NCM_109 topic 2.0 Flashcards
What is a cardiac disorder?
includes a number of heart diseases/defects which include both congenital and acquired conditions.
All classifications of the New York heart association
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.
According to the New York heart association classification for clients with heart diseases, which class does make the mother and baby at risk?
Classes 3 and 4
When a mother with heart disorder is classified as 3 or 4 what are the possible maternal and fetal risks
- maternal heart failure
- maternal dysrhythmias
- spontaneous abortion or premature labor caused by maternal hypoxia
- intrauterine growth retardation
In confirming a cardiac disorder diagnosis, what should we look out for?
- systolic murmurs
- dyspnea or edema in the last trimester
- changes in the position of the heart due to cardiac enlargement
- severe dysrhythmia
Hospitalization of mothers with cardiac disorders?
necessary of 1 to 4 weeks before delivery
a. we must give prophylactic antibiotic to prevent bacterial endocarditis and advice for vaginal delivery
assessment for patients with cardiac disorders?
- FHT and FHR, and vital signs of the mother
- compliance with prescribed therapeutic regimen
- cardiac and respiratory status both at rest and with activity
What is diabetes?
inherited metabolic disorder characterized by a deficiency in insulin from beta cells in the pancreas
What is white’s classification for diabetes?
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
Effects of maternal diabetes to the fetus?
- perinatal mortality
- ketoacidosis
- congenital abnormalities
- hypoxia and fetal death
- LGA
- neonatal hypoglycemia
- newborn injury
- neonatal distress
Tests to be done for pregnant women with diabetes?
- Glucose tolerance test if screening is abnormal
- Mean glucose test for hyperglycemia
- chem strip blood-glucose testing
- 2 hour postprandial blood glucose to evaluate diet
- urine glucose monitoring for ketones
- a repat of GTT after 6 weeks postpartum
assessment for diabetes
- s/s of hypo or hyperglycemia
- indications of hydramnios, preeclampsia, infection
- history of LGA
- insulin
requirements
What happens to the fetus if mother is exposed to substance abuse?
Fetus experinces systemic effects of the substance severley and for a longer time which inteferes the normal fetal development and health
Sample of substances that people can abuse
- Caffeine
- Tabacco (nicotine affects blood circulation and carbon monoxide inactivates hemoglobin)
- Alcohol (teratogenic and has long term impacts with mental delays)
- Marijuana (anxiety, hallucinations and tachycardia that can affect cognitive, behavioral, and emotional deficit in infant)
- Cocaine (stimulant causing hypertension, tachycardia, arrythmias, tremors and if down depression occurs. Stimulates contraction leading to premature labor and PROM, low birth weight)
- Amphetamines and Methamphetamines (CNS stimulant causing increase bp pressure and placental abruption causing brain and motor impairment and delayed maturation)
- Antidepressants (selective serotonin reuptake inhibitors affect pulmonary hypertension)
- Opiates (same risks with cocaine and neonatal abstinence with seizures and brain dysfunctions)
Three features of FAS
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
Women in opiate can be treated with these two drugs
- methadone
- buprenorphine
assessment on women in substance abuse
- signs of drug abuse
- seeking prenatal checkup
- failure to keep prenatal appointments
- needle punctures
- grooming
- hostile reactions and emotional response
- mood swings
- fundic height
What is HIV
virus transmitted through sexual intercourse, needle punctures, exposure to infected blood that affects CD4 cells by depleting and impairing them.
Distinct phases of HIV
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)
Normal count of CD4 T-cell
450 to 1,200 cells per microliter when person has 200 or less consider AIDS
Treatment recommended by WHO for people who have HIV and AIDS
ARVs (antiretroviral therapy) and ART (antiretroviral drugs)
What is Rh sensitization?
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.
What happens to baby when there is Rh incompatibility
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)
Tests to be done for Rh diagnosis
- ultrasound (detect organ enlargement such as liver, spleen, heart)
- Doppler ultrasound (measure blood velocities if it becomes to thin, making baby anemic)
- Rh testing to see positive antibodies of mother
- amniocentesis to measure amount of bilirubin in amniotic fluid
- sampling of blood from fetal umbilical cord to check antibodies, bilirubin and anemia.
- Coomb’s test
What is anemia
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
Assessment for Anemia
- Hgb < 11 g/dl or HCT < 37%
- Hgb < 10.5 g/dl or HCT < 35% in second trimester
- Hgb < 10 g/dl or HCT < 33% in third trimester
What to do with pregnant women with anemia?
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
