PIH PREP

TYPES OF HPN IN PREGNANCY

 An important indicator that’ll help us identify or determine the type of
hypertension that the woman is experiencing is that yung DATE kung kalian
naexperience yung high blood pressure.
 There 3 types of hypertension that a woman can encounter during the course of
pregnancy:
o CHRONIC HPN
o GESTATIONAL HPN – NO SYSTEMIC EFFECTS
o PREECLAMPSIA -MORE SERIOUS FORM OF HPN; HIGH BP CAN BE
ACCOMPANIED BY PROTEINURIA OR SYSTEMIC EFFECTS (ORGAN
SA LIVER, KIDNEY, OR SA VISION)

 preeclampsia is a type of hypertensive disorder that occurs during pregnancy,

and it tends to happen after 20 weeks gestation so that halfway point of a normal
40 week pregnancy.

 So, with preeclampsia if it's severe enough, it can actually turn into eclampsia,
and according to the Merriam Webster's dictionary, the term eclampsia means
convulsive state.
 So we want to make sure we are monitoring, a pregnant woman really closely to
make sure we're catching the pre eclampsia condition before it progresses to the
seizure like activity where she starts having seizures which can progress to a
coma and even death.

DIAGNOSING PT WITH PIH

So now let's talk about the criteria used to diagnose a patient with preeclampsia, and as
a nurse. The reason we want to be familiar with these criteria is because we're going to
be responsible for collecting this information, and we want to know if this is abnormal
what we're getting, and what to report to the physician who can use that information to
diagnose the patient with preeclampsia.
o TRIAGE OF PREECLAMPSIA: HPN, PROTEINURIA, ORGAN INJURY /EDEMA

WHAT’S A HIGH BP IN A PREGNANT WOMAN?

 Well, typically with preeclampsia/PIH before that 20 weeks, their blood pressure is
going to be normal, but once I hit that halfway point at 20 weeks you will start to see it
becoming elevated meaning anything greater than 140 systolic and anything greater
than 90 diastolic AND WHEN OBTAINING THIS however, is not just one reading,
 they need to have at least two readings of this that or at least four to six hours
apart.
 Now, with severe preeclampsia, they have a severe format if the systolic can get as
high as 160 and diastolic mean greater than 110.
DIFFERENCE OF PREECLAMPSIA WITH PIH?
 preeclampsia is different than gestational hypertension BECAUSE with gestational
hypertension, the blood pressure does increase, but they do not have protein in their
urine or those signs and symptoms that are telling us that there's probably some
organ injury,
PROTEINURIA AND PIH
 MOST women will have the hypertension along with a proteinurea, pero DI LAHAT
BECAUSE some women may not have the protein in the urine.
 Whenever a woman goes to a prenatal visit she's always submitting a urine sample,
they're looking for a protein, along with glucose and we talked about why they're
looking for glucose (INDICATION gestational diabetes), so any value greater than
plus one whenever they're using a DIPSTICK TEST would indicate that this is
abnormal there's protein in this woman's urine, and typically what the medical
professionals do is that your urine for 24 hours and then submit it to the lab, they'll
check it for protein, and anything greater than 300 milligrams is positive for protein, or
they can do a creatine and protein ratio, and anything greater than 0.3 milligrams per
deciliter is an indication.
Now we have protein urea, then we're looking for signs and symptoms of organ injury,
and what tends to be affected with preeclampsia as you're gonna see here in a moment
is the livers going to be affected the brain and the kidneys, and this can even progress
to severe complications like hellp syndrome. Also, the placenta is going to be affected
which in turn can affect the baby, so it can cause a whole variety of problems and
preeclampsia it really varies among women some women they'll have mild cases. Some
women can have severe cases that do progress to eclampsia.
RISK FACTORS ASSOCIATED WITH PREECLAMP
Now I'll talk about the risk factors associated with preeclampsia because as a nurse
whenever you're talking with this patient you're collecting her health history. You want to
be able to identify these risk factors because it tells us THAT we better be monitoring
this patient very closely for this condition. So some risk factors include
o having a history of preeclampsia or she has a family history of it.
o primipara siya or This is her first pregnancy.
o She has a significant health history prior to this pregnancy. She might be diabetic
have lupus, high blood pressure, kidney disease, obese,
 o MULTIGRAVIDA. She's having more than one baby twins triplets that increases
the risk,
o her age, we're talking about either being very young like less than, 18, or
advanced age greater than 35 years
PATHOPHYSIO OF PREECLAMPSIA
3 KEY PLAYERS:
o 1ST IS THE spiral arteries of the uterus.
-
o THE placenta itself.
o endothelial cells.
These are found in the uterus and they play a big role in supporting THE
pregnancy, THEY supply BLOOD TO THE UTERUS THAT THE BABY NEEDS
FOR GROWTH AND DEVLOPMENT AND if we don't get good blood flow to the
placenta hence the baby can't really grow and develop. Whenever THE
pregnancy progresses ESPECIALLY that midway point. These spiral arteries are
going to increase in their diameter and by doing that, that increases blood flow
from the uterus to this placenta. Hence more blood flows want to go to baby and
baby can grow and flourish.

However, in preeclampsia (PIH) this changing of the spiral arteries in their size
does not occur, what happens Is that there would not be much blood flow so
nagkakaroon ng ischemia. since yung placenta experiences ischemia because
the spiral arteries of the uterus fail to reshape and increase in diameter..

So whenever the placenta becomes ischemic, it gets really stressed out so it's
going to release substances in a mom's circulation in hopes of increasing the
blood flow, but unfortunately these substances are going to be very toxic which
can cause damaged to the endothelial cells. THESE ENDO CELLS ARE found
inside THE blood vessels throughout the whole body, and like to your organs
have some found in your kidneys like the glomerulus, you've had them lining up
through your brain everywhere.

So whenever they become damaged that it causes major issue KASI ONE THING
THAT they DO IS THAT THEY control the tone of that blood vessel AND CONTROLS
HOW THIS vesselS constricts AND KAPAG DAMAGE SILA MAGKAKAROON NG
POOR TONE tone KAYA NAGKAKAROON vasospasm hits constriction WHICH THEN
CAUSES AN elevated blood pressure KASI whenever you constrict a vessel, that
increases pressure within that vessel.
And that's why we will start to see the high blood pressure and our patient. Now as you
know whenever we're looking at the signs and symptoms, you will see these little
asterisks by the signs and symptoms these three signs and symptoms at the top, are
the Hallmark signs and symptoms of preeclampsia.

PROTEINURIA AND PIH

And another thing that these endothelial cells do is that they control the permeability of
the blood vessel. So normally these endothelial cells are nicely knitted together and
they control what they let through them and what they don't. However, whenever these
cells become damaged. They're not nicely knitted together anymore. So normally
SUBSTANCES that wouldn't leak out of them start to leak out of them and one of those
SUBSTANCES is protein.
And as we've talked about in our other lectures especially whenever we whenever renal
disease we talked about how protein regulates oncotic pressure. So whenever protein,
leave this blood vessel, water is going to follow. And this is where we're going to see
these other signs and symptoms so first let's talk about the protein urea, where is this
coming from well in the kidneys specifically the gall merilis, you have endothelial cells
lining that will merilis, and your kidneys normally filter your blood and it picks what
substances it wants from your blood and we absorbs it excretes it and just deals with it
and then you get rid of it as urine, however normally large molecules like protein do not
get filtered by your kidneys.
SPECIFIC PROTEINURIA
However, whenever these endothelial cells are damaged, they are going to leak and
protein can get through. So proteins going to leave the blood will drop protein levels in
the blood, and it's going to go into the urine hence why this person will start testing
positive for protein in their urine. Now our kidneys are not functioning, like they should
we have the vasospasm going on this is decreasing the perfusion to the kidneys, also
from where this water is going to be leaving these blood vessels throughout the body it's
gonna draw blood volume. So, we're going to have less blood volume being able to be
perfusing, these organs specifically the kidney so our kidneys aren't going to be
performing like they should. So normally, they would regulate uric acid levels instead
uric acid levels are going to increase which is a waste product creatine levels are going
to increase in our urinary output is going to decrease, because our kidneys aren't
functioning the way they should. So as a nurse you want to be looking at their urinary
output strict eyes and nose, looking at that creatinine level uric acid level, then you'll
also see a edema, this is swelling with preeclampsia, you may notice it in the face the
face will look puffy the eyes will look puffy and the extremities and three of them this is
happening is because of this permeability issue.
We've dropped the protein in the blood because where's it went it's left that vessel, it's
pulled water with it into those interstitial tissues. So you have the swelling of the tissues
present. Also the lungs can be affected, where the woman will be getting short of breath
because fluid has started to collect in her lungs So pulmonary edema, and she may
notice that she's gaining a lot of weight. This is water weight from where the water has
shifted into the interstitial tissue. So tell her to weigh herself every day and to watch for
weight gain of two pounds or more per week, then we will also have edema, of the brain
so what's what's going to be compromised to the brain but there's also going to be
swelling of that brain tissue cerebral edema because we have individual cells up there,
their probabilities increase. And this is where things can start getting really severe and
progressed to eclampsia that convulsive state because whenever you have swelling of
the brain, you're going to see the neuro changes because our central nervous system is
irritated, it is stressed out to the max so you can start seeing severe headaches vision
changes, hyperreflexia, this is where you have exaggerated deep tendon reflexes