Module 8 (Exam 3) Hypertensive Disorders Flashcards Preview

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Flashcards in Module 8 (Exam 3) Hypertensive Disorders Deck (30):
1

What are the hypertensive disorders of pregnancy?

 

  1. Preeclampsia and Eclampsia
  2. Gestational Hypertension
  3. Chronic Hypertension

2

Preeclampsia

 

An increase in BP after 20 weeks' gestation, accompanied by proteinuria. Most common hypertensive disorder of pregnancy. 2-6% in nuiliparous women

3

Criteria for Preeclampsia

 

 BP 140/90 or greater X2 readings

Proteinuria greater than or equal to 1+

4

Eclampsia

 

The occurence of a seizure in a woman with preeclampsia who has no other identified cause for seizure activity

5

Risk Factors for Preeclampsia/Eclampsia

  1. Primigravid status
  2. Age less than 16 or greater than 35
  3. Family Hisotry
  4. Pre-existing renal or vascular disease
  5. Large Placental mass: diabetes, multiple gestation, gestational trophoblastic disease

6

Onset of preeclampsia and eclampsia

 

  1. During the last 10 weeks of pregnancy
  2. During labor
    1. During the initial 48-72 hours postpartum

7

What is the cure for preeclampsia/eclampsia?

 

Delivery of infant and placenta

8

Current etiology of preeclampsia/eclampsia

 

  1. Incomplete trophoblastric "remodeling" of spiral arteries at implantation
  2. Impaired placental implantation
  3. Compromised placental perfusion
  4. Systemic response

9

How preeclampsia develops

  1. Abonormal placental perfusion stimulates production of blood-borne biochemicals
  2. Multisystemic endothelial (lining of blood vessels) cellular injury
  3. Activation of coagulation system
  4. Platelet clumping at injury site
  5. Increased peripheral vascular resistance
  6. Generalized vasospasm and vasoconstriction
  7. Hypoperfusion

10

What organ systems does preeclampsia effect?

 

  1. Placenta
  2. Kidneys
  3. Brain
  4. Liver
  5. Lungs

11

How does preeclampsia effect the placenta?

  1. Decreased placental perfusion
  2. Fetal hypoxia
  3. Intrauterine growth restriction
  4. Potential for placental infarct/abruption

12

How does preeclampsia effect the kidneys?

  1. Decreased renal perfusion
  2. Impaired glomerular filtration
  3. Loss of intravascular serum albumin leading to proteinuria
  4. Fluid shift from intravascular to extravascular spaces leading to generalized edema
  5. Hypovolemia R/T intravascular volume deficit

13

Mild Preeclampsia Clinical Manifestations

140/90 BP or higher

Proteinuria 1+ or 2+

Rapid weight gain (generalized edema)

14

Home management of mild preeclampsia

 

  1. Rest
  2. Adequate protein intake
  3. Daily weights, BP, urine for proteinuria
  4. Periodic lab values: CBC and platelets, 24 hour urine for creatinine clearance and protein
  5. Fetal: serial NSTs/Kick Counts

15

Severe Preeclampsia Clinical Manifestations

  1. 160/110 X2 readings
  2. Proteinuria of 3+ or greater
  3. Oliguria: Less than 500mL/24 hours
  4. Thrombocytopenia: Less than 100,000
  5. Pulmonary Edema

16

Management of severe preeclampsia

 

  1. Bed rest in lateral position
  2. Chemical management
  3. IVF and electrolyte replacement (strict I&O and weights)
  4. Seizure Precautions: lower stimuli
  5. Neurologic and pulmonary assessments
  6. Fetal: serial NSTs

17

Impending Seizure Activity

  1. Headache
  2. Anxiety, confusioin
  3. Scotomata
  4. Hyperreflexia
  5. Right upper quadrant pain: epigastric pain

18

Hyperreflexia

Increase in deep tendon reflexes R/T neurologic hyperactivity

  1. 0 = reflex absent
  2. 1+ = weak reflex
  3. 2+ = normal response
  4. 3+ = exaggerated response
  5. 4+ = hyperactive: possibly with clonus

19

Clonus

Dorsiflexion causes two beats upon rebound

20

Medications for preeclampsia

 

  1. IV magnesium sulfate
  2. Antihypertensives
    • Nifedipine (Procardia)
    • Hydralazine (Apressoline
    • Labetalol (Normodyne)

21

IV magnesium sulfate

  1. First line treatment for preeclampsia or eclampsia
  2. CNS depressant (primary), anticonvulsant
  3. Peripheral vasodilator (decreases BP)
  4. Antidote: calcium gluconate

22

Therapeutic level of magnesium

4-8mgs/dl

23

Magnesium Toxicity

  1. RR depression (decreased oxygen saturation)
  2. Hypotonic reflexes
  3. Oliguria (less than 30 mL/hour)

24

Nifedipidine (Procardia)

  1. Calcium channel blocker
  2. Also used as a tocolytic

25

Hydralazine (Apressoline)

Vasodilator: placental perfusion

26

Labetalol (Normodyne)

Beta blocker

27

HELLP Syndrome

A coagulation abnormality associated with severe preeclampsia or eclampsia

H: Hemolysis of RBCs

EL: Elevated liver enzymes (ALT, AST)

LP: Low platelets

28

Postpartum Care for preclampsia/eclampsia

  1. Monitor PP hemodynamics closely
  2. Fundal assessments

29

Gestational HTN

  1. Occurs after mid-pregnancy
  2. Not accompanied by proteinuria
  3. May progress to preeclampsia

30

Chronic HTN

  1. May be unrecognized until pregnancy
  2. Does not progress to preeclampsia

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