NU 454 Test IV Flashcards
1
Q
Shunts blood from portal circulation to superior/inferior vena cava
A
Ductus Venosus
2
Q
Provides a passageway for most of the blood from the PA to the descending aorta (bypassing the lungs)
A
Ductus Arteriosus
3
Q
Allows blood to be shunted from the RA to LA
A
Foramen Ovale
4
Q
Direction of blood flow BEFORE birth
A
Right to Left
5
Q
Direction of blood flow AFTER birth
A
Left to Right
6
Q
Increased Pulmonary Blood Flow
A
ASD, VSD, PDA
7
Q
Most common CHD
A
VSD
8
Q
Systemic pressure in the LV is transferred to the R side of the heart. This increases pressure in the pulmonary vasculature, which increases pressure in the lungs reversing blood flow from R to L. (Reverse shunting)
A
Eisenmenger Syndrome
SE of VSD
9
Q
Medication that attempts to close PDA
- inhibits prostoglandins
- vasoconstricts
- IV for 3 doses
- must be
A
Indomethacin (Indocin)
10
Q
Drug that keeps PDA open
A
Prostaglandin E
11
Q
Hypercyanotic spells are seen in what CHD
A
Tetralogy of Fallot
-“Tet Spells”
12
Q
Obstructive Heart Defects
A
Pulmonary stenosis, aortic stenosis, coarction of the aorta
13
Q
Blood pressure and O2 saturation are higher in the arms than legs in what CHD
A
Coarctation of the Aorta
14
Q
Procedure to temporarily fix TGA by inflating a balloon and pulling it from LA to RA
A
Rashkind Procedure
15
Q
Powerful vasodilator prostaglandin E
- IV infusion
- keeps PDA
- monitor BP
- SE: flushing, jitters, elevated temp, apnea
A
Alprostadil (Prostin VR Pediatric)
16
Q
Do not give Digoxin if HR is less than?
A
100
17
Q
Therapeutic Dig level
A
0.8-2.0 ng/mL
18
Q
Post op hemorrhage in the infant
A
5-10 mL/kg/hr
19
Q
Low Birth Weight
A
< 2500 g
20
Q
Very Low Birth Weight
A
< 1500 g
21
Q
Extremely Low Birth Weight
A
< 1000 g
22
Q
Appropriate for Gestational Age (AGA)
A
10-90% on intrauterine growth curve
23
Q
Small for Gestational Age (SGA)
A
< 10% on intrauterine growth curve
-Intrauterine growth retardation (IUGR)
24
Q
Large for Gestational Age (LGA)
A
> 90% on intrauterine growth curve
gestational diabetic moms
25
< 37 Weeks
Preterm Infant
26
38-42 weeks
Full term infant
27
> 42 weeks
Post term infant
28
Death in utero 20 weeks before birth
Fetal death
29
Death in the first 27 days of life
Neonatal death
30
Death after 28 days of life
Postnatal death
31
Eyes are fused
< 24 weeks
32
AOP: the brain does not transmite message to lungs to take a breath
Central Apnea
33
AOP: the upper airway constricts or collapses
Obstructive Apnea
34
Ex. Aminophylline, Theophylline, Caffeine
- CNS stimulants
- Toxicity: tachycardia, vomiting, diuresis, irritability, dysrhythmias
Methylzanthines
| -used to treat AOP
35
Poor feeding, apnea, tachypnea, pallor, tachycardia, murmur, decreased O2 sat
Anemia
36
- Hematocrit > 65%
- Blood too thick to adequately perfuse the body
- S/S: lethargy, irritability, peripheral cyanosis, respiratory distress, hyperbilirubinemia, hypoglycemia
Polycythemia
37
RSV immune globulin used to treat bronchopulmonary dysplasia
Respigam
| -given IV during RSV season (October-May)
38
JVD, cardiomegaly, loud systolic murmur, diastolic murmur, sustained dysrhythmias, clubbing, cyanosis, FATIGUE, chest pain, dyspnea on exertion, syncope on exertion, tachycardia (>120), irregular pulses
S/S of cardiovascular disorders in pregnancy
39
Anticoagulant SAFE in pregnancy
Heparin
40
Anticoagulant CONTRAINDICATED in pregnancy
Warfarin (Coumadin)
41
Normal pregnancy range for Hct
38-45%
42
Morphine
Demerol
Hemabate
NSAIDS
Do not use if have asthma and pregnancy!
43
Safe to be used with myasthenia gravis pregnant women
Pitocin
44
DO NOT use in pregnant women with myasthenia gravis
Mag Sulfate
45
Early miscarriage
< 12 weeks
46
Late miscarriage
12-20 weeks
47
Viable fetus
20 weeks or 500 g
48
Bleeding and closed cervix
threatened miscarriage
49
Cervix is open, but products are not expelled
inevitable miscarriage
50
Fetus is lost, placenta is attached, and bleeding occurs
incomplete miscarriage
51
Fetus is outside of uterus with membranes
complete miscarriage
52
Fetus died and all products are in uterus with no cervical opening
missed miscarriage
53
Thirst, syncope, tachycardia, changed sensorium, hypotension, low UOP, agitated, restless, thready HR
S/S of shock
54
PAINLESS bleeding
placenta previa
55
PAINFUL hard rigid abdomen
abruptio placentae
| -marginal or concealed (grades 1-3)
56
Uterus appears purplish and copper colored (echymotic)
couvelaire uterus
57
Cord begins to branch before it inserts into the placenta
valamentous insertion of the cord (vasa privea)
58
The cord is off to one side rather than centrally located
battledore insertion of the cord
59
Full placenta and small placenta
succenturiate placenta
60
Hypotension, nausea, warmth, flushing, muscle weakness, decreased reflexes (assess DTRs), slurred speech
Mag toxicity
61
Antidote for mag sulfate
calcium gluconate
62
Patterns NOT associated with uterine contractions
Episodic
| EW = episodic without
63
Patterns that ARE associated with uterine contractions
Periodic
| PC = periodic contractions
64
Tachycardia in the fetus most often indicates
Infection in the mother with fever
65
No late decels w/ uterine contractions in a 10 minute frame
Negative oxytocin challenge test
66
Repetitive decels w/ more than half of contractions in a 10 minute frame
Positive oxytocin challenge test
67
MVUs > 400
Uterine tachysystole
68
Apnea in infants
No breathing for > 15 seconds
69
Nitrogen Washout
Administer 100% o2 for 6-12 hours – causes free air to be absorbed by the capillaries to body’s natural response
-contraindicated in premies (risk for ROP)
70
Sudden hypotension, bradycardia, o2 sat that does not improve with oxygen administration
Infant pneumothorax
71
Chest tube insertion location for infant pneumothorax
4th intercostal space; midclavicular line
72
Dx of pneumothorax
Tranallumination of the chest (performed by nurse)
73
Cytomegalovirus results in
Hearing disabilities in the infant
74
IVIG
Tx of sepsis: Intravenous immunoglobulin therapy to enhance baby’s natural immune system
75
Jittery, irritability, cyanosis, apnea, hypotonia, seizures
S/S of hypoglycemia in the infant
76
D15 and D25 can only be administered through
A central line
77
Hypoglycemia in an infant
< 40
78
If blood glucose < 25
Give IV dextrose
79
Nerve damage to one or both arms
Erb's Palsy
80
Perinatal Hypoxic-Ischemic Brain Injury
Stroke
81
May be associated with neurologic damage, hypoglycemia, hypocalcemia
-Repetitive motions of both hands – check blood sugar
Tremors
82
NORMAL; may be associated with crying or stimulation, common in infants during first 4 days of life
-Can be stopped when touched
Jitteriness
83
Therapeutic Phenobarbital
15-40 mcg/mL
84
SE: respiratory depression, elevated LFTs with long term use, vomiting, and diarrhea
Phenobarbital
85
Phenobarbital dosage
3-4 mg/kg/day (max 5 mg/kg/day)
86
Promotes absorption of CSF
Acetazolamide (Diamox)
87
Increases risk for Digoxin toxicity
Hypokalemia
88
Decreases the effectiveness of Digoxin
Hyperkalemia
89
- Fever
- Leukocytosis
- Pericardial effusion
- Friction rub
Postpericardotomy Syndrome
90
Asymptomatic at normal levels of activity
Class I Heart Disease
91
Symptomatic with ordinary activity
Class II Heart Disease
92
Symptomatic with less than ordinary activity
Class III Heart Disease
93
Symptomatic at rest
Class IV Heart Disease
94
Hemodynamics peak in what week?
24 (second trimester)
95
Tx for cardiac pregnant patients
-bed rest
-adequate nutrition
-prophylactic abx
-vacuum delivery w/ NO PUSHING
-anticoagulation therapy
(estrogen increases coagulation)
96
Antidote for coagulation therapy
Vitamin K
97
Spinach, leafy veggies, okra, black-eyed peas
Food high in Vitamin K
98
Chills, fever, pain in back and abdomen, shock
Hemolytic crisis
99
Carbs, bread, pasta, green/leafy veggies, spinach, kale
Foods high in folic acid
100
Least amount of fluid in amniotic sack for proper cushioning
6cm
101
ARDS is precipitated in pregnancy by:
1. DIC
2. PE
3. Aspiration Pneumonia
102
Avonex
Betaseron
Copaxone
MS drugs to be avoided during pregnancy
103
Tx for Bell's Palsy
Steroids and supportive therapy
104
Number one cause of death in Systemic Lupus Erythematous patients
Infection
105
Destroys any residual products of conception that might be left in the tube following a salpingotomy
Methotrexate (Trexall)
106
The margins of the placenta will break away and bleeding occurs in amniotic fluid and out of the vagina
Marginal Abruptio Placentae
107
The bleeding is centrally located, and the sides of the placenta are still sealed around it. No vaginal bleeding
Concealed Abruptio Placentae
108
May or may not have vaginal bleeding, uterine tetany, no maternal/fetal distress
Grade I Concealed Abruptio Placentae
109
Uterine tenderness and tetany, may or may not have vaginal bleeding, shock like s/s and fetal distress
Grade II Concealed Abruptio Placentae
110
Severe board like tetany, fetal monitor is painful, fetus is dead and mother is in profound shock which can lead to DIC
Grade III Concealed Abruptio Placentae
111
Psychosis syndrome resulting form necrosis of the pituitary d/t loss of blood volume
Sheehan Syndrome
112
Small dark adherent clots on maternal side of placenta
0-minimal placentae abruptio
113
10-20% detachment of placental surface; external bleeding < 100mL
1-mild placentae abruptio
114
20-50% detachment, external bleeding 100-500mL; uterine tetany and tenderness
2-moderate placentae abruptio
115
>50% detachment, internal and external bleeding > 500mL; uterine tetany, maternal shock, risk of fetal death and maternal DIC
3-severe placentae abruptio
116
15% blood loss
Normal pulse
Normal SBP
MAP 80-90
Class I PP hemorrhage
117
20-25% blood loss
Pulse 100
Normal SBP
MAP 80-90
Class II PP hemorrhage
118
30-35% blood loss
Pulse 120
SBP 70-80
MAP 50-70
Class III PP hemorrhage
119
40% blood loss
Pulse 140
SBP 60
MAP 50
Class IV PP hemorrhage
120
Placenta attaches to outside of the myometrium
Accrete
121
Placenta invades into the myometrium
Increta
122
Placenta goes all the way through the myometrium and can even enter abdominal cavity
Precreta
123
Gestational HTN/BP elevation after 20 weeks with proteinuria
Preeclampsia
124
Preeclampsia with seizures not related to any other cause
Eclampsia
125
BP elevation detected for the first time after 20 weeks WITHOUT proteinuria
Gestational HTN
126
Gestational HTN w/ no s/s of preeclampsia at time of birth; resolves within 12 weeks after birth - retrospective dx
Transient HTN
127
Chronic elevation of BP which was previously well controlled with new proteinuria
Preeclampsia superimposed or chronic hypertension
128
Common complication of preeclampsia and HTN during pregnancy
Pulmonary edema
129
Urine dipstick > 3g/L or 30mg/dL
Proteinuria
130
BP: > 140/90
Edema: may or may not be seen
Dipstick: > 30mg/dL
UOP: < 30mL/hr
Mild Preeclampsia
131
```
BP: > 160/110
Edema: massive weight gain, swelling
Dipstick: >2gm/24hr
UOP: < 20mL/hr
Hyperreflexia: > 3+
Platelets: < 100,000
Epigastric pain
Blurred vision
N/V
IUGR
Late decelerations
```
Severe Preeclampsia
132
Normal Hgb
12-16
133
Normal Hct
38-45%
134
Normal PT
| Normal PTT
12-14 sec
| 60-70 sec
135
Normal fibrinogen
200-400 mg/dL
136
Fibrin split products and D-dimers are usually
absent
137
Normal BUN
10-20 mg/dL
138
Normal Creatinine
0.5-1.1
139
Normal LDH
Normal AST
Normal ALT
45-90
4-20
3-21
140
Creatinine clearance
80-125 mL/min
141
Burr cells or schistocytes are usually
absent
142
Uric acid
2-6.6
143
Bilirubin
0.1-1
144
Mom: Hypotension, nausea, warmth, flushing, muscle weakness, decreased reflexes, slurred speech, confusion
Fetus: tachycardia, hypoglycemia, hypocalcemia, hypermagnesemia
S/S of mag toxicity
145
Changes in variability; fetal tachycardia or bradycardia
Episodic patterns
146
Early and late decelerations
Periodic patterns
147
Variables =
Cord compression
148
Early =
Head compression
149
Accelerations =
Okay
150
Late decelerations =
Placental insufficiency
151
Reactive non-stress test
2 accelerations of FHR > 15bpm lasting > 15sec in a 20 minute span
152
Non-reactive non-stress test
FM and FHR do not meet criteria in 40 minutes; requires further evaluation
153
Equivocal non-stress test
Fewer than 2 fetal movements occur in 20 minutes, accelerations are < 15 bpm, and FHR is abnormal (160)
154
Inhibits prostoglandins to stop labor
Indomethacin (Indocin)
155
Hypertonic uterine dysfunction in the latent phase; effacement and dilation < 4 cm
Primary Inertia
156
Hypotonic contractions in the active phase; get to 4 cm and then stop
Secondary Inertia
157
Treatment for Group B streptococcal infection
PCN
158
Breastfeeding is contraindicated in which TORCH
HIV
159
Chest pain, coughing, dyspnea, tachypnea
s/s of PE
160
Drug not to be used in pregnant clients with HTN or cardiovascular disorders
Methergine
160
Goal and prevention of mastitis
Continue to breast feed infant
161
Therapeutic Mag level
4-8 mg/dL
162
Maximum Pit dosage
20 U
