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62 Cards in this Set
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Formally called pregnancy induced hypertension
No proteinuria |
Gestational Hypertension
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Leading cause of fetal morbidity with potential lethal complications?
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PIH
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A mult-system disase of vasospasm and vasocontriction?
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PIH
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Development of hypertension, 140/90 during the second half of pregnancy (or 20 weeks)having a previous normal state?
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PIH
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Renal involvement leading to proteinuria in PIH?
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Pre-eclampsia
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CNS involvement leading to seizure?
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Eclampsia
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If hypertension persists beyond 6 weeks PP, it's considered what?
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Chronic hypertension
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A drop in hemolysis (HE)
Elevated liver enzymes (LE) Low Platelets (LP) |
HELLP Syndrome
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Is a variant of severe preclampsia, platelets are less than 100,000, LFTs are 2 times normal, may occur against a background of what may appear to be mild, i.e. blood pressures of like 150/90?
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HELLP Syndrome
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Elevated BP before 20 weeks?
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Is chronic HTN
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Hemoconcentration, hypertension, proteinuria, edema, and decreased blood flow to vital organs?
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PIH
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Primips
Diabetes Obesity Chronic HTN Polyhydramnios Poor nutritional intake Grand multips Macrosomia Adolescents Multi fetal? |
Risk factors for PIH, pre-eclampsia, eclampsia
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PIH with renal involvement is?
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Pre-eclampsia
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PIH with CNS involvement leading to seizure leads to?
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Eclampsia
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Increased vascular resistance
Decreased vessel diameter with endothelial damage Impedes blood flow Increases ________ and decreases ________. |
BP; circulation to vital organs
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Decrease GRF
BUN/Creatinine/Uric Acid increase Glomerular damage causes protein molecules to leak into general circulation Change in osmotic pressure causes fluids shifts and third spacing resulting in hypovolemia Increased viscosity and increased hct? |
Kidney Effects of PIH, Pre-eclampsia, eclampsia
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Vasospasm
Vasoconstriction causes rupture of small vessel's Headache Visual disturbances Hyper-reflexia Convulsion? |
Brain Effects of PIH, Pre-eclampsia, eclampsia
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Decreased circulation leading to impaired function
Hepatic edema Epigastric pain Sub capsular hemorhage Increased liver enzymes DIC? |
Liver changes in PIH, Pre-eclampsia, eclampsia
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Decreased circulation
Ischemia IUGR - fetal distress - hypoxia Abruption |
Placental changes in PIH, pre-eclampsia, eclampsia
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Signs are hypertension, proteinuria and edema
Disase classified as mild or severe May progress from mild to severe? |
Signs and symptoms of PIH, pre-eclampsia, eclampsia
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BP greater than 140/90
Proteinuria 1+ to 2+ Weigh gain > 4lbs/week Mild edema of face and extremities Hyper-reflexia, clonus? |
Mild PIH
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BP 160/110
Proteinuria 3+ to 5+ in 24 hours Oliguria Visual and retinal changes Pulmonary Edema Increasing edema Hepatic dysfunction Epigastric Pain Hyper-reflexia and clonus? |
Severe PIH
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B/P
Edema - weight gain DTRs Fetal heart / uterine contractions NST, L/S ratio Breath sounds, Headache/LOC Urinary output, cbc, u/a, LFS, BUN, Creatinine, Fibrinogen, Blood type and cross |
Assessments for PIH, Pre-eclampsia-eclampsia
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Bedrest with bathroom privileges only
Kick counts BPs 2-4 times each day Daily weights at the same time each day Daily urinalysis for protein using first voided specimen Uterine activity monitoring for signs of preterm labor Medication administration as directed by physician |
Management of mild preeclampsia
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Bedrest with reduced environmental stimuli
Intravenous administration of magnesium sulfate (the drug of choice in the United States to prevent convulsions)? |
Management of Severe Preeclampsia
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Diet hi in protein 60-70gm/day
Increase Calcium to 1.5 - 2gm/day Increase fluids to 3000ml/day |
Diet for severe preeclampsia
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Early recognition and intervention
Low dose ASA (reserved for women of known risk) *Calcium supplementation (food) to lessen sensitivity to the pressor effects of Angiotensin 2 |
Prevention of PIH, preeclampsia, eclampsia
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CNS depressant relaxing smoot muscle
Anticonvulsant properties to prevent seizure Used to inhibit PTL Initial dose 4-6gm loading dose over 15-20 minutes Maintenance dose 2-3 gm/hr |
Magnesium Sulfate
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Blocks release of acetylcholine at neuromuscular junction, thus decreasing neuromuscular irritability, including vasomotor and uterine irritability. Causes slight peripheral vasodilation, reduces edema in the brain, and increases perfusion to brain and placenta. Not used in kidney impairment because it is excreted unchanged from kidney. Cumulative doses may occur.
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Action of Parenteral Magnesium Sulfate
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Mostly ringer's lactate, can be D5W, 15 to 20 minutes?
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Dose/route by infusion 4-6gm of Magnesium Sulfate
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To keep in therapeutic range must be 2 g/hr, regulated by titrating with client's responses of reflexes, output, respirations, and magnesium levels?
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Maintenance dose for Magnesium Sulfate
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10% calcium gluconate 10 mL; keep syringe and ampule at bedside?
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Antidote for Magnesium Sulfate
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Sweating, warmth, flushing, and heavy feeling in limbs. May become lethargic and confused, with depressed reflexes and respirations. Nausea and vomiting.
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Mothers side effects and adverse effects from Magnesium Sulfate
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Decreased beat-to-beat variability and potential for tachycardia. Monitor newborn for magnesium levels, hypotonia, and hyporeflexia?
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Fetal side effects from Magnesium Sulfate
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More difficult to obtain therapeutic levels in preterm labor than in PIH because kidney involvement in PIH reduces excretion. Monitor for respiratory rate under 12 breaths/min, urine output under 25 mL/hr, and depressed reflexes, and perform neurologic check every 4 hours. Assess for changes of headache, visual disturbances, and epigastric pain. Continue seizure precautions for PIH. Monitor contractions and fetal heart tones in both preterm labor and PIH?
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Precautions for Magnesium Sulfate
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1.8-2.5 mEq/dl Magnesium.
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Normal Magnesium levels
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4.0-7.0 mEq/dl Magnesium?
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Therapeutic Magnesium Levels
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Hyporeflexia, slurred speech, nausea, somnolence, double vision: what Magnesium level?
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9.0-12.0 mEq/dl
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Magnesium level for respiratory distress?
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12.0 mEq/dl
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Magnesium level for cardiac arrest?
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15.0 mEq/dl
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Causes decreased neuromuscular irritability
< deep tendon reflexes Measure hourly output should be 25-30cc/hr use foley catheter Measure respirations must be 12 or > Measure Mg levels for toxicity? |
Magnesium Sulfate Observations
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Hypertension in Pregnancy
MgSO4 is given for 12-24 hr PP Then tapered slowly till it is dc'd Breast feeding may begin then? |
Post Partum
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PIH which progresses to seizure
Tonic/Clonic seizures result from cerebral edema BP and temp may rise sharply Precursors - blurred vision, severe headache, hyper-reflexia, epigastric pain, oliguria, clonus? |
Eclampsia
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Administer oxygen by mask
Turn on left side Use pulse oximeter Prevent aspiration Artificial airway and suction Medication administration |
Nursing Management of Eclampsia
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Often semi comatose for 1-4
Observe closely for labor which may begin, trigger another seizure or go undetected Potential risks for abruption Risks of fetal hypoxia |
Post Ictal Phase concerning PIH, preeclampsia, eclampsia
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What is the only cure for PIH?
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Delivery
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Pt should be stable 12-24 hours post seizure
Check L/S ratios for fetal lung maturity NSVD is the delivery of choice Induction may be used? |
Resolution of PIH, preeclampsia, eclampsia
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Occurs with sever PIH
Hemolysis, Elevated Liver Enzymes, and Low Platelets 20% mortality rate, occurs in 4-12% of PIH Hematological and Hepatic involvement? |
HELLP Syndrome
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A life threatening complication in which coagulation and anticoagulation factors are activated at the same time.
The result is simultaneous decrease in clotting factors and increase in the anticoagulation factors that leave the blood unable to clot. Occurrence of micro emboli. Extrinsic factors respond to blood vessel damage and cause tissue trauma. Platelet aggregation to cell walls and platelets fall. Fibrin degradation is secreted to reduce aggregation (FSP) The live can't compensate? |
Disseminated Intravascular Coagulation
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Missed abortion, abruption, PIH, spsis, demis, amniotic embolism.
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Major predisposing conditions of disseminated intravascular coagulation
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Oozing, bruising, profuse bleeding from any site including placental?
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Symptoms of disseminated intravascular coagulation
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Correct the trigger, deliver fetus and placenta, blood replacement, correct hypovolemia, Heparin?
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Treatment of disseminated intravascular coagulation
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Hypertension occurring prior to 20wks or concurrently with PIH
Occurs in older women, obesity and DM Clients must maintain a high protein diet, not use excessive salt, and weigh often Continue all meds, may add more Aldomet the most common antihypertensive due to minimal fetal effect Frequent monitoring? |
Chronic Hypertension
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Increased blood volume a burden to and already compromised heart
Resulting in Cardiac Decompensation or CHF Two categories - Congenital and Rheumatic Fever Disease? |
Heart Disease in Pregnancy
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Uncompromised, no limitation of physical activity. Asymptomatic with ordinary activity?
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Class I Heart Disease in Pregnancy
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Slightly compromised, requiring slight limitation of physical activity. Comfortable at rest, but experience fatigue, dyspnea, palpitations, or anginal pain with ordinary activity?
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Class II Heart Disease in Pregnancy
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Marke limitation of physical activity; comfortable at rest, but less than ordinary activity causes excessive fatigue, palpitations, dyspnea, or anginal pain; markedly compromised?
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Class III Heart Disease in Pregnancy
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Inability to perform any physical activity without discomfort, has symptoms of cardiac inusfficiency even at rest. In general, maternal and fetal risks for Classes I and II disease are small, but risks are greatly increased for Classes III and IV.
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Class IV Heart Disease in Pregnancy
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The most dangerous time is 28-32 weeks as the blood volume peaks
Symptoms of deterioration include, SOB during ADL's Frequent coughing with or without hemoptysis or crackles Palpitations or recognized arrhythmias Generalized edema |
Heart Disease in Pregnancy
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Ensure cardiac demand does not exceed the functional capability of the heart
Limit physical activity to be s/s free Avoid excessive weight gain Prevent anemia Prevent infection Assess for CHF, PE or Arrhythmia Anticoagulation if needed Antiarrythmics if needed Diuretics if needed? |
Goals of Treatment Antepartum for Heart Disease in Pregnancy
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Minimize labor effects on the CV system
Prevent fluid volume overload Sims position, head and shoulders elevated Oxygen prn Sedation/anesthesia, calm quiet room Keep legs level Use of foceps or vacuum Monitor for circulatory overload? |
Intrapartum Management of Heart Disease in Pregnancy
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Observe for CHF
Fluid Overload Infection Hemorrhage Thrombophlebitis Early ambulation? |
Postpartum management of Heart Disease in Pregnancy
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