Chapter 27 and ATI chapter 9

How can we assess fluid retention in patients?

Assess for edema, which is assessed through distribution, degree and pitting. Dependent edema is edema on the lowest parts of the body

What's clonus?

Clonus: hyperactive reflexes (spastic muscles and nerves)

Why all the confusion?

Confusing because standard definitions are not used consistently by all health care providers.

What is the only "cure" for preeclampsia?

DELIVERY Prevention: early prenatal care of the identification of women at risk and early detection of the disease.

What's the role of bed rest in treating preeclampsia?

Doesn't really work. Usually recommended to keep blood pressure in check. Restricted activity is recommended more than complete bed rest now that studies show this.

What is the difference between preeclampsia and eclampsia?

Eclampsia is the presence of seizure activity.

Look at Table 27-3 on page 656. Why are most of the liver enzymes increased in HELLP and not in PIH?

Endothelial damage and fribrin depositis in the liver lead to impaired liver function and can cause hemorrhagic necrosis. Liver enzymes are elevated due to heptatic tissue damage seen with HELLP and not PIH (Pregnancy-induced hypertension).

What are some seizure precautions that are used?

Environment: quiet, nonstimulating, lighting subdued, suction equipment tested and ready to use, oxygen administration equipment tested and ready to use. Call button is also within reach.

What are the different hypertensive disorders that can occur during pregnancy?

Gestational hypertension: Is the onset of hypertension without proteinuria after week 20 of pregnancy. Hyptertension is defined as a systolic blood pressure greater than 140 mm Hg or diastolic BP more than 90 mm Hg. (more frequent cause of hypertension) Preeclampsia:is a pregnancy-specific condition in which hypertension and proteinuria (protein in urine at or greater than 40 mg/dl concentration) develop after 20 weeks of gestation in a previously normotensive woman. It is a vasospastic, systemic disorder and is usually categorized as mild or sever for purposes of management. Usually with primiparous women or women having twins or more. Encourage use of antihypertensives (but can cause birth defects, and seizures) Eclampsia: is the onset of seizure activity or coma in a woman with preeclampsia, with no history of preexisting pathology, which can result in seizure activity. Eclamptic seizures can occur before, during or after birth. Chronic Hypertension: defined as hypertension that is present before the pregnancy or develops before 20 weeks of gestation. It is also classified as chronic hypertension if the hypertension during pregnancy persists longer than 6 weeks postpartum. Over 140/90. Chronic Hypertension with Superimposed Preeclampsia: HELLP: diagnosed when platelets drop below 100K (because bleeding risk). Considered severe pre-eclampsia that involves hepatic dystuction

In what ways are preeclampsia and HELLP different?

HELLP has seizures present, but also right upper quadrant pain, body aches and pain, and fatigue.

Do you think preeclampsia or HELLP syndrome is more serious? Why?

HELLP is more serious because it is a liver disorder and considered a severe type of preeclampsia.

What medications can be used to control hypertension in preeclampsia patients?

Hydralazine, labetalol, methyldopa and nifedipine are effective drugs for treating hypertension.

What are the two conditions that need to present in preeclampsia?

Hypertension and proteinuria.

What happens to the intravascular blood volume and what are some sequelae?

Intravascular volume is reduced as fluid moves out of the intravascular compartment, resulting in hemoconcentration, increased blood viscosity (thick), and tissue edema. The hematocrit value increases as fluid leaves the intravascular space. Arteriolar vasospasm can lead to endothelial damage and increased capillary permeability, predisposing the woman to pulmonary edema.

What does HELLP stand for?

It is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction, characterized by hemolysis (H- process of blood breakdown), elevated liver enzymes (EL), and low platelet count (LP).

Why is magnesium sulfate used in preeclampsia?

Magnesium sulfate is a drug administered IV per protocol to prevent and treat seizure activity caused by severe preeclampsia or eclampsia. It is given piggy back- you don't have to stop the main IV if you need to stop Mag. Does is 4-6 grams every 15-30 minutes and maintence dose is 2 g an hour. Watch for preeclampsia. Side effects are: confusion (don't want them too confused), deep tendon reflexes tells us that she might be reacting to toxicity (decreased respirations), want Mg level to be < 7.9

In preeclampsia and eclampsia, what is the role of arterial vasospasm?

Normally, the arteries in the uterus will accommodate to the increase blood volume, but in preeclampsia, this doesn't happen at all or occurs minimally, resulting in decreased placental perfusion and hypoxia. This causes generalized vasospam (where blood vessels spasm and then constrict and leads to tissue ischemia(blood supply not getting to tissues) and tissue death). The main pathogenic factor is not an increase in BP but poor perfusion as a result of vasospasm and reduced plasma volume.

What is the immediate concern for a patient with a seizure?

Patient's airway and safety (prevention of aspiration and injury from convulsions), suction, O2 Bed: low and padded

What other medication do you want to have available if your patient is on MgSO4?

Probably want to have calcium gluconate or calcium chloride to prevent respiratory or cardiac arrest if magnesium toxicity is suspected.

What about diet and preeclampsia. The authors don't focus on the need for increased protein, but that is important.

Regular diet with adequate protein, calcium, folic acid, zinc and sodium. Also, plenty of water to enhance renal perfusion and bowel function.

What are other symptoms we look for in preeclampsia?

Signs: Sudden swelling of hands, face and feet Vomiting Increased Deep Tendon Reflexes Proteinuria Decreased urine output (less than 30 mL/hr) High BP (over 140/90), severe (160/100-110) Lates due to decreased placental perfusion irritability Clonus Symptoms: Intense headaches which refuses to subside with over the counter medications Intense pain right upper gastric due to liver enlargement Blurred vision and or appearance of spots in front of the eyes nausea

In what ways are preeclampsia and HELLP similar?

Similar symptoms: headaches, vision problems, nausea and vomiting malaise, upper gastric pain. NO HPT

What is our role in caring for patients hospitalized with severe preeclampsia? (p. 662)

Through evaluation of maternal fetal status. Maternal assessments include monitoring of BP, urine output, cerebral status, and the presence of epigastric pain, abdominal tenderness, signs of labor, or placenetal abruption. Labs: platelet count, liver enzymes and serum creatinine.

Looking at Box 27-3 on p. 665, what would you say are the underlying causes of the Reportable Conditions?

elevated BP: vasospasm respiratory depression <12: mag toxicity urinary output <25 or 30: Headache: central nervous system irritability Severe DTR: central nervous system irritability Loss of DTR: mag toxicity