Outline: Hypertension and Magnesium Sulfate Essay

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Preeclampsia pathophysiology
Common lab tests
Preeclampsia dangers

Preeclampsia pathophysiology
Preeclampsia progresses along a continuum from mild to severe preeclampsia, HELLP syndrome, or eclampsia. There is no definitive cause of preeclampsia, but the pathophysiology is distinct.
Preeclampsia develops after 20 weeks gestation in a previously normotensive woman.
Elevated blood pressure is frequently the first sign of preeclampsia.
The client also develops proteinuria.
While no longer considered a diagnostic measurement of preeclampsia, generalized edema of the face, hands, and abdomen that is not responsive to 12 hours of bedrest is often present

Common lab tests
Common lab tests done to diagnose pregnancy-induced hypertension
1. Blood test
2. Renal function
3. Creatinine
4. BUN

Preeclampsia dangers
The main pathogenic factor is poor perfusion as a result of arteriolar vasospasm. Function in organs such as the placenta, liver, brain, and kidneys can be depressed as much as 40 to 60%. As fluid shifts out of the intravascular compartment, a decrease in plasma volume and subsequent increase in hematocrit is seen. The edema of preeclampsia is generalized. Virtually all organ systems are affected by this disease, and the mother and fetus suffer increasing risk as the disease progresses. Preeclampsia is associated with risks of placental abruption, acute renal failure, cerebrovascular and cardiovascular complications, disseminated intravascular coagulation, and maternal death.

Initial History and Assessment
At 09:26 a.m. Jennie is brought to the Labor and Delivery triage area by her sister.
Jennie: I feel lousy. I’ve had this unbelievable headache for the past 2 days. I can’t seem to get rid of it even with Tylenol. On top of that my hands and face are huge.
Sister: "I felt like that when I had toxemia during my pregnancy. She’s been dizzy sometimes, too."

Family history
Both the grandparents from the mother’s side died from old age. From the father’s side, the grandmother died from hypertension and the father was died from pneumonia. The mother is not experiencing any health problems but the father has hypertension and asthma. Jennie had not experienced any health problems prior to the pregnancy.

Admission assessment by the nurse: Jennie is at 38 weeks gestation per early ultrasound. Today's weight is 182 pounds with a pre-pregnancy weight of 145, T 99.1° F, P 76, R 24, BP 138/88, 4+ pitting edema, and 3+ protein in the urine. Heart rate is regular, and lung sounds are clear. Deep tendon reflexes (DTRs) are 3+ biceps and triceps and 4+ patellar with 1 beat of ankle clonus.

Jennie’s blood pressure was at 155/90 at 10a.m.; 163/100 at 11 a.m. While normal blood pressure is below 120/80, blood pressure between 120/80 and 139/89 is called “pre-hypertension,” and a blood pressure of 140/90 or above is considered high.

Jennie’s hypertension is probably related to:
a. preeclampsia
b. chronic hypertension
c. gestational hypertension
d. renal disease

A Feedback. Your conclusion that Jennie is in jeopardy of developing a hypertensive disorder was based on which risk factors?
a. Weight, temperature, proteinuria, edema
b. Increased blood pressure, edema, proteinuria
c. Increased blood pressure, respiration, reflexes
Click CONTINUE to return to patient’s room.

B Feedback. Chronic hypertension in pregnancy is defined as a) hypertension that precedes pregnancy, b) hypertension that occurs in pregnancy prior to 20 weeks of gestation, or c) hypertension that persists beyond the sixth postpartum week.
Click CONTINUE to return to patient’s room.

C Feedback. Gestational hypertension is defined as hypertension induced by pregnancy beginning after 20 weeks of gestation and resolving by the
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