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Mom & Baby Exam 2 > Chapter 27: Hypertensive Disorders in Pregnancy > Flashcards

Chapter 27: Hypertensive Disorders in Pregnancy Flashcards

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1
Q

What are the 3 type of Hypertensive Disorders ?

A
  • Gestational hypertension
  • Preeclampsia
  • Eclampsia
  • Chronic hypertension ?
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2
Q

True or False: The rate of pregnancy related hypertension has risen steadily since 1990 for all ages and ethnic groups ?

A

True

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3
Q

True or False: The rate of chronic HPTN in mothers >40 is nearly 10x higher than those younger than age 20 ?

A

True

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4
Q

What things cause Maternal Morbidity ?

A
  • Placental abruption
  • Cerebral hemorrhage
  • Hepatic or renal dysfunction
  • DIC (disseminated intravascular coagulation)
  • Pulmonary edema
  • Seizures
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5
Q

True or False: Pregnancy-related hypertension accounts for 10% to 15% of maternal deaths worldwide ?

A

True

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6
Q

True or False: Preeclampsia accounts for more than 500,000 maternal deaths each year ?

A

True

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7
Q

Gestational hypertension is also known as what ?

A

Pregnancy induced hypertension

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8
Q

True or False: With Gestational hypertension, there are generally good outcomes for both mom and baby ?

A

True

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9
Q

Gestational Hypertension is defined as what ?

A

The onset of hypertension WITHOUT proteinuria

- can occur after the 20th week of pregnancy

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10
Q

Preeclampsia is defined as what ?

A

A pregnancy specific syndrome in which hypertension develops after 20 weeks of gestation in a previously normotensive woman

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11
Q

gestational hypertension is defined as Blood Pressure of what ?

A

Systolic BP > 140mmHg

Diastolic BP > 90mmHg

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12
Q

The diagnosis of onset of Gestational hypertension during pregnancy is based on what ?

A

2 measurements on 2 separate occasions, that meet criteria for gestational BP elevation within a 1-week period

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13
Q

Gestational hypertension USUALLY develops when ?

A

at or after 37 weeks of gestation

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14
Q

What do we know, in terms of gestational hypertension, and the patients BP before and after pregnancy ?

A
  • Women with GH have no preexisting hypertension

- BP returns o normal within 6 weeks after birth

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15
Q

If a women is Dx with GH before 35 weeks, it may progress to what ?

A

preeclampsia

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16
Q

What is Preeclampsia characterized by ?

A

Reduced organ perfusion with presence of hypertension and proteinuria

(essentially a problem causing hypertension. may or may not have proteinuria)

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17
Q

What is the only known cure for Preeclampsia ?

A

Birth

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18
Q

True or False: Preeclampsia may lead to Eclampsia ?

A

True

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19
Q

What do we know about Preeclampsia, and the signs and symptoms ?

A

Signs & symptoms develop only during pregnancy and disappear after birth

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20
Q

True or False: There is no reliable method to predict Preeclampsia ?

A

True

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21
Q

What are risk factors for Preeclampsia ?

A
  • Primigravida (pregnant for 1st time)
  • Second pregnancy with a new partner/father
  • Multifetal pregnancy
  • Extremes of age (>40 or <19)
  • Obesity
  • Preexisting medical condition
    (chronic HTN, renal dz, DM 1, collagen dz)
  • Preeclampsia in a previous pregnancy
  • Family Hx of Preeclampsia
  • Poor outcome in previous pregnancy
    (IUGR, Fetal death)
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22
Q

What is the main pathophysiologic factor with Preeclampsia ?

A

An increase in BP, but poor perfusion resulting from vasospasm

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23
Q

With Preeclampsia, there is a significant decrease in placental what ?

A

kidney, liver and brain function

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24
Q

Mild Preeclampsia is characterized by what types of things ?

A
  • BP > 140/90
  • Transient headache
  • Normal Liver functions
  • Proteinuria
    • > +1
    • 24hr > 300mg
    • output > 25-30cc/hr
  • Reduced placental perfusion
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25
Sever Preeclampsia is characterized what ?
- BP > 160/110 - Persistent/severe headache - Liver functions may be altered - Proteinuria - > +3 - 24hrs > 5gms - output < 400-500cc/24hrs - Possible Epigastric pain - Visual problems - blurred - Pulmonary edema - Decreased placental perfusion - Abnormal fetus status on tests
26
What is Eclampsia ?
The onset of seizure activity or coma in a woman with preeclampsia
27
What are signs & symptoms of Eclampsia ?
- seizure activity or coma in women diagnosed with preeclampsia - No Hx of previous seizure disorder - Scotomata - Blurred vision - Epigastric pain - Vomiting - Persistent or severe headache - Neurologic hyperactivity - Pulmonary edema - Cyanosis
28
What is HELP Syndrome associated with ?
Severe Preeclampsia & Liver dysfunction
29
What is the HELLP acronym ?
``` Hemolysis Elevated Liver enzymes Low Platelet count ``` - Associated with Preeclampsia
30
If a pregnant women has true HELLP what should be done ?
Deliver the fetus ``` 1st = Stabilize mother 2nd = Deliver baby (baby is making mom sick) ```
31
HELLP is the result of what ?
- arteriolar vasospasm - endothelial cell dysfunction w/ fibrin deposits - adherence of platelets in blood vessels
32
HELLP Syndrome is associated with an increased risk for what types of things ?
- Pulmonary edema - Acute renal failure - Disseminated intravascular coagulation (DIC) - Placental abruption - Liver hemorrhage or failure - Adult respiratory distress syndrome - Sepsis - Stroke - HIGH RISK FOR MATERNAL DEATH*
33
HELLP Syndrome is associated with a high risk for what ?
High risk for maternal death
34
Signs and symptoms of HELLP syndrome may include ?
- Elevated BP - Proteinuria - Edema - N/V - General malaise - Epigastric pain Can lead to misdiagnosis of other problems
35
In regards to HELLP Syndrome, regardless of BP, when a woman presents with proteinuria, what should she have done ?
- CBC - Platelet count - Liver enzymes - Urine studies
36
True or False: Checking reflexes in OB is very important ?
True
37
What is the goal with mild gestational hypertension and mild preeclampsia ?
To ensure maternal safety and deliver a healthy newborn
38
What should be down with a pregnant women with severe gestational HTN and preeclampsia ?
Should be hospitalized for 24hr observation and fetal surveillance * We want the mother to calm down & decrease stimuli * - Limit visitors - Quiet environment - Dark environment
39
What medication is given to prevent seizures in woman with severe gestational HTN and preeclampsia ?
Magnesium sulfate
40
What kind of medication is Magnesium sulfate ?
CNS depressant
41
What is the drug of choice for Preeclampsia ?
Magnesium Sulfate
42
In women with Sever gestational HTN & Preeclampsia, moms will be on a monitor for how long ?
Continuously
43
How often should you draw labs for a mother on Magnesium sulfate ? and why ?
- Every 6 hrs --> to make sure she is staying between 4-7mEq/L - to monitor for toxicity
44
Initially how should Magnesium Sulfate be given ?
``` Give Bolus (4g to 6g IV) - mom may be flushed ``` Bolus = giving it very fast
45
After the initial dose of Magnesium sulfate, what will be given next ?
A maintenance dose of 2g
46
How will the mom feel after receiving the maintenance dose of Magnesium sulfate ?
Tired, weak, etc - Normal to feel this after a few days
47
What are toxicity s/s of Magnesium sulfate ?
- Respiratory depression - Low urine output - Decreased deep tendon reflexes - Sometimes decreased LOC
48
What are the management goals for Severe Preeclampsia ?
- Ensure maternal safety (padded side rails, etc) - Assess degree of maternal and fetal risk - Formulate a birth plan - Prevent eclampsia and other complications - If 34weeks or >: C/S or IOL - risk of pregnancy is greater than risk of preterm birth - IF < 34weeks: meds to prevent seizures & control BP - corticosteroids to enhance FLM (Bethamethasone given to mom, but affects the babies lungs)
49
- What should normally happen in a healthy mom/person if you dorsi flex the foot up towards the leg ? - In a pregnant mom, if the foot has a jerky movement, it could be a sign of what ?
- The foot should just fall slowly and normally back to normal position - Preeclampsia (disturbances between the brain & spinal cord)
50
What is the Antidote for Magnesium Sulfate ?
Calcium Gluconate
51
What is the Hospital management for Preeclampsia ?
- Maternal assessment of systems - Continuous fit's and contractions - VS - Hydration via IV fluids - 125cc/hr - I/O - Bed rest with seizure precautions - Quiet environment - Emergency drugs, oxygen, suctions, delivery kit
52
What does the care management for Eclampsia include ?
- Immediate care - Seizures last 3-4 minutes and are self limiting - ensure a patent airway - pt safety a major concern - Magnesium sulfate - ICU - fetal assessment - post-seizure decision regarding timing and method of birth - Assess if HELLP syndrome - Lab evaluation - Infusion of blood products
53
Chronic Hypertension is associated with an increased incidence of what things ?
- Abruptio placentae - Superimposed preeclampsia - Increased perinatal mortality
54
What are fetal effects of Chronic Hypertension ?
- IUGR - Small for gestational age - Fetal hypoxia - Prematurity - Death related to abruption
55
For Chronic Hypertension, Management ideally begins when ?
Begins before conception
56
What are examples of Antihypertensive drugs that are used to treat Chronic Hypertension ?
- Aldomet - Labetolol - Niphedipine
57
True or False: With Chronic Hypertension, lifestyle changes may be necessary ?
True !
58
True or False: In postpartum, high risk women are monitored closely for complications ?
True
59
True or False: Women with Chronic Hypertension, may safely breastfeed even though low levels of Antihypertensive medications will be in the breast milk ?
True
60
What dose Nursing care for women with Chronic Hypertension include ?
- Monitor BP, urine, & edema every visit - Headaches - Epigastric pain - Oliguria - Visual disturbances - Pulmonary edema - Fetal growth
61
Hypertensive disorders during pregnancy are a leading cause of worldwide what ?
Infant and maternal morbidity and mortality
62
True or False: the cause of preeclampsia is unknown ?
Ture
63
Is there a reliable test for predicting which women are at risk for preeclampsia ?
No
64
True or False: Preeclampsia is a mutisystem disease rather than an increase in BP only ?
True
65
True ro Flase: HELLP Syndrome can occur in women with severe preeclampsia and is considered life threatening ?
True
66
True or False: Once preeclampsia becomes clinically evident, therapeutic interventions may slow the progression of the disease, allowing the pregnancy to continue ?
True
67
What is the Anticonvulsive agent of choice for preventing eclampsia ?
Magnesium Sulfate !
68
Magnesium sulfate requires careful monitoring of what things ?
- Reflexes - Respirations - Urinary output
69
True or False: The antidote to Magnesium Sulfate, which is Calcium gluconate, should be available at the bedside ?
True
70
What are the 2 main Nursing actions during a convulsion ?
- Ensuring a patent airway | - Pt safety
71
True or False: Chronic Hypertension in pregnancy is associated with - Abruption placentae - Superimposed preeclampsia - Fetal growth restrictions - Increased perinatal mortality
True
72
True or False: Women with preeclampsia have an increased risk of adverse perinatal outcomes in a future pregnancy ?
True

Mom & Baby Exam 2 (5 decks)

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