Rasmussen College NUR2633 Study Guide Exam 2

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 is<1% o Interventions: Stop/delay the Labor! Identify and treat infection. Bedr