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Questions and Answers
Gestational hypertension is diagnosed when a pregnant woman, previously normotensive, exhibits a systolic blood pressure greater than 140 mmHg or a diastolic blood pressure greater than 90 mmHg. How far apart should the two elevated readings be?
Gestational hypertension is diagnosed when a pregnant woman, previously normotensive, exhibits a systolic blood pressure greater than 140 mmHg or a diastolic blood pressure greater than 90 mmHg. How far apart should the two elevated readings be?
- 4 hours (correct)
- 1 hour
- 6 hours
- 2 hours
Which of the following is the primary root cause of gestational hypertension (GHTN)?
Which of the following is the primary root cause of gestational hypertension (GHTN)?
- Maternal obesity with a BMI over 30
- Maternal age exceeding 35 years
- Spiral artery malformation in the placenta (correct)
- Pre-existing maternal hypertension
Gestational hypertension is typically resolved with the delivery of the placenta. How long does it usually take for a woman's blood pressure to return to baseline postpartum?
Gestational hypertension is typically resolved with the delivery of the placenta. How long does it usually take for a woman's blood pressure to return to baseline postpartum?
- By 12 weeks postpartum (correct)
- Within 6 weeks postpartum
- Within 24 hours postpartum
- Immediately after delivery
What percentage of women diagnosed with gestational hypertension (GHTN) may later be diagnosed with chronic hypertension?
What percentage of women diagnosed with gestational hypertension (GHTN) may later be diagnosed with chronic hypertension?
What percentage of women with gestational hypertension (GHTN) will progress to preeclampsia?
What percentage of women with gestational hypertension (GHTN) will progress to preeclampsia?
Preeclampsia is classified by new onset hypertension after 20 weeks gestation with or without proteinuria and/or other systemic findings. Which of the following platelet counts would indicate preeclampsia?
Preeclampsia is classified by new onset hypertension after 20 weeks gestation with or without proteinuria and/or other systemic findings. Which of the following platelet counts would indicate preeclampsia?
A pregnant patient is diagnosed with preeclampsia. Besides hypertension, which of the following new-onset findings would confirm the diagnosis, even in the absence of proteinuria?
A pregnant patient is diagnosed with preeclampsia. Besides hypertension, which of the following new-onset findings would confirm the diagnosis, even in the absence of proteinuria?
Which of the following blood pressure readings is indicative of severe preeclampsia?
Which of the following blood pressure readings is indicative of severe preeclampsia?
Which assessment finding is specifically associated with severe preeclampsia?
Which assessment finding is specifically associated with severe preeclampsia?
A pregnant patient with severe preeclampsia reports pain in the upper right quadrant. What condition should the nurse suspect?
A pregnant patient with severe preeclampsia reports pain in the upper right quadrant. What condition should the nurse suspect?
A pregnant woman diagnosed with severe preeclampsia suddenly experiences a seizure. What is the term for this progression of the disease?
A pregnant woman diagnosed with severe preeclampsia suddenly experiences a seizure. What is the term for this progression of the disease?
A client experiencing eclamptic seizures should have interventions performed for her safety. Which of the following interventions should NOT be performed during the seizure?
A client experiencing eclamptic seizures should have interventions performed for her safety. Which of the following interventions should NOT be performed during the seizure?
Which of the following is a key characteristic that distinguishes eclampsia from severe preeclampsia?
Which of the following is a key characteristic that distinguishes eclampsia from severe preeclampsia?
For a pregnant patient with eclampsia, after the convulsions cease, what is the priority nursing action?
For a pregnant patient with eclampsia, after the convulsions cease, what is the priority nursing action?
What laboratory findings are characteristic of HELLP syndrome?
What laboratory findings are characteristic of HELLP syndrome?
A pregnant patient is suspected of having HELLP syndrome, but her blood pressure is only slightly elevated and she has no protein in her urine. Which intervention is most important?
A pregnant patient is suspected of having HELLP syndrome, but her blood pressure is only slightly elevated and she has no protein in her urine. Which intervention is most important?
Which of the following statements is correct regarding HELLP syndrome and preeclampsia?
Which of the following statements is correct regarding HELLP syndrome and preeclampsia?
What is the primary treatment for HELLP syndrome?
What is the primary treatment for HELLP syndrome?
What is an early symptom commonly reported by women who are later diagnosed with HELLP syndrome?
What is an early symptom commonly reported by women who are later diagnosed with HELLP syndrome?
Which maternal factor increases a woman's risk for gestational hypertension (GHTN)?
Which maternal factor increases a woman's risk for gestational hypertension (GHTN)?
Which pre-existing condition increases a woman's risk for gestational hypertension (GHTN)?
Which pre-existing condition increases a woman's risk for gestational hypertension (GHTN)?
Which of the following findings during assessment of a pregnant woman with gestational hypertension (GHTN) requires immediate attention?
Which of the following findings during assessment of a pregnant woman with gestational hypertension (GHTN) requires immediate attention?
Which diagnostic test would the nurse anticipate to be ordered for a client with gestational hypertension (GHTN)?
Which diagnostic test would the nurse anticipate to be ordered for a client with gestational hypertension (GHTN)?
What defines chronic hypertension in pregnancy?
What defines chronic hypertension in pregnancy?
During the prenatal counseling of a client with hypertension, which of the following medications should the nurse inform the client are not safe for use during pregnancy?
During the prenatal counseling of a client with hypertension, which of the following medications should the nurse inform the client are not safe for use during pregnancy?
A pregnant client with chronic hypertension is diagnosed with superimposed preeclampsia. What findings are associated with this condition?
A pregnant client with chronic hypertension is diagnosed with superimposed preeclampsia. What findings are associated with this condition?
A pregnant woman with GHTN is being managed expectantly at home before 37 weeks gestation. In addition to blood pressure monitoring and medication, what other antepartum management should the nurse include in the plan of care?
A pregnant woman with GHTN is being managed expectantly at home before 37 weeks gestation. In addition to blood pressure monitoring and medication, what other antepartum management should the nurse include in the plan of care?
Which medication is most likely to be prescribed for a pregnant client with gestational hypertension?
Which medication is most likely to be prescribed for a pregnant client with gestational hypertension?
A nurse is caring for a patient receiving magnesium sulfate for severe preeclampsia. Which assessment finding indicates magnesium toxicity?
A nurse is caring for a patient receiving magnesium sulfate for severe preeclampsia. Which assessment finding indicates magnesium toxicity?
A patient is receiving magnesium sulfate. What medication should the nurse have readily available at the bedside?
A patient is receiving magnesium sulfate. What medication should the nurse have readily available at the bedside?
A nurse is providing discharge instructions to a client who had gestational hypertension and preeclampsia during pregnancy. What should the nurse include?
A nurse is providing discharge instructions to a client who had gestational hypertension and preeclampsia during pregnancy. What should the nurse include?
A primiparous client at 39 weeks gestation is being discharged. She had gestational hypertension during pregnancy. What should the nurse include in postpartum education?
A primiparous client at 39 weeks gestation is being discharged. She had gestational hypertension during pregnancy. What should the nurse include in postpartum education?
Which deep tendon reflex action is associated with spinal nerve roots C5-C6?
Which deep tendon reflex action is associated with spinal nerve roots C5-C6?
Which of the following is a potential nursing diagnosis for a pregnant client with a hypertensive disorder?
Which of the following is a potential nursing diagnosis for a pregnant client with a hypertensive disorder?
What is the purpose of administering corticosteroids like betamethasone or dexamethasone in the management of gestational hypertension (GHTN)?
What is the purpose of administering corticosteroids like betamethasone or dexamethasone in the management of gestational hypertension (GHTN)?
After administering supplemental oxygen to a client undergoing eclamptic seizures, what is the next emergent intervention?
After administering supplemental oxygen to a client undergoing eclamptic seizures, what is the next emergent intervention?
A client with GHTN is prescribed daily low-dose aspirin (81 mg). What is the primary rationale for this medication?
A client with GHTN is prescribed daily low-dose aspirin (81 mg). What is the primary rationale for this medication?
The health care provider prescribes magnesium sulfate for eclampsia. What is the rationale of this pharmacological treatment?
The health care provider prescribes magnesium sulfate for eclampsia. What is the rationale of this pharmacological treatment?
During assessment of a client with preeclampsia, her blood pressure is 180/110, has 4+ DTRs, and reports headache. What additional assessment would help confirm a diagnosis of severe preeclampsia?
During assessment of a client with preeclampsia, her blood pressure is 180/110, has 4+ DTRs, and reports headache. What additional assessment would help confirm a diagnosis of severe preeclampsia?
A patient has a BP >160/110, proteinuria >3+, oliguria, and has pulmonary edema. What nursing action should be performed after administering prescribed medications?
A patient has a BP >160/110, proteinuria >3+, oliguria, and has pulmonary edema. What nursing action should be performed after administering prescribed medications?
Flashcards
Gestational Hypertension (GHTN)
Gestational Hypertension (GHTN)
New onset of hypertension in a normotensive woman after 20 weeks gestation.
Preeclampsia (PreE)
Preeclampsia (PreE)
Onset of hypertension after 20 weeks gestation with or without proteinuria plus systemic findings.
Eclampsia
Eclampsia
Severe preeclampsia manifestations with the onset of seizures or coma.
HELLP Syndrome
HELLP Syndrome
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Chronic Hypertension in Pregnancy
Chronic Hypertension in Pregnancy
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Chronic Hypertension with Superimposed Preeclampsia
Chronic Hypertension with Superimposed Preeclampsia
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Magnesium Sulfate
Magnesium Sulfate
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Antepartum Management of GHTN/PreE
Antepartum Management of GHTN/PreE
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Discharge Instructions for GHTN/PreE
Discharge Instructions for GHTN/PreE
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Antidote for Magnesium Toxicity
Antidote for Magnesium Toxicity
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Study Notes
- ACOG & National High Blood Pressure Education Program collaborated to create criteria for hypertension in pregnancy
- There are currently 2 categories
Gestational Hypertensive Disorders
- Includes gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome
Chronic Hypertension Disorders
- Includes chronic hypertension and superimposed preeclampsia
Gestational Hypertension (GHTN)
- It is the new onset of hypertension in a normotensive woman
- GHTN Develops after gestational week 20
- Diagnosed with a systolic blood pressure of > 140 or diastolic >90 X 2 > 4 hours apart
- Develops from spiral artery malformation in the placenta
- It is a progressive disease process
- It is cured with delivery of the placenta
- There is no protein in the urine
- Blood pressure returns to baseline by 12 weeks postpartum, sometimes taking up to 12 months
- Up to 50% of women are diagnosed with chronic HTN after GHTN
- It occurs in 5-10% of all pregnancies
- 25-30% of GHTN progresses to preeclampsia
Preeclampsia (PreE)
- It is the "onset of hypertension after 20 weeks gestation, with or without proteinuria, and/ or with other systemic findings in a woman with normotension"
- The blood pressure is the same as in gestational hypertension
- Proteinuria is >300mg in 24-hour urine or 2+ on dipstick
- Thrombocytopenia is <100,000
- Impaired liver function (x2 LDH/AST)
- New-onset renal insufficiency is defined as >1.1 creatinine, increased BUN, plasma uric acid elevation (>5.9%)
- Pulmonary edema may be present
- New-onset HA or visual disturbances
- Peripheral edema is not indicative of Pre-E
Severe PreEclampsia
- Maternal signs of severe PreE include B/P>160/110
- Proteinuria is >3+ on dipstick
- Oliguria may be present
- Cerebral or visual disturbances
- Hyperreflexia with possible ankle clonus
- Pulmonary edema
- Cardiac dysfunction
- Extensive peripheral edema (hands, face, ankles)
- Abnormal kidney function study results
- BUN, serum creatinine (>1.1)
- ALT, AST, PT, BILI are elevated liver enzymes
- Epigastric pain, RUQ pain
- Plasma uric acid elevation (>5.9%)
- Thrombocytopenia (<100,000)
Eclampsia
- Severe PreE manifestations occur here with the onset of seizures or coma
- It is usually preceded with HA, severe epigastric pain or RUQ pain, hyperreflexia, and hemoconcentration
- It can occur before, during, or after delivery
- Occurs with 50% of women with PreE before delivery, and 30% of women with PreE after delivery
HELLP Syndrome
- H = Hemolysis (breaking down of RBCs)
- EL = Elevated liver enzymes
- LP = Low platelets
- It is a laboratory diagnosis of a severe variant of preeclampsia
- There may or may not be high B/P or severity signs and symptoms of Pre-E
- Many women have slightly higher than normal BP, and no protein in their urine
- It is the number one reason for preterm delivery
- Caucasian women are at the highest risk
- Perinatal mortality rate is 7-34%
- Maternal mortality rate is 1%
- Signs and symptoms: begins in the antepartum period
- Typical client complaints: malaise, flu-like symptoms, nausea/vomiting
- Patient statement of, "I just don't feel right" or "Something is wrong”
- Epigastric or RUQ pain, abnormal bleeding (gums, around IV site, petechiae)
- Treatment is delivery with PP medication
Gestational Hypertension (GHTN) Risk Factors
- No one factor can identify a woman at risk
- Risk factors include <19 or >40 years old
- First pregnancy (nulliparity), chronic renal DX
- Multi-fetal pregnancy, H/O Pre-E, Chronic HTN
- Chronic renal DX, Diabetes (GDM and Type 1)
- Autoimmune disorders (RA, Lupus), obesity (BMI >30)
- History of obstructive sleep apnea
Gestational Hypertension (GHTN) Expected Findings
- Severe, continuous HA
- Nausea or Blurred vision
- Flashes of light or dots before the eyes
- Hypertension or Proteinuria
- Edema - face, hands, periorbital pitting edema of dependent extremities
- Vomiting, Oliguria, Hyperreflexia
- Scotoma (visual changes), Epigastric pain
- RUQ pain, Dyspnea, decreased breath sounds
- Seizures or Jaundice
- Worsening labs
- Progression of disease: worsening of liver and kidney labs, worsening HTN, cerebral involvement (HA, hyperreflexia, onset of seizures)
Gestational Hypertension (GHTN) Diagnostic Testing
- Dipstick urine (protein)
- 24-hour urine (protein, creatine clearance)
- NST/CST/BPP/US
- Daily kick counts
- Doppler flow studies
Chronic Hypertension in Pregnancy
- Hypertension is present before pregnancy or that initially manifests before 20 weeks of pregnancy
- SBP ≥ 140 mm Hg and/or DBP ≥ 90 mm Hg on two occasions at least 4 hours apart (same as GHTN)
- Maternal and fetal outcomes of pregnancy better when the client has good B/P control at the time of conception
- Prenatal counseling of hypertensive women is important
- Assess B/P medication the client is taking and ensure it is safe for pregnancy
- ACE inhibitors or angiotensin II receptors not safe in pregnancy
Chronic Hypertension with Superimposed Preeclampsia
- The development of preeclampsia (with or without severe features) in women with chronic hypertension
- Signs and Symptoms may include HA, visual changes, proteinuria, seizures, epigastric pain, laboratory findings reflecting elevation in PLT, liver studies, creatinine
- POC includes Magnesium, corticosteroids, delivery
Medical Management for Gestational hypertension and Preeclampsia (without severe features)
- Antepartum management is to promote safety is the first priority
- Stabilize B/P and systemic changes
- Frequent lab testing for identification of severe features/progression of gestational hypertension to preeclampsia
- Expectant management at home before 37 weeks gestation with PO medication
- May or may not be on modified bedrest
- Twice-weekly prenatal visits and prenatal testing beginning at 32 weeks gestation
- NST and BPPs completed
- Education about subjective and objective signs/symptoms of worsening preeclampsia
- When to notify HCP of findings. Goal to get to 37 weeks gestation
- Corticosteroid administration to promote fetal surfactant development
- In-patient care: daily weights, strict I&O, modified bedrest
Medication for GHTN
- Aspirin: 81 mg daily
- Antihypertensive: Methyldopa, Nifedipine, Hydralazine, Labetalol: Key one, hypertensive moms, IV or PO
- Betamethasone: Celestone, Dexamethasone
- Anticonvulsant/neuroprotectant: Magnesium sulfate
Magnesium Sulfate
- Used to prevent seizure activity in the pregnant client and for neuroprotection of the fetus
- Initiate seizure precautions: side rails up, padded, intubation supplies ready
- Have O2 & suction ready for calm environment
- Dosing: Load with 4-6g over 15-30 mins, maintenance with 1-2g/hr
- Therapeutic levels are 4-7 mEq/L
- Antidote for Magnesium: calcium gluconate (1g)
- Expected side effects: flushing, feeling hot ("on fire"), nausea/vomiting
- Drowsiness, Pain at IV site
- Signs and Symptoms of Magnesium toxicity: absence of DTR, UOP <30ml/hr _ RR <12, and decreased LOC
- Cardiac dysrhythmias, any S/S of toxicity stop Mag infusion, administer Ca gluconate, watch for respiratory or cardiac arrest
- Anticipate delivery of a depressed infant caused by Magnesium crossing the placenta
- Infant magnesium levels are close to maternal levels
- Infants exposed to magnesium may show signs of decreased respiratory effort and poor tone, notify NICU team
- NEVER abbreviate Magnesium Sulfate as MgSO4
Nursing Management of Client Having Eclamptic Seizure
- Record the note time of onset and ending of seizure
- Turn the client to her side and call for help from the bedside
- Administer supplemental oxygen at 10 L/min. with a nonrebreather
- Remove anything from the bed that could be a safety hazard and do not place anything in the mouth during a seizure
- Clear airway with suction if needed
- Continue to administer 10 L oxygen per facemask and apply pulse oximeter
- Start IV if not already in place and start magnesium sulfate if not already infusing
- Insert foley, if able complete an assessment of the cervix and be prepared for C/S
- Complete vital signs per protocol and Explain what is happening to the family and provide emotional support
- Once the client is alert and oriented, explain the situation
Medical Management: Gestational hypertension and Preeclampsia
- Discharge instructions:
- Bedrest, side-lying position several times a day
- Perform diversional activities
- Avoid foods high in sodium
- Avoid ETOH and tobacco, limit caffeine
- Increase H2O intake to at least 8 glasses/day
- Maintain a quiet, calm environment
- Maintain an airway in the event of a seizure. Know S/S of worsening condition
- Take antihypertensives as prescribed
- Keep HCP appointments (anticipate weekly HCP/OB visits until B/P stable or delivery)
- Postpartum
- Continue administration of magnesium sulfate for 24-48 hours postpartum
- Close follow-up after hospital discharge, earlier and more frequent postpartum visits is paramount
- Anticipate 1st PP OB visit in the first week after D/C and offer home health nursing care
- Educate family on:
- Preeclampsia in future pregnancies, hypertension (increased risk by of 4-fold)
- Ischemic heart disease, venous thromboembolism, CVA (2-fold risk) and HTN may persist for up to 1 year after delivery
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