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Complex care 2 > Module 2 > Flashcards

Module 2 Flashcards

1
Q

hypertension in pregnancy is defined as

A

BP above 140/90

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2
Q

chronic hypertension is

A

all hypertension before pregnancy occured

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3
Q

Renal hypertension complicates…

A

kidney disease of any kind. Sodium retention by the kidney leading to water retention and an increased blood volume is usually a factor

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4
Q

Phaeochromocytoma

A

adrenal gland tumour secreting the dopamine hormones adrenaline/noradrenaline

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5
Q

Coarctation of the aorta

A

narrowing of the aorta more common for patients with congenital heart disease

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6
Q

Cushings syndrome

A

excess of glucocorticoid hormones

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7
Q

Conns syndrome

A

excess of aldosterone hormone causing sodium retention and associated hypokalaemia

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8
Q

in 1st trimester of pregnancy, what happens to BP

A

marked vasodilation causes a drop in systemic vascular resistance which sees BP fall in all women – exaggerated effect in hypertensive women

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9
Q

complications of hypertension in pregnancy

A

Fetal growth restriction  poor placentation – NICE advocates USS at 28-30 weeks and 32-34 weeks to indentify and monitor SGA
Placental abruption - 1% of pregnancies – smoking aids significantly to this risk
Severe hypertension - acute pharmacological management – labetalol, hydralazine, nifedipine
Super-imposed pre-eclampsia high risk, significant protein 300mg suggestive of preeclampsia – Uric acid raised

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10
Q

chronic hypertension - non-pregnancy treatment and care

A
  • Majority of women with proven hypertension will be on one or more anti-hypertensive drugs – ACE inhibitor (enalapril or lisinopril) or an angiotensin receptor blocker (losartan or irbesartan) beta-blocker (atenolol)
  • Low dose aspirin (75mg)
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11
Q

chronic hypertension - pre-conception issues and care

A

Referred to consultant OB so risks can be discussed and meds can be changed to labetalol or nifedipine , advised on lifestyle factors

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12
Q

medical management and care in pregnancy for hypertension

A
  • Blood pressure meds reduced or stopped in first 20 weeks
  • Labetalol – combined alpha and beta-blocker – first line – avoided in asthmatics
  • Nifedipine – calcium-channel blocker (short and long acting)
  • Methyldopa – centrally active
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13
Q

midwifery management and care - hypertension

A
  • Antenatal visits
  • SFH measurement
  • BP
  • Urine dipstick
  • Ask about symptoms of preeclampsia
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14
Q

Medical management and care (labour issues) hypertension

A
  • IOL from 37 weeks
  • Usual meds
  • Avoidance of syntometrine or ergometrine for 3rd stage
  • CTG
  • Consider epidural to aid BP
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15
Q

midwifery care labour hypertension

A

hourly BP
oxytocin 3rd stage

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16
Q

medical management postnatal hypertension

A
  • No known adverse affects of anti-hypertensives on breast-fed babies
  • Methyldopa changed to pre-pregnancy meds
  • Review at 2 weeks of meds
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17
Q

midwifery management postnatal hypertension

A
  • Target BP 140/90
  • Daily BP checks day 1 and 2
  • Encourage compliance with meds
  • Contraceptive advice and lifestyle factors
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18
Q

preeclampsia

A

Pregnancy specific syndrome characterised by variable degrees of placental dysfunction and a maternal response featuring systemic inflammation and by the development of new hypertension and protein

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19
Q

risk factors of preeclampsia

A
  • AMA
  • Primip
  • Hypertension
  • Family history
  • Previous hx
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20
Q

complications of preeclampsia

A
  • Fetal (growth restriction, prematurity, placental abruption, intrauterine death)
  • Mother (renal and liver failure, intracerebral bleeds, eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets), disseminated intravascular coagulation, liver rupture and death
21
Q

pre-conception issues and care for preeclampsia

A

aspirin (75mg) from 12 weeks

22
Q

medical management and care pregnancy preeclampsia

A
  • Inpatient care
  • BP should be treated with first-line oral labetalol if more than 150/100
  • FBC, U&E, LFTs should be measured 2-3 times a week
  • USS for growth, AFI and umbilical artery doppler
  • TED stockings
23
Q

midwifery management pregnancy preeclampsia

A
  • Measure BP accurately
  • Measure protein
  • If any symptoms, transfer care to doctors and get opinions
  • Psychological support
24
Q

labour medical management preeclampsia

A
  • Corticosteroids for fetal lung maturation
  • Blood tests
  • Delivery
  • Avoid syntometrine or ergo
  • BP closely observed
  • CTG
  • FBC , U&E and LFTs if not performed in last 2-3 days
  • Continue antihypertensives
25
Q

midwifery care preeclampsia labour

A
  • Hourly BP
  • Call for urgent help if review
  • Do not limit second stage unless needed
  • Oxytocin
  • Prepare for preterm delivery
26
Q

medical management postnatal preeclampsia

A
  • Close observation of BP
  • Obstetric review
  • Repeat bloods 48-72 hours after if indicated
  • Start antihypertensives if never medicated
  • Continue meds – reduce once under 130/80
27
Q

midwifery care postnatal preeclampsia

A
  • BP check 4 times daily
  • BP once 3-5 days
  • Refer for medical care if BP >150/100
28
Q

gestational hypertension

A
  • Describes new hypertension in 2nd half of pregnancy in absence of protein
  • 10% of women
29
Q

severe preeclampsia and eclampsia

A
  • Systolic BP >160mmHg or diastolic >110mmHg 2 times with protein and other clinical features
30
Q

severe preeclampsia symptoms

A
  • Severe headache
  • Visual disturbances
  • Epigastric pain
  • Liver tenderness
  • Clonus
  • Papilloedema
  • Platelet count <100
  • Abnormal liver function
  • HELLP syndrome
31
Q

eclampsia

A
  • One or more generalised convulsions on the background of pre-eclampsia
  • Fatality rate 1.8% up to 35% of women suffer major complication
32
Q

medical management and care antenatal severe preeclampsia and eclampsia

A
  • BP high – urgent intervention
  • IV administration of labetalol or hydralazine often becomes necessary and use follow local guidelines
  • Fluid restriction is advised to reduce fluid overload
  • Restriction – evidence of postpartum diuresis
  • IV mag sulph – halves risk of eclampsia – 24 hr prior to delivery
  • 4g slow IV 5 min – 1g/hr for 24 hr
  • Continue after 24 hrs post birth or 24 hrs post seizure
  • Recurrent seizures – 2-4g bolus or increase infusion
  • Magnesium toxicity – reduced urine output, loss of deep tendon reflexes, decreased resps
  • Diazepam and thiopentone can be used (rare)
33
Q

midwifery care severe preeclampsia and eclampsia

A
  • One-on-one care HDU, hourly output, reflexes, resp, BP
  • Well documented fluid balance
  • IV infusions
  • six 12 hrly blood tests
34
Q

postnatal cares preeclampsia and eclampsia

A
  • 24-48 hr HDU
  • Debrief
  • 4 days inpatient , baby SCN
  • BF support
35
Q

HELLP syndrome

A
  • Haemolysis (RBC rupture – drop in HB level)
  • Elevated liver enzymes (raised alanine transaminase (ALT) or aspartate transaminase (AST) liver damage
  • Low platelets (cell fragments involved in clotting process)
  • Multi-system disorder characterised by activation of the coagulation system leading to increased deposition of the protein fibrin throughout the body
  • Can occur postnatally
36
Q

differential diagnoses - HELLP syndrome

A
  • Acute fatty liver – nausea, vomiting
  • Haemolytic uraemic syndrome-thrombotic thrombocytopenic pupura – haemolytic anaemia, low platelets, renal failure, severe headache
  • Exacerbation of systemic lupus erythematosus (SLE) chronic inflammatory disease affecting multiple organs
37
Q

complications - HELLP syndrome

A
  • Disseminated intravascular coagulation
  • Placental abruption
  • Acute renal failure
  • Pulmonary oedema
  • Liver haematoma and rupture
38
Q

cardiovascular disease

A

diseases of the heart and blood vessels

39
Q

examples of CV disease

A

ischaemic heart disease
stroke
hypertensive heart disease
aortic aneurysms
atrial fibrillation
congenital heart disease
endocarditis
peripheral artery disease

40
Q

rheumatic heart disease

A

-acquired
-caused by rheumatic fever
-Group A strep
-developing countries (ATSI)

41
Q

cardiomyopathy

A
  • inflamed, enlarged and weakened heart muscle
  • hereditary
  • viral infection/bacterial
  • fungal or parastitic infection
  • ischaemia
42
Q

other valve, atrial and ventricular defects

A
  • marfan syndrome (inherited disorder that affects connective tissue)
  • Eisenmengers syndrome
  • Down syndrome
  • Brugada syndrome
  • Wolff-parkinson white syndrome
43
Q

effect on pregnancy - CV disease

A
  • 4% affected
  • most common cause of indirect maternal death in developed world
  • pre-conception counselling
  • accurate assessment
  • collaborative team
44
Q

treatment CV diseases

A

 minimise complications
- Pharmacology – antihypertensives, diuretics
- Rest
- Optimum delivery method
- Appropriate anaesthesia
- Appropriate management PP

45
Q

renal changes

A
  • Changes to the renal system
  • Higher renal plasma flow
  • Higher GFR (glomerular filtration rate – how well your kidneys filter blood)
  • Higher kidney size
  • UTI rates higher
  • Overt proteinuria
46
Q

congenital renal disease

A
  • Primary defects of the kidney tissue (parenchymal disease) *
  • Obstruction of the urinary tract (hydronephrosis with obstruction)
    • Hydronephrosis without obstruction
    • Cystic diseases
    • Metabolic diseases *
  • Syndromes
47
Q

acute renal disease

A
  • Infection : e. coli
  • Hemolytic uremic syndrome
  • Nephrotic syndrome
  • Poisioning
48
Q

chronic renal disease

A
  • Diabetes
  • Hypertension
  • Glomerulonephritis
  • Cancer
  • Medicine
49
Q

measuring renal function

A
  • Dipstick
  • 24 hr collection – protein/creatine ratio
  • Haematological creatinine

Complex care 2 (9 decks)

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