HTN disorders Flashcards
gestational hypertension
SBP greater than or equal to 140
DBP greater than or equal to 90
occurs after 20 weeks
No proteinuria
What occurs if blood pressure is still elevated Six weeks after delivery?
diagnosed with chronic hypertension
Should normally resolved within 6 to 12 weeks postpartum
preeclampsia
Increased blood pressure after 20 weeks with proteinuria
risk factors of preeclampsia
Chronic hypertension
Renal disease
Diabetes
Family history
Less than 20 years old
Greater than 40 years old
BMI greater than 30
Patho of preeclampsia
Vasoconstriction causes decreased renal perfusion
Intravascular fluid redistribution
Narrowing of endometrium
treatment for preeclampsia
Aspirin at 12–21 weeks at risk
Avoid ace inhibitors and diuretics
maternal symptoms of preeclampsia
Epigastric pain – liver area
Scotoma, blurred vision, headache
Hyperreflexia
Proteinuria
Facial edema, pulmonary edema
Ascites, pleural effusions
Oliguria
Labs for preeclampsia
CBC
AST, ALT, LDH
BUN/Cr
Glucose
Uric acid
Type and screen
** 24 hour protein/creatinine clearance
Mild preeclampsia
SBP greater than or equal to 140
DBP greater than equal to 90
On two occasions, at least four hours apart when previously normal
Proteinuria greater than 300/24 hours
Proteins/creatinine clearance greater than or equal to 0.3
Positive urine dipstick
mild eclampsia without proteinuria
Platelets less than 100,000
Cerebral vision changes
Creatinine greater than 1.1 or doubled concentration.
Pulmonary edema
Liver enzymes double than normal
treatment for Mild preeclampsia
Frequent rest
Lateral position
Daily blood pressure and weight, FMC
Bedrest in hospital
Moderate to high protein and sodium
severe preeclampsia
SBP greater than or equal to 160
DBP greater than or equal to 110
on two occasions, four hours apart, while on bedrest
Proteinuria greater than 300/2 hours
Platelets less than 100,000
Severe, persistent, epigastric pain
Liver enzymes double the normal
treatment for severe preeclampsia
Complete bed rest
Magnesium sulfate
Corticosteroids
Antihypertensives-labetalol/hydralazine
what to do if SBP remains greater than 160 or DBP greater than 105
IV. Labetalol.
IV. Hydralazine.
Oral nifedipine
contraindication for IV labetalol
Asthma
contraindication for IV hydralazine and oral Nifedepine
Tachycardia
medication for prevention of seizures
Magnesium sulfate
Given for at least 24 hours postpartum
Normal magnesium sulfate side effects
headache
Nausea/vomiting
Flushing
Sedation/tired
Muscle weakness
magnesium sulfate toxicity
Decreased or absent reflexes
Decreased respiratory rate
Change in LOC
Fetal HR less than 110
Increased CR, AST/ALT
Decreased platelets
antidote for magnesium toxicity
Calcium gluconate
Eclampsia
obstetric emergency
Onset of seizure, secondary due to preeclampsia
emergency delivery if fetal hypoxia/abruption
HELLP syndrome
hemolysis
Elevated liver enzymes due to obstructed blood flow, liver distention
Low platelet count < 100,000
s/sx HELLP syndrome
Nausea/vomiting
flu, like symptoms, epigastric pain
Treatment for HELLP syndrome
Steroids and delivery of fetus after 48 hours if less than 34 weeks
chronic hypertension
SBP greater than or equal to 140
DBP greater than or equal to 90
Before pregnancy, 20th week or after sixth week postpartum
Treatment for chronic HTN
bedrest, left side lying
Increase protein and sodium in diet
nifedipine, labetalol
Labs – Preeclampsia panel
chronic hypertension with super imposed preeclampsia
Sudden increase in previously control blood pressure
New proteinuria
Upper extremity edema
Increase uric acid
