Rasmussen College NUR2633 Study Guide Exam 2.

Rasmussen College NUR2633 Study Guide Exam 2. SUCCESS. Study guide Exam 2 o Preeclampsia and HELLP: Usually occurs after 20 weeks gestation. Gestational HTN PLUS Protein in urine. Usually 2+ or above on random dipstick. o Predisposing conditions: Primigravida, younger, Chronic Renal Disease, chronic HTN, diabetes, Rh incompatibility, family Hx gestational diabetes. o MILD preeclampsia Interventions: o Bed Rest (left lateral side), Monitor BP, Weight, Neuro status checks (hypoxia – impending seizure). o Deep Tendon Refluxes – dangle legs over bed, strike patellar tendon below knee cap with hammer, look for leg extension (2+ Full extension, 1+ Weak extension, 0 No extension –- 3+ Hyperactive, 4+ Hyperactive with positive clonus, foot wiggle) o Insure adequate fluids, I&O, anything under 30mL/hr concerned for decreased kidney function. o Increase dietary protein and carbs. Medicate BP problems. Monitor for HELLP syndrome o HELLP: form of preeclampsia that becomes advanced. Hemolysis of RBC, Elevated Liver enzymes, LOW platelets o SEVERE preeclampsia Interventions: o Complete Bedrest, Mag Sulfate to prevent seizures o Monitor signs Mg toxicity (Flushing, sweating, Hypotension, decreased deep tendon refluxes (toxic overwhelms them), CNS depression – usually respiratory, people can code! o Calcium Gluconate is antidote for Mg tox, o Admin HTN meds, prep for labor induction. o Complications of Preeclampsia: Abruptio Placenta, Disseminated Intravascular coagulation (DIC), Thrombocytopenia, Placental insufficiency, intrauterine growth restriction, Intrauterine Fetal Death o If mom doesn’t respond to treatment: Mag Sulfate, bed rest, etc. and her BP is still high and she is at risk for seizure. We would want to deliver the baby. Preferably Vaginal delivery – they key is to know age of baby, and if baby would need meds for lung maturity. o Mom will be on Mag Sulfate for 24hrs after delivery if Mag taken during labor: Important to monitor for PP hemorrhage because Mag relaxes the uterus. – Monitor lochia and fundal height. Listen to lungs and watch for respiratory depression. Vitals every hour, monitor urine output because she will diuresis. o POSTPARTUM EDUCATION: Preeclampsia is associated with major maternal and perinatal morbidity and mortality. Because the condition abates following delivery of the placenta, most obstetric units tend to discontinue seizure prophylaxis within 48 hours postpartum. However, up to 26% of eclamptic seizures occur beyond 48 hours and as late as 6 weeks after childbirth. Prior to discharge, an important nursing intervention centers on teaching patients about prodromal symptoms that may herald preeclampsia-eclampsia: headache, shortness of breath, blurry vision, nausea, vomiting, edema, seizure, other neurological deficit, and epigastric pain o Preterm labor: Labor after the 20th week or before the 37th week. o Risk Factors: Hx preterm birth, HTN, Diabetes, clotting disorders, low prepregnancy wt., abruption, uterine overdistention, cervical incompetence, hormonal changes (stress), bacterial infections or STI’s, smoking/drinking/drugs, trauma, age 16/40, periodontal disease o Assessment: Uterine Contractions (Painful or painless). Abd cramping (may have diarrhea – infection?), Low back pain (maybe contraction), Pelvic pressure or heaviness, Change in character and the amount of usual discharge (Rupture of membranes), N/V o Diagnosis PTL: 20-37 weeks, persistent uterine contractions 4q20 min or 8 in 1 hr, cervical effacement 80%, dilation 1cm or documented change in dilation. o Have Pt empty bladder, lie on side, drink 2-3 glasses water, feel for uterine contractions o Fetal Fibronectin Test: (results 24-48hrs) Negative test = likelihood for labor in following week is1% o Interventions: Stop/delay the Labor! Identify and treat infection. Bedrest/lateral position. Monitor VS and FHR. Fluids: dehydration can cause contractions. Medications. o Preterm rupture of membranes – rupture of membranes before onset of labor at any gestational age o Risk factors: smoking, STI’s, multiple gestation, hydramnios, amniocentesis, vaginal bleeding o Assessment: Pt will report gush of fluid from vagina (PUT ON FETAL MONITOR FIRST) Avoid vaginal exams because the rupture may be d/t infection and don’t want to risk baby becoming septic o Nitrazine (AmniSure/Fern Test) can confirm PROM o Oligohydramnios = decreased amniotic fluid o INTERVENTIONS: Gestational age established. US for fetal position, fluid, and growth. – Inpatient observation unless membranes reseal and leakage stops (modified bed rest, fetal monitoring to promote amniotic fluid reaccumulation, VS q4hr to monitor for infection, US exams to assess fluid levels) o Patients with advanced labor, intrauterine infection, significant vaginal bleeding, or nonreassuring fetal testing are best delivered promptly, regardless of gestational age o Placenta Previa: Improperly implanted placenta in the lower uterine segment near or over the internal cervical os. (Marginal – on the side, Complete, low-lying – close but not on cervix, can trial labor?) - Sudden onset of PAINLESS, bright red vaginal bleeding occurs in the last half of pregnancy. - Fundal height may be more than expected for gestational age - Interventions: Monitor VS, FHR, Fetal Activity, and UC. Ultra Sound, Avoid vaginal exams, bedrest with side lying position (promotes good blood flow to baby). Assess Bleeding/Pad checks (treat signs of shock if present). IV fluids, blood products PRN or tocolytic medications (prevent labor from starting). - C-Section if heavy bleeding. OB emergencies: s/s, nursing interventions and treatment o Placenta abruption: premature separation of the placenta from the uterine wall after the 20th week of gestation and before the fetus is delivered. o Concealed abruption (don’t see bleeding because placenta is up high) o Dark red vaginal bleeding with severe abd PAIN (Contractions). Uterine rigidity, signs of fetal distress. Signs of maternal shock if bleeding is excessive. o Emergency situation – Emergency C-section (vaginally if contractions deliver baby) o Interventions: Monitor VS, FHR, fetal activity, UC. Assess Bleeding/pad checks, abd pain, and increase in fundal height. Complete Bedrest, Oxygen, IV fluids, and blood products PRN. Trendelenburg position (HOB down/backwards) to decrease the pressure of the fetus on the placenta OR Left Lateral position with the HOB flat if hypovolemic shock occurs. o **Monitor for DIC in the PP period. o Prolapsed cord: Amnioinfusion may be used in an attempt to reduce the severity of repetitive variable decelerations caused by cord compression o Who is at Risk: Anytime when we are not sure baby is fully engaged into pelvis: Breech presentation, transverse, polyhydramnios o s/s: decelerations on fetal monitor – do vaginal exam – feel pulsing of cord, nurse will then apply pressure to the presenting part OFF the cord. Do not push on the cord. STAT C-Section. o Uterine Rupture: o Who is at risk: Prior C-Section, Big babies (macrosomia), multiples, uterine fatigue, o s/s: changes on fetal monitor, vaginal bleeding, distended abdomen, feel baby parts under moms skin with very little tissue in between o C-Section ASAP! o Shoulder Dystocia: Head is delivered and then retracts, or non-progressing second stage. o RN ROLE – prepare to push on anterior symphysis (under direction of MD). o Who is at risk: Diabetic moms with uncontrolled sugars o Assessment of baby: Mobility of arms, check clavicle. Look for flaccid arm/never damage to brachial plexy (Erbs Palsy). Check baby grasp. – Baby will need Physical therapy if damage o Amniotic Fluid Emboli: Goal is to get baby as quickly as possible. o Who is at risk: Everyone o s/s: Respiratory distress, dyspnea, chest pain