Flashcards in Test 4 Medical Surgical Disorders Deck (49):
What are hemodynamic changes of pregnancy?
- CO increases 30-50% by mid-pregnancy
- Placental fluids back into vascular system after birth
CV changes during pregancy constitute a major complication for the client with ____ ____ ____.
preexisting heart disease
What is cardiac decompensation?
inability to maintain adequate cardiac output
What are the NYHA classifications r/t Functional Ability? (Mom with CV problems are rated this way)
Which class? Asymptomatic, no limitations of activity
Which class? Symptomatic with slight limitation of activity
Which class? Symptomatic, marked limitation, normal activity leads to cardiac symptoms
(risk for MI, may need c-sec)
Which class? Cardiac insufficiency or angina occurs even at rest.
(poor fetal perfusion, c-sec b/c mom can't handle the stress of vaginal delivery)
The greatest risk for CV issues is ___-___. Why?
That's when the mom's volume peaks
Can the NYHA classification change for mom during pregnancy?
Yes, it is not absolute
What are the 3 major cardiac concerns during pregnancy?
1) cardiac decompensation
3) circulatory changes lead to decreased uterine perfusion
Decreased uterine perfusion can lead to...
- spontaneous abortion
- preterm labor and birth
Symptoms of CHF:
1) Edema (progresses from pedal edema to generalized, pitting, and pulmonary edema)
2) Fatigue increasing
3) Dyspnea with ADL
4) Crackles at bases of lungs
What do you monitor in a pt with CV issues?
Symptoms of decompensation
Symptoms of infections
Why do we worry about infection in a CV pt?
Infection increases the workload of the heart
What diagnostic tests are often used on a CV pt?
Fetal status (serial testing - baby gets checked multiple times a day)
When is a prophylactic antibiotic given to mom? Why?
- invasive procedures
- at birth
(to prevent bacterial endocarditis)
What drug can be given to mom to increase contractility of the heart and slow heart for effective filling?
What meds are commonly given to moms with CV probs?
- prophylactic antibiotic
- diuretic (controversial)
FDA categories for drugs
A: no risk
B: harm not confirmed
C: only if benefits justifies the potential risk to fetus
D: fetal risk, but benefits may out weigh the risk
X: never give to pregnant woman
4 reasons for anemia during pregnancy?
- iron deficiency
- folate deficiency
- sickle cell trait
- sickle cell disease
An autosomal recessive genetic disorder that results in mild obstructive lung disease.
What can severe cystic fibrosis result in?
maternal & perinatal mortality
What is a risk for the fetus with CF?
uteroplacental insufficiency --> IUGR
What antiepileptic meds should be avoided during pregnancy? Why?
(neural tube defects)
If antiepileptic meds must be given, what should be remembered?
- take lowest dose possible
- folic acid 4mg/day
Substances frequently abused in United States are:
5) Crack cocaine
What are effects of substance abuse on pregnancy?
- spontaneous abortion
- preterm labor/fetal demise
- placental abruption
- neonatal addiction
- fetal alcohol syndrome
Monitor addicted client for:
- inadequate nutrition and weight gain
- Preterm labor
- Random urine toxicology screening may be ordered
Methods of fetal monitoring:
biophysical profile (BPP)
What should we teach a mother with substance abuse problems?
- support pt's efforts to change behavior
- don't stop cold turkey
- heroin addicts may be put on methadone hcl (Dolophine)
What is methadone hcl (Dolophine)?
narcotic agonist that lacks the severe symptoms of heroin withdrawal
HIV is transmitted through contact with ____ ____ and ____ ____.
How can HIV progress to AIDS?
decreased immunity and overwhelming opportunistic infection
Does pregnancy change the course of AIDS for the mother?
Why is the mom with HIV managed as high risk?
b/c she is vulnerable to infections
How can an infant contract HIV from the mother?
- contact with infectious material at birth
- breast feeding
Can the mom with HIV/AIDS breastfeed?
What med is given to treat AIDS during pregnancy?
When is ZDV begun?
after 14 wks gestation
How is ZDV given during labor?
When is ZDV given to the infant?
at 6 weeks after delivery
Interventions for pregnancy with AIDS: PRENATAL
- prevent opportunistic infections
- avoid procedures that increase the risk of preinatal transmission (ie, amniocentesis)
Interventions for pregnancy with AIDS: INTRAPARTUM
- avoid use of scalp electrodes
- avoid episiotomy to decrease the amount of maternal blood around the birth canal
- pitocin not administered b/c strong UC may cause vaginal tears or require episiotomy
- Zidovudine IV as ordered to mom during labor
- Minimized neonates exposure to blood
Interventions for pregnancy with AIDS: POSTPARTUM
- mom in protective isolation if immunosuppressed
- NO breastfeeding
- monitor for infection
What can reduce the risk of HIV transmission to neonate?
- antiviral meds
- reduction of neonatal exposure to maternal blood & body fluids
- early identification of HIV
What should be done BEFORE any invasive procedures of a baby with an HIV mom?
Bathe before any invasive procedures
(Vitamin K, heel sticks, venipuncture)
Cholelithiasis & Cholecystitis: Pregnant client is 2x more likely to form gallstones because increased ____ levels. Why?
(because bile thickens, decreased muscle tone leads to prolonged gastric emptying time)