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Mom & Baby Exam 2 > Chapter 27: Hypertensive Disorders in Pregnancy > Flashcards

Chapter 27: Hypertensive Disorders in Pregnancy Flashcards

1
Q

What are the 3 type of Hypertensive Disorders ?

A
  • Gestational hypertension
  • Preeclampsia
  • Eclampsia
  • Chronic hypertension ?
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2
Q

True or False: The rate of pregnancy related hypertension has risen steadily since 1990 for all ages and ethnic groups ?

A

True

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3
Q

True or False: The rate of chronic HPTN in mothers >40 is nearly 10x higher than those younger than age 20 ?

A

True

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4
Q

What things cause Maternal Morbidity ?

A
  • Placental abruption
  • Cerebral hemorrhage
  • Hepatic or renal dysfunction
  • DIC (disseminated intravascular coagulation)
  • Pulmonary edema
  • Seizures
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5
Q

True or False: Pregnancy-related hypertension accounts for 10% to 15% of maternal deaths worldwide ?

A

True

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6
Q

True or False: Preeclampsia accounts for more than 500,000 maternal deaths each year ?

A

True

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7
Q

Gestational hypertension is also known as what ?

A

Pregnancy induced hypertension

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8
Q

True or False: With Gestational hypertension, there are generally good outcomes for both mom and baby ?

A

True

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9
Q

Gestational Hypertension is defined as what ?

A

The onset of hypertension WITHOUT proteinuria

- can occur after the 20th week of pregnancy

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10
Q

Preeclampsia is defined as what ?

A

A pregnancy specific syndrome in which hypertension develops after 20 weeks of gestation in a previously normotensive woman

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11
Q

gestational hypertension is defined as Blood Pressure of what ?

A

Systolic BP > 140mmHg

Diastolic BP > 90mmHg

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12
Q

The diagnosis of onset of Gestational hypertension during pregnancy is based on what ?

A

2 measurements on 2 separate occasions, that meet criteria for gestational BP elevation within a 1-week period

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13
Q

Gestational hypertension USUALLY develops when ?

A

at or after 37 weeks of gestation

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14
Q

What do we know, in terms of gestational hypertension, and the patients BP before and after pregnancy ?

A
  • Women with GH have no preexisting hypertension

- BP returns o normal within 6 weeks after birth

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15
Q

If a women is Dx with GH before 35 weeks, it may progress to what ?

A

preeclampsia

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16
Q

What is Preeclampsia characterized by ?

A

Reduced organ perfusion with presence of hypertension and proteinuria

(essentially a problem causing hypertension. may or may not have proteinuria)

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17
Q

What is the only known cure for Preeclampsia ?

A

Birth

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18
Q

True or False: Preeclampsia may lead to Eclampsia ?

A

True

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19
Q

What do we know about Preeclampsia, and the signs and symptoms ?

A

Signs & symptoms develop only during pregnancy and disappear after birth

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20
Q

True or False: There is no reliable method to predict Preeclampsia ?

A

True

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21
Q

What are risk factors for Preeclampsia ?

A
  • Primigravida (pregnant for 1st time)
  • Second pregnancy with a new partner/father
  • Multifetal pregnancy
  • Extremes of age (>40 or <19)
  • Obesity
  • Preexisting medical condition
    (chronic HTN, renal dz, DM 1, collagen dz)
  • Preeclampsia in a previous pregnancy
  • Family Hx of Preeclampsia
  • Poor outcome in previous pregnancy
    (IUGR, Fetal death)
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22
Q

What is the main pathophysiologic factor with Preeclampsia ?

A

An increase in BP, but poor perfusion resulting from vasospasm

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23
Q

With Preeclampsia, there is a significant decrease in placental what ?

A

kidney, liver and brain function

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24
Q

Mild Preeclampsia is characterized by what types of things ?

A
  • BP > 140/90
  • Transient headache
  • Normal Liver functions
  • Proteinuria
    • > +1
    • 24hr > 300mg
    • output > 25-30cc/hr
  • Reduced placental perfusion
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25
Q

Sever Preeclampsia is characterized what ?

A
  • BP > 160/110
  • Persistent/severe headache
  • Liver functions may be altered
  • Proteinuria
    • > +3
    • 24hrs > 5gms
    • output < 400-500cc/24hrs
  • Possible Epigastric pain
  • Visual problems - blurred
  • Pulmonary edema
  • Decreased placental perfusion
  • Abnormal fetus status on tests
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26
Q

What is Eclampsia ?

A

The onset of seizure activity or coma in a woman with preeclampsia

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27
Q

What are signs & symptoms of Eclampsia ?

A
  • seizure activity or coma in women diagnosed with preeclampsia
  • No Hx of previous seizure disorder
  • Scotomata
  • Blurred vision
  • Epigastric pain
  • Vomiting
  • Persistent or severe headache
  • Neurologic hyperactivity
  • Pulmonary edema
  • Cyanosis
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28
Q

What is HELP Syndrome associated with ?

A

Severe Preeclampsia & Liver dysfunction

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29
Q

What is the HELLP acronym ?

A 
Hemolysis
Elevated
Liver enzymes
Low
Platelet count
  • Associated with Preeclampsia
30
Q

If a pregnant women has true HELLP what should be done ?

A

Deliver the fetus

1st = Stabilize mother
2nd = Deliver baby (baby is making mom sick)
31
Q

HELLP is the result of what ?

A
  • arteriolar vasospasm
  • endothelial cell dysfunction w/ fibrin deposits
  • adherence of platelets in blood vessels
32
Q

HELLP Syndrome is associated with an increased risk for what types of things ?

A
  • Pulmonary edema
  • Acute renal failure
  • Disseminated intravascular coagulation (DIC)
  • Placental abruption
  • Liver hemorrhage or failure
  • Adult respiratory distress syndrome
  • Sepsis
  • Stroke
  • HIGH RISK FOR MATERNAL DEATH*
33
Q

HELLP Syndrome is associated with a high risk for what ?

A

High risk for maternal death

34
Q

Signs and symptoms of HELLP syndrome may include ?

A
  • Elevated BP
  • Proteinuria
  • Edema
  • N/V
  • General malaise
  • Epigastric pain

Can lead to misdiagnosis of other problems

35
Q

In regards to HELLP Syndrome, regardless of BP, when a woman presents with proteinuria, what should she have done ?

A
  • CBC
  • Platelet count
  • Liver enzymes
  • Urine studies
36
Q

True or False: Checking reflexes in OB is very important ?

37
Q

What is the goal with mild gestational hypertension and mild preeclampsia ?

A

To ensure maternal safety and deliver a healthy newborn

38
Q

What should be down with a pregnant women with severe gestational HTN and preeclampsia ?

A

Should be hospitalized for 24hr observation and fetal surveillance

  • We want the mother to calm down & decrease stimuli *
  • Limit visitors
  • Quiet environment
  • Dark environment
39
Q

What medication is given to prevent seizures in woman with severe gestational HTN and preeclampsia ?

A

Magnesium sulfate

40
Q

What kind of medication is Magnesium sulfate ?

A

CNS depressant

41
Q

What is the drug of choice for Preeclampsia ?

A

Magnesium Sulfate

42
Q

In women with Sever gestational HTN & Preeclampsia, moms will be on a monitor for how long ?

A

Continuously

43
Q

How often should you draw labs for a mother on Magnesium sulfate ? and why ?

A
  • Every 6 hrs –> to make sure she is staying between 4-7mEq/L
  • to monitor for toxicity
44
Q

Initially how should Magnesium Sulfate be given ?

A 
Give Bolus (4g to 6g IV)
- mom may be flushed

Bolus = giving it very fast

45
Q

After the initial dose of Magnesium sulfate, what will be given next ?

A

A maintenance dose of 2g

46
Q

How will the mom feel after receiving the maintenance dose of Magnesium sulfate ?

A

Tired, weak, etc

  • Normal to feel this after a few days
47
Q

What are toxicity s/s of Magnesium sulfate ?

A
  • Respiratory depression
  • Low urine output
  • Decreased deep tendon reflexes
  • Sometimes decreased LOC
48
Q

What are the management goals for Severe Preeclampsia ?

A
  • Ensure maternal safety (padded side rails, etc)
  • Assess degree of maternal and fetal risk
  • Formulate a birth plan
  • Prevent eclampsia and other complications
  • If 34weeks or >: C/S or IOL
    • risk of pregnancy is greater than risk of preterm birth
  • IF < 34weeks: meds to prevent seizures & control BP
    - corticosteroids to enhance FLM
    (Bethamethasone given to mom, but affects the babies lungs)
49
Q
  • What should normally happen in a healthy mom/person if you dorsi flex the foot up towards the leg ?
  • In a pregnant mom, if the foot has a jerky movement, it could be a sign of what ?
A
  • The foot should just fall slowly and normally back to normal position
  • Preeclampsia
    (disturbances between the brain & spinal cord)
50
Q

What is the Antidote for Magnesium Sulfate ?

A

Calcium Gluconate

51
Q

What is the Hospital management for Preeclampsia ?

A
  • Maternal assessment of systems
  • Continuous fit’s and contractions
  • VS
  • Hydration via IV fluids - 125cc/hr
  • I/O
  • Bed rest with seizure precautions
  • Quiet environment
  • Emergency drugs, oxygen, suctions, delivery kit
52
Q

What does the care management for Eclampsia include ?

A
  • Immediate care
  • Seizures last 3-4 minutes and are self limiting
    - ensure a patent airway
    - pt safety a major concern
    - Magnesium sulfate
    - ICU
    - fetal assessment
    - post-seizure decision regarding timing and method of birth
  • Assess if HELLP syndrome
    - Lab evaluation
    - Infusion of blood products
53
Q

Chronic Hypertension is associated with an increased incidence of what things ?

A
  • Abruptio placentae
  • Superimposed preeclampsia
  • Increased perinatal mortality
54
Q

What are fetal effects of Chronic Hypertension ?

A
  • IUGR
  • Small for gestational age
  • Fetal hypoxia
  • Prematurity
  • Death related to abruption
55
Q

For Chronic Hypertension, Management ideally begins when ?

A

Begins before conception

56
Q

What are examples of Antihypertensive drugs that are used to treat Chronic Hypertension ?

A
  • Aldomet
  • Labetolol
  • Niphedipine
57
Q

True or False: With Chronic Hypertension, lifestyle changes may be necessary ?

58
Q

True or False: In postpartum, high risk women are monitored closely for complications ?

59
Q

True or False: Women with Chronic Hypertension, may safely breastfeed even though low levels of Antihypertensive medications will be in the breast milk ?

60
Q

What dose Nursing care for women with Chronic Hypertension include ?

A
  • Monitor BP, urine, & edema every visit
  • Headaches
  • Epigastric pain
  • Oliguria
  • Visual disturbances
  • Pulmonary edema
  • Fetal growth
61
Q

Hypertensive disorders during pregnancy are a leading cause of worldwide what ?

A

Infant and maternal morbidity and mortality

62
Q

True or False: the cause of preeclampsia is unknown ?

63
Q

Is there a reliable test for predicting which women are at risk for preeclampsia ?

64
Q

True or False: Preeclampsia is a mutisystem disease rather than an increase in BP only ?

65
Q

True ro Flase: HELLP Syndrome can occur in women with severe preeclampsia and is considered life threatening ?

66
Q

True or False: Once preeclampsia becomes clinically evident, therapeutic interventions may slow the progression of the disease, allowing the pregnancy to continue ?

67
Q

What is the Anticonvulsive agent of choice for preventing eclampsia ?

A

Magnesium Sulfate !

68
Q

Magnesium sulfate requires careful monitoring of what things ?

A
  • Reflexes
  • Respirations
  • Urinary output
69
Q

True or False: The antidote to Magnesium Sulfate, which is Calcium gluconate, should be available at the bedside ?

70
Q

What are the 2 main Nursing actions during a convulsion ?

A
  • Ensuring a patent airway

- Pt safety

71
Q

True or False: Chronic Hypertension in pregnancy is associated with

  • Abruption placentae
  • Superimposed preeclampsia
  • Fetal growth restrictions
  • Increased perinatal mortality
72
Q

True or False: Women with preeclampsia have an increased risk of adverse perinatal outcomes in a future pregnancy ?

Mom & Baby Exam 2 (5 decks)

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