Published Nov 27, 2001
Right? What is the difference in eclampsia and pre-eclampsia? And what are the most important things to monitor and know about your patient on magnesium infusion?
PIH is an umbrella term under which are prg. induced hypertension with no other symptoms, preeclampsia, eclampsia, and HELLP syndrome.
Pregnancy induced hypertension is hypertension over baseline with no proteinuria, etc.
Preeclampsia's s/s: hypertension (new criteria 140/90 on more than one occasion), proteinuria, edema, epigastric pain, headache, scotoma, elvated liver enzymes. Not all these are present in every case.
Eclampsia: the above plus SEIZURES!!!!
HELLP: hemolysis of the red blood cells, elevated liver enzymes, low platelets, may or may not include hypertension.
One of the most important things about mag for PIH is to avoid fluid overload. Remember that dec. urine output is part of the disease of preeclampsia, because of the kidney involvement, so the tendency is to hydrate. If you do this, you are risking more third-spacing, leading to pulmonary edema (remember the pink, frothy sputum?) leading to ARDS, vents, ICU, very bad place for a pregnant lady!!
Hope this brief overview helps.
KRVRN, BSN, RN
Yeah, the basic difference is that eclampsia is pre-eclampsia that's worsened to the point of seizures.
Just one other thought regarding the mag - it is excreted through the kidneys and in the presence of altered kidney function, as with preeclampsia, you can't anticipate safe dosage solely on gram administration. Because of varying urine output, the same dose may lead to varying levels; non-therapeutic for the excellent kidney of the fine pregnant patient to toxic in the extremely compromised patient. Urine output needs to be evaluated in order to help anticipate mag levels between actual serum levels. (If you have a low urine output, you may end up with a high serum mag level.) Subsequently some of the nasty effects, like respiratory depression, can sneak in and, even more so, ruin your day.
Concerning the general question of preeclampsia diagnosis, my recent experience is that it is quite a wiley disease process. We have had some atypical presentations lately that have simply left me scratching my head and saying, "well I'll be darned." Don't underestimate it; even seemingly mild preeclamptics seize and organ damage can be general or extremely specific.
My added question is this: Realizing that unstable preecclamptic patients are a higher acuity, what is your protocol regarding the frequency of assessments while patients are on mag? In particular, how often are you recording vital signs? Our policy currently is that we take vitals every 5-min during the bolus and then every 15-30 minutes thereafter. Mag patients are on mag at a minimum of 24 hours and this doesn't provide for the rest she may at some point in time need. I realize that the choice of frequency should probably include nursing judgement, but about everything I have seen in the standards refers to "frequent" assessments but doesn't give a time reference. What is everyone out there in the big world doing?
We're doing q 5 min during the bolus then q 1 hour thereafter and prn. SOmetimes our docs will write for resps q 1 hour at night with other vs q 2 or sometimes even q 4 hours if they are stable and sleeping.
I have seen q5min during bolus, q15 min X 1 hour, then q30 min X 1 hour, then hourly.
Also, to add to the mag. protocol, we check output qh...PERIOD, and with less then 25-30cc output an hour, mag. is stopped & doc. is notified.
Stay safe out there.
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