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RNSG 1251 UNIT 2 > ch. 27: hypertensive disorders > Flashcards

ch. 27: hypertensive disorders Flashcards

1
Q

What are the 3 common types of hypertensive disorders?

A

1) gestational htn
2) preeclampsia
3) chronic essential htn

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2
Q

When do gestational htn and preeclampsia develop?

A

after 20 weeks of gestation

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3
Q

What is PREECLAMPSIA?

A

-pregnancy-specific condition
-HTN & PROTEINURIA develops after 20 weeks of gestation in a previously normotensive woman
-can also develop for FIRST time during POSTPARTUM

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4
Q

What is PREECLAMPSIA defined as in the absence of PROTEINURIA?

A

HTN along w/
-thrombocytopenia
-impaired liver func
-new onset renal insufficiency
-pulmonary edema
-new-onset cerebral or visual disturbances

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5
Q

What is the ROOT CAUSE of PREECLAMPSIA?

A

-placenta
-only cure is delivery

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6
Q

What is the pathophysiology of PREECLAMPSIA?

A

-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

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7
Q

What does the generalized vasospasm in preeclampsia lead to?

A

-poor tissue perfusion
-↑ peripheral resistance and BP
-↑ endothelial cell permeability: LEAKING EVERYWHERE

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8
Q

What are common risk factors for PREECLAMPSIA?

A

-multifetal preg
-hx of preeclampsia
-chronic htn
-preexisting diabetes &/or thrombophilias
-women w/ limited sperm exposure w/ same partner
-paternal factors

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9
Q

What is HELLP syndrome?

A

-lab dx for a variant of preeclampsia that involves hepatic dysfunction characterized by:
1) HEMOLYSIS
2) ELEVATED LIVER ENZYMES
3) LOW PLATELET

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10
Q

Who can develop HELLP syndrome?

A

can develop in women who DONT have htn or proteinuria

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11
Q

What is HELLP syndrome a result of?

A

result of arterial vasospasm, endothelial cell dysfunction w/ fibrin deposits, & adherence of platelets in blood vessels

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12
Q

What are signs and symptoms of HELLP syndrome?

A

-hx of malaise
-flu like s/s
-epigastric or RUQ pain
-s/s WORSEN at night and IMPROVE during DAYTIME

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13
Q

Is there a reliable test or screening tool to ID preeclampsia?

A

no

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14
Q

What are elevated levels of PROTEINURIA?

A

+1 on dipstick OR > 300mg/day in a 24 hr collection

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15
Q

What do you assess for in preeclampsia?

A

-BP
-edema
-DTR
-proteinuria

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16
Q

What are signs of SEVERE preeclampsia?

A

-headache
-epigstric pain
-RUQ abd pain
-visual disturbances

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17
Q

What is the GOAL of interventions for GESTATIONAL HTN & PREECLAMPSIA W/O SEVERE FEATURES?

A

1) ensure maternal safety
2) deliver a healthy newborn as close to term as possible

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18
Q

Are there any benefits of activity restrictions for women w/ preeclampsia?

A

no

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19
Q

What is the best environment for women w/ preeclampsia?

A

-quiet
-nonstimulating
-dark, lighting subdued

20
Q

What are the seizure precautions?

A

-suction equipment tested and ready to use
-O2 administration equipment tested and ready to use
-call button within easy reach

21
Q

What is MAGNESIUM SULFATE?

A

med of choice for PREVENTING and TREATING SEIZURE ACTIVITY (eclampsia)

22
Q

How do you administer magnesium sulfate?

A

as a secondary infusion (piggyback) by a volumetric infusion pump

23
Q

What is the initial loading dose for magnesium sulfate?

A

4 to 6 g over 15-30 min

24
Q

What is the maintenance dose for magnesium sulfate?

A

2 to 3 g an hour

25
Q

What effect does MAGNESIUM SULFATE have on MATERNAL BP?

A

-has little effect on maternal blood pressure when administered in that fashion

26
Q

What is the therapeutic level for magnesium sulfate?

A

4 to 7

27
Q

What are COMMON SIDE EFFECTS of magnesium sulfate?

A

-feeling of warmth
-flushing
-diaphoresis
-burning at IV site

28
Q

What are SYMPTOMS of MAGNESIUM TOXICITY?

A

-ABSENT DTRs
-decreased RR
-decreased LOC

29
Q

What is the antidote for magnesium sulfate?

A

calcium gluconate in 10% solution (10 ml)
-give 1g over 3 min

30
Q

When are ANTIHYPERTENSIVE MEDS indicated?

A

-SBP > 160
-DBP > 110

31
Q

Is Magnesium Sulfate continued after birth?

A

yes for seizure prophylaxis
-usually for 24 hrs after delivery

32
Q

What are premonitory s/s for ECLAMPSIA?

A

1) persistent H/A & BLURRED VISION
2) EPIGASTRIC OR RUQ PAIN
3) ALTERED MENTAL STATUS

33
Q

What is the INTERVENTION during a seizure?

A

-ensure a patent airway
-call for help but stay at bedside
-raise bed rails and pad them
-observe and record convulsion activity

34
Q

What is the IMMEDIATE CARE AFTER a seizure?

A

-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

35
Q

What is GESTATIONAL HTN?

A

onset of htn W/O PROTEINURIA or other systemic findings diagnostic for PREECLMAPSIA after 20 weeks of pregnancy
-SBP > 140
-DBP > 90

36
Q

What is ECLAMPSIA?

A

onset of SEIZURE ACTIVITY or COMA in a woman w/ PREECLAMPSIA

37
Q

What are women w/ chronic htn w/ superimposed preeclampsia at HIGH RISK of?

A

-stroke
-AKI
-cardiac failure
-placental abruption and death

38
Q

What are the MATERNAL EFFECTS of Hydralazine (Apresoline, Neopresol) ?

A

-H/A, flushing, palpitations, TACHYCARDIA, increase HR, increase CO, increase in O2 CONSUMPTION, n/v, some decrease in uteroplacental blood flow

39
Q

What are NURSING ACTIONS for Hydralazine (Apresoline, Neopresol) and Methyldopa (Aldomet)?

A

-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

40
Q

What meds should NOT be given to pts w/ tachycardia?

A

Hydralazine (Apresoline, Neopresol) and Nifedipine (Adalat. Procardia)

41
Q

What are the MATERNAL EFFECTS of Labetalol Hydrochloride (Normodyne, Trandate)?

A

-lethargy, fatigue, sleep disturbances
-MINIMAL: flushing, tremulousness, orthostatic hypotension, minimal change in pulse

42
Q

What are the NURSING ACTIONS for Labetalol Hydrochloride (Normodyne, Trandate)?

A

-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

43
Q

What are the MATERNAL EFFECTS of Methyldopa (Aldomet)?

A

-sleepiness, postural hypotension
-constipation
-hepatic dysfunction and necrosis
-hemolytic anemia

44
Q

What are the MATERNAL effects of Nifedipine (Adalat, Procardia)?

A

-hedache, flushing
-TACHYCARDIA
-may interfere w/ labor

45
Q

What med should you AVOID administering if the pt is on MAGNESIUM SULFATE?

A

Nifedipine (Adalat, Procardia): bc skeletal muscle blockade can result

RNSG 1251 UNIT 2 (5 decks)

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