S/SX
What is criteria (definition) for Gestational HTN
BP's >140/90 (greater than or equal to) on 2 different occasions 4 hours apart after 20 weeks GA
and No other symptoms of preeclampsia
What is the medication used for patients with severe preeclampsia to prevent seizures?
What is Magnesium Sulfate
What is the amount we give? loading dose and maintenance?
True or False: Patients that have eclamptic seizures have severe range BP's and symptoms before the seizure
False
Name a medication that can be given to prevent or delay the onset of preeclampsia
What is: 81 mg Aspirin started before 16 weeks GA and continued until birth for patients with CHTN and with other risk factors for developing preeclampsia
What does the "H" in HELLP stand for?
What is Hemolysis?
What is the criteria for preeclampsia?
SBP > or = 140 mmHg or > or = 90 mmHg DBP after 20 weeks
AND proteinuria
OR thrombocytopenia, renal insufficiency, impaired liver fxn, pulmonary edema, or new onset HA unresponsive to meds
You are starting Magnesium Sulfate to a severe preeclampsia patient. What is the loading dose and maintenance dose?
4-6 gram bolus via pump over 20-30 min
Maintenance: 1-2 gm/hr via pump
Your patient presents to triage and has 2 BP's: 144/90 & 154/98. The provider asks you to get preeclampsia labs...what should you get?
What is: CBC (complete blood count), CMP (complete metabolic panel) & urine clean catch for Protein: Creatinine ratio
A platelet count less than this level indicates severe preeclampsia
What is: < 100,000
What does the "EL" in HELLP stand for?
What is Elevated Liver Enzymes?
What is the lab value used to diagnose Preeclampsia proteinuria?
What is: clean catch urine sample for Protein: Creatinine ratio
P:C ratio > or equal to .3 mg/dl
> or equal to 300 mg/24 hour urine
List 3 antihypertensives we use to manage severe range BP's
What is Labetalol, Hydralazine and Nifedipine (p.o.)
This is the only definitive treatment for preeclampsia but it may not be ideal if the fetus is immature
What is delivery?
Your patient with severe preeclampsia is complaining of severe epigastric pain. What might you be worried about?
What are: liver hematoma or ruptured liver
What does the "LP" stand for?
What is Low Platelets?
What is the BP criteria for Severe Preeclampsia?
BP's: > or equal to 160 systolic and/or > or equal to 110 diastolic
This class of medication may be administered if pulmonary edema develops
What are diuretics (Lasix)
Your patient just got to triage and her BP is 160/112
What are your next steps? When do you repeat the BP?
What are: call the provider & notify of severe range BP Repeat BP in 15 min.
If severe range should give antihypertensive medication within 30-60 min. Start IV, draw labs, get meds. call for help if unable to get IV
What is the primary underlying pathology that occurs in the vessels that lead to elevated BP's and endothelial damage?
What is vasoconstriction and arteriolar vasopasms
Patient with HELLP may present with this symptom?
What is pain in the RUQ, lower chest, or epigastric area?
What assessments should be completed for patients with Magnesium/Preeclampsia?
Auscultate lungs/DTR's q 2 hours
Assess/document changes r/t HA, epigastric pain, edema, U.O. (Strict I & O's: 2-4 hours)
Vital signs (Resp, HR, BP) q 1 hour on magnesium
Mag bolus: BP, HR, Resp, o2 sat & LOC q 15 min x 1 hr, then q 30 min x 1 hr, then q hour. Cont EFM.
Strict I&O's ( q 2-4 hours)
If your patient becomes Magnesium toxic this med is given as an antidote
What is Calcium gluconate 1 gm IV push over 7-10 min per OHSU order
Your patient had severe range BP's and had 2 doses of antihypertensive meds. BP is now 156/100. How often should you now take BP's
What is follow the "In Target BP after antihypertensive treatment" bottom of algorithm:
BP q 10 min x 1 hour, BP q 15 min x 1 hour, BP q 30 min x 1 hr, then q 1 hr x 4 hours
True or False: A patient with BMI < 30 will always use a Regular size BP cuff
False: The most accurate way to determine BP cuff size is to measure the arm.
True or False: HELLP only occurs in patients with severe preeclampsia
What is False