10.1d Chronic Hypertension and Eclampsia

Question 1

Eclampsia Preceding Signs

Answer 1

• Persistent Headache
• Blurred Vision
• Photophobia (discomfort in bright light)
• Severe Epigastric/RUQ pain
• Altered Mental Status
• Seizures can appear suddenly without warning even in stable women with only minimal BP elevation

Question 2

Immediate Care During Seizure

Answer 2

• Number 1 concern is airway patency and client safety
• Note time of onset and duration of seizure
• Call for help but remain at bedside
• Siderails should be raised with padding
• After the seizure, lower head of bed and turn patient on their side to avoid aspiration of vomitus

Question 3

After Seizure Care

Answer 3

• Goal is maternal stabilization
• Assess Airway, Breathing, Pulse (ABC’s)
• If apnea is present, open the airway and administer oxygen (ANBU Bag), then activate cardiac arrest code
• If breathing is present, suction secretions and administer 10L/min oxygen via face mask
• Magnesium Sulfate should be administered to treat seizure and prevent re-occurrence

Question 4

After Seizure Stabilization

Answer 4

• Assess Uterine Activity, Cervical Status, Fetal Status
• During seizures uterus becomes hypercontractile and hypertonic which can cause membrane ruptures or rapid cervix dilation (birth may be imminent)
• FHR with bradycardia, late decels, or absent/minimal variability should resolve once seizure ends.

Question 5

Anesthesia for Eclamptic Women

Answer 5

• Do not use regional anesthesia if platelets are lower than 50,000
• If c-section is needed, general anesthesia is used

Question 6

Chronic Hypertension

Answer 6

• Associated with superimposed preeclampsia, stroke, AKI, HF, Placental Abruption, and Death
• Fetal Risks include IUGR and Preterm Birth

Question 7

Chronic Hypertension Management

Answer 7

- Begin management before pregnancy (contraception) 
LIFESTYLE CHANGE
- smoking/alcohol cessation
- aerobic exercise
- losing weight

Question 8

Low Risk - High Risk Chronic Hypertension

Answer 8

• Low Risk Chronic Hypertension (antihypertensive medications are discontinued before pregnancy)
  High Risk Chronic Hypertension (antihypertensives are continued and frequent assessments are done on maternal/fetal well-being)

Methyldopa (Aldomet) - Most recommended medication for chronic hypertension in pregnancy

Other medications
- Labetalol, nifedipine, thiazide diuretics

Question 9

Chronic Hypertension After Birth

Answer 9

Monitor for complications

• Pulmonary Edema
• Hypertensive Encephalopathy
• Renal Failure

Question 10

Nursing Management of Potential Eclampsia

Answer 10

• Ask about headaches, visual disturbances, epigastric pain
• Check urine protein, BP in semi-fowler position, DTR, edema or rapid weight gain
  RISKS FACTORS of Eclampsia
• 35+, primigravida, onset happens most frequently during the 3rd trimester

Question 11

Risks of Severe Preeclampsia

Answer 11

• Seizure
• Liver Rupture
• Stroke
• Placental Abruption
• IUGR
• Death