Cardiac Meds & Electrolytes

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Questions and Answers

Which medication is used to relieve shortness of breath and anxiety in acute heart failure situations by reducing preload and afterload?

  • Furosemide
  • Metoprolol
  • Digoxin
  • Morphine (correct)

A patient is prescribed digoxin. What electrolyte level should be closely monitored due to the risk of digitalis toxicity if it is too low?

  • Magnesium
  • Calcium
  • Sodium
  • Potassium (correct)

What is the primary action of nitrates in treating heart failure?

  • Increasing heart rate
  • Vasodilation and reduced afterload (correct)
  • Decreasing blood pressure
  • Promoting blood clotting

Which medication is classified as a positive inotrope and is used to improve the heart's ability to pump blood?

<p>Dopamine (C)</p> Signup and view all the answers

What is the purpose of administering aspirin to a patient with a cardiac condition?

<p>To limit clotting and decrease platelet adherence (A)</p> Signup and view all the answers

Which of these medications stops the heart and resets it, and is used to treat severe supraventricular tachycardia (SVT)?

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

What is the expected outcome of administering atropine to a patient?

<p>Increased heart rate (B)</p> Signup and view all the answers

What is the primary concern associated with fluid volume overload in heart failure patients?

<p>Excessive water in the bloodstream (C)</p> Signup and view all the answers

What nursing intervention is most appropriate for a patient experiencing fluid volume overload?

<p>Administering loop diuretics (A)</p> Signup and view all the answers

For which heart condition is verapamil, a calcium channel blocker, typically prescribed?

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

Prior to administering digoxin, what crucial nursing action must be performed?

<p>Counting apical pulse for one full minute (B)</p> Signup and view all the answers

What is a potential adverse effect of heparin administration that necessitates close monitoring?

<p>Thrombocytopenia (C)</p> Signup and view all the answers

In the context of heart sounds, what physiological or pathological condition could cause a murmur?

<p>Turbulent blood flow (A)</p> Signup and view all the answers

When auscultating heart sounds, at which anatomical location should the stethoscope be placed to best hear the mitral valve?

<p>Apex of the heart at the 5th intercostal space, midclavicular line (D)</p> Signup and view all the answers

What does the acronym MONA stand for in the initial management of a patient presenting with chest pain?

<p>Morphine, Oxygen, Nitroglycerin, Aspirin (D)</p> Signup and view all the answers

A patient is receiving heparin therapy. Which laboratory value requires careful monitoring to assess the effectiveness of the heparin?

<p>aPTT (C)</p> Signup and view all the answers

A pregnant patient is diagnosed with gestational diabetes. What potential complication can poorly controlled blood glucose levels lead to for the mother?

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

What is a potential risk for a neonate born to a mother with gestational diabetes?

<p>Neonatal hypoglycemia after birth (D)</p> Signup and view all the answers

During pregnancy, which of the following instructions should be emphasized to a patient with gestational diabetes?

<p>Maintaining strict glucose control for the well-being of the baby (D)</p> Signup and view all the answers

During labor, the healthcare provider notes variable decelerations on the fetal heart rate monitor. What is the most likely cause of this pattern?

<p>Cord compression (A)</p> Signup and view all the answers

What event characterizes the third stage of labor?

<p>Delivery of the placenta (C)</p> Signup and view all the answers

Which of the following is a risk factor for preterm labor?

<p>Maternal obesity or underweight (C)</p> Signup and view all the answers

Following delivery, a nurse notes that the patient has saturated one perineal pad with blood within 15 minutes. Approximately how much blood loss does this indicate?

<p>1000 mL (B)</p> Signup and view all the answers

What is a contraindication in a patient diagnosed with placenta previa?

<p>Vaginal examination (D)</p> Signup and view all the answers

What is the priority nursing intervention for a patient experiencing placental abruption?

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

A pregnant patient presents with dark red vaginal bleeding and a rigid, board-like abdomen. Which condition does this presentation most likely indicate?

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

A newborn exhibits cyanosis of the trunk. What does this assessment finding indicate?

<p>A serious underlying condition (C)</p> Signup and view all the answers

What is the primary purpose of administering magnesium sulfate to a pregnant woman with severe pre-eclampsia?

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

What acronym is used to remember the signs of magnesium toxicity?

<p>BURP (C)</p> Signup and view all the answers

A patient receiving magnesium sulfate has a decreased urinary output. Why is it important for the nurse to report this finding?

<p>It suggests impending magnesium toxicity. (D)</p> Signup and view all the answers

What is the primary action of terbutaline when administered to a pregnant woman experiencing preterm labor?

<p>Stopping uterine contractions (D)</p> Signup and view all the answers

A pregnant woman is diagnosed with pre-eclampsia. What is a hallmark sign of this condition?

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

Which of the following findings differentiate stage 1 class 1 placental abruption from all other types?

<p>Slight uterine tenderness (B)</p> Signup and view all the answers

During stage 2 placental abruption, which VS change would lead you to believe the Pt. requires intervention?

<p>Hypotension upon standing (D)</p> Signup and view all the answers

In rare cases of pre-existing diabetes in pregnancy, researchers can use one distinct piece of information to determine if the gestational diabetes has resolved itself postpartum. What is this piece of information?

<p>The patient's A1C level (D)</p> Signup and view all the answers

The diastolic blood pressure must be greater than what value in order for a pregnant patient to be diagnosed with pre-eclampsia?

<p>90 mmHg (D)</p> Signup and view all the answers

A patient with gestational diabetes is scheduled for a cesarean section. What factor in her history most significantly increases the risk of postpartum hemorrhage?

<p>Enlarged uterus due to fetal macrosomia (A)</p> Signup and view all the answers

Which medication would likely be used in the event of magnesium sulfate toxicity?

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

Which of the following is the primary mechanism by which beta-blockers like metoprolol reduce myocardial oxygen demand?

<p>By decreasing heart rate and force of contractions. (D)</p> Signup and view all the answers

What is the intended therapeutic effect of administering loop diuretics like bumetanide (Bumex) or furosemide (Lasix) to a patient with heart failure?

<p>To reduce congestion in the lungs and edema by increasing urine production. (D)</p> Signup and view all the answers

Which class of medications, often used in conjunction with loop diuretics, works to eliminate excess fluid and manage fluid balance in heart failure patients?

<p>Thiazide diuretics (A)</p> Signup and view all the answers

If a patient with heart failure is taking digoxin, what signs and symptoms might suggest digitalis toxicity?

<p>Yellow-tinted vision and dysrhythmias (B)</p> Signup and view all the answers

Which of the following describes the action of ACE inhibitors in the management of heart failure?

<p>Decrease blood pressure and prevent further remodeling of the heart (B)</p> Signup and view all the answers

How does aspirin contribute to the management of cardiac conditions?

<p>By limiting clotting and decreasing platelet adherence (A)</p> Signup and view all the answers

What is the primary mechanism of action of calcium antagonists in treating certain cardiovascular conditions?

<p>Causing arteriole dilation (A)</p> Signup and view all the answers

Which medication is used to treat severe supraventricular tachycardia (SVT) by stopping the heart and resetting it?

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

A patient presents with bradycardia. Which medication would the nurse anticipate administering?

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

What is the underlying cause of fluid volume overload in heart failure patients, according to the provided information?

<p>Constant cycling of the RAAS, leading to excessive water retention. (C)</p> Signup and view all the answers

Prior to administering digoxin, the nurse should assess which vital sign?

<p>Apical Pulse (A)</p> Signup and view all the answers

Which of the following laboratory values should be closely monitored in a patient receiving heparin therapy?

<p>Partial Thromboplastin Time (PTT) (B)</p> Signup and view all the answers

A patient with atrial fibrillation is prescribed heparin. What is the primary reason for administering this medication?

<p>To reduce thrombus formation and embolization (C)</p> Signup and view all the answers

Which heart valve is best auscultated at the apex of the heart in the 5th intercostal space, midclavicular line?

<p>Mitral valve (A)</p> Signup and view all the answers

Which of the following is the fundamental concern associated with gestational diabetes for the pregnant patient?

<p>Increased risk of pre-eclampsia and cesarean delivery. (B)</p> Signup and view all the answers

Following delivery, what specific maternal complication is heightened due to an enlarged uterus caused by gestational diabetes?

<p>Risk of postpartum hemorrhage (B)</p> Signup and view all the answers

A neonate born to a mother with gestational diabetes is at risk for which of the following complications?

<p>Macrosomia and neonatal hypoglycemia (A)</p> Signup and view all the answers

What is the primary reason a newborn of a mother with gestational diabetes is at risk for respiratory distress?

<p>Hyperinsulinemia interferes with surfactant production (B)</p> Signup and view all the answers

During prenatal education for a patient with gestational diabetes, which aspect should be emphasized?

<p>Emphasize glucose control for well being of baby. (B)</p> Signup and view all the answers

During labor, variable decelerations are noted on the fetal heart rate monitor. What intervention might the nurse implement?

<p>Move the mom (C)</p> Signup and view all the answers

Which stage of labor constitutes the delivery of the placenta?

<p>Third stage (D)</p> Signup and view all the answers

Assess the following patient data: pt under 18, hx of drug use, twins. Based on patient data, what is the patient at risk for?

<p>Preterm labor (A)</p> Signup and view all the answers

What is the best position for a patient with placenta previa?

<p>Left lateral position (B)</p> Signup and view all the answers

What is the most important assessment when a patient is diagnosed with placental abruption?

<p>Assessing patient ABCS (A)</p> Signup and view all the answers

Which of the following assessment findings would lead the nurse to believe that the patient needs intervention in placental abruption stage 2?

<p>Decreased urinary output (B)</p> Signup and view all the answers

A newborn's assessment reveals cyanosis of the trunk. What does this finding indicate?

<p>A serious problem requiring immediate intervention. (B)</p> Signup and view all the answers

What is the therapeutic intent of administering magnesium sulfate to a pregnant woman diagnosed with severe pre-eclampsia?

<p>To prevent seizures and lower blood pressure (D)</p> Signup and view all the answers

Why is it crucial for a nurse to promptly report decreased urinary output in a patient receiving magnesium sulfate?

<p>Mag toxicity (A)</p> Signup and view all the answers

A pregnant patient is receiving terbutaline. What is the primary goal of this medication?

<p>Prevent preterm labor (C)</p> Signup and view all the answers

What blood pressure measurement defines the threshold for diagnosing pre-eclampsia in a pregnant woman?

<blockquote> <p>140/90 mmHg (C)</p> </blockquote> Signup and view all the answers

A patient with gestational diabetes delivers via cesarean section. Which historical factor presents the greatest risk for postpartum hemorrhage?

<p>Overdistended uterus (C)</p> Signup and view all the answers

What is the antidote medication you would administer for magnesium sulfate toxicity?

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

Which of the following actions should the nurse implement after administering Adenosine?

<p>Ensure the doctor can be seen (SEEN by doctor). (A)</p> Signup and view all the answers

Lab values for creatinine are impacted by which of the following patient determinants?

<p>Gender and age. (D)</p> Signup and view all the answers

What is the significance of auscultating S1 heart sounds?

<p>closure of the AV valves. (B)</p> Signup and view all the answers

Your patient has a heart murmur; this is due to:

<p>Turbulent Flow. (D)</p> Signup and view all the answers

Which valve is best auscultated at the pulmonic site?

<p>Pulmonic Valve (C)</p> Signup and view all the answers

What is a main teaching point for a patient taking positive inotropes?

<p>Monitor for increasing BP (B)</p> Signup and view all the answers

A patient vomits 300 mL emesis. What impact would that have on their potassium levels?

<p>Hypokalemia (C)</p> Signup and view all the answers

During auscultation, the LUB sound symbolizes:

<p>Closure of the AV valves initiating systole (A)</p> Signup and view all the answers

A patient is diagnosed with Class 1 placental abruption. What are the common findings?

<p>Vitals remain normal (C)</p> Signup and view all the answers

Which acronym can you use to remember the signs and symptoms of magnesium TOXICITY?

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

Which medication would be MOST appropriate for a patient experiencing symptomatic bradycardia?

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

A patient with heart failure is prescribed bumetanide (Bumex). The nurse should emphasize which dietary modification to counteract a potential side effect of this medication?

<p>Increase intake of potassium-rich foods (D)</p> Signup and view all the answers

A pregnant patient at 32 weeks gestation is diagnosed with placenta previa. What intervention is CONTRAINDICATED for this patient?

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

Which assessment finding would differentiate a Class 1 placental abruption from other classifications of placental abruption?

<p>Minimal or no signs of bleeding, normal vital signs (B)</p> Signup and view all the answers

A patient at 28 weeks gestation presents with painless, bright red vaginal bleeding. The uterus is soft and non-tender. What condition is MOST likely?

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

A patient is receiving magnesium sulfate for severe pre-eclampsia. Which finding requires IMMEDIATE intervention?

<p>Urinary output of 20 mL/hour (C)</p> Signup and view all the answers

Which statement is MOST accurate regarding the use of terbutaline in preterm labor management?

<p>Terbutaline is used to suppress uterine contractions (A)</p> Signup and view all the answers

Following delivery, a patient saturates one perineal pad in 10 minutes. What is the BEST initial nursing action?

<p>Assess the uterine fundus for firmness and position. (C)</p> Signup and view all the answers

After administering adenosine for SVT, the nurse should prioritize which action?

<p>Observing the patient for flushing and a brief period of asystole. (C)</p> Signup and view all the answers

A primigravida patient with gestational diabetes is scheduled for a cesarean section. Which historical factor MOST significantly elevates her risk of postpartum hemorrhage?

<p>Macrosomia leading to uterine overdistension (B)</p> Signup and view all the answers

Flashcards

Beta Blockers (e.g., Metoprolol)

Slows heart rate, decreases contraction force, lowers blood pressure, and reduces myocardial oxygen demand.

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

Increases urine production to reduce fluid overload, alleviating lung congestion and peripheral edema, thus easing shortness of breath.

Morphine in Acute Heart Failure

Reduces preload and afterload, easing the heart's workload and improving symptoms in acute situations.

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

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

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Digitalis Glycoside (Digoxin)

Increases the force of heart contractions and slows the heart rate; monitor potassium levels to prevent toxicity and dysrhythmias.

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RAAS Inhibitors (ACE inhibitors)

Decreases blood pressure and resistance, preventing further remodeling of the heart in heart failure patients.

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Nitrates

Vasodilates blood vessels, reducing resistance and easing the heart's pumping effort, thus reducing afterload.

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Aspirin

Limit clotting and decrease platelet adherence.

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Calcium Antagonists

Arteriole dilation leading to decreased systemic vascular resistance.

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Atropine

Slows heart rate, use for bradycardia.

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Adenosine

Stops the heart and resets it; used for SVT.

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Fluid Volume Overload

Excessive amount of water in the bloodstream; RAAS constantly cycles water into the blood in heart failure.

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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 for patients with AFib.

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First Heart Sound (LUB S1)

Closure of the AV valves. Systole-close Diastole-Open

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Second Heart Sound (DUB S2)

Closure of semilunar valves

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Heart Murmurs

Turbulent blood flow, which can be caused by physiological(anxiety, fear, pregnancy) or pathological changes (valve deformities or dysfunction)

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MONA (for acute cardiac issues)

Morphine, Oxygen, Nitro, Aspirin.

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Heparin

Prevent blood clots but can cause thrombocytopenia (low platelets.)

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Gestational Diabetes

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

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Variable Decelerations in Fetal Heart Rate

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

After placenta delivery, monitor uterus and for bleeding.

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Postpartum Hemorrhage (PPH)

Excessive bleeding after delivery, which can be from uterine atony, retained placental fragments, or injury to blood vessels.

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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; occurs after 20 weeks/3rd trimester.

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Tocolytics

Medications for preterm labor.

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Pre-Eclampsia

Elevated BP after 20 weeks gestation, may also develop postpartum. Hallmark signs is >140/90 mmHg and proteinuria.

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Magnesium Sulfate

Administered to prevent seizures (eclampsia) and promote vasodilation.

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Magnesium Toxicity

Blood pressure decreases, Urine output decreases. REPORT URINE OUTPUT

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Study Notes

Cardiac Medications and Electrolytes

  • Beta blockers (Metoprolol) slow heart rate, decrease contraction force, lower blood pressure, and reduce myocardial oxygen demand.
  • Loop Diuretics (Bumex, Lasix) increase urine production to reduce body fluid, alleviate lung congestion and peripheral edema, relieving 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, easing heart workload.
  • Positive inotropes (Dopamine/Dobutamine) enhance the heart's pumping ability, increasing cardiac output and systolic blood pressure; Dopamine is used for bradycardia.
  • Digitalis Glycoside (Digoxin) increases contraction force and slows heart rate; potassium levels must be monitored as hypokalemia can lead to digitalis toxicity and dysrhythmias, indicated by a yellow tint.
  • RAAS inhibitors (ACE inhibitors) lower blood pressure and resistance, preventing further heart remodeling in heart failure patients.
  • Nitrates vasodilate, relax blood vessels, and reduce resistance, easing heart's pumping effort and reducing afterload.
  • Aspirin limits clotting by decreasing platelet adherence.
  • Calcium antagonists dilate arterioles, reducing systemic vascular resistance.

Medications List

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

Specific Medications

  • Atropine is administered for bradycardia.
  • Dopamine is administered for heart failure.
  • Adenosine stops and resets the heart (SVT); requires medical supervision ("SEEN" by doctor).
  • Amiodarone is a regular heart medication that can be taken at home.

Fluid Volume Overload

  • Fluid volume overload occurs when there is excessive water in the bloodstream.
  • In heart failure, the RAAS cycle brings excessive water into the blood.
  • Nursing interventions for fluid volume overload include loop diuretics, adjusting infusion rates, and administering heart failure medications.

Medications (Examples)

  • Verapamil: antiarrhythmic calcium channel blocker for AFib to maintain normal sinus rhythm
  • Digoxin increases contraction force and slows heart rate; apical pulse must be checked for 1 minute before administration, holding if below 60 BPM.
  • Heparin is used to reduce thrombus formation or embolization in atrial fibrillation.
  • Lidocaine is used for VTach and MI.

Heart Sounds

  • S1 (LUB) is the first heart sound, caused by the closure of the AV valves during systole (Diastole-Open ).
  • S2 (DUB) is the second heart sound, caused by the closure of semilunar valves.
  • Murmurs are turbulent blood flow that can be physiological (e.g., anxiety, pregnancy) or pathological (valve deformities/dysfunction).

Auscultation of Heart Sounds

  • Mitral valve sounds are best heard at the apex of the heart, 5th intercostal space, midclavicular line.
  • Tricuspid valve sounds are best heard at the left sternal border, fourth intercostal space.
  • Pulmonic valve sounds are best heard at the base of the heart, second intercostal space.
  • Aortic valve sounds are best heard at the second intercostal space, right sternal border.

MONA

  • Morphine: To relieve pain.
  • Oxygen: To increase oxygen levels.
  • Nitro: To relax arteries and increase blood flow to the heart.
  • Aspirin: To thin blood.

Respiratory & Perfusion

  • Heparin prevents blood clots but can cause thrombocytopenia (low platelets). 3L per day

Normal Values

  • BUN: 10-20 mg/dL
  • Creatinine (serum): 0.5-1.3 mg/dL (gender and age-related)
  • Hemoglobin: 12-18 g/dL (gender-related)
  • Potassium: 3.5-5.0 mEq/L
  • Heparin: PTT 60-80 seconds

Acute OB: Gestational Diabetes

  • Gestational diabetes is glucose intolerance with onset during pregnancy, usually in the second or third trimester.

Concerns for Mom

  • Poorly controlled blood glucose can lead to pre-eclampsia, increased risk of infection, higher likelihood for cesarean delivery.
  • Large baby can lead to lacerations or tears during vaginal delivery, enlarged uterus could lead to postpartum hemorrhage.
  • Increased risk of developing T2DM later in life.

Concerns for Baby

  • Large birth weight (macrosomia), neonatal hypoglycemia, respiratory distress, and long-term metabolic issues.
  • Shoulder dystocia could lead to fracture, nerve damage, or brain damage.
  • Respiratory distress is caused by 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.
  • Due to glucose crossing the placenta and entering the baby's bloodstream as insulin does not and leads to hypoglycemia after birth

Teaching

  • Monitor glucose closely during pregnancy with DM education on medications.
  • Teach the patient about diet and exercise.
  • Emphasize glucose control for the well-being of the baby.

Decelerations

  • Variable decelerations indicate cord compression and require moving the mom.

Stages of Labor

  • Stage one: cervix dilates.
  • Stage two: baby is delivered.
  • Stage three: placenta is delivered.
  • Stage four: after placenta delivery, monitor uterus and for bleeding.

Causes of Preterm Labor

  • Multifetal gestation, history of previous premature deliveries, maternal obesity or underweight, family history of preterm birth.
  • Uterine anomalies, advanced or very young maternal age, smoking or drug use during pregnancy.

Postpartum Hemorrhage (PPH)

  • Excessive bleeding can occur after a C-section due to uterine atony, retained placental fragments, or injury to blood vessels.
  • Prompt medical attention is necessary, potentially requiring medication, compression, or surgery.
  • Saturation of a pad indicates approximately 1000ml blood loss; blood loss >1000ml in vaginal birth and hemorrhage after c-section is >500ml loss.

Placenta Previa

  • The placenta partially or completely covers the cervical os.
  • Risk factors: age over 35, previous C-section, multiparity, uterine injury, cocaine use, previous D&C, endometrial ablation, prior placenta previa, infertility treatment, multiple gestations, previous induced surgical abortion, smoking, previous myomectomy to remove fibroids, short interval between pregnancies, hypertension, or diabetes.
  • Identification: painless bright red bleeding during 2nd or 3rd trimester; soft, relaxed, non-tender uterus with normal tone; reassuring FHR; normal vitals (unless significant blood loss); decreasing urinary output could mean blood loss.
  • Interventions: refrain from vaginal exam, place mom in left lateral position to reduce pressure on inferior vena cava (compression impedes blood flow), and prepare for cesarean section.

Placental Abruption

  • Premature separation of the placenta from the uterus; can be complete or partial.
  • Occurs after 20 weeks/3rd tri. Leading cause of maternal death and significant fetal mortality.
  • Risk factors: hypertension, blunt force trauma, cocaine use, previous abruption, smoking, multifetal pregnancy, prelabor membrane rupture.
  • Symptoms: dark red vaginal bleeding, rigid abdomen.
  • Treatment: bed rest, delivery, IV fluids, and blood products.

Four Classes of Abruption

  • Class 0: diagnosed after delivery.
  • Class 1: minimal or no signs of bleeding, normal vitals, slight uterine tenderness, no fetal distress.
  • Class 2: no to moderate bleeding, uterine pain with tetanic contractions, VS changes (tachycardia, orthostatic BP), fetal distress, abnormal clotting labs/low fibrinogen.
  • Class 3: no to heavy vaginal bleeding, rigid uterus, signs of maternal shock, fetal demise.

Pregnancy

  • Infection spreads to the vaginal vault.
  • Acrocyanosis is normal; truncal cyanosis is abnormal.

Medications: Mag Sulfate, Terbutaline

  • Magnesium sulfate (tocolytic) is used for preterm labor and severe pre-eclampsia (seizure prophylaxis).
  • Terbutaline (tocolytic) is used for preterm labor.

Pre-Eclampsia

  • Elevated blood pressure after 20 weeks gestation; may also develop postpartum.
  • Signs: hypertension (>140/90 mmHg), proteinuria, pitting edema in extremities, hands, face.
  • Magnesium sulfate is administered to prevent seizures (eclampsia) and promote vasodilation to lower blood pressure as an added benefit.

Magnesium Toxicity

  • Watch for signs of magnesium toxicity using the BURP acronym:
    • Blood pressure decreases.
    • Urine output decreases. (Report Urine Output)
    • Respiratory rate decreases.
    • Patellar reflex absent.

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