Hypertension In Pregnancy 210 Exam 2

Front 1

Formally called pregnancy induced hypertension
No proteinuria

Back 1

Gestational Hypertension

Front 2

Leading cause of fetal morbidity with potential lethal complications?

Back 2

PIH

Front 3

A mult-system disase of vasospasm and vasocontriction?

Back 3

PIH

Front 4

Development of hypertension, 140/90 during the second half of pregnancy (or 20 weeks)having a previous normal state?

Back 4

PIH

Front 5

Renal involvement leading to proteinuria in PIH?

Back 5

Pre-eclampsia

Front 6

CNS involvement leading to seizure?

Back 6

Eclampsia

Front 7

If hypertension persists beyond 6 weeks PP, it's considered what?

Back 7

Chronic hypertension

Front 8

A drop in hemolysis (HE)
Elevated liver enzymes (LE)
Low Platelets (LP)

Back 8

HELLP Syndrome

Front 9

Is a variant of severe preclampsia, platelets are less than 100,000, LFTs are 2 times normal, may occur against a background of what may appear to be mild, i.e. blood pressures of like 150/90?

Back 9

HELLP Syndrome

Front 10

Elevated BP before 20 weeks?

Back 10

Is chronic HTN

Front 11

Hemoconcentration, hypertension, proteinuria, edema, and decreased blood flow to vital organs?

Back 11

PIH

Front 12

Primips
Diabetes
Obesity
Chronic HTN
Polyhydramnios
Poor nutritional intake
Grand multips
Macrosomia
Adolescents
Multi fetal?

Back 12

Risk factors for PIH, pre-eclampsia, eclampsia

Front 13

PIH with renal involvement is?

Back 13

Pre-eclampsia

Front 14

PIH with CNS involvement leading to seizure leads to?

Back 14

Eclampsia

Front 15

Increased vascular resistance
Decreased vessel diameter with endothelial damage
Impedes blood flow
Increases ________ and decreases ________.

Back 15

BP; circulation to vital organs

Front 16

Decrease GRF
BUN/Creatinine/Uric Acid increase
Glomerular damage causes protein molecules to leak into general circulation
Change in osmotic pressure causes fluids shifts and third spacing resulting in hypovolemia
Increased viscosity and increased hct?

Back 16

Kidney Effects of PIH, Pre-eclampsia, eclampsia

Front 17

Vasospasm
Vasoconstriction causes rupture of small vessel's
Headache
Visual disturbances
Hyper-reflexia
Convulsion?

Back 17

Brain Effects of PIH, Pre-eclampsia, eclampsia

Front 18

Decreased circulation leading to impaired function
Hepatic edema
Epigastric pain
Sub capsular hemorhage
Increased liver enzymes
DIC?

Back 18

Liver changes in PIH, Pre-eclampsia, eclampsia

Front 19

Decreased circulation
Ischemia
IUGR - fetal distress - hypoxia
Abruption

Back 19

Placental changes in PIH, pre-eclampsia, eclampsia

Front 20

Signs are hypertension, proteinuria and edema
Disase classified as mild or severe
May progress from mild to severe?

Back 20

Signs and symptoms of PIH, pre-eclampsia, eclampsia

Front 21

BP greater than 140/90
Proteinuria 1+ to 2+
Weigh gain > 4lbs/week
Mild edema of face and extremities
Hyper-reflexia, clonus?

Back 21

Mild PIH

Front 22

BP 160/110
Proteinuria 3+ to 5+ in 24 hours
Oliguria
Visual and retinal changes
Pulmonary Edema
Increasing edema
Hepatic dysfunction
Epigastric Pain Hyper-reflexia and clonus?

Back 22

Severe PIH

Front 23

B/P
Edema - weight gain
DTRs
Fetal heart / uterine contractions
NST, L/S ratio
Breath sounds, Headache/LOC
Urinary output, cbc, u/a, LFS, BUN, Creatinine, Fibrinogen, Blood type and cross

Back 23

Assessments for PIH, Pre-eclampsia-eclampsia

Front 24

Bedrest with bathroom privileges only
Kick counts
BPs 2-4 times each day
Daily weights at the same time each day
Daily urinalysis for protein using first voided specimen
Uterine activity monitoring for signs of preterm labor
Medication administration as directed by physician

Back 24

Management of mild preeclampsia

Front 25

Bedrest with reduced environmental stimuli
Intravenous administration of magnesium sulfate (the drug of choice in the United States to prevent convulsions)?

Back 25

Management of Severe Preeclampsia

Front 26

Diet hi in protein 60-70gm/day
Increase Calcium to 1.5 - 2gm/day
Increase fluids to 3000ml/day

Back 26

Diet for severe preeclampsia

Front 27

Early recognition and intervention
Low dose ASA (reserved for women of known risk)
*Calcium supplementation (food) to lessen sensitivity to the pressor effects of Angiotensin 2

Back 27

Prevention of PIH, preeclampsia, eclampsia

Front 28

CNS depressant relaxing smoot muscle
Anticonvulsant properties to prevent seizure
Used to inhibit PTL
Initial dose 4-6gm loading dose over 15-20 minutes
Maintenance dose 2-3 gm/hr

Back 28

Magnesium Sulfate

Front 29

Blocks release of acetylcholine at neuromuscular junction, thus decreasing neuromuscular irritability, including vasomotor and uterine irritability. Causes slight peripheral vasodilation, reduces edema in the brain, and increases perfusion to brain and placenta. Not used in kidney impairment because it is excreted unchanged from kidney. Cumulative doses may occur.

Back 29

Action of Parenteral Magnesium Sulfate

Front 30

Mostly ringer's lactate, can be D5W, 15 to 20 minutes?

Back 30

Dose/route by infusion 4-6gm of Magnesium Sulfate

Front 31

To keep in therapeutic range must be 2 g/hr, regulated by titrating with client's responses of reflexes, output, respirations, and magnesium levels?

Back 31

Maintenance dose for Magnesium Sulfate

Front 32

10% calcium gluconate 10 mL; keep syringe and ampule at bedside?

Back 32

Antidote for Magnesium Sulfate

Front 33

Sweating, warmth, flushing, and heavy feeling in limbs. May become lethargic and confused, with depressed reflexes and respirations. Nausea and vomiting.

Back 33

Mothers side effects and adverse effects from Magnesium Sulfate

Front 34

Decreased beat-to-beat variability and potential for tachycardia. Monitor newborn for magnesium levels, hypotonia, and hyporeflexia?

Back 34

Fetal side effects from Magnesium Sulfate

Front 35

More difficult to obtain therapeutic levels in preterm labor than in PIH because kidney involvement in PIH reduces excretion. Monitor for respiratory rate under 12 breaths/min, urine output under 25 mL/hr, and depressed reflexes, and perform neurologic check every 4 hours. Assess for changes of headache, visual disturbances, and epigastric pain. Continue seizure precautions for PIH. Monitor contractions and fetal heart tones in both preterm labor and PIH?

Back 35

Precautions for Magnesium Sulfate

Front 36

1.8-2.5 mEq/dl Magnesium.

Back 36

Normal Magnesium levels

Front 37

4.0-7.0 mEq/dl Magnesium?

Back 37

Therapeutic Magnesium Levels

Front 38

Hyporeflexia, slurred speech, nausea, somnolence, double vision: what Magnesium level?

Back 38

9.0-12.0 mEq/dl

Front 39

Magnesium level for respiratory distress?

Back 39

12.0 mEq/dl

Front 40

Magnesium level for cardiac arrest?

Back 40

15.0 mEq/dl

Front 41

Causes decreased neuromuscular irritability
< deep tendon reflexes
Measure hourly output should be 25-30cc/hr use foley catheter
Measure respirations must be 12 or >
Measure Mg levels for toxicity?

Back 41

Magnesium Sulfate Observations

Front 42

Hypertension in Pregnancy

MgSO4 is given for 12-24 hr PP
Then tapered slowly till it is dc'd
Breast feeding may begin then?

Back 42

Post Partum

Front 43

PIH which progresses to seizure
Tonic/Clonic seizures result from cerebral edema
BP and temp may rise sharply
Precursors - blurred vision, severe headache, hyper-reflexia, epigastric pain, oliguria, clonus?

Back 43

Eclampsia

Front 44

Administer oxygen by mask
Turn on left side
Use pulse oximeter
Prevent aspiration
Artificial airway and suction
Medication administration

Back 44

Nursing Management of Eclampsia

Front 45

Often semi comatose for 1-4
Observe closely for labor which may begin, trigger another seizure or go undetected
Potential risks for abruption
Risks of fetal hypoxia

Back 45

Post Ictal Phase concerning PIH, preeclampsia, eclampsia

Front 46

What is the only cure for PIH?

Back 46

Delivery

Front 47

Pt should be stable 12-24 hours post seizure
Check L/S ratios for fetal lung maturity
NSVD is the delivery of choice
Induction may be used?

Back 47

Resolution of PIH, preeclampsia, eclampsia

Front 48

Occurs with sever PIH
Hemolysis, Elevated Liver Enzymes, and Low Platelets
20% mortality rate, occurs in 4-12% of PIH
Hematological and Hepatic involvement?

Back 48

HELLP Syndrome

Front 49

A life threatening complication in which coagulation and anticoagulation factors are activated at the same time.
The result is simultaneous decrease in clotting factors and increase in the anticoagulation factors that leave the blood unable to clot.
Occurrence of micro emboli.
Extrinsic factors respond to blood vessel damage and cause tissue trauma.
Platelet aggregation to cell walls and platelets fall.
Fibrin degradation is secreted to reduce aggregation (FSP)
The live can't compensate?

Back 49

Disseminated Intravascular Coagulation

Front 50

Missed abortion, abruption, PIH, spsis, demis, amniotic embolism.

Back 50

Major predisposing conditions of disseminated intravascular coagulation

Front 51

Oozing, bruising, profuse bleeding from any site including placental?

Back 51

Symptoms of disseminated intravascular coagulation

Front 52

Correct the trigger, deliver fetus and placenta, blood replacement, correct hypovolemia, Heparin?

Back 52

Treatment of disseminated intravascular coagulation

Front 53

Hypertension occurring prior to 20wks or concurrently with PIH
Occurs in older women, obesity and DM
Clients must maintain a high protein diet, not use excessive salt, and weigh often
Continue all meds, may add more
Aldomet the most common antihypertensive due to minimal fetal effect
Frequent monitoring?

Back 53

Chronic Hypertension

Front 54

Increased blood volume a burden to and already compromised heart
Resulting in Cardiac Decompensation or CHF
Two categories - Congenital and Rheumatic Fever Disease?

Back 54

Heart Disease in Pregnancy

Front 55

Uncompromised, no limitation of physical activity. Asymptomatic with ordinary activity?

Back 55

Class I Heart Disease in Pregnancy

Front 56

Slightly compromised, requiring slight limitation of physical activity. Comfortable at rest, but experience fatigue, dyspnea, palpitations, or anginal pain with ordinary activity?

Back 56

Class II Heart Disease in Pregnancy

Front 57

Marke limitation of physical activity; comfortable at rest, but less than ordinary activity causes excessive fatigue, palpitations, dyspnea, or anginal pain; markedly compromised?

Back 57

Class III Heart Disease in Pregnancy

Front 58

Inability to perform any physical activity without discomfort, has symptoms of cardiac inusfficiency even at rest. In general, maternal and fetal risks for Classes I and II disease are small, but risks are greatly increased for Classes III and IV.

Back 58

Class IV Heart Disease in Pregnancy

Front 59

The most dangerous time is 28-32 weeks as the blood volume peaks
Symptoms of deterioration include, SOB during ADL's
Frequent coughing with or without hemoptysis or crackles
Palpitations or recognized arrhythmias
Generalized edema

Back 59

Heart Disease in Pregnancy

Front 60

Ensure cardiac demand does not exceed the functional capability of the heart
Limit physical activity to be s/s free
Avoid excessive weight gain
Prevent anemia
Prevent infection
Assess for CHF, PE or Arrhythmia
Anticoagulation if needed
Antiarrythmics if needed
Diuretics if needed?

Back 60

Goals of Treatment Antepartum for Heart Disease in Pregnancy

Front 61

Minimize labor effects on the CV system
Prevent fluid volume overload
Sims position, head and shoulders elevated
Oxygen prn
Sedation/anesthesia, calm quiet room
Keep legs level
Use of foceps or vacuum
Monitor for circulatory overload?

Back 61

Intrapartum Management of Heart Disease in Pregnancy

Front 62

Observe for CHF
Fluid Overload
Infection
Hemorrhage
Thrombophlebitis
Early ambulation?

Back 62

Postpartum management of Heart Disease in Pregnancy