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HOUR TEST 4 STUDY GUIDE 1. How is labor, delivery and postpartum of the woman with cardiac disease managed? Labor and birth- A Swan-Ganz catheter may be inserted top accurately monitor hemodynamic status during labor and birth. Promote cardiac function by minimizing anxiety with a calm atmosphere. Provide guidance by keeping patient and family informed. Perform nursing techniques to promote comfort like a back rub. Cardiac function is supported by keeping the womans head and shoulders elevated and body parts resting on pillows. The side-lying position usually facilitates positive hemodynamics during labor. Epidural anesthesia provides better pain relief than narcotics and causes fewer alterations in hemodynamics. Have the woman flex her knees and place her feet flat on the bed. To prevent compression of popliteal veins and an increase in blood volume in the chest and trunk as a result of the effect of gravity, DO NOT USE STIRRUPS. Open glottis pushing is recommeneded. Mask oxygen is important. Episitomy and vacuum extraction or outlet forceps may be used to decrease the length of the second stage of labor and decrease the workload of the heart in the second stage. C-section is not recommened for women with heart conditions. Antibiotics ordered for women with Class II or higher cardiac disease. Look at care plan page 606 (plan of care and interventions) Postpartum- Monitor for cardiac decompensation (page 607). The first 24 to 48 hours postpartum are the most hemodynamically difficult for the woman. Hemorrhage or infection or both may worsen the cardiac condition. The woman with a cardiac disorder may continue to require a Swan- Ganz catheter and ABG monitoring. Assessment includes: vital signs, oxygen saturation levels, lung and heart auscultation, edema, amount and character of bleeding, uterine tone and fundal height, urinary output, pain (especially chest pain), the activity-rest pattern, dietary intake, mother- infant interactions and emotional level. The head of the bed is elevated, and the woman is encouraged to lie on her side. Bowel movements should be without strain- give stool softners, high fiber diet and fluids. Breastfeeding is NOT contraindicated with heart conditions but not all women will be able to do so. Monitoring for cardiac decompensation continues through the first few weeks after birth because of hormonal shifts that effect hemodynamics. Maternal cardiac output is usually stabilized by 2 weeks postpartum. (page 609). 2. How is CPR modified for the pregnant woman? CPR on a pregnant woman is airway obstruction caused by choking. Position woman on flat, firm surface with uterus displaced laterally with a wedge (e.g. a rolled towel placed under her hip) or manually, or place her in a lateral position Chest compressions are performed slightly higher on the sternum if the uterus is enlarged enough to displace the diaphragm into a higher position.
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