Care of Pregnant Patients Flashcards
(21 cards)
What are the coagulation changes for pregnant patients?
!PT, PTT, platelet count, bleeding time, all decrease.
Care of Pregnant Patients
What is PT, PTT, INR?
PT is for warfarin therapy
Normal PT 11-13.2 seconds
APTT is for heparin therapy
Normal APTT 22.5-32.2 seconds
INR is standard test for hemostasis
Normal range 0.9 to 1.2
Care of Pregnant Patients
What is the normal platelet count?
- between 200,000 and 450,000 per mm3
- surgery and postanesthesia phase hemostasis at 100,000 per mm3 or higher
- at 50,000 to 100,000 per mm3, possible ecchymoses
- < 50,000 per mm3, possible alterations in bleeding
What are respiratory changes for pregnant patients?
!PaCO2 decreases to ~ 30, resulting in respiratory alkalosis
!Left shift in oxyhemoglobin dissociation curve - more O2 is made available to fetus
Normal PaCO2 between 35-45 mmHg
What is the best position for pregnant patients?
!Left lateral position to promote blood flow to uterus
!Maintain uterine displacement with hip wedge
Why assess deep tendon reflexes hourly for OB patients?
!Absence of dtr is a sign of magnesium sulfate toxicity
Calcium gluconate is antidote for magnesium sulfate toxicity
What are side effects of eclampsia for OB patients?
!DIC
Cerebral vasospasm, edema, hemorrhage
Hypertensive encephalopathy
What is DIC?
Disseminated Intravascular Coagulation
(a pathological form of clotting, consuming large amounts of clotting factors in the body)
What is the treatment for DIC?
FFP - best source of clotting factors
FFP must be ABO compatible.
What is the goal of treatment for eclampsia?
Goal: Control seizure activity by administer Magnesium sulfate 4-6g IV loading dose, then 2-4g/hr IV
Assess LOC, signs of increased ICP
Caution with antihypertensive therapy
What is the definition of severe preeclampsia?
equal to or greater than 2x BP reading of >155/105
What is the late sign of preeclampsia?
Proteinuria
What are the other symptoms of preeclampsia?
Elevated BUN/ Creatinine, uric acid
Decreased liver function (elevated ALT/AST)
Decreased serum glucose
Thrombocytopenia
Possible altered LOC
How is preeclampsia managed?
Assess LOC, s/s increased ICP, deep tendon reflex hourly, MgSO4
absence of dtr sign of MgSO4 toxicity
Care of Pregnang Patient s
What are other signs/ symptoms of magnesium sulfate toxicity?
sedation
myocardial depression
muscular weakness with diminished reflexes
respiratory difficulty
Treatement is calcium gluconate IV followed by diuretic and fluid bolus
Odom-Forren J. Drain’s Perianesthesia Nursing: A Critical Care Approach. 6th ed. St. Louis, MO; Saunders; 2013: 200.)
What is HEELP Syndrome in OB patients?
triggered by pre-eclampsia:
!Hemolysis, elevated liver enzyme, low platelets
What is the antidote for magnesium sulfate toxicity?
calcium gluconate
What is the common symptom for HEELP Syndrome in OB patients?
!RUQ pain
What are the hemodynamic changes in pregnant women?
murmurs present in 90% of pregnant women
HR increased 15-20 above baseline
Cardiac output (CO) increased 30-50%
CO significantly influenced by maternal position
The pregnant patient has increased potential for pulmonary aspiration because:
Physiologic changes include decreased gastric motility, delayed gastric emptying, decreased lower esophageal muscle tone, increased intragastric pressure
Always treat as with full stomach, thus need rapid sequence intubation
After 10 minutes in PACU, patient states “All of a sudden I feel nauseated and faint.” Patient’s BP decreased from 130/70 to 100/60. What is the initial nursing intervention?
Pregnant patient should be positioned left or right lateral tilt position to reduce compression of inferior vena cava that will ensure venous return and cardiac output to fetus
