Final AD - Intrapartum Flashcards
What is HTN?
a SBP >140 and a DBP > 90 recorded on at least 2 separate occasions 4-6 H apart within max of 1 week. MAP > 105 mmHg.
onset of HTN without proteinuria after 20 weeks’ gestation
GHTN
Usually occurs 20 weeks after gestation in a previously normotensive pt and has proteinuria. May be mild or severe. Proteinuria at or above 30 mg (>1+ on dipstick) or more in 2 random specimens at least 6 H apart or > 300 mg in 24H.
preeclampsia
the occurrence of seizures or coma in a woman with preeclampsia
eclampsia
HTN that occurs before pregnancy or DX before 20th week gestation also if it persists more than 6-12 weeks postpartum.
chronic HTN
women with HTN chronic HTN with new proteinuria or an exacerbation of HTN or Proteinuria, thrombocytopenia, or increased in hepato-cellular enzymes.
preeclampsia superimposed on chronic HTN
Complications of HTN?
*Preeclampsia - eclampsia
*Abruptio placentae: placenta has pulled away from uterine wall, painful bleeding, or no bleeding
*DIC: DIC = DEAD, IV in both arms, bleeding out of nose, vagina, eyes, IV holes are bleeding, etc.
*Acute renal failure
*Hepatic Failure
*Adult respiratory distress syndrome (ARDS)
*Cerebral Hemorrhage
*HELLP syndrome: syndrome not diagnoses, must be diagnoses with preeclampsia, HTN, etc.
Nursing interventions for mild preeclampsia?
Home bedrest: if proteinuria < 0.3 Gm on a 24H urine specimen, without subj. complaints, and home situation and support system conductive.
Daily monitoring of BP and weight: perform in a consistent manner and report abnormal weight gain and elevations in BP.
Fetal surveillance: home – fetal kick count daily and if available home NST 1-2 times weekly, Hospital – NSTs; biophysical profiles indicated. U/S for fetal growth at diagnosis and every 3 weeks
Monitor urine protein: dip urine daily and report any increase in value
S/S to report: Bp >140/90, decreased FM, HA, visual disturbances, epigastric or upper R quadrant pain, increased proteinuria, decreased urinary output, N/V, malaise, and any sign of labor, vaginal bleeding, or abd tenderness
Diet: same as a normal healthy pregnant woman, do not limit salt, except possibly in the chronic HTN, because they already have low plasma levels, and they need salt to maintain blood volume and perfuse the placenta.
Emotional support: both pt and family, address concerns and fears, and assist with adjustment to bed rest.
Nursing interventions for severe preeclampsia?
Hospital bed rest: management of severe preeclampsia is best achieved in a tertiary care center, management ranges from conservation to immediate delivery depending on maternal and fetal status, as well as the gestational age.
Maternal and fetal surveillance: May require an ICU setting and/or homodynamic monitoring, invasive monitoring should be considered for women with severe cardiac disease and/or renal failure, and in some instances pulm. Edema. Close fetal surveillance is warranted, observing for signs of uteroplacental insufficiency – daily NST, biophysical profile, umbilical artery doppler flow studies. Baseline labs and frequent lab monitoring observing for an increase in liver enzymes, decrease in platelets, change in coagulation studies and electrolytes. Assess for HELLP and DIC. Daily weights, I&O, foley catheter placement to assess for renal function.
Pharm Interventions: Magnesium sulfate, quiet the CNS, have Ca+ Gluconate available for MG toxicity. Oral antihypertensive. Give with caution – if DBP is below 90 mmHg could reduce uteroplacental perfusion.
Environment: Should be quiet and non-stimulating due to CNS irritability, emergency meds and equipment close by and readily available (suction and O2)
Delivery: If immediate delivery is indicated then C-Section would most likely be the delivery mode of choice, especially if the cervix is unfavorable. A prolonged labor could increase risk for maternal morbidity.
PP interventions?
Frequent BP and VS
Mag sulfate (12-24 H): may not go to PP, may go to antepartum and stay there for 12-24 H, MAG slows everything down
Uterine tone and lochia: check where fundus is (encolushia, must see how much it has gone down every day, must see if it is hard or soft, etc.)
Family support and bonding
HELLP syndrome interventions?
Assess and observe for signs of bleeding petechiae or bruising from BP cuff, IV site, gums, epigastric pain or R upper quadrant pain or tenderness - some women report it as bad indigestion
Jaundice
Monitor Lab values and report to DR
Fetal status (at risk for abruption)
DIC interventions?
Monitor for bleeding: petechiae, oozing from injection sites, hematuria, and reposition frequently to assess for bleeding in dependent tissues
Monitor urinary output with foley
If still pregnant, place side lying position
O2 if ordered (10-12 L/M)
Administer blood and blood products as ordered
Patient and family education and emotional support
premature separation of the placenta.
DX = painful abd pain with or without bleeding, uterine tenderness, confirmed after delivery. Bright red bleeding, HA, feels like someone is stabbing you in the abd, etc. - the mom NEEDS to come back to the hospital.
Management = immediate delivery.
Placenta Abruption
Misc. = 3 grades based on separation - 1 (mild) 10-20% <500mL, slight pain, no shock, 2 (moderate) 20-50% 1000-1500mL, mild shock, 3 (severe) >50% >1500mL, agonizing pain, sudden.
Placenta is implanted in lower uterine segment. DX = painless bright red bleeding after 20 weeks. DO NOT DO A VAGINAL EXAM! Management = observation and bedrest.
Placental previa
Misc. = NO vaginal exams, C-section delivery, complete may have a gush where a marginal may have a trickle.
Evaluate the bladder during labor – why?
*Check for distension of bladder
*Urinary retention secondary to loss of bladder elasticity and tone and/or loss of bladder sensation resulting from trauma, meds, or anesthesia. A distended bladder as a result of urinary retention can cause infection, uterine stony, and displacement to one side. The ability of the uterus to contract is also lessened.
*Post-partal diuresis with increased urinary output begins within 12 H of delivery
