Mark Klimek Notes

What is Zoloft (Sertraline)

it is an antidepressant

What can sertraline cause

• insomnia

What drugs does sertraline interact with?

• St Johns wart: increases risk for serotonin syndrome

• warfarin: increases risk of bleeding

What are the S/S of Serotonin Syndrome:

“SAD HEAD”

S: sweating

A: apprehensive

D : Dizziness

HEADache

What is Clozaril (Clozapine)?

• atypical antipsychotic

  • used for severe schizophrenia

What are the side effects of Clozapine?

• aGranulocytosis: monitor WBC

  • they will be immunocompromised

What is Haldol (Haloperidol)

• tranquilizer

What are the side of Haloperidol?

A: anticholinergic

B: blurred vision

C: constipation

D : drowsiness

E: EPS ( tremors, parkison)

F: foto sensitivity

G: aGranulocytosis

What is Prozac (Fluoxetine)?

• SSRI mood elevator

What are the side effects of Fluoxetine?

A: anticholinergic

B: blurred vision

C: constipation

D : drowsiness

E: euphoria

What Adverse Effects can Fluoxetine have?

Insomnia

• administer before noon

What is Lithium

• mood stabilizer

• used to treat bipolar disorder

What are the S/S of Lithium?

• peeing

• pooping

• paresthesia

What should you monitor in a pt taking Lithium?

sodium level:

• low sodium increases risk for lithium toxicity

• high sodium decreases the effects of lithium

What are the Toxic Effects of Lithium?

• tremors

• metallic taste

• severe diarrhea

What is a MAOI?

antidepressant

What are some MAOI medications?

• MARplan

• NARdil

• PARnate

What should you teach you pt that is taking an MAOI

• AVOID tyramine foods

• AVOID BAR:

  • B: banana

  • A: avocados

  • R: raisins

• yeast

• meats:

  • liver, kidney,heart, no preserved meats, hot dogs

What are the S/S of MAOI?

A: anticholinergic

B: blurred vision

C: constipation

D : drowsiness

What is a Benzodiazepine?

• anti- anxiety

• minor tranquilizer

What are S/S of Benzo’s?

A: anticholinergic

B: blurred vision

C: constipation

D : drowsiness

What are some Benzodiazepine medications?

• clonazepam

• diazepam

What is Valium?

• anti- anxiety

• muscle relaxant

What can Valium be used for?

• seizures

• pt’s on ventilators to relax there airway

• pre-op induction of anesthesia

What are Tricyclic Antidepressants?

• mood elevators

What are some TCA medications?

• Elevil

• Trofanil

• Aventyl

• Desyrel

What are the S/S of TCA’s?

A: anticholinergic

B: blurred vision

C: constipation

D : drowsiness

E: euphoria

How long does it take for TCA’s to start working?

2-4 wks

What does Phenothiazines do?

• anti psychotics

• 1st generation antipsychotics

• major tranquilizers

What are some Phenothiazine medications?

• thorazine

• compazine

what are the S/S of phenothiazines?

A: anticholinergic

B: blurred vision

C: constipation

D : drowsiness

E: EPS

G: aGranulocytosis

What changes do psychiatric drugs have on the body?

• they cause weight changes and lower BP

What is the Naegle Rule?

• add 7 days

• minus 3 months to determine pregnancy

What is the Fundal Height?

• when the fundus is midway between the umbilicus and the pubis

When can the Fundal height be palpated?

at 12 wks

When can the fundus be palpated?

can be palpated at the umbilicus at 20-22 wks

What are some positive signs of pregnancy?

• fetal skeleton

• Prescence of fetus on ultrasound

• hear fetal hr on doppler

• examiner palpates fetal movement

What are maybe signs of Pregnancy?

• positive urine/blood hcG test

• Chadwick sign: cervical discoloration change to cyanosis

• Goddel Sign: softening of the cervix

• Hegar Sign: softening of the uterus

What are the ranges of FHR?

1) Earliest: FHR 8wks, Quickening 16wks

2) Midway: FHR 10wks, Quickening 18wks

3) Latest: FHR: 12 wks, Quickening 20 wks

What is the most valid sign of Labor?

• onset of regular and consistent contractions

What is dilation?

opening the cervix 0-10 cm

What is Effacement:

• thinning of the cervix 0-100%

What is station

• the relation between the fetal positioning and the mother’s ischial spine

What is effacement?

• the presenting part at the ischial spines is 0.

How many phases of Labor

• 3 phases of labor

What is the first phase of Labor

-latent stage:

• onset of labor

• contractions happen 5-30 min apart

• contractions last 15-30 sec

• Dilation is 0-4 cm

What is Stage 2 phase of Labor?

-active stage

• cervical dilation of 5-7cm

• contractions are 3-5 min apart

• contractions last 30-60 secs

What is the 3rd phase of Labor?

-transition

• cervical dilation of 8-10 cm

• contractions are 2-3 min apart

• contractions last 60-90 sec

How many stages of labor?

4 stages of labor

what is the 1st stage of labor

• onset of labor

what is the 2nd stage of labor:

• delivery of baby

What is the 3rd stage of Labor?

• delivery of placenta

What is Stage 4 of Labor?

• recovery and bleeding will stop 2 hrs after

What are signs of Uterine Tetany?

• contractions that last longer than 90 seconds

What are some complications of Labor

• prolapse cord

• tetany

• maternal hypertension

• vena cava syndrome

• toxemia

• uterine rupture

What do you do for a prolapse cord?

• push the head off of the cord, and position the mother knee-to chest or Trendelenburg

• prepare for c-section

How do you treat maternal hypertension, vena cava syndrome, tetany, toxemia, and uterine rupture?

L : turn mother on left side

I: IV fluid

O: Oxygen

N: notify physician

What are the seven the FHR patterns?

• low FHR

• Variable FHR

• High FHR

• Low baseline variability

• High baseline variability

• early decelerations

• late decelerations

What is Low FHR

• below 110

• treatment:

  • L: turn mother on left side

  • I: IV fluid

  • O: oxygen

  • N: notify physician

What is High FHR?

• above 160

• document decelerations

• take temp of mother

• not a priority

What is Low baseline Variability?

• FHR doesn’t change

  • L: turn mother on left side

  • I: IV fluid

  • O: Oxygen

  • N: notify physician

• stop pitocin if it is running

What is High baseline Variability?

• VEAL CHOP

  • Variable = cord compression

  • Early decels = Head compression

  • Accelerations = okay

  • Late decels = placental insufficiency

• FHR is changing which is good

What are early decelerations?

• normal

  • document finding

What are Variable deceleration?

• VERY BAD

• indication of prolapse cord

What is Late Decelerations?

• VERY BAD

  • L: turn the mother on the left side

  • I: IV fluid

  • O: oxygen

  • N: notify physician

What should you assess for Postpartum?

• assess every 4 hours

• B: breasts

• U: uterine fundus: should be firm, if boggy massage

• B: bladder

• B: bowl

• L: lochia

  • rubra = red

  • serosa = pink

  • alba = white

• E: episiotomy

• H: hemoglobin

• E: extremities:

  • looking for thrombophlebitis

• A: affect

• D : discomforts

Cephalohematoma

• DOES NOT CROSS SUTURE LINES

• collection of blood between the periosteum of skull bone and the bone itself

• develops within 24- 48 hours after birth

Caput Succedaneum

• edema on the scalp of the neonate during the birth from mechanical trauma of the initial portion of scalp pushing through narrow cervix.

• crosses suture lines

What is physiologic jaundice in newborns?

• is normal for baby to develop jaundice after 24-28 hours AFTER birth

What is pathologic jaundice in newborns?

• it is bad, to have baby born yellow

What are Tocolytic medications?

• Terbutaline

• Mag Sulfate

What is the function of Terbutaline?

• it stops contractions, and stop labor

• S/S:

  • maternal hypertension

What is the function of Mag Sulfate?

• it helps slow everything down

  • HR will decrease

  • BP will decrease

  • RR will decrease

  • reflexes will decrease

  • LOC will decrease

What are some Oxytocic Medications?

• Pitocin

• Methergine

What is the function of Pitocin?

• strengthens contractions

  • S/S:

  • contractions longer than 90 seconds

    • If this does happen, lower the dose/rate of pitcocin

What is the function of Methergine?

• S/S

• HTN

What are some Fetal Lung medications?

• betamethasone

• surfactant (survanta)

What is the function of Betamethasone?

• Given to mother IM

• can repeat as long as the baby is in utero

  • S/S:

    • increase glucose

What is the function of Surfactant?

• given to baby via transtracheal route

• given after birth

Post- op Laminectomy

• log roll the patient

• mobilizing these pts are after laminectomy is very good

What is Anterior Thoracic Laminectomy?

• when they go through the anterior chest wall through to the spine

• the pt will have a chest tube

What is a Lumbar Laminectomy?

• Nerve root decompression in the lower back

• Assess for urinary retention and leg problems

What is a Thoracic Laminectomy?

• Nerve root decompression in the upper back

• assess cough, and bowel

  • post-op complication:

    • Monitor for pneumonia and paralytic ileus

What is a cervical Laminectomy?

• Nerve root decompression in the cervical area of the spine

• post-op:

  • assess breathing

  • Assess the arm and hands

What are three locations of Laminectomy?

• Cervical

• Thoracic

• Lumbar

What are the S/S of Nerve root compression?

• pain

• paresthesia (tingling)

• paresis ( muscle weakness)

What is a Laminectomy?

• nerve root decompression

What age group do adolescents fall into

12-18

What happens during the adolescent years?

• peer group association

What age group is School Age?

• 7-11 yrs

What are the 3 C’s for School Age?

• creative

• collective

• competitive

What age group is Preschool?

• 3-6

What skills can Preschoolers do?

• they can draw, write, and use scissors

• they also have FINE motor skills

• characterized by parallel play

What are skills that you can WORK on with preschoolers?

• balance

What age are Toddlers?

1-3

What skills can you WORK on with toddlers ?

• work on GROSS motor skills

• running

• jumping

What is the best toy for Preschoolers?

• push-pull toys

  • lawn mowers

What skills do 0-6 month old’s have?

• sensory motor skills

• best toy:

  • muscial mobile

What skills do 6-9 month old’s have?

• object/performance

• best toy:

  • something that they can cover and uncover

  • jack in the box

What skills do 9-12 month old’s have?

• vocalization

• best toy:

  • tickle me elmo