Chronic Hypertension Flashcards
S- has the pt been previously dxed with chronic htn?
review hx, prior workup, any complications such as myocardial infarction, end organ involvement.
- previously undxed chronic hypertension mandates full workup.
S- is the pt currently taking any hypertensive medications? what drugs are contraindicated during pregnancy because they have teratogenic renal effects?
angiotensin-converting enzyme inhibitors.
S- What is the pt’s current activity level?
ACTIVITY RESTRICTION should be applied during pregnancy to avoid DECREASED PLACENTAL PERFUSION
O -bp measurment
bp measurements should be performed serially over periods of time to establish dx and confirm degree of disease.
O perform PE
check differences between radial and femoral pulses.
check for signs of cushing’s syndrome - thinning of skin, bruising, muscle weakness/atrophy
O - what are latest US results?
early US establishes accurate dating of the pregnancy. info is useful in managing complications associated with CHTN : pregnancy-induced hypertension, preterm labor, evaluating suspected intrauterine growth restriction
O - consider renal function
- UA to detect proteinuria
- Serum creatinine to evaluate renal insufficiency. renal insufficiency pts pt at greater risk for fetal loss and developing superimposed preeclampsia.
- doppler flow studies to detect renal artery stenosis.
A- Chronic Hypertension (Assessment is the diagnosis)
Mild HTN range __/__
Severe CHTN __/__
Mild chtn: >= 140/90mmhg
Severe chtn >= 180/110
before 20 weeks gestation.
reversible causes of htn should always be considered as etiologies and include:
renal disease, pheochromocytoma, coarctation of the aorta, cushing’s syndrome (too much cortisol in the body from steroids, from tumors) , primary aldosteronism
pheochromocytoma
Pheochromocytoma is a rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure .
P - Monitor BP serially and determine need for therapy. bp is physiologically lowered during normal pregnancy, so pts with mild chtn can sometimes discontinue meds and be followed closely. primary purpose of bp surveillance and control is for MATERNAL benefit to avoid end organ damange. even though CHTN is associated with increased risk of preterm birth, placental abruption, superimposed preeclampsia, iugr, fetal death, treatment does NOT appear to reduce __
perinatal morbidity.
P - treatment is customarily initiated for sbps >180 or dbp>110 meds:
methyldopa 250mg bid
labetalol 100mg bid
P obtain 24 hr urine
24 hr urine protein collection will reveal any underlying proteinuria.
a baseline value often helps evaluate for superimposed preeclampsia if signs develop later in pregnancy.
P refer to appropriate specialists
end- organ damage should be evaluated, esp with long-standing disease. refer pt to CARDIOLOGIST, NEPHROLOGIST, OPHTHALMOLOGIST to assess the respective organ systems.
P monitor for sx of superimposed preeclampsia.
superimposed preeclampsia affects 25% of pregnancies with chtn. monitor bp weekly beginning at 30 weeks.
P consider AP testing
indications for ap testing should be individualized. initiate for signs of iugr or preeclampsia.
