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99 Cards in this Set
- Front
- Back
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neonate Hgb |
14-28 |
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most critical extrauterine adjustment for newborn to make |
establishment of respiratory function |
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heparin antidote |
protamine sulfate |
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warfarin antidote |
phytonadione- Vit K |
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coag test to monitor for Heparin |
aPTT |
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aPTT normal level for P on Heparin |
1.5-2 times control of 30-40 seconds [45-80 seconds] |
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coag test to monitor for P on warfarin |
PT and INR |
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PT levels for P on warfarin |
1.5-2 times control of 11-12.5 [16.5-25 seconds[ |
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INR level for P on warfarin |
2 to 3 |
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special instructions for warfarin P |
1. teratogenic medication 2. do not use with oral contraceptives because of increased risk of thrombosis 3. alcohol inhibits effects of warfarin |
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meds for P w/ pulmonary embolis |
heparin warfarin thrombolytics: -alteplase -streptokinase -similar side effects and contraindications as anticoagulants |
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idiopathic thrombocytopenic purpura |
coagulopathy that is an autoimmune DO in which the life span of platelets is decreased by antiplatelet antibodies |
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disseminated intravascular coagulation |
coagulopathy in which clotting and anticlotting mechanisms work concurrently |
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when do you suspect coagulopathy |
when normal measures to stimulate uterine contractions fail to stop vaginal bleeding |
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what are tocolytics used for |
to treat/prevent preterm labor |
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what are the common tocolytic drugs |
terbutaline (Brethine) nifedipine (Adalat and Procardia) magnesium sulfate indomethacin hydroxyprogesterone caproate ritodrine (Yutopar) |
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adverse effects of terbutaline (Brethine) |
nervousness, restlessness, trembling HA tachy, palpitations hyperclycemia hypokalemia pulmonary edema hypertension |
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adverse effects of nifedipine (Adalat) |
palpitations peripheral edema hypotension syncope HA |
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adverse effects of magnesium sulfate |
decreased deep tendon reflexes (DTR) resp. depression flushing, warmth, nasal congestion hypermagnesemia decreased biophysical profile score decreased FHR variability |
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adverse effects of indomethacin (NSAID) |
reduced platelet aggregation |
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adverse effects of hydroxyprogesterone caproate |
THROMBOEMBOLISM uticaria, pruritus hypertension N/D jaundice fluid retention |
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adverse effects of ritodrine (Yutopar) |
BP changes palpitations tachy (med not DC'd unless mom >140bpm) pulmonary edema hyperglycemia ***notify HCP if >120bpm or RR>20 because these could be s/s of pulmonary edema |
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contraindications for tocolytics in general |
hypertension antepartum hemorrhage heart disease >37 weeks advanced cervical dilation/effacement fetal demise choriamnionitis |
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contraindications for terbutaline (Brethine) |
>34 weeks gestation DM hypertension hyperthyroidism severe heart D cardiac dysrhythmias |
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contraindications for magnesium sulfate |
heart block significant myocardial damage renal failure myasthenia gravis |
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contraindications for indomethacin |
should only be used if gestational age is less than 32 weeks gestation should not be used for > 48 hours |
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contraindications for nifedipine (Adalat and Procardia) |
should not be used concurrently with magnesium sulfate |
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side effects and danger signs for combined oral contraceptives |
CP SOB leg pain (poss DVT) HA eye problems hypertension |
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contraindications for combined oral contraceptives |
hx blood clots, stroke, cardiac problems, breast or estrogen related cancers, pregnancy, smoker, >35yo |
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meds that can decrease the effectiveness of oral contraceptives |
certain drugs that affect liver enzymes such as anticonvulsants and and some antibiotics |
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function of betamethasone (Celestone) |
a glucocorticoid that is given to enhance fetal lung maturity and surfactant production |
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how is betamethasone given and when is it effective |
2 IM injections 24 hours apart requires a 24-hr period to be effective |
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therapeutic level of magnesium sufate |
4-8 mg/dL |
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at what level of magnesium sulfate will patient experience loss of DTRs |
8-10 mg/dL |
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at what level of mag sulfate will P experience respiratory depression |
> 10 mb/dL |
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what is a toxic level of mag sulfate that will result in a cardiac arrest |
>12 mg/dL |
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how long should mag sulfate be continued post delivery for severely pre-eclamptic patients |
24 hours |
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when is mag sulfate DC'd immediantly |
s/s pulmonary edema |
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antidote for mag sulfate |
calcium gluconate |
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monitor newborn for ____________ when mom has been given mag sulfate |
decreased BP decreased reflexes decreased RR |
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monitor newborn for _____________ when mom has been given ritodrine (Yutopar) |
hypoglycemia notify if FHR > 160/min |
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Hcg rises until what week of pregnancy |
15 weeks gestation |
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when is heartbeat auscultated first by doppler or ultrasonic transmitter |
10-12 weeks gestation |
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fetoscope can be used to hear fetal heartbeat by |
18-20 weeks gestation |
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normal FHR |
120-160bpm |
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US confirmation of gestational sac should be made by |
week 6 gestation |
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early amniocentesis is performed at approx. |
between 14 and 16 weeks gestation |
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when is chorionic villus sampling done |
10 to 12 weeks gestation |
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what common genetic anomaly cannot be determined by chorionic villus sampling |
spina bifida or anencephaly |
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what is the L/S ratio? |
lecithin/spingomyelin lung sufactants found in 3rd trimester |
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the higher the _____________, the more mature the lungs are |
lecithin |
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When is the alpha-fetoprotein level assessed |
16-18 weeks gestation |
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what does an elevated alpha-fetoprotein level indicate |
spina bifida, hydrocephalus |
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how does one obtain and alpha-fetoprotein level |
maternal blood sample amniocentesis |
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the fertilized egg stays in the fallopian tube for about ____________ days |
4 days |
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how many days between fertilization and implantation |
7 days |
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oral contraceptives predispose patients to |
candidiasis |
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GTPAL indicates |
# pregnancies # term deliveries # preterm deliveries (20-37weeks) # abortions (<20wks) # living children |
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Hagar's sign |
uterus becomes globular in shape, softens, and flexes easily over the cervix-a probable sign of pregnancy |
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Goodell's sign |
cervical softening due to increased vascularity congestion and edema - a probably sign of pregnance |
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Chadwick's sign |
the bluish discoloration of the cervix -a probable sign of prenancy |
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quickening is felt when |
16-20 weeks for multipara about 18 weeks for pimipara |
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legal point of fetal viability |
22 weeks |
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Nagele's rule |
subtract 3 months add 7 days |
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recommended weight gain |
3-4 lbs/month first trimester 1 lb/week thereafter total of 25 to 35 lbs |
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considered postpartum hemorrhage for vag birth |
>500 mL blood loss |
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considered postpartum hemorrhage for c-section |
>1000mL blood loss |
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meds for postpartum hemorrhage |
oxytocin (Pitocin) methylergonovine (Methergine) misoprostol (Cytotec) carboprost tromethamine (Hemabate) |
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ballottment usually observed during |
4th or 5th month gestation |
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gestational hypertension parameters |
begins after 20 wks >140/90 at least twice, 4 to 6 hours apart no proteinuria (BP will return to baseline w/in 6 wks postpartum) |
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mild preeclampsia parameters |
>140/90 proteinuria >+1 possible transient HAs possible episodes of irritability edema may be present |
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severe preeclampsia |
> 160/100 proteinuria > 3+ oliguria serum creatinine > 1.2 mg/dL HA/blurred vision hyperreflexia w/ poss anle clonus pulmonary/cardiac/hepatic involvement extensive peripheral edema epigastric and RUQ pain thrombocytopenia |
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eclampsia |
usually preceded by HA, severe epigastric pain, hyperreflexia, and hemoconcentration, which are warning signs of probable convulsions |
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HELLP |
variant of GH in which hematologic conditions coexist with severe preeclampsia involving hepatic dysfunction. *** diagnosed by lab tests, not by s/s |
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HELLP stands for |
Hemolysis resulting in anemia and jaundice ELevated ALT or AST, epigastric pain, N/V LP platelets < 100,000/mm3 resulting in abnormal bleeding and clotting time, bleeding gums petechiae, and possible DIC(disseminated intravascular coagulopathy) |
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gestational hypertensive diseases are associated with |
placental abruption kidney failure liver rupture preterm birth fetal and maternal death |
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hyperemesis gravidarum is associated with |
altered thyroid disease hx migraines, first pregnancy or multiples fetus with chromosomal abnormalities, gestational trophoblastic disease |
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gestational DM is associated with |
spontaneous abortion increased urinary and vag infections hydramnios hypoglycemia hyperglycemia maternal age >25 previous large baby |
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high risk groups for preeclampsia are |
African Americans young primipara |
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antidote for magnesium sulfate that should always be on hand |
calcium gluconate |
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untreated DM can lead to |
polyhydramnios macrosomis |
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uncontrolled glucose metabolism is assoc with |
increased incidence of; -preeclampsia -stillbirth -neonatal hypoglycemia -respiratory distress syndrome -premature delivery |
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differential between placenta previa and placenta abruptiva |
placenta previa is painless BRB bleeding |
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the most common cause of bleeding in the 2nd and 3rd trimesters |
placenta previa |
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abruption placentae is characterized by |
abd pain or low back pain blood is dark red |
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a woman with ___________ is more likely to have infection of hemorrhage postpartum |
placentae previa |
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recommended amount of milk for pregnant woman to drink per day |
one quart |
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cerclage |
purse-string suture to prevent premature cervical dilation |
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symptoms of spontaneous abortion |
vag bleeding abd cramping backache |
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normal fetal heart rate |
120-160bpm |
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the four Ps the four components of childbirth |
Powers Passage Passenger Psyche |
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Station refers to |
the location of the presenting part in relation to the ischial spines and indicates the degree of advancement of the presenting part through the pelvis |
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stations are represented by |
cm above (-) ischial spine cm below (+) ischial spine *** remember 4 on the floor! + 4 presenting part crowning |
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definitive signs of labor |
progressive uterine contractions and effacement and dilation of cervix |
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prematory signs of labor (prodromal signs) |
weight loss of 1-3 lbs nesting instinct burst of energy passage of mucous plug |
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primaparas cervix will |
efface and then dilate |
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multiparas cervix will |
efface and dilate at the same time |
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four stages of labor |
1) 0 to 10 cm dilated 2) BIRTH-full dilation thru birth 3) DELIVERY of neonate 4) maternal stabilization from delivery of placenta to stabilization of v/s |
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Phases of the first stage of labor |
1) latent 0-3 cm dilation 2) active 4-7 cm dilation 3) transition 8-10 cm dilation |
