week 6 Flashcards
classification of hypertension in pregnancy
gestational
- onset of HTN during pregnancy or in the first 24 hours after birth
chronic
- present before the pregnancy or diagnosed before week 20
- requires collaborative management to reduce risk or perinatal morbidity and mortality
- may develop pregnancy related complications
effects of hypertension
vasoconstriction
reduction in blood flow
potential decreased blood flow to placenta
potential decreased oxygenation and nutrition
use of meds:
- continue current regimen if chronic
- Methyldopa and Procardia commonly used
- careful to not “over reduce” BP- can cause hypotension.
pre-eclampsia
- pregnancy-specific syndrome
- HTN develops after 20 weeks of gestation in previously normotensive woman
- disease of reduced organ perfusion with presence of HTN and proteinuria
- maternal vasospasm (arterial)
- decreased plasma volume
- coagulation changes
- changes in renal function
- changes in liver function
- potentially CNS function changes
etiology of pre-eclampsia
s/s develop only during pregnancy and disappear after birth associated high risk factors: - prior history of pre-eclampsia - primigravidity or new partner - multifetal pregnancy - obesity - before age 20, after age 40
pathophysiology of pre-eclampsia
Differs from chronic hypertension
- main pathogenic factor is not an increase in BP, but poor perfusion resulting from vasospasm
- ateriolar vasospasm diminishes diameter of blood vessels, which impedes blood flow to all organs and increases BP
- fuction in placenta, kidneys, liver, and brain depressed as much as 40-60%
- risk for other complications (HELLP, DIC)
mild pre-eclampsia
- BP > 140-90 on 2 occasions
- proteinuria (1+ dipstick)
- changes in liver function test
severe pre-eclampsia
- 2+ - 3+ proteinuria
- > 500gm in 24h urine collection
- oliguria
- BP> 160 systolic
- BP > 110 diastolic
emerging data - elevated creatinine levels are more significant than protein alone.
eclampsia
- CNS involvement
- seizure activity or coma
- emergency situation
pre-eclampia/eclampsia assessment
- accurate BP measurement (sitting not lying)
- urine dipstick for protein
- weight gain/edema: not diagnostic. further assess periorbital, facial, sacral. >2kg one week suspicious
- deep tendon reflexes brisk
pre-eclampia/eclampsia symptoms
- headache
- persistent heartburn
- visual changes: blurry vision, spots before eyes (scotoma)
- RUQ pain (liver engorgement)
pre-eclampia/eclampsia laboratory tests
- CBC
- liver function test
- coag panel
- 24h urine collection
pre-eclampia/eclampsia management
“cure” is delivery
mild pre-eclampsia and home care
- activity restrictions
- monitor symptoms
- low salt diet not effective; need adequate protein
- more frequent maternal-fetal assessments
pre-eclampia/eclampsia: moderate to severe management
seizure precaution control of bp & symptoms - low stimulation environment - limited noise - low lighting - safety precautions magnesium sulfate
magnesium sulfate
prevention or control of seizures
reduces CNS irritability & neuromuscular activity (smooth muscle relaxation)
administered via IVPB on infusion pump
- loading dose
- maintenance dose
- TIGHTLY controlled
- therapeutic dose: 5-8mg/dL
excreted in urine
- toxicity. if experiencing oliguria, make sure processing enough urine.
interferes with labor progress: pitocin augmentation
risk of PPH from atony
may require additional treatments to control PP bleeding (methergine)
magnesium sulfate nursing care
frequent assessments
hourly vital signs
- decrease in BP: if does not decrease below 160/110 may need hydralizine
- respiratory assessment: risk for respiratory depression. discontinue if 10-12 breaths per minute or less. may need calcium gluconate (antidote for Mag)
urine output
- increased urine output indicates improved kidney function
- decreased urine output increases risk of toxicity
deep tendon reflexes
- decrease in DTRs indicates effectiveness
