Mat part 1 in class Flashcards
Sample nursing diagnoses for women with complex maternal health challenges (those who already have illnesses)
Ineffective tissue perfusion (cardiopulmonary) r/t poor heart function secondary to mitral valve prolapse during pregnancy
Social isolation r/t prescribed bed rest during pregnancy secondary to concurrent illness
Ineffective role performance r/t increasing level of daily restriction secondary to chronic illness and pregnancy
Knowledge deficit r/t normal changes of pregnancy vs illness complications
Fear regarding pregnancy outcome r/t chronic illness
Health –seeking behaviours r/t to the effects of illness on pregnancy
Situational low self-esteem r/t illness during pregnancy
Guiding Principles for care of mom + babe during preg when woman already has illness
The mother and fetus are one
Pre-existing disease is usually exacerbated by pregnancy
Illness increases a mother’s anxiety levels, and is often viewed as a loss of “normal”; feelings of guilt are common
The nurse must know the illness itself, and then apply knowledge of the normal symptoms of pregnancy
What do women secrete a lot of during preg that can make pre-existing illness worse?
How does maria want us to see pre-existing illness in preg woman?
Secrete a lot of cortisol when we’re pregnant…this can actually help IBD and arthritis. But generally other problems get worse
Need to think of these issues as being urgent but stable – not conditional on fixing with in next three hours or will die, but rather an ongoing disease needs to be managed well or may die.
Establishing a trusting relationship with preg woman is critical. Why?
need it so they tell you what’s happening. There is a tendency to normalize – reluctant to disclose they have become addicted to substances, use chronic pain meds, found alternative ways to treat themselves
Systematic, consistent, thorough and ongoing assessments are critical. Why?
warning changes can be really minimal + start small.
Prevalence of CVD in preg’s and maternal mortality?
How has view of CVD in preg changed over time?
- Cardiovascular disease: 1% of pregnancies, 5% of maternal deaths (used to say you shouldn’t have kids if you had CV disease…now we are managing better)
Inc age of child bearing more CV challenges
How does blood vol change with preg? Why?
30-50% inc in blood vol during preg may not know you have CV disease until becomes preg and then it is stressed enough to become symptomatic
This occurs mainly because there’s such a big risk of hemm after; only partially due to fact that need to perfuse placenta + fetus
When does blood vol peak in preg? Implications of this for hem risk?
Blood vol peaks 28-32 weeks (symptoms may not appear until this time)
If deliver during these weeks, will lose more blood.
How is fetus affecte by CVD illness in mom?
IUGR Intruterine growth restriction – placenta not a priority!! Not receiving enough nutrients, wastes not being taken away..baby doesn’t grow as well.
Pharmacology considerations for pregnancy?
Which is common and toxic?
How is dosage likely to be changed?
– check preg class!
Teratogenic warfarin (rat poison, will cause still birth)
Most cardiac meds safe
Inc dose?? Yes, because added blood vol many meds require inc in dose.
What sort of symptoms do you see in a normal pregnancy?
How do these change with disease processes (indicating need to see doctor)
- Mild edema to hands + feet only (shouldn’t go up around spine, into eyes, etc)
- Shortness of breath on exertion (SOBOE), quick recovery
- Some postural SOB (just need to change position)
- Orthostatic HoTN – may get dizzy when get up
- Supine hypotension
– dizziness, nausea, bp tanks
Abnormal: Edema – profuse, pulm edema, JVD Inc fatigue Orthopnea – have to sleep sitting up…may be getting fluid in lungs! Renal fx declines Chest pain SOB - slow recovery Weight gain (above + beyond 1-2lbs/wk)
Why supine HoTN in preg women?
vena cava compressed by weight of baby
Why is left lateral best pos for woman with CVD in preg?
max perfusion to the placenta
What are cardiac pt’s at risk of?
Cardiac pt’s at higher risk of infection! Esp resp infection (pneumonia). Ensure are being careful around this.
How much weight gain is ok in preg women with CVD?
In this population important don’t gain more than 20 to 25lbs as this will inc worload of heart
Do CVD preg women get epidurals and why or why not?
Tend to give epidural…don’t want much pain as this is hard on the heart + pushing mechanisms also hard on heart…maybe mild pushing, may use forceps
What baseline assessments need to be done early in preg (for CVD pt)?
Baseline Early in Pregnancy: Fatigue Cough Increased RR Tachycardia Decreased amniotic fluid volume (AFV) IUGR Poor fetal heart tone and variability during electronic fetal heart monitoring (EFM) Edema
What interventions are necessary for pt with CVD?
Two naps a day and good night’s rest, sleep in LL or HOB slightly elevated, keep pressure off the VC
- Limit exercise or work
- Control weight gain, lower salt?, iron
- Meds: abx?, teratogens, increase dose?
- Teach to avoid infection and control visitors
- Consider the need for O2 or bedrest, hospitalization
- LDR: no pushing? Epidural?
- Stool softeners
- Time with babe, reassure babe normal
After delivery, sudden change in circulating blood volume may cause sudden _____?
CHF
How are normal CBC lab values changed for preg + non-preg?
Hg for preg: ~120-160 (12-16 g/dL) Hct for non-preg: 35-44 HCt for preg: 28-40 Platelets for non- preg: 165-450 x 10^9 Platelets for preg: 146-42 X 10^9 WBC for non-preg: 3.5-9.1 WBC for preg: 5.6 – 16.9
Why higher WBC count in preg woman?
have higher white count, need is b/c risk of infection
What is pneudoanemia?
in preg, blood is dilute in pregnancy, vol is high but RBCs require lots of resources
* normal
What sort of referrals may be needed if woman has anemia?
SW appropiate referral b/c often has to do w socioeconomic status
Nutritionist if needs dietary teaching
Nursing interventions for woman with iron def anemai?
Rest periods and coping
Limit exercise or work
Nutritional support and supplements
Iron (120-400 mg once daily - note different than normal??), Folic Acid (400 micrograms once daily), Vitamin C taken with iron
Stool softeners, increase fluids and fibre
