Cardiac Meds and Electrolytes

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Questions and Answers

A patient with heart failure is prescribed metoprolol. What is the primary mechanism by which this medication improves their condition?

  • Increasing the force of myocardial contractions to enhance cardiac output.
  • Dilating peripheral blood vessels to reduce afterload and improve blood flow.
  • Increasing urine production to reduce fluid volume and alleviate pulmonary congestion.
  • Slowing the heart rate and decreasing the force of contractions to reduce myocardial oxygen demand. (correct)

A patient with acute heart failure is experiencing severe shortness of breath and anxiety. Which medication would be most appropriate for immediate symptom relief in this scenario?

  • Bumetanide (Bumex)
  • Dopamine
  • Morphine (correct)
  • Digoxin (Lanoxin)

A patient is prescribed digoxin for heart failure. The nurse understands that monitoring which electrolyte level is crucial to prevent digoxin toxicity?

  • Potassium (correct)
  • Magnesium
  • Sodium
  • Calcium

A patient with heart failure is prescribed an ACE inhibitor. What is the primary rationale for using this class of medication in heart failure management?

<p>To dilate blood vessels and reduce resistance, preventing further remodeling of the heart. (C)</p> Signup and view all the answers

A patient is receiving dopamine for the treatment of heart failure. What specific hemodynamic effect of dopamine is most beneficial in this context?

<p>Increased systolic blood pressure (D)</p> Signup and view all the answers

A patient is prescribed nitroglycerin for the management of angina. What primary physiological effect of nitroglycerin leads to the relief of chest pain?

<p>Dilating blood vessels to reduce resistance and improve blood flow to the heart. (C)</p> Signup and view all the answers

A patient is diagnosed with fluid volume overload related to heart failure. Which nursing intervention is most appropriate to manage this condition?

<p>Administering loop diuretics to increase urine production and reduce fluid volume. (D)</p> Signup and view all the answers

A patient with atrial fibrillation is prescribed verapamil. What is the primary goal of using verapamil in this patient's treatment plan?

<p>To maintain normal sinus rhythm by acting as an antiarrhythmic calcium channel blocker. (C)</p> Signup and view all the answers

A nurse auscultates a heart murmur during a patient's cardiac assessment. What physiological phenomenon is the most likely cause of a heart murmur?

<p>Turbulent blood flow through the heart, often due to valve abnormalities. (B)</p> Signup and view all the answers

A patient is suspected of having a myocardial infarction (MI). The physician orders MONA. What does each component of this treatment strategy aim to achieve in the context of an MI?

<p>Morphine: relieve pain; Oxygen: increase oxygen supply; Nitroglycerin: relax arteries; Aspirin: thin blood. (D)</p> Signup and view all the answers

A patient on heparin is found to have a critically low platelet count. Which potential complication is most concerning given this laboratory result?

<p>Increased risk of bleeding. (C)</p> Signup and view all the answers

A pregnant woman is diagnosed with gestational diabetes. What specific risk is most concerning for the neonate immediately after birth?

<p>Hypoglycemia (B)</p> Signup and view all the answers

A pregnant patient with gestational diabetes reports experiencing polydipsia, polyphagia, and polyuria. What underlying physiological process best explains these symptoms?

<p>Elevated blood glucose levels causing osmotic diuresis and compensatory mechanisms. (D)</p> Signup and view all the answers

During labor, a fetal monitoring strip shows variable decelerations. What is the most appropriate initial nursing intervention?

<p>Reposition the mother to relieve potential cord compression. (C)</p> Signup and view all the answers

Following delivery of the placenta, the nurse's priority assessment in the fourth stage of labor is to monitor for what specific complication?

<p>Uterine contraction and bleeding. (B)</p> Signup and view all the answers

Which factor is most strongly associated with an increased risk of preterm labor?

<p>History of previous premature deliveries. (A)</p> Signup and view all the answers

Following a Cesarean section, a patient saturates a perineal pad within 15 minutes. What volume of blood loss is most concerning and indicative of postpartum hemorrhage?

<p>1000 mL or more. (D)</p> Signup and view all the answers

A patient at 32 weeks gestation presents with painless bright red vaginal bleeding. The uterus is soft, relaxed, and nontender. What condition is most likely?

<p>Placenta previa. (D)</p> Signup and view all the answers

A patient with placenta previa is admitted to the hospital. What intervention is contraindicated?

<p>Digital vaginal examination. (B)</p> Signup and view all the answers

A patient at 35 weeks gestation presents with sudden onset of dark red vaginal bleeding and a rigid, board-like abdomen. What condition is most likely?

<p>Placental abruption. (B)</p> Signup and view all the answers

A patient experiencing a placental abruption is exhibiting signs of maternal shock, including tachycardia and hypotension. Which immediate intervention is most critical?

<p>Preparing the patient for immediate delivery. (D)</p> Signup and view all the answers

A newborn infant exhibits cyanosis of the trunk. What does this suggest?

<p>Underlying respiratory or cardiac compromise. (C)</p> Signup and view all the answers

What is the primary therapeutic goal of administering magnesium sulfate to a pregnant patient with severe pre-eclampsia?

<p>To prevent seizures (eclampsia). (A)</p> Signup and view all the answers

A patient receiving magnesium sulfate for pre-eclampsia has decreased urine output, and her blood pressure has dropped. What priority action should the nurse take?

<p>Stop the magnesium sulfate infusion and notify the physician. (C)</p> Signup and view all the answers

A patient with pre-eclampsia is being treated with magnesium sulfate. Which finding is an early sign of magnesium toxicity?

<p>Loss of deep tendon reflexes (C)</p> Signup and view all the answers

A patient is diagnosed with pre-eclampsia. What major sign differentiates pre-eclampsia from gestational hypertension?

<p>Proteinuria. (A)</p> Signup and view all the answers

A patient who is 28 weeks pregnant is diagnosed with preeclampsia. Which assessment finding would be most concerning and indicative of severe preeclampsia?

<p>Blood pressure of 160/110 mmHg and 3+ protein in the urine. (A)</p> Signup and view all the answers

When auscultating heart sounds, the nurse hears a split S2 sound. This finding is most likely due to:

<p>Asynchronous closure of the aortic and pulmonic valves. (A)</p> Signup and view all the answers

What condition requires Atropine?

<p>Bradycardia (B)</p> Signup and view all the answers

For which condition is adenosine suitable?

<p>Stops heart and resets- SVT (D)</p> Signup and view all the answers

What condition requires amiodarone?

<p>Is regular heart med. You can do it alone at home (A)</p> Signup and view all the answers

What is the therapeutic affect of heparin? 3 L per day

<p>Prevent blood clots (D)</p> Signup and view all the answers

Which are the four classes used for placental abruption?

<p>0, 1, 2, 3 (B)</p> Signup and view all the answers

After 20 weeks/3rd tri, separation of the placenta from the uterus is?

<p>Placental abruption (A)</p> Signup and view all the answers

What is the most common risk factor for placental abruption?

<p>Hypertension (B)</p> Signup and view all the answers

Hypertension that develops after 20 weeks, may also develop postpartum is called?

<p>Pre-Eclampsia (A)</p> Signup and view all the answers

Which of the following hemodynamic effects is the most likely result of administering a beta-blocker like metoprolol to a patient with heart failure?

<p>Reduced myocardial oxygen demand due to decreased heart rate and contractility. (A)</p> Signup and view all the answers

A patient with acute heart failure is prescribed morphine. Besides relieving anxiety, what additional beneficial effect does morphine provide in this clinical scenario?

<p>Reduced preload and afterload, easing the workload of the heart. (D)</p> Signup and view all the answers

A patient with heart failure is prescribed an ACE inhibitor. What specific effect of ACE inhibitors makes them beneficial in managing heart failure?

<p>Prevention of adverse remodeling of the heart by inhibiting the RAAS system. (D)</p> Signup and view all the answers

A patient with bradycardia is receiving dopamine. What specific effect of dopamine makes it beneficial in this context?

<p>Increased heart rate and increased cardiac output. (D)</p> Signup and view all the answers

A patient is prescribed nitroglycerin for angina. What primary mechanism explains nitroglycerin's effectiveness in relieving chest pain?

<p>Vasodilation, reducing preload and afterload, and improving blood flow to the heart. (B)</p> Signup and view all the answers

A patient with fluid volume overload related to heart failure is being treated. Which intervention is most directly related to addressing the underlying cause of the overload?

<p>Administering loop diuretics to promote fluid excretion. (B)</p> Signup and view all the answers

A patient with atrial fibrillation is prescribed verapamil. What physiological effect does verapamil exert to achieve the desired therapeutic outcome?

<p>Decreased AV node conduction, helping to control the ventricular rate. (A)</p> Signup and view all the answers

A nurse auscultates a heart murmur. What specific aspect of blood flow is most directly responsible for the generation of a heart murmur?

<p>Turbulent blood flow, often due to valve abnormalities or increased flow. (A)</p> Signup and view all the answers

In the context of MONA for myocardial infarction, what specific physiological outcome does nitroglycerin aim to achieve?

<p>Relax arteries and increase blood flow to the heart, reducing ischemia. (D)</p> Signup and view all the answers

A patient on heparin develops critically low platelet count. What direct consequence is most likely to arise from this laboratory abnormality?

<p>Increased risk of bleeding. (D)</p> Signup and view all the answers

What primary risk is most concerning for a neonate born to a mother with poorly controlled gestational diabetes immediately after birth?

<p>Hypoglycemia due to hyperinsulinemia developed in response to high maternal glucose levels. (B)</p> Signup and view all the answers

A pregnant patient with gestational diabetes experiences polydipsia, polyphagia, and polyuria. What underlying mechanism best explains these symptoms?

<p>Osmotic diuresis due to elevated blood glucose levels exceeding the kidney's reabsorption capacity. (B)</p> Signup and view all the answers

During labor, a fetal monitoring strip shows variable decelerations. Beyond repositioning the mother, what additional intervention should the nurse implement?

<p>Administering oxygen to the mother. (A)</p> Signup and view all the answers

Following delivery of the placenta in the fourth stage of labor, what critical assessment finding requires immediate intervention to prevent postpartum hemorrhage?

<p>A boggy uterus that does not respond to massage. (D)</p> Signup and view all the answers

Which specific maternal factor is most strongly associated with an increased risk of preterm labor?

<p>History of previous premature deliveries. (B)</p> Signup and view all the answers

Following a Cesarean section, a patient saturates a perineal pad within 15 minutes. Beyond ongoing assessment, what is the priority nursing intervention?

<p>Initiating fundal massage and notifying the healthcare provider. (D)</p> Signup and view all the answers

A patient at 32 weeks gestation presents with painless bright red vaginal bleeding. The uterus is soft, relaxed, and nontender. What intervention is contraindicated?

<p>Digital vaginal examination. (B)</p> Signup and view all the answers

A patient at 35 weeks gestation presents with sudden onset of dark red vaginal bleeding and a rigid, board-like abdomen. What specific assessment finding would be most concerning?

<p>Absent fetal heart tones. (A)</p> Signup and view all the answers

A patient experiencing a placental abruption is exhibiting signs of maternal shock. What immediate intervention is most critical?

<p>Preparing for immediate delivery. (D)</p> Signup and view all the answers

What primary physiological effect of administering magnesium sulfate is most beneficial to a pregnant patient with severe pre-eclampsia?

<p>Reducing blood pressure through vasodilation and preventing seizures. (C)</p> Signup and view all the answers

A patient receiving magnesium sulfate for pre-eclampsia has decreased urine output, and her blood pressure has dropped. What is the priority action?

<p>Stop the magnesium sulfate infusion and prepare to administer calcium gluconate. (C)</p> Signup and view all the answers

A patient who is 28 weeks pregnant is diagnosed with preeclampsia. Which assessment finding would be evidence of severe preeclampsia?

<p>Visual Disturbances. (B)</p> Signup and view all the answers

When auscultating heart sounds, the nurse hears a split S2 sound. That finding is caused by?

<p>Delayed closure of the pulmonic valve relative to the aortic valve. (D)</p> Signup and view all the answers

For which condition is Heparin suitable?

<p>Prevent blood clots- also causes thrombocytopenia (low platelets). 3 L per day. (C)</p> Signup and view all the answers

What laboratory value represents the therapeutic range for PTT on a patient receiving heparin?

<p>60-80 seconds. (B)</p> Signup and view all the answers

After 20 weeks/3rd trimester, what is the separation of the placenta from the uterus called?

<p>Placenta Abruption (B)</p> Signup and view all the answers

Hypertension that develops after 20 weeks of gestation, which may also develop during postpartum, is called?

<p>Gestational Hypertension (D)</p> Signup and view all the answers

A patient is receiving TPA. What condition requires TPA?

<p>Blood clots. (B)</p> Signup and view all the answers

Which statement best integrates the physiological effects of loop diuretics with the management of fluid volume overload?

<p>Loop diuretics increase urine production, reducing fluid congestion in the lungs and edema in peripheral tissues. (C)</p> Signup and view all the answers

A patient with fluid volume overload, secondary to heart failure, is prescribed Bumex. The primary goal is?

<p>Reduce peripheral edema. (B)</p> Signup and view all the answers

A patient asks why they need spironolactone and not lasix. You say:

<p>Spironolactone spares potassium. (A)</p> Signup and view all the answers

A patient is dx with stage 1 placental abruption. Is there fetal distress?

<p>No, vitals are normal and there is just some slight tenderness. (B)</p> Signup and view all the answers

A patient with heart failure is prescribed spironolactone instead of furosemide (Lasix). What is the most likely reason for this therapeutic decision?

<p>Spironolactone helps to counteract the potassium-wasting effects of other diuretics, preventing hypokalemia. (B)</p> Signup and view all the answers

A patient with a history of SVT is prescribed adenosine. Why is the patient SEEN after administration?

<p>Due to the short half-life and the need for continuous cardiac monitoring for potential side effects. (C)</p> Signup and view all the answers

A patient with a history of pre-eclampsia receives magnesium sulfate. What is the primary reason for administering magnesium sulfate in this context?

<p>To prevent seizures associated with eclampsia. (D)</p> Signup and view all the answers

Following the delivery of a newborn, the nurse observes cyanosis of the trunk. What does this indicate?

<p>Central cyanosis and requires immediate intervention. (B)</p> Signup and view all the answers

A patient at 35 weeks gestation presents with sudden onset of dark red vaginal bleeding, uterine tenderness, and a rigid abdomen. What is the priority nursing intervention?

<p>Prepare the patient for an immediate cesarean section. (A)</p> Signup and view all the answers

A patient with gestational diabetes is being discharged. Which statement indicates a need for further education?

<p>&quot;I don't need to test my blood sugars anymore because I am not pregnant.&quot; (B)</p> Signup and view all the answers

A pregnant patient is diagnosed with placenta previa at 32 weeks gestation. What assessment finding would necessitate immediate notification of the physician?

<p>The patient experiences a decrease in urinary output and an increase in pulse rate. (B)</p> Signup and view all the answers

A patient is receiving magnesium sulfate for pre-eclampsia. Which assessment finding warrants immediate intervention?

<p>Urine output of 20 mL/hour. (D)</p> Signup and view all the answers

A patient is postpartum after a cesarean section. Which finding requires priority intervention?

<p>Uterine fundus is boggy and displaced to the right. (C)</p> Signup and view all the answers

The healthcare provider orders the administration of TPA for a patient, which condition is this intervention indicated for?

<p>Ischemic stroke (D)</p> Signup and view all the answers

Flashcards

Beta Blockers (e.g., Metoprolol)

Slows HR, decreases force of contractions, lowers BP, and decreases myocardial oxygen demand.

Loop Diuretics (e.g., Bumex, Lasix)

Increase urine production to reduce fluid in the body, easing congestion and edema.

Thiazide Diuretics

Eliminates excess fluid, sometimes used with loop diuretics.

Morphine (for Heart Failure)

Relieves SOB and anxiety in acute situations by reducing preload and afterload.

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Positive Inotropes (e.g., Dopamine, Dobutamine)

Improve the heart's ability to pump blood, increasing cardiac output and systolic BP; dopamine used for bradycardia.

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Digitalis Glycoside (Digoxin)

Increases the force of contraction and slows the heart rate; monitor potassium levels due to risk of toxicity. Watch for yellow tint as sign of toxicity.

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RAAS Inhibitors (ACE Inhibitors)

Decrease BP and resistance, preventing further remodeling of the heart in heart failure patients.

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Nitrates

Vasodilate blood vessels, reduce resistance, and ease the heart's workload, reducing afterload.

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Aspirin

Limit clotting and decrease platelet adherence.

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Calcium Antagonists

Arteriole dilation, decreasing systemic vascular resistance.

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Atropine

Medication used to treat bradycardia.

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Adenosine

Stops and resets the heart to treat SVT.

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Amiodarone

Heart medication for arrhythmias.

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Fluid Volume Overload

Excessive amount of water in the bloodstream.

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Verapamil

Antiarrhythmic calcium channel blocker used to maintain normal sinus rhythm in AFib.

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Heparin (for Afib)

Reduce thrombus formation or embolization in Afib.

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S1 (LUB)

Closure of the AV valves (mitral and tricuspid).

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S2 (DUB)

Closure of the semilunar valves (aortic and pulmonic).

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Heart Murmurs

Turbulent blood flow in the heart due to physiological or pathological changes.

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Apex of heart at 5th intercostal space, midclavicular line

Mitral area to hear heart valve sounds

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Left sternal border, fourth intercostal space

Tricuspid area to hear heart valve sounds

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Base of heart at second intercostal space

Pulmonic area to hear heart valve sounds

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Second intercostal space, right sternal border

Aortic Valve area o hear heart valve sounds

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MONA

Morphine, Oxygen, Nitro, Aspirin - a treatment approach for chest pain.

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Gestational Diabetes

Glucose intolerance with onset during pregnancy, usually diagnosed in the second or third trimester.

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Macrosomia

Large birth weight due to high glucose levels in utero.

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Neonatal Hypoglycemia (in gestational diabetes)

Glucose crosses the placenta, stimulating the baby's pancreas to make extra insulin and leading to hypoglycemia after birth.

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Variable Decelerations

Cord compression, move the mom.

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Stage One of Labor

Cervix dilates.

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Stage Two of Labor

Baby delivered.

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Stage Three of Labor

Placenta delivered.

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Stage Four of Labor

Monitor uterus and for bleeding.

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Causes of Preterm Labor

Multifetal gestation, history of premature delivery, maternal obesity, uterine anomalies, smoking/drug use, etc.

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Postpartum Hemorrhage (PPH)

Excessive bleeding after delivery; saturation of a pad in 15 minutes. C-section >1000ml loss

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Placenta Previa

The placenta partially or completely covers the cervical os.

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Placental Abruption

Premature separation of the placenta from the uterus; can be complete or partial.

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Pre-Eclampsia

Hypertension, proteinuria, and edema after 20 weeks gestation.

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Magnesium Sulfate (in Pre-Eclampsia)

Prevent seizures (eclampsia) and promote vasodilation to lower blood pressure.

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Signs of Magnesium Toxicity

Blood pressure decreases, Urine output decreases, Respiratory rate decreases, Patellar reflexes absent.

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Study Notes

Cardiac Medications and Electrolytes

  • Beta Blockers (Metoprolol): Slows heart rate, decreases contraction force, lowers blood pressure, and reduces myocardial oxygen demand
  • Loop Diuretics (Bumex or Lasix): Increase urine production to reduce body fluid, alleviate lung congestion, and reduce peripheral edema and shortness of breath
  • Thiazide Diuretics: Eliminate excess fluid and can be combined with loop diuretics for fluid management
  • Morphine: Relieves shortness of breath and anxiety in acute situations by reducing preload and afterload
  • Positive Inotropes (Dopamine/Dobutamine): Enhance the heart's pumping ability, increasing cardiac output and systolic blood pressure; dopamine treats bradycardia
  • Digitalis Glycoside (Digoxin): Increases contraction force and slows heart rate and requires potassium level monitoring due to hypokalemia leading to digitalis toxicity (yellow tint in vision) and dysrhythmias
  • RAAS Inhibitors (ACE Inhibitors): Decrease blood pressure and resistance, preventing further heart remodeling in heart failure patients
  • Nitrates: Vasodilate to relax blood vessels, reduce resistance, and ease the heart's pumping effort, reduce afterload
  • Aspirin: Reduces clotting and platelet adherence
  • Calcium Antagonists: Cause arteriole dilation, decreasing systemic vascular resistance

Key Cardiac Medications

  • Heparin, Plavix, TPA, Digoxin, Bumex, Losartan, Lisinopril, Captopril, Enalapril, Carvedilol, Spironolactone, Nitroglycerine, Dopamine, Levophed, Epinephrine, Labetalol, Amiodorone (for arrhythmias), Adenosine (for severe SVT), Atropine, Morphine

Medications for Bradycardia, Heart Failure and SVT

  • Atropine: Used for bradycardia
  • Dopamine: Used for heart failure
  • Adenosine: Stops and resets the heart in severe SVT

Specific Antiarrhythmic Meds

  • Amiodarone: For regular heart rhythm maintenance
  • Adenosine: For severe supraventricular tachycardia (SVT); stops the heart to reset its rhythm

Fluid Volume Overload

  • Characterized by an excessive amount of water in the bloodstream
  • In heart failure, the RAAS constantly cycles, leading to excessive water retention
  • Loop diuretics, adjusting infusion rates, and heart failure medications address fluid overload

Specific Medications

  • Verapamil: Antiarrhythmic calcium channel blocker for atrial fibrillation (AFib) to maintain normal sinus rhythm
  • Digoxin: Increases contraction force and slows heart rate, requires apical pulse check for 1 minute before administration, hold if below 60 BPM
  • Heparin: Reduces thrombus formation or embolization in AFib
  • Lidocaine: Used for VTach? MI?

Heart Sounds

  • First Sound (S1/LUB): Closure of the atrioventricular (AV) valves (mitral and tricuspid) during systole
  • Second Sound (S2/DUB): Closure of the semilunar valves (aortic and pulmonic)
  • Murmurs: Indicate turbulent blood flow potentially due to physiological changes, valve deformities, or dysfunction

Auscultation Locations

  • Mitral: Apex of the heart, 5th intercostal space, midclavicular line
  • Tricuspid: Left sternal border, 4th intercostal space
  • Pulmonic: Base of the heart, 2nd intercostal space
  • Aortic: 2nd intercostal space, right sternal border

MONA Treatment

  • Morphine: Relieve pain
  • Oxygen: Increase oxygen
  • Nitro: Relax arteries and increase blood flow to the heart
  • Aspirin: Thin blood

Heparin

  • Prevents blood clots but can cause thrombocytopenia (low platelets); maintain 3 L fluid intake per day

Normal Lab Values

  • BUN: 10-20 mg/dL
  • Creatinine: 0.5 – 1.3 mg/dL (varies by gender and age)
  • Hemoglobin: 12-18 g/dL (varies by gender)
  • Potassium: 3.5-5.0 mEq/L

Heparin and Platelets

  • PTT: 60-80 seconds; Heparin leads to abnormally low platelets

Acute OB - Gestational Diabetes

  • Glucose intolerance with onset during pregnancy, usually in the second or third trimester

Concerns for Mom

  • Poorly controlled blood glucose leading to pre-eclampsia, increased infection risk, higher cesarean delivery likelihood and large baby leading to lacerations. Enlarged uterus could lead to postpartum hemorrhage and increased risk of developing T2DM later in life

Concerns for Baby

  • Large birth weight (macrosomia), neonatal hypoglycemia, respiratory distress, long-term metabolic issues, shoulder dystocia, and potential brain damage
  • Respiratory distress is from hyperinsulinemia interfering with surfactant production

Hyperglycemia Symptoms

  • Polydipsia, polyphagia, polyuria, nausea, abdominal pain, flushed dry skin, fruity breath

Hypoglycemia Symptoms

  • Nervousness, headache, weakness, irritability, hunger, blurred vision

Teaching Points for Gestational Diabetes

  • Monitor glucose closely, understand medications, recognize symptoms, and adhere to diet and exercise plans
  • Stress glucose control for the baby's well-being

Fetal Heart Rate Decelerations

  • Variable: Cord compression; intervention is to move the mother

Stages of Labor

  • Stage 1: Cervical dilation
  • Stage 2: Baby delivered
  • Stage 3: Placenta delivered
  • Stage 4: Post-placenta, monitor uterus and bleeding

Causes of Preterm Labor

  • Multifetal gestation, history of premature deliveries, maternal obesity/underweight, family history, uterine anomalies, advanced/young maternal age, smoking/drug use

Postpartum Hemorrhage (PPH)

  • Excessive bleeding after delivery, including C-sections, due to uterine atony, retained placental fragments, or blood vessel injury

Assessing Blood Loss w/ PPH

  • Saturation of a pad indicates approximately 1000 mL loss
  • Blood loss >1000ml for saturation of pad
  • Expected blood loss is >500 mL for cesarean section

Placenta Previa

  • Placenta partially or completely covers the cervical os
  • Risk factors: Over 35 yrs, previous c section, multiparity, uterine injury, cocaine, prev D&C, endometrial ablation, prior placenta previa, infertility tx, multiple gestations, previous induced surgical abortion, smoking, previous myomectomy to remove fibroids, short interval between preg, hypertension or diabetes

Identifying Placenta Previa

  • Painless bright red bleeding during the 2nd or 3rd trimester
  • Uterus is soft, relaxed, non-tender with a normal tone and reassuring fetal heart rate

Interventions for Placenta Previa

  • Avoid vaginal exams
  • Place mother in left lateral position to reduce inferior vena cava compression
  • Cesarean section is required for delivery

Placental Abruption

  • Premature separation of the placenta from the uterus (partial or complete) which occurs after 20 weeks

Placental Abruption Risks

  • Most common risk factor is hypertension; also blunt force trauma, cocaine use, previous abruption, smoking, multifetal pregnancy, prelabor membrane rupture

Placental Abruption Symptoms

  • Dark red vaginal bleeding, board-like rigid abdomen

Placental Abruption Treatment

  • Bed rest, delivery, IV fluids and blood products

Placental Abruption Classifications

  • Class 0: Diagnosed after delivery
  • Class 1: Minimal bleeding, normal vitals, slight uterine tenderness, no fetal distress
  • Class 2: Moderate bleeding, uterine pain with tetanic contractions, vital sign changes, fetal distress, abnormal clotting
  • Class 3: Heavy bleeding, rigid uterus, maternal shock, fetal demise

Cyanosis

  • Acrocyanosis: (Blue hands/feet) normal
  • Truncal cyanosis: Bad (Blue Torso)

Medications: Mag Sulfate, Terbutaline

  • Mag Sulfate: Tocolytic used for pre-term labor, also used for severe pre-eclampsia for seizure prophylaxis.
  • Terbutaline: Tocolytic used for pre-term labor.

Pre-Eclampsia

  • Elevated BP after 20 weeks gestation, may also develop postpartum
  • Signs and symptoms- hypertension (blood pressure elevation: >140/90 mmHg. Hallmark sign of preeclampsia), proteinuria, Pitting Edema: Edema seen in extremities, hands, face

Magnesium Sulfate

  • Prevents seizures (eclampsia) and promotes vasodilation to lower blood pressure

Magnesium Toxicity

  • Watch for signs of magnesium toxicity using the BURP acronym:
  • Blood pressure decreases.
  • Urine output decreases. REPORT URINE OUTPUT
  • Respirations < 12
  • Patellar Reflex absent

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