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NUR 437 Exam 2 Questions and Answers Latest Update
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NUR 437 Exam 2 Questions and Answers Latest Update
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NUR 437 Exam 2 Questions andAnswers Latest Update
Hypertension - Answer-BP > 140/90
Gestational Hypertension - Answer-is hypertension after 20 weeks WITHOUT
proteinuria or other system findings, B/P greater than 140/90
Diagnosis based on 2 measurements meeting criteria within a 1 week period
More common in primigravidas and multifetal pregnancies
Goals of therapy: ensure maternal safety and deliver a healthy newborn
Home care
Maternal and fetal assessment
Activity restriction
Diet
Preeclampsia - Answer-hypertension and proteinuria
Risk factors:
Primigravidity in woman <19 or >40 years of age
First pregnancy or a new partner
History of preeclampsia
Multifetal pregnancy or hydatiform mole
Cause: unknown
Patho
Inadequate vascular remodeling leads to decreased placental perfusion and hypoxia
which causes endothelial cell dysfunction(vasospasm, increased peripheral resistance,
and increased endothelial permeability) causing decreased tissue perfusion which
manifests in the signs and symptoms
S/sx of Preeclampsia - Answer-Hypertension
Proteinurea(albumin)
Serum uric acid increases, sodium and water retained(oliguria)
Serum albumin decreases
Hematocrit increases
Pulmonary edema
Elevated liver enzymes
epigastric/right upper quadrant pain
Cerebral edema and hemorrhage, headaches, hyperreflexia, positive ankle clonus, and
seizures
Visual disturbances
Fetal effects
Fetal growth restriction, decreased amniotic fluid volume, abnormal fetal oxygenation,
low birth weight, preterm birth
,Chronic Hypertension - Answer-elevated B/P before 20 weeks; women may acquire
preeclampsia or eclampsia
Eclampsia - Answer-is development of convulsions or coma: 1 in 2000 births, 50% in
the antepartum period
Nursing care of the preeclamptic/eclamptic patient - Answer-Preconception counseling
for modifiable risk factors(smoking, weight)
Exercise can be protective
Stress management
Assess blood pressure and subtle clinical changes like sudden weight gain, edema,
headache, oliguria, reflexes, right sided pain, and fetal distress(fetal monitoring)
Environmental alteration(limit visitors, lower lights, and minimal sound)
Low dose aspirin(60-80mg) has been found to reduce preeclampsia
HOSPITAL PRECAUTIONARY MEASURES
Environment
Quiet
Nonstimulating
Lighting subdued
Seizure precautions
Suction equipment tested and ready to use
Education on long term effects
Women with severe preeclampsia have an increased risk:
a. in a future pregnancy.
b. of developing chronic hypertension and
cardiovascular disease later in life.
Women should be educated about lifestyle changes (maintaining a healthy weight,
increasing physical activity, and avoiding smoking) that may decrease the risk for
developing future health problems.
HELLP syndrome and s/sx - Answer-Variant of severe preeclampsia that involves
hepatic dysfunction that involves H-hemolysis, EL-elevated liver enzymes, LP-low
platelets
Result of arteriolar vasospasm, endothelial cell dysfunction with fibrin deposits, and
adherence of platelets in blood vessels
The clinical presentation is often nonspecific; most women with the disorder report the
following:
History of malaise
Influenza-like symptoms
Epigastric or right upper quadrant abdominal pain
Symptoms worsen at night and improve during the daytime.
Pregestational DM - Answer-Women who have either Type 1 or Type 2 diabetes prior to
pregnancy which may be complicated by vascular disease, retinopathy, nephropathy, or
other diabetic complications.
, Gestational DM - Answer-Only women whose glucose intolerance was diagnosed
during pregnancy but who do not meet the criteria defining type 1 or type 2 diabetes are
included in the gestational diabetes category.
Risk factors for gestational DM - Answer-family history of diabetes and a previous
pregnancy that resulted in an unexplained stillbirth or the birth of a malformed or
macrosomic fetus. Other risk factors for GDM include obesity, hypertension, glycosuria,
and maternal age older than 25 years. However, more than half of all women diagnosed
with GDM do not have these risk factors. More likely to occur among Hispanic, African-
American, Native-American, Asian, and Pacific Islander women than Caucasians and is
likely to recur in future pregnancies;
When are most women screened for gestational DM? - Answer-24-28 weeks, those with
strong risk factors screened earlier
What happens when women develop gestational DM after the 1st trimester? - Answer-
No increase in the incidence of birth defects has been found among infants of women
who develop GDM after the first trimester because the critical period of organ formation
has already passed by that time.
Preconception/antepartum care of presentational DM - Answer--Preconception
counseling on glycemic control
-frequent monitoring
-Diet, exercise, insulin therapy
-self monitoring
-urine testing
-fetal surveillance
Preconception/antepartum care of gestational DM - Answer-Dietary modification is the
mainstay of treatment for GDM. The woman with GDM is placed on a standard diet for
women with diabetes. The usual prescription is 30 kcal/kg/day based on a normal
preconception weight. For obese women the usual prescription is up to 25 kcal/kg/day,
which translates into 1500 to 2000 kcal/day. Carbohydrate intake is restricted to
approximately 50% of caloric intake.
A moderate exercise program is recommended for overweight or obese women with
GDM in order to improve blood sugar control and facilitate weight loss.
A typical schedule for monitoring blood glucose is on rising in the morning, 1 or 2 hours
after breakfast, before and after lunch, before dinner, and at bedtime.
Approximately 25% of women with GDM require insulin during the pregnancy to
maintain satisfactory blood glucose levels, despite compliance with the prescribed diet.
Intrapartum nursing care of presentational diabetes? - Answer--Monitoring for
dehydration
-Blood glucose levels carefully monitored
-Continuous EFM
-Intravenous infusion
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