NCM_109 topic 2.0

Question 1

What is a cardiac disorder?

Answer 1

includes a number of heart diseases/defects which include both congenital and acquired conditions.

Question 2

All classifications of the New York heart association

Answer 2

Class 1: no limitation of activity; no symptoms of cardiac insufficiency

Class 2: slight limitation of activity; asymptomatic at rest; ordinary activities cause fatigue, palpitations, dyspnea, or angina.

Class 3: marked limitation of activities; comfortable at rest; less than ordinary activities cause discomfort.

Class 4: unable to perform any physical activity without discomfort; may have symptoms even at rest.

Question 3

According to the New York heart association classification for clients with heart diseases, which class does make the mother and baby at risk?

Answer 3

Classes 3 and 4

Question 4

When a mother with heart disorder is classified as 3 or 4 what are the possible maternal and fetal risks

Answer 4

1. maternal heart failure
2. maternal dysrhythmias
3. spontaneous abortion or premature labor caused by maternal hypoxia
4. intrauterine growth retardation

Question 5

In confirming a cardiac disorder diagnosis, what should we look out for?

Answer 5

1. systolic murmurs
2. dyspnea or edema in the last trimester
3. changes in the position of the heart due to cardiac enlargement
4. severe dysrhythmia

Question 6

Hospitalization of mothers with cardiac disorders?

Answer 6

necessary of 1 to 4 weeks before delivery

a. we must give prophylactic antibiotic to prevent bacterial endocarditis and advice for vaginal delivery

Question 7

assessment for patients with cardiac disorders?

Answer 7

1. FHT and FHR, and vital signs of the mother
2. compliance with prescribed therapeutic regimen
3. cardiac and respiratory status both at rest and with activity

Question 8

What is diabetes?

Answer 8

inherited metabolic disorder characterized by a deficiency in insulin from beta cells in the pancreas

Question 9

What is white’s classification for diabetes?

Answer 9

Class A: diabetes that can often be controlled by diet; includes gestational diabetes (90% of all pregnant diabetics)

Class B: onset after age 20; duration 0-9 years; no vascular involvement

Class C: onset at age 10-19; duration 10-19 years; no vascular involvement

Class D: onset before age 10; duration 20 or more years; calcification present in legs; retinitis

Class E: presence of calcified pelvic vessels

Class F: presence of nephritis

Question 10

Effects of maternal diabetes to the fetus?

Answer 10

1. perinatal mortality
2. ketoacidosis
3. congenital abnormalities
4. hypoxia and fetal death
5. LGA
6. neonatal hypoglycemia
7. newborn injury
8. neonatal distress

Question 11

Tests to be done for pregnant women with diabetes?

Answer 11

1. Glucose tolerance test if screening is abnormal
2. Mean glucose test for hyperglycemia
3. chem strip blood-glucose testing
4. 2 hour postprandial blood glucose to evaluate diet
5. urine glucose monitoring for ketones
6. a repat of GTT after 6 weeks postpartum

Question 12

assessment for diabetes

Answer 12

1. s/s of hypo or hyperglycemia
2. indications of hydramnios, preeclampsia, infection
3. history of LGA
4. insulin
   requirements

Question 13

What happens to the fetus if mother is exposed to substance abuse?

Answer 13

Fetus experinces systemic effects of the substance severley and for a longer time which inteferes the normal fetal development and health

Question 14

Sample of substances that people can abuse

Answer 14

1. Caffeine
2. Tabacco (nicotine affects blood circulation and carbon monoxide inactivates hemoglobin)
3. Alcohol (teratogenic and has long term impacts with mental delays)
4. Marijuana (anxiety, hallucinations and tachycardia that can affect cognitive, behavioral, and emotional deficit in infant)
5. Cocaine (stimulant causing hypertension, tachycardia, arrythmias, tremors and if down depression occurs. Stimulates contraction leading to premature labor and PROM, low birth weight)
6. Amphetamines and Methamphetamines (CNS stimulant causing increase bp pressure and placental abruption causing brain and motor impairment and delayed maturation)
7. Antidepressants (selective serotonin reuptake inhibitors affect pulmonary hypertension)
8. Opiates (same risks with cocaine and neonatal abstinence with seizures and brain dysfunctions)

Question 15

Three features of FAS

Answer 15

Growth restriction in length, weight and head circumference

CNS deficits

facial features of microcephaly, short palpebral fissures, flat midface, low nasal bridge, thin upper lips

Question 16

Women in opiate can be treated with these two drugs

Answer 16

1. methadone
2. buprenorphine

Question 17

assessment on women in substance abuse

Answer 17

1. signs of drug abuse
2. seeking prenatal checkup
3. failure to keep prenatal appointments
4. needle punctures
5. grooming
6. hostile reactions and emotional response
7. mood swings
8. fundic height

Question 18

What is HIV

Answer 18

virus transmitted through sexual intercourse, needle punctures, exposure to infected blood that affects CD4 cells by depleting and impairing them.

Question 19

Distinct phases of HIV

Answer 19

Acute (fever, pharyngitis, rash, and myalgia occurs 2 to 6 weeks after exposure)

seroconversion (after 3 to 12 months, person is infectious

asymptomatic (after acute phase)

Question 20

Normal count of CD4 T-cell

Answer 20

450 to 1,200 cells per microliter when person has 200 or less consider AIDS

Question 21

Treatment recommended by WHO for people who have HIV and AIDS

Answer 21

ARVs (antiretroviral therapy) and ART (antiretroviral drugs)

Question 22

What is Rh sensitization?

Answer 22

Rh factor incompatibility occur when mother’s Rh is negative and baby’s positive, making the mother to produce antibodies to fight baby’s body.

Question 23

What happens to baby when there is Rh incompatibility

Answer 23

Anemia as baby’s RBC are destroyed and fetal bilirubin level increase making the amniotic fluid yellow.

Congestive heart failure due to generalized edema (hydrops fetalis)

Question 24

Tests to be done for Rh diagnosis

Answer 24

1. ultrasound (detect organ enlargement such as liver, spleen, heart)
2. Doppler ultrasound (measure blood velocities if it becomes to thin, making baby anemic)
3. Rh testing to see positive antibodies of mother
4. amniocentesis to measure amount of bilirubin in amniotic fluid
5. sampling of blood from fetal umbilical cord to check antibodies, bilirubin and anemia.
6. Coomb’s test

Question 25

What is anemia

Answer 25

reduction in red blood cell volume, is measured by hematocrit (Hct) or a decrease in the concentration of hemoglobin (Hgb) in the peripheral blood resulting to reduce capacity to carry oxygen

Question 26

Assessment for Anemia

Answer 26

1. Hgb < 11 g/dl or HCT < 37%
2. Hgb < 10.5 g/dl or HCT < 35% in second trimester
3. Hgb < 10 g/dl or HCT < 33% in third trimester

Question 27

What to do with pregnant women with anemia?

Answer 27

Monitor Hgb and GCT at initial antenatal

dietary counseling

take oral iron compounds such as ferrous sulfate or gluconate with folic acid of 5mg/24 hr orally

refer genetic counselling and observe symptoms of hemolytic crisis