NURSING 306 OB QUIZ 6 STUDY GUIDE: 1. What are the major differences between gestational hypertension, preeclampsia and eclampsia? .....

NURSING 306 OB QUIZ 6 STUDY GUIDE: 1. What are the major differences between gestational hypertension, preeclampsia and eclampsia? .1. What are the major differences between gestational hypertension, preeclampsia and eclampsia? What is the pathophysiology that leads to these conditions? The major difference between the three is that they are different hypertensive states of pregnancy. Gestational hypertension is the first indication of blood pressure increase during pregnancy. This can happen without any signs or symptoms and blood pressure usually returns to normal within 6 weeks of birth. Preeclampsia occurs after 20 weeks of gestation and is regulated by the presence of gestational hypertension plus proteinuria. Preeclampsia can range from mild to severe and requires more treatments and better health management. Eclampsia is the more severe hypertensive disorder of the three, because it involves the occurrence of seizures in a woman with existing symptoms of preeclampsia. The pathogenic factor that leads to these conditions is not an increase in blood pressure but poor perfusion as a result of vasospasm. The arteriolar vasospasm is what diminishes the diameter of blood vessels, which prevents blood flow to all organs therefore increasing blood pressure. 2. What is HELLP syndrome, and how does it differ? HELLP syndrome is a severe version of preeclampsia, which is depicted by the presence of Hemolysis, elevated liver enzymes and low platelets. HELLP results from complications of preeclampsia and eclampsia and is considered more life- threatening than the rest. 3. What are the common medications used to treat preeclampsia, and what risks do they carry? What is the nursing management for each? Hydrazaline (apresoline, neopresol) Arterolar vasodilator Mother: headache, flushing, tachycardia, increased heart rate and cardiac output, increased oxygen consumption, N and V. Fetus: tachycardia, late decelerations and bradycardia if maternal diastolic pressure is 90 Labetalol Hydrachloride (normodyne) Beta blocking agent causing vasodilation without significant change in cardiac output. Mother: Minimal flushing, tremulousness, minimal change in pulse rate. Fetus: Minimal if any Methyldopa (Aldomet): Maintenance therapy if needed. Mother: sleepy, postural hypotension, constipation, drug induced fever Fetus: After 4 months maternal therapy positive coombs tests results. Nifedipine (Procardia) Calcium channel blocker Mother: Headache, flushing, possible potentiation of effects on CNS if administered concurrent with magnesium sulfate, may interfere with labor. Fetus: minimal. 4. What assessments need to be frequently conducted for the patient with preeclampsia? The assessments that need to be frequently conducted are: • Evaluate the maternal-fetal unit 2-3 times a week • Every 3 weeks, examine the fetal growth rate by ultrasound • Teach daily fetal movement counts • Conduct a non-stress test 1-2 times per week • Recommend bed rest in lateral recumbent position • Recommend a diet • NST test 1-2 times per week • Blood pressure to be taken on the same arm in a sitting position daily • Checking weight at the same time everyday, after voiding and before breakfast • Dipstick test urine samples to asses proteinuria • Review clinical observations of all tests to see any differences 5. Describe deep tendon reflexes and how they are graded. Deep tendon reflexes are used as baseline to detect any changes in “pitting edema,” which is edema that leaves a small pit after finger pressure is applied to a swollen area. The biceps, patellar reflexes and ankle clonus are assessed. It is also apart of the physical examination process for preeclampsia. There are 5 grades to it: • 0: No response • 1+: Sluggish or diminished • 2+: Active/expected response • 3+: More brisk than expected; slightly hyperactive • 4+: Brisk, hyperactive, with intermittent or transient clonus 6. Discuss why a patient with preeclampsia is at risk for seizures. What are seizure precautions, and how are they instituted? Preeclampsia can progress from a mild disease to eclampsia, which is the onset of seizure activity. There are a few seizure precautions that patients should take: • Maintain a quiet, darkened environment to avoid stimuli that may cause seizure activity. • Patient’s room should be consistently monitored and close to staff and emergency supplies, such as suction and oxygen administration equipment (tested and ready to use). • Weight should be measured everyday. • Indwelling urinary catheter that monitors renal function and effectiveness of therapy. • Electronic monitoring to determine fetal status is initiated at least once a day.