Doenças hipertensivas específicas da gestação: percepção do enfermeiro / Pregnancy-specific hypertensive diseases: nurses' perception / Enfermedades hipertensivas específicas del embarazo: percepción de las enfermeras

Introdução: Gestação é um evento fisiológico que dura em média 40 semanas. Nesse período, uma pequena parcela de gestantes, por serem portadoras de algumas comorbidades, apresentam maiores probabilidades de uma evolução não favorável da gestação. Dentre estes problemas, que podem ser graves ou fatais, estão as doenças hipertensivas da gestação. O papel do enfermeiro é fundamental no acompanhamento da gestante com síndrome hipertensiva específica da gestação. Objetivo: Identificar a percepção de enfermeiros de uma maternidade do interior paulista em relação ao conhecimento e a forma de atuação relacionada às doenças hipertensivas específicas da gestação desde sua detecção até o puerpério. Material e Método: Estudo descritivo, de abordagem qualitativa, desenvolvido em uma fundação hospitalar localizada no noroeste paulista, onde, em local reservado, as enfermeiras responderam às perguntas de um formulário com questões sobre dados pessoais e concederam uma entrevista sobre o tema, gravada e transcrita na íntegra. Resultados: Observou-se a partir das falas das entrevistadas que apesar de terem conhecimento sobre o tema, este conhecimento é parcial e está ancorado em protocolos e condutas médicas no que se refere aos cuidados com a gestante, embora tenham demonstrado conhecimento prático e estejam treinadas e aptas a realizarem tais cuidados. Conclusão: A hipertensão arterial na gestação, quando detectada, exige dos enfermeiros e sua equipe, uma boa preparação técnica e científica para identificar sinais e sintomas sugestivos e oferecer ações preventivas adequadas, visando oferecer segurança ao binômio materno-fetal.

Introduction: Pregnancy is a physiological event that lasts on average 40 weeks. In this period, a small portion of pregnant women, because they are carriers of some comorbidities, are more likely to have an unfavorable evolution of pregnancy. Among these problems, which can be serious or fatal, are hypertensive diseases of pregnancy. The role of nurses is fundamental in the monitoring of pregnant women with specific hypertensive syndrome of pregnancy. Objective: To identify the perception of nurses of a maternity hospital in the interior of São Paulo in relation to knowledge and the form of action related to specific hypertensive diseases of pregnancy from its detection to the puerperium. Material and Method: Descriptive study, with a qualitative approach, developed in a hospital foundation located in the northwest of São Paulo, where, in a the nurses answered the questions of a form with questions about personal data and granted an interview on the subject, recorded and transcribed in full. Results: It was observed from the speeches of the interviewees who despite having knowledge about the subject, this knowledge is partial and is anchored in protocols and medical conduct with regard to the care of the pregnant woman, have demonstrated practical knowledge and are trained and able to perform such care. Conclusion: Hypertension in pregnancy, when detected, requires nurses and their staff, a good technical and scientific preparation to identify suggestive signs and symptoms and offer adequate preventive actions, aiming to provide security to the maternal-fetal binomial.

Introducción: El embarazo es un evento fisiológico que dura un promedio de 40 semanas. Durante este período, un pequeño número de gestantes, por presentar algunas comorbilidades, tienen mayor probabilidad de tener una evolución desfavorable del embarazo. Entre estos problemas, que pueden ser graves o fatales, se encuentran las enfermedades hipertensivas del embarazo. El papel de la enfermera es fundamental en el seguimiento de la gestante con síndrome hipertensivo específico del embarazo. Objetivo: Identificar la percepción de los enfermeros de una maternidad del interior de São Paulo en relación al conocimiento y la forma de actuar relacionados con las enfermedades hipertensivas propias del embarazo, desde su detección hasta el puerperio. Material y Método: Estudio descriptivo, con enfoque cualitativo, desarrollado en una fundación hospitalaria ubicada en el noroeste de São Paulo, donde, en un lugar reservado, las enfermeras respondieron las preguntas de un formulario sobre datos personales y concedieron una entrevista sobre el tema, grabado y transcrito en su totalidad. Resultados: Se observó a partir de los discursos de las entrevistadas que a pesar de tener conocimientos sobre el tema, estos conocimientos son parciales y están anclados en protocolos y conductas médicas con respecto al cuidado de la gestante, aunque han demostrado conocimientos prácticos y están capacitados de llevar a cabo tal cuidado. Conclusión: La hipertensión arterial durante el embarazo, cuando detectada, requiere una buena preparación técnica y científica de los enfermeros y su personal para identificar signos y síntomas sugestivos y ofrecer acciones preventivas adecuadas, con el objetivo de ofrecer seguridad al binomio materno-fetal.

Cardiac Disease in Pregnancy.

In the United States, cardiac disease is a leading contributor to maternal mortality and morbidity. This review addresses the impact of cardiac disease on management of pregnancy and how the physiological changes of pregnancy complicate patient treatment. Approaches to assessing risk in pregnant women with cardiac disease are reviewed. Key elements of a successful disease management strategy are reviewed. Management of cardiac arrest in a pregnant patient is discussed.

Atrial fibrillation case study.

This article discusses the irregular heart rhythm caused by atrial fibrillation (AF). A brief overview of the pathophysiology will be provided. A case study is discussed to highlight the treatment and management of AF. The care provision describes common signs and symptoms and also the treatment and management of AF within the maternity care setting. The importance of maintaining the mother-baby dyad is highlighted. For the purpose of maintaining confidentiality the woman will be referred to as Shama.

Metodología enfermera aplicada a mujeres primigestas con preeclampsia grave / Nurse methodology applied to primigravid women with severe pre-eclampsia

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Looking after your health. 3. Avoiding varicose veins.

This article is to summarise key concepts for the health of the midwife with particular focus on standing for prolonged periods. One of the resultant factors relating to standing postures is the slow but avoidable progression of varicose veins. There is a strong genetic bias to these veins, which can be distressing, but here we will highlight awareness and current research.

Cardiomyopathy During Pregnancy.

Cardiomyopathy is an acquired cardiac disorder that, although rare, accounts for a rising proportion of reported pregnancy-related deaths in the United States. During pregnancy, cardiomyopathy may be divided into 2 groups. The first group is peripartum cardiomyopathy; the second group is stratified according to 3 classically defined pathophysiologic presentations: hypertrophic, dilated, or restrictive. Within this second group, the cardiomyopathy can be either idiopathic or due to a specific identified cause. This disorder poses significant risks of morbidity and/or mortality to the pregnant woman and fetus/neonate. This article describes types of cardiomyopathy during pregnancy, perinatal risks, and general management principles with a focus on intrapartum care. Hemodynamic and oxygen transport data are presented to illustrate interpretation of patient assessment findings and the effects of interventions for abnormal maternal and fetal findings.

Multisystem Effects of Hypertensive Disorders of Pregnancy: A Comprehensive Review.

Hypertension predisposes the woman and fetus to adverse outcomes during the pregnancy and postpartum. The risk for maternal complications and neonatal morbidity associated with the necessity of preterm birth extends beyond the postpartum and postnatal period. A comprehensive review of the multisystem effects of hypertensive disorders and underlying pathophysiology is provided to support the role of prompt identification of and management of acute complications of hypertension.

Teaching about cardiac emergencies: implications for maternal/child nurse educators.

Women with comorbidities and obesity and aging women are presenting obstetrical challenges to healthcare providers. Cardiovascular events such as myocardial infarction, spontaneous coronary artery dissection, and stroke on obstetrical units are not as rare as they may have been even 5 years ago. Early recognition and treatment of these maladies can assist in decreasing the mortality of both the mother and unborn baby. The Joint Commission advocates using periodic drills for obstetric emergencies. The content on cardiac emergencies and case studies in this article will assist staff development educators to integrate didactic and clinical practice time into orientation and continuing education programs.

Using reflective nursing practice to improve care of women with congenital heart disease considering pregnancy.

This article examines the issue of congenital heart disease (CHD) in women, specifically women who are considering pregnancy. Some of the authors' experiences with women with CHD are described, and a reflective approach to clinical practice is used to gain a greater understanding of the women's perspective. Women with CHD need to balance general lifespan developmental tasks with issues specific to their CHD, such as changes in functional abilities or the possibility of a shortened life expectancy. In women with CHD, physiological, psychological, and family issues need to be considered when they are contemplating pregnancy. As women with CHD move through this debate, nurses may play a key role in assisting them in their decision-making process by exploring issues related to pregnancy and CHD. This exercise in reflective nursing practice allowed us to review the literature, gain new knowledge from our patients, use that knowledge to help other patients, and thoughtfully consider what still needs to be discovered in the care of reproductive-aged women with CHD. The subject of pregnancy contemplation in women with CHD in requires systematic research.

Assessment and evaluation of the woman with cardiac disease during pregnancy.

Maternal heart disease complicates 0.2 to 3% of pregnancies and is responsible for 10% to 25% of maternal deaths. Many healthy women manifest subtle signs of cardiac failure during uncomplicated pregnancy and birth. Classic symptoms of heart disease mimic common symptoms of late pregnancy, such as palpitations, shortness of breath with exertion, and occasional chest pain. A complete cardiovascular examination assists the healthcare team to fully assess and evaluate the pregnant woman with known heart disease. Detailed assessment of the woman throughout pregnancy may lead to initial discovery of heart disease. Compilation of these objective data with subjective functional capacities allows for risk stratification and assignment to a New York Heart Association functional classification.

Modifying labor routines for the woman with cardiac disease.

The childbearing woman with cardiac disease presents a unique challenge to healthcare providers. The physiologic adaptations that accompany pregnancy and labor predispose the woman with cardiac disease to cardiac decompensation. Ideally, these women are identified to perinatal nursing staff prior to admission to the hospital in labor or for obstetrical procedures in order to provide adequate time for review of the specific cardiac lesion and development of an interdisciplinary plan of care. This article provides a comprehensive review of typical intrapartum routines that require modification and discusses strategies for adapting labor management for the woman with cardiac disease.