Unit 2 3SEM PIH Gabe quizlet deck

How is the vascular system altered by pregnancy?
Normal resting HR for pregnant women?

Cardiac Output rises as early as 1st trimester, reaching peak values at 20-24 week. This is due to a 50% increase in blood volume (stroke volume) and a 30% increase in HR.
Normal resting HR for pregnant woman can be on average 20 bpm faster than normal

Why does the body produce more blood during pregnancy

Uterine blood flow increases by at least 1 liter per minute, requiring the body to produce more blood during pregnancy

Types of hypertensive disorders in pregnancy

Chronic Hypertension
Gestational Hypertension
Preeclampsia
Eclampsia
Chronic hypertension with superimposed preeclampsia

chronic hypertension in pregnancy

BP of 140/90 or more that exists prior to pregnancy or before 20 weeks gestation

Gestational hypertension

Temporary blood pressure elevation (140/90) on at least 2 occasions 4-6 hours apart after 20 weeks gestation without proteinuria. Blood pressure returns to normal by 12 weeks post partum
Women known to be normotensive prior to this time and prior to pregn

preeclampsia

most common hypertensive disorder of pregnancy. develops with proteinuria after 20 weeks gestation.
multisystem, vasopressive disorder that targets the cardiovascular, hepatic, renal, and central nervous systems.
Can cause widespread pathologic changes th

Chronic hypertension with superimposed preeclampsia

occurs in approximately 20% of pregnancy women with increased maternal and fetal morbidity rates.
This condition occurs in women who have been diagnosed with chronic high BP before pregnancy but worsen and develop proteinuria or other health complications

Diagnostics for hypertension in pregnancy

24 hour urine
CBC
serum electrolytes
BUN
creatinine
Liver panel
ECG
echocargiogram
Nonstress test beginning at approximately 32 weeks gestation
Serial ultrasounds to assess fetal growth and amniotic fluid volume
Question woman about fetal movement and eva

Management of pregnancy induced hypertension

PEACE
Promote bedrest, quiet environment
Ensure high protein intake (1g/kg / day)
Antihypertensive drug: Hydralazine (Apresoline)
Convulsions (Magnesium Sulfate)
Evaluate Physical Parameters

Drug therapy for hypertension in pregnancy

diuretics like Lasix to prevent heart failure
Digitalis to increase contractility and decrease HR
Antiarrhythmic agents (lidocaine)
Beta blockers (labetalol)
Calcium Channel Blockers (nifedipine) to treat hypertension
Anticoagulants (low molecular weight

Which hypertensive drug is NOT recommended for pregnant women and why?

Warfarin (Coumadin)
It crosses the placenta and has been associated with spontaneous abortion, multiple birth defects, fetal growth restriction, and stillbirth

All types of shock have these things in common:

Hypoperfusion of tissues
Sympathetic nervous system is activated
Hypermetabolic response
Inflammatory response

Mean Arterial BP =

#NAME?

Cardiac output =

#NAME?

Peripheral Resistance is determined by:

arteriole diameter

MAP

Mean arterial pressure, must exceed 65

pulse pressure = (and normal value)

systolic pressure - diastolic pressure
30-40
Narrowed or decreased pulse pressure is an earlier indicator or shock than a drop in BP

When should you notify a healthcare provider for shock patients?

- report a systolic lower than 90
- report a drop in systolic of 40
- report a map less than 65
- report a narrowing or decreased pulse pressure

Neurogenic shock has a higher risk of:

DVT

Most common colloid used to treat hypovolemic shock is:

5% Albumin

What is taken during 1st trimester that significantly reduces the incidence of Gestational HTN

Progesterone

Preeclampsia diagnosis with proteinuria?

Mild" is no longer used to categorize the severity of preeclampsia. The woman has it or not, with or without severe features (thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, visual or cerebral changes). Proteinuria is no

Gestational age recommendation for birth for women with eclampsia and preeclampsia

The ACOG recommends women with preeclampsia without severe features should give birth at 37 0/7 weeks; and women with preeclampsia with severe features give birth at 34 0/7 weeks

Blood pressure levels & hypertension classifications

Normal: systolic less than 120 mm Hg, diastolic less than 80 mm Hg
Prehypertension: systolic 120 to 139 mm Hg, diastolic 80 to 89 mm Hg
Mild hypertension: systolic 140 to 159 mm Hg, diastolic 90 to 99 mm Hg
Severe hypertension: systolic 160 mm Hg or highe

What can be done before pregnancy to reduce the chances of pregnancy hypertension?

Preconception counseling is important in fostering positive outcomes. Typically, it involves lifestyle changes such as diet, exercise, weight loss, and smoking cessation.
Treatment for women with chronic hypertension focuses on maintaining normal blood pr

When to administer antihypertensives in pregnancy?

Once the woman is pregnant, antihypertensive agents are typically reserved for severe hypertension >160 mm Hg systolic and >100 mm Hg diastolic

Anti-Hypertensives used with pregnancy

Methyldopa (Aldomet) is commonly prescribed because of its safety record during pregnancy. This slow-acting antihypertensive agent helps to improve uterine perfusion.
Other antihypertensive agents that can be used include labetalol (Trandate), atenolol (T

What other medication besides anti-hypertensives can pregnant women with hypertension take?

daily low-dose aspirin (81 mg/day) after 12 weeks of pregnancy in women with chronic hypertension and other risk factors who are at high risk for preeclampsia to reduce its occurrence.

How often should a pregnant woman with hypertension be seen by her doctor?

The woman with chronic hypertension will be seen more frequently (every 2 weeks until 28 weeks and then weekly until birth) to monitor BP and to assess for any signs of preeclampsia.
At approximately 24 weeks' gestation, the woman will be instructed to do

Risk factors for hypertension in pregnancy

The pathogenesis of hypertension is multifactorial and includes many modifiable risk factors such as smoking, obesity, caffeine intake, excessive alcohol intake, excessive salt intake, and use of nonsteroidal anti-inflammatory drugs (NSAIDs).
Also be aler

Signs of abruptio placenta

Sudden onset of dark red vaginal bleeding, sharp abdominal pain, and tender rigid uterus (board like)

Signs of superimposed preeclampsia

elevation in blood pressure, weight gain, edema, proteinuria

How to maximize placental perfusion with hypertensive pregnant women?

Stress the importance of daily periods of rest (1 hour) in the left lateral recumbent position to maximize placental perfusion. Encourage women with chronic hypertension to use home blood pressure monitoring devices. Urge the woman to report any elevation

Mild Preeclampsia Requirements

BP greater than 140/90 after 20 weeks
Proteinuria - 300mg/ 24 hr or greater than 1+ protein on at least two random urine samples collected at least 4 to 6 hours apart with no evidence of urinary tract infection
Mild facial or hand edema
Weight gain
NO sei

Severe preeclampsia requirements

BP greater than 160/110
Proteinuria - Greater than 500 mg/ 24 hour, greater than than 3+ on a random dipstick urine sample
Hyperreflexia
Headache
Oliguria
Blurred vision
Scotomata (blind spots)
Pulmonary edema
Thrombocytopenia (platelet count less than 10

Hyperreflexia

Overactive or overresponsive reflexes. Examples of this can include twitching or spastic tendencies
Result of nervous system damage

Thrombocytopenia

low platelet count (usually less than 100,000)

HELLP syndrome

hemolysis, elevated liver enzymes, low platelet count

Eclampsia Requirements

BP greater than 160/110
Marked Proteinuria
Seizures/ Coma
Hyperreflexia
Generalized edema
Severe headache
RUQ or epigastric pain
Visual disturbances
Cerebral hemorrhage
Renal failure
HELLP syndrome

preeclampsia stages

2 - vasospasm and then hypoperfusion
The first stage of generalized vasospasm results in elevation of blood pressure and reduced blood flow to the brain, liver, kidneys, placenta, and lungs.

abruptio placentae

premature separation of the placenta from the uterine wall

Treating Preeclampsia

Management varies depending on the severity of her condition and its effects on the fetus.
The "cure" for preeclampsia/eclampsia is always delivery of the placenta.

What to take to prevent preeclampsia

According to recent studies, prevention of preeclampsia should be considered with daily low-dose aspirin from 12 weeks' gestation and onward to women identified at high risk for it.

management of mild preeclampsia

Woman has no signs of renal or hepatic dysfunction
A woman with mild elevations in BP may be placed on bed rest at home- lateral recumbent position to improve uteroplacental blood flow, reduce BP, and promote diuresis.
Antepartal visits and diagnostic tes

Diet for mild preeclampsia

A balanced, nutritional diet with no sodium restriction is advised.
In addition, she is encouraged to drink six to eight 8-oz glasses of water daily

Management of severe preeclampsia

Birth of the infant is the only cure, because preeclampsia depends on the presence of trophoblastic tissue. Therefore, the exact age of the fetus is assessed to determine viability.
Therapy focuses on controlling hypertension, preventing seizures, prevent

Labor with preeclampsia

Vaginal delivery preferred. PGE2 gel may be used to ripen the cervix. A c section if they are seriously ill
The woman in labor with severe preeclampsia typically receives oxytocin to stimulate uterine contractions and magnesium sulfate to prevent seizure

Magnesium dose for preeclampsia labor

Magnesium sulfate is given intravenously via an infusion pump. A loading dose of 4 to 6 g is given over 5 minutes. Then, a maintenance dose of 2 g/hr is given.

Monitoring after preeclampsia labor with magnesium sulfate

A newborn whose mother received high doses of magnesium sulfate needs to be monitored for respiratory depression, hypocalcemia, and hypotonia (muscle weakness), loss of reflexes, neurologic depression.
Decreased fetal heart rate variability may occur but,

eclampsia seizure

The convulsive activity begins with facial twitching, followed by generalized muscle rigidity.
The woman's face initially may become distorted, with protrusion of the eyes, and foaming at the mouth may occur.
Respirations cease for the duration of the sei

Management of eclampsia

As with any seizure, the initial management is to clear the airway and administer adequate oxygen.
Positioning the woman on her left side and protecting her from injury during the seizure are key.
Suction secretions from her mouth after the seizure is ove

monitoring after eclampsia seizure

Serum magnesium levels, respiratory rate, reflexes, and urine output in women receiving magnesium sulfate are closely monitored to avoid magnesium toxicity and prevent cardiac arrest.

Risk factors for preeclampsia

Primigravida status
Chromosomal abnormalities
Structural congenital anomalies
Multiple gestation
History of preeclampsia in a previous pregnancy
Excessive placental tissue, as is seen in women with GTD
Chronic stress
Use of ovulation drugs
Family history

nutritional assessment for preeclampsia

complete a nutritional assessment that includes the woman's usual intake of protein, calcium, daily calories, and fluids.

teaching for women with preeclampsia

Rest in a quiet environment to prevent cerebral disturbances.
Drink 8 to 10 glasses of water daily.
Consume a balanced, high-protein diet including high-fiber foods.
Obtain intermittent bed rest to improve circulation to the heart and uterus.
Limit your p

When should a woman at home with preeclampsia contact the home health nurse

Contact the home health nurse if any of the following occurs:
Increase in blood pressure
Protein present in urine
Gain of more than 1 pound in 1 week
Burning or frequency when urinating
Decrease in fetal activity or movement
Headache (forehead or posterio

interventions for severe preeclampsia

Maintain the client on complete bed rest in the left lateral lying position.
Ensure that the room is dark and quiet to reduce stimulation.
Give sedatives as ordered to encourage quiet bed rest.
Institute and maintain seizure precautions, such as padding t

Assessing severe eclampsia

Closely monitor the client's blood pressure.
Assess the client's vision and level of consciousness.
Report any changes and any complaints of headache or visual disturbances.
Assess the woman for signs and symptoms of pulmonary edema, such as crackles and

Treating pulmonary edema in eclampsia

The treatment of acute pulmonary edema is symptomatic and includes the administration of vasodilating agents and of diuretics. The development of acute pulmonary edema in women with hypertension during pregnancy is associated with high levels of IV fluid

Magnesium sulfate for Preeclampsia

Blockage of neuromuscular transmission, vasodilation
Prevention and treatment of eclamptic seizures
Loading dose of 4-6 g by IV in 100 mL of fluid administered over 15-20 minutes, followed by a maintenance dose of 2 g as a continuous intravenous infusion.

magnesium sulfate for eclampsia nursing considerations

Monitor serum magnesium levels closely.
Assess DTRs and check for ankle clonus.
Have calcium gluconate readily available in case of toxicity.
Monitor for signs and symptoms of toxicity, such as flushing, sweating, hypotension, and cardiac and central nerv

Hydralazine Hydrochloride (Apresoline) for eclampsia + nursing considerations

Vascular smooth muscle relaxant, thus improving perfusion to renal, uterine, and cerebral areas
Reduction in blood pressure
Administer 5-10 mg by slow intravenous bolus every 20 min as needed.

Labetalol Hydrochloride (Normodyne) for eclampsia + nursing considerations

Alpha-1 and beta blocker
Reduction in blood pressure
Be aware that drug lowers blood pressure without decreasing maternal heart rate or cardiac output.
Administer IV dose of 20-40 mg every 15 min as needed and then administer intravenous infusion of 2 mg/

Nifedipine (Procardia) for eclampsia + nursing considerations

Calcium channel blocker/dilation of coronary arteries, arterioles, and peripheral arterioles
Reduction in blood pressure, stoppage of preterm labor
Administer 10-20 mg orally for three doses and then every 4-8 hr.
Monitor for possible adverse effects such

Sodium Nitroprusside for eclampsia plus nursing considerations

Rapid vasodilation (arterial and venous)
Severe hypertension requiring rapid reduction in blood pressure
Administer via continuous IV infusion with dose titrated according to blood pressure levels.
Wrap intravenous infusion solution in foil or opaque mate

Furosemide (Lasix) in eclampsia

Diuretic action, inhibiting the reabsorption of sodium and chloride from the ascending loop of Henle
Pulmonary edema (used only if condition is present)
Administer via slow IV bolus at a dose of 10-40 mg over 1-2 min.
Monitor urine output hourly.
Assess f

Testing for the fetus during eclampsia

Testing may include the nonstress test, serial ultrasounds to track fetal growth, amniocentesis to determine fetal lung maturity, Doppler velocimetry to screen for fetal compromise, and biophysical profile to evaluate ongoing fetal well-being

Lab tests for eclampsia

Tests may be performed to determine if it is progressing into HELLP syndrome.
These include:
Liver enzymes such as lactic dehydrogenase (LDH), ALT, and AST
Chemistry panel, such as creatinine, BUN, uric acid, and glucose
CBC, including platelet count
Coag

clonus in eclampsia

Clonus is the presence of rhythmic involuntary contractions, most often at the foot or ankle. Sustained clonus confirms CNS involvement.

Serum magnesium levels

Although exact levels may vary among agencies, serum magnesium levels ranging from 4 to 7 mEq/L are considered therapeutic, whereas levels more than 8 mEq/dL are generally considered toxic.
As levels increase, the woman is at risk for severe problems:
10

When is HELLP diagnosed?

Although it has been reported as early as 17 weeks' gestation, most of the time it is diagnosed between 22 and 36 weeks' gestation

HELLP Maternal Risks

HELLP syndrome leads to an increased maternal risk for developing liver hematoma or rupture, stroke, cardiac arrest, seizure, pulmonary edema, DIC, subendocardial hemorrhage, adult respiratory distress syndrome, renal damage, sepsis, hypoxic encephalopath

HELLP Complications

Women with HELLP syndrome are at increased risk for complications such as cerebral hemorrhage, retinal detachment, hematoma/liver rupture, acute renal failure, disseminated intravascular coagulation (DIC), placental abruption and maternal death

HELLP Treatment

The treatment for HELLP syndrome is based on the severity of the disease, the gestational age of the fetus, and the condition of the mother and fetus.
The mainstay of treatment is lowering of high blood pressure with rapid-acting antihypertensive agents,

Medications for HELLP

Magnesium sulfate is used prophylactically to prevent seizures.
Antihypertensives such as hydralazine or labetalol are given to control blood pressure.
Blood component therapy - such as fresh-frozen plasma, packed red blood cells, or platelets - is transf

Labs in HELLP

A diagnosis of HELLP syndrome is made based on laboratory test results, including:
Low hematocrit that is not explained by any blood loss
Elevated LDH (liver impairment)
Elevated AST (liver impairment)
Elevated ALT (liver impairment)
Elevated BUN
Elevated

Nursing assessment for HELLP

Similar to that for the woman with severe preeclampsia.
Be alert for complaints of nausea (with or without vomiting), malaise, epigastric or right upper quadrant pain, and demonstrable edema.