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Maternal Exam 3 > Hypertensive Disorders > Flashcards

Hypertensive Disorders Flashcards

1
Q

When does gestational hypertension begin?

What is the criteria?

How can this easily be confirmed?

A

In pregnancy after 20 weeks gestation

On 2 occasions at least 4 hours apart
Systolic OR diastolic pressure can be affected

If the BP falls back down after PG within 12 weeks

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2
Q

What is one reason why you may not even know when someone’s hypertension started and thus, you can’t accurately diagnosis if the hypertension is from PG or not?

A

If mom came in to the doctor and checks up later on in her PG rather than earlier so you don’t know when the HTN started

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3
Q

What is pre-eclampsia?

A

Similar to gestational hypertension. The BP will be hypertensive with the onset of pregnancy EXCEPT she will also have proteinuria.
It’s the next pitstop i guess.

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4
Q

What is hypertension for pregnancy?

A

When BP is 140/90 after 20 weeks but only ONE of these numbers has to be high

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5
Q

What are the other addition symptoms you can often see that happens with pre-eclampsia in addition to the proteinuria?

A 
Thrombocytopenia (low platelet)
Abnormal liver enzymes like ALT , AGT etc
Creatinine labs high from renal issues
Vision disturbances
Pulmonary edema
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6
Q

What is Eclampsia?

When is the onset?

A

New onset of hypertension in pregnancy with proteinuria but also a seizure or coma with someone without hx of any of this happening

  • New HTN
  • Proteinuria
  • Seizure/Coma

Onset for the actual eclampsia can be during PG, labor, or early postpartum

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7
Q

What is chronic hypertension? Is it the same things as the 3 hypertensions of gestational, pre-eclampsia, and eclampsia?

How is the chronic hypertension treated?

A

It is when the woman has hypertension before she was ever even pregnant and it stays long after she delivers

Methyldopa: Aldamet
Labetalol
Thriazide diuretics or Nifedipine diuretics

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8
Q

What is it called when a pregnant woman who ALREADY had chronic hypertension starts to develop pre-eclamptic symptoms like proteinuria?

A

Superimposed Preeclampsia.

Again, this is chronic hypertension she already had. But maybe now she is spilling protein. Having thrombocytopenia, liver issues, renal problems, pulmonary edema, visual problems, etc

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9
Q

When is the usual timing of pre-eclampsia?

A

Beyond 20 weeks usually but most prominent in the 30-40 week mark, during labor, or 48 hours after delivery. This is the time frame when those pre-eclampsia symptoms really show up.

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10
Q

T/F

Pre-eclampsia, eclampsia, and superimposed eclampsia can all show up while PG, during labor, and postpartum.

A

True! Just bc you are done being pregnant doesn’t mean you’re out of the woods yet.

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11
Q

What ages can put you at more risk of having Pre-eclapmsia?

A

Teenagers but also the older gravida moms as well.

So opposite ends of the spectrum

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12
Q

Why is that those women who are in their FIRST pregnancy have a higher risk of getting pre-eclampsia than say a woman who is in her third pregnanct?

A

We assume pre-eclampsia is an autoimmune response due to a foreign body (the fetus) being in the mom’s body.

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13
Q

What are the chances of you being pre-eclamptic if you’ve had it before?

A

17% chance and so yes people who’ve has previous hx are at higher risk

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14
Q

Which race is more likely to have pre-eclampsia?

A

African Americans

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15
Q

Who has a higher risk of pre-eclampsia: a mom carrying one baby or a mom with multiple gestations (twins)?

A

Mom with twins has higher odds of being pre-eclamptic

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16
Q

This type of fertilization risk can increase Pre-eclampsia odds

A

In vitro fertilization w donor eggs

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17
Q

Types of blood disorder conditions that increase risk of pre-eclampsia?

A

Factor 5 Leiden
Antiphospholipid
Antibody syndrome

  • but many of these people are on aspirin or heparin so make sure to ask if WHY someone is taking these meds to figure out if its the blood clotting disorder
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18
Q

Do scientists understand the patho of pre-eclampsia?

A

No they don’t because women are all different BUT they do know it has something to do with the placenta and it is progressive (and it won’t go away until you deliver).

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19
Q

What happens to the vessels of Pre-eclamptic women versus what normally happens?

A

Pre-eclamptic women’s vessels constrict which is abnormal since pregnancy usually should make you dilate your vessels. And so this leads to a lack of perfusion which effects organs and fetus. Baby can come out SGA from lack of O2 or decreased in active, or even having non-reassuring status.

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20
Q

So again, since the vessels of pre-eclamptic women are not acting right, what happens to the baby?

A

The constriction leads to less O2 for the baby. Baby can be SGA, have decreased movement, or even have a non-assuring status.

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21
Q

T/F

Pre-eclamspia actually doesn’t affect the kidneys

(Uric acid?)

A

False. Pre-eclampsia causes less perfused to the Kindeys and this affects the GFR. She begins to leak protein (PROTEINURIA!!) and urine output turns oliguric (less).

Uric acid will go up now bc it isn’t being excreted.

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22
Q

T/F

Pre-eclampsia causes decreased endothelial permeability

A

False.
The permeability of the endothelial increases which results in the edema you see in PG.
Hematocrit goes up.
Thrombocytopenia causes thick blood (which does not help constricting vessels btw)

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23
Q

T/F

Pre-eclampsia women don’t have to worry about pulmonary edema due to the mother and fetal circulation being different

A

False. Mom is at risk for pulmonary edema due to the increased capillary permeability that comes from endothelial permeability

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24
Q

We mentioned that thrombocytopenia or low platelets can happen too with pre-eclampsia in addition to the proteinuria. Why is this?

A

The coagulation cascade is activated but also because endothelial damage and so platelets are lost

(less than 100k)

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25
Q

We mentioned that liver enzyme issues can happen with pre-eclampsia. Why?

A

Due to decreased perfusion from vessel constriction. and so liver enzymes AST, LDH, ALP become elevated. And then you see RUQ pain

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26
Q

Again we mentioned renal insufficiency with pre-eclampsia. explain this

How does this affect the albumin levels and cause what?

A

The constriction of the vessels don’t allow the kidneys to be perfused.

  • kinda why you see proteinuria happening
  • albumin levels in serum decrease which leads to decrease osmotic pressure and water causes edema EVERYWHERE or generalized.
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27
Q

What happens to the reflexes in pre-eclamptic women?

A

Hyperreflexia - Exaggerated reflexes are at 3+ or 4+ due to CNS irritability which can also give headaches that can’t be relieve by Tylenol … and seizure is coming.

CNS irritability = hyperreflexia + headache = seizure and eclampsia

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28
Q

Explain hemoconcentration in pre-eclamptic women?

A

Serum levels of Creatinine, BUN, and uric acid increase

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29
Q

Pre-eclampsia risks that are Life threatening?

A

Acute renal failure
Abruptio placenta
Disseminated intravascular coagulation DIC
Pulmonary edema

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30
Q

What was “ Preeclampsia without severe symptoms” known as? What must BP be ?

A

Mild pre-eclampsia = pre-eclampsia without severe symptoms

Be around 140/90 still.

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31
Q

What are the symptoms of “Preeclampsia without severe symptoms” ?

A

The onset of hypertension is still new here too after 20 weeks.
She will have that CNS irritability.
She is spilling protein (dipstick is 1+ or 300 mg)
- gold standard is 24 hr urine collection
Edema can be present but not needed for dx.
Visual changes or scatoma ?
Thrombocytopenia
Renal insufficiency
Impaired liver function
Pulmonary edema (respiratory symptoms may be prevalent with this condition )

so really not that much different from pre-eclampsia

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32
Q

Does “Pre-eclampsia without severe symptoms” need to be addressed in the hospital?

A

Not really, It can be managed at home

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33
Q

When caring for someone with “Pre-eclampsia without severe symptoms” what is the main, general thing you are monitoring for?

A

Just make sure their symptoms that they are already having don’t worsen

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34
Q

How can the “Pre-eclampsia without severe symptoms” people monitor their baby’s status at home?

How should “Pre-eclampsia without severe symptoms” patients do activity at home?

A

Fetal kick counts

Limit activity and lay in the left lateral or right position depending on what baby wants

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35
Q

What specific measurements should you monitor daily

A

Blood pressure, weight, and urine protein amounts everyday

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36
Q

Testing done for “Pre-eclampsia without severe symptoms” that can be done by homehealth?

A 
LAB
Kick count assistance
NST
Ultrasound
BPP
amniocentesis 
doppler

etc. you don’t really need to know

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37
Q

If a “Pre-eclampsia without severe symptoms” does complain of headache, dizziness, visual changes, SOA

A

Call her physician.

38
Q

Maternal fetal medicine specialist at Via christi

A

Dr. Wolfe

39
Q

“Pre-eclampsia without severe symptoms” women use LDAT. What is this?

A

Low dose aspirin therapy in 2nd trimester - at 150 mg now!

40
Q

How should mom be sitting when checking reflexes? BP?

A

Sitting and dangling for both.

41
Q

What is checking for clonus in pre-eclamptic women?

What does it indicate?

A

Abruptly dorsiflex the foot and then releasing it in order to inspect for jerking of the foot.
Two jerks = 2 beats of clonus

It means CNS irritability seizure risk in eclampsia

42
Q

What was “Pre-eclampsia WITH severe symptoms” known as?

Criteria?

A

Severe Preeclampsia where

BP is 160/110 & same hrs rule

43
Q

With “Pre-eclampsia WITH severe symptoms” being super high, what does them put them at big risk for?

A

CVA or stroke

44
Q

What will mom’s activity be like in hospital with “Pre-eclampsia WITH severe symptoms” ?

A

Bedrest

45
Q

What same symptoms are gonna be present in “Pre-eclampsia WITH severe symptoms” ?

A 
Proteinuria
Oliguria (500 mL)
Visual disturbances
Headache and hyperreflexes
RUQ pain
*Pulmonary edema with dyspnea, crackles, or cyanosis 
Elevated liver enzymes
Thrombocytopenia
46
Q

How does “Pre-eclampsia WITH severe symptoms” affect the baby?

A

Just more signs of the fetus not doing well really.May seem some lates.

47
Q

What is the drug of choice for pre-eclampsia PREVENTION and what specific stage is this started in?

(what other category of patients get this??)

A

Magnesium Sulfate! It is started when “Pre-eclampsia WITH severe symptoms” happens. Its purpose is to decrease seizures bc it is a CNS depressant.

(preterm can get this from neuro protection from cerebral palsy)

48
Q

Side effects of Magnesium sulfate (for pre-eclampsia prevention)?

What is the antidote for Mag sulfate? And what do you need to monitor?

A

Being warm, diaphoresis, flushing
Burning at the IV site
- Maybe get a fan

Calcium gluconate or other forms of calcium really.
Make sure to monitor reflexes to see if the reflexes are decreasing and therefor toxicity.
- from oliguria
- or giving her too much.. (38:00)

Look at reflexes, serum mg, and vitals

49
Q

What type of diet does a “Pre-eclampsia WITH severe symptoms” need to be on?

A

High protein due to her losing it through the urine
Sodium might be reduced too from fluid overload
- less calories as well bc she will be on bed rest

50
Q

How do you assess for edema in “Pre-eclampsia WITH severe symptoms” in the hospital?

What symptoms might mom report of edema?

A

Observe for edema but also weight them daily
- and don’t forget dependent edema.

“my face feels puffy”
“my face feels tight”
“i feel bloated”

51
Q

Why do we give corticosteroids for “Pre-eclampsia WITH severe symptoms” ?

A

Fetal lung development protection..

methadone, dexamethazone IV or IM 24 mg for baby benefit

52
Q

Magnesium sulfate in “Pre-eclampsia WITH severe symptoms” is used to prevent seizures but what other meds will mom be on to address BP?

A

Antihypertensives

Acute: Hydralazine, Labetalol, Nifedipine

Chronic: Methyldopa

53
Q

How does HYPERTENSION of mom affect OUTCOME of baby?

What about from their maternal drugs?

A

SGA from lack of O2
Fetal hypoxia and malnutrition
Death
Prematurity

Hypermagnesmia - you can tell from a relaxed flexion at birth affecting apgar score
Sedation

54
Q

Signs that Eclampsia is on the way?

A

You see the other symptoms but most of all you see

Scotoma
Epigastric pain
Headache
*Tonic clonic seizure

Mom can even slip into coma and die.

55
Q

Your PG patient is having a tonic clonic seizure from eclampsia. What do you need to document?

How should you position them?

Post seizure interventions?

Post seizure assessment of fetus?

What state will pt be in after seizure?

A

Document the time, how long it lasts, and characteristics

Turn to side

Suction and give Oxygen @ 10 L to make sure they can breath for mom.

Assess the fetus and signs of abruption (can also happen if you bring pressure down too fast btw).

Very confused

56
Q

What medication do you give DURING a seizure?

A

Ativan IV

57
Q

Seizure and _____ can cause abruptio placenta in eclampsia/hypertension patients .

A

Bringing blood pressure down too quick and too much

- won’t see 110/60 for this

58
Q

How do doctors treat pulmonary edema in the pre-eclamptic patients?

A

Furesomide diuretics

- but only if pulmonary edema symptoms show up.. not edema.

59
Q

Important assessments done to check for pulmonary edema in eclampsia ?

A 
Respiratory rates
Respiratory sounds
Pulses 
O2 sat 
Skin color

Be very thorough .

60
Q

The only cure for eclampsia?

A

Giving birth

61
Q

How important is it to monitor vitals in any woman who has anything close to eclampsia conditions?

A

VERY

Monitor vitals and do the weights!

62
Q

What should the PG mom’s urine output be to make sure they aren’t oliguric? What do you check in urine?

A

30 ml/hr.
If it is less, she is oliguric

Protein
SG (if it is greater than 1.040 = oliguria)
63
Q

You see a nurse checking DTR’s and CLONUS. what is the reasoning

A

DTR”s (all 4 main extremities )and Clonus check for CNS irritability

64
Q

HELLP Syndrome to help YOU with lab diagnosis in severe pre-eclampsia ?

Can you also use this with someone who is normal blood pressure or normotensive?

A

CBC & Metabolic profile revealing:
Hemolysis
Elevated Liver
Low platelets

Yes normostensive women can use this with proteinuria.

65
Q

What does basic metabolic profile look at? (HELLP)

What does complete metabolic profile look at? (HELLP)

A

Electrolytes only

Electrolytes + liver function

66
Q

What is microangiopathic hemolytic anemia?

A

It is when rbcs get destroyed while trying to pass through the vasoconstricted vessels of mom
- will drop the H&H and rbc

67
Q

Major symptoms of HELLP is?

A

Liver issues like epigastric pain due to elevated liver enzymes.
Can have jaundice too due to bilirubin levels.
Nausea and vomiting like flu symptoms

68
Q

When does HELLP go away?

A

After birth

69
Q

Types of delivery done with anyone who has BP issues?

A

Induction of labor : Done if you have time

C-section : Done in an emergency

70
Q

Induction of labor needs

A

Continous Fetal Monitoring
Watch for abruptions
Quiet place
Asses all involved body systems

71
Q

In postpartum, how do we know mom’s BP/eclampsia state is improving like it should?

A

More urine

Less edema

72
Q

In post partum, how long will mom be on magnesium sulfate for prevention?

What other meds might they be on post partum?

A

To prevent any possible seizures, she will be on it for 24 hours
- and she’ll be on labor end
Bc she can seize up to 48 hours later

Antihypertensive still
Anticonvulsants like Dilantin

73
Q

How should labs be doing after delivery?

A

They should trend to improvement

74
Q

T/F

Women with complicated PG like eclampsia are at higher risk of Post partum depression

A

true and educate them on this

75
Q

Is there anyway to prevent the gestational hypertension, pre-eclampsia, eclampsia, etc?

What type of med can help prevent these issues from happening to a woman again though in her next PG?

A

No

LDAT - low dose aspirin therapy

76
Q

What drives all symptoms of eclampsia/BP?

A

Vasoconstriction in mom is the reason why all of these issues happen

77
Q

Eclamptic conditions are described as _______ in nature.

A

Progressive in nature

78
Q

What is the decision to deliver in eclamptic conditions based off of?

A

Whether there is a risk to mom or baby

  • often why we do early inductions or c -sections if needed
  • NICU is so good, the baby may do better there than in the womb
79
Q

P1 for Preeclampsia

A

Occurs only in Pregnancy

Proteinuria (if greater than 1+)

80
Q

R in Preeclampsia

A

Reflexes checked
Hyperreflexia = not good
Hyporreflexia = from magnesium sulfate

81
Q

E1 in Preeclampsia

A

Evaluate BP
Pre not severe= 140/90
Pre severe = 160/110

82
Q

E2 in Preeclampsia

A

Edema so check weights daily

83
Q

C in Preeclampsia

A

Calcium gluconate is the antidote for magnesium sulfate toxicity

84
Q

L in Preclampsia

A

Left side laying preferred for at home management of non-severe preclampsia but you can lay on the right if baby doesn’t like it

85
Q

A1 in Preeclampsia

A

Assess for CNS irritability and seizures with reflexes and clonus

86
Q

M in Preeclampsia

A

Magnesium sulfate is used to prevent seizures

87
Q

P2 in Preeclampsia

A

Protein rich diet since they spill it in urine but reduce sodium. Mom may need less calories too if she is bedrest.

88
Q

S in Preeclampsia

A 
Severe potential complications 
HELLP
DIC
Abruptio placenta
Stroke
89
Q

I in Preeclampsia

A

Intake and output monitoring

  • if it is less than 30 ml = oliguria
  • SG greater than 1.040 also = oliguria
90
Q

A2 in Preeclampsia

A

Antihypertensives

Methyldopa
Apresoline
Labetalol
Nifedipine

Maternal Exam 3 (8 decks)

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