Exam (elaborations)
COMPLETE STUDY GUIDE FOR FIRST OBSTETRICS EXAM (VERIFIED)
- Course
- NUR 2421
- Institution
- Keiser University
COMPLETE STUDY GUIDE FOR FIRST OBSTETRICS EXAM (VERIFIED)
[Show more]
Content preview
COMPLETE STUDY GUIDE FOR FIRST OBSTETRICS EXAM(VERIFIED)
Hypertensive Disorders of Pregnancy
Care of the Woman with Hypertensive Disorder
• Classifications
– Gestational Hypertension (>20 weeks) elevated BP that was not there prior to 20 weeks
– Chronic hypertension present before 20 weeks or when they were not pregnant
– Chronic hypertension with superimposed preeclampsia elevated BP prior to 20 weeks with
proteinuria
How is preeclampsia diagnosed? Elevated BP and proteinuria (24hr urine collection), unrelenting HA
– Pre-eclampsia (>20 weeks) without seizure
– Eclampsia patient has seizure, decreased oxygen during seizure for pt and baby
If pre-eclampsia worsens, how is it cured? Giving birth, at risk up to 2 weeks after
Hypertensive Disorders: Maternal Risks
• Maternal risks:
– Stroke- anti-hypertensive meds should be given to lower BP about 15% to prevent stroke, needs to be
checked within 15 min, decreases chance by 90% by giving meds
– Pulmonary edema
– Death
1. What patient complaint might be a “Red Flag” for preeclampsia? headache
2. Worsening pre-eclampsia will cause a marked increase of deep tendon reflexes. Why? check every hr
DTR; CNS is becoming more irritated causing increased DTR
Hypertensive Disorders: Fetal Risks
• Fetal-neonatal risks:
– Small for gestational age: SGA spiral artery not getting good blood flow
– Intra Uterine Growth Restriction: IUGR
– Placental abruption due to maternal hypertension
– Prematurity
– Over sedation due to maternal medications – magnesium sulfate
,– Intra Uterine Fetal Demise: IUFD
Preeclampsia: symptoms and nursing care
Clinical Manifestations and Diagnosis
Most common cause of maternal & fetal death
• Mild preeclampsia
– After 20 weeks, BP 140 mm Hg systolic or 90 mm Hg diastolic
– Proteinuria (3 g/24 hours)
• Severe preeclampsia (life-threatening)
– BP 160 mm Hg systolic or 100 mm Hg diastolic
– Proteinuria (5 g/24 hours)
– Elevated creatinine (>1.1 mg/dL)
• Underlying Cause: Vasospasms causing poor tissue perfusion
Hospital Care of Pre-eclampsia
• Mild preeclampsia
– Low activity, diet (well-balanced, high protein)
– Frequent monitoring for fetal and maternal well-being
• Severe preeclampsia
– Immediate hospitalization for treatment
– Possible early childbirth, foley catheter in
Hospital Care of Preeclampsia (cont’d)
• Rapid initiation of medication to lower BP
• Therapeutic goal – diastolic BP between 90-100 mm Hg
• Medications
– Labetalol (Trandate) IV
– Hydralazine (Apresoline) IV
– Nifedipine (Procardia) PO
– Magnesium Sulfate IV (4-7 mg/dl is therapeutic level) – prevent seizure, lowers BP short term; given for
at least 24hrs
-Antidote: Calcium Gluconate IV
,Eclampsia
• Occurrence of seizure or coma
• Treatment
– Magnesium sulfate
– Antihypertensive agents
• Observe fetal reaction to seizure
• Fetus should recover when mother stabilizes
• Give supplemental oxygen following seizure
Lab Diagnosis: HELLP Syndrome
• Hemolysis
• Elevated Liver enzymes
• Low Platelet count
Associated with severe preeclampsia
• Symptoms
– Nausea, vomiting, malaise, epigastric pain (liver), RUQ pain
– Results in anemia, thrombocytopenia, jaundice
– HELLP should be delivered regardless of gestational age!
Nageles’ Rule
Nägele’s Rule important to know
• Most common method of determining EDB
• First day of LMP, – 3 months, + 7 days, and (add 1 year if needed) = EDB
Nägele’s Rule Examples
A. Last Menstrual Period: Dec 18, 2013 = Sept 25, 2014
B. Last Menstrual Period: Jan 15, 2013 = Oct 22, 2013
Know How Determine Gravida and Para: TPAL
Pregnancy and Birth History
• Gravida – number of pregnancies including current pregnancy twins = 1 Gravida
, • Para– Birth after 20 weeks’ gestation, regardless of whether the infant is born alive or dead how many
births
– full Term – number of pregnancies delivered at 38.0 weeks or later
– Preterm – number of pregnancies delivered from 20 to 37.6 weeks
– Abortion – number of pregnancies ending in spontaneous or therapeutic abortion prior to 20.0
weeks
– Living Children– number of currently living children
(Consideration for more than 1 fetus)
Acronym “Florida Power And Light”
GTPAL Examples
A. May is 6 weeks pregnant. Her previous two pregnancies ended in live births at 41 weeks
G3 T2 P0 A0 L2
B. Sue is experiencing her fourth pregnancy. Her first pregnancy ended in a spontaneous abortion
at 8 weeks, the second resulted in the live birth of a son at 38 weeks, and the third resulted in
the live birth of a daughter at 34 weeks.
G4 T1 P1 A1 L2
Goodell’s, Chadwick’s, Hegar’s, and McDonalds Signs
More Objective (Probable Signs) Changes
• Hegar’s Sign: softening of the lower uterine segment
• Goodell’s Sign: Softening of the cervix
• Chadwick’s Sign: Blue-ish discoloring of the cervix, vagina, and labia due to increased blood flow
Know how to assess the fundal height and correlation with gestational age
Uterine Assessment
• Physical assessment
• Fundal height fetus grows about 1 cm each week- measure from top of pubic symphysis to top of
uterine fundus
Most accurate btwn 22-36 weeks; +/- 2cm is considered normal
– McDonald’s method (18-38 weeks gestation is accurate)
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Edumaxsolutions. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $11.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
83507 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now