OB week 9

What is gestational hypertension?

Hypertension developing after 20 weeks of gestation in a previously normotensive patient

What is preeclampsia?

Hypertension and proteinuria developing after 20 weeks in a woman who previously had neither condition

What is eclampsia?

The development of seizures or coma in a patient with preeclampsia and no prior seizure disorder

What is chronic hypertension in pregnancy?

Hypertension present before pregnancy or diagnosed before 20 weeks gestation

What is superimposed preeclampsia?

Chronic hypertension combined with preeclampsia during pregnancy

What is the most accurate method to diagnose hypertension in pregnancy?

Two elevated BP readings at least 4 hours apart

When does gestational hypertension typically resolve?

Usually by 12 weeks postpartum

Define oliguria according to MEWS criteria

Less than 35 mL/hour urine output for 2 consecutive hours

What maternal systolic BP requires immediate action per MEWS?

Less than 90 mmHg or greater than 160 mmHg

What diastolic BP requires immediate action?

Greater than 100 mmHg

Name one major obstetric risk factor for preeclampsia

Multifetal gestation

How does maternal age influence preeclampsia risk?

Risk increases for mothers ≥35 years

What prior condition greatly increases risk for preeclampsia?

Previous preeclampsia

Does obesity increase risk for preeclampsia?

Yes, prepregnancy BMI >30 is a risk factor

What autoimmune disorder is associated with preeclampsia?

Systemic lupus erythematosus

How does assisted reproductive technology affect risk?

It increases risk of preeclampsia

What chronic diseases increase preeclampsia risk?

Hypertension, diabetes, kidney disease

How does nulliparity affect preeclampsia risk?

It increases the risk

What coagulation disorder increases risk?

Antiphospholipid antibody syndrome

What sleep condition is a risk factor for preeclampsia?

Obstructive sleep apnea

What vascular change normally occurs in pregnancy but fails in preeclampsia?

Remodeling of spiral arteries

What is the result of inadequate vascular remodeling?

Reduced placental perfusion and hypoxia

What is the hallmark of preeclampsia pathophysiology?

Endothelial dysfunction leading to vasospasm

How does vasospasm affect blood flow?

It decreases tissue perfusion

How does increased endothelial permeability manifest?

Proteinuria and edema

What causes generalized edema in preeclampsia?

Leakage of plasma proteins into interstitial spaces

What organ is primarily affected by glomerular damage?

The kidneys

What happens to hematocrit in preeclampsia?

It may increase due to hemoconcentration

What type of edema may indicate pulmonary involvement?

Pulmonary edema

How does liver ischemia present clinically?

Right upper quadrant or epigastric pain

What BP measurement indicates severe preeclampsia?

≥160/110 mmHg

What protein level in urine indicates preeclampsia?

≥300 mg in 24 hours

What lab value indicates thrombocytopenia?

Platelets <100 × 10⁹/L.

What reflex changes are associated with worsening preeclampsia?

Hyperreflexia and clonus

What is an early neurological symptom of preeclampsia?

Persistent headache unrelieved by Tylenol

What renal change is a common sign of preeclampsia?

Proteinuria

What visual change may indicate cerebral involvement?

Blurred vision or visual disturbances

What symptom suggests pulmonary edema?

Shortness of breath

What fetal complication can result from preeclampsia?

Intrauterine growth restriction (IUGR)

What psychological symptom may accompany severe preeclampsia?

Agitation or confusion

How is proteinuria quantified?

24-hour urine collection or protein/creatinine ratio

What ratio indicates significant proteinuria?

Protein/creatinine ratio ≥0.3

What happens to creatinine levels in preeclampsia?

They increase

What liver enzymes elevate in preeclampsia?

ALT and AST

What does elevated uric acid indicate?

Reduced renal clearance

What happens to fibrinogen in HELLP syndrome?

It decreases

What happens to bilirubin in HELLP?

It increases (>1.2 mg/dL)

What is the normal platelet range in pregnancy?

150–400 × 10⁹/L

What lab values define HELLP?

Hemolysis, elevated liver enzymes, low platelets

What does the acronym HELLP stand for?

Hemolysis, Elevated Liver enzymes, Low Platelets

How often should vital signs be assessed in severe preeclampsia?

Every 15–30 minutes until stable

What type of environment is recommended for preeclampsia patients?

Quiet, darkened room to decrease stimuli

What reflexes should be assessed regularly?

Deep tendon reflexes and clonus

What type of IV access is recommended?

Large bore IV, often two sites

What is the total fluid limit per hour in preeclampsia management?

125 mL/hr including magnesium infusion

Why should side rails be padded?

To prevent injury if a seizure occurs

What emergency medication must be readily available?

Calcium gluconate (antidote to magnesium sulfate)

When should the neonatologist be notified?

If the baby is preterm or delivery is imminent

How is oliguria managed in preeclampsia?

Strict I&O monitoring, often via catheter

What patient teaching is critical during magnesium therapy?

Purpose of therapy and signs of toxicity

What are common antihypertensive drugs used in preeclampsia?

Labetalol, Hydralazine, Nifedipine

What is the first-line IV medication for severe hypertension?

Labetalol

What is the maximum cumulative dose of IV Labetalol in 24 hours?

300 mg

What are contraindications for Labetalol?

Maternal pulse <60 bpm, asthma, CHF, heart disease

What drug prevents seizures in preeclampsia?

Magnesium sulfate

What is the loading dose for magnesium sulfate?

4–6 grams over 15–30 minutes

What is the maintenance infusion rate for magnesium sulfate?

1–3 grams per hour

How must magnesium sulfate be administered?

Via IV pump as a piggyback on the port closest to IV hub

Can magnesium sulfate be given IM?

Not typically; IV is preferred for safety and control

What must occur before magnesium administration?

Two-RN verification

What are the signs of magnesium toxicity?

Loss of reflexes, respiratory depression, cardiac arrest.

What is the antidote for magnesium sulfate?

Calcium gluconate

How should respiratory rate be monitored during magnesium therapy?

Continuously or at least hourly

What urine output indicates magnesium toxicity risk?

Less than 30 mL/hr

What reflex change is the earliest sign of magnesium toxicity?

Diminished or absent DTRs

What must be available at bedside during magnesium infusion?

Oxygen and suction setup

Why should total fluids be limited on magnesium sulfate?

To prevent pulmonary edema

What is a safe therapeutic magnesium level?

4–7 mEq/L.

What happens if magnesium level exceeds 9 mEq/L?

Respiratory paralysis can occur

What is the immediate action if toxicity is suspected?

Stop the infusion and notify the provider

What is the defining feature of eclampsia?

Seizures in a patient with preeclampsia

What is the first nursing action during an eclamptic seizure?

Ensure airway and call for rapid response

How should the patient be positioned after a seizure?

On her side with the head of bed lowered

What medication may be given if magnesium is unavailable?

IV Valium

What should be assessed after an eclamptic seizure?

Fetal heart rate and maternal status

What causes HELLP syndrome?

Severe preeclampsia leading to hepatic dysfunction and hemolysis

What percentage of all pregnancies develop HELLP?

0.5–0.9%

What percentage of preeclamptic women develop HELLP?

10–20%

What organ is most affected in HELLP?

The liver

Why is HELLP life-threatening?

It progresses rapidly with high maternal and perinatal mortality

What does EMTALA require hospitals to provide?

Emergency evaluation and stabilization of laboring patients

What is key in high-risk obstetric communication?

Standardized tools and face-to-face handoffs

Why should interruptions be minimized during handoffs?

To ensure accurate information transfer

What type of communication should be avoided as the sole method?

Electronic or paper communication alone

What technology can enhance communication?

Electronic records and bedside monitoring systems

What vital sign changes require immediate action?

BP >160/100, HR <50 or >120, RR <10 or >30

What symptom combination signals urgent evaluation?

Hypertension with non-remitting headache or shortness of breath

Why is interprofessional collaboration vital in preeclampsia care?

To recognize condition changes early and prevent complications

What should nurses educate families about during preeclampsia?

Signs of worsening condition and when to seek help

What should be prepared in case of imminent delivery in eclampsia?

Neonatal resuscitation equipment and team readiness