NCM 109 Maternal Lec PDF

NCM 109 / MATERNAL LEC COURSE CODE 2ND SEM - WED & SAT (2:30 P.M. - 5:30 P.M.) Pelvic inadequacy of HIGH-RISK PREGNANCY misshape...

NCM 109 / MATERNAL LEC COURSE CODE 2ND SEM - WED & SAT (2:30 P.M. - 5:30 P.M.) Pelvic inadequacy of HIGH-RISK PREGNANCY misshape Uterine incompetence, position, or structures A IDENTIFICATION OF HIGH-RISK CLIENT Secondary major illnesses Poor gynecologic or TECHNICAL TERM/KEY TERM obstetric history ​ A high-risk pregnancy is one in which a concurrent disorder, pregnancy-related History of previous poor complication, or external factor pregnancy jeopardizes the health of the mother, the outcome(miscarriage, fetus, or both. stillbirth) History of a child with congenital anomalies Factors That Categorize a Pregnancy as High Risk: (Prepregnancy) Obesity Pelvic inflammatory Psychological history of drug disease dependence History of inherited History of intimate disorder partner abuse Potential of blood History of mental illness incompatibility History of poor coping mechanism Younger than 18 years or Survivor of childhood older than 35 years sexual abuse Cigarette smoker Cognitively challenged Substance abuser Social Occupation involving handling of toxic substances ( including radiation and anesthesia gases) Environmental contaminants at home A1 CARDIOVASCULAR DISORDERS AND Lower economic level PREGNANCY Poor access to transportation for care High altitude ​ The number of women of childbearing Highly mobile lifestyle age who have heart disease is diminishing as more congenital heart Poor housing anomalies are corrected in early infancy. Lack of support for ​ Cardiovascular disease is still a concern in people pregnancy because it can lead to serious complications. ​ It is responsible for 5% of maternal deaths Physical Visual or hearing during pregnancy challenges PAGE 1 K.M.J.S. - BSN2-H - IDC-CON  NCM 109 / MATERNAL LEC COURSE CODE 2ND SEM - WED & SAT (2:30 P.M. - 5:30 P.M.) ​ The danger of pregnancy in women with cardiac disease occurs primarily because A2 A WOMAN WITH CARDIAC DISEASE of this increase in circulatory volume ​ The most dangerous for her is weeks 28 to 32 just after the blood volume peaks. ​ Cardiac disease can affect pregnancy in ​ As a rule, a woman with an artificial but different ways depending on whether it well-functioning heart valve, a woman involves the left or the right side of the with a pacemaker implant, and even with heart. a heart transplant can expect to have a successful Normal Blood Circulation Classification of Heart Disease ​ Unoxygenated blood from the different parts of the body empty into the Superior and Class I Inferior Vena Cava —- Right Atrium —- Uncompromised. Tricuspid Valve —- Right Ventricle —- Ordinary physical activity causes no discomfort Pulmonary Artery —and lungs for No symptoms of cardiac insufficiency and no Oxygenation. the aorta anginal pain. ​ Oxygenated blood from the Lungs will empty into the Pulmonary Veins —- Left Atrium —- Mitral Valve —and left Ventricle —the Class II aorta —- to be delivered to different body Slightly compromised parts. Ordinary physical activity causes excessive fatigue, palpitation, and dyspnea or anginal pain. A2.1 A WOMAN WITH LEFT-SIDED HEART FAILURE Class III Markedly compromised During less than ordinary activity, women ​ Left-sided heart failure occurs in experience excessive fatigue, palpitations, dyspnea, conditions such as Mitral Stenosis, Mitral or anginal pain. Insufficiency, and Aortic Coarctation. ​ In these instances, the left ventricle cannot move the large volume of blood Class IV that it has received by the left atrium Severely compromised from the pulmonary circulation forward. Women are unable to carry out any physical ​ This causes back pressure - the left side activity without experiencing discomfort. of the heart becomes distended, Even at rest, symptoms of cardiac insufficiency or systemic blood pressure decreases in the anginal pain are present. face of lowered cardiac output and pulmonary hypertension occurs. Additional Notes ​ Pulmonary Edema produces profound ​ A woman with class I or II heart disease shortness of breath, interfering with can expect to experience a normal oxygen-carbon dioxide exchange. pregnancy by maintaining special interventions such as bed rest. ​ If pulmonary capillaries rupture under ​ Women with class III can complete a pressure, small amounts of blood leak pregnancy by maintaining special into the alveoli, and the woman develops interventions such as bed rest. a productive cough with blood-speckled ​ Women with class IV heart disease are sputum. usually advised to avoid pregnancy ​ Because of the limited oxygen exchange, because they are in cardiac failure even at a woman with left-sided heart failure is at rest and when they are not pregnant. an extremely high risk for spontaneous PAGE 2 K.M.J.S. - BSN2-H - IDC-CON  NCM 109 / MATERNAL LEC COURSE CODE 2ND SEM - WED & SAT (2:30 P.M. - 5:30 P.M.) miscarriage, preterm labor, or even HEART FAILURE maternal death. ​ A woman experiences increased fatigue, weakness, and dizziness. ​ Right-sided heart failure occurs when the ​ The placenta may not receive adequate right ventricle is overwhelmed by the blood because of the decreased amount of blood received by the right peripheral circulation. atrium from the vena cava. ​ As pulmonary edema becomes severe a ​ It can be caused by an unprepared woman cannot sleep in any position congenital heart defect such as except with her chest and head elevated pulmonary valve stenosis, but the (Orthopnea), as elevating her chest this anomaly most apt to cause right-sided way allows fluid to settle to the bottom of heart failure. her lungs and freeze space for gas ​ With this congestion of the systemic exchange. venous circulation and decreased cardiac ​ She may also notice Paroxysmal output to the lungs occurs. Nocturnal Dyspnea - suddenly waking ​ Blood pressure decreases in the aorta at night with shortness of breath. This because less blood can reach it. occurs because heart action is more ​ In contrast, pressure is high in the vena effective when she is at rest. cava from the back pressure of blood. ​ With the more effective heart action, ​ Both jugular venous distention and interstitial fluid returns to the circulation. increased portal circulation are evident. This overburdens the circulation, causing ​ The liver and spleen both become increased left-side failure and increased distended. pulmonary edema. ​ Extreme liver enlargement can cause this dyspnea and pain in a pregnant woman because the en; large liver, as it is pressed upward by the enlarged uterus, puts extreme pressure on the diaphragm. ​ Distended abdominal and lower extremity vessels can lead to exudate of fluid from the vessels into the peritoneal cavity or peripheral edema. A3 ASSESSMENT OF A WOMAN WITH CARDIAC DISEASE ​ Nurses play a major role in the care of pregnant women with cardiovascular disease because continuous assessment of women’s health status, health education, and health promotion activities are so essential. ​ Assessment begins with a thorough health history to document prepregnancy cardiac status. ​ Document a woman’s level of exercise performance. A2.2 A WOMAN WITH RIGHT-SIDED ​ Ask if she normally has a cough or edema. PAGE 3 K.M.J.S. - BSN2-H - IDC-CON  NCM 109 / MATERNAL LEC COURSE CODE 2ND SEM - WED & SAT (2:30 P.M. - 5:30 P.M.) ​ Documenting edema is also important A5 A WOMAN WITH VENOUS because the usual innocent edema of THROMBOEMBOLIC DISEASE pregnancy must be distinguished from the beginning of edema from heart failure. ​ The incidence of venous ​ An important difference is the usual thromboembolic disease increases edema of pregnancy involves only the during pregnancy because of a feet and ankles but becomes systemic combination of stasis of blood in the with heart failure. lower extremities from uterine pressure ​ It can begin as early as the first trimester, and hypercoagulability. and other symptoms such as irregular ​ When the pressure of the fetal head at pulse, rapid or difficult respiration and birth puts additional pressure on lower perhaps chest pain on exertion will extremity veins, damage can occur to the probably be present. walls of the veins. ​ Be certain to record a baseline blood ​ With this triad of effects in place (stasis, pressure, pulse rate, and respiratory rate vessel damage, and hypercoagulation), in either a sitting or lying position at the the stage is set for thrombus formation first prenatal visit. in the lower extremities. ​ At future health visits, always obtain ​ The likelihood of deep vein thrombosis these in the same position for the most (DVT) leading to pulmonary emboli is accurate comparison. highest in women 30 years of age or ​ Making comparison assessments for nail older because increased age is yet bed filling and jugular venous distention another risk factor for thrombosis can also be helpful throughout formation. pregnancy.y Terms: A4 A WOMAN WITH CHRONIC ​ Hypercoagulability - the tendency to have thrombosis HYPERTENSIVE VASCULAR DISEASE ​ Thromboembolism - used to describe a blood clot that forms in a blood vessel, ​ Women with chronic hypertensive breaks loose, and is carried by the disease enter pregnancy with an bloodstream to block another vessel. ​ Stasis - blood is not flowing or circulating to elevated blood pressure (140/90 mmHg all parts of the body. or above) Heparin= Anticoagulant ​ Hypertension of this kind is usually = used to prevent blood clotting associated with arteriosclerosis or renal disease, making it a problem for older pregnant women. ​ Chronic hypertension can be serious because it places both the woman and the fetus at high risk because of poor heart, kidney, and/or placental perfusion during the pregnancy. ​ Management includes a prescription of β-blockers and ACE inhibitors to reduce blood pressure.e ​ Methyldopa (Aldomet) is a typical drug that may be prescribed. PAGE 4 K.M.J.S. - BSN2-H - IDC-CON  NCM 109 / MATERNAL LEC COURSE CODE 2ND SEM - WED & SAT (2:30 P.M. - 5:30 P.M.) ➔​ After this, she may be prescribed subcutaneous heparin she can self-inject every 12 or 24 hours for the duration of the pregnancy. ➔​ It is generally recommended lower abdomen be used for rotating sites for subcutaneous heparin administration. With pregnancy, however, this site is usually avoided and the injection sites are limited to the arms and thighs. ​ Signs of a pulmonary embolism ➔​ Chest pain ➔​ A sudden onset of dyspnea ➔​ Cough with hemoptysis ➔​ Tachycardia or missed beats ➔​ Dizziness and fainting ❖​ Need to be recognized because it is an immediate emergency and measures should be immediately begun. ❖​ Caution with women taking heparin during pregnancy is not to take any additional injections once labor begins to help A5.1 THE RISK OF THROMBUS CAN BE reduce the possibility of REDUCED BY: hemorrhage at birth. ​ Women taking heparin are not candidates for routine episiotomy or ​ Avoiding the use of constrictive epidural anesthesia for the same reason knee-high stockings. unless at least 4 hours have passed since ​ Not sitting with legs crossed at the knee the last heparin dose was given. ​ Avoid standing in one position for a long period. B HEMATOLOGIC DISORDERS AND PREGNANCY A5.2 CLINICAL MANIFESTATION. ​ Women will notice pain and redness usually in the calf of a leg. It is diagnosed B1 ANEMIA AND PREGNANCY by a woman’s history and Doppler ultrasonography. ​ Because the blood volume expands ​ To keep the thrombus from moving and during pregnancy slightly ahead of the becoming a pulmonary embolus red count cell, most women have pseudo ➔​ A woman will be treated with bed anemia in early pregnancy. rest and intravenous heparin for ​ True anemia is typically considered to 24 to 48 hours. present when a woman’s hemoglobin PAGE 5 K.M.J.S. - BSN2-H - IDC-CON  NCM 109 / MATERNAL LEC COURSE CODE 2ND SEM - WED & SAT (2:30 P.M. - 5:30 P.M.) concentration is less than 11 g/dl ​ Because the body recognizes that it (hematocrit