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 |
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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
FACTORS THAT CAUSE A PREGNANCY AS HIGH RISK
FACTORS THAT CAUSE A PREGNANCY AS HIGH RISK
PRE-GESTATIONAL CONDITIONS AFFECTING OUTCOMES
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1. Cardiac disease
2. diabetes mellitus
3.thyroid problems
4.asthma
5.obesity
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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 |
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NURSING CARE FOR MOTHER WITH RHD
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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 |
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Pregnant Women With Cardiac Disease
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Assessment Ask for the history of :
•rheumatic fever
•heart lesion
•Dyspnea
•paroxysmal nocturnal dyspnea
•Orthopnea
•Hemoptysis
•Prophylaxis with long acting penicillin
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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
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Diagnostic Test • Chest x-ray (cardiac enlargement, pulmonary congestion or pleural effusion)
• Echo cardiography/2d echo (cardiac structure and functions)
• Electrocardiogram (ECG)
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Effects of Heart Disease on Pregnancy • Abortion
•Intrauterine Growth Retardation
•still birth
•premature labor
•Intrauterine fetal demise
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MANAGEMENT •antenatal visit
•More rest
•Diet is directed
•avoid infection
•Hospitalization
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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
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SURGICAL TREATMENT •THERAPEUTIC ABORTION: considered in class Ill and IV
•CARDIAC SURGERY: alternative
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CLASSIFICAT!ON OF HEART DISEASE
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HEART DISEASE is divided into 4 categories based on criteria established by the New York State Heart Association. |
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LABOR AND DELIVERY |
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Class 1 No discomfort
EASY AND NOT A PROLONGED
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Class 2 ordinary activity
EASY AND NOT A PROLONGED
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Class 3 less than ordinary activity
complete bed rest
NO “TRIAL LABOR”".
ELECTIVE CESAREAN SECTIO
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Class 4 dyspnea at rest
usually advised to avoid pregnancy.
NO “TRIAL LABOR”".
ELECTIVE CESAREAN SECTIO
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POSTPARTUM
Observation for 48 hours
early ambulation is desirable to avoid
thromboembolism
Breastfeeding is not allowed
ligation maybe advised
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