Exam 3: Hypertension in Pregnancy

Question 1

Gestational hypertension

Answer 1

Hypertension without proteinuria that occurs after 20 weeks gestation

Question 2

Preeclampsia

Answer 2

Multi-system disease process characterized by hypertension and proteinuria occurring after 20 weeks gestation

Question 3

Eclampsia

Answer 3

Seizure activity in patient with preeclampsia

Question 4

Chronic hypertension

Answer 4

Hypertension prior to pregnancy or diagnosed prior to 20 weeks gestation

Question 5

Chronic hypertension with superimposed preeclampsia

Answer 5

Chronic hypertension with proteinuria or a worsening of hypertension after 20 weeks gestation

Question 6

Predisposing factors to preeclampsia

Answer 6

First pregnancy
Maternal age
Multiple gestation
African American
Diabetes
Obesity
Renal disease
Immunologic disorders
Pre-existing hypertension
Hx of preeclampsia
IVF

Question 7

Effects of preeclampsia on the placenta/fetus

Answer 7

Vasoconstriction causes hypo-perfusion of placenta

Prematurity
Intrauterine growth restriction (IUGR)
Hypoxia
Acidosis
Placental abruption
Death

Question 8

Severe complication of preeclampsia

Answer 8

HELLP Syndrome
Hemolysis
Elevated Liver enzymes
Low Platelets

⬇ Hematocrit
⬆ AST, LDH, ALT
⬇ Platelets

Question 9

Effects of preeclampsia on pregnant patient

Answer 9

Pulmonary edema
Renal failure
Cardiac failure
Disseminated intravascular coagulation (DIC)
Death

Question 10

Cure for preeclampsia

Answer 10

Delivery is the only cure for preeclampsia

Question 11

Management of preeclampsia without severe features

Answer 11

Home care or impatient care; Rest

Nursing assessment:
BP
Daily weight gain, edema
Daily protein dipstick
Diet
Reflexes
Lab testing
Fetal well-being
Assess s/s of worsening preeclampsia

Question 12

Management of preeclampsia with severe features

Answer 12

Hospitalization is necessary

Expectant vs. expeditious delivery

Psychosocial support

Educate on disease process

Question 13

Care of PT with preeclampsia with severe features in labor

Answer 13

Administer magnesium sulfate
Administer antihypertensives if necessary
Provide calm, quiet environment
Bed rest with side-lying position
Analgesia
IV hydration (for perfusion)
Pitocin

Question 14

Magnesium sulfate

Answer 14

Decreases CNS irritability; CNS depressant and anticonvulsant

Side effects: decreased DTRs, decreased fetal heart rate variability

Adverse effects: Decreased LOC, absent DTRs

Question 15

Nursing interventions for magnesium IV administration

Answer 15

Strict I&O daily
Reflexes and breath sounds Q2 hours
Second RN sign-off to administer
Have antidote ready at bedside (calcium gluconate)
Continuous EFM while pregnant
Continue mag infusion 24 hrs. after delivery
Monitor labs
Assess for mag toxicity

Question 16

Actions during a seizure

Answer 16

Lower PTs head
Turn PT to side
Suction
Do not restrain
Document time, length, and type
Call for help
Notify provider

Question 17

Actions after a seizure

Answer 17

Hyperoxygenate
Auscultate lungs
Assess fetal HR, labor activity, s/s of abruption
Avoid stimulation

Question 18

Postpartum care for preeclampsia

Answer 18

Continue to monitor for 24 hrs.
Continue admin of mag for 24 hrs.
Routine postpartum assessment (increased risk for uterine atony)

Long-term follow up: preeclampsia = risk factor for CV disease