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Leopold maneuvers

·         1st maneuver- determines fetal part lying in fundus and fetal presentation

·         2nd- which direction fetus back facing

·         Third maneuver determines part of fetus at inlet and mobility

·         4th- fetal attitude and degree of flexion of head

Meconium aspiration

·         Intubation and immediate suction needed-no longer than 5 sec

·         If HR low, PPV given and suction performed later

·         Don’t suction with bulb syringe when head pass-no longer recommended

RR

·         20-40breaths/min

HR

·         90-130 bpm

BP

·         90/56

Calories

 

·         An increase of 340 calories/day is recommended during the second trimester.

·         An increase of 462 calories/day is recommended during the third trimester.

·         Add 330 when breastfeeding

Protein

 

·         Folic acid- prevent neural tube defects

·         Leafy green veggies, dry beans/peas, Orange juice

Iron

·         Increase rbc mass

·         Take 1 hour before meals

·         Take empty stomach

·         Give with vit C

·         Don’t give with milk/caffeine

·         Can cause constipation- give fiber

·         Increase absorption of iron

·         Avoid calcium containing foods-milk and yogurt

·          

Maternal PKU

·         Genetic disease

·         Increase levels phenylalanine

·         Resume diet 3 months before pregnancy and throughout pregnancy

·         Avoid high protein foods in phenylalanine

·         Mental retardation/behavior problems

Pap Smear

·         Class 1 through Class V

·         Class 3- indicate abnormal but doesn’t confirm cancer diagnosis

·         Reveal abnormal cervical cell growth

Supine Hypotension

·         Vena cava syndrome

·         Dizziness common sign

Epidural anesthesia

·         Maternal blood pressure decrease(hypotension)-give fluids

·         CNS depressant

·         Most effective in active labor

·         Cause bradycardia in fetus-bolus mom with 500 mL of IV fluid before inserting epidural catheter

·         Given before active phase of labor- prolongs the labor-take longer for cervix to dilate and efface

Spinal anesthesia

·         headaches

Fundus

·         Displaced when bladder full

·         Post-delivery- found firm at midline

Magnesium sulfate

·         Calcium gluconate antidote-reverse CNS depression

·         Given to women to prevent preterm labor/stop contractions

·         Can cause resp depression in mom

·         Treat PIH- decrease BP

·         Prevent seizures in pre-eclamptic women

·         Cause CNS depression in neonate-monitor for respiration depression

·         Smooth muscle relaxant

·         Report decreased U/O

·         Reduce RR

·         Depressed or absent reflexes

·         Hypotension

·         Decreased cardiac function

·         AE

o   Decreased bp

o   Depressed dtr

o   Lethargy

Nalbuphine

·         Opioid pain relief

 

Pre-eclampsia/PIH

·         Cause HTN and proteinuria-monitor closely

·         Edema of hands and face common finding

·         Indicate hepatic involvement

·         Report epigastric pain

·         Report pitting edema of ankles

·         Expect 3+ deep tendon reflex

·         Oliguria

·         Proteinuria greater than 0.3 q 24 hrs

·         Expect blurred vision and photophobia

·         Symptoms- sudden weight gain, swelling, edema, severe headache, reports of seeing spots, blood in urine, dizziness, nausea, vomiting

·         When worsened- baby may need to be delivered or mag sulfate given IV to prevent seizures

·         Call 911 to be evaluated

·         Can last for many weeks after delivery

·         Rest sidelying-increase tissue perfusion

·         Daily fetal kick count

Drug Addiction

·         Increased muscle tone

·         Respirations greater than 60

·         Hyperactivity –CNS irritability

·         Don’t stimulate infant-need calm environment with minimal stimulation to promote rest and reduce stress

Active Labor

·         Check cervix before giving pain meds

·         Given too close to delivery can cause resp depression in neonate

Contraction Stress Test

·         Fetus repeated decels of FHR response to contractions

·         Don’t give oxytocin for positive CST at 38 weeks- compromise fetal oxygen supply

·         Positive-abnormal-late decels

·         Neg- normal-no late decels

·         Nipple stiumation

Ectopic Preg

·         Fertilized egg implant outside uterus

·         Scarring from tubal infection/surgery- PID

Betamethasone(Celestone)

·         Glucocorticoid

·         Prevent resp distress syndrome in premature infants

·         No effect on neonatal VS

·         No effect on baby temp

·         Given at 30 weeks gestation

·         Given to stimulate fetal lung maturity-prevent resp distress

·         Cause hyperglycemia in mom

·         Can cause baby to have hypoglycemia 1st few hours after delivery

PIH

·         Develop edema, elevated BP, proteinuria

·         Reflex normally plus 2

 

Nonstress Test(20 min)

·         Measure FHR accelerations with normal movement

·         Fetal acc. Positive sign

·         Increase 15/min and last 15 sec

·         Nonreactive- no acc.

·         Reactive- norm baseline/moderate variability

·         Sit in reclining chair or on left side/don’t walk

·         Give mom OJ and crackers to stimulate fetus movement

·         Press button when feel fetal movement

FHR

·         V C- variable decels cord compression

·         E H-early decels- head compression

·         A O-accelerations ok

·         L P-late decels placenta insufficiency

Oxytocin

·         Stimulate contractions

·         Can cause decreased FHR and hypoxia due to increased uterine pressure

·          

·         AE- subarachnoid hemorrhage, seizure, coma, HTN, abruption placenta

·         Don’t bolus

·         Give through IV pump

·         Always monitor FHR

·         Discontinue when contractions q 1-2 min lasting 90-100 sec

Weight Gain

·         25-30 lbs entire preg

·         4 lb- 1st tri

·         12 lb- 2/3 tri

·         normal- 1-3kg/month 2nd/3rd trimester

 

ITP

·         Autoimmune response with decreased platelet count

·         Increased megakaryocytes

 

6 weeks gestation + 24 weeks

·         GBS done at 35-37 weeks

·         Rubella titer done at initial prenatal visit to determine rubella immunity

·          

Glucose tolerance test

·         3 hour gtt done in women with elevated glucose levels after 1 hour test is done at 28 weeks

 

LGA(macrosomnic infant)

·         heel stick glucose 50 normal

·         respirations 50 notmal

·         acrocynaosis normal

·         jittery is sign of hypoglycemia

 

Breastfeeding and engorgement

·         apply cold cabbage to relieve pain

·         breast binders suppress lactation

·         breast shells for patients with inverted nipples or flat or pts with sore nipples

 

Prolapsed umbilical cord

·         call for help

·         apply internal upward pressure to presenting part

 

Abruptio placenta

·         cocaine use increase risk for vasoconstriction and abrupted placenta

Infant safety

·         set hot water heater no higher than 49 C 120 F

·         crib slats no more than 6.3 cm 2 3/8 in apart

·         no comforter in crib

 

hyperemesis gravidarum

·         eat to taste to avoid nausea

·         eat healthy snack at bedtime

·         alternate liquids and solids every 2 hour

·         eat protein following sweet snack

 

Vaginal hematoma

·         pressure in vagina

·         persistent vaginal pain

 

 

 

terbutaline

·         protect from light

·         relax smooth muscle

·         primary action- bronchodilation

·         subqqa 4 hrs no longer than 24 hr

·         AE- headache, dizzy, arrhythmias, nausea, paradoxical bronchospasms, tachycardia, hyperglycemia, hypoklemia

Hydatidiform mole

·         Placental abnormal

·         Chorionic villi of placenta develop into grape like mass-clear vesicles

·         With or w/o fetus present

·         Avoid preg for 1 year

·         As cells slough- discharge dark brown vaginal

Jaundice

·         Pathological- 1st 24 hrs, inform HCP- stat bilirubin test

·         Physiological- breastfed after 24 hours

Late decels

·         Placental insufficiency

·         Pressure on IVC-decrease O2 to placenta and fetus

·         Turn on left side, give O2, then give fluids

Naloxone

·         Reverse respiratory depression, hypotension of opiods

·         AE- seizures, pulmonary edema, tachycardia, HTN, V FIB

Diaphragm

·         Remove after 24 hrs-clean with mild soap water

·         Replace q 2 years

·         Insert on empty bladder

·         Weight gain greater/less 10-15 lbs refitted

·         Keep in place 6 hours after sex

Chadwick sign

·         Blue discoloration in cervix, vagina

 

Low Back pain

·         Posterior-face mom back

·         Rub lower back-help relax muscles in low back and relieve pressure of fetus head

Cerclage

·         Reinforce weak cervix

·         Use sutures that go around cervix, hold it close

·         Go to hospital first sign of labor

·         Can have sex

Polyhydramnios

·         Excessive fluid surrounding fetus

·         Increased fundal height

·         Increased weight gain

·         Increased urination

·         GI fetal malformations and neuro disorders-anticipate

Oligohydraminos

·         Volume amniotic fluid less than 300

·         Fetal renal dysfunction

·         Obstructive uropathy

·         Confirmed by US

·         IUGR

Mineral oil

·         Treat constipation

·         Take at bedtime on empty stomach

·          

Abruption placentae

·         Premature separation of placenta from uterine wall

·         Platelet count decreased

·         Prolonged partial thromboplastin

·         Decreased fibrinogen

·         Normal clotting time

·         Abdominal pain-sharp painful bleeding

Placenta previa

·         Placenta attach low in uterus

·         Painless vaginal bleeding

·         Life threatening-need continued hospitalization and close monitoring

·         Near or covering cervix opening- partially or totally

·         Don’t perform vaginal exams

·         Monitor fetal heart tones- continuous EFM

·         Take vs q 15 min

·         Most common in 3rd trimester

 

Abdominal US

·         Need full bladder

·         Ask when last voided

Rubella

·         When mom titer neg, give another after delivery

·         Avoid preg at least one month after vaccine

·         Mild rash and joint ache 7-10 days after

·         Get each preg

·         May have low grade fever

 

Erythromycin ophthalmic

·         Give within 1st hour

·         Gonorrhea/chlamydia

Hep B vaccine

·         Given several hours after birth

·         Parent consent

Vitamin K

·         Used for synthesis of clotting factors in liver

·         Given to prevent bleeding

·         Newborns risk of bleeding-lack of intestinal flora needed to make vit K

Cephalhematoma

·         2-6 weeks for edema and discoloration to disappear

·         no treatment needed

caput succedaneum

·         resolve 2-3 days

 

 

 

Ergotamine

·         treat migraine

·         one tab at onset of migraine

·         max 3 in 24 hr period

·          

Methylergonovine(methergine)

·         treat PP hemorrhage

·         monitor VS and vag bleeding

·         AE- seizures, stroke, headache, nausea, chest pain, palpitations, increased BP

·         CI- high BP

 

Bethanechol

·         Cholinergic stimulate muscarinic receptors

 

Phenytoin

·         Don’t take with mil or calcium

·         Less than 10mcg subtherapeutic-cause seizures

·         Levels more than 20 toxic effects

·         Cause gingival hyperplasia- tell dentist

·         Report nystagmus

 

Anticholinergic drugs

·         Worsen urinary retention

·         Atropine

·         Scopolamine

·         Benztropine

o   Constipation

o   Tachycardia

o    

                                                      

Glucose in infants

·         Normal ranges 40-95 mg/dL

·         Fasting glucose 60-90 for pregnant

Bilirubin

·         Report greater than 8

Hct

·         Normal 48-69%

LGA

·         Weight above 90th percent

·         Increase risk for hypoglycemia

 

Congenital hip dysplasia

·         Limited abduction indicate head femur slipped out of acetabulum

·         Limited abduction of hip

·         Asymmetrical gluteal folds

Stepping reflex

·         Should be gone by 4 weeks

Moro reflex aka startle reflex

·         8 weeks

Babinski reflex

·         1 years

·         Stroke bottom of foot

Extrusion

·         Infant spit out food

tonic neck

·         3-4 months

 

 

 

 

 

Jet hydrotherapy

·         Doppler device, fetoscope, wireless external monitor safe

·         Don’t use internal electrode

Newborn assessment

·         Posterior fontanel should be larger than anterior

·         Assess apical pulse for 1 full minute-when baby quiet

·         Overlapping suture line

·         Lanugo over shoulders normal

·         Breast nodules up to 10mm

·         T 36.5-37.2C

·         Weight 2.5-4 kg

·         Length 45-55cm

·         Chest circumference in term 2 cm less than head circumference-measured at nipples

·         Head circumference greater than 37cm or less than 33cm investigate for neurologic involvement

Neonatal sepsis

·         Temp instability

·         Tachypnea

·         Hypotonia

·         Lethargy

·         Nasal flaring

·         Irritability

Vaginal hematoma

·         Pressure in vagina

·         Persistent vaginal pain

 

Infant safety

·         Hot water heater no higher than 49 C 120 F

·         Crib slats no more than 2 3/8 inch

·         No loose bedding in crib

 

Amniocentesis

·         Rhogam given following procedure

·         Potential of fetal RBC entering maternal circulation

·         Given at 28 wks

Circumcision

·         Sterile gauze for bleed

·         Petroleum jelly each change

·         Don’t wipe off yellow exudate- normal

·         Document voids after- secondary

·         Change diaper at least q 4 hours

·         Avoid soap and water

·         Rim usually fall off in 1 wk

·         1st priority is to monitor for bleeding q 15 min for 1st hour after procedure

·         DON’T APPLY petroleum jelly after circumcision when plastibell used

·         Complications-hemorrhage, infection, urethral fistula formation

Mastitis

·         Unilateral breast pain with tenderness

Reposition, increase fluids, give oxygen 8L

 

Itp

·         Decreased platelet

·         Increased megakaryocytes

GBS

·         35-37 wks

3 hr glucose

·         28 wks

Heparin

·         don’t take aspirin

·         bedrest

·         don’t massage

·         apply warm compress not cold

hperbilirubinemia

·         yellow mucous membranes, bron or gold urine, maculopapular rask normal

·         irritable complication

Uterine Inversion

·         Don’t remove placenta if still attached- can cause larger SA for bleeding

·         Large amt blood suddenly gush from vagina

·         Fundus not palpable in abdomen

·         Don’t give oxytocics- compounds the inversion

·         Assess VS and establish IV access and fluids

·         Discontinue uterotonic drugs-allow uterine relaxation for replacement

 

 

 

 

 

Pharmacology NCLEX practice questions

 

 

 

Acetazolamide

·         Diuretic

·         For chronic open angle glaucoma, epilepsy, edema

·         AE

o   Paresthesia-tingling fingers

o   Hyperglycemia

Oxybutynin

·         For urinary incontinence

·         Anticholinergic effects-dry mouth, photophobia,  constipation, blurred vision, tachycardia

 

Dopamine

·         Increase BP in cardiogenic shock

·         Cardiac stimulation

·         No effect on RR

·         Increase renal circulation- incr UO

Doxycycline

·         Tetracycline antibiotic

·         CI

o   Pregnancy

o   Effects on developing bone and teeth

Regular insulin

·         Manage gestational diabetes

Baclofen

·         Decrease seizure threshold in pt with epilepsy

·         Decr freq and severity of muscle spasms

·         No effect on cognition

·         Inhibits reflexes at spinal level

Tamoxifen

·         Treat breast cancer

·         AE

o   Menstrual irregular

o   Hot flashes-anti estrogen

o   Bruising

 

Inhibitor overdose

·         Antidote- atropine sulfate

Neuromuscular blocker overdose

·         Neostigmine- cause nausea, increased salivation, bradycardia

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