NCLEX

Monitor INR/PT

Warfarin

Warfarin range

2-3

Risk of skin necrosis in first week

warfarin

Warfarin toxicity

stop, give fresh frozen plasma and vitamin K

Oral vit. K preferred if no bleeding

warfarin

Antidote is vitamin K

Warfarin (Coumadin)

Black tarry stools

warfarin

nosebleeds, hematomas, risk of bleeding

warfarin

prophylaxis for venous thrombosis and PEs

warfarin

off label use is preventing stroke and TIA

warfarin

eat leafy greens

warfarin

Avoid Alcohol, Chamomile or green tea, Cranberry juice, Grapefruit juice

warfarin

contraindicated for patients with a bleed or pre/eclampsia

warfarin

Interactions with NSAIDS, fibrinolytics, antiplatelets, antiarrhythmics, and antimicrobials

warfarin

used in emergencies to dissolve blood clots

alteplase (fibrinolytic)

critical in treating: ischemic stroke, acute MI, PE, and occluded central vein catheters

alteplase (fibrinolytics)

contraindicated for bleeds, especially potentially fatal intracranial hemorrhage

alteplase (fibrinolytics)

medications for postpartum hemorrhage

oxytocin, misoprostol, tranexamic acid

Misoprostol (L&D drug)

prostaglandin E1 analog also used to promote contractions

tranexamic acid

Oxytocin (Pitocin)

stimulates uterine contractions, used to induce labor

Methergine (Methylergonovine)

Stimulates uterine contractions and vasoconstriction. It's given IM, and should be avoided in patients with hypertension.

uterine atony

Failure of the uterus to contract effectively, most common cause of uterine hemorrhage

Magnesium Sulfate (labor)

Smooth muscle relaxant. Decreases contractions during preterm labor.

LION PIT (Low fetal heart rate, Low baseline variability

Late decelerations)

Leftside, IV increase, O2, notify doctor, pitocin (if pitocin is running, shut off first)

VEAL CHOP

V- Variable C- Cord Compression

E- Early Decels H- Head Compression

A- Accelerations O - OK

L-Late Decels P - Placenta

Variable decelerations

HR up or down, cord compression = VERY BAD

Prolapsed cord= push head up, change mom position

Early decelerations

Head pressed on. This is ok.

Late decelerations

Bad (placental insufficiency)

LION

Prolonged decelerations (very bad)

These decelerations are abrupt, FHR decreases of at least 15 bpm from baseline longer than 2 minutes but less than 10 minutes

Excessive bleeding with perineal pads

saturates the pad in less than 15 minutes

Temp. after pregnancy delivery

normally elevated to 100.4 first 24 hours after labor, anything above is reported

to prevent bladder distention

ensure mom pees right after delivery and within 8 hours of catheter removal

bladder distention is cause for

lack of contractions, ergo hemorrhage

every 15 minutes for the first hour

assess mom's vitals, fundus, and lochia

Look for blood loss in mom by

weighing saturated perineal pads

atelectasis

Complete or partial collapse of a lung or a section (lobe) of a lung

common causes of atelectasis

-post surgery

-anesthesia

-complication of:

ARDS, pulmonary edema, pleural effusion, pneumothorax, pulmonary embolism, neuromuscular diseases

intervention for atelectasis

breathing exercises, medications, surgery

polydipsia

excessive thirst

Polyphagia

excessive hunger/swallowing

if fundus is displaced from midline

have mom pee

Immediately after delivery (fundus)

should be firm and located at or near the level of the umbilicus

Every 24 hours (fundus)

is expected to descend approximately 1 cm (one finger-breadth) below the umbilicus

shoulder dystocia

delayed or difficult birth of the fetal shoulders after the head is born

Subinvolution

failure of uterus to return to non-pregnant state

Lochia rubra, serosa, and alba

vaginal discharge after birth

1) _____ = delivery to day 3; dark red, contains mostly blood

2) _____ = day 4-10; pink, contains old blood, serum, leukocytes, tissue debris

3) _____ = day 10-6 weeks; white, leukocytes, epithelial cells serum bacteria

SHOULD NEVER REGRESS

main causes of shoulder dystocia

prior births, overweight, uncontrolled diabetes

amniocentesis

cystic fibrosis, down syndrome, neural tube defects

detected by measuring alpha-fetoprotein (AFP)

neural tube defects (spina bifida, anencephaly)

chorionic villus sampling (CVS)

A technique for diagnosing genetic and congenital defects in a fetus

performed between 10 and 13 weeks

chorionic villus sampling

if mom has fever or foul smelling discharge

CBC, blood cultures, antibiotics

Ricketts

osteomalacia in children; causes bone deformity, take vitamin d

suspected muscular dystrophy

muscle tissue biopsy

polymyositis

a muscle disease characterized by the simultaneous inflammation and weakening of voluntary muscles in many parts of the body

anencephaly

congenital deformity in which some or all of fetal brain is missing

Sarcopenia

age related loss of muscle mass and strength

Dermatomyositis

inflammation of the skin and muscles

avolution

lack of motivation

ataxic

An irregular , unpredictable respiratory rate and tidal volume.

hyperparathyroidism

hypersecretion of the parathyroid glands, usually caused by a tumor

Alogia

A decrease in speech or speech content; a symptom of schizophrenia. Also known as poverty of speech.

Hypokinetic

lack of appropriate level of movement

Addison's disease

A rare, chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid hormones.

Anhedonia

inability to experience pleasure

lithium range

0.6-1.2

Cushing's syndrome

a condition caused by prolonged exposure to high levels of cortisol

Cushing's syndrome s/s

Moon face, truncal obesity, buffalo hump, peptic ulcers, hypertension, low immune system

S/S of lithium toxicity

vomiting, diarrhea, slurred speech, decreased coordination, drowsiness, muscle weakness, twitching

diabetes insipidus

Condition causing excessive thirst and urination.

Cushings Syndrome treatment?

surgery to remove tumor, drug or radiation therapy, total adrenalectomy

What to do if lithium toxicity is suspected?

Emphasize maintaining consistent sodium intake and adequate fluid intake

lithium

avoid medications that increase lithium levels

NSAIDS, ACE inhibitors

lispro (humalog)

rapid acting insulin

Glargine (Lantus)

Long-acting insulin

Onset 1 hour

Peak (none)

Duration 10-24 hours

Aspart (Novolog)

rapid acting insulin

Detemir (Levemir)

long acting insulin

Glipizide (Glucotrol)

a sulfonylureas, for type 2 diabetes mellitus to lower blood glucose.

- monitor CBC, assess for allergy to sulfonamides

May mask signs of hypoglycemia

beta blockers

may cause aplastic anemias, hypoglycemia, photosensitivity, dizziness, drowsiness, headache, diarrhea

glipizide (glucotrol)

simvastatin

antilipemic, statin

what are the two drug to drug contradictions for sulfonylureas?

Rosuvastatin

antilipemic, statin

Spironolactone

potassium sparing diuretic

contraindicated with: vancomycin, tetracycline, calcium channel blockers, amiodarone

digoxin

treats a-fib

Digoxin

Mannitol

osmotic diuretic, ICP

sign mannitol is working

increased urine output

ventricular catheter

Soft tube put through burr hole. for ICP, drains excess CSF. Increased risk for infection.

Acetazolamide

- This is a med used for open angle glaucoma

- Adverse effect of this med is tingling of fingers and hyperglycemia

What angle for ID injection?

15 degrees

halo traction

Frame apparatus for cervical fractures; four pins inserted in skull attached to metal ring and then to body frames

Furosemide

loop diuretic

foley catheter care

-clean insertion site with soap and water three times a day and after bowel movements

-keep collection bag below level of bladder

-make sure tubing is not kinked (and no dependent loops)

foley catheter (hand washing)

Wash hands before and after touching any part of the catheter system and before and after applying gloves

Hydrochlorothiazide

thiazide diuretic

gloves for foley catheter care

non-sterile

Lisinopril

ACE inhibitor; used to treat high blood pressure, heart failure, and to improve survival after a heart attack