4. HTN & Blood

what is gestational hypertension?

new hypertension after 20 weeks in a previously normotensive patient, without features of preeclampsia

gestational hypertension presents _____ signs of preeclampsia

without

treatment for gestational hypertension

normal HTN management

• diet changes

• monitor blood pressure at home

• aspirin

• teach patient signs to watch out for

what is preeclampsia?

new-onset hypertension after 20 weeks with proteinuria and/or signs of organ dysfunction

what is mild preeclampsia ?

preeclampsia without severe features

• hypertension ≥140/90 but below 160/110 mmHg

• may be present proteinuria

what home care is needed for mild preeclampsia?

• daily BP monitoring

• fetal movement counts

• report headache, visual changes, or upper abdominal pain

what is severe preeclampsia?

preeclampsia with BP more than or equal to 160/110 and/or significant organ dysfunction

signs of severe preeclampsia

• severe hypertension: BP ≥160 systolic or ≥110 diastolic

• persistent headache

• blurred vision

• hyperreflexia

• thrombocytopenia

• edema

how is preeclampsia with severe features managed?

hospitalization

• oxytocin for labor induction

• magnesium sulfate

• preparation for birth

• seizure precautions

medication used for preeclampsia patients during labor

iv magnesium sulfate

• decreases excitability in the central nervous system, reducing the risk of seizures

what is eclampsia?

new-onset seizures in a patient with a pregnancy-related hypertensive disorder that cannot be explained by another cause

what distinguishes eclampsia from preeclampsia?

seizures

how is eclampsia managed?

• seizure management

• administer magnesium sulfate

• administer antihypertensives

• prepare for birth after seizures are controlled

what should the nurse assess with pregnancy-related hypertension?

• risk factors

• BP

• nutritional intake and weight

• edema

• urine protein

• other indicated labs

what nursing care is needed during hospitalization for severe preeclampsia?

• maintain a quiet environment

• implement seizure precautions

• administer prescribed antihypertensives

• assess deep tendon reflexes and magnesium toxicity

• monitor for labor

what should the nurse monitor during eclampsia management?

• seizures and maternal status

• fetal heart rate

• uterine contractions

• prepare for birth

• follow-up care

what does HELLP stand for?

• hemolysis (RBCs destroyed)

• elevated liver enzymes (liver cells are damaged)

• low platelets (increased bleeding risk)

characteristic HELLP sign

epigastric or RUQ pain from liver cell destruction

• might feel like heartburn

how is HELLP managed?

similarly to severe preeclampsia

• closely monitor maternal status and laboratory results

• stabilize the patient and prepare for birth

which medications lower BP in severe preeclampsia or HELLP? *

• CCBs: nifedipine (Procardia)

• beta blockers: labetalol

• ARBs & ace inhibitors are contraindicated in pregnancy

why is magnesium sulfate given for preeclampsia or eclampsia?

to prevent or control seizures

what effect can magnesium sulfate have on uterine contractions?

tocolytic: relaxes uterine smooth muscle and can suppress contractions

what findings suggest magnesium toxicity? *

• decreased/absent DTRs

• respiration depression

• lethargy / decreased consciousness

• cardiac complications (cardiac arrest)

• decreased urine output

effect of magnesium toxicity on respirations *

depresses diaphragm → decreased respiratory rate

• BAD sign

• nurse must MONITOR RESPIRATIONS on magnesium

what urine output should be reported during magnesium sulfate therapy? *

less than 30 mL/hr

why does decreased urine output increase magnesium-toxicity risk? *

reduced renal excretion allows magnesium to accumulate

what is the antidote for magnesium toxicity?

calcium gluconate

what position helps improve uteroplacental perfusion in severe preeclampsia or HELLP? *

left lateral position

what should never be placed in the mouth during an eclamptic seizure? *

anything, including fingers or objects

what maternal and fetal blood types commonly cause ABO incompatibility?

type O mom with type A or B fetus

• usually less severe than Rh incompatibility

how does Rh sensitization occur?

1. an Rh-negative mother is exposed to Rh-positive fetal blood and produces antibodies

2. antibodies can attack fetal RBCs in subsequent Rh-positive pregnancies

what blood information is assessed early in pregnancy?

• maternal ABO blood type

• Rh status;antibody screen

what does the maternal indirect Coombs test detect?

circulating antibodies against RBC antigens

• positive result = prior sensitization

what does a positive direct Coombs test in a newborn mean?

antibodies are attached to the newborn’s RBCs

which pregnant patients receive RhoGAM? *

unsensitized Rh-negative patients

• prevents antibody formation

• does not reverse existing sensitization

when is routine RhoGAM given during pregnancy? *

at 28 weeks

when is postpartum RhoGAM given to an unsensitized Rh-negative mother? *

within 72 hours after birth if the newborn is Rh-positive