Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MCN 109 Midterms > Pregnancy Induced Hypertension > Flashcards

Pregnancy Induced Hypertension Flashcards

1
Q

PIH

A
  • disorder occuring during pregnancy after 20th week of gestation
  • 5-10% of all pregnancies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Gestational Hypertension

A
  • elevated blood pressure (140/90 mmHg)
  • no proteinuria or edema
  • blood pressure returns to normal after birth

SYSTOLIC: >30 mmHg
DIASTOLIC: >15 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mild Eclampsia

A
  • preeclampsia with no severe features
  • edema in upper part
  • weight gain of more than 2lb per week (2nd trimester), 1lb per week (3rd trimester)

BP: 150/90 (2 occasions, 6 hours apart)
PROTEINURIA: 1+ or 2+ or 300 mg/ 3 g (24 hour urine specimen collection) or 0.3 higher on urine protein-creatinine ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Severe Eclampsia

A
  • preeclampsia with severe features
  • oliguria
  • increased serum creatinine
  • cerebral or virtual disturbances
  • extensive peripheral edema
  • hepatic dysfunction
  • thrombocytopenia
  • severe epigastric pain
  • extreme edema over bony surfaces
  • nausea and vomiting
  • visual changes
  • headache
  • marked hyperreflexia, ankle clonus
  • shortness of breath

BP: 160/110 mmHg (2 occasions, 6 hours apart at bed rest)
PROTEINURIA: 3+ or 4+ or more than 500 mg/ 5 g
DECREASED URINE OUTPUT: 400-600 mL per 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Eclampsia

A
  • seizure
  • coma accompanied
  • signs and symptoms of preeclampsia
  • Gran Mal (tonic-clonic seizure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk Factors

A
  • women of color
  • multiple pregnancy
  • primipara (<20 y.o)
  • maternal age (>35 y.o)
  • women with low socioeconomic status
  • multipara women (>5 pregnancy)
  • women with polyhydramnios
  • type 1 or type 2 diabetes before pregnancy
  • hx of essential hypertension
  • hx of heart disease
  • hx of renal disease
  • preeclampsia in previous pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Patho: Early Pregnancy

A
  • villous cytotrophoblast invades myometrium and spiral arteries = lose endothelium and most of muscle fibers
  • dilatation of lumen, invasion of trophoblast into the vessel wall
  • replacement of muscular and elastic tissue by a fibrinoid material
  • increased circulating blood volume during pregnancy
  • decrease action of prostacyclin = increase thromboxane production
  • endothelial dysfunction (cell injury)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Patho: Vasoconstriction

A
  • increase production of angiotensin and norepinephrine
  • increase peripheral resistance
    ○ increase BP = decrease perfusion/ blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Patho: Kidney Effects

A

increase blood flow resistance = decrease glomerular filtration rate = increase permeability of glomerular membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Proteinuria

A

albumin and globulins escape into urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Patho: Increased Kidney Tubular Reabsorption

A
  • decrease urine output (oliguria)
  • creatinine clearance
  • increased retention of fluid diffusion from bloodstream to interstitial tissues
  • edema formation (where sodium goes, water follows)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Patho: Pancreas Effects

A
  • increase blood flow resistance = decrease blood flow to pancreas
  • ischemia to pancreas
  • epigastric pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Patho: Retina Effects

A
  • increased blood flow resistance = decrease blood flow to eyes
  • spasms of arteries of retina
    ○ retinal hemorrhages and blindness
    ○ blurry vision (scotoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Patho: Placenta Effects

A

increased blood flow resistance = decrease utero-placental transfusion = decrease nutrients to fetus and o2 supply
○ increased uterine growth restriction
○ fetal injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nursing Dx

A
  1. ineffective tissue perfusion r/t vasoconstriction of blood vessels
  2. deficient fluid volume r/t fluid loss to interstitial tissue
  3. risk for fetal injury r/t reduced placental perfusion secondary to vasoconstriction
  4. social isolation r/t prescribed bed rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MP Management: Antiplatelet Therapy

A

low dose aspirin (ASA): 81 mg baby aspirin

17
Q

MP Management: Bed Rest

A
  • aids in increased evacuation of sodium and encouraging diuresis of edema fluid
  • left lateral position = prevent supine hypotension
18
Q

MP Management: Food Nutrition

A
  • continue pregnancy nutrition while on bed rest
  • RAAS
19
Q

MP Management: Emotional Support

A
  • educate woman and family on severity of condition
  • explore on financial problems, child care arrangement
  • reiterate frequent prenatal visits
20
Q

SP Management: Hospital Care

A

> 37 WEEKS AOG: labor can be induced, CS to end pregnancy
< 37 WEEKS AOG: attempt to alleviate symptoms and monitor fetal well being to term
COMPROMISED FETUS: vaginal or CS even if preterm

21
Q

SP Management: Maternal Wellbeing

A
  • monitor BP
  • periodic assessment of lab values:
    ○ CBC with platelet
    ○ liver function test (AST, ALT)
    ○ lactic dehydrogenase (LDH)
    ○ uric acid
    ○ serum creatinine
    ○ bilirubin
    ○ protein and creatinine clearance (urine)
  • obtain daily weight: food retention
  • foley catheter as ordered
22
Q

SP Management: Fetal Wellbeing

A
  • doppler auscultation
  • non-stress test
  • biophysical profile
  • fetal kick: decrease in movement = distress
23
Q

SP Management: Nutritious Intake

A
  • moderate to high protein diet
  • moderate sodium diet
  • fluid and electrolyte replacement
24
Q

SP Management: Antihypertensives

A
  • BP should not be lower than 80-90 mmHg
  • may cause tachycardia, assess vs before and after adm
  1. PO Methyldopa
  2. Hydrazaline (Apresoline)
  3. IV Labetalol
  4. PO Normodyne or Nifedipine
25
Q

SP Management: MgSO4

A
  • prevent eclampsia, seizure
  • infuse loading dose (4-6 g) slowly over 15-30 mins
  • piggyback infusion as maintenance dose (1-2 g/hr) IV
  • observe CNS depression and hypotonia in infant at birth
  • observe calcium deficit in mother
  • assess BP and FHR continuously with bolus IV administration

URINE OUTPUT: over 30 mL/ hr
RR: 12/ min
SERUM MAGNESIUM: below 7.5 mEq/L

26
Q

MgSO4 Toxicity

A

ASSESS:
1. RR
2. urine output
3. deep tendon reflexes
4. clonus
5. patellar reflex

ANTIDOTE: Calcium Gluconate (should be at bedside)

27
Q

E Management: Tonic-Clonic Seizure

A
  • maintain patent airway
  • assess time of onset, progress, body involvement, duration, incontinence. status of fetus, signs of placental abruption
  • turn to side = allow secretions to drain (prevent aspiration)
  • adm MgSo4 or diazepam (Valium) IV as emergency measure
  • assess oxygen saturation (adm by face mask)
  • assess maternal and fetal-wellbeing (FH, contractions, signs of bleeding)
  • maintain NPO
28
Q

E Management: Birth

A
  • deliver infant in stable position )12-24 hours post seizure)
  • vagina; birth: minimum anesthesia
  • no labor = ROM or induction of labor with IV oxytocin (if ineffective and fetus in danger = CS)
29
Q

Management during Postpartum Period

A
  • monitor postpartum vaginal bleeding
  • palpate uterus and massage when not contracted
  • monitor vs, urine output
  • monitor hematocrit, platelet, uric acid, AST and ALT daily
  • NO METHERGINE ADMINISTRATION

MCN 109 Midterms (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions