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EXPLANATION
✔Correct answer:
Occurrence of pulmonary edema. Pulmonary edema is a serious and potentially life-threatening complication associated with the use of certain tocolytic agents, particularly beta-adrenergic agonists (e.g., terbutaline) and calcium channel blockers (e.g., nifedipine). These medications work to relax the uterine muscles to delay preterm labor, but they can also have significant effects on the cardiovascular and respiratory systems. Pulmonary edema, which involves the accumulation of fluid in the lungs, can occur due to the increased capillary permeability or fluid overload caused by these medications. This condition can lead to severe respiratory distress, requiring immediate medical intervention.
Tocolytic agents, especially beta-adrenergic agonists, can increase heart rate, relax smooth muscle, and cause fluid retention. These effects can overwhelm the heart's ability to pump effectively, leading to fluid leakage into the alveoli of the lungs, resulting in pulmonary edema. Pulmonary edema presents with symptoms such as shortness of breath, hypoxia, crackles on auscultation, and possibly pink frothy sputum, all of which indicate the need for rapid treatment.
Imagine the lungs as a sponge. Under normal conditions, they absorb just the right amount of fluid. But when too much fluid is pushed into the sponge (as can happen with certain medications), it becomes saturated and starts leaking, which in this case means fluid leaking into the air spaces of the lungs, making it hard to breathe.
Nurse Alyssa should be vigilant for signs of pulmonary edema in Maria and take the following precautions:
- Monitor respiratory status closely, including respiratory rate, oxygen saturation, and lung sounds.
- Assess for early symptoms of pulmonary edema, such as dyspnea, tachypnea, and cough.
- Monitor fluid intake and output to prevent fluid overload.
- Evaluate the patient’s cardiovascular status, including heart rate and blood pressure, as tocolytics can also cause tachycardia and hypotension.
- Be prepared to discontinue the tocolytic agent and initiate appropriate treatment (e.g., diuretics, oxygen therapy) if pulmonary edema is suspected.
✘Incorrect answer options:
Onset of diabetic ketoacidosis. Diabetic ketoacidosis (DKA) is a complication primarily associated with diabetes, particularly when blood glucose levels are poorly controlled. Tocolytic therapy is not directly associated with the development of DKA. DKA is characterized by hyperglycemia, ketosis, and acidosis, which are not typical side effects of tocolytics.
Development of hyperemesis gravidarum. Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy, typically occurring in the first trimester. It is not related to tocolytic therapy, which is used later in pregnancy to manage preterm labor. The medications used as tocolytics do not typically cause hyperemesis gravidarum.
Exacerbation of sickle cell anemia. Sickle cell anemia is a genetic blood disorder that can be exacerbated by various factors such as dehydration, infection, or hypoxia, but it is not specifically associated with tocolytic therapy. While managing sickle cell anemia during pregnancy requires careful monitoring, the focus with tocolytics is more on cardiovascular and respiratory complications rather than hematologic ones.
References
- Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2017). Maternal Child Nursing Care. Elsevier.
- Simpson, K. R., & Creehan, P. A. (2014). Perinatal Nursing. Lippincott Williams & Wilkins.