Baby, Drugs Psych tips Flashcards
What do you do for Low Fetal HR <110?
LION
Left side
IV
Oxygen
Notify HCP
Stop Pitocin first if running
What do you do for High Fetal HR >160?
Document acceleration of fetal HR
Not a high priority and baby is WNL
What do you do for Low Baseline Variability?
LION and stop Pitocin first if running
What do you do for High Baseline Variability?
Document findings because this is good since baby HR is changing
What do you do for an early deceleration?
This is normal
Generally caused be head compression
What do you do for variable deceleration?
VERY BAD
Prolapsed cord/cord compression
Push baby head off the cord and then position mom in knee-chest of trundleberg position
What do you do for late decelerations?
BAD
Placental insufficiency
LION and stop Pitocin first if running
REMEMBER VEAL CHOP
Variable decels …… Cord compression
Early decels….. Head compression
Accelerations…. OKAY
Late decels….. Placental insufficiency
During the second stage of labor what are the order of events?
Deliver the head - mom stop pushing
Suction baby mouth then the nose
Check for nuchal (around the neck) cord
Deliver the shoulders then body
Baby MUST have ID band on before leaving L&D area
What should you look for in the third stage of labor?
Delivery of the placenta
Make sure the placenta is complete and intact
Check for 3 vessels, 2 arteries and 1 vein. AVA
There are ____ things you do in the 4th stage ____ times an hour. What are they?
There are 4 things you do in the 4th stage 4 times an hour.
- VS - assess for shock, BP decreases and HR increases, pt looks cool, clammy and pale
- Fondus - if its boggy, massage it. If its displaced, catheterization
- Check perineal pads - excessive bleeding if pad saturated in 15 minutes or less
- Roll patient over and check for bleeding underneath
What does BUBBLE HEAD stand for?
Breasts
Uterine fundus
Bladder
Bowels
Lochia
Episiotomy
Hemoglobin/hematocrit
Extremities
Affect
Discomforts
What are you looking for in regards to uterine fondus?
Fondus should be FIRM
Height of fondus should be at the navel and decrease 2 cm per day
If boggy, massage it
If displaced and boggy, catheterization
What is lochia? What should you monitor?
Vaginal discharge
Rubra - red
Serosa - pink
Alba - white
Moderate - 4-6 inches on pad in hour
Excessive - saturate a pad in 15 minutes or less
What are you looking for in the extremities are labor?
Thrombophlebitis
The best way to monitor for this is to measure bilateral calf circumference
What are normal variations in a baby?
Milia - white spots
Epstein pearls - palatal cysts/deposits
Mongolian spots - bluish discoloration
Erythema toxic neoratorum - normal newborn rah. Pick each with firm yellow/white papule
Hemangioma - abnormal accumulation of blood vessels in skin. Most common birth mark
Vernix - white secretions
Acrocyanosis - blue discoloration of hands/feet
Nevi - stork bites. Easily blanched lesion and disappear by 2
Port wine stain/nevus flemus - red to purple in color and does not blanch
Cephalohematoma is…
Collection of blood between the periosteum of skull bone and bone itself
Occurs in one or both sides of head but does not cross the midline
Devleops within 24-48 hours
What is Caput Succedaneum?
Edema of the scalp of the neonate during birth from mechanical trauma of scalp pushing through narrow cervix
Crosses the suture lines and caput symmetrical
What are totolytics? What are 2 that are used in labor?
Given to women in premature labor that must be stopped
Terbutaline
Mg Sulfate
What is a side effect of terbutaline?
Maternal tachycardia
What is a side effect of Mg sulfate?
Hypermagnesemia –> going goes down
Decreased HR, decreased BP, decrease reflexes, decrease LOC
Really important to monitor RR and reflexes
If RR<12 then decrease dose
If reflexes 0, +1 then decrease dose
If reflexes +3, +4 then increase dose
What are oxytoxics? What are 2 commonly used in labor?
Stimulate and strengthen labor
Pitocin
Methergine
What are SE of Pitocin?
Uterine hyperstimulation - longer than 90 seconds, closer than 2 minutes
If this occurs then lower the Pitocin
What are SE of methergine?
HTN
What are two medications used to to babies lung mature?
Betamethasone - given IM to mother while baby is in utero. SE: increased glucose
Surfactant - given to baby after birth via transtracheal route
What is humalin 70/30?
Mix of N and R
70% N and 30% R
The numerator is on top of so is N
How do toy mix insulin in the same syringe?
Clear before cloudy OR RN R before N
Which needle would you pick for an IM injection?
21 gauge that is 1 inch long
What needle would you use for an SubQ injection?
25 gauge that is 0.5 inches
Heparin route? Onset? How long can it be used? Antidote? Labs? Pregnancy?
IV or SubQ
Works immediately but cant be used for more than 21 days (except lovenox)
Antidote is protamine sulfate
Labs: PTT
Can be used in pregnancy
Warfarin route? Onset? How long can it be used? Antidote? Labs? Pregnancy?
PO
Takes a few days to a week to work but can be used for entire life
Antidote: vitamin K
Labs: PT/INR
Cant be used during pregnancy
What is the only antipsychotic drug that can be given in pregnant women?
Haldol
How do you know if a diuretic is potassium sparing or wasting?
Any diuretic that ends in X, Xes out K –> wastes K PLUS Diuril
Lasix (furosemide), Bumex (bumetanide), clotrix (clotrimazole), Esidrex (hydrochlorothiazide), Demadex (thosemide), Diuril (chlorothiazide)
What are baclofen and cyclobenzaprine?
Muscle relaxers
SE: fatigue/drowsiness and muscle weakness
Teaching: don’t drive, don’t drink, don’t operate heavy machinery
How do you teach a child that is in sensory motor (0-2)?
You can only teach them in the present
Teach them what you are doing as you are doing it. Use words b/c they don’t understand play
How do you teach a child that is in preoperational (3-6)?
They are fantasy oriented, imaginative, illogical, and their thinking obeys no rules but they do understand future/past
Teach them what you are going to do before (morning of, day of, 2 hours before) you do it with play
Don’t want to teach them too far in advance because they are in the imaginative stage and can imagine the worst
How do you teach a child that is in concrete operations (7-11)?
Rule-oriented, live and die by rules, cannot abstract think, only one way to do things
Teach then a day or two ahead of time and teach them by using age appropriate reading and demonstration (skills)
How do you teach a child that is in formal operations (12-15)?
Can think abstract and think about cause and effect
AS SOON AS children become 12, teach them like an adult
When can a child first manage their own care?
at 12 years old
Before 12 they can help with tasks but after 12 they can actually manage their can meaning they know you can do when you can, and seek help when you cannot
What are 7 principles to answering psych questions?
Know what phase of the relationship you are in
Don’t give/accept gifts
Don’t give advice
Never guarantee anything (if you cry it’ll make you feel better)
Immediacy (between 2 answers pick the one that keeps them talking and don’t refer anyone)
Concreteness (psych pts take you literally so no figures of speech)
Empathy (chose the answer that focuses on the patients feeling that were displayed in what the patient said, don’t focus on what the patient said)
