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