final 3

When is RhoGam given?

-28 weeks -within 72 hours of birth -anytime that mother experiences bleeding

What is the nursing care for preeclampsia?

-Check for edema, clonus, deep-tendon reflexes, proteinuria, lab values -Quiet environment, seizure precautions, continuous monitoring of maternal and fetal well-being

What are some nursing considerations with preeclampsia?

-Consistent B/P monitoring -Check urine for presence of protein -Watch for edema in face, hands, abdomen -Headaches, blurred vision -Deep Tendon Reflexes (DTR's)

What are some complications of HELLP syndrome?

-DIC -renal failure -pulmonary edema -ruptured liver hematoma -placental abruption

What is nursing care for seizures?

-Ensure patent airway, prevent aspiration, turn on side -Do not leave patient -Do not force anything in mouth -Check uterine activity, cervical status, fetal status (Membranes intact? Birth imminent?)

What is DIC?

-Forms clots indiscriminately -Uses up clotting factors -No clotting factors results in widespread external & internal bleeding

What are the different classifications of hypertension?

-Gestational Hypertension -Preeclampsia -Severe Preeclampsia -Eclampsia -Chronic Hypertension

What is HELLP syndrome?

-Hemolysis -Elevated Liver enzymes -Low Platelets *characterized by hepatic dysfunction

What is Preeclampsia?

-Hypertension after 20 wks gestation -PROTEINURA present (1+) -Pathologic EDEMA - face, hands, abdomen -Increased cell permeability resulting in loss of protein and fluid, less plasma volume, resistance -Elevated B/P is first sign - systolic above 140, diastolic above 90 -Rapid weight gain over 2kg (4.5lbs) week -CNS irritability

Nursing Care for DIC

-Identify cause and treat -Replace essential factors and fluid, blood -Through assessment, watch for oozing -Monitor fetal well-being

What is Severe Preeclampsia?

-Systolic B/P above 160, diastolic B/P above 110 -2+ PROTEINURA -Less than 400-500ml of urine within 24 hr -Cerebral and/or visual disturbances -Hepatic involvement -Decreased platelet - less than 100,000 -Pulmonary/cardiac involvement -hyperreflexia -HELLP syndrome

What drug is used for mild/severe preeclampsia?

-magnesium sulfate which decreases CNS irritability -side effect is decrease in BP -magnesium sulfate: prevention and control of seizures, relaxation of smooth muscles, decreased reflexes

What is gestational HTN?

-the onset of HTN without proteinuria after week 20 of pregnancy (most common around week 37) -BP is at 140/90mm Hg or greater at least twice, 4-6 hrs part, and within a 1 week period

What are three things to watch for when administering magnesium sulfate?

1) decrease in respirations (below 12/minute) 2) loss of DTR (HYPOreflexia) 3) less than 30 mL/hr urine output

Initial Client Assessment shows: BP 160/110 mmHg, Pulse 88 bpm, RR 22, reflexes 3+/4+ with 2 beat clonus. Urine specimen reveals +3, neg sugar and ketones. Based on the findings, the nurse would expect the client to have which complaints? A. HA, blurred vision, facial/extremity swelling B. abd pain, urinary frequency, pedal edema C. diaphoresis, nystagmus, dizziness D. lethargy, chest pain, SOB

A. HA, blurred vision, facial/extremity swelling

A nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is: A. Hypertension B. Hyperemesis gravidarum C. Hemorrhagic complications D. Infections

A. Hypertension

A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? SELECT ALL THAT APPLY A. Respirations fewer than 12/min B. Urinary output less than 30 ml/hr C. Hyperreflexic deep-tendon reflexes D. Decreased LOC E. Flushing and sweating

A. Respirations fewer than 12/min B. Urinary output less than 30 ml/hr D. Decreased LOC *absence of DTR is a sign of toxicity *flushing and sweating are adverse effects of mag sulfate

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: A. A sleepy, sedated affect B. A respiratory rate of 10 breaths/min C. Deep tendon reflexes of 2+ D. Absent ankle clonus

B. A respiratory rate of 10 breaths/min

With regard to preeclampsia and eclampsia, nurses should be aware that: A. Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters B. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain C. The causes of preeclampsia and eclampsia are well documented D. Severe preeclampsia is defined as preeclampsia plus proteinuria

B. Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain *Vasospasms diminish the diameter of blood vessels, which impedes blood flow to all organs.

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if: A. Blood pressure is reduced to prepregnant baseline B. Seizures do not occur C. Deep tendon reflexes become hypotonic D. Diuresis reduces fluid retention

B. Seizures do not occur

A client with pregnancy induced HTN (PIH) receives magnesium sulfate, 4 g in 50% solution IV over 20 minutes. What is the purpose of administering magnesium sulfate to this client? A. to lower BP B. to prevent seizures C. to inhibit labor D. to block dopamine receptors

B. to prevent seizures

Nurses should be aware that HELLP syndrome: A. Is a mild form of preeclampsia B. Can be diagnosed by a nurse alert to its symptoms C. Is characterized by hemolysis, elevated liver enzymes, and low platelets D. Is associated with preterm labor but not perinatal mortality

C. Is characterized by hemolysis, elevated liver enzymes, and low platelets

What is the antagonist for magnesium sulfate?

Calcium gluconate

A nurse is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected? A. Nifedipine (Adalat) B. Pyridoxine (Vit B6) C. Ferrous sulfate D. Calcium gluconate

D. Calcium gluconate

When is Rh incompatibility an issue?

Rh- mother and Rh+ fetus, during birth mother builds antibodies to destroy Rh+ blood in successive pregnancies

If mother is Rh-, what is given to prevent formation of antibodies?

RhoGam

What does TORCH stand for?

T - toxoplasmosis O - other infections (hepatitis) R - rubella virus C - cytomegalovirus (primary) H - Herpes Simplex virus

What is the leading cause of maternal morbidity and mortality with seizures?

aspiration

When does the client's bp return to normal if they have gestational HTN?

by 6 weeks postpartum

What cures preeclampsia?

fetal death or delivery

What is the most common complication of pregnancy?

gestational hypertension

What is important to know about the Herpes Simplex Virus?

if active lesion is present...then C-section must be done

What are the TORCH infections?

infectious agents that can cross the placenta and harm the fetus

What are the distinguishing characteristics of eclampsia?

its severe eclampsia with the onset of seizure activity or coma

How is HELLP diagnosed?

labs - NOT clinical **send to ICU

Who is at risk for HELLP syndrome?

older, caucasian women *many have NO signs of preeclampsia

What does HELLP syndrome result in?

tissue hypoxia

What is the underlying mechanism for gestational hypertension?

vasospasms which decreases perfusion to vital organs