Peripartum Bleeding
Priority intervention with vaginal bleeding
What is fundal massage
Severe Range blood pressure parameters in a peripartum patient
What is greater than or equal to 160 systolic and/or 110 diastolic
How pregnancy affects cardiovascular disease
What is: Profound hemodynamic changes, Increase in cardiac output
The goal BG for a pregnant patient
What is 100-150
2 physiological goals for pregnancy.
What is keep MAP >65 and PaO2 >90
What amount is atypical blood loss following a cesarean hysterectomy
What is > 1.5L
The frequency to check DTR’s during maintenance dose administration of MgSO4 in an peripartum patient
What is Q 4 hours
At what time during pregnancy is a patient at greatest risk for pregnancy related cardiac failure
What is postpartum
List at least 5 s/sx of DKA in pregnancy
What are: Increased thirst, Frequent urination, n/v, Abdominal pain, Anorexia, Weakness/fatigue, SOB, Hyperventilation, Fruity-scented breath, Confusion, Drowsiness, Hot, dry skin, Blurred vision
Organ that provides protection, nutrition, respiration, excretion and hormone production to the fetus.
What is the placenta
Name 5 medication used to treat postpartum hemorrhage
What are:-Oxytocin-Hemabate-Methergine-Misoprostol-TXA
Priority medication treatment for a peripartum patient experiencing an eclamptic seizure
What is a magnesium sulfate 4-6gm bolus over 15-20 minutes
Name 4 obstetric code blue key differences
What are:-Manual, Left Uterine Displacement-Difficult intubation-Difficult to BVM-NO Nasal airway/adjuncts-Resuscitative cesarean section at 4 minutes after loss of ROSC
The percentage of pregnant patients who have Euglycemic DKA
What is 30%
Name all of the obstetrical SIRS criteria?
What are:Temp <36C or >38C, HR >110, RR >24
WBC >15K <4K, >10% bands
The categories of abnormally implanted placentas are those that implant into the myometrium, the myometrium, or through the myometrium into additional organs.
What are adherent placentas-accreta, increta, and percreta
List the 3 medications used to treat severe range blood pressures and 1 contraindication for each medication
• Labetalol–Asthma, heart block, pulse <60 bpm, CHF, meth use* Hydralazine–Mitral valvular rheumatic heart disease, CAD • Nifedipine–CAD, cardiac arrhythmia, aortic stenosis, HR >120
Name 3 diagnostic criteria for peripartum cardiomyopathy
What are:-Ejection fraction <45%-Develops in last month of pregnancy or postpartum-No other cause of heart failure
Name 4 reasons that IV hydration is important in the pregnant patient
What is: Increases tissue perfusion-Reduces acidemia-Improves cardiac function-Reduces glucose by hemodilution-Increases renal loss of glucose
Frequency for breast pumping in ICU
What is every 2-3 hours, not to exceed 1 4-5 hour stretch without pumping
Name 5 obstetric causes of DIC
What are:-Abruption-AFE-IUFD-Septicemia-Massive hemorrhage-Preeclampsia-Transfusion Reaction-Fatty Liver
3 interventions for a patient experiencing RR <12, O2 saturation < 95%, loss of DTR’s, and ALOC when on MgSo4
Notify MD–Have MD come to bedside to assess pt• D/C MgSo4 infusion, Obtain a STAT Mg level • Administer O2–10L/min via mask • Give Ca Gluconate/Chloride
Name 4 complications of endocarditis in pregnancy
What are:-CHF-Septic emboli-High maternal mortality-High fetal mortality
List 4 treatment goals of DKA
What are:-Reverse ketogenesis-Manage Fluids-Do not initiate insulin drip until K > 3.3mlEq/L-Continue insulin drip at least 6 hours after anion gap closes
Name 5 indications for ICU admissions in the peripartum patient
What are:-Trauma-Heart Disease-Preeclampsia-Sepsis-Neurologic injury-DKA-PPH