Cardiac (Heart) Disease in Pregnancy
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Study Tools For Cardiac (Heart) Disease in Pregnancy
Cardiovascular Changes in Pregnancy (Image)
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Outline
Overview
- Pregnant patients with underlying cardiac disease may not be able to compensate appropriately for the increased blood volume / cardiac output
Nursing Points
General
- Concerning cardiac issues include, but are not limited to:
- Heart valve replacements (tissue and mechanical
- Marfan syndrome
- Cardiomyopathy
- Pulmonary HTN
- Congenital heart issue
- Heart failure
Assessment
- Baseline assessment of hemodynamics of both mom and fetus important
- Auscultate and note abnormal heart/lung sounds
- Murmurs are normal in pregnancy because of the extra blood volume
- Note any pain, discomfort with normal activity
- Cardiac monitoring may be indicated during labor
Therapeutic Management
- Manage as usual for the specific cardiac disease
- Administer diuretics to decrease preload if needed
Nursing Concepts
- Perfusion
- Fluid & Electrolytes
Patient Education
- Educate on appropriate weight gain
- Baseline obesity will place the client at even greater risk
- Healthy diet, low sodium
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Cardiac (Heart) Disease in Pregnancy
Transcript
In this lesson I will explain cardiac disease in a pregnancy and your role in caring for this type of patient.
Let’s look at cardiac disease and why it is a problem in pregnancy. Pregnancy puts an increased workload on the heart because there is extra volume and then there is also increased weight that increases the work on the heart so this is even more of a problem for a patient that already has a not so good heart. Now let’s look at the heart. The heart is a pump and it is not able to pump effectively if there is cardiac disease. So the pump will be working harder in pregnancy to move the extra volume and get healthy blood flow through the placenta and to the fetus.
Some concerning cardiac issues can include heart valve replacements, marfan syndrome, cardiomyopathy, pulmonary HTN, congenital heart issue, and heart failure. Of course these are not all of them but a few examples that could lead to extra workload on the heart. Even women with no cardiac diseases can develop a problem in pregnancy because the heart can’t keep up with the extra weight and or volume.
For assessment we always need a baseline. So a baseline assessment of hemodynamics for mom and fetus is important. We need to auscultate heart and lung sounds. If there is any abnormality it needs to be noted. It is important to be aware that murmurs can be a normal finding in pregnancy because of the extra blood volume. If there is any pain or discomfort with normal activity it needs to be noted and reported.
For management we need to treat the disease, Whatever cardiac disease it is we need to manage with whatever is specific for the disease. If fluid overload is a piece of the problem we can give diuretics to decrease the preload. In this picture you can see how if there is an increase in preload, the blood coming into the heart, it is going to add increased work on the heart and if the heart is already diseased it will be even harder for the “pump” to pump.
Perfusion, oxygenation and fluid & electrolytes are the concepts. We need good perfusion to get to the blood and oxygen to the tissues and fetus. Fluid and electrolytes are important to manage and balance with cardiac disease.
For education we need to educate on appropriate weight gain. We do not want a cardiac patient to gain too much weight because this will add extra work to heart. If a patient is already overweight or obese this will put the patient at an even greater risk. A healthy diet should be instructed so the patient stays at a healthy weight and a diet low in sodium is important. Patients should also know signs to report such as a sudden increase in edema, shortness of breath, decreased fetal movement, and extreme tiredness.
Our key points to bring it all together are that in pregnancy there is an increased workload on the heart so the pump can get tired. The pump is also broken, it is not working at 100%. Pregnancy makes it even harder to manage the disease because of the pump being tired. Perfusion is the last key point. Not only do we need to perfuse the body as usual but also a placenta to get nutrients to the fetus. This is essential for healthy growth of the fetus. If our pump isn’t effective the perfusion to the body and placenta won’t be effective.
Make sure you check out the resources attached to this lesson and review different management of the various cardiac diseases. Now, go out and be your best selves today. And, as always, happy nursing.
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Study Plan Lessons
Alkalosis and Acidosis Nursing Mnemonic (Kick Up, Drop Down)
Blood Grouping
Blood Plasma
Blood Pressure (BP) Control
Breathing Control
Breathing Movements
Causes of Poor Gas Exchange Nursing Mnemonic (All People Can Value Lungs)
EKG (ECG) Waveforms
Electrolytes – Location in Body Nursing Mnemonic (PISO)
Electrolytes Involved in Cardiac (Heart) Conduction
Fluid & Electrolytes Course Introduction
Fluid Volume Deficit
Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Nursing Care Plan (NCP) for Fluid Volume Deficit
Renal (Kidney) Fluid & Electrolyte Balance
Renal (Kidney) Acid-Base Balance
Respiratory Functions of Blood
Tonicity of Solutions – Live Tutoring Archive
Trach Suctioning
12 Points to Answering Pharmacology Questions
ACLS (Advanced cardiac life support) Drugs
Anti-Infective – Antifungals
Anti-Platelet Aggregate
Antianxiety Meds
Antidepressants
Barbiturates
Buspirone (Buspar) Nursing Considerations
Cefdinir (Omnicef) Nursing Considerations
Carbidopa-Levodopa (Sinemet) Nursing Considerations
Cyclosporine (Sandimmune) Nursing Considerations
Drug Interactions Nursing Mnemonic (These Drugs Can Interact)
Hydralazine
IM Injections
Injectable Medications
Insulin
Insulin – Long Acting (Lantus) Nursing Considerations
Insulin Mixing
Interactive Pharmacology Practice
IV Infusions (Solutions)
IV Push Medications
Maintenance of the IV
Mannitol (Osmitrol) Nursing Considerations
Medication Errors
Meperidine (Demerol) Nursing Considerations
Metoclopramide (Reglan) Nursing Considerations
Montelukast (Singulair) Nursing Considerations
Mood Stabilizers
Olanzapine (Zyprexa) Nursing Considerations
Parasympathomimetics (Cholinergics) Nursing Considerations
Rh Immune Globulin in Pregnancy
SubQ Injections
The SOCK Method – Overview
Introduction to Metabolism
Anti-Infective – Antifungals
Antiviral Agents for Treatment
Hb (Hepatitis) Vaccine
Infection or Inflammation? The Quick & Dirty on CBCs – Live Tutoring Archive
Infection or Inflammation? The Quick & Dirty on CBCs 2 – Live Tutoring Archive
Infection Stages
Key Nutrients in the Prevention of Chronic Disease
Nursing Care Plan (NCP) for Infection
Tonicity of Solutions – Live Tutoring Archive
Viruses & Fungi
Scientific Notation & Measurement
Care for Asian-Indian Patient Populations
Care for Hispanic Patient Populations
Care for Native American Patient Populations
Care of Vulnerable Populations
Caring for African Patient Populations
Child Abuse/Neglect – Warning Signs Nursing Mnemonic (CHILD ABUSE)
Communicable Diseases
Community Health Course Introduction
Community Health Tool Nursing Mnemonic (MAP-IT)
Continuity of Care
Cultural Care
Environmental Health
Epidemiology
Fire and Electrical Safety
Health Promotion & Disease Prevention
High Risk Behavior Nursing Mnemonic (HEADSS)
Levels of Prevention
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Technology & Informatics
Program Planning
1st Degree AV Heart Block
Acute Confusion
Acute Coronary Syndrome (ACS)
Acute Respiratory Distress
Aneurysm & Dissection
Atrial Fibrillation (A Fib)
Calling for RRT, Code Blue
Crush Injuries
Delegation of Tasks to Assistive Personnel for Certified Emergency Nursing (CEN)
Drugs for Bradycardia & Low Blood Pressure Nursing Mnemonic (IDEA)
Dysrhythmia Emergencies
EKG Basics – Live Tutoring Archive
Fall and Injury Prevention
Heart (Heart) Failure Exacerbation
Hypertension (HTN) Concept Map
Hypertensive Emergency
Increased Intracranial Pressure
Legal & Ethical Issues in ER
Nursing Care Plan (NCP) for Atrial Fibrillation (AFib)
Pulmonary Embolism
Rapid Sequence Intubation
Premature Ventricular Contraction (PVC)
Premature Atrial Contraction (PAC)
Safety Check Nursing Mnemonic (MADLE)
Stress and Crisis
Supraventricular Tachycardia (SVT)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Ventricular Fibrillation (V Fib)
Ventricular Tachycardia (V-tach)
Aggressive & Violent Patients
Cultural Awareness and Influences on Development
Developmental Stages and Milestones
Erikson’s Theory of Psychosocial Development
Handling Death and Dying
Kohlberg’s Theory of Moral Development
Overview of Childhood Growth & Development
Overview of Developmental Theories
Growth and Development – Prenatal
Piaget’s Theory of Cognitive Development
Vocabulary
Brief CPR (Cardiopulmonary Resuscitation) Overview
Abortion in Nursing: Spontaneous, Induced, and Missed
Abruptio Placentae (Placental abruption)
Acyclovir (Zovirax) Nursing Considerations
Addicted Newborn
Antepartum Testing
Babies by Term
Betamethasone and Dexamethasone
Bicarbonate (HCO3) Lab Values
Blood Cultures
Blood Transfusions (Administration)
Cardiac (Heart) Disease in Pregnancy
Causes of Chorioamnionitis Nursing Mnemonic (Pregnancies Are Very Interesting)
Causes of Labor Dystocia Nursing Mnemonic (Having Extremely Frustrating Labor)
Causes of Postpartum Hemorrhage Nursing Mnemonic (4 T’s)
Day in the Life of a Labor Nurse
Congestive Heart Failure (CHF) Labs
Disseminated Intravascular Coagulation (DIC)
Diuretics (Loop, Potassium Sparing, Thiazide, Furosemide/Lasix)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Fetal Alcohol Syndrome (FAS)
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Fundal Height Assessment for Nurses
Gestation & Nägele’s Rule: Estimating Due Dates
Gestational Diabetes (GDM)
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HELLP Syndrome
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Newborn of HIV+ Mother
Nifedipine (Procardia) Nursing Considerations
Nursing Care Plan (NCP) for Dystocia
Nursing Care Plan (NCP) for Mastitis
Nursing Care Plan (NCP) for Premature Rupture of Membranes (PROM) / Preterm Premature Rupture of Membranes (PPROM)
OB Non-Stress Test Results Nursing Mnemonic (NNN)
Oxytocin (Pitocin) Nursing Considerations
Pediatric Vital Signs (VS)
Placenta Previa
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Preload and Afterload
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Prolapsed Umbilical Cord
Spironolactone (Aldactone) Nursing Considerations
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Terbutaline (Brethine) Nursing Considerations
Transient Tachypnea of Newborn
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
Cardiac Terminology
Hematology Oncology & Immunology Terminology
MedTerm Basic Word Structure
Psychiatry Terminology
ACE (angiotensin-converting enzyme) Inhibitors
Acute Renal (Kidney) Module Intro
Addisons Assessment Nursing Mnemonic (STEROID)
Addisons Disease
Altered Mental Status Nursing Mnemonic (AEIOU TIPS)
Angiotensin Receptor Blockers
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Antidiabetic Agents
ASA (Aspirin) Nursing Considerations
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Blood Flow Through The Heart
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Canes Nursing Mnemonic (COAL)
Cardiac Stress Test
Cardiovascular Disorders (CVD) Module Intro
Cataracts
Causes of Dyspnea Nursing Mnemonic (The 6 P’s)
Causes of Pancreatitis Nursing Mnemonic (BAD HITS)
Central Line Dressing Change
Chest Tube Assessment Nursing Mnemonic (Two AA’s)
Chest Tube Management
CHF Treatment Nursing Mnemonic (UNLOAD FAST)
Circulatory Checks (5 P’s) Nursing Mnemonic (The 5 P’s)
Cirrhosis Complications Nursing Mnemonic (Please Bring Happy Energy)
Coagulation Studies (PT, PTT, INR)
Clopidogrel (Plavix) Nursing Considerations
Complications of Immobility
Continuous Renal Replacement Therapy (CRRT, dialysis)
COPD Concept Map
Cor Pulmonale – Signs & Symptoms Nursing Mnemonic (Please Read His Text)
Coronary Artery Disease Concept Map
Crohn’s Morphology and Symptoms Nursing Mnemonic (CHRISTMAS)
Cushings Assessment Nursing Mnemonic (STRESSED)
Dementia and Alzheimers
Diabetes Insipidus Nursing Mnemonic (DDD)
Diabetes Management
Diabetes Mellitus Type 1- Signs & Symptoms Nursing Mnemonic (The 3 P’s)
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Discharge (DC) Teaching After Surgery
Diverticulitis Complications Nursing Mnemonic (Please Fix His Abscess SOon)
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Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
Dopamine (Inotropin) Nursing Considerations
Encephalopathies
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Essential NCLEX Meds by Class
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Fibromyalgia
Fluid Volume Overload
Gastrointestinal (GI) Bleed Concept Map
Genitourinary (GU) Assessment
Glaucoma
Glipizide (Glucotrol) Nursing Considerations
Hearing Loss
Heart (Cardiac) Failure Therapeutic Management
Heart (Cardiac) Sound Locations and Auscultation
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Hemodialysis (Renal Dialysis)
Heparin (Hep-Lock) Nursing Considerations
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
HMG-CoA Reductase Inhibitors (Statins)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycaemic Hyperosmolar Non-ketotic syndrome (HHNS)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hyperthermia (Thermoregulation)
Hypertonic Solutions (IV solutions)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoparathyroidism
Hypotonic Solutions (IV solutions)
Hypovolemic and Distributive Shock for Certified Emergency Nursing (CEN)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
Individualized Physical Assessments for Certified Perioperative Nurse (CNOR)
Informed Consent
Insulin Mnemonic (Ready, Set, Inject, Love)
Intake and Output (I&O)
Integumentary (Skin) Important Points
Interventions for Aphasia Nursing Mnemonic (PROP)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Isoniazid (Niazid) Nursing Considerations
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Losartan (Cozaar) Nursing Considerations
Macular Degeneration
Malignant Hyperthermia
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Mechanical Aids
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meniere’s Disease
Metabolic Acidosis (interpretation and nursing diagnosis)
Methylprednisolone (Solu-Medrol) Nursing Considerations
Mobility & Assistive Devices
Montelukast (Singulair) Nursing Considerations
Myocardial Infarction Nursing Mnemonic (MONATAS)
Naproxen (Aleve) Nursing Considerations
Neurogenic Shock for Certified Emergency Nursing (CEN)
Nursing Care and Pathophysiology for Acquired Immune Deficiency Syndrome (AIDS)
Nursing Care and Pathophysiology for Cardiogenic Shock
Nursing Care and Pathophysiology for Cardiomyopathy
Nursing Care and Pathophysiology for Cholecystitis
Nursing Care and Pathophysiology for Cirrhosis (Liver Disease, Hepatic encephalopathy, Portal Hypertension, Esophageal Varices)
Nursing Care and Pathophysiology for Compartment Syndrome
Nursing Care and Pathophysiology for Cushings Syndrome
Nursing Care and Pathophysiology for Distributive Shock
Nursing Care and Pathophysiology for Epididymitis
Nursing Care and Pathophysiology for Hashimoto’s Thyroiditis
Nursing Care and Pathophysiology for Hepatitis (Liver Disease)
Nursing Care and Pathophysiology for Herpes Simplex (HSV, STI)
Nursing Care and Pathophysiology for Human Papilloma Virus (HPV STI)
Nursing Care and Pathophysiology for Hyperthyroidism
Nursing Care and Pathophysiology for Hypothyroidism
Nursing Care and Pathophysiology for Hypovolemic Shock
Nursing Care and Pathophysiology for Meningitis
Nursing Care and Pathophysiology for Osteomyelitis
Nursing Care and Pathophysiology for Pulmonary Edema
Nursing Care and Pathophysiology for Rhabdomyolysis
Nursing Care and Pathophysiology for Rheumatoid Arthritis (RA)
Nursing Care and Pathophysiology for Sepsis
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Nursing Care and Pathophysiology for SIRS & MODS
Nursing Care and Pathophysiology for Tuberculosis (TB)
Nursing Care and Pathophysiology of Acute Respiratory Distress Syndrome (ARDS)
Nursing Care and Pathophysiology of BPH (Benign Prostatic Hyperplasia)
Nursing Care and Pathophysiology of COPD (Chronic Obstructive Pulmonary Disease)
Nursing Care and Pathophysiology of Diabetic Ketoacidosis (DKA)
Nursing Care and Pathophysiology of Diabetes Mellitus (DM)
Nursing Care and Pathophysiology of Endocarditis and Pericarditis
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Nursing Care and Pathophysiology of Myocarditis
Nursing Care and Pathophysiology of Nephrotic Syndrome
Nursing Care and Pathophysiology of Osteoarthritis (OA)
Nursing Care Plan (NCP) for Addison’s Disease (Primary Adrenal Insufficiency)
Nursing Care Plan (NCP) for Aspiration
Nursing Care Plan (NCP) for Bronchoscopy (Procedure)
Nursing Care Plan (NCP) for Cardiogenic Shock
Nursing Care Plan (NCP) for Emphysema
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)
Nursing Care Plan (NCP) for Hypovolemic Shock
Nursing Care Plan (NCP) for Respiratory Failure
Nursing Care Plan (NCP) for Risk for Fall
Nursing Care Plan (NCP) for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma
Nursing Care Plan (NCP) for Spinal Cord Injury
Nursing Care Plan (NCP) for Systemic Lupus Erythematosus (SLE)
Nursing Care Plan (NCP) for Thoracentesis (Procedure)
Nursing Care Plan (NCP) for Thrombophlebitis / Deep Vein Thrombosis (DVT)
Nursing Care Plan (NCP) for Thrombocytopenia
Nursing Care Plan for Amputation
Nursing Care Plan for Compartment Syndrome
Nursing Care Plan for Distributive Shock
Nursing Case Study for Pneumonia
Nursing Case Study for Diabetic Foot Ulcer
Oncology Important Points
Oxygen Delivery Module Intro
Pain and Nonpharmacological Comfort Measures
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Patient Consent for Treatment for Certified Emergency Nursing (CEN)
Patient Communication Techniques for Certified Perioperative Nurse (CNOR)
Patients with Communication Difficulties
Perioperative Nursing Course Introduction
Peritoneal Dialysis (PD)
Pneumonia Concept Map
PPE Donning & Doffing
Pressure Ulcers/Pressure injuries (Braden scale)
Propylthiouracil (PTU) Nursing Considerations
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Sepsis Concept Map
Sepsis Labs
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Specialty Diets (Nutrition)
Stages of Hepatitis Nursing Mnemonic (PIP)
Strabismus
Stroke Assessment (CVA)
TB Drugs Nursing Mnemonic (RIPE)
The Medical Team
Thrombolytics
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Trach Care
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Understanding Blood Pressure Meds! – Live Tutoring Archive
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasopressin
Warfarin (Coumadin) Nursing Considerations
Who Needs Dialysis Nursing Mnemonic (AEIOU)
Wound Infections for Certified Emergency Nursing (CEN)