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MIDW 305 > CBL 6 – Thyroid and Hypertension > Flashcards

CBL 6 – Thyroid and Hypertension Flashcards

1
Q

Who do we screen for thyroid (risk factors)?

A
  • > 30 yrs
  • 2 prior preg
  • Hx PTL, infertility, loss
  • T1DM/ Celiac /Auto-immune
  • BMI >/=40
  • Hx thyroid disease
  • Family Hx of thyroid disease
  • Goitre
  • Taking meds for thyroid
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2
Q

What is normal thyroid levels in T1 for someone with prev thyroid disease?

A

0.1-4

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3
Q

What is the normal thyroid levels in T1 for someone with no prev thyroid disease?

A

0.1-5.0

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4
Q

What is subclinical hypothyroidism?

A

Elevated TSH normal T4

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5
Q

What are clinical symptoms and values of hyperthyroidism?

A

low TSH, high T3/T4
high energy, weight loss, tremor, hot, agitated mood

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6
Q

What are clinical symptoms and values of hypothyroidism?

A

high TSH, low T3/T4
low energy, tired, depressed mood, weigh gain, getting cold easily

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7
Q

What is thyroid storm?

A

Massive dump of T4/T3

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8
Q

When is thyroid storm more likely?

A

after surgery, infection, or after birth (postpartum)

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9
Q

What does a thyroid storm look like?

A

tachy, extreme irritability, cardiac event if not managed.

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9
Q

What is the thyroid feedback loop?

A

Pit releases TSH -»T3 and T4 -» more TSH/less TSH

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10
Q

How much dietary iodine recommended per day?

A

150 mcg

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11
Q

Perinatal complications hyperthyroidism?

A

Pre-eclampsia
PTL
Thyroid storm
IUGR
LBW
Fetal demise

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12
Q

Perinatal complications hypothyroidism?

A

Hypertension
Preeclampsia
Anemia
Miscarriage
PTB
PPH
LBW
Stillbirth

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13
Q

What should you avoid with levothyroxine?

A

Fe and Ca

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14
Q

Numbers needed for levothyroxine Rx?

A

TSH >=10

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15
Q

What is the leading cause of maternal morbidity worldwide?

A

HDPs

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16
Q

What are HDPs classified as? (4)

A

Chronic hypertension
Gestational hypertension
Preeclampsia
White coat hypertension

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17
Q

What is considered hypertension?

A

Systolic >=140
Diastolic >=90

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18
Q

Which part of BP is more concerning with hypertension?

A

Persistently high diastolic

19
Q

What is severe hypertension?

A

Systolic >=160
AND/OR
Diastolic >=110

19
Q

What is the criteria for pre-eclampsia?

A

Hypertension
AND one or more:
- Maternal organ dysfunction
- Fetal growth restriction

20
Q

Criteria for Eclampsia?

A

Hypertension
Same as pre-eclampsia
Seizures with no known origin

20
Q

Symptoms hypertension involving organ systems?

A

CNS –
Headaches
Flashing lights
Blind spots
Irritability
Hyperreflexia

CVS
Chest pain
Dyspnea (shortness of breath)
Distended neck veins

Liver
RUQ pain
Epigastric pain
Nausea / Vomiting

Kidney

Proteinuria
Oliguria
Edema (no longer part of criteria though – not specific enough)

Placenta
IUGR

21
Q

Symptoms of gestational hypertension?

A

RUQ pain
Headaches
Visual dist

21
Q

Risk factors for hypertension?

A

Obesity
Diabetes
Existing renal disease
Chronic hypertension
Prior preclampsia
Family Hx preeclampsia, gest hypertension
Carrying multiples
ART
New partner
Abnormal genetic screening analytes
Nulip
>40 yo

22
Q

Symptoms of pre-eclampsia?

A

Headache
Visual disturbances
Vomiting

23
Q

Symptoms of HELLP?

A

Epigastric pain
Platelet type bleeding
Jaundice

24
Q

Symptoms of Eclampsia?

A

Seizures

25
Q

What are the 4 principles of managing hypertension?

A

Evaluate well being of fetus/birther
Prevent severe complications
Manage symptoms
Expedite delivery

25
Q

Proper BP reading to confirm hypertension?

A

Blood pressure should be taken with the client in a
sitting position, with an appropriate sized cuff, and the
upper arm at the level of the heart.
* If blood pressure is elevated, take two readings with a
minimum rest period of 15 minutes between.

26
Q

What tests if hypertension? (5)

A

CBC
Creatinine
ALT/AST
Urine protein: UPCR, 24 hour urine (which people don’t do cuz it’s gross)
Assessment of fetal well being: growth, doppler, fluid

27
Q

What is the most significant distinguishing feature of preeclampsia vs hypertension?

A

Presence of proteinuria W hypertension

28
Q

What is proteinuria defined as?

A

> = 300 mg/day 24 hour urine collection
2+ on dipstick
UPCR <30

29
Q

Steps if proteinuria?

A

Consult OB
NST

30
Q

What is done in management of eclampsia?

A

Magnesium sulfate
Expedite delivery real fast
TRANSFER CARE

31
Q

What can reduce HDP? (5)

A

Low dose ASA
Calcium
Vit D
Exercise
Dietary advice

32
Q

Who should take low dose ASA in preg?

A

Prior pre-eclampsia
BMI >30
Chronic hypertension
Diabetes before preg
Kidney disease
Lupus
ART

2 or more:
Placental abruption
Prior stillbirth
Prior IUGR
>40
Nulip
Multifetal preg

33
Q

What are some possible hypertensive meds?

A

Labatalol 100-200 mg TID
Nifedipine 20 mg BID
Methyldopa 250 mg TID

34
Q

IOL for chronic hypertension?

A

Consider 37-38

Def by 40

immediate if unable to control BP >12 hours

34
Q

IOL for gestational hypertension?

A

Consider 37-38

Def by 40

immediate if unable to control BP >12 hours

35
Q

Preclampsia IOL?

A

(36-36+6) delivery should be considered - if stable

<24 should be considered

If BP cannot be controlled, increased organ dysfunction, or fetal indication - any GA

36
Q

How much ASA?

A

81-162 mg starting before 16 wks to 36 wks

37
Q

What is the purpose of controlling BP for HDP?

A

Decreasing the chance of maternal stroke

38
Q

Who should take calcium with ASA?

A

Only those people who don’t get enough dietary Ca intake

39
Q

What should be considered with transport for HDPs?

A

-maternal BP stable
-seizure prophylaxis given
-skilled HCP accompany to admin meds

40
Q

What is recommended PP for people with HDPs?

A

Monitoring of BP first 2 weeks of pp
BP checked again at 6 wks pp

MIDW 305 (13 decks)

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