68wm6 Phase 2 Test 9
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| Acme | Peak or period of greatest strength of a uterine contraction
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| Bloody show | mixture of cervical mucus and blood fromruptured caprillaries in the cervix; often procedes labor and increases with cervical dilation.
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| Decrement | period of decreasing strength of a uterine contraction
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| duration | period from the begining of a uterine contraction to the end of the same contraction
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| fontanel | space at the intersection of suturers connecting fetal or infant skull bones
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| increment | period of increasing strength of a uterine contraction
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| interval | period between the end of one uterine contraction and the beginning of the next
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| lochia | vaginal drainage after birth
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| ripening | softening of the cervex as labor nears as the result of a increase in water content and the effects of relaxin on the connective tissue of the cervix
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| station | measurement of fetal descent in relation to the ischial spines of the maternal pelvis
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| amniotomy | artificial rupture of the membranes
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| crowning | appearance of the fetal scalp or presenting part at the vagina
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| EDD | estimated date of delivery
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| gravida | a pregnant women; also refers to a womens total number of pregnancies.
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| multipara | a women who has given birth after two or more pregnancies of at least 20 weeks of gestation; also description of pregnant woman prior to birth of second child
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| nuchal cord | umbilical cord around the fetal neck
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| para | a women who has given birth after a pregnancy of at least 20 weeks of gestation; also designates the number of a womans pregnancies that have ended after at least 20 weeks of gestation.
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| amnioinfusion | infusion of sterile isotonic solution into the uterine cavity during labor to reduce umbilical cord compression; may also be done to dilute meconium in amniotic fluid and reduce the risk that the infant will aspirate thick meconium.
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| asphyxia | insufficiant oxygen and excess carbon dioxide in the blood and tissues
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| hypercapnia | excess carbon dioxide in the blood, evidenced by an elevated Pco2
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| hypertonic contractions | uterine contrations that are too long or too frequent, have too short a resting interval or have an inadequete relaxation period to allow optimaluteroplacental exchange
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| hypoxemia vs hypoxia | reduced O2 in the blood vs reduced O2 in the tissues
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| oligohydramnios | abnormally small amount of amniotic fluid, less then about 500 ml at term
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| anesthesia | loss of sensation, especially to pain
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| aspiration pneumonitis | chemical injury to the lungs that may occwith regurgitation and aspiration of acidic gastric secretions
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| epidural space | area outside the dura, between the dura mater and the vertebral canal
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| motor block | loss of voluntary movement caused by regional anesthesia
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| pain threshhold | the lowest level of stimulus one percieves as painful, relatively constant under different conditions
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| pain tolerance | maximum pain one is willing to endure. pain tolerance may increase or decrease under different conditions
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| general anesthesia | systemic loss of sensation with loss of consciousness
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| regional anesthesia | anesthesia that blocks pain impulses in a localized area without loss of consciosness.
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| sensory block | loss of sensation caused by regional anesthesia
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| subarachnoid space | space between the arachnoid mater and the pia mater containing cerebrospinal fluid
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| abruptio placentae | premature seperation of a normally implanted placenta
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| amniotomy | artificial rupture of the amniotic sac
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| augmentation of labor | artificial rupture of the uterine contractions that have become ineffective.
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| cephalopelvic disproportion | fetal head sie that is too large to fit through the maternal pelvis at birth
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| cesarean birth | c section; surgical birth of the fetus through an incision in the abdominal wall and uterus.
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| chignon | newborns scalp edema created by a vacum extracor
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| chorioamnionitis | inflammation of the amniotic sac; usually caused by bacterial and viralinfections; also call amnionitis
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| dystocia | difficult or prolonged labor; often associated with abnormal uterine activity and cephalopelvic disproportion
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| hydramnios | excessive volume of amniotic fluid
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| iatrogenic | term used to describe and adverse condition resulting fromt treatment
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| induction of labor | artificial initiation of labor
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| version | turning the fetus from one presentation to another before birt, usually from breech to cephalic
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| PROM | premature rupture of the membranes; rupture of the membranes before the onset of labor
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| placenta previa | abnormal implantation of the placenta in lower uterus
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| What is gametogenesis? | Development of ova in the woman and sperm in the man -Somatic cells reproduce by the process of mitosis
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| How long can the ovum and sperm survive in the reproductive tract? | 24 hours ovum; 5 days sperm
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| Define: zygote, embryo, and fetus. | Zygote – cell formed by union of sperm and ovum -Embryo – 3rd week to 8th week of development -Fetus – 9th week until birth
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| During what trimester are most teratogens most destructive? | Teratogens cause damage to the developing embryo and fetus. Eg. Viral, drugs/medication/radiation/toxic chemical exposures 1st trimester
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| What is the age of viability? | 20 weeks
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| What happens at 28 weeks that increases the premature infant’s chances of survival? | Increased production of surfactant
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| Name the three fetal circulatory shunts. | 3. Foramen ovale: Opening between atria in fetal heart.
Ductus venosus:Branch off the umbilical vein which diverts blood to the IVC.
Ductus arteriosus:Blood vessel diverting fetal blood from the pulmonary arteries to the aorta (away from the lungs).
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| Which two can re-open after birth if certain congenital defects are present? | FV, DA. due to heart not pumping proper amount to put pressure on flap.
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| How many vessels are there in the umbilical cord? | Three vessels; two arteries one vein. Ateries carry deoxygenated blood back to placenta. Vein carries oxygenated blood to fetus.
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| Name three functions of the amniotic fluid. | Provides cushion to protect infant from trauma; maintains constant temperature, allows symetrical growth, allows buoyancy and fetal movement.
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| What is the function of the placenta? | Placenta is the organ of respiration and excretion for the fetus.
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| Which twins originate with one fertilized ovum? | Identical twins- monozygotic
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| Name three of the possible complications from a multi-gestational pregnancy? | SAB, chromosomal anomalies, pre-term delivery, growth restriction, congenital defects, fetal death, pre-eclampsia
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| What does gravida mean? What does para mean? | Gravida=preganancies, para=children
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| What is amenorrhea? | lack of shedding blood during menstrual cycle;Lack of menstruation
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| What is quickening? | Mother feels the baby move for the first time
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| What is the usual schedule for prenatal care visits? | One visit a month through the 7th month, then every two weeks a month and then weekly until delivery.
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| What advice about working would you give to a pregnant active duty soldier. | The pregnancy profile should address working conditions such as limits on lifting, long periods of time standing or sitting. Frequent rest periods during the day, at least every two hours. Whenever possible the woman should work while elevating her legs.
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| What hormone is the basis for pregnancy tests? | Human Chorionic Gonadotropin (HCG)
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| What test is the most accurate to determine pregnancy? Blood or urine? | Blood
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| What is the significance of a pregnant woman’s rubella titre? | RUBELLA IS A TERATOGENIC DISEASE. IF SHE IS NON-IMMUNE WE NEED TO VACCINATE HER AFTER DELIVERY SO SHE WILL BE IMMUNE BEFORE ANY SUBSEQUENT PREGNANCY OCCURS. Titre is blood test for Rubella vac.
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| What is the significance of a pregnant woman’s RH status? | isoimmunization happens which results in erythroblastosis if mom is Rh - and fetus is Rh +
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| Name four complications associated with smoking in pregnancy. | SAB, Pre term labor(PTL), Low birth weight (LBW) ,ABRUPTION, PREVIA,
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| What is FAS? | FETAL ALCOHOL SYNDROME. CHARACTERIZED BY FLAT FACE, THIN UPPER LIP, SMALL EYES AND SMALL CHIN.
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| Why do we discourage taking drugs and most medications during pregnancy? | MOST DRUGS CAN CROSS THE PLACENTA AND SOME MAY BE TERATOGENIC. FEW CONTROLLED STUDIES ARE AVAILABLE.
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| Give two nursing interventions for the following common discomforts in pregnancy: Nausea Heartburn | eat small meals 6times daily/ dont drink fluids while eating meals/ dont lay one hour after eating meals/ avoid greasy foods that might cause heart burn, avoid irritating smells theat may cause nausea, antiametics,Zantac or tums for heart burn/gerd.
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| Name two food sources each for protein | meat, poultry, dairy, bean, legumes and nuts
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| Calcium | dairy, soy, green leafy vegetables, sardines and canned salmon
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| iron and folic acid | liver, lean beef, kidney and lima beans, dried beans and dark green leafy veg., potatoes, whole wheat breast and peanuts. Iron: red meats, organ meats, molasses, whole grains, dark green leafy veg and dried fruit.
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| What is the recommended daily allowance for calcium in pregnancy? | Recommended Calcium is 1200mg qd.
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| What color does iron turn your stool? | dark green
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| What special dietary considerations are there for adolescent pregnancies? | Need to provide adeq calories and nutrition to meet Mom’s developmental needs as well as the fetus’s.
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| How much weight should a normal weight woman gain during pregnancy? | 25-35 lbs. NORMAL WT. 3.5lbs per week per first trimester. 1lb for week after first trimester.
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| How much weight should an obese woman gain during pregnancy? | 15 LBS FOR OBESE WOMAN.
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| How can you best communicate with a patient who does not speak your language? | Talk to charge nurse about getting a hospital translater.
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| How can you verify that a woman or her family understands what the nurse has told her? |
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| Name eight danger signs in pregnancy. | Gush of fluid Vaginal bleeding, Fever Dysuria, Epigastric pain, Visual changes, edema above the waist, persistant HA unrelieved by tylenol Decreased fetal movement.
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| Name three uses of ultrasound in pregnancy. | US: DETERMINE VIABILITY (CARDIAC ACTIVITY); DETERMINE DUE DATE, MEASURE AMNIOTIC FLUID, GUIDE AMNIOCENTESIS OR CVS; SCAN FOR CONGENITAL DEFECTS, PERFORM BIOPHYSICAL PROFILE, ESTIMATE GROWTH. doppler measures bloodflow through placenta.
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| What is the rationale for having a full bladder for U/S in the second trimester? | A full bladder elevates the uterus out of the pelvis for better visualization. Instruct the patient to drink several glasses of water an hour before the procedure.
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| Name two purposes of amniocentesis testing. | AMNIOCENTESIS; CHECK FOR FETAL LUNG MATURITY, INFECTION OR CHROMOSOMAL ABNORMALITIES.
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| Define a reactive non-stress test. | TWO ACCELERATIONS WTIHIN A 20 MINUTE WINDOW WITH A BASELINE WNL.
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| Define an SAB: | Spontanious abortion
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| More than half of all SABs are caused by: | Chromosomal abnormalities or congenital defects incompatible with life.
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| What is the difference between a threatened abortion and an inevitable abortion? | THREATENED ABORTION = CRAMPING AND BLEEDING. INEVITABLE ABORTION=CERVICAL DILATION, ROM AND/OR DEATH OF FETUS.
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| What are your priority nursing assessments for the woman with an ectopic pregnancy or SAB? | VS, I&O, ASSESS FOR SIGNS OF SHOCK, OR SUDDEN CHANGES IN THE QUALITY OF THE PAIN, ASSESS AMOUNT OF BLEEDING, ASSESS H/H.
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| What is a missed abortion? | FETAL DEMISE WITHOUT SPONTANEOUS EVACUATION OF THE PRODUCTS OF CONCEPTION BY THE BODY.
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| Define ectopic pregnancy. | IMPLANTED EMBRYO OUTSIDE THE UTERUS
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| What are the s/sx of ectopic pregnancy? | S/SX: VAGINAL BLEEDING, ABDOMINAL PAIN, AMENORRHEA OR ‘MISSED PERIOD’
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| What is Rhogam? | ANTIBODIES TO RH FACTOR FROM POOLED DONOR SERUM TO PREVENT RH SENSITIZATION IN RH NEGATIVE MOTHERS.
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| What is DIC? | Disseminated intravascular coaglulation*
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| When should pregnant women get Rhogam? | 28 WEEKS AND POSTPARTUM (IF BABY IS RH +)
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| What is erythroblastosis fetalis? | ERYTHROBLASTOSIS FETAL IS MASSIVE LYSIS OF RBCS DUE TO BLOOD INCOMPATIBILITY, USUALLY RH, BETWEEN MOTHER AND FETUS. mother has -RH and baby has +RH.
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| What are s/sx of placenta previa vs. placental abruption. | PAINLESS BLEEDING
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| Define gestational hypertension (GHTN). | PIH = PREGNANCY INDUCED HYPERTENSION, HTN DIAGNOSED AFTER 20 WEEKS OF PREGNANCY.
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| Define pre-eclampsia and eclampsia. | pre-E=HTN + PROTEINURIA/ Eclampsia= HTN,Protienuria, seizures
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| What pathophysiologic change underlies all the symptoms/issues associated with pre-eclampsia. | Vasospasm
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| What is the priority of care for the patient with pre-eclampsia? | Improve placental perfusion and fetal oxygenation and prevent seizures and other complications r/t pre-e such as stroke.
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| What is clonus and how do you check it? | clonus is the refelx of the mother
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| How often should you check DTRs on the patient on magnesium sulfate. |
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| The criteria for proteinuria in pre-eclampsia is ___ milligrams in 24 hours? | >300 mg/24 hours or a random urine dipstick of > 1+
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| What is HELLP syndrome? | HELLP = HEMOLYSIS, ELEVATED LIVER ENZYMES, LOW PLATELETS.
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| What is the role of magnesium sulfate in the treatment of pre-eclampsia? | PREVENTION OF SEIZURES.
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| What should you teach the woman with mild pre-eclampsia who is being managed as an outpatient? | Check blood pressure 2-4x/day, to rest frequently during the day and in the lateral position for at least 1.5 hours/day. and to report sx that suggest worsening pre-e such as visual disturbance, severe HA or epigastric pain or decreased fetal activity.
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| How often should a diabetic pregnant woman check her blood glucose? | PREGNANT DIABETICS SHOULD CHECK BLOOD GLUCOSE 5-6 OR MORE TIMES/DAY INITIALLY
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| How many meals and snacks should she have a day? | 3MEALS AND 3 SNACKS.
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| What risks of pregnancy are increased in a pregnant woman with pre-existing diabetes? | Insulin requirements increase the most in the second trimester. They are at an increased risk for hypo and hyperglycemia, pre-eclampsia, UTIs, PROM, polyhydramnios and C/S.
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| What are some of the potential fetal and neo-natal effects on infants of diabetic mothers? | LGA OR MACROSOMIA, HYPOGLYCEMIA, HYPOCALCEMIA AND JAUNDICE, INCREASED RISK FOR LUNG IMMATURITY.
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| What topics should you cover in the teaching of a diabetic pregnant woman? | How to check blood glucose, pt teaching on what foods are appropriate to eat and are not, S/S of hyperglycemia and hypoglycsemia
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| What should the FBS be for pregnant women with gestational diabetes? | FBS GOAL <95
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| How much does blood volume increase during pregnancy? How does this impact the woman with heart disease? | 40-50% INCREASES WORK LOAD ON THE HEART;
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| Name 4 signs of CHF in a pregnant woman. | Dyspnea, chest pain, hemoptysis, peripheral edema, sudden weight gain. Riskiest time for acute CHF is during labor and immediately after delivery
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| Your textbook defines anemia in pregnancy as a hct/hgb of: | Anemia is h/h < 32% or hgb < 11 g/dL
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| Why does the risk of DVT increase in pregnancy? | INCREASED ESTROGEN > INCREASED CLOTTING FACTORS, DECREASED ACTIVITY AND DILATION OF BLOOD VESSELS PROMOTES VENOUS STASIS.
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| Folic acid deficiency is associated with what birth defect? | OPEN NEURAL TUBE DEFECTS.
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| What ethnic population is at highest risk for sickle cell disease? | African American
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| How many parents must carry sickle cell trait for the child to have the disease? | Both parents
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| What is the prognosis for a child with Cooley’s anemia? | POOR. CHILDREN RARELY SURVIVE CHILDHOOD.
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| What foods aid absorption of iron? | ACIDIC FOODS LIKE CITRUS.
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| Name the most common side effects associated with TORCH infections in pregnancy. | SAB, CONGENITAL DEFECTS
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| List the TORCH infections. | TORCH – TOXOPLASMOSIS, OTHER, RUBELLA, CMV, HERPES/HEPATITIS B
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| How is Herpes transmitted to the fetus and newborn? | VIRUS CAN CROSS THE PLACENTA IN PRIMARY INFECTIONS. MOST INFECTION OCCURS FROM DIRECT CONTACT WITH AN OPEN LESION.
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| What prophylactic drug is offered to women with herpes at 36 weeks? | acyclovir(Zovirax)
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| What is GBS? | GROUP B STREP. MOST COMMON CAUSE OF SERIOUS NEWBORN INFECTIONS LIKE MENINGITIS AND PNEUMONIA.
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| What disease can be transmitted by cat feces? | TOXOPLASMOSIS
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| Name three categories of bioterrorist biological agents. | A- easily transmitted: small pox, anthrax or tularemia B spread via food and water: Q fever, brucellosis and Staph. Enterotoxin C: Weaponized: hantavirus and tick born encephalitis.
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| Name five symptoms of acute withdrawal in infants born to mothers addicted to narcotics or who are methadone dependent. | Disturbed sleep cycles, irritability, crying, tremors, persistant yawning or sneezing.
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| In FAS what system is most affected in the fetus? | NEUROLOGICAL
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| What are the typical facial features of a child with FAS? | Flat mid face, low bridge of nose, no or indistinct philtrum, small eyes, thin lips, small head and jaw. Growth restriction.
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| What is your priority of care for the pregnant woman with traumatic life threatening injuries? | ALL HANDS GO DOWN WITH THE SHIP, STABILIZE MOM FIRST THEN WORRY ABOUT BABY.
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| Name the three leading causes of traumatic death in women during the child bearing years. | MVA, HOMICIDE, SUICIDE.
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| Name three ways to prevent traumatic injuries to pregnant women. | Seat belts, sensible shoes, steps to avoid falls, high index of suspicion for domestic abuse
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| What nursing interventions are important after a cord prolapse? | Turn mom to side with hips elevated on pillows, in knee chest position, or in trendelenberg and use a hand in the vagina to push the baby up off the cord. Call the OR team STAT for an emergency C/S delivery.
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| When dealing with patients from different cultures what is the most important thing to keep in mind? | There culture, religion and customs about child birth.
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| Name one advantage and one disadvantage of delivering in hospitals or at home. | Hospitals; Adv:better suited for emergencies. Dis Adv: Not a relaxing environment/Cost Home; adv:comfortable/cost Dis adv: Not well suited for emergencies.
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| Describe when laboring women should come into the hospital | Primigravida go to hospital when contractions are five minutes apart for one hour and can no longer walk or talk through contractions (i.e. increased intensity),
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| Why should a woman with SROM go to the hospital even if she is not contracting? | Contractions:5 minutes apart q 1 hour- first labor. 10 minutes apart q 1 hour-second & subsequent labors. Ruptured membranes;feeling of wetness any thought that the water might have broke. Bleeding other than bloody show.Decreased fetal movements (4) Hour
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| What is the difference between true and false labor? How does the nursing care differ? | True:Regular contraction pattern,Close together, Stronger,Last longer, Bloody show False:no bloody show contractions are not patterned and can be decreased in strength and pain.
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| Define effacement and dilation. | effacement is thining of the cervix lining at the os. Dialation is the dialation of the os.
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| What is the difference between latent labor and active labor? |
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| Compare and contrast the care for pt.’s with hypotonic labor dysfunction and hypertonic labor dysfunction. | Hypertonic labor: frequent painful contractions without cervical change (very similar to false labor) encourage rest and offer pain relief.Hypotonic labor dysfunction:Labor starts normally and then stalls out after 4 cm.
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| Name one risk factor for dysfunctional labor. |
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| What part of the skull is used to describe the infant’s “position” in the pelvis during labor? | occipital. Back is diamond
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| What does LOA mean? ROP? | Left Occiptal anterior, Right occipital posterior
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| What are the four P’s? | powers: contractions leading to efacement/dialation.
Passage: pelvis
Passenger: fetus / placenta
psyche: emotional parts of L&D
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| What is a breech presentation and why is it potentially dangerous? | Breech presentations may be frank breech, full breech and footing breeching. Problem with breech is risk of head entrapment with cord compression with part of cord outside of mother’s body. Footing breech also has an increased risk for cord prolapse.
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| What causes labor pain? | Labor pain is caused by stretching of the cervix, vagina and perineum.
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| What is the most important assessment immediately after ROM? | FHR for at least 60 seconds.
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| What are the three phases of the first stage of labor? | Early/latent, active and transition
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| Describe signs of imminent delivery. | grunting sounds, bearing down with contraction, bulging of the perineum, sitting on one buttock.
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| What drug is usually given first to help the uterus contract? | Pitocin
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| What is the most likely cause of hemorrhage post partum? | Uterine atony (boggy uterus)
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| Name three risk factors for postpartum hemorrhage. | Obesity, use of pitocin for induction or augmentation of labor, prolonged labor, previous history of PPH, pre-eclampsia, multiple pregnancy macrosomia,uterine hyperdistension during pregnancy, Grand multiparity >5 delveries. Bleeding disorders
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| What role does the bladder play in affecting uterine hemorrhage? | A full bladder may lift the uterus out of the pelvis and cause uterine atony > hemorrhage.
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| What should you assess after ROM? | FHR. fetal movement, the color, ordor and mount of liquid.
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| What are two signs of maternal infection during labor. | fever above 100.4,
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| Name 3 potential maternal complications from a precipitous labor. Fetal complications? | Maternal fever > 100.4, abdominal tenderness (btn contractions) fetal tachycardia, foul smelling amniotic fluid.
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| What is your priority nursing intervention for a boggy uterus? | Massage the fundus.
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| What are your priority nursing interventions after a pre-eclampsia seizure? | Turn pt to side to prevent aspiration, have suction immediately available tq the bedside if needed, apply O2 at 8-10L/sfm, put up side rails and pad to prevent injury in the event of another seizure.Admin MG sulfate per your standing orders for pre-eclamp
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| Name 5 signs of magnesium sulfate toxicity. | Early signs include excessive thirst and flushing, later signs include absent DTRs, decreased LOC, decreased UO, RR< 12/min.
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| What electrolytes should you monitor in the patient on pitocin and why? | Na and Cl due to fluid retention from pitocin’s ADH like side effects.
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| What risks does pitocin pose for the fetus? |
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| What is the most common side effect associated with terbutaline? | achycardia and palpitations (heart pounding in her chest). Other common SEs include insomnia, anxiety and HA
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| pre-embryonic period | zygontic period 0-2 weeks
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| days of implantation | 6-10
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| embyonic period | 3-8 weeks; all major organ systems formed, very high risk of serious damage if exposed to teratogens
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| nueral tube closes | 4 weeks
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| heart develops 4 chambers | 6 weeks
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| 10 weeks | may be able to hear fetal heart beat with a hand held doppler
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| fetal gender can be visually determined | 12 weeks
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| 16-20 weeks | quickening(first feel baby movemt) percieved by mother
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| 20 weeks | legal age of viability
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| 24 weeks | primitive alveoli begin to produce surfactant
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| 28 weeks | increase in survival rates for premies
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| 32 weeks | increase in variability in fetal heart rate with maturation of autonomic nervous system. surfactant production nearly mature
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| 38-42 weeks | full term baby
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| Placenta function | Produces: -Progesterone -Estrogen -Human Chorionic Gonadotropin (hCG) -Human Placental Lactogen (hPL) -Site of exchange of nutrients, oxygen, and waste products
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| intrathecal injection of opoid analgesic | provides another pain option for pain mgmt without sedation. Injected into subarachnoid space
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| advantages of intrathecal analgesics | rapid onset of pain relief without sedation, not motor block, enabling the women to ambulate during labor, no sympathetic block with its hypotensive effects
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| disadvantages | limited duration of action, possibly requiring another procedure for continued pain relief, inadaquete pain relief for late labor and the birth, requiring another procedure for continued relief.
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| some examples of opiod analgesics include | meperidine(Demerol), Fentanyl, butorphanol, and nalbuphine,
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| drugs used for hyperemesis gravidarum? | Hyperemesis Gravidarum is treated with antiemetics, antiulcer, and corticosteroid agents. Use: manage nausea and vomiting.
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| antiametics used for HG | Antiemetics: promethazine (Phenergan). diphenhydramine (Benadryl). metoclopramide (Reglan). ondansetron (Zofran).
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| anti ulcer drugs used for HG | Antiulcer: Histamine-Receptor Antagonist: famotidine (Pepcid). ranitidine (Zantac).
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| Nsg implications for HG | Assess nausea, vomiting, bowel sounds, and abdominal pain before and following administration.Monitor hydration status, nutrition status and intake and output. Patients with severe nausea and vomiting may require IV fluids.
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| Pt teaching for HG | Small sips of water, small meals 2-3 hours, rid environment of bad odor, sit up after eating, non greasy meals, ^potasium and Mg meals, Oral hygiene, slow movememnt changes, call nurse when ambulate,
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| Antihypertensive agents | Beta Blockers: labetalol, Vasodilators: hydralazine* (Apresoline). give if systolic over 160, diastolic 105. increases blood flow through placenta and increases cardiac output.
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| what is the primary side effect of the opiod anagesics | resp depression
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| what drugs are used to treat opiod pruritis | Diphenhydramine, Atarax/Vistril, Narcan, Nubain
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| what drug should you have immidietly available to treat opiod induced respdepression in the newborn and what dose | narcan 0.1 mg/kg iv
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| what are the potential side effects of a sub-aracnoid block? | Maternal hypotension, bladder distension, Spinal HA
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| which two drugs used for labor pain have opiate agonist-antagonist effects? | Stadol and Nubain
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| what contraindication do they have? | Drug addiction, do not give after a pure opiod, allergies,
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| what drugs are often used to treat n/v in labor may increase the resp depressive effects of opiods | phenegran and hydroxyzine
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| name four interventions for spinal puncture headaches | lie FLAT, hydrate, caffiene, blood patch,
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| what areas does a pudendeal block numb? | lower vagina and part of the perineum
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| what are the potential complications of pudendal block? | toxic reaction, rectal puncture, hematoma, sciatic nerve block,
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| what are the major adverse effects associated with general anesthesia during c/s | aspiration, resp dep, uterine relaxation which may lead to post op hemmorhage
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| when is the neonate is the most likely to be affected by pain medication administered at what times? | less than four hours before delivery, baby born at the peak of drug action
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| how does epidural anesthesia affect the fetus? | epidural causes decrease in BP that may cause hypotension and lead to decreased placental circulation>> fetal distress, TX by iv fluid bolus
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| what is the right amount of iv fluids to admin before an epidural block | 500-1000ml
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| what sensations should you tell a women she might feel during placement of the epidural catheter? | feels like a breif electric shock,
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| how often should you assess vital signs after placement of a epidural block | Q 2-3mins for 15-20 mins after initial dose.
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| what drug should be available to counterat epidural induced hypotension during labor? | Ephedrine
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| what defines a significant decrease in BP during epidural pain mgmnt | SBP < 100 or more than 20% from baseline
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| what is the indication for narcan | severe resp depression r/t opoid overdose
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| what is the duration of action | 5-20 mins, duration of action of opiods may outlast narcan
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| what is the dose for a neborn | 0.1mg/kg
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|
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| name two short acting insulins? | Regular and Aspart..Short Acting (IV/SQ): regular insulin (Humulin R, Novolin R, Iletin II Regular).
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|
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| name two medium acting insulins | NPH and Lente
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|
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| 2 long acting insulins | insulin glargine (Lantus)and Ultra-Lente, insulin determir (Levemir)
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|
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| which are clear and which are cloudy? | Regular- clear, NPH-cloudy
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|
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| when mixing in one syringe which goes first | clear to cloudy( just like WA every ten mins)
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| when are the inuslin doeses administered? | Prior to breakfast: combination of short-acting (Regular) and intermediate-acting (NPH). Before dinner: short-acting (Regular).Bedtime: intermediate-acting (NPH).
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| insulin NSG implications? | S/S hypoglycemia,Assess serum electrolytes, ketones, glucose and glycosylated hemoglobin throughout therapy, MO daily weights,Maintain normal blood glucose levels.
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| what is the most commonly used drug for induction and augmentation of labor contractions? | Pitocin
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|
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| why is the oxytocin line inserted in the primary iv line in the port closest to the patient? | to limit the amount of drug infused after changing to a non additive solution.
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|
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| At what point during labor is it common for the oxytocin to be stopped or decreased | when there is not break between contractions.
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| name three signs of hypertonic uterine activity that would tell you to stop pitocin | contractions< 2 mins, interval< 60 seco, duration of contractions> 90-120 sec or increased resting tone greater then 20.
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| name three contraindications to starting pitocin | placenta previa, non-reasuring fetal heart tones, breech or prolapsed cord, active HSV lesions, previous uterine scar/incision. known pelvis abnormalities.
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| what should the nurse do if a patient on pitocin deminstrates hypertonic contactions? | stop pitocin, turn pt to left, give O2 at 8-10/min, doc might order terbutaline or other tocylitic.
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| Why is recording I&O important for the patient on oxytocin | oxytocin acts like ADH, Fluid retention, water intoxication
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|
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| what drugs are used in the treatment of hyperemesis | anti-emetics, ant acid, proton pump inhibitor- (prilosec), steriods
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|
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| according to murray what three anti hypertensives are most often used to treat BP in severe pre eclampsia? | Labetalol, apresoline, nifidipine- used to stop contractions.
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|
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| How does apresoline work? what effects does it have on perfusion? | vaso dilator, increases it. also increases cardiac outpu without increasing cardiac workload
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|
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| why is mag sulfate used in treatment of pre-eclampsi? | to prevent seizures
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|
||||
| Name three important actions/uses of mag sulfate? | tocolytic, anti-convulsant, antihypertensive
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|
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| early & late pregnancy anti hypertensives | early cronic htn- aldomet.
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|
||||
| what is the serum therapeutic level of magnesium sulfate? | 4-8mg/dl
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|
||||
| what is the most important adverse effect of MG sulfate | Resp depression
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|
||||
| what is the antidote for MG toxicity | Calcium gluconate slow IV push
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|
||||
| Name four key nursing assessments for the patient on MG sulfate iv for pre-eclampsia | BP< RR< DTR's*, UO<30hr are high risk for mag toxicity, and lung sounds, LOC
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|
||||
| Name 4 signs of MG toxicity? | flushing/sweating, Abscent or decreased DTR's, decreased BP, Resp depression <12,
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|
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| What is the drug of choice for mgmt of hypertension in early pregnancy? | Aldomet
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|
||||
| What is your priority of care for the patient with Pre-E | Preventing seizures
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|
||||
| Name three times other than after childbirth, when Rhogam is indicated | after SAB, After intrauterine procedures like CVS
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|
||||
| in what time frame should rhogam be given? | at 28 weeks and within 72 hours of birth.
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|
||||
| will rhogam administration improve fetal outcomes in women who are already sensitized to RH protien | NO!
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|
||||
| name 5 signs of over Anti-coag medication? | Bleeding gums, nosebleeds, easy brusing, blood in uring or stool, increase in vaginal bleeding
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|
||||
| What lab should you moniter during heparin therapy? | PTT
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|
||||
| what should you teach your patient on anti-dysthrythmics aboout taking ther meds? | Do not chew or crush tabs, do not skip does, do not double up if you miss a dose.
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|
||||
| Why is delaying preterm birth advantageous to the baby? | it allows time to admin steriods which act to mature the fetal lungs and may also decrease the risk for resp distress syndrome.
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|
||||
| what are four categories of drugs used in tocolysis? | beta adrenergics like terbutaline, MG sulfate, nsaids like Indomethacin, Calcium channel blockers like Procardia.
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|
||||
| Name three common side effects of Terbutaline | Tachy, Hyperglycemia, anxiety, palpations, Headache, and elevated blood sugar.
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|
||||
| name three common side effects of MG sulfate? | flushing, blurred vision, Low DTR, Resp dep,
🗑
|
||||
| name three potential side effects of indocin? | constriction of Ductus Arteriosis, hypertension, olighydramios, low blood clot factors
🗑
|
||||
| name three potential common side effects of procardia? | maternal flushing, dizziness, Hypotension, Tachy, Orthostatic hypotension.
🗑
|
||||
| name three common side effects of steroids? | High WBC count, hyperglycemia, fluid retention, insomnia/anxiety, * can mask sysptoms of infection.
🗑
|
||||
| name four drugs used to manage postpartum hemorrhage? | Pitocin, cytotec(misoprostol), methergine and hemabate(carboprost)
🗑
|
||||
| name the major contraindication to methergine? | Hypertension or Corincary artery disease or vascular disease
🗑
|
||||
| name the major contrindication to hemabate? | history of asthma,
🗑
|
||||
| What are the most common side effects to hemabate? | Fever/chills, DIARRHEA, N/V, Headacher/t hyper or hypo Tension.
🗑
|
||||
| Bethamethasone | prevention of RDS in pre-term infants
🗑
|
||||
| MG sulfate | prevention of seizures in pre-e
🗑
|
||||
| Terbutaline | stops or slows contractions in preterm labor
🗑
|
||||
| hemabate/ prostin | treatment of postpartum atony and hemorrhage
🗑
|
||||
| stadol | narcotic agonist/antagonist
🗑
|
||||
| cytotec/misoprostol | cervical ripening and induction of labor
🗑
|
||||
| pitocin | induction or augmentation of labor
🗑
|
||||
| rhogam | prevents RH iso-immunization in RH- mothers
🗑
|
||||
| what is the major adverse side effect for prostaglandin | no breaks between contractions.
🗑
|
||||
| what is the major adverse side effect for prostaglandin | no breaks between contractions.
🗑
|
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