Mark K Flashcards
If pH and Bicarb go in the same direction its?
Metabolic
As the pH goes —-
So does my patient except POTASSIUM
MacKussmal =
Kussmaul respirations in Metabolic acidosis
If prolonged GI, vomit or suction what acid/base disorder?
Metabolic alkalosis
(all other metabolic acidosis)
What does a high pressure alarm mean?
What are 3 solutions?
OBSTRUCTION
1. Kink = unkink
2. Water = Empty
3. Mucous = Cough/deep breath
What does a low pressure alarm mean?
What are 3 solutions?
DISCONNECTS/decreased resistence
1. Main tubing - reconnect
2. Oxygen sensor tube - plug in sensor
Ventilator too high can cause what acid/base imbalance?
Respiratory alkalosis
Ventilator too low can cause what acid/base imbalance?
Respiratory acidosis
What are the 5 stages of Grief?
DABDA
Denial, Anger, Bargain, Depression, Acceptance
What is Wernike (Koraskoffs) syndrome?
Psychosis induced by B1 vit or thiamine deficiency
-Amnesia with confabulation
What is antabuse used for?
When to use/stop
Adverse effects
AVOID?
Aversion therapy
* 2 weeks before it works / stop 2 weeks before drinking
Side effects Nausea, vomit, deathin
AVOID mouthwash, perfume, aftershave, insect repellent, OTC ending in elixer, vanilla extract, hand sanitizer, unbaked icing.
What are UPPERS?
DOWNERS?
- Uppers = Caffeine, Cocaine, PCP/LSD, Methamphetamines, Adderall
- Downers = everything else
What do we give alcohol withdrawl syndrome and DTs?
HTN
Tranquilizer
Multivitamin
4 Nursing interventions for AWS VS DTS
Diet?
Room?
Activity?
AWS
* Reg Diet
* Semi-private/anywhere
* up as needed / no restraint
DT
* NPO / clear liquid
* Privtate room near RN
* Restricted to bed rest / restraints
Aminoglycosides
Remember?
all end in ____, what 3 that end in __ that are not aminoglycosides?
Toxic effects?
8?
Do not give which route? unless what?
Big gun antibiotics / A MEAN OLD MYCEN
* Mycin except Azithormycin, Clarithromycin, if it has THRO, throw it OUT
* TOXIC - Mice - Ototoxic. Monitor hearing, balance, tinnitus. Kidney - nephrotoxicity. Creatinine
* 8- Toxic to cranial nerve 8, give q 8 hours, IM or IV.
* Do not give PO unless Hepatic encephalopahty & bowel surgery (Neomycin & Kanomycin
Calcium Channel blockers
Like what?
Negative ___
Treats?
S/S
Drug? ending in plus __ + __
Monitor?
Like valium for your heart
* Negative inotropic, dromotropic, chronotropic
Treat - A, AA, AAA
* Antihypertensive, AA - Anti-angina, AAA - Anti atrial arrhythmias
S/S Headache & hypotension
Drugs - anything ending in DIPINE + verapamil & Cardizem
Monitor BP and hold if SYS is under 100
Meds for arrhythmias
For ventricular?
For supraventricular/Atrial?
For V-fib?
Asystole?
- Ventricular - LIDOCAINE
- Atrial - ABCD. A-denocard/adenosine, B - betablockers, C- Calcium channel blockers, D- Lanoxin, Digitalis, Digoxin
- V-fib - Defib
- Asystole - epinephrine and atropine
CHEST TUBES
Apical for? Basilar for?
*If water seal breaks?
*If tube comes out?
Bubbling in water seal..Intermittent? Continuous?
Bubbling in suction control.. Intermittent? Continuous?
Apical (high) to remove air & Basilar (low) to remove blood
* If water seal breaks = Clamp. Submerge in water then unclamp
* If tube comes out - Cover with gloved hand, vaseline gauze & dry sterile dressing & tape on 3 sides
Bubbling in water seal- intermittent - good, Continuous - bad
**Bubbling in suction control **- Intermittently - bad, continuous good
To remember congenital heart defects use TROUBLE
All CHD kids will have ___&___
what are the 4 defects of Tetralogy of Fallot?
TRouBLe - Right to Left shunting = Surgery, B - cyanotic, Starts with letter T
(ex. Trunkis arteriosis, transposition of great vessels, Tetralogy of fallot)
All CHD kids will have a murmur and echocardiogram
4 defects of Tetralogy of Fallot - VarifieD PictureS Of A RancH
VD - Ventricular defect
PS - Pulmonary Stenosis
OA - Overring Aorta
RH - Right hypertrophy
Contact precautions
Used for
What to do?
- anything enteric (cdiff, Hep A), staph, RSV, Herpes
RSV on CONTACT precautions even though transmitted DROPLET - Private room preferred unless cohort, No mask, Yes gloves, gown, handwashing, dedicated or disposable equipment,
Droplet precautions
Used for
What to do?
- Droplet - bugs that travel 3ft (meningitis & H flu)
- Private room preferred/cohort. Yes mask, gloves, handwashing, dedicated/disposable equipment. No gown, neg airflow
Airborne precautions
Used for
What to do?
- Airborne - MMR, TB, Varicella
- **Private room **required/cohort, Yes Mask, gloves, handwashing, dedicated equipment, N95 (Tb only) mask when leaving room, neg airflow yes
TB on AIrborne precautions but spread by droplet
DONNING/DOFFING
Order to take off?
Order to put on?
- Remove in alphabetical order - Gloves, Goggles, Gown, Mask
- On is reverse alphabetical but mask comes second - Gown, Mask, Googles, Gloves
How to measure crutches?
2-3 finger widths below the anterior axillary fold to a point lateral to and slightly in front of foot
Hand grips elbow flexion about 30 degrees
CRUTCH gaits
2 point?
3 Point?
4 point?
Swing through?
When to use even? odd?
Stairs?
Cane?
2 - point. Move 1 crutch and the opposite foot together
3 - point. Moving 2 crutches and a bad leg together
4 - point. You move 1 thing at a time, Crutch, leg, crutch, leg
Swing through - non-weight bearing/amputee
* Even for even, odd for odd. Use the even gaits (2,4) when you have a weakness evenly. 2-point for mild, 4 for severe
* Use an odd gait when one leg is odd. (3)
* STAIRS - up with good, down with bad. /Crutches always move with a bad leg
* CANE - always hold the cane on the unaffected side
Delusion - define
3 types
Delusions - False fixed idea / no sensory component
* Paranoid delusion
* Grandiose delusion - think your superior
* Somatic delusion - Xray vision, the body is hollow
Illusion
Hallucinations - 5 types
Illusion - Misinterpretation of reality / referent in reality
Hallucinations - False fixed sensory
Auditory
Visual
Tactile
Gustatory - tasting things that are not there
Olfactory - smelling things that are not there
Functional Psychotic - 4 types
How to handle them - 4 steps
Narrowed self concept?
**Functional Psychotic - can function in life. Schzio, Schzio, Major, Mania
1. Acknowledge feeling
2. Present reality “I understand you see___ but I do not see them”
3. Set a limit
4. Enforce the limit
* Narrowed self-concept - when a psychotic refuses to change clothes. They are who they are by what they wear and what room they are in
Psychosis of Dementia - 4 conditions
How to handle - 2 steps?
**Psychosis of Dementia **- brain damage. Alzheimer’s, Wernickes, organic brain syndrome, dementia
* Acknowledge the feeling
* Redirect
Psychotic delirium - causes
How to handle - 2 steps?
Psychotic delirium - Temporary episodic secondary sudden loss of reality due to chemical imbalance (UTI, Thyroid imbalance, electrolyte imbalance)
* Acknowledge feeling
* Reassure safety and temporariness
Diabetes Insipidus - Symptoms
Diabetes Mellitus - Symptoms
SIADH - Symptoms
Diabetes insipidus = Polyuria, polydipsia leading to dehydration due to low ADH
Diabetes Mellitus = Polyuria, Polydipsia, high blood glucose
SIADH = Oliguria, not thirsty
Regular Insulin
Onset
Peak
Duration
Give what route?
Onset - 1 hour
Peak - 2 hours
Duration - 4 hour
give IV
NPH
Onset
Peak
Duration
Give what route?
Onset - 6 hour
Peak - 8-10 hours
Duration - 12 hour
Cloudy / NO IV!!
Humalog/Lispro
Onset
Peak
Duration
Give what route?
Onset - 15 mins
Peak - 30 mins
Duration - 3 hour
Give WITH a meal
Glargine/Lantus
Onset
Peak
Duration
Give what route?
Onset - Slow
Peak - No peak
Duration - 12-24 hours
Give at bedtime
Insulin shock/hypoglycemia
Caused by?
S/S
Treatment
Insulin shock/hypoglycemia = too much insulin, not enough food, too much exercise
* “Drunk in shock” Cerebral impairment, vasomotor collapse - hypotension, tachycardia, tachypnea, cold, clammy, slow reaction time, liable
* Admin rapidly metabolized carb (candy, honey) + protein. If unconscious = iVD50, IM glucagon
DKA/Diabetic Coma
Causes
S/S
Treatment
**DKA/Diabetic Coma **= too much food, not enough insulin, not enough exercise, Viral upper respiratory infection within last 10 days
* DKA - Dehydration(dry, hot flushed), Ketones/Kussmaul breathing/high K+, Acidosis/Acetone breath/ Anorexia
* Regular insulin IV + IV fluids 200mg/hr (FAST)
Type 2 high sugar / HHNK/HHNC
S/S
Treatment
Type 2 High blood sugar - HHNK or HHNC Hyperosmolar, non-ketotic coma - Severe dehydration
* S/S Dry, increased HR, decreased skin turgor, hot, flushed
* Rehydrate
Long term complications of diabetes - 2
Normal Ha1C?
Long-term complications of Diabetes = Poor tissue perfusion (doesnt heal well, renal failure) Peripheral neuropathy (Cant feel injury, incontinent)
Ha1C - 6 and below is normal, 8 and higher out of control
What is it for? Therapeutic & Toxic levels
Lithium
Lanoxin (Digoxin)
Aminophylline
Dilantin/phenytoin
Bilirubin
Lithium - Antimania
* 0.6-1.2
* 2.0
Lanoxin (Digoxin) -Afib & CHF
* 1-2
* 2.0
Aminophylline - relief of airway bronchospasm
* 10-20
* 20
Dilantin /Phenytoin
* 10-20
* 20
**Bilirubin - **
* 10-20 - elevated level for newborn
* 20
Kernicterus?
Opisthotonos?
**Kernicterus **- is bilirubin in the CSF / bilir at 20
Opisthotonos - position baby assumes when bili on the brain. Hyperextension. Place on their side
**Hiatal Hernia **- define
S/S
Treatment
**Hiatal hernia **- 2 chamber stomach - acid regurgitation into esophagus bc upper stomach herniates upward. Moving in the wrong direction at the correct rate
* GERD - heartburn and indigestion
* Hiatal hernia if you lie down after you eat and get GERD
TREATMENT - High HOB, lots of fluids, high carb, low protein
Dumping Syndrome - define
S.S
Treatmetn
Dumping syndrome - Gastric contents dump too quickly. Right direction incorrect rate
* DRUNK - impaired speech, liable, cerebral impairment
* SHOCK - hypotension, tachycardia, cold, tachypneia
* Acute abdominal distress - distended, guarded, hyperactive bowel sounds, diarrhea, cramping, bloating
TREATMENT - low HOB, low fluids during meals, low carbs, high protein
Kalemias -
Does –?
Hypo?
Hyper?
Never push?
Decrease fast? slow?
Same as prefix, except HR and Urine output
Hypo - Lethargy, Bradypnea, U wave, Ilius / constipation, Flaccidicy, Tachycardia, Increased urine / polyuria
Hyper - Agitated, Seizures, Tachypnea, Diarrhea, Spasticity/clonus , Bradycardia ,Oliguria
* NEVER PUSH IV / No more than 40mEq of K+/liter of IV fluid
* Give D5W & Insulin to decrease K+ FAST - hides K in cells
* Kayexalate - K+ exists-late SLOW - gets K out via poop
Calemias
(Calcium)
Does?
Hypo?
Hyper?
Opposite as prefix
Hypo - Agitation/ Irritability, Seizure, Tachycardia, Clonus, Diarrhea, Hyperactive reflexSpasicity / clonus, Polyuria Chvosteks, Trousseau
HYPER - Lethargy, Bradycardia, U wave, Bradypnea, Ilius / Constipation.Flaccidicy / hypoactive reflexes, Oliguria
Magnesemias
(Magnesium)
Does?
Hypo?
Hyper?
Opposite as prefix
HYPO - Agitation/ Irritability, Seizure, Tachycardia, Clonus, Diarrhea, Hyperactive reflexSpasicity / clonus, Polyuria
HYPER - Lethargy, Bradycardia, U wave, Bradypnea, Ilius / Constipation, Flaccidicy / hypoactive reflexes, Oliguria
HypErnatermia - Causes?
S/S
HypOnatermia - causes?
S/S
**HypErnatermia **
(DKA, DI, HHNK)
S/S- dehydration - Dry skin, Thready pulse, Rapid HR
HypOnatermia
(SIADH)
S/S - Overlaod
If a symptom involves nerve or skeletal pick?
For any other symptom pick?
Earliest sign of electrolyte imbalance is?>
*If a symptom involves nerve or skeletal pick - CALCIUM. For any other symptom pick POTASSIUM (generally anything affecting blood pressure)
**Earliest sign of electrolyte disorder is NUMBNESS, TINGLING (paresthesias)
Chadwicks sign
Color change of cervix to cyanosis
Goodells SIgn
Cervical softening
Hegar sign
Uterine softening
What order does Chadwick, Goodells, Hegar signs happen?
Alphabetical order
Chadwick
Goodell
Hegar
When do pregnant women come in for office visits?
1/mo until week 28
q 2 weeks until week 36
then every week
1st trimester problems?
Morning sickness - dry carb
Urinary incontinence - void q 2hour
2nd & 3rd trimester problems?
Dyspnea - Tripod position
Back pain - Pelvic tilt exercises
3rd - Urinary incontinence
Define
Dilation?
Effacement?
Station?
Dilation - 0-10cm
Effacement - thinning of cervix
Station - relation of fetal presenting part to moms ischial spine
- nEgative = above spine, Positive - below spine
Define
Engagement?
Lie?
Presentation?
Engagement - station 0 at ischial spines
Lie - relation between spine of baby and spine of mom
Presentation - part of baby that enters birth canal first. Most common ROA/LOA
Stage 1
Stage 2
of labor and delivery
Stage 1 ALL OF LABOR- Dilate and phase of cervix
* Latent phase -
* Active phase
* Transitional phase
Stage 2 - Delivery of baby
Stage 3
Stage 4
of Labor and delivery
Stage 3 - Delivery of placenta
Stage 4 - Recovery, first 2 hours to stop bleeding
Latent phase
CM dilated?
Contraction freq?
Duration?
Intensity?
0-4cm
Contractions freq 5-30min
Contraction duration 15-30 sec
Mild intensity
Active phase
CM dilated?
Contraction freq?
Duration?
Intensity?
5-7cm
Contraction freq 3-5mins
Contration duration 30-60sec
Moderate intensity
Transition phase
CM dilated?
Contraction freq?
Duration?
Intensity?
8-10CM
Contraction freq 2-3mins
Contration duration 60-90 sec
Strong intensity
Contractions should not be longer than ___ or closer than every —-Mins?
90sec
2mins
Contraction
Freq
Duration
Intensity
Freq - beginnign of 1 to the begining of next
Duration - Beginign to end of 1 contraction
Intensity - Strength of contraction
What complication is indicated if mom is having painful back pain?
Baby turned backwards
-Position knee-chest
What to do with a prolapsed corD?
Push head back in off cord and position in knee-chest or trendelenburg
Interventions for all other labor complications?
Left side/lateral
IV increase
Oxygen
Notify
Stop PIT
Interventions for
Low fetal hR
FHR accelerations?
Low baseline variability?
High baseline
Late decels
Early decels?
Variable decels>
- Low fetal HR = LION
- FHR accels = Nothing
- Low baseline - LION
- High baseline - Nothing
- Late decels - LION
- Early decels -
- Varibale - Could be prolapse cord!!
Hyperthyroidism
S/S
Radioactive iodine
Surgical removal
Total Vs Subtotal
Hyperthyroidism = Hyper-metabolism
* Weight loss, diarrhea, increased HR, hot/heat intolerance, cold tolerance, HTN, Exopthalmos
* Graves Disease
* Radioactive iodine - isolated for 24 hours, double flush/careful with urine, Propylthyroid utisil PTU -Knocks out WBC
* Surgical removal - total removal needs lifelong hormone replacement, at risk for hypocalcemia. Subtotal do not need hormone replacement. BUT are at risk for THYROID STORM. Totals are never at risk for this
Thyroid storm - S/S & Treatment
Post op risk for total and Sub in 1st 12 hours?
For total in 12-28hours?
For Sub in 12-28hours
THYROID STORM - Extremely high vital signs, extremely high fever 105^, psychotically delirious. MEDICAL EMERGENCY.
Treatment - oxygen and lower body temp
Total - Tetany Subtotal = Storm
* Post-op risk for total and subtotal in 1st 12 hours = Airway/breathing, bleeding
* Post op risk for a total in 12-28 hours = tetany r/t decreased CA
* Post-op risk for sub in 12-28 hours = thyroid storm
Hypothyroidism - S/S & AKA
TreatmetnT
Never – these people?
Hypothroidism = Hypometabolism
* Weight gain, HTN, constipation, lethargy, cold intolerance, slow
* AKA Myexedema
* Thyroid replacement / never hold thyroid pills
* Do NOT SEDATE these people
Adrenal Cortex diseases start with?
Addisons disease - define, S/S, treatment
Cushings syndrome - S/S. Treatment
- Adrenal Cortex Diseases start with A or C
- Addisons disease is UNDERSECRETION of adrenal gland
S/S Hyperpigmented (darker), doesnt respond to stress well = go into SHOCK
Treatment - steroids/need to wear a medical braclet
Add-a-sone / Glucocorticoids. Ex. Betamethasone - Cushing Syndrome is OVERSECRETION of adrenal cortex
S/S of cushings and SIDE effects of steroids! Moon face, hirutism (increased body hair), water retention, gynecomastia, buffalo hump, central obesity, skinny limbs, decreased bone density, easy bruising, irritability, immunosuppression
Treatment - adrenalectomy - replacement therapy - steroids
TOYS
0-6months
6-9 months
9-12 months
Toddlers
Preschoolers
0-6 - Music mobile
6-9 - Cover/uncover
9-12 - Verbal toy
Toddlers - Push/pull
Preschoolers - Fine motor
Avoid what answers for children under 9months?
BUILD, SORT, STACK, MAKE, CONSTRUCT
Toys/activities
School age (7-11)
Adolescents (12-18)
School age - Creative, Competitive, collective
Adolescents - Peer group association
Laminectomy - Define
S/S
3 locations
Do not
Post op complications
Laminectomy -Removal of vertebral spinus process / to treatment nerve root compression
* S/S of nerve root compression - Pain, paresthesia, paresis.
* 3 locations - Cervical (upper extremities & breathing)
Thoracic (cough & bowel sounds)
Lumbar (urine output & legs)
* Always LOG ROLL your pt
* Do NOt dangle/sit on side of bed, allowed to walk, sit, stand, lie down, limit sitting 20-30 min at a time
* POST OP complication - Cervical - pneumonia, Thoracic - Pneumonia & paralytic illeus, Lumbar - urinary retention
D CRITICAL LABS - 5
- Potassium greater than 6
- pH in 6’s
- CO2 in 60’s (nonCOPD)
- PO2 in 60’s
- Platelets below 40,000
C - CRITICAL LABS - Moderate priority (10)
- INR above 4
- Potassium lower than 3.5
- Potassium between than 5.4 - 5.9
- Hemoglobin below an 8
- CO2 in 50’s (nonCOPD)
- PO2 70-77
- 02 less than 93
- Sodium - high or low
- WBC below 5,000
ANC below 500
CD4 below 200 - Platelet below 90,000
What is therapeutic level of
Creatinine
INR
Potassium
02 Sat
BNP
Creatinine - Best indicator of Kidney function / 0.6-1.2
INR - monitors Coumadin (warfarin) therapy / 2-3, Increased = bleed risk, 4 or greater is critial
Potassium - 3.5-5.0
**02 Sat **- 93-100 /Anemia & Dye procedure in last 48hours falsely elevates 02
BNP - Good indicator of CHF, Therapeutic range 100 or less
Neutropenic Precautions
Neutropenic Precautions - Reverse/Protective isolation
Strict handwashing
Shower BID with antimicrobial soap
Avoid crowds
Private room / limit # of staff entering & limit visitors
No fresh flowers or plants
Low bacteria diet, no raw fruits,veggies or undercooked meat
Do not drink water that has been standing 15 mins
Vitals q 4 hours
Check WBC/ANC daily
Avoid indwelling cath
Do not reuse cups
Use disposable plates, cups, etc
Dedicated items in room
Phenothiazines
-All end in___
Large doses = Small doses =
S/S
Teach
- All end in ZINE
- LARGE doses - antipsychotic, SMALL doses - antiemetic
S/S ABCDEFG
A-Anticholinergic
B-Blurred vision & Bladder retention
C - Constipation
D - Drowsiness
E - EPS
F - Fhotosensitivity
G - aGranulocytosis (low WBC) - Teach to report sore throat and signs of infection. Never stop the ZINE
TCA / NSSRI
Drugs
S.S
How long does it take?
Tricyclic Antidepressants / NSSRI
* Mood elevators used to treat depression (Elavil, Trofranil, Aventyl, Desyrel)
S/S ABCDE- Euphoria
* Must take 2-4 weeks before effects
BEnzodiazepines
Always have – or – in name?
Prototype
Can also be used for
Do not take more
S/S
Benzodiazepines / Antianxiety “minor”
* Always have PAM or LAM in name
* Valium
* Can also be used as anesthetic, muscle relaxant, alcohol withdrawk, seizures
* Must NOT take more than 6wks to 3months
S/S ABCD
MAOI
Used for
What 3 begining of drug names
Interactions
MAOI / Antidepressants
* Depression thought to be causes by lack of NE, dopamine, serotonin.
* MAR, NAR, PAR beginning of drug names
* S/S - ABCD
* Interactions - MUST AVOID foods containing TYRAMINE or will have severe HTN. AVOID - Salad BAR - Bananas, avocados, raisins (any dried), grains made from active yeast, no organ meats, no preserved meats, no cheese, no alcohol, caffeine, chocolate, locorice, soy sauce. They can have mozzarella and cottage cheese
Lithium
S/S
Toxic?
Intervention
Monitor
Lithium / an electrolyte used to treat bipolar disorder
* S/S 3P’s - Polyuria, Pooping, Paresthesia
* Toxic - Tremors, metallic taste, severe diarrhea
* Intervention, fluid. Not water - give gatorade
* MONITOR lithium. Low sodium can make lithium more toxic. High sodium can make it less therapeutic
PROZAC
S/S
Prozac / SSRI antidepressant mood elevator
* S/S ABCD. Give before noon. Watch for suicide when changing dose in adolescent.
Haldol
S/S
NMS VS EPS
Haldol / Tranquilzer
* S/S ABCDEFG
Elderly can develop NMS from overdose - potently deadly fever with temp over 104 w/ anxiety and tremors
* EPS - side effect, no big deal - Anxiety & Tremore
NMS vs EPS is NMS has a fever!!!
**Clozaril **- used for
end in?
S.S
Does not have what side effecT?
Clozaril / atypical antipsychotic / used to treat severe schizophrenia /
* end in ZAPINE - new “major” antipsychotics
**S/S **Agranulocytosis (worse than cancer drugs),
* Does not have side effects ABCDE
Zoloft
- Causes
- Water for interaction with?
- S.S?
Zoloft (sertraline) . SSRI / Antidepressant
* Causes insomnia.
* Watch for interaction with St, Johns wart - Serotonin syndrome and Warfarin - bleeding
* S/S SAD head - S-sweating, A-Apprehensive, D- dizzy, Headache
Total weight gain for avg pregnancy?
Weight gain 1st trimester & 2/3rd trimester
Trick to determine acceptable weight gain
Total weight for AVG 28lbs + or - 3lbs (normal weight)
1st trimester - 1lb each month
2nd/3rd trimester - 1lb/week
- Take the week of gestation and minus 9
When is fundus palpable?
When is it at umbilicus?
- not palpable until week 12!
- At umbilicus - at 20-22 weeks gestations (date of viability / end of 2nd trimester)
4 positive signs of pregnancy
- fetal skeleton on Xray
- Fetal on ultrasound
- Auscultation of fetal heart
- Examiner palpate fetal movement)
What to do if
Low fetal HR. Under 11-
high fetal HR over 160
Low variable
High variable
Late decel
Early decel
Variable
Low - LION
High - Nothing
Low variable - Not good
High variable - Nothing
Late decel - LION
Early decel - Nothing
Variable - VERY BAD / prolapse cord
VEAL CHOP
Variable - Cord compression
Early decel - Head compression
Acceleration - OK
Late decel - Placental insufficency
BUBBLEHEAD
Breasts
Uterine Fundus - Firm, midline, height =day postpartum
Bladder & Bowel
Lochia - Rubra “red”, Serosa “Rosey”, Alba “white” (occurs in order)
Epsiotomy
Hemotocrit & Hemoglobin
**Extremity check **- Thromboplablitis - Bilateral calf circumference
Affect
Discomforts
Cephalohemtoma VS Caput succedaneum
C.S - crosses sutures & symmetrical
Cephalohematoma - bleeding, does not cross sutures
Tocolytics
3 drugs and major side effects
Stop labor
Terbutaline - causes maternal tachycardia
**Mag sulfate ** - everything goes down, RR (below 12, titrate), reflex (+1 titrate), HR, etc
Nifedipine - headache & hypotension
Oxytocics
3 drugs and major side effects
Stimulate labor
Pitocin (oxytocin) - Uterine hyperstimulation (longer than 90sec closer than q 2min)
Cervidil - dialtes cervix - Uterine hyperstimulation
Methergyne - increase bp
Fetal lung meds
2 meds
Betamethasone - give to mom IM before baby born
Survanta - Given transtracheal to baby after born
Steps of drawing up insulin
(5)
Draw total dose of air
Put air in N vial
Put air in R vial
Draw up R dose
Draw up N dose
What do you draw up first Regular insulin or NPH?
Regular then NPH
RN
What needle to pick
IM?
SQ?
IM - answer with 1 in it
SQ - answer with 5 in it
Heparin
Route
Works when
Not given more than
Antidote
Lab that monitors
Pregnancy?
- Given IV or SUBQ
- Works immediatly
- No more than 3 weeks
- Antidote: protamin sulfate
- PTT
- Can use in pregnancy, Class C
Coumadin
Route
Works when
Not given more than
Antidote
Lab that monitors
Pregnancy?
- PO only
- Takes days to work
- Can take for life
*Antidote Vit K - Lab: PT, INR
- Cannot use in pregnancy/Cat X
K wasting or sparing K diuretics
Any diuretic ending in X - Wastes K+ + diurel
Baclofen (lisoresal) / flexoril
Used for
S/S
teaching
Muscle relaxant
S/S tired and muscle weakness
Teach: dont drink, drive or operate machine
How to teach children
0-2years
3-6years
7-11years
12-14 years
0-2 - teach in present as doing
3-6 - teach slightly ahead of time (morning of/day of). Play, toys, stories
7-11 - days ahead of time, how to do skills. Age approp reading/demo
12-14 - teach like an adult
Pressure sore
Stage 1
Stage 2
Stage 3
Stage 4
Stage 1 - Skin intact, red
Stage 2 - Ulcerated, pink, dermis
Stage 3 - Yellow subq fat
Stage 4 - Red/white, muscle bone
