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Eclampsia Flashcards

1
Q

What is gestational HTN

A

Onset of HTN after 20 weeks

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2
Q

If left untreated or even if treated, gestational HTN may progress to __

A

Preeclampsia

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3
Q

how is Preeclampsia-eclampsia diagnosed?

A
  • Systolic greater than 140 and/or a diastolic of 90 or higher on two occasions at least 4 hours apart and after 20 weeks
  • With or without proteinuria
  • Or severe HTN after 20 weeks ( sys at or above 160 and/or a dia at or above 110)
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4
Q

What are the qualifications for proteinuria?

A

300mg or more in a 24 hours collection or a random urine dipstick test of 1+ or higher)
-Protein to creatinine ratio of 0.3mg

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5
Q

What is eclampsia?

A

WHen preeclampsia progresses into a generalized seizure

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6
Q

What is defined as chronic HTN for a pregnant woman?

A

HTN before pregnancy, DX before 20 weeks, or continuing beyond 12 weeks PP

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7
Q

How is superimposed (over chronic HTN) preeclampsia determined?

A
  • Onset of proteinuria after 20 weeks
  • Increase in pre-existing proteinuria
  • sudden exacerbation of controlled HTN
  • Change in labs (Plate less than 100K, Elevated LFT, decreased renal function)
  • Development of HA, Epigastric pain, or visual changes
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8
Q

What is the only known cure for preeclampsia?

A

Birth

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9
Q

What is the Initial patho of preeclampsia?

A
  • Generalized VC

- Vasospasms

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10
Q

What is the current theory as to why preeclampsia happens?

A
  • Begins during placental formation
  • Abnormal development in maternal spiral ateries leads to decreased perfusion and oxygenation
  • Diminished perfusion leads to a release of placental micro-particles that cause a systemic inflammatory response
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11
Q

A woman may have HELLP syndrome and be absent of ___. if she does she still is considered to have ____

A

HTN

Preeclampsia

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12
Q

Normotensive woman should be considered to have preeclampsia if she has___

A

Other signs of reduced organ perfusion

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13
Q

During treatment of preeclampsia, why is fluid replacement monitored and managed

A

To avoid worsening the womans’ reduced intravascular volume without giving her too much that would cause pulmonary edema or ascites

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14
Q

What type of birth is prefered for a preeclamptic mother? Why?

A

Induced vaginal

-To avoid bleeding and clotting that comes with c-sections

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15
Q

What are the three main effects of preeclampsia on the CV/pulmonary system?

A
  1. Increased vascular resistance
  2. Increased Cardiac output and stroke volume
  3. Decreased colloid osmotic pressure
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16
Q

Describe how preeclampsia affects the CV and Pulmonary system

A
  • Increased sensitivity to angiotensin causes an increase in BP via vasoconstriction.
  • As BP rises, so does CO and SV creating increased vascular resistance
  • This raise in Vascular resistance causes excess permeability of capillaries and in turn, will decrease plasma volume and edema will occur (especially in the lungs)
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17
Q

What are the three main effects of preeclampsia on the hematologic system?

A
  1. Thrombocytopenia (deficiency of platelets)
  2. Altered platelet function
  3. Hemolysis
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18
Q

Describe how preeclampsia affects the hematologic system

A
  • hemoconcentration occurs d/t loss of plasma volume, this increased the viscosity of the blood.
  • The increased viscosity causes hemolysis in the microvasculature and platelet clumping
  • The clumping damages the platelets as well as endothelial cells leading to reduced platelets and an increased in thromboxane A (TXA) (altered Thromboxane: Prostacyclin ratio)
  • Thromboxane A causes vasoconstriction and platelet aggregation this continuing the process when it is elevated
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19
Q

What are the 3 main effects of preeclampsia on the neurological system?

A
  1. Hyperreflexia
  2. Headache
  3. Seizure (eclampsia)
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20
Q

Describe how preeclampsia affects the neurological system

A
  • The vasoconstriction and vasospasms cause ruptures in the small capillaries in the cerebral vasculature
  • These ruptures cause small hemorrhages that eventually cause cerebral edema
  • This cerebral edema causes headaches and hyperreflexia
  • If it continues, seizures will occur
21
Q

What are the two major effects of preeclampsia on the renal system?

A
  1. proteinuria

2. Altered function

22
Q

Describe how preeclampsia affects the renal system

A
  • Decreased glomerular blood flow from the HTN causes damage to the glomeruli
  • This damage alters the function of the filtration and allows for protein to be lost through the urine (proteinuria) as well as causing an increased BUN, creatinine and uric acid
  • When the protein leaves colloid osmotic pressure decreases causing edema
  • When the edema occurs, hypovolemia occurs as well. This increases the viscosity of the blood and triggers angiotensin/aldosterone thus furthering the pathology
23
Q

What are the two main effects of preeclampsia on the hepatic system?

A
  1. Hepatic dysfunction

2. Hepatic rupture

24
Q

Describe how preeclampsia affects the hepatic system

A

-Hepatic function is altered as vascular resistance and inflammation occurs and hepatic edema occurs
-This eventually leads to a subcapsular hematoma
-This causes increased liver enzymes and epigastric pain
(HELLP SYNDROME)

25
Q

What are the 6 main effects of preeclampsia on the fetus?

A
  1. Fetal intolerance to labor
  2. Preterm birth
  3. Oligohydramnios
  4. Intrauterine growth restriction
  5. Intrauterine fetal death
  6. Abruptio placentae
26
Q

Describe how preeclampsia affects the fetus

A
  • Decreased placental perfusion leads to reduced O2 and nutrients
  • This decreased in O2 causes hypoxia which can lead to late decelerations and decreased/absent variability
  • The decreased nutrients can lead to intrauterine growth restriction and intrauterine fetal death
  • This can also lead to placental abruption as the spiral arteries have less circulation
27
Q

What does HELLP syndrome stand for?

A

Hemolysis, elevated liver enzymes, low platelets

28
Q

What labs are checked for preeclampsia?

A
  • CBC
  • Urine dipstick to detect protein and maybe glucose
  • Liver enzymes and bilirubin
  • GFR
  • BUN, Creatinine, Uric acid
  • AFI
29
Q

What is the main medication given to prevent preeclampsia from progressing to eclampsia? What is it preventing specifically?

A

Magnesium Sulfate to prevent seizures

30
Q

What is the loading dose for Mag sulfate? Maintainance dose?

A

4g over 20 minutes

2g/hr after

31
Q

What are some common SE’s of mag sulfate during the loading dose?

A

N/V and flushing heat

32
Q

What is the duration of magnesium sulfate administration?

A

for 24 hours after delivery (the orders will tell you)

33
Q

Why is Mag toxicity a serious likelihood for preeclamptic women?

A

Because it is excreted renally

34
Q

What are the Signs/Symptoms of Magnesium citrate toxicity?

A
  • Decreased RR
  • Decreased DTR
  • Altered LOC and mental status
35
Q

What is the safe serum magnesium level?

A

4-8

36
Q

What is the antidote to magnesium sulfate?

A

A 10ml push of 10% calcium gluconate over 3-5 minutes

37
Q

How will mag sulfate affect FHT?

A

decreased variability

38
Q

A urine output of ____ is an indicator of elevated magnesium levels

A

under 30ml/hr

39
Q

Preeclamptic BP needs to be treated if the systolic is above ___ and/or the diastolic is above ___

A

160

110

40
Q

What consideration needs to be taken when decreasing BP?

A

If it is done too fast it can affect Cerebral blood flow

41
Q

What are the three main BP meds for preeclamptic mothers?

A
  1. Labetalol
  2. Hydralazine
  3. Nifedipine
42
Q

When treating maternal HTN in a preeclamptic mom, when should you notify the MD? 3

A
  1. Diastolic below 80 or above 150
  2. Cat II or III tracing
  3. HR below 50 or above 120 after med administration
43
Q

What are some considerations for Labetalol?

A

Beta blocker

decreases PVR but not CO or HR

44
Q

What are some considerations for Hydralazine?

A

It is a vasodilator and the higher the does the lower the BP or watch for dizziness

45
Q

What are some considerations for Nifedipine?

A

-It is synergistic with Mag sulfate and can drastically lower BP, DTRs, and HR

46
Q

If seizures occur, what medication is given?

A

Lorazepam

47
Q

What are some considerations for Lorazepam?

A
  • It is a benzo with anti seizure properties
  • Skeletal muscle relaxant
  • anti-emetic
48
Q

What are the nursing interventions/care for an eclamptic patient

A
  • Seizure precautions
  • Cluster care
  • SaO2 above 95
  • Stop Labor
49
Q

What medication (that controls bleeding) should not be given if the woman has preeclampsia/eclampsia

A

Methylergonovine (Methergine)

Because it will increase BP and stroke them out

OB (14 decks)

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