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90 Cards in this Set
- Front
- Back
When doing a vaginal exam and the nurse feels pulsating this is a sign of? What must the nurse do next?
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This is sign of a prolapsed cord. The nurse must stay there until a cesarean section can be performed.
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What is Occiput Posterior and what is management?
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the babies head is down and faced towards the mothers stomach instead of towards her back.
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Delivery is imminent when?
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The mother says "the baby is coming", Pressure, or involuntary pushing or if you can see the babies head coming out of the vagina.
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Shoulder dystocia is?
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Impaction of anterior fetal shoulder within or above maternal pelvis after delivery of fetal head.
A medical emergency it is most common with with macrosomia, the babies shoulders can be crepatice. |
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PLACENTA ACCRETA is?
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abnormal adherence to myometrium
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Cervical Ripening is?
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Process of effecting physical softening and distensibility of cervix
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Labor Induction is?
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Stimulation of uterine contractions before spontaneous onset of labor
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Labor augmentation is?
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Stimulation of ineffective uterine contractions after spontaneous onset of labor to manage dystocia
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When do you hold Methylergonovine
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BP of 140/90
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What does the nurse do if the patients uterus is up and to the left?
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Have the patient void or straight cath.
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Women more at risk of compromise of a postpartum hemorrhage?
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preeclampsia, anemia, dehydration, small suture.
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PP Blues is?
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Occurs in 50%-85% in women, occurs 3 - 4 days after birth, intervention is often not needed,
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PP Depression is?
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occurs in 10% - 20% in women, within 1 - 6 months after birth, intervention may be needed with antidepressant therapy and psychotherapy.
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PP psychosis is?
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1-2/1000 of women, occurs with first couple days, the patient can have hallucinations, delusions and phobias. Is a severe medical emergency that requires hospitalization
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Physiologic Jaundice ?
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developmental jaundice
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Pathological jaundice is?
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Occurs in the first 24hrs of life.
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TORCH Infections?
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Toxoplasmosis
Other (gonorrhea, syphilis, varicella, hepatitis, HIV) Rubella CMV Herpes simplex virus |
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What is NEC?
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Acute inflammatory disease of GI mucosa
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Signs and Symptoms of NEC?
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Decreased activity
Hypotonia Recurrent apnea and bradycardia Metabolic acidosis Abdominal distention Vomiting Grossly bloody stools Abdominal tenderness Abdominal wall erythema |
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Postterm Infant: Meconium Aspiration Syndrome
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Meconium stained fluid occurs in approximately 13% of all births
MAS incidence 5% of all infants born in meconium stained fluid 5-12% mortality rate |
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Postterm Infant: Meconium Aspiration Syndrome sign is?
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Overdistended, barrel-shaped chest with increased AP diameter can develop hypoxia.
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Infant Pain
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Infants experience pain
Infants remember painful experiences Infants show memory of pain by exhibiting defensive behaviors when painful procedures are repeated |
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Why do we give prostaglandin gel?
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To ripen the cervix, especially at 42 weeks to prep for preop labor induction.
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Which assessment is most relative to epidural narcotics?
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respiratory rate
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What is the advantage of a woman having an epidural during birth instead of general anesthesia?
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the airway stays intact
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What medication do you give pre-op to a woman having a c-section for her GI tract?
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bicitra
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What's the normal fetal heart rate?
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110-160 bpm
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If a pt. comes in at 42 weeks and the fetus has only moved 2 times in the last four hours, is this a concern?
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Yes
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What are some cues of a baby being overstimulated?
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hiccups and bad tensing of body. If the baby is gazing at the caregiver, the baby isn't overstimulated.
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If a baby has a heart rate of 80-90 bpm and an overdistended barrel shaped chest, this is a sign of what?
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meconium aspiration syndrome
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What should be part of the best reason to do a routine pain assessment on newborns?
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newborns will remember painful experiences
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If you have a baby that has low O2 saturation, what do you want to do?
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auscultate the breath sounds. if you have an ET tube, assess patency or increase oxygen. Notify the physician.
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If you have a baby that has a respiratory rate of 88 breaths/min, should you start a feed?
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No, do not start a feed. Wait until respiratory rate is normal (40-60 breaths/min)
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What is the normal blood sugar of a baby?
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40-60mg/dL
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What are some complications of a baby that was born at 42 weeks gestation?
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dry cracked skin, meconium aspiration syndrome, hypoglycemia
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what is the normal respiratory rate of the newborn?
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40-60 breaths/min
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How will labor be different if the baby is in occiput posterior (OP) position?
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the patient will experience more back pain
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If a pregnant woman has her water broken, what is the priority nursing assessment?
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assess the FHR before and after
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You are taking care of a patient that has been laboring for several hours and she is not progressing. She is 7cm, 0 station, and 100% effaced. She is having persistent late decels. The doctor says to begin pitocin augmentation, what is the nurses responsibility?
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inform the physician you aren't going to start the pitocin and that he/she needs to come to the hospital. A c-section will most likely need to be done.
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What does it mean when there is an impending delivery?
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the baby is coming the patient says. DO NOT leave the room.
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If a pt. is asked to sign a consent regarding the delivery, but doesn't understand, what should the nurse do?
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Call the doctor and have them give more detailed information to the patient
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What is considered full dilation?
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10cc
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What is the difference between true labor and false labor?
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true labor brings about cervical dilation with progressive cervical change. False labor will show consistent contractions without cervical change.
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What would be a good reason to discontinue pitocin?
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uterine hyperstimulation
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what would be considered another sign of true labor?
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when the cervix is effacing and dilating
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What do you want to assess before giving terbutaline to a 32 week pregnant woman?
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assess maternal HR
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What do you want to assess with the administration of methargen?
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confirm BP
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MgSO4 toxicity shows signs of:
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absence of deep tendon reflexes, decreased respiratory rate
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If a pregnant mom was involved in a motor vehicle accident, what will be done?
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K-B assay Kleihauer test to rule out abruption, blood transfusion, Rh-, administer Rhogam, assess uterus for contractions
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What is one important thing you want to do for a patient that is having a c-section?
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give the proper teaching regarding c/s even if it is a repeat procedure. Ensure they understand pre and post op care and procedures.
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What are important things to know about breech presentation?
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more likely to have meconium stained fluid, preterm labor and birth, usually early rather than late
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What is the purpose of giving bicitra?
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to prevent chemical pneumonitis, which causes aspiration
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What are the five P's?
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Psyche- psychological response of mom to labor
Power- hyper/hypotonic uterine dysfunction and inadequate bearing down efforts Passage- alterations in pelvic structure Position- changes in position facilitate labor in a positive manner Passenger- the baby and its presentation, size, anomalies, and multiples |
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What is a velamentous insertion?
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complications of labor (variable decels, IUGR, fetal exsanguination)
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cervical ripening is:
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physical softening and distensibility of cervix
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bishop's scoring system is used for:
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to indicate the relative likelihood of an induction attempt being succesful
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what are some cervical ripening mechanical methods?
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laminaria tents, synthetic hygroscopic dilators, and balloon catheters
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laminaria tents:
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absorb cervical fluids and swell, causing mechanical dilation and prostaglandin release
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How do laminaria tents and synthetic hygroscopic dilators (SHD) differ?
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Both absorb cervical fluids causing the cervix to dilate and the release of prostaglandins. laminaria tents swell 2-3 times their original size, where SHDs swell 3-4 times their original size.
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what are two types of synthetic hygroscopic dilators?
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lamicel and dilapan
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what are some pharmacologic agents used for cervical ripening?
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cervidil PGE2, prostaglandin gel, and cytotec PGE1
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what needs to be monitored with the use of prostaglandin gels?
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FHR and uterine activity should be monitored for 30mins to 2 hrs
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misoprostol should not be used:
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patients who have had prior c/s or major uterine surgery
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what are the two types of induction of labor?
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stripping of membranes and amniotomy
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Can a nurse perform an amniotomy?
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no, not in scope of practice. Can apply FSE per AZ Nurse Practice Act
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The only agent approved by the FDA for induction of labor with a living fetus?
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oxytocin
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oxytocin must be administered:
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IV piggyback via infusion pump
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During the active phase of labor, what would be considered adequate progress?
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cervical dilation of 1cm/hr
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what do you want to assess before any increase or decrease in oxytocin?
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FHR; contraction frequency, duration, and intensity; uterine resting tone
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oxytocin has what kind of effect when given in large doses?
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antidiuretic; kidneys rebsorb water and urinary output is decreased
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If uterine hyperstimulation occurs, what intervention should the nurse do?
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remove prostaglandin or stop oxytocin, administer tocolytic, in-utero resuscitation prn
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Regional anethetics can cause what kind of effect?
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hypotension
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general anesthesia is only used for:
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emergency delivery or contraindication to regional anesthesia
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what are the two types of operative vaginal delivery (OVD)?
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vacuum and forceps
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what is the most common complication with cesarean deliveries?
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infection
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what are the three types of incisions for c-sections?
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classical, low classical, and low transverse
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What should be assessed during post-op care of c-section?
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pain; VS q10-15 mins for 1-2hrs; assess airway; assess fundus and incision
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what is the normal cord length in-utero?
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50-60cm
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if a cord is too short, what is a possible complication?
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placental abruption or uterine inversion
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if the cord is too long, what is a possible complication?
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true knots, prolapse of cord, or wrapping around baby
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what are some pharmacologic agents used for cervical ripening?
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cervidil PGE2, prostaglandin gel, and cytotec PGE1
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what needs to be monitored with the use of prostaglandin gels?
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FHR and uterine activity should be monitored for 30mins to 2 hrs
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misoprostol should not be used:
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patients who have had prior c/s or major uterine surgery
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what are the two types of induction of labor?
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stripping of membranes and amniotomy
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Can a nurse perform an amniotomy?
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no, not in scope of practice. Can apply FSE per AZ Nurse Practice Act
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The only agent approved by the FDA for induction of labor with a living fetus?
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oxytocin
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oxytocin must be administered:
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IV piggyback via infusion pump
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During the active phase of labor, what would be considered adequate progress?
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cervical dilation of 1cm/hr
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what do you want to assess before any increase or decrease in oxytocin?
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FHR; contraction frequency, duration, and intensity; uterine resting tone
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oxytocin has what kind of effect when given in large doses?
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antidiuretic; kidneys rebsorb water and urinary output is decreased
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