His height and weight are both between the 25 to 50th percentiles and his head circumference is within 2 standard deviations of the mean. They are used with caution. Loss of sensation (including vibration, proprioception, temperature, and pinprick sensations) in distal extremities suggests peripheral neuropathy, as does a distal-to-proximal gradient of reflex elicitation. Antihypertensive agents, Risk factors for DIC: Abruptio placenta, Severe preeclampsia, HELLP syndrome, Maternal sepsis, Amniotic fluid embolism, Prolonged retention of dead fetus, Molar pregnancy Diminished reflex response in an obstetric patient can result from magnesium administration or regional block such as an epidural EXAM 2 Recall Question - Exam 2 Recall Questions Fluid & Call your health professional immediately. Obstetric complications include IUGR, placental abruption, and fetal demise.12, HELLP Syndrome. This sign is generally measured by a healthcare provider and otherwise difficult for you to observe yourself. Unless you're one of a lucky few, you may notice a little extra puffiness in your feet (good luck fitting into your pre-pregnancy shoes!). Deep reflexes include patellar, Achilles, plantar, triceps, and biceps reflexes. Do not try to lose weight during pregnancy by restricting your diet. Boston: Butterworths; 1990. Preeclampsia & Eclampsia Nursing Maternity Review - Registered Nurse RN A second opinion regarding the patient's diagnosis and management also should be considered before initiating long-term opioid therapy. This widening of the spiral arteries is thought to be influenced by how well the trophoblast burrowed into the uterus during early pregnancy. In these cases, a specialized test directed at autonomic functions, and other non-electrodiagnostic tests (e.g., epidermal skin biopsy) may yield the diagnosis. (n.d.). Treasure Island (FL): StatPearls Publishing; 2022 Jan. In non-pregnant normotensive women this was recorded once. Classic sign: right upper quadrant pain, also N&V and severe edema, jaundice (look at eyes too for signs of jaundice) A DTR is a brisk contraction of a muscle in response to a sudden stretch induced by a sharp tap by a finger or rubber hammer on the tendon of insertio Hyperreflexia refers to hyperactive or repeating (clonic) reflexes. Peripheral neuropathy has a variety of systemic, metabolic, and toxic causes. Hyperreflexia refers to hyperactive or repeating (clonic) reflexes. #shorts #anatomy, >140/90 (>140 mmHg systolic & >90 mmHg diastolic), Is one reading sufficient? As the nurse, you want to watch out for the following measurements: . During a reflex test, your muscle shortens (contracts) in response to deep tendon taps from the reflex hammer. Rationale: The normal potassium level is 3 to 5 mEq/L (3 to 5 mmol/L). Injection Gone Wrong: Can You Spot The Mistakes? A more recent article on hypertensive disorders of pregnancy is available. The increased glomerular filtration rate of pregnancy lowers serum creatinine, and levels greater than 0.9 mg per dL (80 mol per L) are abnormal in pregnancy. Deep tendon reflexes are usually brisk, and muscle tone is spastic. Normally during pregnancy, the spiral arteries within the uterus widen in diameter to help increase blood flow to the placenta, which is very vital as the pregnancy progresses and baby requires more nutrients and oxygen. Nausea or vomiting can be confused with the flu or gallbladder problems, so insist on getting your blood pressure checked and checking your urine for proteinuria. By convention the deep tendon reflexes are graded as follows: 0 = no response; always abnormal 1+ = a slight but definitely present response; may or may not be normal 2+ = a brisk response; normal 3+ = a very brisk response; may or may not be normal 4+ = a tap elicits a repeating reflex (clonus); always abnormal Your doctor or midwife has asked you to use telehealth for some of your check-ups. Magnesium sulfate is the drug of choice to prevent and treat eclampsia. By accessing any content on this site or its related media channels, you agree never to hold us liable for damages, harm, loss, or misinformation. Tendon reflex response demonstrates a balance of signals between the cerebral cortex and the spinal cord Hyperreflexia is seen with pre-eclampsia Brisk reflexes are the result of an irritable cortex and indicate central nervous system . Small nerve fiber damage may constitute the earliest stages of some peripheral neuropathies and cannot be detected by electrodiagnostic studies.2,5. If unresponsive: administer anticonvulsants Minimize stimulation: low lights, noise, activity to decrease probability of seizures In: StatPearls [Internet]. One fourth of women will experience adverse effects, especially flushing.42 Table 5 outlines the standard dosing regimen.1,7,12 Serum magnesium levels should be monitored in women with elevated serum creatinine levels, decreased urine output, or absent deep tendon reflexes.43 Magnesium toxicity can lead to respiratory paralysis, central nervous system depression, and cardiac arrest. Deep tendon reflexes are increased in many women prior to seizures, but seizures can also occur without hyperreflexia. RECAP: Youre assessing for new onset of hypertension (>140/90most likely to start occurring at 20 weeks and onward), protein in the urine proteinuria, signs and symptoms of organ injury. Electrodiagnostic studies can help determine whether the neuropathy is the result of damage to the axons (axonal neuropathy) or the myelin (demyelinating neuropathy), or both (mixed). In neuropathic conditions, reinnervation changes are recorded, the details of which are beyond the scope of this article. Lower back pain is a very common complaint of pregnancy. 8600 Rockville Pike FOIA Morning sickness should disappear after the first trimester and the sudden appearance of nausea and vomiting after mid pregnancy may be linked to preeclampsia. Paralysis or partial paralysis. EKG Rhythms | ECG Heart Rhythms Explained - Comprehensive NCLEX Review, Simple Anatomy Quiz Most Nurses Get WRONG! We joined a number of maternal health organizations How to Handle Prenatal and Postpartum Appointments, From Home
Magnesium sulfate is the treatment of choice for women with preeclampsia to prevent eclamptic seizures (NNT = 100) and placental abruption (NNT = 100). Excessive dietary protein may cause problems in women with underlying kidney disease. Weighing in, checking your blood pressure and testing your urine for protein, each important for detecting preeclampsia, should take place at every prenatal visit. Disclaimer. Signs of shock with progression: Rapid shallow respirations, rapid pulse, fall in BP, skin pale and cool, decreased urinary output, changes in level of consciousness, laboratory signs-decreased platelets, prolonged prothrombin time, bleeding time prolonged, increased fibrin split products, decreased fibrinogen, Life threatening defect in coagulation that may occur w/ severe preeclampsia or eclampsia There is a fine line that has to be followed when using blood pressure medication on a pregnant woman because blood flow must be maintained to the placenta and baby. Though the Centers for Disease Control and Prevention (CDC) have recently lifted many of the recommended COVID restrictions, COVID-19 infection increases risk of developing life-threatening hypert Pregnancy is an ideal time to get familiar with your blood pressure. Indicates the CNS is stressed out and at risk for a seizures: assess neuro status, vision changes, headaches, ankle clonus (check out the lecture to see how to check for this), Magnesium Sulfate may be ordered to decrease the risk of seizure activity: Watch for decreased or absent reflexes because this could indicate, Remember hypertension criteria: >140/90 two separate times at least 4 or 6 hours apart, weight gain of 2 lbs or more in a week and weigh self daily, Edema can be in the face, eyes, and extremity swelling, Follow hospitals protocol: have seizures precautions in place beforehand if there is a risk (suction, airway management supplies, padded side rails etc. Monitor presence of headache, epigastric pain, edema Like headache and visual changes, hyperreflexia may indicate changes in your nervous system. Edema monitoring (watch for and educate mother about this): Calcium gluconate: antidote for magnesium sulfate toxicitybe sure to have it handy, Left side-lying position (helps prevent placenta ischemia and increases blood flow to baby), bed rest/limit stimulation, fetal heart rate monitoring (report decrease in fetal activity), Assess for seizure activity eclampsia: there is a risk during and after labor (up to 48 hours), Magnesium sulfate administered to prevent seizures during and after labor (risk for seizures up to 48 hours after delivery), Protein-rich diet (remember there may be low protein in blood due to proteinuriaprotein leaks into the urine and leaves blood), I & Os: strict monitoring (may need Foley catheter), abnormal sign: low urinary output less than 30 cc/hr (kidneys arent being perfused very well), Antihypertensives (labetalol, hydralazine), Test your knowledge: Preeclampsia NCLEX Questions, Gestational Hypertension and Preeclampsia. Expectant management, with close monitoring of the mother and fetus, delays delivery when possible and reduces neonatal complications and length of stay in the newborn intensive care nursery.4749 Contraindications to expectant management include persistent severe symptoms, multiorgan dysfunction, severe IUGR (i.e., estimated fetal weight below the 5th percentile), suspected placental abruption, or nonreassuring fetal testing.49, In women with HELLP syndrome, the fetus is delivered at an earlier gestation; specifically, fetuses older than 28 weeks are routinely delivered 24 to 48 hours after the first maternal dose of corticosteroids is administered.34 Conservative management of HELLP syndrome remains experimental and, for most women, the clinical course is too rapid to complete the steroid regimen before initiating delivery.33, Vaginal delivery is recommended for women with severe preeclampsia if there is no evidence of maternal or fetal compromise or other obstetric contraindication.1 Some experts recommend cesarean delivery for fetuses younger than 30 weeks when the cervix is not ripe, but a trial of induction may be considered.1,7 In patients with HELLP syndrome, cesarean delivery carries special risks, such as bleeding from thrombocytopenia and difficulty controlling blood pressure because of depleted intravascular volume.33,34, Postpartum Management. The damage and clinical manifestations are usually located distally with a proximal progression. The site is secure. This was reasonable. By using our website, you consent to our use of cookies. Magnesium sulfate in eclampsia and pre-eclampsia - PubMed Paraneoplastic panel (anti-Hu, anti-Yo, anti-Ri, anti-Tr, anti-Ma, and anti-CV2 antibodies), Mainly demyelinating, especially in viral hepatitis, Hepatic transaminase, bilirubin, albumin, and alkaline phosphatase levels, Fasting blood glucose level, glucose tolerance test, A1C level, Serum creatinine and blood urea nitrogen levels, Usually acute or subacute, but can be chronic, Phenolic glycolipid-1 antibody, skin biopsy, Urine and serum protein electrophoresis with immunofixation, Axonal damage predominates after treatment, Monoclonal gammopathy of undetermined significance, Rapid plasma reagin, VDRL, cerebrospinal fluid analysis, Peripheral neuropathy is intermixed with upper motor neuron signs, Neuropathy with liability to pressure palsies, Heavy metals (e.g., arsenic, lead, mercury, gold), Lead and mercury mainly cause motor neuropathy, 24-hour urine collection for heavy metal titers, Urinalysis (including 24-hour urine collection), Heavy metal toxicity, porphyrias, multiple myeloma, Antimyelin-associated glycoprotein and antiganglioside antibodies, Salivary flow rate, Schirmer test, rose bengal test, labial gland biopsy, Acute or chronic inflammatory demyelinating neuropathy. A maternal blood pressure measurement of 140/90 mm Hg or greater on two occasions before 20 weeks of gestation indicates chronic hypertension. The optimal level of blood pressure control in pregnancies complicated by hypertension is unknown.2,6 Less tight control may decrease the risk that the infant will be small for gestational age, but it may increase the risk of respiratory distress syndrome of the newborn, severe hypertension, and antenatal hospitalization.2,5 Although traditional recommendations are based on diastolic blood pressure, a retrospective review of 28 women with severe preeclampsia who experienced a cerebrovascular accident demonstrated that more than 90 percent had systolic blood pressure over 160 mm Hg, but only 12.5 percent had diastolic blood pressure over 110 mm Hg.45, Intravenous labetalol and hydralazine are commonly used for the acute management of preeclampsia.1,46 A Cochrane review showed no evidence that one parenteral agent had superior effectiveness.46 For women with severe preeclampsia undergoing expectant management remote from term, oral labetalol and nifedipine are acceptable options.7, Fluid Management. During late pregnancy, you may be advised to lie on your left side to prevent restriction on certain veins which could also contribute to elevated blood pressure. The difference between the two is not with the reflex arc, because both deep and superficial reflexes involve the action of the reflex arc. Deep tendon reflexes. If the trophoblast failed to do this properly, the spiral arteries stay narrow and fail to widen as the pregnancy progresses, which will cause an ischemic placenta (the placenta is deprived of oxygen-rich blood flow it needs to flourish and grow). Call your care provider. 2002;19(4):286-95. doi: 10.1080/0899022021000037755. A serum potassium level higher than 5 mEq/L (5 mmol/L) indicates hyperkalemia. InMerriam-Webster.com dictionary. NOTE: Preeclampsia varies in how severe it getssome women have mild cases while others have severe cases that progress to seizures and/or coma and the complications below. 2 1 the nurse should check the clients patellar. During pregnancy, a rise in the lower number (diastolic) of 15 degrees or more, or a rise in the upper number (systolic) of 30 degrees or more can also be a cause for concern. It is important to help patients control troublesome symptoms of peripheral neuropathy, such as severe numbness and pain, as well as to alleviate disability resulting from weakness.12 Several pharmacologic options exist to treat neuropathic pain, including some antiseizure medications (e.g., gabapentin [Neurontin], topiramate [Topamax], carbamazepine [Tegretol], pregabalin [Lyrica])13,14 and antidepressants (e.g., amitriptyline).1517 Topical patches and sprays containing lidocaine (Lidoderm) or capsaicin (Zostrix) also may relieve pain in some patients.18 Other supportive measures, such as foot care, weight reduction, and shoe selection, may also be helpful.2 Narcotics may have a role in the treatment of chronic neuropathic pain in selected patients19; candidates initially should be evaluated for their risk of substance abuse and addiction, and several nonnarcotic regimens should be tried first. Lesions of the plexus are asymmetric with sensorimotor involvement of multiple nerves in one extremity. If you experience any of these changes in vision, you should contact your healthcare provider immediately or go directly to the hospital. Headaches Blurry vision Change in behavior Fatigue Change in balance or coordination Numbness or tingling in the arms or legs Decrease in movement of the arms or legs Injury to the head, neck, or back Temperature of unknown source Seizures Slurred speech Weakness Tremor What is done during a neurological exam? your healthcare . Clonus reflex is a set of rhythmic, involuntary muscle movements. Report all medications prescribed by other doctors to your prenatal care provider so that these products can be checked regarding their safe use during pregnancy. Treasure Island (FL): StatPearls Publishing; 2022 Jan. His deep tendon reflexes are exaggerated. The acronym HELLP describes a variant of severe preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelet count.31 HELLP syndrome occurs in up to 20 percent of pregnancies complicated by severe preeclampsia.32 The clinical presentation of HELLP syndrome is variable; 12 to 18 percent of affected women are normotensive and 13 percent do not have proteinuria.33 At diagnosis, 30 percent of women are postpartum, 18 percent are term, and 52 percent are preterm.32 Common presenting complaints are right upper quadrant or epigastric pain, nausea, and vomiting. However, if the reading is 1+ or greater, it may signify the onset of preeclampsia, even if your blood pressure is below 140/90. Sometimes healthcare providers will have you collect your urine for 12 or 24 hours to determine the exact quantity of protein in the urine. Please enable it to take advantage of the complete set of features! Eclampsia may occur postpartum; the greatest risk of postpartum eclampsia is within the first 48 hours.43 Magnesium sulfate is continued for 12 to 24 hours, or occasionally longer if the clinical situation warrants. At every prenatal visit a woman will have her urine assessed for protein and glucose (glucose measurement is important for detecting gestational diabetes). By convention the deep tendon reflexes are graded as follows: 0 = no response; Dtr or deep tendon reflex is a test done on physical exam to evaluate specific nerve function. These usually indicate an interruption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion, that is, a lesion above the level of the spinal reflex pathways. please help, this is urgent. With preeclampsia, the blood pressure is usually normal at the beginning of the pregnancy, but around 20 weeks gestation it starts to elevate. Certain nerves like cervical and lumber spinal nerves Muscles get "tetanic" when there isn't enough. It can be confused with heartburn, gallbladder problems, flu, indigestion or pain from the baby kicking. Common vision changes include sensations of flashing lights, auras, light sensitivity, or blurry vision or spots. It is a neurological condition that affects the nerve cells that control muscle movements. +4= Hyperactive reflex; clonus may also be present, +1 Minimal edema of lower extremities A physical examination may be performed, as well as a test of the deep tendon reflexes. Nerve biopsy should be considered when the diagnosis remains uncertain after laboratory and electrodiagnostic testing, or when confirmation of the diagnosis is needed before initiating aggressive treatment (e.g., in cases of vasculitis when steroids or chemotherapy is used). Monitor maternal serum magnesium levels (therapeutic levels 4-8 mg/dl) However, these substances are very toxic to moms endothelial cells. Deep tendon reflexes, magnesium, and calcium: assessments and Classification Of Hypertensive Disorders Of Pregnancy Nursing Management 1. Many patients have a history of malaise or nonspecific symptoms suggesting an acute viral syndrome.33 Any patient with these symptoms or signs of preeclampsia should be evaluated with complete blood count, platelet count, and liver enzyme determinations.34. Preeclampsia: Updates in Pathogenesis, Definitions, and Guidelines. All of these pain symptoms may be a sign of HELLP Syndrome or a related problem in the liver. A 128-Hz tuning fork should be used to test the vibratory sensations in extremities. That means using your smart phone camera or just a reg A new study recently published by the New England Journal of Medicine found that women at high risk for preterm preeclampsia who took aspirin were less likely to develop the condition than women who w What is AFLP? Decisions regarding the timing and mode of delivery are based on a combination of maternal and fetal factors. The criteria are based on three things: What is considered an elevated blood pressure for preeclampsia? There are five primary deep tendon reflexes: biceps, brachioradialis, triceps, patellar, and ankle. A common regimen for expectant management of mild preeclampsia is outlined in Table 4.1,7 Nonstress tests, amniotic fluid index measurements, and biophysical profiles are used to monitor patients for uteroplacental insufficiency.1,7 Umbilical artery systolic/diastolic ratios measured by Doppler ultrasonography may detect early uteroplacental insufficiency.36,37 The decision to deliver involves balancing the risks of worsening preeclampsia against those of prematurity. Preeclampsia is the development of new-onset hypertension with proteinuria after 20 weeks of gestation. The former is usually achieved by eliminating offending agents, such as toxins or medications; correcting a nutritional deficiency; or treating the underlying disease (e.g., corticosteroid therapy for immune-mediated neuropathy).8 These steps are important to halt the progression of neuropathy, and they may improve symptoms. Biophysical profile This content is owned by the AAFP. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Monitor respirations closely: concerned if <12/minute In other disorders, such as acute inflammatory demyelinating disorder (i.e., Guillain-Barr syndrome) and chronic inflammatory demyelinating polyneuropathy, weakness rather than sensory loss typically predominates and may be the earliest sign of the disease. PG, Tendon reflex response demonstrates a balance of signals between the cerebral cortex and the spinal cord 2022 Sep 12. Home readings should never replace prenatal visits, nor should a "normal" reading mean you can ignore other symptoms of preeclampsia. The motor unit action potential on voluntary muscle contraction also is assessed. Loss of touch sensitivity in your fingers or toes. It is also influenced by the brai a very sensitive test, depends on how performed and your mental state at that time. +3= Brisker than average reflex The effect of stimulation of Golgi tendon organs and spindle receptors from hindlimb extensor muscles on supraspinal descending inhibitory mechanisms. The rooting reflex is present if stroking the lateral upper lip causes movement of the mouth toward the stimulus. Otherwise, a 6-g loading dose is given intravenously over 15 to 20 minutes, followed by maintenance infusion of 2 g per hour. Fetuses older than 34 weeks, or those with documented lung maturity, are also delivered without delay.7, For patients with severe preeclampsia between 24 and 34 weeks of gestation, the data are insufficient to recommend interventionist versus expectant management.47 Subspecialty consultation is indicated.48,49 Corticosteroids are administered to accelerate fetal lung maturity.7 Interventionist management advocates induction or cesarean delivery 12 to 24 hours after corticosteroid administration. Some causes of peripheral neuropathy are characterized by mononeuropathy, some involve multiple nerves, and others have autonomic dysfunction or pain prominence (Table 2). The use of magnesium sulfate for seizure prophylaxis in women with mild preeclampsia is controversial because of the low incidence of seizures in this population. One study estimated that the prevalence of peripheral neuropathy in the family medicine setting is 8 percent in persons 55 years and older.1 The prevalence in the general population may be as high as 2.4 percent.2 A community-based study estimated the prevalence of peripheral neuropathy in patients with type 2 diabetes mellitus to be 26.4 percent.3. Chapter 19 OB: test 2 Flashcards | Quizlet Hyperreflexia is when your reflexes are so strong that when your knee is tapped by a rubber hammer, your leg bounces back hard. DIC allows excess bleeding from any vulnerable site: incisions, IV site, gums, nose, urine, ecchymoses Deep Tendon Reflexes - Stanford Medicine 25 The influence of increased muscle spindle sensitivity on Achilles tendon jerk and H-reflex in relaxed human subjects. Why hyperactive deep tendon reflex occure in hypocalcemia? This Physician Locator may help. An official website of the United States government. Shoulder pain is often called referred pain because it radiates from the liver under the right ribs. Monitor BP Magnesium sulfate Magnesium Toxicity - StatPearls - NCBI Bookshelf Would you like email updates of new search results? Peripheral Neuropathy: Differential Diagnosis and Management The nurse plays a vital role in helping detect these conditions. Whether magnesium is given to prevent seizures or for tocolysis . A healthy, balanced diet and optimal weight may make a significant difference for some women. . However, sometimes it may indicate a problem with the liver, especially if it accompanies other symptoms of preeclampsia. (2016). Ask, "What is my blood pressure?" La preeclampsia, en todas sus formas, puede requerir muchos anlisis, tanto durante como despus del embarazo. The afferent neuron whose cell body lies in a dorsal root ganglion innervates the muscle or Golgi tendon organ associated with the muscles; the efferent neuron is an alpha motoneuron in the anterior horn of the cord. Electromyographically recorded patellar reflex in normotensive pregnant Prior to getting pregnant, achieve a healthy weight (a BMI of 30 or less) since obesity has been shown to increase the chances of getting preeclampsia. This limits their sensitivity in detecting neuropathies of the small nerve fibers (i.e., those with pain, temperature, and autonomic functions). Preeclampsia and eclampsia nursing maternity NCLEX review for students! The perinatal nurse, in collaboration with physicians, can use deep tendon reflexes as a powerful tool in determining the need to start, adjust, or stop magnesium infusion. Clonus of the Ankle Test - Physiopedia Please note that home monitors are not always as accurate as those used in clinics or hospitals. Hypertensive disorders represent the most common medical complication of pregnancy, affecting 6 to 8 percent of gestations in the United States.1 In 2000, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy defined four categories of hypertension in pregnancy: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension.1, Chronic hypertension is defined as a blood pressure measurement of 140/90 mm Hg or more on two occasions before 20 weeks of gestation or persisting beyond 12 weeks postpartum.1 Treatment of mild to moderate chronic hypertension neither benefits the fetus nor prevents preeclampsia.24 Excessively lowering blood pressure may result in decreased placental perfusion and adverse perinatal outcomes.5 When a patient's blood pressure is persistently greater than 150 to 180/100 to 110 mm Hg, pharmacologic treatment is needed to prevent maternal end-organ damage.1,2,4,6, Methyldopa (Aldomet; brand no longer available in the United States), labetalol, and nifedipine (Procardia) are oral agents commonly used to treat chronic hypertension in pregnancy. In disorders that cause acute peripheral neuropathy, such as those produced by toxic exposures, patients may present with similar but more fulminant symptoms, and pain predominates; symptoms also typically have a faster progression. Hyperactive deep tendon reflexes area sign of upper motor neuron lesion. An accurate weight is vital for a proper diagnosis. +2 Marked edema of lower extremities When these reflexes are disrupted, hyperreflexia (disease induced) or. Unauthorized use of these marks is strictly prohibited. Acute Fatty Liver of Pregnancy (AFLP) is a relatively rare disorder that happens only during human pregnancy. As the nurse it is important youre aware of how this condition is diagnosed. Intravenous labetalol or hydralazine may be used to treat severe hypertension in pregnancy because neither agent has demonstrated superior effectiveness. Therefore, eclampsia causes seizure activity, which can lead to coma and death. Fetal factors include gestational age, evidence of lung maturity, and signs of fetal compromise on antenatal assessment. Deep Tendon Reflexes In a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a two-neuron reflex arc involving the spinal or brainstem segment that innervates the muscle. When the tendon is tapped with a re What are deep tendon reflexes and how they are graded? A Video Atlas of Neuromuscular Disorders - Oxford Academic Note: this also drops protein levels in the blood (why the woman needs a protein-rich diet). High blood pressure during pregnancy is one of the biggest red flags that preeclampsia may be developing. What should the nurse do next? National Library of Medicine Do not be afraid to question your caregiver if any of these tests are omitted. A systematic approach begins with localization of the lesion to the peripheral nerves, identification of the underlying etiology, and exclusion of potentially treatable causes.
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