11.2b Cardiovascular Care Management Flashcards
Problems Experienced with Cardiac Issues
- Fear of fetal/maternal risks
- Decreased ability to cope
- Reduced functional ability (bathing, dressing, toileting)
- Activity intolerance
- Bed Rest and Limited Activity
- HYPOTENSIVE SYNDROME (due to lower tissue perfusion)
- Reduced Stamina (activity intolerance)
EDUCATION
- How pregnancy affects their condition
- Medication
- How to alter their self-care activities
Antepartum Interventions
- Focuses on minimizing stress of the heart (intensifies as CO increases)
- CO rises significantly early in pregnancy and peaks at 25-30 weeks
TREATMENT
- Treat emotional stress
- Treat hypertension
- Treat anemia
- Treat hyperthyroidism
- Treat obesity
- INFECTION SHOULD BE TREATED RAPIDLY DUE TO RISK OF INCREASED HR AND SPREAD OF MICROORGANISMS (streptococci) TO HEART STRUCTURES
Cardiac Disease Risk
- Risk of iron deficient anemia
- Educate on iron and folate supplements as well as proper nutrition
- Iron supplements can cause constipation so educate on increasing fluid and fiber intake
- Stool softeners should be provided to prevent VALSALVA STRAIN
- Monitor Hypokalemia especially if diuretics are being used
Medications Treatment
- Increased plasma volume and renal clearance of drugs can alter medication dosage
ANTICOAGULATION IS USED FOR
- Venous thrombosis
- Pulmonary embolus
- RHD - Rhematic Heart Disease
- Prosthetic Valves
- Cyanotic Congenital Heart Defects
Cardiac Decompensation
S/S
- Fatigue or Difficulty Swallowing during normal activity
- Feeling smothered
- Frequent Cough
- Palpations (heart is racing)
- Generalized edema (face, feet, legs, fingers - ring no longer fits)
Objective Signs
- Irregular weak, rapid pulse (>100bpm)
- Progressive edema
- Crackles in lungs that do not clear after coughing
- Orthopnea and Dyspnea
- Rapid Respirations (>25 breaths per min)
- Moist frequent coughs
- Cyanosis of Lips and Nailbed
EDUCATION
- Report signs (generalized edema, distended veins, dyspnea, moist cough, palpations)
- Report thromboembolism signs (pain, redness, tenderness, swelling in extremities or chest pain)
- Avoid constipation by adequate fluid and fiber (Valsalva Maneuver)
- Take daily weight at same time each day
- Go to all prenatal appointments
- Limit activity per provider instruction
Heart Surgery
- Should be done before pregnancy
- Avoid hypothermia which can hurt fetus
- Risk to fetus is least during 3rd trimester for heart surgery
Intrapartum Care
- Monitor ABG’s
- Pulmonary artery catheter used to monitor hemodynamic status during L&D
- ECG, BP, O2 SAT, FHR
- Keep head and shoulders elevated on pillows to promote cardiac function
- Side lying position also helps promote hemodynamics
- Relieve discomfort with medication (epidurals are encouraged)
- MAIN GOAL IS TO PROMOTE CARDIAC FUNCTION, ANSWER QUESTIONS, PROMOTE COMFORT
Terbutaline (Brethine)
Beta Adrenergic Agents
- DO NOT USE IN PATIENTS WITH HEART DISEASE
SIDE EFFECTS
- Tachycardia
- Irregular Pulse
- Myocardial Ischemia
- Pulmonary Edema
Intrapartum Care
- Supine position should be avoided in patients with heart disease
- If used, use a wedge under a hip to displace the uterus and prevent supine hypotension
- Stirrups are contraindicated
- Valsalva maneuver discouraged when pushing
- Use of episiotomy and vacuuums/forceps to decrease length of second stage labor and heart workload
- C-sections are not recommended due to risk of dramatic fluid shift, and blood loss
- Antibiotics to prevent endocarditis IS NOT RECOMMENDED
Intrapartum Care
- Provide oxytocin after birth to prevent hemorrhage
- Do not provide ergot products (Methergine) due to increased BP
PostPartum Care
- Monitor cardiac decompensation (first 24-48 hours is the most hemodynamically difficult)
- Continue pulmonary artery catheter and ABG monitoring
PostPartum Care
- Monitor cardiac decompensation (first 24-48 hours is the most hemodynamically difficult)
- Continue pulmonary artery catheter and ABG monitoring
MAKE SURE
- Bed is Elevated
- Encourage Sidelying
- Progressive ambulation as tolerated (may need to assist with grooming and hygiene)
- Stool Softeners to prevent bowel movement stress
PostPartum
FIRST 2 WEEKS
- Extracellular fluid is mobilized and diuresis begins (may cause cardiac strain)
- Vascular resistance is increased
- CO returns to normal in 2 weeks
MEDICATIONS
Digoxin - Treats arrhythmias and HF
Procainamide and Verapamil - Treats Maternal/Fetal Arrhythmias
Betablockers - Hypertension, arrhythmia, ischemia, mitral stenosis, cardiomyopathy, hyperthyroidism, Marfan syndrome
Heparin/Warfarin - Anticoagulation
Diuretics - Hypertension and Congestive HF
Lidocaine - Local anesthetic and arrhythmias
Quinidine - Arrhythmias
Nifedipine - Hypertension and TOCOLYSIS
ACE inhibitors - Hypertension
Sodium Nitropusside - Hypertension and Aortic Dissection
DIAGNOSIS - Fatigue due to Cardiac Disease
OUTCOME
- Verbalize plan of modified lifestyle to reduce risk of cardiac decompensation
INTERVENTION
- Identify factors that decrease activity tolerance and explore limitations
- Educate how to check pulse rate, RR, and reduce activities that cause fatigue
- Suggest making an activity log
