NCP 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

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: 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

In patient care not required unless complications develop.