Antepartum Cardiac Diseases Flashcards
Women should avoid lying on their backs how long into their pregnancy?
20+ wks
Cardiac classifications 2-4 are placed on antibiotic prophylaxis during labor and postpartum for what reason?
to prevent bacterial endocarditis
During which stage of labor does pushing begin?
stage 2
Which type of HTN occurs after 20 wks of preggo w/o proteinuria?
gestational HTN
Gestational HTN criteria?
- two BP readings > 140/90, at least 6-8 hrs apart
- occurs after 20 wks of preggo w/o proteinuria
HTN after 20 wks with proteinuria?
preeclampsia
Preeclampsia?
- HTN (> 140/90) after 20wks of preggo with proteinuria
- can be mild or severe
Differential Diagnosis between mild and severe preeclampsia (BP)?
BP:
- mild: ≥ 140/90
- severe: > 160 systolic &/or > 110 diastolic
Differential Diagnosis between mild and severe preeclampsia (proteinuria)?
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
Mild Preeclampsia S/S?
- 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
Severe Preeclampsia S/S?
- 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
Which labs are increased during preeclampsia?
CBC and uric acid
Which labs are increased during HELLP?
BUN, creatinine, liver enzymes
Which labs are decreased during HELLP?
CBC, platelet, fibrinogen
Mild Preeclampsia Management (3)
- Expectant management: wait and see
- Home Management: bed rest, daily fetal move counts, NST
- Hospital Management
Nursing Assessment of the Patient With Preeclampsia?
- Vital signs q 1 - 4 hours
- Same arm
- Same position
- Careful I & O
- Urine output
- May need foley catheter
- > 30 ml per hr
Severe Preeclampsia Management (meds)?
- Magnesium Sulfate 4-6g bolus (in labor to 24hrs PP)
- Anti-hypertensives
What is the maintenance dose of Magnesium Sulfate during labor and PP to tx severe preeclampsia?
2-4 mg/hr
Magnesium Sulfate blood levels:
1) therapeutic
2) reflexes disappear
3) resp distress
4) cardiac conduction probems
1) 4-8 mg/dl
2) 8-10 mg/dl
3) 10-15 mg/dl
4) > 15 mg/dl
Magnesium Sulfate Side Effects?
Resp depression, N /V, ,lethargy, weakness, sweating, flushing, nasal congestion, HA, visual blurring, slurred speech
What is the first sign of Mag Sulfate toxicity?
loss of reflexes
At what resp rate do you stop mag sulfate administration?
< 12/min
Mag sulfate antagonist?
calcium gluconate
Medications to treat mild or chronic Hypertension in Pregnancy
Hydralazine (1st line agent)
Labetalol (1st line)
Nifedipine
Methydopa )
