4 Nursing Across The Lifespan 1

140/90

Gestational hypertension requires a BP of over ___ or increase of 30mm systolic and 15mm diastolic from prepregnancy levels.

Gestational Hypertension

Manifestations include: Elevation in blood pressure, proteinuria, changes in the retina, brisk deep tendon reflexes, facial edema.

Gestational Hypertension

The dangers of _____ ______ are that

1) it can develop and progress rapidly

2) the early symptoms are not often detected

Delivery

The only definitive treatment for gestational hypertension.

5-10

Gestational hypertension is involved with __-__% of pregnancies, with the highest risk group being women over 40.

Gestational Hypertension

Leading cause of maternal and perinatal morbidity and mortality worldwide.

Gestational Hypertension

Mortality from _____ _____ is primarily from hepatic rupture, placental abruption, and eclampsia.

160/110

Severe gestational hypertension involves a blood pressure of over __ /__

Eclampsia

Seizure activity or coma in woman diagnosed with preeclampsia.

Nonsevere Preeclampsia

BP > or = to 140/90 mm Hg but not
exceeding 160/110 mm Hg
• MAP > 105 mm Hg
• Protienuria >0.3 g in 24 hour specimen
or > or = to 30 mg/mmol urinary
creatinine in random urine sample

Severe Preeclampsia

Proteinuria
• Systolic BP >160 mm hg
• Diastolic BP >110 mm hg
• Mean arterial pressure (MAP) >105
mm Hg
• Cerebral disturbances
• Epigastric pain

Preeclampsia

The main pathogenic factor is not an increase in BP but poor perfusion resulting from
vasospasm.
• Arteriolar vasospasm diminishes the diameter of blood vessels, which impedes blood
flow to all organs and increases BP.
• Function in placenta, kidneys, liver, and brain is depressed by as much as 40 to 60%

HELLP Syndrome

Laboratory diagnostic variant of severe pre-eclampsia that involves hepatic dysfunction, characterized by:
• Hemolysis
• Elevated liver enzymes
• Low platelets

HELLP Syndrome

is associated with an increased risk of :
• Placental abruption
• Renal failure
• Pulmonary edema
• Ruptured liver hematoma
• Disseminated intravascular coagulation (DIC)

Deep Tendon Reflexes

increased in women with preeclampsia prior to seizure.

Gestational Diabetes

onset of glucose intolerance first dx during pregnancy. Insulin may or may not be required.

Glucose Challenge Test

Gestational diabetes is diagnosed through a ____ ____ ____, where 50g of oral glucose is ingested followed by a blood test.

7.8

<_._mmol/L is the normal value for glucose challenge test.

7.8-11.0

_._-__._ mmol/L requires additional test for glucose challenge test.

11.1

>__._ mmol/L during glucose challenge test is considered positive.

Hyperemesis Gravidarum

Persistent, uncontrollable vomiting that begins in the first weeks of pregnancy and may continue throughout the pregnancy.
• Weight loss, dehydration, acidosis from starvation, elevated blood and urine ketones,
alkalosis from hydrochloric acid and gastric fluids, hypokalemia, disturbances in the
liver enzymes.
• Cause is unknown
• Serious cases affect 0.5-1% of pregnancies

Hyperemesis Gravidarum

Interventions aim at:
• Control of nausea, balance of electrolytes and creatinine levels, administration of
vitamins (B6), administration of antiemetics such as Zofran, IV therapy, long-term
administration of Diclectin (doxylamine & pyridoxine).
• Daily weight, consult with a nutritionist for a diet rich in potassium and magnesium,
emotional support, education

Placenta Previa

placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix. Results in excessive bleeding, need for C-section and exit is blocked by placenta.

Half

Placenta previa and placental abruption represent ____ of all bleeding in the third trimester

Threatened Abortion

condition in early pregnancy characterized by vaginal bleeding and lower abdominal pain, with a closed cervix and no expulsion of the fetus. It suggests a risk of miscarriage but does not guarantee it will occur.

Inevitable Abortion

condition in early pregnancy where vaginal bleeding and abdominal cramping occur, and the cervix is open, indicating that miscarriage is unavoidable. There is no way to prevent the loss of the pregnancy at this stage.

Incomplete Abortion

not all products of conception are expelled, requires oxytocin, dilation and curettage.

Dilation and Curettage

surgical procedure where the cervix is dilated, and the lining of the uterus is scraped or suctioned out. It is commonly used to remove tissue after a miscarriage, treat abnormal uterine bleeding, or diagnose certain uterine conditions.

Complete Abortion

all is expelled from the uterus; cervix closes after the abortion. No interventions unless bleeding heavily.

Missed Abortion

fetus dies during the first ½ of pregnancy but is retained in the uterus. Requires dilatation and curettage (D&C).

Misoprostol

Medication used to stimulate uterine contractions to end a pregnancy. Evacuates the uterus after abortion to ensure passage of all the products of conception.

Mifepristone

Medication that acts as a progesterone antagonist, allowing the prostaglandins to stimulate uterine contractions causing the endometrium to slough to end pregnancy.

Ectopic Pregnancy

Implementation of the fertilized ovum in the area outside of the uterine cavity. 95% occur in fallopian tube. Diagnosis before rupture is important. Interventions include: methotrexate (inhibits cell reproduction), surgical interventions if rupture occurs.

Placenta Previa

Diagnosis includes ultrasound to determine if complete, marginal, or low-lying.

Placental Abruption

Separation of normally implanted placenta before fetus is born. Occurs when there is bleeding on the maternal side of the placenta. As the clot expands, separation occurs. Can also result in hemorrhage and DIC for mother.

Placental Abruption

Manifestations include vaginal bleeding, abdominal pain, back pain, uterine irritability
(low intensity contractions), high uterine resting tone, uterine tenderness (localized)

Placental Abruption

Treatment includes Ultrasonography, hospitalization, bed rest, meds to decrease uterine contractions, immediate caesarean section birth in many cases, intravenous fluid and possible blood replacement therapy, external fetal monitoring, emotional support, education.

RH Incompatibility

Occurs when mother is RH-’ve and father is RH+’ve. Mother produces RH antibodies that attack infant. First child is usually unaffected.

Cervical Ripening and Induction

Process of softening and thinning the cervix in preparation for labour, as well as the medical methods used to induce labour.

Artificial Rupture of Membranes

Medical procedure where the amniotic sac is deliberately ruptured to release amniotic fluid. Used to induce or augment labour, assess fetal status, or facilitate delivery.

Preterm labor

True labor that occurs before 37 weeks.

Cord Prolapse

Condition where a portion of the umbilical cord falls out in front of, lies beside, or hangs below the fetal presenting part following rupture of membranes.

Overt Cord Prolapse

Umbilical cord delivered before baby.

Occult Cord Prolapse

Cord delivered alongside baby.

Cord Prolapse

Risk factors include: abnormally long cord, malpresentation, preterm labour, fetal abnormalities, polyhydramnios, amniotomy if the presenting part is high, premature rupture of membranes, multiparity, low birth weight, obstetrical procedures.

Cord Prolapse

Nursing priority is to have the pt in trendelenburg or knee high position to keep pressure off chord.

Instrumental Assisted Delivery

Risks include facial nerve damage, skull fractures, intracranial hemorrhage. Subgaleal hemorrhage is specific to the use of a vacuum extractor.

Subgaleal Hemorrhage

Accumulation of blood between skull and scalp, possible complication of vacuum extraction.