Lecture 10 Medical-surgical problems in pregnancy

Question 1

Signs and symptoms of cardiac decompensation

Answer 1

Dyspnea; crackles; an irregular, weak, and rapid pulse; rapid respirations; a moist and frequent cough; generalized edema; increasing fatigue; cyanosis of the lips and nailbeds.

Question 2

Which important component of nutritional counseling should the nurse include in health teaching for a pregnant woman who is experiencing cholecystitis?

Answer 2

Instruct the woman to eat a low-fat diet and to avoid fried foods.

Question 3

Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?

Answer 3

Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms. [Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can perform limited normal activities with discretion, although they still need a good amount of sleep.]

Question 4

The client makes an appointment for preconception counseling. The woman has a known heart condition and is unsure if she should become pregnant. Which is the only cardiac condition that would cause concern?

Answer 4

Eisenmenger syndrome.

Question 5

What form of heart disease in women of childbearing years generally has a benign effect on pregnancy?

Answer 5

Mitral valve prolapse. [Mitral valve prolapse is a benign condition that is usually asymptomatic. Cardiomyopathy produces congestive heart failure during pregnancy. Rheumatic heart disease can lead to heart failure during pregnancy. Some congenital heart diseases produce pulmonary hypertension or endocarditis during pregnancy.]

Question 6

A pregnant woman at 33 weeks of gestation is brought to the birthing unit after a minor automobile accident. The client is experiencing no pain and no vaginal bleeding, her vital signs are stable, and the FHR is 132 beats per minute with variability. What is the nurse’s highest priority?

Answer 6

Using continuous EFM for a minimum of 4 hours. [Monitoring the external FHR and contractions is recommended after blunt trauma in a viable gestation for a minimum of 4 hours, regardless of injury severity. If the maternal and fetal findings are normal, then EFM should continue for a minimum of 4 hours after a minor trauma or a minor automobile accident.]

Question 7

Peripartum cardiomyopathy (PPCM)

Answer 7

1. The development of CHF in the last month of pregnancy or within the first 5 months postpartum.
2. Diagnosis requires the absence of preexisting heart disease before the last month of pregnancy.

Question 8

Bacterial endocarditis prophylaxis during labor and birth - high risk

Answer 8

1. Initial therapy: Ampicillin + gentamicin.
2. Maintenance therapy: Ampicillin or amoxicillin.
3. If patient is allergic to penicillin: Vancomycin + gentamicin.

Question 9

Bacterial endocarditis prophylaxis during labor and birth - moderate risk

Answer 9

1. Amoxicillin or ampicillin.

2. If patient is allergic to penicillin: Vancomycin.

Question 10

Medications permissible during labor for the asthmatic patient

Answer 10

1. Cytotec and Cervidil.
2. Fentanyl and/or epidural for pain.
3. Magnesium sulfate.
4. Oxytocin

Question 11

Medications to avoid giving during labor for the asthmatic patient

Answer 11

1. Hemabate
2. Morphine and meperedine.
3. Beta-agonists - Brethine.
4. NSAIDs - Indocin.
5. Methergine.

Question 12

Management of antiphospholipid syndrome (APS)

Answer 12

1. Assess maternal BP and renal function.

2. Anticoagulation therapy - daily heparin; daily low dose aspirin (75-80 mg).