Perfusion: Gestational Hypertension/Eclampsia Flashcards
What are the different classifications of hypertension in pregnancy?
- Chronic hypertension
- gestational hypertension
- Preeclampsia
- preeclampsia superimposed on chronic hypertension
At what point can gestational hypertension occur in pregnancy?
In the second half of pregnancy
What classifies preeclampsia?
- Systolic BP of >140 or Diastolic BP of >90 occurring 20 weeks of pregnancy
- proteinuria (>0.3g in a 24-hour urine collection, which usually correlates with a random urine dipstick evaluation of <1+)
What are the risk factors for hypertension during pregnancy?
- Chronic health problems affecting the vascular system (diabetes, renal disease, chronic HTN)
- Family or personal history of gestational hypertension
- Primigravida or first pregnancy with a new partner
- Multiple gestations
- age less than 20 or over 35
- poor nutrition
What classifies Gestational hypertension?
- no proteinuria with HTN after 20 weeks of pregnancy
- Systolic > 140 mmHg or Diastolic >90 mmHg that develops after 20 weeks but returns to normal within 6 weeks postpartum
What classifies chronic HTN?
- elevated BP was known to exist before pregnancy
- Systolic BP >140 or diastolic >90
- Also diagnosed if the HTN does not resolve during the postpartum period
What medications are used or avoided during pregnancy for chronic HTN?
- Aldomet (Methyldopa) is the drug of choice in pregnancy
- May also use Beta-blockers and CCB’s if Aldomet is not effective (Nifedipine)
- ACE inhibitors are contraindicated but may be used in PP period
- Diuretics are avoided if possible as they shrink the blood volume
What is preeclampsia superimposed on chronic HTN?
chronic HTN with a new onset of proteinuria (>0.3 g in a 24 hour urine collection)
How many pregnancies end up having Preeclampsia in the US?
5-8% of pregnancies, major cause of perinatal death, often associated with FGR
What are the risk factors for preeclampsia?
- first pregnancy
- first pregnancy for father of baby
- Age: “younger” or “older”
- Family or personal hx of preeclampsia
- Obesity
- diabetes
- multifetal pregnancy
- Pregnancy from ART
What are the clinical manifestations of Mild preeclampsia?
- high BP
2. high level protein in urine
What are the clinical manifestations of Severe preeclampsia?
- BP >160/110
- headache, tinnitus
- Visual disturbances
- Hyperreflexia
- changes in kidney function
What are the clinical therapies for mild preeclampsia?
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
What are the clinical therapies for antepartum management of preeclampsia?
- Depends on severity
- May be managed at home or in hospital
- Assess BP, weight, urine protein, fetal movement monitoring
- Bed rest, lying on left side
- Limit sodium intake
- Steroids indicated when preterm birth is anticipated
What are the clinical therapies for antepartum management of preeclampsia in the hospital?
- bolus of 4-6 g magnesium sulfate IV over 5 minutes
- Antihypertensive agents
- Assess for signs of labor
- Intensive care admission
- Induce labor
What are the clinical therapies for intrapartum management of preeclampsia in the hospital?
- chemical induction of labor
- cesarean birth may be necessary
- Continuous assessment of woman and fetus
What are the clinical therapies for postpartum management of preeclampsia in the hospital?
- rapid improvement after delivery
2. risk of seizures up to 48 hours after delivery
What are the clinical therapies for severe preeclampsia?
- hospitalized care (delivery is usually necessary, even if gestation is less than 34 weeks)
- Ongoing assessment of mother and fetus (Check DTR on patient every 4 hours)
- Alternate between a left and right lateral position
- Seizure precautions
What medications are often used for severe preeclampsia?
- sedatives
- Magnesium Sulfate (IV piggyback)- have calcium gluconate available
- Antihypertensives- Hydralazine (Apresoline)
What does HELLP mean?`
- H- Hemolysis
- EL- Elevated Liver enzymes
- LP- Low platelet count
What are the clinical manifestations of HELLP syndrome?
- Severe RUQ pain, neck pain, shoulder pain
- nausea and vomiting
- general malaise
- Severe edema
- distended liver that is painful
What are the risk factors of HELLP syndrome?
- hx of preeclampsia, chronic HTN, or kidney
- Obesity
- African ethnicity
- Women over age 35
What collaborations are often used for HELLP syndrome?
- meds (magnesium sulfate)
- Fresh frozen plasma or platelets
- Delivery of fetus if mature enough
What are the nursing interventions for HELLP syndrome?
- monitor client frequently (VS, FHM)
- Be alert for S/S of complications
- AVOID PALPATING THE ABDOMEN
What can occur during eclampsia?
seizures
What are the nursing interventions for preventing seizures during eclampsia?
- admit to quietest room, keep door closed
- Keep lights low, noise to a minimum, may need to block telephone calls
- group nursing assessments, allow periods of uninterrupted rest
- Restrict visitors
What are the nursing interventions for monitoring for signs of impending seizures?
- hyperreflexia and/or the presence of clonus
- increased cerebral irritability (HA, visual disturbances)
- Epigastric or RUQ pain, nausea, or vomiting
What immediate care is needed for someone with eclampsia during a seizure?
- ensure a patent airway during the seizure
- turn to the side to prevent aspiration
- suction PRN
- Oxygen by face mask
- IV if one is not in place
- Note time, duration, and description of the seizure
- Monitor fetus (observe for decelerations, bradycardia, tachycardia, decreased variability)
What assessments should be conducted?
- BP, temp, FHR, urine output, protein, specific gravity
- edema/weight
- deep tendon reflexes
- pulmonary edema
- placental separation
- Signs of HTN (headache, visual disturbances, epigastric pain, LOC, emotional response, level of understanding)
What nursing interventions are involved with community-based nursing care for a pregnant woman with preeclampsia or eclampsia?
- Help client identify and discuss concerns (fear of losing unborn child, family issues, finances)
- Teach client to monitor symptoms and report signs of worsening condition
- Customize diet plan
- offer community resources
What nursing interventions are involved with hospital-based nursing care for a pregnant woman with preeclampsia or eclampsia?
- prognosis for client/infant
- quiet, low-stimulus environment
- place the client in the recumbent, left-lying position
- limit visitors/phone calls
- Care during a seizure
- monitor fetal heart tones continuously
What are the nursing interventions for nursing management during labor and birth with someone who has preeclampsia or eclampsia?
- continuously monitor deep tendon reflexes, breath sounds, LOC, I&O, CNS, lab values
- watch for signs of placental abruption
- position on left side in quiet environment
- Assess fetal heart rate
- Put in side lying or semi sitting position
What are the interventions for nursing management during the postpartum period for someone who has preeclampsia or eclampsia?
- Assess vaginal bleeding and observe for signs of hypovolemic shock
- Take vital signs every 4 hours for 48 hours
- Check hematocrit daily
- Monitor I&O
- Monitor for signs of worsening preeclampsia
- Be alert for signs of postpartum depression
