Exam 2- Hypertensive disorders of pregnancy Flashcards
Hypertension disorders is more prevalent as?
as age and weight increases
Categories of hypertensive disorders
- Chronic Hypertension
- Gestational Hypertension
*Preeclampsia/Eclampsia/HELLP - Chronic hypertension with superimposed
preeclampsia
what is considered chronic hypertension?
Blood pressure exceeding 140/90 before pregnancy
or before 20 weeks gestation.
gestation hypertensive?
- Onset after 20 weeks
- Resolving 12 weeks postpartum
- Without proteinuria**
- BP greater than 140/90
PRE-ECLAMPSIA
Hypertension + proteinuria develop after 20
weeks of gestation
systemic wide
PRE-ECLAMPSIA : categorized as
- Categorized as mild or severe
- Remains one the leading causes of death and severe
maternal morbidity worldwide.
PRE-ECLAMPSIA : may be accompanied by
May be accompanied by maternal organ dysfunction
of cardiovascular, hepatic, renal, and central
nervous system (CNS).
PRE-ECLAMPSIA: etiology
- Unique to human pregnancy
- Cause is unknown
- Theories exist to try to explain etiology
PRE-ECLAMPSIA: patho
- Progressive multisystem disorder results from abnormal
placental plantation and a maternal vascular response.
Abnormal development of blood vessels in placenta
- All result in placental ischemia. (Decreased placental
perfusion and hypoxia)
PATHO-PLACENTAL ISCHEMIA &
VASOSPASM
Placental ischemia
- Cells of placenta aren’t getting
enough oxygen (Poor tissue perfusion in all
organ systems)
- Release of inflammatory molecules
that are toxic to endothelial cells.
- Endothelial cell dysfunction caused
by placental ischemia.
- This anomaly causes generalized
vasospasm.
*All leading to signs and symptoms of
preeclampsia.
Pre-eclampsia: PATHO-SIGNS AND SYMPTOMS
- Vessels lose
ability to
control tone
and relax-
increased
BP - Increased
permeability
and capillary
leakage
Pre-eclampsia patho: Kidney function
- Kidney function (increased
permeability and capillary
leakage) leak protein; proteinuria Kidney
(vasospasm) serum uric acid increases
Pre-eclampsia patho: other blood vessel leak where? causing what?
Other blood vessels leak into
tissue (remember water follows
protein)-edema/generalized
Pre-eclampsia patho: dysfunction of vessels in brain causes what symptoms?
Dysfunction of vessels in brain;
cerebral edema and cortical
brain spasm-CNS irritability-HA,
hyper-reflexia, seizures(eclampsia)
Pre-eclampsia patho: Liver dysfunction (ischemia) causes what symptoms?
- Liver dysfunction (ischemia):
elevated enzymes-AST, ALT,
epigastric pain, N/V
Pre-eclampsia patho: lungs symptoms
- Lungs: Pulmonary edema
Pre-eclampsia patho: eyes symptoms
- Eyes: (vasospasm) decreased
blood flow to retina; visual disturbances
Pre-eclampsia: results on the fetus
- IUGR (baby stops growing d/t not enough perfusion)
- Decreased amniotic fluid
- Low birth weight
- Preterm birth
- Abnormal fetal oxygenation=fetal distress
Pre-eclampsia: overall s/sx to look for
- HA
- Visual changes
- Epigastric pain
- Swelling
- Reflexes-hyper
- Unusual bleeding or bruising (d/t the low platelets)
Pre-eclampsia: labs to look for
- Protein in urine
- Elevated liver enzymes
- Low platelets Thrombocytopenia
NURSING
CONSIDERATIONS FOR
HYPERTENSIVE
DISORDERS
- Monitor BP
- Quiet environment
- Call light in reach
- Seizure precautions
- Fetal surveillance
- Ongoing Assessments for
evidence of disease progression - Neurological status
- Assess lab values
PHARMACOLOGIC
CONTROL OF BP
*Hydralazine/ Apresoline
* Labetalol (beta blocker)
* Nifedipine (Procardia)
* Furosemide (Lasix) Diuretic
(Pulmonary Edema)
Drug of choice in prevention and treatment of
seizure activity
MAGNESIUM SULFATE
- (IV)
- calcium channel blocker
MAGNESIUM SULFATE: loading dose
Loading dose 4-6 grams
(initial)
MAGNESIUM SULFATE: maintenance dose
Maintenance dose 1-2 grams
MAGNESIUM SULFATE: antidote
*High alert medication
- calcium gluconate
MAGNESIUM SULFATE: nursing interventions
- Monitor serum magnesium
levels - Assess deep tendon reflexes
(DTRs) and clonus - Calcium gluconate available
MAGNESIUM SULFATE: s/sx of toxicity
- S&S of toxicity (CNS and
respiratory depression,
hypotension. Level of consciousness
RISKS WITH PREECLAMPSIA
- Placental
abruption - Preterm birth
- Intrauterine
growth restriction
(IUGR) - Fetal distress
MATERNAL
PROGNOSIS/effects
AFTER
PREECLAMPSIA
- At risk for cardiovascular
disease later in life - More likely to develop Chronic
hypertension
Takes longer to normalize BP
after delivery than gestational hypertension does
- Intriguing disease unique to
pregnancy
ECLAMPSIA: onset
- Onset of seizure activity or
coma in a woman with
preeclampsia
ECLAMPSIA: seizures occur when?
- Seizures can occur before,
during, or after birth - 1/3 of eclamptic seizures occur
after birth within the first 48
hours after birth
ECLAMPSIA: priority intervention
- Patient safety is primary
concern.
CHRONIC
HYPERTENSION WITH
SUPERIMPOSED
PREECLAMPSIA
- Women with CHTN and
preeclampsia
CHTN and
preeclampsia
causes what syndrome?
HELLP SYNDROME
HELLP SYNDROME: stands for?
- H=hemolysis
- EL=elevated liver enzymes
- LP=low platelets
life threatening
HELLP SYNDROME: diagnosis by?
Laboratory diagnosis NOT a clinical diagnosis
