Hypertensive Disorders of Pregnancy Flashcards
1
Q
Overview of hypertensive disorders
A
- 25% increase in 20 years
- Preeclampsia is the leading cause of maternal mortality worldwide
- These can be diagnosed postpartum
2
Q
Diagnosis of hypertensive disorders
A
- Urine protein > 300 mg in 24 hours
- BP > 140/90 twice four hours apart after 20 weeks pregnant
- Platelets < 100,000
- Serum creatinine 1.1 mg
- Liver function: double the normal values
3
Q
4 classifications of disorders
A
- Chronic HTN - pre-existing pregnancy (can be diagnosed retroactively) and remains after 12 weeks PP
- Preeclampsia/Eclampsia - only difference is seizure
- Gestational HTN - develops during pregnancy and will be gone by 12 wks PP
- Chronic HTN with preeclampsia
4
Q
What is preeclampsia
A
- Multisystem, vasospastic disease process of reduced organ perfusion
- Presence of CNS irritability, HTN, protein in urine
- Cause is unknown and more common in primigravidas
- Pregnancy-specific disease develops after 20 weeks gestation
- Only cure is delivery
- Issue is CNS irritability and HTN is a side effect (not root cause)
5
Q
What are risk factors for preeclampsia?
A
- Chronic renal disease
- Chronic HTN
- Family hx of preeclampsia
- Multiple gestations
- First baby with new partner
- Primigravida
- Maternal age under 19 or over 40
- Diabetes
- Obesity
- Rh incapatability
6
Q
Preex is an OB emergency
A
- Women die from it
- Babies can be severely damaged or born prematurely
- Women may experience long-term damage
- Usually required 1:1 nursing care
- Women may be transferred to higher level hospital and sometimes prolonged stay
- Often early delivery
7
Q
Preex Nursing focus on teaching
A
- Importance of rest and quiet
- Assessment and documentation of symptoms (headache, blurred vision, epigastric pain)
- Increasing comfort
8
Q
Preex Medical Intervention
A
- Bed rest
- BP and pulse monitoring
- Fetal well-being monitoring via movement and non-stress test
- Steroids to fetus in case of early delivery
- Meds (goal is to reduce the risk of seizure)
- Seizure precautions
9
Q
Drug of choice for preex
A
- Mag sulfate
- Reduce risk of seizure and decrease organ damage and increase ability of blood to flow to fetus
- Give 4 g loading dose over 30 min, then 1-2 g/hour until symptoms decrease
10
Q
Nursing actions for mag
A
- Have calcium gluconate available
- Monitor output via a foley for kidney damage
- Patient NPO
- Check lungs/RR/BP every hour w output
- Keep patient quiet
- Prepare for side effects of mag: metallic taste, weakness, feeling hot
- Peds present at birth
- Monitor fetal response
- Labs for mag levels and liver damage
11
Q
PP Mag
A
- Stay on mag for 24-48 hours then 12-24 hours PP
- Prevent woman from having a seizure and baby dying
- Be ready for bleeding bc muscle relaxation from mag
12
Q
Eclampsia
A
- Only difference from preex is seizure
- Onset of seizure/coma in woman diagnosed with preex with no hx of seizure
- Can result in loss of fetus and mother
- BP >140 systolic and >90 diastolic
13
Q
Gestational HTN
A
- Onset of HTN without proteinuria after 20 weeks gestation
- Final diagnosis is made PP after BP returns to normal
- If not normal BP by 12 weeks PP then this was chronic HTN
14
Q
Chronic HTN
A
- HTN present before pregnancy or diagnosed before 20 weeks gestation or persists after 12 weeks PP
- Usually treated wtih oral HTN meds and close monitoring
15
Q
HELLP Syndrome
A
- Lab diagnosis for variations in preex that involve hepatic dysfunction
- Hemolysis
- Elevated liver enzymes
- Low platelets
- Associated with many possible abnormalities: placental abruption, renal failure, preterm birth, hepatic rupture, fetal and maternal death