Chapter 4: Sophie Bloom (Preeclampsia) Flashcards
physical changes first trimester
- Fatigue
- Swollen tender breasts
- Morning sickness
- Cravings or aversions to certain foods
- Moodiness
- Constipation
- More frequent urination
- Headaches
- Heartburn
- Weight gain or loss
physical changes second trimester
- aches and pains
- linea nigra
- darkening nipples and areola
- hyperpigmentation
- numbness/tingling of hands/fingers
- itchy palms, soles, abdomen
- heartburn
physical changes third trimester
- heartburn
- SOB
- ankles, feet, face swelling
- hemorrhoids
- breast tenderness
- colostrum
- sleep disturbance
- contractions
- baby dropping
When can fetal heart tones be heard with a doppler?
10-12 weeks, normally about 110-160 bpm
Uses for ultrasound in the first, second, and third trimesters
- Pregnancy dating
- Fetal anomaly
- Amniotic fluid
- Placenta location
- With procedures like amniocentesis
- Assessment of fetal well-being
- Assessment of vaginal bleeding
- Cervical length evaluation
What not to consume in pregnancy and why
- Raw food
- Unpasteurized dairy products or juice
- Large fish (mercury)
- Raw sprouts
- Alcohol
- Tap water high in lead
- Caffeine
- BPA
- Herbal teas or supplements unless approved
Expected fundal height at 12-, 16-, 20-, and 36 weeks gestation
fundal height in cm = gestational weeks from 12-36 weeks
How many weeks gestation for the anatomical ultrasound?
16-20 weeks
How many weeks gestation for TDaP immunization and RhoGAM administration?
28 weeks
How many weeks gestation for the oral glucose tolerance test?
24-28 weeks
What are the risk factors for preeclampsia?
- Low or high age
- African descent
- Low socioeconomic status
- Family or personal hx of preeclampsia
- First pregnancy (nulliparity)
- Pregnancy with new partner
- UTI
- Gestational diabetes
- DM1
- Obesity
- Chronic HTN
- Kidney disease
- Thrombophilia
- Abnormalities of fetus
- Hydatidiform mole
- Multifetal pregnancy (twins, triplets)
- Donated eggs or sperm
What laboratory tests are ordered in preeclampsia?
- UA or 24-hour urine collection
- CBC: platelets
- Liver enzymes ALT AST
- BUN/Cre
- CMP
What are typical standing orders (assessments, precautions) for patients that preeclampsia is being “ruled out”?
- Minimal outside stimuli (seizure precautions)
- FHR and uterine contraction monitoring
- DTR and clonus
- Vitals
- Breath sounds, pulse ox, head to toe
- Fetal ultrasound for BPP + amniotic fluid volume
what is clonus? how to assess and what does it look like?
- beating of foot 3 or more times
- assess by rapidly dorsiflexing (towards their nose) pt’s foot
what is an abnormal finding for reflexes in preeclampsia?
hyperactive (ex. hit below knee, pt kicks ya)
why do clonus and hyperactive reflexes occur with preeclampsia?
preeclampsia hyperstimulates the CNS
What is the management of mild preeclampsia?
- Deliver at 37 wks
- Assessing for decreased fetal movement, increased swelling, epigastric pain, SOB, headache, vision change
- Bp checks
- Platelets and liver function tests
What is magnesium sulfate used for in pregnancy? How is it given?
- Prevent seizures or eclampsia
- Given IV piggyback
What are signs of magnesium toxicity?
- resp depression
- oliguria
- absent reflexes
- lethargy
- slurred speech
- muscle weakness
- loss of consciousness
what is a spinal?
single dose, lasts 1-3 hours
what is a epidural?
indwelling catheter that allows for multiple doses or continuous by pump
what is a spinal epidural?
- single dose injected and then epidural catheter is placed
- allows for more mobility
What are the signs of hypotension from epidurals?
- Decrease in BP or systolic 100 or less
- Fetal bradycardia (below 120)
- FHR variability decrease
Nursing interventions for epidural hypotension?
- Notify
- Position on side
- O2
- Vasopressor
- Elevate legs
- Continue to monitor
how to providers try to prevent epidural hypotension?
fluid bolus beforehand
What needs to occur during the first period of reactivity for newborns?
- HR 160-180 bpm, decreasing to 100-120 bpm
- Alert and mobile
