Quiz 4 Flashcards
Patho phys of HTN
Vasospastic process through reduced organ perfusion and activated the coag cascade
- Hypo perfusion, vasospasm, endothelial cell damage, platelet aggregation
Infant/Maternal risks of hypertensive disorders
Infant: uteroplacental insufficiency, preterm birth
Mother: renal failure, coag, cardiac/liver problems, abruption, seizure, stroke
Classification of gestational HTN
BP over 140/90, after 20 wks, no protinuria
Normally resolves in first week MUST resolve by 12 weeks
Classification of preeclampsia
HTN (140/90) and proteinuria after 20 wks
OR
HTN and thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral/visual symptoms
Classification of Eclampsia
Convulsions or coma with no other causes, no preexisting seizure patho, can occur postpartum
Chronic HTN Classification
When HTN is prepregnant or persists after 12 wks post partum
Classification of preeclampsia
Women with chronic HTN who acquire pre/eclampsia
Risk factors for preeclampsia
Primigravida or age extremes (young <19 and old >35)
- Chronic HTN
- Diabetes
- Nephropathy
- Vascular/connective tissue disorders
- Family history
- Infection/Inflammation (UTI)
- Obesity + Race
- Recurrence 65% if dx prior to 30 wks and 25% if dx in third trimester
Paternity effects on HTN
If changing father same risk as nulliparous woman
Fathers whos mother had a history of preeclampsia have higher risk
Preeclampsia assessment
Proteinuria (late sign), assess for HA, epigastric pain, RUQ pain, visual disturbances, deep tendon reflexes, clonus (flexed ankle and feeling muscle pulses of calf)
With/without severe preeclampsia
Without: no bedrest, deliver close to term, manage outpatient, monitor labs
With: Delivery plan, hospitalization, antihypertensive meds + corticosteroids, bed rest with side rails up, dark environment, continuous FHR and contractions
Magnesium
IV piggyback, prevents and treats seizure, initial loading then maintenance, little effect on maternal BP
- Interferes with platelet aggregation
- Contraindicated in: myasthenia gravis (respiratory failure) heart block, cardiac insufficiency
Preeclampsia with severe features
Creatinine >1.1 mg/dL can indicate progressing renal insufficiency
Pulmonary edema
Visual disturbances: flashing lights, auras, light sensitivity, blurry vision, spots in vision
BP: >160 (taken 4 hrs apart on bedrest)
Platelets <100,000
Severe epigastric or RUQ pain
Signs of eclampsia
persistent HA, blurred vision, epigastric/RUQ pain, altered mental status
- Can appear without warning
Eclampsia Immediate care
Ensure airway/safety
- Time, onset and duration of seizure
Call for help and remain at bedside
HELLP syndrome
Hemolysis (Of RBCs when going through constricted vessels, reduces O2 capacity)
Elevated Liver enzymes (vasospasm leads to decreased BF to liver)
Lowered Platelets (platelets gather at damaged vascular endothelium’s)
Dx: CBC, CMP, uric acid + BUN increases, 24 hr protein/creatinine clearance
Cerebral Hemorrhage Warning Signs
Progressive decrease in LOC, complaints of flashes of light, neurologic deficits, new vomiting, sudden increase in BP (sign of bleeding)
MgSO4 Dosing
Bolus: 4-6g over 30 minutes
Maintenance: 2-4g
MgSO4 Lab values
Normal: 1.5-2
Therapeutic: 4-7
ECG changes: 5-10
Loss of reflexes: 8-12
Respiratory distress: 15
Cardiac arrest: 25
Magnesium side effects
Flushing, lethargy, nausea, depressed reflexes, cardiac dysrhythmias, circulatory collapse, diaphoresis, blurred vision
Mag nursing interventions
I/O, vitals Q5-15 with loading and the Q30-60 with maintenance
- Hourly reflexes, seizure precautions, lung sounds
Magnesium antidote
Calcium gluconate or calcium chloride
Should be on the unit
Miscarriage classifications
Pregnancy that ends as result of natural causes before 20 wks
Fetal weight of <500g
Early is before 12 weeks (normally chromosomal abnormalities)
Late: maternal causes (inadequate nutrition, anomalies of reproductive track, infection, drug use)
Threatened miscarriage
Spotting, mild uterine cramping, O closed
