Pre-Gestational Conditions

Question 1

It is responsible for 5% of maternal
deaths during pregnancy.

Answer 1

CARDIOVASCULAR DISORDER
AND PREGNANCY

Question 2

the cardiovascular disorders
that most commonly cause
difficulty during pregnancy
are valve damage concerns
caused by

Answer 2

rheumatic fever or
Kawasaki disease and
congenital anomalies…

Question 3

as the number of women
delaying their first pregnancy
until later in life
increases…increase in the
incidence of _____ ________ ____
during pregnancy…

Answer 3

coronary artery
disease and varicosities

Question 4

Blood volume and Cardiac Output
increases approximately __-__%
during pregnancy.

Answer 4

30-50

Question 5

Danger of pregnancy in a woman
with Cardiac Disease occurs
primarily because of the increase in _____

Answer 5

in circulatory volume

Question 6

Towards the end of pregnancy , her
heart may become overwhelmed
by the increase in ____ ______
that her cardiac output falls to the
point vital organs (including the
placenta) can no longer be
profused adequately

Answer 6

blood volume

Question 7

It is imperative for the woman with
cardiac disease. This allows for a
complete history, physical, and
workup to determine the risk to
pregnancy and to initiate
treatment to optimize
pregnancy outcomes.

Answer 7

PRECONCEPTION
COUNSELING

Question 8

ASSESSMENT OF A WOMAN WITH
CARDIAC DISEASE

Answer 8

➔ Thorough Physical History
➔ Document
➔ Level of exercise performance
➔ (SOB, cyanosis…)
➔ Coughing (pulmonary edema)
➔ Edema (normal vs.*systemic edema)
➔ Irregular pulse
➔ Rapid/difficult respiration
➔ Chest pain on exertion
➔ VS- BP, PR, RR (same position for next
visits)

Question 9

Diagnostic Tests

Answer 9

Echocardiogram Chest
Xray
Electrocardiogram
(ECG)
Doppler
Studies
O2
Saturation
Level
Physical
Activity

Question 10

Uncompromised. Ordinary physical activity causes no discomfort. No symptoms of cardiac insufficiency and no angina pain.

Answer 10

Good

Question 11

Slightly compromised. Ordinary physical activity causes excessive
fatigue , palpitation, and dyspnea or angina pain.

Answer 11

Good

Question 12

Markedly compromised. During less than ordinary activity, woman
experiences excessive fatigue, palpitations, dyspnea, or angina pain

Answer 12

Moderate;
may need
hemodynamic
monitoring and
special anesthetic
management
during labor

Question 13

Severely compromised. Woman is unable to carry out any physical
activity without experiencing discomfort. Even at rest, symptoms of
cardiac insufficiency or angina pain are present.

Answer 13

Poor; will need
hemodynamic
monitoring and
special
anesthetic,
management
during labor

Question 14

A condition in which the heart
valves have been permanently
damaged by rheumatic fever.

Answer 14

Rheumatic
Heart Disease

Question 15

is an
inflammatory connective
tissue disease that can involve
the heart, joints, central
nervous system (CNS), skin,
and subcutaneous tissue.
This condition may develop
from untreated streptococcal
infections. (group A
β-hemolytic streptococcus)

Answer 15

Rheumatic fever

Question 16

Over time, the heart valves
can be inflamed and become
scarred resulting in the heart
valve _____ ____
making it more difficult for
the heart to function normally.

Answer 16

narrowing or leaking,

Question 17

Clinical Assessment

Answer 17

• Fever, Weakness and
  fatigue
• Being easily tired,
  shortness of breath and
  chest discomfort
• Swollen, tender, red and extremely
  painful joints particularly the knees
  and ankles
• Increased risk for
  Congestive Heart Failure
  (CHF)

Question 18

Clinical Assessment for Baby on

Answer 18

Low Birth
Weight/Small for
Gestational Age
➢ Preterm Labor

Question 19

to replace or
repair a badly
damaged valve

Answer 19

1. Surgery

Question 20

(benzathine
benzylpenicillin,
Phenoxymethylpenici
llin and erythromycin

Answer 20

2. Antibiotics and
   Anti-inflammatory
   drugs

Question 21

A rare syndrome of heart failure/ is a dysfunction of
the left ventricle that occurs in late pregnancy or
within the first 5 months postpartum in a woman
with no previous history of heart disease

Answer 21

Peripartum
Cardiomyopathy

Question 22

Mortality rate:
as high as 50% on.

Answer 22

Occurs most often in Black
multiparas in conjunction
with gestational
hypertension

Question 23

The cause is ______
◆ The patient typically has no
history of cardiac disease.
➔ Symptoms are often
attributable to chronic
hypertension, mitral stenosis,
obesity, or viral myocarditis.
➔ The condition usually presents
with anemia and infection

Answer 23

unknown.

Question 24

CLINICAL ASSESSMENT:

Answer 24

◊ Dyspnea/ SOB
◊ Orthopnea
◊ Chest pain
◊ Palpitations
◊ Fatigue/weakness
◊Edema (nondependent)
◊ Radiological findings are
consistent with
cardiomegaly

Question 25

decrease
preload and relieve
pulmonary congestion

Answer 25

Diuretics

Question 26

to
improve contractility /
maintain cardiac
function e.g., Digoxin

Answer 26

Digitalis Therapy

Question 27

To
prevent
thrombophlebitis

Answer 27

Anti-coagulant -

Question 28

antepartum and
Coumadin if postpartum

Answer 28

Heparin

Question 29

Therapeutic Managements

Answer 29

Diuretics - decrease
preload and relieve
pulmonary congestion
➔ Beta-adrenergic
blockers
➔ Digitalis Therapy - to
improve contractility /
maintain cardiac
function e.g., Digoxin
Therapeutic Management
➔ Fluid and Sodium
restriction
➔ Anti-coagulant - To
prevent
thrombophlebitis
Heparin antepartum and
Coumadin if postpartum
➔ Strict Bed Rest

Question 30

is
strongly discouraged
because the disease tends
to RECUR AND WORSEN
during pregnancy

Answer 30

Subsequent pregnancy

Question 31

are
contraindicated
because of the danger
of Thrombophlebitis

Answer 31

Oral contraceptives

Question 32

two rest
periods a day & a full night’s
sleep on what position

Answer 32

Left Lateral Recumbent
Promote Rest

Question 33

Nursing Interventions
for Pregnant a Woman
with Cardiac Disease

Answer 33

➔ Promote Healthy Nutrition
➔ Educate regarding
medications
➔ Educate regarding avoidance
of infection
➔ Be prepared for emergency
actions

Question 34

is a blood disorder that
results when the body has less
red blood cells than normal.
RBC’s acts by transporting oxygen
throughout the body using a
protein called hemoglobin.

Answer 34

Anemia

Question 35

This type of anemia is most often
secondary to folic acid deficiency.
This is characterized by RBC’s that
are macrocytic or larger than
average hence they may not be
able to exit the bone marrow in
order to reach the bloodstream and
provide oxygen.

Answer 35

Megaloblastic
Anemia

Question 36

The deficiency may take several
weeks to develop… may be apparent
until the SECOND TRIMESTER OF
PREGNANCY.
Contributory factor in early
miscarriage or premature separation
of placenta and neural tube defects.

Answer 36

Megaloblastic
Anemia

Question 37

Hemoglobin concentration is < 11 g/dl
(hematocrit <33%) in the [first or third trimester
of pregnancy]
❖ Hemoglobin concentration is less than 10.5g/ dl
(hematocrit <32%) [second trimester]

Answer 37

True anemia

Question 38

Folic acid req

Answer 38

400 ug

Question 39

Foods rich in folate

Answer 39

leafy greens
asparagus
broccoli
papaya and oranges
avocado
seeds and nuts
brussels sprouts

Question 40

______ _____ ___(cardiopulmonary) related to
poor heart functions secondary to mitral valve prolapse
during pregnancy

Answer 40

Ineffective tissue perfusion

Question 41

related to prescribed bed rest during
pregnancy secondary to concurrent illness

Answer 41

Social isolation

Question 42

regarding steps to take to reduce the
effects of maternal cardiovascular disease on the
pregnancy and fetus

Answer 42

Deficient knowledge