Cardiac Disease MCN 2 PDF

CARDIAC DISEASE New York Heart Association Class 1 – Ordinary physical activity does not cause dyspnea, chest pain and undue fatigue – No pulmonary congestion – Asymptomatic – No limitation of ADL’s Class 2...

CARDIAC DISEASE New York Heart Association Class 1 – Ordinary physical activity does not cause dyspnea, chest pain and undue fatigue – No pulmonary congestion – Asymptomatic – No limitation of ADL’s Class 2 – Slight limitation of ADL’s – No symptoms at rest but Symptoms with increased activity – Basilar crackles and S3 murmur may be detected Class 3 – Markedly limitation on ADL’s – Comfortable at rest but symptoms present in less than ordinary activity Class 4 – Symptoms are present even at rest NURSE ALERT: ** remember a pregnant woman with heart disease should avoid infection, excessive weight gain, edema & anemia because these conditions increase the workload of the heart. Mx: A. Prenatal care: 1. Promotion of rest (class 1 & class II) * 8 hours of sleep during the night & have frequent rest periods during the day. * Light work is allowed but no heavy work, no stair climbing, no exhaustion. 2. Diet  * High in iron, protein, minerals & vitamins 3. Avoid high altitudes, smoking areas, unpressurized planes & overcrowded areas. Cigarette smoking & alcoholic beverages are strictly prohibited. 4. Prevention of infection avoid persons with active infections (colds, cough). early treatment of infections 5. Provide instructions on danger signs of heart failure: cough with crackles is usually the first sign of an impending heart failure. INCREASING DYSPNEA, TACHYCARDIA, RALES, EDEMA Medications: Iron supplementation to prevent anemia >digitalis to strengthen myocardial contraction and slow down heart rate >nitroglycerine to relieve chest pain antibiotics to prevent and treat infection Diuretics may be prescribed in case of heart failure INTRAPARTAL CARE 1. Early hospitalization- woman is hospitalized before labor begins to promote rest, for closer supervision and prevent infection 2. Woman labors in semi-fowler’s position or left lateral recumbent position. No litothomy position. 3. Vital signs- vital signs are monitored continuously. Tachycardia and respiratory rate more than 24 are signs of impending cardiac decompensation. During the first stage, monitor vital signs every 15 minutes and more frequently during the second stage 4. Epidural anesthesia- is instituted for painless and push less delivery. Forceps is used to shorten the second stage. Pushing is contraindicated (valsalva maneuver) 5. Women with heart disease are poor candidate for cs due to increased risk for hemorrhage, *infection and thromboembolism POSTPARTUM CARE 1. THE MOST DANGEROUS PERIOD IS THE IMMEDIATE POSTPARTUM BECAUSE OF THE SUDDEN INCREASE IN CIRCULATORY BLOOD VOLUME. 2. 2. MONITOR VITAL SIGNS. 3. 3. PROMOTE REST- RESTRICT VISITORS TO ALLOW PATIENT TO REST, THE WOMAN STAYS IN THE HOSPITAL LONGER, UNTIL CARDIAC STATUS HAS STABILIZED. 4. 4. EARLY BUT GRADUAL AMBULATION TO PREVENT THROMBOPHLEBITIS. 5. 5. MEDICATIONS 6. *ANTIBIOTICS 7. *STOOL SOFTENERS TO PREVENT STRAINING AT STOOL CAUSED BY CONSTIPATION. SEDATIVES MAY BE ORDERED TO PROMOTE REST. Disseminated Intravascular Coagulation (DIC) Disorder of blood clotting Fibrinogen levels fall below effective limits Symptoms Bruising or bleeding  massive hemorrhage initiates coagulation process causing massive numbers of clots in peripheral vessels (may result in tissue damage from multiple thrombi), which in turn stimulate fibrolytic activity, resulting in decreased platelet and fibrinogen levels and signs and symptoms of local generalized bleeding (increased vaginal blood flow, oozing IV site, ecchymosis, hematuria, etc) monitor PT, PTT, and Hct, protect from injury; no IM injections; early anticoagulant therapy is controversial