Sample Healthcare Paper on Preeclampsia

Introduction

Preeclampsia is a hypertensive disorder in pregnancy and is characterized by high blood pressure more than 140/90mmHg or excess protein in urine after 20 weeks of pregnancy. This medical condition is among the leading cause of maternal and neonatal mortality and morbidity in both developed and developing countries. Globally estimated 2-8% of complicated pregnancies and 10-15% maternal deaths are due to preeclampsia. Developing countries in Asia and Africa are the most affected for example studies of preeclampsia prevalence in Ethiopia range from 4-12% and account for 15% maternal deaths (Belay et al, 2020)

 

                                                              Signs and symptoms

The presentation signs and symptoms in women with preeclampsia is associated with multiple organ systems. These include high blood pressure, protein in urine, weight gain within 2 days because increased body fluids, swelling, pulmonary edema, severe headache, nausea and severe vomiting, dizziness, chest pain, stomach pain in the upper right part, vision disturbances, elevated creatinine levels because of impaired kidney function and elevated liver enzymes.

The symptoms occur rarely after 20weeks of gestation and often set in 34 weeks of pregnancy, some few symptoms may present within 48 hours after delivery and tend to disappear own their own but can present up to 12 weeks.

                                                                  Pathogenesis

Pathogenesis of preeclampsia involves two stages: abnormal development of placenta and development of maternal syndrome.

Abnormal development of placenta.It is alleged that preeclampsia originates from the placenta. It is either failure of development or poor functioning of blood vessels that supply blood to the placenta resulting in low oxygen supply to the placenta and oxidative stress. This is caused by inadequate flow of blood to uterus, immune system disorder, damage of the blood vessels and genetic factors (Nephrol, 2019)

Maternal syndrome: The hallmarks of preeclampsia are not limited to the placenta only; there are extensive effects to the mother. The aetiology of martenal syndrome is believed to be imbalance of angiogenic factors. Angiogenic factors regulate vascular development and blood supply to the placenta. Preeclampsia and eclampsia pathologic lesions are indicated by extensive endothelial lesions in a variety of organs. In a study autopsy  of 317 women died of eclampsia, it was developed that 68.4%  of the women had  brain lesions with perivascular edema , 36.8% haemorrhage, 31.6%haemosiderin,10.5% small vessel thrombosis, 15.8% parenchymal necrosis. 72.2% of the women, liver lesions with sinusoidal fibrin, portal and periportal necrosis and in 44.4% hepatic arterial medial necrosis. The renal tissues indicated glomerular endothiliosis which is bloodless tissue due to hypoxia (Nephrol, 2019)

                                                                  Risk factors

These are factors that increase the chances of developing of preeclampsia in women.

Age is associated with preeclampsia where maternal age of below 18 and above 40 years has increased risk.WHO global survey of maternal and newborn health indicated high risk of preeclampsia to women >35 and < 19 years(Zahra et al,2016).

Family history of preeclampsia,there is a great possibility of familial pattern in  inheritance of preeclampsia. If a woman experiences a preeclampsia, it is a significant indicator of her daughter to experience preeclampsia. In a report by Chesley and Cooper the rate of preeclampsia occurance is sisters (37%), daughters (26%) and grand-daughters (16%) (Zahra et al, 2016).

History of preeclampsia, there is high risk of developing preeclampsia in a following pregnancy in women who had preeclampsia in their first pregnancy.

Long inter pregnancy intervals. Interbirth intervals of 4 years or more increases the risk of developing preeclampsia (Zahra et al, 2016). In a study done on Latin American and Carribean women indicated that 59 months intervals between pregnancies has higher risk of  preeclampsia than 18-23month interval(Noureen et al,2014).

Multiple pregnancies increases the risk of developing preeclampsia and this is attributed to the increased placental mass and subsequent increased placenta originated antiangiogenic markers   in circulation (Zahra et al, 2016)

In vitro fertilization is related with increased risk of preeclampsia and gestational hypertension than in spontenious conceived pregnancies. A cohort study indicated hypertensive disorder incidence in 5.9% of singleton and 12.6% of twin in assisted reproductive pregnancies and 4.7% of singleton and 10.4% of twin pregnancies in non assisted reproductive technology pregnancies (Zahra et al, 2016).

Preexisting medical conditions such diabetes mellitus, kidney diseases, lupus and rheumatoid arthritis. The risk of developing preeclampsia increases with severity of pregestational diabetes and also gestational diabetes. There is also increased risk of preeclampsia in women with preexisting autoimmune diseases such as lupus and rheumatoid arthritis (Zahra et al, 2016)

                                                              Diagnosis

A diagnostic criterion follows that onset of symptoms 20 weeks of pregnancy with remission 6-12 weeks after delivery. Preeclampsia can be mild or severe depending on the blood pressure levels. (i) mild preeclampsia is indicated by high blood pressure with two readings of more than 140/90mmHg at interval of 4-6 hours and proteinuria  with urine dipstic of > 1+ or > 300mg/24hours. (ii) severe preeclampsia is indicated  by one or more of the following, sustained blood pressure of  more than 160/110mmHg and sudden oliguria,pulmonary edema, nephritic range proteinuria, central nervous system symptoms or cyanosis(Nephrol.2019)

 

                                                      Management and prevention

The only treatment of preeclampsia is delivery. Other supportive care prevent progression to eclampsia include tight monitoring and control of blood pressure by using antihypertensives.

Preconception counseling, blood pressure control, management of complications, delivery and postnatal monitoring is crucial (Nephrol, 2019).

It is important to focus on the prevention of preeclampsia because of its significant mortality and morbidity. There is prophylactic use of aspirin. In high risk pregnancies take Aspirin 81mg daily after 12 weeks of pregnancy control blood pressure for the chronic hypertensives, avoid smoking, weight loss and control of obesity, regular exercise. Nurses should advice pregnant women on weight control, obesity and avoiding risk factors.

                                                       Nursing care and intervention

Nursing care for preeclampsia and pregnant induced hypertension entails providing good prenatal care, sufficient nutrition and control of pregestational hypertension. Early detection and management of preeclampsia can prevent its progression to eclampsia.

There a several nursing diagnosis and interventions that can help in early recognition and treatment of preeclampsia (Gil Wayne, 2019).

Deficient fluid volume can be related to plasma protein loss, osmotic pressure and fluid shift from vascular compartment. The indicators are sudden weight gain, edema, swelling, less peeing, vomiting. Nurses can intervene by checking weight of the patient regularly, monitor fluid input and output and regularly monitor blood pressure. Collaborate with other health care workers like physicians and nutritionist for a better management of the patient condition (Gil Wayne, 2019).

Decreased cardiac output indicated by change in blood pressure, shortness of breath, alteration of mental status and edema. Nurses should check vital signs especially pulse and blood pressure. Control blood pressure using suitable antihypertensives.  Collaborate with physician to determine whether labor induction is possible or surgical procedure (Gil Wayne, 2019).

Maternal injury can be related to tissue hypoxia or edema, abnormal blood profile and convulsions. Nurses should check for central nervous system involvement indicated by headache, visual changes and irritability, palpitation of the lower abdomen to check for uterine tenderness.  Collaborate with physician to manage convulsions, magnesium sulphate infusion is used (Gil Wayne, 2019).

                                                                 Conclusion

Managing preeclampsia and pregnancy induced hypertension is essentially to ensure safety of the mother and fetus. Nurses need to be vigilant in empowering women on the importance of prenatal clinic visits to check the progression of pregnancy. Patient and family education is a crucial tool that can be used to eliminate the risks of preeclampsia and other pregnant induced hypertension. Pregnant women and other home care givers should be trained on weight measurement, symptom checking and reporting any unusual sign and symptom. Nurses and obstetricians should be keen in constant monitoring of high risk pregnant women of preeclampsia because sometimes it fails to demonstrate early symptoms and signs

                                                                   References

Gil Wayne,BSN,R.N.(2019) 6 Pregnancy Induced Hypertension Nursing Care Plans.        https://nurseslabs.com

Belay Tolu et al, (2019) Maternal and perinatal outcome of preeclampsia without severe feature among pregnant women managed at a tertiary referral hospital in urban Ethiopia.PLoS ONE 15(4):e0230638. https//doi.org/10.1371/journal.pone.0230638

Nat Rev Nephrol, (2019) Preeclampsia: pathogenesis, novel diagnostics and therapies.15 (5): 275–289. doi:10.1038/s41581-019-0119-6.

Dr Zahra Hoodbhoy and Beth Payne, (2016) The FIGO Textbook of Pregnancy Hypertension: 1-                      195.The Global Library of Women’s Medicine