Module 8 (Exam 3) Hypertensive Disorders

Question 1

What are the hypertensive disorders of pregnancy?

Answer 1

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

Question 2

Preeclampsia

Answer 2

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

Question 3

Criteria for Preeclampsia

Answer 3

BP 140/90 or greater X2 readings

Proteinuria greater than or equal to 1+

Question 4

Eclampsia

Answer 4

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

Question 5

Risk Factors for Preeclampsia/Eclampsia

Answer 5

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

Question 6

Onset of preeclampsia and eclampsia

Answer 6

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

Question 7

What is the cure for preeclampsia/eclampsia?

Answer 7

Delivery of infant and placenta

Question 8

Current etiology of preeclampsia/eclampsia

Answer 8

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

Question 9

How preeclampsia develops

Answer 9

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

Question 10

What organ systems does preeclampsia effect?

Answer 10

1. Placenta
2. Kidneys
3. Brain
4. Liver
5. Lungs

Question 11

How does preeclampsia effect the placenta?

Answer 11

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

Question 12

How does preeclampsia effect the kidneys?

Answer 12

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

Question 13

Mild Preeclampsia Clinical Manifestations

Answer 13

140/90 BP or higher

Proteinuria 1+ or 2+

Rapid weight gain (generalized edema)

Question 14

Home management of mild preeclampsia

Answer 14

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

Question 15

Severe Preeclampsia Clinical Manifestations

Answer 15

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

Question 16

Management of severe preeclampsia

Answer 16

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

Question 17

Impending Seizure Activity

Answer 17

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

Question 18

Hyperreflexia

Answer 18

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

Question 19

Clonus

Answer 19

Dorsiflexion causes two beats upon rebound

Question 20

Medications for preeclampsia

Answer 20

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

Question 21

IV magnesium sulfate

Answer 21

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

Question 22

Therapeutic level of magnesium

Answer 22

4-8mgs/dl

Question 23

Magnesium Toxicity

Answer 23

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

Question 24

Nifedipidine (Procardia)

Answer 24

1. Calcium channel blocker
2. Also used as a tocolytic

Question 25

Hydralazine (Apressoline)

Answer 25

Vasodilator: placental perfusion

Question 26

Labetalol (Normodyne)

Answer 26

Beta blocker

Question 27

HELLP Syndrome

Answer 27

A coagulation abnormality associated with severe preeclampsia or eclampsia

H: Hemolysis of RBCs

EL: Elevated liver enzymes (ALT, AST)

LP: Low platelets

Question 28

Postpartum Care for preclampsia/eclampsia

Answer 28

1. Monitor PP hemodynamics closely
2. Fundal assessments

Question 29

Gestational HTN

Answer 29

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

Question 30

Chronic HTN

Answer 30

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