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CMCA Maternal NCM 109, Cheat Sheet of Nursing

Virgen Milagrosa University Foundation (VMUF)Nursing

CMCA Maternal NCM 109 BSN 2nd Year

Typology: Cheat Sheet

2022/2023

Uploaded on 03/13/2023

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PREGNANCY INDUCED
HYPERTENSION(PIH)
Hypertension is a unique disorder with pregnancy with three
classic symptoms:
EDEMA
HYPERTENSION
AND PROTEINURIA.
It is categorized as Pre-eclampsia or eclampsia.
If mild ( blood pressure not over 140/110
•Treatment is Bed rest and perhaps low – dose aspirin .
•If severe ( blood pressure over 160/ 110), bed rest plus
Administration of Magnesium sulfate is necessary , if
seizure occurs, the condition becomes eclampsia.
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PREGNANCY INDUCED

HYPERTENSION(PIH)

Hypertension is a unique disorder with pregnancy with three classic symptoms:  (^) EDEMA  (^) HYPERTENSION  (^) AND PROTEINURIA. It is categorized as Pre-eclampsia or eclampsia. If mild ( blood pressure not over 140/

  • (^) Treatment is Bed rest and perhaps low – dose aspirin.
  • If severe ( blood pressure over 160/ 110), bed rest plus Administration of Magnesium sulfate is necessary , if seizure occurs, the condition becomes eclampsia.

PIH OCCURS:

 (^) Hypertension that develop after 20th^ week s gestation  (^) Unknown cause and known as TOXEMIAS before  (^) Occurs any time after the 20th^ week of gestation up to 2 weeks post partum  (^) Develops during pregnancy and resolves during post partum period PREDISPOSING FACTORS: a. Large fetus b. Older than 35, younger than 17 c. Primi gravida d. Multiple pregnancy or H-mole e. Poor nutrition f. History of Diabetes Mellitus, renal and vascular disease g. Morbid obesity or weight less than 100 pounds h. Family history

TYPES OF PIH

A. GESTATIONAL HYPERTENSION- Hypertension only, No Proteinuria and edema B. MILD PREECLAMPSIA ( HEP) or with Hypertension, Edema and Proteinuria  (^) Bp of 140/90 mm Hg or increase of 30 /15 mm Hg  (^) +1 to + 2 proteinuria  (^) Slight generalized edema may be present, weight gain of 1-5 lbs/week C. SEVERE PREECLAMPSIA ( HEP)  (^) Bp of 160/ 110 mm Hg  (^) + 3 to +4 proteinuria  (^) Headache and epigastric ( aura to convulsion)  (^) Oliguria of 400 ml less in 24 hours ( Normal UO or urine output per day 1500 ml)  (^) Cerebral or visual disturbances

d. ECLAMPSIA- OBSTETRICAL EMERGENCY  (^) The most severe classification of PIH  (^) With HEP with CONVULSION  (^) Coma IMMEDIATE INTERVENTION FOR ECLAMPSIA: a. Maintain IV line with large bore needle b. Monitor fluid balance c. Minimize stimuli d. Have airway and oxygen available e. Give medication as ordered ( example Magnesium sulfate , Apresoline, Valium) f. Prepare possible delivery of baby g. Type and cross match for blood h. Post partum- monitor vital sign and watch for seizure

CHECK FOR SIGNS OF MAGNESIUM SULFATE TOXICITY

  1. DTR Hyyporeflexia- absent tendon reflex (DTR)
  2. UO – Oliguria- less than 30 ml per hour
  3. RR bradypnea – below 12-16 RR ANTIDOTE: CALCIUM GLUCONATE – given 10% IV to maintain cardiac and vascular tone Earliest sign of MgSo4 toxicity  (^) Disappearance of knee jerk/patellar reflex Method of delivery – preferably NSD but if not possible CS Prognosis: the danger of convulsions is present until 48 hours post partum

f. Cathartics- cause shift of fluid from the extra cellular spaces into the intestines from where the fluids can be excreted Dosage: 10 gms initially- either by slow IV oush over 5-10 minutes or deep IM, 5 gms/ buttock , then an IV 1drip of 1 gm per hour ( 1 gm/ 100 ml D10W Intervention: a. Advise bed rest, left lateral position b. Encourage a well balanced diet c. Weigh daily, keep daily log d. Education on self – assesment e. Family support