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ABSN > OB exam 1 - HTN disorders > Flashcards

OB exam 1 - HTN disorders Flashcards

1
Q

HTN causes an increased risk of

A

placental abruption, preterm delivery, and intrauterine growth restriction

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2
Q

how to take a correct BP

A

-the cuff size (width) should be ~40% of the arm and 80% of the arm circumference should be covered by the cuff
-pt at rest for 5 mins prior
-pt in sitting or semi reclining position
-arm at least w/ heart

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3
Q

gestational HTN dx

A

SBP >/140 or DBP >/ 90
-occurs after 20wks
-no proteinuria
-if still elevated 6wks after delivery, pt is dx w/ chronic htn

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4
Q

Preeclampsia

A

increased BP after 20 wks gestation accompanied by proteinuria
categorized by mild or severe

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5
Q

risk factors for preeclampsia

A

-chronic HTN
-chronic renal disease
-diabetes
-rH incompatibility
-primigravidity (1st preg)
-family hx
-maternal age <20 or >40
-multiple gestation
-IVF
-new paternity

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6
Q

what decreased in preeclampsia that can contribute to the etiology

A

prostacyclin which is a vasodilator so vasoconstriction can occur and there is reduced renal perfusion which can lead to hypoxia of baby

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7
Q

pathophys of a normal pregnancy

A

-inc blood plasma volume
-vasodil
-dec systemic vascular resistance
-inc CO
-dec colloid osmotic pressure

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8
Q

pathophys of preeclampsia

A

inc BP leading to dec placental perfusion causing
1)vasco
2)activation of coagulation cascade
3)intravascular fluid redistribution

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9
Q

how do we prevent preeclampsia for pt’s who are at risk

A

start 81mg of low dose aspirin between 12-28wk

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10
Q

where does funneling of preeclampsia occur and what does it prevent

A

funneling occurs between the endometrium and myometrium and it prevents good blood flow to the uterus

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11
Q

preeclampsia symptoms

A

-epigastric pain
-CNS (headache, blurred vision)
-bleeding
-N/v

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12
Q

hemolytic issues in preeclampsia

A

-low platelets
-aqueous liver enzymes
-DIC
-renal failure
-HELLP syndrome

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13
Q

what do capillary leaks cause in preeclampsia

A

-proteinuria
-facial edema
-pulmonary edema
-ascites
-pleural effusions

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14
Q

fetal manifestations of preeclampsia

A

-chance of placental abruption
-abnormal umbilical artery doppler d/t abn blood flow
-low ammonitic fluid
-growth restriction
-stillbirth

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15
Q

symptoms of severe preeclampsia

A

-visual disturbances & headaches
-fetal growth restrictions
-irritability/hyperreflexia
-retinal edema, retinal arteriolar narrowing d/t dec perfusion

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16
Q

if the kidneys are not being perfused well during preeclampsia, what are the effects

A

-oliguria
-proteinuria
-general edema

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17
Q

what are labs to be checked for preeclampsia

A

CBC, liver enzymes (LDH, AST, ALT), chemistry panel (BUN, creatinine, glucose, uric acid), type & screen and/cross mathc
+24 hr urien collection for protein & creat clearance

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18
Q

mild preeclampsia dx

A

-SBP >/ 140 or DBP >/ 90 on 2 occasions at least 4hrs apart w/ previously normal BP
-proteinuria >300mg/24hr
-pro:creat >/ 0.3
~edema

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19
Q

severe preeclampsia dx

A

-SBP >/ 160 or DBP >/ 110 on 2 occasions at least 4 hrs apart while pt is on bedrest (unless on anti htn)
-proteinuria >/ 300mg/24hr
-platelet count <100,000
-pulmonary edema
-cerebral or vision changes
-liver enzymes > twice the upper limit
-epigastric pain

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20
Q

home mgt of mild preeclampsia

A

-education to recognize worsening preeclampsia
-encourage frequent rest, lateral position
-daily BP & wt
-daily fetal movement count

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21
Q

if home mgt of preeclampsia is not successful, what is hospital mgt

A

-bed rest
-daily wts
-daily pressure 4x a day
-diet: mod to high pro, moderate Na
-fetal movement assessments

22
Q

what are the major difference in check between GHTN & preeclampsia

A

GHTN: check NST 1x/wk & check for protein
Pre: do not need to check protein bc we know it is present & NST 2x/wk

23
Q

what does a deep tendon reflex tell us

A

how irritated the CNS is
important bc the most irritated means the higher chance for a seizure

24
Q

what does preeclampsia mean

A

“before the seizure”

25
Q

clonus reflex

A

relax the lower leg and dorsiflex the foot, if the foot taps back, those taps are called beats of clonus -> this shows an irritated central nervous system
doc each foot separately

26
Q

what is the main form of anticonvulsant therapy

A

magnesium sulfate

27
Q

care for severe preeclampsia

A

-complete bed rest + decreased environmental stimuli
-mag sulfate
-fluid & lytes replacement
-corticosteroids for lung maturity
-anti htn (labetalol and hydralazine)

28
Q

what medications are used to treat acute severe htn

A

-IV labetalol
-IV hydralazine
-oral nifedipine

29
Q

contraindication for labetalol

A

asthma

30
Q

contraindication for hydralazine

A

tachycardia

31
Q

contraindication for nifedipine

A

tachycardia

32
Q

how to give mag sulfate

A

start w/ a loading dose of 4-6g IV bolus over 20 mins then maintenance of 2g/hr

33
Q

how long do you continue mag sulfate postpartum

A

24 hours -> within this time if a seizure occurs then give another 2g bolus

34
Q

IV mag sulfate can help treat what conditions

A

eclampsia, severe preeclampsia & HELLP

35
Q

common side effects of mag sulfate

A

headache
N/v
hot flushes
sedation
muscle weakness

36
Q

mag sulfate toxicity

A

-decreased or absent reflexes
-decreased respiratory rate
-change in LOC
therapeutic level is 4-7

37
Q

what is the antidote to magnesium sulfate

A

IV calcium gluconate

38
Q

eclampsia

A

when a patient has a grand mal seizure during pregnancy that can lead to a coma

39
Q

how do we manage a seizure during pregnancy (eclampsia)

A

prevent recurrence
maintain airway & place pt on side -> assess fetus -> proceed w/ emergent delivery if there is evidence of fetal hypoxia or abruption
note time of onset, body involvement, duration, suction as needed

40
Q

what do we give during an eclampsia seizure

A

mag sulfate bolus -6gm

41
Q

after seizure occurs (eclampsia), what is the following assessments

A

-check fetal status & signs of labor
-check for signs of placental abruption (vaginal bleeding, uterine rigidity)
-consider induction of labor if delivery is delayed

42
Q

intrapartal mgt

A

-possible induction w/ oxytocin or c section
-signs of worsening preeclampsia assessed
-electronic fetal monitoring
-pain relief

43
Q

postpartum mgt

A

-monitor vaginal bleeding, signs of shock
-assess BP and pulse
-continue to monitor fo seizures during the first week PP
-continue mag sulfate for 24 hours after delivery

44
Q

HELLP syndrome

A

hemolysis, elevated liver enzymes, and low platelet count associated w/ severe preeclampsia which causes liver distention, epigastric pain and possible liver rupture
possibly ends in DIC

45
Q

HELLP sx

A

N/v
flu like symptoms
epigastric pain

46
Q

HELLP tx

A

attempt to stabilize
delivery of fetus regardless of gestation 34 wks benefit from being on steroids for 48 hours for lung maturity

47
Q

chronic HTN

A

SBP >/ 140 or DBP >/90 either before pregnancy, before 20 wk GA, or remains 6wks PP

48
Q

goals of chronic HTN

A

-watch for development of superimposed preeclampsia
-evaluate growth of fetus every 4wk by ultrasound

49
Q

chronic htn tx

A

home mgt as much as possible
-bed rest
-lateral side lying
-diet (balanced, ade/high pro. ade Na)
-meds
-24hr urine study for baseline
-labs (as as preC)
-regular NST & BPP

50
Q

chronic HTN w/ superimposed preeclampsia

A

sudden increase in previously well controlled BP or if more anti htn meds are needed

51
Q

chronic HTN w/ superimposed preeclampsia sx

A

new proteinuria (or escalation)
upper body edema
rise in serum uric acid

52
Q

chronic HTN w/ superimposed preeclampsia tx

A

originally treated for chronic but now treated as if they have preeclampsia

ABSN (161 decks)

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