Pre-eclampsia- Maternity Statement of facts from Case Studies.

HTN
is age related and also hereditary. HTN used to be called Toxemia.

What is the most important information from the pre-natal record to obtain?
Prenatal blood pressure reading.

What is the pathophysiology behind a pounding headache and elevated DTR’s?
Cerebral Edema. As fluid leaks into the extra vascular spaces, organ edema as well as peripheral edema occurs. This is conjunction with cortical brain spasms, causes headache, deep tendon reflexes, and clonus.

Clonus
Cyclical, spasmodic alteration of muscular contraction and relaxation in response to a sustained stretch of a spastic muscle.

Diuretics during pregnancy
is especially dangerous because it decreases blood flow to the placenta by decreasing blood volume.

What technique is used to take blood pressure while client is on bedrest?
Have the pt lie in lateral position and take the blood pressure on the dependent arm. The lateral position supports placental perfusion. The lower dependent arm should be positioned so that the pt is not lying on it.

Placental Perfusion
maternal blood flow to the uterus

Lateral position
Position in which the patient is lying on the left or right side.

Non Stress Test
A noninvasive procedure that monitors response of the FHR to fetal movement. Accelerations of the FHR in response to fetal movement.

HELLP syndrome
Hemolysis, Elevated Liver enzymes, Low Platelets, a complication of pre-eclampsia / eclampsia–an acronym used in regards to PIH. Some patients have HELLP syndrome with PIH, and some progress into it.Expected Lab Results would be Decreased hemoglobin and hematocrit with Burr cells, elevated liver enzymes and a Platlet count of greater than 100,000 mm3.

Magnesium Sulfate
Anticonvulsant, CNS depressant, smooth muscle relaxant. Given to reduce eclamptic seizures. If receiving Mag Sulfate, then Oxytocin needs to be increased to establish labor.

Magnesium Sulfate Toxicity
may cause respiratory depression when used in high doses. Other side effects of magnesium therapy include flushing and headache. Decreased urine output to lss than 30 mLs/ hr. and absent DTRs. Magnesium is cleared by the kidneys. Magnesium in the fetus matches the mothers.

DTR
Deep Tendon Reflex

Aspiration
is the leading cause of fetal morbidity and mortality after an eclamptic seizure. Lateral position with a pillow behind to maintain that position, then a patent airway can be maintained. Supine hypotension is prevented.

Supine Hypotension
a drop in blood pressure due to altered venous return from a gravid uterus exerting pressure on the ascending vena cava., occurs when the woman lies on her back, the uterus compresses blood flow through inferior vena cava, reducing amount of blood returned to her heart, also causes reduction in blood flow to placenta resulting in fetal hypoxia.

Late decelerations
• Nonreassuring patterns that reflect impaired placental exchange or uteroplacental insufficiency. Characterized by a gradual decrease from the baseline that begins after the contraction has started and does not return the baseline when the contraction has ended.

What should a nurse do to ensure intrauterine resuscitation?
Implement a prescribed bolus to improve fluid blood volume. Normal Saline or Ringers will increase the maternal fluid volume.

Calcium Gluconate should be on hand.
Is the antidote for Magnesium Sulfate.

Epidurals
block the nerve to block perception of pain. Pt should be properly hydrated. Hypotension is a risk factor.

When the urge to push is felt…
Take a deep breath and bear down while exhaling breath for 5 to 7 seconds. Then take another deep breath and repeat until the urge to push resides. OPEN GLOTTIS method of pushing.

Neonatal hypermagnesia
decellerated muscle tone or floppiness( HYPOTONIA), decreased respiratory rate.

Carboprost Tromethamine- to treat postpartum hemmorhage.
Hemabate., Uterine Agent. This drug may be used with Hypertensive clients.