Exam 1 Flashcards
Pitocin MOA
Synthetic oxytocin
Stimulates uterine contraction (CTXN) and milk let-down
When is Pitocin used
Induction of labor
Postpartum hemorrhage (PPH)
Pitocin route and dosages
IV
Induction: 1-2 milliunits/min, increased every 15-20 mins
PPH: 125-200 milliunits/min or 10-20 units IM
Nursing considerations for Pitocin
Monitor FHT and CTXN q 15 mins
Monitor for uterine tachysystole - more than 5 contractions in 10 mins over 30 min window
Decrease Pitocin if uterine tachysystole or baby distress occurs
Cytotec (misoprostol) uses
Cervical ripening
Tx for postpartum hemorrhage
Cytotec (misoprostol) routes
Oral, vaginal, rectal
Cytotec (misoprostol) adverse effects
H/A
N/V/D
Fever/chills
Nursing considerations for Cytotec (misoprostol)
For:
Cervical ripening - continuous fetal monitoring
Postpartum hemorrhage (PPH) - monitor vaginal bleeding and uterine tone
Methergine (methylergonovine) uses
Tx of uterine atony (soft uterus) and PPH (postpartum hemorrhage)
Methergine (methylergonovine) route and dose
0.2 IM q 2-4 hours
Up to 5 doses
Methergine (methylergonovine) adverse effects
HTN & hypotension
N/V
H/A
Tinnitus
Dizziness
Contraindications for Methergine (methylergonovine)
HTN or pregnancy induced HTN - AE
Preeclampsia
CVD
Lactation
Nursing considerations for Methergine (methylergonovine)
Check BP before giving (do not give if >140/90)
Monitor vaginal bleeding and uterine tone (therapeutic effect)
Hemabate (carboprost/15methyl pg f) uses
Postpartum uterine bleeding r/t uterine atony
Hemabate (carboprost/15methyl pg f) route and dose
0.25 mg (250 mcg) IM q 15-90 mins
Hemabate (carboprost/15methyl pg f) adverse effects
Explosive diarrhea
N/V
H/A
Fever/chills
Tachycardia
HTN
Contraindications for Hemabate (carborprost/15methyl pg f)
Asthma
HTN
Cardiac, pulmonary, or hepatic disease
Nursing considerations for Hemabate (carboprost/15methyl pg f)
Administer with antidiarrhea (adverse effect)
Monitor vaginal bleeding and uterine tone (therapeutic effect)
TXA (Tranexamic acid) use
PPH
TXA (Tranexamic acid) route and dose
1g slow IV injection
Mixed with 50 or 100 mL IVF
- Administer over 10 minutes
TXA (Tranexamic acid) adverse effects
Hypotension
Visual abnormalities
N/V/D
Anaphylaxis
Contraindications for TXA (Tranexamic acid)
Hx or risk of thromboembolic disease
Caution with pt with renal impairment
Nursing considerations for TXA (Tranexamic acid)
Monitor hemodynamic - assessing for thromboembolic events (contraindication)
Magnesium sulfate MOA
CNS depressant
Relaxes smooth muscle - uterus
Magnesium sulfate uses
Preterm labor
Pregnancy induced HTN
Preeclampsia
Magnesium sulfate route
IV
Magnesium sulfate doses
Loading dose: 4-6g over 20-30 mins
Maintenance dose: 1-4 g/hr
- D/c within 24-48 hrs
Limit of 125mL/hr
Magnesium sulfate adverse effects
Maternal
- Hot: Flashes, sweating, burning IV site, dry mouth, drowsiness, blurred vision, H/A, weakness, lethargy, dizziness
- Hypocalcemia
- Transient hypotension
- Dyspnea
Intolerable AE
- RR less than 12/min
- Pulmonary edema
- Absent DTR’s
- Chest pain
- Severe hypotension
- Altered LOC
- UOP less than 30mL/hr
- Serum Mg 10 mEq or more
Fetal
- Decreased FHR
- Decreased fetal movement
Antidote for magnesium sulfate overdose
Calcium gluconate
Nursing considerations for Magnesium sulfate
Monitor DTR’s
- Increased = low Mg, Decreased = high Mg
Foley for strict I/O’s
D/c infusion if intolerable AE occur
Contraindications for Magnesium sulfate
Myasthenia gravis
Hypocalcemia
Renal failure
Brethine (terbutaline) MOA
Relaxes smooth muscle
Inhibits uterine activity
Causes bronchodilation
Brethine (terbutaline) uses
Tx of preterm labor
Brethine (terbutaline) route and doses
SQ
0.25 mg q 4 hours
Not for more than 24 hours
Contraindications for Brethine (terbutaline)
Dilated to over 4 cm
Suspected heart disease (AE)
Pregestational or gestational diabetes (AE)
Preeclampsia/eclampsia
Hyperthyroidism
Glaucoma
Seizure disorder
Brethine (terbutaline) adverse effects
Maternal
- Tachycardia, palpitations, chest discomfort
- Tremors, dizziness, nervousness
- H/A
- N/V
- Hypokalemia, hyperglycemia, hypotension
Intolerable
- Tachycardia over 130
- BP lower than 90/60
- Chest pain (not just discomfort)
- Cardiac arrhythmias/MI
- Pulmonary edema
Fetal
- Tachycardia
- Decreased FHR variability
Nursing considerations for Brethine (terbutaline)
Notify provider of intolerance adverse effects
Typically continuous fetal monitor is required
Procardia (nifedipine) MOA
Relaxes smooth muscle (uterus) by blocking calcium entry
Procardia (nifedipine) route and dose
PO
Initial dose: 10-20mg q 3-6hrs - until contractions are rare
Maintenance dose: 30-60mg q 8-12 hrs
Procardia (nifedipine) adverse effects
Maternal
- Hypotension
- H/A
- Flushing, dizziness, nausea
Fetal
- Hypotension
Contraindications for Procardia (nifedipine)
Intrauterine infection
HTN, cardiac disease
Do not give with magnesium sulfate (calcium is the antidote)
Do not give with or immediately after Brethine (terbutaline)
Do not give sublingual
Betamethasone or Dexamethasone MOA
Glucocorticoid
Stimulates fetal lung maturity by promoting the release of enzymes that produce lung surfactant
Betamethasone or Dexamethasone use
Prevent/reduce respiratory distress syndrome (RDS) in infants 24-34 weeks gestation
- Off label use
Betamethasone or Dexamethasone route and dose
IM
Betamethasone: 12mg in 2 doses, 24 hours apart
Dexamethasone: 6mg in 4 doses, 12 hours apart
Nursing consideration for Betamethasone or Dexamethasone
Must be given IM (ventral gluteal or vastus lateralis)
Assess BG in pt with gestational/pregestational diabetes
Narcan (naloxone hydrochloride) use
Reverse opioid induced respiratory depression in mother or newborn
Narcan (naloxone hydrochloride) routes
IV, IM, or SQ
Narcan (naloxone hydrochloride) doses
Adult: 0.4-2 mg q 2-3 min until 10mg
Infant: 0.1 mg/kg for infants over 5 kg
Narcan (naloxone hydrochloride) adverse effects
Hypotension or HTN
Tachycardia, hyperventilation
N/V
Sweating, tremors
Nursing considerations for Narcan (naloxone hydrochloride)
Delay breastfeeding for 2 hrs after last dose
Do not use if mother or baby is opioid dependent
Rhogam (rhophylac) MOA
Concentrated immunoglobulin
Suppresses immune response in nonsensitized Rh-negative women who may have infant with Rh-positive blood
Rhogam (rhophylac) use
Prevents the production of anti-Rho(D) antibodies in Rh-negative mothers
Contraindications for Rhogam (rhophylac)
Rh positive moms
Sensitized moms (have anti-Rho(D) antibodies)
Rhogam (rhophylac) route
IM - deltoid or gluteal muscle
Rhogam (rhophylac) administration considerations
All Rh-negative moms receive dose 28 wks antepartum
All Rh-negative moms with Rh-positive baby receive 2nd dose within 24 hrs of delivery
Rh-negative moms with invasive testing or could mix blood with fetus receive it
Nursing considerations for Rhogam (rhophylac)
Observe for 20 mins after administration for reaction
Document lot and expiration date
Made from human plasma - Jehovah’s Witness
Rubella vaccination uses
Provides immunity to non-immune mothers
Nursing considerations for Rubella vaccination
Do not give to pregnant pt
Give postpartum
Do not get pregnant for 28 days after administration
Breastfeeding is ok (does not pass through breast milk)
If given with Rhogam check titer after 3 months
Do not give if living with immunocompromised person
Congenital Rubella Syndrome (CRS) birth defects
Hearing loss
Eye defects
Heart defects
Developmental delays
Neurological defects
- Also miscarriage if rubella is contracted in early pregnancy
Rubella infection effects on the mother
Mild illness
Arthritis/Arthralgia
Rare - encephalitis or thrombocytopenia
Risks of rubella infection across each trimester
1st: Highest risk for severe fetal effects
2nd: Risk of CRS decreases, but still significant
3rd: Risk is lower, but can still cause late-onset issues
Antepartum
During pregnancy
Nagele’s rule
How to determine due date
Last menstrual period - 3 months + 7 days = Estimated date of confinement (EDC)
Gravida
Number of pregnancies, regardless of outcome
Para
Term: After 37 wks
Preterm: 20-36 6/7 wks
Abortion: Spontaneous (miscarriage/SAB) or elective (EAB)
Living: Living children
What does G1 P2 mean
Twins
Fundus
Top of uterus
Fundal height
Should measure in cm how many wks pregnant you are
18 cm = 18 wks
Intrapartum
During labor
Tocodynamometer (toco)
External monitoring during labor
Measures uterine activity
Strapped directly over fundus
Records activity on bottom line of strip
Where are FHT best heard
Posterior chest wall of fetus
How often are cervical assessments done
q1-2h
Sterile vaginal exam
Assessing for: Dilation, effacement, station (baby head placement), membrane status
First Leopold’s maneuver
Palpate upper abd with both hands
Head = firm
Butt = soft
- Feeling if baby is head down or breach
Second Leopold maneuver
Move hands towards pelvis
Back = smooth
Feet/arms = Bumpy
Third Leopold maneuver
Palpate symphis pubis to see if fetal head is engaged
Fourth Leopold maneuver
Face towards woman’s feet, at their head
Move hands from upper to lower abd, feeling for fetal head
Post partum assessment acronym
Breasts
Uterus
Bowels
Bladder
Lochia (discharge after birth)
Episiotomy/laceration/C section
Involution
The rapid reduction of uterus size and return to similar prepregnancy state
- Takes ~6wks
What should the fundal position be immediately after birth
Midway between symphysis pubis and umbilicus
What happens to fundal position 6-12 hrs after delivery
Fundus rises back to the level of the umbilicus
When does fundus start to descend
Descends 1cm or 1 fb per day on the first postpartal day
Boggy fundus
Fundus rises as it fills with blood and clots
When the uterine muscles fail to contract properly, the fundus becomes boggy instead of firm
What is the intervention if fundus is high and deviated to the right
Have pt empty bladder
Rubra
Type of Lochia
Bright red
First 2-3 days
Serosa
Type of Lochia
Light pink or brown
Days 4-10
Alba
Type of Lochia
Creamy yellow
Days 11 - 4 wks
Normal RR for newborns
30-50 breaths per min
60-70 during delivery
Acrocyanosis
Peripheral cyanosis, normal finding
Abnormal findings for newborns
Retractions, grunting, nasal flaring
- Indicate respiratory distress
Normal types of breathing for newborns
Diaphragmatic (diaphragm breathing)
Shallow/irregular
Synchronous chest movement
Short episodes of apnea
Nose breathers
Normal neonatal HR
120-130
100 when sleeping
120-160 when awake
180 when crying
What does vitamin K injection do for babies
Activates coagulation factors
Without it babies have risk of bleeding - no surgery/procedures
What babies are at risk for bleeding
Moms who took:
Dilantin or Phenobarbital
Heparin
Aspirin
Meconium stool
Thick, tarry stool formed in utero
Consists of amniotic fluid and mucus cells
Released in utero with fetal distress
Transition stools
Thin, brown green
Day 2-3
Breastfed: Yellow
Bottle: Pale brown
How many stools/day is normal
2-3, up to 10 stool per day
How often is Apgar score done
1 min and 5 mins
Normal neonatal length
18-22 inches
Normal BPD (biparietal diameter) for neonates
32-37 cm
Normal head measurement for neonate
2cm more than chest
Normal chest measurement for neonates
30-35 cm
Neonatal temperature
97.7-98.6
Q15mins for first hour, then Q1H for 4hrs
What does a decreased temp indicate in babies
Infection
What does increased temp indicate in babies
Dehydration/overheating
Normal BP for newborns
80-60/45-40 at birth
100/50 at day 10
Mottling (newborn)
Lacy pattern of blood vessels due to circulation fluctuations
Harlequin sign
Deep red color on one side
Lasts 1-20 mins
Due to vasomotor instability
No clinical significance
Erythema toxicum
A perifollicular eruption of skin lesions
Firm, vary in size white/yellow papules
“newborn rash” no tx
Vernix
White, cheesy substance lubricates the skin and provides protection
Milia
Sebaceous glands
White spots
No tx necessary
Telangiectactic nevi
“stork bites”
Pink/red spots
Found on nose, eyelids, neck, occipital bone
Disappears by 2nd birthday
Mongolian spots
Areas of blue/black pigment on buttock
Common in darker skin
Disappears by age 2
How many arteries and veins does umbilical cord have
2 arteries, 1 vein
(2 areolas, 1 vagina)
When does the cord start to dry
Within 1-2 hours
When does cord start to slough off
7-10 days
Hypospadius
Newborn male
Urinary meatus on ventral side
Epispadias
Newborn male
Urinary meatus on dorsal side
Phimosis
Newborn male
Foreskin cannot be pulled over glans
Hydrocele
Collection of fluid surrounding testes in the scrotum
When is circumcision performed
After 24 hrs of birth, day of discharge
After vitamin K
Stable temperature
Potential side effects of circumcision
Hemorrhage
Infection
Difficulty voiding
Discomfort
Adhesions
Entrapment and urethral damage
Comfort measure for circumcision
Sucrose water on pacifier
Signs of distress in neonates
Respirations under 60
Sternal retractions
Cyanosis
Abd distention
Failure to pass meconium - increased bilirubin
Temp below 97.7
Glucose below 40
Vomiting green
Jaundice within 24 hrs
Wharton jelly
Mucoid connective tissue that surrounds the two arteries and one vein of the umbilical cord
