Health Challenges in Pregnancy Flashcards
(44 cards)
Risk factors for gestational HTN?
Cause is unknown. Risk factors- obesity, previous pregnancy with HTN/pre-eclampsia, chronic HTN, pre-gestational diabetes, CKD, ART (IVF), nullipara (never been regent before), age (40+), multiple gestation, previous stillbirth/IUGR, ethnicity (INDG, asian, black)
Gestational HTN classification? severe? and what is chronic HTN?
Systolic BP >140 and diastolic >90. Occurs after 20 weeks PP and up to 12 weeks PP.
Severe- >160/>110
Chronic HTN- develops before pregnancy or less than 20 weeks
How to be accurate in BP measurements?
Use appropriate cuff size, BP based on average of at least 2 measurements taken after 5 minutes of rest/15 min apart using same arm
Preeclampsia, severe preeclampsia, and eclampsia?
PE- gestational HTN with proteinuria and 1/more adverse condition
SPE- severe HTN with proteinuria, 1/more adverse condition or severe organ complication
E- experience seizure
Adverse conditions for pre-eclampsia?
Headache/visual disturbances/abdominal+epigastric+RUQ pain (these more likely to be signs of pre-eclampsia). Also N/V, chest pain, SOB, fetal morbidity, abnormal maternal lab values
Consequences of preeclampsia for pregnant client/fetus?
PC- stroke, pulmonary edema, hepatic failure, jaundice, seizures, placental abruption, acute renal failure, HELLP
Fetal- IUGR, oligohydramnios, placental abruption, prematurity, fetal compromise (metabolic acidosis), intrauterine death
Why does pre-eclampsia occur
Abnormal placentation leads to mismatch between fetal demand and supply from the uterus. Leads to decreased plasma volume and vasospasm because mom’s cells are dysfunction. Causes pre-eclampsia
How to prevent eclampsia?
Use low dose aspirin (75-100 mg/day) in pt with increase risk starting pre-pregnancy or before 16 weeks to delivery. Lifestyle changes for exercise and diet. Calcium supplements for clients with low intake of dietary calcium (healthy calcium levels help prevent HTN)
Management of pre-eclampsia and HTN?
Assess pt/fetus, stress reduction, treat BP with antiHTN meds, treat symptoms present, consider seizures prophylaxis
Management at home for non severe HTN?
Monitor own BP, measure weight/test urine protein daily, report S+S of adverse conditions
Management of severe PE or eclampsia in hospitals?
Evaluate fetus (movement, NST, biophysical profile, U/S, measure AFI). Hourly intake/output, frequent VS, montior for adverse conditions, and blood work (liver enzymes, platelets, Hct)
Anti-hypertensives for pre-eclampsia?
Labetalol, nifedipine, hydralazine, and aldomet
Magnesium sulphate? and SE
It’s an anti-convulsant used to prevent seizures and reduce CNS irritability. Usually given 4g IV in 100 mL NS then 1g/h. SE- tachycardia, muscle weakness, lack of energy, respiratory depression, low BP, it can slow labour, and make sure to test reflexes
Signs of magnesium toxicity? and how to treat?
RR <12, oliguria (<30 mLs/hr), diminished/absent DTR, serum magnesium above or below 4.8-9.6 mEq.
Treat with calcium gluconate (antagonist that reverse toxicity)
What is HELLP syndrome?
Hemolysis, elevated liver enzymes, low platelets. This is an issue caused by severe eclampsia where palettes aggregate at sites of vascular damage
What is DIC?
Disseminated intravascular coagulation. Caused by pre-eclampsia, hemorrhage, intrauterine fetal demise, amniotic fluid embolism, sepsis, HELLP. It causes over-activation of normal clotting mechanisms so mini clots develop=depleted platelets=can lead to excessive bleeding
What is gestational diabetes?
Glucose intolerance with onset/first recognition during pregnancy. More common in INDG women
How does pregnancy alter carb metabolism?
- Fetus takes glucose from mother
- Placenta creates hormones which alter effects of/resistance to insulin and glucose tolerance
Effect gestational diabetes has on pregnant client?
Pre-eclampsia/eclampsia risk b/c of vascular changes, PROM, polyjdriamnios, preterm labour, increased shoulder dystocia/C-section risk, increase gestational HTN/T2D later in life, worsening myopathies (vascular, renal, retinal)
Gestational diabetes fetal, baby, and child effects?
F- LGA, IUGR, fetal demise, congenital anomalies (pre-existing diabetes)
B- hypoglycemia, high bilirubinemia, immature respiratory development (RDS)
C- increased risk developing diabetes/obesity
Risk factors for gestational diabetes?
35 yrs+, from high risk population (INDG, african, asian, spanish, south asian), using corticosteroid long term, GDM in previous pregnancy, family with T2D, polycystic ovary syndrome, previous newborn >4 kg
Screening test for gestational diabetes?
Routine for all women. Around 24-28 weeks use non fasting 50g glucose test. Normal results are <7.8, if between 7.8-11 then perform a fasting GTT, and if >11.1 then you get a GDM dx
Care/managament for GD?
Controlled diet, insulin as needed, exercise, glucose monitoring 4-7x/day, want to maintain euglycemic state (hemoglobin A1C <7%), increased folic acid, oral anti glycemics if they are safe
Iron deficiency anemia and S+S? how to treat
Occurs in 30% of pregnancies. S+S are fatigue, weak, dizzy, irritable, hair loss, dyspnea. Oral iron is first lien treatment (parenteral iron is safe in 2nd trimester and on)
