Chapter 27

Question 1

Hypertensive disorders

Answer 1

Gestational hypertension
Preeclampsia (only cure deliver baby)
Eclampsia (only cure deliver baby)
Chronic hypertension

Question 2

Common medical complication of pregnancy

Answer 2

• Complicates 5% to 10% of all pregnancies

- Rate of pregnancy-related hypertension has risen steadily since 1990 for all ages and ethnic groups

Question 3

hypertensive disorders are a major cause of

Answer 3

prenatal death and IUGR (interuterine growth retardation)

10-15% of death

Question 4

predisposing factors

Answer 4

• Family history
• Primagravida
• Pre-existing abnormality of vascular, metabolic or endocrine systems
• Hypertension
• Molar pregnancy- don’t have viable fetus (false pregnancy)
• Twins - more Hcg
• renal disease/renal problems

Question 5

Morbidity

Answer 5

• Placental abruption (not during 3rd stage of labor)
• Cerebral hemorrhage
• Hepatic or renal dysfunction
• DIC (diminished intrmuscular cognation
• Pulmonary edema
• Seizures

Question 6

Mortality

Answer 6

Pregnancy-related hypertension accounts for 10% to 15% of maternal deaths worldwide

Question 7

Gestational hypertension

Answer 7

Onset of hypertension without proteinuria after week 20 of pregnancy
Systolic BP >140, diastolic BP >90 (have to have two different readings two different days)
-bp will return to normal 6 wks after delivery

Question 8

Preeclampsia

Answer 8

Pregnancy-specific syndrome in which hypertension develops after 20 weeks of gestation in a previously normotensive woman
-move from preeclampsa to eclampsia when pt has a seizure

Question 9

Eclampsia

Answer 9

• Onset of seizure activity or coma in a woman with preeclampsia
• No history of preexisting pathology
• 70% of eclamptic women develop the condition while pregnant
• 30% develop eclampsia in the immediate postpartum period (can still have seizure in postpartum period especially 1st 48 hours

Question 10

chronic hypertension

Answer 10

Hypertension present before pregnancy or diagnosed before week 20 of gestation and persists after 6 weeks postpartum

Question 11

Chronic hypertension with superimposed preeclampsia

Answer 11

Women with chronic hypertension may acquire preeclampsia or eclampsia

Question 12

Preeclampsia etiology

Answer 12

A condition unique to human pregnancy

Signs and symptoms develop during pregnancy and disappear after birth

Question 13

Preeclampsia Common risk factors:

Answer 13

• Primigravidity or new partner in this pregnancy
• Extremes of maternal age 35
• Multifetal pregnancy
• Obesity
• Preexisting medical condition

Question 14

Preeclampsia pathophysiology

Answer 14

• Current thought: poor perfusion and endothelial cell dysfunction
• Arteriolar vasospasm diminishes diameter of blood vessels, which impedes blood flow to all organs and increases BP
• Main pathogenic factor is vasospasm and reduced plasma volume
• Decreased placental perfusion contributes significantly to restriction of fetal growth (less plasma volume so part of intrauterine growth retardation)

Question 15

Vascular Damage patho

Answer 15

Platelet aggregation
Fibrin deposits
Hemolysis of RBC’s
Decreased placental blood flow & IUGR

Question 16

Hypertension patho

Answer 16

Decreased vascular vol. & increased extravascular vol
Obstructed blood flow to liver & kidneys
Cerebral ischemia & CNS irritability.

Question 17

HELLP syndrome

Answer 17

-Laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction: Hemolysis (H), Elevated liver, enzymes (EL)
Low platelets (LP)
-Diagnosis associated with increased risk for adverse perinatal outcomes
-Usually develops in third trimester or within 48 hours of birth

Question 18

Evaluating HELLP is important so

Answer 18

that early and aggressive therapy is initiated to prevent maternal and neonatal mortality

Question 19

Identifying and preventing preeclampsia

Answer 19

No reliable test or screening tool has been developed

Question 20

Health assessment

Answer 20

Dependent edema
Pitting edema
Deep tendon reflexes (DTRs)

Question 21

Mild gestational hypertension and mild preeclampsia Care Management

Answer 21

Goals of therapy are to ensure maternal safety and deliver a healthy newborn close to term
Home care
Maternal and fetal assessment
Activity restriction
Diet

Question 22

Home Care for Mild Preeclampsia

Answer 22

Activity restrictions
Monitoring of fetal activity (kick counts)
Blood pressure monitoring (2-3 times a day)
Weight measurement (bc of edema)
Urinalysis for protein (1st void)
Diet without added salt
Fetal surveillance

Question 23

Severe gestational hypertension and severe preeclampsia Care Management

Answer 23

Goals of care are to ensure maternal safety and formulate a plan for delivery
Intrapartum care

Question 24

Severe gestational hypertension and severe preeclampsia - Intrapartum care -

Answer 24

Bed rest with side rails up
Darkened environment
Magnesium sulfate therapy
Antihypertensive medications

Question 25

Severe gestational hypertension and severe preeclampsia - postpartum care -

Answer 25

Vital signs, DTRs, level of consciousness 30% of cases of eclampsia and HELLP syndrome occur postpartum Unable to tolerate excessive blood loss

Question 26

Severe gestational hypertension and severe preeclampsia - future health care -

Answer 26

Seven-fold risk of developing preeclampsia or eclampsia in a future pregnancy Increased risk of adverse perinatal outcomes

Question 27

Eclampsia-SeizuresPreventive measures

Answer 27

``` Provide quiet private room and closed door Minimize lights and noise Group assessments and care together Avoid startling disruptions Restrict visitors ```

Question 28

Eclampsia-Seizures watch for:

Answer 28

Premonitory signs: persistent headache and blurred vision Epigastric or right upper quadrant pain Altered mental status Convulsions appearing without warning

Question 29

Protecting the woman and fetus (interventions for seizures)

Answer 29

- Remain with the woman - During the clonic phase, turn the woman on her side– give MgSO4 IV push - Ensure a patent airway - Note the time and sequence of the convulsion - After the seizure, insert an airway - Suction woman's mouth and nose - Administer oxygen - Observe fetal monitor patterns for signs of hypoxia

Question 30

Chronic hypertension affects

Answer 30

4% to 5% of pregnant women

Question 31

chronic hypertension Associated with increased incidence of:

Answer 31

Abruptio placentae Superimposed preeclampsia Increased perinatal mortality (IUGR, Preterm birth)

Question 32

Chronic hypertension Postpartum complications include:

Answer 32

Pulmonary edema Renal failure Heart failure Encephalopathy

Question 33

Chronic hypertension

Answer 33

- Def: hypertension precedes pg, or before the 20th week of pg or continues after the postpartum period (i.e. 6 weeks after delivery) - More common in older women, with obesity, DM, Black women - More likely to develop preeclampsia - Management: high protein diet, weigh q3 days, antihypertensive meds

Question 34

Hypertensive disorders during pregnancy are a leading cause

Answer 34

of worldwide infant and maternal morbidity and mortality

Question 35

Cause of preeclampsia is

Answer 35

unknown, and there are no known reliable tests for predicting which women are at risk for preeclampsia

Question 36

Preeclampsia is a

Answer 36

multisystem disease rather than an increase in BP only

Question 37

HELLP syndrome can occur

Answer 37

in women with severe preeclampsia and is considered life threatening

Question 38

Once preeclampsia becomes clinically evident therapeutic interventions

Answer 38

may slow progression of the disease, allowing the pregnancy to continue

Question 39

Magnesium sulfate, the anticonvulsive agent of choice for

Answer 39

preventing eclampsia, requires careful monitoring of reflexes, respirations, and urinary output -Antidote, calcium gluconate, should be available at bedside

Question 40

Nursing actions during a convulsion:

Answer 40

ensuring a patent airway and client safety

Question 41

Chronic hypertension in pregnancy associated

Answer 41

with abruptio placenta and superimposed preeclampsia, fetal growth restrictions, and increased perinatal mortality

Question 42

Women with preeclampsia have an increased risk of

Answer 42

adverse perinatal outcomes in a future pregnancy