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Maternal Newborn - Cher > Test 4 Hypertensive Disease > Flashcards

Test 4 Hypertensive Disease Flashcards

(54 cards)

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1
Q

A SBP >140 and a DBP >90 recorded on at least 2 separate occasions 4-6 hours apart within a maximum of 1 week.

A

Hypertension Definition

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2
Q

onset of hypertension without Proteinuria after 20 weeks gestation

A

gestational hypertension

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3
Q

Usually occurs 20 weeks after gestation in a previously normotensive pt AND has proteinuria May be mild or severe.
Proteinuria at or above 30mg (> 1+ on dipstick) or more in 2 random specimens at least 6 hours apart or > 300 mg in 24 hours

A

preeclampsia

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4
Q

The occurrence of seizures or coma in a woman with preeclampsia

A

eclampsia

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5
Q

HTN that occurs before pregnancy or DX before 20th week gestation also if it persists more than 6-12 weeks postpartum.

A

chronic hypertension

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6
Q

Women with HTN Chronic HTN with new proteinuria or an exacerbation of HTN or Proteinuria, thrombocytopenia or increased in hepatocellular enzymes.

A

Preeclampsia superimposed on Chronic Hypertension

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7
Q

Hypertension WITHOUT proteinuria after 20 weeks gestation

A

gestational hypertension

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8
Q

What fixes preeclampsia and eclampsia

A

having the baby

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9
Q

Gestational HtN
Primigravidas __% to ___%
Mulitparous __% to __%

A

6-17

2-4

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10
Q

How many pressures have to be elevated to meet criteria for gestational hypertension

A

1

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11
Q

Hypertension AND Proteinuria developed after 20 weeks

A

preeclampsia

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12
Q

mild preeclamsia =

A

BP 140/90mm Hg x2 > 4-6hrs apart
MAP > 105
24hr urine protein > 0.3g

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13
Q

severe preeclampsia

A

BP > 160/110mm Hg
MAP >105
24hr urine protein >2g

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14
Q
  • 24-hour urine protein result of > ______g protein in 24 hours = proteinuria
A

0.3

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15
Q

Risk factors for preeclamsia

A 
Chronic renal disease
Chronic hypertension
Family history of preeclampsia
Multiple gestation
Primigravidity or new partner
Maternal age
Diabetes
Rh incompatibility
Obesity
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16
Q

Low platelets can be precursor to:

A

HELLP syndrome

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17
Q

Potentially lethal complications of hypertension in pregnancy:

A 
pre-eclampsia
placental abruption
DIC
Acute renal failure
hepatic failure
adult resp distress syndrome
cerebral hemorrhage
HELLP syndrome
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18
Q

Usually develops at or after 37 weeks with no preexisting HTN

A

gestational hypertension

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19
Q

Gestational hypertension BPs return to normal within___-___weeks after delivery

A

1-12

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20
Q

Hypertension AND Proteinuria developed after 20 weeks

A

preeclampsia

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21
Q

Often 1st sign of preeclampsia:

A

elevated blood sugar

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22
Q

Disruption in placental perfusions and endothelial cell dysfunction

Study These Flashcards
A

etiology of preeclampsia

23
Q

Is the major pathological factor of preeclampsia elevated BP?
What is it then?

Study These Flashcards
A

No

It is poor perfusion as a result of vasospasm.

24
Q

Preeclampsia:
Vasoconstriction results from sensitivity to vasopressors (like _____________ II)
-Arteriolar vasospasm diminishes the diameter of _________ ______, which impedes blood flow to all organs and increases BP.
-Endothelial cell dysfunction as a result of __________

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A

angiotensin
blood vessels
vasospasm

25
Effects of Preeclampsia: Placental - Impaired perfusion leads to early aging of the ________ and _______ of the fetus Renal - Decreased glomerular filtration rate (GFR) results in ________, increased excretion of protein (mainly albumin) decreased ______ acid clearance. Sodium and water retention Hepatic-Decreased _______ can result in hepatic edema and subcapsular hemorrhage as evidenced by the complaint of epigastric pain or right upper quadrant pain- A sign of impending eclampsia Liver enzymes become _________ (AST, ALT, and LDH).
placenta, IUGR oliguria uric Perfusion elevated
26
preeclampsia effects: Neurological- vasospasms and decreased perfusion can result in: - Cerebral ______- change in emotion, mood, and LOC - CNS irritability-manifested as _______, hyperreflexia, positive ankle clonus, and occasionally eclampsia - Visual disturbances- scotomata and _________
edema headache blurring
27
scotomata
?
28
Laboratory values:
serum albumin decrease Hct increase Bun increase
29
What constitutes proteinuria?
Concentration at or above 30 mg/dL >+1 on dipstick in at least 2 specimens at least 6 hrs apart In a 24 hour specimen: concentration at or above 300 mg/dl Both in absence of UTI
30
Seizure activity or coma in a woman with preeclampsia with no history of preexisting pathology that can result in seizure activity.
eclampsia
31
Interventions for eclampsia:
1. keep oatient safe 2. turn onto side 3. suction 4. O2 5. IV mag 6. monitor fetus 7. uterine & cervical assessment 8. document
32
*Following a seizure a decision must be made regarding delivery. May try to postpone delivery until antenatal ___________ can be given and benefit received
glucocorticoids
33
What should the nurse do at the first prenatal visit to assess for preeclampsia
The nurse should take a thorough history at the 1st prenatal visit to identify risk factors for the development of preeclampsia Assess for signs and symptoms of preeclampsia at each subsequent prenatal visit
34
_______ are only used in preeclampsia when there is evidence of CHF or pulmonary edema. Diuretic therapy further reduces intervillous blood flow ( placental perfusion), which may lead to serious fetal jeopardy.
diuretics
35
edema assessments with preeclampsia
- assess for distribution, degree, pitting - breath sounds for crackles - daily weights
36
Management of mild preeclampsia: Home Bedrest If : Fetal surveillance: Home- Hospital- Monitor urine protein
Home Bedrest | If proteinuria
37
Monitoring mild preeclampsia: Report these symptoms
``` Signs and symptoms to report ^BP - >140/90 Decreased fetal movement Headache Visual disturbances Epigastric or upper right quadrant pain Increased proteinuria Decreased urinary output N/V Malaise Any sign of labor, vaginal bleeding, or abdominal tenderness ```
38
Management of Severe preeclampsia
-Hospital bed rest -Maternal & fetal surveillance -Possibly in an ICU setting -Quiet, nonstimulating -environment & seizure precautions -Pharmacological interventions Delivery
39
severe preeclampsia | pharmacological interventions
Pharmacological interventions Magnesium sulfate- quiet the CNS Oral antihypertensive – Given if systolic >160 to 180mm Hg; diastolic BP 100 to 110 mm HG [See box 855 for pharmacologic agents] - Give with caution- if diastolic BP below 90 mm Hg could reduce uteroplacental perfusion
40
postpartum preeclampsia
Frequent BP & vital signs Magnesium Sulfate (12-24 hrs) Uterine tone and lochia Family support & bonding
41
*_______ of all cases of preeclampsia occurred after delivery in a recent study and the risk remains for up to 28 days post partum.
1/3
42
Magnesium sulfate is administered ___-___ hours post delivery to prevent the development of eclampsia
12-24
43
_________ _________ can interfere with the uterus clamping down thus causing a boggy uterus and heavy lochia flow, placing the woman at risk for postpartum hemorrhage
mag sulfate
44
methergine postpartum to contract uterus in preeclamsia?
no -- high BP
45
post partum BP preeclapmsia:
BP should be monitored every 4 hours for 48 hours
46
Is mag sulfate contraindicated to breastfeeding
no
47
What does HELLP syndrome stand for:
Hemolysis Elevated Liver enzymes Low Platelets
48
signs and symptoms of HELLP
Range from no signs or symptoms of preeclampsia to N/V, epigastric pain or right upper quadrant pain, general malaise
49
complications of HELLP
``` Renal failure Pulmonary edema Ruptured liver hematoma DIC Placental abruption ```
50
Triangular helmet shaped cells found in blood, usually indicative of disorders of small blood vessels.
burr cell
51
Nursing responsibilities for HELLP syndrome
- Assess and observe for signs of bleeding – petechiae or bruising from blood pressure cuff, IV site, gums - Epigastric or right upper quadrant pain or tenderness- some women report it as bad indigestion - Jaundice - Monitor lab values and report to physician - Fetal status- at risk for abruption
52
Pathological form of diffuse clotting that consumes large amounts of clotting factors causing widespread external and/or internal bleeding.
DIC
53
IS DIC ever a primary diagnoses
no always secondary
54
Risk factors for DIC in the obstetric population:
- Placental abruption - Gram-negative sepsis - HELLP syndrome - Intrauterine death with retained fetus - Severe pre-eclampsia - Retained placenta - Amniotic fluid embolism (usually not able to be determined until autopsy) - Hemorrhagic shock - Transfusion reaction

Maternal Newborn - Cher (6 decks)

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