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Title: A client at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What ... Post by: XIOMARAMR on Feb 5, 2018 A client at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What should the nurse expect to see in the medical record?
1. Dyspnea and chest pain with mild exertion 2. Elective cesarean birth scheduled for 37 weeks 3. Discussed need for labor epidural and vacuum extraction 4. Respiratory rate 28, pulse 110, 3+ pre-tibial edema bilaterally Title: A client at 24 weeks has a history of class II heart disease secondary to rheumatic fever. What ... Post by: adbuchy on Feb 5, 2018 3
Explanation: 1. Dyspnea and angina with mild exertion are not expected with class II heart disease even during pregnancy, but are symptoms seen in class IV heart disease. 2. Cesarean birth is only undertaken in cardiac clients for fetal or maternal intrapartal indications, not for cardiac reasons alone. 3. Lumbar epidural analgesia decreases the stress response during labor, while vacuum extraction or forceps decreases maternal pushing efforts. Both of these decrease stress on the heart during birth. 4. 3+ pre-tibial edema is never an expected finding during pregnancy. Pulse over 100 and respiratory rate over 24 are indicators of cardiac decompensation. |