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PCC4 > Perfusion: Gestational Hypertension/Eclampsia > Flashcards

Perfusion: Gestational Hypertension/Eclampsia Flashcards

1
Q

What are the different classifications of hypertension in pregnancy?

A
  1. Chronic hypertension
  2. gestational hypertension
  3. Preeclampsia
  4. preeclampsia superimposed on chronic hypertension
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2
Q

At what point can gestational hypertension occur in pregnancy?

A

In the second half of pregnancy

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3
Q

What classifies preeclampsia?

A
  1. Systolic BP of >140 or Diastolic BP of >90 occurring 20 weeks of pregnancy
  2. proteinuria (>0.3g in a 24-hour urine collection, which usually correlates with a random urine dipstick evaluation of <1+)
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4
Q

What are the risk factors for hypertension during pregnancy?

A
  1. Chronic health problems affecting the vascular system (diabetes, renal disease, chronic HTN)
  2. Family or personal history of gestational hypertension
  3. Primigravida or first pregnancy with a new partner
  4. Multiple gestations
  5. age less than 20 or over 35
  6. poor nutrition
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5
Q

What classifies Gestational hypertension?

A
  1. no proteinuria with HTN after 20 weeks of pregnancy
  2. Systolic > 140 mmHg or Diastolic >90 mmHg that develops after 20 weeks but returns to normal within 6 weeks postpartum
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6
Q

What classifies chronic HTN?

A
  1. elevated BP was known to exist before pregnancy
  2. Systolic BP >140 or diastolic >90
  3. Also diagnosed if the HTN does not resolve during the postpartum period
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7
Q

What medications are used or avoided during pregnancy for chronic HTN?

A
  1. Aldomet (Methyldopa) is the drug of choice in pregnancy
  2. May also use Beta-blockers and CCB’s if Aldomet is not effective (Nifedipine)
  3. ACE inhibitors are contraindicated but may be used in PP period
  4. Diuretics are avoided if possible as they shrink the blood volume
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8
Q

What is preeclampsia superimposed on chronic HTN?

A

chronic HTN with a new onset of proteinuria (>0.3 g in a 24 hour urine collection)

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9
Q

How many pregnancies end up having Preeclampsia in the US?

A

5-8% of pregnancies, major cause of perinatal death, often associated with FGR

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10
Q

What are the risk factors for preeclampsia?

A
  1. first pregnancy
  2. first pregnancy for father of baby
  3. Age: “younger” or “older”
  4. Family or personal hx of preeclampsia
  5. Obesity
  6. diabetes
  7. multifetal pregnancy
  8. Pregnancy from ART
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11
Q

What are the clinical manifestations of Mild preeclampsia?

A
  1. high BP

2. high level protein in urine

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12
Q

What are the clinical manifestations of Severe preeclampsia?

A
  1. BP >160/110
  2. headache, tinnitus
  3. Visual disturbances
  4. Hyperreflexia
  5. changes in kidney function
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13
Q

What are the clinical therapies for mild preeclampsia?

A 
1. may be cared for at home
Teach pregnant woman to monitor:
2. BP
3. daily weight
4. Daily fetal movement counts
5. signs of worsening condition
6. UA for protein
7. Diet: Limit sodium intake
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14
Q

What are the clinical therapies for antepartum management of preeclampsia?

A
  1. Depends on severity
  2. May be managed at home or in hospital
  3. Assess BP, weight, urine protein, fetal movement monitoring
  4. Bed rest, lying on left side
  5. Limit sodium intake
  6. Steroids indicated when preterm birth is anticipated
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15
Q

What are the clinical therapies for antepartum management of preeclampsia in the hospital?

A
  1. bolus of 4-6 g magnesium sulfate IV over 5 minutes
  2. Antihypertensive agents
  3. Assess for signs of labor
  4. Intensive care admission
  5. Induce labor
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16
Q

What are the clinical therapies for intrapartum management of preeclampsia in the hospital?

A
  1. chemical induction of labor
  2. cesarean birth may be necessary
  3. Continuous assessment of woman and fetus
17
Q

What are the clinical therapies for postpartum management of preeclampsia in the hospital?

A
  1. rapid improvement after delivery

2. risk of seizures up to 48 hours after delivery

18
Q

What are the clinical therapies for severe preeclampsia?

A
  1. hospitalized care (delivery is usually necessary, even if gestation is less than 34 weeks)
  2. Ongoing assessment of mother and fetus (Check DTR on patient every 4 hours)
  3. Alternate between a left and right lateral position
  4. Seizure precautions
19
Q

What medications are often used for severe preeclampsia?

A
  1. sedatives
  2. Magnesium Sulfate (IV piggyback)- have calcium gluconate available
  3. Antihypertensives- Hydralazine (Apresoline)
20
Q

What does HELLP mean?`

A
  1. H- Hemolysis
  2. EL- Elevated Liver enzymes
  3. LP- Low platelet count
21
Q

What are the clinical manifestations of HELLP syndrome?

A
  1. Severe RUQ pain, neck pain, shoulder pain
  2. nausea and vomiting
  3. general malaise
  4. Severe edema
  5. distended liver that is painful
22
Q

What are the risk factors of HELLP syndrome?

A
  1. hx of preeclampsia, chronic HTN, or kidney
  2. Obesity
  3. African ethnicity
  4. Women over age 35
23
Q

What collaborations are often used for HELLP syndrome?

A
  1. meds (magnesium sulfate)
  2. Fresh frozen plasma or platelets
  3. Delivery of fetus if mature enough
24
Q

What are the nursing interventions for HELLP syndrome?

A
  1. monitor client frequently (VS, FHM)
  2. Be alert for S/S of complications
  3. AVOID PALPATING THE ABDOMEN
25
Q

What can occur during eclampsia?

A

seizures

26
Q

What are the nursing interventions for preventing seizures during eclampsia?

A
  1. admit to quietest room, keep door closed
  2. Keep lights low, noise to a minimum, may need to block telephone calls
  3. group nursing assessments, allow periods of uninterrupted rest
  4. Restrict visitors
27
Q

What are the nursing interventions for monitoring for signs of impending seizures?

A
  1. hyperreflexia and/or the presence of clonus
  2. increased cerebral irritability (HA, visual disturbances)
  3. Epigastric or RUQ pain, nausea, or vomiting
28
Q

What immediate care is needed for someone with eclampsia during a seizure?

A
  1. ensure a patent airway during the seizure
  2. turn to the side to prevent aspiration
  3. suction PRN
  4. Oxygen by face mask
  5. IV if one is not in place
  6. Note time, duration, and description of the seizure
  7. Monitor fetus (observe for decelerations, bradycardia, tachycardia, decreased variability)
29
Q

What assessments should be conducted?

A
  1. BP, temp, FHR, urine output, protein, specific gravity
  2. edema/weight
  3. deep tendon reflexes
  4. pulmonary edema
  5. placental separation
  6. Signs of HTN (headache, visual disturbances, epigastric pain, LOC, emotional response, level of understanding)
30
Q

What nursing interventions are involved with community-based nursing care for a pregnant woman with preeclampsia or eclampsia?

A
  1. Help client identify and discuss concerns (fear of losing unborn child, family issues, finances)
  2. Teach client to monitor symptoms and report signs of worsening condition
  3. Customize diet plan
  4. offer community resources
31
Q

What nursing interventions are involved with hospital-based nursing care for a pregnant woman with preeclampsia or eclampsia?

A
  1. prognosis for client/infant
  2. quiet, low-stimulus environment
  3. place the client in the recumbent, left-lying position
  4. limit visitors/phone calls
  5. Care during a seizure
  6. monitor fetal heart tones continuously
32
Q

What are the nursing interventions for nursing management during labor and birth with someone who has preeclampsia or eclampsia?

A
  1. continuously monitor deep tendon reflexes, breath sounds, LOC, I&O, CNS, lab values
  2. watch for signs of placental abruption
  3. position on left side in quiet environment
  4. Assess fetal heart rate
  5. Put in side lying or semi sitting position
33
Q

What are the interventions for nursing management during the postpartum period for someone who has preeclampsia or eclampsia?

A
  1. Assess vaginal bleeding and observe for signs of hypovolemic shock
  2. Take vital signs every 4 hours for 48 hours
  3. Check hematocrit daily
  4. Monitor I&O
  5. Monitor for signs of worsening preeclampsia
  6. Be alert for signs of postpartum depression

PCC4 (38 decks)

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