📚 Reading: Exam 3 — confirmed by the recording; week split inferred
💡 The one idea
Preeclampsia is a whole-body vascular disease, not just a blood pressure number.
Vessels constrict and leak, so every organ gets less blood and fluid moves into tissue.
Gestational HTN
Preeclampsia
Severe features
BP
≥140/90 after 20 wks
≥140/90
≥160/110
Protein
None
Present
Present
Also
—
Edema of face and hands
Headache, visual changes, RUQ pain, low platelets
🖼️ Preterm labor.Swipe it sideways if it is cut off, or tap to open it full size.
🚨 The three symptoms that mean a seizure is coming
Severe headache unrelieved by acetaminophen
Visual changes — blurring, spots, flashing lights
Right upper quadrant / epigastric pain — liver capsule stretch
Epigastric pain in preeclampsia is not indigestion. It is a late and ominous sign of impending eclampsia.
⭐ Magnesium sulfate — what it is actually for
Magnesium prevents seizures. It is not an antihypertensive. That distinction is worth
marks on its own.
🔴 Monitoring magnesium — in the order they disappear
Check
Toxicity sign
Deep tendon reflexes
Absent reflexes — the FIRST warning
Respiratory rate
<12/min — hold the infusion
Urine output
<30 mL/hr — magnesium is renally cleared
Level of consciousness
Lethargy, slurred speech
Antidote: calcium gluconate — keep it at the bedside.
Reflexes go first. If you can only check one thing, check the reflexes.
🧠 HELLP syndrome
Haemolysis · Elevated Liver enzymes · Low
Platelets. A severe variant of preeclampsia — and it can occur with only mildly
raised blood pressure, which is what makes it dangerous.
⭐ High-yield — what the exam actually asks
Show 5 moreHide these 5
Preeclampsia = BP ≥140/90 with proteinuria, at or after 20 weeks. Severe features: BP 160/110, severe headache, visual changes, epigastric or RUQ pain.
Third-trimester headache plus visual disturbance = preeclampsia. Assess BP, check proteinuria, notify. Anticipate progression to eclampsia or HELLP.
Her lab thresholds: platelets <100,000 (95,000 is abnormal) · AST elevated (80) · proteinuria >300 mg/24 hr (350 qualifies) · creatinine abnormal only above 1.1, so 0.6 is normal · she also counts uric acid 6.2 as supportive.
Severe preeclampsia care: BP every 1–2 hours, not q4h · left lateral · quiet, dark, low-stimulus room · seizure precautions · assess deep tendon reflexes regularly · low-sodium diet · magnesium sulfate.
Magnesium monitoring = deep tendon reflexes plus respiratory status.Hyperreflexia signals deterioration. Toxicity order: reflexes go first → respirations <12/min → urine output <30 mL/hr → cardiac arrest. Therapeutic ~4–7 mEq/L. Antidote is calcium gluconate.
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A 2 lb weight gain in a week at 30 weeks is within normal.
Calc — magnesium sulfate: 4 g in 100 mL over 30 min. Volume ÷ time in hours = 100 ÷ 0.5 = 200 mL/hr.
Preterm labor: terbutaline relaxes uterine smooth muscle and causes maternal tachycardia — hold if HR >120. Betamethasone 12 mg IM ×2, 24 hours apart, between 24 and 34 weeks, for fetal surfactant.
📕 From your ATI review book
Covered by ch. 9 (gestational hypertension) · ch. 10 (magnesium as tocolytic).
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Gestational hypertension: after 20 weeks, ≥140/90 on two occasions at least 4 h apart, no proteinuria, resolving by 12 weeks postpartum.
Proteinuria is NO LONGER REQUIRED to diagnose preeclampsia. New hypertension after 20 weeks plus proteinuria or end-organ involvement — thrombocytopenia, renal insufficiency, transaminitis, pulmonary edema, or new cerebral/visual symptoms. Headache and edema alone are not diagnostic.
HELLP is a LABORATORY diagnosis: hemolysis, elevated ALT/AST, platelets under 100,000. Hgb falls in HELLP but rises with hemoconcentration in preeclampsia.
Magnesium is an anticonvulsant here, not an antihypertensive. It prevents seizures; it does not lower blood pressure.
Toxicity appears in this order: loss of patellar reflexes → urine output <30 mL/hr → respirations <12/min → decreased LOC → dysrhythmias. Stop the infusion FIRST, then calcium gluconate, then respiratory support.
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Flushing, sweating, warmth, weakness and drowsiness are EXPECTED, not toxicity. Reduced FHR variability is an expected drug effect too.
ACE inhibitors and ARBs are contraindicated. Use labetalol, hydralazine, nifedipine, methyldopa — and never combine magnesium with nifedipine.
Magnesium doubles as a tocolytic and as fetal neuroprotection before 32 weeks.
Low-dose aspirin from late first trimester for prior early-onset preeclampsia or chronic hypertension.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 21–22 (hypertensive disorders of pregnancy).
Preeclampsia is defined by two findings: hypertension and proteinuria. Oedema is common but is not part of the definition.
DIC can follow abruption or hypertensive disease — it is a complication of the complication, and it is why coagulation studies are drawn.
⚠️ Exam traps
Reflexes disappear first in magnesium toxicity. If they are absent, stop the infusion before you check anything else.
Hyper-reflexia means the preeclampsia is worsening. Hypo/absent reflexes mean the magnesium is too high. Opposite problems, opposite actions.
🧠 Mind maps 2
One per disorder, built from the structure of your ATI chapter.
Medical Conditions
🎯 Who gets it
In-utero DES exposure (banned after 1971) raises cervical insufficiency risk
A history of cervical trauma or an early pregnancy loss raises insufficiency risk
Multifetal gestation and gestational trophoblastic disease raise hyperemesis risk
A history of migraines or family hyperemesis raises risk of recurrence
👀 What you see
Cervical insufficiency: pelvic pressure or urge to push, often with painless dilation
Cervical insufficiency: ultrasound shows a cervix under 25 mm, funneling, or effacement
Cerclage is typically placed around 13 to 14 weeks and removed at 36 to 37 weeks
Hyperemesis: prolonged vomiting with dehydration, weight loss, and electrolyte imbalance
🧪 What confirms it
Hyperemesis: urine ketones/acetones is the key initial test; specific gravity is elevated
Hyperemesis: sodium, potassium, and calcium drop; metabolic acidosis or alkalosis can occur
Hyperemesis: CBC shows an elevated Hct from hemoconcentration
Anemia is diagnosed with Hgb under 11 mg/dL
🩺 What you do
Cervical insufficiency: watch for contractions, ROM, or infection signs after cerclage placement
Hyperemesis: track intake/output, skin turgor, vital signs, and daily weight
Iron-deficiency anemia: recommended intake is 27 mg/day; prenatal vitamins have about 30 mg
If iron-deficient, dosing increases to 60 to 120 mg/day elemental iron
💊 Drugs
Hyperemesis: IV fluids for hydration are the first priority
Hyperemesis: pyridoxine (B6) alone or with doxylamine is first-line and ACOG-recommended
Hyperemesis: antiemetics are used cautiously; corticosteroids are reserved for refractory cases
GDM is managed first with diet and exercise; insulin is added if glucose stays high
💬 What you teach
Hyperemesis: avoid known triggers like specific odors
Hyperemesis: start with bland foods (dry toast, crackers, rice) and advance as tolerated
Severe hyperemesis may require enteral tube feeding or TPN
ATI Active Learning Template — System DisorderEarly Onset of Labor
Filled from ATI chapter 10, row by row from that chapter’s own sections — 12 of 12 rows have content.
3 rows came from outside your ATI chapter — 3 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Preterm labor — contractions with cervical change between 20 and 36 6/7 weeks — together with membrane rupture before labor starts (PROM) and the preterm form (PPROM). Focus: spotting who is at risk, what to monitor, and what protects mother and fetus.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from StatPearls, 2024.
Vaginal progesterone is recommended for patients with a shortened cervix under 25 mm, even without a prior preterm birth.
Standard progesterone dosing is a single daily 90 mg8% intravaginal gel, or a 200 mg micronized vaginal capsule.
Combining cerclage with vaginal progesterone appears more effective at preventing preterm birth than either intervention alone.
StatPearls (NCBI Bookshelf) · Cervical Insufficiency · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Genitourinary or intrauterine infection raises preterm labor risk
Prior preterm birth
Multifetal pregnancy
Smoking or substance use
History of violence or abuse
Uterine abnormalities or a short/shortening cervix
Low prepregnancy weight or low BMI
Advanced maternal age
Assessment — Expected Findings
Uterine contractions
Pelvic pressure with menstrual-like cramping
Persistent low backache
GI cramping, sometimes with diarrhea
Increased vaginal discharge
Change in discharge amount, odor, or blood tinge
Cervical dilation change on exam
Regular contraction pattern
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Fetal fibronectin testing
Cervical cultures
CBC
Urinalysis
Nitrazine test (blue, pH 6.5-7.5) or ferning pattern confirms membrane rupture
Diagnostic Procedures
Fetal fibronectin swab positive between 22 and 34 6/7 weeks signals higher preterm labor risk
Transvaginal ultrasound measures cervical length; 25 mm or less strongly predicts preterm labor
Cervical culture and sensitivity results guide antibiotic choice if infection found
Biophysical profile or nonstress test assesses fetal wellbeing
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Preterm labor management focuses on stopping contractions
Modified bed rest with bathroom privileges preferred; avoid strict bed rest
Left lateral positioning boosts uterine blood flow and lowers contraction activity
Report changes in vaginal discharge amount, color, consistency, or odor
Monitor vitals/temperature; fever plus tachycardia suggests intrauterine infection
Fetal tachycardia over 160/min can signal infection with preterm labor
PROM care depends on gestational age and signs of infection or fetal/maternal compromise
Medications
Nifedipine: calcium channel blocker; blocks calcium entry into smooth muscle to suppress contractions
Ampicillin: antibiotic used to treat intrauterine infection
Obtain vaginal, urine, and blood cultures before starting ampicillin
Betamethasone: glucocorticoid that boosts fetal lung maturity/surfactant in fetuses 24-34 weeks gestation; takes 24 hr to work
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2024.
For a history-indicated cerclage, clinicians usually place the stitch around 12 to 14 weeks gestation, before problems arise.
Exam-indicated cerclage is considered before 28 weeks when the cervix is dilated 1 to 4 cm without labor.
The McDonald technique, a purse-string suture around the cervix, is generally preferred for its simpler placement and removal.
The stitch is usually taken out around 36 to 37 weeks gestation once the pregnancy nears term.
StatPearls (NCBI Bookshelf) · Cervical Insufficiency · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Change positions slowly, supine to upright; sit until dizziness resolves (nifedipine)
Keep well hydrated to offset nifedipine-related hypotension
Magnesium sulfate is a CNS-depressant tocolytic; may add fetal neuroprotection if given before 32 weeks gestation
Perform daily fetal kick counts; report contractions to the nurse
Stay on bed rest with bathroom privileges only
Interprofessional Care
Not in your ATI chapter — filled from StatPearls, 2024.
Cervical insufficiency management involves obstetricians or maternal-fetal medicine specialists coordinating diagnosis and ongoing care.
Anesthesia clinicians and operating room staff support the cervical cerclage placement procedure itself.
Radiology technicians perform the ultrasound cervical-length screening used to guide cerclage and progesterone decisions.
Pharmacists and nurses provide medication education and safety monitoring for patients on progesterone therapy.
StatPearls (NCBI Bookshelf) · Cervical Insufficiency · open the source →
⚠️ What goes wrongComplications
Complications
Major risk: intrauterine infection or sepsis
Other risks: placental abruption, cord compression/prolapse, fetal pulmonary hypoplasia, death
Management is often conservative; hospitalization may prolong pregnancy while monitoring risk signs
Restrict activity to bathroom privileges only
Maintain hydration
Self-monitor for uterine contractions
Track daily fetal kick counts
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Preeclampsia = BP ≥140/90 with proteinuria, at or after 20 weeks. Severe features: BP 160/110, severe headache, visual changes, epigastric or RUQ pain.
Her lab thresholds: platelets <100,000 (95,000 is abnormal) · AST elevated (80) · proteinuria >300 mg/24 hr (350 qualifies) · creatinine abnormal only above 1.1, so 0.6 is normal · she also counts uric acid 6.2 as supportive.
Severe preeclampsia care: BP every 1–2 hours, not q4h · left lateral · quiet, dark, low-stimulus room · seizure precautions · assess deep tendon reflexes regularly · low-sodium diet · magnesium sulfate.
Magnesium monitoring = deep tendon reflexes plus respiratory status.Hyperreflexia signals deterioration. Toxicity order: reflexes go first → respirations <12/min → urine output <30 mL/hr → cardiac arrest. Therapeutic ~4–7 mEq/L. Antidote is calcium gluconate.
A 2 lb weight gain in a week at 30 weeks is within normal.
Calc — magnesium sulfate: 4 g in 100 mL over 30 min. Volume ÷ time in hours = 100 ÷ 0.5 = 200 mL/hr.
Preterm labor: terbutaline relaxes uterine smooth muscle and causes maternal tachycardia — hold if HR >120. Betamethasone 12 mg IM ×2, 24 hours apart, between 24 and 34 weeks, for fetal surfactant.
Gestational hypertension: after 20 weeks, ≥140/90 on two occasions at least 4 h apart, no proteinuria, resolving by 12 weeks postpartum.
Proteinuria is NO LONGER REQUIRED to diagnose preeclampsia. New hypertension after 20 weeks plus proteinuria or end-organ involvement — thrombocytopenia, renal insufficiency, transaminitis, pulmonary edema, or new cerebral/visual symptoms. Headache and edema alone are not diagnostic.
HELLP is a LABORATORY diagnosis: hemolysis, elevated ALT/AST, platelets under 100,000. Hgb falls in HELLP but rises with hemoconcentration in preeclampsia.
Toxicity appears in this order: loss of patellar reflexes → urine output <30 mL/hr → respirations <12/min → decreased LOC → dysrhythmias. Stop the infusion FIRST, then calcium gluconate, then respiratory support.
ACE inhibitors and ARBs are contraindicated. Use labetalol, hydralazine, nifedipine, methyldopa — and never combine magnesium with nifedipine.
Magnesium doubles as a tocolytic and as fetal neuroprotection before 32 weeks.
Low-dose aspirin from late first trimester for prior early-onset preeclampsia or chronic hypertension.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
