Rheumatic fever with mitral valve stenosis

    Ana Dela Cruz, 22 years old, is a gravida 1, para 0 woman, 34 weeks pregnant, whom you meet in the emergency room. Her electronic record shows you she had rheumatic fever with mitral valve stenosis as a child. During this pregnancy, she developed gestational diabetes. At 34 weeks, she has already been hospitalized twice for hyperglycemia. This afternoon, she fainted while participating in her weekly hour-long aerobics class. Her serum glucose at the moment is 207 mg/dl. Blood pressure is 90/40 mmHg; pulse rate is 130 beats/min; the fetal heart rate is 180 beats/min. A uterine monitor shows she is having moderate-strength contractions 7 minutes apart. Ana asks you, “If exercise is supposed to be good for you, why did this happen?”

1.  What if Ana is diagnosed as having class II heart disease. Because of her work as a fundraiser, she is on her feet all day. What suggestions could the nurse make to help her incorporate more rest into each day?
2.  What if Ana tells the nurse she has abruptly discontinued taking the daily penicillin she has been prescribed for her heart disease since childhood. As it has been a long time since she had rheumatic fever, would the nurse recommend she could omit taking this during pregnancy?
3. What if Ana develops gestational diabetes. She’s resistant to learn much about her condition, though, because she knows her symptoms are only temporary and will fade at the end of pregnancy. What type of teaching plan would the nurse devise to help her learn in the face of this attitude?