Chapter 20-Pregnancy COmplications, Pre-exisiting conditions
The signs of a pulmonary embolism, are
1.chest pain, 2.a sudden onset of dyspnea, 3.a cough with hemoptysis, 4.tachycardia or missed beats, 5.dizziness and fainting need to be recognized because it is an immediate emergency and measures should be immediately begun
Clinical Manifestations of Diabetes Mellitus
1.dehydration 2.concentrated blood serum 3.decrease in total blood volume 4.Glucose spilling in urine 5.polyuria 6.metabolic acidosis 7. Hypo or hyperglycemia 8.decrease in LOC, drowsy
Class: Gestational Diabetes
A condition of abnormal glucose metabolism that arises during pregnancy. Possible signal of an increased risk for type 2 diabetes later in life
Insulin pump therapy dosage
A continuous rate (basal) of insulin is given to the patient through the pump, and the patient can program the pump to give extra doses as boluses prior to meals or correctional doses related to her blood glucose values after meals.
Class:Impaired glucose homeostasis
A state between "normal" and "diabetes" in which the body is no longer using and/or secreting insulin properly. a. Impaired fasting glucose: a state when fasting plasma glucose is at least 110 but under 126 mg/dl b. Impaired glucose tolerance: a state when results of the oral glucose tolerance test are at least 140 but under 200 mg/dl in the 1-hour sample
Class: Type I
A state characterized by the destruction of the beta cells in the pancreas that usually leads to absolute insulin deficiency. a. Immune-mediated diabetes mellitus results from autoimmune destruction of the beta cells. b. Idiopathic type 1 refers to forms that have no known cause.
Class: Type II
A state that usually arises because of insulin resistance combined with a relative deficiency in the production of insulin.
At what stage of pregnancy will a woman with left-side heart failure be scheduled for an ultrasound to monitor fetal health and rule out poor placenta perfusion ?
A woman will be scheduled for serial ultrasound and nonstress tests after weeks 30 to 32 of pregnancy to monitor fetal health and to rule out poor placental perfusion
Although successful pregnancies in women with kidney transplants are to be expected, women should be considered individually to determine whether they will be able to carry a pregnancy to term before a pregnancy is initiated Criteria to be evaluated include:
A woman's general health and the time since the transplant (preferably >2 years) A woman's serum creatinine level The presence of proteinuria or hypertension or signs of graft rejection Medications the woman is taking to reduce graft rejection It is helpful if the drugs a woman is taking are limited to prednisone to ensure fetal safety during pregnancy.
Renal and Urinary Disorders and Pregnancy
Adequate kidney function is important for a successful pregnancy outcome because a woman is excreting waste products not only for herself but also for the fetus. This dual function makes any condition that interferes with kidney or urinary function always potentially serious.
Urge women, however, not to reduce their intake to below
1,800 calories during pregnancy as an intake this low in carbohydrates can lead to fat breakdown and acidosis.
Education Regarding Nutrition During Pregnancy.
1. Educate on how many carbohydrates a pregnant woman should eat in order to administer a number units of insulin 2. Educate them to try to continue a nutritional regime of 1,800- to 2,400-calorie diet (or one calculated at 30 kcal/kg of ideal weight), divided into three meals and three snacks to try and keep carbohydrate evenly distributed during the day so the glucose level remains constant, is a typical nutrition regimen during pregnancy 3. a woman's diet should be certain to include a reduced amount of saturated fats and cholesterol and an increased amount of dietary fiber. Increasing fiber decreases postprandial hyperglycemia and so lowers insulin requirements. 4.Urge a woman to make her final snack of the day one of protein and a complex carbohydrate (e.g., an egg and whole grain toast, hummus and whole grain crackers) to allow slow digestion during the night 5.ideally, 20% of dietary calories should be from protein, 40% to 50% from carbohydrate, and up to 30% from fat
Education Regarding Exercise During Pregnancy. If a woman begins an exercise program for the first time during pregnancy, she may notice excessive glucose fluctuations at first. Therefore, it's best if she
1. inform to begin exercise rountain before pregnancy starts 2.blood glucose levels decrease because the muscles increase their need for glucose, an effect which lasts for at least 12 hours after exercise 3.If the arm in which a woman injected insulin is actively exercised, the insulin is released so quickly that it can cause hypoglycemia. 4.eat a snack consisting of a protein or complex carbohydrate before exercise and should maintain a consistent exercise program—she should not do aerobic exercises one day and then none the next, but rather, do 30 minutes of walking every day
Nursing Diagnosis Diabetes mellitus:
1.Deficient knowledge related to a therapeutic regimen necessary during pregnancy 2.Imbalanced nutrition, less than body requirements, related to inability to use glucose
The most apt to cause right-sided heart failure in women of reproductive age is
1.Eisenmenger syndrome, 2.a right-to-left atrial or ventricular septal defect with an accompanying pulmonary valve stenosis note: congestion of the systemic venous circulation and decreased cardiac output to the lungs occurs
Risk factors for developing gestational diabetes include:
1.Obesity 2.Age over 25 years 3.History of large babies (10 lb or more) 4.History of unexplained fetal or perinatal loss 5.History of congenital anomalies in previous pregnancies 6.History of polycystic ovary syndrome 7.Family history of diabetes (one close relative or two distant ones) 8.Member of a population with a high risk for diabetes (Native American, Hispanic, Asian)
Therapeutic Management for UTI's
1.Obtain a clean-catch urine sample for culture and sensitivity to assess for asymptomatic bacteriuria or symptoms of UTI 2.A sensitivity test will then determine which antibiotic will best combat the infection. Amoxicillin, ampicillin, and cephalosporins are effective against most organisms causing UTIs and are safe antibiotics during pregnancy. 3.The sulfonamides can be used early in pregnancy but not near term because they can interfere with protein binding of bilirubin, which then leads to hyperbilirubinemia in the newborn
Assessment TB
1.S/S of chronic cough, are substantial weight loss, hemoptysis (coughing blood), a low-grade fever, extreme fatigue, and waking at night with night sweats 2.Assess for positive or negative tb test
As part of prenatal education, remind all women during pregnancy of common measures to prevent UTIs, such as:
1.Voiding frequently (at least every 2 hours) 2.Developing a habit of urinating as soon as the need is felt and emptying the bladder completely when urinating 3.Wiping front to back after voiding and bowel movements 4.Wearing cotton, not synthetic fiber, underwear 5.Voiding immediately after sexual intercourse 6.Drinking a glass of cranberry juice daily
Educate Regarding Medication.
1.Women taking cardiac medication, such as digoxin, before pregnancy may need to increase their maintenance dose because of their expanded blood volume during pregnancy 2.To aid a woman in continuing to think of herself as basically a well person, help her to understand this does not mean her heart function is weakening, but rather, it is only temporarily being stressed by the increased circulatory load of pregnancy 3. inform women who had rheumetic fever as a child who take penicillin to continue the therapy ( should be taken for 10 years) 4.Help women with heart disease to understand there are valid exceptions to the rule of "no medicine during pregnancy" so they make out reminders to adhere to their prescribed regimen.
ASSESSMENT OF A WOMAN WITH CARDIAC DISEASE
1.history to document prepregnancy cardiac status 2.level of exercise performance (i.e., what level she can do before growing short of breath 3.physical symptoms she experiences, such as cyanosis of the lips or nail beds) 4. Ask if she normally has a cough or edema (it's important that women with cardiac disease always report coughing during pregnancy because pulmonary edema from heart failure may first manifest itself as a simple cough
At the point that maternal blood pressure becomes insufficient to provide an adequate supply of blood and nutrients to the placenta, fetal health can be compromised. For this reason, assess the infants of these women for ?
1.low birth weights or be small for gestational age because of acidosis, which develops due to poor oxygen/carbon dioxide exchange or not being furnished with enough nutrients 2.If the placenta is not filling well, a fetus may not respond well to labor (evidenced by late deceleration patterns on a fetal heart monitor), and a cesarean birth may be necessary (an increased risk for both the mother and fetus).
Assessment of UTI in Pregnant women
1.manifests as frequency and pain on urination' 2.With pyelonephritis, a woman develops pain in the lumbar region (usually on the right side) that radiates downward. The area feels tender to palpation. She may have accompanying nausea and vomiting, malaise, pain, and frequency of urination. 3.Her temperature may be elevated only slightly or may be as high as 103° to 104°F (39° to 40°C) 4.A urine culture will reveal over 100,000 organisms per milliliter of urine, a level diagnostic of infection.
What are some tests for diabetic pregnant women to test for if the baby is okay ? Because women with diabetes tend to have infants with a higher than normal incidence of birth anomalies, a woman will have a
1.serum α-fetoprotein level obtained at 15 to 17 weeks to assess for a neural tube defect and an ultrasound examination performed at approximately 18 to 20 weeks to detect gross abnormalities. 2.A creatinine clearance test may be ordered each trimester. A normal creatinine clearance rate suggests a woman's vascular system is intact because kidney function is normal. By default, this also implies uterine perfusion is also adequate. 3.Placental functioning may also be assessed by a weekly nonstress test or biophysical profile during the last trimester of pregnancy
Patient-Teaching: To prevent iron-deficiency anemia, women should do what ?
1.take prenatal vitamins containing 27 mg of iron as prophylactic therapy during pregnancy. 2.eat a diet high in iron and vitamins (e.g., green leafy vegetables, meat, and legumes) so the supplement is truly a supplement. 3.take their iron medication (120 to 200 mg elemental iron per day), usually in the form of ferrous sulfate or ferrous gluconate.
Folic acid-deficiency anemia occurs most often in multiple pregnancies because of
1.the increased fetal demand; in women with a secondary hemolytic illness in which there is rapid destruction and production of new red blood cells; 2.in women who are taking hydantoin, an anticonvulsant agent that interferes with folate absorption; 3.and in women who have poor gastric absorption, such as in those who have had a gastric bypass for morbid obesity
Promote Rest.
1.two rest periods a day (fully resting, not getting up frequently) and a full night's sleep (not tossing and turning) to obtain adequate rest. 2.Rest should be in the left lateral recumbent position to prevent supine hypotension syndrome and increased heart effort. 3.plan activities so they stop exercising before the point when cardiac output becomes insufficient to meet systemic body demands causing peripheral and uterine/placental constriction 4. Ask enough questions, to make certain a woman's definition of "heavy work" is the same as yours and her primary care provider's.
ANEMIA AND PREGNANCY True anemia is typically considered to be present when a woman's hemoglobin concentration is less than
11 g/dl (hematocrit <33%) in the first or third trimester of pregnancy or when the hemoglobin concentration is less than 10.5 g/dl (hematocrit <32%) in the second trimester
A fasting plasma glucose greater than or equal to or a nonfasting plasma glucose greater than or equal to ?
126 mg/dl or a nonfasting plasma glucose greater than or equal to 200 mg/dl meets the threshold for the diagnosis of diabetes and does not need confirmation.
If the result of glucose challenge test is
140 mg/dl (some providers use 130 mg/dl as the cutoff), then the woman will need to do a three hour glucose tolerance test.
3 hr
145
A woman can promote urine drainage by assuming a knee-chest position for
15 minutes morning and evening. In this position, the weight of the uterus is shifted forward, releasing the pressure on the ureters and allowing urine to drain more freely.
2 hr
155
1 hr
180
Iron stores are also apt to be low in women who were pregnant less than how many years before their current pregnancy ?
2 years before the current pregnancy or those from low socioeconomic levels who have not had iron-rich diets.
KEY POINTS FOR REVIEW for TEST- 20
2.Teaching is an important nursing intervention because a woman with a preexisting illness must modify her usual therapy to adjust to pregnancy. 3.Because blood volume increases by as much as 50% during pregnancy, cardiac function may become inadequate if cardiovascular disease is present. Cardiac illnesses that cause difficulty can be either acquired disorders such as Kawasaki disease and rheumatic fever or congenital disorders such as mitral valve stenosis and coarctation of the aorta. 4.Iron-deficiency anemia, sickle-cell anemia, and folic acid-deficiency anemia are examples of various forms of anemia that can also cause complications of pregnancy. Such anemias can result in fetal distress because of inadequate oxygen transport. 5.Urinary tract disorders can lead to pregnancy complications because pregnancy increases the workload of the kidneys. UTIs and chronic renal disease are two disorders that may lead to early pregnancy loss. 6.The incidence of tuberculosis is on the increase and special assessments and care are needed for these women. 7.The major endocrine disorder seen during pregnancy is diabetes mellitus. Gestational diabetes is diabetes that occurs only during pregnancy.
It is recommended that all pregnant women receive a 50-g glucose challenge test between
24 and 28 weeks gestation to determine if they are at risk for gestational diabetes.
Pyelonephritis occurs as an extension of a UTI or infection that originated in or spread to the kidney . If this develops, a woman may be hospitalized for
24 to 48 hours while she is treated with intravenous antibiotics. After this acute episode, she will be maintained on a drug such as oral nitrofurantoin (Macrodantin) for the remainder of the pregnancy.
The danger of pregnancy in a woman with cardiac disease occurs primarily because of this increase in circulatory volume.
28 to 32, just after the blood volume peaks.
The pregnant woman with a UTI needs to take the additional measure of drinking an increased amount of fluid to flush out the infection from the urinary tract. To be most effective, do not simply tell her to "push fluids" or "drink lots of water." Give her a specific amount to drink every day up to
3 to 4 L per 24 hours to make certain she increases her fluid intake sufficiently.
The likelihood of deep vein thrombosis (DVT), formation of a blood clot in the veins of the lower extremities, leading to pulmonary emboli is highest in women
30 years of age or older because increased age is yet another risk factor for thrombosis formation
Iron-deficiency anemia is confirmed by a corresponding low serum iron level under ?
30 μg/dl and an increased iron-binding capacity over 400 μg/dl
All women expecting to become pregnant are advised to begin a supplement of
400 μg folic acid daily in addition to eating folate-rich foods (e.g., green leafy vegetables, oranges, dried beans). Over-the-counter women's multivitamin preparations generally do contain adequate folic acid for pregnancy so be certain women are specifically taking a prenatal or women's multivitamin.
Fasting
95
Assessment of Sickle-Cell anemia in Pregnant Black women
All Black women who have not been previously tested should be screened for sickle-cell anemia at a first prenatal visit. Hemoglobin levels for all women with sickle-cell disease should then be obtained throughout pregnancy. A woman with sickle-cell disease may normally have a hemoglobin level of 6 to 8 mg/100 ml.
Documenting edema is also important because the usual innocent edema of pregnancy must be distinguished from the beginning of edema from heart failure (serious). Why ?
An important difference is the usual edema of pregnancy involves only the feet and ankles but becomes systemic with heart failure
Insulin pump therapy
An insulin pump is an automatic pump with thin tubing, which is placed subcutaneously, most often on the woman's abdomen. Insulin is given through this tube and injection of insulin is therefore eliminated.
Angelina is prescribed an insulin pump to administer insulin for her gestational diabetes. What patient education would the nurse want to provide to explain why nighttime is a particularly hazardous time for her fetus during pump therapy? a.The fetus can develop hyperglycemia from excessive insulin administration. b.Continuous insulin administration with no food intake can lead to hypoglycemia. c.Her lack of exercise at night tends to lead to hypercalcemia from muscle disuse. d.Her lack of fluid intake during the night causes a relative increase in serum insulin levels.
B. The nurse should explain that continuous insulin administration with no food intake can lead to hypoglycemia. Women should typically eat a high-protein/complex carbohydrate snack such as peanut butter and celery before bedtime to prevent fetal hypoglycemia from ingesting little food during the night.
Additional notes for promoting rest
Be certain they know exactly how much they should limit their exercise. Some women, for example, may need to discontinue employment early in pregnancy rather than work until the end. A prescription to allow "normally heavy" housework may mean nothing more strenuous than dusting to some women. To others, it may mean washing windows, turning mattresses, and shoveling snow. Ask enough questions, therefore, to make certain a woman's definition of "heavy work" is the same as yours and her primary care provider's.
Assessment
Because diabetes is such a serious complication in pregnancy, all women should be screened during pregnancy for gestational diabetes
Patient Teaching A sickle-cell anemia postpartum patient is worried that her child may have inherited her sickle-cell anemia trait, her husband was found to not be a carrier of the trait, what is the nurse best respond ?
Because this disorder is recessively inherited, if one of the parents has the disease and the other is free of the disease and trait, the chance the child will inherit the disease is zero. If a woman has the disease and her partner has the trait, the chance the child will be born with the disease is 50%. If both parents have the disease, all their children will also have the disease
PATIENT-CENTERED CARE Angelina develops a DVT while in the hospital on bed rest and is prescribed low-molecular-weight heparin. The nurse identifies which action as important when planning care for her? a.Showing her how to self-administer the drug as a rectal suppository b.Cautioning her that her hemoglobin level will be closely monitored during therapy c.Allowing her to choose a subcutaneous site for the injection d.Monitoring her white blood cell count daily for decreased coagulation
C. Allowing her to choose a subcutaneous site for the injection
A WOMAN WITH CARDIAC DISEASE
Cardiac disease can affect pregnancy in different ways depending on whether it involves the left or the right side of the heart.
Educate Regarding Avoidance of Infection.
Caution women with heart disease, to avoid visiting or being visited by people with infections and to alert healthcare personnel at the first indication of an upper respiratory tract infection or urinary tract infection (UTI) so that, if warranted, antibiotic therapy can begin early in the course of the infection. Monthly screening for bacteriuria with a clean-catch urine test at prenatal visits should help detect UTIs.
Blood glucose monitoring
Completed four times a day by the patient. The patient pricks her finger and uses a glucometer to determine her blood glucose. She should track these numbers with a chart and bring it to her OB visits. Her provider will determine if any adjustments in her insulin or oral diabetic regimen are needed.
What tests are usually done during pregnancy to diagnosed sickle-cell anemia in the fetus ?
Electrophoresis of red blood cells obtained from maternal serum or by amniocentesis during pregnancy can reveal the presence of the disease on the few β-hemoglobin chains already present in fetal life. If not assessed during pregnancy, although the symptoms of sickle-cell disease do not become clinically apparent until 3 to 6 months of age, a routine newborn serum screening at birth will also reveal the disease.
What is the most accurate statement regarding exercise and nutrition during pregnancy for a woman with diabetes? A.Extreme exercise may cause hypoglycemia; therefore, it should be avoided. B.During the last trimester, caloric intake should be decreased to less than 1,800 calories to control fetal weight gain. C.Exercise reduces the need for insulin; therefore, beginning an exercise regimen during pregnancy is recommended. D.Ideally, dietary calorie intake should be approximately 20% from protein, 40% to 50% from carbohydrates, and up to 30% from fats.
D. Ideally, dietary calorie intake should be approximately 20% from protein, 40% to 50% from carbohydrates, and up to 30% from fats. Rationale: This caloric balance allows for good glycemic control. Because exercise programs may cause glucose fluctuations, they need to be initiated before pregnancy. Extreme exercise can cause hyperglycemia because of glucose release by the liver to compensate for energy need and lack of insulin to metabolize it. Intake of less than 1,800 calories may result in fat breakdown and acidosis.
Nursing Diagnosis:
Deficient knowledge regarding steps to take to reduce the effects of maternal cardiovascular disease on the pregnancy and fetus
A WOMAN WITH DIABETES MELLITUS
Diabetes mellitus is an endocrine disorder in which the pancreas cannot produce adequate insulin to regulate body glucose levels. The disorder affects 3% to 5% of all pregnancies and is the most frequently seen medical condition in pregnancy . It is increasing in incidence as more and more obese adolescents develop type 2 diabetes
Class III Markedly compromised.
During less than ordinary activity, woman experiences excessive fatigue, palpitations, dyspnea, or anginal pain.
Postpartum Adjustment
During the postpartum period, a woman who came into pregnancy with diabetes must undergo yet another readjustment to insulin regulation.
✔Education related to recording fetal movement
Educate a woman to monitor fetal kicks , 10 times in an hr, If for a second time the baby is not felt moved for another 1 hr kick , call provider.
A Woman With Folic Acid-Deficiency Anemia
Folic acid, or folate or folacin, one of the B vitamins, is necessary for the normal formation of red blood cells in the woman as well as being associated with preventing neural tube and abdominal wall defects in the fetus.
Nursing Interventions During Labor and Birth
Frequently assess a woman's blood pressure, pulse, and respirations and monitor fetal heart rate and uterine contractions during labor for women with heart disease to be certain their circulatory system is not failing and the placenta is filling adequately.
Therapeutic Management for sickle cell anemia
If a crisis occurs, controlling pain, administering oxygen as needed, and increasing the fluid volume of the circulatory system to lower viscosity are important interventions
Pathophysiology
If a woman's insulin production is insufficient, glucose cannot be used by body cells. The cells register the need for glucose, and the liver quickly converts stored glycogen to glucose to increase the serum glucose level. Because insulin is still not available, however, the body cells still cannot use the glucose, so the serum glucose levels rise (i.e., hyperglycemia). When the level of blood glucose reaches 150 mg/100 ml (normal level is 80 to 120 mg/dl), the kidneys begin to excrete quantities of glucose in the urine (i.e., glycosuria) in an attempt to lower the level. This causes large quantities of fluid to be excreted with urine (i.e., polyuria).
✔Education related to blood glucose monitoring
If the patient is hypoglycemic, she should have some carbohydrate rich food, like crackers, and a protein, like milk. Simple sugars can create hyperglycemia and rebound hypoglycemia.
Be Prepared for Emergency Actions.
If women with heart disease overexert during a prenatal visit, they may need supplemental oxygen or cardiac resuscitation. The rules for cardiac resuscitation for women who are pregnant do not differ from the usual technique
Insulin therapy
Needed by pregestational and gestational diabetics who are uncontrolled with diet or oral therapy. Necessary for the cells to take glucose from the bloodstream
Outcome Evaluation:
Oral temperature is below 100.4°F (38°C), and a clean-catch urine specimen has a bacteria count below 100,000 colonies per milliliter.
Class II Slightly compromised.
Ordinary physical activity causes excessive fatigue, palpitation, and dyspnea or anginal pain.
Class I Uncompromised.
Ordinary physical activity causes no discomfort. No symptoms of cardiac insufficiency and no anginal pain.
Outcome Evaluation:
Patient identifies danger signs such as angina pain and steps to take when they occur; maternal blood pressure is maintained above 100/60 mmHg and fetal heart rate at 110 to 160 beats/min.
Outcome Evaluation Diabetes:
Patient states importance of careful attention to nutrition, exercise, and home monitoring of glucose levels during pregnancy; describes nutrition and exercise program; states intention to keep nutrition and exercise constant.
Nursing Diagnosis:
Risk for infection related to stasis of urine with pregnancy
A woman with gestational diabetes usually demonstrates normal glucose values by 24 hours after birth and then will need no further diet or insulin therapy. What will she need careful observation for if polyhdramnios was present during pregnancy ?
She requires careful observation during the immediate postpartum period because if polyhydramnios was present during pregnancy, she is at risk of hemorrhage from poor uterine contraction.
Insulin Dosage
Short-acting insulin may be used alone or with an intermediate type. Two thirds of daily insulin needs are given before breakfast and one third before dinner. Insulin should be given subcutaneously and at a 90-degree angle to the skin. The injection site should generally be the same each injection (arms OR legs OR abdomen).
A WOMAN WITH SICKLE-CELL ANEMIA
Sickle-cell anemia is a recessively inherited hemolytic anemia caused by an abnormal amino acid in the beta chain of hemoglobin. If the abnormal amino acid replaces the amino acid valine, sickling hemoglobin (HbS) results; if it is substituted for the amino acid lysine, nonsickling hemoglobin (HbC) results. An individual who is heterozygous (i.e., has only one gene in which the abnormal substitution has occurred) has the sickle-cell trait (HbAS). If the person is homozygous (i.e., has two genes in which the substitution has occurred), sickle-cell disease (HbSS) results
Why are tetracyclines avoided in pregnant women with UTI's ?
Tetracyclines are contraindicated during pregnancy as they cause retardation of bone growth and staining of the deciduous teeth
Cardiovascular Disorders and Pregnancy
The cardiovascular disorders that most commonly cause difficulty during pregnancy are valve damage concerns caused by rheumatic fever or Kawasaki disease and congenital anomalies such as atrial septal defect or uncorrected coarctation of the aorta
A WOMAN WITH VENOUS THROMBOEMBOLIC DISEASE
The incidence of venous thromboembolic disease increases during pregnancy because of a combination of stasis of blood in the lower extremities from uterine pressure and hypercoagulability (the effect of elevated estrogen
A pyelonephritis UTI , usually occurs on what side ?
The infection usually occurs on the right side because there is greater compression and urinary stasis on the right ureter from the uterus being pushed that way by the large bulk of the intestine on the left side.
✔Education related to pump care and us
The patient should clean the site daily and cover it with a dressing to keep it clean. The site also needs to be changed every 24-48 hr to ensure optimal absorption and decrease infection.
Blood glucose monitoring dosage
The patient should obtain fasting and 1-hour postprandial values. Her goals include fasting numbers that are 90 and below and postprandial values that are less than 140.
Postpartum Nursing Interventions
The period immediately after birth is a critical time for a woman with heart disease because, with delivery of the placenta, the blood that supplied the placenta is released into her general circulation, increasing her blood volume by 20% to 40%
Women with known vesicoureteral reflux (i.e., backflow of urine into the ureters) tend to develop
UTIs or pyelonephritis more often than others. The organism most commonly responsible for UTI is Escherichia coli from an ascending infection.
A WOMAN WITH TUBERCULOSIS
With tuberculosis, lung tissue is invaded by Mycobacterium tuberculosis, an acid-fast bacillus. Macrophages and T lymphocytes surround the invading bacillus, but rather than actually killing it, they merely surround and confine it. Fibrosis, calcification, and a final ring of collagenous scar tissue develop, effectively sealing off the organisms from the body and any further invasion or spread. The antibodies produced will thereafter cause a woman to have a positive response to a Mantoux test (purified protein derivative [PPD]) test.
Class IV Severely compromised.
Woman is unable to carry out any physical activity without experiencing discomfort. Even at rest, symptoms of cardiac insufficiency or anginal pain are present.
✔Education related to insulin
Women should eat immediately after injecting insulin to avoid hypoglycemia. Different body areas take up insulin at different rates. Rotate within the same type of injection site.
A WOMAN WITH CHRONIC HYPERTENSIVE VASCULAR DISEASE
Women with chronic hypertensive disease enter pregnancy with an elevated blood pressure (140/90 mmHg or above).
Patient Teaching: A woman may be disappointed during labor to learn her labor is not going to be "natural." Stress that these measures may not be what she anticipated, but they can help her achieve her ultimate goal,
a healthy newborn and a mother able to care for her new baby
At birth , neonates with mothers with uncontrolled diabetes are more prone to what? Select all that apply ? a. hypoglycemia b.respiratory distress syndrome c.hypocalcemia d. hyperbilirubinemia e. hyperglycemia f.hypercalemia g. congenital anomally/caudual regression syndrome
a. hypoglycemia b.respiratory distress syndrome c.hypocalcemia d. hyperbilirubinemia g. congenital anomally/caudual regression syndrome
TEAMWORK & COLLABORATION Angelina had tuberculosis as a teenager, and her primary care provider orders a chest X-ray during pregnancy. The nurse would want care team members to know that this is necessary because of which danger of tuberculosis during pregnancy? a.Calcium deposits that wall off old tuberculosis lesions can break down. b.Latent tuberculosis can turn to pneumonia if a woman has a folic acid deficit. c.PPD tests are always negative during pregnancy so tuberculosis often goes undetected. d.The disease can result in neural tube defects in the fetus.
a.Calcium deposits that wall off old tuberculosis lesions can break down.
What are some high incidence or risk factors a woman with with uncontrolled diabetes mellitus infant or her is at risk for or prone to ? Select all that apply . a.caudal regression syndrome b.miscarriage c.still birth d. healthy bouncing baby d.low-birth weight e.tiny baby g. large infants born over 10lbs
a.caudal regression syndrome b.miscarriage c.still birth g. large infants born over 10lbs
Analyzing A patient with severe renal disease comes into a dialysis clinic, and the nurse is preparing her for dialysis, which would the nurse adminster intramusculary to prevent the risks of preterm labor before the procedure ? a.progesterone may be administered intramuscularly b.insulin c.Estrogen may be administered intramusculary d.tylenol
a.progesterone may be administered intramuscularly
For the 3-hour fasting glucose test, after a fasting glucose sample is obtained, the woman drinks an oral 100-g glucose solution; a venous blood sample is then taken for glucose determination at 1, 2, and 3 hours later. If two of the four blood samples collected for this test are abnormal or the fasting value is
above 95 mg/dl, a diagnosis of diabetes is made.
After pregnancy, women with aPLA should not begin what type of contraceptive ?
an oral contraceptive because it can increase blood coagulation and the possibility of thrombi formation.
Right-side heart failure can occur due to what ?
an unrepaired congenital heart defect such as pulmonary valve stenosis,
To prevent thrombus formation, a woman may be prescribed an .
anticoagulant.
If coarctation of the aorta is causing the difficulty, dissection of the what can occur ?
aorta from high blood pressure from trying to push blood past the constriction can occur
In type 1 diabetes, which, although unproven, is probably an
autoimmune disorder because marker antibodies are present, the pancreas fails to produce adequate insulin for body requirements
Patient Teaching ( Important) It is generally recommended the lower abdomen be used for rotating sites for subcutaneous heparin administration. With pregnancy, however, this site is usually accepted or avoided ?
avoided and the injection sites are limited to the arms and thighs. Heparin dosage is regulated by the anti-Xa test, the most accurate assay for monitoring unfractionated heparin and low-molecular-weight heparin
The risk of thrombus formation can be reduced through common-sense measures such as
avoiding the use of constrictive knee-high stockings, not sitting with legs crossed at the knee, and avoiding standing in one position for a long period.
Patient Teaching A pregnant client with pyelenophritis asks the nurse if it is alright for her to continue taking her medication of sulfonamides near term , how should the nurse response ? a. Yes, it is safe to use b. No, sulfonamides were found to cause hyperbilirubin in newborns c. Sure, just call your doctor and ask him/her to up your dose if finished d. no, but I don't see why it will hurt you baby
b. No, sulfonamides were found to cause hyperbilirubin in newborns
Which statement by a woman who is 8 weeks pregnant and has cardiac disease would you most likely follow up closely? a."I have been really constipated for the last few weeks." b."I have gained 4 lb during the last week, but I'm not eating more than before." c."I have not felt any fetal movement as yet." d."I have had episodes in the morning when I have almost thrown up."
b."I have gained 4 lb during the last week, but I'm not eating more than before." Rationale: Constipation and nausea are common during the first trimester. Fetal movement (quickening) is not usually felt until the second trimester. Weight gain of 4 lb within a week during the first 8 weeks of pregnancy without additional intake could signal increased circulatory fluid and impending heart failure.
Because a pregnant woman with sickle-cell anemia has vascular stasis, they are more susceptible to what ?
bacteriuria than other women; periodically collect a clean-catch urine sample during pregnancy to detect developing bacteriuria while a woman is still asymptomatic.
peritoneal dialysis is actually preferred over hemodialysis why ?
because it normally causes less drastic fluid shifts. This can be accomplished on an ambulatory basis (continuous ambulatory peritoneal dialysis) throughout pregnancy.
If a thrombus does occur during pregnancy, a woman may notice pain and redness usually in the calf of a leg. It is diagnosed by a woman's history and Doppler ultrasonography. In order to keep the thrombus from moving and becoming a pulmonary embolus, a woman will be treated with
bed rest and intravenous heparin for 24 to 48 hours. After this, she may be prescribed subcutaneous heparin she can self-inject every 12 or 24 hours for the duration of the pregnancy.
Women with class III can complete a pregnancy by maintaining special interventions such as
bed rest.
When assessing a pregnant woman for cardiac disease you should record a baseline?
blood pressure, pulse rate, and respiratory rate in either a sitting or lying position at the first prenatal visit; at future health visits, always obtain these in the same position for the most accurate comparison. Making comparison assessments for nail bed filling (should be <5 seconds) and jugular venous distention can also be helpful throughout pregnancy.
Pharmacology: In the postpartum period, a stool softener can be prescribed to prevent straining with bowel movements. Agents to encourage uterine involution, such as oxytocin (Pitocin), should be used with caution because they tend to increase
blood pressure, which necessitates increased heart action.
Many women with renal disease routinely take a corticosteroid such as oral prednisone at a maintenance level. This drug therapy typically is continued throughout pregnancy. Although animal studies have shown an increased incidence of cleft palate from corticosteroid use during pregnancy, this does not appear to be true in humans. The infant may be born with what due to predisone >
born hyperglycemic because of the suppression of insulin activity by the corticosteroid.
Patient Education: A nurse should advise a woman with sickle-cell anemia to not do which of the following ? a. drink about 8 glasses of water a day b. take rest periods and elevating her legs for ciculation c. take iron pills to replenish red blood cells d. report to the hospital if she is having a sickle cell crisis
c. take iron pills to replenish red blood cells
SAFETY Angelina is friends with a woman in the clinic who has sickle-cell anemia, and they often talk together about their care. Which statement would alert the nurse that her friend may need further instruction on prenatal care? a."I understand why folic acid is important for red cell formation." b."I'm careful to drink at least eight glasses of fluid every day." c."I take an iron pill every day to help grow new red blood cells." d."I've temporarily stopped jogging so I don't risk becoming dehydrated."
c."I take an iron pill every day to help grow new red blood cells."
QUALITY IMPROVEMENT While reviewing antenatal electronic records, the charge nurse of a prenatal clinic notes that a high number of pregnant women seen in the clinic, including Angelina Gomez, have developed UTIs during their pregnancies. The nurse should emphasize the need for staff nurses to do which of the following? a.Ensure that the housekeeping department is adequately cleaning the toilets. b.Suggest all women be prescribed a prophylactic antibiotic during their first trimester. c.Educate women on the need for sound perineal care during pregnancy. d.Urge women to restrict fluid to keep their urine acidic and concentrated.
c.Educate women on the need for sound perineal care during pregnancy.
A woman who had tuberculosis earlier in life must be especially careful to maintain an adequate level of what mineral and why ?
calcium during pregnancy to ensure the calcium tuberculosis pockets in her lungs are not broken down and the disease is not reactivated.
For an additional cardiac status assessment, an electrocardiogram (ECG) or an echocardiogram may be done at periodic points in pregnancy. Assure the woman that an ECG merely measures her ?
cardiac electrical discharge and so cannot harm her fetus in any way. Echocardiography uses ultrasound and, likewise, will not harm her fetus.
Women with class IV heart disease are usually advised to avoid pregnancy because they are in
cardiac failure even at rest and when they are not pregnant.
A macrosomic infant may create birth problems at the end of the pregnancy because of
cephalopelvic disproportion. This, combined with an increased risk for shoulder dystocia, may make it necessary for infants of women with diabetes to be born by cesarean birth.
As pulmonary edema becomes severe, a woman cannot sleep in any position except with her, what postion ?
chest and head elevated (orthopnea), as elevating her chest this way allows fluid to settle to the bottom of her lungs and frees space for gas exchange.
At any time in life, sickle-cell anemia is a threat to life if vital blood vessels such as those to the liver, kidneys, heart, lungs, or brain become blocked. In pregnancy, blockage to the placental circulation can directly do what ?
compromise the fetus, causing low birth weight and possibly fetal death
A high-risk pregnancy is one in which a
concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the woman, the fetus, or both.
To decrease the strain on the aorta, antihypertensives may be prescribed to do what ?
control blood pressure,
If a woman with heart failure pulmonary edema, what positional comfort measure should the nurse advise her to do ?
elevate her head and chest (a semi-Fowler's position) to ease the work of breathing. If this is necessary, be certain to place a towel under her right hip to shift the uterus off the vena cava, the same as would happen with a side-lying position.
When the pressure of the fetal head at birth puts additional pressure on lower extremity veins, what can occur >
damage can occur to the walls of the veins With this triad of effects in place (stasis, vessel damage, and hypercoagulation), the stage is set for thrombus formation in the lower extremities
To compensate for these circulatory changes, a woman may need a program of
decreased activity and possibly anticoagulant and digoxin therapy until her circulation stabilizes
Many women enter pregnancy with a deficiency of iron stores resulting from a combination of a
diet low in iron, heavy menstrual periods, or unwise weight-reducing programs
the left ventricle cannot move the large volume of blood forward that it has received by the left atrium from the pulmonary circulation. This causes back pressure—the left side of the heart becomes
distended, systemic blood pressure decreases in the face of lowered cardiac output, and pulmonary hypertension occurs.
Extreme liver enlargement caused by right-sided heart failure can cause what to occur ?
dyspnea and pain in a pregnant woman because the enlarged liver, as it is pressed upward by the enlarged uterus, puts extreme pressure on the diaphragm.
In the postpartal period, What is recommended that postpartum patients do after delivery to reduce the risks of thromboembolism?
early ambulation and wearing pressure stockings or IPC boots can help reduce the risk of thromboembolism from stasis in lower extremities
If an operative birth is necessary, What is the anesthisa method of choice used ?
epidural anesthesia is the method of choice because general anesthesia poses a possible risk of hypoxia.
Women with chronic renal disease need to be monitored carefully during pregnancy because their diseased kidneys may not produce what ?
erythropoietin, a glycoprotein necessary for red cell formation and so they may develop a severe anemia Fortunately, synthetic erythropoietin is now available and is safe to take during pregnancy
A woman with iron deficiency anemia may experience?
extreme fatigue and poor exercise tolerance because she cannot transport oxygen effectively. The condition is mildly associated with low birth weight and preterm birth. Because the body recognizes that it needs increased nutrients, some women with this condition develop pica, or the craving and eating of substances such as ice or starch . It is also associated with restless leg syndrome
Distention of abdominal and lower extremity vessels due to right-sided heart failure can lead to
exudate of fluid from the vessels into the peritoneal cavity (i.e., ascites) or peripheral edema. Women who have an uncorrected anomaly of this type may be advised not to become pregnant.
Digoxin has a unique use during pregnancy as it can be administered to the woman to slow the ?
fetal heart if fetal tachycardia is present.
Heart failure can start as early as the ?
first trimester, and other symptoms such as -irregular pulse -rapid or difficult respirations, -chest pain on exertion will probably also be present
Later in pregnancy a woman with daibetes mellitus , she must be extremely nutrition conscious to maintain good control of her ?
glucose levels and to keep her weight gain to a suitable amount (approximately 25 to 30 lb) in the hope of limiting the size of her infant and making a vaginal birth possible.
If an anticoagulant is required, what dose will be given ?
low-molecular-weight heparin is the drug of choice for early pregnancy because it does not cross the placenta and so does not have teratogenic effec
Because a woman who has had gestational diabetes is at risk for developing type 2 diabetes later in life, she should have what test done throughput life if planning to become pregnant again ?
glucose testing done during health maintenance visits throughout life. Be certain that women receive contraceptive information as appropriate. Remind women with ongoing diabetes before they plan a second pregnancy that they will need to be certain their disease is stabilized and in good control.
In type 2 diabetes, there is a
gradual loss of insulin production, but some ability to produce insulin will still be present.
All women appear to develop an insulin resistance as pregnancy progresses or insulin does not seem as effective during pregnancy, a phenomenon that is probably caused by the presence of the hormone human placental lactogen (i.e., chorionic somatomammotropin) and high levels of cortisol, estrogen, progesterone, and catecholamines. This resistance to or destruction of insulin is helpful in a ?
healthy pregnancy because it prevents the maternal blood glucose from falling to dangerous limits. -It causes difficulty for a pregnant woman with diabetes because she must then increase her insulin dosage beginning at about week 24 of pregnancy to prevent hyperglycemia.
After birth, the increase in pressure takes place within 5 minutes, so the heart must make a rapid and major adjustment, you should assess for >
heart failure
Remember, fatigue is a symptom of heart decompensation. Evaluate women carefully, therefore, to determine whether the fatigue a woman reports is
heart or labor related.
Chronic hypertension can be serious because it places both the woman and fetus at high risk because of poor
heart, kidney, and/or placental perfusion during the pregnancy
Before discharge, be certain a woman has thought through if she will need what >
help at home, so she can continue getting periods of rest. Also ensure that she schedules a return appointment for a postpartum checkup for both her gynecologic health and her cardiac status
If a woman develops an infection that raises her temperature and causes her to perspire more than usual (which creates dehydration) or contracts a respiratory infection that compromises air exchange so that her PO2 is lowered, What should the nurse tell the patient is required for monitoring for a sickle cell crisis ?
hospitalization for observation may be necessary to rule out the development of a sickle-cell crisis and subsequent hemolysis of crowded cells
Be certain to keep a woman w/sickle cell anemia in labor well
hydrated and help her resist strenuous exertion.
In a woman with poor blood glucose control, extreme exercise will cause ?
hyperglycemia and ketoacidosis as the liver both releases glucose and breaks down fatty acids in an attempt to supply enough energy for the exercise, yet the body cannot use them because of inadequate insulin.
A woman with diabetes mellitus must guard against what from occuring during pregnancy and why ?
hypoglycemia (i.e., lowered serum glucose levels) and ketoacidosis caused by the constant use of glucose by the fetus.
Antiembolic stockings or intermittent pneumatic compression (IPC) boots may be prescribed to
increase venous return from the legs.
Fetal health is usually monitored during pregnancy by an ultrasound examination at 16 to 24 weeks to assess for ?
intrauterine growth restriction and by weekly nonstress or ultrasound examinations beginning at about 30 weeks. Blood flow through the uterus and placenta may be measured by blood flow velocity. If blood flow velocity is reduced, the chance of intrauterine growth restriction increases.
In sickle-cell anemia the majority of red blood cells are
irregular or sickle shaped, so they cannot carry as much hemoglobin as normally shaped red blood cells can.
Women with kidney disease who normally have a serum creatinine level greater than 2.0 mg/dl may be advised not to undertake a pregnancy in case the increased strain on already damaged kidneys leads to
kidney failure
Infants of women with poorly controlled diabetes tend to be small or large and why?
large (>10 lb) because the increased insulin the fetus must produce to counteract the overload of glucose he or she receives acts as a growth stimulant Hydramnios may develop because a high glucose concentration causes extra fluid to shift and enlarge the amount of amniotic fluid.
If a woman's heart disease involves right-sided heart failure, assess her ?
liver size at prenatal visits. Keep in mind that liver assessments can become difficult and probably inaccurate late in pregnancy because the enlarged uterus presses the liver upward under the ribs and makes it difficult to palpate.
Assess a woman with sickle cell anemia's what ?
lower extremities at prenatal visits for varicosities or pooling of blood in leg veins, which can lead to red cell destruction. Standing for long periods during the day increases this pressure, whereas sitting on a chair with the legs elevated or lying on the side in a modified Sims position encourages venous return from the lower extremities. Help a woman plan her day so she has limited long periods of standing and adequate rest periods.
Folic-acid anemia develops as a
megaloblastic anemia (enlarged red blood cells). Because of the size of the cells, the mean corpuscular volume will be elevated in contrast to the lowered level seen with iron-deficiency anemia. Slow to progress, the deficiency may take several weeks to develop or may not be apparent until the second trimester of pregnancy. Full blown, it may be a contributory factor in early miscarriage or premature separation of the placenta.
Iron deficiency anemia is characteristically a
microcytic (i.e., small red blood cell) and hypochromic (i.e., less hemoglobin than the average red cell) anemia, which occurs when such an inadequate supply of iron is ingested that iron is not available for incorporation into red blood cells
Left-sided heart failure occurs in conditions such as
mitral stenosis, mitral insufficiency, aortic coarctation
If women with a uncorrected right-side heart failure plan a pregnancy, they will need what to ensure their saftey and fetal growth development ?
need oxygen administration and frequent arterial blood gas assessments to ensure fetal growth, they can expect to be hospitalized for at least some days during the last part of pregnancy.
An extremely rare condition, peripartal cardiomyopathy, can originate in pregnancy in women with ?
no previous history of heart disease
Patient Teaching : A woman with heart disease is often interested in close inspection of her baby immediately after birth because she wants to know if her infant has a heart defect or was harmed by any medication she took during pregnancy. Be certain to point out that acrocyanosis is
normal in newborns, so she does not interpret her baby's peripheral cyanosis as cardiac inadequacy.
A woman with class I or II heart disease can expect to experience a
normal pregnancy and birth.
If a woman cannot eat because of vomiting or nausea early in pregnancy or heartburn in later pregnancy, she should immediately do what ?
notify her healthcare provider as she may need temporary intravenous fluid and glucose supplementation.
If women are on a low-potassium diet to avoid a buildup of potassium that accumulates because their diseased kidneys do not evacuate it well, they may need a
nutrition consultation to be certain they can continue to avoid potassium yet also eat a healthy pregnancy diet.
Throughout pregnancy, monitor a woman's with sickle cell anemia what ?
nutritional intake to be certain she is consuming sufficient amounts of folic acid and possibly an additional folic acid supplement, which is necessary for replacing red blood cells that have been destroyed. Ensure the woman is drinking at least eight glasses of fluid daily to be certain she is guarding against dehydration to prevent sickle crisis
Patient Teaching: Caution women taking heparin during pregnancy not to take any additional injections once what occurs ?
once labor begins to help reduce the possibility of hemorrhage at birth. Women taking heparin are not candidates for routine episiotomy or epidural anesthesia for this same reason unless at least 4 hours has passed since the last heparin dose was given.
Ethambutol tx for TB has the side effect of causing What test is used to dx this side effect ?
optic atrophy and loss of green color recognition in the woman. To detect this, test the woman's ability to recognize green at prenatal visits using the color section of a Snellen (eye test) chart. If symptoms develop, inform her health provider about possibly discontinuing the drug.
Patient Teaching: Advise women, , to take iron supplements with
orange juice or a vitamin C supplement, which supplies ascorbic acid.
Women with extreme heart disease may need oxygen administered during labor because of the need for extra what ?
oxygen due to the exertion of labor; continuous hemodynamic monitoring such as by a Swan-Ganz catheter to monitor heart function may be prescribed.
Women with diabetes may breastfeed because insulin is one of the few substances that does not
pass into breast milk from the bloodstream
If UTI infectious organism is determined to be Streptococcus B, vaginal cultures should be obtained because streptococcal B infection of the genital tract is associated with what in newborns ?
pneumonia in newborns.
The majority of thromboses that occur with pregnancy occur in the
postpartum period;
With insulin resistance gone, often she needs no insulin during the immediate postpartum period; in another few days, however, she will return to her
prepregnant insulin requirements. One- or 2-hour postprandial blood glucose determinations help to regulate how much insulin she needs during this adjustment period.
A woman is usually advised to wait 1 to 2 years after the infection becomes inactive before attempting to conceive , WHY ?
pressure on the diaphragm from the enlarging uterus changes the shape of the lung and can break open recently calcified pockets more readily than well-calcified lesions. Pockets may also break open during labor from the increased intrapulmonary pressure of pushing. Recent inactive tuberculosis may also become active during the postpartum period as the lung returns to its more vertical prepregnant position following birth.
Women with severe renal disease may require dialysis to aid kidney function during pregnancy . With dialysis, there is a risk of
preterm labor, perhaps because progesterone is removed with the dialysis
Important to remind a pregnant woman to take iron to prevent what ?
prevent anemia. Anemia is important to prevent because it places an extra burden on the heart because her circulatory system must circulate blood more vigorously than usual to distribute oxygen to all body cells.
If pulmonary capillaries rupture under the pressure, small amounts of blood leak into the alveoli and the woman develops a
productive cough with blood-speckled sputum.
To prevent this complication of preterm labor , what is adminstered before a dialysis procedure ?
progesterone may be administered intramuscularly before the procedure. If hemodialysis is used, it should be scheduled frequently and for short durations to avoid acute fluid shifts.
Women who are identified as aPLA positive may be started on a
prophylactic program of aspirin or subcutaneous heparin during pregnancy that is continued postpartum to reduce the possibility of DVT
During labor, they a woman with right-sided heart failure may need a ?
pulmonary artery catheter inserted to monitor pulmonary pressure. Women with this condition also need extremely close monitoring after epidural anesthesia to minimize the risk of hypotension.
Many women with heart disease should not push with contractions, Why should the nurse advise this >
pushing requires more effort than they should expend. That makes epidural anesthesia the anesthetic of choice for women with heart disease because this decreases the sensation of pushing and can make both labor and birth less taxing
Asymptomatic urinary infections are potentially dangerous because they can progress to
pyelonephritis (i.e., infection of the pelvis of the kidney) and are associated with preterm labor and premature rupture of membranes.
Urge a woman to post a chart on her
refrigerator door or in her bathroom as a reminder to take the medication. Encourage her not to leave the medication on the counter as a reminder because she needs to begin to childproof her home.
Promote Healthy Nutrition
remind her to take prenatal vitamin with iron, maintain healthy weight and limit sodium. not restrict to obtain enough sodium to maintain fluid volume and balance as well as furnish an adequate supply of blood to the fetus.
Right-sided heart failure occurs when what happens ?
right ventricle is overwhelmed by the amount of blood received by the right atrium from the vena cava
Acidifying urine by the use of ascorbic acid (vitamin C), which is often recommended in nonpregnant women, is not usually recommended during pregnancy because a newborn can develop what ?
scurvy in the immediate neonatal period from vitamin C withdrawal.
What are some therapies that can be done for a pregnant woman experiencing peripartum heart disease ?
she must sharply reduce her physical activity; many women also need a diuretic, an arrhythmia agent, and digitalis therapy to maintain heart function. Low-molecular-weight heparin may be administered to decrease the risk of thromboembolism.
A woman with peripartum cardiomegaly develops signs of myocardial failure such as
shortness of breath, chest pain, nondependent edema. Her heart increases in size (i.e., cardiomegaly)
advise a woman with cardiac issues to assume what position during labor
side-lying position during labor to reduce the possibility of supine hypotension syndrome
Because of the limited oxygen exchange, a woman with left-sided heart failure is at an extremely high risk for
spontaneous miscarriage, preterm labor, or even maternal death.
In a pregnant woman, because the ureters dilate from the effect of progesterone,what can occur ?
stasis of urine can occur. The minimal presence of abnormal amounts of glucose (glycosuria) that also occurs with pregnancy provides an ideal medium for growth for any organisms present. Combined, these factors cause asymptomatic UTIs
Although the cause of peripartal cardiomyopathy unknown, this apparently occurs because of what ?
stress of the pregnancy on the circulatory system. The mortality rate can be as high as 50%. It occurs most often in Black multiparas in conjunction with gestational hypertension
INH, totx TB, may result in a peripheral neuritis if a woman does not do what ?
take supplemental pyridoxine (vitamin B6).
A pregnant woman with left- side heart-failure may notice paroxysmal nocturnal dyspnea—suddenly waking at night with shortness of breath. Why ? increased pulmonary edema.
the heart's action is more effective when she is at rest. With the more effective heart action, interstitial fluid returns to the circulation. This overburdens her circulation, causing increased left-side failure and
Although tuberculosis can be spread by the placenta to the fetus, if it is active, it usually is spread to the infant after birth by
the mother's coughing. Obtaining a negative sputum culture after birth rules out active tuberculosis. Urge the woman to continue taking her tuberculosis medications as prescribed during breastfeeding as only small amounts of these are secreted in breast milk and so are safe for her infant.
If mitral stenosis is present, it is so difficult for blood to leave the left atrium that a secondary problem of what may occur ?
thrombus formation can occur from noncirculating blood.
diuretics and B-blockers may be prescribed for left-side heart failure in pregnant woman to ?
to reduce blood volume, and β-blockers to improve ventricular filling.
After birth, a woman who developed more than one UTI may have an ultrasound scheduled to detect any
urinary tract abnormality that might be present, such as vesicoureteral reflux, to help prevent future infections.
Which group of women has been identified as being more susceptible to thrombi formation, spontaneous miscarriage, fetal death, and hypertension of pregnancy than others. They include women with :
women with antiphospholipid antibodies (aPLAs)
Patient Teaching: Some women report constipation or gastric irritation when taking oral iron supplements. Increasing roughage in the diet and always taking the pills with food can help reduce these symptoms. Ferrous sulfate turns stools black, so caution women about this to prevent them from
worrying that they are bleeding internally. If iron-deficiency anemia is severe and a woman has difficulty with oral iron therapy, intravenous iron can be prescribed.
Management for chronic hypertension includes a prescription of
β-blockers and calcium channel blockers to reduce blood pressure by peripheral dilation to a safe level but not to reduce it below the threshold that allows for good placenta circulation. Labetalol (Trandate) and nifedipine (Procardia) are typical drugs that may be prescribed.
