ob chapter 20 Flashcards
What conditions can cause left-sided heart failure?
Mitral stenosis, mitral insufficiency, and aortic coarctation.
Why does left-sided heart failure cause back pressure?
The left ventricle cannot move blood forward effectively, leading to distention, decreased systemic BP, and pulmonary hypertension.
What happens when pulmonary vein pressure reaches 25 mm Hg?
Fluid moves from pulmonary capillaries into interstitial lung spaces and then into alveoli, causing pulmonary edema.
How does pulmonary edema affect breathing?
It interferes with oxygen-carbon dioxide exchange, causing profound shortness of breath.
What severe complications can result from left-sided heart failure in pregnancy?
High risk for spontaneous miscarriage, preterm labor, or even death due to limited oxygen exchange.
What is orthopnea, and why does it occur in left-sided heart failure?
Orthopnea is difficulty breathing when lying flat. Patients must elevate their chest and head to allow fluid to settle at the lung bases and free space for gas exchange.
What secondary problem can occur with mitral stenosis in left-sided heart failure?
Thrombus formation due to blood stagnation in the left atrium.
What is the preferred anticoagulant in early pregnancy for preventing thrombus formation?
Low-molecular-weight heparin (LMWH) because it does not cross the placenta and is not teratogenic.
What medications are used to manage left-sided heart failure?
Anticoagulants (for thrombus prevention), antihypertensives (to control BP), diuretics (to reduce blood volume), and beta-blockers (to improve ventricular filling).
What are the three main risk factors for venous thrombosis disease?
Stasis, vessel damage, and hypercoagulation.
How does stasis contribute to venous thrombosis risk in pregnancy?
Blood pools in the lower extremities due to uterine pressure.
How does vessel damage contribute to venous thrombosis risk?
Pressure from the fetal head at birth can compress lower extremity veins, causing damage.
How does hypercoagulation contribute to venous thrombosis risk?
Elevated estrogen levels increase blood clotting tendencies.
What can be done to reduce the risk of thrombus formation?
Avoid constrictive knee-high stockings, do not sit with legs crossed at the knee, and avoid standing in one position for long periods.
What are common signs of a deep vein thrombosis (DVT) in pregnancy?
Pain and redness, usually in the calf of a leg.
How is DVT diagnosed?
Through patient history and Doppler ultrasonography.
What is the primary treatment for DVT during pregnancy?
Bed rest and intravenous (IV) heparin for 24-48 hours.
What anticoagulant is commonly used for DVT treatment during pregnancy?
Heparin, initially IV, followed by subcutaneous injections.
How often is subcutaneous heparin given after initial IV treatment?
Every 12 or 24 hours for the duration of pregnancy.
Where should heparin injections be given during pregnancy?
Arms and thighs, avoiding the abdomen.
When are pregnant patients screened for sickle-cell anemia?
At their first prenatal visit.
Why should pregnant patients with sickle-cell anemia have periodic urine tests?
They are more susceptible to bacteriuria.
Why is monitoring nutritional intake important for pregnant patients with sickle-cell anemia?
To ensure sufficient folic acid intake for replacing destroyed red blood cells.
Why should pregnant patients with sickle-cell anemia take additional folic acid supplements?
To support red blood cell production.
Why should routine iron supplements be avoided in sickle-cell anemia?
Sickled cells cannot incorporate iron effectively.
How much fluid should pregnant patients with sickle-cell anemia drink daily?
At least eight glasses of fluid to prevent dehydration.
What is a periodic exchange transfusion used for in pregnant patients with sickle-cell anemia?
To replace sickled cells with nonsickled cells and remove excess bilirubin.
What are the key interventions for managing a sickle-cell crisis?
- Controlling pain, 2. Administering oxygen as needed, 3. Increasing fluid volume to lower viscosity.
What is an important prenatal education topic for preventing UTIs?
Common measures to prevent UTIs, such as proper voiding habits and hygiene.
How often should pregnant patients void to prevent UTIs?
At least every 2 hours.
Why is it important to urinate as soon as the need is felt?
To prevent urine stasis, which can lead to infection.
What is the proper wiping technique after voiding or bowel movements to prevent UTIs?
Wipe front to back.
What type of underwear should be worn to help prevent UTIs?
Cotton underwear, not synthetic fibers.
What is an important step after sexual intercourse to prevent UTIs?
Urinating immediately.
How much fluid should a pregnant patient with a UTI drink?
Up to 3-4 liters per 24 hours to help flush out the infection.
What are the common symptoms of tuberculosis in pregnancy?
Chronic cough, substantial weight loss, hemoptysis (coughing blood), low-grade fever, extreme fatigue, and night sweats.
What test is offered to assess tuberculosis in pregnant patients?
A PPD (tuberculin skin test).
What is done if a pregnant patient has a positive PPD test?
A chest X-ray or sputum culture is performed to confirm the diagnosis.
