Quiz 4

Question 1

Patho phys of HTN

Answer 1

Vasospastic process through reduced organ perfusion and activated the coag cascade
- Hypo perfusion, vasospasm, endothelial cell damage, platelet aggregation

Question 1

Infant/Maternal risks of hypertensive disorders

Answer 1

Infant: uteroplacental insufficiency, preterm birth
Mother: renal failure, coag, cardiac/liver problems, abruption, seizure, stroke

Question 2

Classification of gestational HTN

Answer 2

BP over 140/90, after 20 wks, no protinuria
Normally resolves in first week MUST resolve by 12 weeks

Question 3

Classification of preeclampsia

Answer 3

HTN (140/90) and proteinuria after 20 wks
OR
HTN and thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral/visual symptoms

Question 4

Classification of Eclampsia

Answer 4

Convulsions or coma with no other causes, no preexisting seizure patho, can occur postpartum

Question 5

Chronic HTN Classification

Answer 5

When HTN is prepregnant or persists after 12 wks post partum

Question 6

Classification of preeclampsia

Answer 6

Women with chronic HTN who acquire pre/eclampsia

Question 7

Risk factors for preeclampsia

Answer 7

Primigravida or age extremes (young <19 and old >35)
- Chronic HTN
- Diabetes
- Nephropathy
- Vascular/connective tissue disorders
- Family history
- Infection/Inflammation (UTI)
- Obesity + Race
- Recurrence 65% if dx prior to 30 wks and 25% if dx in third trimester

Question 8

Paternity effects on HTN

Answer 8

If changing father same risk as nulliparous woman
Fathers whos mother had a history of preeclampsia have higher risk

Question 9

Preeclampsia assessment

Answer 9

Proteinuria (late sign), assess for HA, epigastric pain, RUQ pain, visual disturbances, deep tendon reflexes, clonus (flexed ankle and feeling muscle pulses of calf)

Question 10

With/without severe preeclampsia

Answer 10

Without: no bedrest, deliver close to term, manage outpatient, monitor labs
With: Delivery plan, hospitalization, antihypertensive meds + corticosteroids, bed rest with side rails up, dark environment, continuous FHR and contractions

Question 11

Magnesium

Answer 11

IV piggyback, prevents and treats seizure, initial loading then maintenance, little effect on maternal BP
- Interferes with platelet aggregation
- Contraindicated in: myasthenia gravis (respiratory failure) heart block, cardiac insufficiency

Question 12

Preeclampsia with severe features

Answer 12

Creatinine >1.1 mg/dL can indicate progressing renal insufficiency
Pulmonary edema
Visual disturbances: flashing lights, auras, light sensitivity, blurry vision, spots in vision
BP: >160 (taken 4 hrs apart on bedrest)
Platelets <100,000
Severe epigastric or RUQ pain

Question 13

Signs of eclampsia

Answer 13

persistent HA, blurred vision, epigastric/RUQ pain, altered mental status
- Can appear without warning

Question 14

Eclampsia Immediate care

Answer 14

Ensure airway/safety
- Time, onset and duration of seizure
Call for help and remain at bedside

Question 15

HELLP syndrome

Answer 15

Hemolysis (Of RBCs when going through constricted vessels, reduces O2 capacity)
Elevated Liver enzymes (vasospasm leads to decreased BF to liver)
Lowered Platelets (platelets gather at damaged vascular endothelium’s)
Dx: CBC, CMP, uric acid + BUN increases, 24 hr protein/creatinine clearance

Question 16

Cerebral Hemorrhage Warning Signs

Answer 16

Progressive decrease in LOC, complaints of flashes of light, neurologic deficits, new vomiting, sudden increase in BP (sign of bleeding)

Question 17

MgSO4 Dosing

Answer 17

Bolus: 4-6g over 30 minutes
Maintenance: 2-4g

Question 18

MgSO4 Lab values

Answer 18

Normal: 1.5-2
Therapeutic: 4-7
ECG changes: 5-10
Loss of reflexes: 8-12
Respiratory distress: 15
Cardiac arrest: 25

Question 19

Magnesium side effects

Answer 19

Flushing, lethargy, nausea, depressed reflexes, cardiac dysrhythmias, circulatory collapse, diaphoresis, blurred vision

Question 20

Mag nursing interventions

Answer 20

I/O, vitals Q5-15 with loading and the Q30-60 with maintenance
- Hourly reflexes, seizure precautions, lung sounds

Question 21

Magnesium antidote

Answer 21

Calcium gluconate or calcium chloride
Should be on the unit

Question 22

Miscarriage classifications

Answer 22

Pregnancy that ends as result of natural causes before 20 wks
Fetal weight of <500g
Early is before 12 weeks (normally chromosomal abnormalities)
Late: maternal causes (inadequate nutrition, anomalies of reproductive track, infection, drug use)

Question 23

Threatened miscarriage

Answer 23

Spotting, mild uterine cramping, O closed