Podcast
Questions and Answers
A patient with heart failure is prescribed metoprolol. What is the primary mechanism by which this medication improves their condition?
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?
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?
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?
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?
A patient is receiving dopamine for the treatment of heart failure. What specific hemodynamic effect of dopamine is most beneficial in this context?
A patient is receiving dopamine for the treatment of heart failure. What specific hemodynamic effect of dopamine is most beneficial in this context?
A patient is prescribed nitroglycerin for the management of angina. What primary physiological effect of nitroglycerin leads to the relief of chest pain?
A patient is prescribed nitroglycerin for the management of angina. What primary physiological effect of nitroglycerin leads to the relief of chest pain?
A patient is diagnosed with fluid volume overload related to heart failure. Which nursing intervention is most appropriate to manage this condition?
A patient is diagnosed with fluid volume overload related to heart failure. Which nursing intervention is most appropriate to manage this condition?
A patient with atrial fibrillation is prescribed verapamil. What is the primary goal of using verapamil in this patient's treatment plan?
A patient with atrial fibrillation is prescribed verapamil. What is the primary goal of using verapamil in this patient's treatment plan?
A nurse auscultates a heart murmur during a patient's cardiac assessment. What physiological phenomenon is the most likely cause of a heart murmur?
A nurse auscultates a heart murmur during a patient's cardiac assessment. What physiological phenomenon is the most likely cause of a heart murmur?
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?
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?
A patient on heparin is found to have a critically low platelet count. Which potential complication is most concerning given this laboratory result?
A patient on heparin is found to have a critically low platelet count. Which potential complication is most concerning given this laboratory result?
A pregnant woman is diagnosed with gestational diabetes. What specific risk is most concerning for the neonate immediately after birth?
A pregnant woman is diagnosed with gestational diabetes. What specific risk is most concerning for the neonate immediately after birth?
A pregnant patient with gestational diabetes reports experiencing polydipsia, polyphagia, and polyuria. What underlying physiological process best explains these symptoms?
A pregnant patient with gestational diabetes reports experiencing polydipsia, polyphagia, and polyuria. What underlying physiological process best explains these symptoms?
During labor, a fetal monitoring strip shows variable decelerations. What is the most appropriate initial nursing intervention?
During labor, a fetal monitoring strip shows variable decelerations. What is the most appropriate initial nursing intervention?
Following delivery of the placenta, the nurse's priority assessment in the fourth stage of labor is to monitor for what specific complication?
Following delivery of the placenta, the nurse's priority assessment in the fourth stage of labor is to monitor for what specific complication?
Which factor is most strongly associated with an increased risk of preterm labor?
Which factor is most strongly associated with an increased risk of preterm labor?
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?
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?
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?
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?
A patient with placenta previa is admitted to the hospital. What intervention is contraindicated?
A patient with placenta previa is admitted to the hospital. What intervention is contraindicated?
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?
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?
A patient experiencing a placental abruption is exhibiting signs of maternal shock, including tachycardia and hypotension. Which immediate intervention is most critical?
A patient experiencing a placental abruption is exhibiting signs of maternal shock, including tachycardia and hypotension. Which immediate intervention is most critical?
A newborn infant exhibits cyanosis of the trunk. What does this suggest?
A newborn infant exhibits cyanosis of the trunk. What does this suggest?
What is the primary therapeutic goal of administering magnesium sulfate to a pregnant patient with severe pre-eclampsia?
What is the primary therapeutic goal of administering magnesium sulfate to a pregnant patient with severe pre-eclampsia?
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?
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?
A patient with pre-eclampsia is being treated with magnesium sulfate. Which finding is an early sign of magnesium toxicity?
A patient with pre-eclampsia is being treated with magnesium sulfate. Which finding is an early sign of magnesium toxicity?
A patient is diagnosed with pre-eclampsia. What major sign differentiates pre-eclampsia from gestational hypertension?
A patient is diagnosed with pre-eclampsia. What major sign differentiates pre-eclampsia from gestational hypertension?
A patient who is 28 weeks pregnant is diagnosed with preeclampsia. Which assessment finding would be most concerning and indicative of severe preeclampsia?
A patient who is 28 weeks pregnant is diagnosed with preeclampsia. Which assessment finding would be most concerning and indicative of severe preeclampsia?
When auscultating heart sounds, the nurse hears a split S2 sound. This finding is most likely due to:
When auscultating heart sounds, the nurse hears a split S2 sound. This finding is most likely due to:
What condition requires Atropine?
What condition requires Atropine?
For which condition is adenosine suitable?
For which condition is adenosine suitable?
What condition requires amiodarone?
What condition requires amiodarone?
What is the therapeutic affect of heparin? 3 L per day
What is the therapeutic affect of heparin? 3 L per day
Which are the four classes used for placental abruption?
Which are the four classes used for placental abruption?
After 20 weeks/3rd tri, separation of the placenta from the uterus is?
After 20 weeks/3rd tri, separation of the placenta from the uterus is?
What is the most common risk factor for placental abruption?
What is the most common risk factor for placental abruption?
Hypertension that develops after 20 weeks, may also develop postpartum is called?
Hypertension that develops after 20 weeks, may also develop postpartum is called?
Which of the following hemodynamic effects is the most likely result of administering a beta-blocker like metoprolol to a patient with heart failure?
Which of the following hemodynamic effects is the most likely result of administering a beta-blocker like metoprolol to a patient with heart failure?
A patient with acute heart failure is prescribed morphine. Besides relieving anxiety, what additional beneficial effect does morphine provide in this clinical scenario?
A patient with acute heart failure is prescribed morphine. Besides relieving anxiety, what additional beneficial effect does morphine provide in this clinical scenario?
A patient with heart failure is prescribed an ACE inhibitor. What specific effect of ACE inhibitors makes them beneficial in managing heart failure?
A patient with heart failure is prescribed an ACE inhibitor. What specific effect of ACE inhibitors makes them beneficial in managing heart failure?
A patient with bradycardia is receiving dopamine. What specific effect of dopamine makes it beneficial in this context?
A patient with bradycardia is receiving dopamine. What specific effect of dopamine makes it beneficial in this context?
A patient is prescribed nitroglycerin for angina. What primary mechanism explains nitroglycerin's effectiveness in relieving chest pain?
A patient is prescribed nitroglycerin for angina. What primary mechanism explains nitroglycerin's effectiveness in relieving chest pain?
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?
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?
A patient with atrial fibrillation is prescribed verapamil. What physiological effect does verapamil exert to achieve the desired therapeutic outcome?
A patient with atrial fibrillation is prescribed verapamil. What physiological effect does verapamil exert to achieve the desired therapeutic outcome?
A nurse auscultates a heart murmur. What specific aspect of blood flow is most directly responsible for the generation of a heart murmur?
A nurse auscultates a heart murmur. What specific aspect of blood flow is most directly responsible for the generation of a heart murmur?
In the context of MONA for myocardial infarction, what specific physiological outcome does nitroglycerin aim to achieve?
In the context of MONA for myocardial infarction, what specific physiological outcome does nitroglycerin aim to achieve?
A patient on heparin develops critically low platelet count. What direct consequence is most likely to arise from this laboratory abnormality?
A patient on heparin develops critically low platelet count. What direct consequence is most likely to arise from this laboratory abnormality?
What primary risk is most concerning for a neonate born to a mother with poorly controlled gestational diabetes immediately after birth?
What primary risk is most concerning for a neonate born to a mother with poorly controlled gestational diabetes immediately after birth?
A pregnant patient with gestational diabetes experiences polydipsia, polyphagia, and polyuria. What underlying mechanism best explains these symptoms?
A pregnant patient with gestational diabetes experiences polydipsia, polyphagia, and polyuria. What underlying mechanism best explains these symptoms?
During labor, a fetal monitoring strip shows variable decelerations. Beyond repositioning the mother, what additional intervention should the nurse implement?
During labor, a fetal monitoring strip shows variable decelerations. Beyond repositioning the mother, what additional intervention should the nurse implement?
Following delivery of the placenta in the fourth stage of labor, what critical assessment finding requires immediate intervention to prevent postpartum hemorrhage?
Following delivery of the placenta in the fourth stage of labor, what critical assessment finding requires immediate intervention to prevent postpartum hemorrhage?
Which specific maternal factor is most strongly associated with an increased risk of preterm labor?
Which specific maternal factor is most strongly associated with an increased risk of preterm labor?
Following a Cesarean section, a patient saturates a perineal pad within 15 minutes. Beyond ongoing assessment, what is the priority nursing intervention?
Following a Cesarean section, a patient saturates a perineal pad within 15 minutes. Beyond ongoing assessment, what is the priority nursing intervention?
A patient at 32 weeks gestation presents with painless bright red vaginal bleeding. The uterus is soft, relaxed, and nontender. What intervention is contraindicated?
A patient at 32 weeks gestation presents with painless bright red vaginal bleeding. The uterus is soft, relaxed, and nontender. What intervention is contraindicated?
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?
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?
A patient experiencing a placental abruption is exhibiting signs of maternal shock. What immediate intervention is most critical?
A patient experiencing a placental abruption is exhibiting signs of maternal shock. What immediate intervention is most critical?
What primary physiological effect of administering magnesium sulfate is most beneficial to a pregnant patient with severe pre-eclampsia?
What primary physiological effect of administering magnesium sulfate is most beneficial to a pregnant patient with severe pre-eclampsia?
A patient receiving magnesium sulfate for pre-eclampsia has decreased urine output, and her blood pressure has dropped. What is the priority action?
A patient receiving magnesium sulfate for pre-eclampsia has decreased urine output, and her blood pressure has dropped. What is the priority action?
A patient who is 28 weeks pregnant is diagnosed with preeclampsia. Which assessment finding would be evidence of severe preeclampsia?
A patient who is 28 weeks pregnant is diagnosed with preeclampsia. Which assessment finding would be evidence of severe preeclampsia?
When auscultating heart sounds, the nurse hears a split S2 sound. That finding is caused by?
When auscultating heart sounds, the nurse hears a split S2 sound. That finding is caused by?
For which condition is Heparin suitable?
For which condition is Heparin suitable?
What laboratory value represents the therapeutic range for PTT on a patient receiving heparin?
What laboratory value represents the therapeutic range for PTT on a patient receiving heparin?
After 20 weeks/3rd trimester, what is the separation of the placenta from the uterus called?
After 20 weeks/3rd trimester, what is the separation of the placenta from the uterus called?
Hypertension that develops after 20 weeks of gestation, which may also develop during postpartum, is called?
Hypertension that develops after 20 weeks of gestation, which may also develop during postpartum, is called?
A patient is receiving TPA. What condition requires TPA?
A patient is receiving TPA. What condition requires TPA?
Which statement best integrates the physiological effects of loop diuretics with the management of fluid volume overload?
Which statement best integrates the physiological effects of loop diuretics with the management of fluid volume overload?
A patient with fluid volume overload, secondary to heart failure, is prescribed Bumex. The primary goal is?
A patient with fluid volume overload, secondary to heart failure, is prescribed Bumex. The primary goal is?
A patient asks why they need spironolactone and not lasix. You say:
A patient asks why they need spironolactone and not lasix. You say:
A patient is dx with stage 1 placental abruption. Is there fetal distress?
A patient is dx with stage 1 placental abruption. Is there fetal distress?
A patient with heart failure is prescribed spironolactone instead of furosemide (Lasix). What is the most likely reason for this therapeutic decision?
A patient with heart failure is prescribed spironolactone instead of furosemide (Lasix). What is the most likely reason for this therapeutic decision?
A patient with a history of SVT is prescribed adenosine. Why is the patient SEEN after administration?
A patient with a history of SVT is prescribed adenosine. Why is the patient SEEN after administration?
A patient with a history of pre-eclampsia receives magnesium sulfate. What is the primary reason for administering magnesium sulfate in this context?
A patient with a history of pre-eclampsia receives magnesium sulfate. What is the primary reason for administering magnesium sulfate in this context?
Following the delivery of a newborn, the nurse observes cyanosis of the trunk. What does this indicate?
Following the delivery of a newborn, the nurse observes cyanosis of the trunk. What does this indicate?
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?
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?
A patient with gestational diabetes is being discharged. Which statement indicates a need for further education?
A patient with gestational diabetes is being discharged. Which statement indicates a need for further education?
A pregnant patient is diagnosed with placenta previa at 32 weeks gestation. What assessment finding would necessitate immediate notification of the physician?
A pregnant patient is diagnosed with placenta previa at 32 weeks gestation. What assessment finding would necessitate immediate notification of the physician?
A patient is receiving magnesium sulfate for pre-eclampsia. Which assessment finding warrants immediate intervention?
A patient is receiving magnesium sulfate for pre-eclampsia. Which assessment finding warrants immediate intervention?
A patient is postpartum after a cesarean section. Which finding requires priority intervention?
A patient is postpartum after a cesarean section. Which finding requires priority intervention?
The healthcare provider orders the administration of TPA for a patient, which condition is this intervention indicated for?
The healthcare provider orders the administration of TPA for a patient, which condition is this intervention indicated for?
Flashcards
Beta Blockers (e.g., Metoprolol)
Beta Blockers (e.g., Metoprolol)
Slows HR, decreases force of contractions, lowers BP, and decreases myocardial oxygen demand.
Loop Diuretics (e.g., Bumex, Lasix)
Loop Diuretics (e.g., Bumex, Lasix)
Increase urine production to reduce fluid in the body, easing congestion and edema.
Thiazide Diuretics
Thiazide Diuretics
Eliminates excess fluid, sometimes used with loop diuretics.
Morphine (for Heart Failure)
Morphine (for Heart Failure)
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Positive Inotropes (e.g., Dopamine, Dobutamine)
Positive Inotropes (e.g., Dopamine, Dobutamine)
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Digitalis Glycoside (Digoxin)
Digitalis Glycoside (Digoxin)
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RAAS Inhibitors (ACE Inhibitors)
RAAS Inhibitors (ACE Inhibitors)
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Nitrates
Nitrates
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Aspirin
Aspirin
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Calcium Antagonists
Calcium Antagonists
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Atropine
Atropine
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Adenosine
Adenosine
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Amiodarone
Amiodarone
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Fluid Volume Overload
Fluid Volume Overload
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Verapamil
Verapamil
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Heparin (for Afib)
Heparin (for Afib)
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S1 (LUB)
S1 (LUB)
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S2 (DUB)
S2 (DUB)
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Heart Murmurs
Heart Murmurs
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Apex of heart at 5th intercostal space, midclavicular line
Apex of heart at 5th intercostal space, midclavicular line
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Left sternal border, fourth intercostal space
Left sternal border, fourth intercostal space
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Base of heart at second intercostal space
Base of heart at second intercostal space
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Second intercostal space, right sternal border
Second intercostal space, right sternal border
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MONA
MONA
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Gestational Diabetes
Gestational Diabetes
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Macrosomia
Macrosomia
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Neonatal Hypoglycemia (in gestational diabetes)
Neonatal Hypoglycemia (in gestational diabetes)
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Variable Decelerations
Variable Decelerations
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Stage One of Labor
Stage One of Labor
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Stage Two of Labor
Stage Two of Labor
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Stage Three of Labor
Stage Three of Labor
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Stage Four of Labor
Stage Four of Labor
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Causes of Preterm Labor
Causes of Preterm Labor
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Postpartum Hemorrhage (PPH)
Postpartum Hemorrhage (PPH)
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Placenta Previa
Placenta Previa
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Placental Abruption
Placental Abruption
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Pre-Eclampsia
Pre-Eclampsia
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Magnesium Sulfate (in Pre-Eclampsia)
Magnesium Sulfate (in Pre-Eclampsia)
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Signs of Magnesium Toxicity
Signs of Magnesium Toxicity
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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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