Pre-existing Hypertension, Cardiac and Renal Disease Flashcards Preview

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Flashcards in Pre-existing Hypertension, Cardiac and Renal Disease Deck (29):
1

Define: Chronic Hypertension

Hypertension diagnosed prior to 20 weeks gestation

2

What are the 4 types of Hypertension

Gestational Hypertension
Chronic Hypertension
Pre-eclampsia
Pre-eclampsia superimposed on chronic hypertension

3

What are the 3 types of Chronic Hypertension

Essential hypertension
White coat hypertension
Secondary hypertension

4

Define: Essential Hypertension (type of chronic hypertension)

a BP greater than or equal to
Systolic 140mm
Diastolic 90mm

Diagnosed before pregnancy or before 20wks gestation WITHOUT a known cause

5

Define: White Coat Hypertension (type of chronic hypertension)

is high BP in the presence of a clinical person but otherwise normal BP when assessed outside the clinical environment

- lower risk of developing superimposed preeclampsia

6

In pre-eclampsia, it is characterised by hypertension and the involvement of 1 or more of what body systems

Renal
Haematological
Liver
Neurological
Pulmonary oedema
Fetal growth restriction

7

What % of women with chronic hypertension will develop Pre-eclampsia superimposed on chronic hypertension

40-50%

8

With Preeclampsia superimposed on chronic hypertension there are increased risks/rates of....

Stillbirth
Neonatal death
Prematurity
Growth restriction
NICU admission

9

What are the treatments for Chronic hypertension

Antihypertensives

10

Post Birth

Explain: Care and considerations for women with Chronic hypertension

Unstable BP immediately after birth- will need medication altered
BP and U/A follow-up at 6wks GP visit

11

In response to the increase in blood volume what are some of the normal physical changes

Reduction in exercise tolerance
Dyspnea
Tiredness
Pronounced jugular vein – visible pulse

12

What are some Cardiovascular diseases

Ischaemic heart disease
Stroke
Hypertensive heart disease
Rheumatic heart disease
Aortic aneurysms
Cardiomyopathy
Atrial fibrillation
Congenital heart disease
Endocarditis
Peripheral artery disease

13

What are some syndromes that involve the heart

Marfan syndrome
Eisenmengers syndrome
Down syndrome
Brugada syndrome
Wolff-Parkinson White syndrome

14

Define: Cardiomyopathy

Inflamed, enlarged and weakened heart muscle

Main causes
Hereditary
Viral infection
Bacterial infection
Fungal or parasitic infection
Ischaemia
Alcohol/drugs
Obesity
Chemotherapy/radiation

15

Explain: Changes to renal system in pregnancy

Increased: renal plasma flow
Increased: kidney size
Increased: risk of UTI

16

What are types of renal disease

Congenital renal disease:
Obstruction of the urinary tract  (hydronephrosis with obstruction)
Hydronephrosis without obstruction
Cystic diseases
Metabolic diseases
Syndromes

Acute renal disease: Infection
Hemolytic uremic syndrome
Nephrotic syndrome
Poisoning

Chronic renal disease:
Diabetes
Hypertension
Glomerulonephritis
Cancer
Medication use

17

What are some treatment options for Renal diseases in pregnancy

Pre-conception counselling
Outcomes depends on renal functioning
Good evidence for aspirin use from early pregnancy

18

How do you measure Renal Function

Dipstick
24 hour collection – protein/creatinine ratio
Haematological creatinine

19

How do you measure BP

Sphygmo
Always use correct technique

20

What do beta blockers do

They work on the sympathetic nervous system acting as an antagonist blocking hormones such as adrenaline
- Which lowers BP and Cardiac output

21

Define: Dyuria

painful urination

22

Explain: Management of Gestational Hypertension

Pregnancy
- Surveillance: ongoing BP checks
- antihypertensive or beta blocker therapy
- U/A
- hydration
- should be allowed to go to term before considering delivery
- If high risk, delivery of fetus is priority

Labour and Birth
- if high risk: before 34wks delay birth for 24-48hrs if possible to allow for cortiocosteroids
- Bloods: FBC, U&E, LFT
- AVOID syntometrine/ergotmetrine
- BP hourly

Postnatal
- Continue anti-hypertensives until BP stable
- Repeat bloods 48-72hrs
- Close BP obs until anit-hypertensives ceased
- OB r/v at 6-8wks
- GP at 6wk

23

Explain: Management of Chronic Hypertension

Pregnancy
- Ongoing BP checks
- Anti hypertensive therapy
- fluids/hydration

Labour/Birth
- Low dose slow incremental epidural anaesthesia to manage the stressors of labour,
- TED stockings
- Ongoing assessment of the mother’s haemodynamic status: B.P., pulse oximetry, CVP,
- continuous ECG

Postnatal
- BP is unstable for 1-2wks. Monitor BP
- alter or commence anti hypertensive therapy
- follow-up GP at 6wks

24

Define: Atrial Septal Defect (ASD)

cardiac disorder

is the incomplete closure of the wall between the upper chambers of the heart (L&R atrium)

25

Explain: Management of ASD

Pregnancy
- If closed/treated, problems are unlikely
- specialised cardiac U/S for fetus needed
- Possible cardiac failure/cardiac decompensation
- Possible trouble with breathing, cold extremities, chest pains or tightness

Labour
- Normal care if ASD treated
- anaethetist r/v prior to labour
- If not treated: compression stockings, anticoagulation considered if immobile
- 2nd stage: restricted time frame for active pushing
- 3rd stage: active management

Postnatal
- Baby needs cardiac screening
- encourage ambulation: decreases thrombo-embolic disease
- standard care
- follow up with cardiac specialist and GP

Possible effect on woman
- atrial fibrilation
- stroke
- heart failure

26

Case Study

Alison is a 32y.o G4P1 who presents to the birth unit tonight at 29 weeks with a 2 day history of UTI signs and symptoms, worsening dysuria and now haematuria. She describes a pre-pregnancy history of UTI and was treated for symptomatic bacteriuria at 14 weeks this pregnancy. On examination she describes severe right flank pain and has costovertebral angle tenderness (CVAT)

What is your provisional diagnosis and why?
What is your care and management for Alison and her baby?

Provisional Diagnosis:
Pyelonephritis

Why:
- Hx UTI signs
- Hx of symptomatic bacteriuria at 14wks
- Haematuria
- worsening dysuria
- Severe right flank pain
- Costovertebral angle tenderness

Care/Management:
- Obs (hrly)
- Urgent r/v
- U/A & dipstick
- blood cultures ( w/ FBC & LFT)
- CTG
- Abx
- Cannulation
- fluids
- Pain relief
- IDC
- Fluid balance

27

Case Study

Akira is a 38y.o G2P1 now at 24 weeks and has been referred to your Day Assessment Unit for a B.P profile and other B.P investigations. The medical team are concerned that Akira is developing pre-eclampsia superimposed on existing chronic hypertension which she developed after her last pregnancy. In her previous pregnancy she was diagnosed with pre-eclampsia at 32 weeks.

Discuss the issues that Akira has
Management for pregnancy, birth and in the postnatal period.

Risk Factors
- AMA
- Hx of pre-eclampsia
- Chronic hypertension

Pregnancy
- Increase surviellance (CTG, U/S)
- Aspirin therapy
- ? admit as in-patient
- U/A each visit
- PE bloods: FBC, U&E, LFT
- Corticosteroids <34wks
- Individualised care plan

Labour/Birth
- EDB useful inconjunction w/ anti-hypertensive therapy
- AVOID ergometrine, NSAIDS
- Oxytocin should be given slowly
- Hourly BP
- Continuous EFM

Postnatal
- Close BP obs
- repeat bloods
- continue meds until stable
- obstetric r/v at 6-8weeks

28

Explain: Management of Pre-eclampsia

Risk Factors
- AMA
- Hx of pre-eclampsia
- Chronic hypertension

Pregnancy
- Increase surviellance (CTG, U/S)
- Aspirin therapy
- ? admit as in-patient
- U/A each visit
- PE bloods: FBC, U&E, LFT
- Corticosteroids <34wks
- Individualised care plan

Labour/Birth
- EDB useful inconjunction w/ anti-hypertensive therapy
- AVOID ergometrine, NSAIDS
- Oxytocin should be given slowly
- Hourly BP
- Continuous EFM

Postnatal
- Close BP obs until anit-hypertensives ceased
- repeat bloods 48-72hrs
- continue meds until stable
- obstetric r/v at 6-8weeks

29

Explain: Management of Pyelonephritis

Diagnose- MSU
Treat: appropriate Abx if not at Pyelonephritis stage

Pregnancy
- monthly MSU for asymptomatic bacturia (clinically indicated if dysuria, increased urination, lower abdo pain or renal tenderness or pyrexia present)
- 2L water daily
- empy bladder after sex
- wipe front to back

Pyelonephritis
may require:
- hospitalisation
- IV hydration
- monitor fluid balance
- IV Abx, then oral Abx when controlled
- Monitor U&E, urine and blood cultures
- 4hrly temp obs