Antepartum Cardiac Diseases

Question 1

Women should avoid lying on their backs how long into their pregnancy?

Answer 1

20+ wks

Question 2

Cardiac classifications 2-4 are placed on antibiotic prophylaxis during labor and postpartum for what reason?

Answer 2

to prevent bacterial endocarditis

Question 3

During which stage of labor does pushing begin?

Answer 3

stage 2

Question 4

Which type of HTN occurs after 20 wks of preggo w/o proteinuria?

Answer 4

gestational HTN

Question 5

Gestational HTN criteria?

Answer 5

• two BP readings > 140/90, at least 6-8 hrs apart

- occurs after 20 wks of preggo w/o proteinuria

Question 6

HTN after 20 wks with proteinuria?

Answer 6

preeclampsia

Question 7

Preeclampsia?

Answer 7

• HTN (> 140/90) after 20wks of preggo with proteinuria

- can be mild or severe

Question 8

Differential Diagnosis between mild and severe preeclampsia (BP)?

Answer 8

BP:

• mild: ≥ 140/90
• severe: > 160 systolic &/or > 110 diastolic

Question 9

Differential Diagnosis between mild and severe preeclampsia (proteinuria)?

Answer 9

mild:
- >1+ on a urine dipstick
- ≥ 300mg protein In 24 hour urine specimen
Severe:
- >2+ on a urine dipstick or ≥ 5 g protein in 24 hour urine specimen

Question 10

Mild Preeclampsia S/S?

Answer 10

• B/P ≥ 140/90
• Proteinuria
  
  • > 1+ on a urine dipstick
  • ≥ 300mg protein In 24 hour urine specimen
• No evidence of organ dysfunction
• May have normal reflexes
• May have normal lab tests

Question 11

Severe Preeclampsia S/S?

Answer 11

• BP: > 160 systolic &/or > 110 diastolic
• Proteinuria
  
  • > 2+ on a urine dipstick or ≥ 5 g protein in 24 hour urine specimen
• Oliguria: < 500mL 24hr
• Visual disturbances
• Epigastric pain (RUQ)
• Impaired liver function

Question 12

Which labs are increased during preeclampsia?

Answer 12

CBC and uric acid

Question 13

Which labs are increased during HELLP?

Answer 13

BUN, creatinine, liver enzymes

Question 14

Which labs are decreased during HELLP?

Answer 14

CBC, platelet, fibrinogen

Question 15

Mild Preeclampsia Management (3)

Answer 15

• Expectant management: wait and see
• Home Management: bed rest, daily fetal move counts, NST
• Hospital Management

Question 16

Nursing Assessment of the Patient With Preeclampsia?

Answer 16

• Vital signs q 1 - 4 hours
  
  • Same arm
  • Same position
• Careful I & O
• Urine output
  
  • May need foley catheter
  • > 30 ml per hr

Question 17

Severe Preeclampsia Management (meds)?

Answer 17

• Magnesium Sulfate 4-6g bolus (in labor to 24hrs PP)

- Anti-hypertensives

Question 18

What is the maintenance dose of Magnesium Sulfate during labor and PP to tx severe preeclampsia?

Answer 18

2-4 mg/hr

Question 19

Magnesium Sulfate blood levels:

1) therapeutic
2) reflexes disappear
3) resp distress
4) cardiac conduction probems

Answer 19

1) 4-8 mg/dl
2) 8-10 mg/dl
3) 10-15 mg/dl
4) > 15 mg/dl

Question 20

Magnesium Sulfate Side Effects?

Answer 20

Resp depression, N /V, ,lethargy, weakness, sweating, flushing, nasal congestion, HA, visual blurring, slurred speech

Question 21

What is the first sign of Mag Sulfate toxicity?

Answer 21

loss of reflexes

Question 22

At what resp rate do you stop mag sulfate administration?

Answer 22

< 12/min

Question 23

Mag sulfate antagonist?

Answer 23

calcium gluconate

Question 24

Medications to treat mild or chronic Hypertension in Pregnancy

Answer 24

Hydralazine (1st line agent)
Labetalol (1st line)
Nifedipine
Methydopa )

Question 25

Signs of Impending Eclampsia?

Answer 25

Rapid Increase in  B/P
Rapid Weight Gain
Generalized Edema
Proteinuria 
Oliguria (100cc/4 hr)
Epigastric Pain
Marked Hyperreflexia
Severe Frontal HA
Vomiting
Visual Disturbances
Drowsiness
Pulmonary edema

Question 26

Eclampsia Nursing Care: During Seizure

Answer 26

• Ensure patient airway
• Turn head to side
• Place pillow under back or a shoulder
• Call for assistance
• Side rails up
• Observe & record convulsion activity

Question 27

Eclampsia Nursing Care: After Seizure

Answer 27

• Remain w/ patient
• Start IV fluids & carefully monitor
• Magnesium Sulfate or anticonvulsant
• Monitor blood pressure
• Expedite lab work
• Anticipate delivery

Question 28

What does HELLP stand for?

Answer 28

• Hemolysis
• Elevated Liver Enzymes, and
• Low Platelets