Flashcards in Hypertensive Disorders of Pregnancy Deck (106)
What percent of pregnancies are complicated by preeclampsia?
Pregnancy induced hypertension
What percent of preeclampsia is mild?
What percent of preeclampsia is severe?
Who is at greater risk for preeclampsia (PIH)?
Primigravida, young age, multifetus, obesity, low economic status, diabetes, history, African American
What is a main nursing intervention with preeclampsia?
How should person be positioned for BP reading?
Sitting for 10 min with arm on surface
How much does peripheral resistance decrease by in pregnancy?
What is the rise in total blood volume in pregnancy?
What is the rise in cardiac output in pregnancy?
What does the BP have to be for a diagnosis of preeclampsia?
140/90 X 2, 6 hours apart, less than 7 days apart after 20 weeks gestation
What does proteinuria have to be to diagnose preeclampsia?
1+ on dipstick
What is no longer part of the diagnosis for preeclampsia but you should watch for it?
What is the only cure for preeclampsia?
Birth of fetus and removal of placenta
Systemic disease that involves multiple organs and the fetus
Pathogenesis of preeclampsia
Begins with implantation, trophoblastic invasion of uterine spiral arteries is incomplete, spiral arterioles do not remodel to meet trophoblastic circulation
What is the result of preeclampsia on the fetus?
Decreased placental perfusion resulting in ischemia
Preeclamptics produce 10X more anti-angiogentic substances which decreases what?
Decreased placental perfusion=
Systemic endothelial cell disfunction
Vasospasms target which organs?
Brain, liver, and kidneys
Vasospasms cause decreased renal perfusion causing what?
Increased BUN, creatinine, and uric acid, decreased albumin causing edema
Vasospasms also cause sodium retention because of what system?
Sodium retention causes what?
How do vasospasms cause edema?
Damaged glomeruli, albumin is lost, decreased osmotic pressure = edema
How does the renin-angiotensin system cause edema?
Increased fluid retention
What does disturbed endothelial control of vascular tone cause?
Hypertension, increased permeability, platelet aggregation, and ischemia of target organs
What is the BP in severe preeclampsia?
Systolic > 160 mmHG, Diastolic > 110 mmHg
What is the proteinuria classification of severe preeclampsia?
2+ - 3+ or >5 in 24 hour specimen
How much urine should there be in 24 hours?
500 mL of urine in 24 hours
Other signs of severe preeclampsia
Cerebral or visual disturbances, pulmonary edema, Epigastric pain, fetal growth restriction, impaired liver function, thrombocytopenia
What is a sign of pitting edema?
No bony prominences
What happens to renal labs in severe preeclampsia?
What happens to liver function tests in severe preeclampsia?
What happens to platelets in severe preeclampsia?
Decreased because of clotting
What happens to hematocrit levels in severe preeclampsia?
What causes the elevated LDH in severe preeclampsia?
What differentiates preeclampsia from eclampsia?
Eclampsia also includes a seizure along with all the SE of preeclampsia
Treatment of preeclampsia
May be hospitalized
What diet is used for preeclampsia?
High in protein, moderate sodium, and 6-8 glasses of water per day
How should a person with preeclampsia rest?
Lateral recumbent position
How do you monitor fetal well-being with preeclampsia?
Kick counts, nonstress test, BPP
What can you give for preeclampsia if < 34 weeks?
What do corticosteroids do for the fetus?
Enhance pulmonary maturity
What is the cut off for delivery with a preeclamptic woman?
When will they deliver for treatment of preeclampsia?
> 37 weeks and favorable cervix
Treatment of severe preeclampsia
Hospitalization on bedrest, magnesium sulfate, antihypertentives
When will they deliver for treatment of severe preeclampsia?
> 34 weeks
Blocks ALL neuromuscular impulses
Anticonvulsant to prevent eclamptic seizures
When should you avoid magnesium sulfate?
Women with severe renal impairment
What should you evaluate when administering magnesium sulfate?
Clonus, hyperreflexia, headache, visual disturbances
How long should you continue magnesium sulfate?
12-48 hours postpartum or if patient has diuresis X 3 hours
How often do you take magnesium sulfate levels?
What is the therapeutic magnesium sulfate levels?
Magnesium level 8-10
Magnesium level 10-12
Magnesium level 15
Magnesium level >15
What reverses magnesium sulfate?
What is more critical then lab values with magnesium sulfate?
What antihypertentives are used with preeclampsia?
Aldomet, Normodyne, and Apresoline
How long does it take for Aldomet to take effect?
When on Apresoline what must the mother be on and what is the goal diastolic?
Must be on monitor and goal is 90 mmHg
Magnesium sulfate reduces uterine tone causing what concern postpartum?
Hypertension prior to conception or before 20th week gestation
Preexisting "Chronic" Hypertension
What is used for more severe hypertension?
What do you do if there is a seizure during labor?
Stabilize mother, O2, positioning, give lorezapam 4mg, and magnesium sulfate
What is common for the FHR to do during a seizure?
3-5 min bradycardia
Hypertensive women who develop new onset proteinuria, proteinuria before the 20th week gestation, or sudden uncontrolled hypertension
Preeclampsia superimposed on preexisting hypertension
Highest morbidity and mortality rate
Preeclampsia superimposed on preexisting hypertension
High BP detected for the 1st time after midpregnancy, no preteinuria
When does BP usually return to normal in gestational hypertension?
Complication of severe preeclampsia
Elevated liver enzymes
What causes low platelets?
S/S of the HELLP syndrome
N/V, Epigastric pain, malaise and flu-like symptoms
HELLP lab bilirubin
> 1.2 mg/dL
HELLP lab LDH
> 600 u/L
HELLP lab AST
> 70 u/L
HELLP lab platelets
What are the fibrinogen levels in HELLP?
Who is at a higher risk for HELLP syndrome
Older, caucasian, multiparous
When do HELLP labs return to normal?
72-96 after delivery
How many HELLP patients develop DIC?
1 in 5
An overstimulation of the coagulation process
Disseminated Intravascular Coagulation
Damage to vascular endothelium (blood vessels)
Intrinsic flooring pathway
Extrinsic clotting pathway
What is DIC secondary to?
What is DIC associated with?
Missed abortion, placental abruption, preeclampsia/eclampsia, amniotic fluid embolus, and sepsis
What are the cardinal signs of DIC?
Bleeding, mental confusion, and shock
How many unrelated sites of bleeding must be present for DIC?
What is the main nursing care with DIC?
What lab is for intrinsic clotting pathway?
Partial Thromboplastin Time (PTT)
What lab is for extrinsic clotting pathway?
Prothrombin Time (PT)
What lab increases with DIC?
What labs decrease with DIC?
Fibrinogen and platelet count
How do you manage DIC?
Deliver baby, packed RBCs, fresh frozen plasma, and cryoprecipitate
Why do we not use whole blood?
Increases the risk of hemorrhage