NURS 403 - Hypertensive Disorders During Pregnancy

chronic hypertension

hypertension diagnosed before pregnancy or before 20 weeks gestation, or hypertension that persists more than 12 weeks postpartum

gestational hypertension

new-onset hypertension diagnosed after 20 weeks gestation without proteinuria that resolves by 12 weeks postpartum

20 weeks

gestational hypertension is new-onset hypertension diagnosed after _____ gestation without proteinuria that resolves by 12 weeks postpartum

12 weeks

gestational hypertension is new-onset hypertension diagnosed after 20 weeks gestation without proteinuria that resolves by _____ postpartum

preeclampsia

new-onset hypertension diagnosed after 20 weeks gestation with proteinuria

eclampsia

the onset of seizure activity in preeclampsia

chronic hypertension with superimposed preeclampsia

hypertension diagnosed before pregnancy or before 20 weeks gestation with new-onset proteinuria after 20 weeks gestation

Primigravida > 40 years of age

Chronic hypertension

History of preterm birth

Moderate to severe obstructive sleep apnea

Family history of cardiovascular disease

Obesity

Non-hispanic african descent

risk factors for hypertension during pregnancy (7)

when systolic blood pressure is > 140 mmHg and/or diastolic blood pressure is > 90 mmHg on two separate occasions at least four hours apart

when is gestational hypertension diagnosed?

Widespread vasospasm and hypoperfusion

The woman's response, when symptoms appear

development of preeclampsia occurs in two stages:

aspirin therapy

may be indicated to prevent preeclampsia

Blood pressure ≥ 140/90

Proteinuria

clinical manifestations of mild preeclampsia (2)

Multiple gestation

Previous pregnancy with preeclampsia

Renal disease

Autoimmune disease

Diabetes

First pregnancy

Periodontal disease

Advanced maternal age

In vitro fertilization

risk factors for mild preeclampsia (9)

Complete fetal kick counts and monitor blood pressure at home

Contact the provider with a decrease in fetal movement, increase in blood pressure, or any symptoms of severe preeclampsia (e.g., headache, dizziness, blurry vision, or epigastric pain)

Drink 8-10 oz of water per day

conservative home management for mild preeclampsia (3)

Platelets

Liver enzymes

CBC

Clotting studies

labs for mild preeclampsia (4)

hydralazine

labetalol

nifedipine

*medications for mild preeclampsia are aimed at decreasing blood pressure*

medication management for mild preeclampsia (3)

Blood pressure ≥ 160/110

Proteinuria

Hyperreflexia

Headache

Oliguria

Scotoma (blurred vision)

Pulmonary edema

Thrombocytopenia (platelet count < 100,000)

Cerebral disturbances

Epigastric pain

HELLP syndrome

Progressive renal insufficiency

clinical manifestations of severe preeclampsia (12)

delivery of the fetus and the placenta

the only cure for preeclampsia

betamethasone

magnesium sulfate (MgSO4)

medication management for severe preeclampsia (2)

betamethasone

a steroid indicated for mothers less than 34 weeks gestation to help improve the maturity of the fetal lungs

magnesium sulfate (MgSO4)

drug of choice to prevent and treat seizure activity in severe preeclampsia or eclampsia

4-6 g IV given over 15-30 min

magnesium sulfate (MgSO4) loading dose for severe preeclampsia

1-2 g IV per hr

magnesium sulfate (MgSO4) maintenance dose for severe preeclampsia

4-7 mEq/L

therapeutic magnesium serum level for patients on magnesium sulfate for severe preeclampsia

125 mL/hr

while on magnesium sulfate, patients should minimize hourly fluid intake to no more than _____

25-30 mL/hr

while on magnesium sulfate, patients should maintain urinary output of at least _____

Respiratory depression (RR < 12)

Decreased urine output (UO < 30 mL/hr)

Absent DTRs

signs of magnesium sulfate toxicity (3)

Minimal variability

Respiratory depression post-delivery

effects of magnesium sulfate on the fetus (2)

calcium gluconate

antidote for magnesium sulfate

eclampsia

the onset of seizure activity in preeclampsia

Blood pressure ≥ 160/110

Seizures

Hyperreflexia

Severe headache

Generalized edema

Epigastric pain

Visual disturbances

Cerebral hemorrhage

Renal failure

HELLP syndrome

clinical manifestations of eclampsia (10)

Maintain patient safety

Continue magnesium sulfate for 24 hours

Once the patient is stabilized, prepare for delivery

therapeutic management for eclampsia (3)

24 hours

how long should magnesium sulfate be continued for a woman with eclampsia?

Hemolysis

Elevated liver enzymes

Low platelet count

HELLP syndrome is an acronym for _____

Abnormal vascular tone

Vasospasm

Coagulation defects

HELLP syndrome is characterized by (3)

Disseminated intravascular coagulation (DIC)

Cerebral hemorrhages

Acute renal failure

Placental abruption

Eclampsia

Retinal detachment

Maternal death

complications of HELLP syndrome (7)

Hemolysis —> decreased H/H

Elevated Liver enzymes —> increased AST, ALT, and LDH

Low Platelets —> decreased platelet count (< 100,000)

labs for HELLP syndrome (3)