Chapter 25: Complications of Pregnancy Flashcards
1
Q
what are the 3 most common causes of hemorrhage during the first half of pregnancy?
A
- abortion
- ectopic pregnancy
- gestational trophoblastic dz
2
Q
abortion
A
- loss of pregnancy of less than 20 weeks or a fetus less than 500 g
- can be spontaneous or induced
3
Q
spontaneous abortion
A
- termination of pregnancy w/o action taken by the woman or another person
- incidence inc with paternal age and with inc maternal age
- most occur during first 12 weeks of pregnancy
- most common cause: severe congential abnormalities that are incompatible with life
- also caused by syphilis, listeriosis, toxoplasmosis, brucellosis, rubela, intraabdominal infections
- 6 types:
- threatened
- inevitable
- incomplete
- complete
- missed
- recurrent
4
Q
threatened abortion
A
- first sign is vaginal bleeding
- other S/S are uterine cramping, persistent backache, feelings of pelvic pressure
- mgmt:
- bleeding during 1st half of pregnancy is considered a threatened abortion
- report bleeding and given detailed hx about bleeding and other symptoms
- U/S exam is done and test hCG levels
- should limit sexual activity until bleeding as ceased
- count perineal pads and note quantity/color
5
Q
what problems may result from a pregnancy that does not end in spontaneous abortion after early bleeding?
A
- prematurity
- SGA infant
- abnormal presentation
- perinatal asphyxia
6
Q
inevitable abortion
A
- ROM and cervix dilates
- incomplete evacuation–>infection/sepsis
- mgmt:
- natural expulsion is common
- vacuum curettage: removal of uterine contents with vacuum–>clear uterus if natural process is not effective
- D&C: used if pregnancy is more advanced or bleeding is excessive
- involves stretching the cervical os to scrape/suction uterus
- natural expulsion is common
7
Q
incomplete abortion
A
- some but not all of products of conception are expelled
- S/S: active uterine bleeding, severe abdominal cramping, cervix opened
- mgmt:
- retained tissue prevents uterus from contracting firly, so profuse bleeding occurs
- MUST first stabilize CV state
- draw blood specimen for type and cross
- insert IV for fluid replacement and drug administration
- D&C done to remove tissue
- D&E done if the pregnancy is more advanced w/ a larger amount of tissue
- may need to administer oxytocin or methylergonovine to help stop bleeding
- D&C cannot be done after 14 wks gestation b/c of danger of excessive bleeding
- retained tissue prevents uterus from contracting firly, so profuse bleeding occurs
8
Q
complete abortion
A
- occurs when all products of conception are passed from uterus
- after passage, uterine contractions and bleeding subsides and cervical os closes
- uterus feels small
- negative pregnancy test
- only have to intervene if excessive bleeding or infection occur
- woman should rest and watch for bleeding, pain, fever
- do not have sex until follow up with HCP
9
Q
missed abortion
A
- occurs when fetus dies during first half of pregnancy but is retained in the uterus
- when fetus dies, early signs of pregnancy disappear (nausea, breast tenderness, urinary frequency)
- uterus stops growing and dec in size which reflects absorption of amniotic fluid and maceration of fetus (discoloration, softening, and tissue degeneration)
- mgmt:
- U/S confirms fetal death
- no fetal heart activity can be found
- hCG will be decreasing
- D&C or D&E are done
- PGs or misoprostol may be needed to induce contractions to expel the fetus
- 2 complications:
- infection
- DIC
- U/S confirms fetal death
10
Q
recurrent spontaneous abortion
A
- 3 or more spontaneous abortions
- primary causes: genetic or chromosomal abnormalities and anomalies of the reproductive tract (such as bicornuate uterus) or incompetent cervix
- mgmt:
- examine woman’s body for anomalies
- genetic screening for woman and partner
- cerclage: procedure to prevent early dilation of cervix may be done if abortions caused by cervical incompetence
- RhoGAM can be given to woman with Rh negative blood
11
Q
nursing considerations for abortion
A
- psychological care: help them to grieve, answer questions
- listen to the woman and observe how she behaves
- convey acceptance of the feelings expressed
- teach that grief may last from 6 mos to one year
12
Q
DIC
A
- occurs when anticoagulation is occurring, inappropriate coagulation also is occurring in the microcirculation
- tiny clots form in tiny blood vessels–>block blood flow to organs–>ischemia
- clotting mechanisms activated inappropriately
- consumption of platelets, fibrinogen, prothrombin, factor V and VIII occur and then they are consumed, the blood becomes deficient in clotting factors and can’t clot
- labs results establish dx: fibrinogen and platelets dec, PT and PTT may be prolonged
- tx: correct the cause
- blood replacement
13
Q
dz that cause DIC fall into 3 major groups:
A
- infusion of tissue thromboplastic into the circulatino, which consumes other clotting factors
- ie placetal abruption, prolonged retention of a dead fetus
- conductions characterized by endothelial damage:
- ie severe preeclampsia
- ie HELLP: hemolysis, elevated levels of liver enzymes, and low platelet levels)
- nonspecific effects of some dz:
- ie maternal sepsis, amniotic fluid embolism
14
Q
nursing considerations of DIC
A
- if have a dz that inc risk of DIC, nurse should observe for bleeding from unexpected sites
- sites for IV insertion or lab work, nosebleeds, or spontaneous bruising
- if coagulation studies are abnormal, an epidural block may be contraindicated
15
Q
ectopic pregnancy
A
- implantation of fertilized ovum in an area outside the uterine cavity
- can lead to maternal death from hemorrhage
- leads to scarring of fallopian tubes
- pelvic infection (chlamydia and gonorrhea), failed tubal ligation, and hx of ectopic pregnancy in risk
- also inc risk: IUDs, low dose progesterone contraceptives, assistive reproductive technology
16
Q
manifestations of ectopic pregnancy
A
- missed menstrual period
- positive pregnancy test
- abdominal pain
- vaginal spotting
- signs can depend on exactly where the implantation takes place
- if in distal fallopian tube, can support embryo longer, so may experience normal early signs of pregnancy
- if in proximal fallopian tube, can rupture tube in 2-3 weeks and cause sudden, severe pain in lower quadrants and abdominal hemorrhage which causes radiating pain under the scapula
- hypovolemic shock is a concern
17
Q
mgmt and nursing considerations for ectopic pregnancy
A
- mgmt depends on if tube is intact or ruptured
- goal is to preserve tube and improve chance of future fertility
- methotrexate can be used to inhibit cell division of developing embryo
- surgical mgmt if unruptured–>linear salpingostomy to salvage the tube
- surgical mgmt if ruptured–>control bleeding and prevent hypovolemic shock
- when CV is stable, salpingectomy (removal of tube) w/ ligation of bleeding vessels may be required
- nurses should focus on early identification of hypovolemic shock, pain control, and psych support
- administer analgesics
- teach about SEs of methotrexate: n/v
- edu about refraining from drinking alcohol, taking vits with folic acid, and having sexual intercourse
18
Q
what are the 2 main causes of hemorrhage after 20 weeks of gestation?
A
- placenta previa
- placental abruption
19
Q
placenta previa
A
- implantation of uterus in the lower uterus–>placenta closer to the internal cervical os
- 3 types depending on how much the internal cervical os is covered by the placenta: total, partial, marginal
- marginal: placenta implanted more than 3 cm from internal cervical os
- partial: lower border of placenta w/in 3 cm of internal cervical os but does not completely cover os
- totaL: completely covered os
- more common in: older women, multiparas, women who have had C?S, and women who have had suction currettage
- inc risk if: African/Asian ethnicity, cigarette smoking and cocaine use, and male fetus
20
Q
clinical manifestations of placenta previa
A
- classic sign is sudden onset of painless uterine bleeding in second half of pregnancy
- results from tearing of placental villi from uterine wall
- dx by U/S
- do not manually exam vagina until location and position of placenta verified
21
Q
mgmt and nursing considerations of placenta previa
A
- mgmt: evaluate women to determine amount of hemorrhage and monitor the fetus
- also must consider gestational age
- maintain stable CV status for mother
- try to delay birth to inc birth weight and also administer corticosteroids to mother to speed maturation of fetal lungs
- home care criteria:
- no evidence of active bleeding, bed rest, short distance from hospital, can verbalize risks
- no intercourse to prevent disruption of fetus
22
Q
placental abruption
A
- separation of normally implanted placenta before the fetus is born
- occurs in cases of bleeding and formation of a hematoma on maternal side of the placenta
- as the clot expands, further separation occurs
- dangers for woman: hemorrhage, hypovolemic shock, clotting abnormalities (DIC)
- dangers for fetus: asphyxia, excessive blood loss, prematurity
23
Q
etiology of placental abruption
A
- inc risk: cocaine use (due to vasoconstriction–>abruption), maternal HTN, cigarette smoking, multigravida status, short umbilical cord, abdominal trauma, premature ROM, hx of previous premature separation, maternal age
24
Q
manifestations of placental abruption
A
- bleeding: may be evident vaginally or concealed behind placenta
- uterine tenderness localized at site of abruption
- uterine irritability w/ frequent low intensity contractions and poor relaxation b/w contractions
- abdominal or low back pain that is described as dull/aching
- may be suffen and severe or intermittent and difficult to distinguish from labor contractions
- high uterine resting tone identified with intrauterine pressure catheter
- uterus becomes boardlike and tender
- also may show: nonreassuring FHR, back pain, signs of hypovolemic shick
- amniotic fluid may be a port wine color
25
nursing considerations and mgmt of placental abruption
* mgmt:
* if mild and under 34 weeks, bed rest, tocolytic use, administration of corticosteroids
* if fetal compromise of excessive bleeding: immediate delivery
* blood products for replacement and 2 large bore IV placed for fluid replacement
* may be very frightening b/c of pain and apprent danger
* if C/S is necessary, woman may feel pwerless and nurse should help explain what is going on
* excessive bleeding and fetal hypoxia are major concerns and nurse should monitor for these
26
hyperemesis gravidarum (HEG)
* most n/v in pregnancy should end by 13-14 weeks
* HEG is persistent, uncontrollable vomiting that begins in first weeks of pregnancy and may continue throughout pregnancy
* can have serious consequences (morning sickness is self limiting and has no seirous complications):
* loss of 5% or more of pre-pregnancy weight, dehydration, acidosis from starvation, elevated levels of blood and urine ketones, alkalosis from loss of HCl in gastric fluids, and hypokalemia
* short term hepatic dysfunction w/ elevated liver enzymes
* deficiency of vit K--\>coagulation disorders
* deficiency of thiamine--\>encephalopathy
27
etiology of HEG
* cause is not known, but more common among unmarried white women, during first pregnancies, and in multifetal pregnancies
* possible causes include allergy to fetal proteins, elevation of pregnancy hormones, maternal thyroid dysfunction, h. pylori
28
clinical manifestations of HEG
* persistent n/v
* weight loss
* thirst
* oliguria
* dry mucous membranes/skin
* poor skin turgor
* constipation
* lethargy
* inc urine specific gravity (\>1.025)
* hypovolemia: hypoTN and tachycardia
* labs: inc BUN and hct, dec Na/K/Cl
29
therapeutic mgmt of HEG
* should first exclude other causes of persistent n/v
* lab studies include H&H which may be elevated b/c of dehydration
* electrolytes: dec Na, K, and Cl
* elevated Cr
* tx:
* correct dehydration: IV fluids may be necessary
* antiemetics: ondansetron, promethazine, H2 receptor antagonistis, PPIs, metoclopramide
* improve nutrition:
* vitamin B6 (pyridoxine)
* diet
30
nursing considerations for HEG
* monitor V/S and monitor I&Os
* daily weights
* monitor U/S for growth
* monitor urine for ketones which can indicate fat stores being broken down to meet energy needs
* monitor for signs of dehydration: dec fluid intake, dec urine output, inc urine SG, dry mucous membranes/skin, skin turgor
* monitor labs: BMP, H&H
* to reduce n/v:
* small portions of food
* do not eat foods with strong odors
* carbs are more easily digested
* take soups and liquids b/w meals
* sit up after meals
* maintain nutrition and fluid balance
* eat every 2-3 hours
* salt the food to replace chloride lost in HCl thru vomit
* consume K and Mg rich foods
* IV fluids and TPN if needed
* social support:
* allow verbalization of impact
* explore reluctance to accept pregnancy
* recognize lack of support available
31
gestational trophoblastic dz
* AKA hydatidiform mole--\>developmental anomaly of the placenta
* occurs when trophoblasts develop abnormally, so the abnormality of the placenta develops, and if present, a fetus will have a fatal chromosomal abnormality
* inc risk at both ends of reproductive life and inc risk among Asian women
* inc risk if have already had one GTD
* presents as an edematous grapelike cluster on U/S
* may or may not be malignant
* may develop into choriocarcinoma
32
clinical manifestations of GTD
* higher levels of hCG than expected for gestation
* characteristic snowstorm U/S pattern that shows the vesicles and absence of a fetal sac or fetal hear activity
* uterus larger than expected for gestational age
* vaginal bleeding: varies from dark brown spotting to profuse hemorrhage
* excessive n/v (HEG) which may be related to elevated hCG
* early development of preeclampsia (usually not diagnosed until 24 weeks in "normal" pregnancy)
33
mgmt of GTD
* medical mgmt:
* evacuation of trophoblastic tissue of the mole
* continuous f/u of the woman to detect malignant changes of any remaining trophoblastic tissue
* CXR, CT scan, or MRI can be used to detect metastatic dz
* may need CBC, type and screen in case transfusion is needed
* mole usually removed by vacuum aspiration followed by curettage
* then give oxytocin to contract uterus, but should AVOID oxytocin before evacuation b/c tissue can become embolized if given before
* f/u to check for malignancy
34
four categories of HTN during pregnancy
* gestational HTN: BP elevation after 20 weeks of pregnancy NOT accompanied by proteinuria
* may progress to preeclampsia
* if persists after birth, then called chronic HTN
* preeclampsia: systolic BP of 140 or greater OR diastolic BP of 90 or greater after 20 weeks gestation accompanied by significant proteinuria
* edema is present but non-specific for pre-eclampsia
* eclampsia: progression of preeclampsia to generalized seizures
* chronic HTN: elevated BP was known to exist before pregnancy or before 20 weeks
35
preeclampsia: risk factors
* major cause of perinatal death and IUGR
* risk factors:
* 1st pregnancy
* 1st pregnancy for father of baby or man who has previously fathered one preeclamptic pregnancy
* age \>35
* anemia
* hx of PIH
* chronic HTN
* obesity
* DM
* multifetal pregnancy
* African Americans
36
patho of preeclampsia
* result of generalized vasospasm
* peripheral vascular resistance inc b/c some women are sensitive to Ang II and may have a dec in vasodilators
* vasospasm dec diameter of blood vessels--\>endothelial damage--\>circulation to body organs is dec
* ratio of thromboxane to prostacyclin increases
* only cure is to deliver the baby
37
patho of altered metabolism related to pre-eclampsia: thromboxane vs. prostacyclin
* thromboxane:
* from kidney and trophoblastic tissue
* vasoconstrictor
* platelet aggregation
* uterine irritability
* dec utero placental blood flow
* prostacyclin:
* from placenta and endothelial cells
* vasodilator
* inhibits platelet aggregation
* dec uterine activity
* inc uterine blood flow
38
patho of renal perfusion w/ preeclampsia
* decreased renal perfusion occurs with pre-eclampsia which causes a reduced GFR
* BUN, creatinine, and uric acid levels rise
* protein leaks across glomerular membrane
* loss of protein from kdineys reduces colloid osmotic pressure and allows fluid to shift to interstitial spaces--\>edema and reduction of intravascular volume which causes inc viscosity of blood and rise in hct level
* b/c of reduced intravascular volume, Ang II and aldosterone triggers retention of water and Na which resultsin further vasospasm and HTN--\>edema worsens
39
patho of liver circulation as it relates to pre-eclampsia
* reduced liver circulation impairs function and leads to hepatic edema and subcapsular hemorrhage--\>hemorrhagic necrosis
* shows as elevated liver enzymes and epigastric pain occurs
40
patho of cerebral circulation as it relates to pre-eclampsia
* vasoconstriction of cerebral vessels leads to pressure induced rupture of thin walled capillaries--\>small cerebral hemorrhage
* S/S: HA, cisual disturbances (spots before the eyes), hyperactive DTRs
41
patho of pulmonary circulation as it relates to pre-eclampsia
* decreased colloid oncotic pressure can lead to pulmonary capillary leak--\>pulmonary edema
* dyspnea is primary symptom
42
patho of nutritional deficiency as it relates to pre-eclampsia
* low protein: protein responsible for cellular growth
* hypomagnesemia: magnesium is a vasodilator
* calcium: inverse relationship b/w calcium intake and incidence of eclampsia
43
prenatal preventive measures for pre-eclampsia
* monitor weight gain, BP, and urinary protein level
44
complications of pre-eclampsia
* placental abruption
* hematologic problems: DIC, thrombocytopenia
* CVS
* renal failure
* hepatic failure
* newborn complications:
* SGA r/t utero placental insufficiency
* reduced amniotic fluid
* intrauterine fetal death
45
clinical manifestations of pre-eclampsia
* classic signs: first sign is usually HTN
* proteinuria (identified w/ clean catch urine specimen)
* additional signs:
* retina: vascular constriction and narrowing of small arteries
* hyperactive DTRs
* labs: liver or renal dysfunction
* coagulation may be impaired and platelets dec
* generalized edema: may first show as rapid weight gain
* symptoms:
* continuous HA
* drowsiness
* mental confusion
* visual disturbances: blurred/double vision
* numbness/tingling of hands or feet
* epigastric pain
* dec urinary output
46
diagnostic criteria for mild pre-eclampsia
* BP: 140/90 on 2 occasions 6 hours apart
* proteinuria: 300 mg in 24 hour period, or trace to 1+/2+ by urine dipstick
* I&O
* transient HA
* hyperreflexia 2+ or 3+
* no clonus
47
mgmt of mild preeclampsia
* IV mag sulfate
* antiHTN therapy
* corticosteroids to accelerate fetal lung maturity if \<34 weeks
* activity restriction: rest frequently
* lateral position for at least 1.5 hours/day dec pressure of vena cava and inc cardiac return and circulatory volume
* BP: BP should be checked in same arm and in the same position 2-4 times/day
* weight: weight each morning
* urinalysis: urine dipstick for protein using first void daily
* fetal monitoring: kcik counts, U/S, BPP
* diet: need ample protein and calories
* diet w/o salt or fluid restriction
48
labs to manage pre-eclampsia
* magnesium levels
* liver fcn tests
* CBC w/ platelets
* LDH
* uric acid
* serum creatinine
* bilirubin
* 24 hour urine for protein and creatinine clearance
* need to deliver if unstable or HELLP occurs
49
assessment for pre-eclampsia
* CHHURN:
* *C*ardiovascular system
* *H*ematologic system
* *H*epatic system
* *U*teroplacental system
* *R*enal system
* *N*eurological system
50
assessment of CV system for pre-eclampsia
* assess V/S:
* BP w/ client in left lateral recumbent position
* pulse
* respirations
* temp q4 hrs
* FHR: continuously
51
assessment of hematologic system for pre-eclampsia
* assess for bleeding:
* petechia
* bruising
* epistaxis
* gingival bleeding
* hematuria
* excessive vaginal bleeding
* conjunctival hemorrhage
* oozing from incision/puncture site
52
assessment of hepatic system w/ preeclampsia
* assess n/v:
* RUQ or epigastric pain
* portal HTN may result in epigastric pain and may precede hepatic rupture
* monitor lab values: liver function studies--\>SGOT, SGPT, AST, ALT
53
assessment of uteroplacental system w/ preeclampsia
* antepartum:
* EFM
* NST
* BPP
* U/S
* intrapartum:
* continuous fetal monitoring
54
assessment of renal system w/ preeclampsia
* daily weights: inquire about weight gain
* assess edema
* monitor I&O and urine protein
* notify HCP if \<30 mL/hour
* monitor lab values:
* inc BUN, Cr, and uric acid
* renal damage as indicated by oliguria
55
assessment of neurological system w/ preeclampsia
* assess neuro deficits and LOC
* HAs from CNS irritability--\>severe or continuous
* visual disturbances: blurred vision, seeing spots of flashing lights, diplopia
* drowsy/dizziness
* assess DTRs and clonus q1 hr
* patellar and/or biceps reflexes
56
assessment of clonus w/ preeclampsia
* clonus:
* position client w/ legs dangling over edge of examining table
* support leg w/ one hand and sharply dorsiflex the client's foot w/ other hand
* maintain dorsiflexed position for a few seconds then release foot
57
negative vs. positive clonus
* negative clonus (normal):
* 0 beats
* foot remains steady: no rhythmic oscillations when foot dorsiflexed
* when released, foot drops to flexed position w/ no oscillations
* positive clonus (abnormal):
* 1-4 beats
* rhythmic oscillations when dorsiflexed
* similar oscillations when foot drops to plantar flexed position
58
diagnostic criteria for severe pre-eclampsia
* BP over 160/110 2 readings, 6 hrs apart while on bed rest
* proteinuria \>5 g in 24 hr or 3+ or higher on urine dipstick
* elevated creatinine
* dec platelets
* elevated liver enzymes
* oliguria
* severe, unrelenting HA
* visual disturbances present
* n/v/epigastric pain
* hyperreflexia w/ or w/o clonus
* pulmonary edema or cyanosis
* thrombocytopenia
* fetus: growth restriction and reduced amniotic fluid volume
59
HELLP syndrome
* hemolysis, elevated liver enzymes, and low platelets
* may be assoc with preeclampsia and develop during third trimester
* client at risk for:
* hemorrhage
* pulmonary edema
* hepatic rupture
* tx: mag sulfate to control seizures and hydralazine to control BP
* fluid replacement is managed to avoid worsening reduced intravascular volume
* if woman is near term and has a favorable cervix, induction of labor is preferred to avoid bleeding and clotting complications
60
signs of impending seizures
* hyperreflexia, and possible clonus
* inc signs of cerebral irritability (HA, visual disturbance)
* epigastric or RUQ pain, n/v
61
seizure preventive measures
* reduce external stimuli
* quiet room with door closed
* pad door to reduce noise
* keep lights low and noise to a minimum
* block phone calls
* group nursing assessments to allow woman periods of undisturbed rest
* avoid bumping bed or startling woman
* restrict visitors
62
how to prevent seizure related injury
* padded side rails
* O2 and suction equipment
* preeclampsia box:
* medium plastic airway
* ambu bag w/ mask
* ophthalmoscope
* tourniquet
* reflex hammer
* syringes and needles
* meds: mag sulfate, calcium gluconate
63
how to protect a woman during a seizure
* stay w/ pt and call for help
* turn onto side during tonic phase to permit greater circulation to placenta and prevent aspiration
* note time and sequence
* eclampsia marked by tonic clonic seizure preceded by facial twitching
* insert airway after seizure
* suction mouth and nose
* O2 by mask at 8-10 L/min
* notify HCP
* prepare for med administration
64
administration and antidote of magnesium sulfate
* administration:
* infusion pump: piggyback into mainline IV
* loading dose: 4-6 g then 1-3 g/hour
* antidote: calcium gluconate--\>10 mL of a 10% soln IV push over 10 min
65
serum levels of magnesium sulfate
* 4-8 mg/dL: therapeutic
* 9-12 mg/dL: loss of reflexes
* 15-17 mg/dL: respiratory and muscular paralysis
* 30-35 mg/dL: cardiac arrest
66
class and action of magnesium sulfate
* class:
* beta adrenergic agent
* anticonvulsant
* tocolytic
* action:
* CNS depressant
* competes w/ calcium to reduce muscle excitation to slow and stop uterine activity
* lowers seizure threshold
67
maternal SEs to mag sulfate
* flushing
* HA
* dry mouth
* dizziness
* lethargy
* pulmonary edema
68
fetal SEs to mag sulfate
* drug crosses placenta
* dec in FHR variability
* hypotonia
* lethargy
* respiratory depression
69
signs of mag toxicity
* resp rate \<12 breaths per min
* maternal pulse ox reading less than 95%
* absence of DTRs
* sweating, flushing
* altered sensorium: condused, lethargic, slurred speech, drowsy
* hypoTN
* serum magnesium value above 4-8 mg/dL
70
nursing considerations with mag sulfate
* monitor magnesium and calcium levels
* monitor DTRs
* continuous FHR monitoring
* baseline maternal V/S, then q2-4 hours
* assess resp status
* RR rate: d/c if \<12
* auscultate lungs
* monitor strict I&O
* urinary output of 30 mL/hour
* titrate IV and PO fluids
* postpartum:
* continue magnesium 24-48 hours
* strict I&O
71
respond to signs of mag sulfate toxicity
* notify HCP
* obtain mag sulfate level
* monitor mag sulfate levels q12 hours
* dec mag sulfate per protocol
* monitor fetal well being
* administer calcium gluconate as ordered
* continue close monitoring of client
72
nursing considerations with mag sulfate toxicity
* monitor CNS status: changes indicate cerebral hypoxia or impending seizure
* provide quiet, low stimulus env, limit visitors
* provide bedrest: position client in left lateral position
* monitor DTR and presence of clonus
* monitor FHR and contraction pattern
* provide adequate fluids
* protect client from injury
* initiate seizure precautions
* administer seizure meds
* prepare for delivery after stabilization of client
73
super imposed pre-eclampsia
* woman who has chronic HTN with pre-eclampsia superimposed
* worse prognosis for mother and fetus
* inc risk for:
* placental abruption
* acute renal failure
* IUGR
* fetal demise
* maternal demise
* closely monitor chronic HTN if proteinuria develops or when edema occurs in upper half of body
* serum uric acid is helpful in confirming dx of superimposed PIH
74
eclampsia
* pre-eclampsia that has progressed to include maternal tonic clonic seizures
75
support for family after an eclamptic seizure
* explain what happened
* don't minimize seriousness
* explain that it lasts a few min, pt is unconscious, drowsy for some time
* acknowledge that seizure indicates worsening of condition
* HCP will determine future mgmt
* may include delivery
