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25 Cards in this Set
- Front
- Back
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diagnostic tests for preeclampsia
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CBC
dip stick for urine protein & 24 hour urine collection serum BUN & creatinine serum uric acid liver enzymes (AST,ALT,LDH) coagulation profile (PT, PTT, fibrinogen) blood glucose type & cross |
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ask about:
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health hx - diabetes, renal disease, HTN, when bp changes were noticed)
social hx - significant other, support from family/friends urine output |
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physical assessment:
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bp measurement - same arm and position each time!
proteinuria - dipstick (+1 30mg/dl, +2 100, +3 300, +4 1000) dt reflexes (2+ normal, 4+ severe) abdo - tone, fundus, location, tenderness weight edema headache, epigastic pain, visual disturbances fetal kick count (concern if <3/h) |
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mild preeclampsia bp
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140/90 x 2, >4-6h apart
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severe preeclampsia bp
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>160/110 on 2 separate occasions
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risk factors
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nulliparity
hx of preeclampsia (own or family) obesity multifetal gestation hx of IGR, abruptio placentae, fetal death medical conditions: HTN, renal disease, IDDM, thrombophilias |
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home care for mild
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activity restriction - left lateral recumbent
diversional activities gentle exercise relaxation techniques assess 2-3x/week fetal US q3weeks NST 1-2x/week |
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care for severe (no drugs)
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wt q24h
bloodwork foley cath monitor vag exam - cervix dilation bedrest seizure precautions (bed low, rails up, position on side to ensure airway, have suctioning ready) |
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drugs for severe
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MgSO4 - CNS depressant
Hydralazine - antihypertensive (1st choice) Labetalol - 2nd line |
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name and descibe 3 stages of tonic-clonic convulsion
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stage of invasion - 2-3 sec, eyes fixed, facial musc twitching
stage of contraction - 15-20 sec, eyes protrude + bloodshot, all muscles in tonic contraction stage of convulsion - muscles contract & relax alternately (clonic), resps halt & go again w/ long deep inhalations, coma |
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seizure interventions
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ensure airway - head to one side
call for help side rails up (& padding for them) observe and record convulsion activity |
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interventions imediately after seizure
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don't leave until fully alert
observe for coma, incontinence suction as needed air mask 10L/min IV fluids, monitor intake start MgSO4 as ordered monitor, hygiene lab work |
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abruptio placentae def'n
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premature separation of normal placenta from uterine wall
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manifestations of abruptio
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sudden onset:
vag bleeding (may be internal) abdo pain, tenderness, rigidity shock symptoms fetal distress |
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collab care for abruptio
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monitor mom & fetus
O2 blood & fluid replacment left lateral pos'n avoid vag exam! |
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def'n of disseminated intravascular coagulation (DIC)
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bleeding and coagulation disorder, complication of another condition that causes overstimulation of coagulation process
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manifestations of DIC
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bleeding
shock symptoms peripheral cyanosis |
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Dx tests for DIC
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PT, PTT, platelets, fibrinogen
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collab care for DIC
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close monitoring (ICU)
treat triggering mechanism (underlying disorder) blood & fluids avoid unnecessary needle sticks |
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HELLP stands for:
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Hemolysis, Elevated Liver enzymes, Low Platelets
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HELLP patho
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rbc's break up when moving through damaged blood vessels -> blood flow to liver obstructed by fibrin deposits -> platelet aggregation @ damaged vessels
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HELLP manifestations
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malaise
n&v pain in rt upper quadrant |
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HELLP treatment
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platelet transfusion
cotricosteroids MgSO4 to prevent seizures |
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MgSO4 antidote
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calcium gluconate
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if pt getting oxytocin, what should be done with MgSO4 dosage?
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must be altered - oxytocin contracts vessels but MgSO4 dilated them
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