BP Assessment / Pressures on!
If the BP cuff is too large, the reading may be falsely ___ (high/low)
What is low?
In patients with preeclampsia, you should limit total IV fluid to a maximum of this amount.
What is 80 ml/hour?
When would you assess the patient next if a patient's SBP is between 140 to 159 mmHG OR the DBP is 90-109 mmHg.
What is repeat BP in 15-30 minutes from the same arm?
Hypertensive disorders of pregnancy are an indication for which fetal assessment antepartum and intrapartum?
What is daily NST, Dopplers (2x/ week) and growth US (q2weeks) (AP)? What is intrapartum electronic fetal monitoring (IP)?
PP blood pressure usually peaks around this time, when fluid shifts bring extracellular fluid back into vasculature.
What is 3-7 days?
Encouraged before/while the BP is being taken
What is allow patient to rest for 5-10 minutes, keep still, not to talk, and minimize background noise?
Hold antihypertensive medication if a patient's BP is this.
What is less than 110/60?
If BP is confirmed at SBP greater than or equal to 160 mmHg OR DBP is greater than or equal to 110 mmHg, this is when you should reassess the patient's BP.
What is: REPEAT BP in 15 minutes or less?
Follow up:
1) How often would you reassess BP if it is only greater than or equal to 160/110 x 1?
This is how often to assess BP, HR, RR, SpO2, for stable hypertensive patient, when a patient with is antepartum? When a patient is intrapartum?
What is Q1H for intrapartum? What is Q6H, while awake for AP?
Preeclampsia is correlated with an increased risk of PPH. This medication is contraindicated for PPH management in patients with preeclampsia with severe features. What are some other medications that should be prioritized instead?
What is ergot? Other alternatives include oxytocin, carbetocin, carbroprost, TXA.
If there are concerns with the automatic machine accuracy, you should do this.
What is repeat the BP with a manual manometer and stethoscope?
Ways to detect and monitory pulmonary edema
What is monitor and document fluid balance, IV fluids at 80mL/hr, auscultate lungs?
If BP is greater than or equal to 160/110 x 2, these are your 6 next steps and what you can anticipate.
What are:
- notify the MRP and seek orders for anti-hypertensive medication administration
-prepare for urgent administration of antihypertensive medication
-continue to assess for severe features of preeclampsia
- anticipate likely need to expedite initiation of magnesium sulfate
-consider urgent need for admission/transfer to TACC
-document
A CBC in the last how many hours is required prior to placement of a neuraxial technique in patients with severe preeclampsia or HELLP syndrome?
What is 6 hours?
There are risks of fetal growth restriction, small for gestational age (SGA) and late preterm birth. What might you anticipate?
What are: increased monitoring and blood glucose assessments? (risk of hypoglycemia and may experience bradycardia)
If patient has gestational hypertension or preeclampsia, you should include these 4 things in your assessment
What are:
assess for severe features of preeclampsia, auscultate all lung fields for adventitious sounds, baseline evaluation of deep tendon reflexes
along with MEOWS (including AVPU)
(page 27 of protocol)
When oral nifedipine (5 mg or 10 mg) is administered, repeat MEOWS vital signs at the following interval.
What is:
Q15 mins x 4, then
Q30 mins x 2, then
Q1h x 2, then
every 4 hours x 12-24 hours, then
q shift
Antihypertensive treatment with medications must be initiated as soon as possible to prevent what medical conditions?
What is severe hemmorrhagic and ischemic stroke?
The fetal surveillance that can inform placental dysfunction.
What are umbilical artery doppler studies, ultrasound, FHS?
For patients with reoccurrence of severe hypertension in pregnancy, the addition of this medication may be beneficial in lowering BP and in reducing the need for other antihypertensive medications postpartum.
What is oral furosemide?
Patients with preeclampsia are at higher risk of postpartum mental health disorders. These are some supports we can offer at BCW.
What is PDI screening and offer social work and mental health resources?