Hypertension In Pregnancy

Question 1

Gestational Hypertension

Answer 1

onset of hypertension w/o proteinuria after 20 wks gestation

Question 2

Preeclampsia

Answer 2

Occurs 20 wks after a gestation in normotensive pt and has proteinuria
can be mild or serve

Question 3

Proteinuria

Answer 3

at or above 30 mg (>=1 dipstick)

Question 4

Eclampsia

Answer 4

Occurrence of seizures or coma in a woman w/ preeclampsia

Question 5

Chronic HTN

Answer 5

HTN occurs before pregnancy or diagnosis before 20th week or persists more than 6-12 months after post

Question 6

Preeclampsia superimposed on Chronic HTN

Answer 6

HTN Chronic with new proteinuria or an exacerbation of HTN or Proteinuria, thrombocytopenia or ^ in hepatocellular enzymes

Question 7

HTN Ranges

Answer 7

Systolic BP > 140 mm Hg
Diastolic > 90 mm Hg
MAP >105 mm Hg

Question 8

Primigravidas HTN

Answer 8

First pregnancy HTN
More likely

Question 9

Multiparous HTN

Answer 9

Multiple pregnancies HTN

Question 10

When does BP return to normal after delivery

Answer 10

1-12 wks

Question 11

Mild Preeclampsia

Answer 11

BP 140/90
MAP >105
24 hr urine protein
>= 0.3g or 300 mg = +1dipstick

Question 12

Severe Preeclampsia

Answer 12

BP >= 160/110 mm Hg 2 occasions at least 4 hrs apart
MAP >105
24hr urine protein >2g=2000mg

Question 13

Risk Factors of Preeclampsia

Answer 13

Chronic Renal disease
Chronic HTN
Family hx of preeclampsia
Multiple gestations
Primigradivity or a new partner
Maternal age
Diabetes
Rh incompatibility
Obesity

Question 14

Etiology of Preeclampsia

Answer 14

Disruption in Placental perfusions and endothelial cell dysfunction

Question 15

Consequences of endothelial cell dysfunctions

Answer 15

Vasospasms and decreased organ perfusion
Intravascular coagulation
Increased permeability and capillary leakage

Question 16

Intravascular coagulation

Answer 16

hemolysis RBC, low platelet counts, DIC, ^ Factor 8 antigen

Question 17

Vasospasms and decreased organ perfusion

Answer 17

HTN, uteroplacental spasms, HA, blurred vision, hyperreflexia, ^ liver enzymes, NV, epigastric pain

Question 18

Increased permeability and capillary leakage

Answer 18

Proteinuria, generalized edema, pulmonary edema (dyspnea), hemoconcentration (^ hematocrit)

Question 19

Effects of Preeclampsia: Placental

Answer 19

Impaired perfusion = IUGR and early aging of the placenta

Question 20

Effects of Preeclampsia: renal

Answer 20

v GFR, oliguria, ^ excretion of protein, v uric acid clearance, Na+ and H20 retention

Question 21

Effects of Preeclampsia: Hepatic

Answer 21

v perfusion = hepatic edema and subcapsular hemorrhage, complaint of epigastric pain or RUQ pain

Question 22

Effects of Preeclampsia: Neurological

Answer 22

Cerebral edema, CNS irritability, Visual disturbances

Question 23

Effect of Preeclampsia: Laboratory Values

Answer 23

v serum albumin
^ Hct
^ BUN, creatinine, uric acid

Question 24

Testing for Proteinuria

Answer 24

300 mg/dl >= 1+ on dipstick
At 6 hrs apart or 24 hrs specimen

Question 25

Eclampsia Seizure Precaution

Answer 25

Keep the patient safe
Turn onto side
Suction
O2
IV Magnesium Sulfate
Monitor fetus
Uterine and Cervical Assessment
Document: time, duration, and any urinary/ fecal incontinence

Question 26

How to manage pt with severe preeclampsia

Answer 26

Hospital bedrest
Maternla and fetal surveillance
Quiet, nonstimulating environment and seizure precautions
Pharamcological intervention
Delivery

Question 27

How to manage pt w/ mild preeclampsia

Answer 27

Bedrest
Monitoring BP
Daily weights
Fetal surveillance
Monitor urine protein
Educate on signs to report
Healthy diet and adequate hydration
Emotional support

Question 28

Platelets Lab Value

Answer 28

Should not be less than 150,000