Editing Maternal and Newborn Nursing – RN Flashcards (section)

== Hypertensive Disorders ==

;Diagnostic criteria for preeclampsia
:After 20 weeks, blood pressure 140/90 mm Hg or higher on two occasions at least 4 hours apart, plus proteinuria (300 mg or more per 24 hours, protein-to-creatinine ratio 0.3 or higher, or 2+ dipstick). It can also be diagnosed '''without proteinuria''' when new hypertension occurs with thrombocytopenia, elevated liver enzymes, renal insufficiency, pulmonary edema, or new cerebral or visual symptoms.

;Severe features of preeclampsia
:Systolic 160 mm Hg or higher or diastolic 110 mm Hg or higher; platelets below 100,000/mm3; transaminases about twice normal or severe persistent right upper quadrant pain; creatinine above 1.1 mg/dL or doubled; pulmonary edema; new cerebral or visual disturbance. Note that the '''amount''' of proteinuria is not a severity criterion.

;HELLP syndrome and why it is missed
:'''H'''emolysis, '''E'''levated '''L'''iver enzymes, '''L'''ow '''P'''latelets. It can present with malaise, nausea, and right upper quadrant pain with only modestly elevated blood pressure, so anchoring on blood pressure alone leads to missed diagnosis.

;Purpose of magnesium sulfate in preeclampsia
:'''Seizure prophylaxis''', not blood pressure control. It is a CNS depressant and smooth muscle relaxant. Blood pressure is treated separately with IV labetalol, IV hydralazine, or oral immediate-release nifedipine.

;Magnesium toxicity: order of signs and the antidote
:Loss of deep tendon reflexes appears '''first''', then respiratory depression (below 12 per minute), then decreased level of consciousness, then cardiac arrest. Urine output below 30 mL/hour promotes accumulation. '''Antidote: IV calcium gluconate''', kept at the bedside. Flushing, warmth, and sedation are expected effects, not toxicity.

;Antihypertensives contraindicated in pregnancy
:ACE inhibitors and angiotensin receptor blockers, because of fetal renal injury, oligohydramnios, and death.