A 17-year-old primigravida with a known cardiac condition is admitted at 32 weeks gestation. Discuss her antenatal care, potential complications, and cardiac classifications.

You're on a roll — here is the information for question 3: 3. Ms Barbra Phiri aged 17 years, Prime gravida who is known cardiac patient has been admitted to Antenatal ward at 32 weeks gestation where you are working from. a) i. List five (5) conditions that can worsen cardiac diseases in pregnancy 1. Anemia 2. Infection (e.g., pyelonephritis, pneumonia) 3. Arrhythmias 4. Hypertension (including pre-eclampsia) 5. Thyrotoxicosis (hyperthyroidism) a) ii. Outline the four (4) grading criteria for cardiac conditions The New York Heart Association (NYHA) Functional Classification is used: Class I: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain. Class II: Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. Class III: Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain. Class IV: Unable to carry on any physical activity without discomfort. Symptoms of heart failure or angina may be present even at rest. b) Describe the Midwifery care you will give to Ms. Phiri antenatally Midwifery care for Ms. Phiri will focus on close monitoring, symptom management, and education to prevent cardiac decompensation and ensure optimal maternal and fetal outcomes. Comprehensive Assessment: Conduct a detailed history focusing on her specific cardiac condition, previous complications, and current medications. Perform a thorough physical examination, including vital signs, assessment for signs of cardiac decompensation (e.g., dyspnea, edema, crackles, jugular venous distension), and heart sounds. Assess her current NYHA functional class. Frequent Monitoring: Schedule more frequent antenatal visits than usual. Monitor vital signs, weight gain, and fluid balance closely. Regularly assess for any signs of worsening cardiac function such as increasing shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, or increasing edema. Rest and Activity Management: Emphasize the importance of adequate rest, especially during the third trimester, to reduce cardiac workload. Advise against strenuous physical activity, heavy lifting, and excessive emotional stress. Dietary Management: Provide guidance on a balanced diet, advising against excessive weight gain. Recommend sodium restriction if there are signs of fluid retention or heart failure. Medication Review and Adherence: Collaborate with a cardiologist to review and adjust her cardiac medications, ensuring they are safe for pregnancy. Educate Ms. Phiri on the importance of strict adherence to her prescribed medication regimen and to report any side effects. Infection Prevention and Management: Stress the importance of avoiding infections and seeking prompt treatment for any illness, as infections can significantly worsen cardiac conditions. Fetal Surveillance: Monitor fetal growth and well-being closely with regular ultrasound scans, as cardiac conditions can increase the risk of intrauterine growth restriction (IUGR) and preterm birth. Multidisciplinary Collaboration: Ensure close collaboration with a multidisciplinary team including an obstetrician, cardiologist, and anesthetist to plan for her ongoing care and delivery. Emotional Support: Provide psychological support and address any anxieties Ms. Phiri may have regarding her condition and pregnancy. c) Explain five (5) points you will include in your IEC to Ms. Phiri 1. Importance of Rest: Explain that adequate rest is crucial to reduce the strain on her heart, especially as her pregnancy progresses and her cardiac workload increases. Advise her to take frequent breaks and avoid overexertion. 2. Dietary Modifications: Educate her on maintaining a balanced diet, avoiding excessive salt intake to prevent fluid retention, and managing healthy weight gain to minimize cardiac stress. 3. Medication Adherence: Emphasize the critical importance of taking all prescribed cardiac medications exactly as directed, even if she feels well, and to never stop or change medications without consulting her healthcare provider. 4. Recognition of Warning Signs: Instruct her on specific symptoms that indicate worsening cardiac function (e.g., increasing shortness of breath, chest pain, persistent cough, swelling in legs/ankles, palpitations) and to seek immediate medical attention if these occur. 5. Avoidance of Aggravating Factors: Advise her to avoid activities that increase cardiac workload, such as heavy lifting, strenuous exercise, and exposure to extreme temperatures. Also, counsel against smoking and alcohol consumption. d) List five (5) complications of cardiac diseases in pregnancy 1. Cardiac decompensation/Heart failure 2. Pulmonary edema 3. Arrhythmias 4. Thromboembolism (e.g., deep vein thrombosis, pulmonary embolism) 5. Intrauterine Growth Restriction (IUGR) or preterm birth What's next?