ch. 30 med surg disorders Flashcards
cardiovascular disorders
- 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)
4 classes of cardiovascular disorders
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)
pregnancy in a women with heart disease is associated with increased risk for
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
3 congenital cardiac diseases
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)
acquired cardiac disease
- mitral valve prolapse (tachycardia)
- mitral stenosis (almost always caused by rheumatic heart disease (RHD), a consequence of rheumatic fever
- aortic stenosis
ischemic heart disease
- 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
other cardiac diseases and conditions
- primary pulmonary hypertension (PPH)
- marfan syndrome
- infective endocarditis
- eisenmenger syndrome
- peripartum cardiomyopathy (PCM)
- valve replacement
- heart transplantation
interprofessional care mgmt
- 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)
anemia
- 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
pulmonary disorders
- 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)
integumentary disorders
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
neurologic disorders
1) epilepsy
- generalized epilepsy
- focal epilepsy
- anticonvulsant medications
2) multiple sclerosis (MS)
3) bell palsy:
- one sided facial droop
autoimmune disorders
1) systemic lupus erythematosis (SLE)
2) myasthenia gravis (MG)
gastrointestinal disorders
1) cholelithiasis
- presence of gallstones in the gallbladder
2) cholecystitis
- inflammation of the gallbladder
3) inflammatory bowel disease
- crohn’s disease
urinary tract infections
1) asymptomatic bacteriuria
2) cystitis
3) pyelonephritis
surgery during pregnancy
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
trauma during pregnancy
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)
cardiopulmonary resuscitation of a pregnancy women
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
