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38 Cards in this Set
- Front
- Back
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Name the different types of Hypertensive Disorders
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Gestational HTN
Preeclampsia Eclampsia Chronic HTN Chronic HTN Superimposed Preeclampsia |
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What is Gestational Hypertension?
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HTN without proteinurea after 20 weeks and BP returns to normal 6 weeks after birth
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What is Chronic Hypertension with Superimposed Preeclampsia
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occurs before 20 weeks with a new onset of proteinurea
In women with HTN and proteinurea will have inc HTN and one of the following: 1. New Sx 2. Thrombocytopenia 3. Inc Liver Enzymes |
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What is chronic hypertension?
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HTN occurs before pregnancy or before 20 weeks
usually last >6 weeks post labor |
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What is Preeclampsia?
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elevated BP after 20 weeks gestation with significant proteinurea
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What are the Dx traits of Preeclampsia?
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Proteinurea: +1 or .3g in 24hrs
BP: >140/>90 Usually with Edema Cured by delivery |
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What are the risk factors of Preeclampsia?
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Age <19 and >25
Antiphospholipid Syndrome Angiotensin Gene T235 ** Chronic Renal Disease DM First Pregnancy Family Hx Father of the baby with preeclampsia mother Multiple Gestation Mother or sister with preeclampsia Obesity Preexisting Inc BP or vascular disease Peridontal Disease |
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What are the normal changes in the cardiovascular system during pregnancy?
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Compensatory responses to increased volume and CO including a decrease in PVR and vasodilation occurs
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What is the pathophysiology of preeclampsia?
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lack of compensatory mechanism in normal pregnancy to increased volume and CO
theres a lack of resistance to angiotensin ii causing vasoconstriction and vasospasm limiting flow to organs |
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How does angiotensin ii work?
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Angiotensin ii is a vasoconstrictor that also stimulates aldosterone which promotes Na retention
in Preeclampsia there is a lack of resistance to angiotension ii |
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What are the S/S of preeclampsia?
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BP elevation
Proteinuria, Oliguria Vascular changes (scomata) Inc Liver enzymes, liver edema, and hemorrhage (causing RUQ pain) Low platelets Edema Hyperreflexia (DTRs and clonus), Numbness tingling H/A, drowsiness, confusion |
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What are the mild symptoms of preeclampsia?
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140-159/90-110
Blood levels WNL 1+ proteinuria Little or no inc in liver enzymes No severe H/A Normal fetal growth |
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What are the severe symptoms of preeclampsia?
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160+/110+
Elevated Creatinine Elevated liver enzymes Decreased platelets Severe H/A Visual disturbances RUQ pain, n/v Pulmonary edema Reduced amnio volume IUGR |
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What is eclampsia?
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development of convulsions or coma not attributable to other causes in preeclamptic women
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What are the symptoms of eclampsia?
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Seizures (before, during after labor)
Facial Twitching Body rigidity Tonic-Clonic motions (1min) Uterine irritability (brady or tachy FHR) Aspiration d/t seizure Oliguria Pulmonary Edema Cerebral Hemorrhage |
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What does HELLP stand for?
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Hemolysis
Elevated Liver enzymes Low Platelets may develop with or without preeclampsia/eclampsia |
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What are the Sx of HELLP?
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Liver distention
RUQ pain/ LR chest pain/ midepigastric pain Jaundice Bleeding Hypovolemic Shock Delivery >32 weeks ICU management |
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What is the management of Mild preeclampsia?
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Can be managed at home
Frequent rest (lateral position 1.5 hrs improves perfusion) BP monitoring 2-4xper day in the same position and arm Daily weights Daily Urine dipstick Diet ample protein and calories Same salt and fluid intake |
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What is the management of severe preeclampsia?
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Bed rest in lateral position
Monitor amnio Quiet dark place Padded side rails Have O2 ready Have suctioning ready |
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What drugs are used for Preeclampsia and Eclampsia
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AntiHTN:
Hydralazine for dilation Nifedipine (CC Blocker) Labetalol (BB) Seizure Prevention: Mg Sulfate (relaxes smooth muscle) |
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How is Mg Sulfate Given?
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IV piggy back loading dose of 4-6mg diluted in 100ml over 15-20mins then 2mg per hr
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What are the Sx of Mg Sulfate toxicity?
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inc levels
Diminished UO (watch for oliguria) Thirst Dec DTRs Confusion Dec O2 <95% Dec RR <12 Cardiac Arrest Dec variability in FHR |
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What is the nursing care r/t Mg Sulfate?
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Monitor BP and RR
DTRs per protocol UO qHr Keep Calcium Gluconate close Have resuscitation equipment close Watch for impending seizures Keep room quiet, dark, min distraction, don't startle, restrict visitors |
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What are impending signs of seizures?
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HA
DTRs 4+ RUQ pain N/V |
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What occurs in early pregnancy r/t insulin?
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Insulin release is greater in response to inc glucose: hypoglycemia
Fat stores inc for later use by growing fetus |
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What occurs later in pregnancy r/t insulin?
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Insulin resistance occurs in mother so more glucose is available to the baby: mother hyperglycemic
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Why do GDM babies get so big? (macrosomia)
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the mothers blood brings extra glucose to the baby
baby makes more insulin to store in fat Baby gets bigger |
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What are the risks if the mother has preexisting DM?
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Miscarriage if glucose isn't controlled early on
Preeclampsia Ketoacidosis (>200 in pregnancy, >300 in normal DM) Macrosomia Vascular impairment dec placental perfusion UTIs Hydramnios |
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What are the neonatal risks if the mother has preexisting DM?
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Hypoglycemia (accelerated insulin production)
Hypocalcemia (results with poor maternal control of DM) Hyperbilirubinemia (from hypoxia with extra RBC) RDS (acceleration of insulin retards cortisol production - slows lung maturity) Still Birth |
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What is the management of Preexisting DM?
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Maintain safe glucose levels
Adherence to insulin therapy Usually inc insulin doses in 2nd and 3rd T Assess end organ damage (cardiac, eye, renal fx) |
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What are the predisposing factors to GDM?
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Overweight
HTN >25 Family Hx Fasting glucose >140 or random >200 Hx of: LGA, congenital anomalies, unexplained fetal death, GDM |
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What are the screening tools used for GDM?
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Glucose Challenge Test: blood drawn 1hr after 50g of glucose given if >140 do OGTT
OGTT: NPO night before, get fasting glucose, give 100g of glucose, take glucose 1,2,3 hrs after |
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What are the numbers for OGTT?
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<130-140 negative
>140 positive for GDM (95,180,155,140) |
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What are the maternal and neonatal effects of GDM?
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Same as DM except: Less early problems, less congenital anomalies, and less miscarriage
Inc morbidity and mortality later due to macrosomia and hypoglycemia |
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What is the management for GDM?
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Calories restricted for obese
Exercise usually safe Monitor BG (fasting <95, postparandial 130-140) Insulin ordered based on results Inc fetal surveillance: US, BPP, Kick counts HbA1c |
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What would you educate a woman with GDM?
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diet
BG timing danger signs insulin administration SQ sites Angle Quickly inject infusion pumps |
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What are the S/S of Hyperglycemia?
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Fatigue
Flushed hot Dry mouth, Thirsty Frequent urination Rapid deep RR Drowsy H/A depressed reflexes |
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What are the S/S of Hypoglycemia?
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Shaking
Sweaty Cold clammy Disoriented irratible Hungry Blurred vision |
