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BSNC 5000 > Module 5 > Flashcards

Module 5 Flashcards

1
Q

Hypertensive disorders of pregnancy

A

pre-existing HTN (essential vs. secondary)
gestational HTN
pre-eclampsia
severe pre-eclampsia
eclampsia
HELLP

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2
Q

gestational HTN

A

occurs after 20 weeks
1) with proteinuria (with or without adverse conditions)
2) without proteinuria (with or without adverse conditions)

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3
Q

pre-eclampsia

A

HTN + proteinuria (+1 or greater) OR end-organ dysfunction OR severe consequences (eclampsia)

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4
Q

RF for HTN in pregnancy

A

family hx
extremes of reproductive age (<20 or >35)
primigravida
multiple gestation
diabetes, renal dx, prior HTN
collagen vascular dx
no mid-trimester fall in BPO
excessive weight gain (>2 lb/week)
finger/facial edema

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5
Q

Patho of pre-eclampsia

A

poor placentation
first stage: cytotrophoblast invades endometrium & remodels spiral arteries
second stage: cytotrophoblast invades myometrium & remodels arteries –> wider, low pressure system

pre-eclampsia occurs when this remodeling does not occur. placental ischemia –> release of inflammatory cytokines/factors that get released into maternal circulation and cause endothelial dysfunction

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6
Q

Adverse outcomes of pre-eclampsia

A

vascular remodeling/endothelial vasospasm = HTN
kidney damage = proteinuria, liver damage = elevated enzymes
RBC traveling through damaged blood vessels sheared = hemolysis
clotting activated by endothelial injury/turbulent blood flow thrombocytopenia s/t systemic clotting –> DIC edema (increased capillary permeability)
eclampsia/headache/hemiplegia/visual disturbance (cerebral vasospasm)
cardiomyopathy
ARDS

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7
Q

Nursing mgmt of pre-eclampsia

A

bed rest
fetal assessment (ultrasound/nonstress test)
weight gain
blood pressure measurements
proteinuria
fetal movement
general symptoms

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8
Q

Severe pre-eclampsia

A

gestational HTN with or without proteinuria with 1+ adverse conditions

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9
Q

Severe pre-eclampsia adverse conditions

A

severe N/V
frontal headache
visual disturbance
epigastric/RUQ pain
chest pain
SOB
leukocytosis
abnormal coagulation
thrombocytopenia
increased creatinine/uric aid
increased liver enzymes (AST, ALT, LDH, bili)
decreased albumin
fetoplacental (abnormal FHR, IUGR, oligohydramnios, absent/reversed end-diastolic flow)

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10
Q

Maternal signs of severe pre-clampsia

A

DBP > 110
oliguria <500/day
pulmonary edema
suspected abruptio placenta

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11
Q

Maternal labs for severe pre-eclampsia

A

platelets <100
elevated liver enzymes (AST/ALT)
plasma albumin <18
heavy proteinuria 3+ or greater

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12
Q

Fetal signs of severe pre-eclampsia

A

IUGR
oligohydramnios
absent/reversed end diastolic flow of doppler

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13
Q

S/S of eclampsia

A

**often not observed prior to seizures

severe headache/occipital headache
brisk reflexes
visual disturbances

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14
Q

Severe pre-eclampsia treatment

A

1:1 nursing
calm, quiet environment
transfer to specialized unit
increased monitoring (HR/BP Q15min/4 hours until stabilized –> Q30min)
oral HTN medication
IV insertion
indwelling catheter (monitor output)
proteinuria testing
I&O documentation
O2 supplementation
VTE prophylaxis
seizure precautions (padded rails)
ensue calcium gluconate/maternal resuscitation equipment ready

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15
Q

Pharmacologic management of severe pre-eclampsia

A

nifedipine (CCB)
labetolol (beta blocker)
hydralazine (vasodilator)
methyldopa

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16
Q

Magnesium sulfate

A

seizure prophylaxis

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17
Q

Magnesium sulfate MOA

A

decreases CNS irritability
blocks Ach release –> blocking neuromuscular conduction
relaxes smooth muscle of uterus (competes w/ calcium)
peripheral vasodilation
increased uterine/renal perfusion
increased prostacyclin from endothelial cells (vasodilation)
reduced platelet aggregation
inhibits RAAS

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18
Q

Magnesium sulfate antidote

A

calcium gluconate IV

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19
Q

Magnesium sulfate side effects

A

flushing of skin
hypotension
metallic taste
N/V
palpitations
sweating

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20
Q

Magnesium sulfate toxicity

A

absent deep tendon reflexes
cardiac arrhythmia
CNS depression
excessive drowsiness
muscle weakness, ataxia
respiraotry depression (<12)
slurred speech
hypocalcemia + tetany (competes with calcium which is needed for muscle contraction)

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21
Q

Eclampsia

A

new onset generalized tonic-clonic seizures assoc w/ pre-eclampsia
can occur up to 24 hours postpartum

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22
Q

Gestational diabetes

A

insulin resistance –> diabetes after 20 weeks

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23
Q

Human placental lactogen

A

produced ~6-30 weeks
antagonist to insulin
increases insulin resistance

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24
Q

GDM & fetal development

A

macrosomia (>90th percentile)
hyperinsulinemia = decreased surfactant production
increased fetal BMR = fetal hypoxemia = metabolic acidosis
increased erythropoiesis = polycythemia = decreased iron for developing organs = cardiomyopathy, altered neurodevelopment, cardiac remodeling

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25
Q

RF for GDM

A

age >25
non-white people
PCOS (higher testosterone)
HTN
multiple gestation
family hx
previous macrosomia

26
Q

Maternal complications of GDM

A

increased r/o HTN/pre-eclampsia
polyhydramnios
increased r/o future T2DM

27
Q

Fetal complications of GDM

A

macrosomia
hypoglycemia
respiratory distress syndrome
hyperbilirubinemia
stillbirth
future obesity

28
Q

HDN

A

hemolytic anemia caused by isoimmunization
maternal IgG antibodies attack fetal RBC d/t incompatibility of surface antigens

29
Q

Types of blood incompatibility

A

ABO
RH

30
Q

ABO incompatibility

A

mild
usually resolves on its own
dose not typically result in severe hyperbilirubinemia
**most common with O- mom

31
Q

Rh- incompatibility

A

caused by Rh- mom & Rh+ baby
first pregnancy: maternal IgG antibodies form when mom blood exposed to fetal blood
second pregnancy: maternal IgG antibodies attack fetal RBC

32
Q

HDN treatment

A

rhogam (prevention)
phototherapy
exchange transfusion
IV immunoglobulin (reduces hemolysis)
centesis for hydrops fetalis
in utero RBC transfusion

33
Q

When is rhogam given

A

28 days
72 hours after birth

34
Q

Causes of maternal sensitization (HDN)

A

normal delivery
spontaneous/induced abortion
chorionic villlus sampling
amniocentesis
prenatal hemorrhage
maternal trauma
idiopathic
**only .1 mL needed to activate maternal immune response

35
Q

HDN complications

A

anemia
hyperbilirubinemia
kernicterus
growth restriction
hydrops fetalis

36
Q

HDN complications

A

hyperbilirubinemia –> acute encephalopathy/kernicterus
symptomatic anemia (pallor, lethargy, tachycardia, tachypnea)
hydrops fetalis
IUGR

37
Q

HDN tests

A

DAT (coombs test) measures IgG antibodise
cord blood
IAT
CBC
TCB/serum bili
peripheral blood smear

38
Q

Maternal hormones that act as insulin antagonists

A

human sommatotropic hormone (human placental lactogen)
estrogen
progseterone
prolactin
cortisol
insulinase (degrading enzyme)

39
Q

When does fetus begin secreting insulin

A

10-14 weeks gestation

40
Q

Hypoglycemia in pregnancy

A

<3.2 mmol

41
Q

Pharmacotherapy GDM

A

insulin (first-line, doesn’t cross placenta)
metformin (may cross placenta)
glyburide (last resort if intolerant to metformin & refusing insulin)

42
Q

Hyperglycemia in pregnancy

A

> 11

43
Q

Target blood glucose levels in pregnancy

A

3.8-5.2
(S/S of hypoglycemia may present at <3.8)

44
Q

Fetal consequences of GDM

A

hyperinsulinemia –> decreased surfactant/lung maturation, increased growth (macrosomia)
increased O2 demand = increased erythropoiesis = decreased iron (cardiac myopathy/impaired neural development), increased r/o jaundice
abnormal placenta –> preterm, IUGR
perinatal asphyxia/hypoglycemia upon birth
neonatal respiratory distress syndrome

44
Q

Maternal consequences of GDM

A

higher longterm r/o of T2DM
DKA
macrosomia –> dystocia –> C/S or hemorrhage
pre-eclampsia/HTN
infection
hypoglycemia (higher risk in early 1-2 trimesters as insulin need decreases)

45
Q

GDDC

A

gestational diabetes diet controlled
low glycemic diet
exercise (30 min/daily)
decreased fat/carbs

46
Q

GDID

A

gestational diabetes insulin dependent
insulin indicated when glucose targets cannot be maintained on diet/exercise alone

47
Q

Blood glucose targets in pregnancy

A

FBG <5.3
1 hour postprandial <7.8
2 hours postprandial <6.7

48
Q

Ferritin target in pregnancy

A

> 15

49
Q

Hemoglobin target in pregnancy

A

> 105

50
Q

Entonox

A

nitrous oxide

51
Q

Stages of PPH

A

Stage 1
Stage 2
Stage 3

52
Q

Stage 1 PPH

A

> 500 SVD or >1000 CS with continued bleeding + HR higher than SBP

53
Q

Stage 2 PPH

A

1000-1500 and HR higher than SBP

54
Q

Stage 3 PPH

A

> 1500 blood loss or hemodynamically unstable
anticipated need for 3+ PRBCwithin 1 H or fibrinogen level <2.5 g/L

55
Q

S/S of neonatal adaptation syndrome

A

**caused by exposure to SSRI/SNRi in utero
respiratory distress
feeding difficulty
jitteriness
irritabiilty
temperature instability
sleep problems
tremors
shivering
restlessness
convulsions
jaundice
rigidity
hypoglycemia

56
Q

Onset of NAS

A

0-3 days
duration 2 weeks

57
Q

NAS interventions

A

quiet, low-light enivronment
STS
if s/s toxicity present:
respiratory support
fluid replacement
anticonvulsant therapy

58
Q

Persistent pulmonary hypertension

A

failure of pulmonary vasculature to relax after extrauterine transition –> right-to-left shunting of blood thru fetal circulatory pathways
can cause hypoxemia refractory to treatment

59
Q

SSRI newborn complications

A

neonatal adaptation syndrome
congenital heart defects
persistent pulmonary hypertension

60
Q

is breastfeeding contraindicated with SSRIs?

A

no

61
Q

NESTS self-care acronym

A

nutritious food
exercise (daily)
sleep
time for self-care
support

BSNC 5000 (11 decks)

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