Muddy Points

Question 1

List 9 maternal assessments for antepartum preeclampsia care

Answer 1

bed rest in recumbent position.
Serial blood pressures.
Nutritional intake (focusing on low salt)
Daily weights
Monitoring of edema
Urine output
reflexes
lung sounds
Signs and symptoms (headache, visual changes, epigastric pain)

Question 2

What labs are important for preeclampsia

Answer 2

CBC (to check platelets, low platelets being an issue)
CMP (AST, ALT, uric acid (liver enzymes) as well as BUN and Creatinine)
Coags (PT, PTT, and Fibrinogen)
Urine protein (dipstick of greater than +1, 24 hour collection over 300mg)
Creatinine clearance

Question 3

List 5 antepartum interventions for preeclampsia

Answer 3

Nursing assessment of fetus
Non stress test daily
Fetal kick counts (count to 10/2 hours)
Serial ultrasounds for growth, fluid volume, and well-being/BPP
If preterm gestation - Betamethasone IM steroids

Question 4

When is a preeclamptic patient transferred to L and D

Answer 4

when it becomes severe enough to require continuous IV medications/monitoring, or delivery needs to happen asap

Question 5

List 8 intrapartum interventions for Preeclampsia

Answer 5

continuous FHR monitoring.
Hourly BPs
NPO (if delivery is indicated)
D5LR
Daily weights
Monitor for peripheral or pulmonary edema (lung sounds)
Strict I and O hourly via foley
DTRs (increase means seizure is pending)

Question 6

List 2 big warning signs for intrapartum Preeclamptic care

Answer 6

Ankle clonus, and changes in headaches, vision or epigastric pain

Question 7

Describe seizure precautions for intrapartum preeclamptic care

Answer 7

Side rails up
quiet/dark environment.
Clustering nursing care is vitally important
Emergency drugs
Oxygen, and suction readily available

Question 8

When is immediate birth indicated for preeclamptic intrapartum care

Answer 8

Eclampsia, pulmonary edema, placental abruption, DIC, or renal dysfunction develops

Question 9

How long is Mag sulfate continued after birth

Answer 9

12-24 hours in L and D (HROB)

Question 10

What are 5 important things to watch out for with postpartum preeclampsia

Answer 10

Careful monitoring related to Mag sulfate
Vital signs to keep track of hemodynamic status
DTRs (hyper/hypo)
Urine output
Magnesium levels if ordered

Question 11

List 6 signs of mag toxicity

Answer 11

Decreased BP
Decreased urine output
Decreased RR
Decreased DTRs
Patient may also display decreased consciousness/stupor

Question 12

What is amniocentesis performed during 15-20 weeks for

Answer 12

Confirms chromosomal abnormalities like neural tube defects, and several metabolic defects.
Collection of amniotic fluid to examine fetal cells

Question 13

What is amniocentesis performed at 35 weeks for

Answer 13

Determine fetal lung maturity.
Testing for level of surfactant by assessing L/S ration (2:1 means mature)
Rhogam given if Rh negative

Question 14

Describe amniocentesis in four steps and how long does it take for results

Answer 14

Use ultrasound to assess fluid and guide the needle.
Assess fetal well-being before and after the procedure.
Empty bladder to avoid risk of bladder puncture
Lie in supine position and place wedge under right hip to displace uterus off vena cava.
Can take 3 weeks to get results

Question 15

List 6 risks of amniocentesis

Answer 15

Lower abdominal pain and cramping (can lead to preterm labor)
Spontaneous abortion (Increased risk when completed before 15 weeks)
Maternal or fetal infection (postamniocentesis chorioamnionitis, report fever or chills)
Fetal-maternal hemorrhage
Leakage of amniotic fluid
amniotic fluid embolism

Question 16

How do doppler flow studies monitor placental function

Answer 16

Detects movement of RBCs in vessels.
Detect decreased blood flow to baby from placenta
Identify abnormalities in diastolic flow within the umbilical vessels
Diastolic blood flow may be absent or reversed

Question 17

Name 3 high risk pregnancies that doppler flow can be used to detect fetal compromise in

Answer 17

Pregnancies complicated by HTH, fetal growth restriction, or diabetes

Question 18

What is nice about doppler flow studies

Answer 18

Noninvasive and no contraindications

Question 19

List 4 warning signs in 1st trimester

Answer 19

Spotting/bleeding
painful urination
severe persistent vomiting
lower abdominal pain with dizziness and shoulder pain

Question 20

List the 8 common discomforts of first trimester

Answer 20

Urinary frequency or incontinence
Fatigue
Nausea and vomiting
breast tenderness
constipation
nasal stuffiness, bleeding gums, epistaxis
cravings
leukorrhea

Question 21

List the 4 warning signs of 2nd trimester

Answer 21

Regular uterine contractions
Pain in calf
Sudden gush or leaking fluid from vagina
Not fetal movement for greater than 12 hours

Question 22

List the 5 common discomforts of 2nd trimester

Answer 22

Backache
Leg cramps
varicosities of vulva and legs
hemorrhoids
flatulence with bloating

Question 23

List the 5 warnign signs of 3rd trimester

Answer 23

Sudden weight gain
Periorbital or facial edema
Severe upper abdominal pain
Headache with visual changes
Decrease in fetal movement for greater than 24 hours

Question 24

List the 5 common discomforts of 3rd trimester

Answer 24

Return of 1st trimester discomforts
shortness of breath
heartburn and indigestion
Dependent edema
Braxton hick contractions