Chapter 30 and 34 Flashcards
cardiovascular disorders
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
changes during normal pregnancy that can affect women with cardiac disease:
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)
types of C-V disorders
Mothers with congenital heart disease
Acquired heart disease (more common)
Mitral valve prolapse/ stenosis
Aortic stenosis
Myocardial infarction
Valve replacement
Heart transplantproblems with C-V disorders
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
The degree of disability experienced by a cardiac patient may be more important than
the diagnosis for management during pregnancy
Management of heart disease according
according to NY Heart Association Classification is the standard used
patient graded at
at 3 months and again at 7-8 months to guide care and treatment
antepatumm care management
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
interpartum care management
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)
postpartum care management
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
anemias
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.
anemias types (look in book)
IRON DEFICIENCY
FOLATE DEFICIENCY ANEMIA
SICKLE CELL HEMOGLOBINOPATHY
Postpartum Hemorrhage (PPH) defined as
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
PPH incidence -
Leading cause of maternal morbidity and mortality
Often unrecognized until mother has profound symptoms
risk factors ( anything that will cause uterine atony)
Uterine atony
Marked hypotonia of uterus
Leading cause of PPH
uterine atony associated with
High parity Hydramnios Macrosomic fetus Multifetal gestation (last 3 overextend uterus)
PPH
Lacerations of genital tract
Retained placenta
Uterine Inversion
Retained placenta
uterine contracts but gets to a certain point
Uterine Inversion
inside out uterus, emergency
uterine atony med management
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
Coagulopathies
Idiopathic thrombocytopenic purpura (ITP)
von Willebrand disease (vWD)
Idiopathic thrombocytopenic purpura (ITP)
Autoimmune disorder
Antiplatelet antibodies decrease the life span of platelets
von Willebrand disease (vWD)
A type of hemophilia
Deficiency or defect in blood clotting protein
Thromboembolic Disease
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
Postpartum Infections Puerperal Infections
Endometritis
Wound infections
Urinary tract infections
Mastitis
Endometritis
most common
Mastitis
if breast fed, one sided tear in nipple tissue
infection
temp 100.4 occurs 2 days in a row during 1st 10 days postpartum, excluding 1st 24 hours
