Cardiovascular Disorders

Question 1

Cardiovascular System Changes during Pregnancy

normal

Answer 1

• Incrd intravascular volume
  > maternal blood vol incrs 30-50%/1200-1600mL
• Decreased systemic vascular resistance
  > reduced BP due to dilated blood vessels & incrd blood flow
• Cardiac output changes during labor & birth
• Intravascular volume changes tht occur just after childbirth
  > dcrs due to blood loss
• These are all normal changes that occur in a normal pregnancy

Question 2

Complications from Cardiovascular Disorders

Answer 2

• Incrd incidence of miscarriage
  > due to perfusion issues (blood supply)
• Preterm labor & birth more prevalent
  > fetus puts strain on body, mom’s body will take care of itself 1st
• Intrauterine growth restriction is more common
  > poor blood supply, issues receiving adequate nutrition
• Incidence of congenital heart lesions incrd in children of mothers w/ congenital heart disease
• These mom’s cannot perfuse fetus adequately due to CV disorders

Question 3

Care Management: Cardiovascular Disorders - Antepartum

plan of care

Answer 3

• Therapy focused on minimizing stress on heart
• S/S of cardiac decompensation
  > heart failure s/s
• Bed rest
• Nutrition counseling
  > iron & folic acid supplements, high protein, adequate cals, incrd fluids & fiber
  > may be prescribed stool softener to prevent straining
• Cardiac meds as needed
  > risk vs benefit

Question 4

Signs of Potential Cardiac Decompensation

Answer 4

• Incrd fatigue/difficulty breathing during usual acitivites
• Feeling of smothering
• Moist, frequent cough
• Palpitations: irregular, weak, rapid pulse
• Progressive, generalized edema
• Rapid respirs
• Cyanosis of lips & nail beds

Question 5

Care Management: Cardiovascular Disorders - Antepartum

implentation: anticoag, intrapart, postpart

Answer 5

• Anticoagulant Therapy
  > Heparin: large-molecule drug does not cross placenta
• Intrapartum Care
  > care focuses on promoting cardiac function: elevated positioning, calm atmosphere, meds, O2
  > prophylactic antibiotics: risk of infection (bacterial endocarditis) in vag & cesarean births
• Postpartum Care
  > monitoring for cardiac decomp
  > blood flow back to heart is incrd

Question 6

Medications for Prophylaxis of Infection

Answer 6

• Ampicillin
• Cefazolin (Ancef)
• Ceftriaxone (Rocephin)
• Clindamycin (Cleocin)
• one time doses given at latest of 30-60 mins of birth