preeclampsia and eclampsia
fetal movement
antepartum preeclampsia treatment: -a non-stress test can be used to monitor what?
fetal growth
antepartum preeclampsia treatment: -an ultrasound would be used to monitor what?
suspected or known chronic hypertension
antepartum preeclampsia treatment: -the patient may be placed on labetalol or methyldopa if they have what condition?
antihypertensives
antepartum preeclampsia treatment: -treatment is difficult because most drugs in what class are unsafe during pregnancy?
ECHO, EKG
antepartum preeclampsia treatment: -what 2 baseline labs/cardiovascular studies are used to monitor throughout pregnancy?
ultrasound
antepartum preeclampsia treatment: -what can be used to monitor fetal growth?
non-stress test
antepartum preeclampsia treatment: -what test can be used to monitor fetal movement?
epigastric, RUQ
besides the headache, what are 2 other locations of pain that the severe preeclamptic patient would have?
oliguria
decreased urine output
dipstick
diagnostic criteria for determining if the patient has gestational or chronic hypertension
no
does delivery mean the patient is "all clear" after having preeclampsia during pregnancy?
no
does preeclampsia always resolve after delivery?
placental dysfunction
even though there is an unknown etiology for preeclampsia, it is said to be related to _____________________ that causes endothelial damage and vasospasms of the female vascular system
endothelial damage, vasospasms
even though there is an unknown etiology for preeclampsia, it is said to be related to placental dysfunction that causes _______________ and _______________ of the female vascular system
nulliparity
having borne no children
up to 24 hours
how long does the magnesium sulfate infusion run after delivery?
low lighting
how should the lighting be in the room for patient with preeclampsia?
20 weeks gestation
hypertension is said to be pregnancy-related if it occurs after how many weeks gestation?
preeclampsia
hypertensive disorder during pregnancy: -hypertension that develops after 20 weeks gestation accompanied with signs of organ impairment
gestational hypertension
hypertensive disorder during pregnancy: -hypertension that develops after 20 weeks gestation, primarily occurring in the 3rd trimester -patient has BP of 140/90 on at least 2 occasions at least 6 hours apart
chronic hypertension
hypertensive disorder during pregnancy: -hypertension that is present prior to pregnancy, develops prior to 20 weeks gestations, or continues for at least 12 weeks postpartum
superimposed preeclampsia
hypertensive disorder during pregnancy: -when a patient with chronic hypertension has worsening hypertension and organ impairment after 20 weeks gestation
delivery
if a patient develops eclampsia, what is the only intervention?
no, still risk for preeclampsia
if the patient has a history of chronic hypertension, does it matter if they were compliant/noncompliant with treatment when it comes to risk for preeclampsia?
seizures
if the patient has a severe case of preeclampsia during pregnancy, they may still be at risk for what after delivery?
fetal demise from lack of blood, bleeding in utero could kill patient
if the patient has persistent uterine irritability and the placenta ends up detaching from the wall, what 2 things could subsequently happen?
redo test
if the patient is completing a 24 hour urine specimen collection, what needs to happen if the patient fails to collect all of the urine excreted?
decreased response to natural vasopressors
in a normal pregnancy, the patient has what type of response to natural vasopressors?
increased response to natural vasopressors
in a preeclamptic pregnancy, the patient has what type of response to natural vasopressors?
c-section
intrapartum preeclampsia treatment: -although controlled induction is the preferred method of delivery for these patients, what may be needed if there are complications during the induction?
37 weeks
intrapartum preeclampsia treatment: -the goal is to get the fetus to how many weeks gestation prior to delivery?
FHR, fetal movement
intrapartum preeclampsia treatment: -what 2 things need to be continuously monitored for baby?
pulmonary, neurovascular, cardiovascular, renal
intrapartum preeclampsia treatment: -what 4 systems need to be continuously monitored for mom?
induction of labor
intrapartum preeclampsia treatment: -what does intrapartum preeclampsia treatment focus on?
controlled induction
intrapartum preeclampsia treatment: -what is the preferred method of delivery for this patient?
yes as long as it is safe
is the baby going to stay in utero as long as possible even if the patient has preeclampsia?
uterine irritability
occurs when there is uterine activity occurring with no subsequent changes in FHR
postpartum hemorrhage
patients receiving a magnesium sulfate infusion after delivery are at risk for what?
pulmonary, cardiovascular
postpartum preeclampsia: -these patients may have severe complications with what 2 systems?
initiation, ample supply
postpartum preeclampsia: -these patients often struggle with what 2 parts of breastfeeding?
assist with pumping for breastfeeding, bonding with mom/baby
postpartum preeclampsia: -what are the 2 nursing considerations with this condition?
seizures, stroke, organ damage, death
postpartum preeclampsia: -what are the 4 risks associated with this condition?
stomach pain, N/V, swelling of hands/face, severe headache, SOB, vision changes
postpartum preeclampsia: -what are the symptoms? (6)
FHR, contractions
preeclampsia assessment: -in additional to normal vital signs, what 2 other things are monitored on pregnant patients?
no
preeclampsia assessment: -is it normal to see decelerations in FHR during uterine activity?
headache, vision changes
preeclampsia assessment: -the nurse should ask about what two symptoms when performing a neurovascular assessment?
dilated peripartum cardiomyopathy, additional heart murmurs
preeclampsia assessment: -what 2 things is the nurse monitoring for in the cardiovascular assessment?
flash pulmonary edema
preeclampsia assessment: -what is the nurse monitoring for in the pulmonary assessment?
patellar
preeclampsia assessment: -what reflex should the nurse check when assessing reflexes?
diaphragm is pushed up and compressing the lungs
preeclampsia assessment: -when assessing the lungs, the nurse needs to be aware that there is a decrease in thoracic space from the baby. what is happening anatomically to the lungs?
during uterine activity
preeclampsia assessment: -when is it normal to see accelerations in FHR?
FHR decelerations after uterine activity
preeclampsia assessment: -when would the nurse be especially concerned when assessing FHR changes in response to uterine activity?
hyperreflexia indicates progression to seizure activity
preeclampsia assessment: -why should the nurse check reflexes?
decreases fetal growth, uterine growth restriction, risk of fetal demise
preeclampsia causes less blood to be sent to baby during pregnancy. this causes what 3 things that put the baby at risk?
increase in inflammatory mediators, impairs clotting factors
preeclampsia causes what 2 physiological affects to happen to the pregnant patient?
immune response to fetal cells
preeclampsia is said to be what type of response to the fetal cells?
renal function
preeclampsia treatment: -as ____________________ improves, the disease process returns to a more normal state
renal, fetal
preeclampsia treatment: -putting the patient on their left side and providing oxygen increases perfusion to what 2 areas?
strict I&O
preeclampsia treatment: -the nurse must continue to monitor kidney function. how is this done?
strict bedrest
preeclampsia treatment: -the patient may be hospitalized for new symptoms or if there is a concern with growth and development. when the patient is in the hospital, they will be placed on what?
seizure activity
preeclampsia treatment: -the patient would be placed on magnesium sulfate if there is an onset of what symptom?
supine
preeclampsia treatment: -what position should this patient NEVER be put in?
calm, relaxing
preeclampsia treatment: -what type of environment would the nurse want to create for this patient?
postpartum preeclampsia
rare condition that occurs when the patient has continued hypertension and proteinuria for up to 12 weeks after delivery
fetal growth restriction
severe preeclampsia causes what to happen to the fetus?
gestational age when delivered
the fetus delivered from a preeclamptic patient may suffer multiple obstacles of prematurity after delivery depending on what factor?
blurred vision, blindness, "floaters"
the patient with severe preeclampsia may have what 3 cerebral/visual disturbances?
twice normal
the patient with severe preeclampsia would have impaired liver function giving values that are at least ___________________
< 500 mL in 24 hours
the patient with severe preeclampsia would have oliguria. what is the criteria for this diagnosis?
vasopressor response
the preeclamptic patient had uterine growth restriction related to what physiologic complication?
gestational age, severity
the risk to the fetus with preeclampsia is determined by what 2 factors?
altered LOC, seizures
what 2 neurological symptoms besides headache would be seen in a patient with severe preeclampsia?
pulmonary edema, cyanosis
what 2 respiratory symptoms might be seen in the severe preeclamptic patient?
convulsions
what added symptom turns preeclampsia into eclampsia?
BP 160/110 or higher, proteinuria, persistent headache, oliguria, cerebral/visual disturbances, pulmonary edema or cyanosis, epigastric or RUQ pain, impaired liver function, low platelet count, altered LOC or seizures, fetal growth restriction
what are all of the symptoms of severe preeclampsia?
personal/familial history of HTN/cardiac disease/autoimmune/renal, history of chronic HTN (compliant/noncompliant), kidney/renal disease, nulliparity, diabetes, coagulation disorders, obesity, lack of access to prenatal care, >35 years old, history of fetal conditions with previous pregnancies
what are some of the risk factors for preeclampsia?
>300mg/dl or +2 dipstick
what are the 2 diagnostic values that tell you the patient has proteinuria?
hypertension after 20 weeks gestation, organ impairment
what are the 2 requirements for diagnosing preeclampsia?
140/90, +1 proteinuria
what are the 2 values that indicate mild preeclampsia?
significant hypertension, proteinuria >5g/24hrs, any systemic manifestations of disease
what are the 3 manifestations of severe preeclampsia?
conservative, bedrest, deliver if close to term
what are the 3 ways to manage mild preeclampsia?
chronic hypertension, gestational hypertension, preeclampsia, superimposed preeclampsia
what are the 4 classifications of hypertensive disorders for pregnant patients?
restricted growth, decreased placental perfusion, fetal hypoxia, fetal demise
what are the 4 greatest concerns for the fetus with preeclampsia?
neurovascular, reflexes, cardiovascular, pulmonary, VS
what are the 5 components to assessing the preeclamptic patient?
Foley catheter
what can be used for a 24 hour urine specimen collection for the preeclamptic patient that cannot get out of bed due to increases in BP?
organ impairment
what does proteinuria tell you that the patient has?
increases
what happens to vascular permeability of the vessels in a preeclamptic patient?
proteinuria
what is a marker to see if the patient has organ impairment?
padding rails
what is a nursing intervention when the preeclamptic patient is on seizure precautions?
consider delivery
what is the 1 management intervention for severe preeclampsia?
140/90
what is the BP used as a diagnostic criteria for pregnant patients with hypertension?
35
what is the age considered for geriatric pregnancy?
unknown
what is the etiology for preeclampsia?
160/110 or higher on 2 occasions at least 6 hours apart while the patient is on bedrest
what is the specific diagnostic BP for severe preeclampsia?
5g or higher in 24 hour urine specimen, 3+ or greater on 2 random urine samples collected at least 4 hours apart
what is the specific diagnostic criteria for proteinuria in severe preeclampsia?
giant muscle
what is the uterus?
kidneys
what organ would be the first to suffer if the patient has preeclampsia?
rapid weight and fluid gain
what symptom may guide suspicion of preeclampsia, but is not considered a diagnostic criteria?
low sodium
what type of diet would the preeclamptic patient be on?
persistent
what would the headache be like in severe preeclampsia?
<100,000
what would the platelet count look like in a patient with severe preeclampsia?
do not know how long it has been in bladder, impacts accuracy
when the patient is completing a 24 hour urine specimen collection, why should they discard the first urine excreted?
36 weeks
when treating preeclampsia, the risks and benefits are considered, especially when the gestational age is prior to how long?
placenta may eventually detach from wall
why is uterine irritability a concern for the preeclamptic patient?
