NUR 109 Preeclampsia

Which condition poses the greatest risk to a 32 year old woman who is 15 weeks pregnant with a history of hypertension? A. Abruptio placentae B. Preterm labor C. Spontaneous abortion D. Anemia

A. Abruptio placentae - a hx of HTN predisposes the patient for developing an abruption

A patient with gestational hypertension is experiencing abdominal pain and vaginal bleeding. Which assessment would the nurse perform first? A. Assess fetal heart tones B. Asses strength of contractions C. Assess urinary output D. Assess serum electrolytes

A. Assess fetal heart tones - findings suggest an abruption, you check the fetal heart tones first to determine fetal well being. Most immediate way to assess placental perfusion

Hypertension since 28 weeks gestation, generalized edema, and proteinuria of 4+, and now she is having a seizure. A. Eclampsia B. Chronic HTN C. Gestational HTN D. HELLP Syndrome E. Preeclampsia

A. Eclampsia

A prophylactic administration of Magnesium sulfate is being given IV to a patient who has severe preeclampsia. Which of the following indicate magnesium sulfate toxicity? Select all that apply. A. Respirations less than 12/min B. Urinary output less than 30 mL/hr C. Hyperreflexic deep tendon reflexes D. Slurred speech E. Flushing and sweating

A. RR 12 B. Urinary output less than 30 mL/hr D. Slurred speech Other signs of magnesium sulfate toxicity include the absence of patellar DTRs, decreased LOC. Calcium Gluconate is the antidote for toxicity

Labetalol

Antianginal, antihypertensive, beta blocker Pregnancy Class C Blocks stimulation of beta1 and beta2 adrenergic receptor sites. Decreased BP May cause fetal/neonatal bradycardia, hypotension, hypoglycemia, or respiratory depression Side Effects: fatigue, weakness, orthostatic hypotension. LT - arrhythmias, bradycardia, CHF, pulmonary edema Nursing Implications: monitor BP & pulse, monitor I&O, daily wt, glucagon to treat bradycardia and hypotension, take apical pulse before admin and hold if <50

Hydralazine

Antihypertensive Pregnancy Class C Direct acting peripheral arteriolar vasodilator. Lowering of BP in hypertensive patients Side effects: tachycardia, sodium retention, drug-induced lupus syndrome Nursing Implications: Monitor BP & pulse frequently, take at same time q day with last dose at bedtime, change positions slowly, assess fluid retention

The patient has a BP ranging from 148/92 to 160/98 since childhood. Her weight gain has followed normal patterns, and urinalysis remains normal as well. A. Eclampsia B. Chronic HTN C. Gestational HTN D. HELLP Syndrome E. Preeclampsia

B. Chronic hypertension

Which symptoms are considered danger signs signaling the increase severity of preeclampsia? A. Headache, ankle edema, and polyuria B. Headache, edema of the hands & dysuria C. Edema of the hands and face, visual disturbances, and irritability D. Edema of the ankles, irritability, and visual disturbances

C. Edema of the hands and face, visual disturbances, and irritability - all of these symptoms deal with vasospasm and decreased perfusion. Headache is also concerning

At 24 weeks of gestation, the mother's BP rose from a pre-pregnancy baseline of 120/70 to 150/92. No other problematic signs and symptoms were noted. A. Eclampsia B. Chronic HTN C. Gestational HTN D. HELLP Syndrome E. Preeclampsia

C. Gestational Hypertension

A nurse is caring for a 16 year old patient that has had no prenatal care. The patient is showing signs of early amor and ruptured membranes. Her BP is 168/103. She has 3+ protein in her urine and her face and hands are swollen. What INITIAL medication should the nurse expect to be prescribed for this patient? A. Calcium gluconate B. Oxytocin C. Magnesium sulfate D. Prostaglandin

C. Magnesium sulfate - this is the anticonvulsant prescribed for patients who exhibit signs and symptoms of severe preeclampsia as evidenced by elevated BP and 3+ protein

To ensure consistency and facilitate early detection of BP changes consistent with gestational hypertension, the nurse would: A. Place the woman in a supine position B. Allow the woman to rest for at least 15 minutes before measuring BP C. Use the same arm for each BP measurement D. Use a proper size cuff that covers at least 50% of her upper arm

C. Same arm A - should be seated or in a lateral position B - rest for at least 5 minutes D - cuff should cover at least 80% of the upper arm

A woman has been diagnosed with mild preeclampsia and will be treated at home. Teaching her about the treatment regimen would include: A. Daily weight after dinner or just before bed B. Urine testing to check for protein C. Fluid intake of 4-8 8oz glasses of water each day D. Gentle tensing and relaxing of hands and feet

D. Gentle tensing and relaxing of hands and feet - helps improve circulation and keep muscle tone

The nurse might suspect early preeclampsia if the patient complains: A. I am bleeding very heavily B. I get dizzy and have to lie down C. I get very depressed and cry easily D. I can't wear my wedding ring anymore

D. I can't wear my weeding ring anymore - swelling in the fingers (edema) is a classic early sign of preeclampsia

Urinalysis indicated a protein level of 2+; her weight increased 2kg in 1 week; she exhibited dependent and upper body edema A. Eclampsia B. Chronic HTN C. Gestational HTN D. HELLP Syndrome E. Preeclampsia

E. Preeclampsia

Preeclampsia

Elevated BP (greater than or equal to 140/90) accompanied by proteinuria. Categorized as mild or severe May develop into eclampsia

Gestational Hypertension

Elevated blood pressure (greater than or equal to 140/90) that develops for the first time during pregnancy

Pregnant and hypertensive since her 24th week of gestation. Urinalysis 3+. Further testing reveals a platelet count of 95,000 and an elevated AST and ALT levels; in addition, her hematocrit is decreased. A. Eclampsia B. Chronic HTN C. Gestational HTN D. HELLP Syndrome E. Preeclampsia

HELLP Syndrome

Chronic Hypertension

Hypertension that is present before the pregnancy or develops before 20 weeks of gestation. Also if the hypertension is diagnosed during pregnancy and persists longer than 12 weeks postpartum. Classified as mild or severe based on BP Those with severe chronic HTN have an increased risk of perinatal mortality

Eclampsia

Presence of seizure activity or common in a woman with preeclampsia Seizures are generalized tonic-clonic in nature and only rarely progress to status epilepticus (tonic- stiffening, clonic- rhythmical jerking)

HELLP Syndrome Treatment

Primary goals of therapy are to deliver a healthy baby and restore the woman to a healthy state Assess for severe complications Timing of delivery: corticosteroids for fetal lung maturity

HELLP Syndrome

Severe form of preeclampsia-eclampsia Acronym for hemolysis, elevated liver enzymes, and low platelets Greatly increases the mortality associated with preeclampsia

T/F: One of the first signs of magnesium sulfate toxicity is an absence of reflexes

True - toxicity begins when serum magnesium levels approach 9 mg/dL. First the reflexes disappear, then as the levels increase, respiratory depression and cardiac arrest can follow

Preeclampsia Superimposed on Chronic Hypertension

Women with chronic hypertension may develop superimposed preeclampsia, which increases the morbidity for mother and fetus. Women with hypertension before 20 weeks of gestation. New-onset proteinuria: in women with both HTN and proteinuria before 20 weeks, or significant worsening of HTN or proteinuria