Hypertension in Pregnancy Flashcards
(45 cards)
Different types of HTN associated with Preg (7)
- Gestational Hypertension
- Mild Preeclampsia
- Severe Preeclampsia
- Eclampsia
- HELLP syndrome
- Chronic Hypertension: diagnosis of HTN prior to pregnancy and no protein
- Chronic Hypertension with superimposed preeclampsia –> protein in urine is diagnostic for preeclampsia
Hypertension in pregnancy is a continuum based on…..
end organ effects
How does HTN cause damage to the body? What organs end up being effects?
- Vasospasm in vasculature leads to poor tissue perfusion
- Poor tissue perfusion
- Endothelial cell damage
Organs effected: CNS, Liver, Electrolytes, Lungs, Kidneys, Placenta, Clotting
Risk factors for HTN in preggos (9)
• Maternal age <19 or >40 • 1st pregnancy • extreme obesity • Multifetal pregnancy • Chronic Kidney Disease • Chronic Hypertension • Family history of preeclampsia • DM • Underlying autoimmune disorders: ◦ Rheumatoid Arthritis ◦ Systemic Lupus Erythematous
Onset: after 20 weeks gestation
◦ 140/90 mm Hg or > on 2 different occasions; at least 4 hours apart
◦ No proteinuria
What type of HTN is this?
Gestational HTN
diagnosed w/ HTN prior to 20 weeks gestation/before pregnancy is what kind of HTN?
Chronic HTN
Onset: >20 weeks
◦ 140/90 mm Hg or > on 2 different occasions; at least 4 hours apart
-proteinuria > or =1+
What kind of preggo HTN is this?
Mild Preeclampsia
s/s client may report with mild preeclampsia
◦ Transient headache
◦ Irritability
◦ Edema
interventions for mild preeclampsia
manage at home, RN does a lot of education on notifying provider of changes
◦ increase in BP –> call provider
◦ Bedrest, daily weight
◦ Education for all HTN preg clients: side lying position to allow optimal placental perfusion
◦ Diet- avoid high sodium, alcohol, tobacco, caffeine
◦ kick count
protein in urine will occur 20 weeks or after with a client who already has HTN
What kind of preggo HTN is this?
Chronic HTN + superimposed preeclampsia
• BP 160/110 mm Hg or >
◦ Proteinuria > 3+
What kind of preggo HTN is this?
severe preeclampsia
s/s of kidney involvement with severe preeclampsia (3)
◦ Proteinuria > 3+
◦ Oliguria
◦ Elevated serum creatinine >1.1 mg/dL
POE
CNS involvement with severe preeclampsia? (2)
◦ Cerebral or visual disturbances, headache and blurred vision
◦ Hyperreflexia with possible ankle clonus (jerking) when dorsiflex foot
What kind of edema do we see with severe preeclampsia?
- pulmonary
- extensive peripheral edema
- facial edema
- dependent edema
why do you have peripheral edema with severe preeclampsia?
arterioles vasospasm –> damage in endothelium –> leakage of intravascular fluid into interstitial spaces
Does severe preeclampsia jack up your liver?
YES!
◦ elevated liver enzyme (2x normal)
◦ Epigastric and right upper-quadrant pain due to liver inflammation
What does severe preeclampsia do to your blood components? why do I care?
• Thrombocytopenia - platelets <100,000
◦ decreased ability to clot, risk of hemorrhage
Severe preeclampsia- what are the s/s ?? (BP + 6 other systems)
- BP 160/110 mm Hg or >
- Kidney involvement: ( Proteinuria > 3+, Oliguria, Elevated serum creatinine >1.1 mg/dL)
- CNS (visual disturb, ankle clonus)
- Edema (lungs, face, peripheral)
- Liver (increase enzymes/ RUQ pain)
- Thrombocytopenia
- N/V
management of severe preeclampsia?
- Managed in hospital
- Daily Weight
- I&O
- Encourage rest
Deep tendon reflex scoring? 1-4: what do they mean?
◦ 0 = no response
◦ 1+ = sluggish or diminished
◦ 2+ = active or expected response
◦ 3+ = more brisk than expected, slightly hyperactive
◦ 4+ = brisk, hyperactive with intermittent or transient clonus
Seizure precautions for preecplamsia/eclampsia include:
O2 10L/min face mask, turn on side, suction equipment, not seizure onset/duration, IV access, lights low/diminished stimulation
what are risks to fetus due to preeclampsia/eclampsia
IVGR (growth restriction), premature birth, placental abruption, fetus cannot tolerate labor due to decreased perfusion, born as still birth
What are s/s of eclampsia?
• Manifestations of severe preeclampsia
+ Onset of seizure activity or coma !!
Warning signs for possible convulsions?
◦ Frontal Headache
◦ Severe epigastric pain
◦ Hyperreflexia/ clonus
◦ Hemoconcentrations - blood components are increased
