Te Manaaki Kaiwhakawhanau i ngā Take o te ngoikore o te Manawa
Ko te ngoikore o te ngākau he āhuatanga e kore ai e taea e te ngākau te pupuhi toto kia tutuki ai ngā hiahia o te tinana. I roto i te mahi whānau tamariki, he wero nui te ngoikore o te ngākau nā te mea ko te haputanga tonu ka puta he huringa ā-tinana e whakanui ana i te kawenga o te ngākau. Nō reira, me whānui, me whakamahere, me mahi tahi te tiaki a te kaiwhakawhanau mō ngā wāhine hapu, whānau tamariki, whānau muri i te whānautanga, me te whāngai u me te ngoikore o te ngākau, me ngā tākuta whānau me ngā tākuta ngakau. E matapakihia ana e tēnei tuhinga ngā mātāpono, ngā mahi tiaki, me te arotahi o te tirotiro me whakatinana hei whakarite i te haumaru o te whaea me te tamaiti kei roto i te kōpū.
1. Papamuri: Te Hapūtanga me te Taumahatanga o te Ngākau
I te wā e hapu ana, ka piki ake te nui o te toto, ka piki ake te tere o te ngakau, ā, ka tino piki ake te putanga o te ngakau. He mea noa ēnei huringa, engari mō ngā wāhine he mate ngakau, he ngoikore rānei te mahi papu, ka kore pea e mahi ngā tikanga whakatikatika, ka puta ai ngā tohu o te ngoikore o te ngakau. Ka kino ake pea tēnei āhuatanga, inā koa i te rua me te toru o ngā toru marama, i te wā e whānau ana (nā te mamae, te ahotea, me ngā huringa hemodynamic), me te wā tuatahi i muri i te whānautanga nā te "autotransfusion" mai i te kōpū e piri ana me ngā huringa o te nui o te wai.
Ka pā te ngoikore o te ngākau i te wā e hapu ana i te mate ngākau whānau, ngā rerekētanga o te takirere (pēnei i te mitral stenosis), te cardiomyopathy peripartum, te toto toto tiketike mau tonu, te preeclampsia kino, te anemia kino, te mate pāwera rānei. He mea nui te mahi a te whānautanga ki te kite wawe, ki te ako, ki te aroturuki tata, me te tuku wawe.
2. Ngā Whāinga o te Manaaki Kaiwhakawhanau
Ko te whāinga o te tiaki i ngā wāhine i roto i ngā take o te ngoikore o te ngākau ko:
1. Kitea wawe ngā tohu mōrearea, ā, āraihia te korenga o te utu.
2. Kia mau tonu te pumau o te toto o te whaea me te nui o te hāora e tukuna ana ki roto i te tinana.
3. Whakapai ake i te tipu me te oranga o te kukune i roto i te pēpi.
4. Te whakamahere i tētahi whānautanga haumaru i runga anō i ngā āhuatanga haumanu.
5. Ārai i ngā raruraru i muri i te whānautanga pērā i te pupuhi pūkahukahu, te thromboembolism, me te mate pāwera.
6. Whakarato tohutohu mō te whāngai ū, te whakamahere whānau, me te whakamahere mō te hāputanga e whai ake nei.
3. Aromatawai Whakawhanau
Me whānui te aromatawai, tae atu ki te hītori mate, te whakamātautau tinana, me te aromatawai i ngā āhuatanga mōrearea.
a. Te hītori o mua i whakahaerehia
Me pātai te kaiwhakawhanau:
– Ngā amuamu mō te poto o te manawa (ina koa i te wā e mahi ana koe i tetahi mahi, i te wā e takoto ana/ortopnea, te paroxysmal nocturnal dyspnea rānei).
– Ngāwari te ngenge, te tere o te pupuhi o te roro, te mamae o te uma, te whanoke, te hemo rānei.
– Te maremare, inā koa i te pō, te whewhe, te maremare rānei me te hukahuka (he tohu o te pupuhi pūkahukahu).
– Te pupuhi o ngā waewae, te piki tere o te taumaha, te heke o te putanga mimi.
– He hītori o te mate ngakau/te toto toto tiketike, te whakamahinga o ngā rongoā ngakau, he hītori o te whakaurunga ki te hōhipera.
– Hītori whānau: preeclampsia, toto, anemia, ngā raruraru o mua.
b. Whakamātautau tinana
Arotahi ki:
– Ngā tohu ora: te toto totoka, te manawa, te tere o te manawa, te mākū o te hāora, te pāmahana.
– Ngā tohu o te ngoikore o te ngākau: te pupuhi taha, te pikinga o te JVP (uaua jugular), ngā ira mākū i roto i ngā pukahukahu, te hepatomegaly, te cyanosis.
– Aromatawai i te āhua o te wai: te taurite o te tāuru me te tāuru, te turgor, te nui o te pupuhi.
– Whakamātautau whānau: te teitei o te hope, te āhua o te kukune, te DJJ, te nekehanga o te kukune, ngā tohu o te whānautanga.
c. Ngā whakamātautau tautoko (mahi tahi)
Mā ngā kaiwhakawhanau e āwhina ngā tuku/mahi tahi mō:
– ECG, echocardiography, X-ray o te uma mēnā e tika ana (me te whai whakaaro ki te hāputanga), BNP mēnā e wātea ana.
– Whakamātautau Hb (ka kino ake te ngoikore o te ngākau i te kore toto), te mahi a te whatukuhu, ngā irahiko hiko.
– Te tirotiro i te tipu o te kukune me te wai o te amniotic, te tirotiro i te whanaketanga o te kukune.
4. Te Tātaritanga Whānau me ngā Raru Pea
I roto i te horopaki o te whānautanga, ko ngā raruraru e puta pinepine ana ko:
– Te mōrearea o te hekenga o te putanga o te ngākau ka pā ki te rere o te toto ki roto i te uteroplacental.
– Te kore e manawanui ki ngā mahi tinana nā te kore taurite i waenga i te tuku me te hiahia hāora.
– Te mōrearea o te whakawhitinga hau (te pupuhi pūkahukahu).
– Te mōrearea o te nui rawa o te wai/te pupuhi.
– Te manukanuka me te kore mōhiotanga e pā ana ki ngā āhuatanga, ngā rongoā, me ngā mahere whānau.
– Te mōrearea o te whānautanga o mua, te aukati rānei i te tipu o roto i te kōpū (IUGR) nā te hekenga o te rere o te toto.
5. Te Whakamahere me te Wawaotanga Tiaki Kaiwhakawhanau
a. Ngā panonitanga mātauranga me te āhua noho
Ka whakaratohia e ngā kaiwhakawhanau he tohutohu whai hua:
– Kia nui te okiokinga, moe ki tō taha maui hei whakapiki i te rere o te toto ki roto i te uaua.
– Whakaitihia ngā mahi uaua; whakatenatenahia ngā mahi māmā kia taea ai.
– Te kai taurite, te whakaiti i te tote mēnā ka tūtohutia e te tākuta, me te aroturuki i te pikinga o te taumaha.
– Kaua e kai hikareti, waipiro, me ngā rongoā kāore i te tūtohutia.
– Kia mōhio ki ngā tohu mōrearea: te poto ohorere o te manawa, te maremare huka, te mamae o te uma, te hemo o te ngākau, te pupuhi tere, te ngoikore o te nekehanga o te kukune.
b. Te aroturuki tata i mua i te whānautanga
– Kia maha ake ngā haerenga me te aromatawai i ngā tohu me ngā āhuatanga ora.
– Aroturuki i te taumaha o te tinana, te pupuhi, me te mimi.
– Aroturukihia te hauora o te pēpi: te FHR, te nekehanga o te pēpi, te fundus uterine; me tuku he ultrasound raupapa mēnā e tika ana.
– Kia ū ki ngā rongoā (ngā diuretics, ngā beta-blockers, ētahi anticoagulants, me ētahi atu) e ai ki tā tō tākuta i whakahau ai. Me whakamahara ngā kaiwhakawhanau ki a koe kāore ētahi rongoā mō te ngākau e haumaru i te wā e hapu ana, nō reira me whakahau te tākuta i ngā rongoā katoa.
c. Te mahi tahi me ngā tuku tohutohu
Ko ngā mate ngoikore o te ngākau i te wā e hapu ana he mea tino mōrearea. Me mahi e ngā kaiwhakawhanau:
– Tukuna ki tētahi whare hauora kei a ia ngā ratonga whānau ohorere me te tautoko ICU mēnā e tika ana.
– Mahi tahi ki te whakatau i te akomanga mahi (hei tauira, NYHA), me ngā mahere tuku takitahi.
– Me whakarite kia rite te toto, ngā rongoā ohorere, me te urunga atu ki ngā mahi tere.
d. Te ārai i ngā raruraru
– Te ārai i te mate toto iti: te tāpiringa rino, te whāngai folate, me te whakahaere paerewa mō te mate toto iti.
– Te ārai i te mate urutā: te ako i ngā tikanga akuaku, te kite wawe i ngā mate urutā manawa/ara mimi ka pāngia ai te tinana e te mate urutā.
– Te ārai i te thromboembolism: te nekeneke māmā, te whakamakuku toto, te whakamahi i ngā tōkena kōpeketanga mēnā e taunakitia ana, me te ū ki ngā rongoā anticoagulant mēnā kua tohua.
6. Te Tiaki i roto i te Whānautanga (I te Wā Whānautanga)
Me whakamahere te whānautanga o ngā wāhine e pāngia ana e te ngoikore o te ngākau. Ko te arotahi matua ko te whakaiti i te ahotea, te mamae, me ngā huringa ohorere o te toto.
Ngā mātāpono o te tiaki i roto i te whānautanga:
– Me whakahaere te whānautanga i roto i tētahi hōhipera tuku mai me tētahi tīma maha ngā mātanga.
– Te aro turuki tonu i ngā tohu ora, te mākū o te toto, me te āhua o ngā pukahukahu.
– Tūnga whakatītaha maui/haurua-Fowler hei whakaiti i te taumahatanga ki te ngākau.
– Te whakahaere i te wai kia tino tika: karohia te nui rawa o ngā wai i roto i te uaua.
– He rongoā whakangāwari rawaka hei whakaiti i te urupare ki te ahotea (te mahi tahi me te rongoā whakangāwari).
– Ka whakapotohia te wāhanga tuarua mēnā e tika ana (hei tauira, mā te tango korehau/pūwero e ai ki te tohutohu a te tākuta) kia kore ai te whaea e pēhi roa.
– Āta karohia ngā rongoā ka kino ake te āhua o te ngākau, kāore he tohu tino tika; me tūpato hoki te whakamahinga o te uterotonic, me te whai i ngā tikanga a te tākuta.
Ko te whakatau mō te tikanga whānau (te pokanga tara, te pokanga cesarean rānei) ka whakawhirinaki ki te āhua o te ngākau o te tūroro, te tau hāputanga, me ngā tohu o te whānautanga. He maha ngā wā ka taea te whānau tara me te aroturuki me te whakahaere tika, engari ko ētahi āhuatanga me pokanga.
7. Te Tiaki i muri i te Whānautanga me te Whāngai U
He wāhanga nui te wā muri i te whānautanga, inā koa ngā haora 24–72 tuatahi, nā te mea ka taea e ngā huringa tere o te wai te whakaoho i te pupuhi o te pūkahukahu. Kei roto i te tiaki muri i te whānautanga:
– Te aro turuki i ngā tohu ora, te mākū o te manawa, ngā tohu o te poto o te manawa, me ngā oro o te manawa.
– Te aro turuki i te taurite o te wai me te diuresis.
– Tautokohia te okiokinga, ngā here mahi, me ngā tūranga whakamarie.
– Te ārai i te toto i muri i te whānautanga (ka kino ake pea ngā āhuatanga hemodynamic) me te aro tonu ki te haumaru o ngā rongoā uterotonic.
– Te tohutohu mō te whāngai ū: He maha ngā whaea ka taea tonu te whāngai ū, engari ko te whakatau ka whakawhirinaki ki te pumau o te hauora me ngā rongoā e whakamahia ana (ka taea e ētahi rongoā te uru ki te waiū ū). Me tūtohu ngā kaiwhakawhanau kia toro atu ki te tākuta kia pai ai te haumaru o te whāngai ū.
8. Te Whakamahere Whānau me te Tohutohu Whakamahere Hapūtanga
He mahi nui tā ngā kaiwhakawhanau ki te whakarato tohutohu whakamahere whānau i muri i te whānautanga. Me āta whakamaheretia ngā hāputanga o muri mai, nā te mea ka kino ake te ngoikore o te ngākau. Me whiriwhiri ngā tikanga ārai whānau i runga i te āhua hauora o te tūroro me ngā taunakitanga a te tākuta. I ētahi wā kino rawa, ka nui te mōrearea o ngā hāputanga anō, ā, me whai tohutohu hōhonu mō te ārai whānau mō te wā roa.
9. Te Tuhituhi me te Haere Tonu o te Manaaki
Kei roto i ngā tuhinga katoa ngā tohu, ngā tohu ora, ngā hua aroturuki, te rongoā kua whakaratohia, te mātauranga, ngā tuku mai, me te urupare a te tūroro. He mea nui te haere tonu o te tiaki: ka whakarite ngā kaiwhakawhanau i te whai i ngā whakaritenga aroturuki, te tutuki i ngā tirotiro, me te whakawhitiwhiti kōrero pai i waenga i ngā whare hauora.
Whakamutunga
Ko te tiaki whānau mō te ngoikore o te ngākau me tino mataara, me aromatawai whānui, me aroturuki tata, me ako tonu, me te mahi tahi a ngā momo marautanga. Ko te arotahi matua ko te ārai i te ngoikore o te ngākau, te pupuri i te rere o te toto ki roto i te kōpū, te whakarite i te whānautanga haumaru, me te matapae i te wā tino nui i muri i te whānautanga. Mā te tiaki tika me ngā tuku tika, ka taea te whakaiti i te mōrearea o ngā raruraru, ka hua ake he hua hauora tino pai mō te whaea me te pēpi.
Ki te hiahia koe, ka taea e au te whakarerekē i tēnei tuhinga hei tuhinga pūtaiao (me te kupu whakataki–tikanga–kōrero–whakataunga), me te tāpiri atu rānei i tētahi rārangi pukapuka me ngā tohutoro aratohu haumanu.
