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NM621 Exam #1 > NM 621 exam 1 : SAB & preeclampsia > Flashcards

NM 621 exam 1 : SAB & preeclampsia Flashcards

1
Q

chronic hypertension

A

BP >140/90
Before 20 weeks of gestation
No proteinuria or stable proteinuria

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2
Q

superimposed preeclampsia

A

BP>140/90
new or increase proteinuria
development of increase BPs or HELLP syndrome

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3
Q

preeclampsia

A

BP>140/90
after 20 weeks gestation
proteinuria (+1 dipstick or >3–mg) or absence of proteinuria + thrombocytopenia, renal insufficiency, impaired liver functions, pulmonary edema, or cerebral or visual symptoms

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4
Q

gestational hypertension

A

BP>140/90

no proteinuria and not symptomatic

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5
Q

management for GHTN or preeclampsia w/o severe features

A 
close monitoring
serial assessment of maternal symptoms
DAILY fetal kick counts
BP 2x per week 
WEEKLY Lab : CBC & liver enzymes
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6
Q

when to referral preeclampsia

A

when symptomatic

prophylactic mag sulfate when hospitalized with symptomatic preeclampsia.

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7
Q

HELLP

A

hemolysis
Elevated liver enzymes
low platelets

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8
Q

complaints of HELLP

A

90%–> malaise fatigue and nonspecific complaints
prevalence–> N/V headache and/or abdominal pain
66% –> elevated BP

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9
Q

Gestational Hypertension

A

BP>140/90 for the 1st time during MID-pregnancy
no proteinuria
B/P returns to normal w/in 12 weeks postpartum
final dx made postpartum
50% of women dx with GHTN between 24-35weeks develop preeclampsia

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10
Q

mild Preeclampsia

A

BP >140/90
2 BP readings 4-6 hours apart
Proteinuria >300mg/24 hours urine or >+1 on dipstick on 2 specimens ( on 2 samples 4-6 hours apart)
occurs after 20 weeks gestation
may see: elevated reflexes
elevated hemoglobin d/t hemoconcentration
mild edema

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11
Q

severe preeclampsia

A 
BP >160/110mmHG
on 2 BP readings 4-6 hours apart 
proteinuria >5g/24 hours urine or >+3 on dipstick (on 2 samples 4-6 hours apart) 
occurs after 20 weeks gestation 
may see: epigastric pain 
visual disturbances 
headaches
clonus
dim. renal function ( increase BIN; serum creatinine >1.2mg/dL; decreased creatinine clearance)
thrombocytopenia 
oliguria
edema
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12
Q

Eclampsia

A

Grand mal seizures that cannot be attributed to other causes in a woman with preeclampsia
occurs in 0.1% of women with preeclampsia
cause: fetal distress, abruption, death

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13
Q

chronic HTN

A

REFERRAL

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14
Q

Chronic HTN increased risk for

A 
FGR
preterm birth 
preeclampsia 
placental abruption 
pulmonary edema 
renal failure 
perinatal mortality 3-4 times greater.
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15
Q

chronic HTN superimposed w/ preeclampsia

A

dx HTN prior to 20 weeks gestation and new onset proteinuria >300mg/24 hour after 20 weeks gestation
thrombocytopenia after 20 weeks gestation
worsening of HTN as pregnancy progresses

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16
Q

Preeclampsia etiology

A

abnormal placentation
inflammatory changes provoke endothelial cell injury
mild-severe microangiopathy of target organs such as brain liver kidney placenta
extreme case lead to liver failure, renal failure DIC CNS abnormalities
giving birth is only cure

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17
Q

preeclampsia risk factors

A 
nulliparity
multifetal gestation 
age extremes 35 
African American race 
DM 
prior hx preeclampsia
family hx of HTN or preeclampsi
obesity 
limited exposure to partner sperm (new partner --immunologic factors involved)

smoking does not increase risk for preeclampsia

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18
Q

Data gathering

objective:

A

(1) BP
(2) urine for protein
if 2 positive then :
check for risk factors
weight gain pattern
edema
DTR
epigastric tenderness/liver margins
opthalmic exam fo papilledema

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19
Q

Data gathering

subjective:

A

Headaches ?
dizziness ?
blurry vision
epigastric pain

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20
Q

Best position to take BP

A

after rest
UPRIGHT
NO tobacco or caffeine within 30 minutes of measurement.

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21
Q

LABS for preeclampsia

A

CBC incl. platelets
24 hour urine or albumin to creatinine ratio
liver enzymes (AST, LDH, ALT)
renal function tests (Creatinine clearance, serum uric acid, BUN, serum creatinine)
COAGULATION studies (PTT, fibrinogen, PTPT) if low platelets)

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22
Q

how often do labs done if stable

A

WEEKLY LABS

23
Q

proteinuria (preeclampsia)

A

> 300mg/ 24h

24
Q

urine dipstick (preeclampsia)

A

> 1+

25
Q

protein/creatinine ratio (preeclampsia)

A

> 0.3

26
Q

serum uric acid (preeclampsia)

A

> 5.6 mg/dL

27
Q

serum creatinine (preeclampsia)

A

> 1.2 mg/dL

28
Q

Platelets

A

<100,000/ mm

29
Q

PT or aPTT

A

ELEVATED

30
Q

fibrinogen

A

DECREASED

31
Q

d-Dimer

A

INCREASED

32
Q

Hemolysis

A

abnormal peripheral smear
indirect bilirubin >1.2mg/dL
lactate dehydrogenase >600U/L

33
Q

elevated liver enzymes

A

AST > 70 u/L

34
Q

preeclampsia (Blood)

A

hematocrit increased (hemoconcentration)

platelet count <100,000
lower platelet higher the maternal fetal morbidity

35
Q

preeclampsia (liver)

A

damage d/t subcapsular hemorrhage
function tests increase in severe disease
LDH, ALT, AST

36
Q

renal damage

A

increased serum creatinine , uric acid, and protein urine

decreased creatinine clearance.

37
Q

management : mild preeclampsia

A

obtain initial labs & consult
can use expectant management
co-manage with consultant
if symptoms progress, collaborate care or refer

38
Q

management : severe preeclampsia

A

immediately referral
high proteinuria even w/ mild BP elevation (atypical presenation of preeclampsia rare but may be present and may be quite severe)

39
Q

USN (surveillance)

A

q4 weeks if early preeclampsia

40
Q

NST (surveillance)

A

1-2 x’s per week

41
Q

BPP

A

2x per week

office evaluation twice weekly for BP urine protein symptom evaluation fetal evaluation

42
Q

preeclampsia labs (how often)

A

WEEKLY

43
Q

at home management

A

hospitalize for initial /new onset of preeclampsia
increased daily rest on left side
adequate diet
3x per week urine protein and weight
DAILY BP
DAILY FMC
office visit 2 times per weeks, every 3-4 days
women with mild preeclampsia close to term have outcome similar to normo-tensive women

44
Q

warning signs

A 
persistent headaches
visual disturbances
epigastric pain 
general malaise 
oliguria
sudden wt. gain or facial edema
45
Q

when is induction indicated

A

mild preeclampsia at term with favorable cervix

worsening preeclampsia

46
Q

MgSO4 indicated

A

in severe preeclampsia to prevent seizures

4-6gm bolus followed by 1-2 gms/hr.

47
Q

preeclampsia dx prior 36 weeks is risk for

A

preterm birth

48
Q

Eclampsia prevalences & signs

A 
before birth (38-53%)
during labor (18-36%) 
after birth (11-44% most within 48 hours PP)  
signs: HA, visual changes, epigastric pain, restlessness.
49
Q

actions during seizures

A 
call out for help 
side rails up & pad on sides 
turn on side to prevent aspiration 
insert padded tongue blade
clear airway
Administer oxygen 
IV access for MgSO4 
ASsess fetal status after seizure over
50
Q

HELLP syndrome common presentation

A 
gen. malaise "flu" 
epigastric & RUQ pain 
N/V 
HTN (severe mild or absent) 
proteinuria - significant or absent.
51
Q

HELLP syndrome 3 classic lab abnormalities

A

elevated liver enzymes
low platelet count *best indicator
anemia – last to appear

52
Q

dx preeclampsia

A 
SBP 140 or DBP 90 (4 hours apart) 
SBP >160 or DBP 105 (90-60 minutes)
                    & 
Proteinuria 
>300mg/24 hour
Pro: Cr ratio >0.3mg 
dipstick 1+ 
                   OR 
new onset of : cerebral/vision symptoms, pulmonary edema, platelet count 1.2mg/dL , elevated liver enzym (>2x normal), LDH >600IU/L 
hemoconcentration
53
Q

coagulation studies in preeclampsia

A

PT : elevated
INR :elevated
PTT: elevated
fibrinolgen : LOW

NM621 Exam #1 (1 decks)

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