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old Sophomore cards > Hypertensive Disorders of Pregnancy > Flashcards

Hypertensive Disorders of Pregnancy Flashcards

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0
Q

What percent of pregnancies are complicated by preeclampsia?

A

7-10%

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1
Q

Toxemia

A

Preeclampsia

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2
Q

PIH

A

Pregnancy induced hypertension

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3
Q

What percent of preeclampsia is mild?

A

75%

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4
Q

What percent of preeclampsia is severe?

A

25%

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5
Q

Who is at greater risk for preeclampsia (PIH)?

A

Primigravida, young age, multifetus, obesity, low economic status, diabetes, history, African American

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6
Q

What is a main nursing intervention with preeclampsia?

A

BP monitoring

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7
Q

Steady deflation

A

2-3 mmHg/sec

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8
Q

How should person be positioned for BP reading?

A

Sitting for 10 min with arm on surface

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9
Q

How much does peripheral resistance decrease by in pregnancy?

A

25%

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10
Q

What is the rise in total blood volume in pregnancy?

A

50%

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11
Q

What is the rise in cardiac output in pregnancy?

A

35-50%

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12
Q

What does the BP have to be for a diagnosis of preeclampsia?

A

140/90 X 2, 6 hours apart, less than 7 days apart after 20 weeks gestation

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13
Q

What does proteinuria have to be to diagnose preeclampsia?

A

1+ on dipstick

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14
Q

What is no longer part of the diagnosis for preeclampsia but you should watch for it?

A

Edema

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15
Q

What is the only cure for preeclampsia?

A

Birth of fetus and removal of placenta

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16
Q

Systemic disease that involves multiple organs and the fetus

A

Preeclampsia

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17
Q

Pathogenesis of preeclampsia

A

Begins with implantation, trophoblastic invasion of uterine spiral arteries is incomplete, spiral arterioles do not remodel to meet trophoblastic circulation

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18
Q

What is the result of preeclampsia on the fetus?

A

Decreased placental perfusion resulting in ischemia

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19
Q

Preeclamptics produce 10X more anti-angiogentic substances which decreases what?

A

Placental growth

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20
Q

Decreased placental perfusion=

A

Systemic endothelial cell disfunction

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21
Q

Vasospasms target which organs?

A

Brain, liver, and kidneys

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22
Q

Vasospasms cause decreased renal perfusion causing what?

A

Increased BUN, creatinine, and uric acid, decreased albumin causing edema

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23
Q

Vasospasms also cause sodium retention because of what system?

A

Renin angiotensin

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24
Q

Sodium retention causes what?

A

Edema

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25
Q

How do vasospasms cause edema?

A

Damaged glomeruli, albumin is lost, decreased osmotic pressure = edema

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26
Q

How does the renin-angiotensin system cause edema?

A

Increased fluid retention

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27
Q

What does disturbed endothelial control of vascular tone cause?

A

Hypertension, increased permeability, platelet aggregation, and ischemia of target organs

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28
Q

What is the BP in severe preeclampsia?

A

Systolic > 160 mmHG, Diastolic > 110 mmHg

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29
Q

What is the proteinuria classification of severe preeclampsia?

A

2+ - 3+ or >5 in 24 hour specimen

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30
Q

How much urine should there be in 24 hours?

A

1500mL

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31
Q

500 mL of urine in 24 hours

A

Oliguria

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32
Q

Other signs of severe preeclampsia

A

Cerebral or visual disturbances, pulmonary edema, Epigastric pain, fetal growth restriction, impaired liver function, thrombocytopenia

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33
Q

What is a sign of pitting edema?

A

No bony prominences

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34
Q

What happens to renal labs in severe preeclampsia?

A

Elevated

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35
Q

What happens to liver function tests in severe preeclampsia?

A

Elevated

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36
Q

What happens to platelets in severe preeclampsia?

A

Decreased because of clotting

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37
Q

What happens to hematocrit levels in severe preeclampsia?

A

Elevated

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38
Q

What causes the elevated LDH in severe preeclampsia?

A

Hemolysis

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39
Q

What differentiates preeclampsia from eclampsia?

A

Eclampsia also includes a seizure along with all the SE of preeclampsia

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40
Q

Treatment of preeclampsia

A

May be hospitalized

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41
Q

What diet is used for preeclampsia?

A

High in protein, moderate sodium, and 6-8 glasses of water per day

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42
Q

How should a person with preeclampsia rest?

A

Lateral recumbent position

43
Q

How do you monitor fetal well-being with preeclampsia?

A

Kick counts, nonstress test, BPP

44
Q

What can you give for preeclampsia if < 34 weeks?

A

Corticosteroids

45
Q

What do corticosteroids do for the fetus?

A

Enhance pulmonary maturity

46
Q

What is the cut off for delivery with a preeclamptic woman?

A

40 weeks

47
Q

When will they deliver for treatment of preeclampsia?

A

> 37 weeks and favorable cervix

48
Q

Treatment of severe preeclampsia

A

Hospitalization on bedrest, magnesium sulfate, antihypertentives

49
Q

When will they deliver for treatment of severe preeclampsia?

A

> 34 weeks

50
Q

Blocks ALL neuromuscular impulses

A

Magnesium sulfate

51
Q

Anticonvulsant to prevent eclamptic seizures

A

Magnesium sulfate

52
Q

When should you avoid magnesium sulfate?

A

Women with severe renal impairment

53
Q

What should you evaluate when administering magnesium sulfate?

A

Clonus, hyperreflexia, headache, visual disturbances

54
Q

How long should you continue magnesium sulfate?

A

12-48 hours postpartum or if patient has diuresis X 3 hours

55
Q

How often do you take magnesium sulfate levels?

A

q.6h

56
Q

What is the therapeutic magnesium sulfate levels?

A

4.8-9.6 mg/dL

57
Q

Magnesium level 8-10

A

Depressed reflexes

58
Q

Magnesium level 10-12

A

Respiratory depression

59
Q

Magnesium level 15

A

Respiratory arrest

60
Q

Magnesium level >15

A

Cardiac arrest

61
Q

What reverses magnesium sulfate?

A

Calcium gluconate

62
Q

What is more critical then lab values with magnesium sulfate?

A

Assessment

63
Q

What antihypertentives are used with preeclampsia?

A

Aldomet, Normodyne, and Apresoline

64
Q

How long does it take for Aldomet to take effect?

A

2-3 days

65
Q

When on Apresoline what must the mother be on and what is the goal diastolic?

A

Must be on monitor and goal is 90 mmHg

66
Q

Magnesium sulfate reduces uterine tone causing what concern postpartum?

A

Hemorrhage

67
Q

Hypertension prior to conception or before 20th week gestation

A

Preexisting “Chronic” Hypertension

68
Q

What is used for more severe hypertension?

A

Aldomet

69
Q

What do you do if there is a seizure during labor?

A

Stabilize mother, O2, positioning, give lorezapam 4mg, and magnesium sulfate

70
Q

What is common for the FHR to do during a seizure?

A

3-5 min bradycardia

71
Q

Hypertensive women who develop new onset proteinuria, proteinuria before the 20th week gestation, or sudden uncontrolled hypertension

A

Preeclampsia superimposed on preexisting hypertension

72
Q

Highest morbidity and mortality rate

A

Preeclampsia superimposed on preexisting hypertension

73
Q

High BP detected for the 1st time after midpregnancy, no preteinuria

A

Gestational hypertension

74
Q

When does BP usually return to normal in gestational hypertension?

A

12 weeks

75
Q

Complication of severe preeclampsia

A

HELLP syndrome

76
Q

H=

A

Hemolysis

77
Q

EL=

A

Elevated liver enzymes

78
Q

LP=

A

Low platelets

79
Q

What causes low platelets?

A

Clotting

80
Q

S/S of the HELLP syndrome

A

N/V, Epigastric pain, malaise and flu-like symptoms

81
Q

HELLP lab bilirubin

A

> 1.2 mg/dL

82
Q

HELLP lab LDH

A

> 600 u/L

83
Q

HELLP lab AST

A

> 70 u/L

84
Q

HELLP lab platelets

A

< 100,000/mm3

85
Q

What are the fibrinogen levels in HELLP?

A

Normal

86
Q

Who is at a higher risk for HELLP syndrome

A

Older, caucasian, multiparous

87
Q

When do HELLP labs return to normal?

A

72-96 after delivery

88
Q

How many HELLP patients develop DIC?

A

1 in 5

89
Q

An overstimulation of the coagulation process

A

DIC

90
Q

DIC

A

Disseminated Intravascular Coagulation

91
Q

Damage to vascular endothelium (blood vessels)

A

Intrinsic flooring pathway

92
Q

Tissue injury

A

Extrinsic clotting pathway

93
Q

What is DIC secondary to?

A

Underlying disease

94
Q

What is DIC associated with?

A

Missed abortion, placental abruption, preeclampsia/eclampsia, amniotic fluid embolus, and sepsis

95
Q

What are the cardinal signs of DIC?

A

Bleeding, mental confusion, and shock

96
Q

How many unrelated sites of bleeding must be present for DIC?

A

3

97
Q

What is the main nursing care with DIC?

A

Detect bleeding

98
Q

What lab is for intrinsic clotting pathway?

A

Partial Thromboplastin Time (PTT)

99
Q

What lab is for extrinsic clotting pathway?

A

Prothrombin Time (PT)

100
Q

What lab increases with DIC?

A

FSP

101
Q

What labs decrease with DIC?

A

Fibrinogen and platelet count

102
Q

How do you manage DIC?

A

Deliver baby, packed RBCs, fresh frozen plasma, and cryoprecipitate

103
Q

Why do we not use whole blood?

A

Increases the risk of hemorrhage

104
Q

Cryoprecipitate

A

Fibrinogen

105
Q

What is fresh frozen plasma used for?

A

Stable coagulation factors

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