IM/SQ
What is the MAIN DISADVATNAGE to injected medications?
what is Infection
What does the acronym PQRST stand for?
Provokes, quality, radiates, severity, time
The study of distribution and determinants of health conditions.
Epidemiology.
The lower respiratory System consists of what
Lungs, Bronchi, Bronchioles, Alveolar ducts, Alveoli
The puerperium refers to:
Postpartum(6 weeks)
A baby is born at 44 weeks what is the baby considered
Post due date
A neonate who was born WNL head measures 13 inches what is this considered?
Normal (12.5-13)
Bilirubin is a biproduct of the breakdown of____?
RBC
STIs, Drugs, Alcohal are all example of ____?
Causes of sterility/infertility
Post Partum mother presents with severe headache, visual changes, epigastric pain.
Bonus if you can tell the range of time those can happen
At HRP Pre- Eclampsia
after 40 weeks pregnant- 6 weeks PP
Changes in FHR during Contractions is considered _____?
Periodic
Reading and interp. FHR slide 4
Uterine distention, oxytocin stimulation, and prostaglandin release are all theories of_______?
Labor Onset
L&D slide 3
Th effect boost of energy some woman feel that pushes them to make sure life is in order. It is a sign of Labor.
Nesting
Durrham pg 245
What is Nagele's rule?
Bonus if you can tell me what it is.
Expected date of delivery
First day of Last Menstrual period- 3 months+ 7 days
Antepartum Slide 7
Probable signs of pregnancy are_____?
Observed by examiner, but may be attributed to other causes.
Antepartum slide 9
A single dose, pre-scored around the neck bottle, which needs a filtered needle to administer safely is
Bonus* what don't you do with these
what is ampule
Do not inject air
The psychological dependence/craving/uncontrollable compulsive use of narcotic, which can lead to self destructive behavior is called what?
Addiction
name the 6 factors that increase the rate of emerging/remerging infections.
population density, inadequate sanitation, antibiotic misuse, bioterrorism, low vaccination rate, international travel
Pack year history formula:
#packs a day X # of years Smoked
Term for a women who is pregnant for the first time
Prima Gravata
a baby is born at 4 lbs 8 oz what are they classified as
small for gestational age
You are presented with a baby who was born 6 days ago, they have lost 9% of their body weight what do you tell the mother?
Over a newborns first 7 days of life it is normal for a 5-10% weight loss to occur
A baby is born, immediately after birth it bilirubin levels 6 mg/dl what is that considered.
High
A holistic approach to family planning considers:
religion and culture, psycho-social, economic, effectiveness, RF
28 hours after birth a mother suffers a hemorrhage, what is this considered, what could be the reason, and how would you treat it?
Late stage hemorrhage
, Hemaotome, subinvolution, retained placental tissue,
Bi-manual compression, Uterine tamponade and/or a Perrett
Tachycardia, Bradycardia, and irregular rhythm are all examples of
Non reassuring FHR
Reading and interp. FHR slide 4
What phases are included in stage 1 of Labor? Bonus tell me what they are.
laten phase(cervix thins and opens), active phase(moderate regular freq of contractions), transition phase(time to push/urge to push)
L&D slide 42
What should a newly pregnant woman be health taught in regards to medications?
All Oral, IM, & IV meds affect the fetus.
L&D slide 58
Amenorrhea, Nausea/Vommitting, and Fatigue are all _______ signs?
Presumptive
Antepartum slide 10
What hormone is a at home pregnancy test, testing for?
Bonus tell me what the mom should be Health taught. and if you can tell me what kind of sign it is.
Human Chorionic Gonadotropin (HCG)
First Am urine to get most accurate results. And that they can be inaccurate due to Improper collection, Medications, Hormone-producing tumors.
Probable sign
Antepartum slide 19
When drawing medications from a vial what are the first 2 steps not including the 3rd check?
Wipe the top with alcohol pad and inject air equivalent of amount to be drawn
Narcotics prescribed for moderate to sever pain that act on CNS to cause analgesia.
Opioids
If a pt presents with Measles which precautions should be taken
Airborne precautions
what does IPPA stand for get the order right
Inspection, palpation, percussion, Auscultation
Methragen is a common used med for pregnancy what is it for
Easier contractions, less bleeding
To prevent cold stress what should be maintained
NTE ( Neutral thermal enviroment)
A baby intakes 650mL of fluid per day. What do you health teach the mom?
Normal newborn fluid intake is between 600-700mL of fluid per day.
What are the 4 priorities of a nurse within the first 30-40 mins a newborn's life?
Watch resp, keep warm and dry, feed, bonding with parents
Abstinence, coitus interruptus, Billing's ovulation method are examples of
Natural family planning
A new mother presents with pale and clammy skin, hypotension with tachycardia, bradypnea what is the pt most likely suffering from and what is your intervention?
Uterine atony(hemorrhage/boggy uterus)
encourage void, Possible 02, BW, assess VS, IV to replace BL with crystalloid solution or medication
A FHR of 181 for 12 minutes is considered what?
Fetal Tachycardia.
Reading FHR slide 6/ Durrham pg. 310
A soon to be mother's cervix is softening, shortening, and thinning. What is this called?
Effacement
L&D slide 10
A baby is born with 2200mL of amniotic fluid what is this called what could this lead to?
Polyhydramnios
Fetal GI obstruction/atresia
L&D Slide 78
Sign of pregnancy report by the pt are______?
Presumptive signs
Antepartum slide 9
At a mother's last antepartum appointment she was noted with a BP of 148/98 and Proteinuria. What is she at HRF, and what should she be health taught?
HRF Pre-eclampsia
HT monitoring of CNS changes, possible meds, activity restrictions
Antepartum pt 2 slide 36-38
When giving a SQ injection you are given a needle >1/2", what angle should to injection be given?
45 degree angle
Opiods, like morphine are examples of
Bonus if u tell me what it does
Agonists,
chemical binds to receptor in brain trigger response in the brain
MRSA, and VRE are example of
MDRO's or Multi drug resistant organisms
Which Lung has 3 lobes
Right lung
A soft and spongy uterus which increase the risk for hemorrhage would be called: How is this treated
Boggy, massage the abdomen where the uterus is
A baby has jitteriness, a weak cry, and tremors these could all be symptoms of
Low BS , CNS stress rt low BS
You are speaking with a new mom about regulating a newborns temperature, she says "if a baby is cold, wont it shiver and that's how ill know to help?" Health teach the pt.
Babies cannot shiver. They produce heat through their brown fat which they're born with. It is important to make sure the babies always kept in a neutral thermal environment.
A neonate has been alive for 2 hours what period of reactivity is it most likely in? what is the nurses main priority
First period of sleep/inactivity.
Maintaining NTE
If a pt used condoms for their BC methods it is considered what? How effective are they?
Barrier method, 98% effective
What does the acronym HELLP stand for
Bonus if u can tell me hemolysis range and Platelet count range
Hemolysis, Elevated Liver enzymes, Low Platelet count
hemolysis range <6
Platelet count range <100,000
What are the causes of fetal tachycardia?
Maternal: Fever, Infection, Chorioamnionitis, Dehydration, Anxiety, Anemia, Meds, Illicit drugs, Activity, anemia, Cardiac abnormalities, fetal tachyarrythmias.
Durrham pg 310
What are the 5 P's of labor?
Passenger(fetus), Passageway(mother's physical ability to deliver), Powers(2 types involuntary/voluntary), Position (fetus descend), Psychological(Mother's psyc influence mother).
L&D slide 5
In the transition phase when a mother gets to 10cm of dealation what reflex is inhibited?
Ferguson
A mom is 17 week pregnant when she starts to feel her uterus contract in a tight, intermittent, painless way that has no pattern. What should she be health taught?
These are Braxton-Hick Contractions and are normal in pregnant women past 16 weeks.
Antepartum slide 15
A baby is born with anomalies and less than 300 mL of amniotic fluid what is this called?
Oligohydramnios.
Antepartum slide 35
When giving and IM injection in the VENTROGLUTEAL site, we are looking to place our index finger on what POI.
what is anterosuperior iliac spine
What is a common Mu agonist? and list some side effect.
Hydromorphone (dilaidid), Fentanyl, Oxycodone, Codeine, Methadone
Drowsiness, N/V, constipation, orthostatic hypotension, Depress resp rate
Erythema, Fever, Induration, Elevated WBC, Purulent drainage from wounds are all examples of s/s of ____.
bonus if u can tell me what it needs to be dx
MRSA
+ culture
Medical term for Pigeon chest
Pectus Carinatum
BUBBLEHE is an acronym for assessment in regards to post partum what does it stand for
Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy, Homan's sign/hemorrhoids, Emotional status
The baby is vomitting, jaundice, and has a high pitched cry what could the baby be suffering from? And what is the main form of treatment
Kernicterus, phototherapy(light therapy)
A newborn is brought to you with a respiratory rate of 66 resp per min, and a notable Loss of consciousness. What is the infant most likely suffering from and how do we help treat it?
Cold stress, warm the newborn slowly(double wrap and cap or kangaroo), monitor temp every 30 min, check glucose
A baby wakes up after its very first nap, it is crying, alert to its surroundings, and hungry from what you can tell. What is happening and what are your priorities as a nurse?
The second period of Reactivity
Bond with parents, feed, maintain baby airway, maintain NTE
Long-acting, reversible, highly effective(99%) form of female birth control in which you need a HCP to prescribe that may cause irregular menses'____?
IUD
Loss of 1200 mL of blood during C-section would be considered________ _________.
Post partum hemorrhage.
500 for vaginal 1000 for C-section
post partum complications slide 3
List causes of prolonged deceleration in FHR.
Mechanism of profound change in fetal 02, interruption in uteroplacental perfusion, Interruption of umbilical blood flow, Vagal stimulation.
Durrham pg 318
A woman has entered labor and their cervix is fully dialted, when health teaching a mom about her Voluntary Expulsive efforts which option is the best to tell her?
A. Push until you cant anymore then breath!
B. Push for 6-8 seconds, then exhale. 4 times per contraction.
C. Push as long as you can and hold your breath to keep you diaphragm out of the way, then breath and repeat per contraction.
B. Push for 6-8 seconds, then exhale. 4 times per contraction
Durrham pg 246, 247
A mom who was given an epidural, had a BP of 138/86, after reassessing it is now 94/54. What is your action?
Notify Anesthesiologist/ Nurse
L&D slide 71
The result from increased venous pressure.
Bonus how would you treat it?
Varicosities
support hose, avoid prolonged sitting/standing, avoid crossing legs.
Atepatrum pt 2 slide 15
How many extra calories should pregnant woman be eating to support a baby inutero?
300/day on average or 80,000 total or 300/day 2nd trimester 450/day 3rd trimester
Antepartum pt 2 slide 24
As the number for the gauge of a syringe increase the inside dimension or bore does wha
Shrinks or gets smaller.
Suboxone which is used to treat opioid addiction for an easier withdrawal is an example of a
Partial Agonist
what precautions are taken for a pt + with C-Diff
Contact Precautions.
Difficulty Breathing when lying down
Orthopnea
a commonly used hormone that helps to contract the uterus
Pitocin/ oxytocin
A mom presents in the ER in labor and she mentions she is HIV positive. What is the result of her giving that history?
a scheduled C-section
What 2(ish) things should a baby be given at birth to ensure smooth transition to the outside environment?
Vitamin K(for clotting), eie ointment(protect from blindness), Hep B is optional
APGAR what does it stand for and what is it
Appearance, Pulse, Grimace, Attitude/activity, Respiration
Rapid assessment of the need for resuscitation
Weight gain, irregular bleeding, and skin irritation are just some of the side effect women may face from this for of Birth Control.
Hormonal methods
Early stage hemorrhage in a post partum mom is from ________ to __. And late stage hemorrhage is After____ or up to _-__ _____.
Delivery to 24 hours
After 24 hrs or up to 6-12 weeks.
Postpartum complications slide 4
A FHR is 102 for 10 mins what is this considered? If its not normal what may be the causes?
Fetal Bradycardia.
Maternal: Supine, Dehydration, hypotension, and acute cardiopulmonary compromise (cardiac arrest, seizures), Rupture of uterus or vasa pervia, placental abruption, Medications, fetal response to hypoxia, umbilical cord occlusion, hypothermia, hypokalemia, fetal head compression, fetal brady arrythmias.
FHR slide 6/Durrham pg 311
During your admission assesment the fetal HR is 148 on average over a 10 minute period. What is this considered and what is you nursing intervention if there are any?
Normal, none.
Tachy=>160
Brady=>110
FHR slide 6
A mother is arrives in labor her RR=21 BP=135/86 O2=98 and she is A&Ox3. She is given Fentanyl during the delivery for Pain. Her vitals after med administration read RR=16 BP=98/62 O2=93 and she is A&Ox3. Is anything wrong and what is intervention if there are any?
Administer O2, Place in Lateral position, Increase Iv fluids.
L&D slide 71
A brand new mom has just received a positive sign that she is pregnant. What should she be health taught?
Exercise: Continue as previous. Do not begin strenuous exercise. 30min/day. Avoid overheating
Employment: General practice-cannot forbid. Continue as able, avoid exposure to environmental hazards.
Travel (safe in low-risk pregnancy)
Walk, support hose, stop frequently to decrease
risk of thrombophlebitis.
Smoking IUGR (smoking and 2nd hand smoke)
Preterm labor, PROM, abruptio placenta, placenta
previa, fetal death
Antepartum slide 46
Cravings, Pica, Pagophia are all examples of_____
Bonus describe them
Nutritional problems for pregnant woman.
Pica- non food item cravings
Pagophia- compulsive consumption of ice or iced products
Antepartum pt slide 29
What is the maximum amount you would inject at one time Subcutaneously
1 ML
Naloxone is an example of
bonus tell me what it does
Antagonist
Reverse the effect, blocks the action of the agonist
A pt is dx with "flesh eating disease" what is the medical term for this
Necrotizing Fasciitis
The most inferior point of the sternum is called
Xiphoid Process
a women who has never had a viable birth over 20 weeks
Nully para
An infant is receiving phototherapy for jaundice resulting from Hypoglycemia, what is the major concern while giving this treatment.
Dehydration
3 days after a baby was born their RBC was 7.2 million/mm is this normal? What is the normal range?
No it is High
at birth: 4-6.6 million /mm
2-5 days after changes to 4 million/mm
Heel sticking the baby at birth and 4 hrs after birth is important for what reason? How does this effect the baby?
Bonus if you tell me why these needs might increase?
Glucose levels fall rapidly following birth d/t drop in maternal blood supply. Vital organs depend on glucose for cell function.
LOC, RR, Hypothalamus function
Hypothermia increase glucose need
Acronym for side effect of hormonal contraceptives.
ACHES
Abdominal pain, chest pain, headache, eye problem, severe leg pain/clots
MAP stands for what? How do we Calculate it? What is it useful for?
Mean Arterial Pressure
Systolic+ (2 x diastolic)/ 3
screening for Hypertension(HRF eclampsia)
Postpartum complications slide 27
A fetus has late deceleration what is happening and what is your nursing intervention if there are any?
Uteroplacental insufficiency
Changer maternal position to lateral, elevate legs, increase IV fluids, D/C Oxytocin, O2
L&D slide 89
A mother presents with a Prolapsed cord and vaginal bleeding what is this considered?
Emergency Situation
L&D slide 91
Umbilical cord compression, Nuchal/short/prolapsed knot between the pelvis and fetus are examples of_____? What are you interventions if there are any?
Variable Decelerations.
Change maternal position to Lateral, D/C oxytocin, O2, Vaginal exam
L&D slide 90
What 3 supplements are important for pregnant woman to be on, and for what?
Folic acid for RBC synthesis
Iron for maternal blood supply increase
Sodium major electrolyte
Antepartum pt slides 25-27
A Mom has been determined to have an Ectopic Pregnancy what treatments are used for these?
Laparotomy, Laproscopy, Methotrexate
Antepartum pt 2 slide 44
When giving an oil-based medication what gauge needle would typically be used.
18-25
normal= 20-25
A 3 on the Sedation Scale would be
pt is frequently drowsy, able to be aroused, drifts off to sleep during conversation.
What is the current treatment for Ebola
There is no direct treatment just make the pt comfortable
Spine irregularity that causes bending over which compresses the lungs and decreases the ability to expand
Kyphosis
An incision on the perinium that helps assist with delivery of an infant
Episiotomy
when a baby is born we feed it small amounts, typically 5-10ml what reflex are we trying to avoid?
Hering-Breuer reflex
12 hours after a baby is born their glucose reads 42 mg/dl, is this normal, what is your first action and why?
No the baby is hypoglycemic
Giving the baby a fast acting source of glucose
BS needs to stay up for neurological functioning
A pO2 of 30 at birth is considered?
Normal
20-30= normal range at birth
A 28 year old female pt presented today in the ED with a ingrown toenail that the HCP deemed infected, she has been prescribed Carbamazepine, what should she be Health taught.
This will make hormonal Birth control ineffective while you take it.
What med is used as an anti-convulsive for pt with Eclampsia?
Magnesium Sulfate.
Postpartum complications slide 38
A baby is determined to have an Early Deceleration. What is happening and what is your nursing intervention if there are any?
Head compression, None.
L&D slide 89
A fetus has late deceleration what is happening and what is your nursing intervention if there are any?
Uteroplacental insufficiency
Changer maternal position to lateral, elevate legs, increase IV fluids, D/C Oxytocin, O2
L&D slide 89
A pregnant lady presents she is having strong contractions that are 210 seconds apart, her cervix is dialated 6 cm which stage of labor is she in?
Active Phase of stage 1
L&D slide 42
Nursing care of plecenta previa, and abruptio placenta includes
obtain Hx, Last vaginal exam/US results, VS, Lab tests as ordered, Monitoring fetal HR, Assess uterine tone/contractions.
Antepartum pt 2 slide 54
A pregnant mom is dx with Hyperemesis gravidum what symptoms is she most likely suffering from?"
A. Low BP, hypovolemia
B. High BP, Proteinuria
C. BH contractions, Low BP
A. Low BP, Hypovolemia
s/s include: continued vomiting (hypovolemia), hemoconcentration, wt loss, tachycardia, low BP, poor skin turgor, dry mucous membranes (dehydration), malnutrition, severe cases –
diminished kidney function, ketosis
Antepartum pt 2 slide 39