NURB 331: Hypertensive Disorders
NURB 331: Hypertensive Disorders NURB 331
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This 7 page Class Notes was uploaded by Kelsey Forbeck on Friday September 30, 2016. The Class Notes belongs to NURB 331 at University of Indianapolis taught by Professor Rairdon in Fall 2016. Since its upload, it has received 4 views. For similar materials see Lifespan 1 in NURSING at University of Indianapolis.
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Date Created: 09/30/16
NURB 331: Lifespan 1 Exam 2 Hypertensive Disorders Significance and incidence o Most common medical complication reported during pregnancy o Preeclampsia complicates 5-10% of pregnancy o Contributor to maternal and perinatal morbidity and mortality Hypertension in Pregnancy o No specific diagnostic test available to detect these disorders o MOST RELIABLE IS A RISE IN BP o Classification: Gestational hypertension (formerly called PIH) Preeclampsia Eclampsia Chronic hypertension Preeclampsia superimposed on chronic hypertension Classification o Gestational Hypertension If it occurs after the 20 week, then it is the pregnancies fault BP: 140 or greater / 90 or greater Have hypertension but no proteinuria o Preeclampsia Pregnancy specific Hypertension develops after 20 weeks This is a disease of REDUCED ORGAN PERFUSION Contains proteinuria sometimes o Eclampsia Seizure activity or coma in women diagnosed with preeclampsia No history of seizures Presentation varies: One third in labor One third during delivery One third 72 hours postpartum o Chronic hypertension Present before the pregnancy or diagnosed before week 20 of gestation Have hypertension that isn’t pregnancy induced Chronic hypertension with superimposed preeclampsia Preeclampsia o Unique to us as people o Develop during pregnancy o Go away in post-partum periods o Risk factors: primagraividty, multifetal pregnancy, obesity, preexisting medical condition, preeclampsia in previous pregnancy o Pathophysiology May be caused by disruptions in placental perfusion and endothelial cell dysfunctions Main factor Is not an increase NOT BP but poor perfusion resulting from vasospasm Blood starts leaving blood vessels and going into tissue Edema isn’t part of diagnosis but something we watch out for because the fluid leaves the vessels and goes into tissue A rapid weight gain of more than 2 kilograms in a week Funduscopic exam o Evidence of severe hypertension induced by pregnancy Arteriospasms Edema Hemorrhages Arteriovenous nicking Exudates o Reflexes Normal reflexes are +1 or +2 With CNS irritation hyperreflexia (+3 or +4) May be present Clonus o To cause this sharply dorsiflex foot and the foot will tap back o You count the number of taps o Clonus indicates more pronounces hyperreflexia and is indicative of HELLP Syndrome o Based off of just lab results o Laboratory diagnostic variant of severe preeclampsia involves hepatic dysfunction characterized by: (H) hemolysis of RBCs (EL) Elevated liver enzymes (LP) Low platelets o May occur before signs and symptoms of preeclampsia o 90% of women with this syndrome have symptom before 36 weeks. o Associated with increased risk factors for: Pulmonary edema Acute renal failure Disseminated intravascular coagulation (DIC) Placental abruption Liver hemorrhage or failure Adult respiratory distress Sepsis Stroke HIGH RISK FOR MATERNAL DEATH o Symptoms may include: Nausea Vomiting Malaise Flu like symptoms Epigastric pain o Women with these symptoms should have a CBC with platelet count and liver enzymes drawn. o May need platelet transfusion if count is less than 20000 o Low platelet count Thrombocytopenia is a frequent finding Vascular damage is associated with vasospasms and platelet count but all the other labs come back normal Hospital Care o If severe preeclampsia is diagnosed less than 32 weeks, conservative management may be tried o 32-36 weeks’ labor induction is performed (vaginal before c section) o Bed rest o Quiet place o Assessment of CNS, cardiovascular, renal, and pulmonary systems o Weight Is measured on admission and daily because of fluid retention o Auscultate lungs for crackles because can be pulmonary edema o Measure urine output because of kidney problems o Pulse ox because hemolysis is happening Magnesium Sulfate o Slows down reflexes in muscles o Drug of choice to prevent and manage seizures o Neuromuscular blocker o Causes drop in blood pressure o Dosage: 4-6-gram bolus o 2-3 grams of maintenance dose o Maternal risks and complications Cardio: Vasodilation- flushing and hypothermia Chest pain or palpations Hypotension Cardiac arrest Respiratory Respiratory Depression Pulmonary edema CNS Decrease deep tendon reflexes is one of the first signs Headaches all the time Metabolic Electrolyte imbalance Calcium/magnesium work as a titer totter, when you give mag their calcium goes down Musculoskeletal Drowsiness and lethargy GI Dry mouth Nausea Vomiting Paralytic ileus o Mag sulfate depresses everything and the patients do not remember much and pass out drunk basically o These patients get really relaxed and sometimes feel like they do not need to breath o A sudden change or loss of DTR o Less than 12 respirations Magnesium Sulfate Toxicity o Serum magnesium above 4-8 mg o Rapid change in personality o When the serum magnesium levels rise, neuromuscular and cardiac transmission of nerve impulses is increasingly blocked causing loss of deep tendon reflexes o If this occurs, you will need to stop administering it o If urinary output is below 30 ml or less than 100 ml in 4 hours then NOTIFY PHYSICIAN o Because mag sul is tocolytic (relaxes muscles) it may increase duration of labor o If uterus doesn’t contract it will get boggy o Babies can be doped up also which depresses respirations Calcium Gluconate o ANTAGONIST OF MAGNESIUM TOXICITY o Push slowly over 3 mins o If pushed too fast then may cause vasodilation, bradycardia, ventricular defib, and others Hydralazine (Apresoline) o Antihypertensive that relaxes smooth muscle to reduce BP o Used in preeclampsia her hypertension o May use this instead of Mag Sul Alternative Meds o Nifedipine (Procardia, a calcium channel blocker) o Labetalol (normodyne, a beta adrenergic blocker) o Verapamil o Oral methyldopa (Aldomer) Patient must be in the hospital before being administer antihypertensive meds Assess FHR because a sudden drop in maternal BP may precipitate fetal distress Care Management o Eclampsia Signs and Symptoms Headache Blurred vision Severe epigastric pain Altered mental status Tonic- clonic convulsions Hypotension Coma Immediate Care Ensure a patient airway Patient safety is a major concern Post-seizure decision regarding timing and method of birth HELLP syndrome Lab evaluation Infusion of blood products Chronic Hypertension o Management begins before conception o May need to change lifestyle o High risk mom monitored for complications post-partum o May safely breast feed Chronic hypertension associated with increased incidence of o Abrutpio placentae o Superimposed preeclampsia o Increased perinatal mortality o Fetal effects: Fetal growth restriction Small fro gestational age Safety Precautions o Call button in reach o Emergency birth pack available o Emergency medication tray available o Calcium gluconate o Hydralazine o Environment: Quiet Non stimulating Dim light o Seizure precautions Padded side rails Suction set up and ready for us Oxygen set up and ready for use Eclampsia: Tonic-Clonic Convulsions o Stage of invasion 2-3 seconds Eyes fixed Twitching of facial muscles o Stage of contraction 15-20 seconds Eyes protrude and are blood shot All muscles are in tonic contraction o Stage of convulsion Muscles relax and contract alternately (clonic) Respirations halted and then begin again with long, deep, stertorous inhalation Coma Intervention During Seizures o Keep airway patent o Turn head to one side o Side rails up o Prop back on pillow o Call for assistance o Observe and record convulsion activity Intervention Following Seizures o Don’t leave unattended o Observe for incontinence o Use suction as needed o Administer 100% oxygen via non rebreather mask at 12-15 L/min o Start IV and monitor for fluid overload o Give Mag sul or other ordered anticonvulsants o Insert Foley o Monitor BP o Monitor fetal and uterine status o Expedite lab work o Provide hygiene and quiet environment o Support women and family o Be prepared for delivery when the woman is stable o
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