HTN in pregnancy

Question 1

Onset of hypertension without proteinuria or other systemic findings diagnostic for preeclampsia after week 20 of pregnancy
Systolic BP >140, diastolic BP >90

Answer 1

Gestational hypertension

Question 2

Pregnancy-specific condition in which hypertension and proteinuria develop after 20 weeks of gestation in a previously normotensive woman

Answer 2

preeclampsia

Question 3

In the absence of proteinuria, preeclampsia may be defined as hypertension along with the following:

Answer 3

Thrombocytopenia
Impaired liver function
New development of renal insufficiency
Pulmonary edema
New-onset cerebral or visual disturbances

Question 4

Onset of seizure activity or coma in a woman with preeclampsia
No history of preexisting pathology

Answer 4

eclampsia

Question 5

Women can develop eclampsia…

Answer 5

in the immediate postpartum period OR

50% of eclamptic women develop the condition while pregnant

Question 6

Hypertension present before pregnancy or diagnosed before week 20 of gestation

Answer 6

chronic hypertension

Question 7

Chronic hypertension with superimposed preeclampsia

Answer 7

Women with chronic hypertension may acquire preeclampsia or eclampsia
Can be difficult to diagnose

Question 8

what is the cause of preeclampsia

Answer 8

unknown, many theories

Question 9

Progressive disorder with placenta as the root cause

Begins to resolve after the placenta has been expelled

Answer 9

Preeclampsia

Question 10

Vascular remodeling does not occur or only partially develops in women with preeclampsia leading to what

Answer 10

decreased placental perfusion and hypoxia result

Question 11

what does placental ischemia lead to

Answer 11

endothelial cell dysfunction

Question 12

what does generalized vasospasm

Answer 12

poor tissue perfusion in all organ systems
Increased peripheral resistance and blood pressure (BP)
Increased endothelial cell permeability

Question 13

Laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction

Answer 13

HELLP

Question 14

breakdown the HELLP components

Answer 14

Hemolysis (H)
Elevated liver enzymes (EL)
Low platelets (LP)

Question 15

HELLP syndrome occurs in

Answer 15

0.5% to 0.9% of all pregnancies.

Question 16

Result of arteriolar vasospasm, endothelial cell dysfunction with fibrin deposits, and adherence of platelets in blood vessels

Answer 16

HELLP syndrome

Question 17

The clinical presentation is often nonspecific; most women with the disorder report the following:

Answer 17

History of malaise
Influenza-like symptoms
Epigastric or right upper quadrant abdominal pain
Symptoms worsen at night and improve during the daytime.

Question 18

Identifying and preventing preeclampsia

Answer 18

No reliable test or screening tool has been developed
Low-dose aspirin (60 to 80 mg) may help certain high risk women
Potential biomarkers being investigated
Tyrosine kinase (sFLt) and serum placental growth factor
Abnormal uterine artery Doppler velocimetry in the first or second trimester of pregnancy

Question 19

signs and symptoms of severe preeclampsia

Answer 19

Headaches
Epigastric pain
Right upper quadrant abdominal pain
Visual disturbances

Question 20

when is a proteinuria test done

Answer 20

ideally determined by evaluation of a 24-hour urine collection

Question 21

assessment and diagnosis of preeclampsia

Answer 21

Accurate measurement of BP
Assessment of edema, although the presence of edema is no longer included in the definition of preeclampsia
Deep tendon reflexes (DTRs)
Assess for hyperactive reflexes (clonus)
Proteinuria: ideally determined by evaluation of a 24-hour urine collection
Evaluate for signs and symptoms of severe preeclampsia:

Question 22

goals/interventions of Mild gestational hypertension and preeclampsia without severe features

Answer 22

Goals of therapy are to ensure maternal safety and deliver a healthy newborn close to term.
Home care
Maternal and fetal assessment
Activity restriction
Diet

Question 23

relaxes the CNS, and as a side effect it lower blood pressure

Answer 23

magnesium sulfate therapy

Question 24

goal of severe gestational hypertension and preeclampsia with severe features

Answer 24

to ensure maternal safety and formulate a plan for delivery.

Question 25

intrapartum care of severe gestational hypertension and preeclampsia with severe features

Answer 25

Bed rest with siderails up
Darkened environment
Magnesium sulfate therapy
Antihypertensive medications

Question 26

postpartum care of severe gestational hypertension and preeclampsia with severe features

Answer 26

Vital signs, DTRs, level of consciousness
30% of cases of eclampsia and HELLP syndrome occur postpartum.
Unable to tolerate excessive blood loss

Question 27

future health care of severe gestational hypertension and preeclampsia with severe features

Answer 27

Seven-fold risk of developing preeclampsia or eclampsia in a future pregnancy
Increased risk of adverse perinatal outcomes

Question 28

immediate care of eclampsia

Answer 28

Premonitory signs: persistent headache and blurred vision
Epigastric or right upper quadrant pain
Altered mental status
Convulsions appearing without warning
Ensuring a patent airway and client safety
Maternal stabilization