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Nur 102 Exam 3 Exam Questions And Correct Answers
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Nur 102 Exam 3 Exam Questions And Correct AnswersSymptoms of gestational hypertension
HTN
proteinuria
edema of hands and face
developing BP systolic of 30mmHg or diastolic of 15mmHg over baseline
BP of 140/90 in the 2nd half of pregnancy
BP changed must be noted on 2 occasions 6 or more hours apart
Reference
Pre-eclampsia
most common medical disorder in pregnancy
acute HTN state that develops after the 20th wk of gestation
- usually btwn weeks 20-24 or most often in the last 10 weeks, during labor, or 48 hours
postpartum
- affects brain (seizure), liver and kidney damage, heart, lungs (crackles)
- mild or severe
mild preeclampsia
- HTN 15-30 mmHg above baseline (140/90) 2 times, 4-6 hours apart
- weight gain more than 2#/week in second trimester or 1#/week third trimester
- mild edema (extremities)
- proteinuria 1+/2+
Severe preeclampsia
- 160/110 BP
,- proteinuria 3+ or 4+
- massive edema/ weight gain
- HTN 30-40 mmHg above baseline on bedrest
- less than 400 ml urine output in 24hrs
- severe headache
- abdominal pain
- vertigo, blurred vision, N/V
- epigastric pain (liver)
- hyperreflexia
- protein creatinine over 0.3
eclampsia
- very severe symptoms
- severe edema leading to coma or seizure
- warning of convulsion: headache, epigastric pain, hyperreflexia
maternal mortality as high as 20% caused from cerebral hemorrhage, circulatory
collapse, renal failure
magnesium sulfate
***Actually has the seizure
Risk factors for gestational HTN
younger than 19 yo or older than 40 yo
first pregnancy
extreme obesity
multifetal gestation
chronic renal disease
,chronic HTN
family history of preeclampsia
diabetes mellitus
rheumatoid arthritis
systemic lupus
gestational HTN nursing interventions
bed rest, laying on side
dark room, no noise, no visitors
assess edema including pulmonary
NST, biophysical profile
High protein, low salt diet
seizure precautions
deep tendon reflexes and clonus
prepare for delivery
antihypertensives- labetalol, nifedipine, hydralazine
magnesium sulfate
NO prescribing Ace-Inhibitors, ARB- angiotensin II receptor blockers
Magnesium sulfate
MOA: treats depression to the CNS and acts as a anticonvulsant for pts with eclampsia
and severe preeclampsia
Dose: 2-6g bolus IBPB, then 1-2g/hr IV
S/E: initially se flushing, diaphoresis, anxiety, and feeling of warmth with bolus. Nausea
and lethargy.
, Toxic signs: decreased urine output and B/P, decline in RR, absent patellar reflexes
***antidote: calcium gluconate
Magnesium levels (Magnesium sulfate)
-labs drawn every 6 hours
-5-8 therapeutic
-8-10 loss of DTR's (deep tendon reflexes)
-15-20 respiratory paralysis (RR 10 or less)
->20 cardiac arrest
magnesium sulfate nursing interventions
-VS every 5 mins during bolus
Neurological checks - VS and DTR every 1-2 hours ad ordered
call DR if urinary output is less then 30 ml/hour for 2 hours, RR less than 10, or reflexes
diminished or absent
resuscitation equipment handy
Deep tendon reflex scale (DTR)
4+ hyperactive
3+ brisker than normal
2+ normal
1+ diminished
0 no response
clonus scale
normal= negative if no motion
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