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Maternal Newborn - Cher > Test 4 Hypertensive Disease > Flashcards

Test 4 Hypertensive Disease Flashcards

1
Q

A SBP >140 and a DBP >90 recorded on at least 2 separate occasions 4-6 hours apart within a maximum of 1 week.

A

Hypertension Definition

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2
Q

onset of hypertension without Proteinuria after 20 weeks gestation

A

gestational hypertension

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3
Q

Usually occurs 20 weeks after gestation in a previously normotensive pt AND has proteinuria May be mild or severe.
Proteinuria at or above 30mg (> 1+ on dipstick) or more in 2 random specimens at least 6 hours apart or > 300 mg in 24 hours

A

preeclampsia

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4
Q

The occurrence of seizures or coma in a woman with preeclampsia

A

eclampsia

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5
Q

HTN that occurs before pregnancy or DX before 20th week gestation also if it persists more than 6-12 weeks postpartum.

A

chronic hypertension

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6
Q

Women with HTN Chronic HTN with new proteinuria or an exacerbation of HTN or Proteinuria, thrombocytopenia or increased in hepatocellular enzymes.

A

Preeclampsia superimposed on Chronic Hypertension

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7
Q

Hypertension WITHOUT proteinuria after 20 weeks gestation

A

gestational hypertension

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8
Q

What fixes preeclampsia and eclampsia

A

having the baby

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9
Q

Gestational HtN
Primigravidas __% to ___%
Mulitparous __% to __%

A

6-17

2-4

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10
Q

How many pressures have to be elevated to meet criteria for gestational hypertension

A

1

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11
Q

Hypertension AND Proteinuria developed after 20 weeks

A

preeclampsia

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12
Q

mild preeclamsia =

A

BP 140/90mm Hg x2 > 4-6hrs apart
MAP > 105
24hr urine protein > 0.3g

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13
Q

severe preeclampsia

A

BP > 160/110mm Hg
MAP >105
24hr urine protein >2g

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14
Q
  • 24-hour urine protein result of > ______g protein in 24 hours = proteinuria
A

0.3

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15
Q

Risk factors for preeclamsia

A 
Chronic renal disease
Chronic hypertension
Family history of preeclampsia
Multiple gestation
Primigravidity or new partner
Maternal age
Diabetes
Rh incompatibility
Obesity
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16
Q

Low platelets can be precursor to:

A

HELLP syndrome

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17
Q

Potentially lethal complications of hypertension in pregnancy:

A 
pre-eclampsia
placental abruption
DIC
Acute renal failure
hepatic failure
adult resp distress syndrome
cerebral hemorrhage
HELLP syndrome
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18
Q

Usually develops at or after 37 weeks with no preexisting HTN

A

gestational hypertension

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19
Q

Gestational hypertension BPs return to normal within___-___weeks after delivery

A

1-12

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20
Q

Hypertension AND Proteinuria developed after 20 weeks

A

preeclampsia

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21
Q

Often 1st sign of preeclampsia:

A

elevated blood sugar

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22
Q

Disruption in placental perfusions and endothelial cell dysfunction

A

etiology of preeclampsia

23
Q

Is the major pathological factor of preeclampsia elevated BP?
What is it then?

A

No

It is poor perfusion as a result of vasospasm.

24
Q

Preeclampsia:
Vasoconstriction results from sensitivity to vasopressors (like _____________ II)
-Arteriolar vasospasm diminishes the diameter of _________ ______, which impedes blood flow to all organs and increases BP.
-Endothelial cell dysfunction as a result of __________

A

angiotensin
blood vessels
vasospasm

25
Q

Effects of Preeclampsia:
Placental - Impaired perfusion leads to early aging of the ________ and _______ of the fetus

Renal - Decreased glomerular filtration rate (GFR) results in ________,
increased excretion of protein (mainly albumin) decreased ______ acid clearance. Sodium and water retention

Hepatic-Decreased _______ can result in hepatic edema and subcapsular hemorrhage as evidenced by the complaint of epigastric pain or right upper quadrant pain- A sign of impending eclampsia
Liver enzymes become _________ (AST, ALT, and LDH).

A

placenta, IUGR

oliguria
uric
Perfusion
elevated

26
Q

preeclampsia effects:
Neurological- vasospasms and decreased perfusion can result in:
- Cerebral ______- change in emotion, mood, and LOC
- CNS irritability-manifested as _______, hyperreflexia, positive ankle clonus, and occasionally eclampsia
- Visual disturbances- scotomata and _________

A

edema
headache
blurring

27
Q

scotomata

A

?

28
Q

Laboratory values:

A

serum albumin decrease
Hct increase
Bun increase

29
Q

What constitutes proteinuria?

A

Concentration at or above 30 mg/dL >+1 on dipstick in at least 2 specimens at least 6 hrs apart
In a 24 hour specimen: concentration at or above 300 mg/dl
Both in absence of UTI

30
Q

Seizure activity or coma in a woman with preeclampsia with no history of preexisting pathology that can result in seizure activity.

A

eclampsia

31
Q

Interventions for eclampsia:

A
  1. keep oatient safe
  2. turn onto side
  3. suction
  4. O2
  5. IV mag
  6. monitor fetus
  7. uterine & cervical assessment
  8. document
32
Q

*Following a seizure a decision must be made regarding delivery. May try to postpone delivery until antenatal ___________ can be given and benefit received

A

glucocorticoids

33
Q

What should the nurse do at the first prenatal visit to assess for preeclampsia

A

The nurse should take a thorough history at the 1st prenatal visit to identify risk factors for the development of preeclampsia
Assess for signs and symptoms of preeclampsia at each subsequent prenatal visit

34
Q

_______ are only used in preeclampsia when there is evidence of CHF or pulmonary edema. Diuretic therapy further reduces intervillous blood flow ( placental perfusion), which may lead to serious fetal jeopardy.

A

diuretics

35
Q

edema assessments with preeclampsia

A
  • assess for distribution, degree, pitting
  • breath sounds for crackles
  • daily weights
36
Q

Management of mild preeclampsia:
Home Bedrest
If :

Fetal surveillance:
Home-
Hospital-

Monitor urine protein

A

Home Bedrest

If proteinuria

37
Q

Monitoring mild preeclampsia: Report these symptoms

A 
Signs and symptoms to report
^BP - >140/90
Decreased fetal movement
Headache
Visual disturbances
Epigastric or upper right quadrant pain
Increased proteinuria
Decreased urinary output
N/V
Malaise
Any sign of labor, vaginal bleeding, or abdominal tenderness
38
Q

Management of Severe preeclampsia

A

-Hospital bed rest
-Maternal & fetal surveillance
-Possibly in an ICU setting
-Quiet, nonstimulating -environment & seizure precautions
-Pharmacological interventions
Delivery

39
Q

severe preeclampsia

pharmacological interventions

A

Pharmacological interventions
Magnesium sulfate- quiet the CNS
Oral antihypertensive – Given if systolic >160 to 180mm Hg; diastolic BP 100 to 110 mm HG [See box 855 for pharmacologic agents]
- Give with caution- if diastolic BP below 90 mm Hg could reduce uteroplacental perfusion

40
Q

postpartum preeclampsia

A

Frequent BP & vital signs
Magnesium Sulfate (12-24 hrs)
Uterine tone and lochia
Family support & bonding

41
Q

*_______ of all cases of preeclampsia occurred after delivery in a recent study and the risk remains for up to 28 days post partum.

A

1/3

42
Q

Magnesium sulfate is administered ___-___ hours post delivery to prevent the development of eclampsia

A

12-24

43
Q

_________ _________ can interfere with the uterus clamping down thus causing a boggy uterus and heavy lochia flow, placing the woman at risk for postpartum hemorrhage

A

mag sulfate

44
Q

methergine postpartum to contract uterus in preeclamsia?

A

no – high BP

45
Q

post partum BP preeclapmsia:

A

BP should be monitored every 4 hours for 48 hours

46
Q

Is mag sulfate contraindicated to breastfeeding

A

no

47
Q

What does HELLP syndrome stand for:

A

Hemolysis
Elevated Liver enzymes
Low Platelets

48
Q

signs and symptoms of HELLP

A

Range from no signs or symptoms of preeclampsia to N/V, epigastric pain or right upper quadrant pain, general malaise

49
Q

complications of HELLP

A 
Renal failure
Pulmonary edema
Ruptured liver hematoma
DIC
Placental abruption
50
Q

Triangular helmet shaped cells found in blood, usually indicative of disorders of small blood vessels.

A

burr cell

51
Q

Nursing responsibilities for HELLP syndrome

A
  • Assess and observe for signs of bleeding – petechiae or bruising from blood pressure cuff, IV site, gums
  • Epigastric or right upper quadrant pain or tenderness- some women report it as bad indigestion
  • Jaundice
  • Monitor lab values and report to physician
  • Fetal status- at risk for abruption
52
Q

Pathological form of diffuse clotting that consumes large amounts of clotting factors causing widespread external and/or internal bleeding.

A

DIC

53
Q

IS DIC ever a primary diagnoses

A

no always secondary

54
Q

Risk factors for DIC in the obstetric population:

A
  • Placental abruption
    • Gram-negative sepsis
    • HELLP syndrome
    • Intrauterine death with retained fetus
    • Severe pre-eclampsia
    • Retained placenta
    • Amniotic fluid embolism (usually not able to be determined until autopsy)
    • Hemorrhagic shock
    • Transfusion reaction

Maternal Newborn - Cher (6 decks)

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