Chapter 27 Flashcards by Fatima Avila

Complications occur in ___-___% of all pregnancies

5-10

How well did you know this?

Not at all

Perfectly

_____ disorders are a major cause of perinatal morbidity & mortality worldwide

Hypertensive

How well did you know this?

Not at all

Perfectly

What are the three most common types of hypertensive disorders occuring in pregnancy?

Gestational HTN
Preeclampsia
Chronic HTN

How well did you know this?

Not at all

Perfectly

GESTATIONAL HYPERTENSIVE DISORDERS
-What is gestational hypertension?

development of HTN AFTER 20 weeks of pregnancy in a previously nonhypertensive woman WITHOUT proteinuria or other systemic findings (no organ damage) –> no underlying HTN condition

How well did you know this?

Not at all

Perfectly

GESTATIONAL HYPERTENSIVE DISORDERS
-What is preeclampsia?

Development of HTN in a previously normotensive woman AFTER 20 weeks of gestation OR in the early PP period with proteinuria OR organ damage

How well did you know this?

Not at all

Perfectly

GESTATIONAL HYPERTENSIVE DISORDERS: Preeclampsia
-Even WITHOUT proteinuria, preeclampsia can still cause what? (5)

Thrombocytopenia
Renal insufficiency
Impaired liver function
Pulmonary edema
Cerebral or visual symptoms

How well did you know this?

Not at all

Perfectly

GESTATIONAL HYPERTENSIVE DISORDERS: Preeclampsia
-What do we ask moms for?
-Why?
-What if the mom has a history of HTN?

-A urine sample
-To check for spilling of protein (proteinuria)
-We do a 24 hour urine sample

How well did you know this?

Not at all

Perfectly

GESTATIONAL HYPERTENSIVE DISORDERS: Eclampsia
-What is eclampsia?

Development of seizures OR coma NOT attributable to other causes in a preeclamptic woman due to HTN

How well did you know this?

Not at all

Perfectly

GESTATIONAL HYPERTENSIVE DISORDERS: Eclampsia
-They usually have _____ that are not relieved by meds or have ____ changes

-headaches
-visual

How well did you know this?

Not at all

Perfectly

GESTATIONAL HYPERTENSIVE DISORDERS: Eclampsia
-They will have ______ pain
-What should you do?

-Epigastric (RUQ)
-draw a CMP w/ BUN & creatinine –> could be a liver problem

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSIVE DISORDERS
-What does this mean?

Woman ALREADY had pre-existing issues

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSIVE DISORDERS
-What is chronic HTN?

HTN in a pregnant woman present before pregnancy (diagnosed before 20 weeks of gestation)

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSIVE DISORDERS
-What is superimposed preeclampsia?

Chronic HTN in associated with preeclampsia

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSIVE DISORDERS
-So…
1. Before 20 weeks = ?
2. After 20 weeks = ?

Chronic
gestational or preeclampsia

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSION
-Ideally, the management of chronic HTN in pregnancy begins when?

Before conception

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSION
-What should you encourage?
-Examples?

-Lifestyle modifications
-smoking + alcohol cessation, exercise, weight loss

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSION
-Women with chronic HTN are classified as what?

Either high or low risk for pregnancy complications

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSION
-Women who are high risk are managed with what?

-Antihypertensive medication & frequent maternal/fetal assessments (maternal fetal medicine)

How well did you know this?

Not at all

Perfectly

CHRONIC HYPERTENSION
-We cannot use any HTN drugs other than what?

Labetalol & Procardia

How well did you know this?

Not at all

Perfectly

GESTATIONAL HTN
-How is BP?
-This should be recorded on ___ separate occasions at least ____ hours apart

-Systolic BP >140 & diastolic BP >90
-2; 4

How well did you know this?

Not at all

Perfectly

GESTATIONAL HTN
-When does it resolve?
-How long can it take?

-After giving birth
-12 months

How well did you know this?

Not at all

Perfectly

GESTATIONAL HTN
-Up to __% of women with GHTN go on to develop what?

-50
-preeclampsia

How well did you know this?

Not at all

Perfectly

PREECLAMPSIA
-This occurs in ___-___% of healthy nulliparous pregnant women

2-7%

How well did you know this?

Not at all

Perfectly

PREECLAMPSIA
-What are the common risk factors? (8)

Nulliparity
AMA (>35)
Pre-pregnancy BMI >30
Hx of preeclampsia
Chronic HTN
Preexisting DM and/or thrombophilia
IVF
Sleep apnea

How well did you know this?

Not at all

Perfectly

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -What is the main treatment? -When should it begin? -It should be continued until ____ -What does it do?

-Low-dose aspirin (baby aspirin) -Between 12-28 weeks -birth -Reduces the development of preeclampsia or HTN

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -If mom has GHTN OR preeclampsia (without severe characterstics) & is 37 weeks or more, what should happen? -Why?

-She should give birth -Keeping the baby can increase risk to mom

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -What is magnesium sulfate used to prevent & treat?

Seizures for women with GHTN & preeclampsia with severe features

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -If BP is ____/____ OR greater, when should antihypertensive treatment begin? -HOWEVER, if they BP is between ___-___, we don't want to wait --> intervene!!!

-160/110 -30-60 minutes of acute-onset severe HTN -140-150

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -Go over chart

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -Check ____ & ____ for impaired liver function

AST & ALT

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -Check ____ ___ for thrombocytopenia

platelet count

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -Check ___ & ___ for renal insufficiency

BUN & creatinine

**TREATMENT FOR HIGH & MODERATE RISK FACTORS** -_____ disturbances are associated with severe features

Visual

**PREECLAMPSIA PATHOPHYSIOLOGY** -Preeclampsia is a ____ disorder with _____ as the root cause. -When does it begin to resolve?

-Progressive; placenta -After the placenta has been expelled

**PREECLAMPSIA PATHOPHYSIOLOGY** -Spiral arteries in the uterus normal do what? -Why?

-Become larger & thicker -to handle increased blood volume

**PREECLAMPSIA PATHOPHYSIOLOGY** -What happens to spiral arteries in women with preeclampsia? -What does this cause?

-Vascular remodeling **DOES NOT** occur OR only partially develops -Decreased placental perfusion & endothelial dysfunction

**PREECLAMPSIA PATHOPHYSIOLOGY** -What leads to the endothelial cell dysfunction?

Placenta ischemia

**PREECLAMPSIA PATHOPHYSIOLOGY** -Describe the chain reaction

1. Placenta is not perfused well 2. Vasospasm occurs --> poor tissue perfusion to organs 3. BP & peripheral resistance increase 4. Organs are damaged

**PREECLAMPSIA PATHOPHYSIOLOGY** -What happens to kidney perfusion?

It is reduced --> protein gets excreted through urine

**PREECLAMPSIA PATHOPHYSIOLOGY** -What happens to plasma colloid osmotic pressure? -What does it lead to?

-It decreases -Edema in legs & face

**PREECLAMPSIA PATHOPHYSIOLOGY** -What happens to liver perfusion? -What does it cause?

-It decreases -Epigastric or RUQ pain

**PREECLAMPSIA PATHOPHYSIOLOGY** -What are the 4 neurological complications?

1. Cerebral edema 2. Cerebral hemorrhage 3. CNS irritability 4. Blurred, double vision, or blind/dark spots

**PREECLAMPSIA PATHOPHYSIOLOGY** -What does CNS irritability consist of?

Headache, HYPERreflexia, positive ankle clonus, & seizures

**PREECLAMPSIA PATHOPHYSIOLOGY** -You must monitor for preeclampsia in the ____ time frame -Why?

-PP -A lot of women develop these during that time

**IDENTIFYING & PREVENTING PREECLAMPSIA** -Is there a reliable test or screening tool that has been developed?

**IDENTIFYING & PREVENTING PREECLAMPSIA** -What may help certain high-risk women?

Low-dose aspirin (81 mg daily)

**NURSING ASSESSMENT** -We want to make sure we take accurate measurement of ______ -If it is electronic, ______ diastolic by ____ and _____ systolic by __

-BP -underestimate; 10 -overestimate; 6

**NURSING ASSESSMENT** -How is edema assessed?

+1to +4

**NURSING ASSESSMENT** -How are DTR assessed? -With these, you want to assess for ____ reflexes

-0-+4 -hyperactive

**NURSING ASSESSMENT** -In terms of proteinuria, ideally, we want it to be determined by a....

24-hour urine collection

**NURSING ASSESSMENT** -Evaluate for s/s of severe preeclampsia. What are they? (3)

1. Headaches 2. Epigastric/RUQ pain 3. Visual disturbances

**NURSING INTERVENTIONS**: *GHTN & Preeclampsia* -What are the two goals?

1. Ensure maternal safety 2. Deliver a healthy newborn as close to term as possible

**NURSING INTERVENTIONS**: *GHTN & Preeclampsia* -______ management is usually possible -______ evaluations should continue

-Outpatient -Laboratory

**NURSING INTERVENTIONS**: *GHTN & Preeclampsia* -What is done in terms of fetal evaluation?

Daily kick counts, NST, BPP

**NURSING INTERVENTIONS**: *GHTN & Preeclampsia* -Bedrest improved outcomes (T/F)

False --> there is no evidence against it

**NURSING INTERVENTIONS**: *GHTN & Preeclampsia* -We want to manage this before ____ weeks gestation -Which antihypertensive meds can be given? -What BP do we want to maintain?

-34 -Labetalol, hydralazine, nifedipine -140-150/90-100

**NURSING INTERVENTIONS**: *GHTN & Preeclampsia* -Which medication is used to enhance fetal lung maturity in 34 or less week? --> in case of early delivery!!!!

Corticosteroids

**NURSING INTERVENTIONS**: *GHTN & Preeclampsia* -Women should have continuous _____ & ____ ____ monitoring -_____ rest with side rails up -_______ evironment -Assessed for signs of ______ ____

-FHR; uterine contraction -Bed -Darkened -Placental abruption

**MAGNESIUM SULFATE** -This is a ____ ____ medication!!! -What is it the medication of choice for?

-HIGH ALERT!!! -Preventing & treating seizure activity (eclampsia)

**MAGNESIUM SULFATE** -How is it administered? -Why is it administered this way?

-IV as a secondary infusion (piggyback) by volumetric infusion pump -Initial load dose & then continuous maintenance dose -It has little effect on BP this way

**MAGNESIUM SULFATE** -What is IMPORTANT to monitor when giving mag sulfate?

1. VS 2. Accurate I&O's 3. S/S of mag toxicity

**MAGNESIUM SULFATE** -What are the symptoms of mag toxicity? -What should you do?

1. Absent DTR 2. Decreased RR 3. Decrease LOC -STOP infusion IMMEDIATELY & give calcium gluconate IV

**WHEN SHOULD DELIVERY BE INITIATED** -What are the 7 reasons?

1. Eclampsia 2. Uncontrollable severe HTN (>160/110 x2, 4 hrs apart) 3. Pulmonary edema 4. Placenta abruption 5. DIC 6. Evidence of non-reassuring fetal status 7. Fetal demise

**INTERVENTIONS** -We want to control _____ -____ medications are indicated for BP 160/110 or greater

-BP -Antihypertensive

**INTERVENTIONS** -What are we checking PP? -_____ ____ infusion is continued after birth for _____ prophylaxis as ordered, usually for ____ hours

-VS, DTRs, LOC -Magnesium sulfate; seizure; 24

**INTERVENTIONS** -There is a significant risk of developing _____ in a future pregnancy -There is an increased risk for develop _____ _____ & ______ _____ later in life -Educate patients on what?

-preeclampsia -chronic hypertension; cardiovascular disease -lifestyle changes

**ECLAMPSIA** -What is this?

Seizure activity or coma in a woman with preeclampsia BUT no hx of preexisting (seizure-related) pathology

**ECLAMPSIA** -This occurs in 1 in ____-____ births -When can it occur?

-2000-3448 -before, during, or after birth

**ECLAMPSIA** -What are the premonitory signs? (4)

1. Headache 2. Blurred vision 3. Epigastric or RUQ pain 4. Altered mental status

**ECLAMPSIA** -______ can appear without warning

Convulsions

**ECLAMPSIA** -What should you do when a seizure begins

1. Call for help (REMAIN with patient) 2. Ensure patent airway & safety 3. Turn to side 4. Note the time of onset & duration of seizure 5. Stabilize mom after seizure

**HELLP SYNDROME** -Clinical presentation is often _____ -Most women with the disorder report what 4 things?

-nonspecific 1. Hx of malaise 2. Flu-like symptoms 3. Epigastric or RUQ pain 4. Symptoms worse at night & improve during daytime

**HELLP SYNDROME** -What is this?

A variant of preeclampsia that involves hepatic dysfunction

**HELLP SYNDROME** -What are the lab findings?

**H**emolysis **EL**evated liver enzymes (LDH & AST) **L**ow **P**latelets

**HELLP SYNDROME** -Women with HELLP are often _____ -Rate of preterm birth in women with HELLP is ____%

-misdiagnosed -70

**HELLP SYNDROME** -What are adverse outcomes of this? (4)

1. Pulmonary edema 2. Acute renal failure 3. Disseminated intravascular coagulation (DIC) 4. Placental abruption

**NURSING DIAGNOSIS FOR WOMEN WITH HTN DISORDERS** -What are 3 diagnoses?

1. Anxiety 2. Knowledge deficit 3. Potential for injury to the woman OR fetus

Chapter 27 Flashcards

Hypertensive Disorders (77 cards)