Perfusion Flashcards by Chris Fehnel

Mild Preclampsia s/s

After 20 weeks gestation
Protein in urine
Edema
HTN > 140/90

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Severe Preclampsia S/S

BP > 160/110

HA, visual impairments, hyperreflexia clonus +4

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Mild Preclampsia Tx

Rest / w/ no activity limits
Office visits 1-2 weekly for NST
Bed rest may be problematic
No restrictions in diet unless chronic HTN then avoid salt

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Severe Preclampsia Txf

Hospitalization
Quiet room with no visitors, prevent stimulation, near nurses station
Bed rest on left side (helps kidneys lower angiotensin II)
Daily weights
NST
High protein, moderate salt diet
Monitor F&amp;E
IV (vasopressin)
Mag sulfate to prevent seizures
Tmp a4, q2 if fever
Hourly I&amp;O
Urine diagnosis will be 3-4+ w/ each urine

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Patho of Gest Hypertensive disorders

Increased vascular resistance
Elevation of BP
Decreased blood flow to:

Brain = HA, visual, hyperreflexia
Liver = Impaired function, increased enzymes, epigastric pain
Kidneys = decreased GFR, oliguria, increased Na, BUN, uric acid, and creatinine.
Proteinuria - reduces plasma pressures; moves more fluid to extracellular spaces, increasing fluid and edema.
Placenta: vasoconstriction contributes to IUGR, abruption, fetal hypoxia, and acidosis

Hemoconcentration occurs from decrease in intravascular volume r/t the fluid shifts = elevated Hct and blood viscosity.

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Therapeutic level of mag sulfate

4-7 meg/L

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Bolus dose of mag sulfate

4-6g over 15-20 minutes

acts immediately
lasts only 30-60 mins
administered via IV
hot flushing sensation

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Signs of toxicity of mag sulfate

oliguaria < 30 ml/hr
decreased tendon reflex - patella earliest sign
decreased respirations
decreased LOC

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Piggy back dose of mag sulfate

1-3g/hr (pump)

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Secondary effect of mag sulfate

relaxes smooth muscle, lowers BP, decreases contractions

Tx of pre-term labor to decrease contractions

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Maternal complications of pre-clampsia

Abruption placenta
chronic renal problems
detached retina
chronic HTN
HELLP syndrome
DIC (Disseminated intravascular coagulation)

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Fetal complications of preclampsia

Prematurity
Intrauterine growth restriction
Asphyxsia

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HELLP Syndrome

(H)emolysis
(E)leveated
(L)iver enzymes
(L)ow
(P)latelets

20% of mothers with preeclampsia (same tx as preeclampsia)

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How many pregnancies end in miscarriage

15-20%

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Causes of miscarriage in 1st trimester

genetic abnormalities

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Causes of miscarriage in 2nd trimester

incompetent cervix
hypothyroidism
diabetes
lupus
CMV
HSV

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How many pregnancies are ectopic

1 in 50 (2%)

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Where can ectopic pregnancies be planted?

fallopian tubes
cervix
ovary
abdominal cavity

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Risk factors for ectopic pregnancy

Chlamydia
PID
endometriosis
infertility treatments
tubal surgery
IUDs
PP infection
fibroid tumors
smoking
douching

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Med for ectopic pregnancy

methotrexate (chemotherapeutic med that destroys rapidly developing cells)

Benefits of med in ectopic treatment

Quicker healing time
less scarring
more scarring increases risk of another ectopic pregnancy

Molar pregnancy causes

ovular defect
stress
nutritional deficiency

Complete mole

r/t choriocarcinoma

Molar pregnancy patho

two sperm filled one ovum

Placenta previa

PAINLESS BRIGHT RED VAGINAL BLEEDING marginal can be detected at 20 wk scan. Possibly can grow to size of uterus Partial - most c-section depends on how much near cervix occurs in 1-400 pregnancies

Risk factors of placenta previa

``` advanced maternal age abortion multipara smoking asian descent previous previa previous c-sections ``` 1-160 after 2 1-60 after 3 because increased scar tissue 1-30 after 4 1-10 > 4

Placeta abruption

signs include rigid board like abdomen web not being able to indent uterus at all no oxygen / bleeding complete needs STAT section Partial may be possible vaginal birth

Placenta abruption s/s

"Dark" vaginal bleeding Constant abdominal pain Uterine tenderness Firm uterus

Placenta abruption risk factors

HTN, cocaine, too much fluid, trauma, alcohol, multipara, can lead to DIC.

Occult Umbilical Cord Prolapse

hidden cord

Over Umbilical Cord Prolapse

seen / felt cord

Umbilical Cord Prolapse NI

``` CHANGE MATERNAL POSITION - KNEE/CHEST or trendelenberg with butt in air assess SROM or PROM monitor FHR Don't ambulate Vaginal exam Elevate presenting part Call for help O2 Notify HCP Prepare for stat c-section Explain to pt what is happening ```

Predisposing factors for Cord Prolapse

malpresentation growth restriction hydraminos breech / transverse presentation

Cord Prolapse stats

1-300

Meconium aspiration stats

20%

Meconium aspiration risk factors

``` post-term pregnancies forcep delivery breech maternal HTN CGA Oligohydramnios prolapsed cord IUGR DM ```

Uterine Rupture

A tear in uterus usually at previous c-section initial signs may be sudden fetal bradycardia and acute / continuous ab pain only 10-30 mins before significant damage to fetus occurs

Meconium Aspiration Interventions

O2 support afterwards antibiotics surfactant assess prolonged tachypnea, grunting, cyanosis

Uterine Rupture Risk Factors

trauma, cocaine use, multipara, malpresentation, invasive molar pregnancy, fibroid removal, placenta accreta, excessive uterine stimulation

Postpartum Hemorrhage

Blood loss >500 following vaginal Blood loss >1000 following c-section Most common cause is uterine atony

Postpartum Hemorrhage Tx

``` assess cause to stop bleeding two large bore IVs for transfusion fundal massage; pad count Adminster uterotonic Fluid administration Monitor for s/s of shock ```

Postpartum Hemorrhage Risk factors

``` Big baby Tissue damage Trauma Thrombosis (lack of clotting) infection retained placental fragments ```

Meds for postpartum hemmorhage

oxytocin, miso-rostov, dinoprostone, methylergonovine, prostoglandin

Early signs of shock

``` Normal blood pressure increased HR Normal temp. Cool / moist Anxiety Increased rate / depth of respirations ```

Late Signs of shock

``` low BP Increased HR, weak Pale / cold Coma Increased / shallow resps ```

Shock types

``` HYPOVOLEMIC - inadequate intravascular volume septic cardiogenic distributive toxic drug induced ```

Lab / Diagnostic tests for shock

``` Blood glucose Electrolytes CBC with differential Blood culture C-reactive protein Arterial blood gas Toxicology panel Lumbar puncture Urinalysis Urine culture Radiographs ```

Nursing management of shock

``` ABCs Vascular access Restore fluid volume (LR or NSS [isotonic]) Blood transfusion Foley catheter to measure output ```

Vasoactive meds for shock

Dobutamine - improves cardiac contractility Epinephirine - vasoconstrictor Dopamine - affects heart / vasculature