Maternal Emergency
What items are not kept in the PPH cart
Medication
Frequency of checks and vitals signs for post op C/S patient who had duramorph spinal
q1hr x4- all vitals
RR additional q1hr x4, then q2hrx12 houea
The Jada is best used for which cause of hemorrage-
name the other causes of hemmorage
TONE- Jada- 120/80
Tissue
Trauma
Thrombin
Frequency at which IV site is to be assessed
on placement, qshift, q1hr with high/acute medications - mag, blood transfusion
Post OP C/S discharge instructions should include shower and hygiene instructions- specifically what?
Clean with soap and water
keep incision site dry and clean
What stage of a PPH should MTP be activated
Stage 3- checklist review
Mag patient has what frequency of I&O ordered
Strict q1hr- utilize patient sheet- all PO and IV
Positioning for a brachytherapy patient
supine <8 degrees
only log rolled
name 3 complications from a minimally invasive GYN procedure that nursing should be assessing for
Vascular injury- tachycardia, pallor, increased abdominal girth
Bowel injury- abdominal pain, tachycardia, fever
UTI- blood in urine, gas in foley
hematoma- swelling, pain, ecchymosis
Hyponatremia- caused by fluid overload.
Therapeutic range of the drug of choice to prevent seizure activity in a patient with pre-eclampsia-
how do you check for toxcity
Magnesium sulfate 5mg/DI-8mg/Di
q1hr checks-
Hr, BP,rr,sp02, I&O, reflexes, clonus
During a hypertensive emergency was the typical medications and dosages and frequency
Labetalol 20/40/80 q10 min
Hydralazine- 5mg or 110mg IV q20 min
prior to initiating heparin infusion
6 hours after starting
6 hours after each change in infusion rate
Button on Debif that must be pushed in order to use ECG vs pads for tracing tele
LEAD
Reference cheat sheet -located on carts
What should the MAP be maintained above in a patient with the following vitals
118/56, HR 127,RR 34, temp 38.4, spo2 93.
65
MEWC
blood cultures, vassopressors, antibiotics,
Who should be given and educated on CHG wipes
all antepartum c/s patients the night before- documented in daily care
all patients with a central line
Severe Pre-E patient - post C/S 2 hours ago- report was 2L in pacu due to hypotension- vitals as follow.
130/60, 36.6, HR 106, RR29, sp02 92%
115/55, 37, HR 108, RR 34, SP02 89%
What is potential concern for?
Flash pulmonary edema
importance of I&O and critical thinking- complex medical diagnosis.
At 15 min vital sign check after iniatiting a blood transfusion-
108/62, HR 127, RR20, SPO2 95%, reporting headache and feeling SOB,
what are next steps
stop transfusion
notify provider
document interventions- per provider based on reactions
notify blood bank and sent down product and tubing
up initiating
change of shift
anytime patient leaves the floor-verify rate and dosage with provider assuming care
When is the 4 eyed skin assessment to be done
on admission to UNIT-
direct admits, from OR, from other floors
There are some patients who are unresponsive to oral iron, or have an inability to tolerate oral intake as well as patients with severe anemia who would benefit from what iron supplementation
Venofer infusion
Complex disorder caused by overstimulation of clotting and anticlotting mechanism
Disseminated intravascular coagulopathy-
leads to overwhelming diffuse hemorrhage
predisposing factors- pre E, AFE, sepsis, PPH
All steps to be completed post fall
safe connect
post fall assessment
note
form fast to manager
override to high fall risk
How are meds given via an NG tube
Ensure route in changed to Per NG tube in MAR
Prepare medication-
liquid, tablet=crush, capsule=open
mix all with 30-60 cc sterile water
check placement
must be clamped for 30 mins after meds are given.
Flush before and after
first priority in the care of a patient during a eclamptic seizure
Ensure patient airway
leading cause of maternal morbidity following an eclamptic seizure is aspiration
Frequency and dosages of uterotonics used during a PPH
oxytocin- 10-40ml 500/1000L bag, 10mg IM
methergine- 0.2mg q2-4 hours
hemobate 0.25mg every 15-90 mins max 8 dosages
cytotec- 800mg 1 dose