Mark K Lectures 10-12 Flashcards by Katy Peterson

How to calculate due date

1st day of LMP + 7 days - 3 months

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When can you palpate the fundus?

At 12 weeks

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Presumptive signs of pregnancy

Chadwick
Goodell
Hegar
(In that order - alphabetical)

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What is Chadwick, goodell, and hegar’s signs?

Chadwick: cervical cyanosis
Goodell: cervical softening
Hegar: uterine softening

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Normal ranges for hemoglobin in each trimester of pregnancy

1st: 11
2nd: 10.5
3rd: 10

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Discomforts and treatments for each trimester of pregnancy

1st: morning sickness - dry carbs before out of bed
1st & 3rd: urinary incontinence - void every 2 hrs
2nd & 3rd: difficulty breathing - tripod position
2nd & 3rd: back pain - pelvic tilt exercises (tilt it forward)

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Explain good and bad positioning of baby for labor

Vertical lie = good
Transverse lie = trouble

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4 stages of labor

Labor
Delivery of baby
Delivery of placenta
Recovery (2 hrs)

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Phases of labor

(All are included in the labor stage)
Latent
Active
Transition

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Dilation,
contraction frequency,
contraction duration, and
contraction intensity
for active labor

5-7 cm
3-5 min
30-60 sec
Moderate

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What is considered uterine tetany?

Contractions > 90 seconds long and closer than every 2 mins
Bad

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How to measure frequency of contractions

Beginning of one contraction to beginning of next

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How to measure duration of contraction

Beginning to end of one contraction

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Treatment for painful back labor

Position on hands and knees with knees to chest
Push into sacrum to relieve pain

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Treatment for prolapsed cord

Medical emergency
Push baby head off cord
Position pt on hands and knees with knees to chest

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Treatment for all other labor complications

LION pit

L: left side
I: increase IV
O: give O2
N: notify provider
Pit: stop pitocin (do first)

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Treatment for low FHR

Stop pit
LION

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Treatment for high FHR

Document
Take pt’s temp

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Treatment for low variability

LION pit

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Treatment for high variability

Document (this is good)

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Treatment for late decels

LION pit

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Treatment for early decels

Document
(This is ok)

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Treatment for variable decels

Very bad
Push and position b/c probably cord prolapse

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What causes variable decels

Cord compression

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What causes early decels

Head compression

What causes late decels

Placental insufficiency

What should be done 4 times an hour during recovery stage

Vital signs (watching for shock) Fundus Perineal pads (excessive = 100% saturated in < 15 min) Roll her over to check for bleeding underneath

What should be checked every 6-8 hours postpartum

B - breasts *U - uterus (fundal height = day PP) B - bladder B - bowel *L- lochia E - episiotomy H - hgb & hct *E - extremities (watching for thrombophlebitis - measure calves) A - affect D - discomforts

Differences between Caput succedaneum and cephalohematoma

CS crosses sutures and is symmetrical C does not cross sutures and is not symmetrical (is blood)

Use of terbutaline and main side effect

Stops labor Maternal tachycardia

Use of mag sulfate and main side effect

Stop labor Causes hypermagnesemia (everything goes down, esp HR & reflexes)

Use of pitocin and main side effect

Stimulate contractions Can cause uterine hyper stimulation

Use and main side effect of methergine

Stimulates contractions Causes high BP b.c it contracts blood vessels

Use of betamethasone

Steroid given to mother IM to help with fetal lung maturity

Use of beractant

Lung surfactant given to baby transtracheal after birth to help with lung maturity

What is Humulin 70/30?

Mix of N (70%) and R (30%) insulin

Rule for mixing insulins

Clear (R) to cloudy (N) (RNs do it this way0

Needle length for IM injections

21 g, 1 in ( both parts have 1 like I)

Needle length for subQ injections

25 g, 5/8 in (both have 5 like S)

Route for heparin vs Coumadin

Heparin IV or subQ Coumadin only PO

When do heparin and Coumadin start to work?

Heparin works immediately Coumadin takes a few days to a week

How long can heparin and Coumadin be given for?

Heparin cannot be given for > 3 weeks (expect for Enoxaparin) Coumadin can be given forever

Antidote for heparin

Protamine sulfate

Antidote for Coumadin

Vitamin K

Lab test for heparin

PTT (tt looks like H)

Lab test for Coumadin

Pt /(INR)

Can heparin or Coumadin be given during pregnancy

Heparin can be given during pregnancy and Coumadin cannot be

How to tell the difference between k wasting and k sparing diuretics

Any diuretic ending in X exes out K plus diurel

What is baclofen?

Muscle relaxant (on your back loafin’)

Side effects of baclofen

Fatigue Muscle weakness

Pt teaching for baclofen

Dont drink Dont drive Dont operate heavy machinery

What is cyclobenzaprine used for

Muscle relaxant

Stage for kids 0-2 yrs and how you should teach them

Sensory motor Verbally teach as you’re doing (bc only think about what they are doing right now)

Stage and best way to teach 3-6 year olds

Preoperational (preschool age) Teach shortly before what you are going to do, teach through play (fantasy oriented, understand future and past)

Stage and best way to teach 7-11 year olds

Concrete operations (7/11 is surrounded by concrete) Can teach days ahead what you’re going to do, plus skills Use age appropriate reading and demonstration (bc they’re very rule oriented)

Stage and best way to teach 12-15 yr olds

Formal operations Teach like an adult (*this is the earliest a child can manage their own care, they have abstract thinking and understand cause and effect)

Which types of patients are always unstable?

Hemorrhage Fever > 105 Hypoglycemia Pulselessness/breathlessness

APE to MAN

A: 2nd ICS at Rt sternal border P: 2nd ICS at Left sternal border E: T: 4th ICS at Left sternal border M: 5th ICS in MCL

Organs in RUQ

Liver Gallbladder Duodenum of intestines

Organs in LUQ

Stomach Spleen

Organs in LLQ

Descending colon Left half of transverse colon Sigmoid colon Rectum

Which organs are in the RLQ?

Large intestine Small intestine Appendix