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
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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
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3
Q

4 classifications of disorders

A
  1. Chronic HTN - pre-existing pregnancy (can be diagnosed retroactively) and remains after 12 weeks PP
  2. Preeclampsia/Eclampsia - only difference is seizure
  3. Gestational HTN - develops during pregnancy and will be gone by 12 wks PP
  4. Chronic HTN with preeclampsia
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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16
Q

Nursing actions for any HTN disorder

A
  • Report and document key findings regularly
  • BP
  • Pulse
  • Lung status and RR
  • Edema
  • DTR and clonus
  • I and O
  • Urine dips for protein
  • Fetal well-being and growth/activity
  • Be prepared for hemorrhage
17
Q

Rules about MD orders

A
  • RN must prioritize bc not written in the sequence the nurse will do them and not always detailed
  • All orders must be completed or tell MD
  • Some parts of order can be delegated but RN is ultimately responsible