Impaired Tissue Perfusion in Pregnancy – Flashcards
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Hypertensive disorders of pregnancy
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-chronic HTN -chronic HTN w/ superimposed preeclampsia or eclampsia -Gestational HTN -Preeclampsia-eclampsia
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gestational HTN occurs
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usually after 20 weeks
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self-limiting to pregnancy; -symptoms may appear after delivery -resolves few weeks after delivery
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gestational HTN
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Preeclampsia
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-affects fetus -multi-organ disease
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preeclampsia affects the fetus
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-?placental circulation -^ risk prematurity
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preeclampsia risk factors
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-parity (everybody) -age (>40, <20) -race (africans and caucasians) -socioeconomic status (obesity, poor diet..)
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can be slow onset or gradual; classified as
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-pre-eclampsia -severe pre-eclampsia -eclampsia
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pre-eclampsia s & sx
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- ^BP w/ renal involvement -BP > 140/90 (over baseline) -edema (weight gain >lbs/wk) -proteinuria (1+-2+); impaired kidney perfusion
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severe pre-eclampsia
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-oliguria (abnormally small amounts) -BP > 160/110 @risk for stroke & seizure -generalized edema -3-4+ proteinuria
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severe pre-eclampsia CNS involvement
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-HA -visual changes -^deep tendon reflexes
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nursing priorities
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-BP -weight -I&O-should have a catheter -CNS assessment; "beat of clonus" -edema
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clonus
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muscular spasm involving repeated, often rhythmic, contractions ( push on foot and it occilates)
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eclampsia
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all symptoms + cerebral involvement (seizures)
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seizures
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stop breathing; magnesium sulfate
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magnesium sulfate antidote
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calcium gluconate/chloride
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preeclampsia maternal consequences
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-20% mortality rate -^ risk of; -abrupto placenta -retinal detachment -acute renal failure -cardiac failure -cerebral hemorrhage (rare); microvascular & small bleeds
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abrupto placenta
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premature separation of placenta
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preeclampsia fetal consequences
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-growth restriction -hypoxia -death
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fetal monitors
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-HR -NST -BPP (biophysical profile)
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preeclampsia treatment
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-early detection/prevention -delivery (only cure) -treat symptoms
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early treatment
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-bedrest -regular diet -monitor BP, proteinuria
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treatment for more severe preeclampsia
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-hospitalization -magnesium sulfate IV (w/ lactated ringers)
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magnesium sulfate
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-anti-convulsant -smooth muscle relaxant -safe for fetus
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HELLP syndrome; component of preeclampsia
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-Hemolysis -Elevated -Liver enzymes (AST, ALT) -Low- Platelets (normal=150-350)
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occurs with little or no warning; high risk situation
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HELLP syndrome
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symptoms of HELLP syndrome
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-RUQ pain -lab studies; liver enzymes elevated
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HELLP syndrome nursing diagnosis
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high risk for injury; hemorrhage
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placenta previa
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placenta attached low lying; can cover the cervix w/ any contracting can unlatch from uterine wall
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complete previa
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-covers entire cervical os -bleeding in 3rd trimester usually -cuts off lifeline (placenta) before the baby could come out
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cervical os
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the opening
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partial previa
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-covers portion of cervical os -same symptoms as complete previa
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marginal previa
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"low lying" -close to, but not covering the cervical os -deliver vaginally -at risk for having a previa in future pregnancies -intermittent bleeding
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placenta previa s & sx
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-painless intermittent bleeding -usually by 28 wks -spotting ? gushing -not r/t activity
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placenta previa is confirmed by
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ultrasound
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placenta prevue can be treated w/
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-bedrest -c-section
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abrupto placenta usually occurs
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after 20 weeks; -before/during labor -severity depends on degree of separation
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beta methasone
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steroid to help lung development
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partial abruption (concealed)
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-bleeding retroplacental -rigid or boardlike abdomen -^BP -?HR
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partial abruption (marginal)
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-bleeding apparent -changes in vitals
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complete abruption
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(bleeding concealed or apparent) -bleeding and/or pain -uterus tender, board-like -initial fetal movement -fetal condition declines, rare that fetus survives -S & Sx of shock in mother -can't feel baby
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complete abruption can be associated w/
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-smoking, -cocaine use, -HTN
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abruptio placenta treatment for -mild blood loss
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-bedrest -observation
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abruptio placenta treatment for -severe blood loss
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*medical emergency -deliver baby C-section
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early postpartum hemorrhage
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-uterine atony -lacerations -hematomas
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late postpartum hemorrhage
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-retained placental fragments
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impaired tissue perfusion -nursing care
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-close observation and assessment (monitor vitals) -identification of coping skills -emotional support; social workers, pastoral care, any other disciplines for patient needs
