OBJECTIVES

CONTENT

TIME METHODOLOG RESOURCES ALLOCATION Y

EVALUATION Post test to be given by the clinical instructor.

Specifically, the students will be able to: 1.Define related terms: a. Pregnancy-induced - is a form of high blood pressure in pregnancy, a hypertension condition in which vasospasm occurs during pregnancy in both small and large arteries b. Gestational Hypertension c. Preeclampsia -when a woman develops increased blood pressure (140/90mmHg) but has no proteinuria or edema. - a medical condition in which hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant amounts of protein in the urine. -any status above gestational hypertension and below a point of seizures - The occurrence of convulsions in a pregnant woman who possesses no neurological disorder is considered an advanced presentation of preeclampsia -(Greek, "shining forth"), an acute and life-threatening complication of pregnancy, is characterized by the appearance of tonic-clonic seizures, usually in a patient who had developed pre-eclampsia.

5 minutes

Discussion

Material resources: Internet, ballpen, manila paper, cartolina, bondpapers, pentel pen, computer, ink, money Human resources: C.I., nursing students.

1) Mild Preeclampsia 2) Severe Preeclampsia d. Eclampsia

2.Trace the pathophysiology -The symptoms of pregnancy induced hypertension of Pregnancy induced affect almost all organs. The vascular spasm may be Hypertension caused by increased cardiac output that injures the endothelial cells of the arteries and the action of prostaglandins (notably decreased prostacyclin and increased thromboxane). Normally, blood vessels during pregnancy are resistant to the effects of pressor substances such as angiotensin and norepinephrine, so blood pressure remains normal during pregnancy. With pregnancy induced hypertension, this reduced responsiveness to blood pressure changes appears to be lost. Vasoconstriction occurs and blood pressure increases dramatically (Peters & Flack, 2004). With hypertension, the cardiac system can become overwhelmed because the heart is forced to pump against rising peripheral resistance. This reduces the blood supply to organs most markedly the kidney, pancreas, liver, brain and placenta. Poor placental perfusion may reduce the fetal nutrient and oxygen supply. Ischemia in the pancreas may result in epigastric pain and an elevated amylasecreatinine ratio. Spasm of the arteries in the retina leads to vision changes. If retinal hemorrhages occur, blindness can result. Vasospasm in the kidney increases blood flow resistance. Degenerative changes develop in kidney glomeruli because of back-pressure. This leads to increased permeability of the glomerular membrane, allowing the serum proteins albumin and globulin to escape into the urine (proteinuria). The degenerative changes also result in decreased glomerular filtration, so there is lowered urine output and clearance of creatinine. Increased kidney

15 minutes

Discussion

tubular reabsorption of sodium occurs. Because sodium retains fluid, edema results. Edema is further increased because as more protein is lost, the osmotic pressure of the circulating blood falls and fluid diffuses from the circulatory system into the denser interstitial spaces to equalize the pressure. Extreme edema can lead to cerebral and pulmonary edema and seizures (eclampsia). Yet another effect is that arterial spasm causes the bulk of the blood volume in the maternal circulation to be pooled in the venous circulation, so a woman has a deceptively low arterial intravascular volume. In addition, thrombocytopenia or a lowered platelet count occurs as platelets cluster at the sites of endothelial damage. Measuring hematocrit levels helps to assess the extent of the edema (the higher the hematocrit, the more is being lost). A hematocrit level above 40% suggests significant fluid loss into the interstitial spaces. 3. Identify the causes of Pregnancy Induced Hypertension 5 minutes - The cause of PIH is unknown. Some conditions may increase the risk of developing PIH, including the following: -pre-existing hypertension (high blood pressure) -kidney disease -diabetes -PIH with a previous pregnancy -mother's age younger than 20 or older than 40 -multiple fetuses (twins, triplets) Preeclampsia used to be called toxemia because it was Discussion

thought to be caused by a toxin in a pregnant woman's bloodstream. Although this theory has been debunked, researchers have yet to determine what causes preeclampsia. Possible causes may include: -Insufficient blood flow to the uterus -Damage to the blood vessels -A problem with the immune system -Poor diet 4. Determine the symptoms - The most common symptoms of high blood pressure in presented by Pregnancy pregnancy. However, each woman may experience Induced Hypertension symptoms differently. Other signs and symptoms of preeclampsia which can develop gradually or strike suddenly, often in the last few weeks of pregnancy may include: -increased blood pressure -protein in the urine -edema (swelling) -sudden weight gain, typically more than 2 pounds per week -visual changes such as blurred or double vision -nausea, vomiting -right-sided upper abdominal pain or pain around the stomach -urinating small amounts -changes in liver or kidney function tests -severe headaches 10 minutes Discussion

-dizziness Swelling (edema), particularly in the face and hands, often accompanies preeclampsia as well. Swelling isn't considered a reliable sign of preeclampsia, however, because it also occurs in many normal pregnancies. A. Mild Preeclampsia BP of 140/90 1+ to 2+ proteinuria on random weight gain of 2 lbs per week on the 2nd trimester and 1 lb per week on the 3rd trimester Slight edema in upper extremities and face B. Severe Preeclampsia BP of 160/110 3-4+ protenuria on random Oliguria (less than 500 ml/24 hrs) Cerebral or visual disturbances Epigastric pain Pulmonary edema Peripheral edema Hepatic dysfunction 10 minutes - Most women with preeclampsia deliver healthy babies. The more severe your preeclampsia and the earlier it occurs in your pregnancy, however, the greater the risks for you and your baby. Complications of preeclampsia may include: Discussion

5. Discuss the most common complications of Pregnancy Induced Hypertension

Lack of blood flow to the placenta. Preeclampsia affects the arteries carrying blood to the placenta. If the placenta doesn't get enough blood, the baby may receive less oxygen and nutrients. This can lead to slow growth, low birth weight, preterm birth or stillbirth. Placental abruption. Preeclampsia increases the risk of placental abruption, in which the placenta separates from the inner wall of the uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for both mother and baby. HELLP syndrome. HELLP which stands for hemolysis (the destruction of red blood cells), elevated liver enzymes and low platelet count syndrome can rapidly become life-threatening for both mother and baby. Symptoms of HELLP syndrome include nausea and vomiting, headache and upper right abdominal pain. HELLP syndrome is particularly dangerous because it can occur before signs or symptoms of preeclampsia appear. Eclampsia. When preeclampsia isn't controlled, eclampsia which is essentially preeclampsia plus seizures can develop. Symptoms of eclampsia include upper right abdominal pain, severe headache, vision problems and change in mental status, such as decreased alertness. Eclampsia can permanently damage a mother's vital organs, including the brain, liver and kidneys. Left untreated, eclampsia can

6.Determine the treatment

for Pregnancy Induced Hypertension

cause coma, brain damage and death for both mother and baby. -The goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other complications. Treatment for pregnancy-induced hypertension (PIH) may include: -bedrest (either at home or in the hospital may be recommended) -hospitalization (as specialized personnel and equipment may be necessary) -magnesium sulfate (or other antihypertensive medications for PIH) -fetal monitoring (to check the health of the fetus when the mother has PIH) may include: -fetal movement counting - keeping track of fetal kicks and movements. A change in the number or frequency may mean the fetus is under stress. -nonstress testing - a test that measures the fetal heart rate in response to the fetus' movements. -biophysical profile - a test that combines nonstress test with ultrasound to observe the fetus. -Doppler flow studies - type of ultrasound that uses sound waves to measure the flow of blood through

10 minutes

Discussion

a blood vessel. -continued laboratory testing of urine and blood (for changes that may signal worsening of PIH) -medications, called corticosteroids, that may help mature the lungs of the fetus (lung immaturity is a major problem of premature babies) -delivery of the baby (if treatments do not control PIH or if the fetus or mother is in danger). Cesarean delivery may be recommended, in some cases. The only cure for preeclampsia is delivery. You're at increased risk of seizures, placental abruption and severe bleeding until your blood pressure decreases. Of course, if 7. Discuss the nursing management of Pregnancy it's too early in your pregnancy, delivery may not be the best thing for your baby. Induced Hypertension - NURSING MANAGEMENT -Monitor for, and promote the resolution of, complications. -Monitor vital signs and FHR. -Minimize external stimuli; promote rest and relaxation -Measure and record urine output, protein level, and specific gravity. -Assess for edema of face, arms, hands, legs, ankles, and feet. Also assess for pulmonary edema. -Weigh the client daily.

10 minutes

Discussion

-Assess deep tendon reflexes every 4 hours. -Assess for placental separation, headache and visual disturbance, epigastric pain, and altered level of consciousness. -Provide treatment as prescribed. Mild preeclampsia treatment consists of: -bed rest in left lateral recumbent position -balanced diet with moderate to high protein and low to moderate sodium -administration of magnesium sulfate Severe preeclampsia treatment consists of: -complete bed rest -balanced diet with high protein and low to moderate sodium -administration of sulfate -fluid and electrolyte replacements -sedative hypertensives such as diazepam or phenobarbital or an anticonvulsant such as phenytoin Eclampsia treatment consists of: -administration of magnesium sulfate intravenously -Institute seizure precautions. Seizures may occur up to 72 hours after delivery. -Address emotional and psychosocial needs. Bibliography: London, M.L., Ladewig, P.W., Ball, J.W., and Bindker, R.C. (2007). Fundamentals of maternal and child nursing. 2nd edition. South Asia: Pearson Education Inc. Pillitteri, Adele. (2007). Maternal and child health nursing: Care of the childbearing and childbearing family. 5th edition. Philadelphia: Lippincott Williams and Wilkins

GENERAL OBJECTIVE: After 1 hours of lecture-presentation, the students will be able to render basic knowledge, beginning skills & positive attitude towards the disease Pregnancy Induced Hypertension. SPECIFIC OBJECTIVES: Specifically, we will be able to: 1. Define related terms: a. Pregnancy Induced Hypertension b. Gestational Hypertension c. Preeclampsia 1) Mild Preeclampsia 2) Severe Preeclampsia d. Eclampsia

2. Trace the pathophysiology of Pregnancy Induced Hypertension. 3. Identify the causes of Pregnancy Induced Hypertension 4. Determine the symptoms of Pregnancy Induced Hypertension 5. Discuss the most common complications of Pregnancy Induced Hypertension 6. Determine the treatment for Pregnancy Induced Hypertension. 7. Discuss the nursing management of Pregnancy Induced Hypertension.