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Current thought poor perfusion and endothelial cell

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Current thought: poor perfusion and endothelial cell dysfunctionArteriolar vasospasm diminishes diameter of blood vessels, which impedes blood flow to all organs & increases BPMain pathogenic factor is vasospasm and reduced plasma volumeDecreased placental perfusion contributes significantly to restriction of fetal growthDiagram on s/sx of preeclampsiaOn right are classic s/sx of preeclampsiaHELLP syndrome7
Laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunctionHemolysis (H)Elevated Liver enzymes (EL)Low Platelets (LP)Diagnosis associated with increased risk for adverse perinatal outcomesUsually develops in third trimester or within 48 hours of birthSigns & Symptomsof PreeclampsiaElevation in BP 30 mmHgover booking pressure OR 140/90Decreased urine output with + proteinHeadacheVisual changes: photophobiaEpigastric right upper quadrant painThrombocytopeniaImpaired LFTsEdemaFetal Effects:placental perfusionLaboratory Analysis: “Preeclampsia Labs”CBC Hematocrit and hemoglobin PlateletsChemistry: Cr, BUN & Uric acid Liver function test and Clotting studies Fibrinogen andPT/PTT related to progressed disease: DIC24 hour urineProtein (>5gm/l in 24 hours).Nursing Care Management[For Preeclampsia]Identifying and preventing preeclampsiaNo reliable test or screening tool has been developed Current research is centered on biomarker during prenatalscreening!Health assessmentAssess LOCAssess for visual changesMonitor Urine output and for proteinuriaMonitor for elevated b/p or b/p trending upwardsMonitor 02 sats (sats lower than 97% associated with complications)Assess for dependent and pitting edemaDeep tendon reflexes (DTRs) (hyper reflexes may be present)Activity restrictionDietTreatment[For Preeclampsia]Expectant managementBedrestDietary restrictionsLow salt, calorie controlled, heart healthyMedicationHTN medicationsHospitalizationHTN medicationsMagnesium SulfateDeliveryMagnesium Sulfate MgSO4:Care ManagementSmooth muscle relaxant: requires careful monitoring of reflexes & respirations,Can impair GFR: monitor urinary output (a sign of worsening disease is concentrated urine, increased protein output andlow volume.Safety: Antidote, calcium gluconate, should be readily available ~ no unattended drugs or syringes at the bedside ~ youshould see this coming!Loading dose: 4–6 g intravenously (IV) given over 20–30 min8
Then 2 g/hour by continuous IV infusion (pump required)(Need to make sure don’t give too fast)Contraindicated: Impaired renal functionMagnesium ToxicityFlushing, sweatingHypotensionDecreased/absent DTR’sRespiratory depression12Altered LOCCardiac arrestUrine output30 cc/hour

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Term
Summer
Professor
N/A
Tags
Obstetrics, early pregnancy, amnio

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