L7v2-HTN Disorders in pregnancy

What is the criteria for diagnosis of gestational hypertension?

onset of hypertension after 20 weeks

• BP > 140/90 (only one pressure needs elevation; systolic OR diastolic; or both can be elevated)

• Need two elevated measures at least 4 hours apart

What is the criteria for diagnosis of preecelampsia?

hypertension & proteinuria that develop after 20 weeks gestation and one of the following:

• Thrombocytopenia

• Elevated liver enzymes

• Renal insufficiency

• Pulmonary edema

• Cerebral or visual disturbances

• RUQ pain

• Epigastric pain

• Pulmonary edema

What is the criteria for diagnosis of eclampsia?

preeclampsia + seizures

What is the criteria to be diagnosed with chronic hypertension?

• hypertension that existed prior to pregnancy

OR

• hypertension persisting longer than 12 weeks postpartum

What is the criteria to be diagnosed with chronic hypertension with superimposed preeclampsia?

• sudden increase in BP that previously well controlled

OR

• new-onset proteinuria or a sudden increase in proteinuria in a patient known to have proteinuria before conception or early in pregnancy

What are the risk factors for preeclampsia?

• Nulliparity

• Maternal age > 35yrs

• Preeclampsia in previous pregnancy

• Family hx (mother/sister)

• First pregnancy with new partner

• Partner who fathered a preeclamptic pregnancy in another woman

• Multifetal gestation

• obesity

• chronic HTN

• pregestational diabetes

What is the etiology of preeclampsia?

1. inadequate vascular remodeling

2. decreased placental perfusion and hypoxia

3. endothelial cell dysfunction

4. vasospasm / increased peripheral resistance / increased endothelial cell permeability

5. decreased tissue perfusion

How does preeclampsia relate to IUGR (Intrauterine growth restriction) (PATHO)?

1. vasospasm cause increased BP

2. arteriolar vasospasms result in decreased perfusion of placenta, kidneys, liver, and brain

3. decreased perfusion in placenta leads to early degenerative aging of the placenta, and decreased oxyegn and nutrients to fetus resulting in IUGR

What is HELLP Syndrome and what are the signs?

life-threatening complication of preeclampsia

• H — hemolysis of RBCs

• EL — Elevated liver enzymes (AST, ALT, LDH) or history of hepatic damage

  • RUQ or epigastric pain; hyperbilirubinemia)

• LP — low platelets and history of bleeding (<100,000)

What are the abnormal ranges for the elevated liver enzymes?

• AST > 70 (normal 4-20)

• LDH > 600 (normal 45-90)

• ALT > 50 (normal 3-21)

What medication would a PT with preeclampsia take to prevent/treat seizures?

magnesium sulfate

What are the s/s of severe preeclampsia?

• severe HAs

• blurred vision

• mental confusion

• RUQ or epigastric pain

• N/V

• SOB

• decreased UO

A nurse is preparing to administer a loading dose of magnesium sulfate to a client with severe preeclampsia. Which prescription should the nurse expect?

4–6 g IV over 15–30 minutes via IVPB

After receiving a magnesium sulfate loading dose, the nurse anticipates which maintenance infusion?

1–2 g/hr via IVPB

The therapeutic serum magnesium level for seizure prophylaxis is _____________

4–7 mEq/L.

What device should be used when administering magnesium sulfate?

infusion pump

After being administered magnesium sulfate what are some expected side effects?

• will feel flushed and hot (systemic vasodilation) — cardiovascular

• feels “heavy” and difficult to move extremities easily — musculoskeletal

What are the mild signs of magnesium sulfate toxicity?

• Lethargy

• muscle weakness

• decreased/absent DTRs

• double vision

• slurred speech

What are the severe signs of magnesium sulfate toxicity?

Suppresses CNS

• hypotension

• bradycardia

• bradypnea

• cardiac arrest

If magnesium sulfate toxicity occurs, what is the nurse’s immediate action?

stop infusion and give calcium gluconate

What is magneisum sulfate contraindicated?

• myasthenia gravis (respiratory failure)

• heart block

• myocardial insufficiency

• renal disease

What drugs are used to treat severe hypertension (>160/110) in pregnancy?

• hydralazine (apresoline)

• labetalol (trandate)

• nifedipine (procardia)

If a pregnant PT has a BP > 160/110 (severe hypertension), what are they at risk for?

• stroke

• placental disruption

• seizures

A pregnant PT with a BP > 160/110 and asthma should avoid which BP medication?

labetolol (trandate)

• beta blocker that causes bronchospasm

Which BP medication can help treat severe hypertension and can be taken orally?

nifedipine

A client with severe preeclampsia develops postpartum hemorrhage due to uterine atony. Which medication should the nurse question?

Methylergonovine (Methergine)

• Methergine increases blood pressure through vasoconstriction and is contraindicated in clients with hypertension or preeclampsia.

A client with severe preeclampsia is receiving a magnesium sulfate infusion. The provider prescribes oral nifedipine. Which assessment finding should the nurse report immediately?

hypotension

• Both medications cause vasodilation and can significantly lower blood pressure. Severe hypotension can decrease maternal and placental perfusion.

What is the priority of assessment for a women experiencing eclampsia?

Airway-breathing-pulse

Which complications are associated with chronic hypertension?

• superimposed preeclampsua

• placental abruption

• IUGR

• preterm birth

At which blood pressure is chronic hypertension diagnosed?

140/90

Which medications are used to help treat chronic hypertension in pregnant PTs?

• methyldopa (aldomet)

• labetalol (trandate)

• nifedipine (procardia)

Which BP meds are contraindicated for pregnant PTs?

ARBs (-sartan) & ACEi (-pril)

• These medications can cause serious fetal complications

What are the maternal complications of hypertensive disorders during pregnancy?

• Placental abruption

• Stroke, cerebral hemorrhage, seizures

• Hepatic or renal failure, coagulopathies

• Disseminated intravascular coagulation (DIC)

• Pulmonary edema

What are the fetal complications of hypertensive disorders during pregnancy?

• placental insufficiency

• IUGR

• prematurity

• hypoxia/acidosis