Pregnancy complication from preexisting or newly acquired illness

Question 1

• defined as those pregnancies with pre- existing or current conditions that put the mother, fetus and new born baby at higher than normal risk for complications during or after the pregnancy or birth
• include very young and older women, those with low levels of education and nutrition, as well as those with previous or current medical or obstetric complications and those in poverty or unstable living arrangements
• Should be identified as early as possible so that the patient can be given care for her benefit and especially for the well being of the fetus and newborn
• Identification and management of high risk factor initially and throughout pregnancy improve pregnancy outcomes for the mother and newborn
• Some predictors of hrps are maternal age (too young or too old) primiparas or multiparas, previous obstetric difficulties, other medical conditions (HIV, hypertension, heart disease, diabetes, kidney disease, or depression) malnourishment, poverty, women who attends STI clinic, and use of cigarettes, alcohol or drugs
• Risk factors may include : social and economic factors such as adverse family circumstances, housing, financial status, and working conditions
• Medical and obstetric history provide evidence of previous risk as such frequent abortion, complications in pregnancy, or medical condition that could affect mother during the pregnancy or at the time delivery
• Pregnancy under the age of 16 or 17 or over the age of 35 should automatically define as being at higher than normal
• Grand multiparity( more than 5 previous birth) or first pregnancy(primigravida) should also be considered as an extra risk for the mother, but more so for the newborn
• Standard or guidelines for risk assessment to assist the primary care provider in early detection and referral of patients on the basis of reasonably objective set of criteria for high risk factors
• The forms and guidelines developed should take into account local risk factors, such as high consanguinity rates in some societies or chronic malnutrition in the population
• A well developed HRPs assessment, referral and follow up system contributes to improve outcomes for both mothers and newborn, preventing costly long- term consequences of maternal and infant morbidity and mortality

Answer 1

Overview of High- risk pregnancy:

• High- risk pregnancies (HRPs)

Question 2

• Women of childbearing age who have heart disease is diminishing as more and more congenital heart anomalies are corrected in early infancy
• With improved management of women with cardiac disorder, women who might never have risk pregnancy in the past are able to complete pregnancies successfully today
• Women with cardiovascular disease needs and interprofessional team approach to care during pregnancy
• She should visit her pregnancy care provider for preconception care so her state of health and baseline data when she is not pregnant can be established

Answer 2

Cardiovascular Disorder and Pregnancy

Question 3

Classification of heart disease:

• Ordinary physical activity causes no discomfort. No symptoms of cardiac insufficiency and no anginal pain

Answer 3

Classification of heart disease:
1. Uncompromised

Question 4

Classification of heart disease:

• Ordinary physical activity cause excessive fatigue, palpitation and dyspnea or anginal pain

Answer 4

Classification of heart disease:
2. Slightly Compromised

Question 5

Classification of heart disease:

• During less than ordinary activity, woman experiences excessive fatigue, palpitations, dyspnea or anginal pain

Answer 5

Classification of heart disease:
3. Markedly Compromised

Question 6

Classification of heart disease:

• Woman is unable to carry out any physical activity without experiencing discomfort. Even at rest, symptoms of cardiac insufficiency or anginal pain are present

Answer 6

Classification of heart disease:
4. Severely Compromised

Question 7

Cardiovascular Disorder and Pregnancy:

• occurs in condition such as mitral stenosis, mitral insufficiency, and aortic coarctation
• the left ventricle cannot move the large volume of blood forward that it has received by the left atrium from the pulmonary circulation
• cause black pressure—-the left side of the heart become distended, systemic blood pressure decreases in the face of lowered cardiac output, and pulmonary hypertension occur

Answer 7

Cardiovascular Disorder and Pregnancy:

Left- Sided Heart Failure

Question 8

Cardiovascular Disorder and Pregnancy:

• occurs when the right ventricle is overwhelmed by the amount of blood received by the right atrium by the vena cava
• can be caused by an unrepaired congenital heart defect such as pulmonary valve stenosis, but the anomaly mast apt to cause right- sided heart failure in women of reproductive age is ______? it is a right to left atrial or ventricular septal defect with an accompanying pulmonary valve stenosis

Answer 8

Cardiovascular Disorder and Pregnancy:

Right- Sided Heart Failure

• Eisenmenger syndrome

Question 9

High- Risk Pregnancy: Cardiovascular Clinical Findings

_____? . orthopnea
. paroxysmal nocturnal dyspnea

_____? . distended liver and spleen
. Ascites
. peripheral edema

Answer 9

High- Risk Pregnancy: Cardiovascular Clinical Findings
1. Left- side heart failure

2. Right- sided heart failure

Question 10

• level of exercise
• presence of cough or edema
• comparison of baseline vital signs
• liver size (right- sided heart failure involvement)
• ECG/ echocardiogram
• Fetal size (small for gestational age) and poor response to labor ( FHR deceleration)

Answer 10

High- Risk Pregnancy: Cardiovascular System Assessment

Question 11

• the infants of women with severe heart disease tend to have low birth weights or be small for gestational age because of acidosis, which develop due to poor oxygen/ carbon dioxide exchange or not being furnished with enough nutrients

Answer 11

High- Risk Pregnancy: Cardiovascular System Assessment

• fetal assessment

Question 12

• Deficient knowledge regarding steps to take to reduce the effects of maternal cardiovascular disease on the pregnancy and fetus

Answer 12

High- Risk Pregnancy: Cardiovascular System Nursing Diagnosis (example)

Question 13

• promote rest
• promote healthy nutrition
• educate regarding medication
• educate regarding avoidance of infection

Answer 13

High- Risk Pregnancy: Cardiovascular System Nursing Intervention During Antepartal Period