Gestational HTN/ Pre-e
When does gestational hypertension typically begin?
After 20 weeks gestation
What major event defines eclampsia?
seizures
Where is Calcium gluconate located
Labor Pyxis
what is the antidote to mag
calcium gluconate
what to do if mag level is too high
What is the diagnostic blood pressure threshold?
140/90 or higher for gestational HTN
over 160/110 for pre-e
What does HELLP stand for
Hemolysis, Elevated Liver enzymes, Low Platelets
Where do you chart baseline nursing assessment prior to starting mag
Traceview- under assessment tab
EPIC- flow sheets under pre-eclampsia Philips flowsheet
what needs to be charted q1-2h while on mag
RR, lung sounds, DTR, strict I and O, BP
risk factors for VTE
age greater than 35, multiple gestation, BMT of 30-50, marked varicose veins, pre-e, tobacco use, C-section, QBL greater than 1,000, previous or known DVT
What lab values should be monitored?
Liver enzymes, creatinine, platelets
Name one key seizure precaution.
Padded side rails, suction ready, O2 nearby
CBC w diff, CMP, uric acid blood, protein creat ratio urinalysis and culture
What is the therapeutic level for magnesium sulfate?
4–7 mEq/L
what is the loading dose for mag
4-6g over 30 mins
then followed by 2g per hour
What makes preeclampsia different from gestational hypertension?
Proteinuria or end-organ dysfunction
True or False: HELLP can occur without proteinuria or high BP.
True
what pts should not receive labetalol
pts with asthma, heart disease, CHF, or bradycardia
normal dose is 20mg IV given once to lower BP
for pts with these conditions- they can be given hydralazine/nifedipine
What fetal effect may be seen on the monitor?
Decreased variability
do mag pts need a fluid bolus
no, their fluids should not exceed 125ml/hour
Name one symptom of worsening preeclampsia
Headache, blurry vision, swelling, brisk reflexes, right upper quadrant pain
What is the definitive treatment for HELLP syndrome?
Deliver the baby
where can you get oxygen supplies, suction equipment, and padding for bed rails
store room?
reasons to discontinue mag
change in LOC of baseline, HR less than 90, SBP less than 90, RR less than 12, any sign of fetal distress, urinary output less than 100ml/4hrs, no reflexes, if mag level is greater than 8, signs of pulmonary edema or renal insufficiency
when giving a mag bolus, how often should you get vitals
every 5 mins during bolus, every 15 mins x4, then hourly if stable