Flashcards in Week 4 Mo Parturient with Systemic Diseases Deck (149)
HYPERTENSION, PROTENURIA (> 5 g/day) and EDEMA (hand, face, lung)
Oliguria (< 500 ml /day), headache, visual disturbance , hepatic tenderness, hyperreflexia
(+)Seizures in preeclampsia
What is HELLP syndrome?
(high maternal and fetal mortality). Call for IMMEDIATE DELIVERY
Hemolysis, Elevated Liver enzymes, Low Platelet count
Risk factors for Pregnancy induced hypertension?
Nulliparity, AA, extreme of age (<15 or >35), multiple gestation. Vascular disease due to SLE and DM, + family history, chronic HTN, HELLP SYNDROME
Pathophysiology for pregnancy induced hypertension?
Increased: Thromboxane A2, endothelin-1, renin.
Decreased: PGI2, NO
S/S - pregnancy induced hypertension?
decreased I/V volume, decreased GFR,
decreased uterine BF
CURE of PIH? (Pregnancy induced HTN)
ONLY CURE is delivery of baby. Monitor PT, PTT
Treatment of PIH, that is not delivery?
Hydralazine and methyldopa to control HTN
High dose of nitroprusside (could lead to S/E cyanide toxicity)
Seizures require mag sulf and benzo
Mag Sulf to prevent convulsion (Mag sulf antagonizes calcium)
What do you give for seizures (if your patient has PIH)?
Mag sulfate and benzos
Mag sulfate antagonizes what?
What can occur with high dose Nitroprusside?
Magnesium depresses what?
Magnesium depresses CNS by decreasing Ach release
What prevents Calcium entry into the cell?
If you prevent calcium from entering the cell, what does that cause?
smooth muscle relaxation.
What does magnesium toxicity look like?
Ventilatory failure ( requires prompt intubation and ventilation)
Absent deep tendon reflexes
Heart block (Prolong PQ, wide QRS), cardiac arrest
Drowsiness, atonia and hypoventilation in fetus
With high dose nitroprusside you may have cyanide toxicity, WHY and what will you give to treat the cyanide toxicity?
Nitroprusside metabolism (hydrolysis) results in cyanide ion production. To treat cyanide toxicity give sodium thiosulfate to produce thiocyanate which is less toxic and is eliminated by the kidneys
Treatment of Magnesium toxcity?
Intubation and ventilation
IV calcium gluconate ( calcium antagonizes effects of magnesium)
What anesthesia drug will you avoid if your patient has PIH?
KETAMINE, it causes HTN.
Complications to mother and baby with Pregnancy induced HTN (PIH)?
1.Pulmonary edema/ cerebral hemorrhages (leading causes of maternal death)
4.Intrauterine growth retardation
6.ARF, cerebral edema
Name some things you will see with Mild Preeclampsia?
Headache, somnolence, blurred vision.
Epigastric pain, rapid weight gain, edema , JV distension.
Hyperactive reflexes, clonus.
Proteinuria (>300 mg/24 hrs)
Name some things you will see with Severe Preeclampsia?
S/S of mild preeclampsia PLUS:
Proteinuria (>5 g/24 hrs or 3+ on dipstick
Pulmonary edema, cyanosis
Intrauterine growth retardation
The three most common symptoms preceding an eclamptic attack?
1.Headache, visual changes
3.Seizures; severe if not controlled with anticonvulsant therapy
Management of Preecalmpsia will include?
If term or fetal lung mature; deliver
If severe; expedite delivery by induction or C/S
Bed rest, monitor BP, reflexes, weight and proteinuria
Control BP ; diastolic < 90-100
Seizure prophylaxis by mag sulf
Management of Eclampsia will include?
Mag sulf + benzo
Monitor fetal status
Initiate steps to delivery.
What is Rheumatoid Arthritis?
Chronic, destructive ,systemic inflammatory arthritis characterized by symmetric involvement of both large and small joints. RA causes synovial hypertrophy and pannus formation with resultant erosion of adjacent cartilage, bone and tendons.
What age groups/sex/serotype is more likely to have RA?
MC in female 20-40 age
High incidence with HLA-DR4 serotype
What hx/S/S are common with RA?
Morning stiffness improves with use
Pain warmth, swelling and decreased mobility
Fatigue, anorexia, weight loss
What joints are spared in RA?
Distal interphlangeal joints (DIP) are spared in RA
Physical examination of someone with RA, what will you typically see?
Wrist, metacarpophalangeal and proximal interphalangeal (PIP) joints, ankle, knees, shoulder, hip, elbow and cervical spine (C1, C2)
Cricoarytenoid joint involvement is severe cases
Ulnar deviation of the fingers, swan neck deformities of digits
Vasculitis, Subcutanous nodules
Carpal tunnel syndrome