HYPERTENSIVE DISORDERS OF PREGNANCY

HYPERTENSIVE DISORDERS OF PREGNANCY What is the most common disorder among pregnant women? - Hypertension Medications used to treat Hypertensive Disorders of Pregnancy: - - Beta blocker - CCBs - Central alpha-a ...

HYPERTENSIVE DISORDERS OF PREGNANCY What is the most common disorder among pregnant women? - Hypertension Medications used to treat Hypertensive Disorders of Pregnancy: - - Beta blocker - CCBs - Central alpha-adrenergic inhibitor - Loop diuretics - Anticonvulsant - Peripheral arteriolar vasodilator - Vasodilator - NSAIDs Anti-HTn medications that should be avoided during pregnancy: - - ACEIs - ARBs - Renin inhibitors Safe and effective nursing care for pts on antihypertensive medications: - - Take the medication at the same time each day - Maintain fluid intake and change positions slowly - Do not take any other medications without consulting the prescriber - Avoid excessive exercise in hot weather Beta blocker drug example - Labetalol Beta blocker MOA - Relaxes blood vessels and decreases HR to increase blood flow and decrease BP; blocks epinephrine Beta block SE - - May decrease blood flow to extremities, which is exacerbated with smoking. - Light-headedness - Fatigue - Weight gain - Instability in blood glucose levels - Dizziness CCBs drug example - Nifedipine CCB MOA - Relaxes blood vessels by affecting the movement of calcium into the cells of the heart and blood vessels. Blocks the flow of calcium into the muscle cells around the heart, increases blood supply and oxygen to heart while decreasing the workload. CCB SE - - Headache - Dizziness - Flushing - Edema - Nausea - Constipation - Muscle cramps - Wheezing - Gum hyperplasia - Hypotension Central alpha-adrenergic inhibitor drug example - Alpha-methyldopa Central alpha-adrenergic inhibitor MOA - Centrally active sympatholytic agent. Reduces concentration of epinephrine, norepinephrine, dopamine, and serotonin to dilate blood vessels. Central alpha-adrenergic inhibitor SE - - Maternal edema - Anemia Central alpha-adrenergic inhibitor NC - Safe in breastfeeding Loop diuretic drug example - Furosemide Loop diuretic MOA - Inhibits the luminal 1 Na/1K/2Cl co-transporter in the ascending loop of Henle Loop diuretic SE - May induce neonatal thrombocytopenia when breastfeeding on medication Loop diuretic NC - Assess for: - Dizziness - Drowsiness - Hypotension - Electrolyte disorders Anticonvulsant drug example - Magnesium sulfate Anticonvulsant MOA - Causes resolution of eclampsia by decreasing muscular excitability and neurotransmission Anticonvulsant SE - - Can decrease respirations - Drowsiness - Hypotension Anticonvulsant NC - - Do NOT use with hypermagnesemia, hypocalcemia, anuria, or heart block-therapeutic range 4.8-9.6 mg/dL - Magnesium levels should be monitored - Calcium gluconate should be available as antidote for hypermagnesemia Antidote for an anticonvulsant - Calcium gluconate Peripheral arteriolar vasodilator drug example - Hydralazine Peripheral arteriolar vasodilator MOA - Lowers BP by exerting a peripheral vasodilating effect by relaxing vascular smooth muscle Peripheral arteriolar vasodilator SE - - Tachycardia - Dizziness - Anorexia - Headache Peripheral arteriolar vasodilator NC - Use with Labetalol to prevent reflex tachycardia What two meds should be used together to prevent reflex tachycardia? - Labetalol and Hydralazine (beta blocker and peripheral arteriolar vasodilator) eclampsia - seizure preeclampsia - warning sign that mom has potential for seizures classifications of hypertensive disorders during pregnancy - gestational hypertensive disorders chronic hypertensive disorders gestational hypertensive disorders - gestational hypertension, preeclampsia, eclampsia chronic hypertensive disorders - have it prior to pregnancy, will bring it with them into pregnancy -chronic hypertension -superimposed preeclampsia gestational hypertension - onset of hypertension without proteinuria after the 20th week of pregnancy -around the halfway mark gestational hypertension criteria - -BP>140/90 -need 2 elevated measures at least 4h apart -BP returns to normal within 12 weeks PP gestational hypertension frequently occurs with... - multiple gestation pregnancies preeclampsia - HTN and proteinuria develop after 20 weeks gestation also has: -HTN without thombosytopenia, impaired liver/ renal, pulmonary edema, new onset of visual disturbances