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
CURE = Delivery of Baby

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
S/S: malaise, epigastric or RUQ pain, visual disturbance, severe headache

Can’t clot, liver is not clear toxins, could see liver, blood values sen

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
* Pad side rails, suction @ bedside, O2
* Aim for vag birth b/c don’t want to cut open

Question 12

Drug treatment for Severe Preeclampsia

Answer 12

Mg+ sulfate: only drug used that helps
Anti HTN agents rare, only given if DBP > 110 b/c of CVA risk
* Drug choice if needed is Apresoline Hydralazine HCL

Question 13

Chronic HTN

Answer 13

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

Question 14

Eclampsia

Answer 14

Preeclampsia progression to generalized seizures not r/t other causes
* Worsening preeclampsia s/s
* Seizures can occur b/4, during, or after labor
* Tonic-clonic seizure

Question 15

When To Deliver

Answer 15

• Presistent increase in BP
• Development of severe cerebral s/s
• progressive thrombocytopenia ( < 100,000/mU)
• **ROM, bleeding **
• Abnormal liver enzymes
• Presisent RUQ pain
• Severe IUGR
• Non reasurring fetal assessment
• **Oligohydramnois ( decrease amniotic fluid) **
• GA 38-40 wks

s/s get worse, Mild preeclampsia home on bed rest and fetal kick count

Question 16

Etiology

Patho

Preeclampsia is a progressive disorder, with the placenta as the root cause.

Answer 16

• Poor perfusion and endothelial cell dysfunction (contributes significantly to restriction of fetal growth)
• Arteriolar vasospam diminishes diameter of blood vessels, which impedes blood flow to all organs and increase BP
  *

Placenta Ischemic =Endothelial cell dysfunction = vasospasm, increase peripheral resistance, increased permeability

Question 17

Mg+ Sulfate

prevent seizure

Answer 17

Monitor U/O < 30 ml/hr, RR < 12/ min, Stop if 0 DTRS (absent) , Decel FHR, mom O2 % < 95%
Toxicity:
* S/S: Lethargy, absent reflexes(q1hr), slurred speech, bradycardy , bradypnea (q1hr), mom hypoTN, Altered sensorium confusion (q1hr)
1. STOP mg!
2. IV fluid
3. Calcium Gluconate ( @ beside)
4. Notfiy MD

MOM HypoTN and confusion

2g/hr contains, stay on 24hr after delivery to decreasse the risk of postpartum seizures

Question 18

Mg+ and Pitocin

Answer 18

Need to have both one to prevent seizure and induce labor for pt who has Preeclampsia.

Want a vag birth, carefull about c-section b/c of HELLP syndrome

Question 19

Preeclampsia Meds

Answer 19

Lebatolol/Hydralazine: HTN ( no ACE)
Asones: Fetal lung maturity
Mg+ Sulf: Seizure

Question 20

DEEP TENDON REFLEXES

Answer 20

0= Absent
3= Brisk
4= Very Brisk w/ clonus

clonus= # beats