HELLP Syndrome

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HELLP Syndrome Pathochart (Cheatsheet)
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Outline

Overview

  1.  HELLP
    1. Life threatening
    2. Requires emergent delivery

Nursing Points

General

  1. HELLP
    1. Hemolysis
    2. Elevated Liver enzymes
    3. Low Platelets
  2. At risk
    1. Older
    2. Multiparity

Assessment

  1. Labwork will show:
    1. Low RBC
    2. Elevated liver enzymes (AST, ALT)
    3. Low platelets
    4. Do NOT need all 3 to be diagnosed with HELLP!
    5. Watch lab trends
  2. Petechiae
    1. Low platelets
  3. Dizziness
    1. Hemolytic anemia
  4. Tachycardia
    1. Hemolytic anemia
  5. Nausea, vomiting
    1. Elevated liver enzymes
  6. Observe for DIC –> Patients are at risk
  7. Quick assessment and diagnosis is necessary, death can occur if not discovered

Therapeutic Management

  1. Attempt to stabilize
    1. Magnesium Sulfate
    2. Antihypertensives
    3. IV fluids
      1. Caution because of fluid overload risk
    4. Monitoring
  2. Delivery
    1. The only cure
    2. Emergent
  3. The syndrome should resolve 24-48 hours after delivery

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Transcript

Today we’re going to be talking about HELLP Syndrome.

 

In this lesson on HELLP syndrome we will cover what it is, what to look for, and treatment for this patient. 


Before we really dive in, it is important to know that this is a syndrome just in pregnancy. A patient is going to be more at risk if they are older, older than 34, or carrying multiple or multiparity. Some believe this is an exacerbation of preeclampsia and others believe it to be its own issue. Preeclampsia does occur a lot in these women or they show some symptoms of preeclampsia with HELLP symptoms. Refer to the lesson on preeclampsia to understand more about that disease process.

 

So let’s look at lab work. HELLP is actually a mnemonic so it makes it easy to remember. It is hemolysis, elevated liver enzymes, and low platelets. Now something super important that I want you to all to make sure you remember is that you do NOT need to have all 3 of these to be considered in HELLP syndrome. If you have all 3 you are in bad shape but you can have 1 of them that continues to trend down and still be diagnosed with HELLP. Next let’s look at some symptoms. 

 

Alright here are some symptoms. We have petechiae because we have low platelets. Abdominal pain and nausea/vomitting is because the liver enzymes are elevated and that liver is swollen. Tachycardia and dizziness because we have hemolysis of RBCs. So the patient is anemic. And usually these patients are also hypertensive. Remember when I said that some believe its an exacerbation of preeclampsia which is a hypertensive disorder of pregnancy. So you most likely will see that too. Alright now, what will we do to treat these patients?

 

Ok guys, delivery is the ONLY cure. These moms are very sick and a very sick mom can not grow a very healthy baby. If HELLP is left untreated these women can die. And Ill tell you, I’ve seen it. So it doesn’t matter if the baby is not to viability yet, if that mother is getting sicker and sicker than a delivery needs to happen. At this point, it is better to have 1 patient live than 2 die. Symptoms should resolve within 24-48 hours of delivery. Now if the mother comes in and is showing mild symptoms they will first attempt to stabilize. So medications. We can give mag sulfate as seizure prevention and other antihypertensives. She can be given blood products. We can give IV fluids to hydrate but be cautious in a hypertensive, fluid overloaded individual, right? Labs will be monitored to see if stabilization has occurred. If labs are still shifting in the wrong direction then delivery needs to happen.

 

So let’s wrap this up. HELLP stands for hemolysis, elevated liver enzymes, and low platelets. Remember this patient might present with anemia symptoms like tachycardia and dizziness. The patient might have epigastric pain, nausea from that inflamed liver, and petechiae from low platelets. Treatment to stabilize is mag sulfate if we need to prevent seizures and antihypertensives which are usually labetalol or hydralazine and possibly fluids to hydrate, but we have to be careful because they might be hypertensive and already in fluid overload. And our only cure is to deliver. Remember these patients are very sick and might seem stable but can quickly turn.


We love you guys! Go out and be your best self today! And as always, Happy Nursing!

 

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Maternity/Peds

Concepts Covered:

  • Pregnancy Risks
  • Prenatal Concepts
  • Liver & Gallbladder Disorders
  • Microbiology
  • Newborn Care
  • Postpartum Complications
  • Labor Complications
  • Labor and Delivery
  • Integumentary Disorders
  • Newborn Complications
  • Postpartum Care
  • Fetal Development
  • Cardiovascular Disorders
  • Respiratory Disorders
  • Endocrine and Metabolic Disorders
  • Neurologic and Cognitive Disorders
  • Male Reproductive Disorders
  • Female Reproductive Disorders
  • Sexually Transmitted Infections
  • Hematologic Disorders
  • Hematologic Disorders

Study Plan Lessons

HELLP Syndrome
Nutrition in Pregnancy
Antepartum Testing
Discomforts of Pregnancy
Physiological Changes
Hb (Hepatitis) Vaccine
Phytonadione (Vitamin K)
Eye Prophylaxis for Newborn (Erythromycin)
Rh Immune Globulin (Rhogam)
Meds for PPH (postpartum hemorrhage)
Uterine Stimulants (Oxytocin, Pitocin)
Prostaglandins
Opioid Analgesics
Magnesium Sulfate
Betamethasone and Dexamethasone
Tocolytics
Meconium Aspiration
Newborn of HIV+ Mother
Fetal Alcohol Syndrome (FAS)
Addicted Newborn
Erythroblastosis Fetalis
Hyperbilirubinemia (Jaundice)
Retinopathy of Prematurity (ROP)
Transient Tachypnea of Newborn
Babies by Term
Newborn Reflexes
Body System Assessments
Newborn Physical Exam
Initial Care of the Newborn (APGAR)
Postpartum Thrombophlebitis
Subinvolution
Mastitis
Postpartum Hemorrhage (PPH)
Postpartum Hematoma
Postpartum Discomforts
Postpartum Interventions
Postpartum Physiological Maternal Changes
Dystocia
Precipitous Labor
Preterm Labor
Abruptio Placentae (Placental abruption)
Placenta Previa
Prolapsed Umbilical Cord
Premature Rupture of the Membranes (PROM)
Obstetrical Procedures
Fetal Heart Monitoring (FHM)
Leopold Maneuvers
Mechanisms of Labor
Process of Labor
Fetal Circulation
Fetal Development
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Infections in Pregnancy
Gestational HTN (Hypertension)
Hyperemesis Gravidarum
Hydatidiform Mole (Molar pregnancy)
Hematomas in OB Nursing: Causes, Symptoms, and Nursing Care
Ectopic Pregnancy
Disseminated Intravascular Coagulation (DIC)
Gestational Diabetes (GDM)
Chorioamnionitis
Cardiac (Heart) Disease in Pregnancy
Anemia in Pregnancy
Abortion in Nursing: Spontaneous, Induced, and Missed
Maternal Risk Factors
Fundal Height Assessment for Nurses
Gravidity and Parity (G&Ps, GTPAL)
Gestation & Nägele’s Rule: Estimating Due Dates
Family Planning & Contraception
Congenital Heart Defects (CHD)
Obstructive Heart (Cardiac) Defects
Mixed (Cardiac) Heart Defects
Acute Bronchitis
Bronchiolitis and Respiratory Syncytial Virus (RSV)
Cystic Fibrosis (CF)
Phenylketonuria
Cerebral Palsy (CP)
Nursing Care and Pathophysiology for Male Infertility
Nursing Care and Pathophysiology for Endometriosis
Nursing Care and Pathophysiology for Pelvic Inflammatory Disease (PID)
Nursing Care and Pathophysiology for Polycystic Ovarian Syndrome (PCOS)
Nursing Care and Pathophysiology for Syphilis (STI)
Fever
Nursing Care and Pathophysiology for Sickle Cell Anemia
Nursing Care Plan (NCP) for Sickle Cell Anemia
Sickle Cell Anemia
Mixed (Cardiac) Heart Defects
Anti-Infective – Penicillins and Cephalosporins