Cardiac Conditions - CardiacConditions «

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Cardiac Conditions During pregnancy blood volume increases as much as 50% above the nonpregnant level and is accompanied by  increases in maternal heart rate and stroke volume necessitating a drop in systemic and pulmonary vascular resistance.  The client with heart disease may not be able to readily accommodate the higher workload of pregnancy as a result of  decreased cardiac reserves.  (This plan of care is to be used in conjunction with the Trimesters and The High-Risk Pregnancy.) CLIENT ASSESSMENT DATA BASE Activity/Rest Inability to carry on normal activities Nocturnal/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 systolic murmur, 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 untreated tetralogy 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
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Teaching/Learning Possible history of valve replacement/prosthetic device, mitral valve prolapse, Marfan’s syndrome, surgically  treated/untreated (rare) tetralogy of Fallot DIAGNOSTIC STUDIES White Blood Cell (WBC) Count:  Leukocytosis indicative of generalized infection, primarily streptococcal. Hemoglobin (Hg)/Hematocrit (Hct):  Reveals actual versus physiological anemia; polycythemia. Maternal Arterial Blood Gases:  Provide secondary assessment of potential fetal compromise due to maternal  respiratory involvement. Sedimentation Rate:  Elevated in the presence of cardiac inflammation. Maternal Electrocardiogram (ECG):  Demonstrates patterns associated with specific cardiac disorders, 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:
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Cardiac Conditions - CardiacConditions «

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