45 Questions
What is the term for hypertension that develops in late pregnancy without other findings or preeclampsia?
Gestational hypertension
What is the definition of chronic hypertension in pregnancy?
BP ≥ 140/90 mmHg
What is the term for the coexistence of preeclampsia with preexisting chronic hypertension?
Chronic hypertension with superimposed preeclampsia
What is a risk factor for preeclampsia?
Nulliparity
What is the effect of decreased endothelial prostacyclin production in preeclampsia?
Diminished blood flow
What is a systemic effect of preeclampsia?
Vital organs dysfunction
What is a pregnancy effect of preeclampsia?
Intrauterine growth restriction
What is the result of increased capillary permeability in preeclampsia?
Secrete toxic radicals/substances into the maternal circulation
What is the definition of oligohydramnios?
Abnormally low volume of amniotic fluid
What is the worldwide incidence of hypertensive disorders in pregnancy?
7-12%
What is the primary characteristic of pregnancy-induced hypertension?
Hypertension associated with proteinuria and edema, occurring primarily after the 20th week or near term
What is the definition of mild preeclampsia in terms of blood pressure?
BP ≥ 140/90mmHg
What is the primary characteristic of severe preeclampsia in terms of proteinuria?
Dipstick 3+ or >1-2 g/24-hr urine collection
What is the occurrence of eclampsia in terms of the timing of onset?
25% occurring in the 1st 72 hs postpartum
What is the primary characteristic of gestational hypertension?
Hypertension without proteinuria and edema, occurring primarily after the 20th week or near term
What is the primary characteristic of chronic hypertension preceding pregnancy?
Hypertension without proteinuria and edema, occurring before pregnancy
What is the primary characteristic of chronic hypertension with superimposed PIH?
Hypertension associated with proteinuria and edema, occurring primarily during the 3rd trimester, with superimposed preeclampsia
What is the primary maternal effect of hypertensive disorders in pregnancy?
All of the above
What is the recommended dosage of magnesium sulfate for a continuous infusion?
2g/hr
What is a common side effect of magnesium sulfate?
Flushing
What is a severe adverse effect of magnesium sulfate?
Muscle paralysis
What should be assessed every hour when administering magnesium sulfate?
RR, UO, DTR, and clonus
What is the recommended management for magnesium sulfate toxicity?
All of the above
What is the antihypertensive medication used to decrease hypertension?
Hydralazine
What is the recommended dosage of hydralazine?
5-10 mg/IV
What is a risk for maternal injury related to pregnancy-induced hypertension?
Risk for maternal injury: ineffective tissue perfusion
What is a recommended method of home management to prevent maternal and fetal risks?
Bed rest
What is the abbreviation HELLP syndrome stands for?
Hemolysis, Elevated Liver enzymes, Low Platelet count
Which of the following is a laboratory finding in HELLP syndrome?
Elevated LDH and decreased coagulation factors
What is the primary goal of administering hydralazine in the management of hypertension in pregnancy?
To maintain diastolic pressure over 90 mmHg
What is the loading dose of MgSO4 in the management of preeclampsia?
4-6 g IV
What is the recommended rate of administration of hydralazine in the management of hypertension in pregnancy?
Administer slowly to avoid sudden fall in blood pressure
What is the primary function of FHR monitoring in the management of preeclampsia?
To monitor fetal heart rate
What is the common complication associated with HELLP syndrome?
All of the above
What is the purpose of the non-stress test in the management of preeclampsia?
To assess fetal well-being
What is the recommended dosage of hydralazine in the management of hypertension in pregnancy?
5-10 mg/IV
What is the primary purpose of instructing a client with preeclampsia to monitor her daily weight?
To assess blood concentration
What is the primary goal of restricting visitors and darkening the room for a client with preeclampsia?
To prevent seizure from occurring
What is the purpose of administering magnesium sulfate to a client with preeclampsia?
To prevent eclampsia
Why is it essential to raise the side rails of a client's bed with preeclampsia?
To prevent injury in case a seizure episode occurs
What is the primary purpose of monitoring blood pressure every hour to four hours in a client with preeclampsia?
To detect any increase in blood pressure
What is the purpose of obtaining blood studies as ordered in a client with preeclampsia?
To assess renal and liver function
What is the primary purpose of daily self-monitoring of blood pressure in a client with preeclampsia?
To detect any increase in blood pressure
What is the purpose of administering antihypertensive therapy to a client with preeclampsia?
To control maternal blood pressure
What is the primary purpose of health education in a client with preeclampsia?
To provide information about the condition and self-care
Study Notes
Hypertensive Disorders in Pregnancy
Types of Hypertensive Disorders
- Pregnancy-induced hypertension:
- Mild preeclampsia: BP ≥ 140/90mmHg, proteinuria (dipstick 1+ to 2+ or ≥ 300mg/24-hr urine collection), and weight gain ≥ 2 lbs/week (2nd trimester) or 1 lb/week (3rd trimester)
- Severe preeclampsia: BP ≥ 160/110mmHg, marked proteinuria (3+ or more or >1-2g/24-hr urine collection), and at least one of the following symptoms: cerebral/visual disturbances, epigastric pain, marked edema, oliguria, pulmonary edema, or cyanosis
- Eclampsia: preeclampsia with convulsions
- Gestational hypertension: hypertension in late pregnancy without other findings or preeclampsia
- Chronic hypertension preceding pregnancy: BP ≥ 140/90mmHg before 12 weeks postpartum
- Chronic hypertension with superimposed preeclampsia or eclampsia: coexistence of preeclampsia or eclampsia with preexisting chronic hypertension
Etiology and Pathophysiology
- Decreased endothelial prostacyclin production
- Increased thromboxane A2 secretion by activated platelets
- Increased sensitivity to infused angiotensin II
- Systematic vasoconstriction → resistance and subsequent hypertension
- Diminished blood flow → vital organ dysfunctions, necrosis, and hemorrhage
Maternal and Fetal Effects
- Risk of placental abruption
- Risk of preterm delivery
- Intrauterine growth restriction (IUGR)
- Oligohydramnios
- Systemic effects: vital organ dysfunction, HELLP syndrome, DIC, seizures
Investigation
- Blood tests: elevated Hb or Hct, FDP, liver function, renal function
- Retinal check
- Fetal movement counts (FMC)
- Non-stress test
- Biophysical profile
- Sonographic estimated fetal weight
Treatment
- Antihypertensive medication: hydralazine, diazepam
- Mgso4 to prevent eclampsia and reduce edema
- Management of Mgso4 toxicity: slow i.v. 10% calcium gluconate, oxygen supplementation, cardiorespiratory support
Nursing Management
- Risk for maternal injury: ineffective tissue perfusion
- Risk for fetal injury: reduced placental perfusion
- Home management: bed rest, daily self-monitoring of blood pressure and body weight, health teaching, diet, and fluid intake
- Support bed rest: restrict visitors, darken the room, raise side rails
- Monitor maternal well-being: blood pressure, blood studies, hematocrit levels, and weight
- Monitor fetal well-being: non-stress tests, biophysical profiles, and sonographic estimated fetal weight
- Support a nutritious diet and administer fluids
- Administer medications to maintain BP and prevent eclampsia
- Provide health education and monitor tonic-clonic seizures
This quiz covers the definition, types, etiology, pathophysiology, signs and symptoms, maternal and fetal effects, investigation, and treatment of hypertensive disorders in pregnancy. Also, it discusses nursing management and incidence of this common and serious condition in obstetrics.
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