"E DISE#SE -%
PREDISPSI!G . PRECIPIT#TI!G F#CTRS -*
SIG!S #!D S,/PT/S 0IT" R#TI!#1E -+
/EDICAL /ANAGE/ENT
I)F $0
P"#R/#CT"ER#P, $2
DIET %1
NURSING CARE PLAN %2
DISCHARGE PLANNING *2
LEARNING DERIVED *3
RE-ERENCES
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Pregnancy-Induced Hypertension: A ase !tudy -
22e learn more by looking for the answer to a question
and not finding it than we do from learning the answer itself.3
41loy5 #le6a75er, #mer8ca7 #ut9or, 192-
I7 t9e :8el5 o: 7ur;87<, o7e e7cou7ter; a =85e'array o: >ar8ou; 58;ea;e; a75 co758t8o7;. I7
or5er to <8>e a5e?uate a75 9ol8;t8c care to 8758>85ual;, 8t 8; 7ece;;ary t9at 7ur;e; be e?u8ppe5
=8t9 t9e proper @7o=le5<e a75 ;@8ll; :or 5eal87< =8t9 58::ere7t 9ealt9 ;tate;. It 8; o7ly t9rou<9
co7t87uou; lear787< t9at 7ur;e; ac?u8re t9e 7ece;;ary ;@8ll. # ca;e ;tu5y 8; a mea7; o: co7t87u87<
;uc9 lear787<. I7 5o87< a ca;e ;tu5y, t9e ;tu5e7t; 5el>e 87to t9e ?ue;t8o7, 2=9at 8; t98; 58;ea;e
co758t8o7A3 Stu5e7t 7ur;e; lear7 act8>ely a75 =8ll be able to 9a75le pat8e7t; a75 e6per8e7ce =9at
8t mea7; to care :or a pat8e7t =8t9 t9at part8cular co758t8o7. T9ey lear7, :rom co7t87uou;
87teract8o7 =8t9 t9e pat8e7t; alo7< ;85e =8t9 87?u8re; 87to boo@; a75 87:ormat8>e Bour7al; o: t9e
58;ea;e proce;;, 8t ;ymptom;, a75 corre;po7587< treatme7t;.
Pre<7a7cy'875uce5 9yperte7;8o7 8; o7e o: t9e co758t8o7; =98c9 ;tu5e7t'7ur;e; e7cou7ter
5ur87< t9e8r e6po;ure at t9e cl878cal ;ett87<. T9e 58;ea;e compr8;e; o: comple68t8e; o: t9e
a7atom8cal co7cept; t9at ;ur>ey; a t9orou<9 5e;cr8pt8o7 to u75er;ta75 8t; ma78:e;tat8o7; a75
:ormulate 87ter>e7t8o7;. It 8; 87tere;t87< o7 our part to lear7 8t; 5e:878t8o7, cau;e;, a75 proper
ma7a<eme7t. T9e ;tu5e7t'7ur;e; c9o;e t9e ca;e to be able to 9a>e a7 87;8<9t about t9e
co758t8o7.
Brief Des3ri4$ion
Pre<7a7cy 875uce5 9yperte7;8o7 CPI"D 8; a co758t8o7 87 =98c9 >a;o;pa;m; occur;
5ur87< pre<7a7cy. I7 t98; co758t8o7 ;8<7; o: 9yperte7;8o7, prote87ur8a a75 e5ema 5e>elop 87
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Pregnancy-Induced Hypertension: A ase !tudy $
pre<7a7t a75 po;tpartum =ome7. De;p8te year; o: re;earc9 a75 ;tu58e; 87>e;t8<at87< t9e 58;ea;e,
t9e cau;e o: t9e 58;or5er 8; ;t8ll ;eem87<ly 858opat98c. r8<87ally, t98; co758t8o7 9a; bee7 calle5
t9e to"emia o# pregnancy becau;e re;earc9er; 5ep8cte5 a75 9ypot9e;8Ee5 t9at a to687 o: ;ome
@875 be87< pro5uce; by a =oma7 87 re;po7;e to t9e :ore8<7 prote87 o: t9e <ro=87< :etu;, t9e
to687 lea587< to t9e ;ymptom;. St8ll, 5e;p8te t9e e::ort; 87 :87587< a7 e6pla7at8o7 to t9e cau;e o:
pre<7a7cy 875uce5 9yperte7;8o7, 7o ;uc9 to687 9a; e>er 85e7t8:8e5.
Pre<7a7cy F875uce5 9yperte7;8o7 8; a7 alarm87< co758t8o7 =98c9 ca7 a::ect bot9 t9e
=el:are o: t9e mot9er a75 t9e c98l5. 0ome7 =9o 5e>elop 98<9 bloo5 pre;;ure 87 pre<7a7cy
appear to 9a>e a7 ele>ate5 r8;@ 98<9 bloo5 pre;;ure a75 ;to@e 87 later l8:e. 0ome7 =8t9 a 98;tory
o: 98<9 bloo5 pre;;ure 87 pre<7a7cy, @7o=7 a; <e;tat8o7al 9yperte7;8o7, =ere more l8@ely t9a7
=ome7 =8t9 7o 98;tory to 5e>elop 98<9 bloo5 pre;;ure 87 later year;. I7 term; o: t9e =el:are o:
t9e c98l5 87'utero, t9e :etu; may be place5 87 58;tre;; 5ue to t9e pre;e7ce o: t9e co758t8o7, a75
compl8cat8o7; :rom 98<9 bloo5 pre;;ure ;uc9 a; co7>ul;8o7; ca7 cau;e 58re co7;e?ue7ce;. T9e
ca;e o: pre'eclamp;8a, t9e co758t8o7 ca7 ;tr8@e =8t9out =ar787< cau;87< bloo5 pre;;ure to r8;@ to
5a7<erou;ly 98<9 le>el;. Pre'eclamp;8a may pro<re;; to eclamp;8a 87 =98c9 98<9 bloo5 pre;;ure
a75 co7>ul;8o7; coul5 be :atal to t9e mot9er or c98l5. Pre'eclamp;8a 8; a lea587< cau;e o:
mater7al 5eat9. It ;tr8@e; about :8>e perce7t o: :8r;t t8me mot9er; a75 o7e to t=o perce7t o:
mot9er; 5ur87< ;ub;e?ue7t pre<7a7c8e;.
Cl"ssifi3"$ion of H%4er$ensi5e Dise"ses in Pregn"n3%
C6roni3 H%4er$ension 8; 5e:87e5 a; bloo5 pre;;ure G1-0H90 at I20 =ee@; o: <e;tat8o7.
Pregn"n3% In#u3e# H%4er$ension 8; 5e:87e5 a; a ;u;ta87e5 bloo5 pre;;ure 87crea;e to 1-0H90 at
G20 =ee@; <e;tat8o7.
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Pregnancy-Induced Hypertension: A ase !tudy %
Su4eri(4ose# Pregn"n3%!In#u3e# H%4er$ension 8; 5e:87e5 a; coe68;te7ce o: c9ro78c
9yperte7;8o7 a75 pre<7a7cy'875uce5 9yperte7;8o7.
Clini3"l /"nifes$"$ions of Se5ere Dise"se in P"$ien$s 7i$6 PIH
Bloo5 pre;;ure G1%0'1+0 mm "< ;y;tol8c or G110 mm "< 58a;tol8c
Prote87ur8a G$ <H2- 9 or G 1J o7 58p;t8c@ C7ormal I300 m<H2- 9D
Ele>ate5 ;erum creat8787e
Ge7eral8Ee5 ;e8Eure; Ceclamp;8aD
Pulmo7ary e5ema
l8<ur8a I$00 m1H2- 9our;
/8croa7<8opat98c 9emoly;8;
T9rombocytope78a
"epatocellular 5y;:u7ct8o7 Cele>ate5 ala787e to6em8a preeclamp;8a, am87otra7;:era;e, a;parta;e
am87otra7;:era;eD
I7trauter87e <ro=t9 re;tr8ct8o7 or ol8<o9y5ram78o;
S%(4$o(s sugges$ing signifi3"n$ en#!org"n in5ol5e(en$& 9ea5ac9e, >8;ual 58;turba7ce;, or
ep8<a;tr8c or r8<9t'upper ?ua5ra7t pa87
REASONS -OR CHOOSING THE CASE
T9e ;tu5e7t 7ur;e; 9a>e c9o;e7 t98; ;tu5y becau;e o: 58::ere7t rea;o7; ;uc9 a;, 8t 8; a
>ery commo7 58;ea;e at t9e ob;tetr8c =ar5 a; =ell a; t9e 5el8>ery room. T9ere are a lot o: ca;e;
o: pre'eclamp;8a, t9e top8c 8; 87tere;t87< a75 mo;t e;pec8ally, :or u; to lear7 more about t9e
58;ea;e a75 87 retur7, =e =8ll <a87 more @7o=le5<e about t9e ;tu5y.
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Pregnancy-Induced Hypertension: A ase !tudy *
STATISTICS
Pre<7a7cy 875uce5 9yperte7;8o7 8; a co758t8o7 =98c9 e::ect; ma7y =ome7 87 t9e =orl5.
T98; 8; true e>e7 :or t9o;e e6pect87< mot9er; 87 t9e P98l8pp87e;. Stu58e; o: preeclamp;8a report
about $ perce7t o: 7ull8parou; =ome7 5e>elop preeclamp;8a a75 -0 to $0 perce7t o: t9e;e
=ome7 5e>elop ;e>ere 58;ea;e =orl5=85e. I7 t9e P98l8pp87e;, accor587< to Departme7t o:
"ealt9, /ater7al /ortal8ty Rate C//RD 8; 1%2 out o: 10,000 l8>e b8rt9; CFam8ly Pla7787<
Sur>ey 200%D. /ater7al 5eat9; accou7t :or 1-K o: 5eat9; amo7< =ome7. For t9e pa;t :8>e year;
all o: t9e cau;e; o: mater7al 5eat9; e698b8te5 a7 up=ar5 tre75. Preeclamp;8a ;9o=e5 a7
87crea;87< tre75 o: %.+9KL 20KL -0KL a75 100K. Te7 =ome7 58e e>ery 5ay 87 t9e P98l8pp87e;
:rom pre<7a7cy a75 c98l5b8rt9 relate5 cau;e; but :or e>ery mot9er =9o 58e;, rou<9ly 20 more
;u::er ;er8ou; 58;ea;e a75 58;ab8l8ty. T9e &!FP# o::8ce 87 t9e P98l8pp87e; 5eclare5 t9at :am8ly
pla7787< ca7 9elp pre>e7t mater7al 5eat9; by 3$K.
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Pregnancy-Induced Hypertension: A ase !tudy +
STUDENT NURSE!CENTRED OB8ECTIVES
G
E ! E R # 1
O
B ( E C T I ) E S

A#ter the completion o# this $oo%-$ased case study, the student nurses &ill $e a$le to:
M7o= a75 u75er;ta75 t9e 58;ea;e proce;; a75 co7cept o: pre<7a7cy'875uce5
9yperte7;8o7.
S
P E C I F I C
O
B ( E C T I ) E S
A#ter the completion o# this $oo%-$ased study on pregnancy-induced hypertension, the student
nurses &ill $e a$le to:
Cognitie
Re>8e= t9e proper p9y;8cal a;;e;;me7t CIPP#D a75 e6pecte5 :87587<; 87 a =oma7 =8t9 pre<7a7cy
875uce5 9yperte7;8o7.
&75er;ta75 t9e 58;ea;e proce;;N t9e cau;e;, e::ect;, ma7a<eme7t, treatme7t, a75 po;;8ble
pre>e7t8o7;.
Determ87e t9e pat9op9y;8olo<y o: t9e co758t8o7 =8t9 t9e8r rat8o7ale :or occurre7ce o: eac9
ma78:e;tat8o7.
Determ87e =9y certa87 ma7a<eme7t a75 me58cat8o7; are <8>e7 a75 pro>85e5 :or t9e co758t8o7.
&75er;ta75 9o= a75 =9y certa87 58a<7o;t8c te;t; are 5o7e :or t9e co758t8o7.
Re>8e= t9e co7cept; about t9e a7atomy a75 p9y;8olo<y =8t9 re<ar5; to t9e co758t8o7.
Psy!homotor
I5e7t8:y t9e appropr8ate 9ealt9 teac987<; 87 =98c9 to pro>85e to :uture pat8e7t; =8t9 t9e ;a85
co758t8o7.
"ffe!tie
S9are t9e lear787< ac?u8re5 to co';tu5e7t'7ur;e; to 87crea;e a=are7e;; a75 9elp t9em 8: e>er t9ey
=8ll e7cou7ter pat8e7t =8t9 t9e ;ame co758t8o7.
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DIAGNOSTIC . LABRATORY PROCEDURES
CO/PLETE BLOOD COUNT
#iagnosti! Pro!edure Indi!ations or Pur$ose Possible Results %ormal &alues
HGB C<H51D To mea;ure t9e total
amou7t o: 9emo<lob87 87
t9e bloo5.
/ay be ele>ate5 5ue
to 9emoco7ce7trat8o7
o: bloo5.
120'1%0 <H5l
HCT 9:; To a85 58a<7o;8; o:
ab7ormal ;tate; o:
9y5rat8o7, polycyt9em8a
a75 a7em8a a75 a85; 87
calculat8o7 o:
eryt9rocyte 8758ce;.
/ay be ele>ate5 5ue
to 9emoco7ce7trat8o7
o: bloo5.
3%.0 F -*.0
Pl"$ele$ Coun$
9<0+ =>L;
To e>aluate platelet
pro5uct8o7
T9rombocytocpe78a
or 5ecrea;e5 platelet
;tate; are o:te7 :ou75
87 PI"
1$0 F -00
2BC 9<0+ =>L; To 5eterm87e :or
pre;e7ce o: :or :urt9er
te;t; ;uc9 a; 0BC
58::ere7t8al 87:ect8o7 a75
al;o :or 5eterm87at8o7
cou7t
0BC a75 58::ere7t8al
cou7t; may be
ele>ate5 5epe7587<
upo7 t9e pre;e7ce o:
87:ect8o7 :or t9e
8758>85ual ca;e o: t9e
pat8e7t.
-.+ F 10.+
Differen$i"l Coun$&
Se<me7ter; CKD
To pro>85e a 7umer8c
e;t8mate o: t9e cl8e7tO;
8mmu7e ;tatu;.
cou7t; may be
ele>ate5 5epe7587<
$$'%$K
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87:ect8o7 :or t9e
pat8e7t.
1ymp9ocyte; CKD To c9ec@ :or 8mmu7e
re;po7;e;
cou7t; may be
ele>ate5 5epe7587<
87:ect8o7 :or t9e
pat8e7t.
2$'3$K
Eo;87op98l; CKD To 5eterm87e pre;e7ce o:
mult8cellular para;8te;
a75 certa87 87:ect8o7;
cou7t; may be
ele>ate5 5epe7587<
87:ect8o7 :or t9e
pat8e7t.
2'-K
/o7ocyte; CKD To 5eterm87e pre;e7ce o:
C9ro78c 87:lammatory
58;ea;e, Para;8t8c
87:ect8o7, )8ral 87:ect8o7
cou7t; may be
ele>ate5 5epe7587<
87:ect8o7 :or t9e
pat8e7t.
2'%K
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CO/PLETE BLOOD COUNT
NURSING RESPONSIBILITIES BE-ORE? DURING? AND A-TER PROCEDURE
'efore the Pro!edure
E6pla87 t9e proce5ure to t9e pt. a75 =9y 8t 8; 8758cate5
I7:orm t9e pat8e7t t9at :lu85 a75 :oo5 re;tr8ct8o7 8; 7ot re?u8re5
I7:orm t9e pat8e7t t9at a bloo5 ;ample =8ll be ta@e7.
Tell t9e pat8e7t t9at 9e may e6per8e7ce tra7;8e7t 58;com:ort :rom t9e 7ee5le pu7cture
F8ll up laboratory re?ue;t :orm properly a75 ;e75 8t to t9e laboratory tec978c8a7 5ur87<
t9e collect8o7 o: ;ampleH;pec8me7.
#uring the Pro!edure
I7:orm t9e pat8e7t t9at pa87 may be :elt t9rou<9 pr8c@ 87 t9e 7ee5le
I7;truct t9e pat8e7t to calm 5o=7 to a>o85 u7ea;87e;;.
"fter the Pro!edure
#pply br8e: pre;;ure to pre>e7t blee587<
#pply =arm compre;; 8: "ematoma =8ll 5e>elop at t9e >e78pu7cture ;8te.
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BLOOD CHE/ISTRY
#iagnosti! Pro!edure Indi!ations or Pur$ose Possible Findings %ormal &alues
Creat8787e
So58um C!aJD
Pota;;8um CMJD
B8l8rub87
T98; te;t mea;ure; t9e
amou7t o: creat8787e 87
t9e bloo5. It 8; u;e5 to
58a<7o;e 8mpa8re5 re7al
:u7ct8o7 a75 a;;e;;
<lomerular :8ltrat8o7.
To c9ec@ :or =ater
bala7ce.
To mea;ure ac85 ba;e
bala7ce a75 7ormal
mu;cle act8>8ty.
Te;t; :or t9e pre;e7ce o:
l8>er 58;ea;e or
5y;:u7ct8o7 t9rou<9
e>aluat8o7 o: b8l8rub87
le>el; 87 t9e bloo5.
:te7 7ormal but
may be 87crea;e5 87
ca;e; o: ;e>ere
preeclamp;8a.
!ormal 87 PI", but
may 58::er 5ue to
comorb85 e68;t87<
co758t8o7; :or t9e
pat8e7t
!ormal 87 PI", but
may 58::er 5ue to
comorb85 e68;t87<
co758t8o7; :or t9e
pat8e7t
&;ually belo= $
m<H51
0.$'1.%9 m<H5l
13*'1-$ mmoHl
3.%'$.0 mmoHl
0.2'1.9 m<H51
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#;partate
#m87otra7;:era;e C#STD
#l@al87e P9o;p9ota;e
T9e a;partate
am87otra7;:era;e C#STD
te;t ca7 be u;e5
;pec8:8cally to c9ec@ :or
l8>er or 9eart problem;,
or 8t ca7 be part o:
;ta75ar5 me58cal te;t
;cree787<.
# te;t =98c9 e>aluate;
t9e al@al87e p9o;p9ota;e
le>el; 87 bloo5. T98; 8;
a7 e7Eyme t9at 8;
7ormally pre;e7t 87 98<9
co7ce7trat8o7; 87
<ro=87< bo7e a75 87
b8le. It 8; e;;e7t8al :or t9e
5epo;8t8o7 o: m87eral; 87
t9e bo7e; a75 teet9.
#ST 8; u;ually belo=
$00 I&
#l@al87e p9o;p9ota;e
may 87crea;e 2 to 3
:ol5 87 PI"
%'3- I&H1
20'1-0 I&H1
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Pregnancy-Induced Hypertension: A ase !tudy 1-
BLOOD CHE/ISTRY
E6pla87 t9e proce5ure to t9e pt. a75 =9y 8t 8; 8758cate5
I7:orm t9e pat8e7t t9at :lu85 a75 :oo5 re;tr8ct8o7 8; 7ot re?u8re5
I7:orm t9e pat8e7t t9at a bloo5 ;ample =8ll be ta@e7.
Tell t9e pat8e7t t9at 9e may e6per8e7ce tra7;8e7t 58;com:ort :rom t9e 7ee5le pu7cture
F8ll up laboratory re?ue;t :orm properly a75 ;e75 8t to t9e laboratory tec978c8a7 5ur87<
t9e collect8o7 o: ;ampleH;pec8me7.
I7:orm t9e pat8e7t t9at pa87 may be :elt t9rou<9 pr8c@ 87 t9e 7ee5le
I7;truct t9e pat8e7t to calm 5o=7 to a>o85 u7ea;87e;;.
"fter the Pro!edure
#pply br8e: pre;;ure to pre>e7t blee587<
#pply =arm compre;; 8: "ematoma =8ll 5e>elop at t9e >e78pu7cture ;8te.
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Pregnancy-Induced Hypertension: A ase !tudy 1$
URINALYSIS
#iagnosti! Pro!edure Indi!ations or Pur$ose Possible Findings %ormal &alues
&r87aly;8; For <e7eral 9ealt9
;cree787< to 5etect re7al
a75 metabol8c 58;ea;eL
58a<7o;8; o: 58;ea;e or
58;or5er; o: t9e @857ey
or ur87ary tractL
mo78tor87< pat8e7tO; =8t9
58abete;.
&r87aly;8; re>eal;
Prote87ur8a Cpo;8t8>e
album87 le>el;D a75
occa;8o7al 9yal87e
ca;t;.
ColorN Stra=
yello= to
amber.
Tra7;pare7cyN
tra7;pare7t
Su<arN 7e<at8>e
#lbum87N
7e<at8>e
Spec8:8c
Gra>8tyN 1.01$ F
1.02$
Pu; cell;N $'
10H"PF
RBCN o'2 "PF
Ep8t9el8al cell;N
/o5erate
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Pregnancy-Induced Hypertension: A ase !tudy 1%
URINALYSIS
E6pla87 to t9e ;8<78:8ca7t ot9er; t9e te;t, 8tO; purpo;e a75 9o= 8t 5o7e.
I7:orm t9e ;8<78:8ca7t ot9er; t9at t9e te;t =8ll re?u8re ur87e ;pec8me7.
Pro>85e a clea7 co7ta87er :or t9e ;pec8me7.
1abel t9e ;pec8me7 cup be:ore <8>87< 8t to t9e cl8e7t
#;;8;t t9e cl8e7t 87 t9e com:ort room
I7;truct t9e cl8e7t to ta@e t9e m855le ur87e
"fter the Pro!edure
T9e ;pec8me7 ;9oul5 be 5el8>ere5 to t9e lab =8t987 1 9our.
bta87 re;ult a75 ;ecure 8t to t9e c9art
Re:er re;ult to t9e p9y;8c8a7
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Pregnancy-Induced Hypertension: A ase !tudy 1*
PHYSICAL E@A/INATION . ASSESS/ENT
t9e :ollo=87< p9y;8cal a;;e;;me7t <u85e 9a; bee7 create5 to create a :ull p8cture o: =9at a 7ur;e
may :875 87 t9e cour;e o: a;;e;;me7t o: a pat8e7t =8t9 pre<7a7cy 875uce5 9yperte7;8o7. T9e
:87587<; are 9ypot9et8cal a75 ba;e5 o7 t9e ;8<7; a75 ;ymptom; l8:te5 :rom aut9or; ;uc9 a;
P8ll8ter8 a75 Blac@. T9e actual ;8<7; a75 ;ymptom; o: t9e 58;ea;e may >ary :rom ca;e to ca;e.
"ssessment of the Central %erous (ystem
T8;;ue; are capable o: re<ulat87< t9e8r o=7 bloo5 :lo=L t98; proce;; 8; @7o=7 a; "u$oregul"$ion.
Cerebral per:u;8o7 8; ma87ta87e5 by autore<ulat8o7 at a co7;ta7t le>el o: about $$ m1Hm87H100 <
at a =85e ra7<e o: bloo5 pre;;ure; CF8< 19'1D. "o=e>er, bloo5 pre;;ure may r8;e to le>el; at
=98c9 autore<ulat8o7 ca77ot :u7ct8o7. 09e7 t98; occur;, t9e e75ot9el8al t8<9t Bu7ct8o7; ope7,
cau;87< pla;ma a75 re5 bloo5 cell; to lea@ 87to t9e e6tra>a;cular ;pace. T98; may re;ult 87
petec98al 9emorr9a<e or <ro;; 87tracra78al 9emorr9a<e. T9e upper l8m8t o: autore<ulat8o7 >ar8e;
:rom o7e per;o7 to a7ot9erL e<, c9ro78c 9yperte7;8o7 may cau;e me58al 9ypertrop9y o: t9e
cerebral >e;;el;, re;ult87< 87 a ;98:t o: t9e cur>e to t9e r8<9t CF8< 19'1D. T98; e6pla87; t9e para5o6
o: 2 pat8e7t; =8t9 e?ually ;e>ere 9yperte7;8o7 =9o 9a>e mar@e5ly 58::ere7t cl878cal
pre;e7tat8o7;. T9e you7< pr8m8<ra>85a =9o;e bloo5 pre;;ure 8; 7ormally 110H*0 mm "< may
co7>ul;e =8t9 a bloo5 pre;;ure o: 1+0H120 mm "<, =98le a c9ro78c 9yperte7;8>e may be
a;ymptomat8c or 9a>e o7ly a 9ea5ac9e at t9e ;ame pre;;ure.
T9e mec9a78;m o: t9e cerebral 5ama<e 87 eclamp;8a 8; u7clear. T9e pat9olo<8c :87587<; are
;8m8lar to t9o;e o: 9yperte7;8>e e7cep9alopat9y. T9e;e ab7ormal8t8e; 87clu5e :8br87o85 7ecro;8;
a75 t9rombo;8; o: arter8ole;, m8cro87:arct;, a75 petec98al 9emorr9a<e;. I7 bot9 9yperte7;8>e
e7cep9alopat9y a75 eclamp;8a, t9e le;8o7; are =85ely 58;tr8bute5 t9rou<9out t9e bra87, but t9e
bra87;tem 8; more ;e>erely a::ecte5 87 t9e :ormer, =98le t9e corte6 8; more ;e>erely a::ecte5 87
N-407
Pregnancy-Induced Hypertension: A ase !tudy 1+
t9e latter. t9er 58::ere7ce; 87 t9e t=o co758t8o7; are t9at eclamp;8a may be ;ee7 87 t9e ab;e7ce
o: 9yperte7;8o7 a75 t9at ret87al 9emorr9a<e; a75 87:arct; are rare 87 eclamp;8a. T=o t9eor8e;
9a>e bee7 propo;e5 to e6pla87 t9e pat9o<e7e;8; o: 9yperte7;8>e e7cep9alopat9y, >a;o;pa;m, a75
:orce5 58lat8o7. I7 t9e :8r;t, >a;o;pa;m cau;e; local 8;c9em8a, arter8olar 7ecro;8;, a75 58;rupt8o7
o: t9e bloo5'bra87 barr8er. #ccor587< to t9e ;eco75, a; bloo5 pre;;ure r8;e; abo>e t9e l8m8t o:
autore<ulat8o7, cerebral >a;o58lat8o7 occur;. I78t8ally, ;ome >e;;el ;e<me7t; 58late, a75 ;ome
rema87 co7;tr8cte5. >er58;te7t8o7 o: t9e 58late5 ;e<me7t; re;ult; 87 7ecro;8; o: t9e me58al
mu;cle :8ber; a75 5ama<e to t9e >e;;el =all. It 8; po;;8ble t9at bot9 mec9a78;m; are opera7t.
T9e pre;e7ce o: cerebral e5ema 87 preeclamp;8a'eclamp;8a 8; co7tro>er;8al. 7e ;et o:
re;earc9er; ;tate5 t9at cerebral e5ema =a; 7ot pre;e7t 87 eclampt8c pat8e7t; =9e7 autop;y =a;
per:orme5 =8t987 1 9our o: 5eat9 a75 t9at ;uc9 e5ema =a; a late po;tmortem c9a7<e. I7 co7tra;t,
;ome ot9er; :ou75 <e7eral8Ee5 cerebral e5ema 87 ;ome autop;y ;pec8me7; a75 co7:8rme5
87crea;e5 87tracra78al pre;;ure 87 eclampt8c; =8t9 prolo7<e5 coma CG % 9our;D. Early ;tu58e; o:
cerebro;p87al :lu85 ope787< pre;;ure ;9o=e5 ele>ate5 pre;;ure;L 9o=e>er, more rece7t ;tu58e;
9a>e :a8le5 to co7:8rm t98;.
"ea5 compute5 tomo<rap98c CCTD ;ca7; 87 =ome7 =8t9 eclamp;8a 9a>e ;9o=7 ab7ormal8t8e; 87
about o7e't98r5. By u;87< :ourt9'<e7erat8o7 e?u8pme7t a75 =8t9 a ;9ort 87ter>al :rom ;e8Eure to
CT ;ca7, ab7ormal8t8e; may be 5etecte5 87 9al: t9e pat8e7t;. T9e ma87 :87587<; are :ocal
9ypo5e7;8t8e; 87 t9e =98te matter 87 t9e po;ter8or 9al: o: t9e cerebral 9em8;p9ere; =8t9
occa;8o7al le;8o7; 87 t9e <ray matter, temporal lobe;, a75 bra87;tem. 7e re;earc9er ;u<<e;te5
t9at t9e;e area; o: ra58o<rap98c 9ypo5e7;8ty repre;e7te5 petec98al 9emorr9a<e; accompa78e5 by
local e5ema. Subarac97o85 or 87tra>e7tr8cular 9emorr9a<e; may be ;ee7 87 t9e mo;t ;e>ere
ca;e;.
N-407
/a<7et8c re;o7a7ce 8ma<87< C/RID 8; more ;e7;8t8>e at 5emo7;trat87< ab7ormal8t8e; t9a7 CT
;ca7, but 8t 8; 7ot a; =85ely a>a8lable. T2'=e8<9e5 /RI ;ca7; ;9o= 98<9 ;8<7al 87 t9e cort8cal
a75 ;ubcort8cal =98te matter. /o;t o: t9e ab7ormal8t8e; l8e 87 t9e occ8p8tal a75 par8etal area; 87
=ater;9e5 area; =9ere t9e a7ter8or, m855le, a75 po;ter8or c8rculat8o7; meet. Ba;al <a7<l8a a75
bra87;tem ab7ormal8t8e; occur 87 more cr8t8cally 8ll pat8e7t;.
Cerebral a7<8o<rap9y 9a; bee7 per:orme5 87 a :e= pat8e7t; =8t9 eclamp;8a, re>eal87< 58::u;e
arter8al >a;oco7;tr8ct8o7.
Electroe7cep9alo<ram; CEEG;D ;9o= 7o7;pec8:8c ab7ormal8t8e; 87 about *$K o: pat8e7t; a:ter
eclampt8c ;e8Eure;. T9e patter7 8; u;ually a 58::u;e ;lo=87< o: act8>8ty Ct9eta or 5elta =a>e;D,
;omet8me; =8t9 :ocal ;lo= act8>8ty a75 occa;8o7al paro6y;mal ;p8@e act8>8ty. T9e;e
ab7ormal8t8e; may be ;ee7 87 ot9er co758t8o7;, ;uc9 a; 9ypo68a, re7al 58;ea;e, polycyt9em8a,
9ypocalcem8a, a75 =ater 87to68cat8o7. T9e electroe7cep9alo<rap98c patter7 8; u7a::ecte5 by
ma<7e;8um ;ul:ate. It <ra5ually retur7; to 7ormal %'+ =ee@; po;tpartum. &7compl8cate5
eclamp;8a cau;e; 7o perma7e7t 7eurolo<8c 5e:8c8t.
"ssessment of the Eyes
Bot9 ;erou; ret87al 5etac9me7t a75 cort8cal bl8757e;; may occur.
"ssessment of the Pulmonary (ystem
Pulmo7ary e5ema may occur =8t9 ;e>ere preeclamp;8a or eclamp;8a. It may be car58o<e78c or
7o7car58o<e78c a75 u;ually occur; po;tpartum. I7 ;ome ca;e; 8t may be relate5 to e6ce;;8>e :lu85
a5m878;trat8o7 or to 5elaye5 mob8l8Eat8o7 o: e6tra>a;cular :lu85. It may al;o be relate5 to
5ecrea;e5 pla;ma collo85 o7cot8c pre;;ure :rom prote87ur8a, u;e o: cry;tallo85; to replace bloo5
N-407
lo;;, a75 5ecrea;e5 9epat8c ;y7t9e;8; o: album87. Pulmo7ary e5ema 8; part8cularly commo7 87
pat8e7t; =8t9 u75erly87< c9ro78c 9yperte7;8o7 a75 9yperte7;8>e 9eart 58;ea;e, =98c9 may be
ma78:e;te5 by ;y;tol8c 5y;:u7ct8o7, 58a;tol8c 5y;:u7ct8o7, or bot9. #;p8rat8o7 o: <a;tr8c co7te7t;
8; o7e o: t9e mo;t 5rea5e5 compl8cat8o7; o: eclampt8c ;e8Eure;. T98; may re;ult 87 5eat9 becau;e
o: a;p9y68a :rom part8culate matter plu<<87< maBor a8r=ay; or 87 c9em8cal p7eumo78t8; :rom
a;p8rate5 <a;tr8c ac85. #;p8rat8o7 may cau;e >ar8ou; type; o: p7eumo78a, ra7<87< :rom patc9y
p7eumo78t8; to :ull'blo=7 a5ult re;p8ratory 58;tre;; ;y75rome.
"ssessment of the Cardioas!ular (ystem
Pla;ma >olume 8; re5uce5 87 pat8e7t; =8t9 preeclamp;8a. !ormal p9y;8olo<8c >olume e6pa7;8o7
5oe; 7ot occur, po;;8bly becau;e o: <e7eral8Ee5 >a;oco7;tr8ct8o7, cap8llary lea@, or ;ome ot9er
:actor. Becau;e t9e cau;e o: t9e re5uce5 >olume 8; u7@7o=7, ma7a<eme7t 8; co7tro>er;8al. 7e
t9eory 8; t9at t9e 5ecrea;e5 >olume 8; a pr8mary e>e7t cau;87< a c9ro78c ;9oc@l8@e ;tate.
"yperte7;8o7 8; t9ou<9t to be t9e re;ult o: relea;e o: a pre;;or ;ub;ta7ce :rom t9e 9ypoper:u;e5
uteru; or o: compe7;atory ;ecret8o7 o: catec9olam87e;. Propo7e7t; o: t98; t9eory a5>ocate
a>o85a7ce o: 58uret8c; a75 u;e o: >olume e6pa75er;. #7ot9er t9eory 8; t9at 5ecrea;e5 >olume 8;
;eco75ary to >a;oco7;tr8ct8o7. Propo7e7t; o: t98; t9eory a5>ocate t9e u;e o: >a;o58lator; a75
=ar7 t9at >olume e6pa75er; may a<<ra>ate 9yperte7;8o7 or cau;e pulmo7ary e5ema.
Stu58e; u;87< t9e S=a7'Ga7E cat9eter 9a>e 5emo7;trate5 a ;pectrum o: 9emo5y7am8c :87587<;
87 preeclamp;8a ra7<87< :rom a lo='output, 98<9're;8;ta7ce ;tate to a 98<9'output, lo='re;8;ta7ce
;tate. 7e ;tu5y :ou75 a lo= =e5<e pre;;ure, lo= car58ac output, a75 98<9 ;y;tem8c >a;cular
re;8;ta7ce 87 u7treate5 7ull8parou; preeclampt8c =ome7, =98le pat8e7t; =9o rece8>e5 >ar8ou;
t9erap8e; a75 =ere u;ually re:erre5, a =85e ra7<e o: 9emo5y7am8c; =a; :ou75. T9e co7clu;8o7
N-407
=a; t9at t9e u7treate5 preeclampt8c pat8e7t =a; ;8<78:8ca7tly >olume'5eplete5 a75 t9at t9e =85e
;pectrum o: 9emo5y7am8c :87587<; 87 t9e treate5 <roup re;ulte5 :rom pr8or t9erapy a75 t9e
pre;e7ce o: ot9er >ar8able; ;uc9 a; labor, mult8par8ty, a75 pree68;t87< 9yperte7;8o7.
I7 a7ot9er ;tu5y o: a 9etero<e7eou; populat8o7 o: pretreate5 a75 7o7pretreate5 pat8e7t;, a
<e7erally co7;8;te7t pro:8le emer<e5. Preeclamp;8a =a; 87 <e7eral a 98<9 car58ac output ;tate
a;;oc8ate5 =8t9 a7 87appropr8ately 98<9 per8p9eral re;8;ta7ce. #lt9ou<9 t9e ;y;tem8c >a;cular
re;8;ta7ce =a; =8t987 t9e 7ormal ra7<e :or pre<7a7cy, 8t =a; ;t8ll 87appropr8ately 98<9 :or t9e
ele>ate5 car58ac output. T9e :a8lure o: t9e c8rculat8o7 to 58late 87 t9e ;ett87< o: 87crea;87< car58ac
output appeare5 to be a c9aracter8;t8c :eature o: preeclamp;8a. T9e 7ormal =e5<e a75 ce7tral
>e7ou; pre;;ure; :ou75 87 t9e8r ;tu5y ;u<<e;te5 >e7oco7;tr8ct8o7 =8t9 ce7tral relocat8o7 o:
87tra>a;cular >olume 8: t9e <e7erally accepte5 report; o: 5ecrea;e5 pla;ma >olume 87
preeclamp;8a are correct. T9ey po;tulate5 ;pla7c978c >e7oco7;tr8ct8o7 a; t9e mec9a78;m o: t98;
>olume ;98:t.
!ormal pre<7a7t =ome7 are re;8;ta7t to t9e >a;oco7;tr8ctor e::ect; o: a7<8ote7;87 II. Pre<7a7t
=ome7 re?u8re about 21H2 t8me; t9e amou7t o: a7<8ote7;87 II re?u8re5 by 7o7pre<7a7t =ome7 to
ra8;e t9e 58a;tol8c bloo5 pre;;ure 20 mm "<. Pat8e7t; =9o =8ll 5e>elop ;uper8mpo;e5
preeclamp;8a lo;e t9e8r re:ractor87e;; to a7<8ote7;87 II ma7y =ee@; be:ore 9yperte7;8o7
5e>elop;. T9e;e pat8e7t; may be 85e7t8:8e5 a; early a; 1+'2- =ee@;P <e;tat8o7 by 87:u;8o7 o:
a7<8ote7;87 II.
!ormal pre<7a7t =ome7 lo;e t9e8r re:ractor87e;; to a7<8ote7;87 II a:ter treatme7t =8t9
pro;ta<la7587 ;y7t9eta;e 8798b8tor; ;uc9 a; a;p8r87 or 875omet9ac87L t98; ;u<<e;t; t9at
pro;ta<la7587 8; 87>ol>e5 87 me58at87< >a;cular react8>8ty to a7<8ote7;87 II 87 pre<7a7cy.
N-407
Re:ractor87e;; to a7<8ote7;87 II ca7 be re;tore5 87 pat8e7t; =8t9 preeclamp;8a by t9e
a5m878;trat8o7 o: t9eop9yll87e, a p9o;p9o58e;tera;e 8798b8tor t9at 87crea;e; 87tracellular le>el; o:
c#/P. T9ere:ore, pro;ta<la7587; ;y7t9e;8Ee5 87 t9e arter8ole may mo5ulate >a;cular react8>8ty to
a7<8ote7;87 II by alter87< t9e 87tracellular le>el o: c#/P 87 >a;cular ;moot9 mu;cle.
"ssessment of the Lier
T9e ;pectrum o: l8>er 58;ea;e 87 preeclamp;8a 8; broa5, ra7<87< :rom ;ubcl878cal 87>ol>eme7t
=8t9 t9e o7ly ma78:e;tat8o7 be87< :8br87 5epo;8t8o7 alo7< t9e 9epat8c ;87u;o85; to rupture o: t9e
l8>er. 08t987 t9e;e e6treme; l8e t9e HELLP s%n#ro(e C9emoly;8;, ele>ate5 l8>er e7Eyme;, a75
lo= platelet;D a75 9epat8c 87:arct8o7.
"ssessment of the )idneys
T9e c9aracter8;t8c le;8o7 o: preeclamp;8a, glo(eruloen#o$6eliosis, 8; a ;=ell87< o: t9e
<lomerular cap8llary e75ot9el8um t9at cau;e; 5ecrea;e5 <lomerular per:u;8o7 a75 <lomerular
:8ltrat8o7 rate. F8br87 ;pl8t pro5uct; 9a>e bee7 :ou75 o7 t9e ba;eme7t membra7e by ;ome
ob;er>er;, =9o 9a>e ;u<<e;te5 t9at 87tra>a;cular coa<ulat8o7 may be ;eco75ary to
t9rombopla;t87 relea;e5 :rom t9e place7ta. "o=e>er, t9e :8br87 ;pl8t pro5uct; are :ou75
87:re?ue7tly a75 o7ly 87 ;mall amou7t;. t9er 87>e;t8<ator; 9a>e 5etecte5 I</, I<G, a75
compleme7t 87 t9e <lomerul8 o: ;ome pat8e7t; a75 9a>e ;u<<e;te5 a7 8mmu7olo<8c mec9a78;m.
Ser8al re7al b8op;8e; 9a>e ;9o=7 t9at t9e le;8o7 8; totally re>er;8ble o>er about % =ee@;.
"ssessment of the 'lood
/o;t pat8e7t; =8t9 preeclamp;8a'eclamp;8a 9a>e 7ormal clott87< ;tu58e;. I7 ;ome, a ;pectrum o:
ab7ormal8t8e; may be :ou75, ra7<87< :rom 8;olate5 t9rombocytope78a to m8croa7<8opat98c
N-407
9emolyt8c a7em8a to 58;;em87ate5 87tra>a;cular coa<ulat8o7 CDICD. T9rombocytope78a 8; t9e
mo;t commo7 ab7ormal8tyL a cou7t o: le;; t9a7 1$0,000Hu1 8; :ou75 87 1$'20K o: pat8e7t;.
F8br87o<e7 le>el; are actually ele>ate5 87 preeclampt8c =ome7 a; compare5 =8t9 7ormote7;8>e
pat8e7t;. 1o= :8br87o<e7 le>el; 87 preeclamp;8a'eclamp;8a are u;ually a;;oc8ate5 =8t9 abrupt8o
place7tae or :etal 5em8;e. Ele>ate5 :8br87 ;pl8t pro5uct; are ;ee7 87 20K o: pat8e7t; Cu;ually 87
t9e ra7<e o: 10'-0 u1Hm1D. /8croa7<8opat98c 9emolyt8c a7em8a =8t9out ot9er ;8<7; o: DIC may
be ;ee7 87 about $K o: pat8e7t;, a75 e>85e7ce o: DIC 8; al;o pre;e7t 87 about $K. I7 t9e pa;t,
DIC =a; t9ou<9t to be t9e cau;e o: preeclamp;8aL 7o= 8t 8; re<ar5e5 a; a ;e?uela o: t9e 58;ea;e.
T9e "E11P ;y75rome 5e;cr8be; pat8e7t; =8t9 9emolyt8c a7em8a, ele>ate5 l8>er e7Eyme;, a75
lo= platelet cou7t. Cr8ter8a :or t9e 58a<7o;8; at t9e aut9or;P 87;t8tut8o7 are ;c98;tocyte; o7 t9e
per8p9eral bloo5 ;mear, lact8c 5e9y5ro<e7a;e G %00 &H1, total b8l8rub87 G 1.2 m<H51, a;partate
am87otra7;:era;e G *0 &H1, a75 platelet cou7t I 100,000Hmm
3
. T98; ;y75rome 8; pre;e7t 87 about
10K o: pat8e7t; =8t9 ;e>ere preeclamp;8a'eclamp;8a. It 8; :re?ue7tly ;ee7 87 Cauca;8a7 pat8e7t;
=8t9 5elay 87 58a<7o;8; or 5el8>ery a75 87 pat8e7t; =8t9 abrupt8o place7tae. T9e ;y75rome may
occur remote :rom term Ce<, at 31 =ee@;D a75 =8t9 7o ele>at8o7 o: bloo5 pre;;ure. T9e ;y75rome
8; :re?ue7tly m8;58a<7o;e5 a; 9epat8t8;, <allbla55er 58;ea;e, 858opat98c t9rombocytope78c
purpura, or t9rombot8c t9rombocytope78c purpura. /o;t 9ematolo<8c ab7ormal8t8e; retur7 to
7ormal =8t987 2'3 5ay; a:ter 5el8>ery, but t9rombocytope78a may per;8;t :or a =ee@.
"ssessment of the Endo!rine (ystem
T9e role o: t9e re787'a7<8ote7;87'al5o;tero7e ;y;tem 87 t9e re<ulat8o7 o: bloo5 pre;;ure 5ur87<
7ormal a75 9yperte7;8>e pre<7a7cy 9a; 7ot bee7 clearly 5e:87e5. I7 7ormal pre<7a7cy,
e;tro<e7P; e::ect o7 t9e l8>er mar@e5ly 87crea;e; pro5uct8o7 o: re787 ;ub;trate. T98; 87crea;e;
N-407
pla;ma re787 act8>8ty, pla;ma re787 co7ce7trat8o7, a75 a7<8ote7;87 II le>el;. Pla;ma al5o;tero7e
le>el; r8;e e>e7 98<9er t9a7 ca7 be accou7te5 :or by t9e pre>a8l87< pla;ma re787 act8>8ty. De;p8te
t9e 98<9 pla;ma co7ce7trat8o7 o: al5o;tero7e, t9ere 8; 7o bloo5 pre;;ure 87crea;e or 9ypo@alem8a
87 7ormal pre<7a7cyL 875ee5, bloo5 pre;;ure :all; 87 t9e m85tr8me;ter. T98; may be 5ue to
cou7terre<ulatory :actor; ;uc9 a; t9e 7atr8uret8c e::ect o: pro<e;tero7e or act8>at8o7 o:
>a;o5epre;;or ;y;tem; ;uc9 a; @8787; or pro;ta<la7587;.
I7terpret87< re787, a7<8ote7;87, a75 al5o;tero7e le>el; 87 ;tu58e; o: preeclamp;8a 8; 58::8cult
becau;e o: 58::ere7ce; 87 t9e 5e:878t8o7 o: preeclamp;8a Cpar8ty, 5e<ree o: prote87ur8a, early' or
late'o7;et 58;ea;eD, 58::ere7ce; 87 ta@87< o: bloo5 ;ample; C>alue; may be a::ecte5 by be5 re;t,
;o58um 87ta@e, labor, etcD, a75 58::ere7ce; 87 a;;ay tec978?ue;. I7 t9e maBor8ty o: ;tu58e;, re787,
a7<8ote7;87, a75 al5o;tero7e are all ;uppre;;e5 87 preeclamp;8a, but t9ey are ;t8ll abo>e
7o7pre<7a7t le>el;. T9e a>a8lable e>85e7ce ;u<<e;t; t9at t9e re787'a7<8ote7;87 ;y;tem 8; o7ly
;eco75ar8ly 87>ol>e5 87 preeclamp;8a.
#tr8al 7atr8uret8c pept85e C#!PD 8; a >olume re<ulatory 9ormo7e ;y7t9e;8Ee5 by car58ac
myocyte;, =98c9 9a; pote7t 7atr8uret8c, 58uret8c, a75 >a;orela6a7t propert8e;. #!P ;ecret8o7 8;
;t8mulate5 by 87crea;e5 atr8al pre;;ure a75 alterat8o7; 87 ;o58um bala7ce. Ele>ate5
co7ce7trat8o7; o: #!P accompa7y pat9olo<8c ;tate; c9aracter8Ee5 by :lu85 o>erloa5 ;uc9 a;
C8rr9o;8;, co7<e;t8>e 9eart :a8lure, a75 c9ro78c re7al :a8lure. "o=e>er, #!P 8; ele>ate5 87
preeclamp;8a, a 58;or5er ;uppo;e5ly c9aracter8Ee5 by 9ypo>olem8a. It 8; e>e7 ele>ate5 87 t9e
;eco75 tr8me;ter be:ore t9e o7;et o: cl878cal e>85e7ce o: preeclamp;8a. T9e mec9a78;m :or t9e
ele>at8o7 8; u7@7o=7. It may be t9at e75ot9el87 or a7ot9er >a;oact8>e pept85e 8; ;t8mulat87<
relea;e o: #!P. It may al;o be t9at t9e =85ely accepte5 co7cept o: ce7tral 9ypo>olem8a 87
preeclamp;8a 8; 87correct.
N-407
"ssessment of the Cate!holamines
&r87ary a75 bloo5 catec9olam87e le>el; are t9e ;ame 87 7ormote7;8>e pre<7a7t =ome7, =ome7
=8t9 preeclamp;8a, a75 7o7pre<7a7t co7trol;. "o=e>er, 8t ca77ot be rule5 out t9at ;ympat9et8c
act8>8ty 8; o: pat9o<e7et8c 8mporta7ce :or 878t8at8o7 or ma87te7a7ce o: 9yperte7;8o7 87 pat8e7t;
=8t9 preeclamp;8a. Catec9olam87e le>el; 87crea;e 5ur87< labor, pre;umably o=87< to ;tre;;. T9e
>a;cular re:ractor87e;; to catec9olam87e; 8; lac@87< 87 preeclamp;8a, a; 8; t9e re:ractor87e;; to
ot9er e75o<e7ou; >a;opre;;or; ;uc9 a; a7t858uret8c 9ormo7e a75 a7<8ote7;87 II.
"ssessment of the Prosta!y!lin
Pro;tacycl87 8; a pro;ta<la7587 58;co>ere5 87 19*%. It 87crea;e; 87tracellular c#/P 87 ;moot9
mu;cle cell; a75 platelet; re;ult87< 87 >a;o58lator a75 platelet a7t8a<<re<atory e::ect;. It; 9al:'l8:e
8; about 3 m87ute;, brea@87< 5o=7 87 pla;ma to %'@eto'PGF
1Q
, =98c9 8; ;table a75 ca7 be
mea;ure5 a; a7 8758cat8o7 o: pro;tacycl87 le>el;. T9e;e pla;ma le>el; are lo=, 8758cat87< t9at
pro;tacycl87 act; p9y;8olo<8cally at t9e local le>el rat9er t9a7 a; a c8rculat87< 9ormo7e.
Pro;tacycl87 8; ma5e pr8mar8ly 87 t9e e75ot9el8al cell :rom arac985o78c ac85, catalyEe5 by t9e
e7Eyme cycloo6y<e7a;e. Cycloo6y<e7a;e ca7 be 8798b8te5 by a;p8r87'l8@e 5ru<;. /ec9a78cal or
c9em8cal perturbat8o7 o: t9e e75ot9el8al cell membra7e ;t8mulate; :ormat8o7 a75 relea;e o:
pro;tacycl87. For e6ample, pul;at8le pre;;ure or c9em8cal; ;uc9 a; bra5y@8787 or t9romb87
;t8mulate pro;tacycl87 <e7erat8o7 87 t9e >e;;el =all.
T9rombo6a7e #2 <e7erate5 by platelet; :rom arac985o78c ac85 >8a cycloo6y<e7a;e 875uce;
>a;oco7;tr8ct8o7 a75 platelet a<<re<at8o7. T9u;, pro;tacycl87 a75 t9rombo6a7e 9a>e oppo;87<
role; 87 re<ulat87< platelet'>e;;el =all 87teract8o7.
N-407
#;p8r87 8rre>er;8bly 8798b8t; cycloo6y<e7a;e. Cycloo6y<e7a;e mu;t be pro5uce5 co7t87uou;ly by
e75ot9el8al cell;, becau;e t9ey reco>er t9e8r ab8l8ty to ;y7t9e;8Ee pro;tacycl87 =8t987 a :e= 9our;
a:ter a 5o;e o: a;p8r87. 7 t9e ot9er 9a75, platelet; 5o 7ot 9a>e a 7ucleu; a75 t9ere:ore ca77ot
ma@e :re;9 cycloo6y<e7a;e. T9rombo6a7e ;y7t9e;8; reco>er; o7ly a; 7e= platelet; e7ter t9e
c8rculat8o7. Platelet l8:e ;pa7 8; about 1 =ee@. T9u;, 5a8ly treatme7t =8t9 lo='5o;e a;p8r87 re;ult;
87 c9ro78c 8798b8t8o7 o: t9rombo6a7e metabol8te; a75 5ecrea;e5 e6cret8o7 o: pro;tacycl87
metabol8te; 87 preeclampt8c pat8e7t;. 1o='5o;e a;p8r87 t9erapy 8; a8me5 at re;tor87< t9e
pre;ume5 t9rombo6a7e'pro;tacycl87 8mbala7ce 87 preeclamp;8a.
"ssessment of the %itri! *+ide
!8tr8c o685e C!D 8; a7 e75o<e7ou; >a;o58lator a75 8798b8tor o: platelet a<<re<at8o7 a75 act;
;y7er<8;t8cally =8t9 pro;tacycl87. It 8; pro5uce5 by e75ot9el8al cell; :rom 1'ar<8787e. Sy7t9e;8;
ca7 be 8798b8te5 by ar<8787e a7alo<; ;uc9 a; !
G
'mo7omet9yl'1'ar<8787e a75 !
G
'78tro'1'
ar<8787e. I7tra>e7ou; 87Bect8o7 o: o7e o: t9e;e 8798b8tor; 87to rat;, rabb8t;, or <u87ea p8<; cau;e;
a7 8mme58ate r8;e 87 bloo5 pre;;ure t9at 8; re>er;e5 by 1'ar<8787e. T98; 8758cate; t9at co7t87ual
ba;al relea;e o: ! :rom e75ot9el8al cell; @eep; t9e >a;culature 87 a 58late5 ;tate. ! act; o7ly
87 t9e 8mme58ate >8c878ty o: t9e cell t9at relea;e; 8t. #7y t9at e;cape; 87to t9e bloo5;tream 5ecay;
c9em8cally to :orm 78tr8te or 8; 8mme58ately 87act8>ate5 by 9emo<lob87.
! play; a7 8mporta7t role 87 ;e>eral pat9olo<8c proce;;e;. It 8; o7e o: t9e me58ator; o:
9ypote7;8o7 87 ;ept8c ;9oc@. # 5e:8c8e7cy o: ! co7tr8bute; to t9e cau;e o: 9yperte7;8o7 a75
#t9ero;clero;8;. Curre7tly 8t 8; t9ou<9t t9at t9e ! ;y;tem may be more 8mporta7t t9a7 t9e
pro;ta<la7587; 87 t9e pat9o<e7e;8; o: preeclamp;8a. C9ro78c bloc@a5e o: t9e e75o<e7ou; !
;y;tem pro5uce; a mo5el o: 9yperte7;8o7 a75 re7al 5ama<e 87 pre<7a7t a75 7o7pre<7a7t rat;.
N-407
Some ;tu58e; 9a>e ;9o=7 t9at t9ere 8; 5ecrea;e5 e6cret8o7 o: ! 87 t9e ur87e o: pre<7a7t
preeclampt8c =ome7, but =9et9er ! play; a7 8mporta7t pat9op9y;8olo<8c role 87 t9e
5e>elopme7t o: preeclamp;8a rema87; u7@7o=7.
"ssessment of the Endothelin,1
I7 a558t8o7 to t9e rela687< :actor; pro;tacycl87 a75 !, t9e >a;cular e75ot9el8um relea;e;
>a;oco7;tr8ctor ;ub;ta7ce;. T9e >a;oco7;tr8ctor e75ot9el87 =a; 58;co>ere5 87 19++. T9ere are 3
58::ere7t 8;opept85e;N e75ot9el87 1, 2, a75 3. E75ot9el87'1 8; t9e o7ly e75ot9el87 ma7u:acture5 by
e75ot9el8al cell;. E75ot9el87; are al;o ;y7t9e;8Ee5 by @857ey cell; a75 7er>ou; t8;;ue. T9ere are
=85e;prea5 e75ot9el87'b87587< ;8te; 87clu587< t9o;e 87 t9e bra87, lu7<, @857ey, a5re7al, ;plee7,
87te;t87e, a75 place7ta. It 8; t9ou<9t t9at e75ot9el87; act a; e75o<e7ou; a<o78;t; o:
589y5ropyr8587e';e7;8t8>e calc8um c9a77el;. T9e mo;t ;tr8@87< property o: e75ot9el87'1 8; 8t;
lo7<'la;t87< >a;oco7;tr8ctor act8o7. It 8; 10 t8me; more pote7t t9a7 a7<8ote7;87 II. E75ot9el87
may play a role 87 co7;tr8ct8o7 o: place7tal >e;;el; a:ter 5el8>ery a75 may re<ulate clo;ure o: t9e
5uctu; arter8o;u; 87 t9e 7e=bor7. T9e m8to<e78c e::ect; o: e75ot9el87'1 may cau;e >a;cular =all
9ypertrop9y 87 #t9ero;clero;8; a75 9yperte7;8o7. E75ot9el87'1 may play a role 87 re7al
>a;oco7;tr8ct8o7 87 acute re7al :a8lure. # 3':ol5 ele>at8o7 o: pla;ma e75ot9el87 1 a75 2 9a; bee7
:ou75 87 =ome7 =8t9 preeclamp;8a compare5 =8t9 <e;tat8o7'matc9e5 co7trol;.
7e 9ypot9e;8; 8; t9at pro;tacycl87 8; a7 a7t8platelet a75 >a;o58lator mec9a78;m 9el5 87 re;er>e
to re87:orce t9e ! ;y;tem =9e7 e75ot9el8al 5ama<e occur;. 1ac@ o: ! may be a cau;at8>e
:actor 87 9yperte7;8o7. E75ot9el87'1 8; relea;e5 by e75ot9el8al cell; to co7;tr8ct t9e u75erly87<
;moot9 mu;cle 87 a7 emer<e7cy ;uc9 a; lacerat8o7. E6ce;; e75ot9el87'1 may al;o be 87>ol>e5 87
t9e <e7e;8; o: 9yperte7;8o7.
N-407
"ssessment of the Pla!enta
I7 7ormal pre<7a7cy, t9e prol8:erat87< trop9obla;t 87>a5e; t9e 5ec85ua a75 t9e a5Bace7t
myometr8um 87 2 :orm;N 87ter;t8t8al a75 e75o>a;cular. T9e role o: t9e 87ter;t8t8al :orm 8; 7ot clear
but 8t may ;er>e to a7c9or t9e place7ta. T9e e75o>a;cular trop9obla;t8c cell; 87>a5e t9e mater7al
;p8ral arter8e;, =9ere t9ey replace t9e e75ot9el8um a75 5e;troy t9e me58al ela;t8c a75 mu;cular
t8;;ue o: t9e arter8al =all. T9e arter8al =all 8; replace5 by :8br87o85 mater8al. T98; proce;; 8;
complete by t9e e75 o: t9e :8r;t tr8me;ter, at =98c9 t8me 8t e6te75; to t9e 5ec85uomyometr8al
Bu7ct8o7. T9ere appear; to be a re;t87< p9a;e 87 t9e proce;; u7t8l 1- to 1% =ee@;P <e;tat8o7, =9e7
a ;eco75 =a>e o: trop9obla;t8c 87>a;8o7 e6te75; 5o=7 t9e lume7 o: t9e ;p8ral arter8e; to t9e8r
or8<87 :rom t9e ra58al arter8e; 5eep 87 t9e myometr8um. T9e ;ame proce;; 8; t9e7 repeate5, 8e,
replaceme7t o: t9e e75ot9el8um, 5e;truct8o7 o: t9e me58al mu;culoela;t8c t8;;ue, a75 :8br87o85
c9a7<e 87 t9e >e;;el =all. T9e e75 re;ult 8; t9at t9e t987'=alle5, mu;cular ;p8ral arter8e; are
co7>erte5 to ;acl8@e, :lacc85 uteroplace7tal >e;;el;, =98c9 pa;;8>ely 58late to accommo5ate t9e
<reatly au<me7te5 bloo5 :lo= re?u8re5 87 pre<7a7cy.
Preeclamp;8a 5e>elop; :ollo=87< a part8al :a8lure 87 t9e proce;; o: place7tat8o7. F8r;t, 7ot all t9e
;p8ral arter8e; o: t9e place7tal be5 are 87>a5e5 by trop9obla;t. Seco75, 87 t9o;e arter8e; t9at are
87>a5e5, t9e :8r;t p9a;e o: trop9obla;t8c 87>a;8o7 occur; 7ormally, but t9e ;eco75 p9a;e 5oe; 7ot
occur, a75 t9e myometr8al port8o7; o: t9e ;p8ral arter8e; reta87 t9e8r react8>e mu;culoela;t8c
=all;.
I7 a558t8o7, acute at9ero;8; Ca le;8o7 ;8m8lar to #t9ero;clero;8;D 5e>elop; 87 t9e myometr8al
;e<me7t; o: t9e ;p8ral arter8e; o: pat8e7t; =8t9 preeclamp;8a. T9e le;8o7 8; c9aracter8Ee5 by
:8br87o85 7ecro;8; o: t9e arter8al =all, t9e pre;e7ce o: l8p85 a75 l8pop9a<e; 87 t9e 5ama<e5 =all,
N-407
a75 a mo7o7uclear cell 87:8ltrate arou75 t9e 5ama<e5 >e;;el. #cute at9ero;8; may pro<re;; to
>e;;el obl8terat8o7 =8t9 corre;po7587< area; o: place7tal 87:arct8o7.
T9u;, 87 preeclamp;8a t9ere 8; a7 area o: >a;cular re;8;ta7ce 87 t9e ;p8ral artery becau;e o:
:a8lure o: t9e ;eco75 =a>e o: trop9obla;t8c 87>a;8o7. I7 a558t8o7, acute at9ero;8; :urt9er
comprom8;e; t9e >a;cular lume7. Co7;e?ue7tly, t9e :etu; 8; ;ubBecte5 to poor 87ter>8llou; bloo5
:lo= :rom t9e t8me o: early <e;tat8o7L t98; may re;ult 87 87trauter87e <ro=t9 retar5at8o7 or
;t8llb8rt9. #7t89yperte7;8>e t9erapy may be 5etr8me7tal becau;e per8p9eral >a;o58latat8o7 may
:urt9er re5uce t9e alrea5y comprom8;e5 place7tal bloo5 :lo=.
Repre;e7tat8o7 o: t9e relat8o7;98p bet=ee7 cerebral bloo5 :lo= a75 mea7 arter8al bloo5
pre;;ure. Cerebral bloo5 :lo= 7ormally rema87; co7;ta7t at mea7 arter8al pre;;ure; o: %0'1-0
mm "<. I7 c9ro78cally 9yperte7;8>e pat8e7t;, me58al 9ypertrop9y cau;e; t9e lo=er a75 upper
l8m8t; o: autore<ulat8o7 to be ;98:te5 to 98<9er bloo5 pre;;ure >alue;. C/o58:8e5 a75 repro5uce5,
=8t9 perm8;;8o7, :rom Do7al5;o7 (N !eurolo<y o: Pre<7a7cy. Sau75er;, 19*+.D0
N-407
ANATO/Y . PHYSIOLOGY
T9e :emale repro5uct8>e ;y;tem
co7;8;t; o: t9e o>ar8e;, uter87e
tube; Cor :allop8a7 tube;D, uteru;,
>a<87a, e6ter7al <e78tal8a, a75
mammary <la75;. T9e 87ter7al
repro5uct8>e or<a7; o: t9e
:emale are locate5 =8t987 t9e
pel>8;, bet=ee7 t9e ur87ary
bla55er a75 t9e rectum. T9e
uteru; a75 t9e >a<87a are 87 t9e m85l87e , =8t9 a7 o>ary to eac9 ;85e o: t9e or<a7. T9e 87ter7al
repro5uct8>e or<a7; are 9el5 87 place =8t987 t9e pel>8; =8t9 l8<ame7t;. T9e mo;t co7;p8cuou; 8;
t9e bra5 l8<ame7t, =98c9 ;prea5; out o7 bot9 ;85e; o: t9e uteru; a75 to =98c9 t9e o>ar8e; a75 t9e
uter87e tube; attac9.
O5"ries
T9e t=o o>ar8e; are ;mall or<a7; ;u;pe75e5 87 t9e pel>8c
ca>8ty by l8<ame7t;. T9e ;u;pe7;ory l8<ame7t e6te75;
:rom eac9 o>ary to t9e lateral bo5y =all, a75 t9e o>ar8a7
l8<ame7t attac9e; t9e o>ary to t9e ;uper8or mar<87 o: t9e uteru;. I7 a558t8o7, t9e o>ar8e; are
attac9e5 to t9e po;ter8or ;ur:ace o: t9e broa5 l8<ame7t by :ol5; o: t9e per8to7eum calle5 t9e
me;o>ar8um. T9e o>ar8a7 arter8e;, >e87;, a75 7er>e; tra7;>er;e t9e ;u;pe7;ory l8<ame7t a75
e7ter t9e o>ary t9rou<9 t9e me;o>ar8um.
N-407
# layer o: >8;ceral per8to7eum co>er; t9e ;ur:ace o: t9e o>ary. T9e outer part o: t9e o>ary 8;
ma5e up o: 5e7;e co77ect8>e t8;;ue a75 co7ta87; t9e o>ar8a7 :oll8cle;. Eac9 o: t9e o>ar8a7
:oll8cle; co7ta87; a7 oocyte, t9e :emale ;e6 cell. 1oo;e co77ect8>e t8;;ue ma@e; up t9e 877er part
o: t9e o>ary, =9ere bloo5 >e;;el;, lymp9at8c >e;;el;, a75 7er>e; are locate5.
U$erine Tu'es
# uter87e tube, :allop8a7 tube, or o>85uct C7ame5 a:ter t9e 8tal8a7 a7atom8;t, Gabr8ele Fallop8oD 8;
a;;oc8ate5 =8t9 eac9 o>ary. T9e uter87e tube; e6te75 :rom t9e area o: t9e o>ar8e; to t9e uteru;.
T9e ope7 58rectly 87to t9e per8to7eal ca>8ty 7ear eac9 o>ary a75 rece8>e a7 oocyte. T9e ope787<
o: eac9 uter87e tube 8; ;urrou75e5 by lo7<, t987 proce;;e; calle5 :8mbr8ae.
N-407
T9e :8mbr8ae 7early ;urrou75 t9e ;ur:ace o: t9e o>ary. #; a re;ult, a; ;oo7 a; t9e oocyte 8;
o>ulate5, 8t come; 87to co7tact =8t9 t9e ;ur:ace o: t9e :8mbr8ae. C8l8a o7 t9e :8mbr8ae ;ur:ace
;=eep t9e oocyte 87to t9e uter87e tube. Fert8l8Eat8o7 u;ually occur; 87 t9e part o: t9e uter87e tube
7ear t9e o>ary @7o=7 a; t9e ampulla.
U$erus
T9e uteru; 8; a; b8< a; t9e ;8Ee o: a me58um';8Ee5 pear. It 8; or8e7te5 87 t9e pel>8c ca>8ty =8t9 t9e
lar<er, rou75e5 port8o7 58recte5 ;uper8orly. T9e part o: t9e uteru; ;uper8or to t9e e7tra7ce o: t9e
:allop8a7 tube; 8; calle5 t9e :u75u;. T9e ma87 part o: t9e uteru; 8; calle5 t9e bo5y, a75 t9e
7arro=er part 8; terme5 t9e cer>86 a75 8; 58recte5 87:er8orly. I7ter7ally, t9e uter87e ca>8ty 87 t9e
:u75u; a75 uter87e bo5y co7t87ue; t9rou<9 t9e cer>86 a; t9e cer>8cal ca7al, =98c9 ope7; 87to t9e
>a<87a. T9e cer>8cal ca7al 8; l87e5 by mucou; <la75;.
T9e &ter87e =all 8; compo;e5 o: t9ree layer;N a ;erou; layer or per8metr8um o: t9e uteru;,
co7;8;t; o: ;moot9 mu;cle 8; ?u8te t98c@ a75 accou7t; :or t9e bul@ o: t9e uter87e =all. T9e 877er
mo;t layer o: t9e uteru; 8; calle5 t9e e75ometr8um. T9e e75ometr8um co7;8;t; o: ;8mple
colum7ar ep8t9el8um t8;;ue; =8t9 a7 u75erly87< co77ect8>e t8;;ue layer. S8mple tubular <la75;,
calle5 e75ometr8al <la75;, are :orme5 by :ol5; o: t9e e75ometr8um. T9e ;uper:8c8al part o; t9e
e75ometr8um 8; ;lou<9e5 o:: 5ur87< me7;truat8o7.
T9e uteru; 8; ;upporte5 by t9e broa5 l8<ame7t a75 t9e rou75 l8<ame7t. I7 a558t8o7 to t9e;e
l8<ame7t; t9at ;upport t9e uteru;, muc9 ;upport 8; pro>85e5 87:er8orly to t9e uteru; by ;@eletal
mu;cle; o: t9e pel>8c :loor. I: l8<ame7t; t9at ;upport t9e uteru; or t9e mu;cle; o: t9e pel>8c :loor
are =ea@e7e5 ;uc9 a; 87 c98l5b8rt9, t9e uteru; ca7 e6te75 87:er8orly 87to t9e >a<87a, a co758t8o7
terme5 a; a prolap;e5 uteru;. Se>ere ca;e; re?u8re ;ur<8cal correct8o7.
N-407
V"gin"
T9e >a<87a 8; t9e :emale or<a7 o: copulat8o7 a75 :u7ct8o7; to rece8>e t9e pe78; 5ur87<
87tercour;e. It al;o allo=; me7;trual :lo= a75 c98l5b8rt9. T9e >a<87a e6te75; :rom t9e uteru; to
out;85e t9e bo5y. T9e ;uper8or port8o7 o: t9e >a<87a 8; attac9e5 to t9e ;85e; o: t9e cer>86 ;o t9at a
part o: t9e cer>86 e6te75; 87to t9e >a<87a.
T9e =all o: t9e >a<87a co7;8;t; o: a7 outer mu;cular layer a75 a7 877er mucou; layer. T9e
mu;cular layer 8; ;moot9 mu;cle a75 co7ta87; ma7y ela;t8c :8ber;. T9u; t9e >a<87a ca7 87crea;e
87 ;8Ee to accommo5ate t9e pe78; 5ur87< 87tercour;e, a75 8t ca7 ;tretc9 <reatly 5ur87< c98l5b8rt9.
T9e mucou; membra7e 8; mo8;t ;trat8:8e5 ;?uamou; ep8t9el8um t9at :orm; a protect8>e ;ur:ace
layer. 1ubr8cat87< :lu85 pa;;e; t9rou<9 t9e >a<87al ep8t9el8um 87to t9e >a<87a.
I7 you7< :emale;, t9e >a<87al ope787< 8; co>ere5 by a t987 mucou; membra7e @7o=7 a; t9e
9yme7. T9e 9yme7 ca7 completely clo;e t9e >a<87al or8:8ce 87 =98c9 ca;e 8t mu;t be remo>e5 to
allo= me7;trual :lo=. /ore commo7ly, t9e 9yme7 8; per:orate5 by o7e or ;e>eral 9ole;. T9e
ope787<; o: t9e 9yme7 are u;ually <reatly e7lar<e5 5ur87< t9e :8r;t ;e6ual 87tercour;e. T9e
9yme7 ca7 al;o be per:orate5 5ur87< a >ar8ety o: act8>8t8e; 87clu587< ;tre7uou; e6erc8;e. T9e
co758t8o7 o: t9e 9yme7 8; t9ere:ore 7ot a rel8able 8758cator o: >8r<878ty.
T6e E<$ern"l Geni$"li"
T9e e6ter7al :emale <e78tal8a, al;o calle5 t9e >ul>a, or pu5e75um, co7;8;t; o: t9e >e;t8bule a75
8t; ;urrou7587< ;tructure;. T9e >e;t8bule 8; t9e ;pace 87to =98c9 t9e >a<87a a75 uret9ra ope7. T9e
uret9ra ope7; Bu;t a7ter8or to t9e >a<87a. T9e >e;t8bule 8; bor5ere5 by a pa8r o: t987, lo7<8tu587al
;@87 :ol5; calle5 t9e lab8a m87ora. # ;mall erect8le ;tructure calle5 t9e cl8tor8; 8; locate5 87 t9e
N-407
a7ter8or mar<87 o: t9e >e;t8bule. T9e t=o lab8a m87ora u78te o>er t9e cl8tor8; to :orm a :ol5 o:
;@87 @7o=7 a; t9e prepuce.
T9e cl8tor8; co7;8;t; o: a ;9a:t a75 a 58;tal <la7;. 18@e t9e <la7; pe78;, t9e cl8tor8; 8; =ell ;uppl8e5
=8t9 ;e7;ory receptor;, a75 8t 8; ma5e up o: erect8le t8;;ue. #7 a558t8o7al erect8le t8;;ue 8;
locate5 o7 e8t9er ;85e o: t9e >a<87al ope787<.
7 eac9 ;85e o: t9e >e;t8bule, bet=ee7 t9e >a<87al ope787< a75 t9e lab8a m87ora, are ope787<; o:
t9e <reater >e;t8bular <la75;. T9e;e <la75; pro5uce a lubr8cat87< :lu85 t9at 9elp; ma87t87 t9e
mo8;t7e;; o: t9e >e;t8bule.
1ateral to t9e lab8a m87or are t=o prom87e7t rou75e5 :ol5; o: ;@87 calle5 t9e lab8a maBora. T9e
t=o lab8a maBora u78te a7ter8orly at t9e ele>at8o7 o: t8;;ue o>er t9epub8c ;ymp9y;8; calle 5t9e
mo7; pub8;. T9e lateral ;ur:ace; o: t9e lab8a maBora a75 t9e ;ur:ace o: t9e mo7; pub8; are
co>ere5 =8t9 coar;e 9a8r. T9e me58al ;ur:ace; o: t9e lab8a m87ora are co>ere5 =8t9 7umerou;
;ebaceou; a75 ;=eat <la75;. T9e ;pace bet=ee7 t9e lab8a m87or 8; calle5 t9e pu5e75al cle:t.
/o;t o: t9e t8me, t9e lab8a m87ora are 87 co7tact =8t9 eac9 ot9er acro;; t9e m85l87e , clo;87< t9e
pu5e75al cle:t a75 co>er87< t9e 5eeper ;tructure; =8t987 t9e >e;t8bule.
T9e re<8o7 bet=ee7 t9e >a<87a a75 t9e a7u; 8; t9e cl878cal per87eum. T9e ;@87 a75 mu;cle o: t98;
re<8o7 ca7 tear 5ur87< c98l5b8rt9. To pre>e7 ;uc9 tear87<, a7 87c8;8o7 calle5 a7 ep8;8otomy 8;
;omet8me; ma5e 87 t9e cl878cal per87eum. Tra58t8o7ally, t98; clea7, ;tra8<9t 87c8;8o7 8; t9ou<9t to
re;ult 87 le;; 87Bury, a75 le;; trouble 87 9eal87<, a75 le;; pa87. "o=e>er, ma7y ;tu58e; 8758cate
t9at t9ere 8; le;; 87Bury a75 pa87 =9e7 7o ep8;8otomy 8; per:orme5.
/"(("r% Gl"n#s
N-407
/ammary <la75; are locate5 87;85e t9e brea;t; o: ;e6ually mature :emale bo5y. T9ey are 87
actual8ty mo58:8e5 ;=eat <la75; =98c9 are 87 :act compr8;e5 o: ;ecretory mammary al>eol8 a75
t9e appropr8ate 5uct;. /ammary <la75; are co7;85ere5 to be part o: t9e 87te<ume7tary ;y;tem
rat9er t9a7 t9e repro5uct8>e ;y;tem. T9e <la75; are a;;oc8ate5 =8t9 t9e :emale repro5uct8>e
;y;tem 87 part 5ue to t9e8r a;;8;ta7ce 87 attract87< a mate a; =ell a; t9e8r role 87 7our8;987< a
baby. S8Ee a75 ;9ape o: t9e :emale brea;t are 58::ere7t :or e>ery 9uma7 bo5y a75 :actor; ;uc9 a;
race, a<e, bo5y :at, a75 pre<7a7cy ca7 ma@e a lar<e 58::ere7ce 87 t9e;e >ar8at8o7;.
T9e relea;e o: e;tro<e7 5ur87< puberty relea;e; 9ormo7e; t9at ;t8mulate t9e <ro=t9 o: t9e brea;t;
a75 t9e :u7ct8o7; o: t9e mammary <la75;. Pre<7a7t =ome7 a; =ell a; 7ur;87< =ome7
e6per8e7ce 9ypotrop9y o: t9e brea;t; =98le 8t 8; 7ot u7commo7 :or atrop9y o: t9e brea;t; to
occur a:ter me7opau;e.
Brea;t; are ;8tuate5 o>er r8b; 2 t9rou<9 % a75 o>erlap t9e pectoral mu;cle a; =ell a; ;ome
port8o7; o: t9e obl8?ue mu;cle;. T9e lateral mar<87 o: t9e ;ter7um create; a7 u787te7t8o7al
mar<87 :or t9e e5<e o: eac9 brea;t. Eac9 brea;t al;o :ollo=; t9e a7ter8or mar<87 o: t9e re;pect8>e
a68lla. Com87< =8t987 >ery clo;e pro68m8ty to t9e #68llary >e;;el;, t9e brea;t; up=ar5 a75
laterally to=ar5 t9e a68lla, =98c9 co7tr8bute; to t9e 98<9 87c85e7ce o: brea;t ca7cer 5ue to t9e
a68llary proce;;O lymp9at8c 5ra87a<e.
1$ to 20 lobe; compo;e t9e mammary <la75, a75 eac9 lobe 8; e?u8ppe5 =8t9 8t; o=7 5uct to t9e
out;85e o: t9e bo5y. #58po;e t8;;ue 87 >ary87< amou7t; ;e<re<ate; eac9 lobe. 098le t98; t8;;ue
co7trol; t9e ;8Ee a75 ;9ape t9at t9e brea;t ta@e;, t9ere 8; 7o 5eterm87at8o7 by t98; t8;;ue =9e7 8t
come; to t9e =oma7O; ab8l8ty to ;uc@le 9er you7<. 1obule; are ;ub58>8;8o7; o: eac9 lobe. T9e;e
;ub58>8;8o7; co7ta87 mammary al>eol8. T9e m8l@ o: a lactat87< :emale are pro5uce5 =8t987 t9e
N-407
mammary al>eol8. Su;pe7;ory l8<ame7t; ;upport t9e brea;t; =98c9 are attac9e5 bet=ee7 t9e
lobule; a75 ru7 5eep 87to t9e :a;c8a =98c9 o>erlap t9e pectoral mu;cle;. Brea;t m8l@ 8; ;ecrete5
87to a 7et=or@ o: mammary 5uct; =98c9 rece8>e t9e m8l@ :rom t9e clu;ter; o: mammary al>eol8.
T9e;e mammary 5uct; co7>er<e to :orm lact8:erou; 5uct;. !ear t9e 78pple, eac9 lact8:erou; 5uct
e6pa75; 87to t9e lume7 to allo= :or out=ar5 :lo= o: m8l@. T9e lact8:erou; ;87u;e; ;tore t9e m8l@
be:ore t9e ;uc@l87< act8o7, or a558t8o7al pre;;ure, relea;e; 8t :rom t9e bo5y. T9e m8l@ lea>e; t9e
bo5y :rom t9e t8p o: t9e 78pple.
T9e 78pple co7ta87; ;ome erect8le t8;;ue t9at protru5e; 87to a cyl875r8cal proBect8o7. T9e c8rcular
area arou75 t9e 78pple t9at co7tra;t; 87 color 8; t9e areola. Sebaceou; areola <la75; create a
bumpy ;ur:ace arou75 t9e areola =98c9 re;85e; Bu;t u75er t9e ;ur:ace o: t9e areolaO; ;@87. T9e;e
<la75; ;ecrete :lu85; 5ur87< lactat8o7 a; =ell a; =9e7 a =oma7 8; 7ot lactat87<, =98c9 @eep t9e
78pple ;upple. T9e comple68o7 o: t9e areola 8; ba;e5 o7 t9e comple68o7 o: t9e ;@87 t9at co>er;
t9e re;t o: t9e bo5y, >ary87< 87 p8<me7t; a75 t87t;. Dur87< <e;tat8o7 mo;t areola ;ur:ace; 5ar@e7.
It al;o become; lar<er 87 mo;t ca;e;. T98; 8; t9ou<9t to be more ob>8ou; :or a 7ur;87< 87:a7t to
:875.
Bra7c9e; o: t9e 87ter7al t9orac8c artery are re;po7;8ble :or ;upply87< bloo5 :lo= to t9e 78pple a;
=ell a; t9e re;t o: t9e brea;t a75 mammary <la75;. Bet=ee7 t9e ;eco75, t98r5, a75 :ort9
87tercoa;tal ;pace; t9e;e brac9e; o: t9e t9orac8c artery e7ter t9e mammary <la75;. T9e;e ;pace;
are po;8t8o7e5 laterally to t9e ;ter7um a75 o::er e7try to t9e mammary artery, =98c9 o7ly
;uppl8e; ;upport8>e bloo5. T9e retur7 >e87; ru7 alo7<;85e t9e 878t8al arter8e; =98c9 ;upply t9e
bloo5. Dur87< pre<7a7cy a75 lactat8o7, a75 ;omet8me; 5ur87< ot9er per8o5;, a ;uper:8c8al >e7ou;
ple6u; ca7 be ;ee7 t9rou<9 t9e ;ur:ace o: t9e ;@87.
N-407
T9e :ourt9, :8:t9, a75 ;86t9 t9orac8c 7er>e; 877er>ate t9e brea;t pr87c8pally t9rou<9 ;e7;ory
;omat8c 7euro7;. T9e;e 7euro7; are 5er8>at8>e o: t9e a7ter8or a75 lateral bra7c9e; o: t9e t9orac8c
7er>e;. T9e relea;e o: m8l@ 8; 5epe75a7t upo7 t9e ;e7;ory 877er>at8o7; a; ;t8mulu; 8; t9e o7ly
7atural relea;e a7 87:a7t ca7 pro>85e to be 7our8;9e5.
/ens$ru"l C%3le
/e7;truat8o7 8; t9e ;9e5587< o: t9e l8787< o: t9e uteru; Ce75ometr8umD accompa78e5 by blee587<.
It occur; 87 appro68mately mo7t9ly cycle; t9rou<9out a =oma7P; repro5uct8>e l8:e, e6cept 5ur87<
pre<7a7cy. /e7;truat8o7 ;tart; 5ur87< puberty Cat me7arc9eD a75 ;top; perma7e7tly at
me7opau;e.
By 5e:878t8o7, t9e me7;trual cycle be<87; =8t9 t9e :8r;t 5ay o: blee587<, =98c9 8; cou7te5 a; 5ay
1. T9e cycle e75; Bu;t be:ore t9e 7e6t me7;trual per8o5. /e7;trual cycle; 7ormally ra7<e :rom
about 2$ to 3% 5ay;. 7ly 10 to 1$K o: =ome7 9a>e cycle; t9at are e6actly 2+ 5ay;. &;ually, t9e
cycle; >ary t9e mo;t a75 t9e 87ter>al; bet=ee7 per8o5; are lo7<e;t 87 t9e year; 8mme58ately a:ter
me7arc9e a75 be:ore me7opau;e.
/e7;trual blee587< la;t; 3 to * 5ay;, a>era<87< $ 5ay;. Bloo5 lo;; 5ur87< a cycle u;ually ra7<e;
:rom R to 2R ou7ce;. # ;a78tary pa5 or tampo7, 5epe7587< o7 t9e type, ca7 9ol5 up to a7 ou7ce
o: bloo5. /e7;trual bloo5, u7l8@e bloo5 re;ult87< :rom a7 87Bury, u;ually 5oe; 7ot clot u7le;; t9e
blee587< 8; >ery 9ea>y.
T9e me7;trual cycle 8; re<ulate5 by 9ormo7e;. 1ute878E87< 9ormo7e a75 :oll8cle';t8mulat87<
9ormo7e, =98c9 are pro5uce5 by t9e p8tu8tary <la75, promote o>ulat8o7 a75 ;t8mulate t9e o>ar8e;
to pro5uce e;tro<e7 a75 pro<e;tero7e ;t8mulate; t9e uteru; a75 brea;t; to prepare :or po;;8ble
N-407
:ert8l8Eat8o7. T9e cycle 9a; t9ree p9a;e;N :oll8cular Cbe:ore relea;e o: t9e e<<D, o>ulatory Ce<<
relea;eD, a75 luteal Ca:ter e<< relea;eD.
HOR/ONES AND -E/ALE CYCLES
T9e o>ar8a7 cycle 8;
9ormo7ally re<ulate5 87 t=o p9a;e;.
T9e :oll8cle ;ecrete; e;tro<e7 be:ore
t9e o>ulat8o7L t9e corpu; luteum
;ecrete; bot9 e;tro<e7 a75
pro<e;tero7e a:ter o>ulat8o7.
"ormo7e; :rom t9e 9ypot9alamu; a75
a7ter8or p8tu8tary co7trol t9e o>ar8a7
cycle. T9e o>ar8a7 cycle co>er; e>e7t;
87 t9e o>aryL t9e me7;trual cycle
occur; 87 t9e uteru;.
/e7;trual cycle; >ary :rom bet=ee7 1$ a75 31 5ay;. T9e :8r;t 5ay o: t9e cycle 8; t9e
:8r;t 5ay o: bloo5 :lo= C5ay 0D @7o=7 a; me7;truat8o7. Dur87< me7;truat8o7, t9e uter87e l8787< 8;
bro@e7 5o=7 a75 ;9e5 a; me7;trual :lo=. FS" a75 1" are ;ecrete5 o7 5ay 0, be<87787< bot9 t9e
me7;trual cycle a75 t9e o>ar8a7 cycle. Bot9 FS" a75 1" ;t8mulate t9e maturat8o7 o: a ;87<le
:oll8cle 87 o7e o: t9e o>ar8e; a75 t9e ;ecret8o7 o: e;tro<e7. R8;87< le>el; o: e;tro<e7 87 t9e bloo5
tr8<<er ;ecret8o7 o: 1", =98c9 ;t8mulate; :oll8cle maturat8o7 a75 o>ulat8o7 C5ay 1-, or m85
cycleD. 1" ;t8mulate; t9e rema8787< :oll8cle cell; to :orm t9e corpu; luteum, =98c9 pro5uce; bot9
e;tro<e7 a75 pro<e;tero7e.
N-407
E;tro<e7 a75 pro<e;tero7e ;t8mulate t9e 5e>elopme7t o: t9e e75ometr8um a75
preparat8o7 o: t9e uter87e l8787< :or 8mpla7tat8o7 o: a Ey<ote. I: pre<7a7cy 5oe; 7ot occur, t9e
5rop 87 FS" a75 1" cau;e; t9e corpu; luteum to 58;87te<rate. T9e 5rop 87 9ormo7e; al;o cau;e;
t9e ;lou<987< o:: o: t9e 877er l8787< o: t9e uteru; by a ;er8e; o: mu;cle co7tract8o7; o: t9e uteru;.
-er$iliA"$ion "n# Pregn"n3%
I: a :emale a75 male 9a>e ;e6 =8t987 ;e>eral 5ay; o: t9e :emaleP; o>ulat8o7 Ce<< relea;eD,
:ert8l8Eat8o7 ca7 occur. 09e7 t9e male eBaculate; C=98c9 8; =9e7 ;eme7 lea>e; a ma7P; pe78;D,
bet=ee7 0.0$ a75 0.2 :lu85 ou7ce; C1.$ to %.0 m8ll8l8ter;D o: se(en 8; 5epo;8te5 87to t9e >a<87a.
Bet=ee7 *$ a75 900 m8ll8o7 ;perm are 87 t98; ;mall amou7t o: ;eme7, a75 t9ey S;=8mS up :rom
t9e >a<87a t9rou<9 t9e cer>86 a75 uteru; to meet t9e e<< 87 t9e :allop8a7 tube. It ta@e; o7ly o7e
;perm to :ert8l8Ee t9e e<<.
#bout a =ee@ a:ter t9e ;perm :ert8l8Ee; t9e e<<, t9e :ert8l8Ee5 e<< CEy<oteD 9a; become a mult8'
celle5 'l"s$o3%s$ Cpro7ou7ce5N 'l"s'tu9';8;tD. # bla;tocy;t 8; about t9e ;8Ee o: a p879ea5, a75 8tP;
a 9ollo= ball o: cell; =8t9 :lu85 87;85e. T9e bla;tocy;t burro=; 8t;el: 87to t9e l8787< o: t9e uteru;,
calle5 t9e en#o(e$riu( Cpro7ou7ce5N e7'5o9'(ee'tree'umD. T9e 9ormo7e e;tro<e7 cau;e; t9e
e75ometr8um to become t98c@ a75 r8c9 =8t9 bloo5. Pro<e;tero7e, a7ot9er 9ormo7e relea;e5 by
t9e o>ar8e;, @eep; t9e e75ometr8um t98c@ =8t9 bloo5 ;o t9at t9e bla;tocy;t ca7 attac9 to t9e
uteru; a75 ab;orb 7utr8e7t; :rom 8t. T98; proce;; 8; calle5 i(4l"n$"$ion Cpro7ou7ce5N 8m'pla7'
$"%';9u7D.
#; cell; :rom t9e bla;tocy;t ta@e 87 7our8;9me7t, a7ot9er ;ta<e o: 5e>elopme7t, t9e embryo78c
;ta<e, be<87;. T9e 877er cell; :orm a :latte7e5 c8rcular ;9ape calle5 t9e embryo78c 58;@, =98c9
=8ll 5e>elop 87to a baby. T9e outer cell; become t987 membra7e; t9at :orm arou75 t9e baby. T9e
N-407
Pregnancy-Induced Hypertension: A ase !tudy -0
cell; mult8ply t9ou;a75; o: t8me; a75 mo>e to 7e= po;8t8o7; to e>e7tually become t9e e('r%o
Cpro7ou7ce5N e('bree'oD. #:ter appro68mately + =ee@;, t9e embryo 8; about t9e ;8Ee o: a7
a5ultP; t9umb, but almo;t all o: 8t; part; T t9e bra87 a75 7er>e;, t9e 9eart a75 bloo5, t9e ;tomac9
a75 87te;t87e;, a75 t9e mu;cle; a75 ;@87 T 9a>e :orme5.
Dur87< t9e :etal ;ta<e, =98c9 la;t; :rom 9 =ee@; a:ter :ert8l8Eat8o7 to b8rt9, 5e>elopme7t
co7t87ue; a; cell; mult8ply, mo>e, a75 c9a7<e. T9e fe$us Cpro7ou7ce5N fee'tu;D :loat; 87
"(nio$i3 Cpro7ou7ce5N am'7ee'"6't8@D flui# 87;85e t9e "(nio$i3 s"3. T9e :etu; rece8>e; o6y<e7
a75 7our8;9me7t :rom t9e mot9erP; bloo5 >8a t9e 4l"3en$" Cpro7ou7ce5N plu9'sen'tu9D, a 58;@'
l8@e ;tructure t9at ;t8c@; to t9e 877er l8787< o: t9e uteru; a75 co77ect; to t9e :etu; >8a t9e
u('ili3"l Cpro7ou7ce5N um''i6'l89'@ulD 3or#. T9e am78ot8c :lu85 a75 membra7e cu;98o7 t9e
:etu; a<a87;t bump; a75 Bolt; to t9e mot9erP; bo5y.
Pre<7a7cy la;t; a7 a>era<e o: 2+0 5ay; T about 9 mo7t9;. 09e7 t9e baby 8; rea5y :or b8rt9, 8t;
9ea5 pre;;e; o7 t9e cer>86, =98c9 be<87; to rela6 a75 =85e7 to <et rea5y :or t9e baby to pa;; 87to
a75 t9rou<9 t9e >a<87a. T9e mucu; t9at 9a; :orme5 a plu< 87 t9e cer>86 loo;e7;, a75 =8t9
am78ot8c :lu85, come; out t9rou<9 t9e >a<87a =9e7 t9e mot9erP; =ater brea@;.
09e7 t9e co7tract8o7; o: l"'or be<87, t9e =all; o: t9e uteru; co7tract a; t9ey are ;t8mulate5 by
t9e p8tu8tary 9ormo7e o<%$o3in Cpro7ou7ce5N a9@';ee'$o6';87D. T9e co7tract8o7; cau;e t9e cer>86
to =85e7 a75 be<87 to ope7. #:ter ;e>eral 9our; o: t98; =85e787<, t9e cer>86 8; 58late5 Cope7e5D
e7ou<9 :or t9e baby to come t9rou<9. T9e baby 8; pu;9e5 out o: t9e uteru;, t9rou<9 t9e cer>86,
a75 alo7< t9e b8rt9 ca7al. T9e babyP; 9ea5 u;ually come; :8r;tL t9e umb8l8cal cor5 come; out =8t9
t9e baby a75 8; cut a:ter t9e baby 8; 5el8>ere5.
N-407
T9e la;t ;ta<e o: t9e b8rt9 proce;; 87>ol>e; t9e 5el8>ery o: t9e place7ta, =98c9 8; 7o= calle5 t9e
a:terb8rt9. #:ter 8t 9a; ;eparate5 :rom t9e 877er l8787< o: t9e uteru;, co7tract8o7; o: t9e uteru;
pu;9 8t out, alo7< =8t9 8t; membra7e; a75 :lu85;.
T6e renin!"ngio$ensin!"l#os$erone s%s$e(
T9e re787'a7<8ote7;87'al5o;tero7e ;y;tem CR##SD play; a7 8mporta7t role 87 re<ulat87< bloo5
>olume a75 ;y;tem8c >a;cular re;8;ta7ce, =98c9 to<et9er 87:lue7ce car58ac output a75 arter8al
pre;;ure. #; t9e 7ame 8mpl8e;, t9ere are t9ree 8mporta7t compo7e7t; to t98; ;y;temN 1D re787, 2D
a7<8ote7;87, a75 3D al5o;tero7e. Re787, =98c9 8; pr8mar8ly relea;e5 by t9e @857ey;, ;t8mulate; t9e
:ormat8o7 o: a7<8ote7;87 87 bloo5 a75 t8;;ue;, =98c9 87 tur7 ;t8mulate; t9e relea;e o: al5o;tero7e
:rom t9e a5re7al corte6.
Re787 8; a proteolyt8c e7Eyme t9at 8; relea;e5 87to t9e c8rculat8o7 pr8mar8ly by t9e @857ey;. It;
relea;e 8; ;t8mulate5 byN
N-407
1. ;ympat9et8c 7er>e act8>at8o7 Cact87< >8a U1'a5re7oceptor;D
2. re7al artery 9ypote7;8o7 Ccau;e5 by ;y;tem8c 9ypote7;8o7 or re7al artery ;te7o;8;D
3. 5ecrea;e5 ;o58um 5el8>ery to t9e 58;tal tubule; o: t9e @857ey.

(u6ta<lomerular C(GD cell; a;;oc8ate5
=8t9 t9e a::ere7t arter8ole e7ter87< t9e
re7al <lomerulu; are t9e pr8mary ;8te o:
re787 ;tora<e a75 relea;e 87 t9e bo5y. #
re5uct8o7 87 a::ere7t arter8ole pre;;ure
cau;e; t9e relea;e o: re787 :rom t9e (G
cell;, =9erea; 87crea;e5 pre;;ure 8798b8t;
re787 relea;e. Beta1'a5re7oceptor;
locate5 o7 t9e (G cell; re;po75 to
;ympat9et8c 7er>e ;t8mulat8o7 by relea;87< re787. Spec8al8Ee5 cell; Cmacula 5e7;aD o: 58;tal
tubule; l8e a5Bace7t to t9e (G cell; o: t9e a::ere7t arter8ole. T9e macula 5e7;a ;e7;e; t9e amou7t
o: ;o58um a75 c9lor85e 8o7 87 t9e tubular :lu85. 09e7 !aCl 8; ele>ate5 87 t9e tubular :lu85, re787
relea;e 8; 8798b8te5. I7 co7tra;t, a re5uct8o7 87 tubular !aCl ;t8mulate; re787 relea;e by t9e (G
cell;. T9ere 8; e>85e7ce t9at pro;ta<la7587; CPGE2a75 PGI2D ;t8mulate re787 relea;e 87 re;po7;e
to re5uce5 !aCl tra7;port acro;; t9e macula 5e7;a. 09e7 a::ere7t arter8ole pre;;ure 8; re5uce5,
<lomerular :8ltrat8o7 5ecrea;e;, a75 t98; re5uce; !aCl 87 t9e 58;tal tubule. T98; ;er>e; a; a7
8mporta7t mec9a78;m co7tr8but87< to t9e relea;e o: re787 =9e7 t9ere 8; a::ere7t arter8ole
9ypote7;8o7.
N-407
09e7 re787 8; relea;e5 87to t9e bloo5, 8t act; upo7 a c8rculat87< ;ub;trate, a7<8ote7;87o<e7, t9at
u75er<oe; proteolyt8c clea>a<e to :orm t9e 5ecapept85e a7<8ote7;87 I. )a;cular e75ot9el8um,
part8cularly 87 t9e lu7<;, 9a; a7 e7Eyme,a7<8ote7;87 co7>ert87< e7Eyme C#CED, t9at clea>e; o::
t=o am87o ac85; to :orm t9e octapept85e, a7<8ote7;87 II C#IID, alt9ou<9 ma7y ot9er t8;;ue; 87 t9e
bo5y C9eart, bra87, >a;cularD al;o ca7 :orm #II.
#II 9a; ;e>eral >ery 8mporta7t :u7ct8o7;N
V Co7;tr8ct; re;8;ta7ce >e;;el; C>8a #II W#T1X receptor;D t9ereby 87crea;87< ;y;tem8c
>a;cular re;8;ta7ce a75 arter8al pre;;ure
V #ct; o7 t9e a5re7al corte6 to relea;e al5o;tero7e, =98c9 87 tur7 act; o7 t9e @857ey; to
87crea;e ;o58um a75 :lu85 rete7t8o7
V St8mulate; t9e relea;e o: >a;opre;;87 Ca7t858uret8c 9ormo7e, #D"D :rom t9e po;ter8or
p8tu8tary, =98c9 87crea;e; :lu85 rete7t8o7 by t9e @857ey;
V St8mulate; t98r;t ce7ter; =8t987 t9e bra87
V Fac8l8tate; 7orep87ep9r87e relea;e :rom ;ympat9et8c 7er>ee7587<; a75 8798b8t;
7orep87ep9r87e re'upta@e by 7er>e e7587<;, t9ereby e79a7c87< ;ympat9et8c a5re7er<8c :u7ct8o7
V St8mulate; car58ac 9ypertrop9y a75 >a;cular 9ypertrop9y
T9e re787'a7<8ote7;87'al5o;tero7e pat9=ay 8; re<ulate5 7ot o7ly by t9e mec9a78;m; t9at
;t8mulate re787 relea;e, but 8t 8; al;o mo5ulate5 by 7atr8uret8c pept85e; C#!P a75 B!PD relea;e5
by t9e 9eart. T9e;e 7atr8uret8c pept85e; act; a; a7 8mporta7t cou7ter're<ulatory ;y;tem.
N-407
Pregnancy-Induced Hypertension: A ase !tudy --
T9erapeut8c ma78pulat8o7 o: t98; pat9=ay 8; >ery 8mporta7t 87 treat87< 9yperte7;8o7 a75 9eart
:a8lure. #CE 8798b8tor;, #II receptor bloc@er; a75 al5o;tero7e receptor bloc@er;, :or e6ample, are
u;e5 to 5ecrea;e arter8al pre;;ure, >e7tr8cular a:terloa5, bloo5 >olume a75 9e7ce >e7tr8cular
preloa5, a; =ell a; 8798b8t a75 re>er;e car58ac a75 >a;cular 9ypertrop9y.
N-407
Pregnancy-Induced Hypertension: A ase !tudy -$
BOOB!BASED PATHOPHYSIOLOGY
N-407
Pregnancy-Induced Hypertension: A ase !tudy -%
N-407
Hypertensi
on
Endothea damage Vasospasms
Increased
thromboxane to
prostacydn
Increased
thromboxane to
prostacydn
Increased
endothen &
decreased ntrc
oxde
Increased
endothen &
decreased ntrc
oxde
-IUGR
-Abruption
of
placenta
-increased
uterine
contractili
ty
Edema of
the
hands
face and
abdomen
(depende
nt)
Headach
e
Dyspnea
-elevated liver
enymes
-!ausea and vomitin"
-Epi"astric pain
-Ri"ht Upper
#uadrant $ain
-Decreased blood
"lucose
%hrombocytop
enia
-Decreased
haemo"lobin
-&aternal
hyperbilirubin
emia
-'lurred
vision
Generaz
ed
vasoconst
rcton
Generaz
ed
vasoconst
rcton
Pumonar
y edema
Pumonar
y edema
Cortca
bran
spasms
Cortca
bran
spasms
Gomeru
ar
damage
Gomeru
ar
damage
Uteropacen
ta arteroe
esons
Uteropacen
ta arteroe
esons
Intravascuar
coaguaton
Intravascuar
coaguaton
Fud shfts
from
ntravascuar to
ntraceuar
space
Fud shfts
from
ntravascuar to
ntraceuar
space
Increased
senstvty to
angotensn II
Increased
senstvty to
angotensn II
Disseminated
intravascular
coa"ulation
(eiure
Hepatc
mcro
embo;
Lver
damage
Hepatc
mcro
embo;
Lver
damage
Pateet
aggregat
on and
fbrn
deposto
n
Pateet
aggregat
on and
fbrn
deposto
n
Haemoys
s of RBCs
Haemoys
s of RBCs
Retna
arteroar
spasms
Retna
arteroar
spasms
Hyperrefl
e)ia
$roteinur
ia
Pregnancy-Induced Hypertension: A ase !tudy -*
B
O O B ! B A S E D &
S
Y N T H E S I S O - T H E D I S E A S E
#efinition of the #isease
Pre'eclamp;8a 8; a me58cal co758t8o7 =9ere 9yperte7;8o7 ar8;e; 87 pre<7a7cy Cpre<7a7cy'
875uce5 9yperte7;8o7D 87 a;;oc8at8o7 =8t9 ;8<78:8ca7t amou7t; o: prote87 87 t9e ur87e. Becau;e
pre'eclamp;8a re:er; to a ;et o: ;ymptom; rat9er t9a7 a7y cau;at8>e :actor, 8t 8; e;tabl8;9e5 t9at
t9ere are ma7y 58::ere7t cau;e; :or t9e ;y75rome. It al;o appear; l8@ely t9at t9ere 8; a ;ub;ta7ce
or ;ub;ta7ce; :rom t9e place7ta t9at may cau;e e75ot9el8al 5y;:u7ct8o7 87 t9e mater7al bloo5
>e;;el; o: ;u;cept8ble =ome7.
Preeclamp;8a 8; a 58;or5er t9at occur; o7ly 5ur87< pre<7a7cy a75 t9e po;tpartum per8o5
a75 a::ect; bot9 t9e mot9er a75 t9e u7bor7 baby. #::ect87< at lea;t $'+K o: all pre<7a7c8e;, 8t 8;
a rap85ly pro<re;;8>e co758t8o7 c9aracter8Ee5 by 98<9 bloo5 pre;;ure a75 t9e pre;e7ce o: prote87
87 t9e ur87e. S=ell87<, ;u55e7 =e8<9t <a87, 9ea5ac9e; a75 c9a7<e; 87 >8;8o7 are 8mporta7t
;ymptom;L 9o=e>er, ;ome =ome7 =8t9 rap85ly a5>a7c87< 58;ea;e report :e= ;ymptom;.
Preeclamp;8a 9a; bee7 5e;cr8be5 a; a 58;ea;e o: t9eor8e;, becau;e t9e cau;e 8; u7@7o=7.
Some t9eor8e; 87clu5e C1D e75ot9el8al cell 87Bury, C2D reBect8o7 p9e7ome7o7 C87;u::8c8e7t
pro5uct8o7 o: bloc@87< a7t8bo58e;D, C3D comprom8;e5 place7tal per:u;8o7, C-D altere5 >a;cular
react8>8ty, C$D 8mbala7ce bet=ee7 pro;tacycl87 a75 t9rombo6a7e, C%D 5ecrea;e5 <lomerular
:8ltrat8o7 rate =8t9 rete7t8o7 o: ;alt a75 =ater, C*D 5ecrea;e5 87tra>a;cular >olume, C+D 87crea;e5
ce7tral 7er>ou; ;y;tem 8rr8tab8l8ty, C9D 58;;em87ate5 87tra>a;cular coa<ulat8o7, C10D uter87e
mu;cle ;tretc9 C8;c9em8aD, C11D 58etary :actor;, a75 C12D <e7et8c :actor;. T9e relat8>ely 7e=
t9eory o: e75ot9el8al 87Bury e6pla87; ma7y o: t9e cl878cal :87587<; 87 preeclamp;8a. T9e t9eory
emp9a;8Ee; t9at t9ere 8; more to preeclamp;8a t9a7 9yperte7;8o7. T9e >a;cular e75ot9el8um
N-407
Pregnancy-Induced Hypertension: A ase !tudy -+
pro5uce; a 7umber o: 8mporta7t ;ub;ta7ce; 87clu587< e75ot9el8al'5er8>e5 rela687< :actor or 78tr8c
o685e, e75ot9el87'1, pro;tacycl87, a75 t8;;ue pla;m87o<e7 act8>ator. T9u;, e75ot9el8al cell;
mo58:y t9e co7tract8le re;po7;e o: t9e u75erly87< ;moot9 mu;cle cell;, pre>e7t 87tra>a;cular
coa<ulat8o7, a75 ma87ta87 t9e 87te<r8ty o: t9e 87tra>a;cular compartme7t. Se>eral :87587<;
;u<<e;t e75ot9el8al 87Bury 87 preeclamp;8a.
Predis$osing - Pre!i$itating Fa!tors
0ome7 =8t9 preeclamp;8a 9a>e ab7ormal bloo5 >e;;el; :ee587< t9e place7ta, alt9ou<9 t9e
e6act cau;e o: t98; ab7ormal8ty 8; 7ot @7o=. T9ere are 7o te;t; t9at ca7 rel8ably pre58ct =9o =8ll
<et preeclamp;8a, a75 t9ere 8; 7o =ay to pre>e7t 8t. 0ome7 =8t9 o7e or more o: t9e :ollo=87<
c9aracter8;t8c; 9a>e a7 87crea;e5 r8;@ o: 5e>elop87< preeclamp;8aN
F8r;t pre<7a7cy Ce6clu587< m8;carr8a<e;D
"8<9 bloo5 pre;;ure, @857ey 58;ea;e, lupu;, or 58abete; pr8or to pre<7a7cy
Ge;tat8o7al 58abete;
/ult8ple <e;tat8o7 Ce<, t=87; or tr8plet;D
# :am8ly 98;tory o: preeclamp;8a 87 a ;8;ter or mot9er
# pre>8ou; 98;tory o: preeclamp;8a
#<e u75er 20 year; a75 po;;8bly a<e o>er 3$ to -0 year;
be;8ty
N-407
Co7>er;ely, =ome7 =9o 5o 7ot 5e>elop preeclamp;8a 87 t9e8r :8r;t pre<7a7cy are at lo= r8;@ o:
5e>elop87< 8t 87 a ;ub;e?ue7t pre<7a7cy.
t9er prec8pat87< :actor; may 87clu5eN pre<7a7cy, lo7< 87ter>al pre<7a7cy a75 ur87ary tract
87:ect8o7.
t9er pre58;po;87< :actor; may 87clu5eN <e7et8c;, lo= ;oc8oeco7om8c ;tatu;, race a75 9eart
58;ea;e.
(igns and (ym$toms
S8<7; o: ;e>ere preeclamp;8a T /8l5 preeclamp;8a ca7 =or;e7 a75 become ;e>ere. T98; u;ually
occur; o>er ;e>eral 5ay; to =ee@;, but may occur more ?u8c@ly. Se>ere preeclamp;8a may be
c9aracter8Ee5 by o7e or more o: t9e :ollo=87< ;8<7; or ;ymptom;. "o=e>er, t9e ;8<7; o: bot9
m8l5 a75 ;e>ere preeclamp;8a may be ;ubtle, a75 pat8e7t; ;9oul5 7ot 9e;8tate to me7t8o7 a7y
co7cer7; about po;;8ble ;8<7; o: preeclamp;8a to t9e8r pro>85erN
Bloo5 pre;;ure Y1%0H110 mm"<. 0ome7 =8t9 bloo5 pre;;ure; 87 t98; ra7<e 9a>e a7
87crea;e5 r8;@ o: ;tro@e
Per;8;te7t ;e>ere 9ea5ac9e
)8;ual problem; Cblurre5 or 5ouble >8;8o7, bl875 ;pot;, :la;9e; o: l8<9t or ;?u8<<ly l87e;,
lo;; o: >8;8o7D
#b7ormal @857ey te;t; or 5ecrea;e5 ur87at8o7 Cur87at87< le;; t9a7 $00 m1 87 2- 9our;D
Flu85 87 t9e lu7<;, =98c9 may cau;e 7e= ;9ort7e;; o: breat9
N-407
Pregnancy-Induced Hypertension: A ase !tudy $0
1o= platelet cou7tL platelet; 9elp t9e bloo5 to clot, =98c9 may cau;e ea;y bru8;87< or
blee587<
18>er ab7ormal8t8e; C5etecte5 by bloo5 te;t;DL ;ymptom; may 87clu5e 7au;ea, >om8t87<,
or pa87 87 t9e m85' or r8<9t upper ab5ome7 C;8m8lar to 9eartbur7D
De;truct8o7 o: re5 bloo5 cell; C9emoly;8;, =98c9 8; 5etecte5 by bloo5 te;t;D.
Part8al or complete ;eparat8o7 o: t9e place7ta :rom t9e uteru; Ccalle5 abrupt8o7DL ;ymptom;
87clu5e >a<87al blee587<, uter87e pa87, a75Hor 5ecrea;e5 :etal act8>8ty
N-407
/EDICAL /ANAGE/ENT
I
n $ r " 5 e n o u s
T
6 e r " 4 %
INTRAVENOUS FLUID THERAPY
.edi!al .anagement /eneral #es!ri$tion Indi!ation or Pur$oses
C: De<$rose in L"3$"$e#
RingerDs Solu$ion
C30<tt;Hm87D
"yperto78c Solut8o7
# ;olut8o7 co7ta8787< ;o58um
c9lor85e, pota;;8um c9lor85e,
calc8um c9lor85e a75 ;o58um
lactate5 87 58;t8lle5 =ater,
re:erre5 to 1actate5 R87<erO;
;olut8o7 calor8e; :rom 5e6tro;e
To replace :lu85; a75
electrolyte; lo;;
To 87crea;e >a;cularH
pla;ma >olume 7ece;;ary
5ur87< blee587< or bloo5
lo;;
To reple78;9 :lu85 lo;; o:
t9e bo5y, ma87ta87
7utr8t8o7al 87ta@e =9e7
pat8e7t 8; u7able to tolerate
:ee587<;, al;o ;er>e; a;
me58um :or a5m878;trat8o7
o: me58cat8o7;.
INTRAVENOUS THERAPY
NURSING RESPONSIBILITIES BE-ORE? DURING? AND A-TER
C9ec@ t9e 5octorO; or5er re<ar587< to =9at type o: I)F to be u;e5 a75 al;o 8t; >olume
a75 rate.
E6pla87 t9e proce5ure to t9e pat8e7t.
Gat9er all mater8al; 7ee5e5 :or t9e 87;ert8o7 o: I)F to ;a>e t8me a75 7ot to =a;te t8me :or
loo@87< :or ot9er mater8al;.
0a;9 9a75; be:ore a75 a:ter t9e proce5ure to pre>e7t co7tam87at8o7 :rom 87;ert8o7 ;8te.
N-407
Place pat8e7t 87 a com:ortable po;8t8o7 to :ac8l8tate ea;y 87;ert8o7 o: I) l87e a75 to
5ecrea;e pat8e7tO; :ear about t9e proce5ure.
/a@e ;ure t9at =e <8>e t9e proper I) :lu85 a75 5rop rate accurately becau;e pat8e7t may
e6per8e7ce :lu85 o>erloa5 or 5e9y5rat8o7.
C9ec@ :or 8t; pate7cy by ob;er>87< t9e bac@:lo= o: bloo5 upo7 87;ert8o7.
"fter the Pro!edure
Pre;; t9e ;8te =9ere t9e 7ee5le =a; 87;erte5 a75 ;ecure 8t =8t9 m8cropore.
C9ec@ t9e ;8te o: 9a75 =9ere t9e 7ee5le 8; 87;erte5 8: bul<87< 8; 7ot >8;8ble. I: ;o,
re87;ert8o7 8; to be u75erta@e7.
#5>8ce pat8e7t to a>o85 ;cratc987< t9e ;8te le;; mo>eme7t o: t9e 9a75 =9ere t9e 7ee5le
=a; 87;erte5 to @eep 8t 87 place.
I7;truct pat8e7t a75 ;8<78:8ca7t ot9er; to 87:orm t9e 7ur;e o7 5uty 8: bul<87< o: t9e ;8te 8;
>8;8ble, 8: t9ere 8; bac@ :lo= o: bloo5 o: 8: I)F 8; 7ot 87:u;87< =ell.
b;er>e t9e I) ;8te at lea;t e>ery 9our :or ;8<7; o: 87:8ltrat8o7 or ot9er compl8cat8o7;
:lu85 or electrolyte o>erloa5 a75 a8r embol8;m.
I)F re<ulat8o7 ;9oul5 be c9ec@e5 a75 mo78tore5 upo7 rece8>87< pat8e7t.
#l=ay; c9ec@ t9e 5octorO; or5er :or 7e= or5er; re<ar587< t9e I)F ;uppleme7t o: t9e
pat8e7t.
#l=ay; c9ec@ 8: t9e I)F 8; 87:u;87< =ell a75 87tact.
/o78tor t9e pat8e7tO; ;@87 87te<r8ty.
Pro>85e com:ort :or t9e pat8e7t.
Remo>e a75 58;po;e u;e5 8tem;.
Report a75 recor5 a; appropr8ate.
Place I) ta<
N-407
P
6 " r ( " 3 o l o g i 3 " l
?
/
" n " g e ( e n $
Drugs Gi5en Before Deli5er%
/eneri! %ame
0'rand %ame1
/eneral "!tion #ose and Route
Indi!ation or
Pur$oses
(ide effe!ts 2
"derse Rea!tions
Contraindi!ations
/"gnesiu(
Sulf"$e InEe3$ion
9/"gnesiu(
Sulf"$e> E4so(
S"l$;
.ineral-
"nti!onulsant
/a<7e;8um 8; t9e
;eco75 mo;t
ple7t8:ul cat8o7 o:
t9e 87tracellular
:lu85;. It 8;
e;;e7t8al :or t9e
act8>8ty o: ma7y
e7Eyme ;y;tem;
a75 play; a7
8mporta7t role =8t9
re<ar5 to
7euroc9em8cal
tra7;m8;;8o7 a75
mu;cular
e6c8tab8l8ty.
De:8c8t; are
accompa78e5 by a
>ar8ety o:
;tructural a75
:u7ct8o7al
58;turba7ce;.
-or E3l"(4si"&
I78t8ally 1 to 2 <
87 2$K or $0K
;olut8o7 8; <8>e7
87tramu;cularly.
Sub;e?ue7tly, 1
< 8; <8>e7 e>ery
30 m87ute; u7t8l
rel8e: 8;
obta87e5. T9e
bloo5 pre;;ure
;9oul5 be
mo78tore5 a:ter
eac9 87Bect8o7.
t9e mo;t
commo7
me58c87e u;e5
:or pre>e7t87<
eclamp;8a
C;e8Eure;D
5ur87<
pre<7a7cy
Flu;987<,
;=eat87<, ;9arply
lo=ere5 bloo5
pre;;ure,
9ypot9erm8a,
;tupor a75
ult8mately,
re;p8ratory
5epre;;8o7.
/a<7e;8um ;ul:ate
;9oul5 be <8>e7
>ery caut8ou;ly 87
t9e pre;e7ce o:
;er8ou; 8mpa8rme7t
o: re7al :u7ct8o7
;87ce 8t 8; e6crete5
almo;t e7t8rely by
t9e @857ey;. T98;
pro5uct co7ta87;
alum87um t9at
may be to68c.
#lum87um may
reac9 to68c le>el;
=8t9 prolo7<e5
pare7teral
a5m878;trat8o7 8:
@857ey :u7ct8o7 8;
8mpa8re5.
/a<7e;8um ;ul:ate
;9oul5 7ot be
a5m878;tere5
pare7terally 87
pat8e7t; =8t9 9eart
bloc@ or
myocar58al
5ama<e.
H%#r"l"Aine
9A4resoline;
"nti,hy$ertensie
"y5ralaE87e
appare7tly lo=er;
bloo5 pre;;ure by
e6ert87< a
per8p9eral
>a;o58lat87< e::ect
t9rou<9 a 58rect
rela6at8o7 o:
>a;cular ;moot9
mu;cle.
"y5ralaE87e, by
alter87< cellular
calc8um
metabol8;m,
87ter:ere; =8t9 t9e
calc8um
mo>eme7t; =8t987
Start =8t9 10 m<
:our t8me; 5a8ly
:or t9e :8r;t 2'-
5ay;, 87crea;e to
2$ m< :our
t8me; 5a8ly :or
t9e bala7ce o:
t9e :8r;t =ee@.
For t9e ;eco75
a75 ;ub;e?ue7t
=ee@;, 87crea;e
5o;a<e to $0 m<
:our t8me; 5a8ly.
For
ma87te7a7ce,
a5Bu;t 5o;a<e to
t9e lo=e;t
e::ect8>e le>el;.
a7 87tra>e7ou;
me58c87e :or
?u8c@ly
lo=er87<
;e>erely 98<9
bloo5 pre;;ure
5ur87<
pre<7a7cy
CCommo7DZ
"ea5ac9e,
a7ore68a, 7au;ea,
>om8t87<, 58arr9ea,
palp8tat8o7;,
tac9ycar58a, a7<87a
pector8;.
/# 8798b8tor;
;9oul5 be u;e5
=8t9 caut8o7 87
pat8e7t; rece8>87<
9y5ralaE87e. U;e5
=8t9 caut8o7 87
pat8e7t; =8t9
;u;pecte5 coro7ary
artery 58;ea;e.
#pre;ol87e ;9oul5
be u;e5 =8t9
caut8o7 87 pat8e7t;
=8t9 a5>a7ce5
re7al 5ama<e
N-407
Pregnancy-Induced Hypertension: A ase !tudy $-
t9e >a;cular
;moot9 mu;cle t9at
are re;po7;8ble :or
878t8at87< or
ma87ta8787< t9e
co7tract8le ;tate
/e$6%l#o4"
9Al#o(e$;
"nti,hy$ertensie
#1D/ET 8; a7
aromat8c'am87o'
ac85 5ecarbo6yla;e
8798b8tor 87
a78mal; a75 87
ma7. #lt9ou<9 t9e
mec9a78;m o:
act8o7 9a; yet to be
co7clu;8>ely
5emo7;trate5, t9e
a7t89yperte7;8>e
e::ect o:
met9yl5opa
probably 8; 5ue to
8t; metabol8;m to
alp9a'
met9yl7orep87ep9r
87e, =98c9 t9e7
lo=er; arter8al
pre;;ure by
;t8mulat8o7 o:
ce7tral 8798b8tory
alp9a'a5re7er<8c
receptor;, :al;e
7eurotra7;m8;;8o7,
a75Hor re5uct8o7 o:
pla;ma re787
act8>8ty.
/et9yl5opa 9a;
bee7 ;9o=7 to
cau;e a 7et
re5uct8o7 87 t9e
t8;;ue
co7ce7trat8o7 o:
;eroto787,
5opam87e,
7orep87ep9r87e,
a75 ep87ep9r87e.
;tart87< 5o;a<e
o: #1D/ET
8; 2$0 m< t=o or
t9ree t8me; a
5ay 87 t9e :8r;t
-+ 9our;. 09e7
#1D/ET 8;
<8>e7 =8t9
a7t89yperte7;8>e
; ot9er t9a7
t98aE85e;, t9e
878t8al 5o;a<e o:
#1D/ET
;9oul5 be
l8m8te5 to $00
m< 5a8ly 87
58>85e5 5o;e;L
=9e7
#1D/ET 8;
a55e5 to a
t98aE85e, t9e
5o;a<e o:
t98aE85e 7ee5
7ot be c9a7<e5.
5a8ly 5o;a<e o:
#1D/ET 8;
$00 m< to 2 < 87
t=o to :our
5o;e;. #lt9ou<9
occa;8o7al
pat8e7t; 9a>e
re;po75e5 to
98<9er 5o;e;, t9e
ma68mum
recomme75e5
5a8ly 5o;a<e 8; 3
<
a7 oral
me58c87e :or
co7troll87< 98<9
bloo5 pre;;ure
5ur87<
pre<7a7cy
e5at8o7, u;ually
tra7;8e7t, may
occur 5ur87< t9e
878t8al per8o5 o:
t9erapy or
=9e7e>er t9e 5o;e
8; 87crea;e5.
"ea5ac9e,
a;t9e78a, or
=ea@7e;; may be
7ote5 a; early a75
tra7;8e7t
;ymptom;.
08t9 act8>e 9epat8c
58;ea;e, ;uc9 a;
acute 9epat8t8; a75
act8>e c8rr9o;8;.
08t9 l8>er
58;or5er;
pre>8ou;ly
a;;oc8ate5 =8t9
met9yl5opa
t9erapy. 08t9
9yper;e7;8t8>8ty to
a7y compo7e7t o:
t9e;e pro5uct;.
7 t9erapy =8t9
mo7oam87e
o685a;e C/#D
8798b8tor;.
L"'e$"lol
9Tr"n#"$e;
"nti,hy$ertensie
1abetalol "Cl
comb87e; bot9
;elect8>e,
compet8t8>e,
alp9a1'a5re7er<8c
bloc@87< a75
7o7;elect8>e,
compet8t8>e, beta'
a5re7er<8c
bloc@87< act8>8ty 87
a ;87<le ;ub;ta7ce.
DS#GE
/&ST BE
I!DI)ID&#1I
[ED. T9e
recomme75e5
878t8al 5o;a<e 8;
100 m< t=8ce
5a8ly =9et9er
u;e5 alo7e or
a55e5 to a
58uret8c
re<8me7. #:ter 2
or 3 5ay;, u;87<
a7 87tra>e7ou;
me58c87e :or
?u8c@ly
lo=er87<
;e>erely 98<9
bloo5 pre;;ure
87 t9e 9o;p8tal,
a75 al;o a7 oral
me58c87e :or
co7troll87< 98<9
bloo5 pre;;ure
5ur87<
pre<7a7cy
Bo5y a; a 09oleN
Fe>er.
Car58o>a;cularN
"ypote7;8o7, a75
rarely, ;y7cope,
bra5ycar58a, 9eart
bloc@.
Ce7tral a75
Per8p9eral !er>ou;
Sy;tem;N
Pare;t9e;8a, mo;t
:re?ue7tly
T9e 5ru< 8;
co7tra8758cate5 87
bro7c98al a;t9ma,
o>ert car58ac
:a8lure, <reater'
t9a7':8r;t'5e<ree
9eart bloc@,
car58o<e78c ;9oc@,
;e>ere bra5ycar58a,
ot9er co758t8o7;
a;;oc8ate5 =8t9
;e>ere a75
prolo7<e5
N-407
Pregnancy-Induced Hypertension: A ase !tudy $$
I7 ma7, t9e rat8o;
o: alp9a' to beta'
bloc@a5e 9a>e
bee7 e;t8mate5 to
be appro68mately
1N3 a75 1N*
:ollo=87< oral a75
87tra>e7ou; CI)D
a5m878;trat8o7,
re;pect8>ely.
Beta2'a<o78;t
act8>8ty 9a; bee7
5emo7;trate5 87
a78mal; =8t9
m878mal beta1'
a<o78;t CIS#D
act8>8ty 5etecte5.
I7 a78mal;, at
5o;e; <reater t9a7
t9o;e re?u8re5 :or
alp9a' or beta'
a5re7er<8c
bloc@a5e, a
membra7e
;tab8l8E87< e::ect
9a; bee7
5emo7;trate5.
;ta7587< bloo5
pre;;ure a; a7
8758cator,
5o;a<e may be
t8trate5 87
87creme7t; o:
100 m< b.8.5.
e>ery 2 or 3
5ay;. T9e u;ual
ma87te7a7ce
5o;a<e o:
labetalol "Cl 8;
bet=ee7 200 a75
-00 m< t=8ce
5a8ly.
5e;cr8be5 a; ;calp
t87<l87<. I7 mo;t
ca;e;, 8t =a; m8l5
a75 tra7;8e7t a75
u;ually occurre5 at
t9e be<87787< o:
treatme7t.
Colla<e7
D8;or5er;N
Sy;tem8c lupu;
eryt9emato;u;,
po;8t8>e
a7t87uclear :actor.
Eye;N Dry eye;.
Immu7olo<8cal
Sy;temN
#7t8m8toc9o75r8al
a7t8bo58e;.
18>er a75 B8l8ary
Sy;temN "epat8c
7ecro;8;, 9epat8t8;,
c9ole;tat8c
Bau758ce, ele>ate5
l8>er :u7ct8o7 te;t;.
/u;culo;@eletal
Sy;temN /u;cle
cramp;, to68c
myopat9y.
Re;p8ratory
Sy;temN
Bro7c9o;pa;m.
S@87 a75
#ppe75a<e;N
Ra;9e; o: >ar8ou;
type;, ;uc9 a;
<e7eral8Ee5
maculopapular,
l8c9e7o85,
urt8car8al, bullou;
l8c9e7 pla7u;,
p;or8a:orm, a75
:ac8al eryt9emaL
Peyro78eP; 58;ea;eL
re>er;8ble alopec8a.
&r87ary Sy;temN
D8::8culty 87
m8ctur8t8o7,
87clu587< acute
ur87ary bla55er
rete7t8o7.
"yper;e7;8t8>8tyN
Rare report; o:
9yper;e7;8t8>8ty
9ypote7;8o7, a75
87 pat8e7t; =8t9 a
98;tory o:
9yper;e7;8t8>8ty to
a7y compo7e7t o:
t9e pro5uct
N-407
Pregnancy-Induced Hypertension: A ase !tudy $%
Ce.<., ra;9,
urt8car8a, prur8tu;,
a7<8oe5ema,
5y;p7eaD a75
a7ap9ylacto85
react8o7;.
Nife#i4ine
9A#"l"$;
"nti,hy$ertensie
T9e mec9a78;m by
=98c9 78:e58p87e
re5uce; arter8al
bloo5 pre;;ure
87>ol>e; per8p9eral
arter8al
>a;o58latat8o7 a75,
co7;e?ue7tly, a
re5uct8o7 87
per8p9eral >a;cular
re;8;ta7ce. T9e
87crea;e5
per8p9eral >a;cular
re;8;ta7ce, a7
u75erly87< cau;e
o: 9yperte7;8o7,
re;ult; :rom a7
87crea;e 87 act8>e
te7;8o7 87 t9e
>a;cular ;moot9
mu;cle. Stu58e;
9a>e 5emo7;trate5
t9at t9e 87crea;e 87
act8>e te7;8o7
re:lect; a7 87crea;e
87 cyto;ol8c :ree
calc8um.
Do;a<e ;9oul5
be a5Bu;te5
accor587< to
eac9 pat8e7tP;
7ee5;. It 8;
recomme75e5
t9at #5alat CC
be a5m878;tere5
orally o7ce 5a8ly
o7 a7 empty
;tomac9. #5alat
CC 8; a7
e6te75e5 relea;e
5o;a<e :orm a75
tablet; ;9oul5 be
;=allo=e5
=9ole, 7ot b8tte7
or 58>85e5. I7
<e7eral, t8trat8o7
;9oul5 procee5
o>er a *'1- 5ay
per8o5 ;tart87<
=8t9 30 m< o7ce
5a8ly. &p=ar5
t8trat8o7 ;9oul5
be ba;e5 o7
t9erapeut8c
e::8cacy a75
;a:ety. T9e
u;ual
ma87te7a7ce
5o;e 8; 30 m< to
%0 m< o7ce
5a8ly. T8trat8o7
to 5o;e; abo>e
90 m< 5a8ly 8;
7ot
recomme75e5.
a7 oral
me58c87e :or
co7troll87< 98<9
bloo5 pre;;ure
5ur87<
pre<7a7cy
Bo5y a; a
09oleHSy;tem8cN
c9e;t pa87, le< pa87
Ce7tral !er>ou;
Sy;temN
pare;t9e;8a,
>ert8<o
Dermatolo<8cN ra;9
Ga;tro87te;t87alN
co7;t8pat8o7
/u;culo;@eletalN
le< cramp;
Re;p8ratoryN
ep8;ta68;, r9878t8;
&ro<e78talN
8mpote7ce, ur87ary
:re?ue7cy
Co7com8ta7t
a5m878;trat8o7 =8t9
;tro7< P-$0
875ucer;, ;uc9 a;
r8:amp87, are
co7tra8758cate5
;87ce t9e e::8cacy
o: 78:e58p87e
tablet; coul5 be
;8<78:8ca7tly
re5uce5.
!8:e58p87e mu;t
7ot be u;e5 87
ca;e; o:
car58o<e78c ;9oc@.
M7o=7
9yper;e7;8t8>8ty to
78:e58p87e.
Be$"(e$6"sone
9Di4rolene>
Celes$one;
/lu!o!orti!oid-
Corti!osteroid
!aturally
occurr87<
<lucocort8co85;
C9y5rocort8;o7e
a75 cort8;o7eD,
=98c9 al;o 9a>e
;alt'reta8787<
propert8e;, are
u;e5 a;
replaceme7t
t9erapy 87
a5re7ocort8cal
I7Bectable
Su;pe7;8o7 may
>ary :rom 0.2$
to 9.0 m< per
5ay 5epe7587<
o7 t9e ;pec8:8c
58;ea;e e7t8ty
be87< treate5.
To #ccelarate
t9e
5e>elopme7t o:
;ur:acta7t 87
87:a7t; 87
mot9er; =8t9
PI"
#ller<8c React8o7;N
#7ap9ylacto85
react8o7,
a7ap9yla68;,
a7<8oe5ema.
Car58o>a;cularN
Bra5ycar58a,
car58ac arre;t,
car58ac
arr9yt9m8a;,
car58ac
e7lar<eme7t,
c8rculatory
collap;e,
co7tra8758cate5 87
pat8e7t; =9o are
9yper;e7;8t8>e to
a7y compo7e7t; o:
t98; pro5uct.
I7tramu;cular
cort8co;tero85
preparat8o7; are
co7tra8758cate5 :or
858opat98c
t9rombocytope78c
purpura.
N-407
Pregnancy-Induced Hypertension: A ase !tudy $*
5e:8c8e7cy ;tate;.
T9e8r ;y7t9et8c
a7alo<; are
pr8mar8ly u;e5 :or
t9e8r a7t8'
87:lammatory
e::ect; 87 58;or5er;
o: ma7y or<a7
;y;tem;. #
5er8>at8>e o:
pre578;olo7e,
betamet9a;o7e 9a;
a 1%U'met9yl
<roup t9at
e79a7ce; t9e a7t8'
87:lammatory
act8o7 o: t9e
molecule a75
re5uce; t9e
;o58um' a75 =ater'
reta8787<
propert8e; o: t9e
:luor87e atom
bou75 at carbo7 9.
co7<e;t8>e 9eart
:a8lure, :at
embol8;m,
9yperte7;8o7,
9ypertrop98c
car58omyopat9y 87
premature 87:a7t;,
myocar58al rupture
:ollo=87< rece7t
myocar58al
87:arct8o7,
pulmo7ary e5ema,
;y7cope,
tac9ycar58a,
t9romboembol8;m,
t9rombop9leb8t8;,
>a;cul8t8;.
Dermatolo<8cN
#c7e, aller<8c
5ermat8t8;,
cuta7eou; a75
;ubcuta7eou;
atrop9y, 5ry ;caly
;@87, ecc9ymo;e;
a75 petec98ae,
e5ema, eryt9ema,
9yperp8<me7tat8o7
,
9ypop8<me7tat8o7,
8mpa8re5 =ou75
9eal87<, 87crea;e5
;=eat87<, ra;9,
;ter8le ab;ce;;,
;tr8ae, ;uppre;;e5
react8o7; to ;@87
te;t;, t987 :ra<8le
;@87, t987787<
;calp 9a8r,
urt8car8a.
E75ocr87eN
Decrea;e5
carbo9y5rate a75
<luco;e tolera7ce,
5e>elopme7t o:
cu;987<o85 ;tate,
<luco;ur8a,
98r;ut8;m,
9ypertr8c9o;8;,
87crea;e5
re?u8reme7t; :or
87;ul87 or oral
9ypo<lycem8c
a5re7ocort8cal a75
p8tu8tary
u7re;po7;8>e7e;;
Cpart8cularly 87
t8me; o: ;tre;;, a;
87 trauma, ;ur<ery,
or 8ll7e;;D,
;uppre;;8o7 o:
N-407
Pregnancy-Induced Hypertension: A ase !tudy $+
<ro=t9 87 pe58atr8c
pat8e7t;.
Flu85 a75
Electrolyte
D8;turba7ce;N
Co7<e;t8>e 9eart
:a8lure 87
;u;cept8ble
pat8e7t;, :lu85
rete7t8o7,
9ypo@alem8c
al@alo;8;,
pota;;8um lo;;,
;o58um rete7t8o7.
Ga;tro87te;t87alN
#b5om87al
58;te7t8o7,
bo=elHbla55er
5y;:u7ct8o7 Ca:ter
87trat9ecal
a5m878;trat8o7D,
ele>at8o7 87 ;erum
l8>er e7Eyme
le>el; Cu;ually
re>er;8ble upo7
58;co7t87uat8o7D,
9epatome<aly,
87crea;e5 appet8te,
7au;ea,
pa7creat8t8;, pept8c
ulcer =8t9 po;;8ble
per:orat8o7 a75
9emorr9a<e,
per:orat8o7 o: t9e
;mall a75 lar<e
87te;t87e
Cpart8cularly 87
pat8e7t; =8t9
87:lammatory
bo=el 58;ea;eD,
ulcerat8>e
e;op9a<8t8;.
/etabol8cN
!e<at8>e 78tro<e7
bala7ce 5ue to
prote87 catabol8;m.
/u;culo;@eletalN
#;ept8c 7ecro;8; o:
:emoral a75
9umeral 9ea5;,
calc87o;8;
C:ollo=87< 87tra'
art8cular or
87trale;8o7al u;eD,
C9arcot'l8@e
art9ropat9y, lo;; o:
mu;cle ma;;,
mu;cle =ea@7e;;,
N-407
o;teoporo;8;,
pat9olo<8c :racture
o: lo7< bo7e;,
po;t87Bect8o7 :lare
C:ollo=87< 87tra'
art8cular u;eD,
;tero85 myopat9y,
te75o7 rupture,
>ertebral
compre;;8o7
:racture;.
!eurolo<8cHP;yc98
atr8cN
Co7>ul;8o7;,
5epre;;8o7,
emot8o7al
87;tab8l8ty,
eup9or8a,
9ea5ac9e,
87crea;e5
87tracra78al
pre;;ure =8t9
pap8lle5ema
Cp;eu5otumor
cerebr8D u;ually
:ollo=87<
58;co7t87uat8o7 o:
treatme7t,
87;om78a, moo5
;=87<;, 7eur8t8;,
7europat9y,
pare;t9e;8a,
per;o7al8ty
c9a7<e;, p;yc98c
58;or5er;, >ert8<o.
#rac97o858t8;,
me787<8t8;,
parapare;8;Hparaple
<8a, a75 ;e7;ory
58;turba7ce; 9a>e
occurre5 a:ter
87trat9ecal
a5m878;trat8o7
p9t9alm8cN
E6op9t9almo;,
<laucoma,
87crea;e5
87traocular
pre;;ure, po;ter8or
;ubcap;ular
cataract;, rare
87;ta7ce; o:
bl8757e;;
a;;oc8ate5 =8t9
per8ocular
87Bect8o7;.
t9erN
#b7ormal :at
5epo;8t;, 5ecrea;e5
N-407
Pregnancy-Induced Hypertension: A ase !tudy %0
re;8;ta7ce to
87:ect8o7, 98ccup;,
87crea;e5 or
5ecrea;e5 mot8l8ty
a75 7umber o:
;permatoEoa,
mala8;e, moo7
:ace, =e8<9t <a87.
De<"(e$6"sone
/lu!o!orti!oid-
Corti!osteroid
Glucocort8co85;,
7aturally occurr87<
a75 ;y7t9et8c, are
a5re7ocort8cal
;tero85; t9at are
rea58ly ab;orbe5
:rom t9e
<a;tro87te;t87al
tract.
Glucocort8co85;
cau;e >ar8e5
metabol8c e::ect;.
I7 a558t8o7, t9ey
mo58:y t9e bo5yP;
8mmu7e re;po7;e;
to 58>er;e ;t8mul8.
!aturally
occurr87<
<lucocort8co85;
C9y5rocort8';o7e
a75 cort8;o7eD,
=98c9 al;o 9a>e
;o58um'reta8787<
propert8e;, are
u;e5 a;
replaceme7t
t9erapy 87
a5re7ocort8cal
5e:8c8e7cy ;tate;.
T9e8r ;y7t9et8c
a7alo<; 87clu587<
5e6amet9a;o7e are
pr8mar8ly u;e5 :or
t9e8r a7t8'
87:lammatory
e::ect; 87 58;or5er;
o: ma7y or<a7
;y;tem;.
0.*$ to 9 m< a
5ay 5epe7587<
o7 t9e 58;ea;e
be87< treate5.
To #ccelarate
t9e
5e>elopme7t o:
;ur:acta7t 87
87:a7t; 87
mot9er; =8t9
PI"
#7ap9ylacto85
react8o7,
a7ap9yla68;,
a7<8oe5ema.
Bra5ycar58a,
car58ac arre;t,
car58ac
arr9yt9m8a;,
car58ac
e7lar<eme7t,
c8rculatory
collap;e,
co7<e;t8>e 9eart
:a8lure, :at
embol8;m,
9yperte7;8o7,
9yper'trop98c
car58omyopat9y
87 premature
87:a7t;, myocar58al
rupture :ollo=87<
rece7t myocar58al
87:arct8o7. #c7e,
aller<8c 5ermat8t8;,
5ry ;caly ;@87,
ecc9ymo;e; a75
petec98ae,
eryt9ema,
8mpa8re5 =ou75
9eal87<, 87crea;e5
;=eat87<, ra;9,
;tr8ae, ;uppre;;8o7
o: react8o7; to ;@87
te;t;, t987 :ra<8le
;@87, t987787<
;calp 9a8r,
urt8car8a.
Co7tra8758cate5 87
;y;tem8c :u7<al
87:ect8o7; a75
pat8e7t; =8t9
@7o=7
9yper;e7;8t8>8ty to
t9e pro5uct a75 8t;
co7;8tue7t;.
N-407
Nursing Res4onsi'ili$ies for All Drugs
'efore the administration of drug3
)er8:y DoctorO; or5er
Remember t9e 10RO; o: Dru< a5m878;trat8o7
#uring the administration of drug3
)er8:y pat8e7tO; 85e7t8:8cat8o7
I7:orm t9e pat8e7t =8t9 re<ar5; to 5ru< a5m878;trat8o7
Clea7 t9e I) port pr8or to a5m878;trat8o7 o: t9e 5ru<
"fter the administration of drug3
/o78tor pat8e7t :or a5>er;e e::ect;
I7:orm pat8e7t t9at ea;y bru8;87< may occur
Caut8o7 pat8e7t 7ot to ;top ta@87< 5ru< abruptly =8t9out :8r;t co7;ult87< pre;cr8ber
N-407
D
i e $ .
A
3 $ i 5 i $ %
/
" n " g e ( e n $
LOW SALT, LOW FAT DIET
4y$e of #iet /eneral #es!ri$tion
Indi!ation or
Pur$oses
E+am$les of
Restri!ted foods
1o= Salt, 1o= Fat
58et.
Re5uce5 ;o58um a75
c9ole;terol co7te7t o:
:oo5
To pre>e7t r8;@ :or
ot9er compl8cat8o7;
=98c9 may ar8;e :rom
9yperte7;8o7.
'Fr8e5 :oo5;
'Salty Sauce; CF8;9
;auce a75 ;oy ;auceD
'S7ac@ :oo5;
'Proce;;e5 :oo5;
LO2 SALT? LO2 -AT DIET
NURSING RESPONSIBILITIES BE-ORE? DURING? AND A-TER
C9ec@ t9e 5octorO; or5er.
C9ec@ t9e r8<9t cl8e7t.
Be ;ure t9at t9e 58et 8; properly 87;tructe5.
/o78tor 8: t9e cl8e7t compl8e; =8t9 t9e <8>e7 58et.
Be ;ure pat8e7t 8; ta@87< or eat87< :oo5 9e ca7 tolerate
"fter the Pro!edure
#;;e;; :or pat8e7tO; co758t8o7L 9o= 9e re;po75; to t9e 58et
N-407
hronic '$structi(e Pulmonary )isease: A ase !tudy %3
NURSING CARE PLAN
DECREASED CARDIAC OUTPUT
Cues
%ursing
#iagnosis
(!ientifi!
E+$lanation
*b5e!ties %ursing Interentions Rationale
S=
O= pt. May
manfest:
>paor
>non-
pttng/
pttng
edema
>hypertens
on
>body
maase
>varatons
n bood
pressure
Decreased
cardac
output r/t
atered heart
rate AEB
ncreased
bood
pressure
A hypertensve
pregnant
woman s
caused by
sudden weght
gan. Ths woud
brng
compcatons n
the body
because there s
an nadequate
bood pumped
by the heart to
meet the
metaboc
demands of the
body, there s
an ateraton of
her V/S
especay on
the bood
(hort
%erm*
After 2-3
hours oh
nursng
nterventon
s the pt. w
be abe to
demonstrat
e stabe
cardac
rhythm and
rate wthn
patents
norma
range.
+on"
%erm*
1. Assess other
precptatng factors.
2. Invove cent n
formuaton of pan of
care at eve of abty.
3. Note presence,
quaty of centra and
perphera puses.
4. Montor bood
pressure of the patent.
Measure n both
Enhances deas to
prortze thngs.
Enhances sense of
contro and ads n
cooperaton and
mantenance of
ndependence.
Boundng carotd,
|uguar, rada, femora
puses may be
observed or papated.
Puses n the egs or
feet may be
dmnshed, refectng
effects of
vasoconstrcton and
venous congeston.
Pregnancy-Induced Hypertension: A ase !tudy %-
>anxety
and
restessness
pressure and
heart rate. As a
resut, a
decreased
voume bood
pumped by
ether ventrce
of the heart
each mnute.
After 2-3
days the pt.
w be abe
to
partcpate
n actvtes
that reduce
bood
pressure or
cardac
workoad.
arms/thghs three
tmes, 3-5 mn., then
sttng, then standng
for nta evauaton.
Use correct cuff sze
and accurate technque.
5. Observe skn coor,
mosture, temperature
and capary ref tme.
6. Note ndependent or
genera edema.
7.Poston the cent
wth egs eevated
8. Encourage eg
exercse such as fexon
and extenson of the
feet, actve and
reaxaton of the caf
musces
9. Pace the cent n a
Comparson of
pressures provdes a
more compete pcture
of vascuar
nvovement or scope
of the probem.
Presence of paor,
coo, most skn and
deayed capary ref
tme may be due to
perphera
vasoconstrcton.
May ndcate heart
faure, rena or
vascuar mparment.
To promote venous
return to the heart
To mprove bood fow
and reduce venous
stagnaton
N-407
Pregnancy-Induced Hypertension: A ase !tudy %$
hghfowers poston
10. Instruct the cent
the mportance of
mantanng reguar
physca abty
11. Provde cam, restfu
surroundngs, mnmze
envronmenta actvty
or nose.
12. Mantan actvty
restrctons; provde
comfort measures, e.g.
back and neck
massage, eevaton of
head.
13. Instruct pt. n
reaxaton technque
and guded magery.
To decrease preoad
and reduce pumonary
congeston
To promote crcuaton
and vascuar heath
Can reduce stressfu
stmu produce
camng effect thereby
reduces bood
pressure.
Hep reduce
sympathetc
stmuaton promotes
reaxaton.
Reduces physca
stress and tenson that
affect bood pressure
N-407
Pregnancy-Induced Hypertension: A ase !tudy %%
14. Montor response to
medcatons to contro
hgh bood pressure.
and causes
hypertenson.
Response to drug
therapy s dependent
on both ndvduas
we as the synergstc
effects of the drugs.
Because sde effects,
drug nteractons and
patents motvaton for
takng
anthypertensve
medcaton, t s
mportant to use the
smaest number and
owest dosage of
medcatons.
N-407
hronic '$structi(e Pulmonary )isease: A ase !tudy %*
INEFFECTIVE UTEROPLACENTAL TISSUE PERFUSION
Cues
%ursing
#iagnosis
(!ientifi!
E+$lanation
S=
O=patent
may
manfest the
foowng:
>edema
>materna
bood
pressure of
160/100
mmHg
>ncreased
or
decreased
feta heart
tone
>postve
homans
sgn
Ineffectve
uteropacenta
tssue
perfuson
reated to
vasospasm of
spra arteres
secondary to
preecampsa
Preecampsa s
characterzed
by an ncreased
n bood
pressure
resutng from
vasospasm of
arteres (for ths
case, we are
pertanng to
the spra
artery) that
causes
vasoconstrcton
. Ths then eads
to decrease n
oxygen suppy
to the pacenta
whch s
otherwse
known as
neffectve
uropacenta
perfuson.
(hort
%erm*
After 2
hours of
nursng
nterventon
s, the
patent w
be abe to
verbaze
understand
ng of
condton,
therapy
regmen
and sde
effects of
medcatons
.
+on"
1. Assst the patent n
dentfyng festye
ad|ustment (e.g.,
avodng proonged
sttng, sttng wth
crossed egs, or
standng; deveopng
exercse pan for
cardovascuar ftness
durng pregnancy;
avodng wearng
constrctve cothng;
mantanng a baance
det wth adequate
hydraton) that may be
needed because of
changes n physoogc
functon durng
pregnancy.
2. Check and montor
vta sgns houry.
Decreases factors that
coud ead to
decreased perfuson of
oxygen to uterus,
pacenta, and fetus
Permts montorng of
cardovascuar
response to ness
state and provdes
eary warnng of
perfuson probems.
Pregnancy-Induced Hypertension: A ase !tudy %+
%erm*
After 2-3
days of
nursng
nterventon
, the patent
w be abe
to
demonstrat
e ncreased
perfuson as
ndvduay
approprate
(e.g. vta
sgns,
especay
bood
pressure,
wthn
cents
norma
range and
absence of
edema)
3. Montor feta heart
rate and we beng.
4. Insttute O2, wth an
nta voume of at east
2L/mn.
5. Montor ntake and
output every hour.
6. Instruct the patent to
assume the eft sde
yng poston when
yng down.
Provdes eary warnng
of perfuson probems,
and promotes eary
nterventon.
It enhances
uteropacenta
perfuson thereby
decreasng feta heart
workoad.
To check for rena
perfuson and to
determne fud oss
and need for
repacement or fud
excess whch further
ncreases BP
To promote pacenta
perfuson and prevent
the compresson of
vena cava.
N-407
7. Provde quet, non-
stmuatng
envronment for the
patent.
8. Provde the patent
and famy factua
nformaton and support
as needed.
9. Provde ow-sodum
det (not more than 6g
day or ess than 2.5 g
day). Restrct ntake of
proten.
10. Refer to other
heath care
professonas as
It reduces anxety and
promotes rest. Both
measures w assst n
mantanng perphera
crcuaton by avodng
vasoconstrcton.
It reduces anxety and
provdes teachng
opportunty.
It asssts n controng
bood pressure.
Restrcton of proten
heps mt BUN.
Provdes support and
fosters cost-effectve
coaboraton through
use of ready avaabe
resources
N-407
Pregnancy-Induced Hypertension: A ase !tudy *0
necessary
N-407
ACTIVITY INTOLERANCE
Cues
%ursing
#iagnosis
(!ientifi!
E+$lanation
S=
O=
Pt. may
manfest
-paor
>non-pttng
edema
>hypertens
on
>body
maase
>varatons
n bood
pressure
>anxety
and
restessness
Actvty
ntoerance r/t
mbaance
oxygen
suppy and
demand AEB
abnorma
heart rate or
bood
pressure
response
When there s a
hgh bood
pressure, there
s an
nadequate
bood fow.
Inadequate
bood fow
decreases the
nutrents and
oxygen n the
tssues n the
body as we as
n metaboc
demands. By
then, a person
w not be abe
to meet her
desred
actvtes
because of
depeted energy
that the body
needs to sustan
norma
metaboc rate.
After 2-3
days the pt.
w be abe
to acheve
measurabe
ncrease n
actvty
ntoerance,
evdenced
by reduced
fatgue and
weakness
and by V/S
wthn
acceptabe
mts durng
actvty.
1. Assess for other
precptators or causes
of treatment and pan.
2. Invove cent n
formuaton of pan of
care at eve of abty
3. Assess the patents
response to actvty,
nothng puse rate more
than 20 beats/mn.
faster than restng rate ;
marked ncrease n
bood pressure durng
or after actvty;
dyspnea or chest pan;
excessve fatgue and
weakness; daphoress;
dzzness or syncope.
Fatgue s a sde effect
of some medcatons.
Pan and stressfu
regmens aso extract
energy and produce
fatgue.
Enhances sense of
contro and ads n
cooperaton and
mantenance of
ndependence.
The stated parameters
are hepfu n
assessng physca
responses to the stress
of actvty and f
present are ndcators
of over exerton.
N-407
4. Determne current
cap|abtes and
barrers to partcpaton
n sef care.
5. Evauate acceeratng
actvty ntoerance.
6. Provde assstance
wth sef-care actvty as
ndcated, ntersperse
actvty perod wth rest
perod.
7. Instruct cent
energy-conservng
technques.
Comprehensve
functona assessment
ncudes ndependent
performance of basc
ADLs, soca actvtes,
sensory abtes,
cognton and abty to
ambuate.
May denote ncreasng
cardac
decompensaton rather
than over actvty.
Meets cents persona
care needs wthout
undue myocarda
stress or excessve
oxygen demand.
Energy savng
technques reduced
the energy
expendtures, thereby
assstng n
N-407
8. Encourage
progressve actvty
when toerated.
equazaton of oxygen
suppy and demand.
Gradua actvty
ntoerance
progresson prevents a
sudden ncrease n
cardac workoad.
N-407
hronic '$structi(e Pulmonary )isease: A ase !tudy *-
DISCHARGE PLANNING
/! I7;tructe5 t9e pat8e7t to ta@e t9e :ollo=87< 9ome me58cat8o7 a; or5ere5 by t9e p9y;8c8a7.
E! I7;tructe5 pat8e7t to a>o85 ;tre7uou; act8>8t8e; a75 pract8ce 5eep breat987< e6erc8;e.
I7;tructe5 pat8e7t t9at ;9e may re;ume re<ular e6erc8;e a; tolerate5.
T! 7Ha
H! Emp9a;8Ee5 t9e 8mporta7ce o: brea;t :ee587<.
I7;tructe5 pat8e7t to 9a>e proper 9y<8e7e.
I7;tructe5 pat8e7t to co7t87ue oral me58cat8o7 a; pre;cr8be5 by t9e p9y;8c8a7.
O! #5>8ce pat8e7t to 9a>e :ollo= up c9ec@ up a:ter 1 =ee@.
D! 1S1F
Pregnancy-Induced Hypertension: A ase !tudy *$
LEARNING DERRIVED
A ca;e ;tu5y 8; a re?u8reme7t =98c9 all 7ur;87< ;tu5e7t; mu;t complete 87 or5er to <a87
t9e appropr8ate @7o=le5<e, ;@8ll;, a75 att8tu5e 87 t9e :8el5 o: 7ur;87<. It allo=; t9e ;tu5e7t; to
5el>e 87to t9e ;y7t9e;8; a75 mea787< o: t9e 58;ea;e, t9e ;8<7; a75 ;ymptom;, a; =ell a; t9e
corre;po7587< 7ur;87< care ma7a<eme7t :or t9e ca;e. # boo@'ba;e5 ca;e ;tu5y 8; 7o 58::ere7t,
a75 87 actual8ty, ;tu5e7t; are <8>e7 t9e opportu78ty to lear7 beyo75 =9at cl8e7t; may :eel a75
87to t9e 58::ere7t 58me7;8o7; o: t9e 58;ea;e. I7 ;9ort, t9e ca;e 8; 7ot l8m8te5 to merely t9e
treatme7t; o: t9e pat8e7t to 98; or 9er ;8<7; a75 ;ymptom;.
I7 t9e :our 5ay; 8t too@ to complete t98; ca;e ;tu5y, 8t ca7 be ;a85 t9at t9e ;tu5e7t; 9a>e
really lear7e5 alot about t9e 2to6em8a o: pre<7a7cy3 or pre<7a7cy 875uce5 9yperte7;8o7. It ea;
al;o be7e:8c8al o7 t9e part o: t9e <roup becau;e t9e ca;e ;er>e5 a; a re>8e= o7 pre>8ou; le;;o7;
58;cu;;e5 87 !C/ 101. I7 complet87< t98; ca;e, 9o=e>er, t9e <roup e7cou7tere5 ma7y
58::8cult8e; a75 o7e ;uc9 58::8culty =a; t9e creat8o7 o: t9e pat9op9y;8olo<y.
/a7y boo@; a75 re;earc9e; 9a>e 58::ere7t t9eor8e; o7 t9e 5e>elopme7t o: PI" a75 t9e
et8olo<y o: t9e 58;ea;e. Some t9eor8e; e6pla87 t9e p9e7ome7o7 a; a re;ult o: a 2to6873 =98l;t
ot9er; <o 87to a7 e6pla7at8o7 o: t9e po;;8b8l8ty o: a 2uter87e ;tretc93 :rom t9e <ro=87< :etu;,
=98c9 87 tur7 cau;e; 8;c9em8a a75 >a;oco7;tr8ct8o7. I7 a7 e::ort to 87clu5e t9e;e =ell're;pecte5
t9eor8e; o: 58::ere7t 5octor;, t9e ;tu5e7t 7ur;e; br8e:ly e6pla87e5 eac9 87 or5er to br87< to l8<9t a
po;;8ble e6pla7at8o7 to t9e occura7ce o: t9e 58;ea;e proce;;.
#lt9ou<9 8t rema87; true t9at 98; ca;e ;tu5y =a; 58::8cult to accompl8;9 5ue to a lac@ o:
;upport87< e>85e7ce to elaborate t9e occura7ce o: t98; 58;ea;e, ;t8ll, ma7y lear787<; re<ar587< t9e
ca;e 9a>e bee7 5er8>e5. De;p8te t9e ;leeple;; 78<9t; ;acr8:8ce5 to complete t9e ca;e ;tu5y, t9e
e::ort; 87 t9e e75 9a>e pa85 o::.E>e7 t9ou<9 t9e ca;e 9a5 bee7 5o7e 87 ;uc9 a bu;y a75 turbule7t
t8me CC! 5ay;D, ;t8ll t9e ma7u;cr8pt ;er>e; a; proo: t9at =8t9 t9e bel8e: a75 :a8t9 87 Go5 a75
t9e u78ty o: team =or@, all t987<; are po;;8ble. PR#ISE BE T GD\
N-407
Pregnancy-Induced Hypertension: A ase !tudy *%
RE-ERENCES
Black, J.M., Hawks, J. H. (2009). Medical-surgical nursing: clinical management for
positive outcomes. Vol.2. New York. Saunders.
Blanchard, R., Loeb, S. (2004) Blanchard & Loeb publishers nurses drug handbook.
Michigan. Blanchard & Loeb.
Fischbach, F.T., Dunning, M.B. (2008). A manual of laboratory and diagnostic tests.
Springhouse, PA. Lippincott, Williams, & Wilkins.
Gutierrez, K. J., Peterson, P.G. (2007). Saunders sursing survival guide pathophysiology.
2
nd
Edition. New Orleans Louisiana. Saunders & Elsevier.
Hole, J.W. (1993). Human anatomy and physiology. 6
th
edition. Dubuque, IA. Wm C.
Brown Publishers, inc
Huether, S.E., McCance, K.L. (2000). Understanding pathophysiology.2
nd
edition.
Singapore: Elsevier Science.
Karch, A. M. (2000). Lippincotts nursing drug guide 2000. University of Michigan.
Lippincott, Williams, & Wilkins.
Keogh, J. (2009). Nursing laboratory and diagnostic tests demystified. Boston. McGraw-
Hill Professional.
McCann, J. A., Holmes, H. N., Robinson, J.M., et al. (2003). Professional guide to
pathophysiology. Springhouse, PA. Lippincott, Williams, & Wilkins.
Nicoll, D., McPhee, S.J., Pignone, M., Chuanyi, M.L. (2007). Pocket guide to diagnostic
tests: Lange clinical science series. Springhouse, PA. McGraw-Hill.
Porth, Carol M., (2005). Pathophysiology: Concepts of altered health states. 7
th
Edition.
Boston: Lippincott, Williams, & Wilkins.
N-407
Pregnancy-Induced Hypertension: A ase !tudy **
Stockley, R. A. (2007). Chronic obstructive pulmonary disease. Chicago, IL. Wiley-
Blackwell.
Spratto, G.R., Woods, A.L. (2004). PDR nurses drug handbook. Springfield, IL.
Cengage Learning, inc.
Wallach, J.B. (2007). Interpretation of diagnostic tests: Doodys all reviewed collection.
Springhouse, PA. Lippincott, Williams, & Wilkins.
Weber, J., Kelley, J. (2007). Health assessment in nursing. 2nd edition. Boston.
Lippincott, Williams & Wilkins.
1am, /., C2010D *strogen )ominance: The silent epidemic+ T9e #ut9or8ty o7 !atural
"eal87<. 9ttpNHH===.5rlam.comHart8cle;HE;tro<e7]Dom87a7ce.a;p. #cce;;e5 o7
September 1-, 2010
N-407

Pregnancy Induced Hypertension Case Study

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