Hypertension in Pregnancy

Question 1

Different types of HTN associated with Preg (7)

Answer 1

• Gestational Hypertension
• Mild Preeclampsia
• Severe Preeclampsia
• Eclampsia
• HELLP syndrome
• Chronic Hypertension: diagnosis of HTN prior to pregnancy and no protein
• Chronic Hypertension with superimposed preeclampsia –> protein in urine is diagnostic for preeclampsia

Question 2

Hypertension in pregnancy is a continuum based on…..

Answer 2

end organ effects

Question 3

How does HTN cause damage to the body? What organs end up being effects?

Answer 3

• Vasospasm in vasculature leads to poor tissue perfusion
• Poor tissue perfusion
• Endothelial cell damage

Organs effected: CNS, Liver, Electrolytes, Lungs, Kidneys, Placenta, Clotting

Question 4

Risk factors for HTN in preggos (9)

Answer 4

• Maternal age <19 or >40 
• 1st pregnancy
• extreme obesity
• Multifetal pregnancy 
• Chronic Kidney Disease
• Chronic Hypertension
• Family history of preeclampsia
• DM 
• Underlying autoimmune disorders: 
	◦ Rheumatoid Arthritis 
	◦ Systemic Lupus Erythematous

Question 5

Onset: after 20 weeks gestation
◦ 140/90 mm Hg or > on 2 different occasions; at least 4 hours apart
◦ No proteinuria

What type of HTN is this?

Answer 5

Gestational HTN

Question 6

diagnosed w/ HTN prior to 20 weeks gestation/before pregnancy is what kind of HTN?

Answer 6

Chronic HTN

Question 7

Onset: >20 weeks
◦ 140/90 mm Hg or > on 2 different occasions; at least 4 hours apart
-proteinuria > or =1+

What kind of preggo HTN is this?

Answer 7

Mild Preeclampsia

Question 8

s/s client may report with mild preeclampsia

Answer 8

◦ Transient headache
◦ Irritability
◦ Edema

Question 9

interventions for mild preeclampsia

Answer 9

manage at home, RN does a lot of education on notifying provider of changes

◦ increase in BP –> call provider
◦ Bedrest, daily weight
◦ Education for all HTN preg clients: side lying position to allow optimal placental perfusion
◦ Diet- avoid high sodium, alcohol, tobacco, caffeine
◦ kick count

Question 10

protein in urine will occur 20 weeks or after with a client who already has HTN

What kind of preggo HTN is this?

Answer 10

Chronic HTN + superimposed preeclampsia

Question 11

• BP 160/110 mm Hg or >
◦ Proteinuria > 3+

What kind of preggo HTN is this?

Answer 11

severe preeclampsia

Question 12

s/s of kidney involvement with severe preeclampsia (3)

Answer 12

◦ Proteinuria > 3+
◦ Oliguria
◦ Elevated serum creatinine >1.1 mg/dL

POE

Question 13

CNS involvement with severe preeclampsia? (2)

Answer 13

◦ Cerebral or visual disturbances, headache and blurred vision
◦ Hyperreflexia with possible ankle clonus (jerking) when dorsiflex foot

Question 14

What kind of edema do we see with severe preeclampsia?

Answer 14

• pulmonary
• extensive peripheral edema
• facial edema
• dependent edema

Question 15

why do you have peripheral edema with severe preeclampsia?

Answer 15

arterioles vasospasm –> damage in endothelium –> leakage of intravascular fluid into interstitial spaces

Question 16

Does severe preeclampsia jack up your liver?

Answer 16

YES!
◦ elevated liver enzyme (2x normal)
◦ Epigastric and right upper-quadrant pain due to liver inflammation

Question 17

What does severe preeclampsia do to your blood components? why do I care?

Answer 17

• Thrombocytopenia - platelets <100,000

◦ decreased ability to clot, risk of hemorrhage

Question 18

Severe preeclampsia- what are the s/s ?? (BP + 6 other systems)

Answer 18

• BP 160/110 mm Hg or >
• Kidney involvement: ( Proteinuria > 3+, Oliguria, Elevated serum creatinine >1.1 mg/dL)
• CNS (visual disturb, ankle clonus)
• Edema (lungs, face, peripheral)
• Liver (increase enzymes/ RUQ pain)
• Thrombocytopenia
• N/V

Question 19

management of severe preeclampsia?

Answer 19

• Managed in hospital
• Daily Weight
• I&O
• Encourage rest

Question 20

Deep tendon reflex scoring? 1-4: what do they mean?

Answer 20

◦ 0 = no response
◦ 1+ = sluggish or diminished
◦ 2+ = active or expected response
◦ 3+ = more brisk than expected, slightly hyperactive
◦ 4+ = brisk, hyperactive with intermittent or transient clonus

Question 21

Seizure precautions for preecplamsia/eclampsia include:

Answer 21

O2 10L/min face mask, turn on side, suction equipment, not seizure onset/duration, IV access, lights low/diminished stimulation

Question 22

what are risks to fetus due to preeclampsia/eclampsia

Answer 22

IVGR (growth restriction), premature birth, placental abruption, fetus cannot tolerate labor due to decreased perfusion, born as still birth

Question 23

What are s/s of eclampsia?

Answer 23

• Manifestations of severe preeclampsia

+ Onset of seizure activity or coma !!

Question 24

Warning signs for possible convulsions?

Answer 24

◦ Frontal Headache
◦ Severe epigastric pain
◦ Hyperreflexia/ clonus
◦ Hemoconcentrations - blood components are increased

Question 25

what is a normal fetal HR?

Answer 25

110-160

Question 26

• variant of GH in which hematological conditions coexist with severe preeclampsia involving hepatic dysfunction

Answer 26

HELLP Syndrome

Question 27

Does HELLP syndrome always occur with gestational hypertension?

Answer 27

no! can occur w/o it

Question 28

H in HELLP stands for…

Answer 28

• H: Hemolysis
◦ Anemia
◦ Jaundice

Question 29

EL in HELLP stands for…

Answer 29

• EL: Elevated liver enzymes (due to decrease blood flow –> damaged liver)
◦ Elevated ALT or AST (> 2X normal)
◦ Epigastric pain
◦ Nausea and Vomiting

Question 30

LP in HELLP stands for…

Answer 30

• LP: Low platelets ( <100,000)

Question 31

s/s of low platelets/ concerns

Answer 31

◦ Bleeding gums
◦ Petechiae
◦ Possibly DIC

Question 32

Does HELLP occur in intrapartum or postpartum time?

Answer 32

BOTH

• About 1/3 of cases occur in immediate postpartum timeframe so monitor your post delivery preggos

Question 33

3 antihypertensives they use in preggos

Answer 33

◦ labetalol, nifedipine, hydralazine

Question 34

which antihypertensive can cause a false + for COOMBs test?

Answer 34

labetalol in my notes

methyldopa online/practice question

Question 35

We don’t use labetalol in patients with which other condition?

Answer 35

asthma

Question 36

Don’t use Magnesium Sulfate with which antihypertensive and why?

Answer 36

‣ nifedipine –> can cause skeletal muscle blockade –> cardiac arrest

Question 37

Seizure med of choice for preggos with preeclampsia/ eclampsia?

Answer 37

Magnesium Sulfate

Question 38

What does Mag Sulfate do?

Answer 38

• Depresses the CNS to prevent and treat seizures

Question 39

Mag sulfate side effects to educate your preggo about?

Answer 39

◦ when first start, client will report feeling flush and hot initially, nauseated, sedated
◦ sedating effect , muscle weakness, headache, oliguria side effect –> will have foley cath

Question 40

Very important assessment for Mag Sulfate administration or changes in administration?

Answer 40

Resp status

Question 41

S/s of Mag Sulfate toxicity?

Answer 41

• CNS depression!!

◦ kidney function, if <30mL output/hour --> stop the mag (kidneys need to be able to excrete it)
◦ loss of deep tendon reflex 
◦ respiratory depression (<12)
◦ bradycardia/arrhythmias 
◦ Stop the infusion! notify provider

Question 42

Normal, Therapeutic and Toxic levels of Magnesium Sulfate

Answer 42

Normal= 1.5-2
Therapeutic = 4-7
Toxic = >8

IDK if we need to know all these specifics... I thinks its too much 
ECG changes = 5-10 
Loss of reflexes = 8-12
Respiratory Distress = 15
Cardiac Arrest = 25

Question 43

Antidote for Magnesium Sulfate

Answer 43

• Calcium gluconate or calcium chloride

Question 44

How do we admin calcium gluconate as antidote for Mag Sulfate?

Answer 44

◦ 10 ml/min until sxs are reversed

Question 45

This was a hard section- GOOD JOB!

What is it called when a hospital runs out of maternity nurses?

Answer 45

A mid-wife crisis