HELLP Syndrome

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
Petechiae
1. Low platelets
Dizziness
1. Hemolytic anemia
Tachycardia
1. Hemolytic anemia
Nausea, vomiting
1. Elevated liver enzymes
Observe for DIC –> Patients are at risk
Quick assessment and diagnosis is necessary, death can occur if not discovered

Therapeutic Management

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

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Head to Toe Nursing Assessment (Physical Exam)

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General Assessment (Physical assessment)

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Abdomen (Abdominal) Assessment

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Platelets (PLT) Lab Values

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Direct Bilirubin (Conjugated) Lab Values

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Liver Function Tests

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Total Bilirubin (T. Billi) Lab Values

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Albumin Lab Values

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Cholesterol (Chol) Lab Values

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Lactate Dehydrogenase (LDH) Lab Values

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Lipase Lab Values

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Alanine Aminotransferase (ALT) Lab Values

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Alkaline Phosphatase (ALK PHOS) Lab Values

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Urinalysis (UA)

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Protein in Urine Lab Values

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Coagulation Studies (PT, PTT, INR)

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D-Dimer (DDI) Lab Values

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Corticosteroids

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Betamethasone and Dexamethasone

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Dexamethasone (Decadron) Nursing Considerations

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Hydralazine (Apresoline) Nursing Considerations

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Nifedipine (Procardia) Nursing Considerations

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Magnesium Sulfate

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Fetal Heart Monitoring (FHM)

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Blood Transfusions (Administration)

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HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)

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.

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Outline

Overview

Nursing Points

General

Assessment

Therapeutic Management

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