Care of Mother and Child at Risk or with
PHINMA EDUCATION
Problems(Acute and Chronic)
Module #1 Student Activity Sheet
Name: Class number.
Section: Schedule: Date:
Lesson Title: CARE OF THE HIGH-RISK PREGNANT CLIENT Materials:
(PRE-GESTATIONAL CONDITIONS-CARDIOVASCULAR
DISORDERS AND PREGNANCY) Pen,paper, index card, book, and class List
Learning Targets:
References:
At the end of the module, students be able to:
will
1. Define types and effects of cardiovasculardisorders to
Pilliteri, Adele and Silbert-Flagg, JoAnne
to its
pregnancy, includingpreexisting factors that contribute
(2018) Maternal and Child Health Nursing, 8th
development such ascardiovasculardisease; and,
Edition. USA: Lippincott Williams and Wilkins
2. Integrate knowledge of cardiovasculardisordersto nursing
process to achieve quality maternal and child health nursing
Care.
A. LESSON PREVIEWIREVIEW
Your classroom instructor for this subject,Care of Mother and Child At-Risk or with Problems (Acuteand Chronic), is
Listed below are the additional information vital in orientation:
B. MAIN LESSON .
HIGH-RISK PREGNANCY- is one in which a concurrent RISK FACTORS
disorder, pregnancy-related complication, or external
factor jeopardizes the health of the woman, the fetus, or A. DEMOGRAPHIC FACTORS
both. Age: <16 or over 35 (optimalage: 20-30yo)
V Weight: overweight or underweight
Mother or fetus has a significant increased chance / Height: <5 feet
of harm, damage, injury, or disability(morbidity),
and loss of life or death(mortality) B. SOCIOECONOMIC STATUS
Inadequate finances
Overcrowding, poor standards of housing
Nutritional deprivation
Severe social problems
Unplanned & unprepared pregnancy, especialy
adolescents
[Link] TRIC HISTORY D. CURRENT OBSTETRICAL STATUS
V History of infertility or multiple gestation Late or no prenatal care
Grand multiparity Maternal anemia
Previous abortionor ectopicpregnancy Rh sensitization
Previous losses:fetal death,stillbirth,neonatal Antepartalbleeding;placenta previa, Abruptio
deaths Placenta
Pregnancy Induced Hypertension
THIS DOCUMENTIS THE PROPERTY OF PHINMA EDUCATION
5 Care of Mother and Child at Risk or with
PHINMA EDUCATION Problems(Acuteand Chronic)
Module #1 Student Activity Sheet
Name: Class number:
Section. Schedule: Date:
Previous operative OB: Cesarean Section, Multiple gestation
forceps delivery Premature or postmature labor
Previous uterine/cervical abnormality Polyhydramnios
Previous high-risk infant: Low Birth Weight, Large Premature Rupture of Membranes
for Gestational Age, birth injury or malformation Small for Gestational Age, Large for Gestational
Previous hydatidiform mole Age,abnormality in tests and presentation
E. MATERNAL MEDICAL HISTORYISTATUS Hemoglobinopathies
v Cardiac/pulmonary disease Seizure disorder
Metabolic disease: Diabetes Mellitus, thyroid Malignancy
disease Major emotional disorders, mental retardation
v Endocrine disorders:pituitary, adrenal
Chronic renal disease: repeated Urinary Tract F. HABITS/LIFESTYLE
Infection, bacteriuria V Smoking during pregnancy
Chronic hypertension Regular alcohol intake
Sexually Transmitted Infectios and other Drug uselabuse
infections
Major congenital anomalies of the reproductive
tract
IDENTIFYING CLIENT AT RISK
It begins with the 1st prenatal visit & continues throughout the pregnancy
involves subjective aswell as objective assessment techniques such as screening procedures, laboratory
and diagnostic examinations
Standard Examinations Done in a Prenatal Visit Leopold's Maneuver
CompleteBlood Count- screens for anemia Pelvic adequacyexamination
Edema Check-normally in Lower extremities (if Urinalysis and Culture-screening for
found on leg; in arms & feet, may indicate pre asymptomatic bacteriuria as early as 1st prenatal
eclampsia) visit; if (+), culture is done
Fetal heart Rate (N= 120-160 bpm) Vital Signs
Fundic Height- measured from 22-34 weeks & Weight- patern of weight gain/loss is recorded
correlateswith gestational age with normal Non-Stress Test
pregnancy Oxytocin Contraction Test/Contraction Stress
Height- during initial visit Test
Biophysical Profile
Cardiovascular Disorders and Pregnancy
Effects of Pregnancyon Heart Disease
Blood Volume & Cardiac output
Blood Volume peaks at 24-28 weeks
Cardiac output increases 50%
Heart must contract harder& faster
Postpartum-blood circulating in the uterus & placenta returns to maternal circulation
Team approach to care during pregnancy (intèrnist, OB and nurse). Most dangerous period is in weeks 28 to 32,justafter
the BV peaks, earlier in more severe cases
Most Commonly Cause DifficultyDuring Pregnancy Risk Factors
1. Valve Damage due to Kawasaki Disease or 1. Rheumatic fever- 90% of all 5. Pulmonary disease
Rheumatic Fever cases 6. Renal diseases
2. Congenital heart defects 7. Heart surgery
THIS DOCUMENTIS THE PROPERTY OF PIHINMA EDUCATION
6 Care of Motherand Child at Risk or with
PHINMA EDUCATION
Problems(Acute and Chronic)
Module #1 Student Activity Sheet
Name: Class number:
Section: Schedule: Date:
2. Congenital Anomalies such as ASD or Uncorrected 3. Arteriosclerosis
Coarctation of Aorta 4. Myocardial Infarction:
3. Aortic Dilatation pregnancy is generally
4. Marfan Syndronme contraindicated with
previous MI and who have
severe left ventricular
damage & heart failure
Classification of Heart Disease
Class Description
Uncompromised. Ordinary physical activity causes no discomfort. No symptomsof cardiac insufficiency and no
anginalpain.
Slightly compromised. Ordinary physical activity causes excessive fatigue, palpitation, and dysprnea or anginal
pain.
Markedly compromised. During less than ordinary activity, woman experiences excessive fatigue, palpitations,
dyspnea, or anginal pain.
Severely compromised. Woman is unable to carry out any physical activity without experiencing discomfort.
Even at rest, symptomsof cardiac insufficiency or anginal pain are present.
From Criteria Committee of the New York Heart Association.(1994). Nomenclature and criteria for diagnosis diseases
of the heart and great vessels (9th ed.). Boston, MA: Little, Brown & Co.
Prognosis & Management
1. Woman with Artificial valve Prosthesis
Pregnant women in the past were not advised to get pregnant to the increase blood volume and increase
workload of the heart.
b. To watch out for SUBCLINICALBLEEDINGIHEMOLYSIS
Observe the following:
Petechia
Premature separation of placenta
2. Women with Chronic Hypertensive Vascular Disorder
Women with chronic hypertensivevascular disease before pregnancy is usually associated with atherosclerosisor
renal disease and usually puts the mother and the fetus at risk.
3. Women with Venous ThromboembolicDisease (DVT)
Increases with a combination of the following:
1. Stasis of blood in the lower extremities from uterine pressure
2. Hypercoagulability (effect of elevated estrogen levels)
3. Vessel damage
THIS DOCUMENTIS THE PROPERTY OF PHINMA EDUCAT:ON
3
7 Care of Mother and Child at Risk or with
PHINMA EDUCATION Problems (Acute and Chronic)
Module #1Student Activity Sheet
Name: Class number.
Schedule: Date:
Section:
AT RISK of DEVELOPING Deep Vein Thrombosis (DVT)
a. Spontaneous Miscarriage
b. Fetal death
c. Hypertension of Pregnancy
d. Antiphospholipidantibodies(aPLA)antiphospholipid syndrome
Complications
Pulmonary Emboli Congestive heart failure (LSCHF)
Signs and Symptoms: Maternal dysrhythmias
Chest pain Spontaneous abortion
Suddenonset of dyspnea Premature labor
Hemoptysis Intrauterine growth retardation
Tachycardia/Missed Beats
Dizziness and Fainting
Assessment
Diagnostic Test Criteria for establishing Signs of Cardiac OtherSigns
diagnosis of Heart Disease Decompensation
ECG Persistent murmurs moist cough Syncope w/ exertion
Echocardiography Permanent cardiomegaly Pedal edema:signs of Cyanosis
Echocardiogram Severe dysrhythmias pulmonary edema Clubbing of fingers
(ultrasoundof the Severe dyspnea Dyspnea, increasing with Neck vein distention
heart) activity Cardiomegaly
Tachycardia Puimonary
Tachypnea hypertension
Chest pains on exertion
Cyanosis
Persistent heart murmurs
Safety alert: presence of severe dyspnea, syncope with exertion, hemoptysis, nocturnaltachycardia and angina require
prompt evaluation
A pregnant worman w/ heart disease should avoid infection, excessive weight gain, edema and anemia because these
conditions increase the workload of the heart
Treatment/Management: Individualized
1. Frequent prenatal visits 7.. Iron supplement- prevent/treat anemia
2. Rest, physical and mental: 8. Oxygen as necessary
Sleep at least 8-10 hours at night & 2 rest periods 9. Anticoagulant-Heparin/Enoxaparin to prevent clot
during the day formation with DVT and Pulmonary Emboli as
Instruct client to lie down for 30 mins after meals complication
Allow only light work, no stair climbing, no 10. Nitroglycerin- relievesangina by vasodilation
exhaustion take: 5 min before effort
Activity imitation especially for Class 3& 4 how often: q 5mins up to 3 tabs, if the chest pain
3. Severely affected clients may need to be admitted as is not relieved after 15 mins, go to ER
early as mid-2nd trimester take tablet while sitting down
4. Digitalis. Withhold if PR <60bpm or >100bpm storage:covered, replace every months 3
5. Diuretics. If Potassium-excreting (e.g., Furosemide Side Effects: hypotension, Headache, flushing,
(Lasix) burning & stinging sensation under the tongue
SIDE EFFECTS: hypokalemia increases the risk for Types: tablet, patch, cream, sublingual
digitalis toxicity; report signs like bradycardia, NV, 11. Corticosteroid- help to reduce the formation of
diarrhea, colored vision deficiency (xanthopsia) additional antibodies in aPLA
THIS DOCUMENTIS THE PROPERTY OF PHINMA EDUCATION 4
Risk or with
8 Care of Mother and Child at
PHINMA EDUCATION Problems (Acute and Chronic)
Module #1 Student Activity Sheet
Class number.
Name:
Date:
Section: Schedule:
6 Antibiotics-before any invasive procedure prophylaxis
Vs. Rheumatic Fever; treatment of bacterial infection
CHECK FOR UNDERSTANDING (1) point will be given to correct
answerand this byvourself. This will be recorded as your quiz. One
YOu wll rationalize
or erasures in you answer/ratio is not allowed.
answerand another one (1) point for the correct ratio, Superimpositions
activity
of heart disease and she told the doctor that ordinary physical
1. 26-year-old pregnant client has a history
A Which of the following class of
no symptoms of cardiac insufficiency and no anginal pain.
causes no discomfort and has
heart disease does the client has?
A. Compromised
8. Slightly compromised
C. Markedly compromised
D. Severely compromised
[Link]
Answer:
Rationale:
that when shedo ordinary
of Aorta and shetold the doctor
A pregnant client has Uncorrected Coarctation
2. 28-year-old
and dyspnea or anginal pain. Which of the following class of heart
palpitation,
physical activity it causes excessive fatigue,
disease does the client has?
A. Compromised
B. Slightly compromised
C. Markedly compromised
D. Severely compromised
E. Uncompromised
Answer:
Rationaie:
A pregnant patient was diagnosed when shewas a child Septal Defect and now pregnant, she went to the
with Atrial
3.
due to extreme fatigue, dyspneic and palpitations every time she takes the stairs or walk a couple of meters.
hospital
the of Heart Disease which class does the patient belongs to?
According to Classification
A. Class 1
B. Class 2
C. Class 3
D. Class 4
Answer:
Rationale:
4. A pregnant client is experiencing chest pain and was diagnosed with Chronic Hypertensive Vascular Disorder, her
doctor ordered a medication called Nitroglycerin. The following are correct statement regarding Nitroglycerin, EXCEPT:
A. Nitroglycerin works by relaxing the smooth muscle and blood vessels in the body.
B. A vasodilator drug used for the treatment of chest pain and high blood pressure.
C. Nitroglycerin sublingual tablets should not be chewed, crushed, or swallowed.
[Link] is taken within 5 mins up to3 tablets and if the chest pain is not relieved after 15 minutes the patient will take a rest.
Answer:
THIS DOCUMEIW7 IS THE PROPERTY OF 1itiM UCATicw
9 Care of Mother and Child at Rlsk or with
PHINMA FDUCATION Problems (Acute and Chronic)
Module#1 Student Activity Sheet
Name: Class number:
Section: Schedule: Date:
Rationale:
5.A 28-week pregnant woman came to the Outpatient Department for her prenatal check-up and was requested to do
Utrasound of her heart. Which of the following diagnostic test is called Ultrasound of the Heart?
[Link]
B. Electrocardio raphy
C. Echocardiogram
D. Electroencephalogram
Answer:
Rationale:
[Link] client ask you whatthe common causes of heart disorder in pregnancy are. The following are most common
cause of cardiovasculardisorderduring pregnaricy, EXCEPT:
A. Atrial Septal Defect
B. Uncorected Coarctation of Aorta
[Link] Syndrome
D. Pulmonary Embolism
Answer:
Rationale:
7. A29weeks pregnant came to the emergency room department due to severe dyspnea, hemoptysis, nocturnal
tachycardia,and angina. What makes the client prompt actions means?
A. requires no intervention.
B. requires referral to her doctor.
C. requires immediate intervention.
D. requires rest and oxygen therapy
Answer:
Rationale:
[Link]. an 18-Week pregnant client with an Aortic Dilatation was advised to decrease the workload ofthe heart. The
following conditions increases the workload of the heart.
A. Infection
B. Eupnea
C. Weight Loss
D. Vasodilation
Answer:
Rationale:
9. A pregnant client is taking Furosemide for the treatment of her edema, and she asked you what the side efects of
Potassium-wasting diuretics are. The following are side effects of potassium-wasting diuretics, EXCEPT:
A. Hyperkalemia
B. Hypokalemia
C. Bradycardia
D. Xanthopsia
THIS DOCUMENTIS THE PROPERTY OF PHINMA EDUCATION