Care of Pregnant Patients

Question 1

What are the coagulation changes for pregnant patients?

Answer 1

!PT, PTT, platelet count, bleeding time, all decrease.

Question 2

What are respiratory changes for pregnant patients?

Answer 2

!PaCO2 decreases to ~ 30, resulting in respiratory alkalosis
!Left shift in oxyhemoglobin dissociation curve - more O2 is made available to fetus

Question 3

What is the best position for pregnant patients?

Answer 3

!Left lateral position to promote blood flow to uterus
!Maintain uterine displacement with hip wedge

Question 4

Why assess deep tendon reflexes hourly for OB patients?

Answer 4

!Absence of dtr is a sign of magnesium sulfate toxicity
Calcium gluconate is antidote for magnesium sulfate toxicity

Question 5

What are side effects of eclampsia for OB patients?

Answer 5

!DIC
Cerebral vasospasm, edema, hemorrhage
Hypertensive encephalopathy

Question 6

What is DIC?

Answer 6

Disseminated Intravascular Coagulation
(a pathological form of clotting, consuming large amounts of clotting factors in the body)

Question 7

What is the treatment for DIC?

Answer 7

FFP - best source of clotting factors

Question 8

What is the goal of treatment for eclampsia?

Answer 8

Goal: Control seizure activity by administer Magnesium sulfate 4-6g IV loading dose, then 2-4g/hr IV
Assess LOC, signs of increased ICP
Caution with antihypertensive therapy

Question 9

What is the definition of severe preeclampsia?

Answer 9

equal to or greater than 2x BP reading of >155/105

Question 10

What is the late sign of preeclampsia?

Answer 10

Proteinuria

Question 11

What are the other symptoms of preeclampsia?

Answer 11

Elevated BUN/ Creatinine, uric acid
Decreased liver function (elevated ALT/AST)
Decreased serum glucose
Thrombocytopenia
Possible altered LOC

Question 12

How is preeclampsia managed?

Answer 12

Assess LOC, s/s increased ICP, deep tendon reflex hourly, MgSO4

absence of dtr sign of MgSO4 toxicity

Question 13

What is HEELP Syndrome in OB patients?

Answer 13

triggered by pre-eclampsia:
!Hemolysis, elevated liver enzyme, low platelets

Question 14

What is the antidote for magnesium sulfate toxicity?

Answer 14

calcium gluconate

Question 15

What is the common symptom for HEELP Syndrome in OB patients?

Answer 15

!RUQ pain

Question 16

What are the hemodynamic changes in pregnant women?

Answer 16

murmurs present in 90% of pregnant women
HR increased 15-20 above baseline
Cardiac output (CO) increased 30-50%
CO significantly influenced by maternal position

Question 17

The pregnant patient has increased potential for pulmonary aspiration because:

Answer 17

Physiologic changes include decreased gastric motility, delayed gastric emptying, decreased lower esophageal muscle tone, increased intragastric pressure
Always treat as with full stomach, thus need rapid sequence intubation

Question 18

After 10 minutes in PACU, patient states “All of a sudden I feel nauseated and faint.” Patient’s BP decreased from 130/70 to 100/60. What is the initial nursing intervention?

Answer 18

Pregnant patient should be positioned left or right lateral tilt position to reduce compression of inferior vena cava that will ensure venous return and cardiac output to fetus