HTN Flashcards Preview

NURS783 Exam 2 > HTN > Flashcards

Flashcards in HTN Deck (27)
Loading flashcards...
1
Q

chronic HTN

A
  • ≥140/90 (mild)
  • ≥180/110 (severe)

BEFORE 20 weeks GA OR prior dx that predates pregnancy

2
Q

What are chronic HTN pts at risk of developing?

A

superimposed pre-eclampsia

3
Q

T or F: mild chronic HTN should be treated pharmacologically in pregnancy

A

false

4
Q

What HTN pharm tx are preferred in pregnancy?

A
  • beta blockers

- Ca channel blockers

5
Q

What HTN pharm tx are contraindicated in pregnancy?

A
  • ACE inhibitors

- ARBs

6
Q

What is goal BP while on meds?

A

120-160/80-105

7
Q

When should chronic HTN pts deliver?

A

around EDD

8
Q

gestational HTN

A
  • ≥140/90
  • MAP ≥ 105mmHg

AFTER 20 wks GA, @ least twice, 4-6h apart in ABSENCE of proteinuria or systemic findings

9
Q

When does BP return to baseline in GHTN?

A

12 wks PP

10
Q

pre-eclampsia w/out severe features

A
  • ≥140/90

AFTER 20 wks GA, @ least twice, 4-6h apart WITH proteinuria

11
Q

pre-eclampsia w/ severe features

A
  • ≥160/110

WITH proteinuria
OR
w/out proteinuria AND s/s end-organ damage (e.g. thrombocytopenia, impaired LFT, renal insufficiency)

12
Q

proteinuria

A
- ≥300mg proteinuria/24h 
OR 
- ≥1+ on dipstick on 2 specimens 6h apart 
OR 
- protein/creatinine ratio of 0.3
13
Q

How can pre-eclampsia be prevented?

A

daily, low-dose (60-80mg) ASA beginning late 1st tri (12-16 wks) until 37 wks

14
Q

eclampsia

A

new onset seizures w/ HTN and/or preteinuria

15
Q

HELLP syndrome

A
H emolytic anemia
E levated...
L iver enzymes (inc ALT/AST)
L ow...
P latelets
16
Q

When should pts w/ pre-eclampsia deliver?

A

@ 37.0

17
Q

When should pts w/ HELLP deliver?

A

@ 37.0

18
Q

What are the 3 theories of pathogenesis for HTN in pregnancy?

A

1) systemic inflammatory response –> vascular damage (thromboxane = constrictor > prostacyclin = dilator)
2) abnormal placentation: hypertrophy of muscles surrounding spiral arteries –> constriction –> dec blood flow
3) immune-mediated: rejection of pregnancy; new paternity = risk

19
Q

What are maternal risks of HTN?

A
  • seizure
  • cerebral hemorrhage
  • thrombocytopenia
  • disseminated intravascular coagulation (DIC)
  • renal failure
  • liver failure
20
Q

What are risks of HTN to fetus?

A
  • oligohydramnios
  • growth restriction
  • still birth
  • placental abruption
  • placental infarction
  • intrapartum fetal distress
21
Q

What are obstetric risks of HTN?

A
  • uteroplacental insufficiency
  • premature delivery
  • placental abruption
  • C/S
22
Q

When should pts w/ severe pre-eclampsia deliver?

A

@ 34 wks

23
Q

What s/s should HTN pts be asked about at every visit?

A
  • headaches
  • RUQ pain
  • vision change
  • fetal movement
24
Q

How should pts w/ GHTN or pre-eclampsia w/out severe features be managed?

A

expectantly until 37 wks

  • NST/AFI 2x/wk
  • BP check 1-2x/wk
  • lab eval q1 wk
  • serial growth U/S qq3-4wks

*no anti-HTN meds if BP<160/110

25
Q

How should pts w/ pre-eclampsia w/ severe features be managed?

A

expectant management until 34 wks if no evidence of:

1) HELLP
2) eclampsia
3) pulmonary edema
4) stroke
5) abruption
6) DIC
7) labor or PPROM
8) oligohydramnios
9) new onset or inc renal dysfunction
10) non-reassuring fetal status

26
Q

When should mag sulfate be used?

A

in SEVERE cases of pre-eclampsia to prevent seizure

27
Q

When should mag sulfate be avoided?

A
  • in mild disease

- in pts w/ pulmonary edema