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Maternal Newborn-MJ > T4-Advanced Organizer Part 3 > Flashcards

T4-Advanced Organizer Part 3 Flashcards

1
Q

What is Whites Classification of Cardiac Diseases Class I?

A

Asymptomatic; no limitations

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2
Q

What is Whites Classification of Cardiac Diseases Class II?

A

Symptmatic with slight limitation of activity

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3
Q

What is Whites Classification of Cardiac Diseases Class III?

A

Symptomatic with marked limitations during activity; has cardiac symptoms during normal activity

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4
Q

What is Whites Classification of Cardiac Diseases Class IV?

A

Cardiac insufficiency or angina occurs even at rest

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5
Q

What is cardiac care for class III?

A

Bedrest especially around 34 weeks (CO is greatest)

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6
Q

What class likely cannot go to term w/o serious complications?

A

Class IV

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7
Q

What is cardiac care for class IV?

A

Bedrest
Prob can’t go to term
C/s will likely be needed bc process of pushing=too much on heart

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8
Q

T/F Pregs can go from Class I or class II to class III or IV during pregnancy

A

True–this is due to the CO increases and more stress being placed on heart

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9
Q

What does HELLP stand for?

A

H-hemolysis
EL-elevated liver enzymes
LP-low platelets

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10
Q

How do you know client is in HELLP syndrome?

A

Look at lab values bc liver enzymes will be elevated and platelets will be low (1000 vs 100-125 thousand)

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11
Q

What are s/s of HELLP?

A
  • May not have any

- But if they do then preeclmpsia, NV, epigastric pain, RUQ pain, general malaise

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12
Q

What are the 2 general care areas for pre-eclamp pt in labor?

A
  1. Early identification of FHR abnormalities

2. Prevention of maternal complications

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13
Q

Pre-ecl care in labor: early ID of FHR abnormalities. How is this care done?

A
  • Continous FHR and UC monitor

- Woman assessed for signs of placental abruption

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14
Q

Pre-ecl care in labor. How is this care done?

A
  • Assess CNS, CV, Pulm, Hep, and renal systems
  • VS
  • Education to client and fam
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15
Q

Severe pre-ecl care in labor. What is care?

A
  • 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
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16
Q

Pre-ecl. What are s/s to let MD know about? (there is a lot, just name as many as ya can)

A
  • 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
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17
Q

Why is mag sulfate given?

A

To prevent/treat seizures r/t eclampsia

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18
Q

What does mag sulfate work on?

A

Large smooth muscles (so also slows down UC, reduces BP, slows down everything!)

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19
Q

What is total fluid that can go in?

A

No more than 125 ml/hr

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20
Q

What should UO be in mag sulfate therapy?

A

At least 25-30 mL/hr

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21
Q

What is loading dose of mag?

A

4-6 g (15-30 min)

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22
Q

What is maintenance dose of mag?

A

2-3 g/hr

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23
Q

What are signs of mag toxicity?

A
  • Absent DTR
  • Blurred vision
  • Resp. distress
  • Slurred speech
  • Severe muscle weakness
  • Cardiac arrest
  • Low UO
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24
Q

What is antidote for mag sulfate toxicity?

A

Calcium gluconate

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25
Q

What if pt. has mag sulfate toxicity?

A
  • Give calcium gluconate (we can’t do this tho)
  • Intubate if not breathing
  • Keep side rails up
  • Keep lights dimmed and quiet environment
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26
Q

Why can’t we (nurses) give calcium gluconate?

A

This drug can cause arrhythmias so doc has to give it bc he/she needs to be available if that occured

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27
Q

What is a therapeutic level of mag sulfate?

A

4-7 mEq/L

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28
Q

What s/s would woman experience while on mag?

A
  • Flushed, hot
  • Sedated
  • Nausea
  • May experience burning at IV site especially during bolus
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29
Q

What is BP in mild pre-ecl?

A

140/90 or greater

30
Q

What is BP in severe pre-ecl?

A

160/110 or greater

31
Q

What are some cardinal sings of pre-ecl?

A
  • Elevated BP
  • Proteinuria 2+ on dipstick or greater
  • NV
  • Periorbital edema
  • Visual disturbances/ dizzy
32
Q

What are some signs of eclampsia?

A

Seizures/coma

33
Q

What is proteinuria level (not the 24 hour specimen)

A

30 mg or higher (1+on ds) in at least 2 urine specimens at least 6 hrs apart with no presence of UTI

34
Q

What is proteinuria in the 24 hour specimen?

A

Concentration above 300 mg in 24 hrs; no presence of UTI

35
Q

What can create a great risk for cardiac decompensation that is a normal adaptation in preg woman?

A

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)

36
Q

How many weeks would be the ideal time for a change in CO?

A

Around mid preg (28-32 weeks)

37
Q

What is cardiac decompensation?

A

Inability to maintain adequate CO

38
Q

S/S of cardiac decompensation (subjective)?

A
  • Increase in fatigue
  • Dificult breathing
  • Freq. cough
  • Palpitations
  • Generalized edema
39
Q

S/s of cardiac decompensation (objective)?

A
  • HR 100 or greater
  • Crackles in lungs
  • Orthopnea (increasing dyspnea)
  • 25 or greater RR
  • Cyanosis
40
Q

For cardiac pt, what kind of monitoring is done intrapartum?

A
  • 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!!!
41
Q

During labor for cardiac client, what is the focus?

A

Promoting cardiac function is focus.. also need to minimize anxiety and give anticipatory guidance throughout labor to woman and fam

42
Q

Labor of cardiac pt: support childbirth plan only to the point of it being _____

A

Feasible to cardiac condition

43
Q

Labor of cardiac pt. What kind of comfit can we give?

A

Back massage

44
Q

Labor of cardiac pt.

What positioning?

A
  • Head and shoulders elevated and body parts resting on pillows
  • Side lying position is best for hemodynamics
45
Q

Labor of cardiac pt.

What is the best labor for this type of pt?

A

Short and pain free

  • use pain meds
  • do epidural but avoid hypotension
46
Q

Labor of cardiac pt.

What is best: vaginal or c/s birth

A

Vaginal—can be in side lying to facilitate uterine perfusion if needed

47
Q

Labor of cardiac pt.

Why is c/s usually not recommended?

A

Dramatic fluid shifts, sustained hemodynamic changes, and increased blood loss compared to vag delivery

48
Q

What drugs are contraindicated for cardiac pts?

A

Beta-adrenergic (terbutaline)

49
Q

Cardiac pt. Why will mom get prophylactic antibiotic?

A

To prevent bacterial endocarditis

50
Q

Cardiac pt. What does lanoxin do?

A

Increase contractility of heart

51
Q

Cardiac pt. Are diuretics given?

A

NOT usually; this is a controversial issue

52
Q

How is fetus affected by cardiac problems?

A

Circulatory changes can cause decreased uterine perfusion–spon. abortion, preterm labor or birth, IUGR

53
Q

What h&h constitutes iron def. anemia?

A

Hgb less than 11

Hct less than 33

54
Q

What are maternal symptoms of iron def. anemia (IDA)

A
  • Pallor
  • Fatigue, lethargy
  • Headache
  • Pica habits
55
Q

What are fetal effects of IDA?

A

Baby takes all iron and that can cause sever maternal anemia which causes reduced hgb and O2 so that means compromised baby

56
Q

What are iron preg needs ?

A

30 mg

57
Q

What increase iron absorption? decreases?

A

Increase: Vit C (melon, strawbs)

Decrease: coffee, tea, milk

58
Q

Why do we need folic acid?

A
  • Formation of RBC
  • Cell duplication
  • Placental and fetal growth
59
Q

Maternal symptoms of folic acid def (FAD)?

A

-Megaloblasts (large, immature erythrocytes)

60
Q

What are fetal effects of FAD?

A

NTD

61
Q

How much folate is needed for prego? lactating mom?

A

Preg: 400 mcg

Lactating: 280 mcg

62
Q

Autosomal recessive disorder that causes erythrocytes to assume an S shape clumping together occluding small BV

A

SCA

63
Q

What 2 reasons why preg can precipitate Sickle cell crisis?

A
  1. Jaundice r/t decrease bone marrow function and massive erythrocyte destruction
  2. Pain r/t major infarcts in joints and major organs
64
Q

Fetal effects of mom with SCA?

A
  • Prematurity
  • IUGR
  • Fetal death during a SC crisis
65
Q

What is therapeutic management of SCA?

A
  • Good hydration and nutrition
  • Folate supplement
  • Rest periods
  • Prompt treatment for any illness or infection during preg
66
Q

Normal H&H in a preg?

A

Hct: Greater than 33%

Hgb: Greater than 11

67
Q

What diet does IDA need?

A

Iron supplements

Iron rich food

68
Q

What diet does FDA need?

A

Folic acid supplements

  • Dark green veg
  • Citrus fruits
  • Eggs
  • Legumes
  • Whole grains
69
Q

What diet does SCA need?-

A

-Lots of hydration but avoid fluid overload

70
Q

What is the major consequence of any anemia in preg?

A

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

Maternal Newborn-MJ (29 decks)

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