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Semester Three - Half Two - Nursing 212 > Module 8 (Exam 3) Hypertensive Disorders > Flashcards

Module 8 (Exam 3) Hypertensive Disorders Flashcards

1
Q

What are the hypertensive disorders of pregnancy?

A
  1. Preeclampsia and Eclampsia
  2. Gestational Hypertension
  3. Chronic Hypertension
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2
Q

Preeclampsia

A

An increase in BP after 20 weeks’ gestation, accompanied by proteinuria. Most common hypertensive disorder of pregnancy. 2-6% in nuiliparous women

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3
Q

Criteria for Preeclampsia

A

BP 140/90 or greater X2 readings

Proteinuria greater than or equal to 1+

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4
Q

Eclampsia

A

The occurence of a seizure in a woman with preeclampsia who has no other identified cause for seizure activity

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5
Q

Risk Factors for Preeclampsia/Eclampsia

A
  1. Primigravid status
  2. Age less than 16 or greater than 35
  3. Family Hisotry
  4. Pre-existing renal or vascular disease
  5. Large Placental mass: diabetes, multiple gestation, gestational trophoblastic disease
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6
Q

Onset of preeclampsia and eclampsia

A
  1. During the last 10 weeks of pregnancy
  2. During labor
    1. During the initial 48-72 hours postpartum
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7
Q

What is the cure for preeclampsia/eclampsia?

A

Delivery of infant and placenta

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8
Q

Current etiology of preeclampsia/eclampsia

A
  1. Incomplete trophoblastric “remodeling” of spiral arteries at implantation
  2. Impaired placental implantation
  3. Compromised placental perfusion
  4. Systemic response
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9
Q

How preeclampsia develops

A
  1. Abonormal placental perfusion stimulates production of blood-borne biochemicals
  2. Multisystemic endothelial (lining of blood vessels) cellular injury
  3. Activation of coagulation system
  4. Platelet clumping at injury site
  5. Increased peripheral vascular resistance
  6. Generalized vasospasm and vasoconstriction
  7. Hypoperfusion
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10
Q

What organ systems does preeclampsia effect?

A
  1. Placenta
  2. Kidneys
  3. Brain
  4. Liver
  5. Lungs
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11
Q

How does preeclampsia effect the placenta?

A
  1. Decreased placental perfusion
  2. Fetal hypoxia
  3. Intrauterine growth restriction
  4. Potential for placental infarct/abruption
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12
Q

How does preeclampsia effect the kidneys?

A
  1. Decreased renal perfusion
  2. Impaired glomerular filtration
  3. Loss of intravascular serum albumin leading to proteinuria
  4. Fluid shift from intravascular to extravascular spaces leading to generalized edema
  5. Hypovolemia R/T intravascular volume deficit
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13
Q

Mild Preeclampsia Clinical Manifestations

A

140/90 BP or higher

Proteinuria 1+ or 2+

Rapid weight gain (generalized edema)

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14
Q

Home management of mild preeclampsia

A
  1. Rest
  2. Adequate protein intake
  3. Daily weights, BP, urine for proteinuria
  4. Periodic lab values: CBC and platelets, 24 hour urine for creatinine clearance and protein
  5. Fetal: serial NSTs/Kick Counts
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15
Q

Severe Preeclampsia Clinical Manifestations

A
  1. 160/110 X2 readings
  2. Proteinuria of 3+ or greater
  3. Oliguria: Less than 500mL/24 hours
  4. Thrombocytopenia: Less than 100,000
  5. Pulmonary Edema
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16
Q

Management of severe preeclampsia

A
  1. Bed rest in lateral position
  2. Chemical management
  3. IVF and electrolyte replacement (strict I&O and weights)
  4. Seizure Precautions: lower stimuli
  5. Neurologic and pulmonary assessments
  6. Fetal: serial NSTs
17
Q

Impending Seizure Activity

A
  1. Headache
  2. Anxiety, confusioin
  3. Scotomata
  4. Hyperreflexia
  5. Right upper quadrant pain: epigastric pain
18
Q

Hyperreflexia

A

Increase in deep tendon reflexes R/T neurologic hyperactivity

  1. 0 = reflex absent
  2. 1+ = weak reflex
  3. 2+ = normal response
  4. 3+ = exaggerated response
  5. 4+ = hyperactive: possibly with clonus
19
Q

Clonus

A

Dorsiflexion causes two beats upon rebound

20
Q

Medications for preeclampsia

A
  1. IV magnesium sulfate
  2. Antihypertensives
    • Nifedipine (Procardia)
    • Hydralazine (Apressoline
    • Labetalol (Normodyne)
21
Q

IV magnesium sulfate

A
  1. First line treatment for preeclampsia or eclampsia
  2. CNS depressant (primary), anticonvulsant
  3. Peripheral vasodilator (decreases BP)
  4. Antidote: calcium gluconate
22
Q

Therapeutic level of magnesium

A

4-8mgs/dl

23
Q

Magnesium Toxicity

A
  1. RR depression (decreased oxygen saturation)
  2. Hypotonic reflexes
  3. Oliguria (less than 30 mL/hour)
24
Q

Nifedipidine (Procardia)

A
  1. Calcium channel blocker
  2. Also used as a tocolytic
25
Q

Hydralazine (Apressoline)

A

Vasodilator: placental perfusion

26
Q

Labetalol (Normodyne)

A

Beta blocker

27
Q

HELLP Syndrome

A

A coagulation abnormality associated with severe preeclampsia or eclampsia

H: Hemolysis of RBCs

EL: Elevated liver enzymes (ALT, AST)

LP: Low platelets

28
Q

Postpartum Care for preclampsia/eclampsia

A
  1. Monitor PP hemodynamics closely
  2. Fundal assessments
29
Q

Gestational HTN

A
  1. Occurs after mid-pregnancy
  2. Not accompanied by proteinuria
  3. May progress to preeclampsia
30
Q

Chronic HTN

A
  1. May be unrecognized until pregnancy
  2. Does not progress to preeclampsia

Semester Three - Half Two - Nursing 212 (41 decks)

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