Chapter 27

Question 1

Hypertensive Disorders

Answer 1

Common medical complication of pregnancy

Major cause of perinatal morbidity and mortality due to uteroplacental insufficiency and premature birth

Question 2

Hypertensive Morbidity

Answer 2

Renal failure

Coagulopathy

Cardiac or liver failure

Placental abruption

Seizures

Stroke

Question 3

Gestational Hypertension

Answer 3

Onset of hypertension without proteinuria or other systemic findings diagnostic for preeclampsia after week 20 of pregnancy

Question 4

Preeclampsia

Answer 4

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

Question 5

Conditions Associated with Preeclampsia

Answer 5

Thrombocytopenia

Impaired liver function

New development of renal insufficiency

Pulmonary edema

New-onset cerebral or visual disturbances

Question 6

Eclampsia

Answer 6

Onset of seizure activity or coma in a woman with preeclampsia

No history of preexisting pathology

50% OF ECLAMPTIC WOMEN DEVELOP THE CONDITION WHILE PREGNANT

Women can develop eclampsia in the immediate postpartum period

Question 7

Risk Factors of Preeclampsia

Answer 7

Primigravidity in women < 19 or > 40 years of age

First pregnancy with a new partner

History of preeclampsia

Pregnancy-onset snoring

Question 8

Pathophysiology of Preeclampsia

Answer 8

PROGRESSIVE DISORDER WITH PLACENTA AS THE ROOT CAUSE

Begins to resolve after the placenta has been expelled

THIS VASCULAR REMODELING DOES NOT OCCUR OR ONLY PARTIALLY DEVELOPS IN WOMEN WITH PREECLAMPSIA AND DECREASED PLANCENTAL PERFUSION AND HYPOXIA RESULT

Question 9

HELLP Syndrome

Answer 9

LABORATORY DIAGNOSIS FOR A VARIANT OF SEVERE PREECLAMPSIA THAT INVOLVES HEPATIC DYSFUNCTION

Hemolysis, Elevated Liver enzymes, Low Platelets

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

Question 10

Clinical Presentation of HELLP Syndrome

Answer 10

History of malaise

Influenza-like symptoms

Epigastric or right upper quadrant abdominal pain

Symptoms worsen at night and improve during the daytime

Question 11

Assessment

Answer 11

Accurate measurement of BP

Assessment of edema

DTRs

Hyperactive reflexes (clonus)

Proteinuria

Evaluate for headaches, epigastric pain, RUQ abdominal pain, visual disturbances

Question 12

Interventions

Answer 12

Home care

Maternal and fetal assessment

Activity restriction

Diet

GOALS OF CARE ARE TO ENSURE MATERNAL SAFETY AND FORMULATE A PLAN FOR DELIVERY

Question 13

Intrapartum Care

Answer 13

Bed rest with siderails up

Darkened environment

Magnesium sulfate therapy (1.8-2.4)

Antihypertensive medications (Hydralazine, Labetalol, Nifedipine, Methyldopa)

Question 14

Magnesium Sulfate Therapy

Answer 14

1.8-2.4 is therapeutic

If respirations go below 12, urinary output is less than 30 mL/hr, no DTR, and extreme thirst, stop the infusion

Question 15

Postpartum Care

Answer 15

Vital signs, DTRs, LOC

30% of cases of eclampsia and HELLP syndrome occur postpartum

Unable to tolerate excessive blood loss

Question 16

Immediate Care of Eclampsia

Answer 16

PREMONITORY SIGNS: PERSISTENT HEADACHE AND BLURRED VISION

EPIGASTRIC OR RUQ PAIN

Altered mental status

Convulsions appearing without warning

Ensuring a patent airway and client safety

Maternal stabilization

Question 17

Interventions for Chronic Hypertension

Answer 17

ASSOCIATED WITH INCREASED INCIDENCE OF APRUPTIO PLACENTAE, SUPERIMPOSED PREECLAMPSIA, INCREASED PERINATAL MORTALITY