Exam 2: Meds/newborn reflexes & tests

Question 1

Pitocin

Answer 1

prevents/treats hemorrhage; Pitocin 10-40 units in 500-1,000 mL LR IV bolus; can do 10 units IM without IV access

Question 2

Methergine

Answer 2

treats hemorrhage, 0.2 mg IM
Contraindications: hypertension

Question 3

TXA

Answer 3

1 g in 100 ml NS IV over 10 minutes, repeat in 30 minutes if not effective
Given during first 3 hours after birth

Question 4

Cytotec

Answer 4

give 800-1000 mcg SL, buccal, or rectally

Question 5

Hemabate

Answer 5

treats hemorrhage, give 250 mcg IM, intracervical, or intrauterine
Contraindications: primary = asthma; can cause diarrhea, so have an order for imodium

Question 6

Ephedrine

Answer 6

5-10 mg IV for maternal hypotension (epidural)

Question 7

Narcan

Answer 7

0.1mg/kg Q5min PRN for neonates with confirmed opioid exposure and struggling to transition

don’t use often, typically intubate

Question 8

ambien

Answer 8

5-10 mg PO sedative for prodromal
Benefits: decreases anxiety, allows for rest, inhibits UC (therefore good for prodromal labor)
Risks: neonatal CNS depression, maternal response can vary

Question 9

benadryl

Answer 9

20-50 mg PO
Benefits: induces relaxation and sleepiness (good for early labor when mom is exhausted)

Question 10

promethazine (phenergan)

Answer 10

12.5-25 mg IM or PO antiemetic
Benefits: relieves nausea, vomiting; decreases anxiety; does not relieve pain, but potentiates narcotic

Question 11

fentanyl

Answer 11

50-100 mcg IVP Q10-15 minutes x 5 doses
Onset: rapid; crosses placenta and is in fetal circulation within a minute of admin
Half life: 2-4 hours
** used often bc of it’s fast onset, short half life, and lack of metabolite; downside is short duration, so needs more frequent doses

Question 12

morphine sulphate

Answer 12

2 mg IV + 10 mg IM with PO phenergan for prodromal labor (false contractions)
Onset: 10-30 min
Half life: 2-4 hours
Duration: 4-5 hours

Question 13

nalbuphine

Answer 13

5-10 mg IVP partial opioid agonist
Onset: 2-3 min
Half-life: 3.5-5 hours
Since it’s a partial agonist, provides good analgesia without causing significant respiratory depression in the mother or neonate
Ceiling effect, so additional doses after 30 mg don’t increase respiratory depression
ADRS: drowsiness, dizziness, decreased FHR; less likely to cause n/v, but sedative effects may be greater

Question 14

opioid benefits/risks

Answer 14

pain blunting effect → increased relaxation between UCs; neonatal CNS/respiratory depression, absent/minimal variability during labor; risk of maternal respiratory depression, bradycardia, hypotension, decreased GI motility
Opioids inhibit uterine contractions, which can prolong labor; should not be administered until later in labor unless they are used to help mom rest during a prolonged latent phase of labor

Question 15

nitrous oxide

Answer 15

MOA: unknown… may stimulate endogenous endorphin, corticotropins, and dopamine release; dulls perception of pain

fast on/off (30 secs), self-admin (must hold mask), no effect on fetus, can be used in all stages, fall precautions

Question 16

epidural

Answer 16

continuous injection of pain medication (narcotic +/- “-caine”) into epidural space between L2 and L4 vertebrae t/o labor; has a T8-S5 blocking effect. takes longer to take effect
(walking epidural is without the “-caine”)
Contraindications: allergy to agent, clotting disorders, hx of spinal injury or abnormality
Advantages: good pain relief, assists with coping, mom’s awake, dose can be continuously adjusted, avoids general anesthesia if end up having unplanned c/s, results in vasodilation, which increases placental perfusion and decreases maternal HTN for a time

Question 17

spinal

Answer 17

Onset: immediate, lasts 1-3 hours
Mostly used for c/s, but can be used for vaginal delivery
Lower risk of failure, smaller drug volumes
Complications:
Inadequate block: “hot spot,” one sided, block failure
Breakthrough pain: full bladder, complete dilation, uterine rupture
Procedure related events: nerve root injury, accidental dura puncture, intravascular injection
Sympathetic nerve blockade:
Maternal hypotension leads to late decelerations: tx with ephedrine 5-10 mg IV and fluid bolus, side-lying position, face mask
Urinary retention- foley placement
Fever: possible similar to spinal cord injury
Itching: treat with Nubain or benadryl

Question 18

betamethasone

Answer 18

Speeds up fetal lung maturity –> given prophylactically if PTL expected
Two 12-mg IM doses 24 hours apart

Question 19

erythromycin ointment

Answer 19

¼ inch strand, w/in 1 hour of life to prevent infx

Question 20

Vitamin K

Answer 20

0.5-1 mg IM in vastus lateralis
Neonatal concentration 1 mg/0.5 ml

sterile neonate gut doesn’t produce endogenously

Question 21

Hep B

Answer 21

1st of 3 IM in vastus lateralis

Question 22

Rooting:

Answer 22

stimulate cheek, baby turns towards side of stimulation with open mouth

Question 23

Sucking:

Answer 23

touch roof of mouth, baby should suck

Question 24

Moro:

Answer 24

startle reflex, lift up baby’s arms, should spazz out a bit

Question 25

Palmar grasp:

Answer 25

place finger in palm, baby should grasp

Question 26

Step reflex:

Answer 26

hold up baby vertically, will step

Question 27

Tonic neck (fencing reflex):

Answer 27

turn baby’s head to one side; arm on that side will extend

Question 28

Galant:

Answer 28

baby is supine, stimulate baby on lateral abdomen, leg will go towards that side

Question 29

Plantar grasp:

Answer 29

place finger on bottom of foot near toes, toes should wrap around finger

Question 30

Babinski:

Answer 30

stimulate up the baby’s foot, toes will splay out

Question 31

Protective reflex:

Answer 31

gently cover baby’s eyes and nose with cloth, baby should try to move cloth away with hands

Question 32

Danger/warning signs to teach for discharge

Answer 32

Vomiting (more than 1 feeding)/ Refuses to feed Difficulty breathing Drastic behavior changes to irritable or overly sleepy Inability to void/ Diarrhea Axillary temperature of 99.6 F or higher Change in skin color- pale white, blue or yellow Rashes Umbilical stump infection signs- foul discharge, redness around site Drainage from eyes or ears

Question 33

Physiological jaundice

Answer 33

"normal" incompetent liver and slow gut in neonate >24 hours but <2 weeks (usually 3-4 days) increase feeds and prevent cold stress RBC lysis, impaired transferase, reabsorption of bili through gut from slow motility

Question 34

Pathological jaundice

Answer 34

"abnormal" from trauma at birth/maternal source <24 hours or longer than 2 weeks phototherapy or exchange transfusions (rare & dangerous) ABO, hemolytic, DM, cephalohematoma/ecchymosis, sepsis/infx, preemies

Question 35

Breastfeeding jaundice

Answer 35

2-5 days inadequate feeds --> insufficient calories/stools RN --> support feeds and strict monitor I/Os

Question 36

Breast milk jaundice

Answer 36

5-10 days after milk lets down --> increased fatty acids that inhibit conjugation

Question 37

Resuscitation for non-reassuring fetal heart tones

Answer 37

Position change Check BP (hypo --> bolus & ephedrine) Cervical exam --> prolapsed cord, rapid descent Prep for possible amnioinfusion Alter pushing pattern (every other) IV bolus Help! notify MD & immediate eval assess for tachysystole --> turn off pitocin + consider terbutaline

Question 38

NST

Answer 38

electronic monitoring for 20-40 min most accurate measurement of fetal well-being adequate oxygenation with activity and stimulation

Question 39

Reactive NST

Answer 39

In pregnancies > 32 weeks >15 BPM above baseline for >15 sec In pregnancies 28-32 weeks >10 BPM above baseline for >10

Question 40

Non-reactive NST

Answer 40

Insufficient accelerations in 40 min Needs follow up testing

Question 41

BPP

Answer 41

Biophysical profile US measuring breathing movement, fetal movement, tone, and amniotic fluid volume 8-10/10 normal oxygenated, low risk of asphyxia 6/10 possible asphyxia 0-4/10 very worrisome

Question 42

CCHD

Answer 42

screen at 24 hours to compare oxygenation in a pre-ductal limb (right wrist/hand) to a post-ductal limb (lower extremities) pass if one above 95% and less than 3% difference between the two recheck if 90-95% or greater that 3% difference less than 90% = fail recheck Qhr until pass, fail after 3 hours

Question 43

Category I (fetal monitoring)

Answer 43

Baseline (110-160) Moderate variability No late or variable decelerations May have early decel or accel

Question 44

Category III (fetal monitoring)

Answer 44

Either Absent variability (w/recurrent lates, variables, brady) Or sinusoidal