106 Final: Definition / Classification of Preeclampsia and Magnesium Sulfate information

It is essential that the nurse monitors the patient's ________ closely and has on hand _______ should severe ________ develop.

- blood pressure -vasopressors -hypotension

The patient will receive intravenous fluids and will probably have a ______ in place so that hourly urine may be obtained to check _______ and _____.

- foley catheter -volume -protein

What are the three classifications that preeclampsia can be divided into?

- mild pre-eclampsia - severe pre-eclampsia - and eclampsia

Thus, the important aspects of the care of a patient hospitalized with mild preeclampsia will include ______ vital signs to watch for increasing _____, a high______ diet, and daily _____ to measure the amounts of edema. The patient will also be on ______>

-2-4 hour vital signs -increasing blood pressure -high protein diet -daily weights -on bedrest

Magnesium sulfate is given how?

-4-6 gram bolus over 20-30 minutes -ALWAYS PIGGYBACKED into a mainline - and ALWAYS put on an IV pump where we can control the rate

Hospitalization may also be indicated if what remains?

-BP remains ar 140/90 or in the presence of 2+ proteinuria in midstream urine

Magnesium sulfate toxicity signs are what?

-decreased respirations -and hyporeflexia (reflexes are dinished)

In addition to the teenage mother, who else is a high-risk group for preeclampsia?

-elderly primipara -women from low economic status

During a convulsion there is danger that the patient and her unborn baby will not recieve enough what? Or that the mother may _____ and _________?

-enough oxygen -mother may vomit and aspirate (can cause palcenta to abrupt)

Magnesium sulfate, if given IV, is always given how and with what?

-given IV piggyback -controlled by a pump

What hypotensive drugs may be prescribed in cases of severe htypotension?

-hydralazine (Aspresoline) - and Labetalol

Preeclampsia is characterized by one or more of what signs?

-hypertension -edema -albuminuria (protein int he urine) -and in severe cases, convulsion adn coma

Infants are in danger from the use of what?

-magnesium sulfate -barbiturates -placental vascular changes -anoxia -injuries that may occur in emergency termination of pregnancy

Tests that are used to monitor fetal well-being are ?

-movement/kickcounts -NST (non-stress test) -creatinine determination -biophysical prolife (BPP) -CST (contraction stress test) -ultrasound determination -amniocentesis

Signs of approaching eclampsia may include what?

-muscular twitching -severe headache -and marked visual disturbances

The physician who is present in the delivery room must be prepared to deal quickly with a bay who may be _______ and _______ and must evaluate the baby closely for ____ as a result of _____ ______.

-oversedated -hypermagnesemic -hypoxia -precipitous delivery

Te nurse who admits the patient to the postpartum flow must make certain what equipment is in the patient's room?

-oxygen -suction -seizure protection -low bed and padded rails -padded tongue blades -bite stick

When admitting a severe pre-eclamptic patient, the nurse should do what?

-select a room which is where she can be watched closely and i sprivate and/or quiet

A person with severe preeclampsia may also experience what?

-severe frontal headache (upper right quadrant pain is last symptom they complain about before a seizure) -epigastic pain -visual disturbances such as blurred vision and scotomata (an area of diminished vision) - severe nausea and vomitting

What are the side effects of magnesium sulfate?

-severe respiratory depression -hypotension

Drugs that should be readily available for a severe pre-eclamptic patient includes what?

-valium -anticonvulsant (dilantin) (sodium luminol) -magnesium sulfate -Apresoline -Labetalol -calcium gluconate (lasix and flurosimide are not going to effect edema, just start urine flow)

Another important aspect in the prevention of preeclampsia is control of what?

-weight gain -proper nutrition with high protein and vitamins.

Thus, the 3 symptoms one might expect to find in a patient diagnosed as having mild preeclampsia are what?

1) 140/90 BP or more 2) 1+ or 2+ albuminuria 3) little of no peripheral edema

What are the 3 symptoms one might expect to find in a patient diagnosed as having severe preeclampsia ?

1) 160/100 BP 2) 3+ or 4+ albuminuria and oliguria (small amounts of urine) 3) facial and hand edema

The severity of the 3 primary syptoms of preeclampsia are?

1) edema 2) proteinura 3)hypertension (These will allow us to distinguish between mild and sever pre-eclampsia

Infants of eclamptic mothers are in danger from four sources, what are they?

1)hazards from administration of magnesium sulfate and barbiturates 2)handicaps due to placental vascular changes 3)anoxia (absences of oxygen) 4)injuries which are more likely in emergency termination of pregnancy

Magnesium sulfate can be continued in moms for how long?

24 hours after delivery

Baby should be watched for how long for signs of magnesium toxicity?

24-48 hours

A second dose of magnesium sulfate cannot be given if the patient does not at least excrete how any mL of urine per hour?

30 mL of urine per hour

The danger of preeclampsia occuring persists for how long after delivery?

48 hours

The doctor may prescribe the administration of what?

Barbiturates or magnesium sulfate (used to depress the CNS)

All elements of the care, which a severe pre-eclamptic patient recieved during delivery, will be what?

Continued until the patient is out of danger

What can be associated with preeclampsia?

HEELP Syndrome (stands for : hemolitis, elevated liver enzymes, low platelets)

Magnesium can be given how?

IM or IV (IM is VERY painful and irritating to the skin and should be given very deep.)

Heart rate of the fetus may flatten out over time because why?

Magnesium sulfate crosses the placenta

Therefore the room should contain what?

Oxygen and suction

If output decreases, what is happening?

They are not passing magnesium out in urine

The purpose of magnesium sulfate is what?

a CNS depressant (used to keep the woman from having a seizure, NOT to lower blood pressure)

Magnesium sulfate will keep the woman from having what?

a seizure (not to lower BP, it could lower BP, but that is only a side-effect)

Although the cause of preeclampsia is not known, it is felt that the process involves an increased responsiveness to what?-Which leads up to what?

a)the vasopressor, angiotensin II b)edema, ishemia, and necrosis

As this process of preeclampsia occurs in other parts of the body, the symptoms of what will appear?

albuminuria and edema

Clonus is what and can be checked how?

alternate involuntary muscular contraction and relaxation in rapid succession (toes wobble back and forth)

With respect to the patient's activity the nurse may expect to find the patient on what?

bedrest

The physician may suggest what for them?

bedrest and bi-weekly visits

When we are giving initial bolus, we need to monitor what and how often?

blood pressure every 15 minutes

Clonus can be checked how?

by extending her leg and pushing the foot forward and releasing it

What can be found on the toxemia tray along with valium, various anticonvulsants, Apresoline (hydralazine), and Labetalol?

calcium gluconate

What must be readilt available to reverse the effects of magnesium sulfate?

calcium gluconate

What must be readily accessible so that it may be given if side effects occur?

calcium gluconate

The anecdote for magnesium sulfate is what?

calcium gluconate (IV drip) (calcium can cause heart problems)

Fetal heart tone needs to be monitored how often?

continuously

Eclampsia may be distinguished from pre-eclampsia by the occurence of what?

convulsions

Hopefully these measures will prevent a worsening of the symptoms but if severe pre-eclampsia develops more vigorous treatment may have to be started. Treatment will be directed toward preventing the development of eclampsia, which would be indicated by the prescnce of what?

convulsions

The nurse must also protect the patient from self-injury should what occur?

convulsions

Since treatment remains symptomatic, diuretics and low salt diets are no longer considered to be of any value. What will give an indication of the effectiveness of the treatment?

daily weights (when we weigh, we should use same scale, same time, and same clothing)

External stimuli may trigger a convulsion so it is essential that the enviroment be what?

darkened and quiet

Thus, a patient with the symptoms of BP 160/100, oliguria, facial edema, and severe frontal headaches who convulses would be classified as what?

eclamptic

The presence of what accounts for sudden increased weight gain in patients with preeclampsia?

edema (5 - 10 pounds in a week because of edema)

What is often the sign of impending convulsion ( then eclampsia) and thought to be caused by increased vascular engorgement of the liver?

epigastic pain

While congestion and necrosis in the sinusoids of the liver may be indicated by the presence of what?

epigastric pain

Woman will feel what and it is worrisome to her?

extremly hot and flushed

If blood pressure continues to climb, the nurse should do what?

give 3-4 grams per hour and then back to 1 gram per hour if blood pressure drops or signs of magnesium sulfate toxicity appear

If edema is not relieved by bedrest and bi-weekly visits, and the patient continues to gain 3 pounds or more a week, what may be required?

hospitalization

Once stable, we monitor the blood pressure and what how often?

hourly blood pressure, respirations, and output

Respirations less than 12/minute may mean what?

hypermagnesemic (output should be more than 30mL/hour)

Therefore, one fo the essential elements in the care of a patient with severe preeclampsia is what?

immediate hospitalization

Preeclampsia is a disorder encountered most often when?

in the last 20 weeks of gestation. during labor, or in the first 12-48 hours after delivery

Magnesium sulfate is excreted through the kidneys; therefore, it is essential that urine output is adequate and the patient must be placed on ________ and _________?

intake and output

A patient having a BP ranging from 140/90 or more, or about 30mm Hg above their baseline systolic pressure and 15 mm Hg above their baseline diastolic, would be classified as having what?

mild pre-eclampsia

A toxemic patient admitted to the hospital with these symptoms would be classified as what?

mild preeclampsia

Likewise, an albuminuria of 1+ or 2+ may signify what?

mild preeclampsia

The extent to which edema is present is also significant in classification. We should expect to find little of no peripheral edema in what type of preeclampsia?

mild preeclampsia

Infants of preeclampsia mothers may be what?

oversedated and hypermagnesiemic (evaluate closely for hypoxia)

What is checked on the patient before and after magnesium sulfate is given?

patient's reflexes

Magnesium sulfate can also be used for what?

pre-mature labor (decreases contractions in uterus)

Prevention though good prenatal care and early detection of hypertension, albuminuria, and edema is the best treatment of preeclampsia. Women from lower socioeconomic groups do not seek prenatal care will more likely develop what?

preeclampsia

Tests to evaluate fetal status are done more frequently as a pregnant woman's ________ progresses.

preeclampsia

When chronioc hypertensive vascular disease is noted before the last 20 weeks of pregnancy and persists indfiinitely afterwards, the patient does not have what?

preeclampsia

For this reason the young teenager is also more likely to become what?

preeclamptic

She may also expect that the doctor will want the urine observed for what?

protein

The patient will also have a diet, which is high in what?

protein

When ischemia and infarction of the renal cortical tissue occurs, the symptoms of what will present?

proteinura

Whereas, a patient having a blood pressur greater than 160/100 would be classified as have what?

severe pre-eclampsia

Whereas albuminuria of 3+ or 4+ and oliguria may indicate what type of preeclampsia?

severe preeclampsia

Whereas facial, hand, and possibly pulmonary edema may be present in what type of preeclampsia?

severe preeclampsia (noses will be bigger/swollen/facial edema)

The bed should be made safe by having what in place and an airway?

side rails

Magnesium sulfate is considered to be what type of drug?

smooth muscle relaxant

The only sure for preeclampsia is what?

termination of the pregnancy. (So a patient with severe pre-eclampsia who does not respond to treatment may have her labor induced.)

The process of vasoconstriction , hypertension and fluid retention occuring in the area of the serebrum probably accounts for what?

the frontal headache

After the bolus has gone in, how much do you give per hour to maintain?

usually 2 grams per hour

An increase in both systolic and diastolic pressures in a patient with preeclampsia is due to what?

vasospasm (risk each time because of the father) (nutrition could play a role)

Vasospasm of the retinal vessels together with ishemia and edema are responsible for what?

visual disturbances