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Maternity > Exam 1: Pregnancy > Flashcards

Exam 1: Pregnancy Flashcards

1
Q

How to be the patient advocate?

A

listen to your patient and trust that she knows her body

importance of physical assessment skills

recognize signs that a womens condition is deteriorating (VS, urinary output, level of consciousness)

advocate for your patient, go up the chain of command if needed

follow hospital protocols, be knowledgeable of current EBP initiatives

get involved in professional nursing organizations

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2
Q

What are the Maternal Mortality in the United States?

A

32.9 deaths per 100,000 live births

highest of any resource- rich country

from 2018 - 2022, annual maternal deaths increase from 658-1205

highest for African American Women

80% if deaths were preventable

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3
Q

What are presumptive signs of pregnancy?

A

*usually noted by patient: a possibility of pregnancy

Amenorrhea (no period)

fatigue

nausea + vomiting

urinary frequency

breast changes

quickening (fluttering)

uterine enlargement

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4
Q

What are probable signs of pregnancy?

A

*most likely indicate pregnancy

abdominal enlargement

Hegar’s Sign: softening and compression of lower uterus

Chadwick’s sign: violet color of mucosa + cervix

Ballottement: detecting a floating object by tapping on uterus

Braxton Hicks contractions

postive pregnancy test

fetal outline

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5
Q

What are positive signs of pregnancy?

A

fetal heart rate sounds

visualizations of fetus (by USN)

fetal movement (by experienced examiner)

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6
Q

How to determine patient’s due date?

A

Naegele Rule:
> first day of last menstrual cycle (LMP)
>subtract 3 months
> add 7 days plus 1 year

OR

> 1st day of LMP
add 7 days
count forward 9 months

Ultrasound: more accurate

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7
Q

How to determine Fundal height?

A

measure from the symphysis pubis to top of uterine fundus (18-32 weeks)

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8
Q

What does Gravity mean?

A

number of pregnancies
> nulligravida: no pregnancy
> primigravida: one pregnancy
> multigravida: multiple pregnancy

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9
Q

What does Parity mean?

A

number of pregnancy in which fetus (or fetuses) reach 20 weeks pregnancy, not the number of fetuses. Not effected whether the fetus is still born or alive

> nullipara: never given birth
Primipara: given birth 1 time
Multipara: multiple times

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10
Q

What does GTPAL stand for?

A

Gravity: how many pregnancy
T: how many TERM BIRTHS (38 weeks)
A: abortions/miscarriage
L: living children

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11
Q

What are the physiology of pregnancy?

A

Reproductive: uterus increases in size, changes in shape, position: No ovulation & menses

CV: CO + BV increases to meet metabolic needs. HR increases during pregnancy (5 wks.) to reach peak (+10-15/min above pre-preg rate, 32 wks)

Respiratory: O2 needs increase. Last trimester, chest may enlarge

Musculoskeletal: posture adjustments needed. pelvic joints relax: at risk for a fall

GI: Nausea + vomiting, constipation

Renal: Filtration rate increases d/t hormones & BV metabolic demands

Endocrine: placenta- endocrine organ, producing hormones

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12
Q

What are the different skin changes?

A

Chloasma: pigment changes: brownish patches over face

Linea Nigra: classic pigmentation change

Striae Gravidarum: streach marks

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13
Q

What are the components of Prenatal Care?

A

Client History:
> reproductive & OB History
> medical history
> nutritional history
> family history
> current medications
> psychosocial history
> environmental risk: healthcare, factory
> abuse history/ risk

Birth Plan:
> childbirth education
> pain control, birthing method

Prenatal appt:
> first visit within 12 week
> 16-28 wks: monthly
> 29-27 wks: every 2 weeks
> 36 wks- delievery: weekly

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14
Q

What happens at the initial prenatal visit and ongoing prenatal visits?

A

EDD based on LMP

Medical & nursing history

physical assessment

obtain Labs:
H&H, WBC, blood type + Rh, rubella titre, urinalysis, renal function test, pap test, cervical cultures, HIV, Hep B, toxoplasmosis, RPR, VDRL

Ongoing prenatal:
> weight, VS, UrineEdema
> Fetal development
> FHR
> fundal height (18-30wks)
> fetal movement (16-20 wks)

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15
Q

What are the routine lab test?

A

blood type & Rh factor

CBC with differential, HgB & HCT

Hgb electrophoresis

Rubella titre

Hep B

GBS: 35-37 wks. (vag & rectal cx)
> groupbetastrep * baby can become septic * antibotics used to treat

Urinalysis with micro. exam

1 hr. GTT:
> no fasting, PO glucose, 1 hr. BS
> at 24-28 wks. more than 140 requires follow up (3 hr GTT)

3 hr GTT:
> screening tool for diabetes
> fasting, PO glucose, BS at 1, 2, 3 hrs.

Pap test

Vaginal/cervical culture

PPD

VDRL: syphilis

toxoplasmosis, other infections rubella, CMV, herpes
> herpes: if active lesion than need c-section, if not active can have a vaginal birth

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16
Q

What education should you provide to the patient?

A

avoid OTC counter medication: ibuprofen is a no

Alcohol/substances

exercise

saunas/ hot tubs: no recommended because of heating moms temp

PO fluids

environmental hazards

genetic testing

infection prevention

emotional lability

ambiance

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17
Q

What are common discomfort of pregnancy?

A

nausea + vomiting
breast tenderness
urinary frequency & UTI
fatigue
heartburn
constipation & hemorrhoid
backaches: should not be intermittent (could be labor)
shortness of breath
leg cramps
varicose veins, leg edema
gingivitis, nasal stuffiness, epistaxis
braxton Hicks contraction
supine hypotension

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18
Q

What are the danger signs during pregnancy?

A

First Trimester:
> burning during urination
> severe vomiting
> diarrhea
> fever or chills
> vaginal bleeding
> abdominal cramping

Second Trimester:
> gush of fluid (could be amneotic fluid)
> vaginal bleeding
> abdominal pain
> change in fetal activity
>persistent vomiting
> severe headache, blurred vision, edema, epigastric pain
> elevated temperature
> dysuria

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19
Q

What is the Biophysical profile (BPP)?

A

Do not need to know exact criteria just a general understanding

FHR (NST)
> reactive NST (2)
> nonreactive (0)

Fetal Breathing:
> min. 1 episodes of >30 sec duration in 30 min (2)
> absent or < 30 seconds (0)

Gross body measurements:
> Min 3 body/limb ext. with return to flex in 30 min (2)
> <3 episodes (0)

Fetal Tone:
> min 1 episode of ext. with return to flex (2)
> low ext & flex or lack of flex or no movement (0)

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20
Q

What is the nonstress test?

A

it starts at 28 weeks

Interpreting the NST:
Reactive: Normal Fetal Heart Rate (110-160)
> over 32 weeks: moderate variability with 2 accelerations lasting at least 15 seconds within 20 minutes
> less than 32 weeks (28-32) 2 accelerations lasting at least 10 seconds within 20 minutes (less criteria because the baby is smaller)

Nonreactive:
> does not meet above criteria

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21
Q

What are the indications of the nonstress test (NST)?

A

decreased fetal movement
IUGR
Post maturity
Gestational diabetes
Gestation hypertension
pervious fetal demise
advanced maternal age
sickle cell disease

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22
Q

How do we assess the fetal well-being with ultrasounds?

A

Abdominal vs. transvaginal

doppler Ultrasound blood flow analysis:
2D: standard medical, black + white view
3D: multiple pictures, photo clear
4D: like 3D with video

Indications:
> confirm pregnancy, gestational age, multifetal pregnancy
> determine implantation age
> assess fetal developement, maternal structures, fetal positions
> review potential diagnosis indicating need for ultrasound

Client presentation:
> vaginal bleeding
> questionable fundal height measurement
> decreased fetal movement
> preterm labor
> possible rupture of membranes

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23
Q

What is the ideal weight gain?

A

Recommended 25-35 pounds (single pregnancy)

Gain 1-2 Ib during first trimester

Gain 1 Ib per week in 2nd & 3rd trimester

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24
Q

What is the nutrition assessment?

A

food journal/ recall

caloric intake

Hx of eating disorders

follow up questions

baseline weight

exercise

labs

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25
Q

What should you educate the patient about nutrition?

A

Increase calories:
> 340 cal/day during 2nd trimester
> 462 cal/day during 3rd trimester
> 450-500/day during postpartum/breastfeeding

Increase Protein: essential for growth:
> Folic Acid: important for neuro development, prevention of neural tube defects
> Leafy veggies, dry peas/beans, seeds, OB, breads, cereals, grains fortified with folic acid
> 400 mcg folic acid: childbearing women
> 600 mcg folic acid: pregnancy

Iron:
> facilitaties increase in maternal RBC
>best absorbed between meals, with vitamin C
> milk + caffeine interfere with absorption
> Major side effects: constipation
> Client education: take miralax, or increase fiber

Calcium:
> bone, teeth formation
> milk, nuts, legumes, dark leafy greens
> 1,000 mg/day for pregnant women + nonpregnant women
> 1300 mg/day for younger than 19

Fluid:
>8-10 (2.3 Liters) glasses

Limit caffeine:
> no more than 200 mg (8 ox of coffee)
> fetal risk: spontatanous miscarriage

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26
Q

What are nutritional risk factor during Pregnancy?

A

adolescent
vegetarians, vegans
nausea/vomiting
anemia
eating disorder
PICA
excessive weight gain
FINANCIAL ISSUES, food insecurity

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27
Q

What is the Leopoid manuvers?

A

Palpating the abdomen to determine fetal position and presingtation in the 3rd trimester

1:palpate the fundus
2: palpate the side of the abdomen
3 :Palpating above the symphysis pubis: Locate the fetal presenting part and determine how far the fetus has descended

make sure patient has empty the bladder

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28
Q

What are the indications, nursing care, and Alpha fetal protein {AFP} evaluation in the first trimester?

A

After 14 weeks, needle through abdomen into uterus

Indications:
> previous chrom. genetic anomaly, carrier
>family hx> neural tube defects
> abnormal first trimester testing
> advanced maternal age
> abnormal serum AFP

Nursing Care:
> give rhogam if client Rh - after
> monitor VS & contractions
> teach pt to report s/s of infection or PTL
>rest & PO fluids after procedure

AFP evaluation:
> can be evaluated following abnormal serum AFP
> can be used to detect chromosomal abnormalities or neural tube defects
> High levels: associated with neural tube defects, can also indicate normal multifetal pregnancies
> low levels: chromosomal abnormalities (down syndrome) or gestational trophoblastic disease (hydatidform mole)

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29
Q

What is amniocentesis in the third trimester?

A

Fetal lung testing

less than 37 weeks gestation

with rupture of membranes (ROM)

preterm labor

complications

Lecithin/sphingomyelin (L/S) ratio: 2:1 ratio indicates lung maturity (2.5:1 or 3:1 for client with diabetes mellitus)

presence of Phosphatidylglycerol (PG): absence of PG associated with respiratory distress

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30
Q

What is the percutaneous umbilical blood sampling (PUBS)?

A

fetal blood sampling and transfusion (cordocentesis)

obtains fetal blood cells from imbilical cord

complications: cord laceration, PTL. amnionitis, hematoma, feto-maternal hemorrhage

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31
Q

What is chorionic villus sampling (CVS)?

A

assess of portion of developing placenta, examines genetic/chromosomal abnormalities

can be done at 10-13 weeks

Risk: SAB (higher risk than amnio.) infection (chlorioamnionitis) ROM

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32
Q

What is the Quad marker screening?

A

more reliable than serum AFP

preferred at 16-18 weeks

identifies risk for neonate with chromosomal abnormalities
1. human chorionic gonadotropin (hCG) hormone produced by placenta (High= down syn.)
2. Alpha fetoprotein (AFP) protein produced by fetus (low= down syn. High= neural tube defects)
3. Estriol: protein produced by fetus & placenta (low=down syn.)
4. Inhibin A: protein produced by ovaries & placenta (high= down syn>)

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33
Q

What are the expected findings for a client experiencing a Spontaneous abortion?

A

backache, abdominal tenderness

rupture of membrane

dilation of the cervix

fever

bleeding

hypotension

tachycardia

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34
Q

what lab test would you expect the provider to be ordered for a spontaneous abortion?

A

HgB & Hct

clotting factors

WBC

serum hCG

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35
Q

What therapeutic procedures would you use for spontaneous abortion?

A

ultrasound

cervical exam

dilation & curettage (D&C)

dilation & evacuation (D&E)

prostaglandins

oxytocin

36
Q

What is the nursing care + education for spontaneous abortion?

A

Nursing Care:
pregnancy test
pad count
bedrest
avoid vaginal exam
meds
blood products
assist with termination/procedure
use lay term “miscarriage”
emotional support

education:
notify provider of s/s of infection/hemorrhage
small d/c is okay 1-2 weeks
no tub baths, sexual intercourse, tampons
avoid pregnancy for at least 2 months
seek support

37
Q

Ectopic pregnancy:

A

abnormal implantation of fertilized ovum outside of uterine cavity

usually in fallopian tube

can cause tubal rupture and fatal hemorrhage

common cause of bleeding in pregnancy

can lead to infertility

risk factors: STI, assisted reproductive technology, tubal surgery, contraceptive IUDs

38
Q

what are the expected clinical finding for eptopic pregnancy?

A

unilateral stabbing pain, lower abd

delayed, light menses

scant, dark red or brown spotting 6-8 weeks after normal menses

red vaginal bleeding (ruptured)

referred shoulder pain

shock can develop
> fainting
> dizziness
> pallor
> hypotension
> tachycardia

39
Q

What labs/diagnostic & therapeutic procedures do you do for ectopic pregnancy?

A

Labs:
progesterone & hCG
liver & renal function test
CBC
blood type/RH

Procedures:
medical management if rupture has not occurred (methotrexate)
> inhibits cell division & embryo enlargement dissolving the pregnancy
salpingostomy: to salvage unruptured fallopian tube
Lap salpingetomy: with ruptured tube

40
Q

What nursing care/client education for ectopic pregnancy?

A

replace fluids/electrolytes

emotional support

if on Methotrexate do not get pregnant for 6 months, avoid alcohol & vitamin containing folic acid to prevent toxic response

avoid sun for photosensitivity

41
Q

What is gestational trophoblastic disease (molar pregnancy)?

A

proliferation & degeneration of trophoblastic villi in placenta, become swollen, fluid fillled

embryo fails to develop beyond primitive phase

associated with choriocarcinoma

42
Q

What is the difference between complete vs partial mole?

A

Complete:
all genetic material paternally derived
no fetus, placenta, amniotic fluid, membranes
no placenta to recieve maternal blood-hemm into uterus, vaginal bleeding
approx. 20% progress toward carcinoma

Partial:
genetic material maternally & paternally derived
normal ovum fertilized by 2 sperm or 1 sperm in which mitosis (chromosimal reduction & division did not occur)
often contains abnormal embryonic of fetal parts, an amniotic sac and fetal blood but congenital abnormalities are present
approx. 6% progress toward carcinoma

43
Q

what are risk factors for gestational trophoblastic disease?

A

prior molar pregnancy
early teens (less than 40 years old)

44
Q

what are the expected finding of gestational trophoblastic disease?

A

rapid uterine growth
bleeding( dark brown or bright red) anemia
clinical finding of preeclampsia prior to 24 weeks

45
Q

What labs + therapeutic procedure would you use for gestational trophoblastic disease?

A

Procedure:
ultrasound
suction curettage to aspirate & evacuate mole
RhoGam if rH negative
baseline pelvic exam + USN post op
serum hCG following molar pregnancy weekly x3, then monthly x 6-12 mons.
if malgnant cells found, methotrexate given (no pregnancy for 1 year)

Labs:
hCG after 10-12 weeks

46
Q

What nursing care/education about gestational trophoblastic disease?

A

Nursing Care:
measure fundal height
assess bleeding
assess GI status, appetite
monitor s/s preeclampsia
administer meds
>rhogam if client Rh-
>methotrexate for malignant cells
advise client to save tissue or clots for evaulation

Education:
emotional support
reliable birth control
follow up care important due to risk of carcinoma

47
Q

What is placenta previa?

A

the placenta abnormally implants in the lower segment of the uterus near or over the cervical os

results in bleeding in the third trimester as cervix begins to stretch, thin and open

48
Q

What are the risk factors/ finding for placenta previa?

A

Risk factors:
previous previa
uterine scarring
age over 35
multiple gestation
closely spaced pregnancy
smoking

Findings:
painless, bright red bleeding in 2nd/3rd trimester
soft, relaxed non-tender uterus
fundal height greater than expected, fetus may be in unusual position
normal VS, reassuring FHR
decreasing urine output (good indicator of blood loss)

49
Q

What lab test/diagnostic procedure for placenta previa?

A

Hgb, Hct, blood type & Rh
coagulation profile
kleihauer-betke test
ultrasound
fetal monitoring = fetal well being

50
Q

what nursing care & client education fr placenta previa?

A

assess for bleeding, leaking, contraction, fundal height, leopoid maneuvers

No vaginal exams, pelvic rest, bedrest

IV fluids, blood, meds- Betamethasone (to promote fetal lung development)

C-section delievery

o2 PRN

51
Q

What is abruptio placentae?

A

premature separation of the placenta from the uterine wall (parital or complete)

after 20 weeks, 3rd trimester

significant maternal & fetal death

DIC (disseminated intravacular coagulation) associated with moderate-severe abruption

signs of shock do not appear in pregnancy until 25-30% blood loss occurred

betamethasone may be given if preterm birth anticipated

52
Q

What are the risk factors for abruptio placentae?

A

maternal hypertension

blunt external trauma

cocaine use (causes vasoconstruction)

previous abruption

smoking

PROM

multiples

53
Q

What are the expected findings of abruptio placentae?

A

sudden intense pain, dark red vag, bleeding

uterine tenderness diffse or localized

contraction

fetal distress

can lead to hypovolemic shock

54
Q

What labs/diagnostics are used for abruption placenta?

A

H&H

coagulation factor (decrease)

clotting defects (can lead to DIC)

cross & type for possible transfusion

Kleihauer - Betke test

NST, ultrasound & biophysical profile

55
Q

What nursing care for abruption placenta?

A

palpate uterus

assess FHR

IV (fluid, blood, medication)

oxygen (8-10L)

VS

monitor urine output and fluid balance

family support & education

56
Q

What is vasa previa?

A

fetal umbilical vessels implant into the fetal membranes rather than the placenta

Ultrasound for fetal well being

Monitor L/D for excessive bleeding
1. velamentous insertion: cord exposed, not protected by whartons jelly vulnerable to rupture, cord vessels begin in the branch at the membrane & then course to placenta
2. Succenturiate insertion: placenta divided into 2 (or more) lobes
3. Battledore insertion: marginal insertion, higher risk of fetal hemorrhage

57
Q

What is cervical insufficiency: premature cervical dilation?

A

expulsion of products of conception r/t tissue changes & alterations in cervical length of cervix

58
Q

What are the risk factors of cervical insufficiency: premature cervical dilation?

A

hx of cervical trauma
short labors
pregnancy loss in early gestation
early advanced cervical dilation

in utero exposure to diethylstilbestrol, ingested by client mother in pregnancy

congenital structural defect of cervix or uterus

59
Q

What are the expected finding of cervical insufficiency: premature cervical dilation?

A

pink-tinged vaginal discharge/bleeding or pelvic pressure

cervical shortening via transvaginal ultrasound

gush of fluid/possible ROM

uterine contraction (with expulsion of fetus)

60
Q

What diagnostic
procedures/therapeutic management are used for cervical insufficiency?

A

Procedure:
ultrasound shows a shortened cervix, presence of cervical funneling or effacement of the cervix

Therapeutic:
bed rest, pelvic rest, avoidance of heavy finding
prophylactic cervical cerciage ( done 12-14 wks, removed @ 37 wks)

61
Q

What nursing care would you provide for cervical insufficiency?

A

bedrest
evaluate pt support system
assess vaginal discharge
vital signs
monitor client for contractions & vaginal pressure
administer tocolytics prophylactically to stop contractions

62
Q

What client education should you provide for cervical insufficiency?

A

activity restricition/bedrest

pelvic rest

report s/s labor ROM & infection

home health care

removal of cerslage at 37 wks

63
Q

What is hyperemesis gravidarum?

A

excessive N&V, prolonged past 12 weeks

5% weight loss from pre-pregancy weight

risk for fetal intrauterine growth restriction (IUGR) or preterm labor

64
Q

What are the risk factors for hypermesis gravidarum?

A

younger than 30
history of migraines
obesity
primigravida
multiple gestation
molar pregnancy or fetus with chromonosomal anomaly
psy issue, high emotional stress
hypothryoid
diabetes
GI disorder
family hx

65
Q

What is the physical assessment + lab test for hyperemesis gravidarum?

A

Physical assessment:
excessive N/V, dehydration, electrolyte imbalance, weight loss
increased pulse, decreased BP
signs of dehydration: poor skin turgor, dry mucous membranes

Lab test:
urinalysis, chemistry, thyroid test, CBC

66
Q

What is the nursing care for hyperemesis gravidarum?

A

monitor I&O
s/s dehydration
VS
weight
NPO for 24-48 hrs.

67
Q

What medications for hyperemesis gravidarum?

A

IV fluids, pyridoxine (vitamin B), antiemetic meds)

68
Q

What client education about hyperemesis gravidarum should be provided?

A

with no vomiting, advance to clear liquids at 24 hrs.

advance diet as tolerated

small, frequent meals

separate meals from liquids

start with dry toast, cracker etc and advance to regular diet as tolerated

in severe cases or if vomiting returns, enteral nutrition may be indicated

69
Q

What is gestational diabetes?

A

impaired tolerance to glucose with first onset during pregnancy

ideal blood sugar during pregnancy: 70-110

symptoms usually disappear within a few weeks following delivery

50% develop type 2 diabetes within 5 years

70
Q

What are the risk to the fetus: gestational diabetes?

A

spontaneous abortion

infection:r/t increased glucose in urine

hydraamnios: PROM, preterm labor

ketoacidosis: from increased insulin resistance

hypoglycemia or Hyperglycemia

71
Q

What are the maternal risk factor for gestational diabetes?

A

obesity

increased BP

glycosuria

maternal age older than 25

fx history

pervious delivery of GA baby or previous stillborn baby

72
Q

What are the expected findings of gestational diabetes?

A

hypoglycemia or hyperglycemia

diabete in pregnancy: unstable blood sugar, shaking, clammy pale skin, shallow respirations rapid pulse, vomiting, excess weight gain

73
Q

What are the lab test associated with gestational diabetes?

A

Routine urinalysis, glycosuria, test for ketones

1 hour GTT: (Glucola screening/Non fasting) Screen @ 24-28 weeks, 50 g oral glucose given, Plasma glucose level in 1 hr,
+ screen = 130-140+, follow up with 3 hour test

3 hour GTT: (Oral glucose tolerance test)
Oral glucose tolerance test (OGTT)
Fasting for 12 hours, FBS obtained (92 or <)
100 g Glucose given
Serum glucose levels done at 1, 2 & 3 hours
(1 hr 180 or<, 2 hr 153 or <, 3 hr 140 or <)

74
Q

What are the diagnostic procedure for gestational diabetes?

A

BPP, Fetal monitoring, glucose monitoring

diet control

75
Q

What are the medication for gestational diabetes?

A

Oral meds- Metformin & Glyburide (less common)

Insulin more common rx than oral meds

76
Q

What is the client care for gestational diabetes?

A

preconception counseling, dietary education

blood glucose level control (A1C: less than 7%)

glycemic control

nutritionional managemen

hypoglycemic agents

close maternal and fetal surveillance

kick counts daily

management during labor and birth

plan for pospartum care

77
Q

What are the risk factors of hypertensive disorder of prenancy?

A

maternal age less than 19, older than 40

first pregnancy

obesity

multifetal gestation

chronic renal disease or hypertension

family hx preeclampsia

diabete

rheymatoid arthritis

lupus

78
Q

What are the finding for hypertensive disorder of pregnancy?

A

headache

blurry vision, visual changes

high BP

proteinuria

edema

vomiting

oliguria, jaundice, seizure, decreased breath sound, epigastric pain, hyperreflexia

79
Q

What labs should you use for gestational hypertension?

A

liver enzymes (LDH, AST)
serum creatinine, BUN, uric acid, Mg
CBC
clotting studies
24 hr urine (protein & creatinine clearance)
NST, BPP, Doppler flow analysis

80
Q

What is the abnormal labs for gestational hypertension?

A

elevated liver enzymes

increased creatinine

increased plasma uric acid

thrombocytopenia

decreased Hgb

hyperbillirubinemia

renal function, liver function decrease

81
Q

How to manage gestational hypertension?

A

(20 + wks, 140/90) no proteinuria

Mild preeclampsia: 1 + proteinuria
> bed rest, daily BP monitoring and fetal movement counts
>home for mild, hospitalization as disease progresses: Iv magnesium sulfate during labor
>nursing assessment: risk factors, BP, nutritional intake, weight, edema: urine for protein; other lab test if indicated

Severe Preeclampsia management:
> 160/110 3+ proteinuria, oliguria, creatinine >1.1, visual disturbances, hyperreflexia, clonus, edema, hepatic dysfunction, epigastic pain, thrombocytopenia
>hospitalization: oxytocin + magnesium sulfate: preparation for birth

Eclampsia management:
seizure management, magnesium sulfate, antihypertensive agent; quiet environment, birth once seizure controlled, DTR

82
Q

What are the preeclampsia medication?

A

Goal: control BP, prevent seizure & cerebral hemorrhage

MgSO4: CNS depressant, reduces seizure activity
Antihypertensive: hydralazine: vasodilator in severe cases. use with caution, rapid decrease BP can cause fetal O2 and decrease uteroplacental perfusion
Methydopa: mechanism unknown, may take a few days
Labetolol: beta blocker slow HR and decreases systemic vascular resistance
Nifedapine: calcium channel blocker control hypertension

outpatient care for mild preeclampsia: activity restriction + frequent monitoring

83
Q

What is the care of Magnesium Sulfate?

A

VS before giving, q 5-15 minutes during loading dose, q30-60 minutes until patient is stable

assess DTRs every 2 hrs
>decreased reflexes can predict impending respiratory depression

strict I/O
monitor serum Mg levels every 4-6 hrs. (4-7 is therapeutic)

if toxicity suspected, stop the infusion and notify provider

keep calcium gluconate available (antidote)

maintain seizure precautions

Mg continued for 24 hrs after delivery

84
Q

What does the treatment of magnesium sulfate do?

A

anticonvulsant

pt feels flushed, hot, sedated

monitor resp rate (VS), DTR, LOC, I+Os, headache, epigastric pain, contractions, FHR, fetal movement

Monitor signs of Mg tox:
decrease or absent DTR
decrease urine output
decrease respiratory rate
decrease LOC

85
Q

Preeclampsia Vs Eclampsia Vs HELLP syndrome:

A

Preeclampsia: elevated BP with proteinuria after 20wks.
>mild: transient headache may occur
> severe: higher than 160/110, urine protein greater than 3, oliguria, creatinine more than 1.1, visual disturbance, hyperrflexia, ankle clonus, epigastric pain…. indicating multi-system dysfunction

Eclampsia:
> seizure preeclampsia symptom
>symptoms indicate seizure

HELLP syndrome:
> diagnosed by lab results not clinical symptoms

86
Q

What is HELLP syndrome?

A

Hemolysis (anemia + juandice), elevated liver enzyme (ALT, AST, epigastric pain, V/N) low platelet (less than 100,000 resulting in thrombocytopenia, abnormal bleeding & clotting time, bleeding from gum, petechiae, possible DIC

Nursing assessment: similar to that for severe preeclampsia: lab test results

Nursing management: same as for severe preeclampsia

Maternity (3 decks)

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