NU 404: Unit 7.2 Study Guide Solutions

NU 404: Unit 7.2 Study Guide Solutions Teenage pregnancies - Ans:--risk takers: smoking, drugs, alcohol, bad nutrition, trying to hide pregnancy -developmental task -perinatal risks: little prenatal care Cardiovascular disorders - Ans:--major non-obstetric cause of maternal death -complication: cardiac decompensation; inc blood flow leads to CHF* -incidence of miscarriage inc -preterm labor & birth are more prevalent in pregnant women with cardiac problems -impeded or delayed development of fetus called IUGR is common (if blood flow is compromised to mom, baby's blood flow is compromised as well) Common causes of cardiac arrest - Ans:--trauma -cardiac abnormalities -embolism ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 2/32 -magnesium overdose -sepsis -intracranial hemorrhage -anesthetic complications -eclampsia -uterine rupture New York Heart Association - Ans:--according to function limitations placed on the individual because of the disease* -functional limitations are imposed by the symptoms of the disease when the heart is overburdened (cardiac decompensation) and cannot cope with the activity -functions assessed at 3 and 7-8 months* -symptoms: fatigue, palpitations, dyspnea and/or anginal pain, CP* Class 1 - Ans:--asymptomatic with normal activity* -tx: prophylactic to prevent cardiac decompensation* ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 3/32 -increased PNC, prevent infections, rest 8-10 hrs/day, 30 min naps after eating, SVD (vaginal delivery); forceps (prevents them from having to push) Class 2 - Ans:--symptomatic with inc activity* -slight limitations of physical activity: avoid heavy exertion -comfortable at rest -moderate restriction of activity during pregnancy -tx: same as class 1 except 2 weeks hospitalization prior to EDD, local or regional anesthesia, O2, longer PP stay Class 3 - Ans:--symptomatic with normal activity* -marked limitations of physical activity -comfortable at rest -less than ordinary activities make them symptomatic (walking to bathroom makes them have SOB) -tx: bed rest for most of each day, if symptoms occur then hospitalization, consider therapeutic abortion in 1st trimester, vaginal delivery desirable -30% have cardiac decompensation ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 4/32 Class 4 - Ans:--symptomatic with rest* -"cardiac cripples" -inability to carry on any physical activity without discomfort, even at rest they may be symptomatic (sitting in chair and have labored breathing) Intrapartum care - Ans:--ABG's: assess oxygenation -Swan-Ganz catheter: monitor hemodynamic status (measures pressure that goes into R atrium) -avoid hypotension -penicillin prophylaxis for non-allergic class 2 or higher to protect against bacterial endocarditis in labor or early PP* Subacute bacterial endocarditis - Ans:--all pts with cardiac dz are at risk -prophylactic antibiotic therapy recommended* -vaginal delivery preferred -reduce cardiac strain: forceps, episiotomy (rather than pushing); meds: Fe supplements, anticoagulants, antibiotics, thiazide diuretic, digoxin to inc cardiac output; relaxation therapy to dec anxiety Congenital heart disease - Ans:--septal defects ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 5/32 -ASD, VSD, PDA -mortality rates for shunt defects are less than 1% Rheumatic heart disease - Ans:--develops suddenly several weeks after symptom free inadequately treated group B-hemolytic strep infection* of throat -lifelong prophylaxis with benzathine penicillin, even during pregnancy -heart murmurs (usually mitral), abnormal pulse rate and rhythm Mitral valve stenosis/prolapse - Ans:--acquired cardiac dz -narrowing of opening of mitral valve caused by stiffening of leaflets, which obstructs blood flow from atrium to ventricles -assoc. with 90% RHD in pregnancy -MI: rare event in CB women, usually in 3rd trimester, vaginal birth preferable Peripartum cardiomyopathy - Ans:--failure of heart to maintain adequate CO to maintain adequate circulation* -pressure on heart enlarges it -CHF with cardiomyopathy found in last month of pregnancy or first 5 months ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED FIRST PUBLISH OCTOBER 2024 Page 6/32 -etiology: unknown -African Americans, or = 35 yrs, twin pregnancy, and in presence of PIH Anemia - Ans:--most common medical disorder of pregnancy (20%) -not enough RBCs to carry on in the pregnancy* -increases workload of heart -increased risk of infections -physiologic anemia of pregnancy: physiologic intravascular change, plasma volume increases 50-70%, beginning by 6th wk, RBC mass inc 20-35%, beginning by 12th wk, disproportionate inc in plasma volume over RBC volume (hemodilution), despite erythrocyte production there