Full Mom/Baby Exam 2

oxytocin MOA

stimulates uterine contractions in induction, contraction stress tests

oxytocin ae

headache, nausea, vominting , contraction tachysystole

oxytocin route

IV piggyback with lactated ringers

magnesium sulfate MOA

blocks neuromuscular effects to decrease the risk of seizures with preeclampsia and eclampsia

mag sulfate ae

flushing

hot flashes

diaphoresis

mag sulfate route

IV infusion

IM injection

dinoprostone

also known as cervidil

cervidil MOA

allows for softening and effacement of the cervix before induction of labor

cervidil route

inserted vaginally by provider and removed after 12 hours or until labor

cervidil ae

lightheadedness

slow FHR

nausea

back pain

fever

misoprostol

also known as cytotec

misoprostol moa

used to ripen cervix and labor induction with premature rupture of membranes

prostaglandin

misoprostol ae

diarrhea

abdominal pani

flatulence

heartburn

dehydration

misoprostal nursing

need to wait at east four hours after last dose before oxytoxin, monitor FHR and hydration status

methlergonovine MOA

used for postpartum hemorrhage and to help with placental delivery

causes rapid uterine muscle contractions

methylergonovine ae

hypertension

seizures

headache

methylergonovine route

IM or PO

misoprotol route

vaginal or oral solution

vag more effective

carboprost MOA

used to stimulate uterine contractions to treat severe bleeding or cause second trimester abortion

carboprost ae

nausea

vomiting

headache

fever

hypertension

carboprost route

IM injection

tranexamic acid moa

uterine bleeding and postpartum hemorrhage

tranexamic acid

also known as cyklokaparon

carboprost

also known as hemabate

methylergonovine

also known as methergine

magnesium sulfate

also known as sulfamag

oxytocin

also known as Pitocin

tranexamic acid route

IV

tranexamic acid ae

nausea

vomiting

mild itching

blood clots

terbutaline

also known as brethine

terbutaline moa

used to stop preterm labor and uterine contractions

terbutaline route

subcutaneous

terbutaline ae

nervousness

tremor

bronchospams

HTN

nausea

dyspnea

nifedipine

also known as procardia

nifedipine moa

stops uterine contractions from preterm labor and in pregnancy associated HTN

nifedipine route

PO

nifedipine ae

hypotension

weakness

angioedema

nausea

fatigue

butorphanol tartrate

also known as stadol

stadol route

IV or nasal

Stadol ae

HTN

respiratory depression

sedation

constipation

headache

diaphoresis

nalbuphine

also known as nubain

IV

nalbuphine route

nalbuphine ae

drowsiness

dizziness

dry mouth

sedation

resp depression

nalbuphine moa

used after labor for moderate to severe pain

bethamethasone moa

given for lung expansion during preterm labor

bethamethasone route

IM

bethamethasone ae

decreased fetal movement and breathing

hydralazine, labetalol, nifedipine

three drugs used for the hypertensive protocol in preeclampsia

CV

response to labor

resting pulse increased

CO increased

BP increased

respiratory system

response to labor

increased O2 demand

increased RR

metabolic acidosis - numbness

renal

response to labor

polyuria, hematuria

GI

response to labor

motility and absorption decreased

prolonged emptying

risk for aspiration

immune

response to labor

increased WBC

decreased BG

decreased insulin requirements

fetal response to labor

HR changes

acid base imbalances

healthy placenta reserve protects baby

sensitive to light, sound, touch at 37 weeks

internal fetal monitoring

fetal scalpe electrode

intrauterine pressure catheter

temp

done every 4 hours or 1 hour if ROM

vitals

done every 30-60 minutes or 15 minutes if high risk

cervical exam

assesses dilation and effacement

station of ischial spine

internal monitor

only thing that measures the true intensity of a contraction

frequency

start of one contraction to the start of the next

mild contraction

slightly tense, feels similar to the tip of the nose

moderate contraction

finger to chin, firm fundus

strong contraction

finger to forehead, rigid and boardlike

duration

beginning to end of one contraction

labor epidural

most effective

continuous medication through pump

low side effects

epidural rn role

education

coordinate orders

consent

fluids

constant FHM

narcotics

best for first dose and moderate pain control

nitrate oxide

inhaled, short acting

best during latent period and repair

pt controlled

lightheaded and nausea ae

nonpharm

position changes

breathing

hydrotherapy

imagery

tens machine

110-160bpm

normal fetal heart rate done over a 10 minute interval

bradycardia causes

fetal vagal stimulation

fetal distress

maternal medications - stadol, opioids, nalbuphine

fetal vagal stimulation

can be caused by compression of head during labor or fetal movement

tachycardia causes

fetal anemia

fetal distress

fetal infection

maternal fever

maternal hyperthyroidism

cocaine, meth

dehydration

fever and dehydration

what to check for first with fetal tachycardia

maternal fever

can manifest as hot feeling inside the vagina and indicates an infection

variability

amplitude of baseline in a 10 minute period

moderate variability

6-25bpm

fetus has good oxygenation

normal

moderate variability

absent variability

straight line

bad sign - likely damage to CNS

absent variability

marked variability

>25 bpm

could be stress, medications, blood supply

marked variability

minimal variability

0-5 bpm

narcotics, dehydration , oligohydraminos

bad when persists but also could be fetal sleep cycle

minimal variability

accelerations

periodic increases in FHR

shows baby is okay

accelerations

late decel causes

uteroplacental insufficiency

blood flow/oxygenation issue from mom to baby

late decel tx

position change to allow better blood flow to placenta

fluids

stop oxytocin

oxygen - last ditch

late decel

variable decel causes

umbilical cord compression

Big V/U

variable decel tx

usually dealt with for position changes

hydration

sterile vaginal exam

variable decel

early decel causes

indicator for head compression of the fetus by the pelvis

good signs - baby coming soon

mirror of contraction

early decel

red light

prolonged bradycardia

absent variability

recurrent variable decelerations

yellow light

concerned but holding and watching

moderate variability with recurrent variable or late decelerations

absent variability

prolonged deceleration

green light

baseline within normal limits

no decelerations

accelerations present or not

bishop score

position, consistency (palpation), effacement, dilation, and station

<6 means ripening needs to be done

cervical ripening

softening of the cervix before induction of labor can occur

ripening pharm

misoprostal

cervidil

prepidil