Chapter 30 and 34

Question 1

cardiovascular disorders

Answer 1

Pregnancy with heart disease occurs in about 1% of all pregnancies.
Maternal cardiovascular system undergoes changes during normal pregnancy that can affect women with cardiac disease

Question 2

changes during normal pregnancy that can affect women with cardiac disease:

Answer 2

Increased intravascular volume
Decreased systemic vascular resistance
Cardiac output changes during labor and birth
Intravascular volume changes after childbirth (40-50% extra volume = now gone and heart must adapt)

Question 3

types of C-V disorders

Answer 3

Mothers with congenital heart disease
Acquired heart disease (more common)
      Mitral valve prolapse/ stenosis
       Aortic stenosis
       Myocardial infarction
Valve replacement
Heart transplant

Question 4

problems with C-V disorders

Answer 4

Increased spontaneous abortions - deprived of O2
Increased preterm labor
More SGA/IUGR infants - not getting enough nutrients
Perinatal mortality - moms die and baby increase risk

Question 5

The degree of disability experienced by a cardiac patient may be more important than

Answer 5

the diagnosis for management during pregnancy

Question 6

Management of heart disease according

Answer 6

according to NY Heart Association Classification is the standard used

Question 7

patient graded at

Answer 7

at 3 months and again at 7-8 months to guide care and treatment

Question 8

antepatumm care management

Answer 8

Education on cardiac decompensation to report
Timely treatment of reported infections
Nutritional counseling- iron, folic acid high protein and adequate calories to gain weight
Cardiac meds
Anticoagulant therapy
Assessment of fetal wellbeing

Question 9

interpartum care management

Answer 9

Assess for cardiac decompensation
Possible ABG’s And EKG
Minimize anxiety, pain (meds,postional
changes)
Vaginal birth in side lying position and with pushing avoid the Valsalva maneuver
Prophylactic penicillin (class II or greater)

Question 10

postpartum care management

Answer 10

Monitor for decompensation esp. first 24-48 hours (up to several weeks after delivery)
Elevate HOB and possible bed rest
Support system help with care of infant

Question 11

anemias

Answer 11

20-60% 0f all pregnancies affected
With a decrease in oxygen carrying capacity of the blood the cardiac workload increases. With additional system stressors (PIH, etc.) congestive heart failure can occur.

Question 12

anemias types (look in book)

Answer 12

IRON DEFICIENCY
FOLATE DEFICIENCY ANEMIA
SICKLE CELL HEMOGLOBINOPATHY

Question 13

Postpartum Hemorrhage (PPH) defined as

Answer 13

Loss of 500 ml of blood after vaginal birth
Loss of 1000 ml after cesarean birth
A 10% change in Hgb between labor and postpartum

Question 14

PPH incidence -

Answer 14

Leading cause of maternal morbidity and mortality
Often unrecognized until mother has profound symptoms
risk factors ( anything that will cause uterine atony)

Question 15

Uterine atony

Answer 15

Marked hypotonia of uterus

Leading cause of PPH

Question 16

uterine atony associated with

Answer 16

High parity
Hydramnios
Macrosomic fetus 
Multifetal gestation 
(last 3 overextend uterus)

Question 17

PPH

Answer 17

Lacerations of genital tract
Retained placenta
Uterine Inversion

Question 18

Retained placenta

Answer 18

uterine contracts but gets to a certain point

Question 19

Uterine Inversion

Answer 19

inside out uterus, emergency

Question 20

uterine atony med management

Answer 20

With atony firm the uterus and express any clots
Give medications– p827
Oxygen
Blood replacement if indicated
Assess for S/S of shock
With firm uterus look for lacerations and hematomas
May need to do D&C if retained placental fragments

Question 21

Coagulopathies

Answer 21

Idiopathic thrombocytopenic purpura (ITP)

von Willebrand disease (vWD)

Question 22

Idiopathic thrombocytopenic purpura (ITP)

Answer 22

Autoimmune disorder

Antiplatelet antibodies decrease the life span of platelets

Question 23

von Willebrand disease (vWD)

Answer 23

A type of hemophilia

Deficiency or defect in blood clotting protein

Question 24

Thromboembolic Disease

Answer 24

Results from formation of blood clot or clots inside a blood vessel, caused by inflammation or partial obstruction of vessel
Incidence and etiology
1 per 1000 to 2000 women
Major causes: venous stasis and hypercoagulation
Clinical manifestations
Medical management - give anticoagulant
Nursing interventions

Question 25

Postpartum Infections Puerperal Infections

Answer 25

Endometritis
Wound infections
Urinary tract infections
Mastitis

Question 26

Endometritis

Answer 26

most common

Question 27

Mastitis

Answer 27

if breast fed, one sided tear in nipple tissue

Question 28

infection

Answer 28

temp 100.4 occurs 2 days in a row during 1st 10 days postpartum, excluding 1st 24 hours