Simulations Flashcards
Postpartum hemorrhage
Findings:
uternine atony (hypotonic or boggy uterus)
blood clots larger than a quarter
Perineal pad saturation in 15 min or less
Constant oozing, trickling, or frank flow of bright red blood from the vagina
tachycardia and hypotension
skin pale, cool, clammy with loss of turgor and oale mucous membranes; oliguria
CARE:
Name DOB verify, assessment, pain assessment
- Firmly massage the fundus ( do not leave the fundus)
Monitor vital signs
Start IV Fluids (LR)
-Elevate legs to a 20 to 30 angle
- Oxygen at 4 L
- Administer appropriate drugs per standing orders; verify name and dob (scan)
- STAT Call lab and get CBC, Hemoglobin and hematocrit, blood type and cross, 2 units of fresh frozen plasma on hold.
-Call dr with vitals, lab results and SBAR
Thrombophlebitis
Findings: Leg pain and tenderness, unilateral are of swelling, warmth and redness, hardened vein or the thrombosis, calf tenderness
CARE:
name dob verify
-assessment
-vitals
- Make sure has IV SW #18 (green)
-Call DR with vitals lab results and order for ultrasound and PT, PTT dn INR.
- Call lab for PT, PTT, INR
- radiology for ultrasound
-call dr back with results and ask about activity order?
-measure leg circumferences.
-administer anticoagulants, 8 patient rights (safety!!!)
Postpartum lacerations
Findings: Trickling, bright red blood with firm fundus. sensation of oozing or trickling, excessive rubia (with ot without clots)
Care: Get vitals make sure has a saline well Call doctor for order monitor; if lost a lot call for CBC & H&H, Hemoglobin if HBG gets below 8 start IV for fluids and check oxygen Call dr back with results of labs.
mastitis
Findings:
mastitis: milk stasis from a blocked duct, nipple trauma and cracked or fissured nipples, poor breastfeeding technique with improper latching of the infant onto the breast; decreased in breastfeeding due to supplementation with bottle feeding, poor hygiene and inadequate handwashing when handling perineal pads and touch breasts
increased temperature, greater than 99.8 (100.4 or higher)
painful or tender localized hard mass and reddened area; usually on one breast, chills, fatigue; axillary adenopathy in the affected side (enlarged tender axillary lymph nodes) with an area of inflammation that can be red, swollen, warm and tender.
Care:
- identify, assess, vitals, assess pain
- Call dr for order for labs: WBC count: leukocytosis & CBC. SBAR, repeat back
- Call lab for CBC and WBC, (above 25,000 is infection)
- Call Dr back with lab results, antibiotics?
Uterine infection , metritis
Findings:
Flu-like clinical findings, such as body aches, chills, fever, and malaise, naorexia and nausea; elevated temper of at least 38 C (100.4 F) (greater than 99.8) or 2 more consecutive days, tachycardia
Care:
Identify, assessment, vitals, assessment of pain, fundus, locia, color smell. inspect breasts and all over body
Maintain IV status
CAll dr with vitas, s&s, order for WBC, and culture of discharge
Call Lab for CBC and WBC (above 25,000, infection)
CAll dr back with results. Ask for antibiotic
Administer antibiotic if ordered. and tylenol for fever/pain.
Epidural
Care:
Empty bladder
-vaginal examine for how far dilated (at lead 4 cm for epidura)
- IV of 18 guage, Bolus 1000 mL LR
-Baseline Vitals
- FHR monitor
-position on left side
-FHR
- if BP drops bolus with fluids; still drops> call anesthesiologist to decrease epidural;
-if still down have narcan ready,
-watch for late deceleration & prolonged deceleration
Placenta Previa/Abruptio
Findings:
Previa
Painless, bright red vaginal bleeding during second or third trimester, reassuring vitals and fetal heart rate, fundal height greater than usually expected for gestational age
Abruptio: Dark Red venous blood, painful
Care:
For previa: ask if had sex recently, ask about cramping
Electronic Fetal monitoring,
Assessment, vitals,
Have IV beginning LR 1000mL, 125 ml/hr
Stat CBC, Type and Cross with 2 units on hold
Call Dr with vitals, FHR, lab results, and ask for ultrasound.
Call radiology for Stat ultrasound.
Monitor Blood loss every 15 minutes
Maintain O2 above 90%, if below, 10 L oxygen nonrebreather mask,
Call dr back, ask about activity order,
monitor I&O
Monitor urine output and specific gravity every hour
Peeclampsia/eclampsa
Findings:
Severe continuous headache, nausea, blurred vision, flashes of lights or dots before the eyes, epigastric pain, proteinuria, periorbital, facial, hand, and abdominal edema, pitting edema of lower extremities, diminished breath sounds, seizures.
140/90 2 times (4 hours apart)
CARE:
dimmed lights, padded rails, assess vitals and skin,
Fetal monitor
assess for pitting edema
assess lung sounds,
assess tendon reflexes.
position mom on left side
give mag sulfate
Call dr and ask for order for liver enzymes test, BUN, serum creatinine, mag, PT, PTT, INR, dipstick test for proteinuria.
Call lab with orders cbc, serum creatine, mag, PT, PTT, INR
assess urine output if less than 30ml/hr give furosemide
can’t get pressure down, put in foley
If BP 160/110 start labetalol.
get ready for
Call Dr back with results.
Newborn hyperbilirubinemia
Findings: ruddy, yellow colored newborn, yellow tint to skin, sclera and mucous membranes, press newborn skin to verify jaundice
- hypoxia, hypothermia, hypoglycemia and metabolic -acidosis
Care:
Verify the baby to the mother, scan bracelet,
DO TCB. if 10 or above start bili blanket, wrap in blanket and have mom feed.
Ask about Coombs test.
Call lab to obtain TOTAL & DIrect bilirubin if not done, blood type and screen, ask.
retest TCB and still comes up put under bili lights,
if does not go down, call Dr., ask to supplement with formula is breast fed.
Hypoglycemia/hypotherima
shaking, temors, either hypoglycemia or calcium 7.6-10.4 normal), low temp only - hypothermia Care: get vitals, assessment if temp less than 97.5 undress and put in warmer with temperature probe If shaking get LABS: Calcium and CBC call doctor lethargic don't feed hat off put hat on, vitals 40-45 good 25-40 supplement <25 glucose gel undress, skin to skin on mom, assessment, blood glucose, take temp in 10 minutes, put immediately in warmer, if can't
RDS
Preterm - LS Ratio late baby meconium aspiration diabetic mom on insulin - assess, put tent on baby with oxygen. -call labo get an arterial blood gas -call respiratory to manage oxygen. - Call dr will results and to get chest xray order. call radiology to get portable chest xray stat. -call dr with result. - try weaning off of o2
don’t forget
hand hygiene gloves verify identity vitals assessment turn to side for better perfusion if pregnant skin assessment scan bands call lab and then dr with vitals and results skin to skin warmer tcb bilirubin
