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MIDW 305 > CBL 6 – Thyroid and Hypertension > Flashcards

CBL 6 – Thyroid and Hypertension Flashcards

(46 cards)

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1
Q

Who do we screen for thyroid (risk factors)?

A
  • > 30 yrs
  • 2 prior preg
  • Hx PTL, infertility, loss
  • T1DM/ Celiac /Auto-immune
  • BMI >/=40
  • Hx thyroid disease
  • Family Hx of thyroid disease
  • Goitre
  • Taking meds for thyroid
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2
Q

What is normal thyroid levels in T1 for someone with prev thyroid disease?

A

0.1-4

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3
Q

What is the normal thyroid levels in T1 for someone with no prev thyroid disease?

A

0.1-5.0

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4
Q

What is subclinical hypothyroidism?

A

Elevated TSH normal T4

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5
Q

What are clinical symptoms and values of hyperthyroidism?

A

low TSH, high T3/T4
high energy, weight loss, tremor, hot, agitated mood

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6
Q

What are clinical symptoms and values of hypothyroidism?

A

high TSH, low T3/T4
low energy, tired, depressed mood, weigh gain, getting cold easily

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7
Q

What is thyroid storm?

A

Massive dump of T4/T3

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8
Q

When is thyroid storm more likely?

A

after surgery, infection, or after birth (postpartum)

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9
Q

What does a thyroid storm look like?

A

tachy, extreme irritability, cardiac event if not managed.

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9
Q

What is the thyroid feedback loop?

A

Pit releases TSH -»T3 and T4 -» more TSH/less TSH

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10
Q

How much dietary iodine recommended per day?

A

150 mcg

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11
Q

Perinatal complications hyperthyroidism?

A

Pre-eclampsia
PTL
Thyroid storm
IUGR
LBW
Fetal demise

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12
Q

Perinatal complications hypothyroidism?

A

Hypertension
Preeclampsia
Anemia
Miscarriage
PTB
PPH
LBW
Stillbirth

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13
Q

What should you avoid with levothyroxine?

A

Fe and Ca

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14
Q

Numbers needed for levothyroxine Rx?

A

TSH >=10

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15
Q

What is the leading cause of maternal morbidity worldwide?

A

HDPs

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16
Q

What are HDPs classified as? (4)

A

Chronic hypertension
Gestational hypertension
Preeclampsia
White coat hypertension

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17
Q

What is considered hypertension?

A

Systolic >=140
Diastolic >=90

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18
Q

Which part of BP is more concerning with hypertension?

Study These Flashcards
A

Persistently high diastolic

19
Q

What is severe hypertension?

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A

Systolic >=160
AND/OR
Diastolic >=110

19
Q

What is the criteria for pre-eclampsia?

Study These Flashcards
A

Hypertension
AND one or more:
- Maternal organ dysfunction
- Fetal growth restriction

20
Q

Criteria for Eclampsia?

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A

Hypertension
Same as pre-eclampsia
Seizures with no known origin

20
Q

Symptoms hypertension involving organ systems?

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A

CNS –
Headaches
Flashing lights
Blind spots
Irritability
Hyperreflexia

CVS
Chest pain
Dyspnea (shortness of breath)
Distended neck veins

Liver
RUQ pain
Epigastric pain
Nausea / Vomiting

Kidney

Proteinuria
Oliguria
Edema (no longer part of criteria though – not specific enough)

Placenta
IUGR

21
Q

Symptoms of gestational hypertension?

Study These Flashcards
A

RUQ pain
Headaches
Visual dist

21
Risk factors for hypertension?
Obesity Diabetes Existing renal disease Chronic hypertension Prior preclampsia Family Hx preeclampsia, gest hypertension Carrying multiples ART New partner Abnormal genetic screening analytes Nulip >40 yo
22
Symptoms of pre-eclampsia?
Headache Visual disturbances Vomiting
23
Symptoms of HELLP?
Epigastric pain Platelet type bleeding Jaundice
24
Symptoms of Eclampsia?
Seizures
25
What are the 4 principles of managing hypertension?
Evaluate well being of fetus/birther Prevent severe complications Manage symptoms Expedite delivery
25
Proper BP reading to confirm hypertension?
Blood pressure should be taken with the client in a sitting position, with an appropriate sized cuff, and the upper arm at the level of the heart. * If blood pressure is elevated, take two readings with a minimum rest period of 15 minutes between.
26
What tests if hypertension? (5)
CBC Creatinine ALT/AST Urine protein: UPCR, 24 hour urine (which people don’t do cuz it’s gross) Assessment of fetal well being: growth, doppler, fluid
27
What is the most significant distinguishing feature of preeclampsia vs hypertension?
Presence of proteinuria W hypertension
28
What is proteinuria defined as?
>= 300 mg/day 24 hour urine collection 2+ on dipstick UPCR <30
29
Steps if proteinuria?
Consult OB NST
30
What is done in management of eclampsia?
Magnesium sulfate Expedite delivery real fast TRANSFER CARE
31
What can reduce HDP? (5)
Low dose ASA Calcium Vit D Exercise Dietary advice
32
Who should take low dose ASA in preg?
Prior pre-eclampsia BMI >30 Chronic hypertension Diabetes before preg Kidney disease Lupus ART 2 or more: Placental abruption Prior stillbirth Prior IUGR >40 Nulip Multifetal preg
33
What are some possible hypertensive meds?
Labatalol 100-200 mg TID Nifedipine 20 mg BID Methyldopa 250 mg TID
34
IOL for chronic hypertension?
Consider 37-38 Def by 40 immediate if unable to control BP >12 hours
34
IOL for gestational hypertension?
Consider 37-38 Def by 40 immediate if unable to control BP >12 hours
35
Preclampsia IOL?
(36-36+6) delivery should be considered - if stable <24 should be considered If BP cannot be controlled, increased organ dysfunction, or fetal indication - any GA
36
How much ASA?
81-162 mg starting before 16 wks to 36 wks
37
What is the purpose of controlling BP for HDP?
Decreasing the chance of maternal stroke
38
Who should take calcium with ASA?
Only those people who don’t get enough dietary Ca intake
39
What should be considered with transport for HDPs?
-maternal BP stable -seizure prophylaxis given -skilled HCP accompany to admin meds
40
What is recommended PP for people with HDPs?
Monitoring of BP first 2 weeks of pp BP checked again at 6 wks pp

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