Ward Class - PCI, HPN DX in Pregnancy

Presented by Earl Ben Adrienne A.
Albiar BSN 4-C
Maternal and Child:

COMPLICATIONS
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Maternal and Child: Complications in Pregnancy
GESTATIONAL HYPERTENSION is a
Hypertensive condition in which vasospasm occurs
in both small and large arteries during
Disorders in pregnancy, causing increased blood
Pregnancy pressure.
Hypertensive
Complications
GESTATIONAL HYPERTENSION PREECLAMPSIA
A woman is said to have gestational hypertension It is a pregnancy-related disease process
when she develops an elevated blood pressure of evidenced by increased blood pressure and
140/90 mmHg, but has no proteinuria or edema. proteinuria and edema in its severe phase.
ECLAMPSIA
Manifests a grand mal seizure or
coma has occurred.
Gestational
HPN
A woman is said to have gestational hypertension when
she develops an elevated blood pressure of 140/90
mmHg, or a systolic pressure elevated 15 mmHg above
pre-pregnancy level, but has no proteinuria or edema.
After pregnancy is done, blood pressure returns to
normal.
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Pre-eclampsia
It is a pregnancy-related disease process evidenced by increased blood
pressure and proteinuria and edema in its severe phase. The symptoms of
pre-eclampsia affect almost all organs because of a vascular spasm that
occur which are caused by the increase of cardiac output required by
pregnancy.
Pre-eclampsia
Organs that are effected by pre-eclampsia:
• Heart / Cardiac System
⚬ Overworked heart
⚬ Reduced blood supply to the organs / hypoxia.
￭ Affects kidney, pancreas, liver, brain and the placenta.
• Pancreas
⚬ Ischemia in the pancreas can lead to epigastric pain.
• Eyes
⚬ Vision changes
⚬ Retinal Hemorrhage
⚬ Blindness
Pre-eclampsia
Organs that are effected by pre-eclampsia:
• Kidney
⚬ Decreases GFR and the efficiency of the kidney to remove
waste.
￭ Increased serum BUN and Creatinine.
⚬ Damage to the kidney structures
￭ Proteinuria
⚬ Decreased blood supply to the kidney and
hemoconcentration leads to a release in aldosterone
￭ Retains sodium and increases BP.
Pre-eclampsia
Others:
• Edema
⚬ Generalized Edema
￭ Found in legs. face and hands.
⚬ Pulmonary Edema
￭ Patient complains of cough and shortness of breath.
⚬ Cerebral Edema
￭ Manifests headaches, confusion, and seizures.
Risk Factors for

Preeclampsia
The condition tends to occur most frequently in:
• Women of color
• Multiple pregnancy
• Primiparas younger than 20 years old and older than 40 years of age.
• Women from low socioeconomic backgrounds.
• Multiparas (5 or more pregnancies)
• Polyhydramnios
• With underlying disease
⚬ Heart disease
⚬ DM with vessel or renal involvement.
⚬ HPN
Pre-eclampsia
w/o severe features
Pre-eclampsia is any status above gestational HPN and below a
point of seizures for eclampsia. A woman is said to be pre-eclamptic
when proteinuria is present and blood pressure is 140/90 mmHg
taken on two occasions, 6 hours apart, or a systolic pressure greater
than 30 mmHg and a diastolic pressure greater than 15 mmHg
when compared to pre-pregnancy levels.
Pre-eclampsia
w/ severe features
A woman has passed to preeclampsia with severe features when her blood pressure
rises to 160mmHg/110mmHg or above for at least two occasions 6 hours apart at bed
rest, or her diastolic pressure is over 30 mmHg than her pre-pregnancy level. Marked
proteinuria, and with extreme edema found over the bony prominences of the body.
The accumulating edema will reduce the womans urinary output to approximately 400-
600 ml/day.
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11
Eclampsia
This is the most severe classification of pregnancy related hypertensive
disorder. A woman has passed into this stage when cerebral edema is so
acute a grand mal seizure (tonic-clonic seizure) or coma has occurred. With
eclampsia, the maternal mortality can be as high as 20% from causes such
as cerebral hemorrhage, circulatory collapse, or renal failure. The fetal
prognosis with eclampsia is also poor because of hypoxia, possibly caused
by the seizure, with consequent fetal acidosis. If premature separation of
the placenta from extreme vasospasm occurs, the fetal prognosis becomes
even graver
Edema
Grading
Some possible nursing diagnoses include:

• Ineffective tissue perfusion r/t vasoconstriction of
Nursing blood vessels.

• Deficient fluid volume r/t fluid loss to SQ tissue.
Diagnoses • Risk for fetal injury related to reduced placental

perfusion secondary to vasospasm.
• Social Isolation r/t prescribed bed rest.
Nursing
Interventions
For patients with pre-eclampsia

w/o severe features
• Monitor anti-platelet therapy.
• Promote bed rest.
• Promote good nutrition.
• Provide emotional support.
For patients with pre-eclampsia w/
severe features
• Support bed rest.
• Monitor maternal well being.
• Monitor fetal well being.
• Support nutritious intake.
• Administer medications to prevent
eclampsia:
⚬ Mg Sulfate
⚬ hydralazine
For patients with eclampsia ⚬ diazepam
• SAFETY ⚬ calcium gluconate
• Maintain patent airway and prevent
aspiration.
• Administer oxygen via face mask.
• Apply external fetal heart monitor.
• Check for vaginal bleeding to detect
placental separation.
Nursing
Responsibilities in
the DR
No.17
No.18
Nursing Responsibilities
in the DR
Handle:
1. Ward nurse endorsing the patient to the staff nurse in the DR
2. DR Nurse checks the consent.
3. Patient is transferred from the Labor Room to DR
4. Positioning of the patient, vital signs taken
5. Perennial prep
6. Draping
7. Hand washing and Surgical Scrubbing
8. Gowning, Gloving
9. Prepare instruments
10. Serving Gown and gloves to the Doctor
11. Assist in Draping
No.18
in the DR
Handle:
12. Insertion of straight catheter
13. Assist in delivering the baby
14. Serve scissor if needed for episiotomy
15. Serve 1 straight clamps and cord clamp
16. Serve mayo scissor to cut the cord
17. Serve sponge, clear airway of the baby (suction if needed)
18. Dry the baby
19. Unang Yakap
20. Cover the baby with linen
21. Deliver placenta
22. Serve the bowl
23. Serve sponge/sponge stick
24. For Episiorrhaphy (serve 5cc syringe with Lidocaine)
25. Open suture serve it with the needle holder and tissue forcep with teeth No.18
in the DR
Handle:
26. Cut sutures
27. Do Perineal wash
28. Put on underwear with sanitary napkin
29 Position patient
30. Remove all soiled and place it in the hamper
31. All sharps in the punctured resistant container
32. Throw the pathological waste and placenta in the designated container
33. Proper Instrument Care
34. Help out in the after care
No.18
in the DR
Assist:
1. Help out in positioning the patient in the DR table
2. Get vital signs
3. Coaching the patient during the delivery
4. Take note of the time of BOW rupture and delivery of the baby & placenta
5. Inject syntocinon thru IM in the deltoid muscle
6. Take note of the measurements of the newborn
7. Do the documentation
8. Assist in other activities in the DR
No.18
in the DR
Cord Care:
1. Assist in coaching the mother
2. Prepare the towel and sponge for drying the newborn
3. Cover the newborn
5. Clamp and cut the cord
6. Initiate Unang Yakap
7. Transfer newborn to Bassinette
8. Bring newborn to the Nursery
9. Do the Immediate Newborn Care
10. Weight the baby
11. Measure the baby
12. Assist the baby (Apgar score)
No.18
in the DR
Cord Care:
13. Check patency of the anus
14. Put on the bonnet, clothes of the new born
15. Put on diaper and name tag
16. Prepare and inject the Vitamin K and Hepa vaccine
17. Apply Neomycin in both eyes of the newborn
18. Wrap the baby
19. Check vital signs
20. Position the baby on side lying & keep them warm
21. Initiate breast feeding
22. Check from time to time
23. Do after care
24. Documentation
No.18
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Ward Class - PCI, HPN DX in Pregnancy

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Presented by Earl Ben Adrienne A.

Albiar BSN 4-C

Maternal and Child:

Risk Factors for

Some possible nursing diagnoses include:

Nursing blood vessels.

Diagnoses • Risk for fetal injury related to reduced placental

For patients with pre-eclampsia

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