HTN In Pregnancy

Question 1

Gestational HTN

Answer 1

BP > 140/90 AFTER 20wks and returns to normal w/in 6 wks postpartum

Considered chronic HTN if last longer
Don’t show any other s/s, NO PROTEINURIA
May progress to preeclampsia

Question 2

CHRONIC HTN

Answer 2

HTN BEFORE 20wks pregnancy or lasts >12wks postpartum

Can develop superimposed preeclampsia
Concern during pregnancy blood flow to placenta

Question 3

MILD PREECLAMPISA

Answer 3

BP increases by 30/15 or >= 140/90 AFTER 20wks GA, Proteinuria >= +1 in random urine dipstick
s/s: edema around eyes, face, & fingers, weight gain > 2lbs/ wk, hyperreflexia 3+ usually w/ clonus, CNS s/s, mild headache, IUGR (placenta doesn’t provide enough blood supply)

Multi- organ failure = thrombocytopenia (< 150,00), increase CRT (>1)

Question 4

Patho Preeclampsia

Answer 4

placenta inserts-> poor perfusion -> endothelial cell dysfxn
* Vasospams ; decrease blood flow to organs (inc.brain) & increase BP
* Increase Peripheal resistance
* Increase endothelial cell permeability

Disease of CNS irritablility
goes away when placenta delivered

Question 5

BIGGEST CONCERN OF PREECLAMPSIA

Answer 5

GRAND MAL SEIZURES

Can be Fatal

Question 6

ASSESSMENT OF MILD PREECLAMPSIA

Answer 6

VS Q4HRS, DEEP TEDNON REFLEXES, LOC

Question 7

Interventions of Mild Preeclampsia

Answer 7

Can send home of bed rest, may hospitalized if severe
Cont. Monitoring
Left lateral bed rest
IV w/ Fluid restrictions
Insert a foley-> strict I/O > 30 ml/hr
DTR w/ clonus Qshift or Q4hrs
Early delivery -> monitor closely to determine when
* may induce labor or C-Section if HELLP suspected
Home care: montior fetal activity, BP & Weight, urinalysis for protein,** light salt & protein diet**
* come in ASAP if decrease in Fetal Movement
* see pt usualy every other day
* call provider w/ epigastric pain, N/V, RUQ pain

Question 8

MED TREATMENT FOR MILD PREECLAMPSIA

Answer 8

Mg + sulfate
Given IV in low dose 1st then continuous 2g.hr
* often becomes flush & N/V w/ start of low dose

CNS irritability depressant & helps prevent seizures ( not to low BP, even though it does)
Need to be on seizure precautions !!!
TOXICITY s/s:absent DTR, change in LOC, decrease RR (< 12)
* if developing any s/s: turn off Mg+, give Ca+ gluconate (antidote), notitfy MD (stop delivering aids, like pitocin)
* Increase IV Fluids & wait till s/s goes away

Continue 24hrs after delivery to prevent seizures
Labetalol or Hydralazine-> anti-HTN
Bethamethasone, Dexamethasone -> Helps w/ fetal lung maturity

Question 9

HELLP SYNDROME

Answer 9

Hemolysis
Elevated Liver Enzymes
Low Platelets

Question 10

Severe Preeclampsia

Answer 10

Same as mild execpt +2 of the following:
* BP 160/110 on >= occassions
* Proteinuria >= 3 (uric acid, creatintine increased)
* edema - very puffy face (periorbital) & hands
* pitting pedal edema = normal preg finding

Admitted directly into hospital - need ASAP delivery b/c pt going to have a seizure

S/S: DTR >= +3 & clonus, proteinura >= +3, oliguria (< 100 mL/4hrs)

CNS S/S: severe HA, visual distrubance (hyperelexia) (blurry, photophobia, blind spots), epigastric pain (above umbilicus)

Question 11

Interventions for Severe Preeclampsia

Answer 11

1st: seizure precautions
* no brain stim: dark room, tv off, no electronics, no noise, no stim ppl, quiet private room & closed door

Question 12

Chronic HTN

Answer 12

HTN BEFORE 20 wks pregnancy or lasts >12 wks postpartum
* can develop superimposed preeclampsia
* concern during pregnancy blood flow to placenta