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Maternal-Newborn (Josh) > T4 - Hypertensive Disease (Josh) > Flashcards

T4 - Hypertensive Disease (Josh) Flashcards

1
Q

— disorders are the most common medical complication of pregnancy.

A

Hypertensive

***risen steadily since 1990 in all races and ethnic groups

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2
Q

What are some potentially lethal complications from Hypertensive Disorders?

A

Pre-eclampsia

Abruptio Placentae

DIC

Acute Renal Failure

Hepatic Failure

Adult Respiratory Distress Syndrome (ARDS)

Cerebral Hemorrhage

HELLP Syndrome

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3
Q

How HTN defined in pregnancy?

A

140/90 or more on at least 2 separate occasions 4-6 hrs apart within a maximum of 1 wk

***sitting, no tobacco/caffeine 30 mins prior

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4
Q

What is Gestational HTN?

A

onset of HTN without proteinurea after 20 wks gestation

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5
Q

— usually occurs 20 weeks after gestation in a previously normotensive patient AND has proteinurea.

A

Preeclampsia

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6
Q

What proteinurea is a sign of preeclampsia?

A

above 30 mg (1+ on dipstick) or more in 2 random specimens at least 6 hrs apart

or

300 mg in 24 hrs

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7
Q

What is difference b/t Preeclampsia and Eclampsia?

A

seizures

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8
Q

What is HTN that occurs before pregnancy or diagnosed before 20th week gestation?

A

Chronic HTN

***persists more than 6-12 wks PP

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9
Q

What is Preeclampsia superimposed on Chronic HTN?

A

Chronic HTN patient w/ new proteinurea or an exacerbation of HTN or Proteinurea, thrombocytopenia, or increase in hepatocellular enzymes

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10
Q

What BP is HTN?

What MAP is HTN?

A

140/90

MAP > 105

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11
Q

Are BP elevations over pre-pregnancy values diagnostic for preeclampsia?

A

No

but women with an increase of 30 (systolic) or 15 (diastolic) warrant further watching when they have proteinurea and hyperuricemia (uric acid of 6 or more)

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12
Q

What has to be elevated for it to meet the definition of Gestational HTN?

A

either systolic or diastolic

only one is needed to be elevated for it be diagnostic

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13
Q

What percentage of Primigravidas have Gestational HTN?

Multiparous?

A

Primigravidas = 6-17%

Multiparas = 2-4%

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14
Q

Gestational HTN is more frequent in — pregnancies.

A

multifetal

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15
Q

When does Gestational HTN normally develop?

A

at or after 37 weeks if they have no preexisting HTN

***BP returns to normal within 1-12 wks after delivery

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16
Q

What is Mild Preeclampsia?

A

140/90

MAP > 105

24 hr proteinurea > or = 0.3 g

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17
Q

What is Severe Preeclampsia?

A

160/110

Map > 105

24 hr proteinurea > 2 g

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18
Q

What is usually the first sign of preeclampsia?

A

elevated BP

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19
Q

— occurs in too many normal pregnancies to be used as a marker for preeclampsia.

A

Edema

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20
Q

What is the only cure for preeclampsia?

A

delivery

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21
Q

What weight gain is a sign of preeclampsia?

A

> 2 kg (4.4 lb) in one week

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22
Q

What is the etiology of preeclampsia?

A

disruption of placental perfusions and endothelial cell dysfunction

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23
Q

What is the cause of preeclampsia?

A

uknown

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24
Q

Preeclampsia:

What do disruption of placental perfusions and endothelial cell dysfunctions lead to?

A

Vasospasm

Increased Peripheral Resistence

Increased Endothelial Cell Permeability

***all leading to decreased tissue perfusion

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25
Q

T/F: The major pathological factor in preeclampsia is elevated BP.

A

False

it is poor perfusion as a result of vasospasm

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26
Q

Preeclampsia:

What drug do we give?

A

Mag Sulfate

4-6 g loading dose then a 2-3 g maintenance dose

***have a fan b/c they’ll be hot

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27
Q

What drug is needed in case of Mag toxicity?

A

Calcium Gluconate

28
Q

A/E of Magnesium Sulfate

A

Works on big smooth muscles:

  • affects heart
  • LOC can drop b/c heart has slowed and O2 perfusion is low
29
Q

What urine output is minimal?

A

30 mL /hr

30
Q

Preeclampsia:

What are the affects on the Placenta?

A

impaired perfusion leads to early aging of placenta and IUGR of fetus

31
Q

Preeclampsia:

What are the effects on Renal System?

A

decreased GFR results in oliguria, proteinurea, hyperuricemia, and sodium/water retention

32
Q

Preeclampsia:

What are the effects on Hepatic System?

A

decreased perfusion can result in hepatic edema and subscapular hemorrhage a/e/b complaint of epigastric pain or RUQ pain

liver enzymes (AST, ALT, LDH) elevated

33
Q

What are signs of impending preeclampsia?

A

epigastric pain

RUQ pain

34
Q

Preeclampsia:

What are the Neurological effects?

A

vasospasms and decreased perfusion can result in:

  • Cerebral Edema
  • CNS irritability (headache, hyperreflexia, etc)
  • Visual Disturbances (blurring)
35
Q

Preeclampsia:

Lab Values

A

Decreased Serum Albumin which leads to decreased osmotic pressure –> edema

Increased HCT as a result of hemoconcentration

Increased BUN

Increased Serum Creatinine

Increased Serum Uric Acid

36
Q

Parameters for Proteinurea

A
  • Concentration at or above 30 mg/dL (> or = to 1+ on dipstick)
  • At least 2 specimins
  • At least 6 hrs apart
    or. …
  • 24-hr specimne at or above 300mg/24 hrs

***both in absence of UTI

37
Q

Nursing actions w/ Eclampsia

A

Keep patient safe

Turn on side

Suction

O2

IV Mag Sulfate

Monitor Fetus

Uterine and Cervical Assessment

Document

38
Q

Eclampsia:

Following a seizure, why would we hold off delivery?

A

until antenatal glucocorticoids can be given

39
Q

Why not use Lasix for preeclampsia?

A

Diuretic therapy further reduces placental perfusion

***only used if evidence of CHF or PE

40
Q

— is a sign of impending eclampsia.

A

Hyperreflexia

41
Q

Absence of — in a patient on Mag is a sign of toxicity.

A

reflexes

***mag level > 9 mg/dL

42
Q

Management of Mild Preeclampsia

A

Bedrest

Daily BP and Weights

Fetal Surveillance

Monitor Proteinurea

43
Q

What S/S of preeclampsia should we tell client to report?

A

BP 140/90

Decreased Fetal Mvmt

Headache

Visual Disturbances

Epigastric or RUQ pain

Proteinurea

Decreased Urine Output

N/V

Malaise

Vag Bleeding or Abd. Tenderness

44
Q

What type of diet does a preeclapsia client needs?

A

same as normal healthy pregnant woman

**do not limit salt (except w/ chronic htn) b/c they need it to maintain blood volume

45
Q

Management of Severe Preeclampsia

A

Hospital Bed Rest

Maternal and Fetal Surveilance (possibly in ICU)

Quiet, nonstimulating environment (prevent seizures)

Meds

Delivery

46
Q

Meds for Preeclampsia:

Why give Magnesium Sulfate?

A

calm the CNS to prevent seizures

47
Q

What meds for Preeclampsia?

A

Mag Sulfate

Oral Antihypertensives

48
Q

When would we give an oral antihypertensive med for preeclampsia?

A

> 160/100

***hold if diastolic below 90 b/c it could reduce uteroplacental perfusion

49
Q

Preeclampsia during Postpartum.

A

1/3 of all cases occurred after delivery and the risk remained for up to 28 days PP

50
Q

After delivery, how do we prevent preeclampsia from progressing to eclampsia?

A

Mag Sulfate is given 12-24 hrs post-delivery

51
Q

A/E of Magnesium Sulfate during PP period.

A

Interferes w/ uterus clamping down –> BOGGY UTERUS and heavy lochia (increased risk for PP hemorrhage)

52
Q

Mag Sulfate can cause a Boggy Uterus PP. What meds do we give to counteract?

A

Oxytocin

***Methergine and Ergotrate are contraindicated b/c they can increase BP

53
Q

PP Preeclampsia:

How often should BP be measured?

A

q 4 hrs for 48 hrs

54
Q

PP Preeclampsia:

Why would we be cautious in giving analgesics to help with pains?

A

Mag Sulfate potentiates the effects of analgesics

55
Q

Can mom breastfeed when on Mag Sulfate?

A

Yes

56
Q

HELLP is a — diagnosis, not a — diagnosis.

A

laboratory

clinical

57
Q

HELLP stands for…

A

Hemolysis

Elevated Liver enzymes

Low Platelets

**HELLP Syndrome is a variant of severe preeclampsia that affects 1 in 1000 pregnancies

58
Q

— is a varient of severe preeclampsia where arteriole vasospasm, endotheliel cell damage, and platelet aggregation result in tissue hypoxia.

A

HELLP Syndrome

59
Q

S/S of HELLP Syndrome

A

Can have None

Can look like preeclampsia

N/V

Epigastric Pain or RUQ pain

General Malaise

60
Q

Complications from HELLP Syndrome

A

Renal failure

PE

Ruptured Liver Hematoma

DIC

Placental Abruption

61
Q

Nursing Responsibilities for HELLP

A

Assess for signs of bleeding (petechie, bruising, etc)

Assess for Epigastric or RUQ pain

Assess of Jaundice

Assess Fetal Status (risk for abruption)

62
Q

What is a Burr Cell?

A

triangular helmet shaped cells found in blood

usually indicative of disorders of small blood vessels

63
Q

Management of HELLP Syndrome:

What if client is less than 34 weeks pregnant?

Greater than 34 weeks?

A

Less = administer corticosteroid

Greater = deliver

64
Q

With —, there is always a secondary diagnosis.

A

DIC

***treat the underlying problem to fix it

65
Q

DIC:

What labs are reduced?

A

Platelets

Fibrinogen

66
Q

DIC:

What labs are elevated?

A

Fibrin Degradation Products

Prothrombine Time (PT) = increased

PTT (increased)

D-Dimer Test

Protamine (positive)

67
Q

Nursing responsibilities for DIC

A

Monitor for bleeding

Monitor urinary output w/ Foley

Side-lying position of pregnant

O2 at 10-12 L (as ordered)

Blood products (as ordered)

Maternal-Newborn (Josh) (29 decks)

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