Study Guide Exam 3
What nursing assessments and interventions are done? What
measures are taken for to provide for the safety of the
patient?
Hypertension and proteinuria develop after 20 weeks of gestation – leading cause of
maternal and perinatal morbidity and mortality – placenta is root cause (disruptions in
placental perfusion and endothelial cell dysfunction)
Cerebral Manifestation: cerebral edema, cerebral hemorrhage, headaches,
hyperreflexia, positive ankle clonus, seizures, visual disturbances (dim vision, blind or
dark spots, blurred or double vision)
Liver Manifestations: elevated ALT/AST, RUQ or epigastric pain, hepatic edema,
hemorrhagic necrosis, decreased platelets, jaundice – referred pain: chest or shoulder
Kidney Manifestations: decreased GFR, increased BUN/ Creatinine, oliguria, decreased
uric acid clearance, NA and water retention, acute tubular necrosis and renal failure,
protein and albumin lost in urine, headache, edema/ puffy, increased BP
Prevention: Low-dose aspirin (81 mg) reduces preeclampsia and adverse outcomes in
high risk women – start between weeks 12-28
Exam: BP, edema (distribution, degree, pitting), DTRs, bicep and patellar reflexes,
hyperactive reflexes (clonus) at ankle joint, proteinuria (24 hour urine collection)
Goal: ensure maternal safety and deliver healthy newborn close to term
o Close monitoring of maternal and fetal status
o Vaginal birth by induction and cervical ripening recommended at 37 weeks
o Regular diet without salt restriction
o Go to hospital is abdominal pain, significant headache, uterine contractions,
vaginal spotting, or decreased fetal movement
o CBC and BMP every week
o Complete or partial bed rest for the duration of pregnancy
Severe preeclampsia: In the absence of proteinuria – hypertension with either
thrombocytopenia, impaired liver function, new onset renal insufficiency, pulmonary
edema, or new onset cerebral or visual disturbances
o Evaluate for severe/ persistent headaches, vision changes (blurred or double),
mental confusion, RUQ pain or epigastric pain, N/V, SOB, decreased urinary
output
o GOAL for severe preeclampsia: prevent eclampsia, placental abruption, HELLP
syndrome, fetal growth restriction and fetal demise
o If pregnancy has reach 34 weeks or more, recommended that birth occurs soon
after maternal stabilization
o Placed on Mg sulfate to prevent eclamptic seizures and antihypertensive
medication if necessary
, Corticosteroids (betamethasone 12 mg IM repeated in 24 hours or
dexamethasone) given to enhance fetal lung maturation for gestations
less than 34 weeks
o BP, urine output, cerebral status, presence of epigastric pain or tenderness, labor,
and vaginal bleeding
o Labs: platelets, Liver enzymes, serum creatinine
o Fetal Assessment: continuous electronic FHR, biophysical profile, US eval of fetal
growth and amniotic fluid volume
o Emergency drugs (Hydralazine, Labetalol, Nifedipine, Magnesium sulfate, Calcium
gluconate), oxygen, and suction equipment available
o Quiet, dim lights
What are risk factors for Preeclampsia?
History of preeclampsia, chronic HTN, preexisting diabetes, and preexisting thrombophilia
Limited sperm exposure, nulliparity, age >40, IVF, multifetal gestation, renal disease, Factor V
Leiden mutation, RA, Lupus (autoimmune), African American women
Preeclampsia without severe features how does the patient
present in the clinic?
Preeclampsia Preeclampsia with Severe
Features
Hypertension BP >140/90 at least 4 hours BP >160/110 x2 at least 4
apart hours apart while on bed rest
Proteinuria Proteinuria >300mg
Protein creatinine ratio >0.3
Thrombocytopenia Platelet count <100,000 Platelet count<100,000
Impaired Liver Function Liver enzymes twice the Liver enzymes twice the
upper level of normal normal
Severe persistent epigastric
or RUQ pain unresponsive to
meds
Renal Insufficiency Creatinine >1.2 or doubling Progressive renal
of concentrations insufficiency >1.1 or a
doubling of concentrations
Pulmonary edema Absent Present
Cerebral or visual Absent New Onset
disturbances
, What is the feature of gestation hypertension?
Onset of HTN without proteinuria or other systemic findings diagnostic for preeclampsia
after week 20 of pregnancy
Occurs due to increased need of insulin in 2nd and 3rd trimester – pancreatic insufficiency
Systolic >140mmHG or diastolic >90 mmHg
Recorded on two occasions at least 4 hours apart – only one pressure (systolic or diastolic)
needs to be elevated
Resolves after birth (can take 6-12 months)
What are the signs and symptoms of HELLP syndrome?
Variant of preeclampsia that involves hepatic dysfunction, characterized by hemolysis,
elevated liver enzymes, and low platelet count
Epigastric or substernal pain, N/V/ indigestion with pain after eating, persistent headache,
should pain or pain when breathing deeply, bleeding, changes in vision, swelling of hands or
face, SOB, difficulty breathing, high BP, protein in urine
More common in white women – increases risk of maternal death, pulmonary edema, DIC,
acute renal failure, placental abruption, live hemorrhage or failure, acute respiratory distress
syndrome (ARDS), sepsis, and stroke
LABS
Platelets <100,000
AST/ ALT of >70
LDH (bilirubin) >600
Class 1: most severe – platelets <50,000, high mortality
Class 2: Moderate – platelets 50,000-100,00
Class 3: Mild – platelets 100,00-150,000
What is important information the nurse needs to know when
administrating Magnesium Sulfate to a preeclamptic patient?
Mg Sulfate given to increase threshold for seizures: continued for 24 hours post-partum to
prevent seizure
Buys 48 hours before you MUST END THE PREGNANCY
Give Betamethasone to baby to help mature lungs
4-6mg of Mg sulfate infused over 15-30 minutes followed by maintenance dose diluted in IV
solution
Common side effects: feeling of warmth, flushing, diaphoresis, and burning at IV site
Monitor: urine output, BP, pulse, RR, DTRs, LOC, headache, visual disturbances, epigastric
pain; FHR and activity
BP, pulse, and respiratory status monitored every 5 mins with loading dose and every
hour while on maintenance
Restrict fluid to 125ml/hr – urine output at least 2530 ml/hr
Keep lights dim and quiet environment, side rails up (seizure precautions)
Magnesium toxicity: absent DTRs (consider Calcium gluconate) and decreased LOC
BP decreased – Urine Output decreased – Respirations <12 – Patellar Reflexes Absent
What nursing assessments and interventions are done? What
measures are taken for to provide for the safety of the
patient?
Hypertension and proteinuria develop after 20 weeks of gestation – leading cause of
maternal and perinatal morbidity and mortality – placenta is root cause (disruptions in
placental perfusion and endothelial cell dysfunction)
Cerebral Manifestation: cerebral edema, cerebral hemorrhage, headaches,
hyperreflexia, positive ankle clonus, seizures, visual disturbances (dim vision, blind or
dark spots, blurred or double vision)
Liver Manifestations: elevated ALT/AST, RUQ or epigastric pain, hepatic edema,
hemorrhagic necrosis, decreased platelets, jaundice – referred pain: chest or shoulder
Kidney Manifestations: decreased GFR, increased BUN/ Creatinine, oliguria, decreased
uric acid clearance, NA and water retention, acute tubular necrosis and renal failure,
protein and albumin lost in urine, headache, edema/ puffy, increased BP
Prevention: Low-dose aspirin (81 mg) reduces preeclampsia and adverse outcomes in
high risk women – start between weeks 12-28
Exam: BP, edema (distribution, degree, pitting), DTRs, bicep and patellar reflexes,
hyperactive reflexes (clonus) at ankle joint, proteinuria (24 hour urine collection)
Goal: ensure maternal safety and deliver healthy newborn close to term
o Close monitoring of maternal and fetal status
o Vaginal birth by induction and cervical ripening recommended at 37 weeks
o Regular diet without salt restriction
o Go to hospital is abdominal pain, significant headache, uterine contractions,
vaginal spotting, or decreased fetal movement
o CBC and BMP every week
o Complete or partial bed rest for the duration of pregnancy
Severe preeclampsia: In the absence of proteinuria – hypertension with either
thrombocytopenia, impaired liver function, new onset renal insufficiency, pulmonary
edema, or new onset cerebral or visual disturbances
o Evaluate for severe/ persistent headaches, vision changes (blurred or double),
mental confusion, RUQ pain or epigastric pain, N/V, SOB, decreased urinary
output
o GOAL for severe preeclampsia: prevent eclampsia, placental abruption, HELLP
syndrome, fetal growth restriction and fetal demise
o If pregnancy has reach 34 weeks or more, recommended that birth occurs soon
after maternal stabilization
o Placed on Mg sulfate to prevent eclamptic seizures and antihypertensive
medication if necessary
, Corticosteroids (betamethasone 12 mg IM repeated in 24 hours or
dexamethasone) given to enhance fetal lung maturation for gestations
less than 34 weeks
o BP, urine output, cerebral status, presence of epigastric pain or tenderness, labor,
and vaginal bleeding
o Labs: platelets, Liver enzymes, serum creatinine
o Fetal Assessment: continuous electronic FHR, biophysical profile, US eval of fetal
growth and amniotic fluid volume
o Emergency drugs (Hydralazine, Labetalol, Nifedipine, Magnesium sulfate, Calcium
gluconate), oxygen, and suction equipment available
o Quiet, dim lights
What are risk factors for Preeclampsia?
History of preeclampsia, chronic HTN, preexisting diabetes, and preexisting thrombophilia
Limited sperm exposure, nulliparity, age >40, IVF, multifetal gestation, renal disease, Factor V
Leiden mutation, RA, Lupus (autoimmune), African American women
Preeclampsia without severe features how does the patient
present in the clinic?
Preeclampsia Preeclampsia with Severe
Features
Hypertension BP >140/90 at least 4 hours BP >160/110 x2 at least 4
apart hours apart while on bed rest
Proteinuria Proteinuria >300mg
Protein creatinine ratio >0.3
Thrombocytopenia Platelet count <100,000 Platelet count<100,000
Impaired Liver Function Liver enzymes twice the Liver enzymes twice the
upper level of normal normal
Severe persistent epigastric
or RUQ pain unresponsive to
meds
Renal Insufficiency Creatinine >1.2 or doubling Progressive renal
of concentrations insufficiency >1.1 or a
doubling of concentrations
Pulmonary edema Absent Present
Cerebral or visual Absent New Onset
disturbances
, What is the feature of gestation hypertension?
Onset of HTN without proteinuria or other systemic findings diagnostic for preeclampsia
after week 20 of pregnancy
Occurs due to increased need of insulin in 2nd and 3rd trimester – pancreatic insufficiency
Systolic >140mmHG or diastolic >90 mmHg
Recorded on two occasions at least 4 hours apart – only one pressure (systolic or diastolic)
needs to be elevated
Resolves after birth (can take 6-12 months)
What are the signs and symptoms of HELLP syndrome?
Variant of preeclampsia that involves hepatic dysfunction, characterized by hemolysis,
elevated liver enzymes, and low platelet count
Epigastric or substernal pain, N/V/ indigestion with pain after eating, persistent headache,
should pain or pain when breathing deeply, bleeding, changes in vision, swelling of hands or
face, SOB, difficulty breathing, high BP, protein in urine
More common in white women – increases risk of maternal death, pulmonary edema, DIC,
acute renal failure, placental abruption, live hemorrhage or failure, acute respiratory distress
syndrome (ARDS), sepsis, and stroke
LABS
Platelets <100,000
AST/ ALT of >70
LDH (bilirubin) >600
Class 1: most severe – platelets <50,000, high mortality
Class 2: Moderate – platelets 50,000-100,00
Class 3: Mild – platelets 100,00-150,000
What is important information the nurse needs to know when
administrating Magnesium Sulfate to a preeclamptic patient?
Mg Sulfate given to increase threshold for seizures: continued for 24 hours post-partum to
prevent seizure
Buys 48 hours before you MUST END THE PREGNANCY
Give Betamethasone to baby to help mature lungs
4-6mg of Mg sulfate infused over 15-30 minutes followed by maintenance dose diluted in IV
solution
Common side effects: feeling of warmth, flushing, diaphoresis, and burning at IV site
Monitor: urine output, BP, pulse, RR, DTRs, LOC, headache, visual disturbances, epigastric
pain; FHR and activity
BP, pulse, and respiratory status monitored every 5 mins with loading dose and every
hour while on maintenance
Restrict fluid to 125ml/hr – urine output at least 2530 ml/hr
Keep lights dim and quiet environment, side rails up (seizure precautions)
Magnesium toxicity: absent DTRs (consider Calcium gluconate) and decreased LOC
BP decreased – Urine Output decreased – Respirations <12 – Patellar Reflexes Absent
