PIH EXAM 1 Nur 213
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| what is the most common medical complication of pregnancy | PIH
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| is the progression of PIH predictable | no
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| ****NOTE: mild hypertension must be taken seriously and managed as for pre-eclampsia |
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| what is it called if it is the onset of hypertension without proteinuria after week 20 of pregnancy | gestational hypertension
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| a pregnancy-specific syndrome in which hypertension with proteinuria (and possibly edema) develops after 20 weeks in a previously normotensive woman | preeclampsia
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| the progression of preeclampsia which is characterized by epigastric pain, seizures (w/o warning) and coma | eclampsia
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| what % of eclamptic women develop the condition while pregnant | 70
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| what % of women develop eclampsia in the immediate postpartum period | 30
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| hypertension present before pregnancy or diagnosed before week 20 of gestation | chronic hypertension
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| women with chronic hypertension may acquire preeclampsia or eclampsia - what is this called | chronic hypertension with superimposed preeclampsia
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| what is preeclampsia | its a multisystem disease rather than only an increase in BP
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| what is the triggering mechanism of preeclampsia | failure of trophoblastic invasion of spiral arterioles
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| what does the failure of trophoblastic invasion of spiral arterioles lead to | vasospasm and organ ischemia
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| what organs does preeclampsia involve | every organ system in the body and are present long before clinical manifestations are evident
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| what is the main pathogenic factor in preeclampsia | poor perfusion as a result of vasospasm & reduced plasma volume
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| what diminishes the diameter of the blood vessels | arteriola vasospasm
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| what does this vasospasm impede | blood flow to all organs and increases BP
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| function in the organs is depressed as much as what | 40-60%
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| who has the most severe complications and have higher mortality rates when it comes to preeclampsia | african-american women
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| what are some risk factors for preeclampsia | family hx of htn-DM-morbid obesity-1st pregnancy-multiple gestations-previous hx of PIH-chronic renal disease-molar pregnancy
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| the occurrence for PIH is higher among what age women | <20 and >35 and also primips
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| chronic hypertension in pregnancy is associated with what complication | abruption, hemorrhage, cardiac difficulties/failure,HELLP syndrome,DIC,seizures, coma, pulmonary edema, acute renal failure,hepatic infarction/rupture, death
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| what is the pulmonary edema due to | pulmonary capillary leak, excess IV fluid administration, or myocardial dysfunction
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| what is the acute renal failure due to | renal vasospasm, ATN, or renal cortical necrosis
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| a variant of gestational hypertension in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction | HELLP syndrome
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| NOTE********30% of cases of eclampsia and HELLP syndrome occur postpartum | ***HELLP syndrome is considered life threatning
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| what does HELLP stand for | H:microangiopathic hemolysis- EL:-elevated liver enzymes LP: - low platelets
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| what does the microangiopathic hemolysis result in | anemia and jaundice
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| what enzymes are elevated in HELLP | ALT or AST
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| the elevated ALT or AST in HELLP what are 2 other symptoms someone can have | epigastric pain and N/V
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| what would be considered low platelets in HELLP | <100K/mm
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| what do the low platelets in HELLP result in | thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae and possible DIC
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| what are 3 fetal complications of HELLP | intrauterine growth restriction, fetal distress and perinatal death
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| what is the fetal distress caused by in HELLP | hypoxia
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| signs and symptoms of HELLP - what would BP be like | 140/90 or an increase of 30/ or /15
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| what would edema be like | >1+ to pitting
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| what about weight gain | greater or equal to 5lbs in a week
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| where would you see swelling and when | hands, feet, face-especially in the morning
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| what about protein | proteinuria >1+ or >3g/L in 24 hr collection
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| what would BP be like if the eclampsia was severe | > 160/110
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| what about edema | extensive including pulmonary
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| what about color | cyanosis
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| what about urine output | a decrease in urine output
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| what about vision | visual disturbances - headache
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| what about proteinuria | 3-4+
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| what are 2 other things you can get with eclampsia | seizures and coma
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| visual disturbances typical of preeclampsia are what (2) | scintillations and scotomata
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| what are these due to | cerebral vasospasm
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| the headache that women get may be described as what | frontal, throbbing or similar to a migraine headache
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| what is the epigastric pain from | hepatic swelling and inflammation with stretch of the liver capsule.
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| epigastric pain may be of sudden onset, istypically constant and may be moderate to sever in intensity |
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| NOTE****while mild lower extremity edema is common in normal pregnancy, rapidly increasing or nondependent edema may be a signal of developing preeclampsia |
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| rapid weight gain is a result of what | edema due to capillary leak as well as renal sodium and fluid retention
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| what are 8 things we assess for preeclampsia | weight, vs, breath sounds, edema, urinary output, FHR monitoring, reflexes & clonus, magnesium toxicity
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| what are some nursing dx for a pt with PIH | altered tissue perfussion, high risk for injury(maternal & fetal), fluid volume excess, deficient knowledge, anxiety, fear, powerlessness
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| interventions are aimed at what | assessment, detection and prevention, education, control of hypertension and seizure control and care
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| once preeclampsia is clinically evident what is then palliative | therapeutic intervention
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| home care management is an option but only for what types of women | whose condition is stable, who are able to comply with medical regimen, self-monitor, who can imm. report abnormal s/s
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| mild preeclampsia can be managed at home with what | stimuli and activity restriction (side-lying bedres and dim/quiet environment) and also diet
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| if preeclampsia is severe it has to be treated in the hospital with what | magnesium sulfate and control of BP
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| this care for preeclampsia is all to prevent progression to where | ECLAMPSIA
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| what is the intent of emergency interventions for eclampsia (5) | prevent injury-ensure adequate o2-reduce aspiration risk-establish seizure control-correct maternal acidemia
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| what is the cure for eclampsia | delivery of fetus and placenta
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| what are the 4 drugs used in preeclampsia | ANTIHYPERTENSIVES - Procardia PO - Aldomet PO -Normodyne IV - Apresoline IV (PANA)
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| what is the anticonvulsant drug that is used in preventing eclampsia | magnesium sulfate IV
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| this drug requires one on one nursing care during administration with careful monitoring of what | reflexes, respirations, urinary output
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| what is the antidote for magnesium sulfate | calcium gluconate - this needs to be at the bedside
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| what is the corticosteroid used in preeclampsia | betamethasone IM
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| COMPLETE THE CLINICAL REASONING EXERCISE: SEVERE PREECLAMPSIA - LOWDERMILK CH 27 p 658 - FOR THE ANSWERS SEE "ANSWER KEY" ON BB |
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