Maternal Child: Exam 2 Study Guide GUIDESPRING LATEST UPDATE

1. Preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) a. 24 weeks and beyond b. HTN that occurs during pregnancy c. Only cured by delivering baby and placenta d. Affect liver, brain, kidney, lung, and heart i. Subjective Data 1. Blurry vision 2. Headaches 3. Weight gain 4. Edema of face and hands 5. Epigastric pain/upper abdominal pain 6. Protein in urine 7. Elevated BP (can cause decreased fundal growth) 8. Brisk patellar reflexes 9. N/V ii. Objective Data 1. Elevated BP 2. Protein in urine 3. Pitting edema 4. Hyperreflexia (+3,+4) iii. Laboratory Values 1. CBC 2. Liver enzymes 3. Uric acid 4. 24 hour protein iv. Interventions 1. Bed rest 2. NPO 3. Left side 4. Fetal monitoring 5. Start IV 6. Foley 7. Monitor lungs and respirations every hour v. Treatment 1. Magnesium Sulfate a. Decreases labor 2. Betamethasone a. Given prior to delivery for lung maturity of baby 3. Surfactant a. Given after delivery 4. Oxytocyin/Pitocin a. Induce labor - contractions no closer than 2-3 minutes apart b. Pitocin will need to titrated very carefully 2. Preterm Labor a. Can raise by 2 mu per minute every 20-30 minutes until contracting every 2-3 minutes and making cervical change b. Need IV pump and fetal monitor 2. Prefer to deliver vaginally 3. Magnesium sulfate post-delivery for 24 hours 4. Replace foley catheter after delivery 5. Bed rest 24 hours a. Regular uterine contractions that cause cervical change prior to 37 weeks; little as 2 cm or 80% effaced (thickness of cervix) i. Become closer together with activity 1. Cramping 2. Low back pain 3. Leg pain 4. Increased urination 5. Increased vaginal discharge 6. Pelvic pressure b. Preterm contraction i. Intercourse ii. Dehydration iii. Trauma iv. Bladder spasms c. Interventions i. Place patient on left side ii. Place on fetal monitor iii. Give fluids 1. IV bolus and LR; 500 mL and then increase to 1000 mL iv. Give medications d. Medications i. Terbutaline 1. Beta Agonist 2. Delays preterm labor 3. Given Sub-Q; max of three doses 4. Side Effects a. Shaking b. Restlessness c. Cardiac repercussions d. Respiratory depression 5. Monitor a. Pulse; greater than 120 do not give ii. Magnesium Sulfate 1. Tocolytic 2. 4 g bolus than 2 g maintenance dose 3. Relaxes smooth muscles (contractions and diaphragm) 4. Calcium Gluconate is reversal agent in case of magnesium sulfate toxicity