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OB exam 3 > Ch 27, Hypertensive disorders > Flashcards

Ch 27, Hypertensive disorders Flashcards

1
Q

What are the 3 most common types of HTN disorders in pregnancy?

A

-Gestational Hypertension
-Preeclampsia
-Chronic HTN

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2
Q

Gestational HTN is the development of HTN at the (___) week of pregnancy

A

Gestational HTN is the development of HTN at the (20th) week of pregnancy

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3
Q

What is the systolic/diastolic measurement of Gestation HTN?

What is the recording/measuring process for Gestational HTN?

A

Gestational HTN: >140/90

The process of determining GHTN is by recording the BP twice, 4 hours apart after 20 weeks’ gestation.

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4
Q

What should you do routinely in a patient before declaring GHTN?

A

Monitor routinely.
Just because their BP is 160/90 doesn’t IMMEDIATELY mean GHTN

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5
Q

GHTH typically resolves after (______) but can take between (__-___) months to do so.

A

GHTH typically resolves after (birth) but can take between (_6-12) months to do so.

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6
Q

50% of GHTN patients develop what at the end of pregnancy?

A

Preeclampsia

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7
Q

Preeclampsia is when (___) and (_______) in the urine develop after (__) weeks gestation

A

Preeclampsia is when (HTN) and (protein) in the urine develop after (20) weeks gestation

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8
Q

HTN post-birth and during the postpartum phase can signal that a mother has developed what?

A

Preeclampsia postpartum

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9
Q

Aside from protein in the urine, and HTN (>140/90), what are 4 other symptoms of preeclampsia?

A

-Thrombocytopenia
-Pulmonary edema
-Impaired Liver
-Renal insufficiency

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10
Q

A pregnant patient is experiencing persistent right upper quadrant pain that is unresponsive to pain meds and not accounted for by another diagnosis. What is the most likely cause?

A

Preeclampsia

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11
Q

Seizure activity or coma without prior hx of seizure activity is known as what?

A

Eclampsia

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12
Q

When can eclamptic seizures occur in pregnant women?

A

Before, during and after birth. Many cases appear within 48 hours postpartum

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13
Q

Chronic HTN is diagnosed before what gestational age?

A

20 weeks
(Before 20 is Chronic, after 20 weeks is Gestational HTN or Preeclampsia)

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14
Q

Chronic HTN with superimposed preeclampsia is when you have previously controlled HTN - possibly due to a (____-_______) - that suddenly experiences an (_________) in pressure, and/or new-onset (_________) in the urine

A

Chronic HTN with superimposed preeclampsia is when you have a patient with previously controlled HTN - possibly due to a (Beta-Blocker) - that suddenly experiences an (increase) in pressure, and/or new-onset (protein) in the urine

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15
Q

Preeclampsia is a condition that appears in (-)% of nulliparous women

A

Preeclampsia is a condition that appears in (2-7)% of nulliparous women

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16
Q

Risks for developing preeclampsia are much higher in women who have (__________) gestation, aka (_____)’s, chronic (_____________), pregestational (_________________), or preexisting (_______)philias.

A

Risks for developing preeclampsia are much higher in women who have (multifetal) gestation, aka (twins)’s, chronic (hypertension), pregestational (Diabetes Mellitus), or preexisting (thrombo)philias.

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17
Q

Men who have fathered preeclampsia pregnancies are (_____) as likely to father another preeclamptic pregnancy with a (_________) woman

A

Men who have fathered preeclampsia pregnancies are (twice) as likely to father another preeclamptic pregnancy with a (different) woman

Keep the same baby daddy

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18
Q

For the pathophysiology of preeclampsia, the current thought is that preeclampsia is caused by disruptions in (_________) perfusion and (___________) cell dysfunction that develops (_____) in the pregnancy

A

For the pathophysiology of preeclampsia, the current thought is that preeclampsia is caused by disruptions in (placental) perfusion and (endothelial) cell dysfunction that develops (early) in the pregnancy

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19
Q

What is thought to account for the protein loss in the urine seen in preeclampsia?

A

Reduced kidney perfusion that reduces GFR

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20
Q

Women with preeclampsia will experience (_______) pain or right upper quadrant pain due to decreased (_____) perfusion which increases (______________) levels and can cause a hepatic (_____)

A

Women with preeclampsia will experience (epigastric) pain or right upper quadrant pain due to decreased (liver) perfusion which increases (liver enzyme) levels and can cause a hepatic (edema)

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21
Q

What is HELLP syndrome?

A

A preeclampsia variant that involves hepatic dysfunction and presents similar to preeclampsia but without proteinuria:

Hemolysis
Elevated
Liver enzymes
Low
Platelets

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22
Q

What lab values would need to be checked in HELLP syndrome?

A

AST/ALT
Platelets
CBC count

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23
Q

When assessing a pregnant woman for preeclampsia, and you want to help perfusion and lower blood pressure for a preeclampsia screening, what position do you put her in?

A

Place the patient on her left side, with her BP cuff on the right arm. (Reverse if patient is on her right-side)

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24
Q

What drug has been effective in preventing/reducing the onset/symptoms of preeclampsia in low doses?

A

Low dose Aspirin (81mg/day)

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25
Q

For patients with eclampsia, DTR levels are (__________). DTR’s are important to assess for in high BP/Eclampsia patients, as it shows correlation with their (________________) levels.

A

For patients with eclampsia, DTR levels are (increased). DTR’s are important to assess for in high BP/Eclampsia patients, as it shows correlation with their (Magnesium Sulfate) levels.

26
Q

The presence of proteinuria is ideally determined by the evaluation of what test?

Proteinuria is defined as a concentration of how many mg?
What about a protein/creatinine ratio?

A

24-hour urine collection

Proteinuria is defined as a concentration of 300mg or greater

Protein/Creatinine ratio of 0.3

27
Q

Severe features of preeclampsia are a severe frontal (_________), (____)sis, (___________) pain, right (________________) pain, or visual disturbances such as (____________) and diplopia, aka (____________)

A

Severe features of preeclampsia are a severe frontal (headache), (pyro)sis, (Epigastric) pain, right (upper quadrant) pain, or visual disturbances such as (photophobia) and diplopia, aka (double vision)

28
Q

Outpatient management can be considered for a preeclampsia woman who follows a recommended plan of care provided she has a systolic/Ddiastolic reading of what?

A

Systolic: 155mmHG or less
Diastolic: 105mmHG or less

With no symptoms

29
Q

A preeclampsia woman who is undergoing at-home care must contact a physician immediately if she experiences what symptoms?

A

-Abdominal pain
-Significant headache
-Uterine contractions
-Vaginal spotting
-Decreased fetal movement

30
Q

If a woman presents in the hospital with gestational HTN or Preeclampsia with SEVERE features, what medicine will they be put on to prevent eclamptic seizures?

A

Magnesium Sulfate to fight eclampsia seizures

31
Q

A woman presents with a 33-week gestation with either GHT or preeclampsia and is presenting with contractions. What does this indicate for the baby, and what medications should be given?

A

This indicates that the baby will be pre-term.

-Give Terbutaline to ease contractions
-Give Betamethasone (corticosteroid) via
IM to help baby lung development
-Give Labetalol (BB) or Nifedipine (CCB) for BP management

32
Q

If gestational HTN or Preeclampsia presents with severe symptoms after 34 weeks’ gestation, what is the recommended move?

A

It is recommended that the mother give birth promptly, because severe HTN/preeclampsia is associated with high maternal morbidity, and fetal morbidity as well

33
Q

What BP levels would indicate giving the Antihypertensive drugs Labetalol (Trandate/BB) or Nifedipine (Procardia/CCB) to a Pregnant HTN/preeclampsia patient?

What would the systolic/diastolic BP goal be after giving these meds?

A

160/110mmHG are emergency levels

140/90mmHG are the goal levels

34
Q

What is the medication of choice for preventing and treating eclampsia activity?

A

Magnesium Sulfate

35
Q

MG Sulfate is almost always administered (____) as a piggyback by an (_________) pump. The piggyback solution is typically (__)mg of Mg sulfate in (____)mL’s of (________ _______)

A

MG Sulfate is almost always administered (IV) as a piggyback by an (Infusion) pump. The piggyback solution is typically (40)mg of Mg sulfate in (1000)mL’s of (Lactated Ringers)

36
Q

Magnesium Sulfate is first given as an initial (____________) of (-)g of Mg infused over (__-__) minutes. Then a maintenance dose is maintained by an (___________) pump at roughly (-)g/h to maintain a therapeutic Mg level of (-) mEq/L

A

Magnesium Sulfate is first given as an initial (Loading dose) of (4-6)g of Mg infused over (15-30) minutes. Then a maintenance dose is maintained by an (Infusion) pump at roughly (1-2)g/h to maintain a therapeutic Mg level of (4-7) mEq/L

37
Q

Contrary to popular belief, Mg Sulfate has little to no effect on what?

A

Little to no effect on maternal BP when given through an IV-Infusion pump

38
Q

Why is Mg sulfate typically not given IM?
(3 reasons)

A

-The absorption rate cannot be
controlled
-IM shots are painful
-Tissue necrosis may occur

39
Q

What are 4 common side effects of Mg sulfate?

A

-Feeling of warmth
-Flushing
-Diaphoresis (excessive sweating)
-Burning at the IV site

40
Q

What are 2 things that would be helpful to give a mother before you administer Mg sulfate?

A

An Ice Pack and a vomit bucket

41
Q

If (______) function declines, excretion of Mg sulfate is inadequate, resulting in Mg sulfate toxicity. What are the symptoms of Mg sulfate toxicity?

A

If (renal) function declines, excretion of Mg sulfate is inadequate, resulting in Mg sulfate toxicity. S/S of toxicity:
-Decreased DTR
-Decreased RR
-Decrease LOC

42
Q

WARNING:
High levels of Mg sulfate can cause relaxation of (_______) (________) where?

A

WARNING:
High levels of Mg sulfate can cause relaxation of (smooth) (muscle) in the uterus

43
Q

If Mg toxicity is suspected, the IV administration should be (__________), and the use of (________) (____________) should be given immediately through an IV

A

If Mg toxicity is suspected, the IV administration should be (discontinued), and the use of (Calcium) (Gluconate) should be given immediately through an IV

44
Q

Notify a provider if a pregnant woman on Mg has DTR levels at (-). If the levels are between (-), then adjust the Mg levels accordingly.

A

Notify a provider if a pregnant woman on Mg has DTR levels at (0-1+). If the levels are between (3+-4+), then adjust the Mg levels accordingly.

45
Q

Intrapartum nursing care of severe HTN/preeclampsia is directed towards constant monitoring and early identification of what?

A

Fetal Heart Rate (FHR abnormalities by using Toco and Ultrasound

46
Q

Intrapartum FHR monitoring/Fetal contraction monitoring also necessitates assessing for a placental abruption. What is a trademark sign of a placental abruption?

A

-Tense, tender uterus

47
Q

A woman with preeclampsia with severe features is maintained on (___ ____) with the (____ _____) up in a (_____) and (_______) environment. Emergency (____), oxygen and (________) equipment should be readily available

A

A woman with preeclampsia with severe features is maintained on (bed rest) with the (side rails) up in a (quiet) and (dark) environment. Emergency (drugs), oxygen and (suction) equipment should be readily available

48
Q

To avoid IV fluid overload in an HTN/Preeclampsia patient, Mg sulfate should be limited to?

A

125mL/hr

49
Q

Eclampsia is usually preceded by what 5 symptoms?

A

-Occipital/Frontal headache
-Blurred vision
-Photophobia
-Epigastric/Right upper quadrant pain
-Altered Mental Status

50
Q

Nursing actions during a seizure are directed towards ensuring patients (______) and (______).

A

Nursing actions during a seizure are directed towards ensuring patients (airway) and (safety)

51
Q

During eclampsia activity, is it advisable for a nurse to leave the patient and get help as quickly as possible?

A

No, the nurse should call for help, but remain with the patient at all times

52
Q

During eclampsia activity, where should the side rails be?

Immediately following a seizure, what should the nurse do with the patient’s bed and position?

A

During eclampsia activity, the side rails should be raised (padded too if possible)

Immediately following a seizure, the nurse should lower the HOB and place the patient onto her side to prevent aspiration of vomitus

53
Q

Post-seizure, if apnea is present, the nurse should immediately open the (_________) and begin (___/____ ____________) while calling code for respiratory/cardiac arrest

A

Post-seizure, if apnea is present, the nurse should immediately open the (airway) and begin (Bag/Mask Ventilations) while calling code for respiratory/cardiac arrest

54
Q

Post-seizure, if respirations are present, (____________) should be (___________) from the womans glottis to clear the (___________). O2 should be given at (__)L/min by face mask.

A

Post-seizure, if respirations are present, (secretions) should be (suctioned) from the womans glottis to clear the (airway). O2 should be given at (10)L/min by face mask.

55
Q

Post-seizure, if an IV infusion is in place, (__ _______) should be given as ordered.
If IV is not in place, start one using an (__) gauge needle

A

Post-seizure, if an IV infusion is in place, (Mg sulfate) should be given as ordered.
If IV is not in place, start one using an (18) gauge needle

56
Q

Chronic HTN affects (-)% of all pregnancies, with what race of women being most affected?

A

Chronic HTN affects (1-5)% of all pregnancies, with African American women being most affected?

57
Q

In addition to race, other risk factors for chronic HTN are (_________) and (___)

A

In addition to race, other risk factors for chronic HTN are (Obesity) and (AMA)

58
Q

What is the BP treatment goal threshold for pregnant women with mild chronic HTN?

A

<140/90mmHG

59
Q

Can women with chronic HTN breastfeed, even if they are taking meds like Labetalol or Nifedipine?

A

Yes, if they desire to. No adverse effects have been noted

60
Q

Women with preeclampsia (especially early-onset and preeclampsia with severe failure) have an increased risk for developing (_______ ____________) and (______________) disease later in life

A

Women with preeclampsia (especially early-onset and preeclampsia with severe failure) have an increased risk for developing (chronic hypertension) and (cardiovascular) disease later in life

OB exam 3 (6 decks)

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