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SUM'20 - Advanced Principles > week 3 pain pathways (everything) > Flashcards

week 3 pain pathways (everything) Flashcards

1
Q

which labs need to be obtained during the initial visit of the mother (11)

A 
CBC 
Typing,
Rubella antibody, 
Cervical gonorrhea and chlamydia culture. 
VDRL, 
HBsAg (Hep B)
Pap, 
Urine complete, 
PPD (TB)
HIV (with consent)
BG
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2
Q

15-20 weeks

A

MATERNAL ALPHA FETOPROTEIN: increase in neural tube defects (NTD) and decrease in Downs syndrome. Triple screening (AFP,HCG, Estriol). If abnormal, do U/S or amniocentesis
Folic acid decrease risk of NTD

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3
Q

18-20 weeks

A

U/S for dating. Best time to access fetal development

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4
Q

24-28 weeks

A

Glucose test for ALL

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5
Q

28-30 weeks

A

RhoGAM to Rh(-ve) mom

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6
Q

34-38 weeks

A

CBC

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7
Q

36-40 weeks

A

Cervical chlamydia and gonorrhea culture in high risk patients

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8
Q

does oxytocin level increase during labor

A

NO!

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9
Q

so how does labor start if there is not increase to level of oxytocin
(2 answers)

A

there is increase sensitivity of myometrium to oxytocin

increase synthesis of prostaglandins by fetal membrane and decida helps to start labor

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10
Q

the physiological presentation of labor:

A
  • Increased sensitivity of myometrium to oxytocin
  • synthesis of prostaglandins by fetal membrane and decida
  • Lightening
  • Braxton Hicks contraction
  • Cervical effacement
  • Bloody show due to breaking down of mucous plug
  • Rupture of amniotic membrane
  • Cervical dilatation
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11
Q

Maternal physiology at labor there is a 300% increase in

A

in minute ventilation

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12
Q

in labor what happens to maternal oxygenation?

A

60% increase in oxygen consumption

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13
Q

maternal Hyperventilation in labor results in:

A

decrease PCO2 < 20 mmHg; transient hypoventilation; maternal and fetal hypoxemia; reduce uterine blood flow and fetal acidosis

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14
Q

Each contraction pushes what vol of blood into the circulation?

what is this called?

A

300-500 ml of blood into circulation – auto transfusion

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15
Q

maternal CO results in (increases by how much)

A

a 45% increase in cardiac output

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16
Q

After delivery ,involution of uterus relieves inferior vena caval obstruction resulting in:

A

80% increase in cardiac output and stroke volume

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17
Q

First
Latent
CO?

A

15% increase

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18
Q

first
active phase
co

A

30% increase

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19
Q

second phase CO

A

45%

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20
Q

third phase CO

A

80%

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21
Q

First latent phase start/end

events

A

Regular uterine contractions/ 4 cm dilatation

Cx effaces and slowly dilate

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22
Q

first active phase start end

events

A

4 cm/10 cm (complete dilatation)

Regular intense contractions, fetal head descends into pelvis

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23
Q

second phase start/end

events:

A

Complete cervical dilatation/delivery of baby

Baby undergoes all stages of cardinal movements (Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion)

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24
Q

third phase start/end

events:

A

Delivery of baby/delivery of placenta

Placenta separates and uterus contracts to establish hemostasis

25
Q

first stage– pain initial spot- progression.

level of spinal anesthesia must cover what sections

A

Pain is initially T11-T12 then progress to T10-T12 and L1 during active labor.

level of spinal anesthesia must cover T10-L1

26
Q

second stage- pain spot

level of spinal anesthesia must cover what sections:

A

Pain through by pudendal nerve (S2-S4)
Somatic pain caused by stretching of vagina and perineum by descent of fetus

Level of spinal anesthesia is needed for S2-S4

27
Q

first stage- cause of pain? what is the pressure ?

A

1st stage: Cause of pain is uterine contractions and exceeds 25 mmHg pressure and dilate Cx.

28
Q

level of anesthesia for c section

A

T4

29
Q

how is pain and temperature mediated in the genitalia

A

autonomic nervous system- not lateral spinothalamic tract

30
Q

Uterus and Cx- pain levels ?

pain is carried by what fibers

A

T10 to L1-2

Pain impulses carried in visceral afferent C fiber

31
Q

Perineum

A

S2,S3,S4

Pain impulses carried by somatic nerve fiber; pudendal nerves

32
Q

Inhalation agents

effects on uterus

A

Cause uterine relaxation - increase blood loss

33
Q

Parentral agents effects on labor

A

Opioids minimally decrease progression of labor

34
Q

Regional anesthesia is given for:

A 
Primigravida
Prolong labor
High parenteral analgesic requirement
Use of oxytocin
Large baby
Small pelvis
Fetal malpresentation
35
Q

Vasopressors

a1 stimulation effects

A

uterine contraction

36
Q

Vasopressors

b2 stimulating effects

A

uterine relaxation

37
Q

Small dose on phenylephrine effects

A

increase blood flow increase bp

38
Q

Oxytocin uses

A

Used to induce labor and to prevent postpartum blood hemorrhage

39
Q

oxytocin complications:

A

Complication: fetal distress, uterine tetany, maternal water retention, hypotension, reflex tachycardia

40
Q

Ergot alkaloids

uses

A

to treat uterine atony

41
Q

What is used to treat PPH?

A

Prostaglandins

42
Q

Magnesium

uses

A

Use to stop premature contraction and to prevent eclamptic seizures

43
Q

magnesium side effects

A

Side effects: hypotension, heart block, muscle weakness and sedation. Also INCREASES blockage of non-depolarizing agents. Cardiac and respiratory arrest can occur

44
Q

treatment for magnesium side effects

A

Treatment
D/C- mag
Calcium
Lasix

45
Q

B2 agonist

A

stop premature labor

46
Q

Hypotension

A

Ephedrine, oxygen, left uterine displacement and IV fluids. Small doses of phenylephrine can also be used

47
Q

Unintentional IV injection (of epidural)

A

Place supine with left uterine displacement

Thiopental or propofol to stop seizures

48
Q

Unintentional intrathecal injection

A

Place supine with left uterine displacement
Ephedrine and fluids
Intubation and ventilation in high spinal

49
Q

Postdural puncture headache

A

Bed rest
Hydration
Oral analgesic
Caffeine

50
Q

Postdural puncture headache

A

blood patch

51
Q

Signs of Fetal Distress (7)

A 
Repetitive late deceleration
Loss of beat-to-beat variability
Fetal heart rate < 80
Fetal scalp pH < 7.20
Meconium stained amniotic fluid
Oligohydramnios
Intrauterine growth retardation
52
Q

Obesity what % of ideal body weight
BMI
morbid obesity BMI

A

> 20% of ideal body weight
BMI >30
BMI>40

53
Q

obesity labs

A

High glucose, cholesterol and TG

54
Q

obesity PFT results

A

restrictive lung disease

55
Q

obesity breathing issues

A

increase work of breathing
decrease ERV (expiratory reserve volume)
decrease FRC
decrease chest wall compliance

56
Q

in morbid obesity- closing capacity results in

A

In morbid obesity, closing capacity exceeds FRC - V/Q mismatch - arterial hypoxemia

57
Q

obesity distribution of lipid soluble drugs

A

Increase volume of distribution for lipid-soluble drugs

58
Q

treatment for pickwickian syndrome

A

Oropharyngeal appliances
Positive pressure nasal mask
Surgery

59
Q

Obesity-hypoventilation syndrome leading to (ten things total listed)

A 
Hypercapnia
Hypoxemia
Somnolence; poor sleep at night
Pulmonary HTN
Systemic HTN
RVH / LVH
Dependent edema
Cyanosis-induced polycythemia
Rales
Pulmonary edema

SUM'20 - Advanced Principles (16 decks)

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