Sep 2 Flashcards
TCA example
Amitriptyline
TCA SE
A, B, C, D, E Anticholinergic Blurred vision Constipation Drowsy Euphoria
How to identify a Benzo
contain “zep” in the name
4 uses for Benzos
- pre op
- sz
- alcohol WD
- help when someone fighting the ventilator
MAOI SE
htn crisis (avoid tyramine)
MAOI things to avoid
BAR (banana, avocado, raisins)
organ meat
yogurt, cottage cheese, caffeine
Lithium SE, the 3 Ps
Pee, poop, paresthesia
Lithium TE
Tremor
Metallic Taste
Severe diarrhea
Top lithium intervention
give fluids
Lithium: what do you monitor regarding Na levels
decreased Na = toxicity
increased Na = under medicated
SSRI SE
ABCDEI Anticholinergic Blurred vision Constipation Drowsy Euphoria Insomnia
Haloperidol
1st gen anti psyc
NMS
Neuro malignant syndrome-
- Crazy high temp
- to prevent in the elderly, give 1/2 the dose
- Medical emergency
Difference between NMS and EPS
NMS has the high temp
Clozapine
2nd gen aka atypical
Clozapine SE
decreased WBC
How to identify 2nd gen anti psycs
they end in zapine
If a patient is on sertraline, you will likely need to do what
lower the dose of all other medications
Serotonin Syndrone
Sad Head
Sweating
Apprehension
Dizzy
Headache
Sertraline + Warfarin
you will bleed out
Total weight gain during pregnancy
28 lbs (plus or minus 3)
weight gain in the first trimester
1 lbs each month (total of 3 lbs)
weight gain in the 2nd trimester
1 lbs each week
When is the fundus palpable
week 12 (2nd trimester)
If you palpate the fundus before week 12
it could be a hydatiform mole
What does the fundus tell you about the trimester
no fundus = 1st trimester
fundus at or below naval = 2nd
fundus above naval = 3rd
“when would you first?”
pick the earliest in the range
“when would you most likely?”
pick the middle of the range
“when should you ___ by?”
pick the latest range
When is quickening
16 to 20
Pregnancy: What kind of signs are urine/blood tests
not positive
What is the order of the pregnancy signs
alphabetical:
Chadwick
Goodell
Hegar
Goodell
softening of cervix
Hegar
softening of uterus
Pregnancy: Provider visits: 0 to 28
once a month
Pregnancy: Provider visits: 29 to 36
twice a month
Pregnancy: Provider visits: 37 on
weekly or until week 42
Hemoglobin ___ is normal in 1st trimester
11
Hemoglobin ___ is normal in 2nd trimester
10.5
Hemoglobin ___ is normal in 3rd trimester
10
Pregnancy: when do you eat dry carbs
before getting OOB
Pregnancy: Urinary incontinence tx
void Q 2 h
Pregnancy: Dyspnea tx in 2nd and 3rd trimester
tripod
Pregnancy: back pain tx
pelvic tilt
Truest sign of being in labor
onset of regular, progressive contractions
Effacement means
thinning of the cervix
Not effaced cervix means
its still thick
fully effaced cervix is called
100%
Station
relation of fetal presenting point to ischial spines (tightest space)
Negative station means
baby still above the tight space
positive station means
baby is below the tight space
zero station means
baby is right at the tight space
If the baby is at negative station for a long time
you might need a C section
Vertical lye
its a good thing
means the baby and moms spines are parallel
Transverse lye
its a bad thing, means the spines are perpendicular
4 stages of LD: stage 1
Labor
This stage includes all the 3 “phases”
- latent
- active
- transition
Contractions here are to dilate and efface
4 stages of LD: stage 2
Delivery of baby
4 stages of LD: stage 3
Delivery of placenta
4 stages of LD: stage 4
Next 2 hours
Contractions are to stop the bleeding
Latent phase
1 to 4 cm
contractions 5 to 30 apart
last for 15 to 30 seconds
Active phase
5 to 7 cm
contractions 3 to 5 apart
last for 30 to 60 seconds
Transition
8 to 10 cm
contractions 2 to 3 apart
last for 60 to 90 seconds
If contractions are closer than __ min and longer than __ seconds, mom is in trouble
2 min, 90 seconds
If contractions are closer than 2 min and longer than 90 seconds, mom is in trouble, its an indication to
stop pitocin
Complications of LD: Painful back labor tx
Position knee to chest and push on her sacrum
Complications of LD: Prolapse cord tx
its an emergency
push the baby’s head back up (so that it’s not pushing on the cord) and then position in knee chest
What is the tx for all LD complications (besides painful back labor and prolapse cord)
LION
Left side
Increase IV
Oxygenate
Notify Doc
Don’t give pain meds to labor patient if the baby is likely to be born when
the med peaks
for example a primigravida at 5 cm could have IV pain med. But a multigravida at 8 cm could Not get IM meds
Low fetal HR (under 110)
Bad!
LION
Left side
Increase IV
Oxygenate
Notify Doc
High fetal HR (over 160)
not that serious
fetal: Low baseline variability
Bad
Fetal HR not fluctuating. Do LION
fetal: High baseline variability
Good. Document
Late deceleration
HR gets slow near the end or after contraction.
Bad. Do LION
Early deceleration
Slow before or at beginning of contraction.
Good
Variable decelerate
Very bad. (think Vary = Very)
It’s caused by prolapse cord
Push and position
VEAL
Variable … Cord compression
Early decel ….. Head compression
Acceleration …. OK (it’s fine)
Late decel ….. Placental insufficiency
In general, a good OB answer is
check fetal HR
4 steps of delivering the baby
- Deliver Head
- Suction Mouth then Nose (alphabetical)
- Check for nuchal cord
- Deliver body
woman named Ava
2 arteries and 1 vein
the 4th stage of LD is recovery. In the 4th stage there are 4 things you do 4 times an hour:
Vitals
Fundus check
Check pads
Roll her over to check for bleeding
Recovery phase of LD: Check pads Q 15 min. What do you look for
If saturated in 15 min, that’s bad
