Pregnancy Induced HTN
1. What are the major differences between mild preeclampsia, severe preeclampsia, and ecclampsia? What is the pathophysiology that leads to these conditions? 
Mild-greater than 1+ proteinuria, wt gain, mild facial/hand edema, 140/90 or greater after 20wks
Severe- greater than 3+ proteinuria, hyperreflexia, headache, olguria, blurrd vision, scotomata, pulmonary edema, thrombocytopenia, cerebral disturbances, epigastric/RUQ pain, HELLP, and 160/110 or greater
Ecclampsia-160/110 or greater, marked proteinuria, seizures/coma, hyperreflexia, severe headache, generalized edema, RUQ/epigastric pain, visual disturbances, cerebral hemorrhage, renal failure, and HELLP.
Vasospasms result in elevated Bp and reduced blood flow to the brain, liver, kidneys, placenta, and lungs.
2.  What is HELLP syndrome and how does it differ?
HELLP-hemolysis, elevated liver enzymes, and low platelets. It occurs in 20% of severe preeclampsia patients.
3. What are the common meds used to treat pregnancy-induced htn and what risks do they carry? What is the nursing management for each?
Mg sulfate-treats seizures, monitor serum levels, give over 30mins
Hydralazine HCl-reduces Bp, administer slowly, withdraw slowly to prevent rebound HTN.
Labetalol HCl-reduces Bp, monitor for dizziness, gastric pain, and vertigo
Nifedipine-reduces Bp, monitor for dizziness, peripheral edema, diarrhea, and angina.
Na Nitroprusside-rapid Bp reduction, protect from light, monitor for restlessness, retrosternal pressure, palpitations, and abdominal pain.
Lasix
4. What assessments need to be frequently conducted for the patient with pregnancy-induced htn?
Bp, pulse, fetal heart rate, LOC
5. Describe deep tendon reflexes and how they are graded.
0-absent, 1-hypoactive/diminished, 2-reflex in lower half of normal range, 3-reflex in upper half of normal range, 4-hyperactive, brisk, clonus present.
6. Discuss why a patient with pregnancy-induced htn is at risk for seizures. What are seizure precautions and how are they instituted?
Because of the increasing, constant high Bp. Keep bed close to the floor, move objects away from patient, pad side rails, have O2 available.
7. What are signs of magnesium toxicity in mother and baby?
Mother-bradycardia, absence of deep tendon reflexes, cardiac arrest, and decreased urinary output. Baby-absence of accelerations, late decels.
8. What are the risk to the mother and baby in these conditions? What is the definitive treatment and why? 
Risks-loss of deep tendon reflexes, resp depression, cardiac arrest, death.  The patient would be given calcium gluconate as antidote.  Glucocorticoid treatment would be given to enhance fetal lung maturity and prepare for labor induction if necessary.
9. Identify the common lab tests indicated for the patient with pregnancy-induced htn and discuss the cause of abnormal findings.  In addition, describe L/S ratio and Phosphatidylglycerol and identify why these tests are important prior to delivery of the baby.
Increased thrombonxane, decreased prostacyclin, reduced glomerular filtration rate, increased serum Na, BUN, uric acid, and creatinine,