HELLP Syndrome

HELLP Syndrome Nursing Diagnosis Interventions and Care Plans

HELLP Syndrome NCLEX Review Care Plans

Nursing Study Guide on HELLP Syndrome

HELLP Syndrome is a rare and serious condition that occurs during pregnancy and can last after childbirth.

HELLP Syndrome is a life- threatening syndrome that stands for: Hemolysis or the destruction of red blood cells, Elevated Liver Enzymes, and Low Platelet count. This condition affects the blood, liver, and blood pressure.

Prompt treatment is needed to prevent further complications to the mother and the baby.

HELLP Syndrome is associated with pre-eclampsia and eclampsia, two serious complications of pregnancy that usually occur 20 weeks into pregnancy.

Pre-eclampsia is a condition involving high blood pressure among pregnant women that can lead to complications of the kidneys and liver.

Eclampsia, on the other hand, is its severe form that may induce seizures.

Signs and Symptoms of HELLP Syndrome

The signs and symptoms of HELLP Syndrome may occur suddenly and usually appear in the third trimester.

However, they may also appear during the early stage of pregnancy. Sometimes, HELLP can also cause confusion with the expected pregnancy symptoms.

The severity and onset of symptoms may vary among individuals.

  1. Abdominal pain – the most common symptom of HELLP Syndrome. It is localized in the upper right quadrant of the abdomen and not the usual pain brought about by pregnancy
  2. Fatigue
  3. Blurred vision
  4. Abrupt weight gain
  5. Fluid retention
  6. Facial swelling
  7. Swelling of the hands
  8. Headache
  9. Nausea or vomiting

In some cases, it may also cause:

  1. Seizures
  2. Nosebleed
  3. Prolonged bleeding

 Causes and Risk Factors of HELLP Syndrome

The exact cause of HELLP syndrome is unknown and its pathophysiology is still unclear.

However, certain studies show that it is strongly related to pre-eclampsia and endothelial cell injury.

Endothelial injury can result in vasospasms, and platelet activation causing inflammation, blood coagulation, and thrombocytopenia, a condition characterized by abnormally low platelet count.

Individuals with thrombocytopenia have high numbers of thrombotic micro-angiopathies that cause the breakdown of blood due to erythrocytes fragments.

This coagulation also results in an increased intrahepatic pressure, brought about by fibrin deposits in the liver, which can then result in the elevation of liver enzymes.

Although there is no known cause of HELLP Syndrome, there are certain factors that may increase the likelihood of developing the disease.

There is a higher risk of having HELLP in women who had this condition during their previous pregnancy.

Pre-eclampsia is also considered as a risk factor, but HELLP may also develop among women with normal blood pressure.

Other risk factors of HELLP Syndrome include:

  1. Age: Women older than 25
  2. Race: Caucasian
  3. Previous pregnancies and have given birth 2 or more times
  4.  Obesity and elevated body mass index
  5. Presence of kidney disease or diabetes
  6. History of pre-eclampsia
  7. Metabolic disorders

Complications of HELLP Syndrome

Although rare, individuals with HELLP Syndrome can be at risk of developing life-threatening complications.

If left without treatment, HELLP Syndrome can develop to serious complications such as:

  • Stroke. Cerebrovascular complication such as stroke can occur due to its significant relation with preeclampsia.
  • Placental abruption. This is a condition that involves the premature separation of the placenta from the uterine wall. It can cause bleeding, premature delivery or stillbirth.
  • Disseminated intravascular coagulation. A condition in which abnormal blood clots develop throughout the bloodstream
  • Seizures
  • Liver rupture due to prolonged liver dysfunction
  • Kidney failure
  • Excessive bleeding during delivery

Diagnosis of HELLP Syndrome

Due to the similarities in the symptoms of normal pregnancy and HELLP Syndrome, it is important to obtain an early and accurate diagnosis of the disease. These include

  1. Physical assessment and history taking
  2. Blood tests – to assess for liver function and bleeding abnormalities
  3. Imaging studies – such as ultrasound and MRI if liver dysfunction is suspected

Treatment of HELLP Syndrome

  1. Delivery. The main treatment for HELLP Syndrome is to deliver the baby as soon as possible because the risk for developing fetal and maternal complications increases with pregnancy. In some cases, the baby has to be born prematurely. In some cases, wherein emergency delivery is necessary, medications to induce labor may be given.
  2. Medications. These may include:
  3. Corticosteroids – a type of an anti-inflammatory medication that is used to speed up the development of the infant’s lungs, especially in the case of early delivery.
  4. Antihypertensives – drugs used to control the blood pressure during pregnancy and delivery.
  5. Anticonvulsants – medications used as prophylaxis or to prevent the occurrence of seizures.
  6. Blood transfusion – to correct anemia and increase platelet levels.
    • Blood monitoring. During the treatment, the red blood cells, platelet, and liver enzyme levels will be monitored continuously for any signs of deviation.
    • Fetal monitoring. Close monitoring of the baby’s overall condition will also be included in the management.

Prevention of HELLP Syndrome

Although there is no specific way to prevent HELLP Syndrome, it is still best to ensure overall health all throughout the pregnancy.

Regular prenatal visits help in early detection and treatment of the disease, it is also important that the healthcare team is aware of the client’s history such as previous high-risk pregnancies and a family history of HELLP Syndrome.

Nursing Care Plans for HELLP Syndrome

Nursing Care Plan 1

Nursing Diagnosis: Risk for Maternal Injury related to potential organ damage and seizure

Desired Outcome: The patient will maintain safety and participate in measures that will be able to protect herself during pregnancy.

          InterventionsRationale
Assess the patient’s mental status, or any CNS involvement (seizure activity, headaches, visual disturbances, or irritability).To determine the patient’s level of risk for maternal injury.
Monitor the patient’s level of consciousness using AVPU.  Cerebral edema and vasoconstriction reduce the oxygen supply in the brain, which may result to cerebral ischemia and is evidenced by lower levels of consciousness using AVPU scale (i.e. instead of Alert, the patient is only responsive to Voice, Pain stimuli, or Unresponsive/unconscious).
Prepare the patient for admission if there is any evidence of CNS involvement.To allow the healthcare team to monitor the pregnant mother and her baby, and to provide IV MgSO4 or other prescribed treatments as deemed necessary.
Place the patient in complete bed rest during severe headaches.Stress causes a persistent increase in cortisol levels, which has been linked to people with hypertension. The effects of stress are likely to increase myocardial workload.
In an event of a seizure activity (impending or actual), administer anticonvulsants as prescribed.Anticonvulsants are medications used as prophylaxis or to prevent the occurrence of seizures.  

Nursing Care Plan 2

Nursing Diagnosis: Decreased cardiac output related to increased systemic vascular resistance secondary to HELLP Syndrome, as evidenced by an average blood pressure level of 180/90, shortness of breath, fatigue, and weakness

Desired Outcome: The patient will have an improved cardiac output through well-controlled blood pressure levels throughout the remainder of her pregnancy.

InterventionRationale
Assess vital signs, conduct physical examination, and commence daily weight monitoring.Edema, headaches, visual disturbances, and abdominal pain are associated with HELLP Syndrome. Weight gain is an important symptom of preeclampsia-related HELLP syndrome. Fluid retention may be evident if the mother has a weight gain of more than 1.5kg/month during the 2nd trimester, or more than 0.5 kg/week during the 3rd trimester.
Instruct the patient to have bedrest and avoid environmental stressors.To lower blood pressure levels, improve cardiac rate, and enhance renal-placental perfusion.
Administer antihypertensives as prescribed.To lower blood pressure levels.
Prepare to deliver the baby either by labor induction or Cesarean section.The baby may be delivered earlier than expected if the risks for the mother and the baby become higher.

Nursing Care Plan 3

Nursing Diagnosis: Altered Uteroplacental Tissue Perfusion related to decreased oxygen-carrying capacity of red blood cells secondary to HELLP syndrome as evidenced by fatigue and weakness of the mother, intrauterine fetal growth retardation viewed in the scans, and changes in fetal heart rate

 Desired Outcome: Patient’s baby will have a stable fetal heat rate when subjected to contraction stress test.

InterventionsRationales
Teach the patient and her partner or next of kin on how to perform home assessment which includes noting daily fetal movements and identifying signs of fetal distress and how to get help immediately.Decrease in fetal activity may mean fetal compromise or distress, which requires immediate medical attention.  
Encourage the pregnant patient to follow a healthy lifestyle, such as smoking cessation and avoidance of illegal drug use, proper hydration, enough sleep, and appropriate diet.Fetal movement and activity can be affected by cigarette smoking, drug abuse, dehydration, sleep deprivation, and poor dietary choices.
Educate the patient on the signs of worsening HELLP syndrome such as seizure and maternal bleeding. and instruct to get help immediately if any of these occur.To give the patient enough information on the warning signs of worsening HELLP syndrome, which include uterine tenderness, vaginal bleeding, seizures, and persistent abdominal pain.  
Monitor fetal growth by measuring the fundus and check fetal heart rate at each clinic visit.To determine if the baby is experiencing intrauterine growth retardation related to HELLP syndrome.  
If the baby needs to be delivered prematurely, give IM corticosteroids as prescribed, not more than 7 days prior to expected date of delivery.To enhance the production of surfactants which are necessary to speed up the pulmonary maturity of the fetus and avoid respiratory distress syndrome.
Perform regular blood taking as ordered by the physician.During the treatment, the red blood cells, platelet, and liver enzyme levels will be monitored continuously for any signs of deviation.

Other nursing diagnoses:

  • Fluid volume deficit
  • Anxiety

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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