Complications
What is the number one cause for hemorrhage post delivery for mothers and what is the intervention?
Boggy uterus and fundal massage
What blood vessels supply blood to the heart?
Coronary arteries
What are the three major disadvantages to an epidural? What are we concerned about if the epidural is placed too high?
Hypotension, immobility, pyrexia (elevated temp in mother)
Decreased respiratory drive
What does left sided uncompensated heart failure lead to in the respiratory system?
Pulmonary edema; as pulmonary venous pressure rises, fluid moves from the interstitial space into the alveoli, filling them with fluid.
What is the guiding principle for cardiac patients with regards to taking nitro?
Take one dose as soon as angina occurs, take additional dose every 5 minutes up to three total doses; if pain continues, call 911.
What is acute coronary syndrome?
Caused when a previously stable atherosclerotic plaque ruptures leading to platelet aggregation and thrombus formation. This causes prolonged ischemia and irreversible cardiac damage occurs.
What is a normal ejection fraction percentage?
50-65%
A 30 year old female is 25 weeks pregnant with twins. She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. What is her GTPAL?
G7, T4, P1, A1, L5
What is the NIPS scale?
It is the scale with which you conduct a pain assessment on a newborn;
Facial expression, cry, breathing, arms, legs, alertness. Max of 7 points, considered pain of 4+.
Why do we administer vitamin K to newborns?
Vitamin K is essential for blood clotting and preventing severe bleeding in newborns. Newborns are deficient in it.
What does marked variability (amplitude exceeding 25bpm suggest) in FHR?
Acute hypoxia
What valves allow blood to pass through 1) the right atrium, and 2) the left atrium?
Tricuspid, Mitral/bicuspid
What is the series of conduction in a heart contraction?
SA node, AV node, Bundle of His, perkinje fibers
What are the signs and symptoms of hypoglycemia in a newborn?
*BONUS* 100 points for each, up to 1,000
What is the poison acronym and what does it stand for?
The procedure you implement when your patient is prepared to deliver their baby.
Position, oxytocin off, IV fluids, sterile vaginal exam, oxygen, notify provider
What are three signs of respiratory distress in infants?
Nasal flaring, retractions, expiratory grunting
What amount of cervical dilation is indicative of the transition stage of labor?
8-10cm
How does a newborn compensate from cold stress?
Increasing in oxygen consumption and glucose metabolism.
What is the difference between compensated and uncompensated heart failure?
Compensated- when compensatory mechanisms succeed in maintaining an adequate CO that is needed for tissue perfusion
Decompensated- occurs when these mechanisms fail and can no longer maintain sufficient CO and tissue perfusion
You’re assessing the one-minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 130, pink body and hands with cyanotic feet, weak cry, flexion of the arms and legs, active movement and crying when stimulated. What is your patient’s APGAR score?
7
What is chronic heart failure?
Progressive worsening of ventricular function and chronic neurohormonal activation leading to ventricular remodeling.
*GROUP QUESTION*
Which group can list the most presumptive signs of pregnancy (100 per each, up to 600!)?
What do each of these waves measure in the conduction system of the heart?
P-Wave, QRS Complex, ST- Wave, PR Interval
How is the RAAS system a potentially harmful compensatory mechanism to a patient in heart failure?
1)activates the sympathetic nervous system to increase BP and HR
2) release of aldosterone from the adrenal cortex results in sodium and water retention
3) increased peripheral vasoconstriction increases BP
4) stimulation of the pituitary gland which releases antidiuretic hormone (ADH) causes water reabsorption
What are the 4 classes of meds routinely given to patients with acute decompensated heart failure And what are their purposes?
Diuretics- to remove excess water and salt from the body
Vasodilators- to lower HR and BP and reduce workload on the heart
Morphine- to help manage pain and limit oxygen consumption
Positive inotropes- increase contractility, thus increasing cardiac output