PREEXISTING HEALTH PROBLEMS

CARDIAC DISEASE -remains a problem for women who become

pregnant

CLASSIFICATION OF HEART DISEASE BASED ON THE DEGREE OF COMPROMISE

CLASS
I II

DESCRIPTION
The patient has unrestricted physical activity. Ordinary activities causes no discomfort, cardiac insufficiency, or angina The patient has a slight limitation on physical activity. Ordinary activity causes excessive fatigue, palpitations, dyspnea or angina The patient has a moderate to marked limitation on activity. With less than ordinary activity she experiences excessive fatigue, palpitations, dyspnea or angina The patient cant engage in any physical activity without discomfort. Cardiac insufficiency or angina occurs even at rest.

III

IV

Heart disease and Pregnancy

A patient in class I and II usually completes a successful pregnancy and delivery without major complications A woman in class III must maintain complete bed rest to complete the pregnancy. A patient in class IV is a poor candidate for pregnancy

ASSESSMENT FINDINGS
Dyspnea Tachycardia Fatigue Orthopnea Edema of hands, face and feet Palpitations Diastolic murmur at the hearts apex Cough Hemoptysis Crackles at the bases of the lungs

MANAGEMENT
Activity limitation Frequent prenatal visits Limited sodium intake Prophylactic antibiotic as indicated Serial ultrasounds, nonstress tests

NURSING INTERVENTIONS
Assess maternal VS and cardiopulmonary status closely for changes Monitor weight gain throughout pregnancy Reinforce the used of prescribed medication to control heart disease Alert patient of the danger signs and symptoms that need to be reported immediately Assess nutritional pattern ( high CHON diet) Encourage frequent rest periods

NURSING INTERVENTIONS
Advise to rest on left lateral position Advise to report any signs of infection Prepare the use of epidural anesthesia during labor Monitor maternal VS closely Monitor FHR and uterine contractions Encourage ambulation as soon as after delivery Anticipate administration of prophylactic antibiotics to prevent subacute bacterial endocarditis

PREEXISTING HEALTH PROBLEMS

FOLIC ACID-DEFICIENCY ANEMIA -slowly progressive megaloblastic anemia

(enlarged RBCs) -Folic acid or Folacin,is one of the B vitamins important for normal formation of RBCs and synthesis of DNA -plays a major role in preventing neural tube defects in fetus

PATHOPHYSIOLOGY
Folic acid is found in most body tissues where it acts as coenzyme in metabolic process Folic acid is water soluble and heat labile, and is easily destroyed by cooking With multiple gestation, there is increase demand and will result in folic acid-deficiency anemia within 4 months Certain drugs hydantoins(anticonvulsants interfere with for folate absorption) and hormonal contraceptives

ASSESSMENT FINDINGS
Severe, progressive fatigue (the hallmark of folic acid deficiency) Pallor or jaundice Shortness of breath Palpitations Diarrhea Nausea & anorexia Headaches, weakness, or light-headedness Forgetfulness irritability

DIAGNOSTIC FINDINGS
Macrocytic RBCs Decreased reticulocyte count Increased Mean corpuscular volume Abnormal platelet count Decreased serum folate levels (below 4mg/ml)

MANAGEMENT
Oral folic acid supplementation ( 1 to 5 mg/day) Diet high in folic acid

NURSING INTERVENTIONS
Encourage patient to eat folic acid rich foods: - Green leafy vegetables, wheat products, peanut butter, and liver Encourage to eat a rich source of vitamin C to enhance absorption of folic acid Administer folic acid supplement throughout pregnancy In severe anemia, hospitalization is required for diagnostic tests and rest periods to conserve energy

NURSING INTERVENTIONS
Monitor patients CBC, platelet count, and serum folate levels as ordered Assess maternal VS and HR

POSSIBLE COMPLICATIONS
Early spontaneous abortion Premature separation of the placenta Fetal neural tube defects

IRON DEFICIENCY ANEMIA

A disorder of oxygen transport in which hemoglobin synthesis is deficient Most common anemia during pregnancy, affecting 25 % of all pregnancies Associated with fetal low birth weight and preterm birth Is a microcytic (small-sized RBC), hypochomic (less hemoglobin than the average RBC) anemia As a result, cells arent large or as rich in hemoglobin as they normally are

PATHOPHYSIOLOGY
Enter pregnancy with deficient iron stores due to: -inadequate intake of rich iron food -heavy menstrual period -unwise weight reducing programs During pregnancy, maternal iron stores being used for fetal RBC production

ASSESSMENT FINDINGS
Fatigue Listlessness Pallor Exercise intolerance Pica Exertional dyspnea, tachycardia (if severe)

DIAGNOSTIC TEST FINDINGS

Low hemoglobin level (F: less than 10g/dl) Low hematocrit (F:less than 33%) Low serum iron (less than 30 mcg/dl) Low RBC count, with microcytic and hypochromic cells Decreased mean corpuscular hgb level (less than 30) in severe anemia

MANAGEMENT
Prevention with the incorporation or iron supplementation in all prenatal vitamins Oral iron supplements, such as ferrous sulfate or parenteral iron therapy if anemia is severe Well balanced diet

NURSING INTERVENTIONS
Instruct all pregnant patients to use prenatal vitamins as prescribed Monitor patients CBC, and serum iron levels regularly Asses the familys dietary habits for iron intake Assess for VS and signs of tachycardia Assess for signs of iron def. anemia If hospitalized, monitor FHR frequently, provide frequent rest periods

NURSING INTERVENTIONS
If anemia is severe: Administer O2 as ordered Administer an iron supplement (z-tract) Provide education about the therapy * offer suggestion for high-fiber foods to prevent constipation * warn patient that the medication may cause stools to appear black and tarry

POSSIBLE COMPLICATIONS
Low birth weight neonates Preterm birth

CESAREAN BIRTH

CESAREAN BIRTH
Or birth accomplished through an abdominal incision into the uterus Is used most often as a prophylactic measure

INDICATION
MATERNAL FACTORS -active genital herpes -AIDS -CPD -Cervical Cerclage -Failed Induction -Previous CS by classical incision -Disabling condition ( severe hypertension) -Elective

INDICATION
PLACENTAL FACTORS -placenta previa (totalis) -abruption placenta -umbilical cord prolapse FETAL FACTORS -macrosomic fetus -extreme low birth weight -fetal distress -major fetal anomalies

TYPE OF CS BIRTH
Scheduled CS Birth Emergency CS Birth

EFFECTS OF SURGERY ON A WOMAN

STRESS RESPONSE INTERFERENCE WITH BODY DEFENSES INTERFERENCE WITH CIRCULATORY FUNCTION INTERFERENCE WITH BODY ORGAN FUNCTION INTERFERENCE WITH SELF-IMAGE OR SELFESTEEM

Operative risk for a woman

Poor nutritional status Age variations Altered general health Fluid and electrolyte imbalance fear

PREOPERATIVE DIAGNOSTIC PROCEDURES

Vital signs determination Urinalysis CBC Coagulation profile (PT, PPT) Serum electrolyte and ph Blood typing and cross matching Sonogram to determine fetal presentation and maturity

PREOPERATIVE TEACHING
Orienting the woman with the procedure and any special equipment to be used Answer all specific questions Be certain not to use hospital jargons Explain preoperative measures that will be necessary (ex. Skin prep)

TEACHING TO PREVENT COMPLICATIONS

Deep breathing Incentive spirometry Turning Ambulation

IMMEDIATE PREOPERATIVE CARE MEASURES

Obtain an operative consent Overall hygiene of the woman GIT Preparation Baseline intake and output determination Hydration Preoperative Medication Patient chart and presurgery checklist Transport to surgery

INTRAOPERTIVE CARE MEASURES

Administration of anesthesia Skin preparation Surgical incision Birth of the newborn Introduction of the newborn

TYPES OF CESAREAN INCISION

CLASSIC CESAREAN INCISION - Vertical incision through both the abdominal skin and the uterus -it leaves a wide skin scar also runs through the active contractile portion of the uterus -this type, scar could rupture during next labor LOW SEGMENT INCISION -is one made horizontally across the abdomen just over the symphysis pubis and

POST-OPERATIVE CARE MEASURES

NURSING DIAGNOSIS a. PAIN related to surgical incision - Patient controlled analgesia - Given pain relievers b. Risk for Deficient FLUID volume related to blood loss during surgery - Assessment of incision site - Fundal assessment - Administration of oxytocin

POST-OPERATIVE CARE MEASURES

NURSING DIAGNOSIS c. Risk for Deficient FLUID volume related to postsurgical fluid restriction - Administer IV fluids as prescribed - Assess abdomen for bowel sound - Adequate fluid intake d. Constipation related to effects of abdominal surgery and anesthesia - Administer stool softener as ordered

POST-OPERATIVE CARE MEASURES

NURSING DIAGNOSIS e. Impaired skin integrity related to surgical incision - Assess surgical incision - Assess for signs of infection - Given prophylactic antibiotic - Wound dressing