Pre-eclampsia, Eclampsia, and HELLP Syndrome Flashcards Preview

NURS787 Exam 3 > Pre-eclampsia, Eclampsia, and HELLP Syndrome > Flashcards

Flashcards in Pre-eclampsia, Eclampsia, and HELLP Syndrome Deck (21):
1

What is dx for pre-eclampsia?

- BP >/= 140/90 after 20w GA x2, at least 4h apart
- AND! proteinuria
- OR! thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, cerebral/visual changes

2

What is dx for severe pre-eclampsia?

BP >/= 160/110

3

What is dx for eclampsia?

inclusive of pre-eclampsia dx PLUS new onset seizures

4

What is HELLP?

Hemolysis
Elevated Liver enzymes
Low Platelets

severe form of pre-eclampsia
can present w/ or w/out HTN or proteinuria

5

What is included in the physical assessment of pts w/ PEC?

- q1h BP
- lung sounds, pulse ox, work of breathing = pulmonary edema
- epigastric pain
- headache
- visual changes
- dorsiflex foot to check for + clonus: rapid involuntary rhythmic muscle contractions
- I/Os (O at least > 30mL/h)
- deep tendon reflexes

6

Describe scoring of deep tendon reflexes and what is indicated

0 = absent --> mag toxicity
1+ = diminished --> mag toxicity
2+ = normal
3+ = brisk --> +/- seizure
4+ = hyperactive --> +/- seizure

7

What lab work is included in PEC workup?

1) creatinine (>1.1 = renal insufficiency)
2) CBC
- platelets < 100K = thrombocytopenia
- increased H/H
3) LFTs
- liver enzymes elevated to 2x normal value
- AST: 3rd tri = 4-32; term = 5-103
- ALT: 3rd tri = 2-32; term = 5-115
4) protein:creatinine or 24h urine collection

8

What is dx of proteinuria?

- at least 300mg protine in 24h urine collection
- protein:creatine >/= 0.3
- urine dipstick protein 1+

9

magnesium sulfate (prevention)

preventionof seizures

4-6g IV loading dose, then 1-2g/h infusion

- if creatinine elevated, 1g/h
- keep serum levels at 4-7 mEq/L
- check for mag toxicity (DTRs, respiratory status)

10

calcium gluconate

antidote to mag toxicity

1g IV over 3min

11

hydralazine (Apresoline)

antiHTN

5-10mg IV over 2min q20min

- max dose 20mg in first h
- contraindication: tachycardia

12

labetalol (Normodyne, Trandate)

antiHTN

20mg IV over 2min

- no effect in 10 min --> 40mg IV
- no effect in another 10 min --> 80mg IV
- max dose - 300mg in first h
- contraindications: asthma, CHF

13

nifidepine (Procardia)

antiHTN

10-20mg PO q30min

- max dose 50mg in first h
- contraindications: tachycardia

14

Describe emergency management of a pt having an eclamptic seizure

- put up padded side rails
- place pt in lateral decubitus position
- suction ready if vomit

Airway: 8-10L via face mask
Blood pressure: hydralazine, labetalol, or nifedipine to maintain under 160/110
Convulsions: give mag sulfate
Delivery: do not rush for c/s! Monitor for placental abruption

15

magnesium sulfate (tx)

treatment of active seizure

6g IV loading dose --> 2-3g/h infusion

give 2g IV bolus if seizure persists/recurs

16

What can be given if mag sulfate does not treat an active eclamptic seizure?

lorazepam (Ativan) 1-2mg IV

17

What labs indicate hemolysis in HELLP?

at least two of following:

- abnormal peripheral smear
- bilirubin > 1.2mg/dL
- haptoglobin = 1.2mg/dL

18

What labs indicate elevated liver enzymes in HELLP?

- AST/ALT >2x normal (>70 IU/L)
- lactate dehydrogenase > 2x normal (>600 IU/L)

19

What labs indicate low platelets in HELLP?

platelets < 100,000/mm3

20

HELLP s/sx

nonspecific; similar to PEC
- RUQ/epigastric pain
- N/V
- HA/photophobia
- malaise
- +/- HTN or proteinuria

21

When is immediate delivery indicated in HELLP?

1) DIC
2) liver infarction or hemorrhage
3) renal failure
4) pulmonary edema
5) placental abruption
6) non-reassuring fetal status