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