Question

write a case study on a patient with pregnancy induced labor(PIH)

Answer 1

Case study on a patient with pregnancy induced labor(PIH)

Introduction:

Pregnancy Induced Hypertension (PIH) is a condition in which vasospasms occur during pregnancy in both small and large arteries. Signs of hypertension, proteinuria, and edema develop. It is unique to pregnancy and occurs in 5% to 7% of pregnancies in the united states.

Clinical Manifestations:

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

C. Eclampsia is an extension of preeclampsia and is characterized by the client experiencing seizures.

Diagnostic Evaluation:

1. Based on the presenting symptoms. Often the disease process has been developing and affecting the renal and vascular system
2. Frequently a sudden weight gain will occur, of 2 lb. or more in 1 week, or 6 lb. or more within 1 month. This often occurs before the edema is present.

Medical Treatment and Evaluation:

1. Magnesium Sulfate (Pregnancy risk category B)
   muscle relaxant, prevent seizures
   loading dose 4-6g, maintenance dose 1-2g/h IV
   infuse IV dose slowly over 15-30 min.
      •Always administer as a piggy back infusion.
      •Assess PR, urine output, DTR, and clonus every hour.
      •Observe for CNS depression and hypotonia in infant at birth.
2. Hydrazaline (Apresoline) Pregnancy risk category C
   anti hypertensive (peripheral vasodilator) use to decrease hypertension
   5-10mg/IV
   Administer slowly to avoid sudden fall of BP
      •Maintain diastolic pressure over 90 mmHg to ensure adequate placental filling.
3. Diazepam (Valium) Pregnancy risk category D
   halt seizures
   5-10mg/IV
   administer slowly. Dose may be repeated every 10-15 min. (up to 30mg/hr)
      •Observe for respiratory depression for both mother and infant at birth.
4. Calcium Gluconate (Pregnancy risk category C)
   antidote for Magnesium Sulfate
   1g/IV (10 mL of a 10% solution)
   have prepared at bed side when administering Magnesium Sulfate
   administer at 5mL/min.

Complications of PIH:

1. Intrauterine growth restriction (IUGR) – an abnormally restricted symmetric or asymmetric growth of fetus
2. Oligohydramnios – abnormally low volume of amniotic fluid
3. Risk of placental abruption – premature separation of a normally situated placenta from the wall of uterus
4. Risk of preterm delivery (often iatrogenic) – delivery before 37 weeks of gestation
5. Coagulopathy
6. Stillbirth
7. Seizures
8. Coma
9. Renal failure
10. Maternal hepatic damage
11. Hemolysis
12. Elevated liver enzymes levels
13. Low platelet count (HELLP syndrome)

Nursing Interventions:

Intervention for mild PIH:	Rationale:
1. Assess maternal VS and fetal heart rate.	-to detect any increase which is warning that a women’s condition is worsening.
2. Encourage elevation of edematous arms and legs.	-to increase venous blood return.
3. Encourage compliance with bed rest in a lateral recumbent position.	-to increase evacuation of sodium and encouraging diuresis and lateral recumbent position can avoid uterine pressure on the vena cava and prevent supine hypotension syndrome.
4. Provide emotional support.	-this can make a women underestimate the severity of the situation.
5. Support patient with bed rest and darken the room if possible.	-because a bright light can trigger seizures.
6. Obtain daily hematocrit levels as ordered.	-to monitor blood concentration and help to the extent of plasma loss to interstitial space or extent of the edema.
7. Obtain blood studies (CBC, platelets count, liver function, BUN and creatinine, and fibrin degregation).	-to assess for renal and liver function and the development of disseminated intravascular coagulation which often accompanies severe vasospasms.
8. Obtain daily weights at the same time each day.	-to evaluate tissue fluid retention.
9. Raise side rails.	-to help prevent injury if seizure should occur.
10. Support nutritious diet of moderate to high in protein and moderate in sodium.	-to compensate for protein she is losing in her urine.
11. An indwelling catheter may be inserted as ordered.	-to allow accurate recording of output and comparison with intake.
12. Oxygen administration to the mother may be given as ordered.	-to maintain adequate fetal oxygenation and prevent fetal bradycardia.
13. Administer medication for seizures and hypertension episodes as ordered.	-to prevent seizures and hypertension.

Intervention for severe PIH:	Rationale:
1. Maintain patient’s airway by not putting a tongue blade between a women’s teeth during seizures.	-to prevent broken of teeth which could then be aspirated.
2. Turn a woman on her side.	-to allow secretions to drain from her mouth.

Discharge Plan:

Exercise

1. encourage patient’s on deep breathing exercises.
2. move extremities when lying.
3. elevate the head part when sleeping, to promote increase peripheral circulation
4. encourage overall passive and active exercises program during pregnancy to prevent need for cesarean birth.
5. exercises like tailor sitting, squatting, kegel exercise, pelvic rocking, and abdominal muscle contraction will promote easy delivery.

Treatment:

1. use of drugs
2. catheterization
3. obtaining labs. (CBC, platelets count, liver function, BUN and creatinine, and fibrin degregation)

Health Teaching:

1. Encourage patient foe sodium restriction.
2. Encourage to avoid foods rich in oil and fats.
3. Encourage patient to limit her daily activities and exercises.

Ongoing Assessment:

1. Observe carefully for symptoms at prenatal visit.
2. Give instruction about what symptoms to watch for so she can alert her clinician if additional symptoms occur between visits.

Diet:

1. low fats and sodium diet, restriction if possible.
2. high in protein, calcium and iron.
3. Adequate fluid intake