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Exam 2 NUR 113
DIC/GHTN/Eclampsia/HELLP
| Question | Answer |
|---|---|
| What is Disseminated Intravascular Coagulation (DIC)? | widespread intravascular clotting and bleeding caused by endothelial damage |
| What does DIC often occur secondary to? | An underlying condition (pre-eclampsia, fetal demise, sepsis, pregnancy, placenta abruption etc.) |
| Describe acute DIC. | Actue condition that occurs over hours and requires immediate treatment |
| How does bleeding flow in DIC? | Internally or externally and from a slow ooze to massive hemorrhage |
| What is the first problem/complication in DIC? What does it lead to? (Patho) | Inflammatory response to injury leads to clotting and body responds with fibrinolysis; platelets decrease as they are used up, since they are gone bleeding continues |
| What are some S/S of bleeding? | Skin: purpura, petechiae, bruising, bleeding from old sites nose bleed, ALOC, bone/joint pain, difficulty breathing, renal issues (anuria/oliguria/hematuria) Organ damage due to clots Blood will pool anywhere it can |
| What labs decrease during DIC? | Platelets, fibrinogen |
| What labs will increase during DIC? | PT, PTT, D-dimer, FSP (Fibrin Split Products) |
| What produces FSP? | clot degeneration |
| What is the main focus of DIC treatment? | Fix the underlying cause |
| What can be done during DIC when bleeding is the major manefestation? | administer FFP and platelets to restore clotting factors |
| True or false: Heparin (Warfarin)can never be used for treating DIC | False, can be given in low doses to counteract coagulation to increase platelet count |
| What nursing interventions are used for DIC patients? | - place on bleeding precautions - assess 1-2hr - check dependent areas for pooling blood - assess areas for impaired skin integrity check q15min (IV site) - neuro, peripheries, abd, breathing - treat cause and monitor for hemorrhagic shock |
| What labs should be monitored on DIC patients? | BUN, Cr, ABG, UA, Hemoccult |
| How is preeclampsia diagnosed? | increased BP after 20wks w/ proteinuria |
| What is gestational HTN? | Development of HTN during in second half of pregnancy |
| What is considered chronic HTN? | Diagnosed HTN prior to 20wks and lasts beyond 42nd day postpartum |
| Describe gestational HTN. | onset on or after after 20wks and resolved by 12wks postpartum; no protein in urine |
| Describe preeclampsia. | A marker of pregnancy (only pregnant ppl can get it) Maternal vasospasm causes hypo-perfusion to fetus Vascular damage leads to DIC |
| What are risk factors for preeclampsia? | African American, hx of preeclampsia, obesity, 35+ |
| How is preeclampsia diagnosed? | Elevated BP (140/90) on or after 20 wks and protein in urine, and or increased liver enzymes, increased Cr, decreased platelet |
| What are the manifestations of Preeclampsia? | Hyperreflexia, HA, HTN, Edema of face/hands/lower extremities; decreased placental perfusion, decreased fetal growth and movement; chronic fetal hypoxia; elevated Cr/BUN/Uric acid, sodium retention, proteinuria, |
| What is the difference between eclampsia and preeclampsia? | Seizures; preeclampsia = no seizures |
| What is the difference between mild and severe preeclampsia? | Mild - weight gain, no reflex issues, mild edema, BP >140/90 Severe- BP 160/110; 3+ dip stick; hyperreflexia; RUQ Pain; visual disturbances; HELLP syndrome |
| What are the manifestations of Eclampsia? | mild & severe preeclampsia s/s AND - seizures - coma - generalized edema - cerebral hemorrhage - severe HA |
| What happens to the baby during a seizure? What can happen? | Baby is not getting blood flow/O2; if mom seizes while standing she can fall on the baby/hit her stomach |
| How are GHTN disorders managed during the Antepartum period? | - log fetal movements - bed rest - home management for stable patients - limit sodium - frequent BP assessment |
| How are GHTN disorders managed during the intrapartum period? | Continuous fetal monitoring Monitor for mag toxicity in mom and baby |
| Why is Mag Sulfate used in GHTN Disorders? | Lowers threshold for seizures Lower BP |
| What are the signs of mag toxicity in mom and baby? | mom - Nausea, muscle weakness, decreased I/O, loss of reflexes baby - difficulty breathing immediately after delivery |
| How are GHTN disorders managed during the postpartum period? | Monitor for seizures (can occur up to 48hr post delivery) Monitor BP (Will improve after delivery) |
| How often should a mom on mag be monitored? What are other nursing interventions are provided? | Q 10-15mins till stable, then q30min, then hourly Mostly bed rest (stay in bed as much as possible), monitor mag levels, monitor I/O, check reflexes; KEEP CALCIUM GLUCONATE IN ROOM (antidote to mag) |
| What should be monitored in a newborn when mom was on mag? | Muscle tone (weak), Feeding (difficulty sucking and swallowing), Difficulty breathing; Sluggish to cry |
| What are the fetal-neonatal risks for GHTN babies? | SGA, Sedation at birth, low BP, Hypotonia, lethargy, decreased suck reflex |
| What is the clinical management for GHTN? | -Reduced stimuli (limit visitors, lights low) - Bed rest - Admin mag sulfate - Frequent BP monitor - Elevate extremities for edema - Monitor I&O - Frequent fetal monitoring - Teach mom to monitor fetal movement - Fetal distress = emergent delivery |
| What does HELLP stand for? | Hemolysis Elevated Liver enzymes Low Platelets |
| When does HELLP syndrome occur? | As a complication of Eclampsia/preeclampsia and is linked w/ DIC |
| What is the key sign of HELLP syndrome? | Severe RUQ Pain, neck/shoulder pain, N/V, Liver distention |
| What is the nursing management for HELLP syndrome? | Same as preeclampsia; only cure is deliver baby |
| Name the 4 medications used to treat GHTN. | -Mag Sulfate/Calcium Gluconate for BP and seizures -Hydralazine HCl (Apresoline) for BP _Labetalol (Normodyne) for BP -Nifedipine (Procardia) for BP |
| What is the therapeutic range for mag sulfate? What are the dangerous levels? | -4-9=therapeutic -30 = cardiac arrest |
| What is the KEY sign of cerebral hemorrhage? | temporary loss of vision = impending hemorrhage |
| What should be monitored in Eclampsia patients in relation to the fetus? | S/S of fetal hypoxia (Late decelerations, lost FHR) Monitor for placental abruption (late decelerations, brady tachy) Precipitous Birth after seizure (when birth occurs after seizure d/t relaxation) |
Created by:
failingstudent88
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