ch. 30 med surg disorders

Question 1

cardiovascular disorders

Answer 1

• during normal pregnancy, the maternal cardiovascular system undergoes many changes that place physiologic strain on the heart

various changes:
- increased intravascular volume (40-50%)
- decreases systemic vascular resistance (decreased BP)
- cardiac output changes during labor and birth (increase 15-20%)
- intravascular volume changes after childbirth (decreased)

Question 2

4 classes of cardiovascular disorders

Answer 2

class 1: asymptomatic without limitation of physical activity

class 2: symptomatic with slight limitation of activity (tired)

class 3: symptomatic with marked limitation of activity

class 4: symptomatic with inability to carry on any physical activity without discomfort (chest pain, angina)

Question 3

pregnancy in a women with heart disease is associated with increased risk for

Answer 3

1) decompensation of maternal cardiac status
- maternal arrythmias
- heart failure
- preterm birth
- fetal growth restriction
- fetal death

2) pregnancy complications:
- preterm birth
- fetal growth restriction
- fetal death

• cardiac diseases vary in their effect on pregnancy depending on whether they are acute or chronic conditions

Question 4

3 congenital cardiac diseases

Answer 4

1) septal defects
- atrial septal defect (ASD)
- ventricular septal defect (VSD)
- patent ductus arteriosus (PDA) (incomplete closure)

2) acyanotic lesions
- coarctation of aorta (narrowing of aorta) (LAA narrow)

3) cyanotic lesions
- tetralogy of fallot (multiple heart conditions)

Question 5

acquired cardiac disease

Answer 5

• mitral valve prolapse (tachycardia)
• mitral stenosis (almost always caused by rheumatic heart disease (RHD), a consequence of rheumatic fever
• aortic stenosis

Question 6

ischemic heart disease

Answer 6

• myocardial infarction (MI)
• estimated to occur in only 1/16,000 pregnancies
• occurs most frequently in the 3rd trimester of pregnancy and in multigravid women older than 33 years of age

Question 7

other cardiac diseases and conditions

Answer 7

• primary pulmonary hypertension (PPH)
• marfan syndrome
• infective endocarditis
• eisenmenger syndrome
• peripartum cardiomyopathy (PCM)
• valve replacement
• heart transplantation

Question 8

interprofessional care mgmt

Answer 8

• assessment (interventions)
• antepartum
• heart surgery during pregnancy (MV clipped)
• intrapartum
• postpartum (monitoring for cardiac decompensation d/t placenta release + body tries to compensate, prepare for discharge)

Question 9

anemia

Answer 9

• defined as hgb less than 11g/dL in the first and third trimesters and less than 10.5 g/dL in the second trimester
• hgb less than 6-8 mg/dL is considered severe anemia
• common medical disorder of pregnancy: affects 20-25% of pregnant women
• iron deficient anemia: most common, accounts for 75% cases of anemia, folic acid deficiency anemia, sickle cell hemoglobinopathy, thalassemia

TIP:
- physiologic anemia: d/t increased BV that diffuses hgb

Question 10

pulmonary disorders

Answer 10

• asthma: know meds, last attack, have they ever been intubated
• cystic fibrosis (CF): genetic condition that affects a protein in the body -> causes fluids (sweat, mucous, digestive juices to become thick/sticky)

Question 11

integumentary disorders

Answer 11

1) pruritus gravidarium
- itching
- develops in up to 14% of pregnant women

2) pruritic urticarial papules and plaques of pregnancy (PUPPP), aka polymorphic eruption of pregnancy (PEP) -> tx is meds

3) intrahepatic cholestasis of pregnancy:
- characterized by generalized pruritis, starts in 3rd trimester

Question 12

neurologic disorders

Answer 12

1) epilepsy
- generalized epilepsy
- focal epilepsy
- anticonvulsant medications
2) multiple sclerosis (MS)
3) bell palsy:
- one sided facial droop

Question 13

autoimmune disorders

Answer 13

1) systemic lupus erythematosis (SLE)

2) myasthenia gravis (MG)

Question 14

gastrointestinal disorders

Answer 14

1) cholelithiasis
- presence of gallstones in the gallbladder

2) cholecystitis
- inflammation of the gallbladder

3) inflammatory bowel disease
- crohn’s disease

Question 15

urinary tract infections

Answer 15

1) asymptomatic bacteriuria

2) cystitis

3) pyelonephritis

Question 16

surgery during pregnancy

Answer 16

1) approximately 1/500 women require nonobestetric surgery during pregnancy
- 2 common nonobstetric abdominal conditions requiring surgery during pregnancy:
- appendicitis (occurs in 1/1000 pregnancies)
- symptomatic cholelithiasis

2) interprofessional care mgmt
- assessment
- hospital care
- home care

Question 17

trauma during pregnancy

Answer 17

1) significance:
- most cases of trauma are reported in 3rd trimester
- most are result of MVA
- both maternal/physiologic characteristics

2) mechanisms of trauma:
- blunt abdominal trauma
- penetrating abdominal trauma
- thoracic trauma

3) interprofessional care mgmt:
- immediate stabilization (IV)
- primary survey
- secondary survey (electronic fetal monitoring, fetomaternal hemorrhage, U/S, radiation exposure, perimorterm c-section (resuscitative hysterectomy)

Question 18

cardiopulmonary resuscitation of a pregnancy women

Answer 18

common causes:
- hemorrhage
- heart failure
- amniotic fluid embolism
- sepsis
- aspiration pneumonitis
- venous thromboembolism
- preeclampsia/eclampsia
- anesthetic complications

specific modifications:
- uterine displacement in second half of pregnancy
- defibrillation paddles must be placed one rib space higher

complications of CPR:
- include lacerations of the liver, rupture of the spleen or uterus, hemothorax, hemopericardium, or fracture of ribs or sterum
- ideally perimortem cesarean birth should be accomplished within 5 MINTUES after the time of the rest