T4-Hypertensive Disorders Flashcards
Both gestational HTN and preeclampsia occurs 20 weeks after gestation. How do we determine the difference?
Preeclampsia is 20 weeks after gestation AND has proteinuria!
If a patient is preeclamptic, they are 20 weeks gestation or more and have proteinuria. How do we know they have proteinuria. (2 ways)
- Proteinuria at or above 30 mg (1+ or greater on dipstick) in 2 random samples at least 6 hr apart
OR
- Protein is 300 mg or more in 24 hours
* both in absence of UTI!
_____ is HTN w/o proteinuria after 20 weeks gestation
Gestational HTN
If patient has G. HTN, when does BP return to normal?
1-12 weeks after delivery
What is preeclampsia?
HTN and proteinuria developed after 20 weeks!!!!
What is mild preeclampsia?
- BP 140/90 2x 4-6 hours apart
- MAP greater than 105
- 24 hour urine protein is 300 mg or greater (0.3 g)
What is severe preeclampsia?
- BP 160/110 or greater
- MAP greater than 105
- Urine protein greater than 2 grams in 24 hours
What can preeclampsia progress to?
HEELP syndrome or eclampsia
What is often the first sign of preeclampsia?
Elevated BP
What are some other signs of preeclampsia other than the elevated BP?
- Weight gain of more than 4.4 lbs in 1 wk
- Edema in face, hands or abdomen that does not respond to 12 hours of bed rest
- DTRs/clonus
- Hyperreflexia
- Blurred vision
- Headaches
- Liver functions
- Epigastric pain (RUQ)
- Low platelets (precursor to HEELP)
- Proteinuria
What is the only cure to preeclampsia?
Deliver baby
What is the etiology of preeclampsia?
Disruption in placental perfusions and endothelial cell dysfunction
Cause of preeclampsia:
Placental ischemia is thought to cause the endothelial cell dysfunction by stimulating the release of a substance toxic to endothelia cells. What does this anomaly cause?
Generalized vasospasm
- poor tissue perfusion
- increased peripheral resistance and BP
- increased endo cell permeability–> less plasma volume
Preeclampsia:
The main pathologic factor is NOT an increase in BP but _____ as a result of ____ and ____
Poor perfusion as a result of vasospasm and reduced plasma volume
_____ causes many of the common signs and symptoms of preeclampsia
Endothelial cell dysfunction
What is the drug to help with preeclampsia?
Mag sulfate
How much mag is given..both loading and maintenance?
Loading: 4-6
Maintenance: 2-3
What is antidote to mag?
Calcium gluconate
What is management for mild preeclampsia?
- *Bedrest (home or hospital)
- Monitor BP
- *Daily weights
- Fetal surveillance
- Monitor protein in urine
- Teach pt. s/s
- Healthy diet, good hydration
- Emotional support
What is management in severe preeclampsia?
- Hospital bed rest
- Maternal and fetal surveillance (possibly in ICU)
- Quiet, non stimulating environment; seizure precautions
- Drug interventions
- Delivery
What is given post delivery to prevent the development of eclampsia?
Mag sulfate administered 12-24 hours post delivery
Mag. sulfate is good to prevent dev of eclampsia post delivery. But what can it interfere with?
-Uterus clamping down causing boggy uterus and heavy lochial flow (PPH!!! risk)
Give oxytocin to treat boggy and control uterus
DO NOT GIVE methergine and ergotratate– remember methergine increases BP!
PP for preeclamptic patient…BP should be monitored every ____ for ___
q4h for 48 hrs
PP for preeclamptic pt…We give mag sulfate PP to prevent development of eclampsia. What drug should we give with cation with mag and why?
Analgesics; mag sulfate potentiates their effects
PP for preeclamptic pt…Since we give mag sulfate to prevent the development of eclampsia, should we promote or discourage breastfeed? Explain
Encourage! Breastfeeding is best form of nutrition for premature infant and mag sulfate is NOT a contraindication for breast feeding!
What does HEELP stand for?
Hemolysis
Elevated liver enzymes
Low platelets
What kind of diagnosis is HEELP?
Lab diagnosis NOT clinical
What are s/s of preeclampsia ?
Range from no s/s of preeclampsia to NV, epigastric/RUQ pain, and general malaise
DIC is always a ____ diagnosis
Secondary
What are platelets like in DIC?
Reduced
What is fibrinogen like in DIC?
Reduced
What is fibrin degradation products like in DIC?
Elevated
What is PT like in DIC?
Normal or prolonged
What is PTT like in DIC?
Sometimes prolonged
What is thrombin test time like in DIC?
Prolonged
What is d-dimer test like in DIC?
High level
Positive d dimer tells there is high level of fibrin degrading products in body–aka there has been significant clot formation and breakdown in body
What is protamine like in DIC?
Positive
