Baby, Drugs Psych tips

Question 1

What do you do for Low Fetal HR <110?

Answer 1

LION
Left side
IV
Oxygen
Notify HCP
Stop Pitocin first if running

Question 2

What do you do for High Fetal HR >160?

Answer 2

Document acceleration of fetal HR
Not a high priority and baby is WNL

Question 3

What do you do for Low Baseline Variability?

Answer 3

LION and stop Pitocin first if running

Question 4

What do you do for High Baseline Variability?

Answer 4

Document findings because this is good since baby HR is changing

Question 5

What do you do for an early deceleration?

Answer 5

This is normal
Generally caused be head compression

Question 6

What do you do for variable deceleration?

Answer 6

VERY BAD
Prolapsed cord/cord compression
Push baby head off the cord and then position mom in knee-chest of trundleberg position

Question 7

What do you do for late decelerations?

Answer 7

BAD
Placental insufficiency

LION and stop Pitocin first if running

Question 8

REMEMBER VEAL CHOP

Answer 8

Variable decels …… Cord compression

Early decels….. Head compression

Accelerations…. OKAY

Late decels….. Placental insufficiency

Question 9

During the second stage of labor what are the order of events?

Answer 9

Deliver the head - mom stop pushing
Suction baby mouth then the nose
Check for nuchal (around the neck) cord
Deliver the shoulders then body
Baby MUST have ID band on before leaving L&D area

Question 10

What should you look for in the third stage of labor?

Answer 10

Delivery of the placenta
Make sure the placenta is complete and intact
Check for 3 vessels, 2 arteries and 1 vein. AVA

Question 11

There are ____ things you do in the 4th stage ____ times an hour. What are they?

Answer 11

There are 4 things you do in the 4th stage 4 times an hour.

1. VS - assess for shock, BP decreases and HR increases, pt looks cool, clammy and pale
2. Fondus - if its boggy, massage it. If its displaced, catheterization
3. Check perineal pads - excessive bleeding if pad saturated in 15 minutes or less
4. Roll patient over and check for bleeding underneath

Question 12

What does BUBBLE HEAD stand for?

Answer 12

Breasts
Uterine fundus
Bladder
Bowels
Lochia
Episiotomy
Hemoglobin/hematocrit
Extremities
Affect
Discomforts

Question 13

What are you looking for in regards to uterine fondus?

Answer 13

Fondus should be FIRM
Height of fondus should be at the navel and decrease 2 cm per day

If boggy, massage it
If displaced and boggy, catheterization

Question 14

What is lochia? What should you monitor?

Answer 14

Vaginal discharge

Rubra - red
Serosa - pink
Alba - white

Moderate - 4-6 inches on pad in hour
Excessive - saturate a pad in 15 minutes or less

Question 15

What are you looking for in the extremities are labor?

Answer 15

Thrombophlebitis

The best way to monitor for this is to measure bilateral calf circumference

Question 16

What are normal variations in a baby?

Answer 16

Milia - white spots
Epstein pearls - palatal cysts/deposits
Mongolian spots - bluish discoloration
Erythema toxic neoratorum - normal newborn rah. Pick each with firm yellow/white papule
Hemangioma - abnormal accumulation of blood vessels in skin. Most common birth mark
Vernix - white secretions
Acrocyanosis - blue discoloration of hands/feet
Nevi - stork bites. Easily blanched lesion and disappear by 2
Port wine stain/nevus flemus - red to purple in color and does not blanch

Question 17

Cephalohematoma is…

Answer 17

Collection of blood between the periosteum of skull bone and bone itself

Occurs in one or both sides of head but does not cross the midline
Devleops within 24-48 hours

Question 18

What is Caput Succedaneum?

Answer 18

Edema of the scalp of the neonate during birth from mechanical trauma of scalp pushing through narrow cervix

Crosses the suture lines and caput symmetrical

Question 19

What are totolytics? What are 2 that are used in labor?

Answer 19

Given to women in premature labor that must be stopped

Terbutaline
Mg Sulfate

Question 20

What is a side effect of terbutaline?

Answer 20

Maternal tachycardia

Question 21

What is a side effect of Mg sulfate?

Answer 21

Hypermagnesemia –> going goes down

Decreased HR, decreased BP, decrease reflexes, decrease LOC

Really important to monitor RR and reflexes

If RR<12 then decrease dose
If reflexes 0, +1 then decrease dose
If reflexes +3, +4 then increase dose

Question 22

What are oxytoxics? What are 2 commonly used in labor?

Answer 22

Stimulate and strengthen labor

Pitocin
Methergine

Question 23

What are SE of Pitocin?

Answer 23

Uterine hyperstimulation - longer than 90 seconds, closer than 2 minutes
If this occurs then lower the Pitocin

Question 24

What are SE of methergine?

Answer 24

HTN

Question 25

What are two medications used to to babies lung mature?

Answer 25

Betamethasone - given IM to mother while baby is in utero. SE: increased glucose

Surfactant - given to baby after birth via transtracheal route

Question 26

What is humalin 70/30?

Answer 26

Mix of N and R

70% N and 30% R

The numerator is on top of so is N

Question 27

How do toy mix insulin in the same syringe?

Answer 27

Clear before cloudy OR RN R before N

Question 28

Which needle would you pick for an IM injection?

Answer 28

21 gauge that is 1 inch long

Question 29

What needle would you use for an SubQ injection?

Answer 29

25 gauge that is 0.5 inches

Question 30

Heparin route? Onset? How long can it be used? Antidote? Labs? Pregnancy?

Answer 30

IV or SubQ
Works immediately but cant be used for more than 21 days (except lovenox)
Antidote is protamine sulfate
Labs: PTT
Can be used in pregnancy

Question 31

Warfarin route? Onset? How long can it be used? Antidote? Labs? Pregnancy?

Answer 31

PO
Takes a few days to a week to work but can be used for entire life
Antidote: vitamin K
Labs: PT/INR
Cant be used during pregnancy

Question 32

What is the only antipsychotic drug that can be given in pregnant women?

Answer 32

Haldol

Question 33

How do you know if a diuretic is potassium sparing or wasting?

Answer 33

Any diuretic that ends in X, Xes out K –> wastes K PLUS Diuril

Lasix (furosemide), Bumex (bumetanide), clotrix (clotrimazole), Esidrex (hydrochlorothiazide), Demadex (thosemide), Diuril (chlorothiazide)

Question 34

What are baclofen and cyclobenzaprine?

Answer 34

Muscle relaxers

SE: fatigue/drowsiness and muscle weakness

Teaching: don’t drive, don’t drink, don’t operate heavy machinery

Question 35

How do you teach a child that is in sensory motor (0-2)?

Answer 35

You can only teach them in the present

Teach them what you are doing as you are doing it. Use words b/c they don’t understand play

Question 36

How do you teach a child that is in preoperational (3-6)?

Answer 36

They are fantasy oriented, imaginative, illogical, and their thinking obeys no rules but they do understand future/past

Teach them what you are going to do before (morning of, day of, 2 hours before) you do it with play
Don’t want to teach them too far in advance because they are in the imaginative stage and can imagine the worst

Question 37

How do you teach a child that is in concrete operations (7-11)?

Answer 37

Rule-oriented, live and die by rules, cannot abstract think, only one way to do things

Teach then a day or two ahead of time and teach them by using age appropriate reading and demonstration (skills)

Question 38

How do you teach a child that is in formal operations (12-15)?

Answer 38

Can think abstract and think about cause and effect
AS SOON AS children become 12, teach them like an adult

Question 39

When can a child first manage their own care?

Answer 39

at 12 years old

Before 12 they can help with tasks but after 12 they can actually manage their can meaning they know you can do when you can, and seek help when you cannot

Question 40

What are 7 principles to answering psych questions?

Answer 40

Know what phase of the relationship you are in

Don’t give/accept gifts

Don’t give advice

Never guarantee anything (if you cry it’ll make you feel better)

Immediacy (between 2 answers pick the one that keeps them talking and don’t refer anyone)

Concreteness (psych pts take you literally so no figures of speech)

Empathy (chose the answer that focuses on the patients feeling that were displayed in what the patient said, don’t focus on what the patient said)