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Cardiac Conditions

Cardiac Conditions

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Published by nursereview
NurseReview.org Cardiac Conditions Maternal & Newborn Nursing Care Plans
NurseReview.org Cardiac Conditions Maternal & Newborn Nursing Care Plans

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Published by: nursereview on Feb 05, 2008
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NurseReview.orgCardiac Conditions
During pregnancy blood volume increases as much as 50% above the nonpregnant leveland is accompanied by increases in maternal heart rate and stroke volume necessitating adrop in systemic and pulmonary vascular resistance. The client with heart disease may not beable to readily accommodate the higher workload of pregnancy as a result of decreasedcardiac reserves.(This plan of care is to be used in conjunction with the Trimesters and The High-RiskPregnancy.)
CLIENT ASSESSMENT DATA BASEActivity/Rest
Inability to carry on normal activitiesNocturnal/exertion-related dyspnea; orthopnea
Circulation
 Tachycardia, palpitations; severe dysrhythmia.History of congenital/organic heart disease, rheumatic fever.Upward displacement of the diaphragm and heart proportionate to uterine size.May have a continuous diastolic or presystolic murmur; cardiac enlargement; loud systolicmurmur, associated with a thrill.BP may be elevated or may be decreased with decreased vascular resistance.Clubbing of toes and fingers may be present, with symmetric cyanosis in surgically untreatedtetralogy of Fallot.
Elimination
Urine output may be decreased.Nocturia.
Food/Fluid
Obesity (risk factor)May have edema of the lower extremities
Pain/Discomfort
May report chest pain with/without activity
Respiration
Cough; may or may not be productive.Hemoptysis.Respiratory rate may be increased.Dyspnea/shortness of breath, orthopnea may be reported.Rales may be present.
 
Safety
Repeated streptococcal infections
Teaching/Learning
Possible history of valve replacement/prosthetic device, mitral valve prolapse, Marfan’ssyndrome, surgically treated/untreated (rare) tetralogy of Fallot
DIAGNOSTIC STUDIES
White Blood Cell (WBC) Count:
Leukocytosis indicative of generalized infection, primarilystreptococcal.
Hemoglobin (Hg)/Hematocrit (Hct):
Reveals actual versus physiological anemia;polycythemia.
Maternal Arterial Blood Gases:
Provide secondary assessment of potential fetalcompromise due to maternal respiratory involvement.
Sedimentation Rate:
Elevated in the presence of cardiac inflammation.
Maternal Electrocardiogram (ECG):
Demonstrates patterns associated with specific cardiacdisorders, dysrhythmias.
Echocardiography:
Diagnoses mitral valve prolapse or Marfan’s syndrome.
Radionuclide Cardiac Imaging:
Evaluates suspected atrial or ventricular septal defects,patent ductus arteriosus, or intracardiac shunts.
Serial Ultrasonography:
Detects gestational age of fetus and possible IUGR.
NURSING PRIORITIES
1. Monitor degree/progression of symptoms.2. Promote client involvement in control of condition and self-care.3. Monitor fetal well-being.4. Support client/couple toward culmination of a safe delivery.
DISCHARGE GOALS
Inpatient care not required unless complications develop.
NURSING DIAGNOSIS:Cardiac Output, risk for [decompensation]Risk Factors May Include:
Increased circulating volume, dysrhythmias, alteredmyocardial contractility, inotropic changes in the heart
Possibly Evidenced By:
[Not applicable; presence of signs/symptomsestablishes an
actual
diagnosis]
DESIRED OUTCOMES/EVALUATION
Identify/adopt behaviors to minimize stressors and
CRITERIA—CLIENT WILL:
maximize cardiac function. Tolerate the stress of increasing blood volume asindicated by BP and pulse within individuallyappropriate limits.Demonstrate adequate placental circulation, kidneyfunction with FHR and fetal movement WNL, andindividually appropriate urine output.
 
ACTIONS/INTERVENTIONSRATIONALEIndependent
Determine/monitor client’s functional Useful for identifying client needs/limitations,classification (as outlined by the New York effectiveness of therapies, and progression/Heart Association):remission of condition.Class I: No limitation of physical activity,no discomfort during exertionClass II: Ordinary activity may cause symptomsof palpitation, dyspnea, and anginaClass III: Less than ordinary activity causescardiac symptoms, such as fatigue,dyspnea, and anginaClass IV: Symptoms of cardiac insufficiencyoccur in the absence of physical activity,and mortality risk per Clark’s classificationsystem of risk status for pregnant women.Provide information about the necessity of Minimizes cardiac stress and conserves energy.adequate rest (e.g., 8–10 hr at night and
1
/
2
hr Class IV clients may require bedrest for theafter each meal). duration of the pregnancy. (Refer to ND: ActivityIntolerance, risk for.)Discuss use of left or right lateral position.The occurrence of supine hypotension possibly to thepoint of loss of consciousness can be prevented if theclient avoids the supine position and adopts thelateral recumbent resting position.Monitor vital signs.The beginning stage of decompensation caused byintolerance of circulatory load, infection, or anxietymay first be noted by an insidious change in the vitalsign pattern, associated with increased temperature,pulse (110 bpm or greater), respiration (greater than20–34/min), and BP.Auscultate clients breath sounds.Congestive heart failure (CHF) may develop,especially in clients whose functional classification isclass III or IV. Conversely, clients with mitral valveprolapse may be symptom-free during pregnancy,owing to the increase in left ventricular volume, yetare at high risk for involvement related to chest pain,palpitations, and possibly death after delivery.Evaluate FHR, daily fetal movement count, and Fetal hypoxia caused by beginning stage of NST results as indicated. (Refer to CP: The High-maternal cardiac decompensation may be noted inRisk Pregnancy; ND: Injury, risk for fetal.)the form of tachycardia, bradycardia, or reductionin fetal activity.Assess for evidence of venostasis with resulting Prolonged positioning of legs and ankles belowdependent edema of extremities or generalized the level of the heart further impairs venous returnedema. Instruct client to elevate legs when sitting in an already stressed circulatory system anddown and periodically during the day.places the client at risk for PIH.Instruct client to monitor fluid intake/output.Although intake and output should be(Refer to ND: Fluid Volume, risk for excess.)approximately the same, cardiovascular involvementmay negatively affect kidney function, resulting inoliguria/anuria.

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