Professional Documents
Culture Documents
Pregestational Conditions
Pregestational Conditions
•Diabetes Mellitus
•Substance Abuse
•HIV/AIDS
•Rh Sensitization
•Anemia
I. Heart Disease
Pregnancy results in increased cardiac output, heart
rate & blood volume.
Normal heart is able to adapt to these changes without
difficulty.
Woman with heart disease has decreased cardiac
reserve, making it more difficult for her to handle the
higher workload of pregnancy.
Cardiac disease complicates about 1% of pregnancies.
CLASSIFICATION
1. CLASS I
NO LIMITATION,UNCOMPROMISED, NO DISCOMFORT WITH
ORDINARY PHYSICAL ACTIVITY.
2. CLASS II
SLIGHT LIMITATION, SLIGHTLY COMPROMISED,
ORDINARY ACTIVITY CAUSES DYSPNEA, FATIGUE, CHEST PAIN &
PALPITATIONS.
3. CLASS III
MARKED LIMITATION, LESS THAN ORDINARY ACTIVITY CAUSE
EXCESSIVE FATIGUE; PALPITATIONS, CHEST PAIN & DYSPNEA.
4. CLASS IV
SEVERE LIMITATION; PATIENT EXPERIENCES SYMPTOMS EVEN AT REST;
UNABLE TO PERFORM ANY PHYSICAL ACTIVITY WITHOUT
DISCOMFORT.
1.Congenital Heart Defects
Most commonly seen in pregnant women include:
Atrial septal defect
Patent ductus arteriosus
Coarctation of aorta
Tetralogy of fallot
CYANOSIS
CLUBBING OF FINGERS
NECK VEIN DISTENTION
SYSTOLIC & DIASTOLIC MURMURS
NURSE ALERT:
** REMEMBER A PREGNANT WOMAN WITH HEART
DISEASE SHOULD AVOID INFECTION, EXCESSIVE WEIGHT GAIN,
EDEMA & ANEMIA BECAUSE THESE CONDITIONS INCREASE THE
WORKLOAD OF THE HEART.
Clinical Therapy
Diagnosis
◦ Echocardiogram and chest x-ray
◦ Auscultation of heart sounds
◦ Sometimes cardiac catheterization
Classification of functional capacity
◦ Class 1 through 4
Drug therapy
Nursing Management
Assess the stress of pregnancy on the heart’s functioning
Limitation of activity
Monitor for signs of impending cardiac failure
Health teaching
Evaluate maternal vital signs
Maintain an atmosphere of calm
Fetal assessment
Family support
PRENATAL CARE:
1. PROMOTION OF REST ( CLASS I & CLASS II)
*8 HOURS OF SLEEP DURING THE NIGHT & HAVE FREQUENT REST PERIODS
DURING THE DAY.
* LIGHT WORK IS ALLOWED BUT NO HEAVY WORK, NO STAIR CLIMBING, NO
EXHAUSTION.
2. DIET
* HIGH IN IRON, PROTEIN,MINERALS & VITAMINS
3. AVOID HIGH ALTITUDES, SMOKING AREAS, UNPRESSURIZED PLANES & OVERCROWDED
AREAS. CIGARETTE SMOKING & ALCOHOLIC BEVERAGES ARE STRICTLY PROHIBITED.
4.PREVENTION OF INFECTION
* AVOID PERSONS WITH ACTIVE INFECTIONS (COLDS, COUGH).
* EARLY TREATMENT OF INFECTIONS
5. PROVIDE INSTRUCTIONS ON DANGER SIGNS OF HEART
FAILURE:
* COUGH WITH CRACKLES IS USUALLY THE FIRST SIGN OF
AN IMPENDING HEART FAILURE.
* INCREASING DYSPNEA, TACHYCARDIA, RALES, EDEMA
MEDICATIONS:
IRON SUPPLEMENTATION TO PREVENT ANEMIA
DIGITALIS TO STRENGTHEN MYOCARDIAL CONTRACTION AND
SLOW DOWN HEART RATE
NITROGLYCERINE TO RELIEVE CHEST PAIN
ANTIBIOTICS TO PREVENT AND TREAT INFECTION
DIURETICS MAY BE PRESCRIBED IN CASE OF HEART FAILURE
II. Diabetes Mellitus
An endocrine disorder of carbohydrate metabolism,
results from inadequate production or use of insulin.
Thalassemia
Nutritional Anemias
Symptoms
Easily fatigued
Skin and mucous membranes are pale
Shortness of breath
Pounding heart
Rapid pulse (with severe anemia)
Iron Deficiency Anemia
RBCs are small (microcytic) and pale
(hypochromic)
Prevention
Iron supplements
Vitamin C may enhance absorption
Do not take iron with milk or antacids
Calcium impairs absorption
Treatment
Oral doses of elemental iron
Continue therapy for about 3 months after anemia has
been corrected
Folic Acid Deficiency Anemia
Large, immature RBCs (megaloblastic anemia)
Anticonvulsants, oral contraceptives, sulfa drugs, and alcohol can
decrease absorption of folate from meals
Folate is essential for normal growth and development
Prevention
Daily supplement of 400 mcg (0.4 mg)
Treatment
Folate deficiency is treated with folic acid supplementation
1 mg/day (over twice the amount of the preventive supplement)
Dose may be higher for women who have had a previous child
with a neural tube defect