Respiratory Disorders

Question 1

List 5 things about the breathless pregnant woman

Answer 1

the sensation of being out of breath or being unable to catch your breath

normal changes in pregnancy that may influence breathlessness:
increase in weight
elevation of the diaphragm due to the growing uterus
increased progesterone causing hyperventilation

HOWEVER there are pathological causes of breathlessness.

anaemia - FBC to rule out - treat appropriately

encourage smoking cessation

Question 2

list 5 things about asthma

Answer 2

chronic inflammatory disease of the airways categorised by periods of wheezing, shortness of breath, chest tightness and cough. variable disease which responds to different stimuli. effects 5-15% of the population.

encourage women that well-controlled asthma have better pregnancy outcomes for mum and baby

appropriate smoking cessation advice

triggers: 
smoking
allergens (dust)
exercise
food and drinks; alcohol, peanuts
hormonal - pregnancy

continue of medication - generally safe for pregnancy

well controlled asthma - low risk care

Question 3

list 5 things about pneumonia and chest infections

Answer 3

pneumonia is an acute infection within the lower respiratory tract occurring twice as often in the winter months than summer.

can cause severe respiratory failure
generalised septicaemia

role of midwife if suspects pneumonia to take sputum sample and send to lab, make urgent referral

risk of preterm labour associated with maternal pyrexia

pneumonia in postpartum period - can breastfeed however certain medications not suitable for breastfeeding

Question 4

list 5 things about TB

Answer 4

bacterial infection - mycobacterium tuberculosis spread by direct contact with infected person

primarily affects the lungs so presents with cough, haemoptysis and breathlessness

new uk entrant pregnant women should have a mantoux test - midwife should ascertain this at booking

if admitted to an AN ward needs single room

ensure newborn has BCG vaccine, paid review before discharge

Question 5

list 5 things about cystic fibrosis

Answer 5

the most common life threatening genetic disroder in caucasian people. an autosomal recessive disorder where there are abnormalities in the sodium chloride concentrations in the secretory epithelia throughout the body.

heel prick (guthrie) tests on day 5 screen for CF

malnutrition is common complication - dietary advice potential dietician referral, promote nutritious diet
NICE recommends is a woman will benefit from the findings to weigh at each AN appt

monitor increasing breathlessness and refer promptly if occurs

ensure oxygen is available in birth room, Valsalva manoeuvre NOT advised

anaesthetic review as general anaesthetic may be contraindicated