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Toxemia

Preeclampsia

1

What percent of pregnancies are complicated by preeclampsia?

7-10%

2

PIH

Pregnancy induced hypertension

3

What percent of preeclampsia is mild?

75%

4

What percent of preeclampsia is severe?

25%

5

Who is at greater risk for preeclampsia (PIH)?

Primigravida, young age, multifetus, obesity, low economic status, diabetes, history, African American

6

What is a main nursing intervention with preeclampsia?

BP monitoring

7

Steady deflation

2-3 mmHg/sec

8

How should person be positioned for BP reading?

Sitting for 10 min with arm on surface

9

How much does peripheral resistance decrease by in pregnancy?

25%

10

What is the rise in total blood volume in pregnancy?

50%

11

What is the rise in cardiac output in pregnancy?

35-50%

12

What does the BP have to be for a diagnosis of preeclampsia?

140/90 X 2, 6 hours apart, less than 7 days apart after 20 weeks gestation

13

What does proteinuria have to be to diagnose preeclampsia?

1+ on dipstick

14

What is no longer part of the diagnosis for preeclampsia but you should watch for it?

Edema

15

What is the only cure for preeclampsia?

Birth of fetus and removal of placenta

16

Systemic disease that involves multiple organs and the fetus

Preeclampsia

17

Pathogenesis of preeclampsia

Begins with implantation, trophoblastic invasion of uterine spiral arteries is incomplete, spiral arterioles do not remodel to meet trophoblastic circulation

18

What is the result of preeclampsia on the fetus?

Decreased placental perfusion resulting in ischemia

19

Preeclamptics produce 10X more anti-angiogentic substances which decreases what?

Placental growth

20

Decreased placental perfusion=

Systemic endothelial cell disfunction

21

Vasospasms target which organs?

Brain, liver, and kidneys

22

Vasospasms cause decreased renal perfusion causing what?

Increased BUN, creatinine, and uric acid, decreased albumin causing edema

23

Vasospasms also cause sodium retention because of what system?

Renin angiotensin

24

Sodium retention causes what?

Edema

25

How do vasospasms cause edema?

Damaged glomeruli, albumin is lost, decreased osmotic pressure = edema

26

How does the renin-angiotensin system cause edema?

Increased fluid retention

27

What does disturbed endothelial control of vascular tone cause?

Hypertension, increased permeability, platelet aggregation, and ischemia of target organs

28

What is the BP in severe preeclampsia?

Systolic > 160 mmHG, Diastolic > 110 mmHg

29

What is the proteinuria classification of severe preeclampsia?

2+ - 3+ or >5 in 24 hour specimen

30

How much urine should there be in 24 hours?

1500mL

31

500 mL of urine in 24 hours

Oliguria

32

Other signs of severe preeclampsia

Cerebral or visual disturbances, pulmonary edema, Epigastric pain, fetal growth restriction, impaired liver function, thrombocytopenia

33

What is a sign of pitting edema?

No bony prominences

34

What happens to renal labs in severe preeclampsia?

Elevated

35

What happens to liver function tests in severe preeclampsia?

Elevated

36

What happens to platelets in severe preeclampsia?

Decreased because of clotting

37

What happens to hematocrit levels in severe preeclampsia?

Elevated

38

What causes the elevated LDH in severe preeclampsia?

Hemolysis

39

What differentiates preeclampsia from eclampsia?

Eclampsia also includes a seizure along with all the SE of preeclampsia

40

Treatment of preeclampsia

May be hospitalized

41

What diet is used for preeclampsia?

High in protein, moderate sodium, and 6-8 glasses of water per day

42

How should a person with preeclampsia rest?

Lateral recumbent position

43

How do you monitor fetal well-being with preeclampsia?

Kick counts, nonstress test, BPP

44

What can you give for preeclampsia if < 34 weeks?

Corticosteroids

45

What do corticosteroids do for the fetus?

Enhance pulmonary maturity

46

What is the cut off for delivery with a preeclamptic woman?

40 weeks

47

When will they deliver for treatment of preeclampsia?

> 37 weeks and favorable cervix

48

Treatment of severe preeclampsia

Hospitalization on bedrest, magnesium sulfate, antihypertentives

49

When will they deliver for treatment of severe preeclampsia?

> 34 weeks

50

Blocks ALL neuromuscular impulses

Magnesium sulfate

51

Anticonvulsant to prevent eclamptic seizures

Magnesium sulfate

52

When should you avoid magnesium sulfate?

Women with severe renal impairment

53

What should you evaluate when administering magnesium sulfate?

Clonus, hyperreflexia, headache, visual disturbances

54

How long should you continue magnesium sulfate?

12-48 hours postpartum or if patient has diuresis X 3 hours

55

How often do you take magnesium sulfate levels?

q.6h

56

What is the therapeutic magnesium sulfate levels?

4.8-9.6 mg/dL

57

Magnesium level 8-10

Depressed reflexes

58

Magnesium level 10-12

Respiratory depression

59

Magnesium level 15

Respiratory arrest

60

Magnesium level >15

Cardiac arrest

61

What reverses magnesium sulfate?

Calcium gluconate

62

What is more critical then lab values with magnesium sulfate?

Assessment

63

What antihypertentives are used with preeclampsia?

Aldomet, Normodyne, and Apresoline

64

How long does it take for Aldomet to take effect?

2-3 days

65

When on Apresoline what must the mother be on and what is the goal diastolic?

Must be on monitor and goal is 90 mmHg

66

Magnesium sulfate reduces uterine tone causing what concern postpartum?

Hemorrhage

67

Hypertension prior to conception or before 20th week gestation

Preexisting "Chronic" Hypertension

68

What is used for more severe hypertension?

Aldomet

69

What do you do if there is a seizure during labor?

Stabilize mother, O2, positioning, give lorezapam 4mg, and magnesium sulfate

70

What is common for the FHR to do during a seizure?

3-5 min bradycardia

71

Hypertensive women who develop new onset proteinuria, proteinuria before the 20th week gestation, or sudden uncontrolled hypertension

Preeclampsia superimposed on preexisting hypertension

72

Highest morbidity and mortality rate

Preeclampsia superimposed on preexisting hypertension

73

High BP detected for the 1st time after midpregnancy, no preteinuria

Gestational hypertension

74

When does BP usually return to normal in gestational hypertension?

12 weeks

75

Complication of severe preeclampsia

HELLP syndrome

76

H=

Hemolysis

77

EL=

Elevated liver enzymes

78

LP=

Low platelets

79

What causes low platelets?

Clotting

80

S/S of the HELLP syndrome

N/V, Epigastric pain, malaise and flu-like symptoms

81

HELLP lab bilirubin

> 1.2 mg/dL

82

HELLP lab LDH

> 600 u/L

83

HELLP lab AST

> 70 u/L

84

HELLP lab platelets

< 100,000/mm3

85

What are the fibrinogen levels in HELLP?

Normal

86


Who is at a higher risk for HELLP syndrome

Older, caucasian, multiparous

87

When do HELLP labs return to normal?

72-96 after delivery

88

How many HELLP patients develop DIC?

1 in 5

89

An overstimulation of the coagulation process

DIC

90

DIC

Disseminated Intravascular Coagulation

91

Damage to vascular endothelium (blood vessels)

Intrinsic flooring pathway

92

Tissue injury

Extrinsic clotting pathway

93

What is DIC secondary to?

Underlying disease

94

What is DIC associated with?

Missed abortion, placental abruption, preeclampsia/eclampsia, amniotic fluid embolus, and sepsis

95

What are the cardinal signs of DIC?

Bleeding, mental confusion, and shock

96

How many unrelated sites of bleeding must be present for DIC?

3

97

What is the main nursing care with DIC?

Detect bleeding

98

What lab is for intrinsic clotting pathway?

Partial Thromboplastin Time (PTT)

99

What lab is for extrinsic clotting pathway?

Prothrombin Time (PT)

100

What lab increases with DIC?

FSP

101

What labs decrease with DIC?

Fibrinogen and platelet count

102

How do you manage DIC?

Deliver baby, packed RBCs, fresh frozen plasma, and cryoprecipitate

103

Why do we not use whole blood?

Increases the risk of hemorrhage

104

Cryoprecipitate

Fibrinogen

105

What is fresh frozen plasma used for?

Stable coagulation factors