Preeclamsia Hesi Case Study – Flashcards

--Family history. --Preexisting medical or genetic condition, such as Factor V Leiden. --Nulliparity. Toxemia - is an old term for preeclampsia that some clients may still use. Reason for preeclampsia are unknown, but research shows that preexisting medical conditions and genetic conditions put the client at higher risk for preeclampsia. Nulliparity - first pregnancy places a client at higher risk preeclampsia than multiparty with the same partner.

no definite cause, but the main pathophysiology is poor perfusion as a result of arteriolar vasospasm. Function in organs such as placenta, liver, brain, and kidneys can be depressed as much as 40-60%. As fluid shifts out of the intravascular compartment, a decrease in plasma volume and subsequent increase in hematocrit is seen => generalize edema. Preeclampsia develops after 20 weeks gestation id a previously normotensive women. SS: elevated blood pressure, may also develop proteinuria (no longer considered a diagnosis measurement), generalize edema of face, hands, and abdomen - not responsive to 12 bedrest. Preeclampsia progresses along a continuum form mild to severe preeclampsia, HELLP syndrome, or eclampsia. A client may present to the labor unit anywhere along that continuum.

Prenatal blood pressure readings. BP (138/88) - indicates mild preeclampsia. Blood pressure parameters for mild preeclampsia include a reading f 140/90 taken on 2 occasions 6 hours apart. Blood pressure usually remains the same during the 1st semester. Both systolic and diastolic then decrease gradually up to 20 week gestation. At 20 weeks of gestation, the blood pressure begins to gradually increase and return to 1st trimester levels at term.

Cerebral edema. As fluid leaks into the extravascular spaces,organ edema as well as peripheral edema occurs. This, in conjunction with cortical brain spasms, causes headache, increases DTRs, and clonus

"Let me explain to you about the effects of diuretics on pregnancy." Diuretics decrease blood flow to the placenta by decreasing blood flow. In the case of the preeclamptic client, this is particularly dangerous because the disease has already caused a volume deficit. In addition, the diuretics disrupt normal electrolyte balance and stress kidneys that are already compromised by preeclampsia. The only time they are used is if the preeclamptic client also had a heart failure, but this client has no symptoms of HF.

6 *note: Calculate ml/hr, not drops/min 20 units = 20, 000 mu

--"Do you have a headache?" --"Do you have blurry vision?" --"Do you have epigastric pain?" --"Do you have shortness of breath or chest discomfort?" Central nervous system (CNS) changes such as severe headache, blurred vision, scotoma (spots before eyes), and photophobia indicate a worsening condition.

Have Jennie lie in a lateral position and take the blood pressure on the dependent arm. The lateral position supports placenta perfusion. The lower (dependent) arm should be positioned so the client is not lying on it, and the BP should be taken in that arm. this more closely approximates arterial pressure. Using the arm on the opposite (upper) side will falsely reduce the measurement.

Acceleration of the fetal heart rate in response to fetal movement. The basic of non stress test is that normal fetus with an intact CNS will response to fetal movements by increasing its HR (episodic accelerations). A reactive test is one in which the fetus displays at least 2 acce;rations of 15 beats per min that last for 15 s in a 20 min period in the presence of a normal baseline rate and moderate variability.

Decreased hemoglobin and hematocrit with burr cells, elevated liver enzymes, platelet count 3 HELLP stands for: hemolysis (H), evidenced by burr cells or an elevated bilirubin level; elevated liver enzymes (EL), evidenced by elevated AST and ALT; and low platelets (LP), evidenced by a platelet count of 3.

A 35-year-old gravida 3, para 2, with HELLP syndrome. This client is the most critical among this group of clients and is at the highest risk for morbidity and mortality. HELLP syndrome occurs in only 2 - 12 % of severely preeclamptic clients. Common seen in older, Caucasian, multiparous clients. SS: may complain of a general feeling of malaise over several days, have epigastric, to upper abdominal pain, and may experience nausea, and vomiting. BP may be only slightly elevated, or it may even be normal. Proteinuria may be absent. A non-DIC coagulopathy is often associated with HELLP syndrome.

A CNS depressant. Magnesium sulfate depressed the CNS by interfering with the neuromuscular junction. It is given to prevent or control eclamptic seizures.

No adjustment to the oxytocin induction.

Respiratory rate is <12 and absent DTRs Both indicate toxicity as does urine output of <30ml/hr.

Ask Jennie to explain what she understands about the procedures. It is the responsibility of the nurse to ascertain what the client understands about the procedures and the potential risks associated with those procedures.

"Jennie should sign the consent forms herself since she is the one receiving the care."

The magnesium is being excreted through the kidneys. Magnesium is cleared by the kidneys. Jennie's kidneys are working well (average 100 ml/hr since admission). The magnesium level is not up to therapeutic range (4-8 mg/dl) because it is being excreted from the body.

The fetus has a magnesium level equal to the mother's, causing the fetus to be somewhat sedated. Magnesium sulfate crosses the placenta, the baby will have a magnesium level equal to the mother.

Turn Jennie onto her side and place a pillow behind her to stabilize the position. Aspiration is the leading cause of maternal morbidity and mortality after an eclamptic seizure. By turning Jennie to a lateral position and using a pillow to hold that position, a patient airway can be maintained, the aspiration of vomitus minimized, and supine hypotension prevented.

Late decelerations. Late decelerations are caused by uteroplacental insufficiency. Late decelerations are characterized by a gradual decrease form the baseline that begins after the contraction has started and does not return to baseline until after the contraction ends. Persistence late decelerations usually indicate fetal hypoxemia and can process to hypoxia and academia. In Jennie;s case, the decelerations stem form the eclamptic seizure, during which the oxygen supply to the mother and fetus was compromised.

Implement a prescribed fluid bolus to improve maternal blood volume A bolus of non dextrose IV fluid (normal saline or RINGER;S LACTATES) will increase the maternal fluid volume, thereby improving blood flow and oxygenation to the fetus.

Calcium glutinate. Calcium gluconate is the antidote for magnesium sulfate. It is given slow IV push over at least 3 mins. The client should be monitored carefully for cardiac reactions such as dysrhythmias, bradycardia, and ventricular fibrillation.

Hypotension. Hypotension occurs as a result of sympathetic blockade. It is common occurrence after an epidural if the mother is not adequately pre-hydrated or already has an impaired fluid volume.

When the urge to push is felt, take a deep breath and bear down while exhaling over 5 to 7 seconds. Then take another deep breath and repeat the pushing pattern until the urge to push subsides. this method of pushing utilize both instinctive, spontaneous pushing and open- glottis pushing. It is physiologically correct in that it utilizes Ferguson's (the urge to bear down), at which more oxytocin is released from the exterior pituitary to strengthen bearing down contractions.

Hyporeflexia and decreased respirations. Magnesium sulfate crosses the placenta, the newborn can develop toxic levels of magnesium. Neonatal hypermagnesemia manifest as hypotonia, and marked decrease in respiratory rate. Hypermegnesemia may be treated with calcium and exchange transfusion with citrates blood and or assisted mechanical ventilation until serum levels are normal. As with the mother magnesium is cleared through the kidneys.

Move Jennie to a quiet room close to the nursing station in Labor and Delivery, and assign one RN to care for her.

"Your partner is still at risk for complications, so visitors are limited to family members, and only for short periods of time."

--Carboprost tromethamine. Classification ( prostaglandin, oxitocica) Action: stimulates contraction of the uterus. This medication, a deviated pf prostaglandin F2 alpha, may be administered intramuscularly, intramyometrially at cesarean birth, or intraabdominally after vaginal birth. This drug may be used with th hypertensive client.