Perfusion Flashcards
Mild Preclampsia s/s
After 20 weeks gestation
Protein in urine
Edema
HTN > 140/90
Severe Preclampsia S/S
BP > 160/110
HA, visual impairments, hyperreflexia clonus +4
Mild Preclampsia Tx
Rest / w/ no activity limits
Office visits 1-2 weekly for NST
Bed rest may be problematic
No restrictions in diet unless chronic HTN then avoid salt
Severe Preclampsia Txf
Hospitalization Quiet room with no visitors, prevent stimulation, near nurses station Bed rest on left side (helps kidneys lower angiotensin II) Daily weights NST High protein, moderate salt diet Monitor F&E IV (vasopressin) Mag sulfate to prevent seizures Tmp a4, q2 if fever Hourly I&O Urine diagnosis will be 3-4+ w/ each urine
Patho of Gest Hypertensive disorders
Increased vascular resistance
Elevation of BP
Decreased blood flow to:
Brain = HA, visual, hyperreflexia
Liver = Impaired function, increased enzymes, epigastric pain
Kidneys = decreased GFR, oliguria, increased Na, BUN, uric acid, and creatinine.
Proteinuria - reduces plasma pressures; moves more fluid to extracellular spaces, increasing fluid and edema.
Placenta: vasoconstriction contributes to IUGR, abruption, fetal hypoxia, and acidosis
Hemoconcentration occurs from decrease in intravascular volume r/t the fluid shifts = elevated Hct and blood viscosity.
Therapeutic level of mag sulfate
4-7 meg/L
Bolus dose of mag sulfate
4-6g over 15-20 minutes
acts immediately
lasts only 30-60 mins
administered via IV
hot flushing sensation
Signs of toxicity of mag sulfate
oliguaria < 30 ml/hr
decreased tendon reflex - patella earliest sign
decreased respirations
decreased LOC
Piggy back dose of mag sulfate
1-3g/hr (pump)
Secondary effect of mag sulfate
relaxes smooth muscle, lowers BP, decreases contractions
Tx of pre-term labor to decrease contractions
Maternal complications of pre-clampsia
Abruption placenta chronic renal problems detached retina chronic HTN HELLP syndrome DIC (Disseminated intravascular coagulation)
Fetal complications of preclampsia
Prematurity
Intrauterine growth restriction
Asphyxsia
HELLP Syndrome
(H)emolysis (E)leveated (L)iver enzymes (L)ow (P)latelets
20% of mothers with preeclampsia (same tx as preeclampsia)
How many pregnancies end in miscarriage
15-20%
Causes of miscarriage in 1st trimester
genetic abnormalities
Causes of miscarriage in 2nd trimester
incompetent cervix hypothyroidism diabetes lupus CMV HSV
How many pregnancies are ectopic
1 in 50 (2%)
Where can ectopic pregnancies be planted?
fallopian tubes
cervix
ovary
abdominal cavity
Risk factors for ectopic pregnancy
Chlamydia PID endometriosis infertility treatments tubal surgery IUDs PP infection fibroid tumors smoking douching
Med for ectopic pregnancy
methotrexate (chemotherapeutic med that destroys rapidly developing cells)
Benefits of med in ectopic treatment
Quicker healing time
less scarring
more scarring increases risk of another ectopic pregnancy
Molar pregnancy causes
ovular defect
stress
nutritional deficiency
Complete mole
r/t choriocarcinoma
Molar pregnancy patho
two sperm filled one ovum
Placenta previa
PAINLESS BRIGHT RED VAGINAL BLEEDING
marginal can be detected at 20 wk scan. Possibly can grow to size of uterus
Partial - most c-section depends on how much near cervix occurs in 1-400 pregnancies
Risk factors of placenta previa
advanced maternal age abortion multipara smoking asian descent previous previa previous c-sections
1-160 after 2
1-60 after 3 because increased scar tissue
1-30 after 4
1-10 > 4
Placeta abruption
signs include rigid board like abdomen web not being able to indent uterus at all
no oxygen / bleeding
complete needs STAT section
Partial may be possible vaginal birth
Placenta abruption s/s
“Dark” vaginal bleeding
Constant abdominal pain
Uterine tenderness
Firm uterus
Placenta abruption risk factors
HTN, cocaine, too much fluid, trauma, alcohol, multipara, can lead to DIC.
Occult Umbilical Cord Prolapse
hidden cord
Over Umbilical Cord Prolapse
seen / felt cord
Umbilical Cord Prolapse NI
CHANGE MATERNAL POSITION - KNEE/CHEST or trendelenberg with butt in air assess SROM or PROM monitor FHR Don't ambulate Vaginal exam Elevate presenting part Call for help O2 Notify HCP Prepare for stat c-section Explain to pt what is happening
Predisposing factors for Cord Prolapse
malpresentation
growth restriction
hydraminos
breech / transverse presentation
Cord Prolapse stats
1-300
Meconium aspiration stats
20%
Meconium aspiration risk factors
post-term pregnancies forcep delivery breech maternal HTN CGA Oligohydramnios prolapsed cord IUGR DM
Uterine Rupture
A tear in uterus usually at previous c-section
initial signs may be sudden fetal bradycardia and acute / continuous ab pain
only 10-30 mins before significant damage to fetus occurs
Meconium Aspiration Interventions
O2 support afterwards
antibiotics
surfactant
assess prolonged tachypnea, grunting, cyanosis
Uterine Rupture Risk Factors
trauma, cocaine use, multipara, malpresentation, invasive molar pregnancy, fibroid removal, placenta accreta, excessive uterine stimulation
Postpartum Hemorrhage
Blood loss >500 following vaginal
Blood loss >1000 following c-section
Most common cause is uterine atony
Postpartum Hemorrhage Tx
assess cause to stop bleeding two large bore IVs for transfusion fundal massage; pad count Adminster uterotonic Fluid administration Monitor for s/s of shock
Postpartum Hemorrhage Risk factors
Big baby Tissue damage Trauma Thrombosis (lack of clotting) infection retained placental fragments
Meds for postpartum hemmorhage
oxytocin, miso-rostov, dinoprostone, methylergonovine, prostoglandin
Early signs of shock
Normal blood pressure increased HR Normal temp. Cool / moist Anxiety Increased rate / depth of respirations
Late Signs of shock
low BP Increased HR, weak Pale / cold Coma Increased / shallow resps
Shock types
HYPOVOLEMIC - inadequate intravascular volume septic cardiogenic distributive toxic drug induced
Lab / Diagnostic tests for shock
Blood glucose Electrolytes CBC with differential Blood culture C-reactive protein Arterial blood gas Toxicology panel Lumbar puncture Urinalysis Urine culture Radiographs
Nursing management of shock
ABCs Vascular access Restore fluid volume (LR or NSS [isotonic]) Blood transfusion Foley catheter to measure output
Vasoactive meds for shock
Dobutamine - improves cardiac contractility
Epinephirine - vasoconstrictor
Dopamine - affects heart / vasculature
