Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
155 Cards in this Set
- Front
- Back
|
What is the number one cause of neonatal mortality & the number two cause of infant mortality in the US?
|
Prematurity
|
|
|
What constitutes the diagnosis for Preterm Labor?
|
1 - Gestational age of 20-37 wks, 2 - Documented UC's of => 6/hr & @ least one of the following: ROM *OR* Cervical Change (Dilation => 1cm or 80% effacement)
|
|
|
What are some of the contributing factors to preterm labor?
|
* Inflammation & Infection, * Activation of the Fetal Hypothalamic-Pituitary Adrenal Axis, *Decidual hemorrhage/abruption, *Uterine overdistention, *Psychosocial factors contribute to stress response resulting in UC's (hypothesized)
|
|
|
What is the single most contributing risk factor to preterm labor & birth?
|
A prior preterm birth
|
|
|
List some of the common risk factors for preterm labor & birth
|
*multiple gestation (twins, etc.), *prior preterm birth, *uterine/cervical abnormalities or diethylstilbesterol (DES) exposure, *Infection (esp. GI or periodontal disease), *PROM, *stress, *domestic violence, *vaginal bleeding, *lack of social support, *inadequate nutrition, *< 17 y.o, or > 35 y.o., *smoking, alcohol & illicit drug use, *late or no prenatal care, *low socioeconomic status, *ancestry & ethnicity (highest in AA infants), *chronic health problems (HTN, DM, clotting disorders), *working long hrs, long periods of standing
|
|
|
What are the maternal complications of preterm labor & birth?
|
Complications related to bedrest & treatment with tocolytics
|
|
|
After diagnosis of PTL, what are the expected assessment findings?
|
1 - Persistent UC's, 2 - Dilation to 1 cm *OR* > 80% effaced, 3 - Positive Biochemical Marker
|
|
|
What does a negative fetal Fibronectin tell you?
|
That the woman wil not deliver in the next 7-14 days.
|
|
|
Is fetal Fibronectin better at predicting who will or who will not deliver preterm?
|
Who will not deliver preterm.
|
|
|
What are the positive and negative predictive values of fFN (fetal Fibronectin)?
|
Negative Predictive Value - 95%
Positive Predictive Value - 25-40% |
|
|
Once preterm labor has begun, what is the optimum time to delay delivery & why?
|
72 hours
to give antenatal steroids time to facilitate surfactant production and produce fetal lung maturity & to administer antibiotics if infections are present |
|
|
What is the medical management of preterm labor & delivery?
|
* Tocolytic Drugs
* Bed Rest * Hydration - either IV or oral * Antibiotics * Corticosteroid therapy w/ antenatal steroids * Continuous EFM - If UC's decrease to fewer than 5/hr, women are transferred to less acute antenatal units for further observation for several days * Palpation of maternal abdomen - to assess strength * Maximize Uterine Blood Flow - increase cardiac output by placing pt on side (left preferred) |
|
|
What are the discharge instructions for a woman who was previously in preterm labor but has stabilized?
|
* Bedrest or activity restriction, * Self-Monitoring of UC's, * S&S of Pre-term labor, * Also may include oral tocolytics or use of terbutaline pump therapy.
|
|
|
What are the contraindications to treating preterm labor?
|
* Active Hemorrhage
* Severe Maternal Disease * Fetal Compromise * Chorioamnionitis (Intra-amniotic Infection) * Fetal Death |
|
|
What is the widely used first step in the treatment of preterm labor?
|
Bed rest; however, there is no evidence to support or refute its use at home or in the hospital to prevent preterm birth
|
|
|
What are the potential adverse effects to the woman and her family when prescribing bed rest?
|
Muscle Atrophy, Cardiovascular Deconditioning, Maternal weight loss, Stress for the woman & her family
|
|
|
What are the indications for administering antenatal steroids (Betamethasone or Dexamethasone) during pregnancy?
|
Given to women at 24-34 wks gestation with signs of preterm labor or at risk to deliver preterm.
|
|
|
What is the action produced by administering Corticosteroids during pregnancy?
|
Stimulates the production of more mature surfactant in the fetal lungs to prevent respiratory distress syndrome in premature infants. Goal: Fetal Lung Maturity.
|
|
|
What are the adverse effects of administering Corticosteroids during pregnancy?
|
There aren't any
|
|
|
What is the route & dosage for Betamethasone & Dexamethasone?
|
Betamethasone:
12 mg IM q 24 h x 2 doses Dexamethasone: 6 mg IM q 12 h x 2 doses |
|
|
What are some of the long term sequelae for preterm infants?
|
Cerebral Palsy, Sensory Deficits, Special HC Needs, Special Learning Needs
|
|
|
What group of women are at the highest risk for PTL/PTD?
|
socially disadvantaged, minorities, low education levels, late or no prenatal care, < 15 y.o. or > 45 y.o. & women carrying multi fetuses
|
|
|
What are the two biochemical markers that can be checked when determining PTL?
|
1 - fetal Fibronectin (fFN)
2 - Salivary Estriol (not as widely used as fFN) |
|
|
When is fetal Fibronectin present?
|
Very early & very late in gestation.
|
|
|
What test would we use to determine endocervical length?
|
Vaginal Probe Ultrasound
|
|
|
What effects do prostaglandins have on the uterus?
|
Causes the uterus to contract
|
|
|
What can cause uterine overdistention?
|
Multiple pregnancies, polyhydramnios, macrosomia (lg babies), diseases of the uterus (fibroids)
|
|
|
What constitutes the hormonal triad?
|
1 - Adrenal Axis
2 - Pituitary 3 - Hypothalamus |
|
|
If you, as the nurse, suspect PTL, what should you assess for?
|
Infection & pPROM
|
|
|
What are the physical findings of PTL/PTD?
|
1 - UC's
2 - Cervical Changes 3 - Engagement of the fetal presenting part (settled down into the true pelvis & is easily palpable on digital exam or by abdominal sonogram 4 - Presence of fetal Fibronectin |
|
|
How do we assess the intensity of contractions?
|
Our hands must be on their tummy.
|
|
|
What are the physical findings of PTL/PTD in the presence of an infection?
|
1 - UC's, 2 - Cervical Changes, 3 - Engagement of fetal presenting part, 4 - Application of electronic fetal monitor, 5 - Elevated temp, 6 - Elevated Pulse (mother & fetus), 7 - Serum WBC count > 18,000, 8 - tenderness at costovertebral angle (CVA) indicates Kidney infection, 9 - Evidence of nitrites, leukocytes or WBC/RBC's in urine indicates kidney or bladder infection, 10 - fetal tachycardia
|
|
|
If moms pulse is increased in the presence of a temperature, what happens to the babies pulse?
|
It also increases
|
|
|
What constitutes fetal tachycardia?
|
> 160 bpm
|
|
|
What is the nursing care management of women prior to the onset PTL?
|
The key is prevention & education
1 - identify women @ risk 2 - educate re: S&S between 20-24th week 3 - educate re: appropriate response to S&S of PTL |
|
|
When a woman responds to the early S&S of PTL & presents to the inpatient facility, what is the appropriate nursing care management?
|
1 - Early recognition & diagnosis is key: confirm gestation w/ gestational wheel or naegele's rule
2 - Uterine activity - palpate abdomen to assess intensity of UC's & place electronic fetal monitor 3 - Cervical exam for changes in cervix (thinning & dilation) w/ sterile speculum |
|
|
How do you determine the intensity of UC's through palpation?
|
Place fingers at the fundus of the uterus during a contraction. Mild - feels like tip of nose, Moderate - feels like the chin, Strong - Feels like the forehead
|
|
|
Explain effacement.
|
Presented as a %. The thinner the endocervical length, the higher the %. If original length is 2", then when reduced to 1" = 50% effaced, when shortened to 1/2" = 75% effaced.
|
|
|
What is a major component of semen and what effect does it have on the uterus?
|
Semen is primarily prostaglandins and can cause uterine contractions.
|
|
|
What effect on the uterus does dehydration have?
|
Causes the uterus to contract
|
|
|
What activities should be curtailed in the woman at risk of PTL?
|
Sexual activity
Riding Long Distances Standing for Long Periods Carrying Heavy Loads Hard Physical Labor Climbing Stairs Inability to rest when tired |
|
|
Do we currently have any approved drugs for preterm labor?
|
No. The drugs that are used for their tocolytic effects are actually off-label effects.
|
|
|
Do tocolytic drugs work in women that are already dilated to > 6 cm?
|
No.
|
|
|
Maternal contraindications to the use of tocolytics.
|
Severe preelampsia
Active vaginal bleeding that is undiagnosed Intrauterine infection Cardiac disease Any medical/obstetrical condition that contraindicates prolonging the pregnancy |
|
|
Fetal contraindications to the use of tocolytics.
|
* If > 34 wks gestation
* If fetus has anomaly that is incompatible with life (anencephaly) * Acute fetal distress * Chronic IUGR |
|
|
What is expectant management?
|
When a woman is in preterm labor but > 34 wks, we put them in the hospital, bed rest, watch them. We don't do anything to inhibit or promote delivery.
|
|
|
Why do we not administer glucocorticoids in a woman in preterm labor but > 34 weeks?
|
Stress of labor on the fetus initiates the release of surfactant to the fetal lungs so that they will mature.
|
|
|
What is the most commonly used tocolytic?
|
Magnesium Sulfate
|
|
|
What is the antedote for Magnesium Sulfate?
|
Calcium Gluconate
|
|
|
How is magnesium sulfate coadminstered?
|
With an isotonic IV infusion. ALWAYS ALWAYS ALWAYS infusion pump.
|
|
|
Give examples of isotonic IV solutions.
|
0.9% Normal Saline
Lactated Ringers |
|
|
What are the therapeutic levels of Magnesium Sulfate?
|
5-8 mg/dL in maternal serum levels
|
|
|
Maternal side effects of Magnesium Sulfate?
|
Flushing, Drowsiness, Headache, Lethargy, N/V
|
|
|
What effects do Mangesium Sulfate have on typical anesthesia drugs?
|
Magnesium Sulfate potentiates the effects of anesthesia drugs so we will need lower doses of these drugs.
|
|
|
Fetal side effects of Magnesium sulfate?
|
< in FHR (suppresses SNS & PNS)
< in fetal breathing Can alter the reactivity results of NST |
|
|
Effects of Magnesium Sulfate on babies after they are born?
|
Hypocalcemia - lack of calcium causes hypotonia
Hypotonia - limp muscle tone Lethargic Respiratory Depression Effects of MS are much longer on baby due to the immatury of their major organs and the ability to metabolize and excrete it efficiently. |
|
|
What are the nursing actions be when using Magnesium Sulfate?
|
Protect Patient & Fetus:
EFM: FHR & Uterine Activity Lung Sounds - easy to cause pulmonary edema I & O (very accurate r/t pulm edema) Progression of Labor Monitoring MS serum levels for possible toxicity |
|
|
Give the therapeutic serum magnesium sulfate levels? What effects occur at higher levels?
|
Therapeutic: 5-8 mg/dL
9 mg/dL - resp depression, loss of DTR, changes in consciousness 12 mg/dL - ekg changes 20 mg/dL - heart stops |
|
|
What is the dosage of magnesium sulfate?
|
4-6 g in 20 minutes; then 2-4 g/hr.
|
|
|
What effect does calcium gluconate have on magnesium sulfate?
|
It binds with the magnesium and makes it unusable.
|
|
|
What women would be most susceptible to elevated levels of Magnesium Sulfate?
|
Those with impaired renal or cardiac disease.
|
|
|
What is Terbutaline?
|
A bronchodilator (Beta-Adrenergic Agonist/Beta Mimimic)
|
|
|
What does Terbutaline do?
|
It stimulates the beta receptors which in turn stimulates smooth muscle to relax (uterus)
|
|
|
What are the side effects when using Terbutaline?
|
Maternal tachycardia
Pulmonary edema (most serious) Palpitations Jitteriness Nervousness |
|
|
What maternal heart rate would cause you to hold Terbutaline? Why?
|
Pulse => 120. When the pulse reaches the levels of tachycardia (> 100 bpm) the cardiac output is minimual because there is no time to fill. This is why the Pulmonary Edema happens (the blood backs up in the lungs)
|
|
|
In what women would we never administer Terbutaline?
|
Women with heart disease
|
|
|
What are the nursing actions when administering Terbutaline?
|
Fetal Monitoring, so FHR activity & Uterine activity
I & O - closely watched Maternal Heart Rate Maternal Glucose Levels |
|
|
What are the life threatening complications for Terbutaline?
|
Pulmonary Edema
Myocardial Failure Fluid Volume Overload |
|
|
What is Nifedipine?
|
A Calcium Channel Blocker
|
|
|
What effect does calcium have on the uterus?
|
Calcium is necessary for muscle contraction.
|
|
|
What is Indomethacin?
|
A NSAID.
|
|
|
When is Indomethacin used? Why?
|
In patients that are at 20-30 wks gestation. Indomethacin will cause the premature closing of the Ductus Arteriosis if it is given after 30 wks gestation.
|
|
|
How many doses of antenatal steroids to we want to be administered prior to the delivery of a PT baby?
|
2 doses
|
|
|
What is the most effective antenatal steroid used?
|
Betamethazone
|
|
|
Is diabetes in pregnancy considered high risk?
|
Yes
|
|
|
What two things cause diabetes?
|
1 - impaired insulin secretion
2 - inadequate insulin action on targeted tissues |
|
|
What characterizes diabetes?
|
Abnormal metabolism of carbohydrates, proteins, fats, and electrolytes that result in hyperglycemia and other metabolic disturbances
|
|
|
What can be the result of uncontrolled diabetes?
|
This can result in severe neurologic, cardiovascular, ocular, renal, and microvascular complications.
|
|
|
How is diabetes classified?
|
By it's cause rather than by its treatment.
|
|
|
What is the classification of type I diabetes?
|
By the absolute deficiency of the pancreas to secrete insulin.
|
|
|
What is the classification of type II diabetes?
|
Caused by combination of resistance to insulin action and/or an in adequate response in the tissues.
|
|
|
What type of cells in the pancreas secrete insulin?
|
Beta cells
|
|
|
What is the typical age of a diagnosis of type I diabetes?
|
Before the age of 30.
|
|
|
How is type II diabetes typically managed?
|
Most are managed with diet and exercise. Some will need to use of oral hypoglycemic agents and if that doesn't work then they will move on to insulin.
|
|
|
What percent of women who delivered preterm do not have indicative risk factors?
|
More than 50%
|
|
|
What is fetal fibronectin?
|
A protein that is found in the fetal plasma that is excreted into the amniotic fluid early and late in gestation.
|
|
|
What are the two most common used factors to indicate a increased risk for preterm delivery?
|
Biochemical Marker: Fetal Fibronectin (positive value) & Physical: Shortening Endocervical Length
|
|
|
What are the interventions for PTL?
|
* Hydration - oral or IV
* Maximize Uterine Blood Flow * Continuous EFM * Palpate abdomen to assess UC strength * Administer tocolytics as ordered |
|
|
Can terbutaline be used short term or long term.
|
Short term only
|
|
|
What is the most common & second most common tocolytic used?
|
Most Common: Magnesium Sulfate
2nd: Nifedipine |
|
|
How does nifedipine work?
|
inhibits calcium from entering the smooth muscle cells. When exchange of calcium ions doesn't occur it decreases muscle activity therefore the uterus relaxes.
|
|
|
Why is nifedipine used more often than terbutaline?
|
Less side effects.
|
|
|
What are the maternal side effects of Nifedipine?
|
Hypotension (most common side effect)
Flushing Headache Nausea Transient Tachycardia |
|
|
What are the fetal side effects of Nifedipine?
|
Fetal bradycardia r/t decreased utero placental blood flow from maternal hypotension
|
|
|
When do we withhold Nifedipine?
|
If maternal blood pressure is =< 90/50 or maternal heart rate is > 120 bpm
|
|
|
What is the result of using Nifedipine along side Magnesium Sulfate?
|
Profound Hypotension
|
|
|
What are the nursing actions when administering Nifedipine?
|
EFM: FHR & Uterine Activity
Monitor maternal VS's |
|
|
What is the action of Indomethacin
|
Blocks the production of Prostaglandins
|
|
|
What are the side effects to the neonate when using Indomethacin?
|
Closes or constricts the ductus arteriosis
|
|
|
When is Indomethacin used?
|
Prior to 30 weeks gestation
|
|
|
What are the cautions with using any NSAID on pregnant women?
|
Salicylate allergies - risk for reaction
|
|
|
Who is receiving the benefit from antenatal steroids?
|
The fetus. Not the mother. So that the baby produces its own surfactant.
|
|
|
What are the symptoms of gestational diabetes?
|
Generally mild
Maternal hyperglycemia is associated with increased fetal morbidity. |
|
|
Who is impacted the most by diabetes?
|
The fetus more than the mother.
|
|
|
What effects to the hormones of pregnancy have on insulin?
|
They act as insulin antagonists. So the women cannot effectively uptake the insulin and use it at the target tissues.
|
|
|
Does maternal insulin transport across the placenta to the fetus?
|
No.
|
|
|
What syndrome is often seen in infants born to a diabetic mom?
|
Respiratory Distress Syndrome
|
|
|
What does diabetes do to the infant?
|
Acts as a growth hormone
Decreases surfactant production Uptake of glucose to the brain causes depressed respiration |
|
|
What are the maternal risks and complications of gestational diabetes & changes associated with diabetes?
|
Ketoacidosis
Preeclampsia Maternal Infections are more frequent |
|
|
What are the fetal effects of diabetes?
|
Increase in congenital anomolies (most pronounced is cardiac)
Growth disturbances (macrosomic) Vascular disturbances (< placental perfusion resulting in fetal asphyxia & hypoxia) |
|
|
What happens to macrosomac babies during delivery?
|
Prone to birth injury. Most common fracture is clavicle. Also bruising causing hyperbilirubinemia & jaundice in the newborn.
|
|
|
What are the neonatal effects of diabetes?
|
Respiratory Distress Syndrome r/t decrease surfactant production & the uptake of glucose in the brain
Conditions where they become severely Hypoglycemia, Hypocalcemia, Hypomagnesium, Polycythemia (increase in RBC's), Hyperbilirubinemia |
|
|
What is the nursing care management associated with gestational diabetes?
|
Interview & Physical Exam
Lab Tests (blood glucose monitoring-immediate) Hemoglobin A1C (reflects blood glucose over the last 3 months) Urine - ketone presence (from protein breakdown) Fetal evaluation (ultrasound for fetal growth) Maternal Serum Alphafetoprotein BPP's Amniocentesis (if delivery is expected for fetal lung maturity) Doppler Flow Studies (evaluate placenta & ability to feed baby adequate levels of oxygen & nutrition) |
|
|
What is the nursing care management associated with gestational diabetes during the antepartum period?
|
Diet & Exercise
Insulin Therapy Monitoring Blood Glucose Levels Fetal Surveillance Complications requiring hospitalization Method of delivery & date of delivery Family Planning & Contraception |
|
|
What is included in the nursing care management for a diabetic during the intrapartum period?
|
Maintaining glycemic control - monitor blood glucose q 2 h while in labor. May use hypotonic or isotonic solutions
Administer insulin during labor if needed. |
|
|
What is included in the nursing care management for a diabetic during the postpartum period?
|
Because insulin needs go down significantly after separation of the placenta, the need for finger sticks also go way down.
|
|
|
What is chronic hypertension & what effect does it have on a pregnancy?
|
A pregestational condition of high blood pressure which places a woman at a greater risk for developing pre-eclampsia.
|
|
|
When can a diagnosis of chronic hypertension be made?
|
Prior to pregnancy or before the 20th week of pregnancy.
|
|
|
What is the significant diagnositic difference between chronic hypertension & pre-eclampsia?
|
Chronic hypertension women do not excrete protein in the urine like pre-eclamptic women do.
|
|
|
Explain preeclampsia superimposed on chronic hypertension.
|
These are women who were diagnosed with chronic hypertension who develop new-onset proteinuria.
|
|
|
Can women develop pre-eclampsia in the postpartum period?
|
Yes. These women exhibit high blood pressure with proteinuria.
|
|
|
How does pre-eclampsia present?
|
Hypertension (=>140 systolic/=>90 diastolic) with proteinuria after 20 wks of gestation.
|
|
|
What is eclampsia?
|
Pre-eclampsia with seizures without explanation. Women that have hx of pregnancy are not eclamptic.
|
|
|
HELLP Syndrome
|
A variant of severe pre-eclampsia. Defined by lab value diagnosis.
|
|
|
Give the specific VS values associated with the diagnosis of pre-eclampsia.
|
Systolic >= 140 mm Hg
Diastolic >= 90 mm Hg Mean arterial pressure of 105 mm Hg New onset of HTN based upon 2 elevations 7 days apart |
|
|
A concentration of 3 mg/dL or more in at least 2 random urine specimens collected at least 6 h apart.
|
Proteinuria
|
|
|
What must be ruled out when determining proteinuria?
|
UTI
|
|
|
What is another means of diagnosing proteinuria?
|
24 Hr. Urine Specimen
|
|
|
What level indicates proteinuria?
|
300 mg/L or greater in 24 hr urine specimen
|
|
|
What are the risk factors for pre-eclampsia?
|
Primigravida
Age Extremities < 19 or > 35 Diabetes (Type 1 causes 3x risk) Preexisting HTN, Vascular, Renal Disease Multiple gestation Fetal hydrops Hydatiform mole Preeclampsia in previous pregnancy Family hx of preeclampsia or eclampsia Obesity Immunologic factors |
|
|
What edema in pregnancy is considered abnormal? What could be the diagnosis?
|
Edema of the hands & face *OR* generalized edema. Dx - Pre-eclampsia. Edema of the feet ankles & pretibial is considered normal.
|
|
|
What is the only way to resolve pre-eclampsia, eclampsia or HELLP syndrome?
|
Delivery of the fetus and placenta.
|
|
|
Does the client feel the effects of pre-eclampsia?
|
No. Not until it reaches a stage of severe pre-eclampsia.
|
|
|
How is severe pre-eclampsia diagnosed?
|
Systolic BP => 160 mm Hg
Diastolic BP => 110 mm Hg Proteinuria > 2 g in 24 Hr Specimen Oliguria - urine output < 30 ml/Hr Visual Disturbances Pulmonary Edema - SOA Epigastric or RUQ pain r/t liver enlargement Thrombocytopenia - decreased level of platelet production below 100,000 Hepatic Dysfunction - Lever enzymes elevate IUGR r/t narrowing of vasculature to the placenta May develop into eclampsia or HELLP syndrome |
|
|
What are the maternal effects of pre-eclampsia?
|
Cerebral edema/hemorrhage/stroke
Disseminated Intravascular Coagulation Pulmonary Edema Congestive Heart Failure Hepatic Failure Renal Failure Abruptio Placenta |
|
|
What are the fetal/newborn effects of pre-eclampsia?
|
Prematurity r/t deterioration of maternal status
IUGR r/t decreased uteroplacental perfusion Low Birth Weight r/t IUGR Fetal intolerance to labor r/t decreased placental perfusion Stillbirth |
|
|
Explain the hemolysis and elevated liver enzymes associated with HELLP
|
Pre-eclampsia affects a number of systems including the vasculature which becomes constricted. When RBC's travel through these constricted areas, they get damaged or destructed. This results in hemolytic anemia. With reduced RBC's we have reduced capacity to carry oxygen. You will also see elevation of LDH, elevation of bilirubin levels and jaundice can occur because of rapid destruction of RBC's. On top of that, vasospasm decreases the blood flow to the liver so the liver is not functioning effectively to promote the excretion of waste from the body. AST is elevated as well.
|
|
|
The symptoms of hepatic damage include?
|
RUQ pain
Epigastric pain N/V r/t low functioning liver & gallbladder Tenderness on Right Side when palpating liver |
|
|
Explain the low platelets associated with HELLP
|
Platelets aggregate at all the damaged sites along the endothelium of the vasculature. Its trying to plug up all the leaky holes that are being created. It causes the consumption of platelets and thrombocytopenia results. That is a level of platelets < 100,000.
|
|
|
What do we see once platelets reach a level below 100,000?
|
Bleeding gums
Unexplained bruising Petechia Bleeding from puncture sites such as the IV |
|
|
What is the pathophysiology related to HELLP syndrome?
|
Hemolysis is believed to result because RBCs are damaged by their travel through small, impaired blood vessels.
Elevated Liver enzymes are believed to result from obstruction in liver flow by fibrin deposits. Low Platelets are believed to be the result of vascular damage secondary to vasospasm. |
|
|
What happens if HELLP syndrome become severe enough?
|
Disseminated Intravascular Coagulation - over 80% of all cases of DIC result in death.
|
|
|
What happens when there is overwhelming endothelial cell damage?
|
Decreased blood flow, decreased oxygenation and perfusion of the tissues throughout the body, after that organ failure starts to occur.
|
|
|
What do pre-eclamptic women have greater demand for?
|
Calcium, protein, calories & fluids. Do not restrict sodium unless it was present as a treatment for chronic hypertension prior to the pregnancy; however, they do need to stay within the daily sodium allowance.
|
|
|
What subjective symptoms might a pre-eclamptic woman complain of?
|
RUQ Pain
Epigastric Pain N/V Headaches Visual Disturbances (spots or light bursts, double vision, blurred vision) Decreased fetal movement Edema of the face & hands SOA |
|
|
How much water should a pre-eclamptic woman drink per day?
|
8-10 glasses of water each day because it acts as a natural diuretic so the body does not retain fluids.
|
|
|
What do we want to assess for after a woman presents with the subjective symptoms of pre-eclampsia?
|
Pulmonary Edema
3+ or worse Edema of hands & face Adventitious Breath Sounds Decreased O2 Sat Levels < 95% Tachypnea Anxiety Neurological Assessment includes alteration in LOC, Hyperreflexia, Clonus, Headaches, visual disturbances, tonitis (ringing in ears) Laboratory Assessment includes CBC, type & crossmatch, UA for protein & specific gravity, Electrolytes, Entire Coagulation panel (fibrinogin, fibrinogin split products, v-dimer???) Liver Function Tests - Clotting studies, serum uric acid, BUN, creatinine, creatinine clearance 24 Hr. Urine Specimine (if not previously collected) |
|
|
What is the fetal surveillance in pre-eclampsia?
|
Continuous Fetal Monitoring
Ultrasound - to rule out IUGR Assess Amniotic Fluid Indices as part of the BPP Doppler Flow Studies to assess condition & functioning of placenta Amniocentesis - to determine fetal lung maturity & need for early delivery |
|
|
What is the most common drug used for Hypertension in pregnancy to prevent seizures?
|
Magnesium Sulfate - administered the same way it is administered for preterm labor. But the purpose in the HTN client is for its anti-convulsive effect. We want to prevent seizures in these women.
|
|
|
Name the antihypertensive drugs that might be used to treat HTN.
|
apresoline, labetalol, procardia, nitroprusside, methyldopa
|
|
|
What is the most common antihypertensive drug used with Hypertensive clients is?
|
Procardia. Then Labetalol. Methyldopa is an old time drug that was originally developed for Parkinsonism but is very good at relaxing the microvasculature of pregnant women. It was withdrawn from the market but reintroduced to the market for pregnant women with HTN that don't respond to the other conventional drugs.
|
|
|
What are the hemorrhagic complications with pregnancy?
|
Placenta Previa
Abruptio Placenta Placenta Accreta |
|
|
Define hypertonus
|
The uterine never retracts to its normal tone, it is always tight.
|
|
|
What is the most common affected internal structure on babies born to diabetic moms?
|
Cardiac
|
|
|
What indication tells you a patient is properly hydrated?
|
Urine output of 30 ml/hr = hydrated.
|
