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MIH Final review > Chapter 27 > Flashcards

Chapter 27 Flashcards

1
Q

Why are hypertensive disorders a major cause of perinatal morbidity and mortality ?

A

hypertension can cause Uteroplacental insufficiency and Premature birth

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2
Q

How many maternal deaths worldwide are due to preeclampsia and eclampsia?

A

10-15%

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3
Q

how many maternal deaths are caused by preeclampsia each year?

A

50,000

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4
Q

What are possible compilations related to hypertensive disorders that increase morbidity ?

A

Renal failure
Coagulopathy
Cardiac or liver failure
Placental abruption
Seizures
Stroke

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5
Q

Define gestational hypertension

A

Onset of hypertension without proteinuria or other systemic findings diagnostic for preeclampsia after week 20 of pregnancy
Systolic BP >140, diastolic BP >90

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6
Q

Define preeclampsia

A

Pregnancy-specific condition in which hypertension and proteinuria develop after 20 weeks of gestation in a previously normotensive woman

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7
Q

What is preeclampsia in the absence of proteinuria ?

A

Hypertension along with the following:
Thrombocytopenia
Impaired liver function
New development of renal insufficiency
Pulmonary edema
New-onset cerebral or visual disturbances

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8
Q

What is the general rule for hypertension

A

BP 140/90 or 30 increased in SPB and 15 increase in DBP

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9
Q

When is weigh gain concerning with hypertension?

A

weight gain of 2kg in 1 week

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10
Q

How is protein in urine tested?

A

done via dipstick measure test
Proteinuria is a concentration of 1+ or greater via dipstick measure
If urine dipstick is abnormal , will send to lab for UA
If proteinuria is 3+ on dipstick = great concern

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11
Q

what is done to check for protein if no other symptoms are shown?

A

24 hr urines

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12
Q

Define eclampsia

A

Onset of seizure activity or coma in a woman with preeclampsia
No history of preexisting pathology
Women can develop eclampsia in the immediate postpartum period

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13
Q

Define chronic hypertension

A

Hypertension present before pregnancy or diagnosed before week 20 of gestation
can have chronic HTN that last longer than 6 wks PP

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14
Q

Define Chronic hypertension with superimposed preeclampsia

A

Women with chronic hypertension may acquire preeclampsia or eclampsia
Can be difficult to diagnose

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15
Q

Common risk factors for preeclampsia

A

Primigravidity in woman <19 or >40 years of age
First pregnancy with a new partner
History of preeclampsia
Pregnancy-onset snoring

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16
Q

what is the etiology of preeclampsia

A

the cause is unknown , condition is unique to pregnancy , delivery baby and placenta makes it go away

17
Q

What is the pathophysiology of preeclampsia ?

A

Spiral arteries in the uterus normally become larger and thicker to handle increased blood volume.
the arteries do not get larger/thicker in preeclampsia or partially develops causing decreased placental perfusion and hypoxia

18
Q

symptoms of placental abruption

A

:Increased contractions, rigid, Dark red vaginal, bleeding , painful,

19
Q

what other issues can preeclampsia cause?

A

Placental ischemia → endothelial cell dysfunction
Generalized vasospasm → poor tissue perfusion in all organ systems
Increased peripheral resistance and blood pressure
Increased risk of Abruptio Placentae (detachment)
Increased endothelial cell permeability
Reduced kidney perfusion
Plasma colloid osmotic pressure decreases.
Decreased liver perfusion
Neurologic complications

20
Q

how does preeclampsia affect the liver

A

liver becomes inflamed and elevated LFTs

21
Q

How do you check for clonus ?

A

move foot around then push up and it will bounce
positive clonus is bad

22
Q

what is a normal reflex

A

2+

23
Q

what is HELLP syndrome

A

severe preeclampsia that involves liver dysfunction
H - hemolysis
EL - Elevated liver enzymes
LP - Low Platelets

24
Q

What liver labs do you look at to check for HELLP syndrome ?

A

AST and ALT
ALP is always elevated in pregnancy

25
Q

What causes HELLP syndrome

A

Result of arteriolar vasospasm, endothelial cell dysfunction with fibrin deposits, and adherence of platelets in blood vessels

26
Q

HELLP syndrome symptoms?

A

History of malaise
Influenza-like symptoms
Epigastric or right upper quadrant abdominal pain
Symptoms worsen at night and improve during the daytime.

27
Q

sighs of severe preeclampsia

A

Headaches
Epigastric pain
Right upper quadrant abdominal pain
Visual disturbances
worse at night , better at daytime

28
Q

Preeclampsia assessment

A

accurate BP measurement
edema assessment (no longer a sign of this)
DTRs
hyperactive reflexes
proteinuria from 24 hr urine
and for the s/s mentioned before

29
Q

Interventions for mild hypertension and preeclampsia

A

Bedrest, activity restriction, low sodium diet , more frequent prenatal visits

30
Q

interventions for Severe gestational hypertension and preeclampsia with severe features

A

Bed rest with side rails up, padded rails
Darkened environment
Magnesium sulfate therapy
Antihypertensive medications
O2 at bedside

31
Q

Why is mag sulfate given ?

A

to prevent seizure activity

32
Q

What effects does mag sulfate cause?

A

relaxes body, decreased reflexes q2h, hypotension, decreased RR, monitor UOP, warm, flushed

33
Q

What dose of mag sulfate is given?

A

4 g loading dose, then 2 g / hr , do labs of therapeutic levels frequently

34
Q

signs of mag toxicity ?

A

decreased RR, absent reflexes, change in I&Os, extremely hypotension
Calcium gluconate is antidote, have it readily available

35
Q

Why might a higher dose of Pitocin be needed while on mag therapy

A

May require higher levels of Pitocin due to relaxed uterus
Can increase risk of hemorrhage cuz of relaxed uterus

36
Q

care for eclampsia

A

Premonitory signs: persistent headache and blurred vision
Epigastric or right upper quadrant pain
Altered mental status
Convulsions appearing without warning
Ensuring a patent airway and client safety
Maternal stabilization

37
Q

What are complications associated with chronic hypertension

A

Abruptio placentae
Superimposed preeclampsia
Increased perinatal mortality (IUGR, Preterm birth)

38
Q

Postpartum complications related to chronic hypertension

A

Pulmonary edema
Renal failure
Heart failure
Encephalopathy

39
Q

what meds are given for HTN in pregnancy

A

hydralazine
nifedipine (Procardia) also for preterm labor
labetalol
methyldopa

MIH Final review (16 decks)

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