ch. 27: hypertensive disorders Flashcards
What are the 3 common types of hypertensive disorders?
1) gestational htn
2) preeclampsia
3) chronic essential htn
When do gestational htn and preeclampsia develop?
after 20 weeks of gestation
What is PREECLAMPSIA?
-pregnancy-specific condition
-HTN & PROTEINURIA develops after 20 weeks of gestation in a previously normotensive woman
-can also develop for FIRST time during POSTPARTUM
What is PREECLAMPSIA defined as in the absence of PROTEINURIA?
HTN along w/
-thrombocytopenia
-impaired liver func
-new onset renal insufficiency
-pulmonary edema
-new-onset cerebral or visual disturbances
What is the ROOT CAUSE of PREECLAMPSIA?
-placenta
-only cure is delivery
What is the pathophysiology of PREECLAMPSIA?
-normally the arteries in the uterus become larger and thicker to handle increased BV
-this vascular remodeling DOES NOT OCCUR or only PARTIALLY DEVELOPS in women w/ preeclampsia
-results in: ↓ PLACENTAL PERFUSION & ENDOTHELIAL DYSFUNCTION
What does the generalized vasospasm in preeclampsia lead to?
-poor tissue perfusion
-↑ peripheral resistance and BP
-↑ endothelial cell permeability: LEAKING EVERYWHERE
What are common risk factors for PREECLAMPSIA?
-multifetal preg
-hx of preeclampsia
-chronic htn
-preexisting diabetes &/or thrombophilias
-women w/ limited sperm exposure w/ same partner
-paternal factors
What is HELLP syndrome?
-lab dx for a variant of preeclampsia that involves hepatic dysfunction characterized by:
1) HEMOLYSIS
2) ELEVATED LIVER ENZYMES
3) LOW PLATELET
Who can develop HELLP syndrome?
can develop in women who DONT have htn or proteinuria
What is HELLP syndrome a result of?
result of arterial vasospasm, endothelial cell dysfunction w/ fibrin deposits, & adherence of platelets in blood vessels
What are signs and symptoms of HELLP syndrome?
-hx of malaise
-flu like s/s
-epigastric or RUQ pain
-s/s WORSEN at night and IMPROVE during DAYTIME
Is there a reliable test or screening tool to ID preeclampsia?
no
What are elevated levels of PROTEINURIA?
+1 on dipstick OR > 300mg/day in a 24 hr collection
What do you assess for in preeclampsia?
-BP
-edema
-DTR
-proteinuria
What are signs of SEVERE preeclampsia?
-headache
-epigstric pain
-RUQ abd pain
-visual disturbances
What is the GOAL of interventions for GESTATIONAL HTN & PREECLAMPSIA W/O SEVERE FEATURES?
1) ensure maternal safety
2) deliver a healthy newborn as close to term as possible
Are there any benefits of activity restrictions for women w/ preeclampsia?
no
What is the best environment for women w/ preeclampsia?
-quiet
-nonstimulating
-dark, lighting subdued
What are the seizure precautions?
-suction equipment tested and ready to use
-O2 administration equipment tested and ready to use
-call button within easy reach
What is MAGNESIUM SULFATE?
med of choice for PREVENTING and TREATING SEIZURE ACTIVITY (eclampsia)
How do you administer magnesium sulfate?
as a secondary infusion (piggyback) by a volumetric infusion pump
What is the initial loading dose for magnesium sulfate?
4 to 6 g over 15-30 min
What is the maintenance dose for magnesium sulfate?
2 to 3 g an hour
What effect does MAGNESIUM SULFATE have on MATERNAL BP?
-has little effect on maternal blood pressure when administered in that fashion
What is the therapeutic level for magnesium sulfate?
4 to 7
What are COMMON SIDE EFFECTS of magnesium sulfate?
-feeling of warmth
-flushing
-diaphoresis
-burning at IV site
What are SYMPTOMS of MAGNESIUM TOXICITY?
-ABSENT DTRs
-decreased RR
-decreased LOC
What is the antidote for magnesium sulfate?
calcium gluconate in 10% solution (10 ml)
-give 1g over 3 min
When are ANTIHYPERTENSIVE MEDS indicated?
-SBP > 160
-DBP > 110
Is Magnesium Sulfate continued after birth?
yes for seizure prophylaxis
-usually for 24 hrs after delivery
What are premonitory s/s for ECLAMPSIA?
1) persistent H/A & BLURRED VISION
2) EPIGASTRIC OR RUQ PAIN
3) ALTERED MENTAL STATUS
What is the INTERVENTION during a seizure?
-ensure a patent airway
-call for help but stay at bedside
-raise bed rails and pad them
-observe and record convulsion activity
What is the IMMEDIATE CARE AFTER a seizure?
-dont leave unattended until fully alert
-observe for postconvulsion confusion, coma, incontinence
-suction as needed
-admin O2 via NONBREATHER MASK at 10L/min
-start IV
-insert urinary cath
-give mag sulfate or other anticonvulsant
-monitor mom and baby vs
What is GESTATIONAL HTN?
onset of htn W/O PROTEINURIA or other systemic findings diagnostic for PREECLMAPSIA after 20 weeks of pregnancy
-SBP > 140
-DBP > 90
What is ECLAMPSIA?
onset of SEIZURE ACTIVITY or COMA in a woman w/ PREECLAMPSIA
What are women w/ chronic htn w/ superimposed preeclampsia at HIGH RISK of?
-stroke
-AKI
-cardiac failure
-placental abruption and death
What are the MATERNAL EFFECTS of Hydralazine (Apresoline, Neopresol) ?
-H/A, flushing, palpitations, TACHYCARDIA, increase HR, increase CO, increase in O2 CONSUMPTION, n/v, some decrease in uteroplacental blood flow
What are NURSING ACTIONS for Hydralazine (Apresoline, Neopresol) and Methyldopa (Aldomet)?
-assess for effects of med: assess BP
-wait AT LEAST 20 min before giving another dose
-assess urinary output
-maintain BEDREST in LATERAL POSITION W/ side rails up
What meds should NOT be given to pts w/ tachycardia?
Hydralazine (Apresoline, Neopresol) and Nifedipine (Adalat. Procardia)
What are the MATERNAL EFFECTS of Labetalol Hydrochloride (Normodyne, Trandate)?
-lethargy, fatigue, sleep disturbances
-MINIMAL: flushing, tremulousness, orthostatic hypotension, minimal change in pulse
What are the NURSING ACTIONS for Labetalol Hydrochloride (Normodyne, Trandate)?
-less likely to cause excessive tachy and hypotension and rebound htn than hydralazine
-DO NOT USE IN WOMEN W/ ASTHMA, HEART DISEASE, OR CONGESTIVE HEART FAILURE
-DONT give more than 80 mg in ONE dose
-DONT five >300 mg/ 24 hrs
What are the MATERNAL EFFECTS of Methyldopa (Aldomet)?
-sleepiness, postural hypotension
-constipation
-hepatic dysfunction and necrosis
-hemolytic anemia
What are the MATERNAL effects of Nifedipine (Adalat, Procardia)?
-hedache, flushing
-TACHYCARDIA
-may interfere w/ labor
What med should you AVOID administering if the pt is on MAGNESIUM SULFATE?
Nifedipine (Adalat, Procardia): bc skeletal muscle blockade can result
