T4-Advanced Organizer Part 3 Flashcards
What is Whites Classification of Cardiac Diseases Class I?
Asymptomatic; no limitations
What is Whites Classification of Cardiac Diseases Class II?
Symptmatic with slight limitation of activity
What is Whites Classification of Cardiac Diseases Class III?
Symptomatic with marked limitations during activity; has cardiac symptoms during normal activity
What is Whites Classification of Cardiac Diseases Class IV?
Cardiac insufficiency or angina occurs even at rest
What is cardiac care for class III?
Bedrest especially around 34 weeks (CO is greatest)
What class likely cannot go to term w/o serious complications?
Class IV
What is cardiac care for class IV?
Bedrest
Prob can’t go to term
C/s will likely be needed bc process of pushing=too much on heart
T/F Pregs can go from Class I or class II to class III or IV during pregnancy
True–this is due to the CO increases and more stress being placed on heart
What does HELLP stand for?
H-hemolysis
EL-elevated liver enzymes
LP-low platelets
How do you know client is in HELLP syndrome?
Look at lab values bc liver enzymes will be elevated and platelets will be low (1000 vs 100-125 thousand)
What are s/s of HELLP?
- May not have any
- But if they do then preeclmpsia, NV, epigastric pain, RUQ pain, general malaise
What are the 2 general care areas for pre-eclamp pt in labor?
- Early identification of FHR abnormalities
2. Prevention of maternal complications
Pre-ecl care in labor: early ID of FHR abnormalities. How is this care done?
- Continous FHR and UC monitor
- Woman assessed for signs of placental abruption
Pre-ecl care in labor. How is this care done?
- Assess CNS, CV, Pulm, Hep, and renal systems
- VS
- Education to client and fam
Severe pre-ecl care in labor. What is care?
- Bed rest, side rails up, quiet/dark environment
- Emergency drugs, O2, and suction checked and readily available
- Total fluid not to exceed 125 mL/hr
Pre-ecl. What are s/s to let MD know about? (there is a lot, just name as many as ya can)
- BP greater than 140/90
- Decreaesd fetal mvnt
- Headache; visual issues
- Epig. pain or RUQ pain
- Increased proteinuria
- Decreased UO
- NV
- Malaise
- Any sign of labor, vag bleeding, abdominal tenderness
Why is mag sulfate given?
To prevent/treat seizures r/t eclampsia
What does mag sulfate work on?
Large smooth muscles (so also slows down UC, reduces BP, slows down everything!)
What is total fluid that can go in?
No more than 125 ml/hr
What should UO be in mag sulfate therapy?
At least 25-30 mL/hr
What is loading dose of mag?
4-6 g (15-30 min)
What is maintenance dose of mag?
2-3 g/hr
What are signs of mag toxicity?
- Absent DTR
- Blurred vision
- Resp. distress
- Slurred speech
- Severe muscle weakness
- Cardiac arrest
- Low UO
What is antidote for mag sulfate toxicity?
Calcium gluconate
What if pt. has mag sulfate toxicity?
- Give calcium gluconate (we can’t do this tho)
- Intubate if not breathing
- Keep side rails up
- Keep lights dimmed and quiet environment
Why can’t we (nurses) give calcium gluconate?
This drug can cause arrhythmias so doc has to give it bc he/she needs to be available if that occured
What is a therapeutic level of mag sulfate?
4-7 mEq/L
What s/s would woman experience while on mag?
- Flushed, hot
- Sedated
- Nausea
- May experience burning at IV site especially during bolus
What is BP in mild pre-ecl?
140/90 or greater
What is BP in severe pre-ecl?
160/110 or greater
What are some cardinal sings of pre-ecl?
- Elevated BP
- Proteinuria 2+ on dipstick or greater
- NV
- Periorbital edema
- Visual disturbances/ dizzy
What are some signs of eclampsia?
Seizures/coma
What is proteinuria level (not the 24 hour specimen)
30 mg or higher (1+on ds) in at least 2 urine specimens at least 6 hrs apart with no presence of UTI
What is proteinuria in the 24 hour specimen?
Concentration above 300 mg in 24 hrs; no presence of UTI
What can create a great risk for cardiac decompensation that is a normal adaptation in preg woman?
All pregs can 30-50% in CO by mid-preg. For the women with heart problems, this can cause a major complication due to the inability to maintain CO (cardiac decompensation)
How many weeks would be the ideal time for a change in CO?
Around mid preg (28-32 weeks)
What is cardiac decompensation?
Inability to maintain adequate CO
S/S of cardiac decompensation (subjective)?
- Increase in fatigue
- Dificult breathing
- Freq. cough
- Palpitations
- Generalized edema
S/s of cardiac decompensation (objective)?
- HR 100 or greater
- Crackles in lungs
- Orthopnea (increasing dyspnea)
- 25 or greater RR
- Cyanosis
For cardiac pt, what kind of monitoring is done intrapartum?
- Routine assessments and ones for cardiac decom
- ABG may be needed to assess oxygenation
- ECG monitor
- Continuous monitor of BP and O2
- Continuous FHR monitoring!!!
During labor for cardiac client, what is the focus?
Promoting cardiac function is focus.. also need to minimize anxiety and give anticipatory guidance throughout labor to woman and fam
Labor of cardiac pt: support childbirth plan only to the point of it being _____
Feasible to cardiac condition
Labor of cardiac pt. What kind of comfit can we give?
Back massage
Labor of cardiac pt.
What positioning?
- Head and shoulders elevated and body parts resting on pillows
- Side lying position is best for hemodynamics
Labor of cardiac pt.
What is the best labor for this type of pt?
Short and pain free
- use pain meds
- do epidural but avoid hypotension
Labor of cardiac pt.
What is best: vaginal or c/s birth
Vaginal—can be in side lying to facilitate uterine perfusion if needed
Labor of cardiac pt.
Why is c/s usually not recommended?
Dramatic fluid shifts, sustained hemodynamic changes, and increased blood loss compared to vag delivery
What drugs are contraindicated for cardiac pts?
Beta-adrenergic (terbutaline)
Cardiac pt. Why will mom get prophylactic antibiotic?
To prevent bacterial endocarditis
Cardiac pt. What does lanoxin do?
Increase contractility of heart
Cardiac pt. Are diuretics given?
NOT usually; this is a controversial issue
How is fetus affected by cardiac problems?
Circulatory changes can cause decreased uterine perfusion–spon. abortion, preterm labor or birth, IUGR
What h&h constitutes iron def. anemia?
Hgb less than 11
Hct less than 33
What are maternal symptoms of iron def. anemia (IDA)
- Pallor
- Fatigue, lethargy
- Headache
- Pica habits
What are fetal effects of IDA?
Baby takes all iron and that can cause sever maternal anemia which causes reduced hgb and O2 so that means compromised baby
What are iron preg needs ?
30 mg
What increase iron absorption? decreases?
Increase: Vit C (melon, strawbs)
Decrease: coffee, tea, milk
Why do we need folic acid?
- Formation of RBC
- Cell duplication
- Placental and fetal growth
Maternal symptoms of folic acid def (FAD)?
-Megaloblasts (large, immature erythrocytes)
What are fetal effects of FAD?
NTD
How much folate is needed for prego? lactating mom?
Preg: 400 mcg
Lactating: 280 mcg
Autosomal recessive disorder that causes erythrocytes to assume an S shape clumping together occluding small BV
SCA
What 2 reasons why preg can precipitate Sickle cell crisis?
- Jaundice r/t decrease bone marrow function and massive erythrocyte destruction
- Pain r/t major infarcts in joints and major organs
Fetal effects of mom with SCA?
- Prematurity
- IUGR
- Fetal death during a SC crisis
What is therapeutic management of SCA?
- Good hydration and nutrition
- Folate supplement
- Rest periods
- Prompt treatment for any illness or infection during preg
Normal H&H in a preg?
Hct: Greater than 33%
Hgb: Greater than 11
What diet does IDA need?
Iron supplements
Iron rich food
What diet does FDA need?
Folic acid supplements
- Dark green veg
- Citrus fruits
- Eggs
- Legumes
- Whole grains
What diet does SCA need?-
-Lots of hydration but avoid fluid overload
What is the major consequence of any anemia in preg?
Reduction of O2 capacity in blood–CO is then increased to compensate–CHF can result!
*also can put woman at increased risk of infection due to increased blood loss
