Hypertensive Complications of Pregnancy Flashcards
exam 2
PROM
premature rupture of membranes
happens before the onset of labor
PPROM
preterm premature rupture of membranes
rupture before 37 weeks
what puts a mother at risk for PROM?
previous preterm, UTI, cervical infection, smoking/substance abuse, hydramnios, post amniocentesis
what are the #1 risk for mom and baby during PROM?
mom - RF infections
baby- RF impaired gas exchange
how to confirm ROM?
visualize, speculum exam, nitrazine, fern test, ultrasound
nursing interventions for PROM that are conservative?
bedrest/reposition
relaxation
NO vaginal exams
maintain hydration
monitor for infection (CBC, temp Q2)
can a woman go home if she has PROM?
yes only if leaking has ceased or is minimal and compliance is anticipated
what at home care is anticipated for PROM?
bedrest
pelvic rest
routine NST
serial CBC
monitor vitals
monitor fetal movement
corticosteroids
decreases RDS in preterm infants
single dose w/ second dose in 24hrs (not repeated)
*increases RF infection
when is immediate birth indicated for PROM?
signs of infection are present
fever, positive gram stain, organisms in amniotic fluid
what social factors put a mother at risk for preterm labor?
domestic abuse, trauma, no prenatal care, extremes in ages
what uterine concerns are RF preterm labor?
multiples, polyhydramnios, uterine fibroids, abnormalities
what is fetal fibronectin?
protein that attaches the amniotic sac to the uterine lining
what does a + fibronectin test indicate?
patient MAY go into preterm labor soon or not for weeks
what does a - fibronectin test indicate?
little possibility of preterm labor for 7-10 days
primary prevention of PTL?
BV, STI, UTI treatment
cervical cerclage
progesterone
secondary prevention of PTL?
early diagnosis
identify as at risk
assessments
ritodrine hydrochoride
only tocolytic approved by FDA
not used in clinical practice
what does magnesium sulfate do?
decreases frequency and intensity of contractions
what is magnesium sulfate exclusively given?
hospital use only!
magneisum sulfate antidote
calcium gluconate
mag sulfate recommended loading and maintenance dose?
loading 4-6g IV w/ 1000mL over 20 mins
maintenance 1-4g/hr titrated
magnesium sulfate side effects for mom
immediate hot flushing, headache, burred vision, N, dry mouth, dizzy, lethargy, sluggish
magnesium sulfate side effects for baby
hypotonia
hypermagnesemia
mag sulfate nursing implications
monitor BP and RR
monitor serum mag
assess deep tendon reflexes
I&O
LOC
FHR
betamethasone
used w tocolytic to speed up fetal lung development
enhances surfactant production
deep IM
peak effective 2-7 days after admin.
what is the 2nd leading cause of maternal death in the US
preeclampsia/ eclampsia
preeclampsia
increased BP after 20 wks gestation w proteinuria
hypertension
eclampsia
acute and life treathening complication of pregnancy, seizures
nursing interventions for seizing patient
get pt to lie on side
oxygen
preeclampisa risk factors
Hx of
extremes of age
obesity
primagravida
increased placental mass
multiples
diabetes
kidney disease
chronic hypertension
what is the only ‘cure’ for preeclampsia?
birth of fetus
preeclampsia manifestations
proteinuria
increased sodium retention
decreased urine output
generalized edema (facial, pre-orbital)
increased BP
epigastric pain
