PIH EXAM 1 Nur 213

Question Answer what is the most common medical complication of pregnancy PIH is the progression of PIH predictable no ****NOTE: mild hypertension must be taken seriously and managed as for pre-eclampsia what is it called if it is the onset of hypertension without proteinuria after week 20 of pregnancy gestational hypertension a pregnancy-specific syndrome in which hypertension with proteinuria (and possibly edema) develops after 20 weeks in a previously normotensive woman preeclampsia the progression of preeclampsia which is characterized by epigastric pain, seizures (w/o warning) and coma eclampsia what % of eclamptic women develop the condition while pregnant 70 what % of women develop eclampsia in the immediate postpartum period 30 hypertension present before pregnancy or diagnosed before week 20 of gestation chronic hypertension women with chronic hypertension may acquire preeclampsia or eclampsia – what is this called chronic hypertension with superimposed preeclampsia what is preeclampsia its a multisystem disease rather than only an increase in BP what is the triggering mechanism of preeclampsia failure of trophoblastic invasion of spiral arterioles what does the failure of trophoblastic invasion of spiral arterioles lead to vasospasm and organ ischemia what organs does preeclampsia involve every organ system in the body and are present long before clinical manifestations are evident what is the main pathogenic factor in preeclampsia poor perfusion as a result of vasospasm & reduced plasma volume what diminishes the diameter of the blood vessels arteriola vasospasm what does this vasospasm impede blood flow to all organs and increases BP function in the organs is depressed as much as what 40-60% who has the most severe complications and have higher mortality rates when it comes to preeclampsia african-american women what are some risk factors for preeclampsia family hx of htn-DM-morbid obesity-1st pregnancy-multiple gestations-previous hx of PIH-chronic renal disease-molar pregnancy the occurrence for PIH is higher among what age women <20 and >35 and also primips chronic hypertension in pregnancy is associated with what complication abruption, hemorrhage, cardiac difficulties/failure,HELLP syndrome,DIC,seizures, coma, pulmonary edema, acute renal failure,hepatic infarction/rupture, death what is the pulmonary edema due to pulmonary capillary leak, excess IV fluid administration, or myocardial dysfunction what is the acute renal failure due to renal vasospasm, ATN, or renal cortical necrosis a variant of gestational hypertension in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction HELLP syndrome NOTE********30% of cases of eclampsia and HELLP syndrome occur postpartum ***HELLP syndrome is considered life threatning what does HELLP stand for H:microangiopathic hemolysis- EL:-elevated liver enzymes LP: – low platelets what does the microangiopathic hemolysis result in anemia and jaundice what enzymes are elevated in HELLP ALT or AST the elevated ALT or AST in HELLP what are 2 other symptoms someone can have epigastric pain and N/V what would be considered low platelets in HELLP <100K/mm what do the low platelets in HELLP result in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae and possible DIC what are 3 fetal complications of HELLP intrauterine growth restriction, fetal distress and perinatal death what is the fetal distress caused by in HELLP hypoxia signs and symptoms of HELLP – what would BP be like 140/90 or an increase of 30/ or /15 what would edema be like >1+ to pitting what about weight gain greater or equal to 5lbs in a week where would you see swelling and when hands, feet, face-especially in the morning what about protein proteinuria >1+ or >3g/L in 24 hr collection what would BP be like if the eclampsia was severe > 160/110 what about edema extensive including pulmonary what about color cyanosis what about urine output a decrease in urine output what about vision visual disturbances – headache what about proteinuria 3-4+ what are 2 other things you can get with eclampsia seizures and coma visual disturbances typical of preeclampsia are what (2) scintillations and scotomata what are these due to cerebral vasospasm the headache that women get may be described as what frontal, throbbing or similar to a migraine headache what is the epigastric pain from hepatic swelling and inflammation with stretch of the liver capsule. epigastric pain may be of sudden onset, istypically constant and may be moderate to sever in intensity NOTE****while mild lower extremity edema is common in normal pregnancy, rapidly increasing or nondependent edema may be a signal of developing preeclampsia rapid weight gain is a result of what edema due to capillary leak as well as renal sodium and fluid retention what are 8 things we assess for preeclampsia weight, vs, breath sounds, edema, urinary output, FHR monitoring, reflexes & clonus, magnesium toxicity what are some nursing dx for a pt with PIH altered tissue perfussion, high risk for injury(maternal & fetal), fluid volume excess, deficient knowledge, anxiety, fear, powerlessness interventions are aimed at what assessment, detection and prevention, education, control of hypertension and seizure control and care once preeclampsia is clinically evident what is then palliative therapeutic intervention home care management is an option but only for what types of women whose condition is stable, who are able to comply with medical regimen, self-monitor, who can imm. report abnormal s/s mild preeclampsia can be managed at home with what stimuli and activity restriction (side-lying bedres and dim/quiet environment) and also diet if preeclampsia is severe it has to be treated in the hospital with what magnesium sulfate and control of BP this care for preeclampsia is all to prevent progression to where ECLAMPSIA what is the intent of emergency interventions for eclampsia (5) prevent injury-ensure adequate o2-reduce aspiration risk-establish seizure control-correct maternal acidemia what is the cure for eclampsia delivery of fetus and placenta what are the 4 drugs used in preeclampsia ANTIHYPERTENSIVES – Procardia PO – Aldomet PO -Normodyne IV – Apresoline IV (PANA) what is the anticonvulsant drug that is used in preventing eclampsia magnesium sulfate IV this drug requires one on one nursing care during administration with careful monitoring of what reflexes, respirations, urinary output what is the antidote for magnesium sulfate calcium gluconate – this needs to be at the bedside what is the corticosteroid used in preeclampsia betamethasone IM COMPLETE THE CLINICAL REASONING EXERCISE: SEVERE PREECLAMPSIA – LOWDERMILK CH 27 p 658 – FOR THE ANSWERS SEE "ANSWER KEY" ON BB

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