Final AD - other Flashcards
Mag Sulfate – class, action, and dosage & route?
Class: CNS depressant
Action: relaxes smooth muscle, including uterus
Dosage & Route: IV, loading dose 4-6 gm/30 M, maintenance dose 1-4 gm/H
Mag sulfate SE and fetal SE?
SE: hot flashes, N/V, HA, lethargy, dyspnea, hypocalcemia, blurred vision
Fetal SE: decreased breathing movement, reduced variability, non-reactive NST
Mag Sulfate nursing interventions?
Assess women and fetus for baseline
Drug almost always given IV
Monitor serum Mg levels, therapeutic range: 4-7.5
Be prepared to d/c if intolerable SE occur (RR <12, pulmonary edema, absent DTRs, chest pain, hypotension, altered LOC, urine output less than 25-30 mL/H, serum Mg levels of 10 or >)
Strict I&O
Total IV intake at 125/H
Calcium Gluconate/Calcium Chloride readily available to reverse drug toxicity
Contraindication to tocolytic?
Maternal - severe preeclampsia, eclampsia, bleeding with hemodynamic instability, and contraindications to specific meds.
Fetal - intrauterine fetal demise, lethal fetal anomaly non-reassuring fetal status, chorioamnionitis, and PPROM.
Oxytocin (Pit) class, action, and dosage?
Class: uterine hormone
Action: acts directly on myofibrils, thereby producing uterine contractions; stimulated milk action by the breast; vasoactive.
Dosage: IM; onset 2-7 M, duration 1 H, half-life 12-17 M
Oxytocin (Pit) SE and Fetal SE?
SE: seizures, IC hemorrhage, abruptio placentae, decreased uterine blood flow, hypotension, HTN, dysrhythmias, increased pulse.
Fetal SE: bradycardia, jaundice, visual disturbances, muscle tone, seizures.
Oxytocin (Pit) nursing considerations?
Assess for fetal presentation and pelvic dimensions before use
Monitor all VS closely and continuously
Monitor fetal distress or uterine hyperactivity (discontinue immediately) length and duration of contractions.
Vitamin K?
Administered to prevent hemorrhage disorders. Vitamin K is not produced in the GI tract of the newborn until around day 7. Vitamin K is produced in the colon by bacteria once formula or breast milk is introduced.
Nursing actions: administer 0.5 to 1 mg IM into the vastus lateralis (where muscle development is adequate) soon after birth.
Erythromycin?
Prophylactic eye care is mandatory instillation of antibiotic ointment into the eyes to prevent ophthalmia neonatorum. Infections can be transmitted during descent through the birth canal. Ophthalmia neonatorum is caused by Neisseria gonorrhea or chlamydia trachomatis and can cause blindness.
Nursing actions:
- Single dose unit to avoid cross-contamination
- Apply a 1- or 2- cm ribbon of ointment to the lower conjunctival sac of each eye, starting from the inner canthus and moving outward.
- A possible SE is chemical conjunctivitis, causing redness, swelling, drainage, and temporarily blurred vision for 24 to 48 H. Reassure the parents that this will resolve on its own.
- Application can be delayed for 1 H after birth to facilitate baby-friendly activities during the first period of newborn reactivity
Hep B injection?
Provides protection against Hep B
Nursing actions:
- Recommended to be admin to all NB’s
- Informed consent must be obtained
- For NB’s born to healthy clients, recommended dosage schedule is at birth, 1 month, and 6 months.
- For parents infected with Hep B, Hep B immunoglobulin and the hep B vaccine is given within 12 H of birth. The hep B vaccine is given alone at 1 month, 2 month, and 12 months.
- IMPORTANT DO NOT give vitamin K and Hep B injections in the same thigh!
Caloric Intake?
adequate caloric intake is essential for energy. This allows - growth, digestion, metabolic needs, and activity. Day 1 to 3 months - requires 110 Kcal.kg/day (24 H). 3 months to 6 months - requires 100 Kcal/kg/day (24 H). Breast milk and formula provide 20 Kcal/oz.
Discuss nursing care helpful to families coping with bereavement and therapeutic communication.
You may not have felt like you did much, or you helped but you…
Held my hand
You consoled my husband as well as myself
You held my baby tenderly
You called my baby by name and pointed out his perfect hands
You didn’t rush me
You allowed my family to be with me when I needed them most
You cried with us as we said our goodbyes
You offered me options and choices I didn’t know about
You cared for me and my baby. I heard it in your voice, felt it in your touch and saw it in your actions.
What parents appreciate ?
Involvement in decision making
Being treated like parents
Time to grieve and not be rushed
Positive memories/mementos
Sense of Empathy and being cared for
Time with supportive family & friends
Continuity of care of caregivers
Unlimited time with their infant
Seeing, holding, touching the baby
Direct communication
Memory making ?
Photographs, footprints, armbands, lock of hair
Calling the baby by its name
Involve families in rituals and memory making
Offer Baptism/Blessings. Call the hospital Chaplin and he/she can immediately be available or assist by calling a Rabbi or Priest.
Offer the parents options to bath or dress the baby
- Bereavement supplies are available at the hospitals like smocked gowns and hats, blankets, and educational material.
Erickson’s development stages?
Master of each stage requires a balance between two conflicts that must be resolved before moving to next level in a healthy way.
trust v. mistrust
initiative v. guilt
industry v. inferiority
identity v. role confusion
intimacy v. isolation
generativity v. stagnation
integrity v. despair
child can develop mistrust of others if needs are not met (birth -1)
trust vs mistrust
child can develop self-doubt if not allowed to be independent and self-sufficient (1-3)
autonomy vs. shame/doubt
