Hi guys, it's me Professor D and welcome back to my YouTube channel. On this video, I'm going to be covering part three of preeclampsia and I'm going to be going over patient management of the patient that has preeclampsia without severe features and those with severe features. I hope you guys are enjoying your Thanksgiving weekend.
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Thank you for getting me to 100K. All right, guys. Before one more thing, before we get started, I want to remind you, I do have audio lessons available on my website, NexusNursingInstitute.com. So we're going to start with the intervention for that patient that has preeclampsia, but it's preeclampsia without the severe features. Now, if you haven't watched part one or part two yet, I strongly encourage you to go back and watch that first because it's going to make part three make a lot more sense.
You really need the foundations to understand the pathophysiology of. preeclampsia. Okay. So let's start with preeclampsia without severe features.
So most women with gestational hypertension or preeclampsia without severe features, they can be managed at home. They're going to be managed at home, but they're going to be monitored frequently. A natural birth, vaginal birth, by induction labor preceded by a cervical ripening, if necessary, is recommended between, excuse me, beginning at age.
beginning at 37 gestational weeks. So let's talk about that. So mom that has gestational hypertension, it's recommended that at 37 weeks for her to have a vaginal birth, and it's going to be induced if necessary.
And that surface might have to be ripened in order for that induction of labor to happen. But we want it to happen at 37 weeks. Let's keep going. Outpatient management can be considered for reliable women. What do they mean when they say reliable women?
Guys, whenever you're studying and you see them throw in a word that usually they don't throw in when you're reading your textbook, you have to ask yourself why they say this. They could have just said outpatient management can be considered for women, but they said reliable women. Why did they throw in that adjective?
Because they want you to know that only women that we can trust to do what we tell them to do can do this because we have lots of patients who are what? Non-compliant. So let's go back.
Outpatient management. So we're not keeping them in the hospital, we're managing them at home, but they may have to come into the facility. Outpatient management can be considered for reliable women who have a systolic blood pressure of 155 or less, diastolic of 105 or less, with no symptoms. So they have to be reliable, they have to come in to be checked when they're scheduled to be checked. They have to follow the diet that they're given.
They have to follow the activity restrictions that they're given. The blood pressure has to be 155 over our 105 or lower, right? So you guys do have to know these qualifications.
A regular diet without salt restriction is recommended. So it says a regular diet without salt restrictions. But let me be clear, even though there are no salt restrictions, you have to be clear to them to make sure you tell them not to add. extra salt than what the food is normally cooked with.
Women should be taught to go to the hospital or outpatient facility immediately. If they develop, you got to know this list. Usually you're going to get it as a select all that applies.
Abdominal pain, significant headache, uterine contractions, vaginal spotting, or decreased fetal movement. Any one of them, mom has to come in immediately. Let's keep going.
Maternal and fetal assessment. So we're going to do measurement of the serum creatinine because we need to see what's going on with the kidneys. Platelet count, liver enzymes.
Therefore, hematocrit, platelet count, serum creatinine, liver function tests should be performed, what does it say? Every week. Not every month, not every couple weeks, every single week. Why?
Because we want to catch it early. Women are also evaluated for symptoms. of severe features such as guys let me tell you something whenever you see such as and you see a list or in the textbook they'll give you examples but they put it in parentheses where do you think your select all that applies are coming from these so when you see it make sure you know it so let's look at this list guys this list of those signs and symptoms of um severe features that we're going to be watching out for severe headache Blurred or double vision, mental confusion, right upper quadriabdominal or epigastric pain, nausea or vomiting, shortness of breath, decreased urinary output.
The blood pressure should be monitored twice weekly and proteinuria assessed weekly. Every week, we're going to be checking the urine and make sure there are no protein in the urine. We're going to fetal evaluation generally includes the daily fetal movement counts. non-stress testing or biophysical profile once or twice weekly until birth. And now if you guys don't know what that is, I did another video on that.
Make sure you guys go back and watch that. Ultrasound evaluation of the amniotic fluid status and determination of estimated fetal weight are performed at the time preeclampsia is diagnosed and serially, which means we're going to do it back to back to back to back, serially thereafter, depending on the findings. The Doppler blood flow studies are recommended if intrauterine growth retardation is even suspected.
Before I get into the activity restrictions, I want you guys to take a look at this. I've said it to you a million times, guys. Your test questions are coming from those boxes, those tables, those diagrams, those figures, those illustrations that you guys like to overlook. You just want to read the text.
But these are where your test questions are coming from. Think about it. The test writer is giving you this information in text. And then that same information they're providing text, they give it to you in another format.
That's because it's important to know. That's because you're going to see it on an exam, most likely. So let's go over assessing and reporting clinical signs of preeclampsia. And look what I wrote here. No.
With two exclamation marks. I should have had a third one. Let me add a third one.
So, you know, I'm serious. No. Know this.
So let's take a look. Take your blood pressure as directed. Always sit down to take your blood pressure. When you see always, then when you see only, when you see never, pay attention, it's important.
Always sit to take your blood pressure. Use your right arm each time for consistent and accurate readings. Support your arm on the table in a horizontal position at where? The heart level.
Next, report any increase in blood pressure to the healthcare provider. Dipstick test your clean catch urine sample as directed because what are we looking for? Proteinuria. Are we ever supposed to have a protein in the urine?
Absolutely not. Report to your healthcare provider if proteinuria is one plus or more or if you have a decrease in urine output. Both of us let, both of those guys let us know the kidney's in trouble, right?
Assess the body's, the baby's daily activity. Decreased activity. This is... four or fewer movements per day may indicate that fetal compromise should be reported. Think about it.
That fetus is very active in the womb. So if there's four or less movements, that lets us know something most likely is wrong with the fetus. You have to report it. Keep a daily log of your assessments and muy importante, report any headache, know it, dizziness, know that. Or blurred vision to your healthcare provider.
You see, I put a star next to it. I can't tell you how many times this has been a test question. Don't say I didn't warn you. All right, let's move on to activity restriction. Complete or partial bed rest for the duration of the pregnancy is still recommended frequently by healthcare providers.
However, no evidence has been found that this practice improves. But I'm telling you, they're going to recommend it. They're going to recommend it. Therefore, restrict activity rather than complete bed rest is recommended.
So, you know, you can't be going all over the place doing the most, but you can go to the restroom. You can make yourself lunch. You can, you know, have your activities of daily living, but just don't do the most.
Diversionary activities, including television and computer or smartphone use, a visit from friends and a comfortable and convenient environment are ways to cope with the boredom because you're going to be in bed a lot. Gentle exercise. Notice they could have just put exercise, but they put that adjective before that word, that verb exercise, exercise, gentle exercise. And in parentheses, they're giving you examples.
Select all that applies. Range of motion exercises, stretching. Kegel exercises and pelvic tilt are important in maintaining muscle tone, blood flow, regular bowel function, and a sense of well-being.
So all of these are types of exercises you can teach a patient to do while they're in bed. All right, now we're going to move on to severe gestational hypertension preeclampsia, but with severe features. Women diagnosed with severe gestational hypertension or preeclampsia with severe features should be hospitalized immediately for thorough evaluation of maternal fetal status. This patient is not going to be able to be monitored outpatient. They're not going to be home on bed rest.
They're going to have to be in the hospital. These women are placed on magnesium sulfate to prevent eclampsic seizures and antihypertensive medication if necessary to lower the levels of hypertension. Let me stop right here. I want you to see how the author worded this, and I'm going to explain this to you. I'm going to explain to you why.
I'm going to read the sentence to you again. Pay attention. The women are placed on magnesium sulfate to prevent eclamptic seizures. Look at me in my eyeball for a second.
Stop what you're doing. I need you to look at me in my eyeball when I say this to you. The reason that we're giving magnesium sulfate is to prevent the eclamptic seizures.
not to bring down their blood pressure. Yes, magnesium also, that is one of the side effects of the medication. It brings down blood pressure, which is wonderful, but that is not the indication of that medication for the woman with preeclampsia. You see where I stopped? Where I stopped right here, eclampsic seizures.
Let's keep going. Look at what they put. And hypertensive medication to lower severe levels of hypertension. They worded it like that on purpose. Why?
To make it clear. We're giving them magnesium to prevent the eclampsia, them going into seizures, and then we're giving them antihypertensive medication, if needed, to bring down the blood pressure. If I had a penny for every time a student would have a test question about this, and they would get it wrong because they would choose magnesium as given to lower the blood pressure, I'd be a rich woman now. Let's keep going.
Maternal assessments include blood pressure, urine output, cerebral status, presence of epigastric pain and or tenderness, labor, vaginal bleeding. This looks familiar. All of these signs and symptoms. Weren't those the signs and symptoms that we saw on the other page that we have to watch out for that I told you most likely you're going to see is a select all that applies? This is the third time I'm seeing this list.
Don't say I didn't warn you. You need to know it. Laboratory evaluation includes platelet, oh, we're seeing this again, platelet count, liver enzymes, serum creatinine.
Fetal assessment includes continuous electronic fetal heart monitoring. We're going to do a biophysical profile, ultrasound evaluation of the amniotic fluid. Again, if evidence of fetal growth restriction is found, umbilical artery, Doppler, guys, I can't pronounce, velocimetry is recommended.
This is the second or third time we're seeing this information as well. I'm telling you guys, once you start studying and reading your textbook, the way I'm teaching you to read your textbook, you're going to see your grades go higher. You're going to start to understand. You're going to start to see a pattern. All right.
When you see the author repeating information, most likely it's going to be a test question. Do index cards, whatever you have to do to make sure you understand that if you're seeing something more than once. Let's keep going. If the disease develops after 34 weeks, I circled after 34 weeks, because that's your key. You need to know that if the disease develops after 34 weeks of gestation, it's recommended that the woman give birth.
What promptly as in immediately, because severe preeclampsia has been associated with increased rates of maternal morbidity, which is illness and mortality, which means death. Okay. And not only. Has it been associated with increased illness and death in mom?
It's also been associated with significant fetal risk, risk to the fetus as well. So again, if the disease develops after 34 weeks, that's your key. After 34 weeks, she needs to give birth immediately.
Because at the end of the day, what's causing preeclampsia, that fetus in the womb? Yeah, that gestational hypertension is being caused by the fetus in the womb. Let's go over expected management.
Women who are less than 34 weeks of gestation and have no indication for giving birth immediately may be candidates for expected management. That means we're going to watch and wait. We're going to watch and wait. We're going to intervene, make her go into birth. Not make her go into birth.
Induce labor if we have to, but we're going to watch and see how that goes. That's what they mean when they say expected management, right? But look to see who we're doing expected management for.
We're doing expected management for women who are, look at this, less than 34 weeks. And they don't have any indication that they're going to be going into birth immediately. But let's scroll back up here. Look at this. Again, if they do develop the disease after 34 weeks, oh no, baby, I'm so sorry.
You're going into labor. You see the difference between these two? Let me go ahead and circle this less than 34 weeks so you can remember. Make sure you know that.
Let's keep going. Expected management includes the use of oral antihypertensive medications to maintain the systolic blood pressure between 140 and 155 and the diastolic blood pressure between 90 and 105. The management also includes ongoing maternal and fetal assessment for indicators of worsening condition. What else are they going to get?
Corticosteroids such as beta methadone or... dexamethasone, those are ordered to enhance fetal lung maturation for the gestation is less than what? 34 weeks.
Because remember, if the fetus is 34 weeks, yeah, she's going to be induced. The dose of beta-methasone is 12 milligrams IM repeated in 24 hours, while dexamethasone is given IM as four doses of six milligrams each, 12 hours apart. immediate birth is indicated if any of the following complications are present. Professor D, do I have to know this list of complications?
Absolutely. Bet your bottom dollar. What are they?
Imminent or actual eclampsia. She actually goes into seizures. Uncontrollable severe hypertension. And when they say, look at this word uncontrollable, they could have just said severe hypertension.
There's a reason they put this adjective before severe hypertension. So that word uncontrollable, that lets us know we've given them the oral antihypertensive medications. We've given them the IV antihypertensive medications.
Nothing is working. That's why it's uncontrollable. We've done what we're supposed to do and it's not working. Okay.
Uncontrollable severe hypertension, pulmonary edema, placental abruption, DIC. Remember DIC? That's when they're bleeding, then they're clotting. They're bleeding, then they're clotting. They're bleeding, then they're clotting.
Evidence of non-reassuring fetal status. just fetal gestation age less than 24 weeks or fetal demise. If mom experiences any of these, birth immediate, by the way, immediate birth is indicated.
Okay, so guys, part four, I'm going to go into intrapartum care. But for this video, part three, please let me know what you thought about this video in the comments section. Let me know what you'd like to see more of, or maybe you'd like to see me make a video where I'm covering questions on preeclampsia. I don't know.
Let me know in the comment section what you think. Don't forget, I have audio lessons available on my website, nexusnursinginstitute.com. And also, if you'd like to practice nursing questions with me daily, check out my TikTok, Instagram, or Facebook platform.
Guys, thank you so much for watching the video, and you got to catch me on the next video.