Exam 1 - Hypertensive Disorders of Pregnancy Flashcards
Exam 1
BP equal to or higher than 140/90 in pregnancy before 20 weeks gestation
Chronic hypertension
What is the most common complication of pregnancy?
Hypertensive disorders
Blood pressure of 140/90 at or > 20 weeks gestation on two occasions at least 4 hours apart; no associated proteinuria
Gestational HTN
Which type of HTN will be diagnosed PRIOR to 20 weeks gestation?
Chronic HTN
New onset of hypertension AFTER 20 weeks; BP equal to 140/90 on two occasions at least 4 hours apart OR 160/110
once. Must also have a protein/creatinine ratio
of .3 or higher or 24 hour urine protein of 300mg+
Preeclampsia
Which 2 types of HTN disorders are treated with anti-hypertensives?
(1) Chronic HTN
(2) Gestational HTN
What are the 2 categories of preeclampsia?
With and without severe features
Preeclampsia with severe features includes one of the following:
(1) BP 160/110
(2) abnormal liver function + epigastric pain
(3) renal insufficiency
(4) new onset headache or visual changes
(5) pulmonary edema
(6) thrombocytopenia
The key difference between gestational HTN and preeclampsia without severe features is what?
gestational HTN will not have proteinuria and preeclampsia WILL have proteinuria.
Most patients WITHOUT severe features deliver at
37w0d
Preeclampsia with severe features will deliver when?
Earlier than 37w
Name the 3 anti-hypertensives that are used for HTN disorders in pregnancy
(1) Beta blockers (Labetalol) - IV or PO
(2) Ca channel blockers (Nifedipine) - PO
(3) Vasodilator (Hydralazine) - IV
One seizure prophylaxis drug is what?
Mg Sulfate - IV
Side effects of Mg Sulfate include
(1) Respiratory depression
(2) Fetal intolerance
(3) generalized weakness
(4) flushing/sweating
(5) lack of energy
What is the reversal agent for Mg Sulfate?
Ca gluconate
Therapeutic range for Mg is what?
5-9
Signs of Mg toxicity include…
(1) facial drooping
(2) slurred speech
(3) lack of reflexes
(4) mental confusion
(5) Mg level >9
Mg excess is associated with ____ when testing deep tendon reflex
hyporeflexia
What indicates a positive clonus?
foot bounces or beats 3-4 times when letting go from the dorsiflexion position
New onset of tonic-clonic, focal, or multifocal seizure activity in pregnancy or postpartum with s/s of preeclampsia
Eclampsia
What does HELLP stand for in HELLP Syndrome?
Hemolysis
Elevated Liver Enzymes
Low Platelet count
A severe variant of preeclampsia is what?
HELLP syndrome
What are the main symptoms of HELLP syndrome?
(1) RUQ pain
(2) general malaise
(3) N/V
Name a few nursing considerations for when a pregnant person with HTN condition arrives to the hospital
(1) emergency med orders ready
(2) ready or already placed an IV
(3) low-stim environment
(4) safety precautions
(5) frequent assessments (BP, hyperreflexia, clonus, etc.)
Name at least 3 factors that put someone at high risk for preeclampsia.
(1) preeclampsia in past pregnancy
(2) carrying more than one fetus
(3) chronic high BP
(4) kidney disease
(5) DM
(6) autoimmune disease
Name at least 3 factors that put someone at moderate risk for preeclampsia.
(1) being pregnant for 1st time
(2) BMI over 30
(3) family h/o preeclampsia
(4) age 35+
(5) complications in previous preg
(6) IVR
(7) Black race
(8) Lower income
What lab values should be assessed with Mg Sulfate?
(1) Serum creatinine
(2) CBC w/ platelet
(3) urine: PCR
(4) ALT/AST
(5) Mg levels
During an eclamptic seizure, what interventions should you complete?
(1) Keep airway patent
(2) Call for assistance
(3) Raise side rails
(4) Observe and record activity
After an eclamptic seizure, what should you do?
Do not leave unattended;
Observe for confusion, coma, incontinence;
Use suction as needed;
Administer O2;
Start IV;
Give anticonvulsant as ordered
Name at least 3 maternal complications that are associated with HTN disorders.
(1) seizure
(2) stroke
(3) DIC
(4) hepatic failure
(5) acute renal injury
(6) pulmonary edema
(7) placental abruption
(8) retinal injury
Name at least 3 fetal injuries associated with HTN disorders.
(1) oligohydramnios
(2) Intrauterine growth restriction
(3) utero-placental insufficiency
(4) prematurity
(5) placental abruption
(6) IUFD
