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high risk OB > hypertensive disorders of pregnancy > Flashcards

hypertensive disorders of pregnancy Flashcards

1
Q

4 HTN disorders of pregnancy

A

-chronic HTN
-gestational HTN
-chronic HTN w superimposed preeclampsia
-preeclampsia/eclampsia

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2
Q

elevated BP that predates pregnancy

A

chronic HTN

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3
Q

what normal Tx for chronic HTN are not recommended in pregnancy (2)

A

-weight loss
-extremely low sodium diets

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4
Q

who is at risk for chronic HTN

A

-advanced maternal age
-obesity
-lack of exercise
-comorbidities
-diabetes
-smoking

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5
Q

meds you can’t use to treat HTN during pregnancy

A

ACE inhibitors

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6
Q

med to treat HTN during pregnancy (3)

A

-b blocker (labetalol)
contraindicated in pts with HF or asthma
-CCB (nifedipine)
-methyldopa

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7
Q

blood pressure elevation after 20 weeks of gestation (in absence of proteinuria and other features preeclampsia)

A

gestational HTN

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8
Q

what is considered proteinuria

A

-protein/creatinine ratio 0.3mg/dL (more than +1)
-300 mg or more of protein in 24 hr urine

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9
Q

what bp is treated during pregnancy

A

160/110
(or Sbp +30/Dbp +15 over baseline)

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10
Q

what happens with preeclampsia (patho)

A

-constricted spiral arteries to placenta
-vasospasms (endothelial damage)
-decreased maternal CO (impaired blood flow to organs)
-hypovolemia
-platelet aggregation that further constrict spiral arteries
-decreased tissue perfusion, increased cellular hypoxia

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11
Q

preeclampsia diagnostic criteria (2)

A

-bp 140/90
-protein/Cr ration >0.3 or >300 mg in 24 hr urine
(+edema, thrombocytopenia)

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12
Q

risk factors preeclampsia

A

-genetic
-multiples
->35 yo or teenagers
-diabetes
-obesity
-preexisting HTN/renal disease
-Hx of thrombophilia
-IVF
-SLE (autoimmune disorders)

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13
Q

severe features of preeclampsia (7)
elevated BP + atleast one feature = severe

A

-Sbp >160
-Dbp >110
-thrombocytopenia (plt <100)
-impaired liver function (severe RUQ pain, unresponse to meds)
-progressive renal insufficiency (Cr>1.1)
-pulmonary edema
-new onset cerebral/visual disturbances (headache, blurred vision)

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14
Q

complications severe preeclampsia

A

-pulmonary edema
-MI
-stroke
-acute resp distress
-coagulopathy (DIC)
-severe renal failure
-retinal injury
-abruption

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15
Q

diagnosis of superimposed preeclampsia (with women who had chronic HTN)

A

-sudden exacerbation HTN (previously well controlled)
-sudden onset S+S (headache, blurred vision)
-Plt >100
-development pulmonary congestion/edema
-development renal insufficiency
-sudden/sustained protein increase (proteinuria)

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16
Q

what value is considered thrombocytopenia

A

plt >100,000

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17
Q

prenatal pt care for HTN disorders

A

-daily assessment of symptoms
-daily fetal kick counts
-serial assessments bp (atleast 2x weekly)
-labs weekly (platelets, liver enzymes)
-ultrasound to assess fetal growth
-antenatal steroids (accelerates fetal lung maturity)

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18
Q

PRES
what does it stand for and what is it

A

posterior reversible encephalopathy syndrome
= swelling of brain caused by HTN crisis, leads to seizures

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19
Q

how to elicit clonus

A

sharp dorsiflexion of foot
clonus = shaking of foot

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20
Q

med to protect from seizures with preeclampsia

A

magnesium sulfate
smooth muscle relaxer

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21
Q

when do you worry about creatinine in pregnancy

A

> 1.1

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22
Q

UPCR

A

urine protein creatinine ratio
(should be 0.3 or less)

23
Q

eclampsia interventions

A

-airway
-call for help
-lateral recumbent position
-oxygen
-suction
-VS monitoring
-protect pt
-reorient pt
-magnesium sulfate
(mag not effective: versed, ativan, valium, dilantin)

24
Q

meds you can give if magnesium isn’t working to stop eclampsia

A

versed
ativan
valium
dilantin

25
Q

therapeutic mag levels

A

5-8

26
Q

S+S PRES

A

-quick onset
-seizures are late symptoms
-headache
-blurry vision
-cortical blindness
-N/V
-impaired LOC

27
Q

nursing assessments for pregnant pts

A

-VS
-DTRs
-I&O
-S/S of severe preeclampsia (RUQ pain, headache, blurred vision, edema)
-CTX
-ROM
-abdominal pain
-bleeding
-lab tests
-RR

28
Q

classifications edema

A

+1 = 2 mm
+2 = 4 mm
+3 = 6 mm
+4 = 8 mm

29
Q

*lab values??

A
30
Q

what scan if fetal growth restriction is suspected

A

doppler velocimetry (umbilical artery doppler blood flow)
*deliver if reversed end diastolic velocity

31
Q

Tx/plan of care for preeclampsia/women at risk for preeclampsia

A

-low dose aspirin (after 1st tri)
-antiHTN meds (for >160/110)
-mag (for severe preeclampsia)
-corticosteroids (betamethasone and dexamethasone for fetal lung maturity)
-epidural (vasodilates, as long as plt above 80)

32
Q

corticosteroids to accelerate fetal lung maturity (2)

A

betamethasone
dexamethasone
(usually before 34 weeks, atleast 24 hrs before delivery)

33
Q

delivery indications (maternal)

A

-recurrent severe HTN
-recurrent S+S severe preeclampsia
-progressive renal insufficiency
-persistent thrombocytopenia or HELLP syndrome
-pulmonary edema
-eclampsia
-suspected abruption (depends on amount of abruption)
-progressive labor or ROM

34
Q

when to deliver for preeclampsia w/o severe features?
w/ severe features?

A

37 weeks w/o severe features
34 weeks or sooner if severe features

35
Q

delivery indications (Fetal)

A

-34 wks gestation
-severe fetal growth restriction
-persistent oligohydramnios (<5 cm)
-BPP 4/10 or less on atleast 2 tests
-reversed end-diastolic flow on umbilical artery doppler
-recurrent variable/late decels on NST
-fetal death

36
Q

normal amniotic fluid volume (cm)
what is considered oligo

A

6-25 cm
oligo: <5 cm

37
Q

how can NSAIDs affect bp

A

increases bp

38
Q

what postpartum pts should receive antiHTN therapy

A

persistent BP 150/100 atleast 2 occasions 4-6 hrs apart

39
Q

what postpartum pts should receive mag

A

new onset HTN or visual disturbances

40
Q

what is chronic HTN postpartum

A

elevated bp after 12 weeks PP

41
Q

signs of abruption on TOCO

A

low amplitude, high frequency contractions

42
Q

oxygen deprivation process in fetus

A

-hypoxemia
-hypoxia
-metabolic acidosis
-metabolic acidemia

43
Q

what on TOCO tells us there is an interruption in oxygenation to fetus

A

variable, late or prolonged ecels

44
Q

what on TOCO tells us there will not be metabolic acidemia

A

moderate variability or accelerations

45
Q

what is HELLP syndrome (acronym)

A

hemolysis (RBC)
elevated
liver enzymes
low
platelets

46
Q

S+S HELLP syndrome

A

-malaise
-headache
-N/V, indigestion w pain after eating
-RUQ pain
-shoulder pain/pain with deep breathing
-bleeding
-changes in vision
-swelling

47
Q

Tx HELLP

A

-corticosteroids
-supportive care w blood products

48
Q

subtype of preeclampsia characterized by sudden or progressive deterioration in maternal and/or fetal condition (may or may not have elevated bp; most common in white women)

A

HELLP syndrome

49
Q

med options for severe HTN (>160/110) (3)

A

IV access:
-hydralazine
-labetalol

no IV access:
-nifedipine

50
Q

risk factors for stroke

A

-HTN
-diabetes
-heart disease
-sickle cell anemia
-thrombocytopenia
-smoking
-lupus
-complications of labor

51
Q

types stroke

A

ischemic (infarction)
hemorrhagic:
-intracerebral
-subarachnoid

52
Q

BEFAST acronym for stroke

A

Balance (loss balance, dizziness, headache)
Eyes (sudden loss vision)
Face (uneven)
Arm (weakness)
Speech (difficulty)
Time (call 911)

53
Q

S+S stroke

A

-headache
-visual changes
-epigastric pain
-seizures
-N/V
-focal/global neurologic deficits
-severe HTN
-facial/arm muscle weakness
-facial deficit
-convulsions

54
Q

imaging for stroke

A

CT (can’t see full extent)
MRI (can see ischemic changes)

high risk OB (14 decks)

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