Pathophysiology of Pre-Eclampsia (Nursing)

Vascular System Dysfunction and Endothelial Disruption

• Abnormal placental development in preeclampsia leads to endothelial disruption, triggering the body's response to release factors causing vasospasm and coagulation issues.

• Vasospasm in systemic vessels results in damage and capillary leakage, leading to sensitivity to angiotensin II and hypertension.

• The coagulopathies and abnormalities that arise contribute to thrombocytopenia and other complications.

The body is saying, something is not right, and it responds to that by releasing factors that cause vasospasm and coagulation issues, which are central to the pathophysiology of preeclampsia.

Manifestations and Symptoms

• Vasospasm and decreased perfusion impact multiple organs simultaneously, influencing presentations such as hypertension, uteroplacental spasm, and intrauterine growth restriction.

• Clinical signs include abnormal fundal height growth, glomerular damage indicators like increased uric acid and creatinine levels, and neurologic symptoms such as headaches and seizures.

When vasospasm and decreased perfusion occur, all organs are affected, with manifestations varying from intrauterine growth restriction to neurologic symptoms like headaches and seizures.

Generalized Edema and Upper Extremity Edema as Hallmark Signs

• Pre-eclampsia can lead to generalized edema, not limited to dependent edema, potentially affecting the face, causing the eyes to appear squinted due to excess pressure—resembling raccoons.

• The presence of upper extremity edema is a hallmark sign of pre-eclampsia as rings may not fit due to swelling.

• Clients with pre-eclampsia may also experience pulmonary edema due to systemic vessel involvement.

• Changes in hematocrit (H&H) can occur due to fluid accumulation in the lungs, leading to symptoms like dyspnea.

Having upper extremity edema and difficulty breathing can be key indicators of pre-eclampsia, demonstrating its systemic effects.