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NURSING CARE OF THE HIGH-RISK PREGNANT CLIENT Cheat Sheet (DRAFT) by

MCN NOTES 2ND SEMENTER

This is a draft cheat sheet. It is a work in progress and is not finished yet.

HIGH-RISK PREGNANT CLIENT

cardio­vas­cular or kidney disease
chronic
both can be at risk
close observ­ation
Nursing care for a woman
danger signs to watch

High-Risk Pregnancy

concurrent disord­er➯­jeo­par­dizes health
 
particular circum­stances
enter pregnancy with a chronic illness
develop a compli­cation of pregnancy
poor coping mechan­isms,
poverty,
lack of support people,
genetic inheritance,

FACTORS THAT CAUSE A PREGNANCY AS HIGH RISK

PSYCHOLOGICAL

FACTORS THAT CAUSE A PREGNANCY AS HIGH RISK

SOCIAL

FACTORS THAT CAUSE A PREGNANCY AS HIGH RISK

PHYSICAL

PRE-GE­STA­TIONAL CONDITIONS AFFECTING OUTCOMES

 
1. Cardiac disease
2. diabetes mellitus
3.thyroid problems
4.asthma
5.obesity

RHEUMATIC HEART DISEASE (RHD)

bacteria called strept­ococcus
permanent damage to heart valves
begins with strep throat
inflam­mat­ory­➟heart, joint, skin, or brain
heart work harder to pump blood.
Physical Exam: look 4 murmur or rub
confestive heart failure: damage is perman­ent­/heart cannot pump out all of the blood
 
NURSING CARE FOR MOTHER WITH RHD

antenatal

Assessment
Get the bp in sitting or lying position + same position
Instruct to report coughing + Determine edema
undergo ECG, CXR( use lead apron), or 2D echo

Rest
client needs two rest periods
    1. FULLY RESTING —not getting up
    2. FULL NIGHT'S SLEEP —rest in left lateral recumbent position (prevent supine hypote­nsive syndrome)

NUTRITION
limit salt intakebut not severly restricted
iron supplement to help prevent anemia.

MEDICATION
Digoxin — check the heart rate below 60bmp/slow fetal heart rate
Penicillin Antibiotic—prevent recurrence of rheumatic fever
prophy­lactic penicillin antibiotic —prote­ction from subacute bacterial endoca­rditis.

AVOIDANCE OF INFECTION
Avoid visiting
monthly screening
inform health personnel

LABOR AND BIRTH

Monitor fetal heart rate and uterine contra­ctions
Assess a woman'’s blood pressure, pulse and respir­ations freque­ntly.

POSTPARTUM

Antiem­bolic stockings and ambulation may needed
encourage uterine involution such as oxytocin (Pitocin)
Kegel exercises
stool softener
 

Pregnant Women With Cardiac Disease

Assessment
Ask for the history of :
•rheumatic fever
•heart lesion
•Dyspnea
•parox­ysmal nocturnal dyspnea
•Orthopnea
•Hemoptysis
•Proph­ylaxis with long acting penicillin
Examin­ation
What to expect during examin­ation?
•Murmur
• Accent­uated heart sound
•Arrythmia
•Central cyanosis
•Displaced apex belt

  left side heart failure 

•Gallop rhythm
•crepotations over lung bases
•pleural effusion

  right side heart failure 

•Congested neck vein,
•enlarged tender, liver, ascites
•edema lower limbs
Diagnostic Test
Chest x-ray (cardiac enlarg­ement, pulmonary congestion or pleural effusion)
Echo cardio­gra­phy/2d echo (cardiac structure and functions)
Electr­oca­rdi­ogram (ECG)
Effects of Heart Disease on Pregnancy
• Abortion
•Intrauterine Growth Retard­ation
•still birth
•premature labor
•Intrauterine fetal demise
MANAGEMENT
•antenatal visit
•More rest
•Diet is directed
•avoid infection
•Hospitalization
MEDICAL TREATMENT
•DIGOXIN:indicated in atrial fibril­lation to slow the ventri­cular response and in acute heart failure to increase myocardial contractility.
•DIURE­TICS:used in an acute and chronic heart failure with potassium supplement in prolonged therapy.
•BETA-­ADR­ENERGIC BLOCKERS: as propra­nolol may be indicated for arrhythmia associated with ischemic heart disease.
•AMYNO­PHY­LLINE: relieves bronch­ospasm
•HEPARIN: is indicated in patients with artificial valves or atrial fibril­lation
•MORPHINE 15mg IV: is given to treat acute pulmonary edema by decreasing anxiety venous return
•ADMINISTRATION OF OXYGEN
SURGICAL TREATMENT
•THERA­PEUTIC ABORTION: considered in class Ill and IV
•CARDIAC SURGERY: altern­ative

CLASSI­FIC­AT!ON OF HEART DISEASE

HEART DISEASE is divided into 4 categories based on criteria establ­ished by the New York State Heart Associ­ation.
LABOR AND DELIVERY
Class 1
No discomfort
EASY AND NOT A PROLONGED
Class 2
ordinary activity
EASY AND NOT A PROLONGED
Class 3
less than ordinary activity
complete bed rest
NO “TRIAL LABOR”­".
ELECTIVE CESAREAN SECTIO
Class 4
dyspnea at rest
usually advised to avoid pregnancy.
NO “TRIAL LABOR”­".
ELECTIVE CESAREAN SECTIO
POSTPARTUM
Observ­ation for 48 hours
early ambulation is desirable to avoid
thromboembolism
Breast­feeding is not allowed
ligation maybe advised