27 HTN

Question 1

Gestational HTN

Answer 1

HTN onset w.o proteinuria AFTER 20 week 
	• Systolic BP >140, diastolic BP >90
	• 2 occasions – 4 weeks apart
	• Persists from 1-12 weeks postpartum
Milder form of HTN in prego

Question 2

Chronic HTN

Answer 2

HTN before 20 week pregnancy
• If low risk, may D/C meds before prego as ACE inhibitors can be issue
• Try to maintain BP of 120-160 & 80-105
Meds recommended if needed are Labetalol, nifedipine, or methyldopa

Question 3

preecalmpsia

Answer 3

HTN w/ proteinuria or sign or end-organ damage AFTER 20 wk
• To prevent, will have 6-8 weeks of hypertensive meds
placenta MAY be cause

Question 4

preeclampsia S&S

Answer 4

H/A
right upper quadrant pain (liver; HELLP syndrome)
confusion (CNS change)
decreased outout (kidney)
visual distubrance (neuro)
respirtory difficulty (pulmonary edema) 
N&V
clonus 
deep tendon reflxes

Question 5

HELLP syndrome

Answer 5

hemolysis (H), elevated liver enzymes (EL), low platelets (LP)
complication of preeclampsia
Malise, flu, RUQ pain
more common in 3rd trimester & white women
Increases risk for pulmonary edema, acute renal failure, DIC, placental abruption, liver hemorrhage or failure, ARDS, sepsis , stroke, death

Question 6

peeclampsia management: identification & prevention

Answer 6

identification & prevention

• low-dose aspirin (60 to 80 mg) may help in at risk women
• Potential biomarkers (Tyrosine kinase (sFLt) and serum placental growth factor OR Abnormal uterine artery Doppler velocimetry in the first or second trimester of pregnancy

Question 7

peeclampsia management: assessment

Answer 7

BP
-lateral recumabnt or seated
-let rest 10 min before taking; no caffiene/tobaco 30 min
deep tendon reflexes
clonus?
proteinuria
H/A , Epigastric pain Right upper quadrant abdominal pain, Visual disturbances

Question 8

peeclampsia management: intervention for mild case

Answer 8

home health care only if BP <150/100; stable
maternal fetal assessment (mom take reading & do labs; baby can be measured with kicks; US)
ACITIVTY restriction (DVT risk)
diet
*PLAN FOR DELIVERY AT 37 WEEKS

Question 9

peeclampsia management: intervention for mild case

Answer 9

*PLAN TO DELIVER BY 34 WK
expectant management: betamaethasone
oral HTN meds to keep <160/110
intrapartum care: fluids at 125, bed rails (seizure precautions), emergency equipment, dark room (nonstimualting), meds (labetolol, nifidepine, mag sulfate, clacium gluconate)
labs
S&S
fetal well being
POSTPARTUM
-VS, DTR, consciousness
-mag sulfate for seizure precaution for 12-24 hr
-watch for ecalmpsia & HELLP syndrome
-BP watch for 3 days; meds if BP >150/100
-bonding
- Increased risk in future

Question 10

Magnesium Sulfate

Answer 10

-antidote is calcium gluconate
◊ Drug of choice for preventing & treating seizure activity (eclampsia)
-Given IVPB
-NEVER IM b/c tissue necrosis risk
- Does not decrease blood pressure
-Side effects: warm feeling,flushing, diaphoresis, burning at IV site
-Toxicity: absent deep tendon reflexes, respiratory depression, blurred vision, slurred speech, severe muscle weakness, cardiac arrest
- HIGH ALERT MED
-Initial is 4-6 g infused over 15-20 min BUT 4 grams in 20 minutes maintenance dose_)
-dose should maintain a therapeutic serum magnesium level of 4 to 7 mEq/L
ACTION: Relaxes the muscle for seizure prevention

Question 11

Eclampsia

Answer 11

Onset of seizure activity or coma in a woman with preeclampsia
-up to 6 weeks after delivery
-may need no hx of it
-S&S: clonus, RUQ pain
premonitory symotoms: blurred vission, H/A
- C/S no indicated
- no regional anestheisa is platelts <50,000
-Ensuring a patent airway and client safety
-Maternal stabilization (ABCs, O2 10L, IV if not yet started, more Mag Sulfate (doesn’t depress gag reflex)