Nursing Care for Pregnancy Complications Quiz

Nursing Care of a Family Experiencing a Sudden Pregnancy Complication

• Symptoms of overdose include reduced consciousness, decreased urine output, decreased tendon reflexes, and depressed RR.

Supportive Care

• Support bed rest to enforce hospitalization and close observation.
• Restrict visitors to support people, such as the husband.
• Raise padded side rails to prevent injury.
• Dimly lit room is necessary.

Monitoring Maternal Well-being

• Monitor blood pressure.
• Obtain blood studies as ordered.
• Obtain daily hematocrit levels as ordered, which will rise (>40%) if increased fluid is leaving the bloodstream for interstitial tissue (edema).
• Assess weight daily at the same time.
• Indwelling catheter may be inserted.

Monitoring Fetal Well-being

• External fetal monitor is attached.
• O2 administration may be necessary to maintain adequate fetal oxygenation.

Nutritional Support

• Moderate to high protein diet.
• Moderate sodium in the diet.
• IVF line should be initiated and maintained to serve as an emergency route for drug administration.

Medication Administration

• Hydralazine (Apresoline) to reduce hypertension, administered via IV infusion pump (5-10 mg/IV).
• Hydralazine lowers blood pressure by peripheral dilatation.
• Assess pulse and BP before and after administration.
• Diastolic should not be lowered below 80-90 mmHg to prevent inadequate placental perfusion.

Mild Preeclampsia

• Symptoms include:
  • Systolic BP > 30 mmHg above pregnancy level.
  • Diastolic > 15 mmHg above pregnancy level.
  • Proteinuria +1 to +2.
  • Weight gain: 2 lbs/wk in 2nd trimester, 1 lb/wk in 3rd trimester.

Severe Preeclampsia

• Symptoms include:
  • BP > 140/90 mmHg.
  • Mild edema in upper extremities or face.
  • Cerebral edema.
  • Proteinuria: 3+ to 4+ on a random sample.
  • Oliguria: 500 ml or less in 24 hrs.
  • Pulmonary involvement: shortness of breath.
  • Hepatic dysfunction.
  • Epigastric pain due to ischemia in the pancreas and liver.
  • Visual disturbances: blurred vision or seeing spots.

Antiplatelet Therapy

• Mild antiplatelet agent, such as low-dose aspirin (81 mg), may prevent or delay the development of preeclampsia.

Bleeding Complications

• Common causes of bleeding according to trimester:
  • 1st Trimester: Spontaneous miscarriage, ectopic pregnancy.
  • 2nd Trimester: Gestational trophoblastic disease, premature cervical dilatation.
  • 3rd Trimester: Placenta previa, abruptio placentae, preterm labor, disseminated intravascular coagulation (DIC), abdominal pregnancy.

Nursing Diagnosis and Interventions

• Nursing Diagnosis: Risk for deficient fluid volume related to bleeding during pregnancy.
• Outcome Evaluation: Patient's blood pressure is maintained at above 100/60 mmHg, pulse rate is below 100 beats/min, minimal bleeding is apparent, fetal heart rate (FHR) is maintained at 120-160 beats/min with adequate short and long-term variability, and maternal urine output is greater than 30 ml/hr.

Goals of Therapy for Hypovolemic Shock

• Restoring blood volume.
• Halting the source of hemorrhage as quickly as possible.