Mark K Lectures 10-12 Flashcards
How to calculate due date
1st day of LMP + 7 days - 3 months
When can you palpate the fundus?
At 12 weeks
Presumptive signs of pregnancy
Chadwick
Goodell
Hegar
(In that order - alphabetical)
What is Chadwick, goodell, and hegar’s signs?
Chadwick: cervical cyanosis
Goodell: cervical softening
Hegar: uterine softening
Normal ranges for hemoglobin in each trimester of pregnancy
1st: 11
2nd: 10.5
3rd: 10
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)
Explain good and bad positioning of baby for labor
Vertical lie = good
Transverse lie = trouble
4 stages of labor
Labor
Delivery of baby
Delivery of placenta
Recovery (2 hrs)
Phases of labor
(All are included in the labor stage)
Latent
Active
Transition
Dilation,
contraction frequency,
contraction duration, and
contraction intensity
for active labor
5-7 cm
3-5 min
30-60 sec
Moderate
What is considered uterine tetany?
Contractions > 90 seconds long and closer than every 2 mins
Bad
How to measure frequency of contractions
Beginning of one contraction to beginning of next
How to measure duration of contraction
Beginning to end of one contraction
Treatment for painful back labor
Position on hands and knees with knees to chest
Push into sacrum to relieve pain
Treatment for prolapsed cord
Medical emergency
Push baby head off cord
Position pt on hands and knees with knees to chest
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)
Treatment for low FHR
Stop pit
LION
Treatment for high FHR
Document
Take pt’s temp
Treatment for low variability
LION pit
Treatment for high variability
Document (this is good)
Treatment for late decels
LION pit
Treatment for early decels
Document
(This is ok)
Treatment for variable decels
Very bad
Push and position b/c probably cord prolapse
What causes variable decels
Cord compression
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
