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Rheumatic Heart Disease (RHD)

Brief Description of the condition a condition in which permanent damage to heart valves is
caused by rheumatic fever
Predisposing and Precipitating Factors  Hx of acute rheumatic fever or mild rheumatic disease
 Poverty
 Reduced access to medical care
S/Sx  Shortness of breath
 Fatigue
 Cough
 Increased respiratory rate
 Poor FHT
 Decreased amniotic fluid
 Edema
Lab & Dx Procedures  Blood Tests
 Crdiac biomarkers
 Urinalysis
 Toxicology screen
 Optic nerve exam
 Chest X-Ray
Effects to pregnancy and baby Baby


Possible complications  Pulmonary Edema

 Atrial Fibrillation or clotting
 Mitral Stenosis
 Mitral regurgitation
 Adverse fetal outcomes (e.g. preterm labor, LBW)
 Maternal death
Nx Dx Deficient knowledge regarding steps to take to reduce the
effects of maternal cardiovascular disease on the pregnancy
and fetus
Nx mgmt  Frequently assess woman’s bp, pr, rr and fht
 If she has pulmonary edema, elevate her head and chest
 Refer to tertiary centers with cardiology and intensive
care facilities
 Promote rest
 Promote healthy nutrition
 Educate regarding medication
 Educate regarding avoidance of infection
 Be prepared for emergency actions
Medical mgmt  Anticoagulant therapy
 Antibiotic secondary prophylaxis
 Surgery (mechanical and bioprosthetic valves)
2. DM (Diabetes Mellitus)
Brief Description of the condition An endocrine disorder in which the pancreas cannot
produce adequate insulin to regulate body glucose levels
Predisposing and Precipitating Factors  Obesity
 Age over 25 y.o.
 Hx of large babies
 Hx of unexplained fetal or perinatal loss
 Hx of congenital anomalies in previous pregnancies
 Hx of polycystic ovary syndrome
 Family hx of diabetes
 Member of a population with a high risk for DM
S/Sx  Dizziness if hypoglycemic
 Confusion if hyperglycemic
 Thirst
 Increased risk of PIH
 Hydramnios
 Poor FHT
 Glycosuria, polyuria
 Hyperglycemia
Lab & Dx Procedures  50-g glucose challenge test
 Serum α-fetoprotein level
 Creatinine clearance
 Non-stress test / bio-physical profile
 Kick-count
 Ultrasound
 Amniocentesis
Effects to pregnancy and baby Baby
 Possible Congenital Anomalies (e.g. Caudal Regression
 Poor Tissue Perfusion

 Polyhydramnios
 if CPD, C/S delivery
Possible complications  Congenital anomalies
 Macrosomia
 For the mother, Vascular narrowing (Kidney, heart and
retinal dysfunction)

Nx Dx  Risk for ineffective tissue perfusion r/t reduced vascular

 Imbalanced nutrition, less than body requirements, r/t
inability to use glucose
 Risk for ineffective coping r/t required change in lifestyle
 Risk for infection r/t impaired healing accompanying
 Deficient fluid volume r/t polyuria accompanying the
 Deficient knowledge r/t complex health problem
 Health seeking behaviors r/t voiced need to learn home
glucose monitoring
Nx mgmt  Assess whether patient understands it is healthy for her
to exercise regularly
 Monitor patient’s BP, pulse rate, FHR, and uterine
contractions by continuous monitoring
 Determine patient progress by monitoring and physical
exam. Inform patients signs of beginning labor
 Assess serum glucose every 15 minutes by finger stick
 Document pattern of blood glucose. Administer
intravenous (IV) fluid, insulin additive as prescribed
 Assess patient’s understanding that her complex
situation (both cardiac and diabetes disorders) could be
compromising her pregnancy
 Educate patient about need for rest in lateral recumbent
position until condition is stabilized
Medical mgmt  Insulin tx

3. Substance Abuse
Brief Description of the condition Inability to meet major role obligations, an increase in legal
problems or risk-taking behavior, or exposure to hazardous
situations because of an addicting substance
Predisposing and Precipitating Factors  Low level of education
 poverty
 Unmarried status
 Tobacco use
 Unemployment
S/Sx  behaviors and presentations
o sedation, inebriation, disorientation,
depression, or memory loss
o euphoria, irritability, agitation,
aggressiveness or violent behavior,
paranoia, increased physical activity,
anxiety, nervousness, or panic
o prescription drug seeking behavior
o suicidal attempts or ideation
o psychosis or erratic behavior
 symptoms
o hallucinations, panic, anxiety
o skin conditions such as abscesses, dry or
itchy skin, acne type sores
 physical signs
o markedly dilated or constricted pupils, rapid
eye movements, or nystagmus
o tremors, increased pulse and blood
pressure, or increased body temperature
o weight loss with low BMI, malnutrition, or
hair loss
o track marks or injection site abscesses,
inflamed or eroded nasal mucosa, nose
bleeds, gum or peridontal disease including
broken teeth, severe decay, or infections
 lab signs
o anemia
o hepatitis C infection
o positive sexually transmitted infection test
(retest in third trimester if at risk)
o mean corpuscular volume > 95
o elevated mean corpuscular hemoglobin,
gamma-glutamyl transpeptidase, serum
glutamic oxaloacetic transaminase, bilirubin,
or triglycerides
 medical history including
o frequent hospitalizations, frequent falls,
unexplained bruises
o gunshot or knife wound
o unusual infections such as cellulitis,
endocarditis, atypical pneumonias, or HIV
o cirrhosis, hepatitis, or pancreatitis
o chronic mental illness

Lab & Dx Procedures  4 P’s Plus

 3-item Substance use Risk Profile
 3-item NET screens for alcohol use
 Urine Tests
 Hair or meconium testing
Effects to pregnancy and baby Baby:
 Risk for SGA
 Risk of LBW
 Risk of SIDS
 Risk for congenital malformations
 Risk for intrauterine growth restriction
 Risk for Oral facial clefts
 Risk for Negative newborn neurobehavioral outcomes
 Risk for Poor language development in childhood
 Increase risk of miscarriage
 Increase risk of prenatal death, preterm delivery, LBW
 Increase risk of stillbirth
Possible complications  Substance-dependence
 Fetal abnormalities
 Preterm birth
Nx Dx Risk for injury to self and fetus r/t chronic substance
Nx mgmt  Assessment and feedback after increasing awareness of
risk associated with alcohol use in pregnancy
 Oral and written advice for strategies to reduce or
eliminate alcohol use
 Assistance in developing change strategies, goal setting,
positive reinforcement and referrals
Medical mgmt  Thiamine
 Diazepam
 Lorazepam

Brief Description of the condition Disease that damages the immune system due to a virus
Predisposing and Precipitating Factors  Unhealthy sexual habits
 Drug use
 Poverty
S/Sx  Fatigue
 Anemia
 Diarrhea
 Weight loss
 Flu-like symptoms
Lab & Dx Procedures  CBC
 Kidney function test
 Liver panel
 HIV antibody test
 CD4 T-cell count
 HIV plasma RNA levels
 HIV genotypic resistance
 STI screening
 Serologic screening
 Ultrasound
 ELISA antibody reaction
 Western blot analysis
Effects to pregnancy and baby Baby
 C/S delivery
Possible complications
Nx Dx Risk for infection (opportunistic) r/t dysfunction of the
immune system secondary to invasion of HIV
Nx mgmt
Medical mgmt  Acyclovir
 Pyrimethamine
 Sulfadiazine
 Trimethoprim
 Sulfamethoxazole
 Amniocentesis

5. Rh Sensitization
Brief Description of the condition A phenomenon where the antibodies of the Rh-negative
mother are attacking the Rh-positive fetus.
Predisposing and Precipitating Factors  Rh (-) mother and Rh (+) baby
S/Sx  Blood type incompatibility problems
 Fetal infections
Lab & Dx Procedures  Doppler velocity ultrasound
 Cord blood sampling
 Amniocentesis
Effects to pregnancy and baby Pregnancy
 May increase risk for anemia
 May require tocolytic therapy if fetus is younger than 34
 Early induction of labor
 Direct transfusion of packed RBC
 Risk for anemia or jaundice
 Heart failure
 Enlarged liver
 Respiratory distress
 Purpura
 Kernicterus
Possible complications  Hemolytic Disease of the Newborn
 Miscarriage
Nx Dx
Nx mgmt
Medical mgmt  RhoGAM
 Intrauterine fetal blood transfusion
 Aggressive hydration
 Phorotherapy

6. Anemia
Brief Description of the condition The condition of having a lower-than-normal number of red
blood cells or quantity of hemoglobin
Predisposing and Precipitating Factors  Multiple pregnancy
 Hyperemesis
 Early pregnancy
 Diet low in iron
 Unwise weight-reducing programs
 Low socioeconomic levels
 Are pregnant with multiples (more than one child)
 Have had two pregnancies close together
 Vomit a lot because of morning sickness
 Are a pregnant teenager
 Don't eat enough foods that are rich in iron
 Had anemia before you became pregnant
S/Sx  Pale skin, lips, and nails
 Fatigue
 Dizziness
 Shortness of breath
 Rapid heartbeat
 Trouble concentrating
 Restless leg syndrome
 Pica
Lab & Dx Procedures  Blood Test
 Sickle-cell anemia screening

Effects to pregnancy and baby Pregnancy
 Preterm or LBW
 Blood transfusion
 PPT depression
 Anemic baby
 Preterm or LBW
 Neural tube defects
Possible complications
Nx Dx  Imbalanced nutrition, less than body requirement r/t
increased physiologic needs
 Deficient knowledge r/t need for increased intake of
nutrients especially iron during pregnancy
Nx mgmt  Educate patient about proper diet consisting of green
leafy vegetables, meat and legumes
 Refer to hematologist
Medical mgmt  Prophylactic therapy (27 mg iron)


(Rheumatic heart disease and rheumatic fever, n.d.)

(Clinical Update-Rheumatic heart disease in Pregnancy, 2016)

(French & Poppas, 2018)

(DynaMed, 2018)

(DynaMed, 2018)

(WebMD, 2018)

(Silbert-Flagg & Pilliteri, 2018)

(Healthwise Staff, 2018)