Week 9 part 2

Preeclampsia labs

Increased hct Increased uric acid Increased liver enzymes Increased fibrinogen Increased Cr Decreased RBC Decreased Albumin

Retrograde ejaculation

Ejaculation in which the ejaculate empties into the bladder

Risks of ART

Expensive Mood swings Hot flashes

Gestational hypertension

Onset of hypertension without proteinuria after the 20th week of pregnancy >140/90 on more than one occasion 6 hours apart

Eclampsia

Onset of seizure activity or coma in a woman with preeclampsia No history of preexisting pathology Can develop in the immediate postpartum period

Clomid

Ovulatory stimulant, PCOS

A client presents at 36 weeks gestation presents to L & D complaining of a constant headache for the past two days. She also states that her face seems more swollen than usual. What should be the nurse's first action

Take blood pressure

Sperm and ova timing

42-78 hours, best in first 24 hours Ova: 24-48 hours

Severe preeclampsia

>160/110 Proteinuria plus 3,4 Hyperreflexia Severe headache Visual changes Oliguria Epigastric pain Abnormal labs

A nurse is providing instruction to a couple undergoing zygote intrafallopian transfer (ZIFT). The nurse is aware that instruction have been effective when the woman states

A fertilized egg will be placed into my fallopian tube

Assessment of male infertility

US Semen analysis: Liquification <1 hour Volume >2mL pH 7-8 Sperm count >20 million/mL Morphology >30% normal Motility >50% in forward motion

Assessment of female infertility

Basal body temp charts (before getting out of bed) Cervical mucous charts Ovulation predictor kits Hormone analysis US Hysteroscopy Lararoscopy

Maternal effects of preeclampsia

CVA DIC Renal failure Hepatic failure Pulmonary edema/CHF

Fetal effects of preeclampsia

Decreased placental perfusion Growth restriction Increased risk for abruption Preterm birth Perinatal mortality

Subfertility

Prolonged time to conceive, <1 year with repeated miscarriages

A couple who has sought fertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occurs

The testes are overheated

PP severe gestational htn and preeclampsia with severe features

Unable to tolerate excessive blood loss, can develop eclampsia or HELLP Increased risk of developing preeclampsia or eclampsia in future pregnancy Increased risk of adverse perinatal outcomes

Sterility

Inability to conceive

Pergonal/Pepronex (hMG) menotropins

For women who don't ovulate d/t pituitary hormones

Treatment of mild gestational hypertension and preeclampsia without severe features

Home care Frequent maternal and fetal assessment Activity restriction, but not on complete bedrest Drink water, increase protein, avoid salt, monitor output 2x weekly NST, weekly biophysical markers

Antidote for magnesium toxicity

calcium gluconate 1 gram IV

Female infertility causes

Hormonal (PCOS) Endometriosis STDs PID Previous ectopic pregnancy Fibroids Congenital uterine abnormalities Vaginal/cervical infection Vaginal pH imbalance Age >35 Obesity or underweight Excessive exercise Smoking/alcohol Stress

A client who is undergoing ovarian stimulation for infertility with menotropins calls the infertility nurse and states, "my abdomen feels very bloated, my clothes are tight, and my urine is dark." Which of the following is the appropriate statement for the nurse to make at this time?

It is important for you to come into the office to be examined today

Magnesium sulfate

Loading dose 4-6g/100ml IV fluid in 15-30 minutes Continuous infusion 2g/hour in 100ml 24 hours post delivery Given as IVPB on pump Used to prevent seizures Draw labs 4-5 hours after onset of treatment, therapeutic level 4-7 mEq/L

Side effects of mag sulfate

Nausea Flushing Diaphoresis Dry mouth Weakness Headache Blurred vision Lethargy

Chronic hypertension is associated with increased incidence of

Abruptio placentae Superimposed preeclampsia Increased perinatal mortality

Clinical presentation of HELLP

Nonspecific History of malaise Influenza-like symptoms Epigastric or RUQ abdominal pain Symptoms worsen at night and improve during the day Tx: deliver baby, platelet replacement

Parlodel

Not often used

Assisted reproductive therapy

Fertility treatment in which both eggs and sperm are handled IUI IVF-ET ICSI Assisted hatching Preimplantation genetic diagnosis GIFT ZIFT Donations Surrogates TDI Adoption

Oligospermia

Few sperm cells produced

Magnesium toxicity

Depressed rr <12/min Absent DTR Pulmonary edema Severe hypotension Altered LOC Extreme muscular weakness Cardiac dysrhythmia Oliguria

Preeclampsia effects

Endothelial cell dysfunction Poor perfusion in all organ systems Increased peripheral resistance and BP Reduced kidney perfusion Plasma colloid osmotic pressure decreases Deceased liver perfusion Neurologic complications

Fetal side effects of mag sulfate

FHT Decreased variability Respiratory depression Hypotonia Decreased suck reflex

HELLP

A variant of severe preeclampsia that involves hepatic dysfunction After 20 weeks Hemolysis, Elevated Liver enzymes, Low Plt Platelets aggregate at site of damaged vascular endothelium and decreases overall counts

Pathophysiology of preeclampsia

Progressive disorder with placenta as the root cause Begins to resolve after the placenta has been expelled typically Spiral arteries in the uterus normally become larger and thicker to handle increased blood volume This vascular remodeling does not occur or only partially occurs in women with preeclampsia and decreased placental perfusion and hypoxia result Endothelial inflammation affects the whole body

Male infertility causes

Undescended testes Hypospadius Varicocele Low hormone levels (pit, thyroid, test) Ejaculation problems STDs Substance abuse/smoking Heat Environmental exposure Health issues Medications Excessive exercise Age

Hypertensive disorders are a major cause of perinatal morbidity and mortality worldwide due to the following

Uteroplacental insufficiency Premature birth

Chronic HTN with superimposed preeclampsia

Already had htn diagnosis Increased risk for morbidity Can be difficult to diagnose

Endothelial cell dysfunction

Vasospasm Increased peripheral resistance Increased endothelial permeability

Treatment of severe gestational hypertension and preeclampsia with severe features

Bed rest with side rails up Darkened environment Magnesium sulfate therapy Antihypertensive medications

When a woman is on mag sulfate

Bedside commode, movement assisted, possible cath

Risk factors for preeclampsia

Prinigravidity in women under 19 or over 40 First pregnancy with a new partner History of preeclampsia Pregnancy-onset snoring Cause is unknown

FSH, Gn-RH, HCG

Fertility clinics

Identifying and preventing preeclampsia

No reliable test or screening tool has been developed Low dose aspirin may help certain high risk women Proteinuria is a late sign Increased inhibit A, H/H without drop

Azoospermia

No sperm cells produced

Metformin (Glucophage)

PCOS, Decreased male hormones

Preeclampsia

Pregnancy-specific condition in which htn and proteinuria develop after 20 weeks of gestation in a previously normotensive woman

Mild preeclampsia

Proteinuria plus 1 >140/90 Weight gain and edema

Interventions for infertility

Psychosocial Diet, habit changes CAM Correcting preexisting factors Ovarian stimulation

PP complications of chronic htn

Pulmonary edema Renal failure HF Encephalopathy

Morbidity due to hypertensive disorders

Renal failure Coagulopathy Cardiac or liver failure Placental abruption Seizures Stroke

Couple infertility causes

Subfertility of both parents Allergic responses Technique issues (obesity, positioning, timing, frequency) Stress

In the absence of proteinuria, preeclampsia may be defined as hypertension along with the following

Thrombocytopenia Impaired liver function New development of renal insufficiency Pulmonary edema New onset cerebral or visual disturbances

Male infertility drugs

Thyroid/ Pituitary Viagra Antibiotics OTC cold medication Folic acid Zinc