NURS 4341 OB Exam 2 Study Guide - University of Texas, Arlington

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NURS 4341 OB Exam 2 Study Guide - University of Texas, Arlington HYPERTENSIVE DISORDERS  2nd leading cause of maternal death and is r/t to other HTN complications  Stroke, Placental Abruption... (Complete or Partial Detachment from Uterine Wall), Hepatic Failure/Rupture, Eclampsia & AKI  Blood Pressure > 140/90 RISK FACTORS  Primigravida (6-8x the risk)  Very Young <17yrs or AMA >40  Diabetes | obesity  Pre-existing hypertensive, vascular, collagen vascular or renal disease  Multiple gestation  Hydatiform Mole  egg and sperm unite but have no genetic material  Preeclampsia in previous pregnancy, family history  if dad’s siters or mom had any hypertensive disorders with their pregnancies, then mom has risk for HTN during her pregnancy  First pregnancy with current partner  Can be associated with a new father CHRONIC HYPERTENSION  Hypertension that is diagnosed before the 20th week of pregnancy or persists greater than 6-12 weeks PP  NO proteinuria or Edema  Ages placenta, risks for infarct/abruption.  Watch BP, for edema, kick counts, NST’s, antihypertensive meds. IUGR GESTATIONAL HYPERTENSION  Elevated B/P in pregnancy or 1st 24 hours PP without signs of Preeclampsia  Elevation to 140/90 on 2 occasions 6 hours apart  No previous history of HTN – BP returns to normal within 6 -12wks PP  If hypertension persists for longer than 12 weeks PP = chronic HTN  NO proteinuria or edema HYPERTENSIVE DISORDERS DIFFERENTIATION  Chronic hypertension with superimposed preeclampsia (proteinuria and edema) o Intracranial bleed and abruption  Recognize S&S such as Increased BP and Increase/Decrease of DTR’s PREECLAMPSIA  Blood Pressure > 140/90 after 20wks gestation  If BP is 160/110 or more = severe preeclampsia (mom admitted)  On 2 separate occasions at least 6 hours apart  Proteinuria: 300mg or more on 24-hour urine (or 1+ on dipstick)  Severe= 500mg & 3+ on dipstick  Hallmark Signs  Edema: face & hands, sacral area across lower back. PREECLAMPSIA PATHO  Vasospasms and hypoperfusion of organs (causing the increased BP)  Pulmonary Edema – Listen to the lungs often  Oliguria (decreased renal perfusion possibly leading to renal failure)  Thrombocytopenia (RBC’s get damaged in the vessels with high pressure)  CNS becomes more involved: Brain more stimulated and hypoxic (seizure risk)  HA, blurred vision, hyperreflexia (HALLMARK SIGN), seizures, CVA, stroke for mom  RUQ pain = liver damage or liver rupture.  Poor placental perfusion – FHR late decelerations and increased variability  Leads to IUGR, Fetal Hypoxia, Oligohydramnios (decreases lung development, no cushion around the cord, no room for muscle development) PREECLAMPSIA NURSING MANAGEMENT  Bedrest, drink something, Lie in Lateral position (LLD), quiet environment  Teach how to monitor B/P, urine dipstick for protein if at home  Teach Fetal kick counts (10 movements every hour | check once a day) – check at night when baby is very active, monitoring for contractions, monitor for edema  EFM, seizure precautions, NST’s, low stimulation & stress (away from RN station)  Possibly give glucocorticoids to increase surfactant production aiding in fetal lung maturity  Lessens respiratory distress at birth  Monitor to prevent progression to more severe form  Strict I&O/Foley, Fluid restriction to 125mL/hr  calculate EVERY HOUR (IV meds too)  MgSO4 (Initially 4-6 G over 5-30 min then maintenance dose to 2-4 G/hr) [Show More]

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