WEEK 4 Flashcards
endocrine disorders hypertension disorders
1
Q
pregestational diabetes mellitus (PDM)
A
chronic condition that will require management for a lifetime and is divided into two categories: type 1 diabetes mellitus (DM) and type 2 DM.
2
Q
type 1 DM
A
autoimmune disorder that causes decreased or absent insulin production from the beta cells in the pancreas.
3
Q
type 2 DM
A
may not have sufficient insulin production from the pancreas but do have insulin resistance at the cell wall, creating higher levels of circulating plasma glucose
4
Q
vasodilation
A
Expansion of maternal blood vessels to accommodate the expected increase in maternal blood volume.
causes a decrease in baseline blood pressure
5
Q
why does vasodilation occur
A
hormonal influences of estrogen, progesterone, relax begin to surge
6
Q
why does the maternal blood volume increase
A
the renin-angiotensin-aldosterone system (RAAS) begins water and salt retention, expanding the maternal blood volume
7
Q
what increases with pregnancy
A
SV
HR
CO
8
Q
healthy BMI for pregnancy
A
less than 30
9
Q
elevated BMI
A
can lead to hypertension
10
Q
nonmodifiable risks for hypertension
A
chronic HTN to genetics
race
diagnosis before pregnancy
lower income (SDOH)
AMA (because body’s become less elastic)
primigravida
11
Q
modifiable risk factors
A
BMI over 30
lack of excercise
lack of good diet
12
Q
clinical presentation of hypertension
A
140/90 mmHg after 20 weeks of gestation
Clients presenting with no proteinuria and blood pressure readings of 140/90 mm Hg or higher on two occasions at least 4 hr apart will be diagnosed with gestational hypertension.
13
Q
blood pressure reading
A
cuff should be an appropriate size
length 1.5 times the circumference
covers at least 80% of the arm
upright position for at least 10 min
abstained from caffeine at least 30 min prior to reading
14
Q
Clients who have gestational hypertension have higher rates of
A
thrombocytopenia and liver dysfunction
15
Q
thrombocytopenia
A
Platelet count less than 100,000/mm3.
16
Q
HTN: weekly urine dipsticks to assess for what
A
proteinuria
liver enzymes
serum creatinine
CBC to assess platelets
17
Q
manifestations of worsening HTN
A
visual changes or unresolved headache, lab testing should be repeated
18
Q
what should have NST have
A
reactive: accelerations
19
Q
why do we need to check liver functions of pregnant clients
A
watch clotting factor because it can lead to risk of hemorrhage
20
Q
nonpharmacological interventions for HTN
A
adequate intake of fish oil, vitamin D, vitamin C, vitamin E, folic acid, and sodium reduction reduces the risk of a pregnancy-related hypertensive disorder
21
Q
folic acid
A
prevents neural tube defects in fetal development
22
Q
overloaded vascular system
A
HTN, lower sodium
23
Q
pharma therapy for HTN
A
12-20 weeks take aspirin to help with blood flow
24
Q
methyldopa
A
antihypertensive medication FINISH LATER
25
Labetalol
beta blocker (know that because of the -olol ending)
FINISH LATER
26
nifedipine
antihypertensive, calcium channel blocker FINISH LATER
27
Hydralazine
antihypertensive, vasodilator FINISH LATER
28
acute, severe HTN
hydralazine
greater than or equal to 160/110 mmHg
29
complications of HTN in pregnancy
preterm birth and maternal mortality
organ damage, proteinuria
30
chronic HTN need what
preconception counseling
could be on teratogenic medication
31
prevention
take BP and educate how to do it
refrain from smoking, drinking alcohol, eating high sugar/sodium foods
focus on walking, nutrition, gaining appropriate weight during their pregnancy
32
Clients who have a hypertensive disorder have a higher incidence
preterm birth
C section
placental abruption
preeclampsia
33
grief and loss with chronic hypertension or gestational hypertension
may affect the timing of birth, type of birth, postpartum recovery, and maternal–newborn bonding
34
preeclampsia
A hypertensive disorder diagnosed after 20 weeks of gestation or during the postpartum period involving organ injury. May express with or without severe features. Manifestations of preeclampsia include severe headache, visual changes, upper right abdominal pain, proteinuria, thrombocytopenia, unexpected kidney function, unexpected liver function, and pulmonary edema.
35
pathophysiology of preeclampsia
it is thought to involve unexpected placental implantation and inadequate blood flow to the placenta. thought to be shown that the placenta not being implanted the right way can impact this FINISH LATER
36
preeclampsia into two categories
preeclampsia without severe features and preeclampsia with severe features
37
placenta and preeclampsia
FINISH LATER
38
risk factors for preeclampsia
AMA
Use of assisted reproductive technology
Autoimmune disorders
Chronic hypertension
Chronic kidney disease
Diabetes
Fetal growth restriction
Gestational diabetes
Gestational trophoblastic disease
Multiple gestations
Nulliparity
Primigravida
BMI greater than 30
Obstructive sleep apnea
39
clinical presentation of preeclampsia without severe features
40
clinical presentation of preeclampsia with severe features
41
lab testing without severe features
greater than 140/90 mmHg
two occurrences at least 4 hours apart with ONLY proteinuria
42
lab testing with severe features
160/110 at two occurrences at least 4 hours apart with proteinuria and AT LEAST ONE symptom
Symptoms: persistent headache, pulmonary edema, right upper quadrant pain, or visual changes in conjunction
Additional: 24 hr urine sample; over 300 mg is considered positive for proteinuria; also CBC to test platelets (to test for thrombocytopenia)
43
preeclampsia fetal testing
increased BPP
testing a few times a week
44
how is a BPP done
ultrasound testing with even 2s
45
risk for what with preeclampsia
seizure due to high blood pressure
46
magnesium
2-4 g bolus to help with eclamptic seizure with a client who has preeclampsia with severe features
mom will be super relaxed, BUT still get a responses
47
magnesium
48
if you gave too much magnesium
leads to respiratory depression
decreased RR, no refluxes
administer calcium gluconate
49
how to check a persons reflex
deep tendon: hammer, hit with hands, stethoscope to elicit a response
50
does mag treat BP
NO, it is treating seizures. it will lower as a SYMPTOM but not the therapeutic use
51
antenatal steriods
betamethasone
52
difference with preeclampsia vs eclampsia
eclampsia causes seizures
had a seizure and preeclamptic, you are eclamptic
53
interventions for seizures
lay on side
move objects
no fingers in mouth
time the seizure
try to monitor the baby if possible
54
why do we time seizures
eclamptic seizures you don't breathe so need to see how long you and baby were not breathing
55
during eclamptic seizure
suction of bedside
lay on side
supplemental O2 on mom
56
after eclamptic seizure
continuous monitoring for mom and baby
probable delivery-but not always
generally have C section
57
HELLP syndrome
H: hemolysis
EL: elevated liver enzymes
LP: low platelets
risk for hemorrhage (precautions: no shaving, assist them)
58
what would happen with elevated liver enzymes
jaundice (
59
liver panel labs
bile and CBC? finish later
60
HELLP
begins with inadequate placental trophoblast invasion and poor uterine spiral artery remodeling, resulting in endothelium dysfunction.
61
lab work for DM
A1C and blood glucose (before meals)
62
why can stress increase glucose levels
hormone fluctuation
63
the placenta can pass glucose but not what
insulin
so the baby become hypoglycemic
64
symptoms of hypoglycemia
respitary depression
jittery
65
LGA can increase what
shoulder getting stuck
so you would have a birth injury
66
gestational diabetes
increased insulin resistance
usually diagnosed within the second and third trimester
67
fast acting insulins
ends in -log
68
hyperemesis gravidarum
Nausea and vomiting in pregnancy that is severe and persistent.
dehydration, electrolyte imbalance, and weight loss
69
what is Helicobacter pylori
bacteria in gut
70
hypothyroidism
subclinical hypothyroidism and overt hypothyroidism
when serum levels of thyroid-stimulating hormone are elevated AND the serume levels of thyroxine decrease
71
what does a hypothyriodism patient look like
hair loss
weight loss
all vitals would go down
72
what does Grave's patient look like
bulging eye
weight loss
73
stage one HTN
130-139/80-89
74
stage 2 HTN
140 or higher/90 or higher
75
HTN crisis
180 or higher/120 or higher
76
as maternal blood pressure increases...
placental blood flood decreases and limits O2 to the baby for growth, leading to fetal hypoxia
77
Chronic conditions and comorbidities that reduce uterine blood flow through the placenta, such as
diabetes, have demonstrated an increase in HTN during pregnancy
78
epidemiology of HTN disorders during pregnancy
2nd leading cause of global maternal mortality
increasing due to certain demographics like AMA
1/7 pregnancies diagnosed with a hypertensive disorder
6.8% of maternal deaths in the US are a result of a hypertensive disorder
79
A pregnant client who initially presents with blood pressure readings in a normal range and then presents with a blood pressure of
140/90 mm Hg or higher after 20 weeks of gestation will be diagnosed with a hypertensive disorder of pregnancy.
80
diagnosis of gestational hypertension
no proteinuria
BP readings of 140/90mmHg or higher on two occasions at least 4 hrs apart
81
A client who has chronic hypertension will undergo
a complete history and physical examination during the first prenatal visit to identify risk factors and disease management challenges.
82
Clients who have gestational hypertension have higher rates of
thrombocytopenia
liver dysfunction
83
why consistent fetal testing with hypertensive disorders
HTN leads to vasoconstriction and reduced blood flow through the placenta, therefore fetal growth needs to be monitored.
can lead to non-reassuring fetal status, fetal growth restriction, placental abruption
84
Current recommendations include an ultrasound every
3-4 weeks with amniotic fluid levels checked when having a HTN disorder
85
Clients who have gestational hypertension at or after 37 weeks of gestation should
give birth to prevent disease progression and poor neonatal outcomes.
86
Clients who have chronic hypertension are encouraged to
seek preconception counseling
87
Manifestations such as severe headaches not relieved by
acetaminophen, visual changes, right upper quadrant pain, dyspnea, and oliguria should be immediately reported to the provider.
88
oliguria
Less than 20 mL per hr of urine output.
89
pathophysiology of why preeclampsia occurs
not well understood
however, it is thought to involve unexpected placental implantation and inadequate blood flow to the placenta.
90
The maternal response to preeclampsia
The inflammatory events lead to vasoconstriction, vasospasms, and a decrease in clotting factors
Endothelial cell dysfunction and decreased maternal perfusion can lead to the diagnosis of preeclampsia based on the client's manifestations, laboratory values, and diagnostic testing.
91
however, current studies indicate preeclampsia begins with
unexpected placental implantation and subsequent release of antiangiogenic markers.
92
risk factors for preeclampsia include
Age greater than 35 years
Use of assisted reproductive technology
Autoimmune disorders
Chronic hypertension
Chronic kidney disease
Diabetes
Fetal growth restriction
Gestational diabetes
Gestational trophoblastic disease
Multiple gestations
Nulliparity
Primigravida
BMI greater than 30
Obstructive sleep apnea
93
Primigravida clients are at risk for
preeclampsia
94
Manifestations of Preeclampsia With Severe Features
BP >/= 160/110 on two occasions at least 4 hrs apart
persistent headaches
visual changes
RIGHT upper quadrant pain
pulmonary edema
sudden weight gain
nausea and vomiting
fetal growth restriction
95
Clients who are at 20 or more weeks of gestation and have blood pressure readings greater than or equal to 140/90 mm Hg on two occasions at least 4 hr apart with no other manifestations of disease will be diagnosed with
preeclampsia without severe features
96
lab results for preeclampsia without severe features
no proteinuria
may indicate:
thrombocytopenia
impaired liver function
pulmonary edema
renal insufficiency
headache unresolved with medication
97
long term health effects of preeclampsia
Cerebrovascular events, congestive heart failure, hypertension, myocardial infarction, and peripheral arterial disease are common diagnoses in clients with a history of preeclampsia
98
Timing of Birth
A client between 34 to 36 6/7 weeks of gestation presenting with preeclampsia with severe features is a candidate for birth
99
eclampsia is the severe manifestation of
preeclampsia
severe features with accompanying seizure activity in the absence of causes
100
Eclamptic seizures can lead to
severe maternal hypoxia, fetal hypoxia, aspiration pneumonia, trauma, maternal death, and neonatal death.
101
Nurses need to understand that clients with sudden-onset eclampsia may present without
any manifestations of preeclampsia with or without severe features, or worsening disease
102
The pathophysiology of eclampsia lies in the
progression of worsening disease of preeclampsia with severe features caused by unexpected placental implantation.
103
Eclampsia Risk Factors
Age over 35 years
Assisted reproductive technologies
Autoimmune disorders
Cardiovascular disease
Chronic hypertension
Chronic kidney disease
Diabetes
Genetics
Gestational diabetes
Gestational trophoblastic disease
Multiple gestation
Neurological disease
Nulliparity
BMI greater than 30
Obstructive sleep apnea
Poor nutrition
104
clinical presentation of eclampsia
persistent frontal or occipital headache, blurred vision, and sensitivity to light
105
If the client requires intubation for eclampsia, the nurse should frequently assess
blood pressure because the procedure causes a hypertensive response that may lead to an intracranial hemorrhage.
106
common complications of eclampsia include
pulmonary edema and respiratory failure
107
Maternal and Fetal Complications of Eclampsia
Aspiration pneumonia
Cerebral edema
Cerebral hypoperfusion
Fetal hypoxia
Impaired cerebral autoregulation
Maternal death
Neonatal death
Maternal emotional trauma
108
Clients diagnosed with posterior reversible encephalopathy syndrome (PRES) in conjunction with eclampsia are at
high risk for liver and renal failure
109
care during an eclamptic seizure
The client will be positioned on their left side to improve blood flow from the inferior vena cava.
Airway management, suction, administration of oxygen, prevention of aspiration, frequent vital signs, oxygen saturation, continuous fetal monitoring, and assessment of the seizure are paramount to ensure maternal-fetal safety.
infuse magneisum sulfate and antihypertensives via mulitple IV lines
If the client experiences a persistent seizure, anticonvulsant therapy may be required.
110
common complications of eclampsia maternal
Respiratory failure, pulmonary edema, renal failure, liver failure, posterior reversible encephalopathy (PRES), and the development of cardiovascular disease later in life
111
. An increase in uterine contractions and baseline uterine tone may also be noted during eclampsia, leading to what
placental abruption
112
the pathophysiology of HELLP is the same as
preeclampsia with severe features
113
Clinical Presentation of HELLP syndrome
right upper quadrant abdominal pain and general fatigue
114
additional manifestations of HELLP syndrome
increased abdominal girth, visual changes (such as blurred vision), jaundice, pedal edema, and blood pressure greater than or equal to 140/90 mm Hg
115
what is jaundice
Increase amount of bilirubin circulating in the bloodstream that dissolves in the subcutaneous fat causing a yellow tint to skin and sclera. Also known as icterus.
116
Maternal Complications of HELLP Syndrome
Placental abruption
Eclampsia
Disseminated intravascular coagulopathy (DIC)
Postpartum hemorrhage
Thrombosis
Liver hematoma/rupture
Liver failure
Cerebral hemorrhage and infarction
Cardiovascular instability
Acute kidney damage
Infection and sepsis
Retinal detachment
Death
117
Fetal complications from HELLP syndrome
fetal growth restriction, respiratory distress syndrome, preterm birth, neonatal thrombocytopenia, neonatal neutropenia, neonatal leukopenia, and perinatal death.
118
in pregnancy, an expected physiological process begins in the second trimester that will increase
insulin resistance at the cell wall to increase the transport of available glucose across the placenta to the developing embryo.
process intitated by the secretion of human placental lactogen (hPL) from the placental control of hormone secretion that takes full effect in the early second trimester
119
human placental lactogen (hPL)
Hormone during pregnancy that the placenta releases in preparation for breastfeeding.
120
The level of hPL remains relatively consistent throughout
the second trimester, but it will increase again in the third trimester until it peaks around the 30th week of pregnancy, when fetal weight gain markedly increases and glucose transport across the placenta is vital.
121
Pregnant clients who have type 1 DM will likely have significant
changes to their insulin dosing and will require more frequent blood glucose testing, possibly four to six times a day, to prevent wide fluctuations in their blood glucose levels throughout the day.
122
education for clients who have PDM should include
nutrition, exercise, medication, how often to see the provider during pregnancy, and monitoring of glucose levels
123
individuals who have PDM often have difficulty
conceiving or may have had multiple first-trimester pregnancy losses due to congenital anomalies or unstable blood glucose levels.
124
Some of the most common manifestations of PDM
polyphagia, polydipsia, polyuria, dry skin, blurred vision, slow-healing wounds, fatigue, and more infections than average.
125
Gestational diabetes mellitus (GDM)
increased insulin resistance at the cell wall that typically occurs in the second and third trimesters of pregnancy and essentially mimics the features of type 2 DM
126
risk for developing when having GDM
gestational hypertension or preeclampsia, preterm labor, complications associated with birth (including an operative birth and postpartum hemorrhage), and development of type 2 DM across a lifetime.
127
manifestations of GDM
Increased thirst, increased urination, fatigue, and nausea are a few of the manifestations that may occur with increased serum glucose level
128
Along with dietary modifications, pregnant clients who have GDM must monitor
blood glucose levels four times daily.
129
patho of HG
placenta secretes hCG which rises rapidly over the first 10 weeks
in response to that, the corpus luteum secretes estradiol
Rising levels of progesterone will cause relaxation of the cardiac sphincter, which increases the incidence of gastric reflux and, thus, nausea
130
common risk factor for HG
nulliparous
131
