Part VII Flashcards
(23 cards)
type of HTN: patients who enter the pregnancy already hypertensive or that develops PRIOR to 20 weeks’ gestation
chronic
type of HTN: patients who have new onset HTN (140/90) after 20 weeks’ gestation without proteinuria; BP returns to normal by 12 weeks’ postpartum. (Gestational HTN is better than chronic HTN because it’s temporary)
gestational
________, ________, and ________- Develops after 20 weeks’ gestation, multisystem disease process accompanies by at least one of the following: proteinuria, elevated creatinine, liver involvement, epigastric pain, neurologic complications, or uteroplacental dysfunction.
Preeclampsia/Eclampsia and HELLP
What are some s/s of HELLP Syndrome?
Hemolysis, elevated liver enzymes, low platelet count… any issues related to the liver and bleeding due to low platelets
What is the difference between preeclampsia and Eclampsia?
seizures
What is Chronic HTN with superimposed preeclampsia?
preeclampsia that develops after 20 weeks’ gestation in women who showed s/s hypertension prior to 20 weeks’ gestation.
25% of women with chronic HTN will develop ____________ (proteinuria because there is organ involvement)
preeclampsia
__________: the most common hypertensive disorder of pregnancy
*HTN and proteinuria after 20 weeks’ gestation
*Also known as Eclampsia if seizures take place
When is Preeclampsia typically seen?
Often seen in the last 10 weeks or
1st 48 hours after birth
What is the only cure for preeclampsia?
delivery
What are some s/s of Severe Preeclampsia?
BP 160/110 or higher spaced by 6 hours on 2 separate occasions
· Oliguria (urine output < 500 mL in 24 hours)
· Progressive renal insufficiency (Put them on high protein diet due to the kidneys getting rid of it)
· H/A, Cerebral or visual disturbances
· Pulmonary edema or cyanosis
· Epigastric or right upper quadrant pain (due to liver swelling)
· Impaired LFT at least twice normal limits
· Thrombocytopenia (platelets < 100,000)
· HELLP Syndrome (Hemolysis, elevated liver enzymes, low platelet count) possible
What is the Assessment of Fetal Well-Being during Preeclampsia?
· Frequent non-stress tests, ultrasound for fetal growth/fluid volume, lung maturity assessments possible when considering early delivery (amniocentesis)
· Continuous fetal monitoring when hospitalized
· Fetal movement counts if home
What medication is given to lower BP in Preeclampsia? What should be taught about this?
Magnesium sulfate - lowers BP
*When a pt is started on magnesium, warn them that it may feel tachycardic, nauseous, and sweaty (since BP is dropping fast)
*Hourly checklist - BP, weight, RR, urine output, etc.
What are some s/s or Magnesium Toxicity?
*s/s of Magnesium toxicity - no CNS stimulation, pt is out of it, low BP, low urine output…. whatever is affected by an extremely low BP.
What is the Antidote for Magnesium Sulfate?
Calcium Gluconate
What is the Assessment of Maternal Well-Being during Preeclampsia?
· Medication related assessments (Magnesium sulfate lowers BP)
· BP multiple times daily as ordered; Daily wt., assessments for worsening edema, visual changes, H/A, epigastric pain
· Daily urine proteinuria assessments, foley when hospitalized
· Periodic CBC, LFTs, 24-hour urine, BUN, creatinine, GFR & bilirubin
· Pt. teaching if not hospitalized! BP, bedrest, symptoms to report
What is the Treatment/Care of a Preeclamptic Woman?
· Sometimes hospitalized (severe), sometimes home mgmt.
· Delivery only cure but may not be ideal (vaginal delivery safest!!)
· Bedrest, continuous monitoring
· High-Protein Diet to replace lost proteins
· Anticonvulsants
o Magnesium Sulfate-many side effects!
· Corticosteroids
o Betamethasone- 2 IM injections needed spaced by 24 hours!
· Fluid and Electrolyte replacement
· Antihypertensives
o Labetolol and hydralazine 1st line drugs for acute HTN (given IV)
o Nifedipine (Cardizem) or Labetolol PO for severe preeclampsia requiring longer term meds
What is HELLP syndrome?
· Hemolysis, elevated liver enzymes, and low platelet count
· Thought to be a variant of preeclampsia
o RBCs are distorted during passage through small, damaged blood vessels
o Platelets aggregate at sites of damage causing thrombocytopenia
o Fibrin deposits obstruct hepatic blood flow-jaundice may occur
o Epigastric pain from liver distention, N&V, malaise, flu-like symptoms
o Can end in liver rupture, excessive bleeding, DIC, seizures, stroke, placental abruption, mortality HIGH
· Usually manifests between 27-37 weeks’ gestation
· Delivery must be immediate if true HELLP regardless of gestational age
HELLP syndrome most often occurs in ________ women
white
true or false - Delivery must be immediate if true HELLP syndrome regardless of gestational age
TRUE - Delivery must be immediate if true HELLP
In an ABO incompatibility, there is no treatment for mother.
true
If a mother is Rh-, what happens if a baby’s Rh screen came back saying they were Rh-? What about Rh+?
· Baby blood typed at birth if Rh- nothing needs to happen
· If baby is Rh+
o Rh immune globulin within 72 hours of birth if direct Coombs test on baby is negative
o **RhoGAM given after amniocentesis, CVS, ectopic pregnancy, fetal surgery or death, miscarriage, Induced AB, trauma that may cause bleeding (Anything that could cause bleeding)
If antibodies are present, is RhoGAM given?
no
