Week 4 Mo Parturient with Systemic Diseases Flashcards Preview

SUM'20 - Advanced Principles > Week 4 Mo Parturient with Systemic Diseases > Flashcards

Flashcards in Week 4 Mo Parturient with Systemic Diseases Deck (149)
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61

Preeclampsia S/S

HYPERTENSION, PROTENURIA (> 5 g/day) and EDEMA (hand, face, lung)
Oliguria (< 500 ml /day), headache, visual disturbance , hepatic tenderness, hyperreflexia

62

Eclampsia?

(+)Seizures in preeclampsia

63

What is HELLP syndrome?

(high maternal and fetal mortality). Call for IMMEDIATE DELIVERY

Hemolysis, Elevated Liver enzymes, Low Platelet count

64

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

65

Pathophysiology for pregnancy induced hypertension?

Increased: Thromboxane A2, endothelin-1, renin.

Decreased: PGI2, NO

COCAINE ABUSE

66

S/S - pregnancy induced hypertension?

Vasospasm,
decreased I/V volume, decreased GFR,
edema ,
CNS dysfunctions
decreased uterine BF

67

CURE of PIH? (Pregnancy induced HTN)

ONLY CURE is delivery of baby. Monitor PT, PTT

68

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)

69

What do you give for seizures (if your patient has PIH)?

Mag sulfate and benzos

70

Mag sulfate antagonizes what?

calciujm

71

What can occur with high dose Nitroprusside?

cyanide toxicity

72

Magnesium depresses what?

Magnesium depresses CNS by decreasing Ach release

73

What prevents Calcium entry into the cell?

Mag sulfate

74

If you prevent calcium from entering the cell, what does that cause?

smooth muscle relaxation.

75

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
Hypotension
Drowsiness, atonia and hypoventilation in fetus

76

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

77

Treatment of Magnesium toxcity?

D/C magnesium
Intubation and ventilation
IV calcium gluconate ( calcium antagonizes effects of magnesium)

78

What anesthesia drug will you avoid if your patient has PIH?

KETAMINE, it causes HTN.

79

Complications to mother and baby with Pregnancy induced HTN (PIH)?

1.Pulmonary edema/ cerebral hemorrhages (leading causes of maternal death)
2.Prematurity
3.Prematurity/fetal distress
4.Intrauterine growth retardation
5.Placental abruption
6.ARF, cerebral edema
7.Fetal/maternal death

80

Name some things you will see with Mild Preeclampsia?

>140/90
Headache, somnolence, blurred vision.
Epigastric pain, rapid weight gain, edema , JV distension.
Hyperactive reflexes, clonus.
Proteinuria (>300 mg/24 hrs)

81

Name some things you will see with Severe Preeclampsia?

S/S of mild preeclampsia PLUS:
>160/90
Proteinuria (>5 g/24 hrs or 3+ on dipstick
Oliguria
Pulmonary edema, cyanosis
HELLP syndrome
Oligohydramnios
Intrauterine growth retardation

82

The three most common symptoms preceding an eclamptic attack?

1.Headache, visual changes
2.RUQ/epigastric pain
3.Seizures; severe if not controlled with anticonvulsant therapy

83

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

84

Management of Eclampsia will include?

Supplemental O2
Mag sulf + benzo
Monitor fetal status
Initiate steps to delivery.

85

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.

86

What age groups/sex/serotype is more likely to have RA?

MC in female 20-40 age
High incidence with HLA-DR4 serotype

87

What hx/S/S are common with RA?

Insidious onset
Morning stiffness improves with use
Pain warmth, swelling and decreased mobility
Polyarthropathy
Fatigue, anorexia, weight loss

88

What joints are spared in RA?

Distal interphlangeal joints (DIP) are spared in RA

89

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
Extra-articular manifestations
Vasculitis, Subcutanous nodules
Pericarditis, pleuritis
Carpal tunnel syndrome

90

Evaluation of RA, what labs will be significant?

Rheumatoid factor (anti-Fc IgG antibody)
increased ESR
X-ray: narrowing of joint spaces and erosion, pannus formation