1229 Exam 4: Gestational HTN Flashcards
Hypertension
Most common medical complication
Occurs in 6-8% of pregnancies
2nd leading cause of maternal death
Contributes significantly to stillbirth and neonatal morbidity and mortality
Morbidity/Mortality
Neonate Risk -placental insufficiency -abruptio placenta -IUGR--intrauterine growth retardation Maternal Risk -eclampsia that occurs before week 28 -maternal age >25 -multigravida -chronic renal -HTN
Hypertension defined
Blood pressure greater than or equal to 140/90
S BP > or = to 30mm Hg above baseline
D BP > or = to 15mm Hg above baseline
Must be present on 2 occasions at least 4-6 hours apart
Gestational Hypertension
Blood pressure elevation detected first time after mid pregnancy without proteinuria (previously known as pregnancy-induced hypertension)
Transient Hypertension
Gestational hypertension with no signs of preeclampsia present at the time of birth and hypertension resolves by 12 weeks after birth; this is a retrospective diagnosis
Preeclampsia
Pregnancy-specific syndrome that usually occurs after 20 weeks of gestation and is determined by gestational hypertension, proteinuria, hemoconcentration, and elevated BP
Eclampsia
The occurrence of seizures in a woman with preeclampsia that can not be attributed to other causes
Chronic Hypertension
Hypertension that is present and observable before pregnancy or that is diagnosed before week 20 of gestation
Preeclampsia superimposed on chronic hypertension
Chronic hypertension with new proteinuria or an exacerbation of hypertension (previously well controlled) or proteinuria, thrombocytopenia, or increases in hepatocellular enzymes
Maternal Effects of Mild Eclampsia
BP-reading of 140/90mm Hg x2, >4-6 hr apart, no more than 1 week apart Mean Arterial Pressure- >105mm Hg Proteinuria- >0.3g in a 24 hr specimen Reflexes- may be normal Urine output- output matching intake, >=30 ml/hr or <650 ml/24 hr Headache-absent/transient Visual problems-absent Irritability/changes in affect-transient Epigastric pain-absent Serum creatinine-normal Thrombocytopenia- absent AST elevation-normal or minimal
Maternal Effects of Severe Preeclampsia
BP-rise to >=160/110mm Hg on two separate occasions
Mean arterial pressure- >105mm Hg
Proteinuria- >2g in 24 hr
Reflexes-Hyperreflexia >3+, possible ankle clonus
Urine output-20 ml/hr or <400 ml-500 ml/24 hr
Headache-severe
Visual problems- blurred, photophobia, blind spots on funduscopy
Irritability/changes in affect- severe
Epigastric pain- present
Serum creatinine- elevated
Thrombocytopenia-present
AST elevation- marked
Plan of Care for Chronic Hypertension
Screening-before conception or 1st visit to determine risk
Medication Management-Aldomet; Induction; close monitoring for pulmonary edema, heart failure or renal failure
Lifestyle changes-may limit sodium, exercise limited, no smoking, no alcohol, decreased caffeine, teach how to monitor BP/urine
Breastfeeding-ok with Aldomet
Preeclampsia Risk Factors
Chronic renal disease, hypertension, family history/prior history, obesity, Rh incompatibility, diabetes, 40 years of age, multifetal gestation or primigravidity, african american, hydatidfrom mole
Plan of Care for Mild Preeclampsia
BP 140/90, 1-2+ protein, Pt understands then home management
Follow up visits-maternal fetal assessment 2-3 x week, BP, daily wt, urine dipstick for protein, kickcount, us q 3 weeks, nonstress test 1-2 x week
Activity-bedrest in lateral recumbent to increase blood flow, gentle exercise-ROM, kegel, quiet environment
Diet-may be on low sodium but salt helps maintain blood volume; avoid excessive salty foods; 60-70g protein, 1200mg calcium, 6-8 glasses of water, no alcohol, decrease caffeine
Symptoms to Report
BP values greater than those at time of d/c from hospital Visual changes Epigastric pain Nausea/vomiting Headaches Increasing edema-hands, face Decreased urinary output Decreased fetal movement
Plan of Care for Severe Preeclampsia
Environment-decrease external stimuli, seizure precautions
Monitoring-output via foley, lab work, FHR, daily wt, visual changes, epigastric pain, pulmonary edema, DTR’s & clonus
Bed rest-strict
Magnesium sulfate-prevent or control seizures; decrease risk of eclampsia by 50%
Prepare for delivery-may be delayed to administer steroids to mature lungs
Postpartum
Assess bleeding and fundus Frequent VS Continue Mag Sulfate usually 12-72 hrs-continue those assessments Assess for s/s of preeclampsia Can seizure postpartum Usually improve rapidly after birth
Fetal Status Assessment
FHR-variability, rate, decels Ultrasound NST/Contraction Stress Test Biophysical Profile Doppler Studies
Lab Studies
CBC Bleeding Times Liver Enzymes Chemistry Type and cross Urine-proteinuria
Effects of Magnesium Sulfate
Temp-affects regulating mechanism in hypothalmus; can cause decreased temp
Electrical conduction- decreased conduction from SA to AV node
Resp status-slows breathing
BP- decreases bp; transient & due to smooth ms relaxation; diastolic most affected
Output-mag excreted by kidneys; oliguria leads to increased serum levels
Hypertensive Meds
Hydralazine (Apresoline) agent of choice for severe preeclampsia, IV, target diastolic 95-100
Labetalol Hydrochloride (Normodyne) Betablocker
Methyldopa (Aldomet) Alpha2Receptor
Nifedipine (Procardia) Ca Channel Blocker; used in nonacute, not in hypertensive crisis, or severe HTN
