A WOMAN WITH HEART DISEASE
Oxygen consumption increased 10% to 20%; related
Normal hemodynamic of pregnancy that adversely
affect the client with heart disease.
PRENATAL PERIOD ASSESSMENT:
1. Evidence of cardiac decompensation especially when
blood volume peaks (at week 28-32)
2. Cough and dyspnea
3. Edema
4. Heart murmur
5. Palpitations
6. Rales
Functional or Therapeutic Classification of Heart
Disease During Pregnancy:
NURSING INTERVENTION:
1. Teach client to recognize and report signs of
infection, importance of prophylactic antibiotics.
2. Compare Vital signs to baseline.
3. Instruct on diet and limit weight gain to 15 lbs, Low
Sodium diet.
A WOMAN WITH LEFT SIDED HEART FAILURE:
Left Sided Heart Failure occurs in women with Mitral
Stenosis, Mitral Insufficiency and Aortic Coarctation.
The ventricle cannot move the large volume of blood
that it has received by the left atrium from the
pulmonary circulation. This causes back pressure, the
left side of the heart becomes distended, Pulmonary
Hypertension occurs. Pulmonary edema produces
profound shortness of breath. Pulmonary capillaries
rupture due to the pressure and the woman develops a
productive cough and blood speckled sputum.
Orthopnea- breathing with chest and head elevated.
Paroxysmal nocturnal dyspnea- suddenly waking at
night with shortness of breath.
1.
to the needs of the growing fetus.
2. Plasma level and blood volume increase RBC’s remain
the same.
1. Class I: No limitation of physical activity; no
symptoms of cardiac insufficiency or angina
2. Class II: Slight limitation of physical activity; may
experience severe fatigue, palpitation, angina or
dyspnea; slight limitation as indicated.
3. Class III: moderate to marked limitation of physical
activity; dyspnea, angina and fatigue occur with slight
activity and bed rest is indicated during most
pregnancy.
4. Class IV: Marked limitation of physical activity;
angina, dyspnea and fatigue occur at rest; pregnancy
should be avoided: Indication for termination of
pregnancy.
If Mitral Stenosis is present, it is difficult for blood to
leave the left atrium, and patient is at risk of thrombus
formation.
Anti-coagulant such as LOW MOLECULAR WEIGHT
HEPARIN is needed.
LOW MOLECULAR HEPARIN DOES NOT CROSS THE
PLACENTAL BARRIER THUS PREVENTING THE RISK OF
TERATOGENIC EFFECTS ON THE FETUS.
A WOMAN WITH RIGHT SIDED HEART FAILURE: Right
sided Heart failure occurs when the right ventricle is
overwhelmed by the amount of blood received by the
right atrium from the Vena cava. It may be due to an
unrepaired congenital anomaly such as pulmonary valve
stenosis. Pressure is high in the vena cava due to back
pressure of blood. The liver and spleen both become
distended and can cause dyspnea and pain. Symptoms
of right sided heart failure include distended neck veins.
THROMBOPHLEBITIS/ DVT/ PULMONARY EMBOLISM
DVT:
HOMAN’S SIGN: pain in the leg during dorsiflexion.
Health Teachings:
Do not stand for long periods of Time.
Do not cross legs.
Do not wear tight knee- high socks/ stockings.
Anticoagulant Therapy: Use of LOW MOLECULAR
WEIGHT HEPARIN
SIGNS/ SYMPTOMS OF PULMONARY EMBOLISM
1. Chest pain
2. Sudden onset of dyspnea
3. Cough with hemoptysis
4. Tachycardia/ missed beats
5. Dizziness and fainting
Review of Adult Circulation:
Deoxygenated blood returning from the upper body
travels through the Superior vena cava; that returning
from the lower body returns through the Inferior vena
cava. This blood mixes in the right atrium and goes thru
the Tricuspid valve through the Right ventricle, goes
through the pulmonic valve and to the Pulmonary
artery to the right and left branch of the pulmonary
artery to the lungs.
Once blood is oxygenated it returns to the left atrium by
way of the Pulmonary veins. It goes through the Mitral
valve to the to the Left ventricle, through the Aortic
valve and through the Ascending aorta. It then goes into
the transverse arch to the Descending aorta, goes to the
subclavian, the carotid artery and the left subclavian
artery. When blood leaves the heart, it is fully
oxygenated, and when it returns, it has an average
saturation of 75%.
SUBSTANCE ABUSE
SUBSTANCE ABUSE: It is defined as the inability to meet
major role obligations or increased in legal problems, or
risk-taking behavior, or exposure to hazardous
situations because of an addicting substance.
A pregnant woman is substance dependent when she
has withdrawal symptoms following discontinuation of
an addicting substance combined with abandonment of
important activities , spending much time in activities
related to substance use, using substance for a longer
time than planned, or continuous use despite worsening
problems because of substance use.
Illicit substances tend to be of low molecular weight,
crossing the placenta and may cause fetal defects and
substance dependency.
The risk of Hepatitis B or HIV increases and increase the
risk of sexually transmitted disease if a woman engages
in prostitution.
COCAINE: Cocaine is derived from Erythroxylum coca, a
plant grown exclusively in South America. When sniffed
into the nose or smoked in a pipe, Cocaine is absorbed
into the mucous membranes and affects the Central
Nervous System. As a result, sudden vasoconstriction
occurs. Respiratory, cardiac rate and BP all increase in
response to the vasoconstriction.
Alkaloidal cocaine (crack) is a concentrated mixture,
produces an even more rapid or intense high when
inhaled __so dramatic that immediate death may occur
from cardiac failure.
Extreme vasoconstriction effects of cocaine can
decrease placental circulation leading to premature
separation of the placenta resulting in preterm labor or
fetal death.
Amphetamines (Speed)
Marijuana (Hashish)
Narcotic Agonists:
Examples: Opiates, Morphine, Oxycodone, Meperidine,
Codeine
Heroin: may be administered intradermally (skin
popping), by inhalation (snorting), or IV (shooting);
inhalants (sniffing of aerosol substances)
 When an RH +ve fetus begins to grow in an Rh –ve
mother, the body reacts in the same manner it would if
Infection by Sharing Needles:
the invading factor were a substance, she forms
1. HIV antibodies against the invading substance. The Rh +ve
fetus has a protein factor (D antigen) that the RH-ve
2. Hepatitis B mother does not have.
3. Bacterial endocarditis The maternal antibodies cross the placenta causing
4. Phlebitis destruction (hemolysis) of fetal red blood cells, the
condition called HEMOLYTIC DISEASE OF THE
NEWBORN, or ERYTHROBLASTOCIS FETALIS.
A WOMAN WITH HIV: RhIG (RhoGAM) is given by injection to the mother in
The use of the drug ZIDOVUDINE halts maternal- fetal the first 72 hours after birth of an Rh+ve child to further
transmission. prevent a woman from forming natural antibodies.

HIV transmission is spread by exposure to blood and/ or
other body secretions through sexual contact, sharing
of contaminated needles for injection, transfusion of
contaminated blood or blood products, perinatally from
mother to fetus, needle puncture, needlestick injuries.
Because RhIG (RhoGAM) is passive antibody protection,
it is transient, and in 2 weeks up to 2 months the
passive antibodies are destroyed, ensuring a safe
intrauterine environment for the next pregnancy or any
future pregnancies.

HIV Incubation Period: HIV has a long incubation period After birth, the infant’s blood type will be determined
of about 10 years in adults. The disorder appears to from a sample from the cord blood. If it is Rh+ve, the
progress more rapidly in children of HIV positive mother will receive the RhoGAM injection. If the
mothers without treatment. This children are usually newborn’s blood type is Rh-ve, it means that no
HIV positive by 6 months and develop clinical signs of antibodies have been formed in the mother’s circulation
the disease by 1 to 3 years of age. during pregnancy and none will form, so RhIG
(RhoGAM) is not necessary.
TESTS FOR HIV: HIV test to detect antigen are termed
PCR (Polymerase Chain Reaction) tests, and test to
detect HIV antibody are termed as ELISA ( Enzyme
Linked Immunosorbent Assay) or Western Blot
Confirmation.

RH INCOMPATIBILITY

Rh Incompatibility occurs when a Rh-negative mother

carries a fetus with an RH positive blood type. The Rh
Negative mother one negative for a D Antigen or one
with a dd genotype)

The Rh-positive fetus has (DD or Dd genotype)

For such situation to occur, the father of the child must

either be homozygous (DD) for the factor, 100 % of the
couple’s children will be Rh positive (Rh +ve). If the
father is heterozygous (Dd) for the trait, 50% of the
children will be Rh positive (Rh +ve)