High Risk Pregnancy Part II Student PDF

High Risk Pregnancy Part II Bleeding and Gestational Conditions  Gestational Conditions Gestational Hyperemesis diabetes gravidarum mellitus Hemorrha...

High Risk Pregnancy Part II Bleeding and Gestational Conditions  Gestational Conditions Gestational Hyperemesis diabetes gravidarum mellitus Hemorrhagic Disorders that did not exist disorders Hypertensive before pregnancy disorders of pregnancy Put client and fetus at risk Infections during Non- Trauma pregnancy obstetrical during surgery during pregnancy pregnancy Hemorrhagic Disorders Maternal blood loss decreases 02-carrying capacity. ○ Increased risk for hypovolemia anemia infection preterm labour/birth Early Pregnancy Late Pregnancy miscarriage placenta previa premature dilation of placental abruption cervix ectopic pregnancy cord insertion molar pregnancy disseminated intravascular coagulation  Premature Dilation of the Cervix Passive and painless dilation of the cervix without contractions or labour in the 2nd trimester Acquired – history of previous cervical trauma during childbirth or mechanical dilation for gynecologic procedures Congenital – collagen disorders, uterine abnormalities  Premature Dilation of the Cervix Recurrent pregnancy loss at progressively earlier gestational ages Typically diagnosed based on obstetrical history along with assessment of cervix via speculum/digital examination Short Cervix Less than 25mm indicative of reduced cervical competence Diagnosed through transvaginal ultrasound Medical-surgical management Cervical cerclage ○ Prophylactic Placed at 12-14 weeks ○ Rescue: if cervical change Placed between 16-23 weeks Removed at 36 weeks Conservative management ○ restricted activity (?) ○ Progesterone therapy ○ hydration  Fertilized ovum Ectopic Pregnancy implants outside uterine cavity 95% occur in fallopian tube ○ Most often ampullar Ectopic Pregnancy Classic symptoms: Missed period Spotting 6-8 weeks post-period Mild-mod red or dark brown bleeding Abdominal pain Dull, lower quadrant progressing to sharp, stabbing Risk factors: Previous STI, ART  nitis o rit Pe Blood in Ectopic Pregnancy peritoneal cavity Rupture is a major concern Shoulder pain referred pain -- from blood pooling under diaphragm which shares dermatome with shoulder Blueness around umbilicus (Cullen sign) Due to blood in peritoneum May have hemodynamic instability Shock Medical emergency Tachycardia, dizziness, hypotension (late sign) Would you expect clients with a ruptured ectopic to always have vaginal bleeding?  Termination recommended Treatment options: Pharmacologic Methotrexate: destroys rapidly dividing cells Monitor hcG levels Don’t forget to Surgical check the Salpingostomy: products of conception removed from tube client’s blood Salpingectomy: removal of tube type! Question time! A primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that A. bed rest and analgesics are the recommended treatment. B. they will be unable to conceive in the future. C. a D&C will be performed to remove the products of conception. D. hemorrhage is the major concern. Hydatidiform Mole Abnormal fertilization Benign, proliferative growth of placental trophoblast Vesicles resemble bunch of white grapes Hydatidiform Mole Clinical Characteristics Clinical Manifestations Uterus fills with vesicles distention pain Uterus typically larger than Expulsion of vesicles expected for dates (due to Vaginal bleeding anemia being filled with vesicles) (brown or red) hyperemesis Abnormal trophoblast tissues secrete excess amounts of hCG hCG levels gravidarum  Hydatidiform Mole Pre-eclampsia occurs in more than 70% of rapidly growing molar pregnancies Clients dx with pre-eclampsia before 24 weeks should be investigated for molar pregnancy Diagnosis: hCG levels Transvaginal ultrasound Don’t forget to check Most pass spontaneously the client’s blood type! If not, suction curettage or hysterectomy Require regular monthly hCG testing x 1 year after - rule out progression to gestational trophoblastic disease a ncy-related Should avoid pregnancy during Pregn this time tumors  Question time! A nurse is giving discharge instructions to a patient who just had suction curettage secondary to a hydatidiform mole. The patient asks why they must take oral contraceptives for the next 12 months. What is the basis for the nurse’s response? A. The chance of a successful pregnancy within 1 year of this condition is very small. B. A major risk after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that the body produces during pregnancy. Pregnancy would make this diagnosis more difficult. C. The chance of developing a second molar pregnancy after 1 year is rare but it can and does happen. D. Oral contraceptives are the only form of birth control that are acceptable at this time. All other forms, specifically intrauterine device (IUD), often promote inappropriate growth of trophoblastic tissue.  Placenta Previa Placenta implanted in lower uterine segment such that it completely or partially covers cervix or Close enough to the cervix to cause bleeding when the cervix dilates or effaces Placenta Previa Degree that internal cervical os covered by placenta: Complete Marginal placenta previa placenta previa Os totally covered 2.5cm or closer case of “apparent” placenta Low-lying placenta previa in 2nd trimester Question time! What is the classification of placenta previa when the placental edge is 2.0 cm from the internal cervical os? A. Complete B. Marginal C. Low-lying D. Incomplete  Placenta Previa Hx caesarean birth Pregnancies with male fetuses Factors Advanced age Multiple gestation Risk Multiparity Previous pregnancy with placenta History of prior suction curettage previa Smoking Clinical Manifestations Typically diagnosed by ultrasound Bright, painless bleeding in 2/3rd trimester Soft, non-tender uterus Management of Placenta Previa < 36 weeks, no > 36 weeks or bleeding labour, mild bleeding excessive or persistent Expectant management: Active management: Reduced activity and close obs Immediate C-section Often hospitalized Blood loss may not stop with the Pelvic rest, avoid: infant’s birth * sex risk for PPH vaginal exams decreased musculature in Assess for bleeding lower uterine segment 1gm = 1ml blood * If excessive bleeding cannot be controlled, a hysterectomy may be necessary  Premature separation of Placental Abruption placenta from uterine wall Maternal HTN is major risk factor; also trauma to abdomen, cocaine use, previous abruption By degree of separation Class 1 Class 2 Class 3 mild moderate severe 10-20% separated 20-50% separated > 50 % separated By presence of bleeding Do not always have vaginal bleeding!  Placental Abruption Class 1 Class 2 Class 3 Placenta Previa (10-20%, mild) (20-50%, mod) (> 50%, severe) Pain None Mod to severe Agonizing None Uterine Increased tone, may Tetanic contraction, Normal Normal tone be localized board-like abdomen Vaginal Minimal Absent to moderate Absent to heavy Minimal to severe bleeding Colour of Dark red Bright red blood Maternal Rare Mild Common (DIC) Uncommon shock Effects on Normal FH Atypical Abnormal Normal FH Fetus  Question time! A nurse suspects a patient has a placental abruption, as opposed to placenta previa based on the presence of which clinical manifestations? Select all that apply A. Lack of contractions B. Intense abdominal pain C. Localized uterine tenderness D. The presence of bright red blood Disseminated Intravascular Coagulation (DIC) Conditions such as: Placental abuption Severe pre-eclampsia Trigger… Over-activation of the Retained dead fetus syndrome Amniotic fluid embolus clotting cascade Trauma Gram (-) sepsis Formation of clots Run out of platelets and (can occlude organs) clotting factors Ischemia of organs Widespread Bleeding Hemorrhage, anemia, ischemia  When the trophoblasts (placenta) extends Abnormal Placentation beyond the normal endometrial barrier Beyond normal barrier Extends into myometrium Extends beyond Hemorrhage! uterine serosa C/s between 34-36 Total abdominal weeks hysterectomy Sam’s pregnancy had been progressing as expected until approximately 32 weeks. At this point, Sam reported to her PCP that she has been experiencing more frequent headaches during the past few days. Prenatal assessment findings at today’s appointment as follows: - BP 142/92 (was 144/94 15 minutes ago) - 2+ protein on urine dipstick - Pain just under ribcage - Deep tendon reflexes 3+ Why do we care about hypertension in pregnancy? Acute renal failure Maternal Pulmonary edema HELLP syndrome Morbidity Cerebral edema with seizures Hepatic rupture Maternal Placental abruption Mortality Eclampsia Complications of… Risks to placental abruption preterm birth Fetus IUGR Classifying Hypertension in Pregnancy Non-severe hypertension: Severe hypertension: sBP > 140mmHg sBP > 160mmHg and/or or dBP > 90mmHg dBP > 110mmHg (based on at least 2 measurements taken 15 mins apart) Effects of Hypertension on Fetus Non-severe hypertension: Severe hypertension: sBP > 140mmHg sBP > 160mmHg and/or or dBP > 90mmHg dBP > 110mmHg Fetal heart rate May be abnormal May be abnormal Placental perfusion Reduced, may be olihohydramnios Decreased – IUGR, decelerations in labour Premature aging of placenta None apparent Placenta appears aged at birth  Hypertensive Disorders in Pregnancy 1. Chronic hypertension ○ Present before pregnancy or prior to 20 weeks gestation 2. Gestational hypertension ○ Development of hypertension at or after 20 weeks gestation Normotensive prior to pregnancy 3. Pre-eclampsia Gestational hypertension + new onset proteinuria > 0.3 g/L in 24 hr specimen (+ potentially end-organ damage) Proteinuria Healthy kidneys don’t “spill” protein (albumin) > 0.3 g/L in 24 hr specimen 2+ or greater  Why do some pregnant people Endothelial cell dysfunction get pre-eclampsia Dietary deficiencies/excess Abnormal prostaglandin action Immunologic factors Genetics Coagulation abnormalities Pathophysiology of pre-eclampsia Dietary deficiencies/excess Endothelial cell dysfunction Genetics Immunologic factors Abnormal prostaglandin action Coagulation abnormalities Endothelial Intravascular Activation of fluid cell coagulation redistribution activation cascade Vasoconstriction Pathophysiology of pre-eclampsia Endothelial cell activation Intravascular Activation of fluid Vasoconstriction coagulation Cardiorespiratory redistribution cascade Hematological D E C R E ASE D O R G A N P E R FUSION Renal CNS Hepatic Pathophysiology of pre-eclampsia Endothelial cell activation Intravascular Activation of fluid Vasoconstriction coagulation Cardiorespiratory redistribution cascade Hematological HTN D E C R E ASE D O R G A N P E R FUSION Generalized edema Pulmonary edema Respiratory distress Renal CNS Hepatic Pathophysiology of pre-eclampsia Endothelial cell activation Intravascular Activation of fluid Vasoconstriction coagulation Cardiorespiratory redistribution cascade Hematological HTN D E C R E ASE D O R G A N P E R FUSION Generalized edema Pulmonary edema Respiratory distress Renal CNS Hepatic Headache Visual disturbance Neuromuscular irritability (hyperactive reflexes) Eclampsia Pathophysiology of pre-eclampsia Endothelial cell activation Intravascular Activation of fluid Vasoconstriction coagulation Cardiorespiratory redistribution cascade Hematological HTN D E C R E ASE D O R G A N P E R FUSION Generalized edema Pulmonary edema Respiratory distress Renal CNS Hepatic Proteinuria Headache Acute tubular Visual disturbance necrosis Neuromuscular irritability (hyperactive reflexes) Acute kidney injury Eclampsia Pathophysiology of pre-eclampsia Endothelial cell activation Intravascular Activation of fluid Vasoconstriction coagulation Cardiorespiratory redistribution cascade Hematological HTN D E C R E ASE D O R G A N P E R FUSION Generalized edema Pulmonary edema Respiratory distress Renal CNS Hepatic Proteinuria Inflammation Headache Acute tubular Dysfunction/failure Visual disturbance necrosis Acute kidney injury Hematoma/rupture Neuromuscular irritability (hyperactive reflexes) Eclampsia Pathophysiology of pre-eclampsia Endothelial cell activation Intravascular Activation of fluid Vasoconstriction coagulation Cardiorespiratory redistribution cascade Hematological Hemolysis HTN D E C R E ASE D O R G A N P E R FUSION Generalized edema Thrombocytopenia Pulmonary edema Disseminated Respiratory distress intravascular coagulation Renal CNS Hepatic Proteinuria Inflammation Headache Acute tubular Dysfunction/failure Visual disturbance necrosis Acute kidney injury Hematoma/rupture Neuromuscular irritability (hyperactive reflexes) Eclampsia Explain the following findings in relation to pre-eclampsia: - BP 142/92 - 2+ protein on urine dipstick - Pain just under ribcage - Deep tendon reflexes 3+ (2+ is normal)  HELLP Syndrome Laboratory diagnosis of severe pre-eclampsia Involves hepatic dysfunction, characterized by: Increased risk of: H Placental abruption Hemolysis (RBC breakdown) Renal failure Pulmonary edema EL Ruptured liver hematoma Elevated Liver Enzymes Disseminated intravascular coagulation (DIC) LP Low Platelets (thrombocytopenia) 43 Question time! A pregnant patient with pre-eclampsia is going to be induced. This patient has been diagnosed with HELLP syndrome. Which laboratory finding would the nurse expect to note in the client’s chart? A. Elevated Hb count B. Low AST (liver enzyme) C. Decreased platelet count D. Decreased urinary excretion of protein  Assessing Clients with Pre-eclampsia Health of fetus (NST, Swelling, biophysical profile, weight ultrasounds, kick counts, etc.) gain Intravascular Activation of fluid Vasoconstriction coagulation Cardiorespiratory redistribution cascade Hematological Hemolysis BP, 02 D E C R E ASE D O R G A N P E R FUSION HTN CBC sat Generalized edema Thrombocytopenia Pulmonary edema Disseminated intravascular Lung Respiratory distress coagulation sounds Renal CNS Urinalysis, 24 Hepatic Headache Proteinuria Headache hour urine Inflammation Acute tubular Liver function test Visual disturbance Dysfunction/failure necrosis Changes to vision, spots Neuromuscular irritability (clonus) Acute kidney injury Hematoma/rupture Eclampsia Urine output Epigastric pain Assess reflexes KF test  Question time! A nurse is concerned about which findings in a primigravida at 36 weeks that is being monitored in the prenatal clinic for pre-eclampsia? Select all that apply A. Blood pressure (BP) increase to 132/83 mm Hg B. Weight gain of 0.5 lb during the past 2 weeks C. 24 hr urine protein reading of 0.4 g/L D. Deep tendon reflexes 3+ E. Pitting 1+ pedal edema at the end of the day  Interventions for Clients with Pre-eclampsia Delivery!! Weight daily May need care in ICU if severe Swelling, Health of fetus (NST, weight biophysical profile, ultrasounds, etc.) gain Intravascular Activation of fluid Vasoconstriction coagulation Cardiorespiratory redistribution cascade Hematological Reduced activity Hemolysis BP, 02 HTN CBC Atihypertensives IV access sat Generalized edema Thrombocytopenia Pulmonary edema Disseminated intravascular Lung Respiratory distress coagulation sounds Renal Headache CNS Urinalysis, 24 Hepatic Proteinuria Headache hour urine Inflammation Acute tubular Liver function test Changes to vision, spots MgS04 IV Dysfunction/failure Visual disturbance necrosis infusion Assess reflexes Neuromuscular irritability (clonus) Acute kidney injury Hematoma/rupture Eclampsia Epigastric pain Quiet, non-stimulating Urine output environment with subdued Seizure KF test precautions lighting – visitor restrictions Foley catheter (urimeter)  Antihypertensive Options in Pregnancy Labetolol Methyldopa (Aldomet) Beta blocker Centrally acting antiadrenergics Hydralazine (Apresoline) Nifedipine Vasodilator Calcium channel blocker BP should not be lowered abruptly… can affect placental perfusion Pharmacologic Treatment Magnesium Sulphate aims to prevent/control eclamptic seizures Interferes with release of acetylcholine at synapses Decreased neuromuscular and CNS irritability Depresses cardiac conduction Loading and maintenance dose via IV Pharmacologic Treatment CNS depressant ○ Assess for S&S of toxicity: vomiting, resp distress, hypotension, flushing, muscle weakness, decreased reflexes, oliguria, decreased LOC, slurred speech 1:1 nursing care ○ If toxicity: Stop infusion immediately Prepare Calcium Gluconate (antidote) ○ Monitor FHR Diuresis is sign of improvement ○ MgS04 relaxes blood vessels, decreases vasospasm Increased blood flow/perfusion to kidneys!  Question time! A pregnant patient, who is near term, has been receiving a magnesium sulphate infusion for treatment of severe pre-eclampsia for 24 hours. On assessment a nurse finds the following vital signs: temperature of 37.3°C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The patient states, “I’m so thirsty and warm.” What is the nurse’s initial intervention? A. Call for a stat magnesium sulphate level. B. Administer oxygen. C. Discontinue the magnesium sulphate infusion. D. Prepare to administer hydralazine. E. Administer Calcium Gluconate.  Label the following interventions as appropriate/inappropriate for a 37 week pregnant client with severe pre-eclampsia Intervention Appropriate Inappropriate Lab tests: CBC, KF, LFTs Administer MgS04 to decrease blood pressure Allow no more than 2-3 visitors at a time Assess deep tendon reflexes Place bed in highest position Perform non-stress test Encourage mobilization up and down the hall  Eclampsia Pregnant client and fetus Can have premonitory symptoms and signs or appear not taking in 02 during seizures without warning Tonic clonic muscle activity Muscles alternatively relax and contract Interventions Ensure patent airway Post-seizure care Prevent injury Do not leave the patient Assess for aspiration Record characteristics Provide hygiene Administer MgSo4 Support patient and family Monitor fetus Question time! A pregnant patient with pre-eclampsia has a seizure. What is a nurse’s priority intervention? A. Ensure a patent airway. B. Suction the mouth to prevent aspiration. C. Administer oxygen by mask. D. Turn the patient on their side.  Postpartum Symptoms usually resolve within 48 hours ○ HTN may persist ○ Assess headaches, blurred vision, urine output, etc. Effects of magnesium sulphate Muscle relaxant May potentiate action of narcotics Risk for boggy uterus Administer carefully, ○ Monitor lochia/fundus Assess LOC, BP, P, RR before medicating for ○ Administration of oxytocin pain Future health care ○ 20% recurrence risk Urinary Tract Infection in Pregnancy Asymptomatic Bacteriuria * Cystitis * Bacteria in No urine symptoms “Bladder infection” Pyelonephritis ** Renal infection Testing at initial visit to Dysuria, frequency, check for this suprapubic pain Fever, chills, aching in lubar area, n&v May progress to Can lead to pyelonephritis Can cause preterm ascending UTI if Usually requires labour later in untreated hospitalization ** pregnancy * Treated with antibiotics ** IV antibiotics Question time! A nurse would administer methotrexate as part of the treatment plan for which obstetrical complication? A. Complete hydatidiform mole B. Missed abortion C. Unruptured ectopic pregnancy D. Abruptio placentae Non-obstetrical Surgery in Pregnancy Appendicitis ○RLQ pain ○Appendix is located higher in pregnancy Intestinal obstruction ○Abd pain, emesis constipation Cholelithiasis and cholecystitis ○Pregnancy interferes with gallbladder drainage, hormones ○Surgery may be delayed until post-partum Gynecological problems ○Ovarian cysts for example ○Laparotomy or laproscopy Trauma During Pregnancy Effect of trauma influenced by: ○Length of gestation ○Type and severity of the trauma such as blunt abdominal trauma, stabbing, gunshot, etc. ○Degree of disruption of uterine and fetal physiological features Careful monitoring of fetal status ○Electronic fetal monitor CPR in Pregnant Client Standard resuscitative efforts with: ○ Uterus displaced laterally Consider Caesarean if no maternal response ○ Fluid volume restoration after 4-5 minutes of trying to resuscitate client ○ Defibrillation if needed Perimortem birth rarely Monitor fetus (if possible) successful  NURS 2002 Pre-class Worksheet and Study Guide High Risk Pregnancy Part II 1. Differentiate between chronic hypertension, gestational hypertension, and pre- eclampsia. Hypertensive Disorders in Pregnancy 1. Chronic hypertension ○ Present before pregnancy or prior to 20 weeks gestation 2. Gestational hypertension ○ Development of hypertension at or after 20 weeks gestation Normotensive prior to pregnancy 3. Pre-eclampsia Gestational hypertension + new onset proteinuria > 0.3 g/L in 24 hr specimen (+ potentially end-organ damage) What is proteinuria, and how can it help detect pre-eclampsia? Proteinuria Healthy kidneys don’t “spill” protein (albumin) > 0.3 g/L in 24 hr specimen 2+ or greater What is eclampsia? Is characterized by seizures from profound cerebral effects of pre-eclampsia, is the major maternal risk What is premature dilation of the cervix? How is it diagnosed? Premature Dilation of the Cervix Passive and painless dilation of the cervix without contractions or labour in the 2nd trimester Acquired – history of previous cervical trauma during childbirth or mechanical dilation for gynecologic procedures Congenital – collagen disorders, uterine abnormalities Premature Dilation of the Cervix Recurrent pregnancy loss at progressively earlier gestational ages Typically diagnosed based on obstetrical history along with assessment of cervix via speculum/digital examination Short Cervix Less than 25mm indicative of reduced cervical competence Diagnosed through transvaginal ultrasound  Medical-surgical management Cervical cerclage ○ Prophylactic Placed at 12-14 weeks ○ Rescue: if cervical change Placed between 16-23 weeks Removed at 36 weeks Conservative management ○ restricted activity (?) ○ Progesterone therapy ○ hydration 2. What is an ectopic pregnancy? What clinical manifestations are associated with this condition? Fertilized ovum Ectopic Pregnancy implants outside uterine cavity 95% occur in fallopian tube ○ Most often ampullar  Ectopic Pregnancy Classic symptoms: Missed period Spotting 6-8 weeks post-period Mild-mod red or dark brown bleeding Abdominal pain Dull, lower quadrant progressing to sharp, stabbing Risk factors: Previous STI, ART itis i ton r Pe Blood in Ectopic Pregnancy peritoneal cavity Rupture is a major concern Shoulder pain referred pain -- from blood pooling under diaphragm which shares dermatome with shoulder Blueness around umbilicus (Cullen sign) Due to blood in peritoneum May have hemodynamic instability Shock Medical emergency Tachycardia, dizziness, hypotension (late sign) Would you expect clients with a ruptured ectopic to always have vaginal bleeding? What is a molar pregnancy? What clinical manifestations are associated with this condition? Hydatidiform Mole Abnormal fertilization Benign, proliferative growth of placental trophoblast Vesicles resemble bunch of white grapes Hydatidiform Mole Clinical Characteristics Clinical Manifestations Uterus fills with vesicles distention pain Uterus typically larger than Expulsion of vesicles expected for dates (due to Vaginal bleeding anemia being filled with vesicles) (brown or red) hyperemesis Abnormal trophoblast tissues secrete excess amounts of hCG hCG levels gravidarum Explain the difference between a placenta previa and a placental abruption. Placenta Previa Placenta implanted in lower uterine segment such that it completely or partially covers cervix or Close enough to the cervix to cause bleeding when the cervix dilates or effaces Premature separation of Placental Abruption placenta from uterine wall Maternal HTN is major risk factor; also trauma to abdomen, cocaine use, previous abruption By degree of separation Class 1 Class 2 Class 3 mild moderate severe 10-20% separated 20-50% separated > 50 % separated By presence of bleeding Do not always have vaginal bleeding! What is disseminated intravascular coagulation? Disseminated Intravascular Coagulation (DIC) Conditions such as: Placental abuption Severe pre-eclampsia Trigger… Over-activation of the Retained dead fetus syndrome Amniotic fluid embolus clotting cascade Trauma Gram (-) sepsis Formation of clots Run out of platelets and (can occlude organs) clotting factors Ischemia of organs Widespread Bleeding Hemorrhage, anemia, ischemia  In-class activity High Risk Pregnancy Part II True or False? As we move through the lecture, identify if each of the following points is true or false. Provide rationale for this response. True (why?) False (why?) Premature dilation of the cervix typically involves False abdominal pain and cramping A client had a previous pregnancy loss due to True premature dilation of the cervix. It is expected that they will have a prophylactic cervical cerclage placed between approx. 12-14 weeks Most ectopic pregnancies occur in the abdominal False-> Fallopian tube cavity A client with a ruptured fallopian tube will always False-> Pearatuiem have vaginal bleeding All clients who have an ectopic pregnancy will require False->Metoxrate a salpingectomy (removal of affected fallopian tube) The uterus is typically smaller than expected for False-> Larger dates in clients with a molar pregnancy (hydatiform mole) A low-lying placenta is a case of apparent placenta True previa noted on 2nd trimester ultrasound A client who presents with bleeding due to placenta False previa is also expected to present with abdominal pain Clients with a placental abruption always experience False-> Inside of vaginal bleeding Placentia A client who presents with a severe placental True abruption often also presents with abdominal pain Pre-eclampsia involves general hypertension, new True onset proteinuria, and potentially end-organ damage Proteinuria is diagnosed when serum protein levels False- Urine protein are higher than expected levels Clients with pre-eclampsia usually exhibit hypoactive False-> Hyperactive deep tendon reflexes Clients with HELLP syndrome usually have increased False RBC and platelet counts Clients with pre-eclampsia should be kept in a quiet, True non-stimulating environment Magnesium sulphate is the treatment of choice for False pre-eclampsia as it acts as an antihypertensive Naloxone is the antidote to magnesium sulphate False A client with magnesium sulphate toxicity will have True decreased deep tendon reflexes Cystitis in pregnancy should always be treated with False IV antibiotics