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OB-HTN

Preg at risk-htn disorders in pregnancy

QuestionAnswer
serial bp readings of 145/99, 155/100, 156/98, normal labs, negative for proteinuria with a pre-preg bp of 120/68 indicates gestational hypertension
BP elevation of greater than or equal to 140/90 detected for the first time after mid pregnancy without proteinuria gestational hypertension
HTN with no signs of preeclampsia at birth and resolves by 12 weeks post partum transient hypertension
pregnancy specific syndrome that usually occurs after 20 wks & is typically determined by gestational HTN & proteinuria preeclampsia
occurrence of seizures (or coma) in a woman with preeclampsia that are not attributed to other causes eclampsia
HTN that is present before pregnancy or is diagnosed before week 20 chronic hypertension
chronic HTN with no proteinuria or exacerbation of previously well controlled HTN or thrombocytopenia, or increase in liver enzymes preeclampsia superimposed on chronic hypertension
the pregnant woman with a very high risk for hypertensive emergencies and that is the sickest is the one with preeclampsia superimposed on chronic hypertension
HTN affects on the fetus IUGR, non reassuring fetal heart tone, fetal intolerance to labor, preterm birth, IUFD
IUFD intrauterine fetal demise; a risk associated with HTN
IUGR intrauterine growth restriction; a risk associated with HTN
IUGR can be assessed by a low measurement of the fundal height
what trimester is the period of lowest BPs second trimester
why are BPs normally low in the second trimester decreased by hormones
when is preeclampsia normally diagnosed second trimester
normal blood pressure according to JNC less than 120/80
prehypertensive 120-139/80-89
stage I, mild HTN 140-159/90-99
stage II, severe HTN greater than 160 systolic or 100 diastolic
what is the most effective and reliable method for measuring bp? at level of heart
if the client is laying on their right side which arm should you take the bp on? right side
chronic hypertension does not resolve in postpartum
physical findings of chronic htn increased hr, sudden or gradual onset of pulmonary edema and chf, increased activity of ANS and ECG indicating increased thickness in the left ventricular wall
increased ANS activity and an ECG indicating increased left ventricular wall thickness indicates chronic htn
treatment for chronic htn includes bp monitoring, daily weights, antepartum testing, fetal kick counts and sometimes medication
how should you teach a preg woman to monitor her bp daily, in same position, log results
how should you teach a preg woman to monitor her weight daily, at same time, log results
when would medication be indicated in htn during pregnancy a diastolic bp between 90-104
what medication is the first choice for htn during pregnancy methyldopa
when would methyldopa be used if bp is above 150-160/100-110
should a woman with chronic htn continue her antihypertensives during pregnancy no
seizure or coma indicates eclampsia
the sickest patient preeclampsia superimposed on chronic htn
elevated htn, thrombocytopenia and increased liver enzymes indicate preeclampsia superimposed on chronic htn
HTN, no signs of proteinuria and resolves by 12 wks postpartum transient HTN
diagnosed by week 20, HTN with or without proteinuria preeclampsia
a weight gain of 5-6lbs in a week can indicate preeclampsia or CHF
preeclampsia affects what organ multiple organs are affected
a multisystem vasospastic disease process of reduced organ perfusion preeclampsia
if htn but no proteinuria, suspect what if h/a, blurred vision, abdominal pain and abnormal labs preeclampsia
what is the priority for preeclampsia reduce risk for seizure
what is the cure for preeclampsia? delivery of the placenta
if a woman develops preeclampsia before 30 wks or was superimposed on chronic htn what chance does she have of recurrence in subsequent pregnancies 65%
if a dx of preeclampsia occurs in the last trimester what is the chance of recurrence in subsequent pregnancies 25%
what age groups are at higher risk for preeclampsia under 19 and over 35
over age 40 increases the risk of preeclampsia by how much if primigravida 2-3 times
if a woman is pregnant for the second time but with a new partner she may be at higher risk for preeclampsia
if a woman has a hx of fetal hydrops or hydatiform mole she is at increased risk for developing preeclampsia
the two highest priorities of nursing care for the patient with preeclampsia are prevent seizures and keep the airway clear
how is preeclampsia different from hypertension decreased perfusion as a result of vasospasm
vasospasm impedes blood flow to all organs
oxygenation and perfusion are impaired in preeclampsia
do all women with preeclampsia have edema no
decreased organ perfusion, endothelial dysfunction and hypertension preeclampsia
bp, proteinuria, reflexes urine output, pain, affect/irritability are assessed to determine mild vs severe preeclampsia
a bp of 160/110 x2 or MAP of greater than 105 is considered severe preeclampsia
a bp of 140/90 x2 atleast 4-6hrs apart or a MAP of greater than 105 is considered mild preeclampsia
proteinuria of 0.3g in 24 hrs is mild preeclampsia
proteinuria of 2g in 24 hrs is severe preeclampsia
hyperreflexia greater than or equal to 3+ with possible clonus indicates severe preeclampsia
2+ reflexes indicates mild preeclampsia
out of bp, proteinuria and reflexes, what has to be increased to differentiate severe preeclampsia from mild one parameter
if urine output is 20ml/hr severe preeclampsia
blurred vision with blind spots severe preeclampsia
severe headache severe preeclampsia
no visual problems but decreased urine output of less than 30/hr mild preeclampsia
platelets below 100k severe preeclampsia
late decels, IUGR severe preeclampsia
minimal fetal effects mild preeclampsia
if the placenta infarcts at birth severe preeclampsia
transient affect/irritibility mild preeclampsia
continuously present affect/irritability severe preeclampsia
epigastric pain indicates liver involvement and what form of preeclampsia severe
serum creatinine elevated at greater than 1.1mg/dl can indicate severe preeclampsia
in mild preeclampsia platelets, serum creatinine, AST, ALT, LDH are all normal
normal platelet levels 150-400k
IUGR can be assessed by a low measurement of the fundal height
what trimester is the period of lowest BPs second trimester
why are BPs normally low in the second trimester decreased by hormones
when is preeclampsia normally diagnosed second trimester
normal blood pressure according to JNC less than 120/80
prehypertensive 120-139/80-89
stage I, mild HTN 140-159/90-99
stage II, severe HTN greater than 160 systolic or 100 diastolic
what is the most effective and reliable method for measuring bp? at level of heart
if the client is laying on their right side which arm should you take the bp on? right side
chronic hypertension does not resolve in postpartum
physical findings of chronic htn increased hr, sudden or gradual onset of pulmonary edema and chf, increased activity of ANS and ECG indicating increased thickness in the left ventricular wall
increased ANS activity and an ECG indicating increased left ventricular wall thickness indicates chronic htn
treatment for chronic htn includes bp monitoring, daily weights, antepartum testing, fetal kick counts and sometimes medication
how should you teach a preg woman to monitor her bp daily, in same position, log results
how should you teach a preg woman to monitor her weight daily, at same time, log results
when would medication be indicated in htn during pregnancy a diastolic bp between 90-104
what medication is the first choice for htn during pregnancy methyldopa
when would methyldopa be used if bp is above 150-160/100-110
should a woman with chronic htn continue her antihypertensives during pregnancy no
seizure or coma indicates eclampsia
the sickest patient preeclampsia superimposed on chronic htn
elevated htn, thrombocytopenia and increased liver enzymes indicate preeclampsia superimposed on chronic htn
HTN, no signs of proteinuria and resolves by 12 wks postpartum transient HTN
diagnosed by week 20, HTN with or without proteinuria preeclampsia
a weight gain of 5-6lbs in a week can indicate preeclampsia or CHF
preeclampsia affects what organ multiple organs are affected
a multisystem vasospastic disease process of reduced organ perfusion preeclampsia
if htn but no proteinuria, suspect what if h/a, blurred vision, abdominal pain and abnormal labs preeclampsia
what is the priority for preeclampsia reduce risk for seizure
what is the cure for preeclampsia? delivery of the placenta
if a woman develops preeclampsia before 30 wks or was superimposed on chronic htn what chance does she have of recurrence in subsequent pregnancies 65%
if a dx of preeclampsia occurs in the last trimester what is the chance of recurrence in subsequent pregnancies 25%
what age groups are at higher risk for preeclampsia under 19 and over 35
over age 40 increases the risk of preeclampsia by how much if primigravida 2-3 times
if a woman is pregnant for the second time but with a new partner she may be at higher risk for preeclampsia
if a woman has a hx of fetal hydrops or hydatiform mole she is at increased risk for developing preeclampsia
the two highest priorities of nursing care for the patient with preeclampsia are prevent seizures and keep the airway clear
how is preeclampsia different from hypertension decreased perfusion as a result of vasospasm
vasospasm impedes blood flow to all organs
oxygenation and perfusion are impaired in preeclampsia
do all women with preeclampsia have edema no
decreased organ perfusion, endothelial dysfunction and hypertension preeclampsia
bp, proteinuria, reflexes urine output, pain, affect/irritability are assessed to determine mild vs severe preeclampsia
a bp of 160/110 x2 or MAP of greater than 105 is considered severe preeclampsia
a bp of 140/90 x2 atleast 4-6hrs apart or a MAP of greater than 105 is considered mild preeclampsia
proteinuria of 0.3g in 24 hrs is mild preeclampsia
proteinuria of 2g in 24 hrs is severe preeclampsia
hyperreflexia greater than or equal to 3+ with possible clonus indicates severe preeclampsia
2+ reflexes indicates mild preeclampsia
out of bp, proteinuria and reflexes, what has to be increased to differentiate severe preeclampsia from mild one parameter
if urine output is 20ml/hr severe preeclampsia
blurred vision with blind spots severe preeclampsia
severe headache severe preeclampsia
no visual problems but decreased urine output of less than 30/hr mild preeclampsia
platelets below 100k severe preeclampsia
late decels, IUGR severe preeclampsia
minimal fetal effects mild preeclampsia
if the placenta infarcts at birth severe preeclampsia
transient affect/irritibility mild preeclampsia
continuously present affect/irritability severe preeclampsia
epigastric pain indicates liver involvement and what form of preeclampsia severe
serum creatinine elevated at greater than 1.1mg/dl can indicate severe preeclampsia
in mild preeclampsia platelets, serum creatinine, AST, ALT, LDH are all normal
normal platelet levels 150-400k
preeclampsia is a continuum developing in what order mild to severe to HELLP to eclampsia (MSHE)
mild to severe to HELLP to eclampsia is the continuum of preeclampsia
HELLP is hemolysis, elevated liver enzymes and low platelets
HELLP is most often seen in caucasians older than 25 and multiparas
normal lab value of ALT 5-35
ALT....alot of 5s..... 5-35
AST.....abundance of silly threes..... 9-33
hemoglobin normal value 12-16
hemoglobin....little goblins....teens 12-16
hematacrit....hermit student....ages 37-47
fibrinogen 300-600
fibrin split products are normally absent or minimal
AST (SGOT) 9-33
ALT (SGPT) 5-35
bilirubin is increased if above 1.2
LDH 45-190
BUN 7-23
BUN....had nice buns.... 7-23
creatinine is increased is over 0.9
how does HTN in preg affect potassium increases, for example 7.7
normal mag levels 1.8-2.6
therapeutic levels of magnesium 4-8
respiratory depression occurs at what mag level 14
diminished reflexes occur at what mag level 9-14
peticia, bleeding gums, increased bruising may be signs of HELLP
malaise, epigastric pain, n/v may be signs of HELLP
do all HELLP pts have signs of proteinuria or high bp? no
platelets are transfused to maintain a count of what if a CS is required? greater than 50,000
a productive or non productive cough and anxiety/restlessness and apprehension may indicate HELLP
HELLP pts should be assessed how for respiratory symptoms of pulmonary edema auscultate lungs every hour
neck vein distention is a sign of pulmonary edema
abnormal breath sounds are rales and wheezing, dyspnea, tachypnea
is low oxygen saturation an early or late finding in HELLP late
seizures/cerebral hemorrhage is possible with persistent=severe headaches, tinnitus, visual changes, hyperreflexia, irritability or change in behavior, nuchal rigidity, slurring speeck, n/v
nuchal rigidity is seen when one arm goes rigid
new onset of vomiting, nausea indicate increased intracranial pressure
a firm sternal rub may elicit what response nuchal rigidity
visual changes associated with HELLP are diplopia, blind spots, flashes of light
headaches that can lead to cerebral hemorrhage/seizures often occur where frontal or occipital
what stops for baby during a seizure perfusion
a foley and strict I&O are required after administration of mag
proteinuria of 2-3+ on 2 or more occassions indicate the need for a 24hr urine
bs baseline needed on admission because hypoglycemia can be caused by liver dysfunction associated with HELLP
delivery is indicated if the gestational age is 38+ weeks and the platelets are over 100k
if a preg woman shows persistent CNS or hepatic signs what is indicated? delivery
what is the best delivery method for HELLP vaginal
if a pt is on mag sulfate how will induction be handled oxytocin at higher dose may be required
when calling for epidural what lab must you be aware of platelets
proteinuria of less than 3grams, stable BP and no subjective complaints can be managed at home
activity restriction and home care is a plan of care for mild preeclampsia
severe preeclampsia is treated in dr office or hospital hospital
critical care unit is preferred if invasive hemodynamic monitoring is needed
the goal of mag sulfate is absence of seizures
interferes with relay of acetyclcholine at synapsis mag sulfate
loading dose of mag sulfate 4-6 grams over 20-30 mins
when administering mag sulfate loading dose vitals should be taken every 5-15min, then every 30-60 min
mag sulfate should be used with caution if the pt has impaired renal function
what usually happens to bp when on mag sulfate drops but then may climb
why is it important to watch the urine output while on mag sulfate excreted in kidneys, if not putting out 30ml/hr urine, mag levels could become toxic
flushing is a sign of what mag level? toxic
what is the first side effect to go with toxicity deep tendon reflexes
a mag level of 15 may show what side effect respiratory distress
a mag level of 25 can lead to cardiac arrest
what is the antidote for mag sulfate calcium gluconate
mag will have what affect on FHR decreased variability
fetal affect at birth when mag has been administered hypotonia, respiratory depression and decreased suck reflex
what should you always remember when drawing labs to monitor mag sulfate levels draw in opposite arm administered
how often after loading dose of mag should labs be drawn every 6 hrs
what assessment is the priority when administering mag sulfate? pulse rate/rhythm and quality
what assessments should be done hourly when administering mag sulfate i&o, dtrs, loc and lungs q 2hrs (may have hrly protocol)
vascular damage occurs at what bp level 180-120
if bp is not reduced what will occur cerebral hemorrhage/seizure/stroke
what is the first assessment sign of mag toxicity decreased deep tendon reflexes
what is the highest priority nursing dx for preeclampsia and why injury, risk for seizures because it will affect airway
what is the standard activity order for preeclampsia bed rest or restricted activity
what position should the preeclampsia pt be in lateral lye
glucocorticoids to increase fetal lung maturity can be given after what GA 32 wks or less
intracrania hemorrage is a risk for how long after a seizure up to 6 hours
drowsiness, c/o flashes of light, stupor, focal neuro deficits, sudden increase in bp are all signs of intracranial hemorrhage
postpartum challenge after administration of mag bleeding due to relaxed uterus
when on mag sulfate care should be 1:1 with hrly VS & assessments
when do preeclampsia and eclampsia usually resolve within 48 hrs from birth to several weeks
when is mag sulfate stopped weaned 12-24 hours after birth
what is the highest risk postpartum for mag sulfate recipeients boggy uterus, bleeding
HELLP usually resolves within how long from birth 72-96 hours
signs of mag toxicity BURP...decreased blood pressure, urine, respirations and reflexes
Created by: Lori Dobrisky