LESSON 2

Question 1

What is the most dangerous time for a women— after the blood volume peaks?

Answer 1

28 to 32 weeks

Question 2

It occurs in conditions such as mitral stenosis, mitral insufficiency and aortic coarctation.

Answer 2

A woman with Left Sided Heart Failure

Question 3

The level for the failure is often at the level of the?
left sided heart failure

Answer 3

Mitral Valve

Question 4

When pressure in the pulmonary vein reaches a point of —–, fluid begins to pass
from the pulmonary capillary membranes into the interstitial spaces surrounding the
alveoli and into the alveoli leads to —-

Answer 4

25 mm Hg, Pulmonary edema

Question 5

interferes with oxygen-carbon dioxide exchange because fluid coats
the alveolar exchange space. If pulmonary capillaries rupture under the pressure, small
amounts of blood leak into the alveoli.

Answer 5

pulmonary edema

Question 6

s/sx of left sided heart failure

Answer 6

 Productive cough of blood-speckled sputum
 Increased fatigue
 Weaknesses
 Dizziness – lack of oxygen in the brain
 HR increases.
 Peripheral constriction occurs in an attempt to increase the systemic BP.
 Pulmonary edema
 Orthopneic
 Paroxysmal nocturnal dyspnea (suddenly waking at night with shortness of breath) –
occurs because heart action is more effective when she is at rest.

Question 7

(suddenly waking at night with shortness of breath) –
occurs because heart action is more effective when she is at rest.

Answer 7

Paroxysmal nocturnal dyspnea

Question 8

Risk of left sided heart failure

Answer 8

 Spontaneous miscarriage – because oxygen is limited.
 Preterm labor
 Maternal death
As oxygen saturation of the blood decreases from dysfunction of the alveoli, chemoreceptors
stimulate the respiratory center to increase RR.

Question 9

medications for left sided heart failure

Answer 9

 Antihypertensives – to control increased BP.
 Diuretics – to reduce blood volume.
 Beta blockers – to improve ventricular filling.

Question 10

diet for left sided heart failure

Answer 10

low sodium diet

Question 11

laboratory management for left sided heart failure

Answer 11

serial UTZ and non-stress test after 30-32 weeks of pregnancy and monitor FHR

Question 12

spacial management for left sided heart failure

Answer 12

 Balloon valve angioplasty to loosen mitral valve adhesions.
 If an anticoagulant is required, heparin is the drug of choice – it does not cross the
placenta.

Question 13

If an anticoagulant is required, what is the drug of choice?

Answer 13

Heparn because it does not cross the placenta

Question 14

what is the purpose of balloon valve angioplasty?

Answer 14

it will loosen the mitral valve adhesions

Question 15

Congenital heart defects – pulmonary valve stenosis and atrial and ventricular septal
defects can result in right-sided heart failure

Answer 15

true

Question 16

Blood pressure decreases in the aorta because—
right sided heart failure

Answer 16

less blood is reaching it

Question 17

If the pressure is high in the vena cava, what will happen?
right sided heart failure

Answer 17

both jugular distention and increased portal
circulation occur

Question 18

s/sx of the right sided heart failure

Answer 18

 Liver and spleen distended – leading to dyspnea and pain in pregnant woman because
the enlarged liver, as it pressed upward by the enlarged uterus, puts extreme pressure
on the diaphragm.
 Ascites – distention of abdominal vessels can lead to exudates of fluid from the vessels
into the peritoneal cavity.
 Peripheral edema – fluid also moves from the systemic circulation into lower extremity
interstitial spaces.
 Eisenmenger Syndrome – the congenital anomaly most apt to cause the right sided
heart failure in women of reproductive age.

Question 19

the congenital anomaly most apt to cause the right sided heart failure in women of reproductive age.

Answer 19

Eisenmenger syndrome

Question 20

distention of abdominal vessels can lead to exudates of fluid from the vessels into the peritoneal cavity

Answer 20

Ascites

Question 21

leading to dyspnea and pain in pregnant woman because the enlarged liver, as it pressed upward by the enlarged uterus, puts extreme pressure on the diaphragm

Answer 21

liver and spleen distended

Question 22

fluid also moves from the systemic circulation into lower extremity interstitial spaces

Answer 22

peripheral edema

Question 23

management for right sided heart failure

Answer 23

 Oxygen administration
 Frequent arterial blood assessment to ensure fetal growth.
 During labor – pulmonary artery catheter to monitor pulmonary pressure.
 Close monitoring to minimize the risk of hypotension after epidural anesthesia

Question 24

because the blood volume expands during pregnancy slightly ahead of the red cell count, most women have a —– of early pregnancy. This condition is normal and should not be confused with true types of anemia.

Answer 24

anemia and pregnancy, pseudo anemia

Question 25

woman’s hemoglobin (hgb) concentration is less than 11 g/dL (hematocrit: CT < 33%) during the first and third trimester of pregnancy
* when hgb concentration is < 10.5 g/dL (hematocrit < 32%) during the second trimester

Answer 25

true anemia

Question 26

what is the most common anemia of pregnancy?

Answer 26

A woman with iron-deficiency anemia

Question 27

What are the causes of iron-deficiency anemia?

Answer 27

 diet low in iron- low socio economic status
 heavy menstrual flow
 unwise weight –reducing programs
 getting pregnant less than 2 years before the current pregnancy
 pica

Question 28

s/sx of iron-deficiency anemia

Answer 28

-extreme fatigue and poor exercise tolerance
-associated with low birth weight and preterm birth

Question 29

Management for Anemia and Iron-Deficiency Anemia

Answer 29

1. Intake of prescribed prenatal vitamins containing 27 mg of iron as prophylactic therapy during pregnancy
2. Advise woman to eat diet high in iron and vitamins: green leafy vegetables, meat and legumes
3. Ferrous Sulfate or Ferrous Gluconate- 120-200 mg elemental iron per day
4. Advise woman to take orange juice or a vitamin c – Reason: iron is absorbed in an acid medium

Question 30

what are the possible side effects of medications in iron-deficiency anemia?

Answer 30

1. Constipation – high fiber diet, increase fluid intake 6-8 glasses per day.
2. Gastric irritation – take oral tablet with full stomach.
3. Turning stools black in color-advice woman that this is normal.
    If iron deficiency is severe and woman has difficulty in taking oral tablet, Intravenous iron can be prescribed.

Question 31

This is one of the B vitamins which is necessary for the normal formation of red blood cells in
the woman

Answer 31

Folic-acid or folate or folacin