🤰🏾- Exam 3 Flashcards
0
Q
Risk factors of ectopic pregnancy
A
- hx of previous ectopic pregnancy
- hx of std’s
- multiple partners
- tubal sterilization
- infertility
- IUD
- multiple induced abortions
- assisted reproductive techniques
- infection/inflammation
1
Q
What are the 6 types of spontaneous abortion
A
Threatened- vaginal bleeding occurs
Inevitable- membranes rupture and cervix dilates
Incomplete- dorm products of conception have been expelled but some remain
Complete- all products of conception are expelled from the uterus
Missed- fetus dies during the first half of pregnancy but is retained in the uterus
Recurrent- 3 or more spontaneous abortions
2
Q
Signs of ectopic pregnancy
A
Missed menstrual period
Positive pregnancy test
Abdominal pain
Vaginal “spotting”
3
Q
Linear salpingostomy vs salpingectomy
A
Linear salpingostomy- incision along the length of a Fallopian tube to remove an ectopic pregnancy and preserve the tube
Salpingectomy- removal of the tube
4
Q
What are the signs and symptoms that suggest tubal rupture or bleeding
A
Pelvic, shoulder or neck pain ; dizziness or faintness ; increased vaginal bleeding
5
Q
Gestational trophoblastic disease (hydatidiform mole)
A
Trophoblasts (peripheral cells that attach the fertilized ovum to the uterine wall) develop abnormally
Complete: no fetus present
Partial: fetal tissue or membranes present
**avoid uterine stimulus = embolus
-removed by vacuum aspiration then curettage
6
Q
Clinical manifestations of hydatidiform mole
A
Vaginal bleeding
High hCG levels
Large uterus
Excessive nausea and vomiting
Early development of preeclampsia
wait 1yr to get pregnant again, continuous follow-up to detect malignancies
7
Q
Nursing interventions for early pregnancy hemorrhagic conditions
A
- Provide test and procedure information
- teach infection prevention: first 72hrs greasy risk, no tampons, consult provider about sex
- provide dietary information: high in iron to increase HnH (liver, red meat, spinach, egg yolk, carrots, raisins) high in vitamin c (citrus fruit, broccoli, strawberries, cantaloupe, cabbage, green peppers) adequate fluid intake (2500mL per day) folic acid
- educate on reporting signs of infection: fever >100.4, vaginal odor, pelvic tenderness, malaise
8
Q
Placenta previa
A
Implantation of the placenta in the lower uterus closer to the cervical os
9
Q
Three classifications of placenta previa
A
Marginal- lower border is more than 3cm away from the os
Partial- partial covering of os (within 3cm)
Total- placenta completely covers cervical os
10
Q
What is the classic sign of placenta previa
A
Sudden onset of painless uterine bleeding in the last half of pregnancy
11
Q
What should NOT be done with placenta previa
A
No manual vaginal exams , use ultrasound to locate position of placenta
No pitocin to prevent uterine stimulation
12
Q
Abruptio placentae
A
Premature separation of the placenta
Occurs when a clot forms on the maternal side of the placenta
13
Q
Risk factors for abruptio placentae
A
- cocaine use causes vasoconstriction (narrowing of blood vessels) leading cause
- maternal hypertension, cigarette smoking, multigravida status, short umbilical cord, abdominal trauma, premature ROM, hx of premature separation of placenta
14
Q
Clinical manifestations of abruptio placentae
A
1 bleeding
2 uterine tenderness that may be localized at the site of the abruption
3 uterine irritability with frequent low-intensity contractions and poor relaxation between contractions
4 abdominal or low back pain that maybe described as aching or dull
5 high uterine testing tone
– back pain, nonreassuring FHR patterns, signs of hypovolemic shock , fetal death, board like uterus
15
Q
Uterine resting tone
A
Degree of uterine muscle tension when the woman is not in labor or during the interval between labor contractions
16
Q
Signs of hypovolemic shock
A
Increased ❤️ rate
Increased RR
Decreased BP
Pale color, Cold and clammy skin
Decreased urine output
Weak, diminished, or “threads” pulses
Decreased O2 saturation
17
Q
Nursing interventions for late pregnancy hemorrhagic conditions
A
- monitor for signs of hypovolemic shock: tachycardia, weak peripheral pulses, decreased BP, tachypnea, decreased O2 sat, cool/pale skin
- Monitor the fetus: tachycardia, decreased baseline variability, presence of late decelerations
- promote tissue oxygenation: position, O2, fluids
- fluid replacement
- prepare for surgery
- emotional support
18
Q
Gestational HTN
A
Also known as PIH (pregnancy induced hypertension)
Systolic > 140 or diastolic > 90
After 20 weeks
Protein is NOT present
Can lead to chronic HTN if persists after birth
19
Q
Mild preeclampsia
A
Unknown cause
Systolic > 140 or diastolic > 90
Develops after 20 weeks
Protein IS present in urine= proteinuria
20
Q
Risk factors for pregnancy related HTN
A
First pregnancy
1st pregnancy for man who has previously fathered a preeclamptic pregnancy
Age > 35yrs
Anemia
Family or hx of PIH
chronic HTN or predicting vascular or kidney disease
Obesity
DM
Antiphospholipid syndrome
Multifetal pregnancy
21
Q
Severe preeclampsia
A
Systolic > 160 or diastolic > 110
^ proteinuria
Generalized edema , weight gain , oliguria
Epigastric pain
22
Q
Magnesium sulfate
A
Calcium antagonist and CNS depressant that acts as an anticonvulsant
Therapeutic level: 4-8 mg/dL
Antidote: Calcium Gluconate (1g at 1mL/min)
23
Q
Nursing assessment for severe preeclampsia and magnesium toxicity
A
- rest: on left side
- diet: decreased Na
- weight: daily provides estimate of fluid retention
- VS: mag sulfate decreases RR
- EFM
- Breath sounds: excess moisture associated with pulmonary edema
- DTRs: noreflex= mag toxicity/ hyperreflex= ^ seizure risk
- urinary output: at least THIRTY mL/hr
- LOC: drowsiness indicates therapeutic mag
- labs: ^ creatinine, liver enzymes, or decreased platelets
24
Signs of magnesium toxicity
- RR rate of less than 12
- maternal O2 sat of lower than 95%
- absence of DTRs
- sweating, flushing
- altered sensorium (confused, lethargic, slurred speech, drowsy, disoriented)
- hypotension
25
HELLP syndrome
Hemolysis, elevated liver enzymes and low platelets
Liver enzymes ^ when hepatic blood flow is obstructed by fibrin deposits / low platelets occur cuz of vascular damage from vasospasm
Deliver vaginally
R upper quadrant, epigastric or lower r chest pain
Treatment: mag sulfate and hydralazine
26
Disseminated intravascular coagulation
Life threatening defect in coagulation
Labs: decreased fibrinogen, platelets, increased fibrin degradation and d-dimer is present
27
Hyperemesis gravidarum
Persistent uncontrollable vomiting that can continue throughout pregnancy leading to serious complications
Therapeutic management: meds, fluid replacement
**eat foods high in K+ and Mg+**
28
Characteristics of Hyperemesis gravidarium
- loss of 5% or more of pregnancy weight
- dehydration
- acidosis from starvation
- elevated levels of blood and urine ketones
- alkalosis from loss of hydrochloric acid in gastric fluids (vomiting)
- hypokalemia
29
Home visits
low risk infants vs high risk infants
Low risk- recognize jaundice, family adaptation, adequacy of maternal support
High risk- specialized equipment, ensure proper electricity/heat/telephone. Medically fragile: vents, oxygen therapy, apnea monitors, trach care, tube feedings, suctioning and cAre of IV sites
30
Red flags of telephone triage
- emergency situation (respiratory difficulty, bleeding) call back in 5 mins to make sure parents seek help
- illness (fever, dehydration, change in feeding behavior, unusual rashes)
- present problem or remedies aren't working
- parents affect seems inappropriate for situation
31
Car seat test
Infants less than 37 weeks or LBW are placed in car seat and monitored for VS and oxygen level for 90mins
32
What are the 5S's to consoling colic
Swaddle
Side lying
Shushing sound
Swinging
Suck on pacifier
33
Miliaria
Prickly heat
Develops in infants who are too warmly dressed in any weather / may also occur in infants with fever
Appears as red base with papules or clear vesicles in the center
Treatment: remove excess clothing or lukewarm bath
**avoid ointments
34
Ways to correct regurgitation
"Spit up"
Caused by overfeeding
Treat: burp, smaller frequent feed, enlarge nipple hole, upright after feeding
35
Growth in first 3 months
Gains 1oz/day (2lb per month)
Grows 1.4inches per month
36
Infant milestones
Focus best within a range of 8-12 inches
By 3 months follow objects horizontally
Social smile at 1-3months
Start "cooing" at 1-4 months
Laugh at 3-6 months
37
Well baby checkups occur at what age
1 2 4 6 9 12 months old
38
Common signs of illness in infants
Temp > 100.4
Vomiting
Watery stools or significant increase in stools
Blisters, sores or rashes
Listlessness of sleeping more than usual , irritability or crying more than usual
Coughing, frequent sneezing, runny nose
Pulling or rubbing at ear , drainage from the ear
39
Seek help immediately if infant displays signs of
Dyspnea
Rr > 60
Retractions
Cyanosis or extreme pallor
Difficult to arouse/keep awake
40
Plagiocephaly
Flattening of the head which was rounded at birth , may result from prolonged lying in the supine position
41
SIDS
Abrupt unexplained death of an infant less than 1 year old
3rd leading cause of death in infAnts from birth -1yr
Most common cause of death in infants from 1 month-1 yr
42
Common predisposing factors for PPH
- overdistention of the uterus (multiple gestation, large infant, hydraminos)
- precipitate labor or delivery
- prolonged labor
- use of forceps or vacuum extractor
- cesarean birth
- placenta previa, accreta or low implantation
- surgery, oxytocin, tocolytics, mag sulfate
43
Current definitions of postpartum hemorrhage
Blood loss of more than 500mL after vaginal birth, 1000mL after cesarean, a decrease in hematocrit of 10% or more since admission or the need for a blood transfusion
44
Management and predisposing factors for uterine atony
Management- Fundal massage, bimanual compression, medicine, fluid, blood replacement, hysterectomy
Factors- exhaustion, overexpansion, multi parity, prolonged oxytocin, hyper and hypo uterine contraction, retained placenta
45
Causes of early postpartum hemorrhage vs late postpartum hemorrhage
Early- uterine atony, trauma to the birth canal, hematoma, retention of placenta fragments,
Late- subinvolution and placental fragments that remain attached
46
Pharmacological measures to treat PPH and things to note
- oxytocin
- methylergonovine maleate (methergine) is given IM. Contraindicated in hypertension
- carboprost tromethamine (hemabate, prostin/15M) is given IM. Contraindicated in asthma and causes diarrhea. Keep refrigerated
- cytotec
47
Predisposing factors of retained placenta
Attempts to deliver placenta before it separates from the uterine wall, manual removal of the placenta, placenta accreta, previous cesarean and uterine leiomyomas
48
Therapeutic management of retained placenta
Oxytocin , methylergonovine , dilation and curettage , antibiotics
49
Subinvolution of the uterus
Causes, management, nursing considerations
Delayed return of uterus to non-pregnant state
Causes- retained placental fragments and pelvic infection
Management- methergine PO and antibiotics
Nursing considerations- education about warning signs, excessive bleeding and possible infection. Pelvic or fundal pain, backache and pelvic pressure or fullness
50
Nursing considerations/management of hypovolemic shock
Control bleeding , check VS q3-5 mins , give 8-10L of oxygen and draw labs for H&H, clotting studies and type and cross
51
Factors that increase the risk of thrombosis
```
Inactivity
Prolonged bed rest
Obesity
Cesarean birth
Sepsis
Smoking
Hx of thrombosis
DM
Trauma
Prolonged labor
Age > 35
Dehydration
```
52
What are the major causes of thromboembolic disorders in pregnancy or birth
Endothelial injury
Causes: increased clotting factor, venous stasis, vessel injury= prolonged in stirrups/constriction/flexion
53
Superficial venous thrombosis
Signs and symptoms/management
Signs- swelling of the extremity, redness, tenderness and warmth to CALF OR IV SITE
management- analgesics, rest and elastic support. Elevation improves venous return, warm packs
*avoid standing for long periods
54
Deep venous thrombosis
Signs and symptoms
Pain in leg, groin, lower back or right lower quadrant. Swelling of the leg (>2cm larger than the other), erythema, heat and tenderness
No homans sign -not reliable test
Pain on ambulation, chills, general malaise and stiffness of affected leg
55
Initial treatment of DVT
```
Elevation
Anticoagulants (lovenox, heparin)
Analgesics
Antibiotics
Moist heat
Gradual ambulation
```
**no Coumadin during pregnancy
56
Anaphylactoid syndrome
Amniotic fluid embolism
57
Pulmonary embolism
Signs and symptoms, management
Signs- dyspnea, chest pain, tachycardia , tachypnea, crackles, hemoptysis, decreased O2 sat
Management- VS, elevate HB, give O2, meds (heparin, thrombolytics)
58
Puerperal infection
Temperature of 100.4 or higher AFTER the first 24hrs and occurring on at least 2 of the first 10 days following childbirth
Types: endometritis, wound infection, uti, mastitis and septic pelvic thrombophlebitis
59
Risk factors for puerperal infection
- hx of uti, mastitis, thrombophlebitis
- cesarean birth
- trauma
- prolonged ROM , labor
- excessive number of vaginal exams
- retained placenta
- poor general health, nutrition, hygiene
- DM
60
Endometritis
Bacterial infection of endometrium
Signs- temp > 100.4 within 36hrs of birth, chills, malaise, anorexia, abd pain, uterine tenderness and purulent fouk smelling lochia, tachycardia and subinvolution
Management- IV antibiotics to prevent spread to tubes and ovaries
Nursing considerations- fowlers position to promote drainage of lochia, foods high in vitamin C and protein to aid healing and PO fluids
61
Wound infection
Signs and symptoms, management
Signs- edema, warmth, redness, tenderness and pain
Management- analgesics and warm compress or sitz baths, good hand washing technique
62
UTI
Signs and symptoms, nursing considerations
Signs- dysuria, urgency, frequency and suprapubic pain. Hematuria. Low-grade fever **begin on first or second postpartum day**
Day3-4 may develop pyelonephritis (chills, spiking fever, cva tenderness, flank pain and n/v)
Nursing considerations- increase fluid intake (2500-3000mL), acidic juice (apricot,plum, prune and cranberry) 🚨no carbonated drinks/grapefruit = increase alkalinity
63
Mastitis
Causes, S/S, management, nursing considerations
Causes- constriction , decreased immune system, engorgement
Signs- flu like symptoms (fatigue, achy muscles) temp > 102.2, chills, malaise and headache .. localized lump or wedge shaped area of pain, redness, heat, inflammation and enlarged axillary lymph nodes
Management- antibiotics and continued breastfeeding or pumping from both breasts
**untreated may result in abscess
Nursing considerations- breastfeed q 2-3hrs, warm press, start BF on unaffected side 1st, massage
64
Newborn calorie needs
100-115 kcal/day
Breastfed: 39-45 kcal per pound
Formula: 45-50 kcal per pound
65
Fluid needs of the newborn
27 to 45mL/lb (60-100mL/kg) for the first 3 to 5 days of life
Gradually increasing to 68 to 80mL/lb (150-175mL/kg)
66
Lactogenesis I, II, III
I- begins at 16wks gestation to day 2-3 of birth. Colostrum is rich immunoglobulin A which helps in GI tract protection
II- from day 2-3 to day 10. Transitional milk. Lactose, fat and calories increase
III- mature milk. Contains 20 kcal/oz
67
Nutritional composition of breast milk
Protein: less amount than cows milk
Carbohydrate: lactose
Fat: 50% of calories in breast milk
Vitamins: no vitamin d - supplement 400 IU is recommended (via present in formula)
Minerals: iron in breast milk, not formula
Enzymes: pancreatic amylase, lipase for fat digestion
68
Benefits of breastfeeding
Infant - allergies less likely to develop, helps prevent infection and disease, easier digestion, nutritional content, decreased incidence of overfeeding, constipation less likely
Mom - oxytocin release enhances involution, less blood loss, delayed ovulation, reduction in incidence of some cancers, bonding, convenience and economical
69
Formula for infants with special needs
Soy formulas may be given to infants with galactosemia or lactase deficiency and to those whose families are vegetarians
70
Factors influencing choice to breastfeed
Personal knowledge and past experiences
Support/education from others
Culture
Employment/school
71
LATCH assessment
L- latch
A- audible swallowing
T- type of nipple
C- comfort (breast or nipple)
H- hold (positioning)
72
Hunger cues in infants
licking or sucking movements
Lip smacking
Rooting
Hand to mouth movements
Sucking on the hands
Increased activity
Crying (a late sign)
73
Foremilk vs hindmilk
Foremilk- watery first milk that quenches the infants thirst
Hindmilk- comes at the end of the feeding. Richer in fat, more satisfying and leads to weight gain
74
Signs an infant is having breastfeeding problems
- falling asleep after feeding for less than 5 minutes
- refusing to feed
- smacking or clicking sounds while on breast
- lower lip turned in
- failure to open the mouth widely at latch-on
- dimpling of the cheeks
- short choppy motions of the jaw
75
The football hold is good for which scenario
Avoids pressure against an abdominal incision
76
The cross-cradle is helpful for which scenario
Preterm or have a fractured clavicle
77
The side lying position is good for what scenario
Avoids pressure on episiotomy or abdominal incisions
78
Contraindications of breastfeeding
Drug abuse , active untreated TB, HIV, galactosemia band maternal chemotherapy
**moms on methadone or buprenorphine, hepatitis A/B/C are allowed to breastfeed
79
Milk storage
5hrs at room temp
5 days in fridge
5 months in freezer
80
Polydipsia/polyuria/polyphagia
Polydipsia- increase thirst
Polyuria- excessive urination
Polyphagia- excessive hunger
81
Effect of pregnancy on fuel metabolism
Early pregnancy - metabolic rates and energy needs change little. Increased insulin release. HYPOGLYCEMIA may occur
Late pregnancy - increased placental hormones create insulin resistance. HYPERGLYCEMIA may occur
Birth- maintenance of normal maternal glucose levels is essential to reduce neonatal hypoglycemia
Postpartum - the need for additional insulin falls
82
Classifications of DM
Type 1- insulin deficient
Type 2- insulin resistant
GDM A1- diet controlled
GDM A2- diet and insulin controlled
83
Maternal effects of Preexisting DM
- increased incidence of spontaneous abortion
- fetal malformations
- preeclampsia
- development of ketoacidosis
- increased UTI
- hydramnios
- premature ROM
- macrosomia increased likelihood of cesarean and risk of PPH
84
Fetal effects of preexisting DM
- congenital defects (neural tube defects, caudal regression syndrome, cardiac defects)
- macrosomia increases risk of cesarean or shoulder dystocia
- sga
- IUGR
- oligohydramnios
85
Neonatal effects of preexisting DM
Hypoglycemia , hypocalcemia , hyperbilirubinemia and respiratory distress syndrome
86
Risk factors for gestational DM
```
Overweight
Maternal age > 25 years
Previous GDM
hx of diabetes in a close relative
Member of high risk group
```
87
Insulin therapy in 1,2,3 trimester, during labor and postpartum period
1st- decreased insulin need
2nd and 3rd- increase
During labor- maintenance of tight maternal glucose control during birth is desirable to reduce neonatal hypoglycemia
Postpartum period- insulin needs should decline rapidly after the delivery of the placenta and abrupt cessation of the placental hormones
88
Glucose challenge test
Administered between 24 and 28 weeks of gestation.
Mom ingests 50g of oral glucose solution
A blood sample is taken 1 hour later - > 140mg/dL
89
Oral glucose tolerance test
Gold standard for diagnosing diabetes
Mom must fast from midnight on the day of the test, then ingest 100g of glucose solution. positive GDM if fasting is abnormal or 2 or more values occur
Fasting > 95
1 hour > 180
2 hours > 155
3 hours > 140
90
Signs and symptoms of maternal HYPOglycemia
```
Shakiness (tremors)
Sweating
Pallor, cold clammy skin
Disorientation; irritability
Headache
Hunger
Blurred vision
```
91
Signs and symptoms of maternal HYPERglycemia
```
Fatigue
Flushed, hot skin
Dry mouth; excessive thirst
Frequent urination
Rapid, deep breaths, door of acetone on breath
Drowsiness; headache
Depressed reflexes
```
92
Rheumatic heart disease
Complication that follows strep throat
Causes scarring of the ❤️ valves , resulting in stenosis (narrowing) of the openings between the chambers of the heart.
Leads to pulmonary hypertension , pulmonary edema , chf
93
Intrapartum management of cardiac disease
- Careful I/O
- Position: on side, with head and shoulders elevated
- O2
- monitor
- vaginal delivery
94
Postpartum management of cardiac disease
- may experience cardiac decompensation
- observe closely for signs of infection, hemorrhage and thromboembolism
- observe for signs of chf
- observe for decreased urine output
95
Signs and symptoms of chf
Cough (frequent, productive, hemoptysis)
Progressive dyspnea with exertion
Orthopnea
Putting edema of legs and feet or generalized edema of face, hands or sacral area
Heart palpitations
Progressive fatigue or syncope with exertion
Moist rales in lower lobes, indicating pulmonary edema
96
How do you apply the nursing process in pregnancy and heart disease
- assessment
- telemetry
- VS
- educate on no weight gain , anemia
- 2200 cal diet
- rest
- avoid extreme temps
97
A pregnant woman is considered anemic if her hemoglobin level is less than
10.5 or 11 g/dL
98
The primary sources of iron in food are
Meat, fish, chicken, liver and green leafy vegetables
99
Signs and symptoms of iron deficiency anemia
(Most common type)
Pallor, fatigue, lethargy and headache
Inflammation of lips and tongue and Pica
100
Iron is best absorbed if taken with
Meals and vitamin C
101
Thalassemia
Genetic disorder that involves abnormal synthesis of alpha or beta chains of hemoglobin
Leads to decreased lifespan of RBC
102
Folic acid consumption during pregnancy and foods to obtain it from
Women of childbearing age consume 400mcg daily
600mcg daily when pregnancy is confirmed
Foods- fortified greens, beans (black and lentil), peanuts and fresh green leafy vegetables
103
Antiphospholipid syndrome
Autoimmune condition that produces antiphospholipid antibodies - body rejects pregnancy
Low-dose aspirin and prophylactic heparin are recommended
104
Bell's palsy
Sudden unilateral neuropathy of the 7th cranial (facial) nerve that causes facial paralysis with weakness of the forehead and lower face
105
Name the 5 viral infections in pregnancy
1 hepatitis B - infectious liver infection, transmitted by blood & body fluids
2 rubella - transmitted through droplets or contact with nasopharyngeal secretions , common congenital disorders include developmental delay, hearing loss, cardiac defects, cataracts, IUGR, microcephaly
3 varicella zoster - transmitted by direct contact or through respiratory tract, immune prior to pregnancy, VZIG ** chicken pox in preg=pneumonia
4 cytomegalovirus - spread through contact with body fluids, primary prevention is hand washing
5 parvovirus b19 (5ths disease) - transmitted through respiratory secretions or blood, "slapped checks" rash, fever, malaise, maybe fatal to baby
106
Non-viral infections in pregnancy (3)
1 taxoplasmosis - transmitted via raw or undercooked organisms (handling a litter box), treated with sulfonamides/combination therapy, NEONATAL EFFECTS: abortions or other serious complications
2 group b streptococci - bacterium in vagina/rectum/cervix/urethra , often asymptomatic- cultures @35-37 weeks, treated with PCN/cephazolin/clindamycin, NEONATAL EFFECTS: sepsis, pneumonia, meningitis
3 tuberculosis - transmitted to neonate from amniotic fluid ingestion or respiratory droplet inhalation , NEONATAL EFFECTS: failure to thrive/rds, treated with isoniazid and rifampin
107
Visceral pain vs somatic pain
Visceral- dull, can't pin point, 1st stage
Uterus contracting
Somatic- more specified, sharp, quick, end of 1st and 2nd stage , fetus puts pressure on maternal tissue
108
What are the 4 sources of pain in childbirth
- tissue ischemia
- cervical dilation
- pressure and pulling on pelvic structures
- distention of the vagina and perineum
109
What factors influence tolerance of pain
Labor intensity
Cervical readiness
Fetal position: occiput posterior
Pelvic readiness: size and shape
Fatigue and hunger
Caregiver interventions
**anxiety and fear = ^ muscle tension**
110
Nonpharmacologic pain management during childbirth
Relaxation
Cutaneous stimulation
Hydrotherapy
Mental stimulation
Breathing techniques
111
Epidural block
Given in epidural space
Adjust amount of anesthetic with opioid for motor function
Wait until at least 5cm dilated
No pain felt , but can still feel pressure
112
Epidural blocks are contraindicated in
Bleeding disorders, uncorrected hypovolemia, infection, allergy, scoliosis
113
effects of epidural block
-maternal hypotension (give bolus of fluid, change position, ephedrine and O2)
- bladder distention
- prolonged second stage
- catheter migration
- can feel brief shock in leg
114
Treatment for Dural puncture headache
IV fluids
Bed rest
Caffeine infusion
Blood patch- uses patients blood to patch up CSF leak
115
Subarachnoid (spinal) block
- uses 25 or 27g needle to go deeper into the subarachnoid space (L4 and L5)
- rapid onset, single dose
- lose sensory and motor functions
- used in c-section, forcep delivery or other high risk
- bolus to prevent hypotension
116
What 3 drugs are usually used for active labor/blocks
Meperidine (Demerol)
Morphine sulfate (duramorph)
Fentanyl (sublimaze)
117
What 2 drugs have a sealing effect , which means giving more meds will NOT offer more relief
Butorphanol (stadol)
Nalbuphine (Nubian)
- mixed agonist and antagonist drugs-
118
Which medicine can be used on relieve puritis during labor
Naloxone (narcan)
119
Barbiturates
A sedative that has prolonged depressant effects on the baby
Small dose maybe given to promote rest if mom is fatigued from false labor or a prolonged latent phase
120
When is the best time to medicate mom before , after or during a contraction
Medicate at the beginning of a contraction for limited transfer to fetus
121
What is the biggest concern for general anesthesia
Nonreassuring fetal hear tones and respiratory distress
122
Cricoid pressure in general anesthesia
Or Sellick's maneuver
Used to prevent vomit from entering the woman's trachea while she is being intubated for general anesthesia - obstructs esophagus
123
Local infiltration anesthesia
Numbs the perineum for episiotomy or laceration repair
Not for labor pain
No effect on the baby 👶🏾
124
Pudendal block
Anesthetize the lower vagina and part of the perineum to provide anesthesia for an episiotomy and vaginal birth using low forceps
Given transvaginally with a 6in needle
125
Magnesium hydroxide
Postpartum laxatives
126
Should ibuprofen be given on an empty stomach ?
No - take with food because it causes gastric irritation
127
Acetaminophen&codeine
Tylenol 3
128
Hydrocodone acetaminophen
Vicodin, lortab, norco
129
Oxycodone acetaminophen
Percocet
130
Benzocaine (dermoplast)
Numbing spray
131
Name 3 drugs used to treat hemorrhoids
Witch hazel (tucks) *also for episiotomy
Dibucaine ointment (nupercaine)
Hydrocortisone acetate
