Exam 2: Meds/newborn reflexes & tests Flashcards
Pitocin
prevents/treats hemorrhage; Pitocin 10-40 units in 500-1,000 mL LR IV bolus; can do 10 units IM without IV access
Methergine
treats hemorrhage, 0.2 mg IM
Contraindications: hypertension
TXA
1 g in 100 ml NS IV over 10 minutes, repeat in 30 minutes if not effective
Given during first 3 hours after birth
Cytotec
give 800-1000 mcg SL, buccal, or rectally
Hemabate
treats hemorrhage, give 250 mcg IM, intracervical, or intrauterine
Contraindications: primary = asthma; can cause diarrhea, so have an order for imodium
Ephedrine
5-10 mg IV for maternal hypotension (epidural)
Narcan
0.1mg/kg Q5min PRN for neonates with confirmed opioid exposure and struggling to transition
don’t use often, typically intubate
ambien
5-10 mg PO sedative for prodromal
Benefits: decreases anxiety, allows for rest, inhibits UC (therefore good for prodromal labor)
Risks: neonatal CNS depression, maternal response can vary
benadryl
20-50 mg PO
Benefits: induces relaxation and sleepiness (good for early labor when mom is exhausted)
promethazine (phenergan)
12.5-25 mg IM or PO antiemetic
Benefits: relieves nausea, vomiting; decreases anxiety; does not relieve pain, but potentiates narcotic
fentanyl
50-100 mcg IVP Q10-15 minutes x 5 doses
Onset: rapid; crosses placenta and is in fetal circulation within a minute of admin
Half life: 2-4 hours
** used often bc of it’s fast onset, short half life, and lack of metabolite; downside is short duration, so needs more frequent doses
morphine sulphate
2 mg IV + 10 mg IM with PO phenergan for prodromal labor (false contractions)
Onset: 10-30 min
Half life: 2-4 hours
Duration: 4-5 hours
nalbuphine
5-10 mg IVP partial opioid agonist
Onset: 2-3 min
Half-life: 3.5-5 hours
Since it’s a partial agonist, provides good analgesia without causing significant respiratory depression in the mother or neonate
Ceiling effect, so additional doses after 30 mg don’t increase respiratory depression
ADRS: drowsiness, dizziness, decreased FHR; less likely to cause n/v, but sedative effects may be greater
opioid benefits/risks
pain blunting effect → increased relaxation between UCs; neonatal CNS/respiratory depression, absent/minimal variability during labor; risk of maternal respiratory depression, bradycardia, hypotension, decreased GI motility
Opioids inhibit uterine contractions, which can prolong labor; should not be administered until later in labor unless they are used to help mom rest during a prolonged latent phase of labor
nitrous oxide
MOA: unknown… may stimulate endogenous endorphin, corticotropins, and dopamine release; dulls perception of pain
fast on/off (30 secs), self-admin (must hold mask), no effect on fetus, can be used in all stages, fall precautions
epidural
continuous injection of pain medication (narcotic +/- “-caine”) into epidural space between L2 and L4 vertebrae t/o labor; has a T8-S5 blocking effect. takes longer to take effect
(walking epidural is without the “-caine”)
Contraindications: allergy to agent, clotting disorders, hx of spinal injury or abnormality
Advantages: good pain relief, assists with coping, mom’s awake, dose can be continuously adjusted, avoids general anesthesia if end up having unplanned c/s, results in vasodilation, which increases placental perfusion and decreases maternal HTN for a time
spinal
Onset: immediate, lasts 1-3 hours
Mostly used for c/s, but can be used for vaginal delivery
Lower risk of failure, smaller drug volumes
Complications:
Inadequate block: “hot spot,” one sided, block failure
Breakthrough pain: full bladder, complete dilation, uterine rupture
Procedure related events: nerve root injury, accidental dura puncture, intravascular injection
Sympathetic nerve blockade:
Maternal hypotension leads to late decelerations: tx with ephedrine 5-10 mg IV and fluid bolus, side-lying position, face mask
Urinary retention- foley placement
Fever: possible similar to spinal cord injury
Itching: treat with Nubain or benadryl
betamethasone
Speeds up fetal lung maturity –> given prophylactically if PTL expected
Two 12-mg IM doses 24 hours apart
erythromycin ointment
¼ inch strand, w/in 1 hour of life to prevent infx
Vitamin K
0.5-1 mg IM in vastus lateralis
Neonatal concentration 1 mg/0.5 ml
sterile neonate gut doesn’t produce endogenously
Hep B
1st of 3 IM in vastus lateralis
Rooting:
stimulate cheek, baby turns towards side of stimulation with open mouth
Sucking:
touch roof of mouth, baby should suck
Moro:
startle reflex, lift up baby’s arms, should spazz out a bit
Palmar grasp:
place finger in palm, baby should grasp
Step reflex:
hold up baby vertically, will step
Tonic neck (fencing reflex):
turn baby’s head to one side; arm on that side will extend
Galant:
baby is supine, stimulate baby on lateral abdomen, leg will go towards that side
Plantar grasp:
place finger on bottom of foot near toes, toes should wrap around finger
Babinski:
stimulate up the baby’s foot, toes will splay out
Protective reflex:
gently cover baby’s eyes and nose with cloth, baby should try to move cloth away with hands
Danger/warning signs to teach for discharge
Vomiting (more than 1 feeding)/ Refuses to feed
Difficulty breathing
Drastic behavior changes to irritable or overly sleepy
Inability to void/ Diarrhea
Axillary temperature of 99.6 F or higher
Change in skin color- pale white, blue or yellow
Rashes
Umbilical stump infection signs- foul discharge, redness around site
Drainage from eyes or ears
Physiological jaundice
“normal” incompetent liver and slow gut in neonate
> 24 hours but <2 weeks (usually 3-4 days)
increase feeds and prevent cold stress
RBC lysis, impaired transferase, reabsorption of bili through gut from slow motility
Pathological jaundice
“abnormal” from trauma at birth/maternal source
<24 hours or longer than 2 weeks
phototherapy or exchange transfusions (rare & dangerous)
ABO, hemolytic, DM, cephalohematoma/ecchymosis, sepsis/infx, preemies
Breastfeeding jaundice
2-5 days
inadequate feeds –> insufficient calories/stools
RN –> support feeds and strict monitor I/Os
Breast milk jaundice
5-10 days
after milk lets down –> increased fatty acids that inhibit conjugation
Resuscitation for non-reassuring fetal heart tones
Position change
Check BP (hypo –> bolus & ephedrine)
Cervical exam –> prolapsed cord, rapid descent
Prep for possible amnioinfusion
Alter pushing pattern (every other)
IV bolus
Help!
notify MD & immediate eval
assess for tachysystole –> turn off pitocin + consider terbutaline
NST
electronic monitoring for 20-40 min
most accurate measurement of fetal well-being
adequate oxygenation with activity and stimulation
Reactive NST
In pregnancies > 32 weeks
>15 BPM above baseline for >15 sec
In pregnancies 28-32 weeks
>10 BPM above baseline for >10
Non-reactive NST
Insufficient accelerations in 40 min
Needs follow up testing
BPP
Biophysical profile
US measuring breathing movement, fetal movement, tone, and amniotic fluid volume
8-10/10 normal oxygenated, low risk of asphyxia
6/10 possible asphyxia
0-4/10 very worrisome
CCHD
screen at 24 hours to compare oxygenation in a pre-ductal limb (right wrist/hand) to a post-ductal limb (lower extremities)
pass if one above 95% and less than 3% difference between the two
recheck if 90-95% or greater that 3% difference
less than 90% = fail
recheck Qhr until pass, fail after 3 hours
Category I (fetal monitoring)
Baseline (110-160)
Moderate variability
No late or variable decelerations
May have early decel or accel
Category III (fetal monitoring)
Either
Absent variability (w/recurrent lates, variables, brady)
Or sinusoidal
