Hi, just a question on MESs of PIH patients

[whitebunny]

Im currently writing a paper on a case analysis of PIH patients

and i discussed a lot regarding PIH patient's facial, knee, hand, sacral edema and pulmonary edema

since the pathophysiology behind pulmonary edema is Endothelia (cant spell so tired) tissue dysfunction, this pt is having chest tightness, SOB

why patient is not provided lasix? im just thinking what i did on med/surg

LASIX can expand her lung and get rid of excess fluids and even reduce her BP!!!!

this pt is just given Mg Sulfate and Hydralazine (cant spell so tired) and go for induction!!!

i researched, didnt find nothing regarding lasix on pregnant woman~~~~

million thanks for help!

[whitebunny]

im sry i just cant spell

it is lasix

and it is MEDs

[davidthenurse]

Is you research in the MIMs (the drug Bible used here in Australia), Lasix must NOT be given during pregnancy unless it is absolutely necessary. If treatment with Lasix is to be used during pregnancy, then fetal growth has to be closely monitored.

As you would know, Lasix is a "loop-diuretic" and it has the capacity to cross the placental cord and enter the fetal circulation. The biggest problem with this is that it can cause electrolyte disturbances, and worse yet, thrombocytopenia of the fetus. This is of the biggest risk during early stages of pregnancy. That's not to rule out risks during later stages of pregnancy. The MIMs indicates that "During the latter part of pregnancy products of this type should only be given on sound indications, and then in the lowest effective dose."

An alternative drug which is commonly used to to treat HT in pregnant women is Aldomet, which CAN be used for pregnant women.

Hope that helps !!

[whitebunny]

Is you research in the MIMs (the drug Bible used here in Australia), Lasix must NOT be given during pregnancy unless it is absolutely necessary. If treatment with Lasix is to be used during pregnancy, then fetal growth has to be closely monitored.

As you would know, Lasix is a "loop-diuretic" and it has the capacity to cross the placental cord and enter the fetal circulation. The biggest problem with this is that it can cause electrolyte disturbances, and worse yet, thrombocytopenia of the fetus. This is of the biggest risk during early stages of pregnancy. That's not to rule out risks during later stages of pregnancy. The MIMs indicates that "During the latter part of pregnancy products of this type should only be given on sound indications, and then in the lowest effective dose."

An alternative drug which is commonly used to to treat HT in pregnant women is Aldomet, which CAN be used for pregnant women.

Hope that helps !!

WOW!!!! Thank you very much! That totally clearies my question!

No, im doing a detailed case study of a complex perinatal client. That question just popped out of my mind as i go through the patho, drugs and etc.....thx for the help....i used critical thinking though! =D

[davidthenurse]

No problems, and you're more than welcome !

[babyktchr, BSN, RN]

Think about the swelling you are dealing with. It is interstitial swelling, commonly referred to as "third spacing". Fluid is trapped in the tissues(leaky capillaries), not in the intravascular space. These patients, though they are swollen, tend to already be on the dry side. Giving them Lasix would only further the dehydration and your swelling would still persist. Managing the hypertension and protein imbalances would be your best bet, not a diuretic.

[whitebunny]

Think about the swelling you are dealing with. It is interstitial swelling, commonly referred to as "third spacing". Fluid is trapped in the tissues(leaky capillaries), not in the intravascular space. These patients, though they are swollen, tend to already be on the dry side. Giving them Lasix would only further the dehydration and your swelling would still persist. Managing the hypertension and protein imbalances would be your best bet, not a diuretic.

hi~thank you for clearify the different edema between intravscular and interstital! how would manage the protein imbalances though? cuz research has show little info on diet which could fix PIH~~

[babyktchr, BSN, RN]

Many moons ago, we used to give Albumin for third spacing (anyone remember that). It isn't so much managing the protein, but keeping an eye on protein in the urine and such. You just have to keep an eye on these girls...they can get sick so fast.

[CEG]

Keep in mind that elevated BP is only a symptom of PIH and even if it is lowered does not fix the underlying problem. Edema is no longer considered diagnostic of PIH, but even if we could correct for it we still would not have cured the PIH. The only cure is delivery so you have to question the benefit of introducing other meds on top of what she is already on. Sounds like you have the science down (better than me )

[whitebunny]

Keep in mind that elevated BP is only a symptom of PIH and even if it is lowered does not fix the underlying problem. Edema is no longer considered diagnostic of PIH, but even if we could correct for it we still would not have cured the PIH. The only cure is delivery so you have to question the benefit of introducing other meds on top of what she is already on. Sounds like you have the science down (better than me )

thank you~

yes i did mention that the edema is no longer a diagnostic critieria because it is so commonly seen in pregnancy, and pts who have no PIH can rapidly develop HELLP as well.

She is going to induction, and u r right, we shouldnt add other meds for her cuz the induction is the only way to solve her problem, plus PIH resloves without 48 hours after delivery

thank you for your help!

[whitebunny]

Many moons ago, we used to give Albumin for third spacing (anyone remember that). It isn't so much managing the protein, but keeping an eye on protein in the urine and such. You just have to keep an eye on these girls...they can get sick so fast.

hi hi

thank you for that information, i didnt know that, could u explain it a little bit more? i think we can only keep an eye on her protein nothing could cure that unless induction

and why is the reason you are not giving albumin any more?

i want to add that onto my paper!

[NurseNora, BSN, RN]

there's little that can be done for the low serum protein. Some docs will still order a high protein diet, may not help, but doesn't hurt. The low serum protein is because of the disease's effect on the kidneys. The kidney's dump protein into the urine, serum protein falls, there's not enough osmotic pressure to suck fluid back into the blood stream, edema increases, blood volume decreases, cerebral edema leads to headaches, visual changes and possibly seizures, liver edema causes the epigastric pain, even rupture of the liver.

Keep the blood pressure down to a level where the patient us unlikely to blow out her brainstem, give MgSO4 to prevent seizures, and deliver that baby. Most seizures occur before delivery, but there is still significant risk for 24 hours after delivery. The farther from delivery you are, the safer, but patients have been known to seize up to 6 weeks post partum.