Hi guys, it's me, Professor D, and welcome back to my YouTube channel. Before I even introduce the subject, I would like to bring attention to my Wakanda-themed top, Wakanda Forever. Moving forward, I am half Haitian and half Wakandan.
All right. With that being said, guys, I'm going to be covering preeclampsia. This is going to be part one of a multi-part series.
Also, please do not forget, I have audio lessons available on my website, nexusnursinginstitute.com. So let's get started. Preeclampsia. Take a look.
So it says preeclampsia. This is a pregnancy specific. It's a pregnancy specific condition in which hypertension and proteinuria develop after 20 weeks gestation in a woman who previously had neither condition.
So there are a couple of key elements that you guys have to understand with preeclampsia. So yes, the pregnant woman has hypertension. But in addition to the hypertension, proteinuria has to be present and it develops after 20 weeks of gestation.
That is your preeclampsia. Let's take a look at the etiology. The incidence and severity of preeclampsia is substantially higher in women with multifetal gestation. So if she's carrying twins or triplets, quadriplets. a history of preeclampsia, if she's had preeclampsia in previous pregnancies, chronic hypertension, because remember, preeclampsia is not only the hypertension, it's with proteinuria after that 20 weeks of gestation.
So if she's had chronic hypertension in the past, that's a risk factor, pre-existing diabetes and pre-existing thrombophilias. Now, guys, this list. You have to know those risk factors because usually you will be asked about it and it will be in the form of select all that applies. Don't say I didn't warn you.
Let's take a look at the classifications of hypertensive states in pregnancy, specifically preeclampsia. Again, hypertension and proteinuria after 20 weeks gestation in the early post or in the early postpartum period. Look at this. In the absence of proteinuria, the development of new onset hypertension with a new onset of any of the following thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms. And I'm going to talk about this more in depth, probably going to be the part three video.
Pathophysiology. Freclampsia is a progressive, that means as time goes on, it gets worse. It's a progressive disorder. With the placenta as the root cause, I want you to think about it. If the placenta is the root cause of preeclampsia, what do you think the cure is for preeclampsia?
Giving birth, right? Getting rid of that placenta out of the body. Preeclampsia is the root cause.
Therefore, the disease begins to resolve after the placenta has been expelled. And CLEX expects you to know this. Current thought is that the pathologic changes that occur, there we go, that occur in the woman with preeclampsia are caused by disruptions in placental perfusion. Remember guys, that word perfusion, that's just a fancy word of us knowing how well the organs are being fed, the oxygen rich vitamins, nutrients, minerals, and such.
So take a look. Normally in pregnancy. The spiral arteries in the uterus widen from thick wall of muscular vessels to thinner sac-like vessels with much larger diameters.
That's normally what happens. And that's a good thing that that normally happens because as the walls increase and the diameter becomes larger, what does that mean? That means more oxygen-rich blood is flowing.
And so the uterus is able to be perfused. This change increases the capacity of the vessels, allowing them to handle the increased blood volume of pregnancy. Because this vascular remodeling does not occur or only partially develops in the woman with preeclampsia, decreased placental perfusion and hypoxia result. What does that mean? That means the placenta, which essentially nourishes the fetus, guys.
The placenta is getting less of the oxygen, vitamins, minerals, nutrients that that blood is carrying. It's not being perfused enough in preeclampsia because the thought process is that those vessels aren't. dilating the way that they should. Okay. Take a look at this diagnostic criteria for preeclampsia and preeclampsia with severe features.
Again, part one, we're just so focusing on the preeclampsia. So I want to focus on these two, the hypertension and the proteinuria. Let me make this a little bit larger for you. And you may have to pause to read because I'm not going to go over all of them.
I'm just going over the most important things that you guys need to know. The blood pressure higher than 140 over 90 times two, at least four hours apart, again, after 20 weeks gestation. And somebody that normally did not have hypertension, this wasn't an issue.
Look at proteinuria. Proteinuria of more than or equal to 300 milligrams in a 24-hour specimen. The protein creatinine ratio more than or equal to 0.3.
We'll see one or... one plus or higher on the dipstick for protein. Take a look at these common lab changes in preeclampsia.
And I love that they have the normal non-pregnant woman with the preeclampsia and then they have the health syndrome. That's going to be another video, but I promise it's coming soon. I want to bring your attention to the platelets with preeclampsia decrease.
Less than 100,000. We know platelets help you to clot and not to bleed out. So take a look.
Less than 100,000. Look at the BUN increased. Creatinine increased. Creatinine clearance. The normal non-pregnant woman is about 81-25 with preeclampsia 130 to 180. And as I go into the part two and part three, these labs are going to make much more sense to you.
Look at the risk factors for preeclampsia. Remember guys, I told you, you're gonna see the test question. Most often it's the select all that apply. They already told us the risk factor in the text, right?
And now you're seeing it in the box again. You think that's important to know? Absolutely.
Risk factors, age, older than 40 years old, pregnancy with assisted reproductive techniques. So if mom was taking hormones or something else to get pregnant, family history of preeclampsia. obesity or gestational diabetes multi-fetal pregnancy having preeclampsia in a previous pregnancy um i move my hand so you guys can pause to read make sure you know all of them i don't write your test but i did put a star next to the ones that tend to show up on the nursing exams and collects ati has see the most okay you definitely have to know the risk factors for preeclampsia you Take a look at this figure.
This figure is basically illustrating what we already read. The prop, one of the biggest problems with preeclampsia is that those vessels are dilating the way that they should. So the oxygen rich, you know, uh, blood is not perfusing. Um, the, I'm sorry, you guys are doing work downstairs. You can hear that noise, the placenta.
Okay. So look at this figure, inadequate vascular remodeling. fancy way of saying those vessels aren't stretching the way they're supposed to, causes decreased placental perfusion and hypoxia. The placenta is not getting enough of that oxygen rich blood and it causes hypoxia.
That leads to endothelial cell dysfunction, which causes three things, vasospasms, which further worsens the hypoxia and decrease perfusion, increase peripheral resistance. which also increases the hypoxia and decreased perfusion and increased endothelial cell permeability. All of these decrease tissue perfusion. Vasospasms, which result in poor tissue perfusion.
This happens in all organs, increased peripheral resistance and blood pressure and increased endothelial cell permeability. All of these lead to intravascular. Look at this, guys.
Protein and fluid loss. Guys, are you ever supposed to see protein in the urine? Absolutely not. When it gets to the kidneys, the kidneys not supposed to let, you know how big protein are? It's not supposed to let protein out in the urine.
It's supposed to go back into the bloodstream. Okay. But we see protein and fluid loss and ultimately to less plasma volume. The main pathogenic factor is not an increase in blood pressure, but poor perfusion.
as a result of the vasospasm and the reduced plasma volume. Protein. Primarily, albumin is lost in the urine.
Let's stop for a minute, guys. So you guys know albumin is a part of the blood, but that's the protein portion of the blood. Great.
Did you know that that albumin, that protein, that is what is keeping the fluid within the vessel and not leaking out into the tissue? Yeah. That is very important to understand.
So take a look. Protein, primarily albumin, is lost in the urine. What do you think happens when that protein is lost?
That fluid that was hanging around in the vessels, they're like, oh, party time. No more protein to keep us in the vessels. Let's go out to the tissue. And that's why you see all that edema.
Uric acid clearance is decreased, but serum uric acid levels increase. Why? Kidney's not functioning properly to get rid of that uric acid. So it goes right back into the bloodstream.
Sodium and water are retained, which makes that patient even more edematous. Acute tubular necrosis and renal failure may occur. Serum albumin levels decrease. Why?
It's being lost in the blood. It's being lost in the urine. That's why it decreased. The intravascular volume is reduced as fluid moves out of the intravascular compartment, resulting in hemo concentration, increased blood viscosity, and tissue edema.
They're saying a lot here. So I got to make sure you guys understand what's happening here. Again, remember. albumin is the protein portion of blood that protein is what is keeping all of the fluid within the vascular space so as the albumin gets lost in the urine the fluid that was supposed to stay in the vascular space is now leaving the vascular space going out in the tissue causing tissue edema and the little bit of blood that's left in the vascular space it's thick edamidus okay that's what's causing this chemo concentration and blood viscosity making that blood very thick All of that fluid is going out into the tissues. It's leaving the intravascular space.
Decreased liver perfusion can lead to impaired liver function and elevated liver enzyme levels. And that you can see when you go back and look at these labs. If you, where are these labs? There we are.
Look at the ALT and AST. Both of them are increased. Both of them are increased, your ALT and AST. The liver definitely gets affected, guys. Every single organ in your body needs to be perfused.
So when we're talking about preeclampsia, important organs such as the liver are going to be affected. And definitely the kidneys, you know those kidneys are affected. They're letting all this protein out in the urine.
And that's why you'll see the creatinine clearance. Look at the creatinine clearance. Look at the creatinine.
Look at the BUN. Look at what it's doing. It makes sense. So guys, this is the part one of preeclampsia because I want to cover all of the portions of preeclampsia before I get into HELP syndrome.
But HELP syndrome is very important for you guys to know. It's not different than preeclampsia. It's a type of eclampsia.
So I'm going to get into that after I completely cover the preeclampsia topic. So guys, in the comment section, please let me know what you thought about this first portion of the video. Let me know what you'd like me to go in more detail about.
Please don't forget every Sunday, 1 p.m. Eastern Standard Time, I have a video that's released where I cover nursing questions. I teach you how to answer the questions. I teach you how to eliminate wrong answer choices.
And don't forget, I have audio lessons available on my website, nexusnursinginstitute.com. Thank you so much for watching this video and you guys will catch me on the next video.