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OB-HTN
Preg at risk-htn disorders in pregnancy
| Question | Answer |
|---|---|
| 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
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