PP Comps and MedSurg Disorders PDF

Medical-Surgical Disorders and Postpartum Complications Dr. Christi Camarena, DNP, RNC-OB, C-EFM CSUS School of Nursing N137 Nursing the Childbearing Family The following content is protected and may not be shared, uploaded, or distributed. This PowerPoi...

Medical-Surgical Disorders and Postpartum Complications Dr. Christi Camarena, DNP, RNC-OB, C-EFM CSUS School of Nursing N137 Nursing the Childbearing Family The following content is protected and may not be shared, uploaded, or distributed. This PowerPoint Presentation is protected by U.S. copyright law. I am the exclusive owner of the copyright in the course materials that I create. You may not reproduce, distribute, display, post, or upload my course materials or recordings or course materials in any other way — whether or not a fee is charged — without my express written consent. The following Textbook is used throughout this presentation: Maternity and Women’s Health Care, 13th edition. Lowdermilk, Cashion, Alden, Olshansky & Perr., Elsevier Inc., 2024  Learning Objectives 1. Describe the management of selected cardiovascular disorders in pregnant women, specifically related to cardiac decompensation. 2. Identify nursing interventions for a pregnant woman with a cardiovascular disorder. 3. Discuss anemia during pregnancy. 4. Explain the care of pregnant women with pulmonary disorders. 5. Explain the care of pregnant women with integumentary disorders. 6. Identify the effects of neurologic disorders on pregnancy. 7. Identify the effects of autoimmune disorders on pregnancy. 8. Differentiate signs, symptoms and management of urinary tract infections during pregnancy. 9. Examine the effect of a gastrointestinal disorder during pregnancy. 10. Identify the causes, signs and symptoms, and medical and nursing management of postpartum hemorrhage. 11. Describe hemorrhagic (hypovolemic) shock as a complication of postpartum hemorrhage including medical management and nursing interventions. 12. Describe coagulopathies, including incidence, etiology, signs and symptoms, and medical and nursing management. 13. Compare and contrast venous thromboembolic disorders most common in pregnancy and the postpartum period, including clinical manifestations and medical and nursing management. 14. Differentiate the causes of postpartum infection. 15. Summarize assessment and care of women with postpartum infection, including important patient education. Medical-Surgical Disorders  Cardiovascular (congenital)  Cardiovascular (acquired)  Cardiovascular (other)  Anemia  Pulmonary  Integumentary  Neurologic  Autoimmune  GI  UTI Cardiovascular Disorders  Cardiac Output increases 30-45% beginning in the first trimester and peaks 20-26 weeks, therefore; assessment and reassessment of the functional class is important (typically at 3 months and 7-8 months of gestation) → assess multiple time during pregnancy for pt with underlying cardiac disease  Normal pregnancy cardiac changes that cause stress to a patient with underlying cardiac disease:  Increased intravascular volume  Decreased systemic resistance → d/t more vasodilation so its harder to get blood back to the heart  Changes in cardiac output during labor and birth,  Changes in intravascular volume after delivery → after the placenta is gone and its a big shift so hard on pt with underlying problems  If normal cardiac changes are not well tolerated then cardiac decompensation can occur, which is the inability of the heart to maintain a sufficient cardiac output (fever is a major cause)  Cardiac diseases vary in their effect on pregnancy dependent on whether it is an acute or chronic condition. → stable or unstable?  NYHA Functional Classification of Heart Disease (I to IV)  I-asymptomatic to IV-symptomatic (inability to carry on any physical activity without discomfort) → check the level between but exam won't ask ab what level based on s/s Cardiovascular Disorders: Congenital Ventral septal defect  Septal Defects (ASD, VSD, PDA)Patent ductus arteriosus (rare since normally should be fixed right after birth ) Atrial septal defects  Concern is a left-to-right shunt, arrhythmias, heart failure, pulmonary hypertension, emboli  Treatment (Tx): -ASD is typically asymptomatic, most common CHD in pregnancy -VSD & PDA-Typically corrected as a child -Thromboembolic prophylaxis needed  Acyanotic Lesions (Coarc. of the Aorta) → more narrow  Tx: Typically corrected as a child, rest & beta- blockers → normally asymptomatic the first few days of life → beta blocker to decrease the HR and maybe some fluid restriction  Cyanotic Lesions (Tetralogy of Fallot) → usually associated with Down syndrome (trisomy 21)  Tx: Ideally surgical repair before conception, if uncorrected then maintaining venous return is the priority, the critical period is the late third trimester through early postpartum recovery, maintain blood volume → often corrected as a child Cardiovascular Disorders: Acquired → usually pt don't know they have it  Mitral Valve Prolapse: Common and usually benign, backflow of blood during ventricular systole, Tx: beta-blockers if symptomatic, abx. not necessary → to reduce stress or work load on the heart → only give when have higher risk of infection like endocarditis  Mitral Valve Stenosis: Obstructs flow from left atrium to left ventricle, resulting in pulmonary edema, atrial fib., right-sided heart failure, endocarditis (*Almost always a result of Rheumatic Heart Disease) → usually asymptomatic until pregnancy Goal = reduce work load on the heart and help safely deliver the baby  Tx: Prophylactic abx, Lasix, Digoxin, beta blockers and/or calcium channel blockers (HR control), anticoagulation therapy, activity reduction, diet modification (restrict sodium), pain management/epidural, side- lying position when possible, shorten second Avoid C/S dlt huge fluid volume shift and goal was to decrease time to push stage, possible balloon valvuloplasty so normally do vacuum assisted birth D/t risk of fluid overload in the heart but dont usually give Lasix during pregnant  Aortic Stenosis: Rare in childbearing years. Managed similarly to mitral stenosis Cardiovascular Disorders: Other/Rare  Marfan Syndrome  Generalized weakness of connective tissue, aortic root dilation, preconception counseling, autosomal dominant genetic disorder, Tx: rest & beta blockers  Infective Endocarditis  Know risks (i.e., heart lesions, IV drug use), Tx with abx. → but not mitral valve prolapse  Valve Replacement → hypercoagulable state so a lot of blood monitoring and watching closely  High-risk situation due to need for anticoagulant management, bioprosthetic valve preferred, because anticoag. not usually needed, but less durable valve  Heart Transplantation Very rare  Wait one year, stable immunosuppressant regimen, no evidence of rejection, normal cardiac function=fairly normal pregnancy  Ischemic Cardiac Disease  Rare in childbearing years, standard MI treatment  Cardiovascular Disorders  Peripartum Cardiomyopathy  CHF with cardiomyopathy: incidence is 1 in 3000 to 4000 live births  Criteria: Last month of pregnancy up to 5 months PP, with no underlying cause for heart failure → sudden onset  Clinical manifestations: CHF-dyspnea, fatigue, edema, cardiomegaly, EF30, multiparity, multifetal gestation, pre- eclampsia, chronic HTN, multiparous, black race, obesity, tocolytic therapy  Tx: diuretics, sodium/fluid restrictions, afterload reducing agents, digoxin, anti-coagulants, beta-blockers, ACE inhibitors  50% of women will recover in 6 months, if left ventricular function does not recover, then 85% of women will die in 4-5 years of CHF, reoccurrence is high (20-50%) → end up needing a transplant Cardiac Care Management: Question = who will have a more severe risk of pregnancy? On the exam → mitral valve prolapse or stenosis  Antepartum: Stress on the heart is not good  Minimize stress on the heart: emotional, HTN, anemia, hyperthyroidism, obesity  Treat infections promptly, they are a major cause of cardiac decompensation → during pregnancy UTI will be the most common → utero sepsis → cardiac decompsation  Teach the signs and symptoms of cardiac decompensation Should have regular home health visit to monitor status  Diet: Iron and folic acid supplementation, high protein, adequate calories, monitor potassium, stool softener, possibly limit sodium and fluids  Medications: Monitor drug levels closely, anticoagulant therapy often needed  Fetal Surveillance: Growth and placental sufficiency (NST/AFI)  Avoid beta-adrenergic agents, such as terbutaline, d/t tachycardia & risk for pulmonary edema Cardiac Care Management:  Intrapartum:  Postpartum:  Frequent VS, EKG, continuous  First 24-48 hours Very critical pulse ox, central hemodynamic hemodynamically difficult monitoring prn (ICU), EFM  Avoid Methergine, due to risk  Promote cardiac function and of HTN minimize anxiety and pain (labor  Frequent VS assessment, lung epidurals are usually required) → more complex issues like mitral value prolapse and heart sounds, edema and  Vaginal birth is preferred, avoid a pain long second stage if possible  Maintain fluid balance (episiotomy, vacuum extraction or outlet forceps delivery preferred)  Diuretics can decrease milk  C/S risks: dramatic fluid shifts, supply sustained hemodynamic changes,  Cardiac output usually increased blood loss, infection stabilizes by 2 weeks PP  Increased risk for congenital heart disease in children  Anemia  Anemia results in decreased O2 carrying capacity of the blood, the heart compensates by increased cardiac output.  Per the CDC: Anemia in pregnancy is defined as hemoglobin less than 11 g/dL in the first and third trimesters and less than 10.5 g/dL in the second trimester → lower than adult but dlt dilution of RBCs during pregnancy  Iron Deficiency Anemia  Most common anemia of pregnancy, dx based on serum ferritin (38 degrees Celsius (100.4 F) for 2 successive days during first 10 days postpartum, not counting the first 24 hours after birth  Risk factors: C/S delivery, concurrent medical conditions, operative birth, prolonged rupture of membranes, internal monitoring during labor (IUPC, FSE)  Common Postpartum infections:  Endometritis (most common)  Mastitis  Wound infections (C/S 3-5%)  Urinary tract infections (2-4%) Postpartum Infection Care Management Prevention is the most effective and least expensive treatment of postpartum infections Nursing Interventions  Ongoing careful assessment  Prevention  Nutrition  Perineal & hand hygiene  Aseptic technique  Education/Anticipatory Teaching  PP infections are treated with abx. based on the origin of the infection  Breastfeeding mothers can continue to breastfeed! OB Sepsis Credit: UCDMC Birthing Suites