High-Risk Pregnancy: Assessing and Managing Cardiovascular Issues, Exercises of Nursing

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MANAGEMENT AND CAREOF A WOMAN

WITH RISKSIN PREGNANCY

GAIN ATTENTION

Most of the time having a baby is a natural process. After a full-term pregnancy, women go into labor on or near their due date and give birth to a healthy baby. A day or two later they leave the hospital to begin day-to-day life with their growing family. But not all pregnancies go smoothly. Some women experience what doctors refer to as a high-risk pregnancy. A pregnancy is considered high-risk when there are potential complications that could affect the mother, the baby, or both. High-risk pregnancies require management by a specialist to help ensure the best outcome for the mother and baby. (https://www.webmd.com/baby/managing-a-high-risk- pregnancy) Although pregnancy should be considered a healthy state, thereare many complications that may occur during the antepartum period, some of which result from preexisting conditions and some of which develop during the pregnancy. Any of these can affect the mother and/or the developing fetus.

LEARNING OBJECTIVES

At the end of this module the students will be able to :

1. Define high-risk pregnancy, including preexisting factors that

contribute to its development such as diabetes mellitus or

cardiovascular disease.

2. Assess a woman with an illness during pregnancy for changes

occurring in the illness because of the pregnancy or in the

pregnancy because of the illness.

3. Formulate nursing diagnoses related to the effect of a

preexisting or newly acquired illness on pregnancy.

4. Identify expected outcomes that will contribute to a safe pregnancy

outcome when illness occurs with pregnancy as wellas help families

manage seamless transitions across differing healthcare settings.

5. Implement nursing care for a woman when illness complicates

pregnancy.

6. Evaluate expected outcomes for achievement and effectivenessof

care.

INSTRUCTIONS TO THE USERS

“BE AN INDEPENDENT LEARNER”. This module was carefully crafted for you to

learn independently, conscientiously and innovatively. The following set of guidelines and house rules will lead you to the fulfilment of your goals and objectives as you go along with this module.

1. Schedule and manage your time. Read and understand every part of this module. Read it with great amount of patience and perseverance. If problems arise because of erratic internet connections and government declaring ECQ/MGCQ protocols, thismodule will be delivered asynchronously.

a. Answer the pre-test before browsing and reading the entire module. Remember,

“THE BEST TEST FOR HONESTY IS WHEN NOBODY IS LOOKING.”

2. Make a study schedule along with other modules. Never allow things or workloadsto pile up. Be conscious with your timetable. Follow it religiously.
3. The Google classroom, Google Meet/Hangouts and Zoom will be utilized as our

online learning platforms. Keep posted with the daily announcements by logging on to these sites so as not to miss any discussions and activities.

4. “BE PROACTIVE RATHER THAN REACTIVE.” Accomplish your tasks as prescribed.

ALWAYS SETTLE FOR WHAT IS BEST. AIM FOR EXCELLENCE!

5. Feel free to utilize other learning resources. These will help you understand better the tasks at hand. In so doing, KEEP FOCUS, never miss any part of the module. Accomplish all activities as scheduled.
6. DEADLINES ARE DEADLINES. Always be mindful of it. Corresponding deductionsor demerits will be given to late submissions. For this module, the deadline of submission is
7. ALWAYS KEEP IN TOUCH WITH YOUR TEACHER. If there are unforeseen or unavoidable circumstances that may affect on-time submission of tasks, notify yourteacher the soonest possible time.

8. Finally, “YOU ARE NOT ALONE IN THIS JOURNEY.” You have US to support you: ME, your

family members and your friends. But in accomplishing the tasks, do it on your own.

GOODLUCK and DON’T FORGET TO SMILE. HAPPY MODULating!

STIMULATE RECALL OF PRIOR LEARNING

This assessment will test your prior knowledge

regarding the topic. INSTRUCTIONS: Kindly encircle the letter corresponding with the correct answer.

1. 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.”
2. 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.
3. Which is the most accurate and reliable outcome measure for evaluating an intervention? a. A fasting glucose level of 85 mg/dl b. An oral intake measurement of 720 ml of fluids within 8 hours c. An exercise diary indicating the pregnant woman walked 30 minutes every day for a week

d. The statement by a pregnant woman, “I understand why folic

acid is important for red blood cell formation.”

STIMULATE RECALL OF PRIOR LEARNING

4. A 32-week-gestation client was last seen in the prenatal client at

28 weeks’ gestation. Which of the following changes should the nurse bring to the attention of the nurse? a. Weight change from 128 pounds to 138 pounds. b. Pulse rate change from 88 bpm to 92 bpm. c. Bl oo d p r e ssu r e c h a n ge f r o m 1 2 0 / 8 0 t o 11 8 / 7 8. d. Respiratory rate change from 16 rpm to 20 rpm..”

5. Accurate assessment of pregnant women prenatally includes all of the following except a. establishing baseline vital signs b. objective factors such as edema c. objective factors such as dysuria d. level of exhaustion the woman is experiencing
6. Malou, a 13 year old is 2 months pregnant and she had a history of RHD. Which of the following is true about her risk factors for high risk pregnancy? a. proper nutrition and exercise will eradicate risk factors, Malou may have for complications b. Malou's heart condition will not be affected because her body is already suited for pregnancy. c. Malou's young body will protect her from any complications brought about by pregnancy. d. Both Malou's body, age and history will place her at risk for developing complications brought about by her pregnancy.
7. Your patient develops a gestational diabetes. Which assessment should she make daily? a. test her urine for protein with a chemical reagent strip b. measure her abdominal diameter with a tape measure c. measure her uterine height by hand-span distance d. measure serum for glucose level by a finger prick

STIMULATE RECALL OF PRIOR LEARNING

8.. A patient with diabetes is in the first trimester of pregnancy

and is currently having difficulty maintaining her blood glucose level within a normal limits. The patient explains that she has been "eating for two" so that her baby is healthy. How should your respond to the patient? a. "elevated blood glucose levels cause low birth weights in infants" b. "elevated blood glucose levels ensure the baby has mature lungs at birth" c. Elevated blood glucose levels hasten the development of the fetus in the uteru" d. "elevated blood glucose levels in the first trimester have been linked to congenital anomalies'

9. The nurse determines that a pregnant patient is at risk for developing a DVT. What should you instruct the paient to reduce the risk of this potential complication? Select all that apply. a. avoid foods high in calcium b. take a baby aspirin everyday c. avoid standing in one position d. do not cross the legs at the knee e. do not wear knee-high stockings
10. Your patient was diagnosed with hyperthyroidism. For which medication should you prepare teaching for your patient? a. Methimazole b. Cephalosporin c. levothyroxine d. propylthiouracil

1. B. “I ha v e ga i ne d 4 l b d ur i n g t he l a st w ee k, b ut I’m no t ea ti n g m ore than before.” Rationale: Constipation and nausea are common d u r i n g t h e fi r st t r i me ste r. F eta l m o v eme n t ( q ui c k e ni n g) i s no t 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.

2.. D. I d ea ll y, d i eta r y c a l o r i e i nta ke s houl d b e a pp roxi ma t el y 2 0% from p r o t ei n , 40% t o 50% fr o m c a r b oh yd ra t es, a nd u p t o 3 0% fr o m fa ts Rationale: This caloric balance allows for good glycemic control. B ec a u se e x er c i se p r o g r a m s ma y c a u se gl uc o s e fl uc tua ti on s, t he y 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.

3. A. A fasting glucose level of 85 mg/dl Rationale: Fasting glucose level is the only measure of an outcome. The other three choices a r e ev a l ua ti on o f a c ti v i ti e s ( p r oc ess es) , w hi c h ma y o r ma y not result in a desired outcome.
4. A
5. C
6. the first trimester of pregnancy is the most important time for fetal development. if the patient cannot control hyperglycemia during this time. the chances of a congenital anomaly are greatly

reduced. infants of patients with poorly controlled diabetes tend to be large. at birth, babies born to patients with uncontrolled diabetes are prone to RDS. elevated blood glucose levels do not hasten the development of the fetus in utero and can lead to hydramnios.

7. d. assessing serum glucose reveals both hyperglycemia and hypoglycemia
8. The risk of thrombus formation can be reduced through measures such as avoiding use of constrictive knee-high stockings, not sitting with legs crossed at the knee, and a voiding standing in one position for a long period. calcium restrictions does not reduce the risk of thrombus formation and could potentially harm the developing fetus. the nurse c a nno t p r esc r i b e med i c a ti on , a n d t h e p a ti ent s houl d no t take any medication without direction from the care provider
9. Methimazole is the preferred drug to treat pregnant patients

with hyperthyroidism because it appears to cross the placenta less easily. Propylthiouracil crosses the placenta and can lead to congenital hypothyroidism and an enlarged thyroid gland in the fetus. Cephalosporin is an antibiotic that is not used in the

treatment of hyperthyroidism. levothyroxine is thyroid hormone and is used in the treatment of hypothyroidism

What i s High - Risk P re g n a n c y?

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.

Nursing Process Related to Care of a Woman With a High-Risk Pregnancy

Assessment

Objective data Subjective data Nursing diagnoses Outcome identification and planning Implementation Outcome evaluation It is important to establish baseline vital signs to later identify a complication related to a preexisting condition

PRESENTING THE STIMULUS

NURSING ROLE AND

NURSING CARE DURING PREGNANCY COMPLICATIONS H i g h - R i s k P r e g n a n c y :

Cardiovascular

System

Cardiovascular disease

complicates only 1 % of pregnancies but accounts for 5 % of maternal deaths. Blood volume and cardiac output increase up to 50 %% during pregnancy ( peaks at 28 to 32 weeks), which places stress on a compromised heart. New York Heart Association criteria is commonly used to categorize severity of heart disease. High-Risk Pregnancy: Common Cardiovascular Clinical Findings Left-sided heart failure Orthopnea Paroxysmal nocturnal dyspnea Right-sided heart failure Distended liver and spleen Ascites Peripheral edema

A&B COMPANY PAGE 01

HIGH-RISK

PREGNANCY:

CARDIOVASCULAR

ISSUES

w o m a n w it h an a r t i f i c i a l v a l v e p r o s t h e s i s Advise not to become pregnant^ for fear the increased blood

volume gained during

pregnancy would overwhelm the artificial valve.

Today, evidence shows women with valve prosthesis can

complete pregnancy safely.

woman with chronic hypertensive vascular disease

women with hypertensive disease enter pregnancy with an elevated BP of 140 /90 mm Hg or above.

Hypertension is associated with arteriosclerosis or renal disease.

serious - places the woman and fetus at high risk

because of poor heart, kidney, and/or placental

perfusion during the pregnancy.

management include beta blockers, calcium channel

blockers.

HIGH - RISK PREGNANCY : CARDIOVASCULAR ISSUES

w o m a n w i t h venous thrombo embolic disease formation of a blood clot in the veins of the lower extremities. increases during pregnancy because of stasis of blood inthe lower extremities from uterine pressure and hypercoagulability. triad - stasis, vessel damage, hypercoagulation. diagnosed - history and doppler ultrasonography measures : avoid use of constrictive knee-high stockings, not sitting with legs crossed at the knee, avoiding standing in one position for a long time. treatment: bedrest and IV heparin for 24 to 48 hours then self injectSQ every 12 or 24 hours for the duration of the pregancy

HIGH - RISK PREGNANCY : CARDIOVASCULAR ISSUES

w o m a n w i t h peripartum heart disease extremely rare condition can originate in pregnancy in women with no previous history of heart disease cause is unknown - due to stress of the pregnancy in the circulatory system signs: shortness of breath, chest pain, non dependent edema worsen in the next pregnancies Treatment - reduce physical activity, diuretic, arrhythmia agent, LMWH, digitalis and immunosuppressive therapy. High-Risk Pregnancy: Cardiovascular System Assessment

Level of exerci se

Presence of cough or edema Comparison of baseline vital signs Liver size ( right- sided heart failure involvement ) ECG/ echoca rdiogram Fetal size ( small for gestati onal age) and poor response to labor ( FHR decel era ti on s )

High-Risk Pregnancy:

Cardiovascular System

Nursing Diagnosis

Deficient knowledge regarding steps to take to reduce the effects of maternal cardiovascular disease on the pregnancy and fetus

Ineffective tissue perfusion related to poor heart function secondary to mitral valve prolapse during pregnancy

High- Risk Pregnancy: Cardiovascular System Nursing Interventions During Antepartal Period

Promote rest. Promote healthy nutrition. Educate regarding medication. Educate regarding avoidance of infection.

High-Risk Pregnancy: Cardiovascular System Nursing Interventions During Intrapartum and Postpartum Periods

Intrapartum period

Positioning

Epidural anesthesia and assisted

vaginal delivery

Postpartum period

Assess for heart failure

Anticoagulant and digoxin

therapy

Intermittent pneumatic

compression boots

DIAGNOSTIC TESTS

(ULTRASONOGRAPHY

Measures the

response of sound

waves against solid

objects, is a much-

used tool for fetal

health

assessments.

Note:

Fetal ultrasound

Full bladder. 4 to 6

glasses of l iquid, usually juice or water, about an hour before the test.

A full bladder helps

transmit sound waves and pushes the intestines out of the way of the uterus.

This makes the ultrasound picture clearer.

If an ultrasound is done during the later part of pregnancy, a

full bladder may not be needed.

The growing fetus will push the intestines out of the way